web analytics

More on mental health

Written By: - Date published: 12:36 pm, March 18th, 2008 - 8 comments
Categories: health, history - Tags: ,

After reading Steve’s piece about suicide prevention and the subsequent comments I’ve decided a short history lesson on this issue is needed.

In the late eighties and early nineties the mental health model was shifted from an institutional model to the ‘recovery model’. Effectively this meant mental health patients were shifted from facilities such as Cherry Farm and Sunny Side into the community. While this is an approach that is proven to work for many people with mental illnesses it comes at the price of loss of economies of scale and makes it expensive to monitor illness.

At the time that money was not provided and the task of resourcing that care was left to the family and friends of those lucky enough to have them to fall back on.

On top of that a lot of the cost was transferred onto the Ministry of Social Development which was not prepared to deal with these issues. One of our recent commenters, Vic, reminded me of this with this story:

‘The way the benefit system was structured he [the commenter’s mentally ill friend] had to prove he was financially independent from his parents every single year of university. Administrative delays every year meant that he went without income for weeks and even, on one occasion, more than a month. He couldn’t pay rent, couldn’t buy food at times and ended up being dependent on his mates, which was bad for all of us.’

This kind of problem was not unusual. There had been a shift in the policy at income support (which at the time was rebranded WINZ) toward providing entitlement only on demand. This meant that people with mental illness, who could not advocate for themselves and prepare their own argument and had very little advocacy support, were effectively disenfranchised. Applications would often involve providing considerable documentation and a good understanding of the Act (something that is difficult at the best of times and almost impossible for many mentally ill people.) This left many seriously mentally ill people with no care and often no income. As you can imagine, this did not bode well for society.

This situation reached crisis level very quickly and a series of high profile criminal cases involving people with mental illnesses eventually provoked a review. A turning point was the Raurimu massacre which put pressure on for an investigation that eventually turned into the Blueprint for Mental Health Services in New Zealand (PDF). The Blueprint came out in 1998 and involved an audit of every DHB in the country and increased funding to bring them up to standard to support the 3% of all New Zealanders who suffer serious mental illness.

After finding the report was going to be horrendously expensive to implement the National government quietly shelved it. One of the promises Labour made was to implement the blueprint and it has done so. But there are some serious issues with this model, most of which stem from the one-size-fits-all approach that sees funding set by population (not mentally ill population) and which is still set according to the 3% rate provided by early 90’s research. The funding is also adjusted from what was used in the previous year’s budget rather than what proper services would cost. An ex-mental health administrator I know described the situation under Labour thus:

‘They’d ask me what I’d spent, not what I would spend to provide proper services. Every year we’d scrape through with what we had and that would be the figure they’d use.’

There are also serious shortages of mental health professionals internationally and these have been exacerbated by the liberalisation of training in the 90’s we simply have not produced enough psych nurses or psychiatrists. The last word belongs with Vic:

‘I’ve seen other, less fortunate friends slip through the cracks more recently because the public system is severely under-resourced, even now. And when I say slipped through the cracks I mean they’re dead. This is something that needs to be addressed with as much as we can throw at it.’

8 comments on “More on mental health”

  1. The problem with mental health is it is very expensive and doesn’t make for good PR opportunities. When was the last time you saw a polly do a PR set-piece in the psych-ward? Or for that matter, offer to donate the cost of their election overspend to Kenepuru’s unit… The coverage it does get is always around crime.

  2. higherstandard 2

    RS

    Think you’re being a bit harsh. Coverage for mental health issues has been quite good under the “Like Minds, Like Mine” campaign fronted by John Kirwan and othe notables.

    I recall MPs from the past also fonting regarding their depression and other mental health issues.

  3. Yeah – I guess you’re right about that HS.

  4. Daveo 4

    Good summary IB- really reinforces the fact that all of these statistics happen for socio-economic reasons and have real life affects on ordinary people.

  5. Interesting article IB – I worked in the health sector for a number of years, under a variety of governments. The process of deinstitutionalisation started in the late 1980’s, during which time one Helen Clark was the Minsiter of Health (but we won’t go there!), and continued into the 1990’s under Upton. Deinstitutionalistion was not restricted to Mental Health – services to the elderly also came under the microscope – two groups of very vulnerable people, who caused both National and Labour no small degree of heartache.

    While I was working at the Wanganui Area Health Board (as it was under HC’s 1989 reforms), I was a witness to the managed closure of Lake Alice hospital, including the National Secure Unit – The Block, as it was known. No-one would seriously want to go back to the days of institutional care for so many, but many communities around New Zealand are still getting to grips with managing the needs of the mentally ill within their community. We have a number of “mental health survivors” attend our church, and hear some horror stories about the trauma of being left to fend for themselves without adequate Community Mental Health support. We as a church leadership don’t have the skills to deal with, but often we are the only support some of these people have. It is a real dilemma, and I don’t believe anyone, let alone National or Labour has the answers.

  6. IrishBill 6

    IV2 – a step toward an answer would be another full scale review, increased funding for salaries and intervening to ensure a set proportion of nursing training positions were set aside for psych-specialisation and that a certain number of medical students were directed toward psychiatry.

    One of the big issues at the moment is the lack of decent primary psych health care. Too many GPs and first-contact clinics have insufficient psych training or resource. There are a couple of PHOs that run really good models, hopefully as other PHOs establish themselves that will spread.

    I don’t want to offend your faith but church-based care (especially of the fundamentalist variety) can, in some cases, be worse than no care at all as many mentally ill people have difficulty with the subtleties of religious narrative and the process of applying them to the real world.

    My fear is that the continual right wing attacks on social workers as “bureaucrats” works to further devalue the role of community care and make it harder to staff the recovery model. I need to make this clear: the recovery model is the best option for most people and works very well when done properly but it costs more in the short-term to do properly. Too many people in the 1990’s saw it as a chance to transfer costs to communities and that’s never really been fixed since.

  7. No offence taken IB – whilst our church is under the “umbrella” of a pentecostal organisation, we do things our own way, mainly because we don’t want to put the mental health of our people at risk – we too, have seen spiritual “manipulation” of the most vulnerable, and it does no-one any good. We’re more concerned with the physical welfare in the first instance, and spend time making sure people are safe, housed, fed and clothed – then get in the ear of the CMHT people. We figure that God will take care of the rest!

  8. Hillary 8

    From what I have seen, the baby has been thrown out with the bath water with deinstitutionalisation. A severely mentally ill person I know of who was made a compulsory patient on the West Coast, spent only 3 weeks in the Acute Mental Health Unit and was then returned to the community with very little support.

    The Community Mental Health Team on parts of the West Coast is available only during business hours, with the police picking up the slack at night or in the weekends.

    I know of a young and very bright lad in Canterbury whose friends finally sought help for him on a Friday afternoon. The response was to send him home to his parents who were ill equipped to deal with the problem, and he was dead of an apparent accident or suicide the next day before he had got the help he needed. The lack of help for people with acute mental health problems is criminal.

Links to post

Recent Comments

Recent Posts

  • Wetlands and waterways gain from 1BT funding
    The Government will invest $10 million from the One Billion Trees Fund for large-scale planting to provide jobs in communities and improve the environment, Agriculture Minister Damien O’Connor and Forestry Minister Shane Jones have announced. New, more flexible funding criteria for applications will help up to 10 catchment groups plant ...
    BeehiveBy beehive.govt.nz
    6 hours ago
  • New fund for women now open
    Organisations that support women are invited to apply to a new $1,000,000 fund as part of the Government’s COVID-19 response. “We know women, and organisations that support women, have been affected by COVID-19. This new money will ensure funding for groups that support women and women’s rights,” said Minister for ...
    BeehiveBy beehive.govt.nz
    7 hours ago
  • Govt supports King Country farmers to lift freshwater quality
    Healthier waterways are front and centre in a new project involving more than 300 King Country sheep, beef and dairy farmers. The Government is investing $844,000 in King Country River Care, a group that helps farmers to lift freshwater quality and farming practice, Agriculture Minister Damien O’Connor announced today. “Yesterday ...
    BeehiveBy beehive.govt.nz
    2 days ago
  • Support for arts and music sector recovery
    A jobseekers programme for the creative sector and four new funds have been set up by the Government to help our arts and music industry recover from the blow of COVID-19. Thousands of jobs will be supported through today’s $175 million package in a crucial economic boost to support the ...
    BeehiveBy beehive.govt.nz
    2 days ago
  • Legislative changes to support the wellbeing of veterans and their families
    Minister for Veterans Ron Mark has welcomed the First Reading of a Bill that will make legislative changes to further improve the veterans’ support system.  The Veterans’ Support Amendment Bill No 2, which will amend the Veterans’ Support Act 2014, passed First Reading today. The bill addresses a number of ...
    BeehiveBy beehive.govt.nz
    2 days ago
  • Christ Church Cathedral – Order in Council
    Views sought on Order in Council to help fast track the reinstatement of the Christ Church Cathedral  The Associate Minister for Greater Christchurch Regeneration, Hon Poto Williams, will be seeking public written comment, following Cabinet approving the drafting of an Order in Council aimed at fast-tracking the reinstatement of the ...
    BeehiveBy beehive.govt.nz
    2 days ago
  • New Zealanders’ human rights better protected in new Bill
    The law setting out New Zealanders’ basic civil and human rights is today one step towards being strengthened following the first reading of a Bill that requires Parliament to take action if a court says a statute undermines those rights. At present, a senior court can issue a ‘declaration of ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Deep concern at Hong Kong national security legislation
    Foreign Affairs Minister Winston Peters today reiterated the deep concern of the New Zealand Government following confirmation by China’s National People’s Congress of national security legislation relating to Hong Kong. “New Zealand shares the international community’s significant and long-standing stake in Hong Kong’s prosperity and stability,” Mr Peters said. “New Zealand ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Government invests in New Zealand’s cultural recovery
    Thousands of artists and creatives at hundreds of cultural and heritage organisations have been given much-needed support to recover from the impact of COVID-19, Prime Minister and Minister for Arts, Culture and Heritage Jacinda Ardern announced today. “The cultural sector was amongst the worst hit by the global pandemic,” Jacinda ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Better protection for New Zealand assets during COVID-19 crisis
    Key New Zealand assets will be better protected from being sold to overseas owners in a way contrary to the national interest, with the passage of the Overseas Investment (Urgent Measures) Bill. The Bill, which passed its third reading in Parliament today, also cuts unnecessary red tape to help attract ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Cleaning up our rivers and lakes
    Setting higher health standards at swimming spots Requiring urban waterways to be cleaned up and new protections for urban streams Putting controls on higher-risk farm practices such as winter grazing and feed lots Setting stricter controls on nitrogen pollution and new bottom lines on other measures of waterway health Ensuring ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Record year for diversity on Govt boards
    The Government is on the verge of reaching its target of state sector boards and committees made up of at least 50 percent women, says Minister for Women Julie Anne Genter and Minister for Ethnic Communities Jenny Salesa. For the first time, the Government stocktake measures the number of Māori, ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • New appointments to the Commerce Commission
    The Commerce and Consumer Affairs Minister and Broadcasting, Communications and Digital Media Minister, Kris Faafoi, has today announced the appointment of Tristan Gilbertson as the new Telecommunications Commissioner and member of the Commerce Commission. “Mr Gilbertson has considerable experience in the telecommunications industry and a strong reputation amongst his peers,” ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Historic pay equity settlement imminent for teacher aides
    The Ministry of Education and NZEI Te Riu Roa have agreed to settle the pay equity claim for teacher aides, Education Minister Chris Hipkins announced today. This will see more than 22,000 teacher aides, mostly women, being valued and paid fairly for the work they do. “Teacher aides are frontline ...
    BeehiveBy beehive.govt.nz
    4 days ago
  • Govt delivers security for construction subcontractors
    Subcontractors will have greater certainty, more cashflow support and job security with new changes to retention payments under the Construction Contracts Act says Minister for Building and Construction, Jenny Salesa. A recent review of the retentions money regime showed that most of the building and construction sector is complying with ...
    BeehiveBy beehive.govt.nz
    4 days ago
  • New Zealand and Singapore reaffirm ties
    Prime Minister Jacinda Ardern and Singapore Prime Minister Lee Hsien Loong have marked the first anniversary of the New Zealand-Singapore Enhanced Partnership with a virtual Leaders’ Meeting today. The Enhanced Partnership, signed on 17 May 2019, provides the framework for cooperation across the four main areas of trade, defence and ...
    BeehiveBy beehive.govt.nz
    4 days ago
  • JOINT STATEMENT BY THE PRIME MINISTERS OF NEW ZEALAND AND THE REPUBLIC OF SINGAPORE ON THE FIRST AN...
    On 17 May 2019, New Zealand and Singapore established an Enhanced Partnership to elevate our relations. The Enhanced Partnership – based on the four pillars of trade and economics, security and defence, science, technology and innovation, and people-to-people links – has seen the long-standing relationship between our countries strengthen over the ...
    BeehiveBy beehive.govt.nz
    4 days ago
  • Government investment supports the acquisition of new Interislander ferries
    State-Owned Enterprises Minister Winston Peters has welcomed KiwiRail’s announcement that it is seeking a preferred shipyard to build two new rail-enabled ferries for the Cook Strait crossing. “This Government is committed to restoring rail to its rightful place in New Zealand. Bigger, better ships, with new technology are yet another ...
    BeehiveBy beehive.govt.nz
    4 days ago
  • Better protection for seabirds
    Better protection for seabirds is being put in place with a new National Plan of Action to reduce fishing-related captures, Fisheries Minister Stuart Nash and Conservation Minister Eugenie Sage announced today.   The National Plan of Action for Seabirds 2020 outlines our commitment to reduce fishing-related captures and associated seabird ...
    BeehiveBy beehive.govt.nz
    4 days ago
  • Milestone in cash flow support to SMEs
    Almost $1 billion in interest-free loans for small businesses More than 55,000 businesses have applied; 95% approved Average loan approx. $17,300 90% of applications from firms with ten or fewer staff A wide cross-section of businesses have applied, the most common are the construction industry, accommodation providers, professional firms, and ...
    BeehiveBy beehive.govt.nz
    4 days ago
  • Government protects kids as smoking in cars ban becomes law
    Thousands of children will have healthier lungs after the Government’s ban on smoking in cars with kids becomes law, says Associate Minister of Health Jenny Salesa. This comes after the third reading of Smoke-free Environments (Prohibiting Smoking in Motor Vehicles Carrying Children) Amendment Bill earlier today. “This law makes it ...
    BeehiveBy beehive.govt.nz
    5 days ago
  • Parliament returns to a safe normal
    The special Epidemic Response Committee (ERC) has successfully concluded its role, Leader of the House Chris Hipkins said today. The committee was set up on 25 March by the agreement of Parliament to scrutinise the Government and its actions while keeping people safe during levels 4 and 3 of lockdown. ...
    BeehiveBy beehive.govt.nz
    5 days ago
  • Foreign Minister makes four diplomatic appointments
    Foreign Affairs Minister Winston Peters today announced four diplomatic appointments: New Zealand’s Ambassador to Belgium, High Commissioners to Nauru and Niue, and Ambassador for Counter-Terrorism. “As the world seeks to manage and then recover from COVID-19, our diplomatic and trade networks are more important than ever,” Mr Peters said. “The ...
    BeehiveBy beehive.govt.nz
    5 days ago
  • New Bill to counter violent extremism online
    New Zealanders will be better protected from online harm through a Bill introduced to Parliament today, says Internal Affairs Minister Tracey Martin. “The internet brings many benefits to society but can also be used as a weapon to spread harmful and illegal content and that is what this legislation targets,” ...
    BeehiveBy beehive.govt.nz
    5 days ago
  • Mycoplasma bovis eradication reaches two year milestone in good shape
    New Zealand’s world-first plan to eradicate the cattle disease Mycoplasma bovis is on track the latest technical data shows, says Agriculture and Biosecurity Minister Damien O’Connor. “Two years ago the Government, DairyNZ and Beef + Lamb New Zealand and industry partners made a bold decision to go hard and commit ...
    BeehiveBy beehive.govt.nz
    5 days ago
  • New payment to support Kiwis through COVID
    Further support for New Zealanders affected by 1-in-100 year global economic shock 12-week payment will support people searching for new work or retraining Work programme on employment insurance to support workers and businesses The Government today announced a new temporary payment to support New Zealanders who lose their jobs due ...
    BeehiveBy beehive.govt.nz
    6 days ago
  • PGF reset helps regional economies
    The Provincial Growth Fund will play a vital role in New Zealand’s post-COVID-19 recovery by creating jobs in shorter timeframes through at least $600 million being refocused on projects with more immediate economic benefits, Regional Economic Development Minister Shane Jones has announced. The funding is comprised of repurposed Provincial Growth ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Government exempts some home improvements from costly consents
    Government exempts some home improvements from costly consents Homeowners, builders and DIYers will soon have an easier time making basic home improvements as the Government scraps the need for consents for low-risk building work such as sleep-outs, sheds and carports – allowing the construction sector to fire back up quicker ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Concern at introduction of national security legislation for Hong Kong
    Foreign Affairs Minister Winston Peters says the New Zealand Government has reacted with concern at the introduction of legislation in China’s National People’s Congress relating to national security in Hong Kong.  “We have a strong interest in seeing confidence maintained in the ‘one country, two systems’ principle under which Hong ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Samoa Language Week theme is perfect for the post-COVID-19 journey
    The Minister for Pacific Peoples Aupito William Sio, says the theme for the 2020 Samoa Language Week is a perfect fit for helping our Pacific communities cope with the unfolding COVID-19 crisis, and to prepare now for the journey ahead as New Zealand focuses on recovery plans and rebuilding New ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Adult kakī/black stilt numbers soar
    A nearly 40-year programme to protect one of New Zealand’s most critically endangered birds is paying off, with a record number of adult kakī/black stilt recently recorded living in the wild, the Minister of Conservation Eugenie Sage announced today. “Thanks to the team effort involved in the Department of Conservation’s ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Waikato-Tainui settlement story launched on 25th anniversary of Treaty signing
    The story of the Waikato-Tainui Treaty process and its enduring impact on the community is being told with a five-part web story launched today on the 25th anniversary of settlement, announced Associate Arts, Culture and Heritage Minister Carmel Sepuloni. “I am grateful to Waikato-Tainui for allowing us to help capture ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Taita College to benefit from $32 million school redevelopment
    Taita College in the Hutt Valley will be redeveloped to upgrade its ageing classrooms and leaky roofs, Education Minister Chris Hipkins announced today. “The work is long overdue and will make a lasting difference to the school for generations to come,” Chris Hipkins said. “Too many of our schools are ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Redeployment for workers in hard-hit regions
    The Government is allocating $36.72 million to projects in regions hard hit economically by COVID-19 to keep people working, Economic Development Minister Phil Twyford and Regional Economic Development Minister Shane Jones announced today. Projects in Hawke’s Bay, Northland, Rotorua and Queenstown will be funded from the Government’s $100 million worker ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • $35m to build financial resilience for New Zealanders
    A $35m boost to financial capability service providers funded by MSD will help New Zealanders manage their money better both day to day and through periods of financial difficulty, announced Social Development Minister Carmel Sepuloni. “It’s always been our position to increase support to key groups experiencing or at risk ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • New District Court Judge appointed
    Dunedin barrister Melinda Broek has been appointed as a District Court Judge with Family Court jurisdiction to be based in Rotorua, Attorney-General David Parker announced today. Ms Broek has iwi affiliations to Ngai Tai. She commenced her employment in 1996 with Scholefield Cockroft Lloyd in Invercargill specialising in family and ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • $206 million investment in upgrades at Ohakea Air Force Base
    The Coalition Government has approved a business case for $206 million in upgrades to critical infrastructure at Royal New Zealand Air Force Base Ohakea, with the first phase starting later this year, Defence Minister Ron Mark announced today. The investment will be made in three phases over five years, and ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Review of CAA organisational culture released
    Transport Minister Phil Twyford today released the Ministry of Transport’s review of the organisational culture at the Civil Aviation Authority. Phil Twyford says all employees are entitled to a safe work environment. “I commissioned this independent review due to the concerns I had about the culture within the CAA, and ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • New Board appointed at Stats NZ
    Ensuring that Stats NZ’s direction and strategy best supports government policy decisions will be a key focus for a new Governance Advisory Board announced today by the Minister for Statistics, James Shaw. The new Governance Advisory Board will provide strategic advice to Stats NZ to ensure it is meeting New ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • New Principal Environment Judge
    Environment Judge David Kirkpatrick of Auckland has been appointed as the Principal Environment Judge, Attorney-General David Parker announced today.  Judge Kirkpatrick was appointed an Environment Judge in February 2014. From December 2013 to July 2016 he was Chair of the Auckland Unitary Plan Independent Hearings Panel. Prior to appointment he ...
    BeehiveBy beehive.govt.nz
    2 weeks ago