Mental health budget alone won’t solve mental health problems

The 2019 “Wellbeing” Budget was launched recently with much fanfare, not least because a significant proportion of the budget was earmarked for mental health expenditure.

A $1.9 billion package has been allocated over five years across a range of portfolios including health, education, corrections, justice and housing, namely:
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• $455.1 million over four years for a new front-line service for mental health.
• $40 million over four years for suicide prevention services.
• $20.8 million over four years to fund digital and tele-health services.
• $58 million in operating funding for treating drug and alcohol addiction.
• $200 million ring-fenced in capital for DHBs to fund new and existing mental health and addiction services, which is part of a total $213.1 million from the $2.3 billion for DHBs.
• $4 million over four years for Te Ara in Northland, an initiative with police which provides meth addiction support.
• $8 million over four years to improve responses for people who turn up at hospital emergency departments needing mental health support.
• $128.3 million over four years to expand mental health and other services related to alcohol and drugs for offenders.
• $6 million to support families of homicide victims to help their mental health.
• $197 million to tackle homelessness through Housing First.

At first glance, this expenditure looks impressive.

However, since 1994 there have been 50 (yes, 50) reports into the poor state of mental health services and outcomes in New Zealand, for no meaningful improvement in mental health service delivery over this time.

The reason?

No-one is measuring the outcome effectiveness of the money being spent, or the quality of service delivery for people receiving mental health services.

Formal measurement of client feedback is nothing new, but it’s both virtually non-existent within mental health services in New Zealand, and a seemingly unwelcome topic of discussion within the mental health sector.

Apparently, while it’s legitimate for a Denny’s Restaurant to seek client feedback on its $8.50 budget breakfast, clients of publicly funded mental health services don’t get to have a meaningful influence or say on the services that they are on the sharp end of receiving.

The thinking and practice of not formally measuring client outcomes in the mental health field belongs in the dark ages, and needs to change if the above budget figures are to have any reasonable opportunity for success.

Evidence-informed policy is important as well.

For example, some critics of the 2019 mental health services budget claim that it will take several years to train sufficient people to work in the sector.

It doesn’t take “several years” to train someone to work effectively with other people in mental health – the outcome evidence reveals it takes around 50 hours.
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But no-one in Government seems to be reading the outcome evidence – mores the pity.