Fewer NZers able to access specialist mental health support

There has been a dramatic dropoff in New Zealanders able to access specialist mental health and addiction services over the past five years, the Mental Health and Wellbeing Commission has revealed

The commission's Kua Tīmata Te Haerenga five year monitoring report released on Wednesday shows thousands fewer people are able to access specialist help.

This parallels an uptick in the number of people utilising primary health providers or GPs for mental health and addiction support.

Significant staffing shortages and recruitment challenges have been pinpointed as the primary contributor to the country's declining accessibility for specialist mental health support.

According to the report, the downturn is "not necessarily due to decreasing demand".

"We continue to hear that demand is increasing and some people are still reporting difficulties in getting access to specialist services when needed."

Out of the five recommendations outlined in the report, development of a workforce plan for the sector is specificed as the most pressing assignment now for health authorities.

Mental Health and Wellbeing chief executive Karen Orsborn told RNZ the figures were "concerning".

"We are concerned that access to specialist services continues to be constrained and workforce shortages which is a large contributor are having a real impact on the ability of people to receive the support that they need in a timely way," she said.

In 2022/23, 3.4 percent of the population accessed a specialist service compared to 3.8 percent in 2018/19, representing more than 9300 fewer people using specialist services in five years, according to the report.

"Accounting for population growth, this change equates to a 9.4 percent decrease over the five year period from 3754 for every 100,000 people in 2018/19 to 3,401 for every 100,000 people in 2022/23."

The steep decrease seen in addiction services painted a starker picture, with a fall of about 16 percent during this period, from 51,804 people in 2018/19 to 43,582 in 2022/23.

"This compares with a decrease of 3.1 per cent in mental health service use over the same period.

"Part of the decrease in addiction services comes from declining acceptance rates (from 97.4 per cent in 2018/19 to 91.1 per cent in 2022/23)."

Orsborn said the report's primary findings around workforce gaps and resourcing - and the toll they were taking - were a "real issue" for the workers who were providing specialist services.

"The numbers in the workforce have increased but what we've seen and [continue] to see is those high vacancy rates and higher turnover rates.

"People who are working within services are really feeling the pressure.

"And if you've got someone new who has come into the team, then they may not be able to have the care and support for the same number of people of someone who is more experienced."

By 2022/23, the country's workforce in mental health and addiction services had grown to a total of 15,534 full-time-equivalent (FTE) staff.

But vacancy rates for specialist services had more than doubled in five years, from 5.5 percent to 11.1 percent.

The main problem was the shortage of psychiatrists, psychologists and registered nurses working in the mental health and addiction services, Orsborn told Morning Report.

While there had been a downturn in accessibility for specialist services, schemes such as the Access and Choice programme had provided support within primary and community healthcare settings.

More than 185,000 people had received support through the scheme over the past year.

"That's a fantastic positive development and that's across primary care services, it's kaupapa Māori services, Pacific services and youth specific services," Orsborn said.

The programme was established in 2019 as part of the Labour government's $2 billion mental health package.

It provides support for people with "mild to moderate" mental health needs.

"While the impact of the Access and Choice programme is positive, we also heard that some people with higher needs (moderate to severe) have not been able to access services in a timely way," the report said.

"We heard that people across the continuum of services are presenting with more acute distress and more complex needs."

The country had undergone a tough five years with the Covid-19 pandemic, adverse weather events and a cost of living crisis.

"All of those things actually have impacted for people, particularly for our young people," Orsborn said.

The commission has set out recommendations based on the past give years of monitoring efforts.

To address service capacity and workforce shortages, it is calling on Te Whatu Ora - Health New Zealand to develop a mental health and addiction workforce plan by June 2025.

Other recommendations propose the health authority develop an action plan over the next 12 months to meet the needs of Māori accessing specialist mental health and addiction services.

It also recommended guidance on acute community options to meet the needs of rangatahi (youth), development of a data plan to ensure information systems were integrated and enabling the collection of "quality and timely data"; and that the government commited to funding a "planned programme of work to collect mental health and addiction prevalence data" by next June.

Need for a rebalance

The chairperson of the New Zealand College of Psychiatrists Hiran Thabrew said the report clearly outlined the fears the college had held for about two years.

The workforce had not grown enough to cope with demand, especially for patients with more complex needs.

"The workforce shortages are increasing."

The vacancy rate overall had increased to 11 percent while for psychiatrists it was 20 percent.

Thabrew said while a lot of people were accessing the Access and Choice system it was not serving Māori or children and young people well.

"We certainly know for children and young people they're certainly waiting longer to access specialist mental health services.

"They have more ambulance callouts, more presentations to EDs as well.

"In a complex system like health you have to actually address issues in all parts of the system not just focus on one and, I think, what this report shows is that the balance has swung too far in one direction."