Mental Health Commission Amendment Bill

I move, That the Mental Health Commission Amendment Bill be now read a second time. In speaking to the second reading debate, I wish to congratulate the Health Committee on its sterling work in considering submissions on the bill and in reporting back to the House late last month. I am mindful that although there were relatively few submissions on the bill, for many of those making submissions very strong and heartfelt emotions were in evidence. I am sympathetic to the proposed amendment to clause 6, which makes it clear that the commission is not precluded from reporting to me at any time. I also want to acknowledge the views of those who expressed support for the bill and of those who expressed opposition to the bill.

The Mental Health Commission was originally established in September 1996 as a ministerial committee, and was later established as a Crown entity under the Mental Health Commission Act 1998, with a term of 5 years. The mental health sector has changed considerably since the establishment of the commission. The Government has committed considerable funding and effort to ensure improved levels and quality of mental heath services. The sector is more stable and is not subject to the service difficulties that characterised the period that led to the Mason inquiry. The Government recognises the commission’s important role in supporting the implementation of the national mental health strategy and the development of the mental health sector. One of the commission’s key contributions has been to express the needs and the wishes of mental health service users.

Many challenges lie ahead for the mental health sector. I consider that retaining the commission would assist the sector to address these challenges, provide a voice and support for stakeholders, and help the sector achieve the goals set out in Te Tāhahu—Improving Mental Health, the new national mental health strategy released in 2005, and in the associated action plan, Te Kōkiri, released last year.

Te Tāhahu signifies a new era for mental health and addiction policy and, for the first time, describes the outcomes the Government expects from its ongoing investment in mental health and addiction services. Te Kōkiri focuses directly on implementing Te Tāhahu and sets the programme of action to be achieved so that we meet the outcomes that we all want for mental health and addiction service users, and their families and whānau. This is an important and considerable task. A key role for the Ministry of Health will be to exercise leadership over, and drive the implementation of, Te Tāhahu and Te Kōkiri during the next 10 years. In order to achieve the goals and objectives of Te Kokiri, the ministry will need to work closely with all sector stakeholders, including the Mental Health Commission. However, if the term of the commission was to expire in 2007, the sector would lose an important vehicle for raising issues of substance and encouraging public debate on mental health during the period of the implementation of Te Tāhahu and Te Kōkiri.

The policy behind the Mental Health Commission Amendment Bill was informed by a review of the Mental Health Commission conducted by the Ministry of Health earlier this year. The ministry’s review included public consultation. The vast majority of people who participated in the consultation were very positive about the commission’s contribution to the mental health sector during the past 10 years. Specific achievements noted by submitters included successfully developing the 1998 blueprint on mental health services, which detailed the elements required for comprehensive mental health services in New Zealand; successfully articulating the needs of mental health service users in a way that had not occurred before the commission’s inception; challenging traditional models of care for the mentally ill; and promoting public awareness of mental illness.

Many submitters commented that the development of the mental health sector needs to continue apace, and that allowing the term of the commission to expire would slow progress and reduce the amount of support available to the sector. Some submitters raised questions about the scope of the commission’s role and the nature of the debate it facilitated.

The Mental Health Commission Amendment Bill extends the term of the Mental Health Commission until 2015, and brings the commissioner’s terms of office into line with the Crown Entities Act of 2004. Because the mental health sector has changed considerably during the past 10 years, the bill revises the commission’s current functions to ensure that the commission is well placed to assist the sector from 2007 onwards. This includes new advocacy functions designed to ensure the views of all stakeholders are represented, and changes to the commission’s monitoring functions to ensure clarity around agency accountabilities and to minimise the duplication of effort across agencies.

These revisions recognise that the mental health sector has changed for the better during the past decade. They are intended to address the concerns raised by submitters to the consultation process and those raised in submissions to the committee. I commend the Mental Health Commission Amendment Bill to the House.

We have just heard a pretty low-key address from the Minister of Health. To be honest, it was not very convincing at all. It was obviously a prepared speech, written by the officials.

💬 Judith Collins: It wasn’t his most passionate speech.

It was not really his most passionate speech. The Minister described a long list of reports and different groups that had informed strategy, and it all sounded very sort of officialese. He did not actually tell us what is really happening in mental health in this country.

The problem is that this Government has actually increased spending on mental health by two-thirds compared with the amount that was being spent when it came to power. It is now spending almost $1 billion a year, and we have to ask whether the outcomes in mental health are any better than when Labour came to power. Frankly, the Minister knows they are not. We had a report last year that stated that now, in any one year, one in five New Zealanders suffers from mental illness symptoms. We have had reports saying that 16 percent of New Zealanders have suicidal ideation during the course of their life. [Interruption] I can tell those members who think this is funny that the Labour Government’s frivolous attitude towards this issue is noted out there in the community.

National supports the Mental Health Commission Amendment Bill, although we have some reservations. A lot of people came before the Health Committee; a lot of families came before the Health Committee. National is concerned that the voice of families be heard in the area of mental health, because 0.3 percent of the really seriously ill mental health patients will never get any better, and a big part of the burden of their care falls back on their families. It is fair to say that a lot of families have felt excluded; they have felt excluded from some of the decision-making processes. We are concerned that those voices be heard, because that is where a lot of the burden comes back to; it comes back to the family.

In the Committee stage of this bill National will table a Supplementary Order Paper to prolong the life of the Mental Health Commission for a period of 3 years from the date of the Royal assent. That is not because we do not see a need for the commission. There is a real need for this sort of commission and a real need for the functions that it performs. But we think that one has constantly to review what a commission like this is doing. One of the things we want it to do is to play a greater part in holding the Government to account for those mental health outcomes and outputs. We know there are a lot of problems in mental health in terms of services. We know that this Government, despite spending that $1 billion a year, has failed to adequately address the workforce crisis, has failed to make inroads into suicide rates amongst young women, and has failed to address some key areas of illness. So we say that if the Government is spending a billion dollars a year on a range of programmes, there has to be some accountability. We reckon a key role for the commission is to press the Government on a lot of these issues.

The annual report of the Ministry of Health last year showed that the Government is not delivering, in terms of mental health, for Pacific Islanders and it is not delivering for Māori. Young people are not getting access to services and older people are not getting access to services. The Government’s response has been very much driven by media headlines, so a lot of effort has gone into forensic services and providing services for adults, but some of the less headline-grabbing areas of mental health have not had the same attention. You know, mental health issues occur across the whole period of a person’s lifetime—or they can do—and a lot of work needs to be done with young people. Some of the specialist areas, like eating disorders, are grossly underfunded in this country. But there is a lot of money in the system.

So one has to ask: if the spending has gone up to a billion dollars, yet some really needed services are underfunded, what is the problem? The problem is the management of the system. The person who is responsible for the management of the system is the Minister of Health himself. So although the Minister talks a lot about all these reports on mental health, and he can say the spending has gone up, the actual fact is that he has not made any inroads into the rates of mental illness. We want to see a good, vigorous Mental Health Commission that holds the Government to account and puts a lot more pressure on Minister Hodgson than he has been subject to so far, because we think he has to be accountable for that $1 billion of spending.

I think that Māori and Pacific Island people, old people, and very young people need to be getting a greater share of that service. The Government says that the workforce is an issue; it says that it cannot get the staff. But if the spending is going up like that, why does the Government not just direct some of that spending into the areas where it is needed? The real travesty in all this is that a lot of district health boards are not actually spending the allocation ring-fenced for mental health. Last year, mental health funding was underspent by $18 million. So members can clearly see that it is a problem of mismanagement of the funding.

I think the Minister needs to get up at some stage and take another call to address this issue. He cannot just get up with some speech that has been prepared by the officials and rattle off all this stuff about reports that have been done. They all sound very impressive, and it sounds like the Government is doing something. Well, I will tell members what the Government is doing. It is spending a lot of money, and it is spending it on mental health, but the outcomes are not getting any better.

To summarise, the National Party supports the passage of this bill, but we think there are some things in it that really need to be addressed. We are very keen to table the Supplementary Order Paper, and I am hoping the Māori Party, the Greens, and New Zealand First will support it, because one cannot just give a commission a blank cheque to have another 8 years of life and have it be totally unaccountable. This commission is pretty independent, and it is important that it actually delivers some results in mental health.

One has to look hard at this Government, and I know that at the end of his term as Minister of Health, which could end sooner than one thinks, Mr Hodgson will be looking hard at himself in order to ask what he has actually delivered in mental health, apart from an increase in the budget. What has he actually done to improve the situation, to improve the lot of mental health patients in New Zealand?

I know one thing that the Government will be doing. It will be honouring its pledge to the second-round claimants in the Lake Alice Hospital case, who saw their money secretly lopped by a Cabinet decision—$3 million of it: $35,000 each. As I said the other night in the House, I know that Cabinet is committed to making sure that those people—frankly, some of the most vulnerable people in New Zealand society—get that money, which was awarded to them by Sir Rodney Gallen. That money is legally theirs and they must get it. But we know what happened to the second-round claimants in that case. They had some money secretly withheld—$35,000 each. Many of those people have been severely damaged by some of the past abuses in our psychiatric institutions. For those people that is a heck of a lot of money. They will never be able to get that amount of money together in their lives. Frankly, it was purely by chance that the Cabinet decision was discovered. I know that the Minister is an honourable Minister and I know that he will want to see that addressed sooner rather than later.

But the key point for the House to remember is that before we pour more and more money into mental health we have to make sure that we are actually doing something about getting results. It is not good enough just to say that we are spending more. And this Government is spending more and more. It is spending nearly $12 billion this year, whereas in 1999 the whole health budget was $6 billion. That is a heck of a lot of money. A lot of money is being spent on health. What is lacking is management. What is lacking is the desire to make sure that outcomes are delivered.

I, along with Wayne Mapp, am holding a public meeting for my constituents in Northcote tomorrow at the North Harbour netball courts. It is a meeting about what has been going on at North Shore Hospital. That has parallels to what has happened in mental health. We are going to have a couple of hundred people at the meeting, and they want answers about what is happening with the money being spent by the Waitematā District Health Board.

What has been happening in the mental health arena, I think, really reflects the problems we have in health, full stop. There is a lot of money, but the Government really has not been delivering for people. I can tell members that the people out there who are listening and watching know that is true. Those people have family members whom they have tried to get into facilities, and it just does not happen.

I take great pleasure in rising to speak to the second reading of the Mental Health Commission Amendment Bill, in part because it is important that somebody rebuts some of the unfounded assertions that we have just heard coming from the Opposition speaker Dr Jonathan Coleman.

I use as an example a visit I made recently in the Waitematā District Health Board area, to the opening of a new acute unit for mental health patients at Waitakere Hospital. There are two acute units in the Waitematā District Health Board area, one on the North Shore site and one at Waitakere Hospital. Te Atarau was one of those acute units that was expanded, and it has now become Waiatarau. It has 24 beds, and it is one of the examples of the effect that money going into the mental health sector has had. There have been expanded services and facilities.

Debate interrupted.

The House adjourned at 6 p.m.