Keynote address to the Mental Health Nursing Conference Wednesday, 28 July 1999, Kumeu
by Jim Anderton
MP for Wigram
Leader of the Alliance
Introduction
The mental health of people and their communities is the responsibility of the community as a whole.
Mental well being is more likely if a person is well fed, living in adequate housing, has a satisfying job and a secure
income.
Mental health is not just an issue for a small percentage of people deemed to be 'mentally ill'.
Mental illness can affect all of us at some time of our lives.
UnderfundingThe Government's costly and unpopular health restructuring has failed and the mental health service is one
of its biggest casualties.
The underfunding of health has been a deliberate and admitted policy of successive Governments.
They have been playing games with dollars to make health services 'contestable' and they have demolished mental health
services at the same time.
This has resulted in chaos in mental health - long recognised by the workforce, the clients and the families of
clients.
After several tragic events involving mental health patients in late 1995, the government asked a team of three headed
by Judge Ken Mason to inquire into the state of mental health services in New Zealand.The Mason Report published in May
the following year, was a damning indictment of the system.
Damning but not surprising.
Every single one of the 720 submissions to the Inquiry made the plea for more resources.
Mason suggested that to fully fund the shortfall for all mental health services would require additional funding of
between $124 and $140 million per annum.
He said such funding needed to be ring-fenced to ensure that it was spent on mental health.
This was not forthcoming from the Government.The Alliance is committed to rebuilding the mental health service.
We will provide that funding to mental health services to reach the Mason levels with! in our first term as part of the
Government.Privatising m! ental health servicesAt present, publicly funded services are provided at the primary level
through community mental health centres.
A National-ACT coalition government will extend the privatisation of health.
We can expect 'carrots' to be offered to GPs and counsellors who treat people suffering from anxiety and depression and
drug and alcohol problems.
Subsidising private providers of health services restricts access to such services for those who cannot pay the fees
such providers charge.
Payoffs from mental health services are not as instant as replacing a heart valve or a hip or even removing a cataract.
It is not surprising that there has been little commercial interest in private provision of mental health services
unlike the booming rest home market.The Alliance is not against private healthcare.
Ashburn Hall is the only private institution for young people in the country and is a lifeline for some families who
can afford the $1,600 a week it charges.
! The Alliance will not allow the private healthcare market to be subsidised by the taxpayer however.
Publicly funded and publicly owned mental health centres are the most appropriate agencies to offer specialist services
for anxiety, depression, drug and alcohol problems.Early intervention and choiceTo be effective, mental health systems
should respond to early signs of distress, have an early intervention focus and comprehensive mental illness prevention
strategies.
Effective treatment in mental he alth must take into account the patient's life picture.
It must be holistic with adequate agency support to ensure that the ongoing social needs of the patient are addressed.
Mental and physical health are interconnected and of equal importance.
Emergency, crisis and other services will be taxpayer funded and continuously available.
Community Care
There is a lack of funding for community-based treatment and aftercare and the community support that must accom! pany
deinstitutionalisation.
This means that community ! mental health centres are too overwhelmed to provide the necessary primary mental health
services.
Patients receive acute care and are returned to the community without sufficient support.
Recovery takes much longer, if it happens at all.
Many patients end up back in a psychiatric institution for further acute care.
Many end up in prison.
Many end up harming themselves or others.
Many end up dead. Patient suicidesToday I lay before a public audience for the first time my analysis of known mental
health patient suicides over the last five years.
The information was obtained from hospitals under the Official Information Act.
Each HHS was asked for the number of patients (inpatient and outpatient) who committed suicide in the years 1995-96,
1996-97, 1997-98 and 1999 to date.The results are a sorry indictment of the Government's push towards
de-institutionalisation without adequate community support for patients and their long-suffering families.
The informat! ion provided for the five years 1995-1999 for which HHSs had information shows that 273 mental health
patients are known to have committed suicide in that five year period.
Remember that these are the known suicides.
Some HHSs like Waitemata Health simply do not keep such statistics.
230 or 84% of these were patients in the community under the care of community mental health services and 43 were
inpatient suicides (16%).Information from HHSs which did keep records of patient suicides over the five-yea r period
show that inpatient suicide fluctuated between 6 and 10 annually:There was however a yearly increase in the number of
community mental health patients taking their own lives:
1995/96 28
1996/97 34
1997/98 56
1998/99 72
Of those HHSs who provided information for the year to date (to 12 May 1999) MidCentral Health (13), Healthlink South
(10) Healthcare Otago (9) had the worst record of patient suicides:What can be done to reverse the trend? Ask any cons!
umer.
Ask any family of a mental health patient.
Community mental health services need more money.
Agencies (many of them voluntary) offering support in the community need assurances that they will be supported by
Government.
We cannot expect key support organisations to continue to run cake stalls to provide valuable support networks.
The Alliance will adequately resource voluntary agencies and groups which provide basic support to people in the
community who are coping with a mental disorder.
Urgently needed mechanisms to co-ordinate their work to avoid gaps and overlap will be developed.
We have a Hospital Plan that supports and develops a network of General Hospitals throughout New Zealand, each
providing inpatient psychiatric beds and specialist psychiatric and psychological treatment.
Where a general hospital does not have such services, they will be developed.
A system of local district hospitals will also be developed, capable of providing community treatment programmes and
day care options for the ma! nagement of mental illness.
(See Alliance Hospital Plan)The Alliance believes that there will always be individuals who will require safe care
within a secure psychiatric facility.
It supports the retention of a secure inpatient forensic facility to meet the needs of such patients.
LegislationOnly those defined as having a major mental illness are covered by the Mental Health Act.
People with forms of mental and emotional suffering which do not fall within this narrow legalistic definition -
however d ebilitating or distressing or dangerous - are ignored and untreated.
Many people who have acute 'personality disorders' and commit serious offences often end up in prison because they do
not meet this strict legal definition of what constitutes mental illness. The Alliance will ensure that the Mental
Health Act is interpreted so that people with personality disorders receive appropriate treatment and that they and
their families are safeguarded.
I already have a p! rivate members bill drafted and in the ballot.Workforce d! evelopmentA serious lack of suitably
qualified staff exists at all levels in the mental health service, which lacks funds to recruit and train ancillary
staff.
The mental health service operates mainly on the exploitation of staff goodwill. The health reforms have created an air
of hopelessness, particularly among psychiatrists.
They have huge caseloads.
Burnout has become a big problem.
There is a chronic shortage of qualified psychiatrists in New Zealand.
We are losing our brightest and best to the lucrative private practices in Australia and overseas.
Would you stay around if you had a huge student debt hanging like an albatross around your neck?We have been plugging
the gaps with psychiatrists on short-term contracts for too long.
Linda Astor was one of those.
Our mental health patients deserve continuity of care.
We say if you are coming to New Zealand, make a long-term commitment.The Alliance believes that planning for mental
health staffing must be a priority and that current staffing and training needs at all levels of the workforce must be
urgently addressed.
This is necessary to provide recruitment schemes, incentives and training opportunities to upskill the mental health
workforce and encourage more people into this sector.
Mental Health CommissionAnother main thrust of the Mason Report was that a Mental Health Commission should be
established with the power to spend mental health dollars to purchase the services so obviously required an d to provide
leadership to a demoralised workforce.
Ken Mason even set out a draft bill which would establish and empower such a Commission modelling his vision on the
powers given to the Proceedings Commissioner under the Human Rights Act 1993.Mrs Shipley's Mental Health Commission is
similar in name only to that proposed by Mason.
It offers no independent strategic leadership.
It has been put in place to ensure the Ministry of Health implement's the government's! mental health strategy.
This assumes the government has the correct mental health strategy in the first place.The Alliance will require
substantial legislative amendments be enacted to ensure that the Mental Health Commission as proposed by Mason becomes a
reality.Addictions and advertisingAlcohol and drug abuse (including addiction to tranquillisers) and gambling addictions
will be treated within the public mental health system.
However, the industries should pay towards the addictions they cause.
The Alliance will address, at source, the public policies that allow these problems to proliferate and will ensure that
each industry fully meets the costs of the problems associated with them.
Commitment to non-violenceThe Alliance will work towards reversing the patterns of violence and abuse by requiring all
relevant Ministries to develop programmes to reduce violence.
An appropriate senior Minister will be responsible for co-ordinating violence reduction measures.
There will be a public education programme that encoura! ges parents and caregivers to use alternative non-violent
methods of managing children.
The Alliance is concerned at the impact of media violence in society Funding for voluntary agencies that work in the
area of anger management and violence prevention will be increased.
The Alliance will support programmes for schools which promote emotional literacy.
School programmes aimed at non-violence, assertiveness training and building self-esteem will be supported.
Mental health of children and young a dultsInternationally, New Zealand has appalling youth suicide statistics.
In 1996, a UNICEF study of 32 countries found New Zealand had the third worst male youth suicide rate for the age group
15 to 24 at 29.9 per 100,000.
We had the eighth worst suicide rate for young females.In 1997, 142 young New Zealanders aged between 15 to 24 years
took their own lives.
One way to reduce this appalling figure is to actually provide the funding to develop early intervention ! services and
inpatient services for adolescents.It's time! to stop talking about the shocking youth suicide statistics, and take
action.
It's about committing ourselves to the future mental health of this nation.
If successive Governments had put money into services instead of into thousands and thousands of pages of reports
outlining the problem, it could have saved some of the 140 or so young lives that are lost to us every year through
suicide.The Alliance will fully fund the mental health system to the levels recommended by Judge Ken Mason.
Dedicated mental health services for young people were central to Mason's recommendations and they are central to the
Alliance.We will introduce a range of new services for young people including:
+ Establishing dedicated adolescent mental health crisis units with beds for children and young people.
+ Increasing the number of multi-disciplinary teams
+ Establishing an adolescent eating disorder service+ Trialling home-based psychiatric teams
+ Establishing a service to treat! adolescent anxiety and phobias
Early intervention can prevent youth suicide. It can prevent a worsening of teenage disorders and head off what could be
serious drug and alcohol addictions and may also disclose physical, sexual and emotional abuse, which allows for earlier
counselling and more complete recovery.
The availability of dedicated services will encourage young people to seek help.
Currently, young people in crisis outside Auckland are placed in adult units.
The Alliance will establish crisis facilities with beds for children and young people.
These will be located in specially dedicated psychiatric units to provide a sheltered environment for these young
people at risk.The Alliance also believes that effective early intervention is necessary to give more help at an earlier
stage to victims of sexual, emotional and physical abuse.
Over three years, existing primary and secondary school health clinics will be comprehensively extended and developed
to! provide a range of free health education, preventive care ! and medical services.
Clinic staff will train early childhood workers and teachers to recognise early signs of abuse.
The Alliance has also budgeted for a minimum of one teacher in every state school to receive training in guidance and
counselling.
Services to older peopleThe Alliance will ensure that there are adequate community and self-care facilities for people
suffering from Alzheimer's disease and similar disorders - and their carers. We will also expand services for older
people and focus on prevention of mental illness.
Adequate safe-care facilities for people suffering from Alzheimer's Disease and related disorders will be provided and
asset testing for the sick elderly, including Alzhiemers patients, will be removed.
The Alliance will help and support older people to remain living independently in their own homes as long as possible
with the development of a variety of supported housing options.SummaryThe key to re-establishing an effective mental !
health system is funding.
For too long mental health has been the Cinderella of the public health system.
An Alliance government will spend an extra $90million over three years to upgrade mental health services: $15million in
2000/2001, $30million in 2001/2002 and $45 million in 2003/2004.
The Alliance will also ensure that there is adequate monitoring of mental health spending so that there can be adequate
accountability.
Mason's call for ring-fenced funding for mental health reflects the fact tha t this Government has bled funding from
mental health to prop up other services crumbling under its health reforms.As you stand on the threshold of your career
in mental health nursing the Alliance is the only party committed to ensuring that you have a positive future within
your chosen profession.
ENDS