As we delve into the numbers, the future of mental health in New Zealand appears increasingly bleak.
The number 13 crops up a bit. Could it be a lucky number?
Could funding 13 more training positions for psychiatrists really help us with the mental health crisis?
While we could certainly use some luck, the reality is that we need more than that.
Let’s break it down. The mental health crisis in New Zealand is escalating. We need a comprehensive approach that goes beyond increasing the number of psychiatrists or even, dare I say it, mental health professionals.
So what would it cost to train 13 new psychiatrists?
Considering the average annual salary of a psychiatrist is around $203,666, and multiplying that by five years (the training period — if you’re able to get through in five years) and by 13 (our lucky number), we get a total salary cost of $13,238,290.
Then add on the costs for registration, training fees and assessment fees, and the grand total comes to: $13.5 million.
This is a conservative estimate — I have not factored in sick leave, annual leave, conference leave, breaks in training, other administrative fees and disbursements.
So how does this spend of $13.5m stack up against the coming onslaught? Is it worth the investment?
There are various stats that give a rough idea of how many Kiwis need psychiatric help.
The Ministry of Health has data on specialist inpatient and community mental health and addiction services, but it doesn’t give us an exact number of individuals seeing psychiatrists per year.
It’s estimated that around one in five New Zealanders experience mental illness or significant mental distress each year. Almost half of all people will experience mental distress or illness in their lifetime.
What about those that don’t report their mental unwellness? There are many — just ask your neighbour. A study has shown that a quarter of New Zealanders currently have poor levels of mental and emotional wellbeing.
Now, let’s assess New Zealand’s psychiatrist capacity. As of 2022, New Zealand, with a population of about 5.12 million, has one of the lowest rates of psychiatrists per population in the OECD. This translates to an estimated total of 768 psychiatrists in the country.
If we assume each psychiatrist works 40 hours a week for 48 weeks a year, and each patient visit lasts one hour, the total number of patient visits that these psychiatrists can provide in a year is about 1,474,560.
But here’s the kicker. If there are one million people with psychiatric needs, and each person requires at least one visit per year, the number of visits needed would exceed the number of visits the psychiatrists can provide. People with serious mental health need are going to need more than one visit a year.
Adding 13 more psychiatrists would increase the number of visits by around 24,960 per year, bringing the total potential visits to 1.5m.
While every additional psychiatrist can make a difference, addressing the needs of at least one million people with psychiatric problems will likely require a multifaceted approach.
The cost of training new psychiatrists is significant, but the investment, in my mind, is not justified when considering the broader context of New Zealand’s escalating mental health crisis. It would be like a drop in the bucket.
We need a comprehensive, multi-pronged approach to truly address this crisis.
So what’s the solution? First, we need to understand what is driving the crisis. What is the source of the problem? If we throw psychiatrists at the problem, we’re only going to be playing with smoke and mirrors.
We need to address the root causes and build policies to prevent these factors from coalescing in the first place. Prevention is always better than cure, but this is going to be hard work, and it will take time. I estimate two generations.
The mental health crisis is global and it affects people of every skin colour, creed, age and status. According to one survey, 70% of university students have struggled with mental health since starting university.
But only 37% get help because of past negative experiences, perceived ineffectiveness of mental healthcare, social stigma, cost and uncertainty about accessing resources.
Addressing this crisis requires concerted attention from governments, private industry, universities, schools, workplaces and families.
With effective interventions, digital innovation and rebuilt legislation and policies, I believe we can resolve the crisis or at least mitigate its impact.
Building a mental health system requires a shift in focus.
Diagnosis in psychiatry is often based on subjective data, leading to inconsistencies in care.
The current system often involves multiple layers of assessment and decision-making by professionals who may never meet the patient. This process can be lengthy and impersonal, hindering the development of a therapeutic relationship.
The real power lies within the community — neighbours, teachers, friends — who provide consistent support.
We should focus our efforts on empowering these everyday heroes and invest in community-based systems that form the foundation of resilience.
Instead of funding respite hours only, what if parents could use have access to funds for cleaning, dishwashing, gardening etc so they can spend the time with their child instead?
Funding should be redirected towards community parenting supports, education and grassroots initiatives. Change happens not in sterile clinics, but in living rooms, schoolyards and local gatherings.
The government has pledged $89m to enhance the learning environments for students with special needs, a strategic move towards improving both the mental health and educational outcomes for our children.
We need more peer support or consumer advisers to help patients form a tribe.
Parents can play an incredibly important role in our community, even without personal mental health experiences, particularly through their relationships with their children. They are uniquely positioned to make a significant impact on the mental health crisis.
Innovation cannot thrive in bureaucratic corridors. It flourishes where agility meets resources.
Let’s allow local entrepreneurship and private sector strength to shine. We can’t rely on the government or health professionals to fix the health system.
Raising children in the modern world is hard.
Conventional psychiatry, as it should now be clear, fails to address the mental health crisis we are facing.
Parents and educators are the agents of change we must give all our support if we are going to win. Their intimate knowledge of their child’s history and environment is vital for effective care and support, something that cannot be duplicated in a psychiatrist’s office.
More psychiatrists won’t save us. Stronger communities will.
- Davin Tan is a youth forensic psychiatrist.
