ACT's Brooke van Velden on why NZ needs a stand-alone mental health 'commissioning agency' to help people choose their own treatment

ACT's Brooke van Velden on why NZ needs a stand-alone mental health 'commissioning agency' to help people choose their own treatment

By Brooke van Velden*

Covid will require new ways of doing things in every sector and it’s important mental health isn’t left behind. As we stare down a global pandemic from our island nation, many Kiwis are facing major unplanned disruptions in their lives and uncertain futures in work. We need to support people adversely affected and struggling mentally who reach out for help. But are our mental health services up to scratch? Are the people seeking treatment now getting the help they need?

Mental health care provision should interest all of us. Around 1 in 5 New Zealanders will face a mental health challenge in any given year and as many as 4 in 5 throughout their life. In the last few years there’s been an attitude shift to mental health. More people are opening up and talking about their personal struggle and breaking the stigma, but we still have a long way to go.

Many people don’t ever reach out for help and struggle in silence. Poor mental health goes untreated throughout New Zealand from the classroom to the woolshed. Our youth suicide rate is our darkest statistic.

Too often, those who do reach out for help describe a system that’s difficult to navigate, huge discrepancy in access to care from region to region, and a lack of choice in services to suit their individual needs. Almost no one is satisfied with the state of mental health care in New Zealand.

The Government’s Mental Health Inquiry He Ara Oranga identified that there’s too much bureaucracy in the system, not enough choice of providers, and no whole of Government approach to mental wellbeing.

The Government responded by increasing mental health funding from $1.5 billion to around $2 billion per year and setting up a Mental Health and Wellbeing Commission to provide oversight of mental health in New Zealand.

But increasing funding doesn’t guarantee improvements for people’s care. Neither does setting up a new bureaucracy with no real power. Those actions don’t address the issues of choice, accountability, or getting better value for the mental health dollar or the individuals and communities being served. We can and must do better.

We need systemic change.

The truth is that mental health care is a victim of the ailing District Health Boards. To transform mental health care, we need to remove mental health funding and provision from the hands of the 20 separate DHBs and other government silos.

We need to create one stand-alone nation-wide mental health commissioning agency that empowers those seeking help to make choices for their own therapy and care, rather than simply accept the provider a District Health Board offers.

One central interface would reduce bureaucracy and administrative burden. Creating a purchaser-provider split would level the playing field between the District Health Board’s own services and alternative community providers. As a commissioning agency, it would use its expertise and patterns of data to drive better performance from the sector, evaluating where the money is going, to whom, and what services work based on evidence and data.

The current Covid climate has created an unprecedented amount of stress and uncertainty for all New Zealanders.

People who’ve never accessed mental health care before are likely to struggle getting the help they need at a time when we need it most. Under a new nation-wide agency, we can ensure the vulnerable can access the services and support that is so critical right now.

The world has changed. Once certain futures are now shaky. Now more than ever, we need to be considering whether the Government’s policy frameworks are fit for purpose, including for mental health care.

I want to live in a country where we put people at the heart of mental health care and treat it as important as physical health care. I also want to live in a country where we think for the future and challenge the status quo.

We can’t continue to pump money into a failing model. New Zealanders deserve better. Before we spend more money, we should question what we’re funding and whether it’s working and what can be improved.  

I think we have to be honest. This isn’t an issue about nickel and diming people. It’s making sure that those who are needing help are properly getting the assistance they need at the time when they are most vulnerable. A Mental Health Agency will deliver that and ensure people with problems are properly taken care of.

ACT is campaigning to establish a new Mental Health and Addiction Agency at the 2020 election to support the mental health of New Zealanders. You can read ACT’s mental health policy here.

*Brooke van Velden is the ACT Party's Deputy Leader and Wellington Central candidate. As part of an election series van Velden will be writing regularly for between now and the September 19. Vanushi Walters, the Labour Party's Upper Harbour candidate and 23 on the list, is also writing for

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DHBs in NZ routinely overmedicate. A family friend was sent in for anxiety and ended up on 5 different medications taking around 15 tablets a day total.

He went for a second examination with a private psychiatrist and psychologist and they sounded huge alarm over it and the immediate danger to his health.

DHBs were asleep at the wheel and piling drug on after drug, listening to no feedback as someone spiraled out if control, for what is a common condition.

NZ is also way way behind the rest of the Western world with non-pharmacological interventions. It's all short term fixes and refusing to look at long term causes and systemic issues.

I posted here a few weeks back when I was caring for a woman with Schizophrenia. She came and went a couple of times. I've followed here for 11 years on facebook as she moved from place to place. She will always need some care, any of you want to help out? Because the system simply can't cope with her.

Drawing upon my Police experience from the mid 90's and into the 2000's mental health have never really had the resources to deal with this problem. One time we had the I-Car (two constables rather than one in a Q-Car) plus DAO having to travel from the North Shore of Auckland to Hamilton to the one bed that was found available for a man in a chronic condition. It was a frequent experience to be standing around waiting while the mental health team rang around trying to find a bed in an acute ward. Frequently the people we picked up had walked out of the low security facilities.

Mental health is why I personally think the management of Covid-19 is, and will be a failure. We are going to see the suicide rate increase, as well as other illnesses with a stress component. The death rate will outstrip that of the virus. Then there is the problem of containing those with both mental illness and Covid-19. You won't. I believe that most are just not considering all the factors in play either through bias or lack of capacity to carry all those factors.

A pandemic strains everything whether there is a lockdown or not. People isolate themselves in a pandemic whether it it government mandated or not and pandemics would have an impact on mental health either way. Some argue an unconrtolled, unmitigated pandemic would have a great negative impact.

After the 1918 flu pandemic, those who survived the virus (which was most people) had a much higher rate of mental illness and a higher suicide rate. Viruses and what is referred to as "post-viral syndrome" are highly correlated to longer term worsened mental health outcomes.

I will pass that term "post viral syndrome" onto my professor friend researching the total economic cost.

I'm not really sure it is an epidemic, or pandemic, or than any sort of management will have beneficial effects. One thing I've learnt with business is taht there are lots of people out there who would help me "manage" it, and even more that would take my money so they can "advise".

"Necessity" is the mother of invention but its cousin is "never let a good crisis go to waste" are true of human behaviour, probably since we existed.

Oooh if you have a professor friend looking at the total economic cost, also mention the life trajectories of the babies born to mothers that survive viruses. For instance, the children after 1918 were statistically shorter, less wealthy, more likely to be imprisoned and all manner of other poor indicators (and that's the stats of babies born to Mum's who did vs didn't have the virus not the whole cohort of babies born after 1918).

Here's another piece of research looking at the impact of mitigation strategies on economies.

I can't comment on your personal position as to whether this is a pandemic or not. That is probably an intensely personal and subjective choice.

Canterbury EQ survivors, physically & financially, various degrees of damaged and undamaged, will provide due testament to those observations. The mental health in the aftermath has been under assessed from day one. From Wellington’s point of view you could say, out of sight out of mind. Regret I am no good at posting links, but there are plenty around to confirm this.

My belief is that malnutrition is a lead cause of poor immunity. The same condition that led to those catching the Spanish Flu would generate the same outcomes you talk of. But still, I will pass it on with my own comments attached. A bit like how in places in the UK they still have a height requirement to get into the Police of 6'1". That is intentionally because a person that tall is more likely to have been fed well and suffer less mental defects. I think we'll see the results of doing away with the height requirement turn up on Police statistics eventually, it is a stressful job. Police statistically already have a much reduced life expectancy.

I've helped as much as I can but in the end I've only help build a number of facilities both acute and specialised long term care. There doesn't really seem to be the funding to meet the requirements of our current population. There's a shortfall in both general mental health beds and forensic beds. These facilities would be more useful that building roads everywhere.

Yes, acute mental health care poses problems that are difficult and depressing both to treat and to talk about.
Moving people out of secure facilities is the fashion since the 80s, but we've never really had adequate substitutes. Care in the community works for many, but acute psychosis requires special facilities. They're expensive, though, and depressing, and exhausting to work in, because you're constantly trying to judge whether someone is in such a state that they need to be effectively imprisoned for their own good. Keep people in against their will, or sedate them heavily, and they hate you. Let them out and they commit suicide, there'll be an inquiry. Both paths are inadequate so we go for the cheaper one. I don't think there's a right answer, but we should be honest about the trade-offs we make.

Another thing to consider: workplace Health and Safety is often a bottomless pit of money and bureaucracy for companies but what's often overlooked is the mental health well-being from cost cutting in other areas. Particularly now with negative business sentiment and ongoing redundancies relying on those left standing to carry the slack, if the redundancies are knee-jerk at best.

New Zealand's regressive tobacco taxation is particularly hard on the mentally ill, who themselves smoke at higher rates than the general population.

Data from the United States showed economic contraction of 33% on a quarterly and annualised basis, which is the deepest quarterly contraction in US history. Given the nature of the pandemic, the 34.6% contraction in consumer spending underpinned the decline, while the reduction in investment and inventories followed trends we observed during past recessions.

The US Fed held its meeting which decided to keep rates on hold last week. In its statement and subsequent press conference, there are two clear messages relevant to New Zealand's policy makers and investors. The first is that the US and, by extension, global interest rates will remain low for longer. Secondly, although monetary policy will remain supportive of growth by keeping policy rates low and expanding central bank balance sheets, it will be less effective in mitigating the impact of the crisis without continued strong fiscal support. This week, US lawmakers will deliberate and decide on the future of unemployment benefits. The US Fed wants fiscal support to continue.

There are three main deductions we can make from these developments that are relevant to New Zealand . First, given the lagged effects of global developments on New Zealand's economy, the negative impact of Covid-19 will last longer. Second, the impact of Covid-19 will be deeper and more painful for households, employees and businesses that have already been hard hit. Third, more support will be needed beyond what has been provided for currently.

Excellent article from Brooke van Valden. Independent commission - Yes. Arms length purchasing - Yes. It will direct the resources to the real need, peoples need not services need.
DHBs will become contractors only and will get the work if they are good enough - but they probably can't meet the standard.
There are massive resources in mental heath already - just misallocated.
Brookes article shows a high level of smarts. Just what we need from government.