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l health and addiction seriously
# Theme / recommendation
Expand access and choice
Expand Access
1 Agree to significantly increase access to
publicly funded mental health and
addiction services for people with mild to
moderate and moderate to severe mental
health and addiction needs.
2 Set a new target for access to mental
health and addiction services that covers
the full spectrum of need.
3 Direct the Ministry of Health, with input
from the new Mental Health and
Wellbeing Commission, to report back on
a new target for mental health and
addiction services.
4 Agree that access to mental health and
addiction services should be based on
need so:
· access to all services is broad-based
and prioritised according to need, as
occurs with other core health services
· people with the highest needs
continue to be the priority.
Increase choice of services
5 Commit to increased choice by
broadening the types of mental health
and addiction services available.
6 Direct the Ministry of Health to urgently
develop a proposal for Budget 2019 to
make talk therapies, alcohol and other
drug services and culturally aligned
therapies much more widely available,
informed by workforce modelling, the New
Zealand context and approaches in other
countries.
Facilitate co-design and implementation
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Response Rationale for response
Accept · The Government supports expanding
both access and choice of mental health and
addiction responses that are appropriate
across the needs spectrum and the life
course.
· Measuring increases in access will be
Accept in important to track progress; however, while
principle this can tell us how many people are
accessing treatment, it will not capture how
well services are delivered and whether
Accept in anyone is better off.
principle
· Longer-term transformation planning will
consider a mix of measures to improve both
access and outcomes.
· The involvement of a new Mental Health
Accept and Wellbeing Commission is contingent on
decisions around its establishment, timing
and scope.
· The Government supports broad access
to mental health and addiction services
appropriate to people’s levels of need, and
acknowledges the importance of
simultaneously maintaining services for
those with the highest need.
Accept · Current services do not work well for all
New Zealanders. The Government supports
expanding both access and choice of mental
health and addiction responses that are
Accept appropriate across the needs spectrum and
the life course.
· The Government is committed to the
expansion of talk therapies, alcohol and
other drug (AOD) services and culturally-
aligned therapies. These types of services
are supported by a strong evidence base
and will be crucial to improving equity for
Māori, as well as Pacific peoples and other
population groups that continue to
experience poor outcomes.
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# Theme / recommendation
7 Direct the Ministry of Health, in
partnership with the new Mental Health
and Wellbeing Commission (or an interim
establishment body) to:
· facilitate a national co-designed
service transformation process with
people with lived experience of mental
health and addiction challenges, DHBs,
primary care, NGOs, Kaupapa Māori
services, Pacific health services, Whānau
Ora services, other providers, advocacy
and representative organisations,
professional bodies, families and whānau,
employers and key government agencies
· produce a cross-government
investment strategy for mental health and
addiction services.
8 Commit to adequately fund the national
co-design and ongoing change process,
including funding for the new Mental
Health and Wellbeing Commission to
provide backbone support for national,
regional and local implementation.
9 Direct the State Services Commission to
work with the Ministry of Health to
establish the most appropriate
mechanisms for cross-government
involvement and leadership to support the
national co-design process for mental
health and addiction services.
Enablers to support expanded access and choice
10 Agree that the work to support expanded
access and choice will include reviewing
and establishing:
· workforce development and worker
wellbeing priorities
· information, evaluation and monitoring
priorities (including monitoring outcomes)
· funding rules and expectations,
including DHB and primary mental health
service specifications and the mental
health ring fence, to align them with and
support the strategic direction of
transforming mental health and addiction
services.
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Response Rationale for response
Accept in · Co-design can be an effective approach
principle for incorporating the voices of stakeholders
into transformation; however, a one-off co-
design process may not be sufficient to
deliver the change that is envisioned.
· Meaningful partnership and ongoing
participation with stakeholders to design and
implement change is fundamental to a
transformed approach. This must be
supported by sufficient funding,
communication and engagement planning,
and strong leadership.
· A cross-government investment strategy
is necessary for a cohesive whole-of-
government response, and will support a
coordinated approach to prioritisation,
phasing and implementation.
· The involvement of a new Mental Health
and Wellbeing Commission is contingent on
decisions around its establishment, timing
Accept and scope.
Accept in
principle
Accept in
principle
· Workforce development is critical to
enable expanded access and choice of
services. Currently, workforces are under
considerable pressure and will ultimately be
both a key enabler and constraint for
transformation.
Accept
· Monitoring and evaluation of outcomes is
essential to ensure transformation is
Accept increasing access and choice and improving
outcomes, and must be supported by fit-for-
purpose, real-time information collection and
sharing.
· Funding rules and expectations should
Accept in enable more integrated planning and support
principle more balanced funding across the spectrum
of need.
· These elements have been prioritised for
consideration through longer-term
transformation planning.
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# Theme / recommendation
11 Agree to undertake and regularly update
a comprehensive mental health and
addiction survey.
12 Commit to a staged funding path to give
effect to the recommendations to improve
access and choice, including:
· expanding access to services for
significantly more people with mild to
moderate and moderate to severe mental
health and addiction needs
· more options for talk therapies,
alcohol and other drug services and
culturally aligned services
· designing and implementing
improvements to create more people-
centred and integrated services, with
significantly increased access and choice.
Transform primary health care
13 Note that this Inquiry fully supports the
focus on primary care in the Health and
Disability Sector Review, seeing it as a
critical foundation for the development of
mental health and addiction responses
and for more accessible and affordable
health services.
14 Agree that future strategies for the
primary health care sector have an
explicit focus on addressing mental health
and addiction needs in primary and
community settings, in alignment with the
vision and direction set out in this Inquiry.
Strengthen the NGO sector
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Response Rationale for response
Accept in · The Government acknowledges the
principle importance of having accurate,
comprehensive, up-to-date data on the
prevalence, population need and impact of
mental health and addiction issues, and on
the access to and effectiveness of services.
This data is crucial to inform the optimal mix
and balance of responses, and to establish a
baseline from which to measure progress.
· Further consideration is needed about
other ways, in addition to a regular national
mental health and addiction survey, to
achieve the intent of this recommendation,
including opportunities to better share and
leverage existing surveys and data sets.
· Realising the vision of mental wellbeing
for all will require bold funding commitments,
which will need to be phased over multiple
years.
· Commitment to a staged funding path will
Accept
embed the long-term view needed to give
effect to the transformation called for by He
Ara Oranga.
· Phasing of investment and
Accept implementation will need to take into account
current system constraints, including
workforce capacity and capability, and the
system’s capacity for change, as well as
financial constraints. These will be
considered in the longer-term transformation
Accept
planning.
Accept · The Government is committed to
expanding and enhancing mental health and
addiction responses in primary and
community settings, enabling broad access
to services appropriate to people’s levels of
need.
· The system settings, including funding
arrangements, needed to give effect to
Accept in broad-based access to mental health and
principle addiction support (prioritised by need) will be
considered as part of the current Health and
Disability System Review.
· Future primary health care strategies will
be informed by the outcomes of the Health
and Disability System Review.
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# Theme / recommendation
15 Identify a lead agency to:
· provide a stewardship role in relation
to the development and sustainability of
the NGO sector, including those NGOs
and Kaupapa Māori services working in
mental health and addiction
· take a lead role in improving
commissioning of health and social
services with NGOs.
Enhance wellbeing, promotion and prevention
Take a whole-of-government approach to wellbeing, prevention and social determinants
16 Establish a clear locus of responsibility for Accept in · The Government as a whole has a
social wellbeing within central
government to provide strategic and
policy advice and to oversee and
coordinate cross-government responses
to social wellbeing, including:
· tackling social determinants that
impact on multiple outcomes and that
lead to inequities within society
· enhancing cross-government
investment in prevention and resilience-
building activities.
17 Direct the State Services Commission to
report back with options for a locus of
responsibility for social wellbeing,
including:
· its form and location (a new social
wellbeing agency, a unit within an existing
agency or reconfiguring an existing
agency)
· its functions.
Facilitate mental health promotion and prevention
18 Agree that mental health promotion and
prevention will be a key area of oversight
of the new Mental Health and Wellbeing
Commission, including working closely
with key agencies and being responsive
to community innovation.
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Response Rationale for response
Accept in · Several agencies across Government
principle play a role in supporting and guiding
improvements in the commissioning of social
services, however no single agency currently
has stewardship responsibility for the non-
government organisation (NGO) sector.
· There are opportunities to improve
commissioning and have a more joined up
cross-government approach for NGO
services through enhancing work currently
underway by the Social Wellbeing Board.
· This includes the Ministry of Business,
Innovation and Employment’s tools to
support streamlined contracting with NGOs,
and opportunities for the Ministry of Health to
work more closely with the NGO-district
health board Partnership Group.
principle responsibility for social wellbeing and
addressing the social determinants of mental
health and wellbeing. We have committed to
embedding a wellbeing approach in the way
we operate.
· The Government does not support
introducing a new specific locus of
responsibility for social wellbeing at this
stage, as improving wellbeing should
underpin all Government activities, as
demonstrated by our approach to the 2019
Wellbeing Budget.
· Existing mechanisms and infrastructure
can be used to facilitate improved agency
Do not accept and ministerial collaboration. For example,
the Social Investment Agency uses data and
insights to support strategic cross-
government advice on how we can better
support people’s wellbeing. These existing
options should be exhausted ahead of any
machinery of government changes.
· Longer-term transformation planning will
consider how best to measure and
incentivise cross-government efforts and
investment to support social wellbeing and
cross-sector outcomes.
Accept in · The Government acknowledges that
principle there are missing components in the
continuum of care, as highlighted in He Ara
Oranga, and supports a greater focus on
mental health promotion and prevention.
· Taking a strategic approach to improve
coordination and quality of health promotion
and preventive activities will maximise
positive long-term outcomes across health
and social sectors. This will be considered
alongside recommendation 7 to produce a
cross-government investment strategy and
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# Theme / recommendation Response Rationale for response

related work, for example the development of
19 Direct the new Mental Health and Accept in the Child and Youth Wellbeing Strategy.
Wellbeing Commission to develop an principle
investment and quality assurance · The implementation of these activities as
strategy for mental health promotion and recommended are contingent on decisions
prevention, working closely with key around establishment, timing and scope of a
agencies. Mental Health and Wellbeing Commission.
Place people at the centre
Strengthen consumer voice and experience in mental health and addiction services
20 Direct DHBs to report to the Ministry of Accept in · The Government is committed to placing
Health on how they are including people principle people at the centre of mental health and
with lived experience and consumer addiction services.
advisory groups in mental health and
addiction governance, planning, policy · Inclusion of consumer voice in services
and service development decisions. and resource development is currently
21 Direct the Ministry of Health to work with Accept inconsistent (eg, variation exists in how
people with lived experience, the Health DHBs resource consumer advisors).
Quality and Safety Commission and Addressing this will provide clarity and
DHBs on how the consumer voice and consistency across agencies and will be
role can be strengthened in DHBs, crucial to understanding progress in
primary care and NGOs, including transforming our approach.
through the development of national
resources, guidance and support, and · Renewed prominence of consumers’
accountability requirements. rights, including the rights to be treated with
22 Direct the Health and Disability Accept in respect, to dignity and independence, and to
Commissioner to undertake specific principle be fully informed, will raise awareness and
initiatives to promote respect for and embed people’s rights in their care. This is
observance of the Code of Health and aligned with the New Zealand Disability
Disability Services Consumers’ Rights by Strategy 2016–2026.
providers, and awareness of their rights
on the part of consumers, in relation to
mental health and addiction services.
Support families and whānau to be active participants in the care and treatment of their family
member
23 Direct the Ministry of Health to lead the Accept · Family and whānau form an important
development and communication of support network for people with mental
consolidated and updated guidance on health and addiction needs. Evidence
sharing information and partnering with suggests people who stay connected to their
families and whānau. supports have better outcomes.

24 Direct the Ministry of Health to ensure the
updated information-sharing and
partnering guidance is integrated into:
· training across the mental health and
addiction workforce
Accept · Guidance on sharing information and
partnering with families and whānau will
enable health care providers to communicate
appropriately whilst upholding the rights
(including privacy rights) of the person with
mental health or addiction needs.

· all relevant contracts, standards, · The Government acknowledges the

specifications, guidelines, quality importance of the roles of the Privacy
improvement processes and Commissioner and the current Mental Health
accountability arrangements. Commissioner in this area, and other key
stakeholders, and will continue to involve
them in ongoing work in this area.
Support the wellbeing of families and whānau

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# Theme / recommendation
25 Direct the Ministry of Health, working with
other agencies, including the Ministry of
Education, Te Puni Kōkiri and the Ministry
of Social Development, to:
· lead a review of the support provided
to families and whānau of people with
mental health and addiction needs and
where gaps exist
· report to the Government with firm
proposals to fill any gaps identified in the
review with supports that enhance
access, affordability and options for
families and whānau.
Take strong action on alcohol and other drugs
26 Take a stricter regulatory approach to the
sale and supply of alcohol, informed by
the recommendations from the 2010 Law
Commission review, the 2014 Ministerial
Forum on Alcohol Advertising and
Sponsorship and the 2014 Ministry of
Justice report on alcohol pricing.
27 Replace criminal sanctions for the
possession for personal use of controlled
drugs with civil responses (for example, a
fine, a referral to a drug awareness
session run by a public health body or a
referral to a drug treatment programme).
28 Support the replacement of criminal
sanctions for the possession for personal
use of controlled drugs with a full range of
treatment and detox services.
29 Establish clear cross-sector leadership
and coordination within central
government for policy in relation to
alcohol and other drugs.
Prevent suicide
30 Urgently complete the national suicide
prevention strategy and implementation
plan and ensure the strategy is supported
by significantly increased resources for
suicide prevention and postvention.
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Response Rationale for response
Accept in · Family inclusive practices aim to
principle collaboratively support people seeking
mental wellness, and have a growing
evidence base. There are opportunities to
partner with providers of Whānau Ora
services, Kaupapa Māori services and
Pacific-led services to expand whānau-
centred approaches.
· Longer-term transformation planning will
consider the existing landscape of support
provided to families and whānau of people
with mental health and addiction needs and
gaps.
Further · Harmful use of alcohol and other drugs
consideration has significant, widespread impacts on
needed individuals, families, whānau and
communities.
· The Government agrees with the intent of
reducing harm from alcohol and other drugs;
Further however, further consideration is needed as
consideration to how best to give effect to this, building on
needed work already underway.
· The Government has committed to shift
to a health-based approach and supporting
Further Police discretion in prosecution for
consideration possession for personal use; to hold a
needed binding referendum on Cannabis
Legalisation; and to increase funding for drug
Accept and alcohol responses.
· Given the significant role that alcohol and
other drugs play in people’s wellbeing, a
strong cross-sector forum dedicated to the
advancing AOD policy is critical.
· There are existing mechanisms and
arrangements that can be enhanced to
provide cross-sector leadership and
collaboration in relation to AOD policy.
Accept · A new suicide prevention strategy and
implementation plan is needed to drive a
reduction in suicide rates, particularly for
population groups such as Māori, men, and
youth, who currently experience substantially
higher suicide rates.
· The Minister of Health will report back to
the Cabinet Social Wellbeing Committee with
a draft strategy and plan later this year.
· The strategy will outline our proposed
approach to preventing suicide in New
Zealand and the implementation plan will set
out concrete actions to contribute to
achieving this.
· Following Cabinet agreement, the
strategy and implementation plan will be
publicly released. Implementation of the
strategy and plan will begin following this.
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# Theme / recommendation
31 Set a target of 20% reduction in suicide
rates by 2030.
32 Establish a suicide prevention office to
provide stronger and sustained leadership
on action to prevent suicide.
33 Direct the Ministries of Justice and
Health, with advice from the Health
Quality and Safety Commission and in
consultation with families and whānau, to
review processes for investigating deaths
by suicide, including the interface of the
coronial process with DHB and Health
and Disability Commissioner reviews.
Reform the Mental Health Act
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Response Rationale for response
Do not accept · No suicide is acceptable. To date, there
has been a failure to achieve a meaningful
reduction in New Zealand’s persistently high
suicide rates.
· While a number of countries have set
targets and seen reductions in their suicide
rates, meaningful reductions have been
achieved in other countries without a target.
· A well-resourced, suicide prevention
strategy and action plan that emphasises
that ‘every death by suicide is
unacceptable’ is expected to drive a
reduction in New Zealand’s suicide rate.
· Targets can produce unintended
outcomes, for example:
o an assumption that the remaining
number of deaths by suicide are
‘acceptable’
o a focus on meeting the target
rather than implementing sustainable
change
o increased inequity
· deliberate inaccurate reporting of deaths
by suicide
Accept · There is Government and sector
agreement on the need to strengthen the
governance and leadership of suicide
prevention in New Zealand.
· The Government will establish a suicide
prevention office to enhance leadership of
suicide prevention.
· There is potential for the suicide
prevention office to be based within a new
Mental Health and Wellbeing Commission.
· The suicide prevention office will initially
be housed within the Ministry of Health to
lead the development of the suicide
prevention strategy and implementation plan.
Further work to design the functions, size
and location of the office is required and will
be considered alongside the development of
advice on the form and functions of a Mental
Health and Wellbeing Commission.
Accept · The Government acknowledges that
changing processes for investigating
suspected self-inflicted deaths could help
reduce the burden and re-traumatisation of
families and whānau who have lost their
loved ones.
· The current process is lengthy, and there
are missed opportunities for better
integration of reviews, to better support
bereaved families and to prevent suicide.
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# Theme / recommendation
34 Repeal and replace the Mental Health
(Compulsory Assessment and Treatment)
Act 1992 so that it reflects a human
rights-based approach, promotes
supported decision-making, aligns with
the recovery and wellbeing model of
mental health, and provides measures to
minimise compulsory or coercive
treatment.
35 Encourage mental health advocacy
groups and sector leaders, people with
lived experience, families and whānau,
professional colleges, DHB chief
executive officers, coroners, the Health
and Disability Commissioner, New
Zealand Police and the Health Quality
and Safety Commission to engage in a
national discussion to reconsider beliefs,
evidence and attitudes about mental
health and risk.
36 Establish an independent commission to
provide leadership and oversight of
mental health and addiction in New
Zealand.
Establish the Mental Health and
Wellbeing Commission (with the functions
and powers set out in Figure 4 in section
12.2.2).
37 Establish a ministerial advisory committee
as an interim commission to undertake
priority work in key areas (such as the
national co-designed service
transformation process).
38 Direct the Mental Health and Wellbeing
Commission (or interim commission) to
regularly report publicly on
implementation of the Government’s
response to the Inquiry’s
recommendations, with the first report
released one year after the Government’s
response.
Wider issues and collective commitment
39 Ensure the Health and Disability Sector
Review:
· assesses how any of its proposed
system, structural or service
commissioning changes will improve both
mental health and addiction services and
mental health and wellbeing
· considers the possible establishment
of a Māori health ministry or commission.
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Response Rationale for response
Accept · New Zealand’s Mental Health
(Compulsory Assessment and Treatment)
Act 1992 has not kept pace with shifts
towards a recovery and social wellbeing
model of care, and has never been
comprehensively reviewed.
· The legislative process for a complete
repeal and replace will take multiple years.
Accept While legislative change is underway, the
Government will continue to improve
services and address issues with applying
the current legislation.
· The Minister of Health will report back to
the Cabinet Social Wellbeing Committee with
the proposed scope, timeframes and
resource needed to repeal and replace the
Mental Health Act.
Accept · The Government intends to establish an
independent Mental Health and Wellbeing
Commission to enhance cross-agency
oversight, monitoring and accountability,
including providing oversight of the
implementation of Government’s response to
the Inquiry, and to drive transformation of our
approach to mental health, addiction and
wellbeing.
Further
consideration · Interim arrangements will likely be
needed needed while the Commission is being
Accept in established.
principle
· The Minister of Health and Minister of
State Services will report back to the Cabinet
Social Wellbeing Committee with advice on
Accept in the functions, powers, form and financial
principle implications for establishing a Commission,
including any interim arrangements and a
proposed locus for implementation support
and options.
· Regular reporting on the progress of
Government’s response to the Inquiry will
support transparency and help to drive
progress. Longer-term transformation
planning will consider an appropriate
monitoring and reporting mechanism for the
Government’s response.
Accept · The Health and Disability System Review
will identify opportunities to improve the
performance, structure, and sustainability of
the system with a goal of achieving equity of
outcomes, and contributing to wellness for
all, particularly Māori and Pacific peoples.
· The recommendations for explicit
consideration of mental health and addiction,
as well as mechanisms for improving equity
for Māori, align with the intent of the Health
and Disability System Review and the
Government’s wider priorities.
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# Theme / recommendation Response Rationale for response

40 Establish a cross-party working group on
mental health and wellbeing in the House
of Representatives, supported by a
secretariat, as a tangible demonstration of
collective and enduring political
commitment to improved mental health
and wellbeing in New Zealand.
Accept in · The Government acknowledges the need
principle for cross-party collaboration and collective
commitment to deliver on the vision of
mental health and wellbeing for all, but
considers there are opportunities to enhance
existing arrangements to achieve this.
· The Health Select Committee includes
cross-party membership and will maintain
oversight of significant health topics,
including the transformation of our approach
to mental health and addiction.

· Cross-party groups have historically

proven most effective where they operate
outside structures supported by secretariats.

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