Auditor-General’s overview
E ngā mana, e ngā reo, e ngā karangarangatanga maha o te motu, tēnā koutou.
Mental health concerns are the biggest health issue facing young New Zealanders today.
Although many young people enjoy good mental health and well-being, recent survey data suggests that the mental health and well-being of young New Zealanders has declined rapidly over the past decade.1
For young people, mental health concerns can have a significant impact on every aspect of their lives, including their relationships with friends and family and their ability to participate in education, work, and community life.
Early and effective support for young people with mental health concerns can help reduce the lifelong costs of mental illness for individuals, whānau, and society. The human and economic costs of inaction are high. It is estimated that mental illness costs New Zealand about 5% of gross domestic product annually.2 In 2023, this meant more than $20 billion.
Young people report the highest level of unmet need for mental health care of any age group in the population.3 However, our work found that many young New Zealanders cannot get mental health support when they need it.
Improving the mental health and well-being of young people was critical to the previous Government's goal of making New Zealand the best place in the world to be a child or young person (as described in the 2019 Child and Youth Wellbeing Strategy).
Young people were one of the priority groups in that Government's multi-agency investment of about $1.9 billion of new funding over four years into mental health and addiction (through the 2019 Wellbeing Budget) and in its 2021 Kia Manawanui long-term strategy for mental health and addiction.
Since 2018, government spending on mental health and addiction services has increased by 33%.4 In 2021/22, identifiable public expenditure on mental health and addiction accounted for almost $2 billion of government spending.5
I wanted to find out what difference this spending is making for young people.
What we found
Our audit looked at how effectively government agencies work together to understand and meet the mental health needs of young people aged 12 to 24 years.
Mental health concerns are not evenly distributed in the population. Some groups of young people are particularly affected, including rangatahi Māori, Pacific people, disabled people, Rainbow people, people in care, people not in education, employment, or training, and people in the criminal justice system.
We recognise that determinants of, and supports for, young peoples' mental health and well-being are broad. Not all the answers to the mental health needs of young people will lie in a mental health service. For example, they might be in measures to prevent and respond to family violence or in effective anti-bullying programmes in schools.
New primary mental health and addiction services are making a difference for young people, but there remains significant unmet need
The previous Government's 2019 investment into new primary mental health and addiction services has made a difference in expanding the availability of primary (or first contact) mental health support for young people with mild to moderate mental health needs. About 3,000 young people each month now access the new youth primary mental health and addiction services funded through this investment.
In time, this increased investment in primary care might relieve demand for more specialised services for people with a more severe level of mental health need, such as those provided through specialist infant, child, and adolescent mental health services.
In the meantime, young people in need of specialist mental health support are waiting longer to access specialist care than they were when the Wellbeing Budget 2019 was released.
Agencies need better information about the extent and distribution of young peoples' mental health needs to effectively target support and services
To be able to meet young peoples' mental health needs, agencies require detailed information on the extent and distribution of those needs. However, we found that agencies currently do not understand enough about the nature and scale of young peoples' needs.
New Zealand's last prevalence survey for mental health, Te Rau Hinengaro, was published in 2006 and based on 2004 data, which is now significantly out of date. It did not include children and young people aged under 16 years.
Government agencies need better data on the prevalence of mental health conditions among young people so that funders and policy-makers can make decisions that are well informed and based on population need. Better prevalence data will help give agencies confidence that they are making efficient and effective use of public money by funding the right number and type of services, in the right locations, to meet the needs of young New Zealanders.
Tailoring support to the specific needs of young people can help overcome the barriers young people face to accessing mental health care
Young people are often expected to fit into services and models of care designed for older adults. Many of the barriers young people experience in accessing mental health support can be overcome if services and supports are tailored to the specific needs of young people.
Tailoring support to the specific needs of young people means ensuring such support is available in places where young people commonly spend time, such as schools and accessible community locations.
Meeting the specific needs of young people also means giving young people a voice in the design and delivery of mental health services. Involving young people in designing services and delivery is a strength of some services. However, more needs to be done to strengthen youth voice and participation across all care settings accessed by young people in distress.
Addressing gaps in mental health and addiction service provision will require urgent attention to long-standing workforce capacity issues
Throughout this audit, my staff were impressed by the care and dedication of those in the mental health and addiction workforce, who work hard to support young people. However, they are also a workforce under considerable strain due to capacity pressures across the sector.
Sustained effort will be needed to fill workforce gaps by increasing the local education and training pipelines for new and existing types of mental health and addiction practitioners.
In my view, agencies need to focus on planning for and developing the right size and mix of mental health and addiction workforce so that the system is best placed to meet young New Zealanders' ongoing mental health needs.
Collaborative approaches by agencies and strong system leadership are critical to meeting the needs of young people
The current range of mental health services and support for young people has evolved over time as a collection of services and programmes, often developed in response to a specific need. We saw no coherent system design or vision of how the different parts should fit together as a whole. For young people and whānau who must navigate services, it can feel that the emphasis is on whether young people fit the criteria for a service, rather than on how to meet their needs.
Despite the best intentions and efforts of the many people working in mental health and addiction services, agencies remain too focused on their own programmes and services at the expense of working together to ensure that young people and their whānau are at the centre of the system of support and care.
Co-ordinated approaches by agencies to tailor services and support to the needs of individual young people and their whānau are particularly critical for at-risk groups of young people who are more likely than other young people to experience mental health concerns and to have a range of other health and social needs. These include young people in care, young people not in education, employment, or training, and young people who are in prison.
Building a system focused on the needs of all young people and whānau, rather than agencies and services, will require strong system leadership. It will also need considered design to ensure that young people can access consistent and integrated care as they enter, move through, and leave the care of services.
What I recommend
The mental health services and support currently available to young people is fragmented, and not all young people have timely and barrier-free access to appropriate mental health care. In a country that prides itself on being a good place to bring up children and young people, this is a matter we should all be concerned about.
I have made nine recommendations designed to support a coherent system of mental health services where all young people can access appropriate and consistent mental health care when and where they need it.
I acknowledge that many of the challenges identified in our report are long-standing and will require significant time and sustained focus by governments to address.
Young peoples' mental health and well-being is an ongoing focus for my Office. I will closely monitor government agencies' work on this, including following up on the recommendations made in this report, so that the public and Parliament can continue to hold the Government and agencies to account.
I thank the many people from government agencies and organisations in the mental health and addiction sector who spoke to my staff for this audit.
I also thank the young people with lived experience of mental health issues who spoke to us and provided their feedback on our audit. Their views were invaluable to our work.
Nāku noa, nā
John Ryan
Controller and Auditor-General | Tumuaki o te Mana Arotake
8 February 2024
1: Sutcliffe, K et al (2023), "Rapid and unequal decline in adolescent mental health and well-being 2012-2019: Findings from New Zealand cross-sectional surveys", Australian & New Zealand Journal of Psychiatry, Vol. 57, no. 2, page 280 and Fleming, T et al (2020), Youth19 Rangatahi Smart Survey, Initial Findings: Hauora Hinengaro/Emotional and Mental Health, pages 1-3.
2: Organisation for Economic Development (2018), Mental Health and Work: New Zealand, page 26.
3: Ministry of Health, New Zealand Health Survey 2022/23 annual data explorer: "Mental health care indicator: Unmet need for professional help for their mental health in the last 12 months".
4: Our audit encompassed both mental health and addiction (alcohol and other drug) services for young people. We refer to both these collectively in the report as "mental health services".
5: Based on public mental health and addiction services funded through Vote Health. This excludes direct spending on mental health and addiction services by non-Health agencies and the indirect costs of poor mental health to society in lost income and productivity and increased social and justice sector spending.