Part 2: Understanding young peoples' mental health needs

Meeting the mental health needs of young New Zealanders.

In this Part, we assess how well government agencies understand the mental health needs of young people.

We expected government agencies to collect data on the mental health needs of young people to ensure that service planning and design are informed by the best available evidence on the extent and distribution of need in the population.

Summary of findings

New Zealand lacks up-to-date and comprehensive data on how common mental health conditions are in the population, particularly for children and young people.

This means that government agencies rely on a mixture of data from general population health surveys, historical service access (use) data, and insights from the mental health sector to guide policy assumptions and forecast demand for services.

In our view, this information is not enough for agencies to make informed decisions about service funding and planning. There is not enough detail in survey data to reliably forecast the need for services. Service access data and sector insights are poor proxies for need because a high proportion of mental health need goes unmet and because some groups, such as Māori, have poorer access to services.

Without prevalence data, government agencies cannot be confident that the services they are designing, providing, or funding are best placed to meet the changing needs of young people.

Better data is required to target funding and services to need

New Zealand collects and reports a range of mental health data through brief screening tools based on short questionnaires about peoples' symptoms.18

Surveys based on brief screening tools include the annual New Zealand Health Survey, the Youth2000 survey series of secondary school students and the Ministry of Social Development's 2021 What About Me? survey of secondary students and young people in community settings.

Although screening data is useful for identifying trends in the levels of mental well-being or mental distress New Zealanders are experiencing, it cannot be used to diagnose someone or tell us how common certain mental health conditions are in the population.

There is a risk that screening tools could overestimate the level of need. People might report symptoms of distress that are "mild, situational, or transitory" and do not meet the diagnostic criteria for a mental health condition.19 Factors such as greater public awareness of mental health might lead to increased reporting of distress, without necessarily reflecting an underlying change in prevalence.20

Epidemiological surveys based on full-length structured interviews by trained researchers are considered best practice for understanding the extent and distribution of mental health conditions in a population.

New Zealand's only national prevalence survey for mental health, Te Rau Hinengaro, was completed in 2006 and based on 2003/04 data. It is now 20 years out of date and surveyed only people aged 16 years and over. This means that there is no useful New Zealand-specific mental health prevalence data for children and young people.

One of the recommendations of the 2018 He Ara Oranga report was to carry out a new prevalence survey. The 2022 government data investment strategy identified a lack of robust data on the population prevalence of mental health conditions as a key data gap.21

The Ministry of Health told us that it recognises the need for better prevalence data for mental health and addiction and that improved data is a strong focus of its work programme under Kia Manawanui. It noted that a new prevalence survey will be considered as part of future government decisions about "investment and work programme priorities".

People we spoke to in the sector told us that a new prevalence survey is needed because the distribution of mental health need in the population might be shifting. We heard concerns that there is an increasing concentration of mental health concerns in younger age groups.22

Although overseas prevalence data could indicate likely trends, a New Zealand-specific survey is needed to understand the extent and distribution of mental health need.

We heard that a new prevalence survey or survey series is essential for the accurate planning and resourcing of mental health services, for workforce development, for ongoing monitoring and improvement of service effectiveness, and to achieve equitable outcomes for young people, Māori, and other groups who experience greater mental health needs.

We were told that data on current access to mental health services is not a reliable substitute for prevalence data because many people who experience mental health needs face barriers to accessing these services. For example, Te Rau Hinengaro found that only 40% of people who experienced a mental health condition in the past year had accessed mental health support from a service in that time.23

An example of where current service access data is a poor proxy for population need is in eating disorders. Te Rau Hinengaro found in 2006 that Māori experience eating disorders at similar rates to non-Māori.24 However, Māori appear to access eating disorder services at lower rates than other population groups. Researchers attribute the disparities to a range of access barriers, including a lack of culturally appropriate services.25

Over-reliance on access data for future service provision risks perpetuating inequities in service access.

A minority of people in the sector we spoke with felt that enough is known about population need and that the costs involved in funding a new prevalence survey would be better channelled into services, or that less cost- and time-intensive options might improve knowledge of prevalence without the need for a full-scale survey.

Recommendation 1
We recommend that the Ministry of Health prioritise work to better understand the prevalence of mental health conditions in the population.

18: Examples of commonly used screening tools include the Kessler-10 scale for psychological distress and the GAD-7 scale for anxiety.

19: Te Pou (2022), Understanding population mental health and substance use: An overview of current data, page 6 and Lockett, H et al (2022), "Whakairo: Carving a values-led approach to understand and respond to the mental health and substance use of the New Zealand population", New Zealand Medical Journal, Vol. 135, no. 1567.

20: Baxter, A et al (2014), "Challenging the myth of an ‘epidemic' of common mental disorders: trends in the global prevalence of anxiety and depression between 1990 and 2010", Depression and Anxiety, Vol. 31, Issue 6.

21: New Zealand Government (2022), Government Data Investment Plan 2022, page 52.

22: See Sharma, V et al (2023), Understanding the mental health and impact of substance use on infants, children, and youth in Aotearoa New Zealand: Findings from a scoping review.

23: Oakley Browne, M et al (2006), Te Rau Hinengaro: The New Zealand Mental Health Survey, page 115.

24: Oakley Browne, M et al (2006), Te Rau Hinengaro: The New Zealand Mental Health Survey, page 139.

25: Lacey, C et al (2020), "Is there systemic bias for Māori with eating disorders? A need for greater awareness in the healthcare system", New Zealand Medical Journal, Vol. 133, Issue 1514, pages 71-76 and Lacey, C et al (2020), "Eating disorders in New Zealand: Implications for Māori and health service delivery", International Journal of Eating Disorders, Vol. 53, no. 12, pages 1974-1982.