Delayed, anaemic government reporting on mental health has seen key missing information end up in strange and inaccessible places. Jess McAllen has some simple answers to what are becoming unnecessarily complex problems.
Accessing services is hard enough, we don’t need finding information about them to be a scavenger hunt.
In 2016, sitting in my Wellington flat, I wanted to bang my head in frustration. I’d been trying to find data on wait times for free mental health specialist services for a series of articles but was finding myself up against the efficacy of the Ministry of Health’s brick wall.
Then, a phone call. A man told me to write down a specific set of words and numbers which led to a portal holding key performance indicator data. It felt comically subterfuge. “Who are you, anyway?” I asked. “No one,” he said, hanging up.
Information on our public mental health system, overseen by the Ministry of Health, is scattered at the best of times. It also has a tendency to be skewed ('wait time' data, for example, typically monitors the time between getting in touch with specialist services and the first 'face-to-face' appointment, rather than actual clinical help, which takes longer to access).
This is why Director-General of Mental Health Dr John Crawshaw (a mental health version of pseudo-celebrity Dr Ashley Bloomfield) and his annual report was so important. Every year he would provide information monitoring crucial mental health metrics, contextualise it and compare it to previous years.
But his most recent, massively delayed report was different. Reporting by Stuff revealed senior ministry officials delayed its publication, suggesting it needed a “risk lens” placed over it and bemoaning the huge number of “negative statistics”. The report, covering 2018 and 2019, was finally released in March, but without a number of key metrics, including the number of people accessing specialist services. It also no longer included a little photo of Crawshaw and his foreword which typically accompanied prior reports - less important, sure, but still striking.
To get help you need to be loud, pushy and armed with knowledge: most suicidal people aren’t, it’s in the definition - they want to die, not play phone tag.
The Government is trying to justify this new, anaemic report by suggesting the data is available elsewhere (hello, mysterious phone call!) This claim is as confusing as the size nine font Excel spreadsheet I had to navigate to see particular statistics usually presented in the routine, accessible reporting.
At the heart of this are people trying to access services for more complicated mental health problems, not the “mild to moderate” issues that Labour have rightfully (but also fatally) been focusing on at the expense of those at the moderate-severe end.
Take a close friend of mine. In the first week of December 2018, when the He Ara Oranga mental health inquiry report was released, they were hospitalised after a serious suicide attempt. The Midcentral DHB community mental health team had no room to provide follow-up care. Since my friend had sexual-abuse related PTSD, they were able to access ACC-funded counselling. Unfortunately, after one session the counsellor went AWOL - so they gave up.
Now, years later, my friend is giving the gruelling obstacle course another shot. After the initial DHB intake appointment they waited three weeks for their second appointment, except the social worker wasn't there and didn't notify them. All very off-putting for someone who is already reluctant about counselling, given their past trauma. It's been weeks and the social worker still hasn't made good on their promised rescheduling. To get help you need to be loud, pushy and armed with knowledge: most suicidal people aren’t, it’s in the definition - they want to die, not play phone tag.
Many of the issues plaguing Health Minister Andrew Little - a stern, practical man for whom mental health reforms might not be front of mind, given his enormous mandate to restructure the entire health system and a little thing called Covid-19 - are inherited from his predecessor David Clark. Under Clark, who resigned after bumbling his way through a couple of Covid-19 faux pas, the ministry dithered about doing much until the inquiry reported back, wasting almost a year, time in which incentives for increasing the workforce could have been rolled out (such as free post-grad study for those wanting to be psychologists). After the inquiry released its report, the government pursued a few of its recommendations, focusing on a mix of bureaucratic reforms like setting up the Suicide Prevention Office and establishing new primary care services while largely ignoring more complicated areas. There was also the historic, 2019 “Wellbeing” budget. This included record funding but also obvious holes regarding specialist care which have come back to bite us.
You can’t measure transformation against nothing. Doing things differently means actually doing things differently and then comparing results against the history provided in reports like these.
It’s a tough portfolio. Getting up to speed with all the varying opinions and feuds is hard at any time, let alone during a pandemic. But that doesn’t excuse Little’s antagonistic reaction to critics of the Government’s mental health response. He has derided stakeholder reactions as conspiratorial thinking. Nor does it excuse his ministry’s breezy dismissal that the changes to the annual monitoring report are fine because the report wasn’t a legal requirement anyway — neither are updates on vaccination numbers, but it benefits the public to provide them.
The mental health and addiction directorate, which Bloomfield established, doesn’t seem to care about the uproar. In their weekly self-promoting email update, its Deputy Director-General, Toni Gutschlag, went as far as to suggest the transformation needed in the New Zealand mental health system was the very reason the information was removed
The good news for Little is the answer is simple. Ask for an updated version of the report, with Crawshaw’s usual analysis. Tell staff the report needs to have the same information going forward as it always had (not hard, since staff were clearly fighting for this to happen anyway). Ideally, take on Green MP Chlöe Swarbrick’s suggestion that the reporting should be made a statutory requirement (how depressing that the mental health directorate top dogs are operating in such bad faith that it has come to this). You can’t measure transformation against nothing. Doing things differently means actually doing things differently and then comparing results against the history provided in reports like these.
Less simple, Little might want to inspect (please, not another review!) the risk-averse, redaction-happy leadership of the directorate, particularly those appointed when the ministry was charged with implementing the inquiry recommendations (although one, Robyn Shearer, has since moved on to another high-powered ministry role outside mental health. She was largely behind the report omissions).
He might also want to look more closely into the additions to the bureaucratic mental health buffet, such as the Suicide Prevention Office and the Mental Health Commission. Labour has created a bunch of new government roles, countering a previous and seminal inquiry in the 1990s. In that 1996 inquiry, Ken Mason, who led the inquiry, actually recommended a sunset clause for what would go on to become the first Mental Health Commission, arguing that the group would “stay truer to its intentions” if it did not become “part of the organisational furniture within government”.
The bungling of this report proves why he was right.
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