Over April and May 2020, the Initial Commission sought a range of views to start developing an outcomes framework for mental health and wellbeing.
When they started this work, their aim was to ensure that everyone could have their say on how the system will monitor, measure and improve our country's mental health and wellbeing. However, due to COVID-19, the Initial Commission had to change our approach and target organisations that represent the people and diversity of Aotearoa New Zealand.
The Initial Commission worked with people from across the mental health and wellbeing system to:
The Initial Commission asked what people thought of the World Health Organisation (WHO) definition of mental health, “a state … in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”.
People said the WHO definition does not reflect an indigenous view, is too individualistic, and is overly focused on what the person can do for society through ‘work’. People thought we should have a definition that reflects Te Tiriti o Waitangi, acknowledges people have a social nature and acknowledges the concepts of whānaunatanga, belonging and connection. A definition should also talk about meaning and purpose rather than production. Language should be non-binary, ‘their’ rather than ‘his or her’.
People spoke about challenges defining ‘mental health’ as the term is often associated with ‘mental illness’, carries stigma and is associated with a medical approach, such as illness, diagnosis and medication.
People saw ‘wellbeing’ as a broad and positive concept, compared to ‘mental health’, which is associated with a medical approach and with a deficit or illness.
The Initial Commission heard that a definition of wellbeing should be strengths-based, incorporate a culturally-based definition and be holistic - incorporating community and social determinants of wellbeing.
The Initial Commission also heard that wellbeing is not fixed, but an aspirational state. Some said it’s about being able to function when life is more challenging, and many mentioned the importance of being able to access support when needed.
There were two main views of the connection between mental health and wellbeing. People either saw mental health and wellbeing as one and the same thing or, saw mental health as a component of overall health and wellbeing.
Some people suggested this should be a ‘wellbeing outcomes framework’ rather than a ‘mental health and wellbeing outcomes framework’.
Some people warned of losing sight of those with the most serious needs if there is a shift to a wellbeing focus. People also emphasised mental health and wellbeing can be in the absence or presence of a mental illness diagnosis, or distress.
Addiction was noted as important to keep visible in definitions, and the concept of freedom from addiction.
Te Whare Tapa Whā was mentioned by nearly all people. A further 34 models or frameworks were mentioned; 18 of these developed in Aotearoa, and 16 overseas.
Non-medical models were more commonly mentioned, that offer a broader and more holistic understanding, in preference to those with a narrower focus on mental health.
The Initial Commission asked if the Child and Youth Wellbeing Framework(external link) with six areas of wellbeing, developed in Aotearoa, could cover wellbeing for everyone (including adults and older people). People thought there was some areas of wellbeing that are universal across the life-course, but there are some aspects that change as you get older.
The Initial Commission compiled a list of what people thought should be considered as important for wellbeing. Areas covered in responses, included:
People said wellbeing is fluid, and that wellbeing needs are the same for people with mental distress as for everyone.
The Initial Commission tested a vision statement; “An Aotearoa New Zealand where everyone has good mental health and wellbeing and can get the support we all need to live our best lives.”
Most people did not like the statement. Many found the term “support” problematic, getting easy access to support, when we need it was preferred as a concept, rather than implying “we all need support”. People also thought the statement didn’t reflect that wellbeing is not a permanent state. The report lists the alternative vision statements proposed.
To develop the framework, the Inital Commission sought participation from people across Aotearoa including Māori, Pacific people, and people with lived experience of mental health and addiction.
Outcomes need to be what truly improves people’s wellbeing, and need to be simple and practical, with supports put in place for implementation.
People said it needed to:
Measures need to be meaningful, and be across quantitative, qualitative and mixed methodologies.
To learn more about the co-define phase of this work, download the full report: