Leadership and innovation in New Zealand’s mental health system (A) 2009-89.1

Stepping into the role of New Zealand’s Director of Mental Health in the early 1990s was, Dr Janice Wilson recalled, a baptism of fire. A new government had begun a programme of radical health sector reform. A decade-long overhaul of New Zealand’s mental health legislation had just concluded with the passing of a new Mental Health Act that championed “treatment in the least restrictive environment”. Mental health services were in turmoil, struggling with the consequences of a forty-year drift towards deinstitutionalisation, and long-term under-funding. Many mental hospitals were closed or closing but former patients now found themselves without adequate community-based support. Public attitutes to mental illness were still stigmatising, and sensational headlines about violent crimes committed by former patients were fueling public anxieties. The first-ever national mental health strategy was nearing completion, providing a long overdue policy framework for the sector.

This case considers the complexities of formulating a strategy during a period of rapid change and within a decentralised structure. It examines the practical and policy implications of deinstitutionalisation of the mentally ill.

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• Part B of this case can be used to discuss the complexities of implementation, evaluation, and assessing the value for money of funds expended. It also provides detail for discussion on issues such as service-user leadership in the provision of mental health.