Mental Health Commission Amendment Bill — Third Reading 
Mental Health Commission Amendment Bill — Third Reading 
[Volume:641;Page:10998] 
Mental Health Commission Amendment Bill 
Third Reading 
Hon PETE HODGSON (Minister of Health) 
: 
 I move  
That the Mental Health Commission Amendment Bill be now read a third time 
. It gives me great pleasure to be able to speak to the third reading of the Mental Health Commission Amendment Bill. This bill which proposes to retain the commission until 2015 and revises its functions to support the future direction of the mental health sector is a good indication of the Government’s wish to promote and protect the health and well-being of New Zealanders. 
The ASSISTANT SPEAKER (H V Ross Robertson) 
: Would members leaving the Chamber please show some courtesy to the member trying to address the House. Courtesy is contagious and we will all prosper if we keep within the Standing Orders. 
Hon PETE HODGSON 
: Thank you Mr Assistant Speaker. The bill is another positive step forward in the ongoing development of an efficient innovative and exciting mental health sector. In formulating the new functions of the Mental Health Commission the Government has been guided by public submissions a desire to ensure clarity of roles between key agencies and the need to establish a role for the commission that supports the Government’s objectives for mental health over the next 10 years. The commission’s focus has been tailored to ensure that the investment in the commission provides real benefits for the mental health sector. The commission will provide a voice for all stakeholders in this sector on the ongoing implementation of the mental health strategy and it will provide an independent vehicle to ensure that that voice is heard by the Government. 
The commission will be able to monitor the progress of the sector facilitate dialogue and work with service users families and whanau caregivers providers and key central government agencies to promote and support service development and best-practice models of care. To achieve this the commission will consult with relevant stakeholders and will undertake and promote sound research innovation and best practice in mental health consistent with the goals of Te Tahuhu and the roles of other stakeholders. 
The ASSISTANT SPEAKER (H V Ross Robertson) 
: Could members having conversations please have them quietly. 
Hon PETE HODGSON 
: Although an important focus of the commission will be to identify the needs and aspirations of mental health service users and their families it is important that the commission engage collaboratively with all relevant interest groups and endeavour to reflect a broad range of perspectives in its work. Balancing the risks of stakeholders will be a difficult act. Not all interests will align smoothly all of the time. However the Government considers that it is vital to the future cohesion of this sector that the commission works to promote unity and collaboration in this sector. 
Considering the support expressed by stakeholders in the mental health sector for the retention of the Mental Health Commission and the important role the commission has played in supporting development in the mental health sector the Mental Health Commission Amendment Bill is important legislation that will allow the commission to continue to serve the mental health sector well into the future. 
Finally yesterday the Committee of the whole House approved a Supplementary Order Paper that amended the provisions for the appointment of commissioners in order to give the Minister the necessary flexibility to change commissioners in the next 6-month period for which incumbents are initially appointed by this legislation. This will ensure that there is a smooth transition in the governance of the new organisation and I thank the House for its indulgence. 
Hon TONY RYALL (National—Bay of Plenty) 
: 
 The National Party is of the view that the membership of the Mental Health Commission should not be rolled over for as long as is being proposed in this legislation and we think its performance needs to remain under the close scrutiny of the Government and of Parliament. 
As we travel around the country it is becoming clear to us that all is not well in the provision of mental health services for families and those in need of mental health care. Even though the Government is spending $1 billion a year on mental health many of those people are hard-pressed to tell us that the services for them their family and their family member with a mental health issue are any better at all. It strikes us that in many parts of the mental health sector there is not the drive to improve the services for families and individuals that we would like to see. 
We think that so much more could be done for mental health in primary care. International survey after international survey has found that New Zealand general practitioners consider themselves among the least prepared to deal with mental health issues at a community primary-care level. We think that so much could be done with the huge resources we have in the health sector to get those services improved so that people know they can go to their family health centre and get mental health issues and addiction issues dealt with well by general practitioners and their staff who feel confident to provide that service for them. The reliance on services provided by hospitals is failing many of the communities and many of the families and individuals who face mental health issues every day. 
 It is not just the person with a mental health issue who is vitally interested in mental health services. As we travel around the country we see that it is in fact the family members—the mums and dads the brothers and sisters and the people who try to care for those suffering from mental health issues—who feel incredible frustration with the services being provided in mental health. It would be fair to say that there are those who believe that the Mental Health Commission has done a good job in presenting and advocating for those with mental illness. There are those who would say that the Government has made some effort in its recent media campaigns to raise the awareness of mental illness and what can be done. But raising awareness is only one part of the equation. 
The future of quality mental health services in New Zealand rests in primary care. It rests with an integrated service that brings together not only the health care but also the social care that can be provided in our community to the sufferers of mental illness. The drive to bring those services into primary care which Dr Jonathan Coleman and Jo Goodhew will expand on in their contributions to this debate will deliver a quality-improved service for New Zealand families. People should not have to rely on the remoteness of so many hospital-based services to get the care and support that they need. Our general practitioners and our nurses should feel that they are being properly supported and trusted to provide mental health services much closer to home and much closer to the needs of the community. 
That really is where this bill and this Government are so lacking: there is no sense of vision purpose or future direction for mental health services in New Zealand. It is great to have endless vision hui and plans as this Government has for everything. But equipping trusting and valuing our health professionals to provide an improved quality service for mental health at a primary-care level much closer to home integrated with social care is where the future lies. In the next few months New Zealanders will see a much better plan for mental health services which will integrate and bring together health and social care for New Zealanders at a community level. That will provide a much more exciting vision for mental health services in New Zealand. Members will be seeing that in the next few months. 
So the National Party is very clear. We think the Mental Health Commission Amendment Bill should not extend the life of the commission as far as is proposed. We have some issues about how that collaboration might work and many people have expressed that to the select committee. We will be continuing to monitor the performance of the Mental Health Commission. But more important rather than talk about how much money has gone into the system or how much money is being spent on an advertising campaign we will continue in our efforts to put the focus on what is being done to future-proof mental health services to get them down into the community at the primary-care level thereby integrating them with social care so that we can leverage off the resources that we are spending on our health services in order to provide a much better future for those with mental illness and very importantly a much better future for the families of those with mental illness who are the people who carry most of the care responsibility for these people. 
MARYAN STREET (Labour) 
: 
 It gives me great pleasure to speak to the third reading of the Mental Health Commission Amendment Bill. I wish to develop further perhaps some of the points made by the previous speaker Tony Ryall. 
This bill represents a further step forward in the development of the mental health sector. It recognises that the environment has changed since the national mental health strategy was first published in June 1994. When  
Looking Forward: Strategic Directions for the Mental Health Services 
 was published the sector was in some turmoil as evidenced by the establishment of the Mason inquiry in late 1995. The mental health sector has matured since then and the roles of the commission in the mid-1990s can safely be refocused. For example there has been substantial progress made in the development of the mental health and addictions workforce and I will make some comments about that workforce in the first instance before moving on to a specific thing that I wish to cover. 
Collectively the ministry district health boards and non-governmental organisations are working towards developing a mental health and addictions workforce that has the knowledge the skills and the attitude required to deliver the services that New Zealanders need. The ministry is leading the implementation of  
Tauawhitia te Wero 
— 
Embracing the Challenge: National Mental Health and Addiction Workforce Development Plan 2006-2009 
. The ministry’s funding of workforce development initiatives is aligned with the District Health Boards New Zealand’s sector-wide workforce action plan. A nationwide structure has been established through which workforce initiatives are delivered and this structure is primarily based on four non-governmental organisations. 
There is Te Pou the National Centre of Mental Health Research and Workforce Development which has a work programme that addresses areas such as worker competencies national training needs recruitment and service development. There is Te Rau Matatini which has a focus on increasing the responsiveness of services to the needs of Maori while also promoting careers in health and mental health as rewarding careers for Maori. There is the Werry Centre for Child and Adolescent Mental Health which is located within the University of Auckland’s Department of Psychological Medicine and which works to apply best practice to the skills development of providers of mental health services for New Zealand’s children and young people. There is Matua Raki delivered by the National Addiction Centre at the Christchurch school of medicine and health sciences which has a focus on the infrastructure for the development of a workforce for alcohol and other addictions. It has a commitment to research and evaluation as well. The Ministry of Health also distributes funding for workforce training via the clinical training agency for post-entry clinical training and psychiatry training. Through its extension in this bill the Mental Health Commission will be able to contribute to the workforce initiatives I have just referred to and a statutory requirement for this is necessary. 
I want to speak also about an issue that was raised in the course of the second reading of this bill. There was a degree of misinformation put forward by the Opposition about suicide and suicide statistics and about efforts that have been made through the mental health workforce and the mental health initiatives of this Government to bring down the disturbing trend of suicides that we have seen in past years in this country. I would like to inform the debate with some facts as opposed to the inaccurate assertions promulgated by the Opposition in this area and a few facts will not go amiss. 
The suicide rate in New Zealand for the years between 2002 and 2004 for example for which we have the statistics has decreased by nearly 20 percent from that of 1996 to 1998—by 19.6 percent in fact in case people think I am exaggerating by rounding the figure up to 20 percent. It is true that males continue to have a higher suicide rate than females with approximately three male suicides to every female suicide. It is also true that Maori suicide rates for both males and females are significantly higher than for non-Maori. But it is important to note that Maori suicide rates have decreased by 17.9 percent—or by about 18 percent—in the early 2000s from those recorded in the late 1990s. Similarly the very significant male suicide rate has decreased by nearly 23 percent since the late 1990s. The female rate of suicide also remains less than before although there has been some levelling off of that rate of improvement. 
The previous speaker referred to the need for mental health services to consider the needs of families. That is absolutely right and that is a commitment and a direction for the Labour-led Government in the delivery of mental health services. So the kind of unsubstantiated nonsense that we have heard in this area from the other side of the House needs to be refuted not only by facts but by the spelling out of the initiatives taken in recent times— 
Dr Jonathan Coleman 
: Like what? 
MARYAN STREET 
: —as in workforce development which I have just outlined I say for those opposite who have not heard anything—that have been instrumental in delivering a wider range of mental health services to those people in need and their whanau in recent years. We now have a very committed workforce. I repeat a point I made earlier: at the opening of the acute unit at Waitakere Hospital recently when I asked about the hospital’s staffing levels I was told that the hospital was at its lowest level of turnover ever that it had the lowest number of vacancies in many many years and that the resources that had gone into producing that result—so that the hospital was able to care for people in our communities who had mental health issues and problems and who needed assistance and support in an acute unit for some time—had increased almost immeasurably certainly by comparison with previous years. I look forward to the participation of the Mental Health Commission in the continuing improvement of services for mental health service users and their families in this country. Thank you Mr Assistant Speaker. 
JO GOODHEW (National—Aoraki) 
: 
 I rise to join other National Party MPs in supporting the Mental Health Commission Amendment Bill. We have taken this opportunity as has been brought up by the member opposite to add our own particular views on the way mental illness is dealt with in this country. Although this bill gives the Mental Health Commission the opportunity to review the way it operates given that we had submissions both for and against the continuation of the bill now is a good time to reflect on just how well mental illness is addressed in this country. 
We know that the commission’s role is now slightly altered. When we outline that role we see that it is around advising and reporting to the Minister on the implementation of the national mental health strategy promoting and facilitating collaboration and dialogue about mental health issues and advocating for the interests of people with mental illness and for those of their families generally. That too is the role of a local constituency member within an electorate. I find that I speak with organisations that look to address not only the needs of those who are mentally ill and their families but also the needs of the organisations—the organisations and the families. I have had occasion to meet with groups in the last 20-odd months. I have also had occasion to talk to the families of those who believe they have not been well served by the health sector. 
We know that about $1 billion is spent on mental health in this county. I was at a meeting recently where a large group of people asked: “Why is the district health board not funding some counselling services? Why is the district health board not funding some of the low-level services that may well stop people deteriorating into a higher level of mental illness?”. The district health board said quite plainly: “Because we cannot. We are prohibited from using the blueprint funding for counselling services because that is simply not what that money is for.” But that does not get around the heartache of the people who see their family members or loved ones descending into a state of desperation or suffering from depression. 
 I mentioned the rates of depression in the second reading debate and I will mention again that up to one in four women and one in 10 men can expect to become clinically depressed at some point in their lives. I think that is an understanding that New Zealanders are coming to very gradually and in understanding that particular fact we also increase I believe our understanding of those people. Hopefully we will reduce the discrimination in the community against those with mental illnesses and those who suffer from depression. I am happy to say that there are fewer people out there now who say to someone suffering from depression: “Pull yourself together. Come on. Get a decent night’s sleep. Pull yourself together.” because it is not like that. 
There are a number of different forms of depression. I know that some district health boards are putting money into trying to monitor the occasions of post-natal depression in women who suffer from it. I know that that has been very much a hidden illness in society for many years. This is not just about third-day blues. It is not just about feeling a bit low because one is short of sleep. Post-natal depression is very very real for those who suffer from it. 
The World Health Organization has predicted that by 2020 depression will be the second-highest cause of ill health and disability in the world. That is a phenomenal statistic to hear. So what are we doing in this country? We are spending $1 billion or more on mental health but we are actually doing that for roughly the top 3 percent of New Zealanders who suffer from significant mental illnesses. There are a lot of people who still feel that their needs are not being met—like the lady who came to my office and said that her husband had committed suicide after being in a unit at the local district health board. He was sent home despite the fact that she pleaded with the staff and said he was not well enough to go home. Of course the ultimate tragedy was that he went home and committed suicide. 
All is not completely well within the mental health sector but we know that it is a lot better than it used to be. The Health Committee made some comments about wanting to ensure that addictions were covered within the Mental Health Commission. We recommended that an addiction advisory group be established to provide expert advice to the commission. Certainly as New Zealand’s number of addictions or the types of addictions and the number of people suffering from them continues to grow this is an area that we must give the due interest and the due concern that it deserves. 
In speaking in the second reading debate I noted my concern about the number of masters that the Mental Health Commission has. Those masters include the Ministry of Health the district health boards the mental health service funders the providers those with mental illnesses their families and caregivers and also groups representing the interests of people with mental illness their families and caregivers. There are not a lot of people who do not fit into one of those groups. They are quite a diverse bunch of masters so I am sure the Mental Health Commission’s job is not a simple one. But I also hope the Mental Health Commission reflects on the submissions that we received that said they would rather the commission did not continue and that we did not renew or amend the bill to have a continuation of the Mental Health Commission. I hope it reflects on that and looks at why it was not meeting the needs of those people. 
I will make just one other comment and that is to talk about a group in my electorate that is working very very hard and very very well to meet the needs of those who have a severe mental illness. This is a group called the Victoria House Trust. It is a caring landlord service for those with mental illness. This caring landlord service helps people who experience mental illness to go into rental accommodation. The trust pays the rent on behalf of the person and also the power and phone bills. Those are the sorts of things that can worry someone who has a mental illness—turning on the power then having to pay the power bill. The trust supports those people very very well within that particular arrangement—so well in fact that eventually some of these people are able to go into accommodation without having the caring landlord service. In speaking on this particular bill I just wanted to put forward my thoughts about that organisation. It does a fabulous job in South Canterbury in Aoraki and I think that other areas of the country would be well served if it were happening there too. 
In conclusion I just reiterate that this is a turning point for the Mental Health Commission. We have changed slightly the way it operates. We are now giving it an opportunity to continue to grow and to meet the needs more ably than it has done in the past with those many masters and now that opportunity has arrived as the commission looks forward to the future. 
BARBARA STEWART (NZ First) 
: 
 On behalf of New Zealand First I rise to support the third reading of the Mental Health Commission Amendment Bill. As others have outlined the purpose of this bill is basically to extend the term of the commission to 2015 and to make some amendments to the commission’s role. New Zealand First believes that these are very positive steps forward for the mental health sector. There is a role in New Zealand for the Mental Health Commission and it is a very valuable one. 
We in New Zealand First are aware that the demand for mental health services increased dramatically after the very successful television campaign that starred John Kirwan. This campaign would not have occurred without the assistance or the support of the Mental Health Commission. More people now are aware of depression. They now know what they can do and most important who they can go to for assistance. That was outlined in an article in the  
New Zealand Herald 
. It reported that since the advertisements were run a ministry helpline was fielding between 50 and 300 calls a day from people who were concerned about their mental health. That was a very significant step forward. It was an excellent initiative that has helped to destigmatise a condition that many New Zealanders suffer from. 
In New Zealand First we were pleased to see that the life of the commission is to be extended to 2015. We believe that the commission will now be able to plan the most effective ways to get the greatest benefits for service users and the mental health sector. We believe that in 2015 there should be a thorough review of the commission so that we can be sure it has achieved the objectives it set. We know it is very difficult to implement anything of any great weight with a 3-year deadline looming over the head of any commission and we know too that uncertainty does not produce a results-orientated culture or organisation. 
The longer term the commission now has gives it an opportunity to liaise with parent groups and to solve the apparent conflict that has arisen between these two groups. We heard about that during the select committee process. The commission does need to work with parents if it is to be successful in its function as stated in the bill of advocating for the interests of people with mental illness and their families. It is not good enough for any commission to be at variance with parents who are one of the most important interest groups. 
It was a real concern that during the submission process and afterwards parents said they could get absolutely nowhere with the commission. They said the commission was ideologically captured to the extent that it believed everyone was able to recover from a mental illness and that all mental health patients could live quite successfully in the community or at home with their families. We were given examples that were very sad. Some people were actually living in fear for their own safety. Their lives had been totally altered by a family member who had a mental illness. The commission’s statement to parents that recovery from severe mental illness is possible was not assisting them in any way. There are a lot of tragic examples which we read about in the newspapers—fortunately not regularly—of mental health patients who have created havoc in the community and at home and are not aware of what they have done or even why they have done it. So it is sad. 
We believe it is absolutely essential that the Mental Health Commission reassesses its role with this very important stakeholder group and realises that really parents are working at the forefront and coping every single day in a very stressful and quite lonely environment. We do not believe that parents’ views can be dismissed as lightly as they have been in the past nor can their concerns. New Zealand First looks forward to the commission rectifying the situation that has developed and we believe it should be a very high priority. It has time to put it right and it does need to do so. 
Perhaps the commission could be proactive on this front and involve a parent representative. Other organisations have parent representatives and there is no real reason why the Mental Health Commission should not. There does need to be somebody who can advocate for parent’s interests and who understand the stresses and strains parents have as they cope on a daily basis. We will be very interested to see what occurs as the bottom line is that a Government commission cannot work in isolation and on a totally different tangent from one of its important stakeholder groups. So we will be looking forward to some improved feedback on this aspect of the commission’s work. 
The growth of various addictions in the community is a challenge and those issues are increasing. Along with the latest addiction of telephoning psychics to hear what the day may hold there are gambling and alcohol issues so the range of addictions is expanding quite rapidly. An addiction advisory group and even perhaps an addiction commissioner now may be able to be considered in light of the longer term that the commission actually has. 
Like many others in this House I must say that I have appreciated the work the Mental Health Commission has assisted with: the confidential forum for former inpatients of psychiatric hospitals; its comments earlier in the year on acknowledging the high level of risk of electroconvulsive therapy as a treatment; its call to protect the rights of mental health service users; and the call for advanced directives where people can specify what treatments they do want and what they do not want to receive in the event that they become incompetent. So some good work has been completed. 
We believe there is a very important role for the Mental Health Commission and it is essential that it meets the many functions that are directly attributed to it and most important that it does not isolate any of the stakeholder groups. It is only by working together that it will achieve the most for all its stakeholders. So New Zealand First is supporting this bill and we look forward to further developments in this very important mental health area. 
SUE KEDGLEY (Green) 
: 
 The Green Party like other parties in the House is extremely pleased to support this Mental Health Commission Amendment Bill. I think it really is in a sense a testimony to the Mental Health Commission and to our confidence in and support for it that we are extending its term. The commission was originally set up in 1998 for 5 years and we are now extending that term until 2015. 
This is a brief bill and we did not hear many submissions on it but most of the submissions we heard were extremely positive about the Mental Health Commission. I think that in reviewing the performance of the commission—which the submissions involved—not many organisations could have come under the scrutiny that the Mental Health Commission had with such overwhelming support. The commission has performed an incredibly valuable role and that role is widely acknowledged. Not only does the commission monitor the implementation of the national mental health strategy but it has played a very key role as an advocacy voice that speaks out on behalf of people with mental illness. 
I think that the previous speaker was expressing concern and the concern of some submitters about the approach taken by the Mental Health Commission—namely the assumption it makes that people can recover from mental illness. I am incredibly glad that the Mental Health Commission takes that approach. I do not wish to be Pollyanna-ish about this but to thank God the commission does that because it would be very depressing if it took the other approach and assumed that people could not recover from mental illness. I think we need to reflect upon the not-so-recent treatment of people with mental illness and the assumption not so long ago that people could not recover from it. The consequence of that approach was that we locked people away—we kept them under lock and key. We had them tied up we administered electric shocks to them without anaesthetic and we generally treated them almost as though they were animals. We locked them away and we did not want to know about them. Any of us can read in Janet Frame’s compelling novels about the hideous treatment that was meted out to persons suffering from mental illness. 
So I thank God that we have changed radically our attitudes to people with mental illness. I echo the sentiment of others about the incredibly valuable work the Mental Health Commission has done in its campaigns to reduce the stigma of mental illness and I thank God when we look back now at how persons with mental illness were treated probably only a decade ago that we can really recognise how much society has improved and how much our attitudes have changed in that respect. 
We also need to recognise that the Government has poured a lot of money into mental health. The Opposition has said that we are not getting results from that because one in five New Zealanders still suffer from mental illness. That is a very daunting figure—one in five New Zealanders suffer from mental illness. 
Judy Turner 
: Over a lifetime. 
SUE KEDGLEY 
: One in five over a lifetime; nevertheless in my view that is still a very depressing or concerning figure. We need to think about what is causing such a relatively high degree of depression and mental illness in society but we also need to recognise that we will not be able to change that figure overnight. If people have grown up in families where they have been abused—in dysfunctional families or violent families—and they suffer mental illness as a result even with all the counselling and help in the world it may take them many years to recover. We need to acknowledge that and we should not expect that somehow just throwing a bit of money at the problem will be like waving a magic wand and solving the problem of mental illness. 
We also have to acknowledge the underlying issues particularly the hopelessness and helplessness that many people feel which are often exacerbated by poverty. Some of the parties in this House such as the National Party need to reflect upon the fact that poverty and the growing gap between rich and poor lead to feelings of hopelessness and helplessness which in turn contribute to mental illness. There is a vicious cycle there. It is not just a matter of throwing more money at the blueprint; we really have to deal to the underlying causes of mental illness particularly poverty the growing gap between rich and poor dysfunctional families and violence in our society if we are to really try to reduce the very depressing figures about the number of us who have mental illness. 
Finally I also say that yes we have strengthened and slightly changed the role of the commission. I am particularly pleased that we have given the commission the power to be able to report at any point that it wishes on any issue relating to mental illness. That is the really valuable thing about independent commissioners like the mental health commissioners or the Children’s Commissioner. They can speak out they can raise their voices they can report to Parliament and they can raise issues with an independence that is rarely found in the Government for various reasons. 
The Green Party is very very supportive of the independent role of the commission. We see that as something of a role model and would like to see more independent commissioners because we think the Children’s Commissioner and the mental health commissioners—and in particular the Parliamentary Commissioner for the Environment—have played an incredibly valuable role especially in acting as advocates in their areas and in monitoring the implementation of strategies. We know that we have thousands of strategies but if we do not have somebody who independently monitors the implementation of those strategies they are worth little. 
In summary we strongly support the commission. We think the review that has taken place which has resulted in our extending the term of the commission until 2015 is a vote of confidence in the commission. The staff and the commissioners can all feel very proud of the commission’s work and of the fact that it has gained the overwhelming support of the community and this Parliament for its work. We look forward to its continuing successful work in changing attitudes and monitoring the implementation of the strategy until 2015. Thank you. 
TE URUROA FLAVELL (Maori Party—Waiariki) 
: 
 Tena koe Mr Assistant Speaker; tena tatou katoa. Today is an extremely significant day to be passing the Mental Health Commission Amendment Bill into law. Today 9 August 2007 is the thirteenth commemoration of the International Day of the World’s Indigenous People. It is an important day on which to acknowledge the clear link between mental health and well-being and the strength and resilience of indigenous families and communities—a link that our indigenous brothers and sisters acknowledged long before this bill came into the House. 
As I thought about the significance of this bill on this day I came across a passage from around 1000 AD in a founding document of the Six Nations of the Iroquois Confederacy. Its statement is based upon the principles of peace equity and justice power and the health of the good minds so the founding authority has this to say: “When you sit and counsel for the welfare of the people think not of yourself your family nor even your generation. Think of the future generation so that they will enjoy what you enjoy today. This will ensure peace and health for your generation.” Those words are as relevant today as they were 1000 years ago and we cannot disconnect responsibilities to the present generation or future generations of our people. So the Mental Health Commission Amendment Bill is an important measure towards supporting the mental health and well-being of peoples and their families generally. 
The bill extends the expiry date of the commission from the end of this month to 31 August 2015. Like the Greens we are delighted that the life of this commission has been given another reprieve. The commission has the unique capacity to be able to provide us with the objective report-card we need on mental health and well-being in Aotearoa. If one thinks of the demands that are made on the mental health status of this country even just in this last month one sees that there is no doubting the need for this watchdog body. 
The roll call is rather staggering actually. We have received the report of the confidential forum into the experience of former patients at psychiatric hospitals—a report that concluded there needs to be continued scrutiny of the mental health system. Just last week research was released indicating that work-related stress is a cause of clinical depression and anxiety amongst young adults. The latest findings from the Dunedin multidisciplinary health and developmental study which has followed about 1000 Dunedin-born people since their births in 1972 found that almost half of the cases of depression and generalised anxiety disorders newly diagnosed at age 32 were directly related to workplace stress and high job demands. Then there is the finding that 14 percent of the people whom the police have used Tasers on since the trial began in September last year had mental health issues or were suicidal. 
These three entirely separate and distinct issues—psychiatric institutions workplace stress and Taser use—are but a taste of the full range of complex issues impacting on the mental health of New Zealand individuals and their families. I want to place a particular emphasis on whanau well-being and commend the fact that this amendment bill places a new priority on advocacy for service users and families. The voices of whanau in sharing their experiences of mental health services have often been lost from the record. The House may recall the John Kirwan scenario in which a well-meaning friend told him to “just get over it”. I am told that at the Health Committee there were submitters who talked about the alienation they experienced and the sense of loneliness and desperation they felt as it seemed that the health sector or society in general was telling them to “just get over it”. The Mental Health Commission has come right smack dead into this void. It has been able to look at and unpack what is happening in the mental health system—a quality that we desperately need. 
I want to mention particularly the importance of quality services for tangata whaiora and their whanau. I believe it is critical that we do what we can to support the Mental Health Commission in providing leadership in the sector and that the leadership will involve asking some very important questions for Maori. Why are Maori failing to access services? Why are there proportionately more Maori in acute services? What will this country do to address the high prevalence of mental illness and addictions amongst Maori? I understand that the commission has been prepared to tackle the hard issues before and it must be supported to continue its vital monitoring role in guarding the mental health and well-being of Maori for this and future generations. 
During the passage of this bill we have received a number of emails that underline the critical need for leadership in the recovery-based and whanau approach to mental health and addiction services. One consumer of mental health services highlighted the desperate association between poverty and well health. The email read: “I’m a chronic asthmatic sufferer and when I look at the cost of my medication for both asthma and mental well-being it places me in a position of choosing whether I get my meds at $90 a fortnight each time or food for the fortnight.” How did we get to a position in this country where mental well-being and physical well-being are juggled and compromised by such basic needs as food for the table? Another person wrote in reflecting on one of her kaumatua who had trained and worked as a nurse in a psychiatric hospital. She recalled: “You never ever believed Maori had mental illness. He said it became a stigma placed on people because no answers could be found at the time. My mind always goes to his whakairo when the word ‘mental’ is used for Maori.” 
The comments are not just from people who can “just get over it”; they have come from users from workers from consumers from whanau and from tangata whaiora. The Mental Health Commission is ideally suited for being able to provide an independent voice that allows these concerns to be aired and for aspirations to be shared as well. We are pleased too to recognise that the additional roles articulated in this legislation include the opportunity to nurture dialogue across the mental health sector. 
I want to return to the examples I posed earlier in my speech in order to remind the House that a healthy environment for mental well-being is not just about psychiatric institutions and community care vital as it is to ensure that these mental health services are supported to work together. A healthy environment is also about a mentally healthy workplace. The research from Dunedin reminds us that we all have a responsibility towards collective care. For example employers should put in place support structures to ensure a positive proactive workplace. We all have a role to play in supporting those who experience mental illness. The challenge of reducing stigma and discrimination is a key component in the journey to recovery and well-being—a challenge that the Mental Health Commission has played a vital role in promoting. 
The Maori Party is proud to put its name to supporting legislation that will enable the voices of tangata whaiora and their whanau to be heard. We recognise the continuing need for an independent voice and we support the Mental Health Commission in ensuring that people with experiences of mental illness can lead full and satisfying lives. 
JUDY TURNER (Deputy Leader—United Future) 
: 
 I stand on behalf of United Future to speak in support of the third reading of the Mental Health Commission Amendment Bill. I would like to support the comments of the speaker from New Zealand First Barbara Stewart and pick up on some of the issues she raised. 
We need to make sure that all the stakeholders are catered for and all opinions are considered in this hugely important area. I recently heard this very interesting statement: “A just society should not just be measured by how it cares for the most vulnerable members but also how it attends to the concerns of those who support and care for vulnerable people.” I believe this is a challenge for the ongoing life of the Mental Health Commission. I am not on the Health Committee that heard the submissions but I have certainly gathered that a number of submitters were family members of mental health patients who were not happy with the performance of the Mental Health Commission. Parents spoke of their grave fears during the process of deinstitutionalisation concerning their children who were given to self-harm or spoke of great fears about their children’s serious episodes where other people’s well-being was at risk. 
I want to mention something historical and it may be a challenge for the National Party because in the last Parliament— 
Hon Tau Henare 
: Oh no! 
JUDY TURNER 
: It is all right; just listen carefully. In the last Parliament a National member Dr Lynda Scott had a member’s bill that has not to my knowledge been picked up on by anybody in that caucus and I think it should be found and looked at. Her amendment bill would have ensured the opinions of family members who were primary caregivers for mental health patients were listened to and considered in the treatment of patients. These people said they often felt they were used and abused in the system yet were relied upon heavily. Lynda Scott had a very good proposal which I would love to see somebody from the National side of the House recognise pick up and advance and put it into the ballot. 
I believe that the commission needs to use this extension of time to better engage with families who feel both used and ignored at times by the health system. In fact I suggest the commission needs to ensure that its representation reflects all those who are affected by mental health issues and that includes families and support people. Although United Future is supporting this third reading we believe that those who fear that the commission has been ideologically captured and is a closed door to family stakeholders need to be reassured that their voice their expertise and their contribution are valued and considered. Although moving to new models of care is positive many families have fears and we should not be dismissive of their concerns or trivialise them. 
After the second reading of the bill a mother rang me and described her fears based on firsthand experience of being abused by her mentally unwell son. She feels she was not listened to and is still not assured that her son is properly supervised and that other people are safe from harm by him. Speaking as someone who has personally supported mental health clients and has had them live in my home for extended periods of time I know firsthand both the potential for a normal life that exists but also how quickly a person’s mental health can deteriorate and the carer can be desperate for back-up. I have also experienced firsthand being treated very badly by mental health professionals when trying to secure that help. I have been at times treated like the enemy in the situation; but the same people were very quick to ring me and ask me to come and pick the person up from hospital when he or she was ready to be discharged. My opinions as the process deteriorated before my eyes did not count one iota. This is the concern that people have. I believe it is something the Mental Health Commission needs to give more attention to. 
United Future supports the work of the commission. It does some very fine work in an advocacy role and we think this is a base that could be better covered. We encourage the commission with the extended time it has now been given to do such work. 
SUE MORONEY (Labour) 
: 
 I am pleased to be able to speak to the Government’s commitment to the mental health sector at the third reading of the Mental Health Commission Amendment Bill. I am very pleased that the bill has been dealt with in such a timely fashion by the House. The life of the Mental Health Commission was about to expire so it was important that the Health Committee could progress the bill through all of its processes in a timely fashion. With the third reading of the bill today the conclusion of that process is about to come about and it is not before time. 
The bill gives some certainty to the ongoing life of the commission and it provides an opportunity for the commission to look at its functions as an important watchdog body and enhance those functions in this very important area of mental health. As many speakers have outlined already mental health is an area in which the users are particularly vulnerable so having a commission in both a watchdog role and an advocacy role is extremely important. 
It is from that perspective that I raise concerns about the National’s Party’s view that the life of the commission should not be extended through to 2015. This Government thinks the role of the commission is very important and we have no fear about having an independent watchdog body advocating for families and advocating for users of this service. We have no fear of that but during the select committee process we detected that National was very nervous perhaps about the prospect of becoming the Government. That is a view that it holds—that it may well form the next Government. But there is good news for the rest of the country though: National would not need to think about the issue until 2015 because this Government is extending the life of the commission until then. That change has been supported by the House so it is just as well. 
 The National Party will probably not want to take over mental health services until 2015 at this rate. A party that stands on a platform of tax cuts which must mean cuts to public spending knows very well that that means the health sector will suffer the most from funding cuts. National members know that very well. They desperately would not want to be in the situation of cutting funding to health which would therefore mean a cut to mental health funding and having a watchdog body overseeing that so that it could report every single cut and its impact on users of those services and their families. 
For people listening to this debate that is a warning about the type of attitude that exists within the National Party in respect of the role it wants the commission to have. In fact I think the first position National Party members came up with at the Health Committee was that of not wanting to see the commission exist beyond 2009; they wanted the life of the commission to expire at that point. They are supporting this bill and I thank National members for doing so but they did want to record their view in the report back from the select committee that the commission should not be in place for any longer than 3 years after the passing of this bill. But we are up to the third reading debate and that means that with the support of all the other parties in the House this bill will become an Act. The commission will have its life extended and it will also have new functions. 
I particularly want to speak on the new function of advocacy. The bill puts in place a position where the commission is going to have a function to discuss service user and family advocacy—that is one of the commission’s new functions. So giving a voice— 
Hon Tau Henare 
: Stop reading your speech. 
SUE MORONEY 
: Tau Henare seems to have taken exception to my view of the National Party and its intended cuts to mental health. I did not need to read anything about that Mr Henare; I can see it written all over your face and your body language. 
The ASSISTANT SPEAKER (H V Ross Robertson) 
: Order! 
SUE MORONEY 
: I am sorry Mr Assistant Speaker. I do not mean your face of course but Mr Henare’s face. His body language says it all about his concern about what I have just exposed in respect of the National Party’s agenda. 
Hon Tau Henare 
: Don’t expose yourself. 
SUE MORONEY 
: No no. The National Party has made it clear that it will cut taxes and it will therefore cut funding to the health sector. It is important though that the commission’s new functions allow a voice to be given to the views and concerns of the users of the mental health services and that is a relatively recent phenomenon. In New Zealand the commission has articulated the voice of service users particularly well since its inception in 1996. 
I take the opportunity to thank the commission for the good work it has done to date even though there is a lot still to be done particularly in this area of advocating for service users and their families. Even though the service user advocacy role that the commission has taken is not a function of the commission under the current Mental Health Commission Act many submitters in the policy submission process raised this issue with us and the Health Committee expressed strong support for this role. Many argued that the commission represented service users of mental health services in a way that had not occurred before the commission was established. They saw that as perhaps not giving the same value to the voice of families and whanau. But the wording in the bill is absolutely clear that it gives them equal status so the commission is advocating for both the service user and his or her family or whanau. 
The bill addresses the problem by extending the commission’s advocacy role to the families and whanau of mental health service users. So this is actually an advance in terms of responding to the issues that those submitters brought before us. This will often be a difficult balancing act as not all the interests will align smoothly. However the Government considers it to be vital to the future cohesion of the sector that the commission works to promote a balanced view of the issues facing the sector. The commission in carrying out its advocacy roles will identify and articulate the needs and aspirations of mental health service users as a whole and of their families and whanau as a whole. 
Notwithstanding the strongly held views of those who seek additional protection for the rights of service users the commission will not act as an advocate for individuals or particular families. There are adequate mechanisms in place to discharge the individual advocacy function. The commission will have a valuable role in the mental health sector to ensure that the voices of all of those who wish to be heard are heard. So it very important that we are able to extend the life of this commission through to 2015 not to expire it earlier as the National Party would have us do. 
I thank all the parties in this House for supporting the third reading of this bill so that the life of the commission can be extended and we can continue to have a very strong watchdog and advocacy role in the mental health services. It is so important. 
In conclusion I would like to take the opportunity to thank not just those serving on the commission but those serving in our mental health services. It is a very difficult area for our workforce to be operating in and I know that day-to-day dilemmas arise in those mental health service settings. By and large people deal with those dilemmas professionally. They deal with those issues in the context of using the best resources that they have. We will always continue to have—and should continue to have—an ongoing debate in this country about the adequacy and the appropriateness of mental health services. It is my firm belief that the moment we do not have that debate is the moment we forget the people who need that service so desperately. Thank you. 
Dr JONATHAN COLEMAN (National—Northcote) 
: 
 Is that not disappointing? That was Labour’s last speaker on the third reading of the Mental Health Commission Amendment Bill and all that speaker could do was talk about the National Party. She talked about the National Party for 7 minutes of a 10-minute speech. That was a great opportunity for Labour members to lay out what they are going to do in mental health and I can say that that speech was enough to make a member want to read the Bills Digest for the second time in this session. It was very very disappointing material. The first 7 minutes of that speech were about us and the last 3 minutes were a recitation of what is in the bill which we have heard again and again in this Chamber through the three readings and the Committee stage. There was no vision. There was a lot of talk about us but what that member does not actually realise is that her own Minister of Finance will be cutting taxes well before the next election and if she has not caught up with that yet she really is well back on the backbenches. 
We are supporting this bill. We have made that quite clear. There is some unanimity on this issue and I think the select committee worked pretty well. But some real differences were exposed on the philosophy and the approach to mental health services. What we heard from Maryan Street before was an excuse for Labour’s poor performance in mental health over the past 8 years. It was a recitation of strategic plan after hui after workshop after plan and she said it was the answer in mental health. Well we all know that this Government has spent a billion dollars a year on mental health. That is a 75 percent increase on what was being spent when it came into power. Has mental health got any better in that time? The answer as Labour members actually admit is no; it has not. 
We now know that one New Zealander in five will experience symptoms of mental illness over the course of their lifetime. We know according to the Ministry of Health that people cannot get access to the services they need. We know that Maori cannot get access to the services they need. Young people children and older people are not getting access to those basic services. Were Labour members saying anything about this? No. All they had to say was that more and more money is going in and they are very happy with the Mental Health Commission. 
As I said yesterday we know why that member did not agree with the idea of a 3-year review—because her own 3-year review within the Labour Party is coming up and basically Labour members would be very happy to have their terms extended with no review period. But that is not the reality of what we can do when we are spending public money. The Government is spending $1 billion a year and the public needs to have some accountability. 
We believe that the Mental Health Commission has a very real role to play—we have been quite upfront about that—but when we are spending massive amounts of public money we have to be able to review at regular periods how that money is being spent and whether the taxpayer is getting value for money. We are quite sure that if the Mental Health Commission continues to perform well it will have nothing to fear under a National Government and that term will be extended. But it just seems natural and right that the Act should be reviewed at a date 3 years from the date on which this bill receives the Royal assent. So that is what we were in favour of. Unfortunately we were not supported in that—be that as it may—and the term of the commission will be extended to 2015. 
We want to see the commission hold this profligate spending Government to account. As in all other areas of the health sector spending has gone up and up and the results have not improved at all. In fact the whole health sector is in crisis. We have a Minister of Health who is on the ropes. He has no answers and we are not hearing any answers at all from the Labour team. I hope the Associate Minister will take a call at the end of my speech and tell us what his team will do should heaven forbid they ever get another crack at power. 
Hon Mita Ririnui 
: I’ll tell you something. 
Dr JONATHAN COLEMAN 
: I can tell Mr Ririnui what we are going to do. We are going to make sure that the money is spent in a way that delivers the services. We will actually deal with many more of these mental health problems within primary care. We will resource general practitioners properly and we will give them access to specialists. The Commonwealth Fund health report which Minister Hodgson constantly quotes at us—although of course he quotes selectively and only the good bits—said that New Zealand general practices do not feel equipped to deal with mental health problems. Fifty percent of them did not feel confident. We reckon that if we can give general practitioners the resources they need to do the job a lot of these problems can be dealt with at the primary-care level. 
Judy Turner from United Future made a very good point about the views of families and that point came up again and again at the select committee. There was a great deal of concern amongst submitters that when they have a seriously ill family member they are not part of the decision-making process. When we look at it we see that 0.3 percent of the population suffer from a serious mental illness like schizophrenia and sad as it is those illnesses have a very very low recovery rate. What happens in our system now is that the burden falls back on the family but the family is cut out of the loop. We heard stories about families who were never consulted about their family member’s treatment. They had no information. They felt positively excluded from the whole process and we say that that is not good enough. We want to see the Mental Health Commission involving those families and making sure they are part of that decision-making process—that is what we want to see the commission do. 
We heard from a number of submitters who wanted the commission disbanded because they did not feel it was serving the needs of families. The National Party says there is a role for that commission but we want it to monitor the Government more closely and we want it to take the views of families into account. That will be absolutely vital. 
So there are a number of areas in which the commission maybe could raise its game over the next few years and that will be vital if we want to make some inroads into mental illness in New Zealand. The commission has done a very good job in helping destigmatise mental illness as has been talked about before. The John Kirwan advertisements have gone a long way to bringing mental illness into the mainstream media and making people aware of a lot of those issues. 
Hon Mita Ririnui 
: Good Government initiatives. 
Dr JONATHAN COLEMAN 
: But one thing I wish the Labour members had taken the opportunity to speak on—and I am sure Mita Ririnui is absolutely bursting to get out of his seat to address this—is the issue of the Lake Alice Hospital patients and the 87 second-round claimants who secretly had $35000 lopped off their compensation payment by a secret Cabinet decision. We caught Michael Cullen out on this in this House. He admitted that Cabinet had actually docked that money. We think that this Government which is led by a party that professes to be the party of social justice and the party of the disadvantaged should pay up. The Government has admitted that it owes $3 million. It has decided that it would not appeal the High Court judgment. It is time to pay up I say to Mr Ririnui. I know that he is a man with a conscience and he is an honourable member. He has to tell the Attorney-General to get out the cheque book and sign that cheque. 
We heard Labour members saying earlier that they were doing heaps for Maori mental health. I would like Mita Ririnui to get up and tell members what exactly this Labour Government has done for Maori mental health because I can say that it is pretty much zero. The statistics are absolutely appalling. The Ministry of Health will tell us that Maori just cannot get access to the services they need. This Labour Government which is under severe threat from the Maori Party needs to raise its game for Maori because nothing ever got better for Maori under a Labour Government. I know that the Maori Party will agree with that. I think that Te Ururoa Flavell made some very good points about Maori mental health earlier. It is an issue that needs attention. 
Sue Kedgley’s contribution was interesting. She said that we need to look at issues of poverty and that the National Party especially needs to consider them. Well I tell Ms Kedgley she might note that Labour has been in power for 8 years and it is Labour’s economic mismanagement that has got us into the situation we are in now. So one can safely assume that as long as Labour holds those Treasury benches nothing will improve. 
In summary National supports this bill. We feel we need to have accountability for spending. The amendment to review the legislation 3 years from the date of the Royal assent would have gone quite some way towards doing that but as it is the commission will continue. We will support its work but we want it to keep on the back of Mita Ririnui and his Minister of Health. These guys are not doing the job for the mental health sector and I can tell members that they are not doing the job for Maori in the mental health sector either. The member needs to go back speak to his Minister and address some of these very real issues. 
Bill read a third time.