Mental health and addiction services have got worse for Māori since work began to overhaul the system nearly two years ago and serious gaps remain for young mums and those in forensic units, according to a new report from the mental health commissioner, Kevin Allan.
Allan, who released his latest monitoring report yesterday, said those with serious and complex problems were still missing out.
He noted there had been "significant progress" since his last full report - He Ara Oranga in 2018 - especially in early support available through primary and community care and in laying the foundations for a new stand-alone Mental Health and Wellbeing Commission, which will be up and running in 2021.
However, many of the problems highlighted in the report were "stubbornly similar" to those raised previously, he said.
"We're moving backwards when it comes to Māori."
The report shows:
- Almost one in three Māori live with mental illness or addiction compared with one in five in the general population.
- In 2018 (the latest available figures), 6317 people were subject to a community treatment order (compulsory treatment), an increase of three percent over one year, of whom 38 percent were Māori.
- 44 percent of those put in seclusion (where patients at risk of self-harm or violence towards others are confined to an empty cell to "calm down").
- Suicide is the leading cause of maternal mortality, with Māori whānau most affected.
There were, however, signs of progress, including increased investment in kaupapa Māori approaches, Allan said.
"All services need to work for Māori and be culturally safe. Strengthening Māori participation and leadership in the design and delivery of services is essential - both for improving outcomes and meeting obligations under Te Tiriti o Waitangi."
Another area in need of urgent attention was the lack of specialist forensic services.
Allan said while Corrections had made progress in boosting to addiction and mental health services within prisons, it was increasingly difficult to get help for inmates suffering serious mental problems, especially if they needed admission to secure inpatient forensic facilities for monitoring and care.
There had been a 24 percent increase in the prison population since 2013 and an increase in the prevalence of serious mental illness among prisoners, but forensic bed numbers had increased by only 3 percent (eight beds).
Forensic services were "stretched beyond capacity", despite an investment of $15 million over four years in last year's Budget.
"I fear that services will be close to failure unless urgent action is taken to address capacity and other issues," Allan said.
"All five forensic mental health services are operating beyond capacity in their inpatient units and are carrying considerable waitlists.
"The Ministry of Health notes that pressure on forensic services has led to a narrowing of support to focus on psychosis rather than broader mental health issues.
"The Ministry also refers to incidences where forensic services have been unable to admit people referred to them by Corrections owing to capacity."
Allan said he was calling for a "a clear plan of action" to be developed by the end of the year to deliver on the approach set out in He Ara Oranga.
"Plans on their own are not enough to deliver change.
"In the last 10 years there have been many government documents, plans, and strategies that have talked about shifting from a service-oriented response to a people-centred wellbeing response to mental health and addiction, but have failed to get traction because not enough attention was paid to supporting implementation and tracking progress."
New Zealand's mental health and addiction problems could not be fixed by government alone, nor by the health system - but it was important for one agency to take the lead, he said.
"Currently it is not clear where the responsibility lies for bringing together this collective response. Without clear leadership and resourcing, the collective response is likely to be rudderless or, at best, ad hoc.
"I do not regard this as an onerous demand - it may be that the Ministry of Health is best placed to lead the whole-of-system change required by the He Ara Oranga agenda as well as the health component - but the need for a decision is now pressing."
The collective response to supporting people's wellbeing during the Covid-19 pandemic highlighted what was possible, he said.
"The rapid action to house people without a home and provide intensive mental health, addiction, and other support shows what can be achieved when there is a will.
"We are small enough, smart enough and nimble enough to do this in a way that's much harder to do in a bigger population and a bigger system."
'Government committed to transforming approach to mental health and addiction'
However, the Health Ministry insists it is on track to transform the country's approach to mental health and addiction, in line with He Ara Oranga.
Mental Health and Addiction deputy director-general Robyn Shearer said the government's response made clear that transformation would start with four initial priority areas: establishing the Mental Health and Wellbeing Commission, strengthening suicide prevention efforts, beginning the process to repeal and replace the Mental Health Act, and expanding access and choice of support, starting with primary health.
"Efforts over the past year have focused on these priorities, and this work will continue in the coming years."
The ministry had developed and released Kia Kaha, Kia Māia, Kia Ora Aotearoa: Covid-19 Psychosocial and Mental Wellbeing Recovery Plan, which set out actions over the next 12 to 18 months to support the mental and social wellbeing of New Zealanders, she said.
Alongside this, there was also a 10-year strategy and five-year plan, which were specific to suicide prevention.
"As part of the response to He Ara Oranga, the government also committed to developing a longer-term pathway for transforming New Zealand's approach to mental health and addiction.
"As the Mental Health Commissioner notes, work is underway to adjust the pathway for post-Covid-19 environment."