What Doocey’s strategy needs to deliver

Aotearoa’s last comprehensive mental health and addiction prevalence survey was conducted 20 years ago. It’s impossible to truly understand the scale of national mental health need using data this old, and the way other mental health service data is collected and reported on doesn’t tell us, either. The MHF supports calls from He Ara Oranga and sector experts for investment in collecting and integrating high-quality, timely, nationally-consistent mental health data that covers services, workforce, and use of the Mental Health Act. It’s great to see recent commitments to a child and youth mental health prevalence study – we recommend Doocey’s strategy expands this study in the future to include other populations, and conducts a comprehensive nationwide prevalence study in the long-term.

Aotearoa’s mental health system has been underfunded for decades. Doocey’s strategy needs to deliver integrated, ongoing investment to address the poor mental health outcomes this has created, commensurate to the scale of mental health need. Communities who experience disproportionate levels of discrimination and/or disadvantage contributing to poorer mental health outcomes (such as Māori, Pasifika, Asian peoples, migrants, people with a background as refugees, people with disabilities, Rainbow communities, children and youth, and rural populations) should be included in funding decision-making processes.

The Mental Health Act, the law people can go under when in acute distress, is being replaced by a new Mental Health Bill. Positive changes in the Bill, such as embedding ‘supported decision-making’ (or helping people in acute distress to make their own decisions) and reducing and eventually ending seclusion (where someone is placed in a bare room with only a cardboard toilet and mattress, often for long periods of time) will need targeted investment within Doocey’s strategy to become a reality. 

We will never solve Aotearoa’s mental wellbeing crisis one person at a time – we need a public health approach. Mental wellbeing promotion programmes improve lives, prevent crises, relieve pressure on services and save money, with many showing return on investment after only a short period of time. But without adequate planning and funding, their success, reach and benefits are stifled. Non-government organisations (NGOs) and other community-based groups (like kaupapa Māori organisations) are well-placed to deliver relevant mental health promotion initiatives, but are currently under-utilised. We recommend Doocey’s strategy includes a plan for mental wellbeing promotion, and provides on-going funding that has equitable impacts across communities. 

Severe workforce shortages are limiting access to quality mental health care, particularly in specialist services. As outlined in Health NZ's Mental Health and Addiction Workforce Plan 2024 – 2027, targeted investment is needed to expand training pathways, improve staff retention, and increase support for specialist clinicians. Our mental health workforce also needs to be more representative of (and effective and culturally safe for) our diverse communities, including Māori, Pasifika, Asian communities, people with disabilities, migrants, people with backgrounds as refugees, and Rainbow communities, to prevent the inequitable care and poorer outcomes these communities face.

To alleviate pressure on the mental health system and ensure mental health policies and services are responsive to the people they serve, Doocey’s strategy needs to show a strong commitment to grow the consumer, peer support, and lived experience (CPSLE) workforce. Specifically, we recommend his strategy embeds lived experience wisdom through co-design; supports lived experience co-governance of mental wellbeing services and initiatives; and invests in pathways to develop and progress lived experience leaders (particularly tāngata whaiora Māori) to decision-making roles, enabling them to design and deliver solutions and pathways to grow the lived experience workforce. 

Māori experience some of the poorest mental health and wellbeing outcomes in Aotearoa, which are contributed to by the ongoing impacts of racism and colonisation, and inequitable access to culturally appropriate mental health care. Māori are also disproportionately subjected to traumatic practices (such as seclusion under the Mental Health Act), a breach of Te Tiriti o Waitangi obligations. We recommend Doocey’s strategy embeds kaupapa Māori approaches to mental health and wellbeing that reflect whānau, hapū, and iwi aspirations, prioritise Māori-led solutions, and respond to holistic wellbeing needs. We also recommend scaling up successful initiatives, such as Whānau Ora community-based programmes and kaupapa Māori mental health services, to ensure wider reach and impact.

Non-governmental organisations (NGOs) are essential partners in delivering government-funded mental health, addiction, and wider health and social services, as they best understand the communities they serve. However, the lack of true collaboration with government, funding insecurity, high compliance costs, and fragmented procurement practices undermine the sector's sustainability and its ability to innovate. A shift toward high-trust commissioning, with a focus on outcomes rather than outputs, is needed. We recommend Doocey’s strategy addresses these longstanding issues through practical changes in the short term – such as piloting flexible, mutually-accountable contracts that reduce compliance burdens and enhance collaboration.

Half of all lifelong mental distress or illness begins by age 14, and three-quarters by age 24, with many conditions diagnosed only after they’ve become harder to treat. Responding to mental distress early is crucial, and interventions can be targeted to young people with initiatives like Youth One-Stop Shops (YOSSs) and integrated youth services. We recommend Doocey’s strategy implements the Auditor-General’s suite of recommendations to improve youth mental health; and delivers whole-of-school programmes to teach wellbeing and peer support skills from a young age. 

The Access and Choice programme has made primary and community mental health care more accessible, for people with mild to moderate distress, over the last five years. Early intervention through this programme has also shown positive outcomes, including potentially reducing referrals to specialist services. While this workforce has grown, significant shortages remain in general practice, putting strain on the mental health system overall. Doocey’s strategy will need to expand primary mental health care services (as planned) and address workforce vacancies to ensure this care is timely, comprehensive and meets demand. 

Right now, it is very difficult for people with moderate to severe distress to access specialist services. As people wait, demand rises and needs become more complex, leading to people with the highest needs being prioritised by the stretched workforce available. Doocey’s strategy needs to expand specialist mental health services, including forensic mental health, perinatal and maternal mental health (such as by increasing the number and capacity of mother and baby units) and services for people with co-existing substance use disorders; ensure equitable access by prioritising Māori, Pasifika, disabled people, children and youth, and rural communities, who experience the greatest barriers to specialist care; and improve integration and referral pathways between primary, community, and specialist services to prevent people from falling through the gaps.

People experiencing mental distress or illness and/or addictions are two to three times more likely to die before the age of 65 than people without those challenges. Two-thirds of these deaths are due to preventable physical illnesses, such as cardiovascular disease and cancer. Rates of other illnesses, such as respiratory diseases and diabetes, are also higher for these groups. We recommend Doocey’s strategy ensures people with distress and addictions receive equitable care, such as through better integrating mental and physical health care pathways; improving collaboration between primary and secondary care; and increasing support and training for a range of health professionals. 

People in crisis require timely, empathetic mental health support. We support the piloting of multi-agency co-response teams (designed to safely attend mental health callouts) and peer support roles in emergency departments (to help people in distress navigate the system), but initiatives like these must be greatly expanded before Police can safely withdraw from attending mental health crises. We recommend Doocey’s strategy build on the plan to support Police withdrawal; fund community providers to deliver wraparound crisis care (including kaupapa Māori solutions); and expand urgent support through telehealth, mobile teams, and walk-in crisis services. We also recommend strengthening crisis de-escalation training for frontline responders; increasing the availability of alcohol and drug harm reduction education; and investing in more detox facilities. 

There is strong evidence that integrating employment and mental health services benefits people experiencing mental health challenges, particularly people who have accessed (or are accessing) specialist mental health services, or who have been unemployed for long periods. Integrating housing, employment and mental health supports also produces long-term cost savings and better outcomes. We recommend Doocey’s strategy explores integrating housing, employment and mental health initiatives in a way that prioritises community partnerships, co-designs solutions, and is culturally responsive and sustainable. 

Individual approaches to care overlook the fact that people exist within whānau and communities, where support networks play a crucial role in healing and recovery. Doocey’s strategy must expand access to support, information, advice, and guidance to whānau, to ensure they have the resources they need to effectively support their loved ones in distress and look after their own wellbeing. Investment in community-led initiatives that strengthen whānau-based care, including kaupapa Māori approaches and holistic maternity support, is also needed.

Every year, hundreds of people in Aotearoa die by suicide. For every suicide, an average of six people experience intense grief, and 129 people are affected. Doocey’s strategy needs to support the actions under Every Life Matters – He Tapu te Oranga o ia Tangata: Suicide Prevention Strategy 2019–2029 and the upcoming Suicide Prevention Action Plan 2025-2029 to be delivered. Particularly, investment is needed in sustainable, community-led suicide prevention and postvention initiatives that are safe and culturally responsive, support bereaved whānau, reduce distress and prevent further harm.

Evidence shows preventing poor mental health is one of the most cost-efficient, effective ways to reduce pressure on the mental health system and improve population wellbeing. But as poor mental wellbeing is heavily influenced by social determinants (such as access to housing, employment, education, and safe family environments), only a cross-government approach will ensure success. We recommend Doocey’s strategy establishes clear, measurable ways to drive cross-government collaboration; and holds all relevant government strategies and work programmes accountable for improving mental wellbeing outcomes, by setting common investment goals and integrating systems to assess collective impact.