Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill

I move, That the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill be now read a first time. I nominate the Health Committee to consider the bill.

I might take the first moment, if I can, to acknowledge the impacts of Cyclone Gabrielle a year on from its devastating impact in 2023. I started the day in Wairoa, in the heart of my electorate, in a hīkoi with the community, commemorating what has happened, what has happened since, collecting taonga along the way, and coming together as a community to celebrate that. It was a very, very emotional time. I then travelled back to Napier to join in the commemoration there as well; equally emotional. I just want to acknowledge, in fitting with this bill, the mental health impact of that cyclone and many other devastating weather impacts around the country that we’ve had in the last year.

Mental health is an invisible pain that a lot of people deal with. So I just want to acknowledge everybody that has gone through a huge amount of loss—whether it’s physical, loss to their homes, or loss of loved ones. So I just want to take that time to acknowledge that and, at the same time, what has been done to make a big difference in people’s lives, whether it’s mental health, physical health, and the fixing of all matter of things that we can do for that community.

To talk about this amendment bill is really important. It’s something that we really shouldn’t have to be doing. This member’s bill came about because the addition of mental health – specific features of the Pae Ora (Healthy Futures) Bill were not included at the time that it was passed. But this amendment bill is a step towards where we need to be in mental health in New Zealand. The fact that we need to mandate consideration of mental health and strategic planning in the health sector is a very sad but true fact that we have to deal with at the moment.

This amendment bill—as, hopefully, everybody has read—aims to have the Minister enforced to have strategic planning for mental health and wellbeing as part of health planning and strategy. The reason that’s so important is that today, in 2024, mental health is not on an equal footing with physical health. If we don’t lead from the top, as a Government, nobody else will.

We are still in a time where we treat mental health as an “ambulance at the bottom of the cliff” issue. Sensitively, I will raise that I know stories, both personally and from people I don’t know, as well, who have to present to hospital with an attempt at suicide before they get seen. No cry for help less serious than that generates the attention that it should.

Now, a National Government has gone a long way towards that by having a mental health Minister. We’ve already committed lots of funding toward mental health, both I Am Hope and, again, I point out the work towards the Cyclone Gabrielle recovery and also the funding for those affected by Cyclone Gabrielle and Cyclone Hale and helping them get the mental health support that they need one year on from that cyclone. But we have to have a plan. We have to have a strategy. So it is vital that we accept that this amendment bill will go every step of the direction towards considering mental health in our strategic objectives and plans for the health sector.

Now, when we do that planning, we are setting the tone across the entire sector, both public and private, that outcomes for mental health and wellbeing are as important as physical health. We have a sky-rocketing number of mental health cases, attempted suicides, and suicides across our country—and across the world, in fact. Recently surveyed, 92 percent of surveyed New Zealanders—in just six years, there’s been a 92 percent—sorry—increase in Kiwis reporting that they have unmet mental health needs.

Now, I have long been a staunch advocate for mental health. It comes to people in many ways. It comes at different times. The people that struggle the most are, often, the people you don’t know are struggling. We have all sorts of campaigns to talk with friends, to be open, to share stories. We have an incredible number of NGOs stepping in to do what the Government should be doing. But we need to have a plan, and that’s what this amendment bill aims to do.

Now, I just want to acknowledge the current Minister for Mental Health, but who was the member that put forward this bill. I want to acknowledge Minister Doocey for his hard work putting this member’s bill together. I’m privileged to be able to take this on as the member responsible. It’s so, so important for us to have something like this set the tone for the direction that we are heading.

Now, the reason—and I did allude to it earlier—that the Minister put this amendment bill forward is because the then member had proposed these amendments to the Pae Ora (Healthy Futures) Bill at the time, and they were put down, they were battered back. Now, whether that was political or for other reasons, now that we are putting this amendment bill forward, there should be absolutely no opposition to it, because it is such a simple, simple amendment that will have such a massive impact. The proportionality of a small amendment to absolutely specifically itemise the strategic planning of mental health and wellbeing will have such an impactful outcome on our mental health. So it is vital that our health Minister, our associate health Minister are able to, and mandated to, for all future Governments, have a strategic plan for mental health and wellbeing, because without a strategic plan you cannot look for funding, you cannot make a plan long term, you cannot plan for infrastructure, you cannot plan for long-term funding. All of this stuff is absolutely vital, but it’s common sense. It’s pragmatic. Like I said, absolutely no party should oppose this. It’s a small tweak, it’s something simple for our Government to do, but it’s something that our Government and our party before we were in Government has been absolutely advocating for and absolutely supportive of.

Now, a 92 percent increase of people that have unmet mental health needs is exactly where we need to focus. So if we’re looking at having a strategic plan for mental health and wellbeing, we can start right there. We have facts and figures. It is absolutely fundamental that we focus on those people.

Look, I want to speak, also, to the support that this amendment bill—and the amendments at the time, might I add, when the Pae Ora (Healthy Futures) Bill was brought in by the previous Labour Government—was overwhelming. We had support from the Mental Health and Wellbeing Commission, we had support from the Mental Health Foundation of New Zealand, we had support from Emerge Aotearoa, and we had support from Mental Health Advocacy and Peer Support Trust. Now, that is four organisations whose primary role is mental health, and they felt that it was an absolutely gross oversight to not have that amendment in the bill in the first place. There was intention to change, but it didn’t happen.

Unfortunately, without having this as a mandatory part in an amendment bill, then it just becomes out of sight, out of mind. It is absolutely fundamental that this is an explicit focus for us. We need to lead from the top. If the Government doesn’t change and make this the priority of health as equally considered as physical health, then neither will the rest of our country.

I still know, in many cases, and, sadly, very close to me, people who present with mental health issues in the workplace, and because it’s an invisible issue, it’s not considered in the same way as physical health. I had a very dear friend come to me and say that she feels that she would rather have a broken leg; she wishes that she’d broke her leg so that her employer would understand the importance of what she was going through. The employer’s going to take that from the top; they’re going to take that from the Government. If we have a plan and we put that in place and we lead from the top, then that is what’s going to get us the outcome. We need people to feel like they can talk to someone; they feel that they’re going to be heard; they feel that if they go to a GP, that they’ve got a path to support. They do not want to feel that they have to reach for the worst possible outcome to get the help that they need. Without a plan, we have no action forward. So, with that, I commend it to the House.

The question is that the motion be agreed to.

Thank you, Madam Speaker. I’m letting members opposite know that we will support this amendment bill. It is important but we’re interested to see what kind of impact this Government will be able to do to deliver on this strategic inclusion into the Pae Ora legislation. As the previous speaker, Katie Nimon, has said, there are many people in New Zealand who have experienced mental distress or illness in their life. In fact, half of New Zealanders will do so.

It is my great privilege to be the Opposition spokesperson on mental health, which is a passion I share with the new Minister, and I really want to tautoko to him on his role. I know that he shares that passion from a personal level and is very engaged in it, as I am personally through the experiences of my own family, but also as a fellow of the Rosalynn Carter Mental Health Foundation. Rosalynn was the wife of Jimmy Carter and did a lot globally around the destigmatisation of mental health.

So I know that we have a really committed Minister. My question is: by putting this into the Pae Ora (Healthy Futures) Act, will this have an influence, will it have an impact, or is it just a tick-box exercise? And I do note that the previous speaker hasn’t actually mentioned the lead strategy on this—I’ll speak to that in a moment—but also there is nothing on mental health committed by this Government in its hundred-day plan. There’s been a big talk around this, and we on this side are really keen to know what the Minister is going to deliver. Will he have the funding to deliver? Does he have influence in his Government?

I’m reminding this House and also anyone viewing that, actually, this inclusion is being built on the previous Government’s investment into mental health. It was the biggest ever investment, to lay a whole new foundation for the mental health system, and what this bill will do is ostensibly enable the long-term planning and delivery that’s required to improve mental health and addiction outcomes. The proof will be in the pudding. Again, I query how that’s going to happen in an environment where the Government is requiring Public Service cuts of between 6.5 and 7.5 percent. I also wonder how Māori will be able to deliver on this, given that there will be the disestablishment of the Māori Health Authority.

So we will support this. It’s a good start to add to the other strategies, which the Labour Government introduced around the Māori strategy, Pacific health, women’s strategy, and rural strategy. What we hope it will do is cement in law the mandate for change as envisaged in the Mental Health Foundation report Kia Manawanui Aotearoa, which, as I mentioned, the previous speaker has not alluded to once in her speech.

We agree that without leadership, mental wellbeing promotion will be deprioritised. Leadership has to come straight from the top, and today in the Health Committee it was really good to hear a clear confirmation that the Ministry of Health is accountable for the operational delivery of that leadership around mental health. The strategy, though, we fear will reflect the inherent status quo bias towards an illness-orientated medical approach and service development approach if it doesn’t have the associated wellbeing promotion element to it.

And I note that the Minister himself has said that mental health promotion is one of the key pillars. He said that in his election document—it came after prioritising delivery of more services and enabling tino rangatiratanga around keeping mental resiliency. It was a reference to growing mental wellbeing at the grassroots level. The reason I’m slightly sceptical is because when we look at the wording, it first of all talks about a mental health and wellbeing strategy, and it talks about, in new section 46A(2)—inserted by clause 7—being “a framework to guide health entities for the long-term improvement of mental health and addiction outcomes.”

I query whether that is broad enough. I query whether other agencies should be involved, and I’ll come to that later in terms of how we promote wellbeing rather than a medicalised response. I note that the word “addiction” is not in the heading to new section 46A, which talks about the mental health and wellbeing strategy. When I look at the numbers around what the National Party had said they were going to commit to addiction, it was a four-year promise of $63 million for methamphetamine addiction treatment out of a total commitment—or promise—of $179 million. So it’s a significant portion of the money, and yet the word “addiction” is not in the nomenclature of the new section 46A mental health and wellbeing strategy provision.

So I have a few questions around that. Where is wellbeing?—obviously. Where is addiction? Where are the voices of lived experience? Where is the requirement in the legislation to include the voices of lived experience, which we know from so many reports is essential to the delivery of this? There must be proactive investment in health promotion. It needs to be community based. And who is accountable for the delivery? Obviously, the Minister will be. How is he going to deal with that?

The Mental Health Commission has already identified in several reports that there is a narrow sort of deficit model to mental health and wellbeing promotion. And what I didn’t hear in the Health Committee today—and I did ask about this—was any accountability from the Public Health Agency for mental health promotion. So what we need is for the new Minister to let us know how the strategy is going to be developed. Where is it going to be developed? Is it going to be a desktop exercise? Who will be involved in the consultation? Where is the voice of Māori? Where is the voice of lived experience? What is the element of addiction in it, given that it is not actually included in the provision in the bill? Those are my main questions.

The other element to this, if I talk about how I would like to see it broadened, is a meeting that I’ve had with FinCap, an NGO that supports 200 free financial mentoring services. Now, they have shown a strong research database showing the relationship between debt resilience and mental health. That doesn’t seem to be included in this. There is no reference to social determinants. There are no references to how this could enable people like, for example, former prisoners to be able to access bank accounts, which will support their mental wellbeing, support them into work, and therefore also reduce crime rates. I don’t see the whole-of-Government support for the provision. I support it, but it does feel a little bit like sloganeering.

The other questions I have are around funding, because, as a previous speaker said, funding doesn’t work if there’s no strategy. Well, strategy doesn’t work if there’s no funding. I know the Minister wants to see more funding. He said so to the Southland Rural Support Trust in January this year when he met with farmers and spoke about mental health. Will the Minister commit to getting that funding that is needed? Will he commit to getting the workforce that is so desperately needed? And, again, in the select committee today, we asked about workforce. We were told by the ministry that there are gaps not only in the workforce, big significant gaps, particularly in my part of the world down in in Taieri, in the deep South, but also in the knowledge, in the data baseline of what we know about where the gaps are. So that work has yet to be done. So I do think it’s really ambitious for the Minister to say he’s going to deliver on all of that when we don’t have workforce strategy to do so.

My final point is around the fact that I do support this because it’s explicit, but I would also note that anybody who’s read the health strategies from the other sectors will see a really strong focus on mental health. In the rural strategy, for example, there is almost a dominant focus on access to mental health services and provision of wellbeing. So there could be an argument to ask why this is suddenly needed to be inserted. It makes me suspicious that this could be a little bit more of the sloganeering that we’ve come to see from this Government—great on slogans; how are they going to deliver?

I have more faith in the Minister than that. As I’ve said, the Minister is really invested in this. He wants to make a contribution. I hope he can make a contribution. The questions I have are not really around his commitment to this but around his Government, which hasn’t committed to anything around mental health in the hundred-day plan. Will he have the influence and the support of his caucus colleagues? Will he have the support of his Minister of Finance, who is currently trying to make a 6.5 to 7.5 percent cut in the public health sector? How is he going to manage all of that and deliver on this great ambition, and what is the strategy going to look like? I’m looking forward to seeing that work from the Minister. I want to support him. I think it’s great that we have a Minister of Health and I’m looking forward to hearing the further contributions in the House on this today.

E te Māngai tēnā koe. Tēnā koutou e te Whare. The Greens will be supporting this bill through the House tonight and through select committee, and encourage members of the public to have their say at that select committee stage. I just wanted to acknowledge the member Katie Nimon for taking it on board: congrats, it’s not often that you get your first bill in front of the House in the first few months. But I also wanted to acknowledge and appreciate my colleague the Hon Matt Doocey for the mahi that we’ve done over the last six years in establishing the Cross-Party Mental Health and Addictions Wellbeing Group.

Just to give our listeners at home and those in the Chamber some context behind that cross-party group on mental health and addictions wellbeing, I also need to acknowledge a former member of Labour too—Louisa Wall—for her help in getting that across the line. This was one of the many recommendations out of He Ara Oranga, the mental health and addiction inquiry, which published, I believe, in 2018 or 2019. The cross-party group was one of the recommendations of that mental health and addiction inquiry, and it recommended, effectively, that this cross-party group could look at Governments across generations or across the three-year cycle to see that the recommendations for systemic change, for resourcing, and for funding were actually being meaningfully implemented.

I think there’s a really important point, as was actually raised by my colleagues in the Labour Party—Ingrid Leary in particular—about the fact that there isn’t yet, I believe, enough mind paid to the far more stigmatised element of mental ill health that is, of course, substance addiction and abuse. I’m really interested here to see what progress we can make through the select committee to shine a spotlight on that, because successive Governments have commissioned advice on addiction. This was also the case in He Ara Oranga, that mental health and addiction inquiry, but also Turuki! Turuki! Move together!, the Safe and Effective Justice Advisory Group review, also tabled in my first term, 2017-2020. Both of those recommended that in order to actually meaningfully deal with the issues of substance abuse and addiction, we needed to take them outside of the criminal justice sector and place them squarely within health. And that’s something which we’ve seen no Government, successively, be willing to have a backbone on actually meaningfully implementing. But we have an incredible opportunity here, should this Government like to walk the talk when it comes to their commitments to data and evidence.

As other speakers have already alluded to, this bill has kind of actually already manifest in a strategy that does exist out there, albeit this bill does require that it is mandated for future Governments to do it, so there is of course some value in that. That long-term strategy, or that 10-year strategy, as others have alluded to, is Kia Manawanui Aotearoa. And, again, I believe that there’s a really important point to be made here about the fact that we also need to see an overhaul of the mental health Act in totality. This was something which the former Government was meaningfully looking into, and I acknowledge that in the briefing to the incoming Minister for Mental Health, it was something that was acknowledged that officials had been working on for several years now, especially with the incredible complexities with regard to compulsory assessment and treatment orders.

So, I guess, in a nutshell, the Greens agree that it is important that successive Governments are mandated to produce these strategies and that it’s the case that they should be consulting with stakeholders across the health sector. Noting, of course, that it currently already exists—there is a strategy out there—but that we have continued to see successive Governments ignore the evidence and advice that they have commissioned, which has not been convenient in fitting with political narrative and not doing that hard stuff.

I guess, just with the final minute and a half that’s afforded to me, if I may speak to some of the broader thematics that we have looked into in the cross-party group on mental health and addictions wellbeing, I just wanted to acknowledge the Minister as well for the fact that I believe he is intending to ensure that mental health strategy in this country is akin to the mahi that the Hon James Shaw undertook with the Climate Change Response (Zero Carbon) Amendment Act in our ability to produce cross-partisan strategies and commitments to resourcing, for example. One of those key pieces of evidence that we do need to be looking into is how we meaningfully tackle substance abuse and addiction through, again, using the evidence, which says that we need to take it out of the criminal justice sphere but also that we need to be willing to invest meaningfully in youth one-stop shops. This is a model which we looked into in our second report out of that cross-party group, which, we found, has phenomenal results for our young people, with a no-wrong-door approach. I find it mind-blowing that we don’t have a youth one-stop-shop in Tāmaki-makau-rau, Auckland—in our largest city.

So I just, in closing, wanted to also acknowledge something which the Minister will know I’ve said many times before, including on our special debates on the cross-party group reports: that I find it also rather upsetting that while we can acknowledge that mental ill health is in crisis, we still are not yet willing to address the social determinants. I think there’s a massive opportunity for cross-party consensus there.

Thank you, Madam Speaker. Mental health is an issue that touches every New Zealander. I think every single person in this room will have somebody—whether it’s whānau, whether it’s your friends or yourself—that has experienced some kind of mental health. It’s clear that mental health services are facing serious challenges, and it’s time for us to approach this issue with a fresh perspective.

Despite the significant investment announced in Budget 2019, almost nobody is satisfied with the state of mental health and addiction services in our country. In fact, this is a real shame, and it’s something we honestly should not be proud of at all. Our youth suicide rate is a heartbreaking statistic, and it’s an area where New Zealand, a country accustomed with leading the world in many areas, unfortunately has the worst record. People seeking treatment often describe a system that is complex and difficult to navigate. Sometimes they simply are giving up. There are disparities based on location, lack of options for services that meet individuals’ and the community’s needs.

Non-governmental organisations have voiced concerns about the lack of fairness and genuine partnership, citing a power imbalance as Government agencies often prioritise their own services over community providers. There’s also been a notable absence of a whole-Government approach to mental wellbeing. The Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill represents a positive step forward. It provides a strategy that we desperately need in this space. I agree that the mental health Act needs a full overhaul, but this is a good starting position, and I’d like to congratulate the member the Hon Matt Doocey for bringing this forward and, now, actually, Katie Nimon.

New Zealand has some of the highest rates of mental health issues globally, which I just discussed. However, these statistics—our mental health system is still struggling with those long wait times and limited access to services. Good mental health is not about the absence of mental illness; it’s about our overall wellbeing. It enables us to lead fulfilling lives, contribute to our communities, and reach our full potential. It’s also closely linked to our physical health, with poor mental health increasing the risk of chronic diseases such as diabetes and heart disease.

Grassroots organisations and NGOs play a crucial role in reaching our vulnerable communities. They understand the unique needs of our communities and can tailor their services accordingly. However, many of these organisations are facing financial challenges and staff shortages. By investing in these organisations, we can assure that everyone has the access to the support they need, regardless of where they live.

I’ve had the privilege of meeting with various organisations now that I’ve taken on the spokesperson role for mental health within the ACT Party. Some of these not-for-profit organisations are the sole support providers in our rural areas, such as Twizel, where access to public services can involve a really long journey to get to your public health system. These organisations are essential in bridging the gaps in meeting the needs of our remote communities.

A lack of choice and services is a significant issue for those seeking assistance. A one-size-fits-all approach to mental health care can be more harmful than helpful. Individuals need to be able to access care and services that best suit their needs. While we support the devolution of funding to communities and their organisations, we must also ensure that there are strict criteria for funding services and that services are monitored to ensure New Zealanders receive high-quality care.

The public sector also has a role to play in supporting mental health. This includes funding and regulating mental health services as well as working to reduce the stigma and promote mental health literacy. We need a coordinated approach that brings together Government agencies, NGOs, and communities to make mental health a priority for everybody. I’m proud that this Government is addressing the issues that have previously not been addressed adequately. Mental health is a pressing issue and demands immediate attention. We need action. The ACT Party believes everybody should have access to high-quality mental health services, regardless of their background or their circumstances. We support this bill, and I eagerly await the select committee’s recommendations. Thank you.

It’s time to talk. It’s time to talk about mental health, which is why I’m very honoured to speak on this bill because it’s a topic that’s very dear to my heart and, as I have mentioned before, I haven’t spoken in the House much but I did speak a lot about mental health in my maiden speech. I speak from personal experience and also now being in the helping profession myself and having a lot to do with the addictive process and what it is like to go through and to assist clients with that.

I’m very honoured to be able to stand up and be a voice for some people who feel they don’t have a voice. There are many people out there who are silently suffering and I would like to assure the member in the House that it’s not a tick-box situation here. It really is something that I know New Zealand First is very committed to, and I know as a coalition we are very committed to, and we’ve already said that we will support the Mike King I Am Hope Foundation.

So that is something that we are committed to because we really do know that there is a new pandemic, one might say, within our country, of loneliness, unresolved grief that people are feeling after these last few years, and the addictions as well. People don’t speak up because they are too ashamed to speak up, and the fact that we’re putting this in writing is extraordinary because this is the first step to people being able to say it’s OK to talk about mental health. For someone to be able to put their hand up and say, “It’s OK for me to say that I’m not OK.”, and to know that they are still loveable and they are still worthy and they will not be in any way treated differently because they’ve put their hand up to say that they’ve got something that is harming them inside but we can’t see it on the outside.

So I know I’m coming from a different angle here but I really want to assure the members on the other side that you can rely on us to deliver on this. One of the things that I have noticed, actually, about some of the wording in the bill is to not only say that we are going to put something in place and speak about it but having outcomes and to have deliverable outcomes. So, yes, it is about measuring, it is about being on top of everything as well, and not just speaking to it but being specific on what these outcomes are going to be.

Yes, I know that some of the outcomes are long term but we can also measure short-term outcomes and sometimes short term is just one day at a time for some people, and it may just be that there is a service where someone can pick up a phone and say I need help. So it is very important to have this—

Hon Dr Ayesha Verrall: Imagine if we had that service!

TANYA UNKOVICH: So, yes, it would be great.

Hon Member: What’s the number?

Chlöe Swarbrick: 1737.

TANYA UNKOVICH: Yes, OK.

Hon Matt Doocey: Started under the National Government.

TANYA UNKOVICH: Yes, no, absolutely. Oh, no, no, no. Yes. So let’s talk about what mental health really looks like and, unfortunately, so many people don’t want to speak up because they feel that they are going to be vilified and those of the people out there—

Hon Member: Gaslighting.

TANYA UNKOVICH: Yes, gaslighting, and all that sort of stuff, which is so common at the moment, so people are feeling silenced. Well, I committed when I came to Parliament that I was going to be a voice for the people who don’t have a voice, and if I have to speak louder, then I’m going to speak louder because the message has to get out there and we are going to be committed.

This entire coalition is committed—especially the people from New Zealand First; we are all very committed to supporting this bill to the House. Thank you.

Kia ora. First of all, I’d like to confirm that Te Pāti Māori will be supporting this bill. We’ll be supporting this bill because it is simple and practical. We also note that the founder of this bill, our colleague Minister—gosh, I had better remember: Matt—Matt is one of the good dudes on this side. And even though I called him Chris Luxon for much of the last three years, we must give credit where credit’s due.

I think one of the things that Matt has done is he’s absolutely shared vulnerability and made it OK, and I think it’s really important that we help to destigmatise and use our sphere of influence in the right way. Another thing he did was he reached across cross-parties for engagement, even though one of those cross-parties only had two MPs at times. It mattered. And this is something that really matters to us.

And Te Whare Tapa Whā, which I’m sure many here in the Whare will know, is that we must prioritise mental health alongside every other health objective. So I’ll get that bonding out of the way with you, Matt. It probably won’t happen with you guys ever again, so let’s enjoy it!

But we do have our w’ānau who are desperately in need of help, and they’re in need of us to be able to understand and draw bridges across the systems and use legislation at times to help. So we totally agree with the Green Party’s view that there must be an overhaul in our Mental Health Act and, in fact, the system.

Sadly, what we have seen is a prevalence of mental distress amongst Māori, and we are 50 percent higher affected than non. Māori are 30 percent more likely to go undiagnosed than anyone else in Aotearoa. And our rangatahi suicide rates are beyond any imagination of what it is that we must think about in our solutions.

I want to share, while we’ve got this opportunity, which is why Te Pāti Māori’s health policy—and I don’t want to make this about pitching for our health policy—

Carl Bates: But you’re going to.

DEBBIE NGAREWA-PACKER: —but the reason we specifically talked about—be quiet, Carl—our kaupapa Māori mental health service is because we know we have such dire issues. And our dire issues require us to actually take a really unique view. So we believe we’ve got to work together, but until we can address the inequity and the issues that we have, we believe that we must have a kaupapa mental health service so our mental wellbeing becomes something prioritised first.

And it was something we really talked about when the Pae Ora legislation came out. Part of that was adopting and delivering recommendations from He Tapu te Oranga o ia Tangata: Suicide Prevention Strategy. And I know, Matt, that you will know a lot about that—Minister, sorry—and also that we talked about providing free mental health services in every community. So we all know the number—1737—but it’s not always accessible when digital equity is an issue in a lot of rural areas. We also talked about the fact that we need desperately to be able to normalise and make accessible that our w’ānau get tautoko and awhi when they need it and how they need it, by those they recognise and by those they can relate to.

So a Māori mental health approach must be different. It must be different because our dire and our desperation is so much worse than everyone else. That is not asking for a separatist system; it’s actually asking for a targeted approach to stop the horror that we see going on. And I really appeal that, as a follow-up, we continue to focus on what some of those solutions will look like.

Look, I want to say a couple of other things before we conclude. We are in dangerous land of some of our rhetoric as we tension ourselves between whose way is right or wrong. And I can’t say this enough: Te Pāti Māori’s neither left or right; we’re Māori, first and foremost. And with some of the language, the Tiriti principles bill, the smoke-free environment, and the belief that there is an anti-Māori agenda going on out of this House, we fear that we’re creating harm. And so we will continue to support movements that appeal for unity.

So I just want to say, yep, finally that we do support this bill. We caution on all our responsibilities that we have to make the world a better place, but particularly when it comes to our mental health. So ngā mihi, and I’m really pleased, Matt, that I didn’t call you Christopher Luxon once in this whole speech. Kia ora rā.

It’s a pleasure to speak in support of this bill in the name of my good friend and colleague Katie Nimon. It’s really pleasing to see her pick up the ball and run with it, passed from the very safe hands of National’s new Minister for Mental Health, the Hon Matt Doocey. He’s done great work in this space. I just want to acknowledge that on the many occasions he’s come and visited my electorate when we visited the local youth one-stop shops, we’ve held public meetings, actually one of the first things that he has always acknowledged is that this is one area that, across the House, people work on together. He’s always acknowledged the cross-party work in mental health, and we’ve heard that from almost all the speakers today. I think that’s really admirable.

You know, so often the snapshots that get put on TV shows are the heated moments; they show the tension—actually, I don’t know that that’s great for people’s mental health, to be fair—but it doesn’t capture some of the real meaningful work that takes place. I want to commend not just Matt but all of those across the House who have contributed to this, and particularly some of the contributions today. You know, to hear the Greens and ACT speaking together on the same topic, New Zealand First and Te Pāti Māori, I think is really encouraging.

I wonder if this is actually not the time for politics. What if this was just one of those moments? There will be lots of days this year, there will be lots of questions, there will be lots of speeches, there’s lots of times to heckle and get in the shots, the witty comments—they’re fantastic, but is this the issue to do it on? I just wonder if this is the moment that we can actually show some leadership across the House to New Zealand on this issue, that, actually, this is one thing that we can unite on. I heard the criticism about sloganeering—you know, it could do more.

Frankly, I think it’s great to see this happening, because two years ago this was apparently a step too far for the House. Actually, I think words matter. I think the change is meaningful. I think it matters that we are role modelling, we are demonstrating to the people of New Zealand that we care, that this matters, that this is important. It’s important enough to National to have the first Minister for Mental Health. It’s important enough to this House to put through a bill that says, actually, mental health is important in our strategy; listening to the advice of the Mental Health and Wellbeing Commission is something that we want Ministers to take note of.

I won’t be the only person in this room today that in the last six months has been at a funeral of a friend who’s made a terrible decision. I won’t be the only person in here today who’s been supporting someone or who has supported someone struggling with mental health, who has walked next to them. There will be those who will have even more, perhaps, darker experiences than me. That’s really important.

But this is something that we can’t afford to pass by, not in this moment. Just this week, on Monday, I was meeting with our local police, and they were telling me that 70 percent of their time is taken up—at least 70 percent—just with domestic violence and mental health now. This is a huge issue in our community. I speak with social workers. I spoke with a doctor from Victoria University—90 percent, she reckons, of the issues they are seeing now in our young people are mental health. Making even small, symbolic changes is still meaningful, and it’s worth it.

I think of Raechel and the team at Kāpiti Youth Support in Paraparaumu, in Kāpiti, in my district—the amazing work they do as a youth one-stop shop. I think about Glenn and the youth one-stop shop in Levin, in Horowhenua, and their amazing work. I’m really fortunate that I have two in our electorate—two of just 10, I think, around the country—showing them that, actually, we care; that, actually, this matters; that, actually, their contributions are valued; that this is a meaningful first step.

To hear criticism that we’re not doing anything in the first hundred days, and yet here we are in the first hundred days, saying, well, we’re actually not going to let this go past and we’re not going to make this a political thing. We have the opportunity to all join together, to all take some steps forward together.

So let’s finish. This is not about me; this is about people who I have seen, their work in the community; people who have struggled—it’s about them. So let me finish with a couple of quotes from the experts. We heard from the Mental Health and Wellbeing Commission when they criticised the 2022 bill, talking about mental health being—and I quote—“almost invisible within [it].” They wanted more explicit referencing. The Mental Health Foundation said it showed an—this is a quote—“absence of any ownership [or] leadership”. Well, we have the opportunity today to show that ownership, to take some leadership, and do what the Mental Health Advocacy and Peer Support Trust said, to have the Minister give regard to the advice from the commission, to bring this forward, to bring mental health into the Act. That’s why I’m supporting this bill and commending it to the House.

I’d like to commend that last member who’s just resumed his seat’s remarks, and, really, perhaps the House could join in some reflection on what a bipartisan approach to mental health would mean. And perhaps those members who campaigned on the idea of where did the $1.9 billion in mental health spending go think, if they want to newly embrace bipartisanship on this issue, they could take some time to use the resources that they have as parliamentarians to educate themselves on it.

Now, I’m not going to try to persuade you on my view on that, but members could educate themselves on where that money went, and they could educate themselves on the Access and Choice programme that has served over a million people around the country, and realising that when they were representing to the public that nothing had come out of those funds, they were actually undermining a service that is hugely important. Often there’s no wait to get into these services around the country. They’re your first port of call. You can walk in when you’re at your general practice’s office. There are specific services for Māori, Pacific, and young people. Now, if we’re to take a bipartisan approach, I would hope that a service that has been stood up during a pandemic and tremendous challenge for the health system could be respected and treasured by the Government, rather than having its standing diminished.

This bill is about implementing a statutory strategy. We, as my colleague Chlöe Swarbrick has already mentioned, have a strategy, but not a statutory strategy, on mental health and addiction. That strategy is called Kia Manawanui. I’d like the debate on this bill to answer some questions about why a statutory strategy is required or not—perhaps the Government would like to focus some of their remarks on that. And why this strategy and not others? Why not a cancer strategy? Why not the elderly? Why not a child health strategy? Strong cases can be made for all of these as well. How long would we like the Pae Ora bill to get?

But I think what I suspect with the statutory strategy is that some of the members opposite had no idea that we have a strategy, and therefore didn’t focus their remarks on why we needed a statutory strategy instead. I think we can all agree that a strategy is fine, but I wonder if we haven’t made a case for why a statutory strategy needs to be in place in the arguments that we’ve heard so far. Why spend the extra money and time if the existing one isn’t good enough? I’d like to hear from the Government what their strategy might be. What is the sequence of actions they would take to change the situation they’re in? Do they think targets will change the situation? I’d like to hear their logic for that. Would they like to focus on the complex needs that people with severe mental illness have? How to crack the difficult nut of their housing and challenges and interactions with the justice system? I’d like to know if they thought we got it wrong when we accepted the review in the last Government that said that we needed to focus on early intervention, because that’s why we set up Access and Choice. What is the strategy that you have in mind?

But, in particular, my view as a former medical practitioner is that we have to look at the cause of mental illness. We need to look at the early life experiences that really make people much more likely to have mental illness. We need to particularly look at experiences of violence and abuse, experiences of poverty and addiction, experiences of marginalisation. Those are all factors that contribute to mental illness. So I have questions about what the Government’s mental health strategy will be, and I have questions about why they’re passing this bill on a day when they drove 7,000 more children into poverty. I have questions about how you are promoting mental health when you’re now creating excuses for why the police don’t need to attend family violence. I have questions about how you’ll promote the mental health of Māori if you’re no longer letting their children hear their reo in their school and in public life, and how you think that in their schools they shouldn’t hear the true history of this country. This divisive Government will do more to split the haves and the have-nots, Māori and non-Māori, and they will show hypocrisy when it comes to mental health.

Thank you very much, Madam Speaker. Well, I have a question: why is that former health Minister—Hon Dr Ayesha Verrall—asking the new Government for answers when she had six long years to address these issues? Remember, that last Labour Government came in and promised to transform the mental health system? I won’t be lectured to by someone who wants to talk about taking a bipartisan approach when she, as the last health Minister—like the former health Minister Andrew Little—refused to meet the cross-party mental health group as the health Minister. One of their own recommendations from their own inquiry was the establishment of the mental health cross-party group, and their health Ministers refused to meet it.

Ingrid Leary—and I respect Ingrid a lot, but after hearing her question “Where are the voices of lived experience?”, those voices of lived experience were the submitters who turned up in the select committee process for the Pae Ora health reforms and said time after time after time that mental health was invisible, and those members did not listen then. But now we have a backflip, a U-turn, and a flip-flop. They’ve been dragged, kicking and screaming, to accept that, actually, legislating to put a mental health strategy into the Pae Ora health reforms is the right approach.

The question was asked in the last call about “Why not have a strategy on X or Y or Z?” Yeah, I agree, but it comes down to priorities, and under this Government, mental health will be a priority—that’s why we’re legislating it as one of the strategies under the Pae Ora health reforms. Clearly, under the last Labour Government, it wasn’t a priority, and that’s why they did not legislate for it. Yes, we have a long-term, 10-year strategy—Kia Manawanui—but the issue is that that is not about the Pae Ora entities that we are talking about today.

So the question was posed: what will the strategy be about? Well, it will be about the implementation of all the ideas in mental health that those members talked about but that they delivered very little on, and if that former health Minister wants to talk about the $1.9 billion and sheet it back to us in Opposition, how about the Mental Health and Wellbeing Commission, which they established? Its first report said that despite the $1.9 billion in funding, there was no material improvement. So she should look at their own entities, which were saying that to them.

Actually, what happened was that this former Government—the Labour Government—in mental health got sucked into just thinking it could make big, wide announcements. It was $100 million there, $100 million there, $200 million there, and then, months later, the diligent Opposition spokespeople with their written parliamentary questions would find out that very little would happen. Now we hear from officials that even at the time, when big announcements were being made, the officials knew that they couldn’t deliver on them, and what’s shameful about that is those members were raising hope for some very vulnerable New Zealanders. Announcements were made that people knew couldn’t be delivered on.

So, yep, a valid question: what will the strategy be about? It’ll be about ensuring that we have implementation.

They kicked off an inquiry. They should answer the question as to what happened to the 48 recommendations. They’re sitting on a shelf in their office, and no one’s ever looked at them again.

It will create an implementation plan, and you need only look at some of the submitters who talked about mental health being absolutely invisible in the Pae Ora health reforms. That’s what this strategy is about today: it will prioritise mental health within Pae Ora, within the Ministry of Health, within Health New Zealand, within the Māori Health Authority, and within the other entities.

So they will prioritise mental health because they know that the Government wants them to prioritise mental health, because when those members deprioritised mental health by not putting it in the strategy, they made mental health invisible—and you don’t need to listen to us. Go and talk to the Mental Health Foundation. Go and talk to the Mental Health and Wellbeing Commission. They all said that, and that’s what this Government is delivering today. Thank you.

It’s always a strange day when a Minister comes down from their office to defend a member’s bill from one of their backbenchers, but, none the less, here we are.

On Boxing Day morning, I received a phone call that no family member wants to receive. My niece, my twin brother’s daughter, had taken her own life, and I want to mention her name here so it’s on the Hansard so that she’ll be remembered for ever, as she will be in our hearts: Tī Karohia-te-mārama Hēnare. It was mentioned at Rātana and it was mentioned again at Waitangi, and I agree with members across the House that talk about mental wellbeing, mental health and addiction matters do impact on each and every one of us in this House. I’m no exception. So it’s in that vein that we remember those people.

We also thank the many kaimahi—workers—who work in the mental wellbeing sector around the country. I’ve met thousands of them, from Kaitāia all the way to the Bluff. In my time as an associate health Minister, I’m proud of the work that we did. When I listen to members across the House talk about why this is now a priority, and also in the fact that this bill also mentions the Māori Health Authority, it’s the Māori Health Authority that soon will be on the chopping block. It’s the Māori Health Authority that led the work that allowed us to spend $136 million on Access and Choice for Māori communities right up and down this country. I visited 27 Māori health providers and mental wellbeing providers from Kaitāia to the Bluff, organisations most people have never even heard of. As the member who’s ushering this bill through the House has already mentioned, the work that they were doing was to put a fence at the top of the cliff. It wasn’t the kind of clinical support that everyone thinks of when they think of mental wellbeing. It was the whānau who sat down with the young men and women, the whānau in communities to say, “We’re here to help you.”, and I had the grand opportunity of meeting them right up and down the country.

In fact, not only did we fund them, we changed the way that we can procure the services that they have, because most of the procurement services in the health system—and Minister Doocey will understand this as he comes to grips with his portfolio—are extremely hard to get to the level that the Government requires with respect to sound procurement. Well, that’s all fair and well, because those measures are there for a reason. What that does, however, is limits the scope and the opportunity to support the whānau that need it the most.

It’s interesting how across the House many have talked about the one-year anniversary of Cyclone Gabrielle. Only one or two members that I heard, at least in my time listening to the debate, mentioned COVID and the compounding effect that COVID had on our communities. In my time meeting with health organisations, the Mental Health Commission, and so many others, here are some statistics that I hope, when this legislation passes through, this Government will understand when they look towards how they support it: 72 percent of young Māori under the age of 25 are impacted by mental health issues and addiction issues—let that one sink in: 62 percent of Māori under the age of 42 continue to suffer from mental health and addiction challenges. Our colleague Debbie Ngarewa-Packer has already talked about the under-reporting amongst Māori communities for those with a mental illness and addiction struggles. Let the science dictate what we’re trying to do here to achieve the kind of support that we’ve all spoken about in the House here today.

My encouragement, in the final minute that I have on this part of the bill in the first reading, is to say, if any of the members on the other side of the House want to look at some really good models and want to look at some really sound science, I encourage them to go and see the person who we consider to be the guru on these matters, in particular on Māori health, and that’s Sir Mason Durie, the man who built Te Whare Tapa Whā, who allowed us to look towards the entirety of a person and their wellbeing to understand their spiritual, their physical, their mental wellbeing as they progress through this world. It’s really important I mention that, because it was also Sir Mason Durie who was the architect of Te Aka Whai Ora - Māori Health Authority—yet we know what’s about to happen to that. That’ll be a debate for another day, but it’s important that we look towards what this means in terms of outcomes, how we can continue to support our communities so that we can be stronger and better placed to support all of them into the future. Kia ora.

I appreciate the opportunity to reply to what has been spoken about in the House this evening. I just want to acknowledge the cross-party support first—I think it’s very important—but just to go through and address a few things as this time affords me to do. Now is not the time for questions; that’s question time. Asking questions of the Minister and what he’s going to do and how he’s going to report on it is for question time. This is a member’s bill in its first reading that is going to make a deep impact because one of the other points that members opposite made, or questions asked, was: why, then, does this have to be statutory? Because when else does it become so explicitly prioritised than when it is mandated?

So I just want to thank, first and foremost, the Green Party and the member Chlöe Swarbrick for pointing out the hard work that Minister Doocey has done in this member’s bill. Like I said earlier, I’m really pleased to be shepherding this through the remainder of the process, but exactly that cross-party work is what needs to continue to be done. This is the first step in the right direction. Many of the questions raised are maybe the fourth, fifth, sixth, or seventh step, but we first have to mandate the strategy. I just want to acknowledge the member of the Māori Party. I think, in fact, we are all good dudes on this side—I do just want to acknowledge that. I can speak and I do speak with bias, but I do think that we are all good dudes over here.

Look, it might already be, in document, a mental health and wellbeing strategy, but will it always be if we don’t mandate it? That’s what we are here to do—to formalise the process as it should have been done. Just to acknowledge the irony of saying last year when the Pae Ora (Healthy Futures) Bill was going through that it was a step too far, now it’s not a step far enough. I’m just a little bit confused by that and I think the Minister took the words out of my mouth: you can’t just throw money. So without a mandated long-term strategy with continuity, we will continue to be just throwing money at problems without having strategic objectives—continuity, long-term plans. So let’s make it statutory. I think that’s vital.

But I just want to acknowledge a couple of other things before I finish off. Some of the things mentioned in one example was digital equity. I want to take this opportunity to talk about that, because absolutely we have 1737, but that is what a mental health strategy within the health system will help us understand: the broader outcomes; the broader inputs that we need, because—and I can speak to this on a public transport aspect and I always find a way to bring that in—how do you expand the ability to have demand-responsive transport if people can’t use an app to book a ride? How do you have people access digital mental health services when they don’t have access to that? That is all what a mandated statutory strategy allows us to look into.

I also want to acknowledge substance abuse. This is absolutely an enormous part of our mental health epidemic in this country—and across the world, of course, and I did acknowledge that earlier. We are not not acknowledging that, but mental health and wellbeing—as is said in the amendment to this bill—encompasses all aspects, and that absolutely includes substance abuse.

But the one thing I really want to leave on, in this last minute of my time, is that mental ill health does not discriminate. Now, I acknowledge that members opposite talked about the population representation in Māori and young people—absolutely it does. But every single New Zealander is entitled—and that is the worst word we can say, but it’s the absolute truth—to mental health issues. It is not because of their background, their upbringing, necessarily. Some of the people you would expect to be the happiest, most vital, most able people in the country have the most severe mental health issues. A strategy absolutely will target those most in need, but will not overlook those that also need it the most. So we need not define every single person by their background, but by their mental ill health, and that is what the strategy will do.

So I am absolutely thrilled to be supporting this through its first reading. Thank you.

Motion agreed to.

Bill read a first time.

The question is, That the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill be considered by the Health Committee.

Motion agreed to.

Bill referred to the Health Committee.