More young people are experiencing a mental health crisis.
Children and teenagers are caught in a rising tide of mental distress that has resulted in a 177 per cent increase in the number of young people taken to hospital emergency departments in crisis in the past decade.
But the specialist mental health services dedicated to treating them are so underfunded and understaffed that they can't keep pace with the growing need, according to a Government briefing document obtained by the Herald.
The briefing, provided by Ministry of Health officials to the Health Minister Andrew Little in September, gave a stark assessment of the services run by district health boards for around 51,000 Kiwi infants, children and adolescents with serious mental health problems (known in the sector as "ICAMHS").
Underfunding and staff shortages have constrained these services' capacity to keep up with a troubling increase in numbers of young people with urgent and complex psychological difficulties, including self-harm and suicidal thinking, officials told the minister.
The document was obtained by the Herald as part of an ongoing investigation into the mental health system. Earlier this month, we reported that years of underinvestment and poor planning have left specialist mental health services depleted and struggling to respond to a wave of distress amplified by the Covid-19 pandemic.
Even in a system riddled with pressing needs, services for children and teenagers stand out as particularly challenged, according to interviews with dozens of service users, parents, frontline staff, researchers, and health officials.
These concerns have been on the radar of people at the top of the Government for months, the briefing shows. Among the problems identified by health officials:
• The number of young people seen by DHBs rose by 35 per cent in the past decade but funding for ICAMHS grew by only 25 per cent over that period. "This means that the increase in funding has not kept pace with the levels of pressure on their services, which also have a low level of baseline funding compared with equivalent adult services," officials told the minister.
• ICAMHS receives funding of $3600 for every patient it sees, compared to $5800 per patient for adult services. "This funding disparity is long-standing and does not reflect current needs," the officials say, "or the proven benefits of providing intensive support early in the life course and early in the development of an issue."
• The ICAMHS workforce is under "significant and increasing pressure", and DHBs are struggling to find enough psychiatrists, psychologists, nurses and other skilled staff to fill vital frontline roles. Staff are leaving to other public agencies or private roles where the work is less stressful and better paid.
• Asked to see more patients than they can handle, ICAMHS services have raised their criteria so that "the threshold for acceptance of referrals has become an increasingly high level of severity or distress".
• Mental health crisis teams operated by DHBs saw 50 per cent more young people in urgent distress last year than they did 10 years earlier. In the same period, the number of young people seen in hospital emergency departments for mental health crises increased by 177 per cent, to 3250 in 2020-21, "including a peak after the Covid-19 lockdowns".
• Only 35 per cent of children and adolescents are seen by mental health services within 48 hours, compared to 57 per cent of adults. ICAMHS services are so overwhelmed by crisis cases that "there can be a considerable wait before a further session" for those who are not at immediate risk of harm.
The briefing was prepared after a meeting between Little and Jacinda Ardern in July, at which the Prime Minister asked for more information about the state of ICAHMS.
As the briefing acknowledges, the mental health of young people has been declining for years, following a trend that has been observed in many high-income countries.
In 2006, the last time New Zealand had a national mental health survey, it found that 16- to 24-year-olds had the highest rates of mental health disorders of any age group.
"It is widely accepted that pressures on young people have since intensified," the briefing states.
According to the Youth2000 survey, which tracks the health and wellbeing of secondary students, rates of depression among Kiwi teenagers rose from 13 per cent to 23 per cent between 2012 and 2019.
The coronavirus pandemic has aggravated these long-term trends, officials warned the minister. "Young people, who are at critical developmental periods of life, are predicted to be disproportionately affected by Covid-19," the briefing says.
The document articulates a clear case for addressing mental health problems at a young age. "Intervening early in the life course and in the course of illness provides the greatest return on investment and potential to reduce ongoing disability," it says.
"Evidence-based treatment for infants, children and young people is labour intensive," it adds. "It is less likely than adult services to involve medication and is more likely to involve psychosocial and family/whanau-focused interventions. It often requires working across multiple agencies, such as schools and Oranga Tamariki.
"Funding of services needs to reflect this."
Last week, Labour announced a $200 million boost for mental health in its 2022 Budget, which included an extra $18.7m for specialist child and adolescent services — amounting to less than $5 million a year spread over four years.
The Ministry of Health says the additional money will mean child and adolescent services can see another 1300 young people annually by 2026.
Philip Grady, acting deputy director-general for mental health and addiction, says: "We know that specialist mental health and addiction services are facing immediate pressures, and that people, including young people, are having to wait to access the support they need. This initiative will help to address these challenges, but building the capacity of services and the workforces to deliver them will take time."
Grady pointed out that the ministry has also invested in other support for young people that it hopes will eventually ease pressure on specialist services, including the extension of a schools-based programme to a quarter of DHBs, a national early intervention service in GP surgeries for people with milder conditions, and more funding for digital supports.
The problems identified in the briefing echo those highlighted by the Herald's investigation. In numerous interviews in recent months, dozens of service users, parents, and clinicians in recent months stressed the challenges of getting timely and effective treatment for children who are experiencing serious, and sometimes life-threatening, mental conditions.
Rebecca Toms, the mother of a child with an eating disorder who has campaigned for better mental health services, says families are desperate but feel that not nearly enough is being done.
"Are the Government and DHBs not hearing us?" she told the Herald. "Are we not speaking loud enough?
"Covid was a crisis and the government went, 'Right, everyone needs to get vaccinated'. There was a big national campaign to ensure everyone's safety. Why aren't they doing that with mental health?"
Dr Hiran Thabrew, a child psychiatrist and academic, says: "There's such a big focus on primary care in the Ministry of Health these days, which is great – big gap, needed filling – but when there's a crisis you sometimes also need to bolster up the specialist services for that acute increase. And I don't think that's happening."
HELP US INVESTIGATE
This article is part of a series examining the state of mental health services and how to improve them. We need your help to continue our reporting.
Are you the parent of a child who has needed treatment from ICAMHS services? Do you work for a DHB? If you have information about mental health services, please contact Investigations Editor Alex Spence at alex.spence@nzme.co.nz. We will not publish your name or identify you as a source unless you want us to.
WHERE TO GET HELP
If it is an emergency and you or someone else is at risk, call 111.
For counselling and support
Lifeline: Call 0800 543 354 or text 4357 (HELP)
Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO)
Need to talk? Call or text 1737
Depression helpline: Call 0800 111 757 or text 4202
For children and young people
Youthline: Call 0800 376 633 or text 234
What's Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
For help with specific issues
Alcohol and Drug Helpline: Call 0800 787 797
Anxiety Helpline: Call 0800 269 4389 (0800 ANXIETY)
OutLine: Call 0800 688 5463 (0800 OUTLINE) (6pm-9pm)
Safe to talk (sexual harm): Call 0800 044 334 or text 4334
All services are free and available 24/7 unless otherwise specified.
For more information and support, talk to your local doctor, hauora, community mental health team, or counselling service. The Mental Health Foundation has more helplines and service contacts on its website.
The 36-year-old died on December 19.