The 2019 “Wellbeing Budget” did well to explore outcomes which extended beyond the more usual financial and fiscal parameters.  While balancing the books will always have a degree of prominence, items directly linked to health and wellbeing were likewise prioritised and not limited to more binary indices such as GDP.  Improving Child Wellbeing, Supporting the Aspirations of Māori and Pacifica communities, Building a Productive Nation, and Transforming the Economy were identified as major themes for investment.

A focus on mental health was signalled well before the budget announcement and off-the-back of the recent Mental Health and Addictions Inquiry.  

For those working within the sector, the findings of the Mental Health Inquiry were both unsurprising and unspectacular.  

Identifying a multitude of access and funding issues, suboptimal treatment (for many), and a range of other issues including significant workforce deficits.  While many new emerging issues were identified, consistent with the current service delivery model, many of the challenges expressed bore similarities with issues identified some 30 years prior, as part of the 1998 Mason Report.  To this end, an unexpected outcome of the 2018 inquiry was that in three decades – many issues and challengers in mental health had not changed, and in some parts had simply become much worse.

Placing greater emphasis on mental health and actively implementing most of the recommendations from the inquiry therefore holds some promise that should a future review be undertaken, that positive change can be expected.  Ideally access would have improved 30 years from now, outcomes enhanced, and the scope of available treatment options widened.  Fortunately, the 2019 Budget identifies a range of strategies and initiatives designed to target these very issues.  More services, more workers, and a focus on early intervention.  Wisely, targets associated with reducing prevalence were avoided and to the extent that rates of mental illness are unlikely to be impacted by service enhancements alone – rather factors beyond the reach of the health sector – income, employment, education, and housing for example.  Challenges which are known to sustain wellbeing, but which are not easily ameliorated through health sector interventions alone.

While the focus of the budget investments in mental health will be welcomed, they fundamentally rest on the development of a workforce which does not currently exist.  

Existing clinical energies are well-placed on those most at risk – chronic and severe conditions.  However, the vast majority of those who would benefit from care and support – do not currently receive this.  At least until their mental health problems become too difficult to manage alone.  Developing the mental health workforce will ultimately determine the extent to which the mental health objectives of the “Well-being budget” have or can be achieved.  Increasing the number of psychiatrists and clinical psychologists will take time so too will providing the right educational strategies to incentivise these professions.  However, the objectives for mental health rest on extending the workforce beyond these professions and beyond what is currently available.  Mental health promotion, education, and early intervention.  Support which might best be delivered by a wider group of mental health professionals.  Professions which could offer support to those currently underserved and which do not require the same length of time to develop.

Here the role of Counsellors (mental health and addictions) would be key and through their ability to actively provide support before existing problems escalate.  Before they become acute, more difficult to treat, and before they inevitably require more sustained (and expensive) treatment and care.  Training in these areas is however lacking.  More-so if the intention were to equip this workforce with the skills needed to operate within a kaupapa Māori setting.  

Given the current levels of mental illness with the Māori community it will be critical to ensure that the workforce is both clinically and culturally equipped.  

For no other reason that this blend of skills affords the greatest opportunity to improve the health outcomes of the population most at risk –  Māori.  

Incentivising tertiary providers to deliver these types of qualifications is therefore critical, so too is providing the necessary support through which students might see a long-term career pathway in mental health.  

How this is achieved will in part depend on how this new resource for mental health is administered and prioritised, likewise the extent to which meaningful incentives to develop the mental health workforce are provided.  A failure to do so will be a significant missed opportunity and simply precipitate current challenges and inequities.

Dr Te Kani Kingi

Dr Te Kani Kingi, Ngāti Pūkeko, Ngai Tai me Ngāti Awa, Manager of Strategic Projects at Te Whare Wānanga o Awanuiārangi.

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