Mental Health – A Tsunami Of Unmet Need

A new report by the Association of Salaried Medical Specialists Toi Mata Hauora shows New Zealand cannot afford to waste another three years watching the crisis in mental health spiral further out of control.

The report - What Price Mental Health? The Crisis and the Cure - uses official data and evidence to lay out the extent of underfunding of mental health and addiction services. It also details the huge increase in demand for specialist services and the lack of staff and facilities to match it.

It underlines that in the nearly three years since the 2018 Mental Health and Addiction Inquiry, not only has little changed, but key indicators are worsening, including a concerning increase in the practice of seclusion.

Some of the key facts in the report include:

• DHBs frequently exceed 100% occupancy levels for MHA inpatient beds - well above the 85% occupancy considered clinically safe.
• Specialist MHA service funding has been designated to cover 3% of the population considered to have the most severe need, but the evidence indicates that closer to 5% of the population has a severe need.
• New Zealand has very low numbers of practising psychiatrists per capita and major staffing gaps.
• Māori comprise 34% of the number of clients seen.
• “Referral discharges” to psychiatric inpatient services have increased by 78%, and referrals to outpatients by 156%.
• The number of inpatient MHA beds per population has fallen by nearly 10% in the past five years.
• Solitary confinement increased by 21% between 2014 and 2019.
• New Zealand’s level of need for mental health support is one of the highest among the 37 OECD countries.

ASMS Executive Director Sarah Dalton says the report forms a useful backstory to the current mental health crisis.

“It reinforces everything we hear from our members on the frontline about the struggle of trying to provide specialist services against an ever-increasing tide of patient need, desperate understaffing and a lack of in-patient beds. There is a tsunami of unmet need and it’s an unsafe situation for staff and patients alike”.

The Health Minister Andrew Little has publicly expressed frustration that the Government’s $1.9 billion mental health package is not flowing through to actual services and has hinted at an independent review.

Sarah Dalton says it is totally appropriate to be asking serious questions about where the investment in mental health has been going and what the Mental Health and Addiction Inquiry has achieved.

“Clinical staff would certainly argue there has been no meaningful change to the system at all and that the crisis is deepening”.

“Many of our psychiatrists come from overseas but they often don’t stay because of the difficulties they encounter working in such a stressed system. It’s time to make sure we are offering the pay and conditions to retain the staff we do have and attract the staff we need”.

As part of the report’s recommendations ASMS wants to see funding urgently lifted and ringfenced for specialist MHA services to cover 5% of the population with acute need, better measurement of local MHA demand, and a workforce census to establish exactly where the staffing gaps are.

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