Mental Health Commission Amendment Bill

It is my pleasure to speak in the Committee stage of this Mental Health Commission Amendment Bill. National will support this bill but, as I will discuss shortly, we have tabled an amendment.

I thought the Health Committee members worked very well together on this bill. The Mental Health Commission Amendment Bill, obviously, addresses some issues that are pretty important in New Zealand. We had 22 submissions. The range of opinions expressed over the course of the submissions was interesting. One of the main things that came out of the process, I think, is the importance of involving families in the care of those who suffer from chronic mental illness. We know that 0.3 percent of the New Zealand population suffers from a chronic incurable mental illness, and the burden for much of the care needed falls back on families. We heard a lot from families who were in that situation, and who felt quite concerned that they really were no longer part of the decision-making process. One thing we have to bear in mind, in the mental health sector, is to make sure the views of families are taken into account when we are considering chronic care arrangements for the mentally ill.

The main amendment we have relates to clause 8(1). This bill will extend the life of the commission to 2015. Well, the National Party supports an amendment—and I hope that the rest of the Committee will support it, as well—to limit the life of the commission to 3 years after the date of the Royal assent of the Mental Health Commission Amendment Act 2007. There is a very clear reason for that: we think there really has to be accountability with regard to public money. If we look at what has happened with mental health over the past 8 years, since this Government came to power, we see that spending has gone up by 75 percent. It is now nearly at the $1 billion mark. That is an awful lot of money, but we have to ask what the public is getting for that expenditure.

The reality is that mental health statistics in this country are actually getting worse, but the real issue is that public access to mental health services is deteriorating. There is no question that the sort of headline-grabbing areas of mental health—like forensic services—have been well funded, because politically it is very important for any Government to get that stuff out of newspaper headlines. And this Labour Government has been the epitome of doing just that. That is all very well, but if we look at what has happened for Māori and Pacific Islanders, for children, and for the elderly, we see that they are not getting access to services that they should be getting. We think that is a real crime. When we have so much more money in the system, those people—many of whom are disadvantaged, and many of whom are without a strong voice in our society—should be getting access to a fair share of the services.

I come back to the amendment. Why do we want to limit the life of the commission to 3 years in the first instance, when it will be reviewed? I must say that there is no doubt that the life of the commission will be extended. The reason for the limit is that the National Party believes that we cannot write blank cheques with public money. Basically, we believe that if the Mental Health Commission is written a blank cheque to 2015, it is being given too much latitude. We believe that if the commission is fulfilling the role it should be, and if it is doing a good job, there is no reason why its life will not be extended beyond 3 years from the date of the granting of the Royal assent. But in the age we live in, where we have had so much profligate spending by this Government, and where so much money has been wasted on reports and bureaucracy, we believe that it is irresponsible to extend the life of any commission or Government bureaucracy for 7 years like that, without any accountability. That is what we will be asking for.

We believe that the Mental Health Commission does a good job; there is no question about that. It has done a great job in promoting awareness of mental illness, in a positive way. The John Kirwan ads have really done a lot to destigmatise mental illness. There is definitely a role for the Mental Health Commission, and it does good work that needs to be supported. But, like any body, it has to be constantly watched and monitored.

One thing we want to see the Mental Health Commission doing is pushing this Government much harder, because the Government really has not delivered on mental health. That is the role we will be seeking to have the commission fill.

In speaking to the Committee stage of the Mental Health Commission Amendment Bill, I note, in terms of some of the issues raised by the previous speaker, that National members are very keen to talk about too much money being spent on our health service. Jonathan Coleman again raised this issue of not being happy about the amount of money being spent on mental health services. One of the roles or functions of the Mental Health Commission under the bill that we are speaking to today is to act as an advocate for the interests of people with mental illness, and of their families generally. That includes ensuring that there is a good funding level for the services to be adequate for people in this area.

Dr Coleman also referred to the National Party’s position of wanting to bring the commission to an end earlier than the Health Committee report recommended.

💬 Dr Jonathan Coleman: No, you know that’s not right, Sue. You know that’s not what I said.

Well, it was the National Party’s position. It is recorded in the commentary from the select committee that “New Zealand National’s view is that the principal Act should expire on a date that is three years after the date on which this bill receives the Royal assent.” The rest of the select committee did not uphold that point of view.

At this stage I just point out that the Health Committee has representation on it from many of the parties in Parliament. It has on it members from the Green Party, New Zealand First, the Māori Party, Labour, and National, so it is very representative in its views. It was only the National Party—not even any of the submitters—that wanted the commission to be reviewed earlier than 2015.

I have done some thinking about why that might be, and I know that the National Party has decided in its own mind—it is not in the mind of voters—that it will be the Government come 2008. Well, that is up to the voters to decide, of course, but I think that is the reason National does not really want a watchdog body in place until 2015. If National were to become the Government, it would want to get rid of the commission pretty damn quickly, because this is a party that is standing on a platform of reducing taxes. We all know what that means for areas such as mental health. Reducing taxes equals reducing public spending, and reducing public spending always means cutting the health budget, because that is the largest area of public spending. So when it comes to the Mental Health Commission and its role—its very important advocacy and watchdog role—why would the National Party want to have that body cemented in place through to 2015 if it fully planned to cut funding to mental health services in that period of time?

I say in conclusion that I am fully in support of this part of the bill, because it extends the life of the commission in concrete through to the year 2015. All of the other parties on the select committee, apart from National, agreed with that view. The submissions we heard also agreed with the extension to 2015. Thank you.

I am happy to speak to Part 1 of the Mental Health Commission Amendment Bill. There are a couple of clauses I want to speak about. The first one is clause 5, which defines “stakeholder”. The definition “stakeholder” includes many groups, not just the ministry or the usual bodies or people who are normally named as stakeholders, such as district health boards and traditional providers such as doctors and mental health services. The definition has been widened to include groups who represent the interests of people with mental illness, such as families and caregivers of the mentally ill. I think that is an excellent amendment.

The mental health area is highly dependent on groups and organisations that support families and individuals who have mental health issues. Really, if it were not for non-governmental organisations we would be in dire straits. Probably 20 percent of Vote Health goes to non-governmental organisations across the board, but mental health providers have greater representation than that in the mental health vote, as such—almost 30 percent of the national expenditure. I think they are unsung heroes. Their crucial input is often not acknowledged. They are the glue that keeps our families stuck together. I understand that in the northern region, which is where I live, there are 80 non-governmental organisation providers in the area of mental health. They receive 30 percent of the mental health funding, and that has been devolved to the northern district health boards. It is predicted that the non-governmental groups will actually increase in size over the next 10 years as the shift to services in the community becomes more prominent.

I think that National’s tax package, with breaks for volunteer groups and charitable organisations, went down well, and it will make significant changes to the way community groups will be funded. It was a very successful policy. It was so successful that Labour stole it, word for word, and announced it in this year’s Budget. But it is a good initiative for the non-governmental organisation sector, and I am sure that much more money will flow to this invaluable group.

The next two clauses I will speak about are clauses 7 and 8, which deal with the term of the Mental Health Commission. National, as Jonathan Coleman pointed out, has some concerns about that. We would like the term of the Mental Health Commission to finish 3 years after the date on which the bill receives the Royal assent. There are a number of reasons for this. The Mental Health Commission was established 11 years ago, in 1996. If it is to expire in 2015, that is another 8 years away, and National thinks that date is too far away. The commission is a publicly funded body, and we feel it should have measured outcomes. The 2015 date is too far in the distance. We do support the work of the Mental Health Commission, but we feel it should be accountable and answerable. We feel that the date Dr Jonathan Coleman proposes in his amendment is more realistic and tangible.

I raised the point last night in the second reading debate on this bill that it is interesting how the Mental Health Commission has devolved away from the Ministry of Health, with its own directorate of mental health. If at some point in the future we look at bringing the Mental Health Commission back into the Ministry of Health, then we would want, obviously, a date for its expiry that is not as far away as 2010. Three years from the date of the Royal assent would be a much more realistic date. The Mental Health Commission does very good work. As Jonathan Coleman pointed out, the advertisement aimed at destigmatising depression that features John Kirwan is actually the Ministry of Health’s advertisement. But there are many other facets that the advertisement works on.

I am really concerned about the mental health workforce. That is a particular issue for me. I raised it last night, and I would like to raise it again today. Enrolled nurses are in a threatened workforce. Basically, they have been stigmatised in the mental health workforce. They have been sidelined and pushed out. It really began when Mark Burton, a psychiatric patient, killed his mother, and an enrolled nurse was incorrectly implicated. An edict went out that enrolled nurses should be removed from more acute care situations, including psychiatric facilities. Basically, they have been sidelined ever since. Where was the Mental Health Commission in that situation? That was the question I posed to the House. I went to the commission’s website and looked at all its archived press releases, but I could not find a solitary word in favour or support of this workforce. There are about 4,000 enrolled nurses in New Zealand. About 250 of them are in the psychiatric workforce. Those are 2004-05 figures; we do not have current figures. It is an aging workforce and, as the nurses retire, I doubt that we will see many more unless they are supported.

I rise to speak on this very important Mental Health Commission Amendment Bill. The commission started in 1996 under a National Government. It was brought about after many years of the mental health sector being regarded as a Cinderella sector—much like the disability sector is today. It has meant that there has been an independent advocacy power for people with mental illness, and that has had a very powerful effect over the last 10 years or so.

I am very sympathetic to Dr Jonathan Coleman’s amendment, which suggests a 3-yearly review. This does not mean stopping, or terminating, the Mental Health Commission, but merely reviewing it. It is so important within the context of mental health to ensure that all aspects of it are effectively monitored, and that includes the financial aspects. As this Government has found out, resources are finite and the demand in any aspect of the health sector is almost infinite. It is hugely important that we are responsible.

For a moment or two I want to go over the functions of the commission, which are highlighted in Part 1. These do draw attention to the very important aspects that the commission is there for. Firstly, it is there to act as an advocate for the interests of people with mental illness and their families, because so often they cannot advocate for themselves. We hear this time and time again in the disability review being undertaken at present by the Social Services Committee. So often we have heard the request that a similar commission be set up for the disability sector. Secondly, it will promote and facilitate collaboration and communication about mental health issues among stakeholders and representatives in the mental health, government, academic, and community sectors, and members of the general public. Indeed, there are lots of stakeholders, and it is hugely important that they are given the chance to collaborate, so that their networks are built up and they are all talking the same theme. This is one of the aspects that was not there when the deinstitutionalisation occurred, and it has been built up gradually over the last 10 years.

The commission will work independently and with others to promote better understanding, as I have just mentioned, and to reduce the stigma associated with mental illness. I think Jonathan Coleman just pointed out how successful the recent TV advertisements have been, involving a former All Black, whom many New Zealanders can identify with so easily. John Kirwan has been prepared to give of his time and be so frank about the condition that plagued him; and, obviously, many New Zealanders have realised that this is something that so easily could affect them. Indeed, it pervades so many families throughout our society. So this is one of the very important functions of the commission that needs to be perpetuated.

The commission will monitor, report to the Minister, and advise the Minister on any matter relating to the implementation of the national mental health strategy. This is very important. The blueprint for mental health has meant that there has been an amount of money out there, and at times there have not been the people able to fulfil the duties that are required. For instance, paediatric community mental health has not had paediatric psychiatrists available. This has been of great concern, given that paediatric mental health is one of the areas that are so important. If we are not able to ensure that a child with mental health problems is given early attention, then it can get much, much worse and it is much harder, at a later date, to help that individual. Over the last 6 or 7 years we have seen a dearth of community paediatric psychiatrists, and the situation has not been made much better, to my knowledge, under this Labour Government. This is the sort of function that is very important for the Mental Health Commission to carry out and feel free to report on. The commission reports on a yearly basis, and it is so vital that that can be done without fear or favour of government.

The commission will stimulate and support the policy makers, funders, and providers of mental health services in developing integrated, effective, and efficient methods or systems. One of the things we do know is that many systems are involved with mental health, not only in the health services but in the Ministry of Social Development, and education, and that the complex arrangements around these are often very fragmented. So it is hugely important to perpetuate this commission, and I agree entirely with the very sensible amendment put forward by my colleague Dr Jonathan Coleman that the term be reviewed on a 3-yearly basis.

The question was put that the following amendment in the name of Dr Jonathan Coleman to clause 8 be agreed to:

to omit from subclause (1) the expression “2015” and substitute the words “3 years after the date of the Royal assent of the Mental Health Commission Amendment Act 2007”.