Opinion piece: Keeping people at the centre
Eight years after a suite of recommendations in He Ara Oranga were made to improve mental health and wellbeing outcomes in Aotearoa New Zealand, incoming Chair Dr Barbara Disley assesses where things have progressed, and where there is more work to do.
Every day across Aotearoa New Zealand, people are doing vital work in hospitals and within our communities to provide care and support. As their voices and skills become more visible, people with lived experience and their whānau are changing the face of our services. .
As the new Chair of Te Hiringa Mahara, I see the term ahead of me as a time to keep pushing for more and better services that are collaborative, accessible and responsive. We need to improve access to specialist services when they are needed, while also supporting people to live well within their communities.
Since He Ara Oranga, new services have been funded and set up-including new initiatives in primary care and youth services, peer support in emergency departments and peer-led crisis responses. While these developments are to be celebrated, they are insufficient alone to meet the burgeoning mental health distress and substance harm within our communities; particularly with our young people. Services must have the capacity and capability to support people quickly and well when they need more specialised care.
The challenge ahead is not simply to add more services, but to create a system that is more human, easier to navigate, more equitable, more connected and more responsive to what people and whānau want and need.
Start earlier, especially for young people
Supporting the mental health and wellbeing of young people must be one of our clearest priorities. Prevention and early intervention require sustained investment, not as an optional extra, but as a core part of a mentally healthy society. In times of need, young people require timely access to support before distress escalates. Being able to more easily access responsive specialist mental health services when this is deemed necessary must also be a key priority.
Make help easier to find and crisis support more responsive
People should not have to know the right door to knock on before they receive the support that works for them. We need local networks of services that work as well-oiled, connected hubs, with smooth pathways between primary care, Kaupapa Māori, Pacific and youth services, peer support, community options and specialist responses. This requires substantial change to our current services and a shift to much greater collaboration, connection and respect.
Centre lived experience, whānau and self-determination
People with lived experience and whānau hold deep knowledge about what helps, what harms and what needs to change. Their expertise must shape design, delivery, monitoring and improvement across the system.
Self-determination matters to all of us. A stronger system will offer more choice, more culturally grounded options, and multiple pathways that respond well to people’s different needs, identities and circumstances. When I see where people do have choice it leads to positive results, and we need to see more of it.
Value and support the workforce
We cannot ask people to deliver compassionate, courageous and innovative care without also better valuing and supporting them. This includes growing the lived experience workforce and supporting them to turn their experience into expertise, elevating Māori service leadership and options, training and retaining our skilled specialist people, and investing in supervision.
Look beyond health to the foundations of wellbeing
Mental health and substance harm responses cannot sit within health alone. As He Ara Oranga reminded us, illness and distress are shaped by the conditions in which people live. Services need to be centred in the communities they serve and well connected to other health and social services. A well-functioning mental health system is essential, but it must be supported by coordinated action across government and communities.
Some things have improved since the Government Inquiry into Mental Health and Addiction in 2018; some have stubbornly stayed the same. The underpinning social determinants that play such a vital role in wellbeing need much more attention paid to them.
When it comes to continuing to lift mental health and addiction services, these efforts will be ongoing. Across the sector there is no shortage of commitment, creativity or care. We have a new Mental Health and Wellbeing Strategy, alongside a well-defined implementation plan, to provide a sense of direction. At the same time, adequately addressing the alcohol and substance use challenges facing so many of our whānau will require much more effort.
Our collective task now is to galvanise as a sector, connect our efforts and keep people, whānau and communities at the centre of everything we do. My experience has reinforced that consistent progress requires real commitment and high levels of accountability. We must have visibility of both the money and the mix and levels of staffing, then monitor what difference these make.
Going forward, Te Hiringa Mahara will honour what is already strong within Aotearoa New Zealand’s approach, while continuing to push for better.
The next phase of change will require every ounce of ambition, honesty and persistence we can collectively muster. This is something we at Te Hiringa Mahara will throw ourselves at. I look forward to continuing to walk alongside everyone also committed to achieving our vision of an innovative, well-functioning system where everyone can thrive.
Dr Barbara Disley was appointed Chair of Te Hiringa Mahara – Mental Health and Wellbeing Commission in June 2026. She has an extensive background as a leader of national and international mental health organisations.
MORE: Te Hiringa Mahara has prepared a Roadmap for mental health, addiction, and wellbeing that sets out immediate priorities to improve outcomes. Read more: www.mhwc.govt.nz/roadmap