Question: How do we address gaps in mental health services for youth and children in New Zealand?

Mental health issues are rampantly prevalent among New Zealand’s young people as well. The rates are increasing in line with international trends. In 2019, 23% of high school students reported experiencing significant depressive symptoms; 6% reported having attempted suicide; and 19% reported difficulties accessing mental health support. NZ has the second highest youth suicide rate among OECD countries. An estimated 12% of New Zealanders will experience a substance use disorder in their lifetime, of whom 70% will have a coexisting mental health issue.  

Neuropsychiatric disorders are the leading cause of health loss in NZ, accounting for 19% of total disability adjusted life years. Mental health is the main health challenge for youth (15–24 years). Neuropsychiatric disorders accounted for over 35% of all health lost by this age group in 2013. While New Zealanders are living longer, it is not always in good health. 

Ethnicity related inequities are also well-recognised, with Maori children being 1.5 times more likely than others to experience emotional or behavioural problems and Maori aged 15–24 years completing suicide more often (34.6 deaths per 100,000 vs 16.4 per 100,000 for non-Maori).

The Government’s significant increase in spending on mental health has not materialised as hoped between 2017 and 2021. Particular concern was expressed for young people.  

Despite the clear need for increased mental health support for young people, especially those with more severe issues, in 2019, there were approximately 1.0 FTE child and adolescent psychiatrists per 100,000 population in NZ. This is well short of previous recommendations of 2.0– 4.0 FTE per 100,000 population.

Three key areas for improving child mental services include:Increasing the specialist workforce, including child psychiatrists to recommended levels, improving services to become more holistic and meet the needs of specific groups, and lastly, given the preference of younger digital natives to receive support via online means, and more recent clinician openness to telehealth during the COVID-19 pandemic, well codesigned, evidence-based and culturally acceptable eHealth interventions to augment access to timely support and reduce ethnicity and geographically related inequities of care. 

Mental health problems in child and youth should also be ‘core business’ for primary care. However young people often choose not to present mental health problems to GPs, and many child and youth services are situated within education, social welfare or justice and secondary care delivery frameworks. 

There is evidence that in healthcare, the best return on investment for future wellbeing is made between the years of 0-4 years. While it may be difficult for the wider health system to commit to a long term view, investment in early childhood is likely to provide the greatest gains in improving overall mental health outcomes.