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Response

The Government formally responded to recommendations of the independent Inquiry into Mental Health and Addiction in May 2019.

The Inquiry report – He Ara Oranga : Report of the Government Inquiry into Mental Health and Addiction – was presented to Government by the Inquiry Panel in November 2018.

The Ministry of Health welcomes the Government’s response and acknowledges its stewardship role in many of the report’s recommendations.

The Inquiry made a number of urgent recommendations while recognising that many would require detailed reviews, establishing new bodies, consultation, or legislative change

The Government has asked us to provide them with information on three areas first:

  • suicide prevention
  • reform of the Mental Health (Compulsory Assessment and Treatment) Act 1992
  • establishing a Mental Health and Wellbeing Commission.

Work on other areas, such as improving access, will be guided by investment through Budget 2019.  

About the recommendations

He Ara Oranga contained 40 recommendations, which apply to health, the wider social sector and society as a whole. The Government has accepted, accepted in principle or agreed to further consideration of 38 of the recommendations.

Some recommendations are for the Ministry alone to progress and implement, some require engagement with other government agencies or non-government organisations, and some are led by other government agencies. 

# Theme / recommedation Response
1 Agree to significantly increase access to publicly funded mental health and addiction services for people with mild to moderate and moderate to severe mental health and addiction needs. Accept
2 Set a new target for access to mental health and addiction services that covers the full spectrum of need. Accept in principle
3 Direct the Ministry of Health, with input from the new Mental Health and Wellbeing Commission, to report back on a new target for mental health and addiction services. Accept in principle
4 Agree that access to mental health and addiction services should be based on need so:
  • access to all services is broad-based and prioritised according to need, as occurs with other core health services
  • people with the highest needs continue to be the priority.
 Accept
5 Commit to increased choice by broadening the types of mental health and addiction services available. Accept
6 Direct the Ministry of Health to urgently develop a proposal for Budget 2019 to make talk therapies, alcohol and other drug services and culturally aligned therapies much more widely available, informed by workforce modelling, the New Zealand context and approaches in other countries. Accept
7 Direct the Ministry of Health, in partnership with the new Mental Health and Wellbeing Commission (or an interim establishment body) to:
 
  • facilitate a national co-designed service transformation process with people with lived experience of mental health and addiction challenges, DHBs, primary care, NGOs, Kaupapa Maori services, Pacific health services, Whanau Ora services, other providers, advocacy and representative organisations, professional bodies, families and whanau, employers and key government agencies
 Accept in principle
  • produce a cross-government investment strategy for mental health and addiction services.
 Accept
8 Commit to adequately fund the national co-design and ongoing change process, including funding for the new Mental Health and Wellbeing Commission to provide backbone support for national, regional and local implementation. Accept in principle
9 Direct the State Services Commission to work with the Ministry of Health to establish the most appropriate mechanisms for cross-government involvement and leadership to support the national co-design process for mental health and addiction services. Accept in principle
10 Agree that the work to support expanded access and choice will include reviewing and establishing:  
  • workforce development and worker wellbeing priorities
 Accept
  • information, evaluation and monitoring priorities (including monitoring outcomes)
 Accept
  • funding rules and expectations, including DHB and primary mental health service specifications and the mental health ring fence, to align them with and support the strategic direction of transforming mental health and addiction services.
 Accept in principle
11 Agree to undertake and regularly update a comprehensive mental health and addiction survey. Accept in principle
12 Commit to a staged funding path to give effect to the recommendations to improve access and choice, including:
  • expanding access to services for significantly more people with mild to moderate and moderate to severe mental health and addiction needs 
  • more options for talk therapies, alcohol and other drug services and culturally aligned services
  • designing and implementing improvements to create more people-centred and integrated services, with significantly increased access and choice.
 Accept
13 Note that this Inquiry fully supports the focus on primary care in the Health and Disability Sector Review, seeing it as a critical foundation for the development of mental health and addiction responses and for more accessible and affordable health services. Accept
14 Agree that future strategies for the primary health care sector have an explicit focus on addressing mental health and addiction needs in primary and community settings, in alignment with the vision and direction set out in this Inquiry. Accept in principle
15 Identify a lead agency to:
  • provide a stewardship role in relation to the development and sustainability of the NGO sector, including those NGOs and Kaupapa Maori services working in mental health and addiction
  • take a lead role in improving commissioning of health and social services with NGOs.
 Accept in principle
16 Establish a clear locus of responsibility for social wellbeing within central government to provide strategic and policy advice and to oversee and coordinate cross-government responses to social wellbeing, including:
  • tackling social determinants that impact on multiple outcomes and that lead to inequities within society
  • enhancing cross-government investment in prevention and resilience-building activities.
 Accept in principle
17 Direct the State Services Commission to report back with options for a locus of responsibility for social wellbeing, including:
  • its form and location (a new social wellbeing agency, a unit within an existing agency or reconfiguring an existing agency)
  • its functions.
 Do not accept
18 Agree that mental health promotion and prevention will be a key area of oversight of the new Mental Health and Wellbeing Commission, including working closely with key agencies and being responsive to community innovation. Accept in principle
19 Direct the new Mental Health and Wellbeing Commission to develop an investment and quality assurance strategy for mental health promotion and prevention, working closely with key agencies. Accept in principle
20 Direct DHBs to report to the Ministry of Health on how they are including people with lived experience and consumer advisory groups in mental health and addiction governance, planning, policy and service development decisions. Accept in principle
21 Direct the Ministry of Health to work with people with lived experience, the Health Quality and Safety Commission and DHBs on how the consumer voice and role can be strengthened in DHBs, primary care and NGOs, including through the development of national resources, guidance and support, and accountability requirements. Accept
22 Direct the Health and Disability Commissioner to undertake specific initiatives to promote respect for and observance of the Code of Health and Disability Services Consumers’ Rights by providers, and awareness of their rights on the part of consumers, in relation to mental health and addiction services. Accept in principle
23 Direct the Ministry of Health to lead the development and communication of consolidated and updated guidance on sharing information and partnering with families and whānau. Accept
24 Direct the Ministry of Health to ensure the updated information-sharing and partnering guidance is integrated into:
  • training across the mental health and addiction workforce
  • all relevant contracts, standards, specifications, guidelines, quality improvement processes and accountability arrangements.
 Accept
25 Direct the Ministry of Health, working with other agencies, including the Ministry of Education, Te Puni Kokiri and the Ministry of Social Development, to:
  • lead a review of the support provided to families and whanau of people with mental health and addiction needs and where gaps exist
  • report to the Government with firm proposals to fill any gaps identified in the review with supports that enhance access, affordability and options for families and whanau.
 Accept in principle
26 Take a stricter regulatory approach to the sale and supply of alcohol, informed by the recommendations from the 2010 Law Commission review, the 2014 Ministerial Forum on Alcohol Advertising and Sponsorship and the 2014 Ministry of Justice report on alcohol pricing. Further consideration needed
27 Replace criminal sanctions for the possession for personal use of controlled drugs with civil responses (for example, a fine, a referral to a drug awareness session run by a public health body or a referral to a drug treatment programme). Further consideration needed
28 Support the replacement of criminal sanctions for the possession for personal use of controlled drugs with a full range of treatment and detox services. Further consideration needed
29 Establish clear cross-sector leadership and coordination within central government for policy in relation to alcohol and other drugs. Accept
30 Urgently complete the national suicide prevention strategy and implementation plan and ensure the strategy is supported by significantly increased resources for suicide prevention and postvention. Accept
31 Set a target of 20% reduction in suicide rates by 2030. Do not accept
32 Establish a suicide prevention office to provide stronger and sustained leadership on action to prevent suicide. Accept
33 Direct the Ministries of Justice and Health, with advice from the Health Quality and Safety Commission and in consultation with families and whānau, to review processes for investigating deaths by suicide, including the interface of the coronial process with DHB and Health and Disability Commissioner reviews. Accept
34 Repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act 1992 so that it reflects a human rights-based approach, promotes supported decision-making, aligns with the recovery and wellbeing model of mental health, and provides measures to minimise compulsory or coercive treatment. Accept
35 Encourage mental health advocacy groups and sector leaders, people with lived experience, families and whānau, professional colleges, DHB chief executive officers, coroners, the Health and Disability Commissioner, New Zealand Police and the Health Quality and Safety Commission to engage in a national discussion to reconsider beliefs, evidence and attitudes about mental health and risk. Accept
36 Establish an independent commission to provide leadership and oversight of mental health and addiction in New Zealand. Accept
Establish the Mental Health and Wellbeing Commission (with the functions and powers set out in Figure 4 in section 12.2.2). Further consideration needed
37 Establish a ministerial advisory committee as an interim commission to undertake priority work in key areas (such as the national co-designed service transformation process).  Accept in principle
38 Direct the Mental Health and Wellbeing Commission (or interim commission) to regularly report publicly on implementation of the Government’s response to the Inquiry’s recommendations, with the first report released one year after the Government’s response. Accept in principle
39 Ensure the Health and Disability Sector Review:
  • assesses how any of its proposed system, structural or service commissioning changes will improve both mental health and addiction services and mental health and wellbeing
  • considers the possible establishment of a Maori health ministry or commission.
 Accept
40 Establish a cross-party working group on mental health and wellbeing in the House of Representatives, supported by a secretariat, as a tangible demonstration of collective and enduring political commitment to improved mental health and wellbeing in New Zealand. Accept in principle

Documents provided to the Inquiry

The Ministry provided documents to the Inquiry to assist in their process. 

Due to the time-limited nature of the Inquiry, many of these documents were provided in draft form. These documents have been published in the state they were provided to the Inquiry. All documents and information should be considered to be draft versions, and not as final Government policy, unless otherwise stated.