Mental Health Commission Amendment Bill — In Committee 
Mental Health Commission Amendment Bill — In Committee 
[Volume:641;Page:10929] 
Mental Health Commission Amendment Bill 
In Committee 
Part 1 Amendments to principal Act 
Dr JONATHAN COLEMAN (National—Northcote) 
: 
 It is my pleasure to speak in the Committee stage of this Mental Health Commission Amendment Bill. National will support this bill but as I will discuss shortly we have tabled an amendment. 
I thought the Health Committee members worked very well together on this bill. The Mental Health Commission Amendment Bill obviously addresses some issues that are pretty important in New Zealand. We had 22 submissions. The range of opinions expressed over the course of the submissions was interesting. One of the main things that came out of the process I think is the importance of involving families in the care of those who suffer from chronic mental illness. We know that 0.3 percent of the New Zealand population suffers from a chronic incurable mental illness and the burden for much of the care needed falls back on families. We heard a lot from families who were in that situation and who felt quite concerned that they really were no longer part of the decision-making process. One thing we have to bear in mind in the mental health sector is to make sure the views of families are taken into account when we are considering chronic care arrangements for the mentally ill. 
The main amendment we have relates to clause 8(1). This bill will extend the life of the commission to 2015. Well the National Party supports an amendment—and I hope that the rest of the Committee will support it as well—to limit the life of the commission to 3 years after the date of the Royal assent of the Mental Health Commission Amendment Act 2007. There is a very clear reason for that: we think there really has to be accountability with regard to public money. If we look at what has happened with mental health over the past 8 years since this Government came to power we see that spending has gone up by 75 percent. It is now nearly at the $1 billion mark. That is an awful lot of money but we have to ask what the public is getting for that expenditure. 
The reality is that mental health statistics in this country are actually getting worse but the real issue is that public access to mental health services is deteriorating. There is no question that the sort of headline-grabbing areas of mental health—like forensic services—have been well funded because politically it is very important for any Government to get that stuff out of newspaper headlines. And this Labour Government has been the epitome of doing just that. That is all very well but if we look at what has happened for Maori and Pacific Islanders for children and for the elderly we see that they are not getting access to services that they should be getting. We think that is a real crime. When we have so much more money in the system those people—many of whom are disadvantaged and many of whom are without a strong voice in our society—should be getting access to a fair share of the services. 
I come back to the amendment. Why do we want to limit the life of the commission to 3 years in the first instance when it will be reviewed? I must say that there is no doubt that the life of the commission will be extended. The reason for the limit is that the National Party believes that we cannot write blank cheques with public money. Basically we believe that if the Mental Health Commission is written a blank cheque to 2015 it is being given too much latitude. We believe that if the commission is fulfilling the role it should be and if it is doing a good job there is no reason why its life will not be extended beyond 3 years from the date of the granting of the Royal assent. But in the age we live in where we have had so much profligate spending by this Government and where so much money has been wasted on reports and bureaucracy we believe that it is irresponsible to extend the life of any commission or Government bureaucracy for 7 years like that without any accountability. That is what we will be asking for. 
We believe that the Mental Health Commission does a good job; there is no question about that. It has done a great job in promoting awareness of mental illness in a positive way. The John Kirwan ads have really done a lot to destigmatise mental illness. There is definitely a role for the Mental Health Commission and it does good work that needs to be supported. But like any body it has to be constantly watched and monitored. 
One thing we want to see the Mental Health Commission doing is pushing this Government much harder because the Government really has not delivered on mental health. That is the role we will be seeking to have the commission fill. 
SUE MORONEY (Labour) 
: 
 In speaking to the Committee stage of the Mental Health Commission Amendment Bill I note in terms of some of the issues raised by the previous speaker that National members are very keen to talk about too much money being spent on our health service. Jonathan Coleman again raised this issue of not being happy about the amount of money being spent on mental health services. One of the roles or functions of the Mental Health Commission under the bill that we are speaking to today is to act as an advocate for the interests of people with mental illness and of their families generally. That includes ensuring that there is a good funding level for the services to be adequate for people in this area. 
Dr Coleman also referred to the National Party’s position of wanting to bring the commission to an end earlier than the Health Committee report recommended. 
Dr Jonathan Coleman 
: No you know that’s not right Sue. You know that’s not what I said. 
SUE MORONEY 
: Well it was the National Party’s position. It is recorded in the commentary from the select committee that “New Zealand National’s view is that the principal Act should expire on a date that is three years after the date on which this bill receives the Royal assent.” The rest of the select committee did not uphold that point of view. 
 At this stage I just point out that the Health Committee has representation on it from many of the parties in Parliament. It has on it members from the Green Party New Zealand First the Maori Party Labour and National so it is very representative in its views. It was only the National Party—not even any of the submitters—that wanted the commission to be reviewed earlier than 2015. 
I have done some thinking about why that might be and I know that the National Party has decided in its own mind—it is not in the mind of voters—that it will be the Government come 2008. Well that is up to the voters to decide of course but I think that is the reason National does not really want a watchdog body in place until 2015. If National were to become the Government it would want to get rid of the commission pretty damn quickly because this is a party that is standing on a platform of reducing taxes. We all know what that means for areas such as mental health. Reducing taxes equals reducing public spending and reducing public spending always means cutting the health budget because that is the largest area of public spending. So when it comes to the Mental Health Commission and its role—its very important advocacy and watchdog role—why would the National Party want to have that body cemented in place through to 2015 if it fully planned to cut funding to mental health services in that period of time? 
I say in conclusion that I am fully in support of this part of the bill because it extends the life of the commission in concrete through to the year 2015. All of the other parties on the select committee apart from National agreed with that view. The submissions we heard also agreed with the extension to 2015. Thank you. 
Dr JACKIE BLUE (National) 
: 
 I am happy to speak to Part 1 of the Mental Health Commission Amendment Bill. There are a couple of clauses I want to speak about. The first one is clause 5 which defines “stakeholder”. The definition “stakeholder” includes many groups not just the ministry or the usual bodies or people who are normally named as stakeholders such as district health boards and traditional providers such as doctors and mental health services. The definition has been widened to include groups who represent the interests of people with mental illness such as families and caregivers of the mentally ill. I think that is an excellent amendment. 
The mental health area is highly dependent on groups and organisations that support families and individuals who have mental health issues. Really if it were not for non-governmental organisations we would be in dire straits. Probably 20 percent of Vote Health goes to non-governmental organisations across the board but mental health providers have greater representation than that in the mental health vote as such—almost 30 percent of the national expenditure. I think they are unsung heroes. Their crucial input is often not acknowledged. They are the glue that keeps our families stuck together. I understand that in the northern region which is where I live there are 80 non-governmental organisation providers in the area of mental health. They receive 30 percent of the mental health funding and that has been devolved to the northern district health boards. It is predicted that the non-governmental groups will actually increase in size over the next 10 years as the shift to services in the community becomes more prominent. 
I think that National’s tax package with breaks for volunteer groups and charitable organisations went down well and it will make significant changes to the way community groups will be funded. It was a very successful policy. It was so successful that Labour stole it word for word and announced it in this year’s Budget. But it is a good initiative for the non-governmental organisation sector and I am sure that much more money will flow to this invaluable group. 
The next two clauses I will speak about are clauses 7 and 8 which deal with the term of the Mental Health Commission. National as Jonathan Coleman pointed out has some concerns about that. We would like the term of the Mental Health Commission to finish 3 years after the date on which the bill receives the Royal assent. There are a number of reasons for this. The Mental Health Commission was established 11 years ago in 1996. If it is to expire in 2015 that is another 8 years away and National thinks that date is too far away. The commission is a publicly funded body and we feel it should have measured outcomes. The 2015 date is too far in the distance. We do support the work of the Mental Health Commission but we feel it should be accountable and answerable. We feel that the date Dr Jonathan Coleman proposes in his amendment is more realistic and tangible. 
I raised the point last night in the second reading debate on this bill that it is interesting how the Mental Health Commission has devolved away from the Ministry of Health with its own directorate of mental health. If at some point in the future we look at bringing the Mental Health Commission back into the Ministry of Health then we would want obviously a date for its expiry that is not as far away as 2010. Three years from the date of the Royal assent would be a much more realistic date. The Mental Health Commission does very good work. As Jonathan Coleman pointed out the advertisement aimed at destigmatising depression that features John Kirwan is actually the Ministry of Health’s advertisement. But there are many other facets that the advertisement works on. 
I am really concerned about the mental health workforce. That is a particular issue for me. I raised it last night and I would like to raise it again today. Enrolled nurses are in a threatened workforce. Basically they have been stigmatised in the mental health workforce. They have been sidelined and pushed out. It really began when Mark Burton a psychiatric patient killed his mother and an enrolled nurse was incorrectly implicated. An edict went out that enrolled nurses should be removed from more acute care situations including psychiatric facilities. Basically they have been sidelined ever since. Where was the Mental Health Commission in that situation? That was the question I posed to the House. I went to the commission’s website and looked at all its archived press releases but I could not find a solitary word in favour or support of this workforce. There are about 4000 enrolled nurses in New Zealand. About 250 of them are in the psychiatric workforce. Those are 2004-05 figures; we do not have current figures. It is an aging workforce and as the nurses retire I doubt that we will see many more unless they are supported. 
Dr PAUL HUTCHISON (National—Port Waikato) 
: 
 I rise to speak on this very important Mental Health Commission Amendment Bill. The commission started in 1996 under a National Government. It was brought about after many years of the mental health sector being regarded as a Cinderella sector—much like the disability sector is today. It has meant that there has been an independent advocacy power for people with mental illness and that has had a very powerful effect over the last 10 years or so. 
I am very sympathetic to Dr Jonathan Coleman’s amendment which suggests a 3-yearly review. This does not mean stopping or terminating the Mental Health Commission but merely reviewing it. It is so important within the context of mental health to ensure that all aspects of it are effectively monitored and that includes the financial aspects. As this Government has found out resources are finite and the demand in any aspect of the health sector is almost infinite. It is hugely important that we are responsible. 
For a moment or two I want to go over the functions of the commission which are highlighted in Part 1. These do draw attention to the very important aspects that the commission is there for. Firstly it is there to act as an advocate for the interests of people with mental illness and their families because so often they cannot advocate for themselves. We hear this time and time again in the disability review being undertaken at present by the Social Services Committee. So often we have heard the request that a similar commission be set up for the disability sector. Secondly it will promote and facilitate collaboration and communication about mental health issues among stakeholders and representatives in the mental health government academic and community sectors and members of the general public. Indeed there are lots of stakeholders and it is hugely important that they are given the chance to collaborate so that their networks are built up and they are all talking the same theme. This is one of the aspects that was not there when the deinstitutionalisation occurred and it has been built up gradually over the last 10 years. 
The commission will work independently and with others to promote better understanding as I have just mentioned and to reduce the stigma associated with mental illness. I think Jonathan Coleman just pointed out how successful the recent TV advertisements have been involving a former All Black whom many New Zealanders can identify with so easily. John Kirwan has been prepared to give of his time and be so frank about the condition that plagued him; and obviously many New Zealanders have realised that this is something that so easily could affect them. Indeed it pervades so many families throughout our society. So this is one of the very important functions of the commission that needs to be perpetuated. 
The commission will monitor report to the Minister and advise the Minister on any matter relating to the implementation of the national mental health strategy. This is very important. The blueprint for mental health has meant that there has been an amount of money out there and at times there have not been the people able to fulfil the duties that are required. For instance paediatric community mental health has not had paediatric psychiatrists available. This has been of great concern given that paediatric mental health is one of the areas that are so important. If we are not able to ensure that a child with mental health problems is given early attention then it can get much much worse and it is much harder at a later date to help that individual. Over the last 6 or 7 years we have seen a dearth of community paediatric psychiatrists and the situation has not been made much better to my knowledge under this Labour Government. This is the sort of function that is very important for the Mental Health Commission to carry out and feel free to report on. The commission reports on a yearly basis and it is so vital that that can be done without fear or favour of government. 
The commission will stimulate and support the policy makers funders and providers of mental health services in developing integrated effective and efficient methods or systems. One of the things we do know is that many systems are involved with mental health not only in the health services but in the Ministry of Social Development and education and that the complex arrangements around these are often very fragmented. So it is hugely important to perpetuate this commission and I agree entirely with the very sensible amendment put forward by my colleague Dr Jonathan Coleman that the term be reviewed on a 3-yearly basis. 
The question was put that the following amendment in the name of Dr Jonathan Coleman to clause 8 be agreed to: 
to omit from subclause (1) the expression “2015” and substitute the words “3 years after the date of the Royal assent of the Mental Health Commission Amendment Act 2007”. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 49 
New Zealand National 48; Independent: Copeland. 
Noes 67 
New Zealand Labour 48; New Zealand First 7; Green Party 6; Maori Party 4; Progressive 1; Independent: Field. 
Amendment not agreed to. 
Part 1 agreed to. 
Part 2 Transitional provisions 
Dr JONATHAN COLEMAN (National—Northcote) 
: 
 Part 2 of the Mental Health Commission Amendment Bill deals mostly with issues pertaining to the office of members of the commission. 
One of the things we learnt quite clearly in the Health Committee was that there are many differing approaches to mental health issues. Some of those were represented in the select committee hearing and we heard many different philosophies. It is always a very contentious issue as to how mental health treatment is delivered: who delivers it how it is carried out where mental health clients or patients live and how much influence and say they have in their own treatment and management. Of course things have moved on over the years and we live in a much more informed society now. I think that is reflected in society’s treatment of and approach to people with mental health issues. 
But when we look at the issue of who is on the Mental Health Commission one of the things we need to ensure is that the officers represent a balanced approach to mental health issues. We cannot have the commission philosophically dominated by anyone who is wedded to one particular mode of treatment or philosophical approach. 
In getting back to this issue that Sue Moroney mentioned about a 3-yearly review I know that the idea of a 3-yearly review is probably something the Labour Party members are extremely sensitive about at the moment—because of course those members are facing their 3-yearly reviews and there are several in the House who frankly may as well not turn up because they have failed already. Indeed some of them have faced that situation in the past and have been rejected as members by their electorates but have sort of scooted in on the coat-tails of various retirements or been well camouflaged so far down the party list that they have actually managed to get in there. I can imagine that Ms Moroney is very averse to that concept of the 3-yearly review. 
But when we think about it the Labour Party thinks that 3-yearly reviews are a good idea. The electorate thinks 3-yearly reviews are a good idea. So why would we not want to have a 3-yearly review of another body that spends a lot of public money—the Mental Health Commission? Ms Moroney was quite misleading and wrong when she said that National would cut spending in mental health. That is wrong. The point she does not appreciate is that with this massive increase in spending under this reckless Labour Government the public need to know that the money is being well spent and that the Government is actually delivering the services people need. Even Ms Moroney if she really looks at the facts would be hard-pressed to say this Government has delivered on mental health. She knows that the Government has not done that. Writing a huge stack of reports is not delivering on mental health. Delivering on mental health—the definition of that—is more people getting access to services and Ms Moroney knows that is not the case. The spending has gone up; it has gone up to $1 billion a year. The spending is $1 billion a year on mental health. That is a huge proportion of the Government’s expenditure and for that money people would expect that the Government would actually be delivering something. 
We also have this ridiculous situation where district health boards are not even managing to spend the allocated money in the correct way. So although there is no money for services for young women with eating disorders we still have $18 million across all the district health boards ring-fenced for acute mental health problems that the district health boards are just not managing to spend. 
A National Government would want to free that money up and put it in areas where it is needed. We would make sure that there are services for young people and services for children. We would make sure that people in deprived groups in society would actually be able to access mental health services in the same way that some of the more mainstream groups are doing. 
Really what this idea of a review of the Mental Health Commission comes back to is making sure that it is delivering on what it should be doing. What it should be doing is holding this Government to account because what has been happening is that the spending has gone up and up but the mental health statistics are not improving—in fact they are getting worse. We know that over the course of a year one New Zealander in five will suffer symptoms of a mental illness. That is a fact and we cannot dispute that. We know that is the case and that the situation is not improving in any way. National members say we have to have accountability. 
LESLEY SOPER (Labour) 
: 
 Dr Coleman has once again got it wrong. He is wrong on mental health again. He is using Part 2 of this bill which after all I say to Jonathan is the transitional provisions to have a go at the Government. So I say to him: “Get a life!” Dr Coleman has got it wrong again. He has tried to use Part 2 of the bill—the transitional provisions—to have a go at the Government. The fact is that this Government has actually got it right in mental health and Dr Coleman does not like that. 
All that the National Party can talk about is tax cuts and tax cuts are not going to deliver to mental health users or their families or to the professionals in mental health in the way that the current Government is delivering to mental health through the ring-fenced funding. Dr Coleman does not seem to have grasped that tax cuts are not going to do it in mental health just as they are not going to do it anywhere else. 
Dr Jonathan Coleman 
: I raise a point of order Mr Chairperson. There is nothing in this bill to do with tax cuts. 
The CHAIRPERSON (Hon Clem Simich) 
: The current speaker is actually more relevant to this section than the one before her. 
LESLEY SOPER 
: Thank you very much Mr Chairperson. That was exactly the point I was making—that Dr Coleman was using Part 2 of this bill inappropriately to get in what he felt like talking about rather than actually talking about Part 2. 
We all know that one of the commissioners’ key contributions has been to express the needs and wishes of mental health users. Now Dr Coleman might not believe that and that might not have been what his speech was about but the fact is that Part 2 is about bringing the commissioners’ terms of office into line with the Crown Entities Act 2004 and that seems an eminently reasonable thing for Part 2 to do. 
Under the provisions of this bill the Mental Health Commission is retaining its role in addressing the stigma associated with mental illness. It has a new role to stimulate research and service development and this Part 2 is very sensibly saying: “Let’s bring the commissioners’ terms of office into line with the Crown Entities Act.” It is a very sensible provision. All Dr Coleman could manage to get up to say was that the Government had somehow got it wrong. Well Dr Coleman has got it wrong. The whole bill will do far more for mental health than the tax cuts that the National Party keeps endlessly talking about. 
The innovative things that are going on in mental health and that health boards will continue to bring into place when they have managed to repair the damage in mental health done by the National cuts of the 1990s can be done best under the provisions of this bill. That is what Part 2 is about I say to Dr Coleman; that is why it is part of a good bill and why we on this side of the Chamber support its passing. 
The question was put that the amendment set out on Supplementary Order Paper 135 in the name of Hon Pete Hodgson to clause 9 be agreed to. 
Amendment agreed to. 
Part 2 as amended agreed to. 
Clauses 1 to 3 
The CHAIRPERSON (Hon Clem Simich) 
: We now come to clauses 1 to 3—one debate with separate questions on all three. 
Dr JACKIE BLUE (National) 
: 
 I am happy to speak on the title of the Mental Health Commission Amendment Bill. It is interesting that we had a number of submissions to the Health Committee for the bill and they were very comprehensive and wide ranging. One submission was specifically on the name of the commission. The group submitting it felt very strongly that the name of the commission should be changed from the Mental Health Commission to the “Mental Health and Addictions Commission”. The group felt there was a lot to a name and that the name said it all and that with “Addictions” inserted there would be much more focus on addictions. This group felt quite strongly that addictions in the community—drugs alcohol and gambling—were an issue and that there would be a focus if that name were included. The committee looked at the group’s submission and heard a number of other suggestions apart from the name change. The group also suggested the need for greater expertise in addiction issues the establishment of an addictions consumer advisory group and the appointment of a commissioner. 
The committee took on all the group’s suggestions. We considered them and we recommended finally that there should be an addictions advisory group established to provide expert advice to committees. We certainly hope that this recommendation is taken up because drugs alcohol and gambling cause increasing problems in society and in communities. 
I want to go back and say that I really support the work of the Mental Health Commission. National wants to see accountability. People should not get worried that we want a date of 3 years from the Royal assent. It was more that we should have a checklist—a point where we can look back take some accountability and look at some measurable outcomes. People have obviously got far too wound up about the 3-year date; it is to ensure that public spending is accounted for and that the money is spent wisely. 
Money has been pushed into mental health—quite rightly. National has been concerned about the value of the spend. In fact some district health boards cannot even spend their mental health budgets and that is of great concern. I understand that the main reason for that is that they do not have the mental health workforce to enlist but key objective No. 3 for the Mental Health Commission which is to strengthen the mental health workforce will be critical in the years ahead. We know that the burden is increasing steadily—the statistics have come out today in the speeches—and mental health is a serious issue. It is not going away we cannot cover it up and we must address it. We cannot do that well without a mental health workforce—I think that is quite critical. The problem actually goes across the whole health sector; our whole health sector workforce is in crisis. Its members are an aging workforce they need to be rejuvenated and the mental health workforce is no exception to that. 
We support the work of the Mental Health Commission. We are concerned about the increasing number of hospitalisations for suicide and the increasing concern with depression in the community. We want to support the work particularly in the non-governmental organisation sector and the work of groups on the ground. They are quite critical in our health sector and their people are often the undervalued unrecognised and unsung heroes. 
We talked before about the Ministry of Health and the Mental Health Commission—why it had been split off. Why that happened is quite an interesting matter. The Mental Health Commission was established in 1996. In 1998 it became a Crown entity supposedly to give it independence and autonomy; but with that type of split focus can be lost and there can be two groups working in different directions. I certainly hope there is no duplication of their workloads because that would obviously be a waste of time energy focus and money. Certainly I wonder about the need for both groups to head off in different directions and I hope they are working together. 
I know that the John Kirwan ad was a Ministry of Health initiative and it has been a very good initiative. I think it has raised awareness in the community. People are talking about mental illness freely and without any shame. It is a common illness it is treatable and it is reversible. There is no shame in having a mental illness. I congratulate the ministry on those advertisements and I congratulate John Kirwan who got an honour recently. So National supports the Mental Health Commission but I think people have got hung up on the 3-year date we are proposing. 
JO GOODHEW (National—Aoraki) 
: 
 I also rise in support of the Mental Health Commission Amendment Bill and I do so because along with my colleagues the Hon Tony Ryall and Drs Jackie Blue and Jonathan Coleman I examined the bill at the select committee and believe on balance that there is merit in supporting its passage through the House. In general the purpose of the bill is simply to extend the life of the commission to 2015. But the opportunity this extension offered to improve the bill was taken and there have been changes in the commission’s role: firstly in advising and reporting to the Minister on the implementation of the national mental health strategy; secondly in promoting and facilitating collaboration and dialogue about mental health issues; and thirdly in advocating for the interests of people with mental illness and their families generally. 
It would be fair to say that when we were listening to the 14 submissions and reading the other eight we were given a valuable insight into the complicated lives of the family members of those who experience mental illness. At times we heard tragic stories shared and it was through that experience that we came to realise the significance of a highly functional and effective Mental Health Commission. Sixteen of the submissions were from organisations and groups and six were from individuals. Some family members expressed opposition to the bill and it would seem that that signalled a really important opportunity for the Mental Health Commission to look at why these people felt that their needs were not being met. The commission should see that as an opportunity and not a threat. So when this bill passes through Parliament in a slightly different form the Mental Health Commission should be able to ensure that it addresses the concerns of those people rather than just putting those concerns into the past. My colleague Dr Jonathan Coleman questioned the Minister of Health Pete Hodgson during the select committee estimates process. Of note during that process where spending on mental illness was scrutinised was the sense that although the Ministry of Health believes there have been improvements in the lot of those with mental illness there is actually scant evidence to support this belief and that certainly worried the National members on the Health Committee. 
Spending on mental illness has increased under Labour but as with other areas of the sector it is not enough just to spend more. The public of New Zealand deserves to know that when the Government increases spending there is a corresponding value for money. We in National believe that the mental health sector like other parts of the health sector is a victim of report mania or “report-itis”. When reports get in the way of delivery rather than facilitate improved delivery we then see that as a waste of taxpayers’ money. 
The Mental Health Commission needs to play an important role in monitoring results and providing an assessment of the Government’s role in mental health service provision. Adding to monetary accountability issues are the workforce issues the sector faces but these issues should not happen when some district health boards are underspending their ring-fenced mental health dollars. Meetings with mental health practitioners have shown me that workforce issues including large workloads and a lack of support from the Government should be a very high priority for this Labour-led Government. In my electorate Aoraki we have a district health board that has in the past underspent ring-fenced mental health funding. Much of the problem has been due to a lack of numbers in the workforce to provide that particular service to the local community. We have lacked the specialised people to fill those roles and in fact that is a nationwide problem. As we know the health sector workforce crisis is widespread and the South Canterbury District Health Board is like all other district health boards in that respect. In fact when we looked at the amount of underspent ring-fenced mental health money we found that more than $18 million remained unspent last year. 
The Mental Health Commission has the responsibility to act as an advocate for the interests of people with mental illness and their families generally but it also needs to take into account the interests of other stakeholders. The list of stakeholders in this bill includes the ministry district health boards mental heath service funders and providers those with mental illness their families and caregivers and also groups representing the interests of people with mental illness and their families and caregivers. Therefore a lot of masters are listed in this bill—an awful lot of masters—and I am sure that juggling so many masters gives rise to many tensions. That may be why the select committee heard some submissions that caused us some concern and that may be why some people were highly critical of the Mental Health Commission. 
One thing that has changed over the decades and needs to continue changing—and I will finish on this note—is the way that mental illness is viewed and discussed by the general public. These days mental illness is much less viewed as a taboo subject something that needs to be hidden away and a shameful thing to happen to oneself or one’s family members. More and more we see communities advocating for a fair go for those who suffer from mental illness. The Like Minds Like Mine campaign and John Kirwan’s attempts to destigmatise mental illness have been vital and they have made significant improvements for people who suffer discrimination because they suffer from a mental illness. 
In my electorate a constituent wrote a book about suffering from depression. It is entitled  
No One Gives You Chocolates 
. The author’s penname is Ellen Munro and I commend the book to those wishing to understand depression. This book is about depression and those who suffer from it and it was written by someone who has an absolute understanding of it. The thing about depression and about other illnesses that people need counselling for is that the people concerned do not actually fit the criteria for that ring-fenced money. Time and time again I hear community groups ask how they can access money for those people who need counselling. It is certainly a role for the Mental Health Commission to address the concerns of stigma discrimination and access to services for those people suffering mental illness and needing some counselling. Maybe it is time to look at the blueprint for funding parameters. 
This bill will address some concerns that have been raised and hopefully will continue the work successfully achieved by the Mental Health Commission and develop that work to achieve more. My colleague Dr Jonathan Coleman has indicated that during this Committee stage he will promote a change to the date on which the Act will expire so that instead of being 2015 it will be 3 years after the date on which this bill receives the Royal assent. We in National believe that just as that change to the date will give the Mental Health Commission an opportunity to address its effectiveness it will also give us a chance to reflect on that opportunity and put up an achievement standard for the commission to either achieve or not. It will be another chance for us to scrutinise the Mental Health Commission. 
I commend this bill to the Committee. I support the bill but I also note that some submitters had grave concerns and I urge the Mental Health Commission to address those concerns soon. 
Dr JONATHAN COLEMAN (National—Northcote) 
: 
 In speaking to the title the Mental Health Commission Amendment Bill I think we have made it clear that National sees a real role for the Mental Health Commission well into the future. We think there is a real need for the work it does and it performs that work very very well. I have to take issue though with what Ms Soper was saying—that the Government has got it right on mental health. Quite frankly that is not what members will hear if they talk to anyone who has a family member in care in the mental health system. There is a lot that needs to be done and to let Ms Soper know the reality of it I tell her that one cannot address the problems in the mental health system by just pouring more and more money into it and by issuing more and more reports and that is what has happened under this Government. 
What National members are saying with our amendment to extend the life of this commission for a further 3 years before it is reviewed is that we have to have accountable public spending. But of course that has gone very much out of fashion under this Government. I will give members an example of what is happening in mental health. I have asked every district health board to send me a list of the organisations to which they are contracting out mental health services and to tell us how many clients each service is treating. They can give me a list of the providers but none of them can tell me how many clients each provider is actually seeing. These district health boards are paying out millions and millions of dollars of public money to mental health providers yet they do not have a clue what they are getting for that. They do not know. They could be seeing zero people but the district health boards are still paying the bill. That is the problem with what has happened under this Government—there is no accountability. 
Tariana Turia 
: That’s not true. 
Dr JONATHAN COLEMAN 
: Well it is true because I have asked for it under the Official Information Act. They have sent me a list of providers but they cannot tell how many clients they are seeing. The district health boards do not know. I hope that someone at the Ministry of Health knows because that is hopeless. Lesley Soper says that this Government has got it right in relation to mental health but I think it has a heck of a long way to go. The reality is as I said at the start there are many groups in society—Maori Pacific Islanders young people people in need of specialist services like eating disorder clinics and older people—who are not getting access to services. The Ministry of Health itself states that in its annual report—people are not getting access to the services they need. Yet the Government has increased the spending on mental health by 75 percent to $1 billion a year. 
One would expect that for $1 billion a year we would get some sort of improvement in the level of services and we would expect it to be pretty substantial. But Labour has not delivered in this area. When Labour members came into office they thought they could socialise everything. They thought they could pour money into everything. They have ramped up public spending on health but they forgot to measure the outcomes properly. When we ask the really hard questions on this we can see that the outcomes are just not there. Lesley Soper comes in here and says that Labour has it right on mental health but we need only to go out and ask the families and the people in the system what is happening to be told that they feel badly let down by what this Government has done in mental health. But having said that National is very keen to see the Mental Health Commission continue because we reckon that the Government needs a real eye kept on it in mental health. We want the commission to keep on the Minister’s back and to make sure the Minister delivers on some of his promises in mental health—that the Government is providing services and giving good value for the taxpayer spending that is going on. I can tell members that the spending has been profligate. 
So there we have it. National will support this bill. We want to see a review 3 years from the date of the granting of the Royal assent but if the commission is doing its job there is no reason its life will not be extended. But it is the old story—what gets measured gets done. It is far too long a time to extend the life of this commission to 2015 without any public accountability. 
Clause 1 agreed to. 
Clause 2 agreed to. 
Clause 3 agreed to. 
Bill reported with amendment. 
Report adopted.