A common perception existed of a lack of clear leadership and national directions in mental health and addiction. People pointed to the much-reduced role of the Mental Health Commissioner and were critical of the lack of leadership from the Ministry of Health and the uncoordinated and varying approaches of the DHBs. People talked about what can be achieved when mental health and addiction is a priority area for government and there is clear leadership and direction from a mental health commission with a powerful statutory mandate.
Submitters asked why we don’t have a current national mental health and addiction strategy or a national suicide prevention strategy,33 why the mental health workforce doesn’t receive the same planning and attention as other parts of the health sector, why Kaupapa Māori and Pacific services continue to be under-resourced and why there is no clear direction to fund the sort of community support people are crying out for.
Across the spectrum of promotion or prevention, early intervention, primary care, specialist services and addiction services, people were concerned that a lack of direction and leadership means positive change is not sustained and good ideas are not implemented beyond the pilot stage. They also spoke of a lack of leadership and coordination in government services outside the health system, such as in the housing, police and corrections sectors, which clearly impact on mental health and addiction.
Some organisations and thought leaders expressed support for a single national entity charged with guiding and implementing mental health policy, able to commission services at a regional or local level. There was support for a dedicated national Māori health agency and expansion of regional commissioning of the Whānau Ora model. But there was also concern that a separate Māori health agency would lead to fragmentation and marginalisation.
It was also commonly argued that DHBs are too invested in a healthcare model and that funding decisions should be made by a body with a broader, wellbeing focus. However, some worried that a separate mental health agency might suffer from a ‘poor cousin’ status and lack the levers and authority to influence the wider group of departments whose work impacts on wellbeing. More than simply structural change, people wanted to see effective leadership at national, regional and local levels across the variety of departments and services. There was specific concern that Māori leadership within the health sector has been eroded.
We heard about inspiring services set up by communities with seed funding and support from local authorities and charities and only occasionally with input from DHBs or primary health organisations. People described innovative local initiatives that highlighted the value of non-clinical and peer-support services. We saw and heard about many examples of grass-roots leadership by people with lived experience of mental health and addiction challenges.
Suicide-bereaved families and whānau, families of young people with eating disorders, and other groups described setting up charitable organisations and informal networks to support each other, fill a gap in service provision and reach out to the community.
Submitters called for greater acknowledgment of grass-roots innovations and argued that a system focused on wellbeing should invest in these initiatives and support them to be evaluated and, potentially, replicated in other communities.
33 The draft national suicide prevention strategy prepared in 2017 has not been progressed.