2. Mental Health Services—Funding and StaffingANDREW LITTLE (Leader of the Opposition) to the Prime MinisterMental Health Services—Funding and Staffing2. ANDREW LITTLE (Leader of the Opposition) to the Prime Minister: Does he stand by his response to a mental health nurse who said they are so short-staffed they are working double shifts that they need to be consulting with their employers about the suitability of working those hours"; if so does he know who sets the funding for DHBs that employ mental health nurses?Rt Hon BILL ENGLISH (Prime Minister): Yes I do know who sets the funding for district health boards (DHB) and that is the Government of the day. There is also an additional rule as I understand it that DHBs cannot spend less than they did last year on mental health but they are also always free to spend more. Given the amount of extra money that they have had each year—I think something like half a billion dollars extra last year—I would expect that they have been spending more on mental health because demand has been growing.Andrew Little: In the spirit of New Zealand Sign Language Week I will sign: "Supplementary question Mr Speaker."Mr SPEAKER: Supplementary question Andrew Little.Andrew Little: I will continue practising. Does he know that cash-strapped DHBs closed 12 mental health beds in the last year after employees told their employers that they were too understaffed to safely care for their patients; and how is that a good result?Rt Hon BILL ENGLISH: I know the member understands the way that the hospital system and the services are funded and that is that they have local boards that make decisions about where the money goes. So if a DHB is in a situation where it feels like it does not have sufficient staff it can spend the money to go and get the staff and increase the service. In fact over the last 5 years the number of registered nurses in addiction services has gone up 23 percent in community mental health it has increased 22 percent and in hospital-based mental health services there are 12 percent more nurses. That tells you that DHBs are spending more on mental health services.Andrew Little: Why is his Government requiring underfunded and overstretched DHBs to find $200 million of cuts by the end of the financial year?Rt Hon BILL ENGLISH: The member is not characterising the way it actually works in the DHBs. They get a large amount of extra money each year by far the largest allocation in any Budget this Government has overseen. They are expected to use their own judgment to make the best use of that cash. There are theoretical calculations about efficiency dividends and so on but the core of it is that they get more money every year which has enabled them to employ more doctors and more nurses and provide more services.Andrew Little: What does he say to the mental health worker who told the People's Mental Health Report that mental health services are "stretched inadequate and waiting for the inevitable to occur another major incident."?Rt Hon BILL ENGLISH: If that mental health worker observes some aspect of the service that means that there is a real risk they ought to take it up with their employer. Their employers and the DHBs have—I mean some of these organisations have budgets of over $1 billion and they have the opportunity to fill the gaps where they believe there is real stress or real risk. In fact they are obliged to do that.Andrew Little: Does he stand by his admission about people with mental health issues being caught up in the justice system that "in some cases people have been dealt with inappropriately."; if so why is the Government not doing more at the primary level before people end up in the justice system?Rt Hon BILL ENGLISH: There has been a long-running issue about the delivery of mental health services in prisons and there are statutory reasons why it is complicated. I understand more work is being done because the treatment of mental illness in our prisons was done very poorly under the previous Government and has improved dramatically ever since.Andrew Little: Does he regret signing off on consecutive Budgets that have cut funding for mental health services in real terms resulting in some providers closing their doors and primary mental health care being cut here in Wellington?Rt Hon BILL ENGLISH: Because that is not correct I do not have regrets; nothing like that member's regrets at recruiting Willie Jackson.Andrew Little: Does he not accept that it is time for some fresh thinking; after 9 years of a deteriorating mental health system we actually need to fund our mental health services properly and with a focus on helping people before they reach crisis point?Rt Hon BILL ENGLISH: One of the strengths of this Government is that it is always applying fresh thinking fresh angles to well-understood or well-known problems. In respect of mental health there has been more money but of course unlike Labour we do not believe that endlessly more money answers every problem. We have got a much better understanding of which parts of the population are most vulnerable to mental illness some of whom spend 20 or 30 years in our welfare system because they are under-treated. So our fresh thinking is about applying better ways of applying the money to those needs.Julie Anne Genter: If short-staffing is not such a problem across the country why are desperate parents reporting that children have to be suicidal or self-harming just to get help from the mental health system?Rt Hon BILL ENGLISH: In the first case staffing issues are managed by the DHBs according to the plans laid out by their local boards half of whom are elected people. They actually are the people who make the decisions about where the money goes. They can always apply more money to mental health and they have been when we can see that over 5 years there has been 20 to 25 percent increase in the staffing of most mental health services. With regard to those individuals the response times as I understand are measured and have been improving but there will still be families who are in distress because they cannot get the service straight away for their young person.Julie Anne Genter: Will his Government commit to an independent nationwide inquiry into mental health services to ensure that we can get to the bottom of the structural problems in delivering those services and any need for increased funding given what he described yesterday as "increasing demand and complexity"?Rt Hon BILL ENGLISH: No I do not think an inquiry would tell us anything that is not known already. The issue here is not whether we spend a whole lot of resource on an inquiry; it is better decision making in DHBs if they are overlooking need that they are meant to be meeting among their population because they have to prioritise and finding a better way particularly of approaching the issue of prevention in the case of mental health.Julie Anne Genter: Does he accept that increasing population and increasing demand for mental health services mean that the amounts of increased funding that he has referred to simply have not been sufficient to meet the need out there in the community and how bad will it have to get before his Government responds?Rt Hon BILL ENGLISH: The Government and the Minister of Health and the DHBs have been responding to increased need. They are spending more they are employing more people and there have been quite dramatic increases in some services. I think there is almost double the number of people now in addiction services as there were 6 or 7 years ago. That is a massive expansion and probably now you are more likely to get treatment than used to be the case. The Government will continue to respond to the need."