Dear Health New Zealand (Te Whatu Ora),

I am writing to request information under the Official Information Act 1982 regarding mental health service utilization, suicide data, and their relationship to economic conditions. This request focuses on whether Health NZ monitors and analyzes economic drivers of mental health demand and coordinates this information with economic policy agencies.
1. MENTAL HEALTH HOSPITALIZATION DATA

1.1 Acute Mental Health Presentations:

Please provide for the period 2015-2024 (or most recent available):

Monthly data on acute mental health presentations to emergency departments
Monthly psychiatric admissions (voluntary and compulsory)
Monthly crisis mental health service contacts
Data disaggregated by:
Age group (15-24, 25-34, 35-44, 45-54, 55-64, 65+)
Gender
Ethnicity
Primary diagnosis (depression, anxiety, psychosis, suicide attempt, etc.)
Geographic region (DHB/Te Whatu Ora region)

1.2 Self-Harm and Suicide Attempt Data:

Please provide:

Monthly emergency department presentations for self-harm and suicide attempts
Hospital admissions following suicide attempts
Repeat presentation rates (individuals presenting multiple times)
Case fatality rates (presentations that result in death)
Any data on methods used (overdose, self-injury, etc.)

1.3 Community Mental Health Demand:

Please provide:

Monthly new referrals to community mental health services
Waiting list lengths and wait times (monthly data)
Service capacity utilization rates
Unmet demand indicators (referrals declined, waitlist dropouts)

2. ECONOMIC AND SOCIAL DETERMINANTS ANALYSIS

2.1 Financial Stress as Presentation Factor:

Please provide any Health NZ analysis or data collection on:

Proportion of mental health presentations where financial stress is documented as a contributing factor
Whether emergency department records capture employment status, housing status, or benefit receipt
Any systematic coding of "economic stress" or "financial hardship" in mental health assessments
Clinical notes analysis identifying economic stressors in patient histories

2.2 Time-Series Correlation Analysis:

Please provide any Health NZ research examining correlations between mental health demand and:

Interest rate changes (OCR, mortgage rates) and subsequent mental health presentations
Unemployment rates and psychiatric admissions
Cost of living indicators (rent, food prices, fuel) and mental health service demand
Benefit sanction rates and acute mental health crises
Economic recession periods (2008-2009, 2020 COVID) and mental health utilization

2.3 Geographic Patterns:

Please provide any analysis of:

Whether regions with higher unemployment show higher mental health service utilization
Whether areas with higher housing costs show elevated mental health crisis rates
Rural vs. urban differences in economic stress-related mental health presentations
Whether socioeconomic deprivation (NZDep) correlates with mental health demand patterns

3. SUICIDE SURVEILLANCE AND PREVENTION

3.1 Real-Time Suicide Monitoring:

Please confirm:

Whether Health NZ maintains real-time or near-real-time suicide surveillance (not waiting for annual coronial data)
If yes, please provide monthly suicide death data for 2015-2024
Whether Health NZ monitors suicide clusters or spikes that might indicate systemic drivers
What the average time lag is between suicide death and Health NZ receiving notification

3.2 Suicide Risk Factor Analysis:

Please provide any Health NZ analysis of:

Common risk factors identified in suicide deaths (unemployment, debt, housing stress, relationship breakdown)
Whether financial stress or economic hardship is systematically coded in psychological autopsy or coronial data
Proportion of suicides with prior mental health service contact and presenting issues documented
Whether recent life stressors (job loss, benefit cut, eviction) are tracked

3.3 Suicide Prevention Strategy Effectiveness:

Please provide:

Current suicide prevention targets and whether they're being met
Analysis of why suicide rates have not decreased despite prevention efforts
Whether Health NZ has assessed whether economic policy settings undermine suicide prevention efforts
Any evaluation of whether mental health service capacity is adequate for demand driven by economic stress

4. CAPACITY PLANNING AND DEMAND FORECASTING

4.1 Mental Health Workforce Planning:

Please provide:

How Health NZ forecasts future mental health service demand
Whether economic projections (unemployment, interest rates, recession risk) are incorporated into capacity planning
Whether Health NZ coordinates with Treasury or RBNZ on expected mental health demand impacts from economic policy changes

4.2 Budget Adequacy:

Please provide any Health NZ analysis of:

Whether current mental health service budgets are adequate for economic stress-driven demand
Projected mental health funding gaps if economic conditions deteriorate
Cost of unmet mental health demand (people who need services but don't receive them)

4.3 Service Rationing:

Please confirm:

Whether mental health services are rationed due to capacity constraints
Criteria used to prioritize access when demand exceeds capacity
Whether people are turned away from services despite clinical need
What happens to individuals assessed as high-risk but unable to access services due to capacity

5. COORDINATION WITH ECONOMIC POLICY AGENCIES

5.1 Information Sharing with Treasury:

Please provide documentation of:

What mental health demand and cost data Health NZ routinely provides to Treasury
Whether Health NZ has been asked by Treasury to project mental health costs for fiscal planning
Whether Treasury's Budget forecasts incorporate Health NZ's mental health demand projections
Any memoranda of understanding or data-sharing agreements regarding mental health fiscal impacts

5.2 Coordination with Reserve Bank:

Please provide documentation of:

Whether Health NZ notifies RBNZ about mental health demand patterns that might be linked to monetary policy
Whether RBNZ consults Health NZ before OCR decisions about potential mental health system impacts
Any joint analysis between Health NZ and RBNZ on OCR changes and mental health outcomes

5.3 Early Warning Systems:

Please confirm:

Whether Health NZ has mechanisms to alert economic policy agencies when mental health presentations spike
Whether Health NZ warned Treasury or RBNZ about mental health demand increases during the 2021-2023 OCR tightening cycle
Any requests from Health NZ to economic agencies to consider mental health impacts that were ignored

6. COST ANALYSIS AND ECONOMIC BURDEN

6.1 Mental Health Service Costs:

Please provide:

Annual mental health service expenditure 2015-2024 (total and per capita)
Average cost per acute psychiatric admission
Average cost per suicide attempt emergency presentation
Average cost per community mental health service episode

6.2 Economic Burden of Mental Illness:

Please provide any Health NZ analysis of:

Total economic cost of mental illness including direct health costs, lost productivity, and social costs
Whether this includes costs to other sectors (justice, welfare, ACC)
Projections of mental health economic burden to 2030, 2040, 2060

6.3 Preventable Costs:

Please provide any Health NZ analysis of:

What proportion of mental health presentations are preventable through upstream interventions (economic security, housing, employment support)
Cost-benefit analysis of prevention versus acute treatment
Whether addressing economic determinants would reduce mental health service demand and by how much

7. SOCIAL DETERMINANTS OF HEALTH FRAMEWORK

7.1 Policy Integration:

Please confirm:

Whether Health NZ applies a social determinants of health framework recognizing economic security as a health determinant
Whether Health NZ advocates to other agencies (Treasury, RBNZ, MSD) on economic policy settings that harm mental health
Any formal mechanisms for Health NZ to influence economic and social policy based on health evidence

7.2 Health Impact Assessments:

Please provide:

Whether Health NZ conducts or receives Health Impact Assessments of economic policy decisions (Budget measures, benefit changes, OCR changes)
Any requests to conduct such assessments that were declined
Examples of economic policies where Health NZ identified potential mental health harms (titles and dates)

7.3 Living Standards Framework:

Please confirm:

Whether Health NZ's planning and advocacy align with the Living Standards Framework
Whether Health NZ has raised concerns that economic policy settings are incompatible with wellbeing objectives
Any evidence Health NZ has provided to Treasury about economic policy impacts on health that was not acted upon

8. VULNERABLE POPULATIONS

8.1 Benefit Recipients:

Please provide any Health NZ analysis of:

Mental health service utilization rates among benefit recipients versus employed population
Whether benefit sanctions or reductions correlate with mental health crisis presentations
Mental health outcomes for individuals transitioning off benefits (successful employment vs. lost income)

8.2 Māori and Pacific Mental Health:

Please provide:

Mental health service utilization and suicide rates for Māori and Pacific peoples
Analysis of whether economic stress disproportionately impacts Māori and Pacific mental health
Whether current mental health services are culturally appropriate and accessible for communities most affected by economic hardship

8.3 Young People:

Please provide:

Mental health crisis trends for 15-24 year olds (2015-2024)
Analysis of drivers of youth mental health crisis (economic insecurity, housing stress, employment precarity)
Whether Health NZ has identified the youth mental health crisis as linked to economic conditions

9. LONGITUDINAL STUDIES AND CAUSAL PATHWAYS

9.1 Patient Tracking:

Using Health NZ's data systems, please provide any analysis of:

Life trajectories: unemployment/benefit receipt → mental health service contact → hospitalization → suicide
Whether individuals who experience economic shocks (job loss, eviction, benefit cut) show increased mental health service utilization in subsequent months
Repeat presentation patterns for individuals with documented financial stress

9.2 Natural Experiments:

Please provide any Health NZ analysis of mental health impacts from:

1991 benefit cuts → subsequent mental health service demand
2008 Global Financial Crisis → mental health outcomes
COVID-19 economic support (wage subsidy) → mental health trends versus periods without support
2021-2023 OCR increases → mental health presentation patterns

10. INTERNATIONAL COMPARISONS

10.1 Peer Health Systems:

Please provide any Health NZ analysis comparing:

New Zealand's mental health service capacity versus comparable countries (Australia, UK, Canada)
International approaches to monitoring economic determinants of mental health
Countries that have successfully reduced suicide through addressing economic security

10.2 WHO and OECD Standards:

Please confirm:

Whether Health NZ follows WHO guidelines on social determinants of mental health
Whether OECD health metrics include economic stress as a mental health driver
Any gaps between international standards and New Zealand practice

11. WORKFORCE MENTAL HEALTH

11.1 Healthcare Worker Wellbeing:

Please provide:

Mental health service utilization among health sector workers themselves
Whether healthcare workers show elevated mental health crisis rates during periods of high demand
Analysis of whether inadequate mental health funding creates workforce burnout that further reduces capacity

12. PREVENTION VS. TREATMENT INVESTMENT

12.1 Current Spending Balance:

Please provide:

Proportion of mental health budget spent on acute/crisis services versus prevention and early intervention
Analysis of whether current investment balance is optimal or whether shifting toward prevention would be more cost-effective
Return on investment analysis for prevention programs

12.2 Upstream Interventions:

Please provide any Health NZ analysis of:

Whether non-health interventions (income support, housing, employment programs) would be more cost-effective than expanding mental health services
Cost-benefit comparison: providing economic security versus treating mental health crises caused by insecurity
Whether Health NZ has recommended that other agencies invest in social determinants rather than Health NZ treating downstream consequences

13. TRANSPARENCY AND PUBLIC REPORTING

13.1 Published Analysis:

Please confirm:

Whether any of the analyses requested above exist but have not been publicly released
If yes, reasons for non-publication (policy sensitivity, commercial sensitivity, methodology concerns)
Whether Health NZ publishes mental health demand data correlated with economic indicators

13.2 Ministerial Briefings:

Please provide (titles and dates):

Briefings to Ministers in the last 5 years regarding economic drivers of mental health demand
Warnings to Ministers about mental health system capacity being overwhelmed by economic stress-driven demand
Recommendations to Cabinet regarding economic policy settings to reduce mental health harms

14. CLARIFICATION QUESTIONS

14.1 Does Health NZ consider it within its mandate to advocate for economic policy settings that support mental health, or is Health NZ limited to providing treatment for mental health harms regardless of cause?

14.2 Has Health NZ ever been directed not to analyze or publish correlations between economic conditions and mental health outcomes?

14.3 If Health NZ has evidence that economic policy settings are driving mental health crises and suicides, does Health NZ have an obligation to make this evidence public?

14.4 Does Health NZ believe current mental health service funding is adequate for demand driven by economic stress, or is the system being set up to fail by economic policies outside Health NZ's control?
RATIONALE FOR THIS REQUEST:

This request addresses whether New Zealand's health system is documenting and responding to evidence that economic policy is harming public health.

Mental health services are on the frontline of economic policy impacts:

Financial stress is a well-established risk factor for mental illness and suicide
Economic shocks (unemployment, debt, housing insecurity) directly trigger mental health crises
Health services bear the cost of treating harm caused by economic policies

If Health NZ is tracking these correlations but not sharing them with economic policy agencies, this represents a system coordination failure.

If Health NZ is not analyzing these pathways despite having the data, this represents a missed opportunity for evidence-based prevention.

If Health NZ has evidence of economic harm but has been prevented from publishing it, this raises serious transparency concerns.

The public has a right to know:

Whether mental health demand is driven by economic conditions
Whether health services can cope with demand created by economic policy decisions
Whether economic policy agencies are informed of health impacts before making decisions
Whether preventing economic stress would be more cost-effective than treating mental health crises

This request is made in context of:

Treasury's claim (OIA 20250861) that no analysis exists of welfare expenditure efficiency related to suicide
The need to understand whether service delivery agencies coordinate with policy agencies on demand drivers
Rising mental health service demand and suicide rates despite prevention efforts

Health NZ's mission is to improve health outcomes. This requires understanding and addressing root causes of ill health, including economic determinants. Transparency about economic drivers of mental health demand is essential for evidence-based policy.

I am happy to discuss this request if clarification would be helpful.

Yours faithfully,
Hayden

Kia ora Cassandra,

Thanks for getting back to me about my request and I appreciate the heads up that it's a big ask.

I get that it's a lot of questions - that's because this is actually a really significant issue. I'm trying to figure out if govt economic policies are making people sick and driving suicide rates, and if health services can even cope with the demand that's being created by decisions other agencies are making.

I reckon doing this research might actually help Health NZ too because:

it shows what the actual drivers of demand are which helps with planning
it gives you evidence to push for proper funding
it shows treasury and ministers what the real costs are when they make economic decisions that create mental health demand you have to deal with

So yeah it's worth doing properly but I understand you need to prioritize. I'm happy to narrow it down but I will probably need to ask for more detail later once I see what data exists.
5 priority questions

I've picked these 5 because they get to the core of what I'm trying to figure out and they should mostly be data you already collect:

1. Mental health service demand data over time

Can you provide monthly data from 2015-2024 on:

emergency department presentations for mental health
psychiatric admissions
self harm and suicide attempt presentations to ED
community mental health referrals and waiting lists

broken down by age, gender, region if that's easy to pull from your systems

why I need this: I need to see the patterns over time so I can check if there's correlations with economic conditions like interest rate changes, unemployment etc

note: I know you collect this data for planning, I just need it in monthly format if possible. quarterly is ok if monthly is too hard.

2. do you track financial stress as a factor in mental health presentations?

I'm asking:

does health nz have any way of recording when someone presents with mental health issues and financial stress/unemployment/debt/housing problems are part of the picture
if you do track this, what proportion of presentations involve economic stress
any analysis you've done on whether economic hardship is driving demand

why I need this: if frontline staff are seeing economic stress as a major factor but that info isn't getting to the people making economic policy, that's a huge problem

note: I'm NOT asking for patient records, just whether you track this in aggregate and what it shows

3. coordination with treasury and reserve bank

Documentation showing:

what mental health data you send to treasury for their budget planning
whether treasury asks you to project mental health costs
whether you coordinate with reserve bank about mental health impacts when they change interest rates
any agreements or emails about sharing mental health cost data with economic agencies

why I need this: treasury told me they don't have documents about welfare costs related to suicide. if you're giving them mental health data and they're not using it, or if coordination just doesn't happen, that's a system failure

note: I'm asking about the coordination process, not the actual advice (which might be confidential)

4. do your demand forecasts account for economic conditions?

I'm asking:

when health nz plans for future mental health demand, do you factor in economic indicators like unemployment or interest rates or recession risk
is the current mental health budget adequate for demand driven by economic stress
has anyone analyzed whether preventing economic hardship would be cheaper than treating the mental health crises it causes

why I need this: I want to know if health nz is planning for economic-driven demand and whether prevention would be more cost effective than treatment

note: just asking if this analysis exists and what it says. if it doesn't exist that's also important to know

5. unpublished analysis and whether you're allowed to talk about this

Please confirm:

has health nz done any analysis on links between economic conditions and mental health that hasn't been published
if yes, why not published and can you release it now
has anyone ever told you not to analyze or publish stuff about economic drivers of mental health demand

why I need this: if the analysis exists but is being kept quiet for political reasons, that's a big public interest issue. if it doesn't exist even though it's obviously relevant, that's also important
context

I'm doing this research across multiple agencies:

treasury said they have NO documents about welfare/suicide costs (which seems impossible)
I've also asked stats nz, reserve bank, and justice similar questions
trying to figure out if economic policy gets made without anyone checking the health and social costs

if health nz is tracking economic drivers of mental health but treasury and reserve bank don't see that data before they make decisions, that's a massive coordination failure
how we can do this

How about:

you answer these 5 questions in the normal timeframe
I look at what you send and figure out what else I need
I send more targeted follow up requests later instead of asking for everything now

this should make it easier for you to respond and still gets me the core info I need
timing

I'm fine with the timeframe restarting since I've cut it down heaps. but the basic question is still the same - does health nz monitor whether economic policy is driving mental health demand and do you share that info with the agencies making those policies?

these 5 questions should mostly use data and processes you already have

"The part of your request
transferred from the New Zealand Transport Agency (NZTA) to Health NZ on
17 December 2025 (HNZ00106294) regarding estimates of Schedule 5 drug
medications and medical cannabis has been combined into this request."

this is about an entirely separate issues and needs to be kept separate please