Health funding is tricky. Politically, it's often about robbing Peter to pay Paul, and my experience of working in the public mental health system for many years is that mental health is often the "black sheep" of the health system. In the past, for this reason, spending on mental health treatment has been "ring-fenced" and specific targets (like via the mental health "blueprint") have set up to ensure adequate funding and service provision.
It's also a tricky thing to know at what level health is actually being funded. It's one thing to say that funding for the health budget has been increased (as the National government claimed in this year's Budget) in dollar terms, it's a different question as to whether it has actually increased relative to population growth and demographic factors.
Much cleverer people than me are clear that his year's health budget was actually a relative cut in health spending of $232 million dollars. Analysis from the Green Party, conducted independently by economic consultants BERL, also concluded that the proposed budget outlined for the next three years by the National Government will continue to underfund our public health services, and therefore by default our public mental health services.
So if mental health is your interest, your profession, your life or your experience here's what the main parties have to say about what they will do with our health dollars. Where possible I've given the whole mental health policy (if there was one) from the party's website, and have also approached all the relevant health spokespeople (if there was one) for comment. At the time of publication, only Kevin Hague of the Green Party had replied.
The only policy I've been able to find on the National Party website relating to, or mentioning, mental health is as follows:
"Support young people with mental health issues to get the help they need, and improve services via the PM's Youth Mental Health Project." (Click here for more on this policy)
I also approached the Minister of Health, Hon. Tony Ryall, for comment and further details. He did not respond to my enquiries.
Let's not forget that it is this National led Government that has overseen the dismantling of the Family Court-funded access to couples counselling, attempted repeatedly (albeit unsuccessfully, but only due to massive protest) to severely limit access to the ACC sensitive claims counselling funding for victims of sexual violence and continued to tighten eligibility for what used to be called the Invalids Benefit and counselling funding provided by WINZ. Increased funding for young people with mental illness will do little to counterbalance these losses, in my view.
The Labour Health policy, on the other hand, is quite detailed and health spokesperson the Hon. Annette King, who I heard speak recently, is clear that mental health is a priority for the Labour Party.
From the Labour Health Policy 2014:
"Mental health will be one of Labour's top eight health priorities when in Government. Labour will:
- Acknowledge the importance of mental health by restoring it as a health priority for District Health Boards.
- Require District Health Boards to set appropriate targets for the restoration and enhancement of mental health services.
- Re-instate the ring-fence for mental health funding.
- Enhance the provision of acute services to those most in need.
- Work to ensure equity of access services to those most in need.
- Work to ensure equity of access to health care for those experiencing mental illness.
- Support early intervention programmes for those with mild to moderate mental health issues as a method of providing low cost access to services and reducing costs in the provision of secondary services.
- Include good mental wellbeing as an objective of putting children at the centre of polcy making.
- Support those experiencing lower acuity mental illness through to recovery and/ or self-management and encourage where desirable the transfer of ring fenced funding from hospital to community-based support arrangements.
- Review the contracting arrangements for mental health providers with a view to creating more consistent and efficient approach to contracting.
- Ensure that when community mental health contracts are tendered that priority is accorded to organisations transitioning to a living wage.
- Provide increased resources to the office of the Health and Disability Commissioner to recognise the associated increased workload that has accompanied the trend towards growing interaction with mental health services.
- Work with mental health consumers, mental health organisations, service providers, District Health Boards and the Department of Corrections to eliminate the avoidable use of seclusion and minimize the use of restraints in mental health facilities including psychiatric wards and "at risk units."
- Acknowledge sexual violence as a major cause of mental health issues and work to address the consequences for this."
Green Party of Aotearoa New Zealand
The Green Party has a fairly comprehensive and detailed set of mental health policies:
"The Green Party will:
- Ensure mental healthcare training and practice is grounded in holistic, humanistic perspectives that recognise each individual as whole.
- Encourage mental health providers working within multi-disciplinary teams that hold the well-being of the client at the heart of their practice. Wherever possible, clients have a ‘primary’ provider who remains with them through their recovery process.
- Ensure skilled facilitation of multi-disciplinary teams that enables collaborative ways of working and provides collegial and professional support.
- Utilise client-assessed outcome measurement tools to compare service effectiveness.
- Fund innovative initiatives based on overseas experiences or new initiatives, particularly those that indicate high recovery rates with low/minimal drug use."
I also spoke briefly with Kevin Hague, Health spokesperson for the Green Party, and he outlined the following for me, in response to questions.
Firstly about Labour's policy of re-introducing the ringfence approach to funding for mental health:
"I do favour resuming the ringfence, but it has to go hand in hand with forcing DHBs to actually meet blueprint volumes. Broadly our policy and Labour's are congruent."
And with regards to the Green Party's priorities for mental health spending he had this to say...
"My top priorities (within mental health services - of course our wider social and economic policies will make a significant difference) would be:
"1. restoring a funding path to services (including NGOs) that matches the need services are trying to meet (in contrast to current real terms cuts over past 6 years)
2. Ensuring good access to counseling, brief interventions and other treatment as part of the primary care level, but either directly or through PHOs
3. Ensure full range of community-based support services for people with ongoing mental illness, including residential services, so they don't get stuck in inpatient units (or left unsupported)
4. develop some indicators for service quality in mental health that align with best practice and will require systemic improvement to achieve
5. AOD services ramped up, especially (and in conjunction with other mental health treatment services) for Corrections clients"
When I heard the Hon. Peter Dunne speak to this policy, he was clear to differentiate that it represented United Future policy, and that as such he was not speaking as Associate Health Minister:
"United Future will:
- Encourage government agencies to work together on early intervention, prevention, treatment and rehabilitation in mental health
- Ensure that the right balance is struck between inpatient and community care to prevent people becoming a danger to themselves and society, but with recovery within the community remaining the goal
- Increase resources for mental health professionals to ensure that those patients who may pose a risk to others or themselves are adequately assessed and treated
- Increase the number of community-based mental health workers to ease high caseloads
- Fund child and youth mental health inpatient beds at a level sufficient to achieve the objectives set out in Rising to the Challenge – the Mental Health and Addiction Service Development Plan 2012-2017 and the Prime Minister’s Youth Mental Health Project;
- Tackle the issue of the lack of accommodation and employment support options for people recovering from mental health problems in the community;
Increase drug, alcohol and mental health treatment programmes for prison inmates
- Improve workforce development and funding available for youth-focused counselling services as the first line of defence, rather than over-prescribing pharmaceuticals for mental health problems
- Ensure DHBs plan for secure facilities for treatment of young people with mental health problems
- Promote more research to address youth related health problems such as suicide, alcoholism, and bulimia"
New Zealand First
The New Zealand First Health policy outlines some broad goals, and I also approached the NZ First Health spokesperson Barbara Stewart with some questions about their specific policy. She didn't respond to my inquiries.
"New Zealand First will:
- Increase the options of mental health services available, working towards a community view instead of a medical view of services.
- Improve residential services for people who have severe illnesses or disabilities and/or substance abuse problems.
- Provide additional resourcing for child and youth mental health services, and the necessary resources and funding to address the continuing appalling state of mental health services by completing the full implementation of the recommendations of the Mason report."
Specific mental health policy appears a little thin on the ground, other than ongoing support for Whānau Ora, and more specifically supporting the Prime Minister's Youth mental health intitiative via targeted Whānau Ora funding.
"The Māori Party is committed to... ... inclusion of the 6 week GP check in Well Child/ Tamariki Ora services to ensure signs of postnatal depression and congenital heart disease are identified... [and] ...continued research and evaluation into the effectiveness of suicide prevention, intervention and postvention for whānau Māori."
"The Mana party will:
- Increase access to and funding for mental health services, including those for children and young people.
- Support the use of cannabis for medicinal purposes when made available under prescription from a health professional.
- Give communities a veto over whether and where liquor outlets, fast food outlets, and pokie venues are established."
The Internet party has a very detailed policy document on the use of "E-Health" solutions, but very little else that I could find on health policy. The document doesn't refer directly to mental health.
ACT makes the following policy statement about health funding generally:
"ACT does not support free healthcare as this results in the provision of a service which is not valued."
Says it all really.
The Conservative Party makes the following statement about health:
"A belief that all New Zealanders should have reasonable access to quality health care and education regardless of their ability to pay."
They make no specific statements about mental health, although I have previously expressed some concern about the party's lack of understanding in this area as indicated by the stigmatising use of language in their promotional material see: Off the Couch: Not mental.
So, what's the moral of the story? Well, it should hardly be a surprise that the minor parties on the right either explicitly don't support funding of mental health, or have very little to say about it. The other minor parties, largely on the left or centre-left, seem to support ongoing and increased mental health funding. Of the three major parties, the Labour Party and the Green Party have the most detailed and well-developed polices as to how to increase and make more effective the public mental health system.
And for those of you that think this is a minority issue, as I wrote about last week (see: Off the Couch: What is normal?) just under half of us will experience a mental illness or an addiction at some point in our life, and one in five Kiwis currently are. Make your vote count.
Kyle MacDonald is a psychotherapist and is the New Zealand Association of Psychotherapists Council spokesperson on Public Issues. He writes a regular blog “Off the Couch” at www.psychotherapy.org.nz and can be found on Twitter: @kylemacd