4. Multi-sector planning and funding

We need to develop a system where population wellbeing, distress and addiction are a multi-sector responsibility and not primarily a health one:

  • Trial the removal of mental health and addiction funding from the  District Health Boards with a view to localised multi-sector pooling of all planning and funding functions within the next decade.
  • Set up district or regional governance of planning and funding led by people with lived experience, whānau, Social Development, Health, Education, Housing, Corrections, ACC and others.
  • Māori design and deliver services for Māori.
  • Equitably plan and fund all the Big Community responses with flexible and individualised funding models.
  • Use incentives and accountability levers for providers to achieve improved social, education, employment, financial, housing, personal, health and mortality outcomes for people with distress and addiction, with an emphasis on outcomes for Māori.
  • Test and scale up indigenous, national and international promising and evidence-based practices that enhance Big Community.

The system may require additional funding, but the cost-effective redirection and pooling of existing resources may be sufficient.

Improving equity and outcomes

There is ample evidence that people with mental distress, addiction and loss of wellbeing often experience inequitable responses from services as well as poor life and health outcomes. Big Community must give the highest priority to benchmarking and improving the following types of inequities and outcomes:

Use of services and welfare benefits

  • Around 50% of people with disabling mental distress do not or cannot access services.
  • Māori make up 15% of the population and 25% of people who use mental health services.
  • In 2017, 45% of people on Jobseeker Support (for a health condition) and 35% of people on Supported Living Payment had a mental health condition.

People with ‘serious mental illness’

  • 77% experience social isolation compared to 25% with no ‘mental illness’.
  • 27% are employed compared to 67% of people with no ‘mental illness’.
  • 43% live in hardship compared to 13% of people with no ‘mental illness’.
  • They die up to 25 years younger than average.
  • Recovery outcomes for people with a diagnosis of schizophrenia are better in low income countries than high income countries.
  • There has been no sustained change in recovery outcomes for populations with a diagnosis of schizophrenia since longitudinal studies began in the 1880s.
  • In 2014, the cost of the ‘burden of serious mental illness’ and opioid addiction in New Zealand was $17 billion (7.2% of GDP).

Compulsory treatment

  • Community treatment orders ‘do not result in better service use, social functioning, mental state or quality of life compared with standard voluntary care’.
  • In 2014:
    • 103 people per 100,000 were on inpatient or community treatment orders on any given day – this rate is extremely high by New Zealand historical standards and international standards.
    • There was 6-fold variation in the use of community treatment orders and a 15-fold variation in the use of inpatient orders, between District Health Boards.
    • Māori were 3.5 times more likely to be subject to a community treatment order than non-Māori.
    • Māori were secluded almost four times more than non-Māori.


  • New Zealand has the highest youth suicide rate for adolescents aged 15–19 across 37 OECD and EU countries (15.6 per 100,000) – nine times higher than Portugal, the country with the lowest rate.
  • In 2012, 17.6 per 100,000 of the Māori population completed suicide, compared with 10.6 per 100,000 of the non-Māori population.
  • In 2014, the suicide rate among people who had been in contact with mental health services in the year prior to death was 136.2 per 100,000 compared with 6.3 per 100,000 for the rest of the population.