New Zealand has a population of 4.3 million and, based on the New Zealand Mental Health Survey, 4.7% of people will experience severe mental health or addiction problems requiring district health board (DHB) and/or non-government organisation (NGO) services in any one year (Oakley-Browne et al, 2006). DHBs and the Ministry of Health combined spent $1.2 billion in 2008/2009 on publicly funded mental health services.4 How effectively these funds are allocated is an important determinant of the quality and quantity of mental health services in New Zealand.
This report provides an overview of current funding mechanisms at a DHB level, looks at some of the theoretical and real-world problems that led to the challenge in Te Tāhuhu and identifies case studies of innovative funding arrangements that can be used as exemplars for others in the sector. Innovative funding mechanisms imply, and are usually designed to support, an innovative service delivery programme. As such it is useful to understand both the funding mechanism and the associated service delivery arrangements.
Methodology
Survey
An electronic survey was sent to all 26 identified funders, including all 21 DHBs and three shared services agencies (SSAs) in May 2010. The purpose of the survey was to obtain a general understanding of current funding mechanisms at a DHB level by gathering information on:
- how decisions are made about funding allocation within the budget for mental health and addiction services
- alignment with Te Tāhuhu
- innovative funding approaches
- funder views on the usefulness of the mental health funding ring fence
- funder views on the usefulness of the mental health Blueprint.
The survey results are summarised in Section 3.
Case identification
Case studies of innovative recovery-oriented funding mechanisms were identified through key sector informants. The case studies aim to illustrate the possibilities for funding arrangements that meet the Te Tāhuhu challenge.
The case studies identified are:
- Counties Manukau Mental Health and Addictions Partnership (CHAMP) – as an example of incentivising collaboration between service providers
- Flexi funds (Hawke’s Bay) and packages of care (Waitemata) – as examples of needs-based individual funding
- Tui Ora Māori development organisation (Taranaki) – as an example of pooling funds across health and social sectors
- Community Living Services (CLS) benchmarking services (Counties Manukau) – as an example of collecting and benchmarking service outcome data to monitor effectiveness
- Devolution of clinical services to Māori providers (Hawke’s Bay) – as an example of combining clinical and non-clinical services within the same provider
- Funding upstream (South Canterbury), Primary Solutions (Capital Primary Health Organisation) and ProCare (Auckland, Waitemata and Counties Manukau) – as examples of focusing on primary mental health and early and brief intervention funding.
Case study data gathering
In each of the selected case studies, the lead funders and planners were interviewed to obtain an overview of the programme and a funder view of the rationale for the innovation, and the underpinning principles. Relevant providers and service user groups were interviewed to obtain their perspectives on the particular initiatives.
The interview questions included the following key themes:
- the target population
- underlying principles
- funding
- what value funders felt they were getting for their funding
- what worked well about the programme
- what did not work well about the programme
- what sorts of barrier were encountered when implementing the initiatives
- what sorts of barrier were currently encountered
- their views on the sustainability of the programme
- whether there had been any evaluation/monitoring
- whether there had been identifiable differences in outcomes since the initiative started
- how providers would like to see funding allocations for mental health and addiction services look in an „ideal world‟ without existing constraints.
The survey and the interviews were complemented by a brief review of international directions in mental health funding. These are summarised in the appendix.
Limitations
The information provided by survey and case study respondents has not been independently verified. In some cases different respondents had divergent views about the same programme. There has been an attempt to reflect the divergent views where known, but the veracity of any information supplied cannot be guaranteed.