Reti ShaneDr SHANE RETI (National—Whangarei): It is a pleasure to rise and support the Estimates. In this contribution I would like to focus on what was a substantive discussion in the Estimates which was around mental health—Dr David Clark: Mental health.Dr SHANE RETI: —indeed mental health—and talk about some of the initiatives that we are undertaking with the $224 million that is being appropriated in this Budget. The $224 million is looking to deal with the increasing burden of mental health. We know that 50 percent of all New Zealanders at some point in their lifetime will have a mental health issue and that in any one year 25 percent will have a diagnosable mental health condition.If we break that $224 million down we see $100 million going to district health boards (DHBs) ring-fenced like the old Mason money used to be. There is $100 million to the social investment programme and $24 million to cross-agency initiatives which includes the Ministry of Social Development (MSD) Corrections and the Ministry of Māori Development. Some of the mental health targets that are important and that we are focusing on include acute assessment. For non-urgent cases we are looking to have 80 percent seen in the first 3 weeks and 95 percent seen in 8 weeks. Another target we are focusing on is the post-discharge follow-up and that target is 90 percent in 7 days.And to be fair the Office of the Auditor-General (OAG) report did come out and say: Look we've got some work to do there." It was not quite where we wanted it to be and so I am going to talk about how we are applying ourselves to get there. In fact the main finding of the OAG report was all around collaboration particularly that primary to secondary care transition.I want to talk to each of these three appropriations in a bit more detail then. The $100 million to the DHBs: well what the Minister has done here is make mental health a very clear priority. How do you do that? Well you do that by setting out a letter of expectation to the DHBs saying exactly that. Mental health is a high priority for this Minister and for this Government.What you also do is you make it a key performance indicator reportable in the Ministry of Health's annual reports. That also focuses the attention of the DHBs. Inside of the social investment programme and the $100 million that is being appropriated there we have the national depression index which is an IT-based model with two core websites and the National Telehealth Service wrapping around it. The service for youth is called thelowdown.co.nz and for adults depression.org.nz.Technology is very important in some of the push into the mental health domain. We know from international jurisdictions that people who have suicidal ideation and are feeling depressed are more inclined and more likely to deal with computerised interviews than with personal interviews. That is what the international space is telling us but you know some of our local researchers have also found that. Professor Felicity Goodyear-Smith from the Auckland Goodfellow Unit has an application called eCHAT which uses iPads as a self-assessment tool in a waiting room to look at depression and other mental health illnesses. It is a wonderful project. She published it in The Journal of the American Medical Association I think it was and it is another good indication of technology being useful in this domain.The second initiative inside the social investment programme comes from the document Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012-2017. This outlined four key parts to a framework around how we might address mental health. The first was Activating our existing resources—I called it "ABCD". B was Building integration—here we are again coming back to that transition between primary and secondary care—Covering high needs; and fourthly Delivering increased access. So that is the second initiative.The third thing I want to talk to is the national quality improvement programme managed by the Health Quality and Safety Commission—7.5 million over 5 years reviewed in 3 years. It set itself five priorities. Those five priorities are firstly minimising restrictive care and I would note that the legislation we passed earlier this year the Substance Addiction (Compulsory Assessment and Treatment) Act did exactly that. Second is maximising physical health. We can easily be distracted in mental health on the mental health issue. Let us remember they have other physiological conditions that are often distracting and need attention also. Third is improving medication management. It is always a challenge in mental health. When you are not at your best you are more inclined to say "I don't need to take this medicine because I'm doing well." when in fact you may not be. Recording adverse events—and here we are again their fifth priority is improving service transitions. See all the focus across these frameworks is the really important integration between services.So I think as we can see here there are a number of initiatives at several levels—DHB level the social investment level. I have not even—and probably will not have time to—spoken to the collaborations between MSD Corrections and Māori Development but I think we have made the point that we recognise the challenge of mental health we are applying it and here is actually what we are doing. Thank you."