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.’