Held To Account: Halfway through the Labour-led Government's term, Stuff examines some of its biggest promises to see if it's delivered.
ANALYSIS: To those trapped in the mental health system, the gaps are glaringly obvious.
But no-one is saying the changes required will be easy.
The Government has been sitting on a review that it ordered of the sector, since December. Health Minister David Clark is yet to indicate a response to some 40 new recommendations an independent working group delivered in a 200-page report.
And with a new set of working groups established to tell the Government what's its response should be, some patients are losing confidence in big promises of reform made during the 2017 election campaign.
LIVING IN THE SYSTEM
Christine Welton says she is living in fear that her husband could commit suicide any day. It has been that way for about a year.
Despite an acute awareness of his illness, Luke's depression is sometimes so severe, the compulsion to commit suicide is overwhelming.
While he has managed his depression since his teenage years, the death of his mother early last year triggered its return.
The Taupō couple have sought emergency help on a number of occasions in the past year. A string of doctors who told him to simply "eat better and exercise" failed to understand the gravity of Luke's illness.
At crisis point about eight months ago, a GP gave Luke an urgent referral to the psychiatric team after he started experiencing serious suicidal ideation.
But a cryptic phonecall received a few days later, in which the callers did not introduce themselves as being from the crisis team, saw a well-spoken and reflective Luke inadvertently seem "together" enough for the crisis team to cancel the referral without his knowledge.
They are technically still waiting to see the crisis team.
"And a few weeks ago, my husband told me he was really, really bad - wanting to kill himself. We've been doing everything we can from our end and we both know quite a lot about mental health, but I got to the point where I had no idea what to do.
"I was facing the reality of my husband killing himself."
Welton phoned the Crisis Assessment Team to discover the closest one was based in Rotorua. Although they led her to believe they were on their way, she said they later phoned back to say they did not have access to a work car and sought to defer Luke's assessment until the next day.
Christine rushed Luke to the hospital herself, where he was told by a specialist to cut out energy drinks from his diet - incorrectly citing it as the leading cause of stroke in New Zealand men (that's smoking).
Christine said an exasperated Luke turned to humour to handle the advice, asking if he should drink more.
"The lady said 'do you want a stroke?'. Luke said 'no, I want to die, that's why I'm here"".
He was eventually told he needed to be "more determined".
Welton said she had very little faith the mental health review would deliver meaningful change.
"If this is the team that stands between people and death, then I understand why our suicide rates are so high.
"Because they made him feel like it was all his fault and he wasn't trying hard enough."
The parents of Hamilton man Nicky Stevens know what living in that state of fear is like, but their son was well and truly failed by the mental health system.
Nicky died by suicide in 2015, after walking out of a Hamilton mental health facility where he was under compulsory care.
In December 2018, Coroner Wallace Bain ruled that his death, after going missing from the Henry Rongomau Bennett Centre, was avoidable.
His mother, Jane Stevens, said the review had to led to a move away from the institutional model and provide well-resourced services in communities.
Nicky's father, Dave Macpherson, said it was families and communities that were dealing with the hardest issues, and often with the least support.
"They've got no resourcing, no support at all. And everyone turns and looks for a doctor or a nurse - well they're not available and they're never going to be available in sufficient quantities," he said.
"It's got to be the communities that do that, and at the moment they're not trained, they don't have support and if they do try and get involved they're pushed away."
Jane said it was often not police who were the first responders, it was families who were the people "caring 24/7" to which mental health sufferers were also discharged to.
"Our experience and the experience of many families we've spoken to since [Nicky] died, is that we're just not listened to, our experience and our expertise is not taken account of. And that is absolutely fundamental to the change we need to see happen."
Labour, NZ First and the Greens all spoke loudly of a mental health crisis during the election campaign. But with the Government the sum of three parties, it can be difficult to pin down exactly what progress has been made against party pledges.
They are all accountable to the statements made in Prime Minister Jacinda Ardern's speech from the throne, which lays out their joint goals negotiated in the coalition agreement between Labour and NZ First and Labour's confidence and supply agreement with the Greens.
PROMISES FROM THE THRONE
Not yet achieved - needs to provide more detail.
In the speech from the throne, which sets out the Government's agenda for the entire parliamentary term, Ardern had this to say on mental health:
"There will be a special focus on mental health. A ministerial inquiry into mental health will be set up and the Mental Health Commission will be re-established. A review of mental health and addiction services will identify gaps and what more is needed to better care for people.
"New Zealand’s high suicide rate, especially for adolescents, is shameful. This Government will increase resources for frontline health workers and will put more nurses in schools to make it easier for young people and others with mental health problems to get the help they need. Free counselling will be available for those under 25."
The review was, by far, the largest body of work. It has been completed, gaps have been identified - target achieved.
What's more important is what the Government does with that review and on that, we're still waiting. It's important to know the Government never actually committed to any specific reform.
No indication of preference has been indicated by Health Minister David Clark, and further, it has emerged a 21-member working group to advise the Government on what its response should be has been replaced with nine more working groups.
Among the top recommendations was a national target to measure access to mental health services, a suicide reduction target of 20 per cent by 2030 and an emphasis on wellbeing and community services.
On the re-establishment of the mental health commission - it has not happened and there has been little by way of progress updates.
The Government did allocate about $68 million to National Mental Health services - or the provision of frontline services - at the 2018 Budget. That's about $3.5m more than the previous Government in 2017.
However, this Government clawed back a separate pot of $100m, which the previous National government had placed in a contingency fund for specific mental health projects in development, and put it back into the bottomless pool of general health funding.
Among 17 projects canned before development or pilots could begin, was a plan to place mental health professionals at every emergency police callout and a planned rollout of e-treatment options.
Indeed, as Ardern stated, New Zealand's suicide rates are "shameful" and they show little sign of abating. According the last release of coroner's figures in August, put the number at the highest since records began.
A total of 668 New Zealanders died by suicide in the year to June 30, 2018.
It's unclear what progress the Government has made in placing more nurses in schools, but Clark did make a significant Budget announcement on that last year.
"To further support the health and wellbeing of our young people, we are extending the nurses in schools programme to cover all public decile 4 secondary schools," he said.
"That means an extra 24,000 students will have easy access to support, care and advice from a nurse at their school. The additional funding of $17 million over four years will expand coverage of this programme, which currently covers decile 1 to 3 secondary schools, and teen-parent units."
The Government has made gains in making mental health workers available to schools - with a particular focus on Canterbury.
Eighty mental health workers were promised for Canterbury and Kaikōura schools and progress reports suggest at least 40 were now in place. By June this year, it was planned all primary and intermediate school aged children across greater Christchurch, the Hurunui and Kaikōura areas would have access.
And on that promise of free counselling for everyone aged 18-25? The Government did allocate $10m at the last budget in May, to fund a pilot. In July that year, it was looking for an agency to run it. In February, the Greens along with Clark announced the first pilot to be run in Porirua. The Piki pilot would help young people with "mild to moderate" mental health needs.
The pilot would be rolled out in Wellington, the Hutt Valley and Wairarapa regions and was expected to be in full operation across the three DHB regions by the end of the year. Timelines for a nationwide rollout are unclear.
LABOUR'S MENTAL HEALTH PROMISES
Undertake an independent mental health review - completed.
Establish a two-year pilot programme of primary mental health teams at eight sites across the country to work with GPs, PHOs, DHBs, and mental health NGOs - this could come under the Government promise to increase frontline resources, but this policy did not explicitly make it into Government doctrine and has made no headway.
Labour promised to provide eighty health professionals to provide mental health services in primary and intermediate schools in Christchurch and other earthquake-affected parts of Canterbury, including Kaikōura, for an initial three years - not completed, but clear progress is underway.
NZ FIRST'S MENTAL HEALTH PROMISES
Re-establish the Mental Health Commission - NZ First's only specific election promise in the area of mental health, sewn into the Government agenda, but not yet implemented.
GREENS' MENTAL HEALTH PROMISES
Free counselling for under-25s - this policy was narrowed to 18-25s and was funded at the last budget, the first pilot is under way.
Increasing funding for youth mental health services - mental health funding, as with all health funding goes up year on year. But it's not clear there's been any material increase above expected funding levels here.
Fund more community initiatives in the health and education sector - this is very vague and hard to gauge.
Begin a mental health inquiry and re-establish the Mental Health Commission - check for the first one, little discernable progress on the second.
WHERE TO GET HELP
1737, Need to talk? - Free call or text 1737 to talk to a trained counsellor
Depression.org.nz - 0800 111 757 or text 4202
Lifeline – 0800 543 354
Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO)
Kidsline – 0800 54 37 54 for people up to 18 years old. Open 24/7.
Youthline – 0800 376 633, free text 234, email firstname.lastname@example.org, or find online chat and other support options here.
Rural Support Trust - 0800 787 254
Samaritans – 0800 726 666
What's Up – 0800 942 8787 (for 5–18 year olds). Phone counselling available Monday-Friday, noon–11pm and weekends, 3pm–11pm. Online chat is available 7pm–10pm daily.
thelowdown.co.nz – Web chat, email chat or free text 5626
Anxiety New Zealand - 0800 ANXIETY (0800 269 4389)
Supporting Families in Mental Illness - 0800 732 825.
If it is an emergency click here to find the number for your local crisis assessment team. In a life-threatening situation call 111.