Health Minister Andrew Little has admitted the Ministry of Health "has struggled to achieve as much as we would have liked them to" on mental health after a review highlighted lack of accountability.
The Government allocated $1.9 billion to mental health as part of Budget 2019 in response to the Inquiry into Mental Health and Addiction (He Ara Oranga), which estimated the annual cost of serious mental illness, including addiction, at $12 billion.
But Newshub revealed in June that just five new places for acute mental health patients had been added since 2019, while a Newshub-Reid Research poll found 70 percent of voters didn't think enough was being done in mental health.
The Government commissioned a review in July to assess progress made on the $1.9 billion investment. Released on Friday, it found that initiatives funded in the package were on track to deliver what was expected by at least 2024.
But it also highlighted a lack of accountability over the package, with different agencies focussing on their area, without a cohesive overarching plan to work together.
"Interviews identified that agencies tend to view the $1.9bn package as a collection of individual components and not a unified programme of delivery; no agency or other body formally governs the package," the review found.
"Agencies view themselves as responsible for their own components, accountable to their ministers but not always aware of delivery in areas outside their own.
"The Ministry of Health does not consider itself to have the responsibility or the available levers to exercise system leadership over this programme of work."
Little displayed some disappointment over the findings.
"The report identifies there is more to do in the mental health infrastructure space. Although the funding has been provided, the ministry has struggled to achieve as much as we would have liked them to," he said.
"Since receiving the report, the ministry has written a clear plan for mental health infrastructure. Simple improvements have been made immediately. For example, ministers have recently agreed that the ministry is able to provide DHBs with funding for planning, design and consenting of infrastructure projects so that they can be fast-tracked.
"The Ministry of Health has also identified that specialist health infrastructure people are in short supply, so we have asked the ministry to work with Ōtākaro [a Crown-led agency set up to deliver infrastructure projects in Christchurch] to support the delivery of these projects."
The review found that the business cases for mental health capital projects "are generally taking much longer than they should", which it put down to "a lack of capability in DHBs and partly because the DHBs are not always putting enough focus on service delivery requirements versus property condition".
The need is clear. The review found that only 29 percent of the existing 63 mental health facilities have a good or very good rating, with 73 percent of clinical facilities not meeting recommended size guidelines and 56 percent not meeting contemporary models of care.
Staffing is highlighted as a major issue.
"Agencies cite the available workforce as the main risk to delivery. Growing, developing and retaining a suitably qualified workforce is key to ensuring the mental health and addiction package delivers on its intended benefits."
Budget 2019 funded approximately 1800 to 2000 new full-time positions in mental health and addiction services including clinical, non-clinical and cultural positions in the period to 2023/24.
But the review found there was "no precise figure available for the number of staff hired and trained to date via DHBs, PHOs, NGO providers, and agencies".
The "best estimate" is between 600 to 700.
"The main challenge appears to be hiring clinical staff suited to provide services for Māori and Pacific peoples."
There were some positives from the review.
There are more than 200 GP sites offering Integrated Primary Mental Health and Addiction Services seeing more than 11,000 people per month and providing coverage for an enrolled population of 1.5 million people.
Telehealth capacity increased by 58,000 contacts per year and has met demand; new forensic mental health and addiction professionals are providing services for adults and youth across all regional forensic mental health services; and a full complement of staff are now operating in emergency departments.
But it appears the more than $100 million investment in addiction and suicide prevention is struggling to get off the ground, with just one of the initiatives complete while six are still "in progress".
Little has established an external oversight group for mental health. The Government is launching a new long-term plan to support people who experience mental distress.