GP and general hospital care
Working closely with the Ministry of Health to give effect to a stream of national standards, guidelines and protocols, the Mental Health Commission published two 'blueprints' for improving services in 1998 and 2012 that focused on strategies for recovery, addressing discrimination and the specific needs of Māori and Pacific peoples.
As a result of the blueprints and similar initiatives, specialised services for the mentally ill were expected to support primary health care services such as general practitioners (GPs). In 2011/12 15% of referrals to specialist mental health services came from GPs. People with moderate or mild mental disorders might not need any specialist services. However, GPs were concerned that their patients might understate their mental health problems or delay treatment. In 2007 less than 10% of people visiting a GP gave mental health problems as the main reason for the visit, although about half may have been in psychological distress.
In the 2010s most specialist mental health services were provided by district health boards, contracted by the Ministry of Health. They included crisis and emergency teams, inpatient units, supported accommodation and liaison services. Some services were designed for specific groups such as children and adolescents, mothers and families, older people, Māori or Pasifika, and those with addictions or eating disorders. All services were required to meet national standards, guidelines and protocols.
All Black kicks the ‘black dog’
The world’s first online self-management programme for mild to moderate depression was launched in 2010. ‘The journal’, fronted by former All Black rugby player Sir John Kirwan, who has experienced depression himself, takes people through a series of online video clips, then encourages them to complete a task during their daily routine. The website teaches people techniques to manage their own depression, such as staying positive, better nutrition and physical activity, and finding creative solutions to problems.
Community and inpatient care
Community, rather than hospital-based services have become the largest part of the mental health system since the early 2000s, using nearly three-quarters of total mental health funding. In 2014 only 9% of patients who used district health board services for mental health issues were seen by inpatient teams for close observation, intensive investigation or intervention. Many of those patients were using inpatient services repeatedly. Psycho-pharmaceuticals (drugs designed to combat mental disorders) were the main method of treatment.
A growing proportion of mental health services is provided through non-governmental organisations (NGOs). In 2011/12 27% of mental health clients were seen by NGOs. They ranged from well-known national organisations with multi-million-dollar budgets to very small groups of consumers or caregivers. They provided telephone crisis services, drop-in centres, consumer-run self-help groups, family and community support and a variety of residential services. Christchurch’s Stepping Stone Trust, for example, runs residential and respite services, and visits people in their own homes.
Private mental health services
Privately owned and operated mental health services have always been rare in New Zealand. Ashburn Hall (now the Ashburn Clinic) in Dunedin was set up in 1882 as a licensed private institution. It is still the only such institution outside the state system, although it also provides some services through publicly funded contracts. In 2000 around 15% of psychiatrists worked wholly or part-time in private practice.