A year’s worth of data on the coalition Government’s mental health targets shows the system has met its headline targets for access to mental and addiction services at a national level, but some districts are lagging far behind.
Young people are still struggling to access the specialist help they need in a timely manner.
On Wednesday, the Government released figures on the mental health and addiction system’s performance against the five mental health targets.
On the measures seeking to provide faster access to both primary and specialist mental health and addiction services the system has consistently exceeded its 2030 targets throughout the year.
On access to specialist mental health and addiction services, just over 80.3 percent of people gained access within three weeks of referral during the three months to June. (The 2030 target is 80 percent.)
Meanwhile, 83.8 percent of people gained access to primary mental health and addiction services within one week of referral during the same time period. (The 2030 target is 80 percent.)
On the face of it, the results suggested a system that enabled timely access to appropriate mental health and addiction services at a national level. On these two targets, the system exceeded the 80 percent target every quarter since they were introduced.
Mental Health Minister Matt Doocey told Newsroom he was open to changing the targets if they proved to not be ambitious enough. But the national results did not tell the whole story.
Some health districts were far from reaching the target. For example, only 57.2 percent of people on the West Coast were able to access specialist mental health services in that three-week timeframe.
For Northland it was 58.7 percent, and for Tairāwhiti 65.9 percent during the fourth quarter, from April to June this year.
Of the four regional groupings, just the South Island failed to meet that 80 percent target.
A note from Te Whatu Ora-Health NZ, appended to the data release, said “access to alcohol and other drug specialist services remains a persistent challenge in Te Waipounamu”. It went on to explain steps taken to improve provision in Nelson and Christchurch.
Meanwhile, some regions had improved, with the Central region not meeting the specialist mental health support target at the start of the period (July-September 2024), but finishing the year out with 80.8 percent of people accessing specialist support in the three-week timeframe.
The Government was also gathering demographic data broken down by age. This showed that in quarter four, only 75.4 percent of people in the under-25 age bracket were able to access specialist mental health services within three weeks of referral. This had risen from just 72.8 percent in quarter one (July-September 2024), but was still behind the national average of 80.3 percent.
On access to primary mental health and addiction services the gap between those regions reaching the target and those that weren’t was less pronounced, but still six of the 20 health districts were not hitting the target. Meanwhile, of the four regions, the Central region fell short of the target, but only by a whisker.
On a district level, people needing access to services in Hutt Valley and Taranaki fared the worst, followed by South Canterbury and Nelson Marlborough.
In the South Island, access to primary mental health support in one week improved from 75 percent at the start of the year, to being above the target at 84.7 percent. Meanwhile the Southern district went from being the worst-performing district at 66.4 percent, to one of the best at 91 percent.
“I’ve always been very clear that I’m just not going to be happy with the national average,” Doocey told Newsroom.
The real power of reporting on these targets was the ability to drill down into the 20 health districts, he said.
“This is the holy grail of health and mental health, to be able to really understand what’s happening in specific geographic areas of New Zealand. Because what we want to do is get rid of the post code lottery.”
Now the minister and Health NZ had a baseline of 12 months’ worth of data, the coming year would see them focusing on lifting all districts up to the target level.
The disparity between districts was especially pronounced when it came to the results of the target seeking to reduce the amount of time people seeking mental health and addiction services spent in the emergency department.
The goal was to get 95 percent of people admitted and discharged or transferred within six hours by 2030, with a first annual milestone of 74 percent. At a national level, 69.4 percent of people who presented to EDs were admitted and discharged or transferred in that six hours.
Just one district (South Canterbury) exceeded the overall target at 96.3 percent. Meanwhile, Whanganui, Tairāwhiti and West Coast all hit above 90 percent in quarter four.
Doocey highlighted progress made in the Whanganui district, which went from 81.4 percent to nearly meeting the 95 percent target for shorter mental health stays in emergency departments.
However, eight districts fell below that 74 percent milestone target, with only 37.2 percent of people seen to and either discharged or transferred in the acceptable timeframe in the Capital and Coast District. For Counties Manukau people fared only slightly better, with 40.9 percent admitted, then discharged or transferred within six hours.
The final two targets represented efforts to bolster the mental health and addiction workforce and a greater proportion of the ring-fenced $2.8 billion of mental health and addictions funding going towards prevention and early intervention services.
Speaking on the persistent issue of the postcode lottery in the mental health and addiction system – also a stubbornly persistent phenomenon in the broader health system – Doocey said this wasn’t surprising to him, to sector professionals or those who engaged with services.
It was what everyone was already experiencing, and had anecdotal evidence of, he said. But now there was granular data that allowed more informed conversations between himself, Health NZ regional directors and those working in communities to figure out the barriers to access and put appropriate solutions in place.
The country had done well to remove much of the stigma surrounding mental health and addiction, leading to more conversations about mental health and wellbeing, Doocey said.
“What keeps me up at night … is now people take that leap of faith, and at times, that support is not there in a timely manner.”
The minister acknowledged there was still a lot of work to do to join up the complex and historically fragmented system, but said he believed the services were out there. Now it was up to him and Health NZ to identify the right services for the right area and help fund them.
Doocey spoke to Newsroom about the latest data release from Hokitika, where he was carrying out a rural mental health roadshow. Among others, this week he was visiting communities in the West Coast and Thames.
“Mental health is all about a local response,” he said, adding that he believed Labour’s centralisation of the health system was “dangerous” in the mental health space.
“Because how we respond to middle-aged dairy farmers in North Canterbury is quite different than young Māori in south Auckland.”
The data comes a day after the Government shared its fourth quarter results on overall health targets.
Along the same vein, things looked good at a national level, with the Government meeting three out of five milestones in the first year of measuring its health targets.
Health Minister Simeon Brown specifically celebrated shorter wait times and faster cancer treatments.
But child immunisation rates are still short of where the Government hoped they would be, with Northland significantly lower than other regions, and shorter stays in emergency departments also just shy of the one-year milestone.
While the health minister said the results were encouraging, there were many districts that fell below those milestones with lower socioeconomic districts in the North Island faring the worst.
Health targets – as part of a suite of wider public service targets – were reintroduced under this coalition.
The previous National government had both health and public service targets. These were scrapped by the Labour-led coalition government, which said a focus on meeting targets didn’t guarantee improved care or services.
Some experts have also argued the wrong targets in the wrong place would worsen the health system’s inflexibility. And an outsized focus on meeting targets, without accounting to the overall patient experience and quality of care, could be dangerous.
Doocey told Newsroom he was not a “target fundamentalist”.
The minister pointed to international examples where an obsession with targets had led to poor outcomes. And during his time working for the NHS in the UK, “a fundamentalism around targets had driven perverse behaviours”.
In 2013, the UK government released the results of an inquiry that looked into what went wrong at the Mid Staffordshire NHS Foundation Trust in the mid-2000s.
The inquiry concluded a mix of poor culture, bullying, acceptance of poor behaviours, defensiveness and target-driven priorities had been behind hundreds of avoidable deaths.
The independent inquiry found government policies influenced the quality of healthcare and, in this case, had given the impression of prioritising attainment of targets, and financial balance over patient safety.
It found targets and standards to be defined in professional, organisational, and political terms, not in terms of patients’ experiences of care.
Overall, the inquiry report found aspects of a negative culture had emerged at all levels of the NHS system, and Staffordshire was just one example.
“These include: a lack of consideration of risks to patients, defensiveness, looking inwards not outwards, secrecy, misplaced assumptions of trust, acceptance of poor standards and, above all, a failure to put the patient first in everything done.
“The emergence of such attitudes in otherwise caring and conscientious people may be a mechanism to cope with immense difficulties and challenges thrown up by their working lives,” it said.
While Doocey acknowledged the fraught nature of targets, he believed the gathering of data was important, both so people could hold him to account in his work as minister, but also as a way to strive towards continuous improvement.
WHERE TO GET HELP
Safe to Talk national helpline 0800 044 334 or www.safetotalk.nz
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Shine (For men and women) – free call 0508-744-633 between 9am and 11pm.
1737, Need to talk? Free call or text 1737 any time for mental health support from a trained counsellor
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Kidsline – 0800 54 37 54 for people up to 18 years old. Open 24/7.
Youthline – 0800 376 633, free text 234, email talk@youthline.co.nz, or find online chat and other support options here .
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