Charity close to ‘breaking point’ does not begrudge $24m boost for Mike King’s Gumboot Friday
Tuesday, 4 June 2024
News the National-led government would fund Mike King’s Gumboot Friday charity by $24 million over four years was welcomed across the mental health sector.
But it has raised questions about whether it is the best value for money.
New Zealand has one of the highest rates of youth suicide in the developed world, and many people suffer from mental distress.
Krissy Mackintosh saw the aftermath when her friend’s son died by suicide; the long shadow cast over his family, friends and community. It wasn’t a new experience - she has had 10 men in her life take their own life - but it drove home for her that something needed to change.
Months later, she founded Hear 4 U, a mental health charity focussed on reducing male suicide in Tairāwhiti. In four years, it has supported 486 boys and men, 3500 families, and won a number of awards.
Despite its success, she concedes the charity is “almost at breaking point”. The funding model for charities is “broken”, she said, and she is exhausted by doing all she can to stay above the line.
“We have done so many proposals, budgets, shown the social impacts and statistics, but it is getting tougher and tougher.”
The imperative
New Zealand’s youth suicide rate is the second worst in the developed world, according to the OECD. Social isolation, disrupted education, and diminished job opportunities during the ongoing cost of living crisis have exacerbated the disease burden for mental illness among young people.
Mackintosh does not begrudge Mike King for landing $24 million in public funding for his Gumboot Friday initiative, through which he promises to give free counselling to children and young people aged between five and 25.
But she can only dream about what that money would mean for men struggling in her region, suffering after the February weather event and the economic downturn which has hit forestry jobs.
“Our community would be a different place,” she said of the funding. “We are a charitable trust dedicated to creating healing pathways and breaking the stigma around men’s mental health and preventing suicide. What we do works, but we do it on the smell of an oily rag.”
The politics
The National-led coalition government’s promise to fund King’s Gumboot Friday has sparked a tense political debate. Funding King’s initiative was in NZ First’s manifesto, and its coalition agreement with National.
Matt Doocey, the country’s first mental health minister, has refused to say in the House whether other charities were able to bid for the funding. He has however said the government followed all the usual procurement processes, and King is due to sign the contact on July 1.
There is no suggestion of any wrongdoing by King.
Doocey’s major selling point for awarding the contract to Gumboot Friday was that the charity made a social return of $5.70 for every $1 invested. The figure comes from an Impact Lab report commissioned by the charity. Impact Lab is co-founded and chaired by former National leader and prime minister Sir Bill English.
A source told Stuff that while English was respected, and recognised methodologies would have been used, the report could not be independent if it was commissioned by the charity.
Labour mental health spokesperson Ingrid Leary has questioned the robustness of the procurement process.
But King has hit back at Labour, suggesting it is hypocritical because it gave one-off funding to his charity in 2021 through the mental well-being innovation fund pilot. He said Labour “snuck $600,000 through the backdoor towards us … without going through due process”.
Charities were selected and invited to write proposals as to why they should get the funding, and King was successful.
Stuff also reported Naomi Ballantyne, chair of the I Am Hope Foundation - King’s charity through which Gumboot Friday is operated - donated $27,000 to the National Party prior to the past two elections, and its just-departed chief executive sought the National Party candidacy for Botany in 2019.
Prime Minister Christopher Luxon said the concerns over the close ties between the charity and his party in light of the funding were “outrageous and frankly ridiculous”. He has also criticised the Opposition for raising concerns, and claimed it was politicising mental health.
The best value for money
Leary said she supported extra funding for mental health initiatives, but was critical of the Government’s procurement processes.
“The greater the scale of spend, the more robust the evidence-base should be, and the decision making should be transparent,” Leary said.
On top of this, The Royal Australasian College of Psychiatrists has also condemned the lack of funding for people with severe mental health and addiction issues in the 2024 Budget. It said people with moderate to severe complex mental illnesses are at the greatest risk because of a lack of clinicians.
Leary said the lack of funding for acute mental health and needs, and for the workforce, was “disappointing” and other at-risk groups, such as the rainbow, Maori, Pacific, ethnic communities, disabled communities, young forestry workers and others, did not get a chance to apply for the funding, despite evidence suggesting they have some of the highest mental health needs.
“The Minister appears to have prioritised political expediency over impact and that makes a mockery of his role.”
The ‘missing middle’
Another key concern came from Dr Paul Skirrow, Strategic Advisor at New Zealand College of Clinical Psychologists. He was at pains to point out Gumboot Friday was a good service which many of his members supported, and that he appreciated any investment into mental health.
However he was “surprised” about the funding decision, because National in Opposition had criticised the Labour government for focussing too heavily on mild to moderate mental health disorders, at the expense of disorders which would be dealt with in a secondary-care setting.
“That is what drove talks of crisis - people who are extremely mentally unwell unable to get care, with huge waiting lists in those services,” he said. “In that context, we are a little bit surprised because Gumboot Friday is very much aimed at that mild to moderate end of mental health issues which is great but it is not where we have been crying out for help over the past few years.”
He was also sceptical of King’s claims that early intervention would stop more acute mental health disorders from developing. King, during the government’s announcement, said Gumboot Friday’s entire kaupapa was about prevention: stopping the small issues becoming big issues.
But Skirrow said this was not backed up in evidence. “There is a very weak correlation … it is a bit like eating healthy and heart disease, the more healthy you eat the less likely you are to get heart disease.
“There is no evidence that shows if you help someone with grief counselling, they won’t go on to develop schizophrenia,” he said as an example.
The UK, where Skirrow is originally from, introduced a talking therapy service more than a decade ago, yet the number of young people accessing secondary care services for mental health disorders had not decreased.
“It hasn’t put a dent in that. Secondary care has gone up in the UK.”
Skirrow said it wasn’t just about having someone to talk to, but someone with the right skills to talk to.
Young people with more complex issues - such as those with phobias, having panic attacks, or with obsessive compulsive disorder - would need more than the two sessions funded by the charity. However, King has said those who need it will get more.
But there was still a risk, in Skirrow’s view, that people could fall between the cracks in the very fragmented mental health system. Few people working in the system had a good overview of it as a whole, which included a number of non-governmental organisations and school-based systems, and counsellors may not know how to pick up signs a patients had more complicated mental health disorders.
“Counsellors are terrific as they are, but they don’t have training on working with psychosis and bipolar disorder,” he said.
Those who were referred onwards through clinical pathways were adding to the “missing middle“ - people who needed sessions with a clinical psychologists, but because they were not suicidal were waiting for long tracts of time before seeing a specialist.
The ‘Koru lounge’ of mental health care
King accepted Skirrow’s comments, but said Gumboot Friday could also connect people to the health system if they needed it. King said they had “a list of psychologists” who they could refer patients to.
“From a public health lens he is correct but we are not here to do long-term therapy on suicidal people. We are trying to catch it early,” he said.
“We can pathway them to child mental health services and crisis teams now.”
King, who Stuff spoke to on Wednesday, said he had just come out of a meeting with Robyn Shearer, deputy director general - clinical community & mental health at the Ministry of Health, where they discussed how to take pressure off the frontline crisis teams.
“The way I can explain it is we are like the Koru Club, we will get you on to the plane first.“
Clarification: This story has been amended to clarify New Zealand’s youth suicide rate is the second highest in the OECD, not the general suicide rate. 4/06/2024, 4.07pm.