Mental health crisis talk, but no urgency walk

There have been claims that our health system is in crisis. I guess it depends on what constitutes a crisis.

Speaking out of one side of his mouth Minister of Health David Clark says that parts of the health system are in crisis due to chronic ‘underfunding’, but out of the other side of his mouth he praises the state of Health.

And even though he sees a crisis in Mental Health he is happy to wait for a committee to investigate before taking action. He has justifiably been criticised for this contradiction.

On Q&A yesterday:

Corin Dann: The other criticism is that you’re manufacturing a crisis. Is there a crisis in health, for a start?

David Clark: There are some areas where there is a crisis. I think mental health – people will acknowledge is at a crisis level. But the reason our health system is holding together so well, and it is, is because of the dedicated staff. We have doctors and nurses and allied health workers who have turned up every day in an underfunded environment for years, and they deliver an amazing service, and New Zealanders know that.

There is a crisis, but the health system is holding up well?

Later the interview addresses mental health.

Corin Dann: We’re going to talk mental health now. Talking again to people in the health sector this week, one of the things that came up with mental health was actually an ED nurse, who said they are just seeing a massive increase in the number of presentations at emergency departments from people suffering from mental illness. What are you going to do about that?

David Clark: We know that we have an aging demographic, which includes dementia, and we have a growing population. As more people get weeded out for care in primary care, we have more acute demand at the emergency level. We’re going to need new approaches, new ideas to tackling these issues. And we’re going to need increased capacity in some areas.

No indication of what Clark intends to do, just “we’re going to need increased capacity in some areas”.

Corin Dann: Okay, I know you’ve got an inquiry looking at this issue and presumably that’s going to come up with some big, challenging recommendations for you on mental health, and you’ll deal with that. How quickly can you implement those?

David Clark: Yeah. I’m imaging we won’t be able to implement them all at once. We’ll take it budget by budget, step by step. But the purpose of making that inquiry independent is that it will bring forward hard recommendations. It will bring forward challenging recommendations. And we as a government will then have to wrestle with them. But I don’t want to get some watered-down version as minister. My job is to manage the prioritisation and the politics, and I’ll do that. 

Corin Dann: Sure. Big picture here, because I know you’ve got an inquiry, what is your feeling about the balance in terms of our mental health? Are we keeping people in the community too much? Are we not putting people in care enough? Where is the balance?

David Clark: My gut feeling is we’ve devolved care to the community without putting resource after it. And sometimes it’s been used as a cost-cutting measure. We need to change community attitudes. We need to change the way we’re delivering primary services to some extent. And we need to just make sure that mental health is afforded the priority that it should have. It shouldn’t be possible to cut corners for our most vulnerable.

Corin Dann: You’ve got other promises in mental health, in particular in schools and those sorts of things. Are you going to be able to deliver on those, having nurses or mental health care workers in those sorts of facilities?

David Clark: There are some things that have strong evidence behind them. Nurses in schools is one of those things. We will continue to roll out that programme. The cheaper doctor visits is another way of ensuring that those services are more accessible to people. So we will do some things in the interim. I’m not going to announce the budget detail today, Corin.

Labour rushed in an expensive tertiary fees-free policy, without claiming there was a crisis in education.

The did claim there was a mental health crisis in their Taking action in our first 100 days:

  • Set up a Ministerial Inquiry in order to fix our mental health crisis

One could think that a crisis would be treated a bit more urgently than deferring to a committee.

Labour’s post-100 day brag sheet includes this, but it is well down the list of priorities – 100 days. Here’s what we’ve done.

We’ve announced a ministerial inquiry into our mental health system. It’s time to do better by New Zealanders.

But this isn’t the time to do it apparently.

More details: Inquiry to improve mental health services

The Government has taken a major step towards improving mental health and addiction services with Prime Minister Jacinda Ardern announcing details of a ministerial inquiry.

The Inquiry into Mental Health and Addiction will be chaired by former Health and Disability Commissioner, Professor Ron Paterson, and will report back to the Government by the end of October.

Then any spending to address the so-called crisis will have to wait until the budget in May 2019, unless things get deferred further.

“Nothing is off the table. We all know we have a problem with mental health in this country and our suicide rate is shameful. It is well past time for us to do something about it.”

That was in January. Perhaps something will be done about it in this year’s budget, but even then one could suggest ‘it is well past time for us to do something about it’.

In the meantime: Funding uncertainty for Dunedin rehab service

A Dunedin rehab centre with a waiting list of 142 people, most addicted to methamphetamine, will run out of money in two months.

Addiction treatment services say the public funding model they operate under is creating stress, fostering competition between providers and, worst of all, detracting from the work of rehabilitating addicts.

With only 62 days left in the financial year Ms Aitken still had not been able to secure funding – which comes from a mix of government departments – to continue to run past July.

Perhaps they could go and talk to the mental health crisis working group. Drug addiction is a symptom of mental health problems.

Claims of crisis are not new. from may 2018:  New Zealand’s mental health system is in crisis

The Auditor-General’s new report on discharge planning for mental health patients shows more than ever that the system is in crisis.

The report by Greg Schollum, Deputy Controller and Auditor-General, diagnoses several acute ailments in the system – a lack of planning and liaison between DHBs and community services, limited bed numbers available in inpatient units, and rushed discharges into the community because DHBs cannot cope with growing demand.

“This report provides some alarming insights into the slow decay of the mental health system under this Government, particularly in terms of supporting severely vulnerable patients to re-enter their communities after time in DHB inpatient units,” says Erin Polaczuk, PSA national secretary.

“It’s clear that empty rhetoric and the hollow promises of prioritisation by this Government aren’t enough,” says Ms Polaczuk.

See also (Stuff, 3 February 2018): A growing emergency: Why are cops looking after mental health patients in crisis?

If things go according to current plans another report will be released in October. Perhaps that will call it a crisis too.

Then what?


David Clark has been asked (on RNZ) about the Moana House funding crisis and says it is something that needs to be worked out over time. And pushed on whether urgent funding would be provided he said he won’t be announcing the budget in advance and again said solutions would be forthcoming “over time”.

No apparent urgency given the claims of a crisis.

It is a very difficult situation for Clark (as the portfolio is for any Minister of Health).  But if the Government talks the crisis talk surely they should walk the urgency walk.