Editorial: Facing facts on mental health cash

A new Minister of Health has received a depressing briefing from the body set up to monitor services to the mentally ill. The Mental Health Commission was established in response to the equally depressing Mason Report on the services nearly 10 years ago and since then nothing seems to have improved despite substantial injections of public funds.

The annual allocation for mental treatment rose from $270 million in 1993-1994 to $801.7 million in 2003-2004, an increase of 142 per cent after adjusting for inflation over the decade. Yet despite receiving far more than double the funds in real terms, mental health services are still attending to about the same number of people they were treating a decade ago. And most of these people are being treated in hospital when their conditions become acute, rather than receiving more help to live in the community as the modern philosophy of care would prefer.

The commission believes that little more than half the number of people who need mental health assistance are receiving it, and that those who receive it do so later than they should. It would be better for everyone, the mentally ill as well as the taxpayers, they argue, if district health boards were not "somewhat stuck" on expensive hospital services and put more of the money the Government provides into helping people at an earlier stage.

All of this seems so obvious, and has been said so often to so little effect, that it must be wondered whether it is based on a fallacy. A close reading of the commission's briefing will tell the new minister, Pete Hodgson, that the concern is based in standard calculations of disease distribution rather than actual, or even anecdotal, evidence of need. The commission is working on the "epidemiological evidence" that about 3 per cent of the population needs specialist mental services over any six-month period and yet it found only 1.6 per cent used such services during the first half of last year.

Despite the increased funding, it says, the amount is still below the level required to meet the presumed needs of 3 per cent of the population. About two-thirds of the money is spent on inpatient care and most of the people receiving it would benefit from earlier treatment, says the commission, again on little evidence.

It notes that next year the first epidemiological study of mental health is due to report its findings. The commission is confident it will show a rising incidence of the more common illnesses such as depression, alcohol abuse and obsessive compulsive disorder, and that it will find those needs are not being met. We shall see. At least this study should provide an actual reading of the population rather than an application of standard assumptions.

But it might not convince the public that state funds are really better spent on earlier community services for all mental illness rather than better hospital services for the less common but more serious disorders such as schizophrenia.

Naturally the commission favours both, but funds are finite and choices have to be made. It is sufferers of the more serious disorders who have aroused most public concern when they have been released from hospital care with tragic consequences. The less serious disorders may be more amenable to treatment at private expense. Public spending on health tends to be weighted to the more serious, life-threatening conditions and mental health needs might be no exception.

Health boards and providers are actually underspending their mental health budgets in most cases, which might suggest the need is not as great as the commission thinks. Next year, when that study is done, we might know better.