Mon Feb 19

NZ is bound by international mental health agreements – statistics for Māori show we’re failing to uphold them

Written by Claire Breen, Professor of Law, University of Waikato

Aotearoa New Zealand ranks among the highest in youth suicide rates among OECD countries ^[1] – and it is Māori youth at the forefront of this national crisis ^[2].

Recent statistics ^[3] show the number of suspected self-inflicted deaths for Māori males is nearly double the rate for non-Māori males. The rate for Māori females is around 1.8 times higher than the rate for non-Māori females.

The alarming discrepancy is most notable in the 15-24 age group, where the rate for Māori is about 2.6 times higher than for non-Māori.

Despite these concerning figures, there is no express right to health in New Zealand law, creating a gap in accountability. And by failing to ensure the health and wellbeing of young Māori, Aotearoa New Zealand is falling short of its international obligations.

Progress and retreat

Over the past five years, the government has taken some steps to tackle the country’s mental health crisis. But the priorities of the new government could threaten this already limited progress.

In 2019, NZ$2 billion was injected into the mental health system ^[4] by the then Labour government. And the Mental Health Commission ^[5] was established in 2021 with the aim of contributing to better and equitable mental health and wellbeing outcomes for all people.

Te Aka Whai Ora, the Māori Health Authority, was established under the Pae Ora (Healthy Futures) Act 2022 ^[6]. But while the new coalition government has announced the country’s first ever minister for mental health ^[7], it has also announced plans to scrap the authority ^[8].

The Under One Umbrella ^[10] report, published by the cross-party Mental Health and Addiction Wellbeing Group ^[11], presents a comprehensive, integrated approach to mental health, alcohol and addiction for young people. Significantly, it advocates for a holistic “all-of-government” approach.

Submissions from a recent review ^[12] of the Mental Health Act show strong support for the new legislation to uphold rights in alignment with international conventions, with more focus on tangata whaiora (someone seeking health) and whānau (extended family).

Although these initiatives and pending legislative reform represent a step in the right direction, the statistics related to youth mental health ^[13] are still cause for concern.

International responsibilities to ensure health

One strategy to address the national mental health crisis for Māori youth would be to embed the human right to health in local policy and law. This would also bring Aotearoa New Zealand’s legislation into line with its international obligations.

In 1946, the World Health Organization ^[14] adopted a broad definition of health:

Health is a state of complete physical, mental, cultural and social wellbeing and not merely the absence of disease or infirmity.

Over the course of the next two decades, health was conceived as a human right (in the Universal Declaration of Human Rights ^[15] and later in the International Covenant on Economic Social and Cultural Rights ^[16]).

The International Convention on the Elimination of Racial Discrimination ^[17] also obliged countries to eliminate race discrimination in public health and medical care.

For children, the right to health is further recognised in the Convention on the Rights of the Child 1989 ^[18]. And, specifically for Indigenous communities, in the United Nations Declaration on the Rights of Indigenous Peoples 2007 ^[19].

It is well established within international law ^[21] that the right to health for Indigenous children and youth is linked to their distinct cultural, social and customary practices.

And various UN groups have repeatedly ^[22] emphasised ^[23] that Indigenous people have the right to receive culturally appropriate healthcare services that respect their traditional practices and medicines.

These groups have also urged countries to provide Indigenous communities with the necessary resources to design, deliver and control their own healthcare services.

The need for a legal framework

Aotearoa New Zealand is bound ^[24] by these international agreements, and the rights and obligations that flow from them. Yet the right to health does not appear in our laws ^[25], which leaves a void in accountability and enforcement.

This hinders the implementation of effective health policies for tamariki and rangatahi Māori (children and young people), particularly as it limits the legal avenues available for recourse when the system fails.

The disparities in mental health outcomes point to an immediate national challenge facing Aotearoa New Zealand, which is to formulate an effective mental healthcare framework.

The most appropriate starting point is to include the right to health in national policy and legislation. This would align New Zealand’s national policies and laws with international norms.

It would also mandate the government to take active steps to ensure that the highest attainable standards of mental health and wellbeing for tamariki and rangtahi Māori are met.