On Newshub Nation: Simon Shepherd interviews Health Minister David Clark

Simon Shepherd: Right, so, we’ve heard sweeping changes are coming to mental health care, courtesy of that $1.9 billion, the jewel in the crown of Budget 2019. But what exactly will it look like? Is it going to work? The Minister of Health, David Clark, joins me now. Thank you for your time this morning.
David Clark: Morning, Simon.
Let’s pick up on a couple of points from our expert panel there. Holistic, overall, overarching – not an ambulance at the bottom of a cliff. Can you deliver that?
This package is aimed to be across the spectrum. So, He Ara Oranga, the inquiry into mental health and addiction, identified that one of the big gaps in our system is for those with so-called mild to moderate mental health conditions – those with anxiety, depression – and the first 12 or 14 recommendations focused on that. So that is the centrepiece of the package, but we’re also investing in counselling for bereaved families; we’re also investing in emotional resilience for children, and Shaun spoke a little bit about that when I heard the panel speak. So we are investing across the spectrum here.
There were some glowing recommendations from them, but also a couple of points which they’d like to see you pick up on. One of those is the suicide reduction target. Now, you’ve decided not to do that. Does that not give it a sense of urgency?
We debated this—
A lack of urgency, I mean.
Yeah, we did debated this long and hard as a cabinet. It was one of the most difficult decisions for us, but in the end, none of us were comfortable with the idea that there would be any acceptable level of suicide. One suicide is one suicide too many, and in our view, every life matters. We’re determined to take mental health seriously. I think the investment and the attitude matters more than having a target, which could look like we’re satisfied with a certain number.
Did you look at other worldwide programs? Like there’s one in Scotland which has a very similar target which they almost reached.
Yes, we did. We looked across internationally. There is no strong evidence that a target works. The results are really mixed. Some countries have achieved – Australia and Canada – without a target quite extraordinary results over a period of time, but then lapsed back. Others with a target have achieved, and others haven’t, you know. So we thought in terms of our own comfort that we wanted to focus on this area, but a target wasn’t—
Okay. So how are you actually going to measure success, then?
I think we’ll be judged more broadly by how we are going about this. For me it’s about making sure that everyone in distress can access the services they need.
Okay, so, you accepted 22 recommendations from the review. The rest are accepted in principle and need further consideration. Is that sort of misleading, saying that you’ve accepted more – like, 38 out of 40?
No, we were very clear about the ones we weren’t accepting. Other ones are more challenging or complex. Some of them we accepted the direction of travel, but we didn’t accept the mechanism. An example of that would be the cross-Parliamentary group – that’s not actually for government to determine that. That’s up to the whole Parliament. So we accept that in principle, but it’s not—we don’t accept the finding in its specifics.
A couple of specific points here – Maria wants a Maori health commission to focus purely in a targeted way. Is there an appetite for that?
That’s something that the wider review of the health and disabilities system will look at.
Okay. Now, Shaun was talking about—So that’s a possibility, you’re saying?
I’m saying that there is a review ongoing that’s looking at the whole system settings, and I think that’s appropriate to look at that.
Do you accept her, sort of, point that kaupapa Maori is evidence-based and needs particular attention?
There is evidence around kaupapa Maori programs. We’ve set aside $62 million out of the Primary Care Initiative for mild to moderate specifically for kaupapa Maori initiatives.
So why wouldn’t you—? If there is that evidence now, why wouldn’t you put that Maori mental health commission in place now?
A Maori Mental Health Commission? That’s something that’s going to be looked at in the wider settings. We are looking to have a Mental Health Commission now. That was a recommendation.
The Maori-targeted one?
Yeah, one of the recommendations was to put that in the wider review, and that’s what we’re going to do.
Okay. All right. Shaun wants regulation on alcohol. Now, you’re just looking at that. Why are you not adopting that?
The Parliament itself has looked at alcohol regulation twice in recent history. It traditionally in Parliament is a conscience vote. It is a complex matter. Look, we’re focused more on what we can do immediately, which is things around looking at advertising, sponsorship – those kinds of things. They do impact how people think about alcohol, and we want to have a good look at that.
And what about pricing regulation? Because access to alcohol is very, very easy and it’s low-priced, and that’s one of the drivers, isn’t it?
Yes, and we’re focusing also on those who come forward for support, which until now has not been able to be delivered for many people. So we’ve put additional money in the Budget – $56 million into addiction responses. We need to ramp up in that area. We also put aside $200 million ring-fenced capital for mental health and addiction facilities.
Okay. Let’s look broader. So, psychological distress is evidenced to be three times higher in more deprived neighbourhoods than the less deprived. So do you think the $.19 billion is being targeted in the right way? Or should it go on the causes, like poverty or perhaps putting in a living wage and those kinds of drivers?
It is about balance. In our package you’ll see also we’ve put a focus on housing first, recognising that those things need to be dealt with. On Corrections, you know, those who are at the hardest end of these things need addiction support, need rehabilitation programs for when they go back into the community. So this is a balanced approach, and as a Government, housing has been a major priority for us. Education—
Well, see, housing seemed to drop out of the Budget this year, didn’t it?
We’ve got a focus on child poverty – breaking the cycle; domestic violence – $320 million dollar package. That’s the big contributor, actually, long-term to people’s mental health outcomes. There are measures of prevention, and we think we’ve got the balance right.
$212 million for health workforce training. So, are you confident you’re going to find the people? And how many people do you think you need?
In the package for primary mental health care, for mental health and addictions, there are an anticipated 1600 staff required. That is a lot of staff. Most of those will be already providing health care — so they’ll be nurses, they’ll be occupational therapists, they’ll be social workers — and they’ll receive a top-up qualification, if you like, in cognitive behavioural therapies or talking therapies. So those people are already in the health workforce. About a quarter will be new to the health workforce, we think.
What about the people with lived experience like Maria was talking about?
Indeed. They are a part of that. We absolutely anticipate having peer support workers as a part of that. People with lived experience have a lot to contribute, and that’s already in place in the models that we’ve looked at that we want to build on.
So the five-year plan, $1.9 billion, but Mary O’Hagan, who is a former mental health commissioner, says no one’s painted a picture of this transformation — what it’s going to look like. Can you paint that now?
Yeah. For me, it really is about every person who’s in distress being able to get the services they need when they reach out because the stories I hear, and I get a lot of correspondence about people turning up at emergency departments not being able to get the help they need, people going to their GP getting some pills, but it’s a 15-minute session and they’re out the door. It’s not that people don’t want to help, it’s just that the resourcing and the system hasn’t been set up—
So instead of going to the GP and getting pills, what would happen? What kind of service would they get?
In the model, exactly what happens is they go into their GP, they sit with their GP, the GP at a certain point says, ‘Look, I think you need some support that I’m not qualified to deliver, but actually just down the hallway we’ve got someone in our practice who is specialised in this area. Will you walk with me now?’ And the way that it’s set up is they walk in, what they call a ‘warm handshake’, an introduction. ‘I’ve just spoken with this person. They’ve got these challenges. I need some help solving them.’
So when can someone expect to see that kind of service in place?
Well, it’s already being delivered in some settings around New Zealand. That’s what gives us confidence. There are grass roots models that are already delivering this service, so we’re wanting to roll this programme out over five years across the country. It will be building up.
So give us an example of who is actually doing this right now.
There’s an outfit called ProCare in Auckland who is delivering it. There’s four sites across Auckland. We visited one with the Prime Minister yesterday.
And is that the kind of model that you think should be rolled out?
That’s the kind of model, absolutely. We also visited in Newtown a model that’s been in place for 17 years, with psychiatrists visiting the practice regularly. They’ve got a high number of addiction patients. These things have been proven to work, we just need to make them more accessible.
Just quickly — is $1.9 billion enough or will there be more next Budget?
We will need to continue to invest over time. We’ve put $20 million into digital and tele health. Those services are expanding in their capacity, capability and availability to people. There will be further investment in the future.
OK. Health Minister David Clark, thank you very much for your time.
Thanks, Simon.
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