Final report of the Health and Disability System Review

While the report is light on references to mental health, the focus on keeping people well through population health is extremely heartening, and we welcome its focus on addressing health inequities and the social determinants of health
Found in: News / Statements
Date: 16 June 2020

The Mental Health Foundation (MHF) welcomes the final report of the Health and Disability System Review

“While the report is light on references to mental health, the focus on keeping people well through population health is extremely heartening, and we welcome its focus on addressing health inequities and the social determinants of health,” MHF chief executive Shaun Robinson says.

The Foundation is glad to see the report endorses and expands on the principles of He Ara Oranga (the report of the 2018 Government Inquiry into Mental Health and Addictions), including a commitment to equity and the Treaty of Waitangi and putting people with lived experience and consumers at the centre of the system.

However, the Foundation has some concerns that the references to mental health in the report focus mostly on mental health services, without emphasising a need to increase the wellbeing of New Zealanders through population health approaches. The MHF would like to see the Government exploring mental health approaches that contribute to preventing or minimising mental distress or illness.

The Foundation would also like to see a clearer definition of “disability” as used in the report, and to be assured that provisions made for people who live with disabilities will include people who live with long-term mental distress.

The report encourages the disability support system to move away from relying on diagnosis for initiating eligibility for assistance toward providing assistance to live well, according to an individual’s need.

“This neatly sums up a major shift in assistance eligibility that is needed to support people who live with long-term mental distress,” Mr Robinson says. “It is essential this shift in provision of support applies to these people as well as those living with physical or intellectual disabilities.”

The Foundation strongly welcomes the recommendation to create a Māori Health Authority, and looks forward to seeing extensive investigation and discussion regarding what powers the Authority will have. The MHF notes that the majority of panel members and all of the Māori expert advisory committee recommend the Authority have commissioning powers.

“The key test of the success of this Authority will be its success in reducing health inequities for Māori and improving health outcomes for Māori,” Mr Robinson says. “It should have the necessary powers to do so, and we would be disappointed if it were to be purely an advisory authority.”

While the Foundation understands the implementation process will take time, there can be no excuse to pause or not further invest in ensuring the health system is equitable and upholds Te Tiriti O Waitangi in the meantime.

“Improving health outcomes for Māori will take time and there is no excuse for delays,” Mr Robinson says. “The mahi to create and sustain long-term, high-trust relationships between Māori and health providers must continue and the necessary time, money and people must be allocated to this work.”

Māori have expressed a strong aspiration for a separate mental health commissioning structure. The Foundation hopes the government will explore a structure similar to Whānau Ora to improve Māori health as they determine the role of the Māori Health Authority.

The MHF is also supportive of a plan to reduce the number of DHBs throughout the country and hopes this will lead to less bureaucracy and more transformational change.

“One of the most exciting parts of the report is a recommendation to provide funding five years in advance and for DHBs to create five-year plans. We believe this will remove the barriers and time constraints currently in place and will help to create long-term visions of improved health outcomes for all New Zealanders. It will be vital that mental health funding is clearly identified and is equitable to the level of need in the population, so that the five-year plans don’t perpetuate mental health under-funding,” Mr Robinson says.

As the Government reviews and responds to the report, the Foundation would like to see:

  • More emphasis on reducing the impacts of racism and colonisation
  • A clear implementation plan
  • A clear outline of how the Māori Health Authority will be resourced
  • More emphasis on making long-term improvements in the disability sector
  • An emphasis on improving health for LGBTQI+/Rainbow communities
  • More concrete support for Pacific peoples.

Improving equity requires a new way of thinking – ensuring that communities most affected by health inequities have a leadership role in designing new systems, programmes and responses and have a role in ongoing governance.

“This report, and the Government’s acceptance of the ‘case for reform’ is incredibly exciting,” Mr Robinson says. “It’s a chance for a reset, a chance to make a real difference to the health and wellbeing of New Zealanders. We will be working to ensure that the phrase ‘there is no health without mental health’ is kept in mind as this report is discussed and implemented, and look forward to a clear and specific plan to begin transforming our health system.”