The head of funding at the Southern District Health Board has welcomed possible changes to how mental health is funded, while a Dunedin advocate warns the new direction appears to signal cuts.
The Mental Health Commission released a discussion paper this month introducing its project to develop a second mental health blueprint, which will update the 1998 original.
The 1998 blueprint ensured DHBs properly funded and prioritised mental health; this is the first time it has been updated.
The discussion document warns there may be less money for mental health.
"The environment is shifting with the prospect of constrained resources, requiring us to leverage value from all the resources available to us," the paper said.
"We are facing complex challenges, opportunities and trade-off choices that demand we see the system as a whole while acting locally ...""Prescriptive" funding rules could become more flexible, allowing DHBs to provide services that addressed "local needs, diverse populations and service options".
"Outdated resourcing rules" created "distortions and difficulties" for DHBs managing the 13-year-old blueprint alongside more recent requirements and targets.
The new blueprint would "review functionality of [the funding] ring-fence" and there could be changes to how it worked.
The focus of funding would broaden from the 3% who were most in need, with more attention on children, youth and older adults.
Mental health services were much stronger than in 1998, thus "primary care and the resources of people and whanau" could assume greater importance.
Southern DHB funding and finance general manager Robert Mackway-Jones said moving to population-based funding would be sensible.
"Moving to a [population-based] funding method would allow the DHB to prioritise services in line with all others.
At the moment, mental health funding is ring-fenced and so potentially receives a type of default prioritisation. The new blueprint appears likely to consider how these two policy settings need to work together."
Funding would be "outcome" (results) based, rather than based on "inputs" (such as bed and staff numbers). This matched the DHB's strategic direction, Mr Mackway-Jones said.
Mike McAlevey, of the Otago Mental Health Support Trust, supported a move to results-based funding, which could increase accountability.
However, he was concerned the document pointed to cuts.
"It only points to a reduction in funding services. I can't see any other direction ..."
The concept paper was in parts "vague"; it was uncertain how funding prioritisation requirements might change.
He was heartened by the composition of the advisory group, as its members had strong reputations.
The mental health sector would be consulted early next year.