No one can deny that innovation is needed in the mental health sector. Those who work in health, whether for a District Health Board or an NGO, recognise it as a clunky system that too often prioritises processes over people. The area of mental health suffers particularly poorly as sector as it struggles to come to terms with the reality that mental health is no longer just about ‘health’ but more so all of the factors that contribute to wellbeing – housing and employment being at the top of the list. New Zealand’s first social bonds scheme aims to improve one of these measures of wellbeing – employment, and more specifically employment for people who use mental health services. This is a very difficult area for services to support people with as employment is not just about reducing reliance on benefits but is actually about gaining meaningful employment whether that be fulltime, part-time or voluntary employment.
Where are health services currently at with supporting people with employment? Auckland statistics show that people who use mental health services will leave services without employment. Even worse, people who enter mental health services with a fulltime job do are not keeping their job and end up leaving mental health services with reduced hours or unemployed. This issue is a complex problem with many factors to be looked at and improved on.
Mental health is probably one of the hardest areas of health policy to get right, and the government predominantly thinks it is just about money. It is about money, but it is also about how systems and services are designed, organisational culture, the values of the workforce, and looking at people as whole people. The nature of funding streams is an important factor in delivery of mental health care. In something as complex as setting up an effective mental health service, with its community outreach, it would help if funding were not administered in such a way that different agencies who should collaborate, are forced to compete for funds.
Is a profit motive for achieving outcomes appropriate? Bonds and return on investment schemes drive our businesses and financial sector but this may not be the right incentive track to go down. It has been suggested that people have moved on from old models of motivation driven by rewards and fear of punishment dominated by money. Instead our motivation is largely intrinsic, and that we instead seek autonomy, mastery and purpose. Money still does drive our health sectors but we need to keep in mind that it is possible to do social good while being sustainable and perhaps this is where the partnership of mental health services and social enterprises would be most useful.
Social bonds appear to be the next big endeavour for governments looking at tackling complex social problems. There are now 16 social impact bonds in the UK; four in the US; two in Australia; one in Canada; one in the Netherlands; one in Belgium; one in Germany; and soon to be one in NZ joining this growing group.
But are social bonds working? If we look overseas at the United Kingdom Peterborough Social impact bond, one of the first major instances for using the new private and public partnership scheme, the results show that the programme appears to be successful.
The UK Peterborough Social impact bond pilot aimed to reduce rates of prisoner reoffending, and four years after it started the project shows that prisoner recidivism had been reduced by 8.4% compared with a control group. A reduction of 10% would mean immediate return on the investment, but maintaining a reduction above 7.5% is sufficient for the UK government to pay out the investors.
Could social bonds work in New Zealand? If all the elements of a social bonds scheme are properly considered keeping in mind the best interests of someone trying to enter the workforce then they could be of great benefit to the mental health sector. The government would need to seek investors who are both fiscally responsible as well as socially responsible, private businesses who want to make a difference in the lives of New Zealander’s and not just treat people as a potential source of income.