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Guest Blog: Robert Miller on the Social Bonds Pilot for NZ Mental-Health Services

Commentary on Latest Move of New Zealand Government Over Mental Health Care

UntitledLike many Kiwi’s, Robert Miller from the NZ Schizophrenia Research Group recently received a message from Annette King, health spokesperson for the Labour Party, asking him to sign a petition against the government proposal to trial funding mental-health services with Social Bonds. Here, Robert shares a few of his thoughts on this controversial new move to fund mental-healthcare. Social Bonds involves using a private investment model where companies put up their own funds and are reimbursed (with interest) only if certain outcomes are met. The process of ‘procurement’ is now well under way. By March 2015, seven potential partnerships were being assessed, with a view to ‘moving to implementation in the second half of 2015.’ The Government document mentions ‘NGOs, retail banks, and specially created partnerships’, but provides no details of which organisations are to be involved. The first four Social Bonds contracts have been announced and they all have work targets as the defined outcomes.

Greetings from Masterton!

Yesterday, I received two messages on the same topic – the government’s latest initiative for funding mental health care in New Zealand by what it calls ‘Social Bonds.’ One came from Annette King asking me to sign a petition, which I did. The other came from my good friend Julie Leibrich (former Mental Health Commissioner) expressing her serious concern about the government move. Here is her message –

‘National is planning to use Social bonds to fund mental health services.  Social bonds allow Government to contract out services and funding to non-government or private organisations, with agreed targets and timeframes. If the targets are met, Government pays back the investors, and also pays a return on their investment. The return depended on the level of results, up to an agreed maximum. Labour says that the risks of the policy are huge, because in order to meet targets providers are likely to focus on “easier-to-help” clients and not difficult and expensive ones. The Department of Internal Affairs warned that New Zealand should not “engage in trials or implementation of a social impact bond”. There is a good article about the dangers. I think that people with mental illness struggle enough as it is to get good care, and the idea of them becoming Guinea pigs in a social experiment is appalling. So I would be grateful if you would consider the petition, and if you want to, then sign it.’
~ Julie Leibrich, former Mental Health Commissioner

Since the pilot was announced, there has been much comment on the Social Bond scheme for mental health funding, in newspapers, generally highly critical. Let me make a few of my own comments, briefly, because there is urgency here.

(i) Mental health is probably one of the hardest areas of health policy to get right, and this government seems to think it is just about money. It IS about money, of course, but just as important (perhaps more important), it is about organisational culture, sensitive responsiveness to needs of clients, and morale in mental health services. It is quite possible for dedicated, highly trained and skilled staff to deliver a first class service when physical aspects of the service (buildings etc,) are distinctly below par. It is the ‘human capital’ as much as the funding available which matters. These aspects of a good service cannot be measured in the usual way in which profit and loss are computed.

Nowhere, it seems, does one sense that actual persons with their own hopes and dreams are involved. Collectively, they are just ‘a problem’ to be reduced

(ii) The nature of funding streams IS an important factor in delivery of mental health care. In something as complex as setting up an effective mental health service, with its community outreach, it would help if funding (especially of NGOs for mental health care) were not administered in such a way that different agencies who should collaborate, are forced to compete for funds.

(iii) Earlier this year I learned of someone writing a report about mental health for Treasury, found her e-mail address, wrote to her, but never received a reply. Maybe this government move is related to that report, although it has clearly been under development already for some years. In this case the government seems to be moving to get this inconvenient burden off its shoulders. The un-named banks and financial institutions are likely to have their bases outside New Zealand, have no responsibility to the New Zealand electorate, only to their shareholders. Apart from maximizing profits, mental health is an area which is not a money-making business, is not, and never has been capable of really generating a profit, except in a highly distorted sense of market discipline. In addition, I ask: What would be the ‘quid pro quo’ demanded by those private investors? If it seems that targets are not being met, and the return on investment therefore not likely to be forthcoming, what pressures will be put on services to meet the targets? What corners will be cut on ethical aspects of service delivery? What style of healthcare delivery would they require? Would delivery of mental health services become hostage to multinational enterprises, with agenda quite out of line with our own philosophy of healthcare?

(iv) There may be some merits in the social bond scheme as a way to bring about public/private partnership. However, if so, it would be better to test this particular model of such partnership in an easier area than mental health care. It seems as if this is being tried out in the mental health area first because ‘no one really cares too much about this anyway’. Government policy makers should reconsider the choice of mental health as the first place to try out this approach.

(v) In terms of ‘meeting targets’, the devil is in the detail. The main target appears to be getting people with mental health problems into paid employment; but this depends on many factors beyond control of any mental health service. In addition, for many service users, obtaining employment is the end of a long journey. It might be better to emphasize earlier stages of that journey, namely helping to rebuild personal resources of people whose normal development has been undermined by mental disorders. This might include entering and succeeding in higher education. Entry into paid employment would be a natural flow-on from this, which is a more fundamental form of assistance.

Immense flexibility is needed to cope with the individuality and idiosyncrasies of each client… Target-driven systems are unlikely to achieve this

(vi) In any case, this appears to be setting up a ‘pseudo-market’, possibly a subterfuge for covert administrative and government control. It also seems to imply that the government admits that devising a good mental health system is beyond its capability; and somehow, by offering financial incentives, the market in mental health care will somehow magic up a level of intelligence in this area, which is superior to the government’s own. This stretches credibility.

(vii) Administrators do like to set targets, as if the matter of concern is one where commands can be given, and outcomes/outputs delivered according to plan (but, in today’s world, using the ‘invisible hand’ of market forces as an intermediary). Those at the front line of any human services, especially mental health services, know better. In their practice, immense flexibility is needed to cope with the individuality and idiosyncrasies of each client, for instance in matching each client to the most suitable practitioner of counselor. Target-driven systems are unlikely to achieve this. Such flexibility is one of the features that make for a good organizational culture and good morale in those services.

(viii) The government’s plan is one more move – perhaps more dangerous than others so far – to move small aspects of our social services to enterprises based offshore. Others we know about include setting up private prisons, or catering services in hospitals, to name a couple. Who are the movers of this international trend? What are their real objectives? Early in 2014, as part of a resignation document I wrote, when I left committees of RANZCP, I shared a paragraph expressing my concerns, which contained hints of answers to those questions:

“…that entrusting mental health issues to untrained community people has encouraged re-uniting two policy areas which had been painfully separated in the second half of last century. The two areas are mental health and justice. In the nineteenth century in Western countries (and in many other countries still today), the two were not separated. Authorities who could put you away in an asylum were either medical people or JPs. Since 1950, there has been steady progress in prizing these two apart, so that the area where, inevitably, the two overlap, becomes a difficult and highly specialized discipline of its own – forensic psychiatry. I fear there are now accelerating moves to bring these two back together again. With international consortiums now running both private prisons in many countries, and some mental health NGOs, I fear that merging of the two policy areas is gaining momentum internationally, led by those whose ethical perceptions are quite different from most of those who will be reading this document.”

(ix) I have just sent in an abstract to the New Zealand branch of RANZCP for their forthcoming meeting in Hamilton in September. Basically this is about the history of psychiatry. Sadly I conclude that, over the last century a specialty, which, in the 1890s, had the promise to become a respected branch of personal health care, at least on the continent of Europe, was largely taken over by those who sought the most efficient way to administer a ‘social problem’. This emphasis is quite explicit in the Government document: Under the section titled “What is the Government looking for the Pilot to do? we read in its first bullet point “test the concept within the New Zealand context to see whether this is an effective and efficient way for government to reduce social problems” [emphasis added]. Nowhere, it seems, does one sense that actual persons with their own hopes and dreams are involved. Collectively, they are just ‘a problem’ to be reduced. Mental health care has insidiously become linked in the public mind to other ‘nasties’ of social policy, including (from 1834), workhouses and asylums, and then prisons, together with legal sanctions on prostitution, suicide, sexual orientation, street drugs, ‘welfare dependents’ and so on, all those areas that ‘nice people’ do not want to know about. The battle between these two has been raging for the last century, and more. I fear that parts of that battle are now being waged by international corporations, unaccountable to any electorate, probably in denial about the personal aspects of healthcare, or the person-centred ethical precepts, which should guide healthcare.

(x) Now is the time to challenge this outrageous government move.

Robert Miller

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About the author: Robert Miller was educated in Britain, originally a medical student, until he was overwhelmed by a psychotic disorder. Later he retrained as a neuroscientist and came to New Zealand in 1977 to a position in the Department of Anatomy at Otago Medical School. His research objectives have been to explore the theory of brain function and its relation to mental disorders. He founded and continues to lead the NZ Schizophrenia Research Group in 1994. From 2009-2014 he served as community representative on committees of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) where he learned that one of the biggest problems in mental health is to get different players to listen to one another. Robert tries to stay independent of all organisations, so as best to encourage them to work together. He is not a member of the Labour Party.

International Petition Demands “Let us see Drug Data! Drug hazards are not trade secrets”

A petition has been making its way around the internet urging drug companies to stop lawsuits blocking public access to drug trial data. The petition names physical health medications, but this issue is also highly relevant to the availability of drug trial data about psychiatric medications.

The petitioner, David Healy of Cardiff, Wales writes: 

Drug companies maximize the sales of new drugs by hyping their benefits while downplaying significant risks. In 2010 the European Medicines Agency began releasing patient-level data from the clinical trials used to approve new medicines in Europe – a development hailed by American and European researchers and researchers around the world as a major step towards drug safety.

This process has been shut down by a lawsuit taken by two American corporations – AbbVie, makers of Humira, the number one selling medication in the world with projected sales of $10 billion in 2013; and InterMune, whose pulmonary-fibrosis drug Esbriet has recently been approved in Europe at a cost of over $40,000 per year.

AbbVie and InterMune have filed suit to deny access to the data from their trials on the benefits and harms of these drugs, claiming these vital facts are “trade secrets” whose release would harm their profits. Their action has led to the shutdown of the entire public-access program, leaving millions of patients worldwide, and their doctors, in the dark.

We call on AbbVie and InterMune to drop their European Union lawsuit and release all patient level data on Humira, Esbriet and their other products. Vital data on drug safety should never be hidden as a “trade secret.” By copying this petition to President Barack Obama and members of his Cabinet we call on them to ensure that meaningful public access to clinical trial data becomes the policy of the FDA and is written into any international trade agreements governing the sale of prescription drugs and devices.

Copies to:
President Barack Obama;
Margaret Hamburg, M.D., Commissioner, Food & Drug Administration;
Secretary General Ban Ki Moon, United Nations;
World Health Organization Director Dr Margaret Chan.

Click here to sign the petition.

Petition for Better Mental-Healthcare Choices Presented to Parliament: What Next?

PetitionPresentationPhoto

Annie Chapman completed her Hikoi for Better Mental-Healthcare Choices on Tuesday the 11th of July and presented the final Petition for Better Mental-Healthcare Choices to members of parliament on the steps of the Beehive.

Chapman writes, “Well, the deed is done!! Six months after setting off from Cape Reinga, I handed over the paper petition with 1053 signatures to Paul Hutchison, who presented it to Parliament today. I will hear back from the Health Select Committee, probably in just over a week, of when the petition will be considered by the Committee and will be invited to make a submission at that time.

The petition presentation began with the final leg of the Hikoi as Annie made her way from the Botanic Rose Gardens to the Beehive with a collection of supporters. The procession reached parliament at midday where they were joined by a crowd of about 20 and at 12.30 the politicians arrived: Dr Paul Hutchison (National MP and chair of the Health Select Committee); Annette King (Labour Spokesperson for Health and member of the H.S.C.) Barbara Stewart (NZ First M.P. and member of H.S.C.); Dr Jian Yang (National M.P. and deputy chair of H.S.C.) and Louisa Wall (Labour M.P for Manurewa).

You can still help the Hikoi get results by making a submission to the health select committee about the Petition for Better Mental-Healthcare Choices.

Contact Annie Chapman for more information on hikoiforhealth@gmail.com

Email chairperson of Health Select Committee Paul Hutchison paul.hutchison@parliament.govt.nz

Wellington Community Hikoi Meeting THIS WEEK: 29 May 2013

Wellington_Hikoi_Events_29May11June2013

 

 

One Woman Walking Hikoi Reaches Whanganui Monday 22 April 2013

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Hikoi for Better Mental Healthcare Choices Departs Auckland from Aotea Square

ANNIES FAREWELL FROM AUCKLAND

It’s now confirmed that Annie Chapman’s send-off from Auckland will be from Aotea Square starting at noon on Friday 22nd. All welcome!!

Annie will continue her way along the Te Araroa Trail on her Hikoi to Wellington to seek better mental healthcare choices for those who experience mental-health problems.

Sign the petition to the NZ government and make your voice count!

http://www.change.org/en-AU/petitions/to-the-new-zealand-government-minister-of-health-honourable-tony-ryall-provide-healthy-choices-for-people-in-mental-health-care-in-new-zealand

BEYOND AUCKLAND

  • Paeroa: 27th Feb. War Memorial Hall (supper Room) 7.00 p.m.
  • Thames: 28th Feb. (Possibly 2.30 p.m. at Te Korowai, still to be confirmed)

(Thames/Paeroa contact Beccy Dove, Enviroschools Facilitator | Ph 07 8627113, Cell 021 1448539)

Dates & Some locations from here are tentative.

  • Hamilton 7-9 March
  • Possibly Cambridge
  • Possible side trip to Rotorua
  • Te Kuiti
  • Taumarunui
  • Owhango
  • Te Porere Redoubt
  • Whakapapa Village (if Tongariro Crossing remains closed)
  • National Park
  • Mangapurua Landing
  • Whanganui (via Te Awa …. awesome!!)
  • Possible side trip to New Plymouth
  • Turakina
  • Bulls
  • Fielding
  • Palmerston North
  • Levin
  • Waikanae
  • Paraparaumu
  • Porirua
  • Wellington!!…. Mid May

Stay in the loop on Facebook!

https://www.facebook.com/events/317503728358665/

Petition Seeks Better Mental Healthcare Options in NZ – SIGN TODAY

Petition to Provide Healthy Choices for People in Mental Healthcare in New Zealand 

A petition has been created to request The Minister of Health and the New Zealand Government take measures to improve access to psycho-social, holistic treatment options, evaluate the impact of current mental healthcare and reduce reliance on medication and compulsory treatment.

http://www.change.org/petitions/to-the-new-zealand-government-minister-of-health-honourable-tony-ryall-provide-healthy-choices-for-people-in-mental-health-care-in-new-zealand

Why sign this petition? 
Because lasting recovery comes from life change and life change is not inspired by medication and restricted freedoms, it is inspired by support, psycho-social skills, cultural connections, nourishing lives and therapeutic interventions. Signing this petition will help  send a message to government and ministry that the current status of things is inadequate and needs to change.

What does the petition say? 
We, the undersigned support Annie Chapman in her cause, and hereby request
  1. An independent inquiry into the impact of current mental health treatment for people diagnosed with a mental illness, relative to:
    • Their human rights
    • Their dignity as citizens
    • Their physical health
    • The cost/benefit ratio of long-term high-dose psychiatric medication (taking into account the costs to the health system and to the individuals, of physical side-effects of high-dose medications).
2. We also request that District Health Boards are required to provide, to those diagnosed with mental illness, greater access to health-promoting psycho-social, holistic (mind/body) and culturally diverse treatment options, and aligning with options that research has proven successful here in NZ and other countries in

    • Improving long-term recovery outcomes
    • Reducing dependence on psychiatric medication
    • Reducing reliance on compulsory treatment orders

Petition to Save Auckland’s Rape Crisis Line – Again!

Auckland’s 24 hour rape crisis line is again under threat of closure — less than 12 months since 7,000 people signed the petition that forced PM Key to promise its survival.

2 000 people signed the new petition in the first 24 hours – but it’s not over yet.

The 24 hour rape crisis line is integral to our community. It’s the service that Auckland’s sexual violence survivors can turn to for help. For thirty years, it’s taken a call every hour of every day.

A year ago, PM Key said he’d do his part to help rape survivors by funding the crisis line. But, we always said we’d need to stay vigilant and hold the government to their word. And now that the spotlight has dropped off, the Government thinks it can get away with slashing funding for this essential service. 

The service needs just $116,000 from the government to survive. And we know we can get that commitment again if we continue the pressure. Sign and then share the petition with at least 5 of your friends and have them add their names to support a vital service. An immediate and overwhelming response will show the Prime Minister that we’re still watching.

This service will close unless we act now. The service’s board will soon start offering redundancies to counselling staff — the exact people rape survivors rely on for support and advice in their time of need.

Volunteers and staff are planning some media events and are trying hard to get the word out. But take a moment to share the petition with at least 5 of your friends and do your part to help an essential service that many rely on.

Call for Govt Recognition of Past Abuse in Psychiatric Institutions

Sign the on-line petition: An Acknowledgment of historic injustice against former patients of NZ psychiatric hospitals

Between July 2005 and April 2007 a Confidential Forum was held for former In-patients of psychiatric hospitals. Over 400 former patients spoke about their experiences. The final report of the Confidential Forum Te Aiotonga (2007, available from the Department of Internal Affairs) outlines the themes that emerged including occurrences of physical violence and sexual misconduct; and de-humanising environments. The report remains formally unacknowledged by the government.

A United Nations report on New Zealand’s compliance with the UN convention against torture in 2009 recommended that the NZ government should take appropriate measures to ensure that allegations of cruel, inhuman or degrading treatment in the “historic cases” are investigated promptly and impartially, perpetrators duly prosecuted, and the victims accorded redress, including adequate compensation and rehabilitation.”

Phoenix Group, a Wellington group of people who have experienced mental distress are using the publicity surrounding the release of Jim Marbrook’s Mental Notes to call on the government to make a formal apology.

How can you help? 

Print this postcard and send it to parliament – and give a copy to a friend so they can do the same. Postage is free. 

confidential forum protest postcard for print

And share this notice around!

 

Ma te whakatau, ka mohio

When we are shown, we come to know

Ma te mohio, ka marama

When we know, we come to understand

Ma te marama, ka ora ai tatou

When we understand, we all achieve wellness

Petition for Disability Accessible Parliament

Mojo Mathers made history on Wednesday, when she delivered her maiden speech to Parliament — in sign language. It was an inspirational moment for the entire deaf community. But the elation didn’t last long.

She’s just been told she’ll have to pay $30,000 for electronic note-taking that she needs to do her job. Student Merrin Macleod thinks it’s unbelievable discrimination — in the last three months of 2011 Parliamentary Services paid $3.1 million for MPs’ travel and accommodation perks alone, yet it’s refusing to support Mojo Mathers’ participation in Parliament.

Merrin’s started a Change.org petition calling on Speaker Lockwood Smith to grant the funding immediately. The issue is attracting intense media attention, and the Speaker’s refusal is being condemned as discrimination against the hearing impaired. If thousands join Merrin’s petition now, while the Speaker is under the spotlight, he’ll have no choice but to listen.

Click here to join her and ensure that Parliament doesn’t make Mojo Mathers pay to participate in the democratic process.

This week should have been a triumph for Mojo Mathers and the deaf community — a powerful symbol of progress for a community that has often been marginalised in public life. But the Parliament’s refusal is putting that progress in jeopardy.

Mojo Mathers says the case would set a “dangerous precedent” in a system still weighted against people with hearing impairments and other disabilities. Funding the note-taking will drain her office budget — she’s essentially being asked to choose between fully representing her party and paying to participate in Parliament.

And the issue doesn’t end with Mojo Mathers. Electronic note-taking would eventually lead to the captioning of television coverage — enabling 700,000 hearing impaired people in New Zealand to access the Parliament they pay and vote for. Ensuring she’s supported by Parliament would be a powerful gesture towards equal access and opportunity for every one of these 700,000 people.

Click here to stand with Mojo and ensure that New Zealand’s Parliament commits to equal access for all.