Mental Health Campaign // Further Reading

This FAQ will cover the following:

  • Why are you doing this?
  • What are social impact bonds?
  • Where else has this scheme been tried?
  • Who else is supporting this campaign/call to action?
  • What are the concerns surrounding social impact bonds?
  • Want to read more?

If you have a question that we haven't answered here, feel free to email us on team@actionstation.org.nz

Why are you doing this?

We have been consulting with professional groups on this campaign, and started it on the request of members of ActionStation who have been users of mental health services in New Zealand, as well as people who have worked in the sector - and after a specific request from the New Zealand Association of Psychotherapists to partner with them on this campaign.

We've also been talking to other groups in the sector who support the campaign. In this - as in other issues we've campaigned on - our role is to represent the concerns of our members, and do the part of this work that is often very difficult for professional groups or NGOs to do publicly.

One of the primary concerns is that this initiative has been introduced without consultation with people working in or using mental health services.

What are social impact bonds?

Social Impact Bonds are a new type of performance-based contract. Their innovation is to include third-party investors who provide money upfront to fund the operations of a social service program. If targeted outcomes are achieved, the government agency holding the contract pays for the program by reimbursing investors. If the program does not meet its targets, the investors lose their entire investment. This, in theory, shields service providers and governments from performance and outcome risks.

(From Stanford Social Innovation Review)

Who else is supporting this campaign?

At this point our supporters includes NZAP, Social Work, Massey University and NZ Nurses.  With more to come…

Our primary partner The New Zealand Association of Psychotherapists is a professional organisation which sets, examines and maintains specific standards for the safe and ethical practice of psychotherapy in Aotearoa New Zealand.  The NZAP has members all across New Zealand and with many psychotherapists working in the Mental Health system, and in NGO’s providing services to mental health consumers is in a unique position to offer expert comment on the impact of this policy.

Where else has this social bonds scheme been tried?

The scheme currently in its infancy in Britain, the United States and Australia and those bonds are yet to mature and pay out.

Excerpt from Dita de Boni’s column -

In the US, acute mental health care is a costly business, but it's harder to access when private providers have to chase revenue streams. Consequently, the number of beds available for psychiatric treatment reduces by thousands annually. [...]

Nothing has stopped the privatisation freight train for mental health (or any health) services in the US, not even dire "performance indicators". In North Carolina, according to the state's Child Mental Health Network, highly trained mental health care workers have left the field as private providers took control, decimating the professional public-sector workforce. Service quality suffered as private providers "cherry-picked" the least difficult patients and focused on the most profitable services, including that which could be performed by low-paid, unlicensed workers.

[...] Meanwhile, in Britain cuts to the National Health Service (NHS) have hit mental health particularly hard (some patients are discharged into B&Bs to free up acute beds). Moves to slash NHS mental health services have gone hand in hand with the privatisation of these services, with companies such as Virgin Care (owned by Richard Branson), Serco (a multi-billion dollar concern that also runs some New Zealand prisons) and others lining up for lucrative contracts, despite little experience in acute mental health management.

The countries that have followed this path are what we are supposed to aspire to, despite variable outcomes (to put it kindly).

What are the concerns surrounding social impact bonds?

This is essentially another form of contracting – and an overly complex and expensive one.  And, in the Government’s current proposal they’re used to experiment with new approaches – which is all very well, except when you’re dealing with already vulnerable people.

Some of the criticism overseas of the model has included that:

  • it does not increase the resources directed at achieving particular outcomes

  • the problem with directing funding to closely defined outcomes is that the targets set will corrupt the actual outcomes achieved

  • they rely on outcome measures which are difficult to define and evaluation of the effect of services is weak.

  • they create inflexibility in budgeting and divert money from other projects as they commit to spending some years in advance.

  • they are another form of privatisation

  • they are not cheaper as government will always be able to get cheaper funding than the private sector and they require a complex administrative bureaucracy

  • they assume that the third and private sectors are better managers than the public sector and

  • they encourage job insecurity and low wages for third sector workers.

Want to read more?

Dom Post editorial against SIBs:
A good blog on Public Address:  
Ministry of Health page on the current proposal:  
Unison’s (UK union)  guide to SIBs:  
Social Investment Bonds a further means to erode democracy - Poverty Waikato
Your policy is my life, The New Mental Health
Uses and abuses of Performance Data, April 2015
Do targets do more harm than good?

What are some of the arguments for public ownership?

“Public ownership of key services offers better value for money, more accountability to service users and puts people before profit.” (From WeOwnIt.org.uk)

Click here to read -> Five Reasons Public Ownership is better for you

What are some of the myths surrounding social bonds?

Click here to read -> ‘Debunking the myths behind social impact bond speculation’ by Kyle McKay

 


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