15 Feb 2024

Mental health needs of many young people 'are not being met', Auditor-General investigation finds

4:39 pm on 15 February 2024
Stylised illustration of sad young person crouched over with clouds hanging overhead

An RNZ investigation identified widespread concern over the impact of a major funding boost for mental healthcare. Photo: RNZ

The mental health needs of many youth "are not being met" and waiting times for specialist care are getting longer, a new report from the Auditor-General finds.

The previous Labour government put $1.9 billion into mental health in 2019 but an RNZ investigation last year identified widespread concern over the impact of the spending. Young people in particular have been affected by long wait times and service constraints that some doctors have said are making patients sicker.

The Auditor-General's report, Meeting the mental health needs of young New Zealanders, was tabled in Parliament this afternoon. It evaluates whether the money spent on youth mental health services since the 2019 Wellbeing Budget is making a difference for people aged 12 to 24.

The investigation was prompted by National MP Matt Doocey who wrote to the independent spending watchdog in April 2022 asking it to investigate the effectiveness of Labour's historic spending. Doocey is now the first Minister for Mental Health.

Auditors spoke to 400 people across multiple government agencies as well as young people with experience in the mental health system. They found young people reported the highest level of unmet need for mental health care of any age group. Many still faced barriers when accessing services, which are often not designed for their needs.

"Despite their high level of need, many young people in distress cannot access mental health support when they need it," the report said.

There was a lack of data about the nature and scale of need. There was also a critical worker shortage contributing to the problem.

The report makes nine recommendations to ensure a "coherent system of mental health services" is developed.

The Auditor-General's performance audits manager, Jason Hewett, said the newly developed primary mental health and addiction services for youth funded from the 2019 Budget were successful, helping around 3000 young people a month. But many of those needing specialist care were not getting the help they needed.

"What we found is that, actually, need isn't understood," Hewett said.

"It's hard to say whether needs are met because of the absence of data, and there is some more work to do with regards to agencies working together, especially for those in care, not in employment, education or training and those in prison."

The report found that the increased investment in primary care might relieve demand for more specialised services. But in the meantime, young people in need of specialist support were waiting longer to access specialist care than when the 2019 Budget was announced.

Stylised illustration of crying face with cloud over head

The Auditor-General's report identifies a group of young people falling in between acute and primary care. Photo: RNZ

Doocey said he had already asked officials for advice on adopting the report's recommendations and hoped to set up cross-agency taskforce to oversee their implementation.

"Workforce vacancies are one of our biggest barrier to timely care. Why are we six years in are not even having a workforce plan? So that's why I think it validates this new role as a mental health minister.

"The report clearly states that needs a cross departmental approach, we need to get the relevant ministries together. And I'll be setting up a cross agency work and implementation plan about how we look to take those recommendations forward."

Doocey said he had been going through mental health spending "line by line" and found there had been a "level of underspend."

"I'm working with officials now about how we actually get that underspend out of the beehive into the grassroots, and that's announcements I'll be making in due course."

Doocey said funding a prevalence survey to get up to date data on mental health needs was a priority.

Young people left 'in the middle' without care

Rising demand for specialist services meant the threshold to be seen by a specialist had been raised, leaving a group of people "in the middle" who could not be seen by specialists or primary care, Hewett said.

"The investment in primary care has provided more services for young people, and those in acute or urgent need of care are getting support. But there's a group of people whose lives are still heavily disrupted and they can't participate in education or employment because they're not getting the services they need.

"The investment is making some difference but there's more work to do," he said.

Auditor-General John Ryan said mental health concerns were the biggest health issue facing young New Zealanders today.

"However, we found that many young people cannot get mental health support when they need it. In a country that prides itself on being a good place to bring up children and young people, this is a matter we should all be concerned about," Ryan said in a statement.

One of the reasons services were failing young people was because government agencies did not have enough data about the nature and scale of mental health needs among youth.

The last national mental health prevalence survey for mental health was carried out 20 years ago and only surveyed people aged 16 years and over. "This means there is no useful New Zealand-specific mental health prevalence data for children and young people," the report said.

The audit also found many of the services on offer were designed for older age groups and not suitable for younger people, while the mental health workforce was under "considerable strain because of capacity pressures across the sector".

The report makes nine recommendations:

1. The Ministry of Health prioritise work to understand the prevalence of mental health conditions in the population.

2. Te Whatu Ora work with the Ministry of Health, the Ministry of Education, Oranga Tamariki, and other agencies to evaluate the effectiveness of, and develop consistent guidelines for, the delivery of youth integrated primary health services.

3. The Ministry of Education ensure that sufficient data is collected to understand the effectiveness of the school guidance counselling model for all students.

4. Te Whatu Ora and the Ministry of Education work with other agencies as relevant to better align the objectives and operations of their school-based

health and well-being services.

5. Te Whatu Ora, the Ministry of Education, Oranga Tamariki, and the Department of Corrections consider whether appropriate mechanisms for youth voice and

participation are built into the design, delivery, and governance of new and existing mental health and well-being services for young people.

6. Te Whatu Ora, the Ministry of Education, Oranga Tamariki, and the Department of Corrections ensure that data about outcomes is collected for all mental health and wellbeing services accessed by young people.

7. Te Whatu Ora work with the Ministry of Health, the Ministry of Education, Oranga Tamariki, the Ministry for Social Development, and the Department of Corrections to ensure at-risk groups of young people with mental health concerns can get consistent and continuous care.

8. The Ministry of Health work with Te Whatu Ora, the Ministry of Education, Oranga Tamariki, the Department of Corrections, and other agencies to strengthen its mental health and addiction system leadership role, and to prioritise the development of a plan for Kia Manawanui with clear agency roles and responsibilities.

9. Te Whatu Ora and the Ministry of Health work with the Ministry of Education, Oranga Tamariki, the Department of Corrections, and other agencies to prioritise the development of a national mental health and addiction workforce plan.