Mental Health Commission Amendment Bill

We now come to clauses 1 to 3—one debate with separate questions on all three.

I am happy to speak on the title of the Mental Health Commission Amendment Bill. It is interesting that we had a number of submissions to the Health Committee for the bill, and they were very comprehensive and wide ranging. One submission was specifically on the name of the commission. The group submitting it felt very strongly that the name of the commission should be changed from the Mental Health Commission to the “Mental Health and Addictions Commission”. The group felt there was a lot to a name and that the name said it all, and that with “Addictions” inserted, there would be much more focus on addictions. This group felt quite strongly that addictions in the community—drugs, alcohol, and gambling—were an issue, and that there would be a focus if that name were included. The committee looked at the group’s submission and heard a number of other suggestions apart from the name change. The group also suggested the need for greater expertise in addiction issues, the establishment of an addictions consumer advisory group, and the appointment of a commissioner.

The committee took on all the group’s suggestions. We considered them, and we recommended finally that there should be an addictions advisory group established to provide expert advice to committees. We certainly hope that this recommendation is taken up, because drugs, alcohol, and gambling cause increasing problems in society and in communities.

I want to go back and say that I really support the work of the Mental Health Commission. National wants to see accountability. People should not get worried that we want a date of 3 years from the Royal assent. It was more that we should have a checklist—a point where we can look back, take some accountability, and look at some measurable outcomes. People have obviously got far too wound up about the 3-year date; it is to ensure that public spending is accounted for and that the money is spent wisely.

Money has been pushed into mental health—quite rightly. National has been concerned about the value of the spend. In fact, some district health boards cannot even spend their mental health budgets, and that is of great concern. I understand that the main reason for that is that they do not have the mental health workforce to enlist, but key objective No. 3 for the Mental Health Commission, which is to strengthen the mental health workforce, will be critical in the years ahead. We know that the burden is increasing steadily—the statistics have come out today in the speeches—and mental health is a serious issue. It is not going away, we cannot cover it up, and we must address it. We cannot do that well without a mental health workforce—I think that is quite critical. The problem actually goes across the whole health sector; our whole health sector workforce is in crisis. Its members are an aging workforce, they need to be rejuvenated, and the mental health workforce is no exception to that.

We support the work of the Mental Health Commission. We are concerned about the increasing number of hospitalisations for suicide, and the increasing concern with depression in the community. We want to support the work, particularly in the non-governmental organisation sector, and the work of groups on the ground. They are quite critical in our health sector, and their people are often the undervalued, unrecognised, and unsung heroes.

We talked before about the Ministry of Health and the Mental Health Commission—why it had been split off. Why that happened is quite an interesting matter. The Mental Health Commission was established in 1996. In 1998 it became a Crown entity, supposedly to give it independence and autonomy; but with that type of split, focus can be lost and there can be two groups working in different directions. I certainly hope there is no duplication of their workloads, because that would obviously be a waste of time, energy, focus, and money. Certainly, I wonder about the need for both groups to head off in different directions, and I hope they are working together.

I know that the John Kirwan ad was a Ministry of Health initiative, and it has been a very good initiative. I think it has raised awareness in the community. People are talking about mental illness freely and without any shame. It is a common illness, it is treatable, and it is reversible. There is no shame in having a mental illness. I congratulate the ministry on those advertisements, and I congratulate John Kirwan, who got an honour recently. So National supports the Mental Health Commission, but I think people have got hung up on the 3-year date we are proposing.

I also rise in support of the Mental Health Commission Amendment Bill, and I do so because, along with my colleagues the Hon Tony Ryall and Drs Jackie Blue and Jonathan Coleman, I examined the bill at the select committee and believe on balance that there is merit in supporting its passage through the House. In general, the purpose of the bill is simply to extend the life of the commission to 2015. But the opportunity this extension offered to improve the bill was taken, and there have been changes in the commission’s role: firstly, in advising and reporting to the Minister on the implementation of the national mental health strategy; secondly, in promoting and facilitating collaboration and dialogue about mental health issues; and, thirdly, in advocating for the interests of people with mental illness and their families, generally.

It would be fair to say that when we were listening to the 14 submissions and reading the other eight, we were given a valuable insight into the complicated lives of the family members of those who experience mental illness. At times we heard tragic stories shared, and it was through that experience that we came to realise the significance of a highly functional and effective Mental Health Commission. Sixteen of the submissions were from organisations and groups, and six were from individuals. Some family members expressed opposition to the bill, and it would seem that that signalled a really important opportunity for the Mental Health Commission to look at why these people felt that their needs were not being met. The commission should see that as an opportunity and not a threat. So when this bill passes through Parliament in a slightly different form, the Mental Health Commission should be able to ensure that it addresses the concerns of those people rather than just putting those concerns into the past. My colleague Dr Jonathan Coleman questioned the Minister of Health, Pete Hodgson, during the select committee estimates process. Of note during that process, where spending on mental illness was scrutinised, was the sense that although the Ministry of Health believes there have been improvements in the lot of those with mental illness, there is actually scant evidence to support this belief, and that certainly worried the National members on the Health Committee.

Spending on mental illness has increased under Labour but, as with other areas of the sector, it is not enough just to spend more. The public of New Zealand deserves to know that when the Government increases spending, there is a corresponding value for money. We in National believe that the mental health sector, like other parts of the health sector, is a victim of report mania, or “report-itis”. When reports get in the way of delivery rather than facilitate improved delivery, we then see that as a waste of taxpayers’ money.

The Mental Health Commission needs to play an important role in monitoring results and providing an assessment of the Government’s role in mental health service provision. Adding to monetary accountability issues are the workforce issues the sector faces, but these issues should not happen when some district health boards are underspending their ring-fenced mental health dollars. Meetings with mental health practitioners have shown me that workforce issues, including large workloads and a lack of support from the Government, should be a very high priority for this Labour-led Government. In my electorate, Aoraki, we have a district health board that has in the past underspent ring-fenced mental health funding. Much of the problem has been due to a lack of numbers in the workforce to provide that particular service to the local community. We have lacked the specialised people to fill those roles, and in fact that is a nationwide problem. As we know, the health sector workforce crisis is widespread, and the South Canterbury District Health Board is like all other district health boards in that respect. In fact, when we looked at the amount of underspent ring-fenced mental health money, we found that more than $18 million remained unspent last year.

The Mental Health Commission has the responsibility to act as an advocate for the interests of people with mental illness and their families, generally, but it also needs to take into account the interests of other stakeholders. The list of stakeholders in this bill includes the ministry, district health boards, mental heath service funders and providers, those with mental illness, their families and caregivers, and also groups representing the interests of people with mental illness, and their families and caregivers. Therefore a lot of masters are listed in this bill—an awful lot of masters—and I am sure that juggling so many masters gives rise to many tensions. That may be why the select committee heard some submissions that caused us some concern, and that may be why some people were highly critical of the Mental Health Commission.

One thing that has changed over the decades and needs to continue changing—and I will finish on this note—is the way that mental illness is viewed and discussed by the general public. These days mental illness is much less viewed as a taboo subject, something that needs to be hidden away, and a shameful thing to happen to oneself or one’s family members. More and more we see communities advocating for a fair go for those who suffer from mental illness. The Like Minds Like Mine campaign and John Kirwan’s attempts to destigmatise mental illness have been vital, and they have made significant improvements for people who suffer discrimination because they suffer from a mental illness.

In my electorate a constituent wrote a book about suffering from depression. It is entitled No One Gives You Chocolates. The author’s penname is Ellen Munro, and I commend the book to those wishing to understand depression. This book is about depression and those who suffer from it, and it was written by someone who has an absolute understanding of it. The thing about depression, and about other illnesses that people need counselling for, is that the people concerned do not actually fit the criteria for that ring-fenced money. Time and time again I hear community groups ask how they can access money for those people who need counselling. It is certainly a role for the Mental Health Commission to address the concerns of stigma, discrimination, and access to services for those people suffering mental illness and needing some counselling. Maybe it is time to look at the blueprint for funding parameters.

This bill will address some concerns that have been raised, and, hopefully, will continue the work successfully achieved by the Mental Health Commission and develop that work to achieve more. My colleague Dr Jonathan Coleman has indicated that during this Committee stage he will promote a change to the date on which the Act will expire, so that instead of being 2015 it will be 3 years after the date on which this bill receives the Royal assent. We in National believe that just as that change to the date will give the Mental Health Commission an opportunity to address its effectiveness, it will also give us a chance to reflect on that opportunity and put up an achievement standard for the commission to either achieve, or not. It will be another chance for us to scrutinise the Mental Health Commission.

I commend this bill to the Committee. I support the bill, but I also note that some submitters had grave concerns, and I urge the Mental Health Commission to address those concerns soon.

In speaking to the title, the Mental Health Commission Amendment Bill, I think we have made it clear that National sees a real role for the Mental Health Commission well into the future. We think there is a real need for the work it does, and it performs that work very, very well. I have to take issue, though, with what Ms Soper was saying—that the Government has got it right on mental health. Quite frankly, that is not what members will hear if they talk to anyone who has a family member in care in the mental health system. There is a lot that needs to be done, and to let Ms Soper know the reality of it, I tell her that one cannot address the problems in the mental health system by just pouring more and more money into it and by issuing more and more reports, and that is what has happened under this Government.

What National members are saying with our amendment to extend the life of this commission for a further 3 years before it is reviewed, is that we have to have accountable public spending. But, of course, that has gone very much out of fashion under this Government. I will give members an example of what is happening in mental health. I have asked every district health board to send me a list of the organisations to which they are contracting out mental health services, and to tell us how many clients each service is treating. They can give me a list of the providers, but none of them can tell me how many clients each provider is actually seeing. These district health boards are paying out millions and millions of dollars of public money to mental health providers, yet they do not have a clue what they are getting for that. They do not know. They could be seeing zero people, but the district health boards are still paying the bill. That is the problem with what has happened under this Government—there is no accountability.

💬 Tariana Turia: That’s not true.

Well, it is true, because I have asked for it under the Official Information Act. They have sent me a list of providers but they cannot tell how many clients they are seeing. The district health boards do not know. I hope that someone at the Ministry of Health knows, because that is hopeless. Lesley Soper says that this Government has got it right in relation to mental health, but I think it has a heck of a long way to go. The reality is, as I said at the start, there are many groups in society—Māori, Pacific Islanders, young people, people in need of specialist services like eating disorder clinics, and older people—who are not getting access to services. The Ministry of Health itself states that, in its annual report—people are not getting access to the services they need. Yet the Government has increased the spending on mental health by 75 percent to $1 billion a year.

One would expect that for $1 billion a year we would get some sort of improvement in the level of services, and we would expect it to be pretty substantial. But Labour has not delivered in this area. When Labour members came into office they thought they could socialise everything. They thought they could pour money into everything. They have ramped up public spending on health, but they forgot to measure the outcomes properly. When we ask the really hard questions on this, we can see that the outcomes are just not there. Lesley Soper comes in here and says that Labour has it right on mental health, but we need only to go out and ask the families and the people in the system what is happening to be told that they feel badly let down by what this Government has done in mental health. But, having said that, National is very keen to see the Mental Health Commission continue because we reckon that the Government needs a real eye kept on it in mental health. We want the commission to keep on the Minister’s back and to make sure the Minister delivers on some of his promises in mental health—that the Government is providing services and giving good value for the taxpayer spending that is going on. I can tell members that the spending has been profligate.

So, there we have it. National will support this bill. We want to see a review 3 years from the date of the granting of the Royal assent, but if the commission is doing its job, there is no reason its life will not be extended. But it is the old story—what gets measured gets done. It is far too long a time to extend the life of this commission to 2015 without any public accountability.

Clause 1 agreed to.

Clause 2 agreed to.

Clause 3 agreed to.

Bill reported with amendment.

Report adopted.