Te Hiringa Mahara

Te Hiringa Mahara

Mental Health and Wellbeing Commission
Agency overview
Formed	February 2021
Preceding agency	Mental Health functions of the Health and Disability Commissioner, including the role of Mental Health Commissioner
Jurisdiction	New Zealand
Minister responsible	Ayesha Verrall, Minister of Health
Agency executives	Karen Orsborn, Chief Executive Hayden Wano, Board chair
Parent agency	Ministry of Health
Website	www.mhwc.govt.nz

Te Hiringa Mahara, formerly known as the Mental Health and Wellbeing Commission, is a New Zealand independent Crown entity that opened on 9 February 2021 which focuses on promoting mental health and wellbeing as well as providing leadership to the sector. It was established by the Sixth Labour Government with the passage of the Mental Health and Wellbeing Commission Act 2020.

Te Hiringa Mahara was created after a 2018 inquiry into mental health and addiction in New Zealand recommended the establishment of a Commission to provide oversight and monitoring of the mental health sector. The findings of this inquiry, including the recommendations around the establishment of the Commission, were detailed in the report He Ara Oranga. In December 2020, Minister of Health Andrew Little announced Hayden Wano as chair of the Commission's board. The other board members are Professor Sunny Collings, Kevin Hague, Taimi Allan, Dr Jemaima Tiatia, Tuari Potiki and Alexander El Amanni.

The roles and duties of Te Hiringa Mahara, as set out in the Mental Health and Wellbeing Commission Act 2020, are to:

1. Assess and report on the wellbeing and mental health of people in New Zealand, as well as what affects people’s health in those regards.
2. Analysis and publish findings on the adequacy of how people approach mental health and wellbeing in New Zealand, as well as how that can be improved for greater effectiveness.
3. Promote cross-agency alignment and connection for entities involved with mental health and wellbeing.
4. Support communities with histories of distress or addiction.

Te Hiringa Mahara has released a series of reports based on their duties. A recent collection of small reports focused on Covid-19 effects.

Formation

Mental health in New Zealand tends to follow the trends of mental health in other developed countries. While the suicide rate is comparable with similar countries, the youth suicide rate is much higher. In the mid-1990s, the suicide rate for people aged 15–34 was over 25 per 100,000. By 2015 the rate had fallen to 16.9 per 100,000, still high compared to similar Nations. Many social issues including child poverty or employment are among the contributing factors to high rates of suicide.

New Zealand’s first mental Health Commission was established by the Fourth National Government through the Mental Health Commission Act 1998. Over time, the Commission's powers, scope, and funding were substantially reduced. It was disestablished in 2012, with the position of Mental Health Commissioner subsumed into the Office of the Health and Disability Commissioner.

The Commission operates as an Independent Crown Entity, independent of government policy but with Ministerial oversight. The Commission provides system-level oversight of mental health and well-being in New Zealand and hold the government to account for the mental health and wellbeing of the people of New Zealand.

In December 2020, the Chair and members of the Board were announced by the then Minister of Health, Andrew Little. Appointments were made in accordance with the Crown Entities Act 2004. The Commission is currently chaired by Hayden Wano, and the current board members are Professor Sunny Collings, Kevin Hague, Taimi Allan, Dr Jemaima Tiatia, Tuari Potiki and Alexander El Amanni.

Functions

The main function of the Mental Health and Wellbeing Commission is to assess, monitor and report on the mental health and well-being of the New Zealand people. They are also required to make recommendations on how mental health and addiction services can be improved. The Commission has two main frameworks that they use as instruments to try and achieve this goal. These are the He Ara Āwhina and He Ara Oranga frameworks. The use of these particular frameworks allows for the achievement of their other fundamental function which is to have particular regard for the experience and outcome of Maori by maintaining the principles of the Treaty of Waitangi.

The He Ara Āwhina (pathways to support) framework was developed by the Initial Mental Health and Wellbeing Commission. The final version was published on June 30th 2022. The main function of this framework is to find out what an ideal system would look like, and then use this criterion to assess and monitor services. There are two main perspectives highlighted in this framework which are Te Ao Māori (created by Māori for Māori) and shared (for everyone). These perspectives work together to try and describe what the ideal mental health and addiction system looks like. Alongside this framework are two other groups that were established to provide advice and further oversite on methods, measures, data sources and data gaps. These groups are the Expert Advisory Group (EAG) and the Technical Advisory Network (TAN).

He Ara Oranga's well-being outcomes framework is very similar to He Ara Āwhina. Their main goals and values are the same. The only notable difference is that He Ara Oranga focuses more on measuring the well-being of New Zealanders. The two perspectives previously mentioned also apply here. These two frameworks were created to work in partnership, as it is argued that well-being requires a collaborative approach. This framework was also specifically designed to reflect He Ara Oranga, the Government Inquiry into Mental Health and Addiction.

Te Hiringa Mahara’s Board Head Hayden Wano stated that the name change was done to reflect Te Hiringa Mahara’s principles and its obligations under Te Tiriti o Waitangi. The name change was important to show Te Hiringa Mahara’s goal as the kaitiaki of mental health and wellbeing in New Zealand.

Reports

Te Rau Tira Wellbeing Outcomes Report 2021

On December 8th, 2021, the Mental Health Commission released its first report on wellbeing outcomes. This report details wellbeing results from a Māori perspective and a shared perspective that encompasses both Māori and non-Māori; the He Ara Oranga Wellbeing Outcomes Framework is used to advise the report. Te Kupenga, the General Social Survey, and the national health survey were used to develop the data indicators. Data indicators covered safety, health, financial security, discrimination, and culture. The Commission concluded that most people in New Zealand have positive wellbeing; however, specific marginalised communities are experiencing worse wellbeing outcomes.

Wellbeing from the Māori perspective shows multiple positive movements in economic growth, health, and life satisfaction. From 2013 to 2018, the Māori economy experienced a 60% growth, with an increase in the value of settlement assets. Notably, 77% of Māori rated their physical health highly, and an overall improvement in life expectancy is seen. Māori adults generally felt satisfied with life, with an average life satisfaction rating of 7.8 out of 10. Also, many reported feeling in control of their lives. However, mental health is lower for youth, with only 49% describing good wellbeing. Furthermore, 53 % reported experiencing depression symptoms, and 45% reported suicidal thoughts in the past year. For the Commission, young Māori's mental health and educational experiences remain a concern.

From a shared perspective, the wellbeing outcomes are primarily positive, but there is more variation between different communities. For instance, 66% of participants reported high levels of trust, whereas Māori and Pacific people have lower trust levels. Most adults reported good health (87%) and positive mental wellbeing (78%); however, people from marginalised groups were likelier to rate lower levels, such as rainbow community, disabled people, and prisoners. For the general population, youth show increased psychological distress, with 32% of young people feeling they did not receive adequate support during a difficult time.

The report findings prompted the Commission to create goals to improve wellbeing in New Zealand. These include advocating for disadvantaged groups, higher-quality and timely data indicators, and implementing the government's mental health pathway to benefit all communities.

This monitoring report is the first of its kind and is a reconstructed model of the previous Mental Health Commissioner’s framework. It is a transitional report that serves as a temporary substitute for the He Ara Āwhina (Pathways to Support, a monitoring framework that is currently in the process of development. The Commission desires to see advancements in the provision of services for addiction and mental health in order to transform the system in the direction of He Ara Oranga’s vision.

Between 2016 to 2017 and 2020 to 2021, Te Huringa evaluated and provided transparency on how well mental health and addictions programmes are performing. This has helped measure what needs improvements and how this has changed over time. There is a demand for more government intervention in terms of transforming the mental health and addiction system funded by the public health system post-pandemic. These encompass both primary mental health services and addiction services as well as specialised mental health and addiction services.

According to the report, there hasn’t been much proof of service improvement in the last five years, and the strain on specialized services is an area that requires more attention. Additionally, wait times for mental health services have not diminished, while those for addiction services have increased.

Despite the substantial investment of $883 million in addiction and mental health services, these ongoing challenges have served as a prompt to monitor whether system and service efficiency is improving simultaneously with higher spending. Although, the difficulty in finding and keeping the necessary workforce influences the understandable delay between the commissioning of new services and their implementation.

The findings of this report are accordant with most of the Commission’s previous research, with a specific lens on the necessity to prioritise marginalised groups such as Māori, Pasifika, and youth in the workforce and services development. The measures in this report mostly pertain to services, especially specialized mental health services, where there hasn't been a lot of necessary investment.

Access and Choice Programme Report 2022

The Access and Choice Programme is one of the 2019 Wellbeing Budget's major initiatives, and $664 million has been set aside for its implementation over a five-year period, from 2019–2024. The programme set aside $48.15 million for system enablers, $99.7 million for workforce development, and $516.4 million for four new service categories (Kaupapa Māori, Pacific, Integrated Primary Mental Health and Addiction (IPMHA), and Youth Services). An update on the Access and Choice program's implementation through to June 30, 2022 is provided in this report, giving readers a chance to assess the state of development.

17 additional Kaupapa Māori services have been established, totalling to 29 Kaupapa Māori services spread over 19 districts. To encourage the growth of Pacific services, more concentrated attention is required. There are substantial workforce deficits in Pacific services, and patient and session counts have not increased. Across 7 districts, there are 9 Pacific services. Kaupapa Māori, Pacific, and Youth services were used by 19,250 people in 2022, and 77,000 people are anticipated to use them by 30 June 2024.

In 18 out of 20 districts, there are 23 youth services. To guarantee that all young people in New Zealand have access to services, it is imperative that services be expanded in the remaining two districts. 21% of all access and service decisions see people between the ages of 12 and 24.

Individuals who appear to be experiencing addiction, gambling harm, or substance abuse do not appear to be utilising IPMHA; therefore, the way services are provided needs to be reviewed. This should be done with the help of those who have firsthand experience. There are 364 IPMHA services spread out over 19 districts, and just under 50% of the population who are enrolled with a GP can access them.

The landscape of primary and community mental health and addiction care is changing as a result of the Access and Choice Programme. Only some of the more general proposals from He Ara Oranga are addressed in this programme, which urges continued effort and commitment in order to fully realise the report's intended transformation.

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