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He Ara Oranga – Report of the Government Inquiry into Mental Health and Addiction

4 December 2018

Widespread concern regarding the state of our mental health system made mental health an election issue in 2017.  A Government Inquiry was established, and following widespread public consultation and 'remarkable' engagement from the public and from the mental health and addiction sector (over 2,000 people attended public meetings at 26 locations around the country; over 400 meetings were held with tāngata whaiora, their families and whānau, health and other service providers, Iwi and Kaupapa Māori providers, community organisations, researchers and other experts; and over 5,200 submissions were made to the Inquiry), the Inquiry's report He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction was released publicly today. 

He Ara Oranga emphasises the 'striking degree of consensus' amongst those who engaged with the Inquiry, and calls for 'real and enduring' change (the Inquiry being, in the words of the Panel, a 'once in a generation' opportunity to take action). 

It proposes major changes in current policies and laws, supported by significant increases in funding.  The 40 recommendations made in He Ara Oranga are grouped within the following categories:

  • Expand access and choice from the current target of 3% of the population being able to access specialist services to provide access to the 'missing middle' who cannot access the support and care they need (it suggests a new national health target of 20% within the next five years, noting that approximately one in five people experience mental health and addiction challenges)
  • Transform primary health care so people can get skilled help in their local communities, through general practices and community health services
  • Strengthen the NGO sector to support a more community-based approach (it cites a number of shortcomings in the sector, including short term contracts, high compliance costs and reporting requirements, multiple funders and contracts, and power imbalances)
  • Take a whole-of-government approach to wellbeing and provide a clear locus of responsibility within central government for social wellbeing, with a focus on prevention and tackling major social determinants that underlie inequitable social outcomes
  • Facilitate mental health promotion and prevention with leadership and oversight from a new commission, including an investment and quality assurance strategy for programmes
  • Place people at the centre of mental health and addiction governance, planning, policy and service development
  • Take strong action on alcohol and other drugs with a bolder approach to law reform, better treatment and detox services and clear cross-sector leadership within central government
  • Complete and implement a national suicide prevention strategy, with a target of a 20% reduction in suicide rates by 2030 (it notes that the 2017/2018 suicide rate was our highest since 1999)
  • Reform the Mental Health (Compulsory Assessment and Treatment) Act to reflect a human rights approach, promote supported decision-making, align with a recovery and wellbeing model, and minimise compulsory or coercive treatment
  • Establish a new Mental Health and Wellbeing Commission to act as a watchdog and provide leadership, oversight and public reporting
  • Refer to the Health and Disability Sector Review (ongoing) when considering broader issues such as the future structures, roles and functions in the health and disability system, including the establishment of a Māori health commission or ministry
  • Establish a cross-party working group on mental health and wellbeing to reflect the shared commitment of different parties, noting that mental health is "too important to be a political football".

The Government will respond formally in March 2019.  With the Rt Hon Jacinda Ardern signalling that mental health is a "real priority" going forward, we can expect significant developments in this space as well as increased funding through the 2019 Wellbeing Budget. 

This alert was written by Amy de Joux (senior associate) and Louise Grey (solicitor).