It’s 4 years since the NZ government pledged $1.9 billion for better mental health services – why are we still waiting?

In 2019 the New Zealand government committed an unprecedented NZ$1.9 billion to improving mental health services^[1]. This announcement brought hope to a sector that had been treated like the second-class citizen of the health service^[2] for decades.

But four years later, it is clear these high hopes have not been realised.

It’s easy to find examples of unmet mental health needs in our communities. Fundamental gaps are evident across the sector, from young people in crisis^[3] waiting 70 days to be seen by a therapist, to men struggling with depression^[4], to those with more chronic conditions such as ADHD^[5] struggling to receive diagnoses and care.

Where did the money go?

So what has happened to the billions set aside to improve mental health services?

Almost a quarter of the funding has gone to health improvement practitioners (HIPs) and health coaches based within general medical practices. The aim of these practitioners and coaches is to give fast and early access to people presenting to their general practitioner (GP) with mental health concerns^[6].

Considerable investment has also gone into making mental health apps widely available to the public, a move that was at least partly sparked by the COVID-19 lockdowns^[7].

These initiatives focus mainly on providing proactive support to people with mild symptoms and/or upskilling the general population to help prevent psychological distress occurring.

Robbing Peter to pay Paul

This investment approach by the government has several problems, which mean the country’s collective mental health needs have not been successfully addressed.

Firstly, while the aims of the HIPs programme are to be lauded – it allows a quick and “warm” handover from GP to mental health clinician – it has done little to increase the pool of mental health professionals. The practitioners are drawn from the existing health workforce^[8]. Many nurses and psychologists have taken up practitioner roles, meaning we have robbed Peter to pay Paul as clinicians move from one area of the mental health sector to another.

Read more: Pixels are not people: mental health apps are increasingly popular but human connection is still key^[9]

Secondly, while mental health apps often include excellent psychological tools and techniques that can enhance wellbeing, they are still largely untested, can suffer from low levels of uptake^[10] and don’t always meet the need for human interaction^[11].

Thirdly, it appears the Ministry of Health’s focus on one or two approaches to meeting our mental health demands has blinded it to other possible solutions.

For example, there is a growing body of local and international research^[12] highlighting the relationship of micronutrients and what we eat to our mental health.

Yet this line of intervention has only recently received government support^[13]. Even then the investment is relatively limited.

Going global for ideas

Unsurprisingly, Aotearoa New Zealand is not the only country to be grappling with high demand for mental health services. We can learn from what other countries are doing in response to gaps in their services.

The United Kingdom, for example, has attempted to address its own mental health services shortfall with a programme called Increasing Access to Psychological Therapies (IAPT)^[14]. This is a limited talking therapies programme that is commonly offered to people struggling with anxiety and depression.

Since its launch in 2008, 10,500 additional psychological therapists and practitioners have been trained to work with IAPT referrals. According to recent National Health Service data^[15], 75% of people referred to IAPT services start treatment within six weeks of referral, and 95% start treatment within 18 weeks.

As with any programme developed overseas its applicability in New Zealand would need to be tried and tested but, on its face, IAPT offers some potential solutions. Yet there has been little to no interest in this approach from the current government.

Real action is long overdue

The government’s singular focus on one or two new mental health initiatives has been at the expense of training programmes. In 2021, the then health minister, Andrew Little, claimed New Zealand did not need an “army” of psychologists^[16] but given we are at least 1,000 psychologists short^[17] a battalion would be welcome.

If even a quarter of the funding that has been funnelled to new initiatives had been invested in 2019 in existing psychology training programmes, we could have doubled the numbers of psychologists graduating into the health workforce.

To give the government its due, there has been some recent investment in clinical psychology training^[18] but it feels like an afterthought. It is also still very small compared to investment in other areas.

Read more: Road to nowhere: New Zealanders struggle to get the help they need, 2 years on from a funding boost for mental health services^[19]

The four years that have passed since the government’s bold commitment to addressing our mental health crisis has included several large bumps in the road that would have disrupted even the best-laid plans. Our leaders have had to deal with a physical health pandemic and a restructure of the entire health system. The former was out of anyone’s control, the latter very much of the government’s own making.

Nonetheless, looking at our mental health system in 2023 it feels like very little progress has been made. A blinkered approach to how to spend the $1.9 billion of our health dollars has stymied any good intentions that were behind the original plan.

References

1. ^{^} mental health services (www.beehive.govt.nz)
2. ^{^} second-class citizen of the health service (theconversation.com)
3. ^{^} young people in crisis (www.nzherald.co.nz)
4. ^{^} men struggling with depression (www.nzherald.co.nz)
5. ^{^} chronic conditions such as ADHD (www.rnz.co.nz)
6. ^{^} mental health concerns (www.procare.co.nz)
7. ^{^} sparked by the COVID-19 lockdowns (www.beehive.govt.nz)
8. ^{^} existing health workforce (www.tepou.co.nz)
9. ^{^} Pixels are not people: mental health apps are increasingly popular but human connection is still key (theconversation.com)
10. ^{^} low levels of uptake (www.sciencedirect.com)
11. ^{^} the need for human interaction (www.hpa.org.nz)
12. ^{^} growing body of local and international research (www.ohsu.edu)
13. ^{^} government support (pharmac.govt.nz)
14. ^{^} Increasing Access to Psychological Therapies (IAPT) (www.healthcareers.nhs.uk)
15. ^{^} National Health Service data (www.england.nhs.uk)
16. ^{^} “army” of psychologists (www.beehive.govt.nz)
17. ^{^} 1,000 psychologists short (www.renews.co.nz)
18. ^{^} recent investment in clinical psychology training (www.beehive.govt.nz)
19. ^{^} Road to nowhere: New Zealanders struggle to get the help they need, 2 years on from a funding boost for mental health services (theconversation.com)