About Platform Platform is a national network of community non-government organisations (NGOs) that provide solutions to the complex social health issues of our time. Platform members do this by delivering services on behalf of the many Crown agencies whose work is also impacted by mental illness and addictions; the Ministry of Health, District Health Boards (DHBs), Ministry of Justice, Department of Corrections, Department of Internal Affairs, Te Puni Kokiri, Ministry of Education, Ministry of Social Development, ACC and some local Territorial Authorities. Like many NGOs Platform members also engage in crucial, unfunded and therefore often unrecognised work, in New Zealand communities every day. Platform itself has a long standing relationship with the Ministry of Health and is contracted to:
Promote public trust and confidence in the Sector Improve service user outcomes for services delivered in the Sector Improve the quality of mental health and addictions services in the Sector Improve Mental Health and Addiction NGO organisational capability
A diverse NGO sector NGOs provide a broad range of mental health, addiction and wellbeing services as well as some highly specialised programmes to specific populations, such as Māori and Pasifika. Examples of our member’s services are: Social housing, housing brokerage and homeless services Employment facilitation Healthy lifestyles programmes Family and friends support services Whanau ora services Refugee and migrant Peer support Intellectual and co-occurring disability services
Addiction counselling including methadone treatment Residential rehabilitation and treatment services Vulnerable children and youth services Eating disorder services Respite, crisis and trauma services Sector training and cultural competencies Strategic workforce development
More than just health Given the huge personal, social and economic cost to individuals, families, communities, schools, prisons and workplaces throughout New Zealand, mental health and addictions are no longer just ‘health’ problems that require a solely health response. In 2001 the World Health Organisation estimated that mental health problems cost developed nations between three and four percent of their gross national product.
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Social services, Education, Housing, Justice and Corrections now all bear this cost and in part this can be attributed to insufficient investment at the community and primary care end of the continuum, when compared to high cost, low volume specialist mental health and addictions services. This remains the case in New Zealand. There is overwhelming evidence that change is essential as our traditional responses, staff training models, investment approach, funding and staff training models are no longer keeping pace with the changing expectations and needs of the very people we seek to serve. Together with the decentralised autonomy of our health system and the DHBs’ focus on Government mandated targets (none of which are mental health and addiction specific), has meant the gains New Zealand made in the mid to late 2000s have stalled. While some of the issues are multi-system and require a multi-system response, it is unacceptable that DHBs are not working in a cohesive way to implement Rising to the Challenge.
Recovery happens in the community There are strong links between mental illness, drug and alcohol use, poor housing, unemployment, domestic violence, poor academic achievement and poverty, yet the current mental health thinking and spending continues to be focused on the treatment of acute illness and bricks and mortar hospital/clinical-based care. This is evidenced by the results of an Official Information Act request Platform recently made to the Ministry of Health. The resulting report in early October 2014 showed that despite increased overall investment in mental health and addiction services by successive Governments, the investment in NGO services as a percentage of total spend is now less than it was in 2004. This is extraordinary and shameful given that people live their lives in the community. This pre-occupation with funding high cost, low volume services is out of step with integration and community service development for mental health as recommended by the World Health Organisation and at odds with the New Zealand Government’s own health policy. NGOs play a critical role in supporting people in the community who are living with mental health and addiction issues. The services they provide enable people to get the right help early, and assist with ongoing support. Without this they are more likely to become unwell, reach crisis point and need more intensive and expensive support as their health deteriorates. It also means other agencies are drawn in to be the default emergency service. We see that happening now with the increasing number of after-hours crises calls to the Police in some communities, rather than the DHBs mental health crisis teams. New Zealand has a rich network of NGOs that are already responding to the needs of people with mental health and addiction in both the health and social sector. The past twelve years of competition has delivered a robust sector that is ready to engage. This network could be much more strongly activated to rise to the challenge of leading a new, comprehensive and contemporary alternative to the traditional high cost hospital-based mental health and addiction system. This
PO Box 6380 Marion Square wellington 6141 04 385 0385
approach will require bold leadership as there is a strong financial incentive for DHBs to maintain the status quo. Community, family and people themselves are the untapped resources of improving mental health and wellbeing. Research by the Kings Fund has shown that activating clients to be more involved in their care can reduce health inequalities, deliver improved outcomes, better quality of care and lower costs. Increasingly health systems of the developed world are beginning to understand that people are better served when community based care is strengthened and where there is collaboration between community agencies, primary care and DHBs. Both the literature and our experience tell us that social conditions have a major impact on mental illness and addictions. Our measure of success should reflect the social and economic impacts of mental illness and addictions, for example, access to housing, education, employment and participation in society. This is the core work of the community sector.
An uneven playing field At present, all decisions about funding, service development and service provision are led by 20 District Health Boards. Their focus is specialist and clinical, centred on the treatment of illness and the management of risk, including financial risk in the context of managing hospital budgets. In many ways it is not surprising that DHBs are failing to invest in the community sector which in real terms means it is now going backwards. Specialist clinical services are clearly part of the required care; however they do not always have to be at the forefront of that care. The first point of contact may be in the community where interventions are possible to prevent or reduce the use of specialist intervention and hospital admission. There is an active role for community organisations to working with Primary Care organisations however there is no funding pathway to encourage this. Fragmented funding is a legacy of the past and as we move toward a more collaborative environment, different funding models must follow. Commissioning services is a craft that has been poorly mastered by most DHBs (apart for a few notable exceptions) and there is a major competency gap. This was identified in Rising to the Challenge, but is still yet to be addressed. Work by Treasury and MBIE has led to a whole of Government approach (except DHBs), to getting the best from community organisations by using integrated contracts and a community investment approach. DHBs persist with excessive bureaucratic demands on NGO services, micro-management, wildly different prices for the same services and multiple audits, all of which detract from the work of NGOs and waste tax-payer’s money. None of the same rules apply to their own services. All of these issues are factually and succinctly illustrated on Platform’s Fair Funding website and have been included in the Productivity Commission’s “More effective social services” issues paper. www.fairfunding.org.nz
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The impact of a siloed system Not only do we have a decreasing investment in the community sector and a preoccupation with pushing more and more resource to specialist mental health and addiction services, those services in large part remain disconnected from other parts of the health system. This can be evidenced by people with serious mental health and/or addictions having poorer physical health then the rest of the population and as a result their life expectancy is much lower, in some cases as much as 25 years and worse for MÄ ori or Pasifika. This is a huge personal cost and loss to society, yet because the system is fragmented and mental health services focus on mental illness treatment, people’s physical health is often ignored. Easier access to all health services, through greater integration of health services, could address these long term health needs. In partnership with Te Pou, Platform has been driving Equally Well as a cross sector health initiative. Equally Well is activating a call to action to all areas of health to actively work with their areas of responsibility to address this disturbing trend. http://www.tepou.co.nz/improving-services/physical-health In conclusion we believe the mental health and addiction system needs to be outward looking, where early intervention is common practice, is accessible to the people that need it and is shaped in a way that people want to use it. We have described a system where fragmentation has been allowed to deconstruct what was a world leading service and we have suggested ways to bring it back together. We look forward to working with you to achieve this.
PO Box 6380 Marion Square wellington 6141 04 385 0385