Despite 'red flags', Government insists its scheme to vastly expand access to mental health services is on track to hit its targets in 2025. Marc Daalder reports
Counsellors working in the Government's flagship mental health programme see an average of about two patients a day, according to data released by the Ministry of Health.
The Expanding Access and Choice programme was created with nearly half a billion dollars in funding in the 2019 Wellbeing Budget, with the aim of making mental health and addiction support freely available to all New Zealanders when and where they need it within five years with a new frontline mental health service.
Funded counsellors would work out of GPs' offices, marae, community centres and other locations accessible to both the general population and specific groups like Māori and youth.
A quarterly stocktake of the programme, released by the Ministry of Health in July, says it is on track to meet its long-term targets. But the figures within that report indicate the programme is lagging behind on some metrics.
National Party MP and mental health spokesperson Matt Doocey says the Government should pause the programme to figure out what's wrong.
"I think there's definitely some red flags there. We should be mature enough to say, okay, clearly there's some issues. Are we just going to continue doing the same thing and getting the same results? How long can we continue, knowing there's actually some fundamental flaws in the model?"
Doocey said the Ministry of Health's figures showed, over the March 2022 quarter, each full-time equivalent mental health worker had conducted just one session per day.
When Newsroom presented that calculation to Health New Zealand-Te Whatu Ora, which oversees the programme, the department's group manager for primary and community wellbeing Jo Chiplin said it was based on erroneous assumptions.
"The figure you have arrived at, in this instance, doesn’t account for weekends, public holidays, sickness, the phased nature of the rollout of services and sessional annual leave adjustments for the March quarter against the rest of the year. You have also assumed that all of these FTE (full-time equivalents) were in place at day one of the quarter (New Year’s Day - a public holiday) and not taken into account orientation and the building of service user caseloads for new FTE," Chiplin said.
A subsequent calculation, which incorporates public holidays, weekends and annual leave and which uses the previous quarter's full-time equivalent figure, still shows just over two sessions per full-time worker per working day in the March 2022 quarter. The previous quarter was hardly better, with 2.17 sessions per full-time equivalent per day.
Health Minister Andrew Little also pushed back against criticisms of the programme's output.
"If you just take raw numbers and divide them, as I think the National Party's prone to doing, it doesn't actually tell the picture," he said. "This is a significant undertaking. It's taken some time to roll out. If the ultimate question is, am I satisfied with progress? Yes I am."
Doocey also pointed to figures from the latest stocktake showing only 84,181 people had been seen by the end of March, compared to a target of 105,000. Written parliamentary questions to Little have revealed just 344 GP sites are providing mental health and addiction services funded by the Access and Choice Programme, equating to around a third of GP sites nationwide and covering about 45 percent of the population enrolled in general practices.
Chiplin defended the programme's record on these issues, saying 356 GP sites were now enrolled as of the end of May.
Access and Choice is ahead of schedule in terms of population covered by enrolled GPs "despite the disruption of the pandemic, a challenging labour market and global competition for health workers", she said.
"These factors shouldn’t be dismissed when considering the Access and Choice programme has delivered a frontline primary mental health and addiction service that simply didn’t exist a couple of years ago. It’s important to also consider this programme in context. It is being rolled out across five years and on track to deliver against its key targets."
The report does claim the programme is on track to meet the end-of-year goal of seeing 150,000 people as well as the June 2025 target of 325,000 people seen annually. More than 430,000 separate sessions have been funded through the programme, up by 50,000 from stocktake report, Chiplin said.
Access and Choice is also meeting staffing targets and exceeding expectations in terms of access by Māori (23 percent access, compared to a target of 20 percent), Pacific peoples (12 percent access, versus an 8 percent target) and youth (21 percent versus 15 percent).
Doocey maintains the programme should be paused to ensure it really is on track. He says there's room for cross-party cooperation here, given all parties back the intended outcome of the programme.
The programme came out of the recommendation of the mental health inquiry to expand access to services to the "missing middle" - the 20 percent of the population who may be experiencing mental health challenges at any given time, even if they aren't extreme illness.
"New Zealand has deliberately focused on services for people with the most serious needs, but this has resulted in an incomplete system with very few services for those with less severe needs, even when they are highly distressed," that inquiry noted.
"If we have to shift that dial from providing support for 4 percent of the population to 20 percent, having a workforce that's seeing one person a day is not going to do it," Doocey said.
"I think we do have to look at how we utilise that bipartisan approach to take policy longer than the three-year parliamentary cycle. And I think we also need to have a mature debate where we look at issues like this and say, everyone agrees with the intent, it's the right thing to do, but actually the model that we're starting to roll out is showing some very clear issues."
Little said National was "totally" politicising the issue of mental health, not depoliticising it.
"I'm kind of at a loss to know why the National Party would say that [a pause is needed]. A year or so ago, they were critical of the speed of the rollout. Now they say they want to pause it. This is a very important contribution to our total range of mental health services."
