A ‘rolling crisis’ in youth mental healthcare sees a growing number of children and teenagers in distress waiting weeks for help.
When Hiran Thabrew goes to work each day at Starship Hospital he knows his young patients aren’t always able to get the help they need.
“You’re trained to do things that work, and that are safe to look after people. Then you turned up in a situation where you’re working in a very crisis-driven reactive manner and not being able to provide the care that people deserve,” says the child psychiatrist and paediatrician.
Has Labour’s $2 billion investment in mental health since 2019 made any tangible difference to his work or the lives of his patients?
“I wish I could say that it had, but I don't think I've seen the evidence of that.”
In fact, he believes the mental health system is so under-resourced and strained it is actually making patients sicker. The ones most affected by these failures are children, says Thabrew, who is also the national chair of the Royal Australian and New Zealand College of Psychiatrists.
Read more from RNZ’s investigation into spending on mental healthcare:
* What ever happened to the $2 billion that was poured into mental healthcare?
* The huge mental health scheme gives with one hand, takes with another
* More patients, nowhere near enough doctors - the mental health workforce problem that won’t go away
A ‘rolling crisis’
Youth mental health has been declining for a decade and it only got worse during the pandemic, says Thabrew.
“We had a 50 percent increase in the rate of young people presenting to hospital with self harm. And that’s just the tip of the iceberg because most young people who self harm won’t come near a hospital.
“We also had a tripling in the rate of eating disorders within inpatient settings as well.
“Now, we are seeing the financial consequences of the pandemic playing out which are affecting families and then having a direct impact on young people.”
Mental Health Foundation chief executive Shaun Robinson describes it as a “rolling crisis in youth mental health.”
“I was incredibly frustrated when the figures came out last year that 25 percent of young people experienced significant distress.
“But there was zero urgency in Wellington about this. I was told they needed to analyse the data some more.”
According to Thabrew, it’s now harder for children in severe crisis to get help from secondary mental health services and many young patients won’t even be seen unless they’ve attempted suicide or are an immediate risk to others.
“The thresholds for access to community mental health teams have gone up significantly. There are long waits for therapy.”
The number of days children in crisis were waiting to see a specialist mental health service has doubled in some areas between 2018 and 2022, figures released to Parliament show.
More recent data suggests the situation has not improved much in the last year.
Te Whatu Ora figures released to RNZ show the proportion of under 25-year-olds having to wait more than eight weeks for their first specialist mental health appointment climbed to 12 percent in the year to June 2023.
The table below shows the number of specialist mental health referrals for under 25-year-olds that had a first 'in-scope activity' within the specified wait times between July 2020 – June 2023.
Thabrew says the rise in self harm and eating disorders amongst older children means they are taking up more of the resources, often at the expense of younger children.
“Since the pandemic, rates of access for children and infants have dramatically declined. A lot of work for particularly children with more moderate issues which could be done in those settings is not being done due to lack of capacity,” says Thabrew.
How the government responded
Andrew Little, who was health minister between December 2020 and February overseeing the bulk of Labour’s 2019 $1.9bn mental health package, rejects Thabrew’s view that the mental health system is making patients worse.
“That’s an assertion and it’s not backed up. I haven’t heard any evidence from that person.
“For a senior psychiatrist to make that sort of assertion suggests to me that they are not looking at the whole system, they're focused on their little patch.”
Little points to modest improvements in the rate of suspected suicide in each of the last three years.
But Robinson says it’s “concerning” if Little is pinning its success to the suicide rate.
“He’s grabbed pretty much the only mental health stats that didn’t get worse under Labour. The suicide rate did not fall by much. If they spent over $1.9bn to achieve that, I’d say that’s incompetent.”
There are also complex reasons why the rate has fallen a bit between 2020 and 2023, and many had nothing to do with Labour policy.
“Covid had a positive effect on suicide because vulnerable people were around their whanau 24/7 during lock downs. It’s also well researched that mental health improves during a crisis as people come together in a common cause and those normally more on the outside feel part of the community. This effect fades and the aftermath and long tail endures. We may well be facing that dangerous phase now,” says Robinson.
Aotearoa still has one of the highest youth suicide rates in the OCED.
Only a fraction of Labour’s historic $2b mental health package has gone into youth services, especially at the acute end.
It didn’t include any specific funding for school counselling services, though it did provide $19m to boost existing health services in decile 1-5 schools and wellbeing promotion for more than half a million primary and intermediate school kids.
A further $90m came from Budget 2022 to expand the Mana Ake programme, set up after the Canterbury earthquakes, to five more regions giving 10,500 children access to psychologists, counsellors and social workers by the end of 2024.
An extra $1m went to youth health services during the pandemic, particularly in Auckland which was hardest hit by extended lockdowns.
Little also cites the flagship ‘Access and Choice’ programme, which includes services targeted at youth, as making a difference.
“The feedback I’ve had from GPs, from community organisations who are health improvement practitioners and health coaches, is that they are making a significant difference. And they tell me, particularly for young people - late teens to mid 20s - that service is making a significant difference.”
An October Cabinet paper presented to outgoing health minister Ayesha Verrall says just over a fifth of sessions provided by health coaches and health improvement practitioners via the scheme were taken up by 12-24 year olds.
The same paper warns that the $100m from Budget 2022 allocated to specialist mental health in secondary care was being put at risk by “ongoing recruitment challenges and workforce shortages”.
Eating disorder services, community-based crisis services and child and adolescent mental health were all services requiring “significant attention or action,” it says.
Clinical psychologist Dougal Sutherland worries these acute care services have suffered at the expense of money pouring into primary mental health, particularly for young people.
“When I first started working in Youth Mental Health in the 2010s it was if you were a young person who was engaging in self harming that was almost seen as an urgent criteria that will get you in very quickly.
“Nowadays, that in itself was probably not enough to get you seen by a DHB or a Te Whatu Ora-level secondary mental health service. So the criteria that used to give access just becomes narrower and narrower as services try to figure out how they can cope with this huge tidal wave coming with … the workforce departing to work in other areas.”
Photo: RNZ
What it means for young people
Te Whatu Ora admits long wait times are having an impact on children and their families.
“Wait times are longer than we would like and are due to a range of issues including increasing demand for services and workforce shortages in some areas.
“However, we want to emphasise that when a young person who needs acute care for mental health issues is referred to a specialist service, they are always prioritised and seen urgently,” Mental Health and Addiction Hospital and Specialist Services lead Karla Bergquist says in a statement.
Better services are coming, she says, but will take time to implement.
Budget 2022 included $18.7m for specialist child and adolescent mental health services over four years, which Bergquist says will result in 1300 more patients being seen each year by the end of 2025/26.
In the meantime, the inability to get children into specialist mental health services quickly is creating pressure on schools, says New Zealand Counsellors Association president Sarah Maindonald.
She says school counsellors are “absolutely oversubscribed” and many children are waiting months to be seen.
“In some schools there is one counsellor for one thousand students. There’s one school that had one for two thousand students.
“Schools are seeing more children needing to be referred to specialist services but cannot get them in because they’re under the pump.
“Often kids even with very high needs are having to wait, so we're having to hold a lot of risk.”
The association wants the government to fund one counsellor for every 400 students, at a cost of $66m.
“I think children have to be the priority.”
The new Mental Health Minister Matt Doocey says the National-led coalition government will set up a mental health innovation fund to fund non-governmental organisations to carry out the work the public sector cannot.
“We've made it very clear that we need to get more resources out of Wellington, to the front line,” Doocey says.
The coalition agreement has already pledged $6m to Gumboot Friday, which provides free counselling sessions for young people, despite official advice to previous Health Ministers that the Mike King-founded programme did not meet funding criteria.
Doocey has a different view.
“I challenge that assumption that Gumboot Friday is not a good program to invest in. I have heard from many Kiwis around the country who want the investment to go into Gumboot Friday, and so we are working with the officials to ensure that happens.”