Mental Health Commission Amendment Bill

Before I call the next member I wish to advise the House, under Standing Order 117(2), that when the second reading debate on the Mental Health Commission Amendment Bill was last debated, on 24 July 2007, it was interrupted, and the honourable member Hone Harawira had 2 minutes speaking time remaining if he so wished. I have been advised that Dr Sharples will be completing the speech today under this Standing Order, which states: “An individual speaking time may be shared between two members of the same party or between two members of different parties if both parties agree.”

Tēnā koe, tēnā tātou katoa. I te mutunga kua kitea kāre he tangata kei a rātou ngā tohu, ngā mōhiotanga hoki ki ngā tikanga o tēnā, o tēnā o ngā tūroro me ō rātau tono kākari. I tērā hepetema i pānuitia e Te Rau Hinengaro tētahi rangahau i kī, ahakoa te taumaha o te mate i roto i te Māori me te Pasifika, kāhore e riro i ēnei hunga ngā ratonga oranga hinengaro, kua whakaritea mō te katoa. E te Kaihautū, koia nei ngā take nui kia ora ai tō tātou iwi. Tāpiri atu ki ēnei take ko ētāhi pērā i te āhua o te kaikiri, o te whakahāwea, me ērā atu o ngā take ka taka mai hei whakawehe i te iti me te rahi.

E ngākaunui ana mātou ki te komihana me ōna tāngata. Ngā mihi ki a Mary O’Regan mō tōna ārahi i te komihana mō ngā tau neke atu i te 20, ā, kua rihaina i te mutunga o tēnei wiki. Ngā mihi ki a ia.

Ka tika hoki kia mihi atu ki ērā kaikomihana e rua, arā, te tiamana a Ruth Harrison, me Ray Watson o Kai Tahu, Te Āti Awa hoki. Mā rāua e tirotiro, mā rāua e whakamōhio i te mea, mā rāua tātou e whakatūpato mō te haerenga mai o ētahi kumi ihuroa. Nā, ko tā mātou he whakaatu i ngā wāhanga katoa o tēnei pire, he tono kia tū pakari te kaupapa tirotiro.

Kua mutu ake nei kai te Kaihautū, tēnā koe.

[An interpretation in English was given to the House.]

[Greetings to you, and to all of us. The situation in real terms is that there simply are not enough qualified, culturally appropriate workers in health to meet the urgent demand. The mental health survey released last September, Te Rau Hinengaro, revealed that despite a higher prevalence of disorder, Pasifika groups and Māori are less likely to access mental health services than other population groups. These issues are pivotal to the health and wellbeing of so many of our peoples. Associated with these issues are a whole range of other factors: the impact of institutional racism, discrimination, and other factors that impact on such disparities. 

We have great confidence in the commission and its people. We particularly acknowledge the leadership that Mary O’Regan has demonstrated for over 20 years, and wish her well in her resignation from the commission at the end of this week. 

 It is fitting also to acknowledge the other two commissioners, Ruth Harrison as chairperson, and Ray Watson of Kai Tahu and Te Ātiawa. Both possess wide leadership experience and sector expertise in the mental health sector. We need them to monitor, we need them to report, we need them to warn us of any approaching crocodiles. And we will take up every opportunity at the committee stage of this bill to ensure their strong surveillance stand is protected.

I end here, Mr Deputy Speaker; thank you.]

I rise on behalf of United Future on the second reading of the Mental Health Commission Amendment Bill. This bill received 22 submissions. Nearly a quarter of those were from individuals, and there was lots of advocacy from clients of mental health services and their families. Those submitters represent the value of this commission—the voice of those reliant on our mental health services—because, until funding, workforce, and service shortfalls are up to standard in a consistent way across the whole country, the need for the voice of the commission will remain.

I note with interest that 2015 has been set as the new date when we can expect to relook at the need for this commission. It makes me wonder two things. Firstly, it makes me wonder what services will look like in 8 years’ time and what sort of numbers we will be looking at in New Zealand for those who will be requiring those services from our mental health providers. Current figures suggest that 3 percent of New Zealanders at any one time are in need of mental health services, yet currently only about half of those people are registered in some way with a service. This means that we have a long way to go before we have a national service that can provide services at the kind of level that the blueprint for mental health suggests it should. Again, I say that the commission provides a vital voice for sufferers of mental health conditions.

Like previous speakers, I want to endorse the work to destigmatise mental health issues within New Zealand. Stigma is a fear-based response to circumstances that touch our lives more closely than we dare admit—even to ourselves. As the Hon Tony Ryall mentioned the last time this bill was being debated, it is not uncommon for folk to experience a season of poor personal mental health. For those who have experienced such an episode, the sympathy for those who live with permanent impairment is very real.

The current inquiry into disability services being conducted by the Social Services Committee has highlighted some particular challenges. Mental health clients, if they are to have any sense of self-determination, need to have a better say in the kinds of support services that they are able to avail themselves of. Services need to be tailored to the client rather than for the convenience of the provider. One submitter stated that he would like to trade vacuuming and dusting for a trip to the pub with his mates, but no, vacuuming and dusting is what is on offer. The need for a normal life is often denied by a model of care that is medically rather than socially designed. These issues are the bread-and-butter advocacy work of our commission and United Future happily supports the extension of its work and its role. We are happy to support the second reading.

It is my pleasure as a member of the Health Committee that heard the submissions on the Mental Health Commission Amendment Bill to rise and speak in support of the bill’s second reading. The bill was generally agreed to and supported by the parties represented on the select committee, but members who have read the commentary from the select committee will note—in particular, in the introduction to the report—that there was a dissenting view on the timing of the proposed extension to the commission’s term, and that that dissention was from the National Party.

I would like to draw the House’s attention to this issue, because there is probably much more to it than meets the eye. The National Party is, of course, a party that sees itself as being the next Government. If the prospect of National being in Government is not frightening enough, I ask members to think about the way in which its members on the select committee approached the issue of the timing of the proposed extension of the Mental Health Commission to 2015. They said that it was their view that the principal Act should expire 3 years after the date on which the bill receives the Royal assent—that is, in common language, that it should expire significantly earlier than 2015. In fact, I think their first position on this may well have been that they wanted it to expire in 2009. National members wanted the commission to expire literally a year after the legislation comes into effect. Why might that be?

I think the House should really consider this question seriously. After all, the Mental Health Commission is a body that, under this bill, will act as an advocate. It will promote and facilitate collaboration and communication and will work independently with others to promote understanding and reduce the stigma of mental illness. Those are all good measures, and I think all New Zealanders would agree they are good things. The commission is really a watchdog body that will oversee what is happening in the area of mental health—an area that deals with some of the most vulnerable people in our society.

Why would the National Party, on the basis that it thinks it will be the next Government, want to do away with this watchdog body earlier than the date being proposed by this Government? One can only assume that National, a party proposing significant tax cuts and knowing that the largest area of public spending is health, may not want a watchdog body looking to see what might happen to mental health services under a National Government.

Why else would the National Party have dissented on this particular issue at the select committee? It was not a controversial issue. In fact, none of the 22 submitters who came before the committee raised this issue at all. No one said: “Yes, we do want this commission to have its life extended, but only for a year or so, or 3 years.” None of the submitters said that. It was only the National Party members who sat down and thought: “Golly gosh, because we are so confident we’ll be the next Government, despite what the voters might think, we are not sure we would want such a good, strong advocate for mental health consumers and their families to be in place to watch while we preside over the wrecking of mental health services that were built up by the Labour Government.” I think that is a serious issue that this House needs to think about. Certainly, the public listening to this debate need to be aware that that was the push from the National members on the Health Committee. Fortunately, however, they did not have the numbers on the committee to shorten the life of the commission, and the proposal from the select committee was that the life of the commission be extended through to 2015.

I want to take a few minutes to remind members about some of the issues the select committee dealt with. We were concerned about the wording “eliminate inappropriate discrimination”, and we asked some good questions about it. The issue was raised by a number of submitters, and, as members, we were concerned to know what inappropriate discrimination may be. We felt that discrimination in total is probably inappropriate. At the select committee we talked about the fact that there were some forms of positive discrimination that should be allowed to exist through a bill such as the one we were considering. So, in looking at the whole range of issues around the use of the words “inappropriate discrimination”, we decided that it was in fact inappropriate discrimination that we wanted to ensure did not take place under the auspices of this bill, not positive discrimination, which can happen, should happen, and was supported by the members of the select committee.

I say in conclusion that there was generally broad agreement in principle on extending the life of the commission. Submitters, by and large, supported the role of the commission. Some debated the philosophies they felt were held by members of the Mental Health Commission, and I think that is a debate we always should have in our communities when it comes to mental health. If we are not constantly debating the philosophies and ideologies that are applied to the mental health service setting, then, probably, we have forgotten about the people it is there to serve.

I support the second reading of this bill. I have reservations about the reasons behind National’s wanting to bring the life of the commission to an early conclusion but was pleased to see that, in general, the select committee wholeheartedly wanted to see the commission’s life extended to 2015.

National supports the second reading of Part 2 of the Mental Health Commission Bill. However, it is the National Party’s view that the principal Act should expire on a date that is 3 years after the date on which this bill receives the Royal assent. That is, of course, at variance with the bill, which extends the term of the commission until 2015. National feels that 2015 is too far into the future and considers that its proposal for a date 3 years after the date on which the bill receives the Royal assent is more realistic.

The Mental Health Commission was established and began work in September 1996. It has three key functions: firstly, monitoring and reporting the implementation of the mental health strategy; secondly, promoting better understanding by the public of mental illness and eliminating discrimination; and thirdly, and importantly, strengthening the mental health workforce. National supports the work of the Mental Health Commission but is concerned that we have not seen objective measurable outcomes. The Mental Health Commission has been in existence for 11 years, and the proposal of the Government bill would see the commission continue for another 8 years. National considers that the public spending and the work of the Mental Health Commission should be accountable and produce results.

Mental health is a serious health issue for New Zealanders, and the burden is increasing. A recent survey showed that nearly half of all New Zealanders will meet the criteria of having a mental illness at some time in their lifetime. There are many other serious findings, such as that 16 percent of New Zealanders had thought seriously about suicide at some point. A recent Commonwealth Fund report found that less than half of New Zealand practices felt well prepared for patients with mental health issues. Hospitalisations for attempted suicide have increased 20 percent since 1999. Is this due to increased awareness or increased reporting, or a combination? That is the conundrum? Certainly, the John Kirwan TV advertisements have destigmatised depression in the community and increased awareness. Those advertisements have cost between $7 million and $8 million over the last 4 years. I stand to be corrected, but I understand that they were a Ministry of Health initiative.

That brings me to another point—the split between the Ministry of Health and its mental heath directorate, and the Mental Health Commission. I wonder why there was a split and why these two agencies are working separately. That raises the interesting question of whether the Mental Health Commission should be brought back under the Ministry of Health at some point. I think that as colleagues ponder that question, they will come to the correct conclusion: if that question is on the table, it is very appropriate that the term of the Mental Health Commission should not be a distant 8 years into the future but a time more tangible and closer.

Another interesting question is how and why the Mental Health Commission became a Crown entity in 1998. Another example of a well-known Crown entity is, of course, Pharmac. I will just explain about Pharmac. It was established in the 1990s to curb the rocketing budget, and it was given Crown entity status to give it a degree of independence so that it could be kept at arm’s length and kept up with making the deals. But, of course, Pharmac has morphed into a law of its own. But that is another story in itself, and I will not digress. I also wonder about the sense in having the Mental Health Commission as a Crown entity. Was this really necessary, and should it be under the umbrella of the Ministry of Health?

An important function of the Mental Health Commission is to strengthen the mental health workforce, and this is an area where I feel it has let the workforce down. It brings me to the issue of the enrolled nurse, and the sorry tale that follows. In 2001, after Mark Burton, a psychiatric patient, killed his mother, an enrolled nurse was incorrectly implicated. In 2004, following a health and disability report that raised concerns about the enrolled nurse in an acute mental health unit, the Ministry of Health and the Nursing Council of New Zealand released a joint letter to all district health boards recommending that enrolled nurses should not be working in acute mental health units, and enrolled nurses were subsequently demonised. Subsequently, there was an ethnic cleansing of this workforce. In 2004 there were just on 4,000 enrolled nurses, with only 250 or so working in mental health. In 2005, the figures were much the same. I hate to think what will have happened to the figures in 2007 when they come to hand.

Where was the Mental Health Commission in all of this? Well, I went to its website and I looked up its archived press releases. I could not find one single, solitary release that referred to this issue or that supported its own workforce. It seems that the Mental Health Commission has left this invaluable workforce high and dry.

In summary, National supports the objective and role of the Mental Health Commission but is concerned that there seems to be a lack of accountability. National does not want the indefinite extension to 2015 that this bill would bring. A lot of money has been spent on reports and bureaucracy, and we are concerned that it has not been effectively targeted. National considers that the Mental Health Commission should have a greater monitoring role, and in all of this we are concerned that district health boards are underspending their ring-fenced mental health money. Supposedly, the lack of a mental health workforce is implicated.

National supports this bill, but we wish to amend it so that the commission’s term is not extended to 2015 but rather to 3 years from the day on which it receives the Royal assent. Thank you.

Bill read a second time.