Understanding population mental health and substance use

In July 2022, Te Pou and the Department of Māori Indigenous Health Innovation (MIHI) at the University of Otago, Ōtautahi (Christchurch) started engaging with stakeholders to advocate for, and begin the design work on, a national epidemiological series of studies to understand the mental health and substance use of New Zealanders.

Over the last year, we have successfully changed the narrative from one that recognises the work but says it cannot happen due to high costs, to one where the focus is on finding the funding, the right approach, and making it happen. Now people are stepping up, calling for action and getting involved. For example:

• Te Hiringa Mahara the Mental Health and Wellbeing Commission in their Mental Health and Addiction Services Monitoring Report (2023), Te Huringa Tuarua, made a key recommendation on the need for prevalence data: “We want to see initiatives from government agencies to address critical data gaps, which include: Priority given to commissioning a comprehensive mental health and addiction prevalence study”. (p. 10, 2023)
• Tu Te Akaaka Roa, the New Zealand committee of the Royal Australian and New Zealand College of Psychiatrists, have been consistently highlighting the lack of data on need and unmet need, and calling for investment in a comprehensive prevalence study.

Robust epidemiological data on the nature and prevalence of mental health conditions and problematic substance use in Aotearoa New Zealand is critical to the equitable and efficient planning and delivery of services, honouring Te Tiriti o Waitangi, and the development of effective policy and strategy.

Population-level epidemiological data is as crucial in mental health as it is in physical health research to:

• Describe the detailed mental health status of the population by identifying types of mental health conditions and severity, identifying patterns of distribution and new issues, and quantifying need and unmet need.
• Identify determinants, risk and protective factors, and predict groups at high risk.
• Gather knowledge that can be used to prevent the onset of mental health conditions and problematic substance use, reduce the impact, and support the recovery of the people, whānau, and communities who are impacted.

It is 20 years since the last mental health and substance use prevalence and impact survey. This data is now out of date and cannot be used.

Not having robust information on such an important health and social issue is an untenable situation.

We are now very well placed to conduct another survey, or series of studies.

He Ara Oranga – the report on the Government Inquiry into Mental Health and Addiction (2018) identified an up-to-date prevalence survey as a priority action, and this action is re-iterated in Kia Manawanui Aotearoa – the long-term pathway to mental wellbeing (2021) and the Government Data Investment Plan (2022).

Cost has previously been seen as a barrier, but there is now very good agreement that the next can be a series of interconnected studies, rather than a single one-off study. This also means investment can be spread over several years.

The process we are proposing will deliver accessible, usable, and reliable knowledge on mental health and substance use to be used in the hands of people, communities and the Government to invest well in New Zealander’s mental health and wellbeing now and in the future.

The programme of research can be world leading, integrating mātauranga Māori with lived experience values and perspectives, and Western scientific methods. This time we can include the whole population, from birth to old age.

By taking this approach, this epidemiological research gives us much more knowledge than just the rates of health conditions. It provides information for the fair allocation of resources across the population, establishes a baseline measurement, provides a repeatable survey methodology and a mechanism for government to track progress over time.

To support the early design thinking, Te Pou has published resources to support this collaborative work (see further down page), including a review of existing data sources and measures for adults.

To explore ways in which prevalence studies can be conducted to advance Hauora Māori, MIHI are facilitating a Māori technical rōpū and Flax Analytics – epidemiologists Drs Liz Ellison-Loshmann and Fiona McKenzie and A/Professor Mona Jeffreys commenced a scoping review in August and this is now available.

A scoping review on Infant, Child and Youth has been guided by a technical expert rōpū, facilitated by Whāraurau, a national centre for Infant, Child and Adolescent Mental Health (ICAMH) workforce development, and supported by Te Pou, with funding from Oranga Tamariki. The University of Auckland have completed their report on Child and Adolescent Mental Health workforce development, and it is available here.

Le Va (national centre for Pasifika workforce development) are bringing together a technical rōpū to guide a scoping review of the available Pasifika data, methods and measures.

Two published two editorials, Whakairo: A values-led approach to psychiatric epidemiology and Whakairo – carving a values-led approach to understand and respond to the mental health and substance use of the New Zealand population focus on the importance of a values-led framework to guide this series of studies, and explains why we cannot rely on current data to plan supports and services now and in the future.

Te Pou has published resources, thought pieces, and partner briefings to support this collaborative work.

1. Measuring the prevalence of mental health conditions and problematic substance use to advance Hauora Māori: Findings from a scoping review.
2. Advancing mental health and addiction research in Aotearoa New Zealand.
3. Understanding the mental health and impact of substance use on infants, children, and youth in Aotearoa New Zealand: Findings from a scoping review.
4. Social determinants of mental health challenges and problematic substance use: A rapid review.
5. Understanding the prevalence and impact of mental health and substance use – the urgent need for robust data. June Briefing.
6. Whakairo: A values-led approach to psychiatric epidemiology. ANZJP article
7. Whakairo – carving a values-led approach to understand and respond to the mental health and substance use of the New Zealand population. NZMJ
8. An overview of current data in Aotearoa New Zealand.
9. The New Zealand Health Survey’s mental health module 2016/2017.
10. An exploration of what recent international prevalence data tells us.
11. An overview of commonly used measures to understand population mental health and substance use.