Grafting and Crafting New Zealand’s Mental Health Policy

Abstract

The legal and institutional foundations of the New zealand system were laid by Pakeha (European) settlers with scant regard for Maori insights on mental illness. The colonial system was eclectically British. Colonial conditions favoured direct state management. Bureaucratic continuity prevailed with inquiries held only when publicity exposed unacceptable conditions. There were positive initiatives within the institutional environment. Nevertheless, vested bureaucratic and industrial interests upheld a system insulated from mainstream health services. Those features were largely unchallenged until the notion of integration appealed to hard-pressed ministers to explain systemic deficiencies. Leading officials reluctantly followed suit. In the period after World War Two, the therapeutic revolution, prosperity, growing social acceptance, voluntary organizations and international trends were transforming the character of mental hospitals. Perhaps the greatest example of departmental leadership was a moratorium on further institutional accommodation in 1973. This foreshadowed the last phase of deinstitutionalization. Hospital closures were largely driven locally by a mix of ideology and economy. Nevertheless, the lamentable saga begot a new, post-institutional, policy framework. Moreover, the process has spawned a very diverse policy community. Advocacy groups, voluntary service providers, mental health consumers, Maori organizations, along with longstanding interest groups of professionals and service providers, have all found an effective voice. A great deal was achieved by a synergistic partnership between the Ministry and an independent Mental Health Commission (MHC). Successful change in policy and services needs a sustained, incremental approach under stable organizational conditions. Ring-fenced funding and wise stewardship must protect new initiatives. Widespread political, community, sectoral and intersectoral support is vital. Effective implementation needs detailed planning statements of resource costs and organizational responsibilities. Outcomes should be owned by service users, families and carers.