Mental Health Commission Amendment Bill

on behalf of the Minister of Health: I move, That the Mental Health Commission Amendment Bill be now read a first time. At the appropriate time it is the Government’s intention that the bill be considered by the Health Committee.

This bill extends the term of the Mental Health Commission until 2015. It revises the functions of the commission and brings the commission’s terms in office into line with the Crown Entities Act 2004. Once enacted, the bill will repeal and replace certain sections of the Mental Health Commission Act 1998.

The commission was originally established in response to the recommendations of the 1996 Mason report, the culmination of an inquiry under section 47 of the Health and Disability Services Act 1993 in respect of certain mental health services. It began work in September 1996 and was established as a Crown entity, with a term of 5 years under the 1998 Act. The commission was established to ensure implementation of the national mental health strategy by monitoring and reporting on the performance of the sector. It was also tasked with reporting to reduce discrimination and stigma and promoting workforce training and development. The term of the commission has been extended twice—once in 2000 and again in 2003. The commission is currently due to expire, in legislation, on 31 August 2007.

This bill repeals section 10 of the principal Act and substitutes a new section 10. It amends section 13 of the principal Act. Part 2 details the transitional provisions in relation to the commission. Considering the support expressed by stakeholders in this sector for the retention of the commission and the important role that the commission has played in supporting development of the mental health sector, this bill is important legislation that will allow the commission to continue to serve the mental health sector well into the future.

This bill, which proposes the retention of the commission until 2015 and revises its functions to support the future direction of the sector, is a good indication of this Government’s wish to promote and protect the health and well-being of New Zealanders, in another positive step forward in the ongoing maintenance of an efficient, innovative, and exciting mental health sector.

It is my pleasure to rise to speak in support of the Mental Health Commission Amendment Bill. National sees a role for the Mental Health Commission in monitoring and improving the New Zealand mental health system, and, as such, we wish to see the bill proceed to its first reading. The Mental Health Commission has done much over the past few years to destigmatise mental illness and raise public awareness. It performs some very good work, and, as a result, the general public now has a greater appreciation of just how common the symptoms of mental illness can be.

The National Party believes that there is indeed some real work to be done in mental health. The fact is that mental illness has a significant impact on the lives of New Zealanders, and that burden is growing, not decreasing. According to the New Zealand mental health survey released in September, nearly half of all New Zealanders will meet the criteria for having a mental illness at some time during their lives. One in five New Zealanders experienced a mental illness in the previous year, and that does not take into account the 0.3 percent of the population who suffer from mental illnesses with psychotic features. The survey also found that 16 percent of New Zealanders had thought seriously about suicide. About 5 percent had made a suicide plan, and 4 percent had attempted suicide. These are serious statistics indeed and are worthy of some consideration by members opposite rather than continued ad hominem attacks.

The reality is that under this shameful Labour Government, spending on mental health has increased by 75 percent since 1999 to nearly $1 billion per annum, yet there is no measurable improvement in the mental health of the nation. In fact, mental health statistics seem to be deteriorating. It is important to keep the focus on spending—

💬 Hon Trevor Mallard: Ha! ha!

The member may laugh during this, but this is a very serious matter for many New Zealanders. Mr Mallard can smile and laugh, but this is something that the House should be considering. Members opposite might want to listen to some of this; it does not reflect well on their failure to actually take this seriously.

But I digress. It is important to keep the focus on the spending of taxpayer money in the mental health sector in the most effective manner possible. There has been a lot of money spent by this Government on strategic plans, studies, and bureaucracy, but the reality is that the money is not being targeted effectively. The Minister of Health needs to concede that the management of mental health services and the targeting of funds in this sector are not delivering the results New Zealanders deserve.

The recent Commonwealth Fund report into primary care in seven OECD nations surveyed the views of primary-care doctors. When it came to ability to care for patients with mental health problems, less than half the New Zealand practices surveyed felt that they were well prepared. The National Party believes that we need to be looking to primary care—[Interruption] Mr Assistant Speaker, if these members want to continue their conversation would they like to do it outside, because this is a serious matter.

The ASSISTANT SPEAKER (H V Ross Robertson): Can I just say to the members on my right that I would like them to look at Speaker’s ruling 57/3(1) by Speaker Statham. Interjections are to be rare and reasonable, and, as a former colleague used to say, witty. There are too many.

💬 Hon Trevor Mallard: I raise a point of order, Mr Speaker. I think, given the member’s recent history, it is a bit on the nose for him to invite members on this side to step outside.

The ASSISTANT SPEAKER (H V Ross Robertson): If the member did such a thing, then he should withdraw and apologise, but if he did not, I will take the member’s word. He is an honourable member.

I have nothing to withdraw and apologise for, but I make the point that with Mr Mallard’s history he might want to listen—

The ASSISTANT SPEAKER (H V Ross Robertson): Just get on with the debate.

OK. [Interruption] Mr Assistant Speaker, do you think I should request to be heard in silence? This is a serious matter. There are people out there who want to listen to this speech.

The ASSISTANT SPEAKER (H V Ross Robertson): The member can seek leave for that. He is perfectly entitled.

I seek leave for this speech to be heard in silence. [Interruption]

The ASSISTANT SPEAKER (H V Ross Robertson): The member can require it if he wants to.

OK, I require it.

The ASSISTANT SPEAKER (H V Ross Robertson): The member has asked for silence, and I ask other members to oblige.

Thank you, Mr Assistant Speaker. The recent Commonwealth Fund report into primary care in seven OECD nations surveyed the views of primary-care doctors. When it came to the ability to care for patients with mental health problems, less than half the New Zealand practices surveyed felt that they were well prepared. The National Party believes that we need to be looking to primary care to take on more of the workload in mental health, but to do so, general practices need the resources and training to operate effectively. We would like to see the Mental Health Commission pushing the Government on this, playing a major role in monitoring the subsequent outputs, and providing an objective assessment of the success of such projects.

Hospitalisations for attempted suicides are a good indicator of the mental health of a nation, and the reality is that they have gone up by almost 20 percent since Labour came into power. If one looks at the hospitalisation rate for suicide attempts made by young women since 1999, one sees that they have risen by 45 percent. Suicide attempt statistics represent measurable outcomes in mental health, and by those criteria this Government is failing the public in the management of the sector.

This Government could be doing much more to target the needs of those affected by mental illness. The Government has talked up its 10-year action plan for mental health, Te Kōkiri, and put an emphasis on prevention, but it is all spin and waffle. The specifically listed action for promotion and prevention in the Government’s new 10-year mental health plan is to spend 3 years reviewing the strategic framework, to develop a new framework to develop a plan to set out a strategy.

Workforce development is a major issue in mental health. Earlier this year the Otago District Health Board had to pay out $60,000 to two experienced enrolled nurses in order to remove them from their jobs, following a Ministry of Health reminder that enrolled nurses cannot work in acute care. Mental health nursing is an area where experience is what really counts. All this meant was that the Otago District Health Board ended up two nurses short in acute mental health, and it cost the board $60,000 to arrive at that lamentable situation. A major problem in this sector is that the level of qualification for staff is being raised, thereby excluding many experienced mental health workers. Not only are the staff not available but even if they were, many mental health providers could not afford to employ them.

Then there is the disgraceful mess over the Lake Alice Hospital compensation payout. Michael Cullen has admitted that Cabinet decided to withhold some of the compensation awarded to claimants as a result of the inquiry into Lake Alice Hospital. Continued delays in paying out compensation to Paul Zentveld, a claimant in the case, are completely unsatisfactory. After experiencing outrageous treatment at Lake Alice Hospital, the claimants agreed to settle with the Ministry of Health in two separate compensation rounds. Mr Zentveld had $35,000 secretly lopped off his compensation payment by the Ministry of Health and found out about it quite by chance. He took the ministry to court and he won. Rather than paying up with good grace, this Government is appealing against the decision in the High Court. This is obviously because the Minister knows that the implication of this decision is that up to $3 million will need to be paid to the other second-round claimants who had part of their compensation secretly withheld. This Government keeps droning on about social justice, but when it gets the chance to actually apply some, it ducks for cover. Minister Hodgson needs to stop dodging the issue, write the cheque to Mr Zentveld, and pay back any money that his ministry rightfully owes the 87 other second-round claimants.

Furthermore, there are issues around the mental health blueprint and the funding being applied by various district health boards in fulfilling the blueprint. It is clear that adult and forensic services are being funded to the levels the blueprint dictates, but other areas such as child and adolescent services are falling woefully behind. Yet, at the same time, district health boards are underspending their ring-fenced mental health money to the tune of $18 million a year, much of it in Auckland. Something is grossly wrong here. Mismanagement in the mental health sector is rife.

So all is not as well as it might be in the mental health sector. There is much work for the Mental Health Commission to do, because this Government is spending more and more on mental health but the results are not getting any better. We think the Mental Health Commission has a real future. There are some people of real ability and knowledge at the commission who have extensive knowledge of the mental health system. We think the commission could have a wider role to play, however. We would like to see the commission doing more to hold this Government to account, by speaking out on its performance in mental health. The commission needs to be more demanding of this Government in terms of mental health outcomes. National would want to see the commission monitoring district health board spending in the mental health arena, measuring outputs objectively, and ensuring that the public money spent in mental health really is making a difference to the health of all New Zealanders.

We feel, however, that an extension of the life of the commission to 2015 is excessive. Public spending should produce results, and we would support the extension of the life of the commission until the end of 2009, at which time its output should once again be reviewed. The commission should in no way feel threatened by this, because National supports the work that it does. However, what gets measured gets done, and we feel that a further review of the work of the commission in 3 years’ time is entirely reasonable. The National Party looks forward to working with the commissioners while in Government.

It is with pleasure that New Zealand First supports the first reading of the Mental Health Commission Amendment Bill. It is a very short bill, and we will be taking only a very short call.

This bill is needed to amend the Mental Health Commission Act, so that the term of the Mental Health Commission can be extended to 2015, and so that there can be extensions to the functions of the Mental Health Commission. The current Mental Health Commission should end its term in August 2007; we do not want this to occur.

The Mental Health Commission is a very important body. It provides many important functions to very many people right throughout New Zealand. We understand that there has been extensive consultation with the mental health sector and mental health consumers. They want the Mental Health Commission retained, and they approve of the changes to its functions.

New Zealand needs and wants the development of an integrated, effective, and efficient system of care for mental health. We need to protect the well-being of New Zealand. New Zealand First believes that the Mental Health Commission has a very real future, and we support this bill.

The Green Party is, like everyone else in this House, delighted to support the Mental Health Commission Amendment Bill. We think that the Mental Health Commission has been a real success story. It has been a really independent, respected, and credible voice, and we strongly support its continuance. The Health Committee has had some dealings with the Mental Health Commission over the last 6 years. We have been impressed by the calibre of its submissions and its advice. I think it is a good model to have an independent voice in an area like this. I might say that there was another public health commission, which, regrettably, was disbanded some years ago. I think that is unfortunate.

As previous speakers have said, it is extraordinary that mental illness is so prevalent in New Zealand, and continuing to rise. It calls into question much about our society that we have such a very high rate of mental illness. But, also, there still is a huge stigma and lack of understanding around mental illness. The Mental Health Commission has done some excellent work in some recent campaigns in this area, which I think is contributing a significant amount to reducing the stigma, but there is a major amount of work to be done still.

It is true that we hear terrible stories about what is happening to some people who are suffering from mental illness in our communities, and also about the crisis among mental health workers. There is a huge amount to be done in this sector, and for that reason we are absolutely delighted to support the Mental Health Commission Amendment Bill and to extend the functions and life of the commission. As I say, I think it has earned the support of all members of this House, and indeed of New Zealanders. It has been a genuinely independent, respected, and credible voice in this area. It has earned its keep.

Tēnā koe. Tēnā tātau katoa, meri Kirihimete ki a tātau.

In looking for a kōrero on which to start a discussion on this bill I came across these words: tēnei te kākano ka ruia nei, morimoritia kia puāwai ai hei maunga ringa mā ngā whakatipuranga. This is the seed that was sown, then nurtured to blossom forth, to be held as a prized possession for the generations to follow. I think the general gist of this kōrero is that we must always consider the next generation. The flourishing of our mental health and well-being, the growth of our spiritual foundation, our wairua, the strength of the metaphysical, the hinengaro, the blooming of the ngākau, our emotional strength, is essential to the prosperity of the people. Our future generations will be better if their mental health is in good shape. We really need to consolidate and give shape to families who value mental health and who see that as a part of their pathway forward.

It is because of these beliefs that the Māori Party is delighted to support the Mental Health Commission Amendment Bill, to extend the term of the commission until 2015. On 8 October this year, before the ink was dry on the media release, my humble colleague Tariana Turia was quick to commend the health Minister Pete Hodgson for announcing this legislation to extend the term of the commission. We have valued the work of the Mental Health Commission, which has done much good work on the implementation of Te Tāhuhu, the mental health strategy.

The Māori Party wants to put on record our appreciation and recognition of kaumātua Denis Simpson and the commissioners Ruth Harrison, Mary O’Hagan, and Ray Watson of Ngāi Tahu and Te Ātiawa. I want to mihi to the excellent quality of these people. I know of the work of Ray Watson through his previous role as chief executive of Lakeland Health in Rotorua and Taupō. Denis Simpson of Ngāti Awa has an impressive reputation as chairman of Te Kaunihera Kaumātua Taurahera Council, the Wellington Council of Elders; Ruth Harrison has considerable experience across the disabilities sector; and of course Mary O’Hagan is extremely well known in the mental health field, having initiated the mental health service user movement in New Zealand in the late 1980s and having been the first president of the World Federation of Psychiatric Users.

I have taken time to touch on the credibility of these members and the expertise they bring to their work, the extensive clinical, professional, and managerial experience they demonstrate in the mental health sector, and the unique set of skills they bring to this role, because it reflects on the strength of this commission. This is a commission that is truly independent, a commission that is not afraid to call it as it sees it, but does what is required, giving free and frank advice to the Minister. I must say that the question of independence is always an area of concern for the Māori Party with these sorts of bills.

One of the most crucial functions of the commission is the monitoring role. This bill places too many constraints on this role of the commission. We believe that amendments need to be made to the bill to strengthen the monitoring role, and to make it more in line with the current Act, including monitoring the performance of the key agencies, including district health boards and the Ministry of Health. We are particularly concerned about the two qualifiers included in this bill that act to constrain monitoring to only when the Ministry of Health agrees to it. From our point of view, this is a Clayton’s style of monitoring. We have seen this before, across Government. If we cast our memories back to the distant days when closing the gaps was a priority, the House will recall the raft of reports and projects called for, under the heading that never even made the light of day. Te Puni Kōkiri was caught in the crossfire in the advice that it was obliged to give, in the name of free, frank, and fearless advice. But the constraints became apparent when the Ministers or the ministries that were subject to its monitoring felt that the criticism was too harsh, too critical, or too bad. So somewhere in the bowels of Te Puni Kōkiri there is a whole series of closing the gaps reports that are going nowhere fast. I reckon that this would be quite a good item for a select committee inquiry.

But I come back to the Mental Health Commission Amendment Bill. The qualifiers in this bill need to be taken out. The commission must maintain its independent oversight and monitoring watchdog role. It will not be able to do this under the provisions of the bill—to be independent of Government agencies—if its very work programme is constrained by the approval of the Ministry of Health. Indeed, we believe that it would be very useful to explore the notion that the commission should have a statutory role under the Mental Health Act.

There are three purposes for this: firstly, to maintain people’s rights; secondly, to maintain services delivered; and, thirdly, to report back. There would be a need for a consequential amendment to the Mental Health Act, but it is certainly an idea that we would like to see given further life during the progress of this bill.

There is no denial that the sector greatly values the independence, the autonomy, and the fresh perspective brought to the mental health field through the work of the Mental Health Commission, in particular the development of its blueprint for mental health services—a plan that sets targets for resourcing and services for mental health consumers. This has been invaluable and well received by consumers and providers alike. They have played a significant role in tackling stigmatisation and expanding services for people with mental health issues.

In mid-year we brought to the House the study published in The Lancet, which reported a significant level of self-reported experiences of racial discrimination by Māori, of Māori, Pacific, and Asian New Zealanders, including verbal and physical abuse and unfair treatment in health care, work, and housing. The study showed that Māori were almost 10 times more likely to experience discrimination in three or more settings than their non-Māori counterparts, and that further, they were more likely than Europeans to report low mental health. In this context the courage that the Mental Health Commission has shown in speaking up for the rights of the vulnerable is admired. We all have a part to play in addressing this. We, the Māori Party, are stepping up to the mark, and next year we will be putting forward a bill to address institutional racism.

Finally, while I am not a sailing man, I came across a kōrero recently that I think is very thought-provoking. I believe that it was a Te Arawa person who said it. This is what he said: “The pessimist complains about the wind, the optimist expects it to change, the leader adjusts the sails.” It was a Te Arawa person who said that.

We believe that the Mental Health Commission Amendment Bill helps to address the fundamental issues associated with the treatment and response to mental health in Aotearoa. It is not perfect by any means, and we look forward to the select committee process to ensure that the necessary changes are made. If they are not, then the Māori Party will be back to this Chamber with Supplementary Order Papers in the Committee stage, to ensure that the bill can truly support the very important work of the Mental Health Commission. Kia ora tātou.

I stand on behalf of United Future to speak in support of the first reading of the Mental Health Commission Amendment Bill. As the Māori Party member was keen to mention some of the fine staff who work for the commission, I would also like to state that United Future is thrilled that Selwyn Kātene is now the general manager of the Mental Health Commission. We believe he will be a great contributor to the work of the commission.

This bill is pretty straightforward, in that it restates the functions of the commission and adds some new functions to the list regarding the mandate under which it serves. First of all, there are some general understandings about the commission needing to be independent. It is a client-focused honest broker that wants to make sure the interests of mental health patients are constantly advocated for and listened to. It is a place where people who have experienced mental health services, and would like to suggest ways in which those services can be better delivered, can contribute and send their ideas to someone who will listen seriously and take their advice.

Obviously, one of the key roles of the commission is advocacy. It also works as a facilitator, helping organisations to collaborate their efforts more cohesively, and communicating on that matter. Also, one of the most important roles I have seen the commission working in is the area of communicating within the community and breaking down the areas of stigmatisation that people suffering from mental health problems often incur.

One of the things we need to understand when considering the relevance of the commission is how essential its work is. I have read statistics that show that at any given time, about 3 percent of our population is in need of mental health services. When we do the maths around what we currently deliver in mental health services, we find only half that number are accessing help. That means there is a lot more work to be done. Certainly, the last thing we need to have is a downgrading of a commission that was set up to make sure that the Government is constantly held to account by the people who most need that help and support.

There are also some interesting ideas around stimulating innovation amongst policy makers, and also around the ability to undertake research where that is considered helpful. I agree with the National Party about the fact that we want to see a real movement in mental health services towards better services in the primary health care area. I remember that when the Hon Annette King was Minister of Health, she indicated that there was some funding in the pipeline for primary mental health care. It was on her “to do” list, and high up on that list, as part of the funding to primary health organisations. I am keen to hear the new Minister reiterate that commitment, because I think it is an area that we currently do not do well in. Certainly, primary health care in regard to this matter is really the fence at the top of the cliff, but we need to see better service provision put in place.

I do not think I will take any more of the House’s time on this matter, other than to say we are very supportive of this first reading.

I rise to speak to the first reading of the Mental Health Commission Amendment Bill on behalf of ACT New Zealand. ACT will be opposing this bill, but not for reasons that might immediately be apparent. There are two main reasons.

But firstly I would like to address the barrage that Dr Coleman had to contend with when he was trying to discuss some very important issues relating to mental illness. I think that Labour members have shown that they have very little understanding of mental health issues in this debate. Mr Mallard, who has never shown any interest in mental health issues before, stood up and spoke on behalf of his party. He did not even manage to fill his 10-minute slot in speaking about what good work the Mental Health Commission might or might not have done, but instead took the opportunity, when he sat down, to then lead a barrage from his Labour colleagues about Dr Coleman. Luckily, I was sitting very close to Dr Coleman and could hear what he was saying; he had some very valid points to make. The Labour members that participated in that very shameful behaviour should apologise to those people in New Zealand who suffer from the very serious consequences of mental illness. If those members had something to say to Dr Coleman, then they should not have said it when the proceedings of this bill were taking place. [Interruption] I am ashamed to be part of a House that thinks that that sort of behaviour—the sort of behaviour that we are hearing right now—is participated in.

💬 Madam SPEAKER: I would ask the member to address the bill, please.

Yes, I will. I am coming back to the Mental Health Commission Amendment Bill, which is a very important bill, I have to say.

ACT New Zealand opposes this bill, firstly, because a mental health commission should not be necessary if the mental health division of the Ministry of Health were doing its job properly. I see in the explanatory note of this bill that the Mental Health Commission’s role is being expanded, and our opposition to this bill is no reflection at all on the very good work, particularly in the area of research, that the Mental Health Commission does. But this bill is not necessary because that work should be being done by the mental health division of the Ministry of Health. The commission’s role is being expanded so that it will now advise and report to the Minister on the implementation of the national mental health strategy—something that those working in the mental health division of the Ministry of Health should already be doing—and, secondly, it will now promote and facilitate collaboration and dialogue about mental health issues. Again, that is a role specifically for the Ministry of Health.

The second reason that ACT New Zealand is opposing this bill concerns a matter that Māori Party members have raised, and I support them wholeheartedly in that matter. They worry, very clearly, about the independence of the Mental Health Commission. The commission consists of three commissioners and 16 core staff, and seven members on the advisory committee, as well—and they are appointed by the Ministry of Health. The commission’s independence, then, is very much in doubt. If we are to have a Mental Health Commission—and it is clear that this bill will go to a select committee, because ACT is the only party opposing it—then these things need to be taken into consideration. I would urge the Health Committee, when it considers this bill, to consider very carefully the issue of the independence of this commission, and to write those relevant clauses into this legislation specifically.

There is a great deal of difficulty with the area of mental health in this country. Three percent of the population at any one time requires treatment for a mental illness. That is quite a high proportion, but it is consistent with that in other populations around the world.

The main problem in the area of mental health is that of workforce shortages. Doctors and nurses are being recruited constantly, particularly in the area of mental health—[Interruption]—and it is a pity that, again, Labour members cannot see fit to listen carefully to this debate, when we have people in this country suffering badly from mental illness. Locums are the norm in many psychiatric departments in the hospitals around this country—not locums who come and spend any length of time in New Zealand but, frequently, locums from America and the United Kingdom. They are well-trained locums, but they come, usually, for a period of only 3 to 6 months. If any area requires continuity of care, it is the area of mental health, and having continuity of care is one of the big problems in relation to the workforce shortages experienced in the psychiatric area.

As one other speaker also alluded to—I think it was Dr Coleman—I, too, lament the inability of well-experienced, enrolled nurses to work in this sector any longer.

💬 Madam SPEAKER: Excuse me, but would members please keep their private conversations at a level that enables the member to be heard. Thank you.

Thank you, Madam Speaker. Enrolled nurses have been completely sidelined so that they are now able to work only either under the supervision of registered nurses in general practice—which precludes many of them, because some practices do not employ registered nurses—or in the area of aged care. The mental health sector was propped up very well and very ably by experienced enrolled nurses. Those nurses had a lot of skill and many, many years—in some cases, up to 20 years—of experience in the area of mental health. Sadly, that is a great loss to the mental health sector.

Blueprint issues and district health board underspending are also of great concern. Those should not be issues that have to be looked at and commented on solely by a mental health commission. Again, they are areas that should be looked at by the mental health division of the Ministry of Health, and it seems that this is not the case. One billion dollars, nearly 10 percent of the health budget, is now spent on psychiatric care—the care of the mentally ill.

The Mental Health Commission is due to expire on 31 August 2007. It should not be necessary to extend that term because, in the first instance, the commission was put in as a short-term measure. The role that it has played should have been picked up and run with by the Ministry of Health. Unfortunately that has not been the case, so we will have, effectively, a doubling up of people, a doubling up of numbers, and a doubling up of roles, because the Ministry of Health is failing in its mission to provide adequate care for those with mental illnesses in this country.

ACT New Zealand opposes this bill for the two reasons I have pointed out: firstly, the lack of independence of the commission and, secondly, the fact that the commission should not be necessary if the Ministry of Health were ably carrying out its role in this area.