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John Ryan, Controller and Auditor-General. Photo credit Auditor Generals Office.
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Coordinated action required to meet young people’s mental health needs: Auditor-General
MEDIA RELEASE
A more youth-focused, integrated, and coherent system of care is required to meet young people's mental health needs, says the Auditor-General in a new report.
“Mental health concerns are the biggest health issue facing young New Zealanders today,” says Auditor-General John Ryan. “However, we found that many young people cannot get mental health support when they need it. In a country that prides itself on being a good place to bring up children and young people, this is a matter we should all be concerned about.”
Young people report the highest level of unmet need for mental health care of any age group. Early and effective support can help to reduce the lifelong human and economic costs of mental illness for individuals, whānau, and society.
The Auditor-General’s work focused on how well government agencies understand and work together to meet the mental health needs of young people aged 12 to 24 years.
Young people were one of the groups targeted by the previous Government’s multi-agency investment of $1.9 billion of new spending over four years into mental health and well-being through the 2019 Wellbeing Budget.
The audit found that the 2019 funding of new youth-specific primary mental health and addiction services is making a difference, with about 3,000 young people accessing these services each month.
In time, this increased investment in primary care might relieve demand for more specialised services. However, in the meantime, young people in need of specialist support are waiting longer to access specialist care than when the Wellbeing Budget was released.
To create a more coherent and integrated youth mental health system, agencies need to work together better.
“Despite the best intentions and efforts of the many people working in mental health and addiction services, agencies remain too focused on their own programmes or services,” says Mr Ryan.
“This comes at the expense of working together to ensure that young people can access consistent and integrated care as they enter, move through, and leave the care of services.”
Services and support should also be tailored to meet young people’s needs.
“Young people are often expected to fit into services and models of care designed for older adults,” says Mr Ryan. “Many barriers young people experience in accessing mental health support can be overcome if services and supports are tailored to their specific needs.
“Meeting their needs also means involving young people more in the design and delivery of mental health services.”
The report identifies a need for urgent action to develop a national mental health and addiction workforce plan.
“My staff were impressed by the care and dedication of those in the mental health and addiction workforce, who work hard to support young people,” says Mr Ryan. “However, they are also a workforce under considerable strain due to capacity pressures across the sector.
“Sustained effort will be needed to fill workforce gaps by increasing the local education and training pipelines for new and existing types of mental health and addiction practitioner.”
The audit also found that agencies need better information about the extent and distribution of young peoples’ mental health needs to effectively target services and spending.
The report makes nine recommendations designed to support a coherent system of mental health services where all young people can access appropriate and consistent care when and where they need it.
Young peoples’ mental health and well-being is an ongoing focus for the Office. The Auditor-General will closely monitor government agencies’ work in this area, including following up on the report's recommendations.
Auditor-General.
Meeting the mental health needs of young
New Zealanders
Office of the Auditor-General
Why we did this work
Mental health is the most significant health issue facing young New Zealanders today. Investing in early intervention services and support can help young people experiencing mental health concerns achieve their potential and reduce the lifelong human and economic impacts of mental illness.
The government spends about $2 billion annually on mental health services. In the 2019 Wellbeing Budget, young people were one of the groups the Government’s $1.9 billion investment into mental health and well-being focused on.
We wanted to know whether this government spending was making a difference for young people aged 12 to 24 years.
Why we did this work
Mental health is the most significant health issue facing young New Zealanders today. Investing in early intervention services and support can help young people experiencing mental health concerns achieve their potential and reduce the lifelong human and economic impacts of mental illness.
The government spends about $2 billion annually on mental health services. In the 2019 Wellbeing Budget, young people were one of the groups the Government’s $1.9 billion investment into mental health and well-being focused on.
We wanted to know whether this government spending was making a difference for young people
aged 12 to 24 years.
What we found
- Despite their high level of need, many young people in distress cannot access mental health support when they need it.
- The $1.9 billion investment has increased the availability of primary (or first contact) mental health support for young people with mild to moderate mental health needs. However, young people in need of specialist mental health support are waiting longer to access specialist care.
- Government agencies do not currently understand enough about the nature and scale of young people’s mental health needs. Without this understanding, agencies cannot be confident that the services they design, provide, or fund meet the greatest needs of young people.
- Collaborative approaches by agencies and strong system leadership is critical to meeting the needs of young people. However, agencies remain too focused on agency-specific programmes or services at the expense of working together to ensure that young people and their whānau are at the centre of the system of support and care.
- Young people are often expected to fit into services and models of care designed for older age groups. Many of the barriers young people face when accessing mental health support can be overcome if this support is tailored to the specific needs of young people. Involving young people in the design and delivery of mental health services will help meet these needs.
- The mental health and addiction workforce is under considerable strain because of capacity pressures across the sector. Sustained effort will be needed to fill workforce gaps by increasing the local education and training pipelines for new and existing types of mental health and addiction practitioner.
Figure 1
Average number of days waiting for first, second, and third appointments for 12-19 year-olds referred to district health board specialist mental health services
What next?
We have made nine recommendations designed to support a coherent system of mental health services where all young people can access appropriate and consistent mental health care when and where they need it.
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Figure 2: Percentage of 15-24 year-olds who reported having experienced high or very high levels of distress in the past four weeks
Our recommendations
Our recommendations are designed to support the creation of a coherent system of mental health services so that all young people can access appropriate and consistent mental health care when and where they need it. This will require strong government leadership and co-ordinated approaches from agencies.
We recommend that:
- the Ministry of Health prioritise work to understand the prevalence of mental health conditions in the population;
- Te Whatu Ora work with the Ministry of Health, the Ministry of Education, Oranga Tamariki, and other agencies as relevant to evaluate the effectiveness of, and develop consistent guidelines for, the delivery of youth integrated primary health services;
- the Ministry of Education ensure that sufficient data is collected to understand the effectiveness of the school guidance counselling model for all students;
- Te Whatu Ora and the Ministry of Education work with other agencies as relevant to better align the objectives and operations of their school-based health and well-being services;
- Te Whatu Ora, the Ministry of Education, Oranga Tamariki, and the Department of Corrections consider whether appropriate mechanisms for youth voice and participation are built into the design, delivery, and governance of new and existing mental health and well-being services for young people;
- Te Whatu Ora, the Ministry of Education, Oranga Tamariki, and the Department of Corrections ensure that outcomes data is collected for all mental health and well-being services accessed by young people;
- Te Whatu Ora work with the Ministry of Health, the Ministry of Education, Oranga Tamariki, the Ministry for Social Development, and the Department of Corrections to ensure that integrated care pathways are in place so that at-risk groups of young people experiencing mental health concerns can access consistent and continuous care as they enter, move between, and leave the care of services;
- the Ministry of Health work with Te Whatu Ora, the Ministry of Education, Oranga Tamariki, the Department of Corrections, and other agencies as relevant to strengthen its mental health and addiction system leadership role, and to prioritise the development of a cross-agency implementation plan for Kia Manawanui with clear agency roles and responsibilities; and
- Te Whatu Ora and the Ministry of Health work with the Ministry of Education, Oranga Tamariki, the Department of Corrections, and other agencies as relevant to prioritise the development of a national mental health and addiction workforce plan.
Office of the Auditor-General
Collective effort will make real change - Auditor General’s recommendations on mental health support
Recommendations in the achieving the mental health needs of young New Zealanders report released last week by the Auditor General show there is a long way to go to ensure every young person who needs support can access it.
“We’ve got to do everything we can to ensure rangatahi and young people get support with mental health issues in a timely and appropriate way. These recommendations provide further impetus for change,” said Karen Orsborn, Chief Executive of Te Hiringa Mahara | Mental Health and Wellbeing Commission.
“While many reports and recommendations have come before this one, we are not seeing these translated into action.
“We see this as an opportunity for the first Minister for Mental Health to make a real difference. The recommendations call for system leadership. For this to become a reality the Minister could create a sense of urgency and drive improvements that will deliver for rangatahi and young people.”
“The emphasis on the agencies that plan and fund services working together is the key to untapping collective effort that will make real change.”
The Auditor General highlights how tailoring support to the specific needs of young people helps overcome the barriers accessing services faced by young people.
“Services have got to be where young people commonly spend time, and designed to be accessible, youth appropriate and holistic. To get the best outcomes, young people need to lead in the design and delivery of services that are tailored for them,” Ms Orsborn said.
This report comes at a time when rangatahi and young people are experiencing higher rates of mental distress and longer wait times to access support. In the Commission’s recent Briefing to the Incoming Minister, we pointed to the need to expand access to youth mental health and addiction services so no matter where people live or what their ethnicity or gender is, people can get the help they need.
“We know that Māori, rainbow young people, and young people in state care have higher rates of distress yet can’t always get access to the care they need. We need to see this change,” Ms Orsborn said.
The findings of the Auditor General mirror conclusions we have reached, and those of the Cross-Party Mental Health and Addiction Wellbeing Group whose report Under One Umbrella, released in September 2023, focused on integrated mental health, alcohol and other drug use care for young people.
“Te Hiringa Mahara will continue to advocate for changes that improve access to and quality of mental health care for young people and their wellbeing, and we’ll keep monitoring how things are going,” Ms Orsborn said.
“It is very encouraging to see other agencies taking up these issues and considering how they contribute. We welcome the report from the Auditor General and are very pleased to see he has committed to following up.”
Karen Orsborn, Chief Executive of Te Hiringa Mahara | Mental Health and Wellbeing Commission.
Pigeon Post News, Richmond. |
