Sitting date: 23 October 2024

PAE ORA (HEALTHY FUTURES) (IMPROVING MENTAL HEALTH OUTCOMES) AMENDMENT BILL

Third Reading

KATIE NIMON (National—Napier): I move, That the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill be now read a third time.

Mr Speaker, colleagues, and, hopefully, those watching at home now or in the future, today I believe is a transformative day for New Zealand. We will no longer be making decisions for health without a strategy for the mental health and wellbeing of our people. The Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill, which we're about to pass unanimously, reflects our commitment to building a healthier and more resilient future for all New Zealanders. This bill represents an essential amendment to the Pae Ora (Healthy Futures) Act 2022 and, at its core, it ensures that mental health and wellbeing is at the heart of our health system, with long-term planning to address some of the most critical challenges our communities face today.

The purpose of the Pae Ora (Healthy Futures) Act 2022 was "to provide for the public funding and provision of services in order to—(a) protect, promote, and improve the health of all New Zealanders; and (b) achieve equity in health outcomes among New Zealand's population groups, including by striving to eliminate health disparities, in particular for Māori; and (c) build towards pae ora (healthy futures) for all New Zealanders." Now, I don't believe that you can achieve that without a core focus on mental health and wellbeing, which brings me to the purpose of this bill. As we know, mental health issues and addiction affects every corner of our society: from young people struggling with depression and anxiety to our families facing the harsh realities of addiction. The need for a robust and comprehensive mental health framework has never been more urgent.

The bill seeks to address those needs by improving the way we plan, deliver, and support mental health and addiction services across the country. The elephant in the room is that this should have been included in the original Act in 2022. That is the reason that this amendment is in a member's bill. I want to thank again Minister for Mental Health Matt Doocey for fighting for this amendment in the original bill and for not giving up once it wasn't included, and for writing the amendment into a member's bill. I've been privileged to shepherd this through the House and feel that the support from all sides of the House and the Health Committee have been a true indication of what this means to us all.

The bill's primary purpose is to ensure that mental health and wellbeing receive the dedicated focus they deserve within the broader healthcare landscape. It mandates the creation of a mental health and wellbeing strategy, which will guide our health sector's approach to these issues, promoting holistic wellbeing, and ensuring that those who need help can access it when they need it the most. The strategy will prioritise mental health and addiction services, focusing not only on immediate care but also on prevention, harm reduction, and long-term recovery. It'll also incorporate a strong emphasis on workforce development, ensuring that we have the skilled professionals necessary to meet the growing demand for our mental health services.

Just to touch briefly on what the bill changes, we've talked a bit about the select committee process and what they've introduced—several, maybe three, important amendments. One of those we talked about: the removal of the clause that designated the Mental Health and Wellbeing Commission as a health entity. We've talked about that a number of times. Obviously, it was an original drafting oversight, but I'm pleased for that to be corrected. Maintaining the commission's independence is a very important part of this bill. Another significant amendment was the expansion of the scope of the mental health strategy to include wellbeing—obviously, not just mental health and addiction. It reflects our evolving understanding of what mental health is and how deeply intertwined it is with overall wellbeing. A holistic approach, one that recognises social, emotional, and physical aspects of health, is essential to truly making a difference.

And, furthermore, what I think is an important amendment is adjusting the bill to allow necessary time for the development and implementation of the strategy. Strategy provisions will now come into force 12 months after the bill receives Royal assent, giving the Ministry of Health the time it needs to engage with communities, experts, and stakeholders to create a strategy that truly reflects the needs and aspirations of our people. On that note, my vision and my hope is that this bill is more than just a legal amendment. I see it as a commitment to our future. It's a recognition that mental health is a vital part of our overall health and wellbeing as a nation. We need systemic change, long-term planning, and continuous improvement in how we face mental health challenges.

I just want to acknowledge the 56 submissions that were received from individuals, organisations, and families directly affected by mental health issues. Among those voices was Save the Children, who highlighted the importance for centring children and young people in our mental health strategy. Their voices need to be heard if we're really going to make a difference for the future of mental health in this country. The Mental Health and Wellbeing Commission also strongly supports this bill, and they advocated, actually, for this as long ago as the 2022 Pae Ora (Healthy Futures) Bill. So I really look forward to this enabling them to work with our Government to really make a difference. And I want to thank everybody involved and want to see the difference that it can make and should have made back in 2022.

To address what this bill means for New Zealand, for those struggling with mental health issues, this bill is hope for change. It tells our people that their struggles are seen, that their needs are heard, and that their wellbeing matters. It's a step towards reducing the fragmentation and barriers that have long obstructed our mental health services. For our youth, it promises a future where mental health support is more accessible and where suicide and mental health crises are addressed with the urgency and care that they deserve. For those in recovery from addiction, it signals a commitment to support them not just as patients but as individuals with their full lives ahead of them, deserving of comprehensive care and opportunities to thrive.

I just want to acknowledge how much I've really appreciated the chance to speak on this bill, in the first reading, in front of the select committee, in the second reading, and in the committee of the whole House. I've spoken about some pretty emotional stuff, but I feel it's my job in this process to humanise a health strategy. This is not just about a piece of paper, or hundreds of pieces of paper. It's about more than just one sector of society or one region of New Zealand. This is about an entirely preventable health crisis, a genuine plan for workforce development, for innovation, for investment, and for addressing the stigma of an invisible condition. It won't just change lives; it will save lives.

I've talked about wanting depression and anxiety disorders to be treated like type 2 diabetes. There are so many more comparisons that I could make, but, in short, we're going to create a framework that is going to deliver long-term, measurable improvements to mental health outcomes. This is not just about policy; it's about people. It's about that happy, bubbly person that you just couldn't believe had depression. It's about that amazing classmate that just couldn't cope with the pressure. It's about your friend's dad who thought he was a burden. It's about the brother that couldn't get out of the cycle of fun becoming a problem. Let this bill be a reminder that mental health matters. It matters to every individual, every family, every community. It matters to me, and it matters to our Government. Thank you.

ASSISTANT SPEAKER (Greg O'Connor): The question is that the motion be agreed to.

INGRID LEARY (Labour—Taieri): Speaking as the Opposition spokesperson on mental health, I would like to congratulate the member, Katie Nimon, on the successful shepherding of this bill through the House. We do support the bill, although I do just want to make a few comments about also wanting to support the member's statement that she hopes this is not just a legal amendment. I guess time will tell because of some of the procedural things around how this bill interfaces with the Government policy statement (GPS) and the order of business.

I'll preface my remarks by saying that the reason that Labour did not have a mental health strategy under our Government, even though we were building a mental health sector from scratch and had invested $1.9 billion—a record investment—into that, was that the strategies under the pae ora legislation related to population groups. So mental health, for us, is so fundamental, is so cross-cutting, that we want to see mental health responses embedded across the sector, and we were not sure that having a discrete strategy was actually the best way to achieve that. However, we do appreciate the strategy has been able to bring out the voices of those in the sector to think about what a good strategic approach would look like—and, as with the Government members, we really appreciate their submissions at select committee.

The other usefulness, I think, for us as members of the Health Committee was to get a reassurance from the member and then indications, I guess, from the Minister that there is absolutely no intention to remove the independence of the Mental Health and Wellbeing Commission. That came about a little bit accidentally because it was included in the legislation as initially drafted, and the member very kindly pointed out it was a drafting mistake and that there was no intention to do that, and she was happy to amend the bill accordingly.

The final point, really, is just on the utility of the strategy. I do think it's great to have a strategic approach, and I really support having strategies. The problem that we have is that the Government policy statement on health has already been given. This happens once per parliamentary term—a headline statement that really sets the direction of Government policy on different sectors. So the requirement under the bill to consult and be consulted, and for the Mental Health and Wellbeing Commission to have an input into that, is a little bit academic at this point, unless the Minister is actually going to commit to revisiting or reworking the Government policy statement. I do have questions in to the Minister about that because there was no strategy, in fact, and this had not been mentioned in the Government policy statement. I guess, just with the order of business being a little bit upside down, even the clerks who were looking at the questions were grappling with this idea that there could be a strategy informing a Government policy statement after the Government policy statement had been given. So that is the $64 million question, really: are we going to see the GPS change and inform the strategy, or is this something that is really going to be held over as business for the next parliamentary term?

That aside, the other practicalities are: how will the strategy work in an environment where we have seen cuts to the front line in mental health? We have seen a mental health hiring freeze despite the protestations from the Government. I have personally seen emails and evidence of those front-line cuts in my own electorate, in Taieri, which are really concerning. We also have community groups, mental health groups, who have had funding cuts from contracts from Oranga Tamariki that land fairly and squarely in the mental health sector, providing services to the families of vulnerable children and whānau with complex needs. So there are practical implications too, which, essentially, involve the basics, like adequate money and no hiring freezes, in order to make a strategy work.

Those are things, of course, for the executive, not for the member. So, on that note, really, I just want to again congratulate her for what I do hope will be a useful tool rather than just another legal amendment. As I say, time will tell.

HŪHANA LYNDON (Green): Tēnā koe, Madam Speaker, and tēnā tātou. On behalf of te rōpū Kākāriki, I stand to support this bill and thank Auntie Katie Nimon for your work. I was having a little tangi, as you were having a bit of emotion, because we know mental health affects all members of New Zealand. It's important for us, as members of this House, as we look to support this legislation, to remember the feeling of cross-party support that we have in this Whare for this, but also the need for us to move forward together for the benefit of all New Zealanders.

Now, this legislation is really clear. It's about strategy and planning, and it's important that we do have that strategy as a clear beacon for where we're heading as a country to support the mental health, addictions, and wellbeing of all New Zealanders. The way that we have considered, and as a member of the Health Committee considered, the submissions heard from diverse voices, but also felt the passion of the sector—I think that it's a credit to the way that those who came before the Health Committee and those who have advocated for the adoption of this, having received phone calls myself, it's good that we're at this point in time in the journey of the legislation.

Now, in terms of the Mental Health and Wellbeing Commission, preparing these strategic documents, yes, that's important—and I thank my colleague from the Labour Party for pointing out, you know, that while we prepare the strategy, we also need to think about implementation, and we need to be able to fuel the waka significantly so that it can do the important work that it needs to do. And that includes the mahi tahi with the sector—the various voices, the health professionals, the users, the patients, the whaiora, the whaikaha who engage in the services as well as te iwi Māori.

With the cross-party support that we have, I'd also like to acknowledge the mental health and addictions cross-party group that we have as a bipartisan rōpū that looks to advance mental health and wellbeing solutions across this Whare, and my co-leader Chlöe Swarbrick, who's the chair of this group, because we're all in this together. And, as te rōpū Kākāriki, we understand and we feel the need for us to get behind this amendment—well, this legislation—but to also fuel the waka in order for it to do good in our communities.

May I quote Ingrid Leary, while she may not be here, I want to talk about workforce—

DEPUTY SPEAKER: Can't talk about a member that's not in the House.

HŪHANA LYNDON: I can't talk about—oh, can I quote her?

DEPUTY SPEAKER: But you can thank her.

HŪHANA LYNDON: Can I quote her, because she—

DEPUTY SPEAKER: Yes, you can quote her.

HŪHANA LYNDON: I can quote her. OK, cool—I found a quote. And talking about one of the essential parts of the strategy is having a powered-up workforce, and Ingrid in her addressing of this bill in the last reading shared: "We're going to support this legislation, but with a challenge. Really, the Government members, because everything I heard opposite makes sense and that sounds great. To have a strategy is good news, but without the workforce plan, without the funding, and without transparent procurement, without localised solutions to mental health, the strategy is at risk at sitting on the shelf and gathering dust. And we all don't want that."

Now, in our country, we need to recognise that we've got a mental health crisis and particularly with our youth. Now, mental health is impacted by many things—the wider determinants when we think about violence, family violence, poverty, educational achievement, access to housing, and also social inclusion. So let us not forget that we require a whole-systems approach in delivering a powered-up, community centred, whānau-supported system that can support the mental health and wellbeing of all New Zealanders, that we need to consider in the strategy, but also within implementation, the regional diversity, whether we are rural like myself from the North, even if we're from the deep South like Taieri, and all of our urban centres—the strategy to reflect those diverse voices but also for the implementation to be considered in terms of the diverse voices of community.

Interventions always provide alternative pathways as well and we need to balance both responsibility and accountability with care and protection—so very mindful of those elements of both providing significant support to those in need but also centring our approaches on care and protection for those most vulnerable.

Now, may I talk to our youth, and address the concern for our youth mental health and wellbeing. Now, youth have particular risks in terms of mental health and wellbeing, including sexual, physical, emotional, and even transients—many of our young people don't have secure housing—intergenerational disconnection from whānau and community. Also, there are those who struggle in education settings, victimisation, bullying from peers, and all sorts of other challenges in life. To prevent mental health distress, we need to cast the wider net across the health system. And when I think about a health and social services system, that requires all of us in it together, that this is at the top of our radar as we deliver to our families and communities.

Because we need to be looking out for our young people. We need to have a listening ear and take care of those who may not be comfortable yet to disclose the taimahatanga—those things that are heavy burdens on their shoulders at this time—but be ready as a health, social services system; as education; and as community to be there to support them when they are ready for the help that they do need and deserve.

This strategy requires buy-in from across Governments, and, as members of this House, may I implore us to consider this being a long-term strategy, that it cannot be just for one term. We need to commit bipartisan to keep the waka moving forward.

Government agencies all need to take responsibility for their role in providing for the strategy to get the traction that it needs. And so, again, like I spoke to health, social services, education, community, Government departments, if you can see mental distress occurring, put your radar on, look to be that navigator, and support all those who might need the awhi at that time and place. We don't have to be the skilled practitioners, but we do need to have listening ears and look for the support that that whānau or individual might require.

Now, considering the aims of this bill and also the opportunities that it presents, may I bring the voice of Save the Children, who gave a submission? They are a voice for our young people and our tamariki. They say that our young people also need to be consulted. And for us, as te iwi Māori, it's our tai tamariki, it's the rangatahi, who are the engine room of te iwi Māori. We're nearly 1 million large. But Save the Children said that they provided a survey of 250 young people and they were between 11 to 19 years of age in 2023. And the message was clear that they want to be considered in decision making and policy development. And while we might not think that our young people may have the ability or the discernment to be able to input, they've got opinions and they're watching, and their opinions should count and should matter because, ultimately, they will be service users, but, also, they will be the parents of tomorrow. So by empowering the youth voice, as Save the Children has asked, has sought of us, we can provide the safe space for tai tamariki, for our young people, to input into strategy but also into implementation. So I challenge that for our people of Tai Tokerau, to centre our interventions, our programmes on what youth think are valuable and important.

Now, in thinking about the reports around accessibility, it's also around the workforce, it's also around rurality, and also urban settings. I seek for the strategy to be more than a document on a shelf, that we get a work plan and policies across Government that can be implementing strategies and interventions across the board, that all of our kaimahi know that this is important for this House, that mental health and wellbeing is a priority, and that, by and large, if we are well mentally, physically, spiritually, and environmentally, New Zealand will be well. Nō reira, kia ora tātou.

CAMERON LUXTON (ACT): Thank you, Madam Speaker. It's a pleasure to rise and take a call on the third reading of the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill. Congratulations to my colleague Katie Nimon for having such an important bill shepherded through with support across the House. I think she's done a great job there, advocating for a strategy in mental health, and that is what I'd like to talk about.

Enabling a long-term planning structure for the mental health and wellbeing of New Zealand is something that is coming to light more and more as the years go by, as more and more people are feeling more comfortable to open up about their mental health and wellbeing and also addiction issues that New Zealanders suffer with.

The more we can talk about that, the more we normalise it, the more this House takes it into account and directs our health system in ways that are a more brought-together, lined-up approach so that we can actually get a whole-of-Government approach to some of these things rather than just the scattergun approach that we've had.

In preparing for this speech, I read through the report of the Government's 2019 mental health inquiry, He Ara Oranga. There were some reports given back then that there was inadequate access to many, without a choice of provider. There was a high burden placed on primary healthcare and there's a lot of confusion for patients and people seeking to navigate the bureaucracy and funding mechanism. It found that we need to put the person who's suffering at the centre of this system, rather than having them become a navigator of a confusing web of providers and agencies.

I think a mental health and wellbeing strategy begins work on another recommendation from that report, which is to bring an overarching solution to the problem and bring a whole-of-Government approach to mental wellbeing in general, and I think that is what is being achieved here by this member's bill. I'm glad to see some of the amendments that were taken up by the member and by this House: delaying the commencement to allow proper time to prepare, the much talked-about health entity classification—but I won't touch on that again—and references to "addiction" being changed to "wellbeing", because so often addictions are the manifestation of an underlying wellbeing issue, as we heard during the submission process and as many New Zealanders can attest to in their own lives and that of their family and whānau.

The alignment of mental health with other six health strategies is, I think, putting mental health on a par, where it should be, with some other strategies. I commend this bill to the House.

JENNY MARCROFT (NZ First): Thank you, Madam Speaker. I'm very proud to be able to stand on behalf of New Zealand First in support of the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill. I'd like to begin my contribution in the third reading by congratulating Katie Nimon for bringing through this bill, shepherding it, and providing what you mentioned in your speech—hope for change—because this is what, fundamentally, this bill will do.

Mental health is at the core of every person, and looking around this Chamber today, who could disagree with that? There are ever increasing ways that our mental health is impacted, and I'd just like to point out, particularly, our young people—and the member opposite, Hūhana Lyndon, talked about our young people. The way their mental health is impacted is something that we should all take very seriously. I'd like to point to a couple of things. Social media has a devastating impact on some of our young people. It should be a tool to bring people together. It should be a tool to bring communities together. But there are so many negative impacts on mental health because of the use of social media: increasing rates of depression, anxiety, and the bullying that goes on. These are some of the things our young people tell us and that is really affecting their mental health. Also, there's that constant exposure to these curated lifestyles where we look at someone on Facebook, maybe, and we wish we had their life because it seems so ideal and perfect, and the anxiety that creates, that dissatisfaction in oneself sort of increases that low self-esteem. Those are issues that our young people tell us about.

So social media should be that tool that brings together but what we need to do is we need to build resilient minds in our young people. We need to help set boundaries, help them set their own boundaries, and sometimes just turn off the socials.

In terms of mental health, many diagnoses come down to the question of whether the patient is distressed and unable to function normally. Most of us will probably fit that description, that definition, at some point in time, hopefully not all of us all at the same time. But when we're in our right minds, which I believe we are in the House today, we can re-examine our thinking about how best to care for and restore people to functional mental health. So in conclusion, creating a mental health and wellbeing strategy is a very good start. I commend the bill to the House.

DEPUTY SPEAKER: The next call is a split call.

HANA-RAWHITI MAIPI-CLARKE (Te Pāti Māori—Hauraki-Waikato): Tēnā rā koe e te Pīka, otirā, tēnā rā tātou e te Whare. E tū ana ahau ki te waha i ngā kōrero a Te Pāti Māori mō tēnei o ngā pire i tōna pānuitanga tuatoru. E tautokotia ana e mātou tēnei o ngā pire.

[Thank you, Madam Speaker, indeed greetings to all of us in the House. I stand to give voice to the comments of the Māori Party concerning this particular bill at its third reading. This bill is supported by us.]

Te Pāti Māori is in support of the third reading of the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill. I'd like to mihi to the MP, Katie, nāu i kawe mai tēnei o ngā pire, e mihi ana ki a koe [it was you who brought this particular bill, greetings to you].

I'd also like to mihi to Minister Doocey, who last night brought in the other mental health legislation, which included the recognition of Te Tiriti. I'd like to elaborate; this is what working for Māori and Pasifika looks like. Mental health is a crisis, and referencing Te Tiriti is the rongoā for everyone in this situation. Thank you for bringing life to the recommendations of the panel, which included Tā Meihana Durie. Pae ora, mental health, is one of the first times that the Government included Te Tiriti o Waitangi, and as whaea Debbie said last night, the roof hasn't caved in on us.

It is a sad reality that our whānau experience significantly higher rates of mental illnesses, higher rates of suicide, and greater addictions, while mental health distress among Māori is almost 50 percent higher than among non-Māori. Māori are 30 percent more likely than non-Māori to have their mental illnesses undiagnosed. Māori are less likely to access mental health and addiction services than non-Māori. Our rangatahi and tāne suicide rates are through the roof and we must start to think about implementing solutions that work for our people. And I'd like to reference some of the work that I did prior to coming into Parliament, which was to educate our whānau and kura around the maramataka Māori [traditional Māori calendar] and how Whiro, tērā o ngā maramataka [that particular moon phase], every day on Whiro in August we have the highest suicide rates. So we have our own data on how that looks like, and my job was to go around to many different kura throughout the motu and educate teachers through professional learning and development workshops, through Te Ahu o te Reo Māori or Tupu Ora, around maramataka Māori being a form of rongoā for mental health crises. So these are the types of rongoā and avenues and mechanisms that we've put in place, as te ao Māori, that coincide with Te Whare Tapa Whā, which has been illustrated by Tā Meihana Durie. Our hinengaro is important to our overall wellbeing, and when our taha is unstable, we are imbalanced.

What we have seen in our communities and across Aotearoa is that our whānau continue to struggle, and social factors are huge contributors to our hauora. To list a few: poverty, whānau struggling to pay their bills, lack of affordable housing, unemployment, abuse, trauma, and the list goes on. Our whānau are struggling. This includes our Pasifika, our disability communities, takatāpui communities, and now our rural communities who are losing jobs. We must eliminate all barriers to accessing mental health services.

Our kaupapa Māori mental health service takes a unique and targeted approach in addressing the inequities and issues we believe work by Māori for Māori. We have seen our Whānau Ora Māori health providers, iwi, hapū, and marae start to take their own initiatives in creating a safe environment for our whānau and communities to tackle and respond to the Māori mental health inequities that we are currently tackling. We can see this being achieved using mātauranga Māori, as I've talked about previously in this debate and kōrero—using mātauranga Māori and practising tikanga as key solutions.

We must deliver and continue to adopt the recommendations from He Tapu te Oranga o ia Tangata - Suicide Prevention Strategy, He Ara Oranga. He Arotake: Te Aka Whai Ora suicide prevention and postvention review also identified six recommendations towards addressing mental health. These recommendations must be considered and adopted towards the mental health strategy. What works for Māori will work for all. To conclude, Te Pāti Māori supports this bill. E mihi ana.

STEVE ABEL (Green): Thank you, Madam Speaker. I'm also very happy to rise to support this bill on behalf of Te Pāti Kākāriki. I think many of the key points have been made, but the logic of a joined-up strategy is obvious. In that regard, I think it's important for us to consider the whole-of-society factors that contribute to mental health issues. If we are to address these problems long term, we have to address underlying causes and understand what is going on for people when they are struggling with mental health issues. The determinants of poor mental health and addiction outcomes are well understood by research. The drivers of mental health and addiction outcomes come from an array of determinants, including violence, poverty, and educational attainment or lack thereof, and access to housing and social inclusion are important ways to address the challenges we face.

Having a single whole-system approach to delivering community empowered interventions that tackle drivers of crime, exploitation of vulnerables and geographic places, disconnection from culture—this improves living, working, and recreational environments in the community for residents. Interventions that place alternative pathways balancing responsibility and accountability with care and protection, and which promote access to appropriate support systems—in New Zealand, the youth risk factors include physical, sexual, and emotional abuse; constant transience. Intergenerational disconnection from whānau, whenua, and culture are among issues for tangata whenua Māori; typically low achievement and educational victimisation from peers; challenging behaviour; truancy; and drop out or exclusion.

So, to prevent harm and mental distress, we need to cast the net wider than just the health system and recognise the role that our whole society at large plays in how we feel. This means working to address wealth inequality, ensuring people have secure housing and inclusive education, and building strong communities that improve and provide support and connection for all people.

A long-term strategy should consider the role every segment of society plays. It will also help to repair some of the fragmented approach to mental health services, where people fall through the cracks, especially in our regions. This strategy needs buy-in across Government and across the people in this House, which it has for a start. But we need to really have the ability to think big if we are to address the underlying causes.

It's very important, and the bill states this, that it has the aim to eliminate the use of seclusion in mental health care facilities. I can think of nothing more terrible to do to somebody who is struggling with mental health than to isolate them. There are some practical challenges in mental health facilities. The reason why people are isolated is to protect the welfare of healthcare workers. But the use of exclusion needs to be addressed and we need to find ways that we can eliminate the use of exclusion for those with serious levels of mental distress, because it cannot possibly make the situation better.

Developing an effective strategy needs unity and consultation with the sector and the community at large. Many approaches and designs for supporting this sector suffer from a lack of implementation and evaluation, insufficient diversity considerations, and minimal inclusion of lived experience in design and implementation. And my colleague Hūhana Lyndon pointed to the need to involve youth in the design of how we deal with mental health. Findings suggest that future policy reforms should prioritise the development of whole-of-Government strategies; involve children's perspectives; emphasise prevention, restorative and diversionary responses; multi-agency collaboration; ongoing support for implementation; and rigorous evaluation.

I just want to say that it has been a quite inspiring day today because we've managed to have three bills in a row that we've all agreed on. It's a good thing that we can do that, and it's a good thing that we can have honest conversations and find the common ground that we share across the multiple parties in this House, for making Aotearoa a place that is a better place to be, no matter what your mental health status is. Kia ora.

SAM UFFINDELL (National—Tauranga): Thank you, Madam Speaker. I rise to speak in favour of the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill. I congratulate my colleague Katie Nimon—it looks like this is going to pass through unanimously—and I want to thank all of the people who have contributed today for their contributions.

It's been touched on a number of times how important mental health is. Often we see it playing the poorer cousin to physical health, and it shouldn't do so, because it is just as important, because if you don't have peace of mind or a healthy mind, then the rest of it will deteriorate after that. Ms Nimon spoke about the people you'll see out there who looked to be having these good lives or they're happy, but there are so many other things that you might not know about them in the background, and internally they could be falling apart.

Awareness of mental health has certainly increased a lot over the past couple of decades, but we still have a long way to go, in that regard. This bill is another step in the right direction. The intention there is to enable the long-term planning and delivery to ensure better health and wellbeing across New Zealand, and to ensure people can get access where they need it and they can get it in a timely manner and an efficient manner and making sure that the person is at the centre of all of that treatment. We probably haven't got that where we need it to be just yet, but this bill, and the bill that was introduced last night by Minister Doocey, is a step to improving those outcomes—and I can see that everyone in this House is aligned on making sure that we can achieve that as a country.

I want to thank all the members from the Health Committee here that assisted in this. There were a few improvements, or changes, that were made which have been adopted unanimously, and I think this is a really good step. So thank you to all parties for your support here; thank you to all members of the committee for your unanimous support. Congratulations, Katie Nimon—it looks like this bill will get through very soon—this is a positive step forward for New Zealand, and I commend this bill to the House.

Hon Dr AYESHA VERRALL (Labour): It's a pleasure to rise on a bill that's enjoying such strong support from all across the House and to speak in favour of this amendment to the Pae Ora (Healthy Futures) Act that brings a mental health strategy, alongside the other statutorily required strategies under that Act, that sets up our modern health system.

I had the privilege last night of going to an event with organisations from rural sectors and enjoying some positive feedback from representatives there about the other strategies that are part of the Pae Ora (Healthy Futures) Act; namely, the rural and the women's strategy. The process used to bring those about was to do quite a large public consultation to feed into the strategies that were ultimately adopted. So I hope that is the opportunity that lies ahead with this strategy also—to go out to the public to ask, "Well, what are your 10-year aspirations for mental healthcare in New Zealand?" and to be able to do that. Because when we orientate ourselves around what the public wants, ultimately that creates some momentum for it to endure changes of Government, which is something that a 10-year strategy actually has to do.

I do want to congratulate the member who brought this bill and took it to select committee, and for getting this bill passed. It is an achievement and does reflect a lot of dedication and hard, hard work on that. I also want to mention the submitters who came to select committee and dedicated their time to making improvements to the bill.

There is just one unanswered question for us in the Labour Party as to what next, because the strategies sit in a system of not just setting a strategy but actually operationalising that in the New Zealand Health Plan, which is a budgeted plan, also a statutory requirement, and then being reflected in the Government policy statement (GPS) of Te Whatu Ora, which is what they're going to do in the next three years. We're yet to hear from the Government if there is an intention after creating the strategy to modify the GPS during this term of Government. That would be a really good question to know the answer to because, of course, if we want to see change in the health system, it's only going to happen if those instructions to Health New Zealand are also changed so that they can plan their budgets and so on accordingly. So while I'm grateful for all the people who came to select committee, I do hope that their aspirations are going to be met by the actions of this Government in terms of following through and actually modifying the GPS and making sure that the services that people hope for are actually delivered.

But beyond those remarks, I think there's a lot of really encouraging and heartening comments from around the House as to the contents of what we want in a mental health strategy, both access to care in a timely way, as my colleague Sam Uffindell has mentioned, and also those key social determinants of mental health that my colleague Steve Abel has mentioned. That is a wide ambit of different fronts to be active on, but we know that to make the difference that's needed, we need to look across all of those and provide meaningful change.

Thank you to all my colleagues who have collaborated on the development of this bill, and I commend it to the House.

Dr CARLOS CHEUNG (National—Mt Roskill): I rise today to support the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill. First of all, I would like to congratulate my colleague, Napier MP Katie Nimon, because her member's bill will change the way we approach mental health outcomes by requiring the Minister of Health to determine a mental health and wellbeing strategy. This bill is a transformative step towards improving mental health outcomes across New Zealand. It addresses longstanding gaps in health legislation. It will make meaningful differences to people in Mt Roskill and, of course, New Zealand.

However, I would like to use this opportunity to advocate for the migrant communities which make up a large population in the Mt Roskill electorate. Due to the language barrier and cultural differences, these communities are always being neglected and their voices are not heard. I feel there are concerns raised by the ethnic communities in my electorate and across New Zealand and that there is a lack of research and understanding of mental health issues from an ethnic community perspective. A lack of cultural understanding, a one-size-fits-all approach, an inadequate workforce, and lack of community engagement are among the main concerns. But the good news is that help is on the way.

I have been assured by Minister Matt Doocey that all New Zealanders, including all ethnic and migrant communities, will have the opportunity to contribute to this Government's mental health policy direction, both now and in the future. I am looking forward to this bill passing shortly in this House. Once again, I would like to extend my gratitude to Katie Nimon for introducing this bill to the House.

This bill will have a significant impact on helping this Government to get our approach to mental health on track and delivering for New Zealanders of all ages and stages in life. I'm looking forward to a day when this House can celebrate achieving the target this Government has set up. Because behind each target are tens of thousands of New Zealanders who in many cases will receive the life-changing and potentially life-saving support, care, and treatment they desperately need. I commend this bill to the House.

DEPUTY SPEAKER: The next call is a split call—I call the Hon Willow-Jean Prime.

Hon WILLOW-JEAN PRIME (Labour): Thank you, Madam Speaker, for the opportunity to speak in the third and final reading of this bill. This is my first opportunity to speak to this bill, so I want to acknowledge the member whose name this bill is in and also the select committee who have done the mahi to get us to this point this afternoon—oh, it's still morning, sorry.

The point I want to add to the contributions that I've listened to today is how important it will be to ensure that there is children's and rangatahi voice in the development of the strategy. As a former Minister for Youth and also Labour spokesperson on children and on youth, rangatahi have told us that mental health and climate change are the two biggest issues for them. So I want to get that on the Hansard and into everybody's minds—that, as this passes and as we move forward into the development of a strategy, ensuring that there is children's and rangatahi voice included in that is going to be so important.

I also want to acknowledge the previous contribution from the Hon Dr Ayesha Verrall in referencing feedback she had received from the rural community about the rural and women's health strategies. Don't want to boast, but I was the former Associate Minister of Health that worked on those two particular strategies. Like she has said, we see the importance in having the strategies, but it's not just the strategy itself; it's what happens next: ensuring that the strategies follow through into the health plan and into the Government policy statement (GPS), where the budget decisions are made on the implementation of any of those strategies that have been identified to achieve those strategic plans that have been developed. I, too, look forward to the full process of seeing that happen, so that it doesn't just become a plan that sits on a shelf and isn't influencing the health plan or the GPS, the budget spend, and the initiatives that will enjoy that support to deliver on the aspirations that are outlined in these strategies.

So that's all I wanted to add to the debate on this third reading. We need to make sure that we include our rangatahi and our tamariki voice in that. There is a wonderful little guide to help with that process of engagement with rangatahi to ensure their voices are brought forward into this process. Kia ora.

RIMA NAKHLE (National—Takanini): Madam Speaker, it really is a pleasure to be given the opportunity to speak on the third reading of the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill. It's a pleasure because I'm not usually on the Health Committee, so I'd like to mihi to my colleagues across the House for the great work that you do in that committee. I'd also like to add my acknowledgment—I hope I can make it a bit more unique—to my good friend here, Katie Nimon, the local MP for Napier, and the heart with which she approaches the tasks that are given to her here in the House. We talk about members "shepherding a bill" and it's really interesting that we use that word because, with mental health and wellbeing, what are we doing and what are we aspiring to? We're aspiring that we can formulate in this situation a strategy to help people be shepherded through their mental health circumstances and the times where they need that support—that shepherding, Katie. And so thank you for shepherding this bill with the heart that you have and the compassion that you have.

I really appreciate the fact that our Government—and this is something I said on doorsteps a lot during our campaign, that we were hoping we achieve this, to make our Government have the first Minister for Mental Health. It shows how important mental health and wellbeing is to us and, I know, across the House—it really is.

So I commend this bill to the House. I look forward to having the seventh strategy there. It will help us as a Government be able to focus those plans and those outcomes in the mental health arena. And, Madam Speaker, I'd also like to acknowledge and thank my husband, who's in the gallery today, for shepherding me through the times where I need to be shepherded. I commend this bill to the House.

Dr TRACEY McLELLAN (Labour): Thank you, Madam Speaker, and thank you also for the opportunity to say a few brief words on the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill. I think the name of this bill sums up both the intentionality and the importance of the bill, so I would like to commend the Health Committee—a committee that I don't sit on but I'm very fond of. I also commend the member Katie Nimon for her work in shepherding this bill through, and I acknowledge all of the submitters who would have contributed their expertise, their passion, their lived experience, and their will to see a much improved bill and a much improved Act in place.

Mental health is often the poor cousin to health. The Cartesian dualism of why we sort of take out the brain as a separate organ and turn it into a different type of health has always confused me. It's good to see that mental health—or health—is getting much more recognition. I do agree with previous submitters and previous members who have said that it is important from this point on to make sure that it doesn't just remain a plan but that it remains something that has funding behind it, that has expertise behind it, that has drive behind it, and that the good intentions behind this bill turn it into good legislation, which actually turns it into good mental health outcomes for people. I commend this bill to the House.

Dr HAMISH CAMPBELL (National—Ilam): It's with great honour that I rise to be the last speaker in this debate, as we debate the Pae Ora (Healthy Futures) (Improving Mental Health Outcomes) Amendment Bill, introduced by the very capable MP for Napier, Katie Nimon. It is just a small bill when you actually read it line by line, but it's a transformative piece of legislation that aims to address the longstanding gaps in our country's mental health. I think Katie Nimon summed it up very well when she said mental health matters. I can tell you that this side of the House definitely does believe that.

It's just this week that we've introduced the Mental Health Bill to replace some of our old outdated mental health legislation. I think this bill here, which we're talking about now, is adding to that. And of course, we have the first ever Minister for Mental Health, the Hon Matt Doocey.

So I think the primary purpose of this bill is to amend that Pae Ora (Health Futures) Act, really, to better enable the long-term planning and delivery required to improve mental health and addiction outcomes here in this country. Because we want every New Zealander, no matter where they are, not only to thrive mentally and emotionally but we want them to be able to reach their true potential. That's what the National Party, of course, believes; it's in our core principles. So it's great that everybody in this House is supporting this bill, because it's going to help us create a healthier, more resilient future for our nation.

Motion agreed to.

Bill read a third time.

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