A "ring-fence" guarding mental health funds should be removed within five years, as district health boards treat a broader cross-section of society and focus on prevention, an updated blueprint says.
Released this month by the Mental Health Commission, Blueprint II updates the 1998 original, a key tenet of which was ring-fenced funds to prevent district health authorities from underfunding mental health.
The new blueprint acknowledges risk in removing the ring-fence, which had to pay for specialist treatment for the 3% of the population with serious mental illness.
"[Change] is also being driven by rising pressure on resources across the whole of the health system.
"Current workforce and financial resources are not sustainable as health needs change in the face of an ageing population, economic pressures and global demand for health skills.
"Blueprint II requires investment in services across specialist, community, primary and general health to be as effective as possible."
With less money, and a desire to broaden mental health services to a wider group, ring-fencing was too inflexible, the blueprint said.
Early intervention, prevention, greater help for depression and youth, and delivering services in the community and online are emphasised.
"The ring-fencing ... has protected and increased the level of investment in critical mental health and addiction services for our most vulnerable high-need users.
"Greater flexibility is now needed so that DHBs and service providers can make the most effective use of the funding available, easily integrate services across primary, community and specialist care, and implement a stepped care model.
"To make it safe to remove the ring-fence, we need a highly visible outcomes-based performance framework, reinforced with strong DHB accountabilities." The sector should aim to remove the ring-fence within the next five years.
Change has started, in the current financial year, when DHBs started paying for anti-psychotic drugs and primary mental health care from within the ring-fence.
Because the Mental Health Commission was to be disestablished at the end of this month, responsibility for implementing the blueprint transfers to the Office of the Health and Disability Commissioner.