More on mental health

Written By: - Date published: 12:36 pm, March 18th, 2008 - 11 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.’

11 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

  • Anzac Commemorative Address – Dawn Service, Gallipoli, Türkiye
    Mai ia tawhiti pamamao, te moana nui a Kiwa, kua tae whakaiti mai matou, ki to koutou papa whenua. No koutou te tapuwae, no matou te tapuwae, kua honoa pumautia.   Ko nga toa kua hinga nei, o te Waipounamu, o te Ika a Maui, he okioki tahi me o ...
    BeehiveBy beehive.govt.nz
    7 hours ago
  • PM announces changes to portfolios
    Paul Goldsmith will take on responsibility for the Media and Communications portfolio, while Louise Upston will pick up the Disability Issues portfolio, Prime Minister Christopher Luxon announced today. “Our Government is relentlessly focused on getting New Zealand back on track. As issues change in prominence, I plan to adjust Ministerial ...
    BeehiveBy beehive.govt.nz
    1 day ago
  • New catch limits for unique fishery areas
    Recreational catch limits will be reduced in areas of Fiordland and the Chatham Islands to help keep those fisheries healthy and sustainable, Oceans and Fisheries Minister Shane Jones says. The lower recreational daily catch limits for a range of finfish and shellfish species caught in the Fiordland Marine Area and ...
    BeehiveBy beehive.govt.nz
    2 days ago
  • Minister welcomes hydrogen milestone
    Energy Minister Simeon Brown has welcomed an important milestone in New Zealand’s hydrogen future, with the opening of the country’s first network of hydrogen refuelling stations in Wiri. “I want to congratulate the team at Hiringa Energy and its partners K one W one (K1W1), Mitsui & Co New Zealand ...
    BeehiveBy beehive.govt.nz
    2 days ago
  • Urgent changes to system through first RMA Amendment Bill
    The coalition Government is delivering on its commitment to improve resource management laws and give greater certainty to consent applicants, with a Bill to amend the Resource Management Act (RMA) expected to be introduced to Parliament next month. RMA Reform Minister Chris Bishop has today outlined the first RMA Amendment ...
    BeehiveBy beehive.govt.nz
    2 days ago
  • Overseas decommissioning models considered
    Overseas models for regulating the oil and gas sector, including their decommissioning regimes, are being carefully scrutinised as a potential template for New Zealand’s own sector, Resources Minister Shane Jones says. The Coalition Government is focused on rebuilding investor confidence in New Zealand’s energy sector as it looks to strengthen ...
    BeehiveBy beehive.govt.nz
    2 days ago
  • Release of North Island Severe Weather Event Inquiry
    Emergency Management and Recovery Minister Mark Mitchell has today released the Report of the Government Inquiry into the response to the North Island Severe Weather Events. “The report shows that New Zealand’s emergency management system is not fit-for-purpose and there are some significant gaps we need to address,” Mr Mitchell ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Justice Minister to attend Human Rights Council
    Justice Minister Paul Goldsmith is today travelling to Europe where he’ll update the United Nations Human Rights Council on the Government’s work to restore law and order.  “Attending the Universal Periodic Review in Geneva provides us with an opportunity to present New Zealand’s human rights progress, priorities, and challenges, while ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Patterson reopens world’s largest wool scouring facility
    Associate Agriculture Minister, Mark Patterson, formally reopened the world’s largest wool processing facility today in Awatoto, Napier, following a $50 million rebuild and refurbishment project. “The reopening of this facility will significantly lift the economic opportunities available to New Zealand’s wool sector, which already accounts for 20 per cent of ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Speech to the Southland Otago Regional Engineering Collective Summit, 18 April 2024
    Hon Andrew Bayly, Minister for Small Business and Manufacturing  At the Southland Otago Regional Engineering Collective (SOREC) Summit, 18 April, Dunedin    Ngā mihi nui, Ko Andrew Bayly aho, Ko Whanganui aho    Good Afternoon and thank you for inviting me to open your summit today.    I am delighted ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Government to introduce revised Three Strikes law
    The Government is delivering on its commitment to bring back the Three Strikes legislation, Associate Justice Minister Nicole McKee announced today. “Our Government is committed to restoring law and order and enforcing appropriate consequences on criminals. We are making it clear that repeat serious violent or sexual offending is not ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • New diplomatic appointments
    Foreign Minister Winston Peters has today announced four new diplomatic appointments for New Zealand’s overseas missions.   “Our diplomats have a vital role in maintaining and protecting New Zealand’s interests around the world,” Mr Peters says.    “I am pleased to announce the appointment of these senior diplomats from the ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Humanitarian support for Ethiopia and Somalia
    New Zealand is contributing NZ$7 million to support communities affected by severe food insecurity and other urgent humanitarian needs in Ethiopia and Somalia, Foreign Minister Rt Hon Winston Peters announced today.   “Over 21 million people are in need of humanitarian assistance across Ethiopia, with a further 6.9 million people ...
    BeehiveBy beehive.govt.nz
    3 days ago
  • Arts Minister congratulates Mataaho Collective
    Minister for Arts, Culture and Heritage Paul Goldsmith is congratulating Mataaho Collective for winning the Golden Lion for best participant in the main exhibition at the Venice Biennale. "Congratulations to the Mataaho Collective for winning one of the world's most prestigious art prizes at the Venice Biennale.  “It is good ...
    BeehiveBy beehive.govt.nz
    4 days ago
  • Supporting better financial outcomes for Kiwis
    The Government is reforming financial services to improve access to home loans and other lending, and strengthen customer protections, Commerce and Consumer Affairs Minister Andrew Bayly and Housing Minister Chris Bishop announced today. “Our coalition Government is committed to rebuilding the economy and making life simpler by cutting red tape. We are ...
    BeehiveBy beehive.govt.nz
    5 days ago
  • Trade relationship with China remains strong
    “China remains a strong commercial opportunity for Kiwi exporters as Chinese businesses and consumers continue to value our high-quality safe produce,” Trade and Agriculture Minister Todd McClay says.   Mr McClay has returned to New Zealand following visits to Beijing, Harbin and Shanghai where he met ministers, governors and mayors and engaged in trade and agricultural events with the New ...
    BeehiveBy beehive.govt.nz
    5 days ago
  • PM’s South East Asia mission does the business
    Prime Minister Christopher Luxon has completed a successful trip to Singapore, Thailand and the Philippines, deepening relationships and capitalising on opportunities. Mr Luxon was accompanied by a business delegation and says the choice of countries represents the priority the New Zealand Government places on South East Asia, and our relationships in ...
    BeehiveBy beehive.govt.nz
    6 days ago
  • $41m to support clean energy in South East Asia
    New Zealand is demonstrating its commitment to reducing global greenhouse emissions, and supporting clean energy transition in South East Asia, through a contribution of NZ$41 million (US$25 million) in climate finance to the Asian Development Bank (ADB)-led Energy Transition Mechanism (ETM). Prime Minister Christopher Luxon and Climate Change Minister Simon Watts announced ...
    BeehiveBy beehive.govt.nz
    6 days ago
  • Minister releases Fast-track stakeholder list
    The Government is today releasing a list of organisations who received letters about the Fast-track applications process, says RMA Reform Minister Chris Bishop. “Recently Ministers and agencies have received a series of OIA requests for a list of organisations to whom I wrote with information on applying to have a ...
    BeehiveBy beehive.govt.nz
    6 days ago
  • Judicial appointments announced
    Attorney-General Judith Collins today announced the appointment of Wellington Barrister David Jonathan Boldt as a Judge of the High Court, and the Honourable Justice Matthew Palmer as a Judge of the Court of Appeal. Justice Boldt graduated with an LLB from Victoria University of Wellington in 1990, and also holds ...
    BeehiveBy beehive.govt.nz
    6 days ago
  • Education Minister heads to major teaching summit in Singapore
    Education Minister Erica Stanford will lead the New Zealand delegation at the 2024 International Summit on the Teaching Profession (ISTP) held in Singapore. The delegation includes representatives from the Post Primary Teachers’ Association (PPTA) Te Wehengarua and the New Zealand Educational Institute (NZEI) Te Riu Roa.  The summit is co-hosted ...
    BeehiveBy beehive.govt.nz
    6 days ago
  • Value of stopbank project proven during cyclone
    A stopbank upgrade project in Tairawhiti partly funded by the Government has increased flood resilience for around 7000ha of residential and horticultural land so far, Regional Development Minister Shane Jones says. Mr Jones today attended a dawn service in Gisborne to mark the end of the first stage of the ...
    BeehiveBy beehive.govt.nz
    6 days ago
  • Anzac commemorations, Türkiye relationship focus of visit
    Foreign Affairs Minister Winston Peters will represent the Government at Anzac Day commemorations on the Gallipoli Peninsula next week and engage with senior representatives of the Turkish government in Istanbul.    “The Gallipoli campaign is a defining event in our history. It will be a privilege to share the occasion ...
    BeehiveBy beehive.govt.nz
    6 days ago
  • Minister to Europe for OECD meeting, Anzac Day
    Science, Innovation and Technology and Defence Minister Judith Collins will next week attend the OECD Science and Technology Ministerial conference in Paris and Anzac Day commemorations in Belgium. “Science, innovation and technology have a major role to play in rebuilding our economy and achieving better health, environmental and social outcomes ...
    BeehiveBy beehive.govt.nz
    6 days ago
  • Comprehensive Partnership the goal for NZ and the Philippines
    Prime Minister Christopher Luxon held a bilateral meeting today with the President of the Philippines, Ferdinand Marcos Jr.  The Prime Minister was accompanied by MP Paulo Garcia, the first Filipino to be elected to a legislature outside the Philippines. During today’s meeting, Prime Minister Luxon and President Marcos Jr discussed opportunities to ...
    BeehiveBy beehive.govt.nz
    7 days ago
  • Government commits $20m to Westport flood protection
    The Government has announced that $20 million in funding will be made available to Westport to fund much needed flood protection around the town. This measure will significantly improve the resilience of the community, says Local Government Minister Simeon Brown. “The Westport community has already been allocated almost $3 million ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Taupō takes pole position
    The Government is proud to support the first ever Repco Supercars Championship event in Taupō as up to 70,000 motorsport fans attend the Taupō International Motorsport Park this weekend, says Economic Development Minister Melissa Lee. “Anticipation for the ITM Taupō Super400 is huge, with tickets and accommodation selling out weeks ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Cost of living support for low-income homeowners
    Local Government Minister Simeon Brown has announced an increase to the Rates Rebate Scheme, putting money back into the pockets of low-income homeowners.  “The coalition Government is committed to bringing down the cost of living for New Zealanders. That includes targeted support for those Kiwis who are doing things tough, such ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Government backing mussel spat project
    The Coalition Government is investing in a project to boost survival rates of New Zealand mussels and grow the industry, Oceans and Fisheries Minister Shane Jones has announced. “This project seeks to increase the resilience of our mussels and significantly boost the sector’s productivity,” Mr Jones says. “The project - ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Government focused on getting people into work
    Benefit figures released today underscore the importance of the Government’s plan to rebuild the economy and have 50,000 fewer people on Jobseeker Support, Social Development and Employment Minister Louise Upston says. “Benefit numbers are still significantly higher than when National was last in government, when there was about 70,000 fewer ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Clean energy key driver to reducing emissions
    The Government’s commitment to doubling New Zealand’s renewable energy capacity is backed by new data showing that clean energy has helped the country reach its lowest annual gross emissions since 1999, Climate Change Minister Simon Watts says. New Zealand’s latest Greenhouse Gas Inventory (1990-2022) published today, shows gross emissions fell ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Earthquake-prone buildings review brought forward
    The Government is bringing the earthquake-prone building review forward, with work to start immediately, and extending the deadline for remediations by four years, Building and Construction Minister Chris Penk says. “Our Government is focused on rebuilding the economy. A key part of our plan is to cut red tape that ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Thailand and NZ to agree to Strategic Partnership
    Prime Minister Christopher Luxon and his Thai counterpart, Prime Minister Srettha Thavisin, have today agreed that New Zealand and the Kingdom of Thailand will upgrade the bilateral relationship to a Strategic Partnership by 2026. “New Zealand and Thailand have a lot to offer each other. We have a strong mutual desire to build ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Government consults on extending coastal permits for ports
    RMA Reform Minister Chris Bishop and Transport Minister Simeon Brown have today announced the Coalition Government’s intention to extend port coastal permits for a further 20 years, providing port operators with certainty to continue their operations. “The introduction of the Resource Management Act in 1991 required ports to obtain coastal ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Inflation coming down, but more work to do
    Today’s announcement that inflation is down to 4 per cent is encouraging news for Kiwis, but there is more work to be done - underlining the importance of the Government’s plan to get the economy back on track, acting Finance Minister Chris Bishop says. “Inflation is now at 4 per ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • School attendance restored as a priority in health advice
    Refreshed health guidance released today will help parents and schools make informed decisions about whether their child needs to be in school, addressing one of the key issues affecting school attendance, says Associate Education Minister David Seymour. In recent years, consistently across all school terms, short-term illness or medical reasons ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Unnecessary bureaucracy cut in oceans sector
    Oceans and Fisheries Minister Shane Jones is streamlining high-level oceans management while maintaining a focus on supporting the sector’s role in the export-led recovery of the economy. “I am working to realise the untapped potential of our fishing and aquaculture sector. To achieve that we need to be smarter with ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Patterson promoting NZ’s wool sector at International Congress
    Associate Agriculture Minister Mark Patterson is speaking at the International Wool Textile Organisation Congress in Adelaide, promoting New Zealand wool, and outlining the coalition Government’s support for the revitalisation the sector.    "New Zealand’s wool exports reached $400 million in the year to 30 June 2023, and the coalition Government ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • Removing red tape to help early learners thrive
    The Government is making legislative changes to make it easier for new early learning services to be established, and for existing services to operate, Associate Education Minister David Seymour says. The changes involve repealing the network approval provisions that apply when someone wants to establish a new early learning service, ...
    BeehiveBy beehive.govt.nz
    1 week ago
  • RMA changes to cut coal mining consent red tape
    Changes to the Resource Management Act will align consenting for coal mining to other forms of mining to reduce barriers that are holding back economic development, Resources Minister Shane Jones says. “The inconsistent treatment of coal mining compared with other extractive activities is burdensome red tape that fails to acknowledge ...
    BeehiveBy beehive.govt.nz
    1 week ago

Page generated in The Standard by Wordpress at 2024-04-25T09:08:35+00:00