Appendix A
1. MENTAL HEALTH HOSPITALIZATION DATA
1.1 Acute Mental Health Presentations:
Please provide for the period 2015-2024 (or most recent available):
1. Monthly data on acute mental health presentations to emergency departments
2. Monthly psychiatric admissions (voluntary and compulsory)
3. 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:
4. Monthly emergency department presentations for self-harm and suicide attempts
5. Hospital admissions following suicide attempts
6. Repeat presentation rates (individuals presenting multiple times)
7. Case fatality rates (presentations that result in death)
8. Any data on methods used (overdose, self-injury, etc.)
1.3 Community Mental Health Demand:
Please provide:
9. Monthly new referrals to community mental health services
10. Waiting list lengths and wait times (monthly data)
11. Service capacity utilization rates
12.
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:
13. Proportion of mental health presentations where financial stress is documented as a
contributing factor
14. Whether emergency department records capture employment status, housing status, or
benefit receipt
15. Any systematic coding of "economic stress" or "financial hardship" in mental health
assessments
16.
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:
17. Interest rate changes (OCR, mortgage rates) and subsequent mental health
presentations
18. Unemployment rates and psychiatric admissions
19. Cost of living indicators (rent, food prices, fuel) and mental health service demand
20. Benefit sanction rates and acute mental health crises
21.
Economic recession periods (2008-2009, 2020 COVID) and mental health utilization
2.3 Geographic Patterns:
Please provide any analysis of:
22. Whether regions with higher unemployment show higher mental health service
utilization
23. Whether areas with higher housing costs show elevated mental health crisis rates
24. Rural vs. urban differences in economic stress-related mental health presentations
25.
Whether socioeconomic deprivation (NZDep) correlates with mental health demand
patterns
3. SUICIDE SURVEILLANCE AND PREVENTION
3.1 Real-Time Suicide Monitoring:
Please confirm:
26. Whether Health NZ maintains real-time or near-real-time suicide surveillance (not
waiting for annual coronial data)
27. If yes, please provide monthly suicide death data for 2015-2024
28. Whether Health NZ monitors suicide clusters or spikes that might indicate systemic
drivers
29.
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:
30. Common risk factors identified in suicide deaths (unemployment, debt, housing stress,
relationship breakdown)
31. Whether financial stress or economic hardship is systematically coded in psychological
autopsy or coronial data
32. Proportion of suicides with prior mental health service contact and presenting issues
documented
33.
Whether recent life stressors (job loss, benefit cut, eviction) are tracked
3.3 Suicide Prevention Strategy Effectiveness:
Please provide:
34. Current suicide prevention targets and whether they're being met
35. Analysis of why suicide rates have not decreased despite prevention efforts
36. Whether Health NZ has assessed whether economic policy settings undermine suicide
prevention efforts
37.
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:
38. How Health NZ forecasts future mental health service demand
39. Whether economic projections (unemployment, interest rates, recession risk) are
incorporated into capacity planning
40.
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:
41. Whether current mental health service budgets are adequate for economic stress-
driven demand
42. Projected mental health funding gaps if economic conditions deteriorate
43. Cost of unmet mental health demand (people who need services but don't receive
them)
4.3 Service Rationing:
Please confirm:
44. Whether mental health services are rationed due to capacity constraints
45. Criteria used to prioritize access when demand exceeds capacity
46. Whether people are turned away from services despite clinical need
47. 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:
48. What mental health demand and cost data Health NZ routinely provides to Treasury
49. Whether Health NZ has been asked by Treasury to project mental health costs for fiscal
planning
50. Whether Treasury's Budget forecasts incorporate Health NZ's mental health demand
projections
51. Any memoranda of understanding or data-sharing agreements regarding mental health
fiscal impacts
5.2 Coordination with Reserve Bank:
Please provide documentation of:
52. Whether Health NZ notifies RBNZ about mental health demand patterns that might be
linked to monetary policy
53. Whether RBNZ consults Health NZ before OCR decisions about potential mental health
system impacts
54. Any joint analysis between Health NZ and RBNZ on OCR changes and mental health
outcomes
5.3 Early Warning Systems:
Please confirm:
55. Whether Health NZ has mechanisms to alert economic policy agencies when mental
health presentations spike
56. Whether Health NZ warned Treasury or RBNZ about mental health demand increases
during the 2021-2023 OCR tightening cycle
57. 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:
58. Annual mental health service expenditure 2015-2024 (total and per capita)
59. Average cost per acute psychiatric admission
60. Average cost per suicide attempt emergency presentation
61. Average cost per community mental health service episode
6.2 Economic Burden of Mental Illness:
Please provide any Health NZ analysis of:
62. Total economic cost of mental illness including direct health costs, lost productivity,
and social costs
63. Whether this includes costs to other sectors (justice, welfare, ACC)
64. Projections of mental health economic burden to 2030, 2040, 2060
6.3 Preventable Costs:
Please provide any Health NZ analysis of:
65. What proportion of mental health presentations are preventable through upstream
interventions (economic security, housing, employment support)
66. Cost-benefit analysis of prevention versus acute treatment
67. 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:
68. Whether Health NZ applies a social determinants of health framework recognizing
economic security as a health determinant
69. Whether Health NZ advocates to other agencies (Treasury, RBNZ, MSD) on economic
policy settings that harm mental health
70. Any formal mechanisms for Health NZ to influence economic and social policy based on
health evidence
7.2 Health Impact Assessments:
Please provide:
71. Whether Health NZ conducts or receives Health Impact Assessments of economic
policy decisions (Budget measures, benefit changes, OCR changes)
72. Any requests to conduct such assessments that were declined
73. Examples of economic policies where Health NZ identified potential mental health
harms (titles and dates)
7.3 Living Standards Framework:
Please confirm:
74. Whether Health NZ's planning and advocacy align with the Living Standards Framework
75. Whether Health NZ has raised concerns that economic policy settings are incompatible
with wellbeing objectives
76.
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:
77. Mental health service utilization rates among benefit recipients versus employed
population
78. Whether benefit sanctions or reductions correlate with mental health crisis
presentations
79. Mental health outcomes for individuals transitioning off benefits (successful
employment vs. lost income) 8.2 Māori and Pacific Mental Health:
Please provide:
80. Mental health service utilization and suicide rates for Māori and Pacific peoples
81. Analysis of whether economic stress disproportionately impacts Māori and Pacific
mental health
82.
Whether current mental health services are culturally appropriate and accessible for
communities most affected by economic hardship 8.3 Young People:
Please provide:
83. Mental health crisis trends for 15-24 year olds (2015-2024)
84. Analysis of drivers of youth mental health crisis (economic insecurity, housing stress,
employment precarity)
85. 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:
86. Life trajectories: unemployment/benefit receipt → mental health service contact →
hospitalization → suicide
87. Whether individuals who experience economic shocks (job loss, eviction, benefit cut)
show increased mental health service utilization in subsequent months
88.
Repeat presentation patterns for individuals with documented financial stress
9.2 Natural Experiments:
Please provide any Health NZ analysis of mental health impacts from:
89. 1991 benefit cuts → subsequent mental health service demand
90. 2008 Global Financial Crisis → mental health outcomes
91. COVID-19 economic support (wage subsidy) → mental health trends versus periods
without support
92.
2021-2023 OCR increases → mental health presentation patterns
10. INTERNATIONAL COMPARISONS
10.1 Peer Health Systems:
Please provide any Health NZ analysis comparing:
93. New Zealand's mental health service capacity versus comparable countries (Australia,
UK, Canada)
94. International approaches to monitoring economic determinants of mental health
95.
Countries that have successfully reduced suicide through addressing economic security
10.2 WHO and OECD Standards:
Please confirm:
96. Whether Health NZ follows WHO guidelines on social determinants of mental health
97. Whether OECD health metrics include economic stress as a mental health driver
98.
Any gaps between international standards and New Zealand practice
11. WORKFORCE MENTAL HEALTH
11.1 Healthcare Worker Wellbeing:
Please provide:
99. Mental health service utilization among health sector workers themselves
100.
Whether healthcare workers show elevated mental health crisis rates during
periods of high demand
101.
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:
102.
Proportion of mental health budget spent on acute/crisis services versus
prevention and early intervention
103.
Analysis of whether current investment balance is optimal or whether shifting
toward prevention would be more cost-effective
104.
Return on investment analysis for prevention programs
12.2 Upstream Interventions:
Please provide any Health NZ analysis of:
105.
Whether non-health interventions (income support, housing, employment
programs) would be more cost-effective than expanding mental health services
106.
Cost-benefit comparison: providing economic security versus treating mental
health crises caused by insecurity
107.
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:
108.
Whether any of the analyses requested above exist but have not been publicly
released
109.
If yes, reasons for non-publication (policy sensitivity, commercial sensitivity,
methodology concerns)
110.
Whether Health NZ publishes mental health demand data correlated with
economic indicators 13.2 Ministerial Briefings:
Please provide (titles and dates):
111.
Briefings to Ministers in the last 5 years regarding economic drivers of mental
health demand
112.
Warnings to Ministers about mental health system capacity being overwhelmed
by economic stress-driven demand
113.
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.
Requested dated 17 December 2025 (HNZ00106294)
SECTION 3: POPULATION IMPACT ESTIMATES
(g) Estimates or calculations of:
114.
Number and percentage of New Zealanders who regularly take Schedule 5
medications (by drug category)
115.
Number of medicinal cannabis prescription holders
116.
Geographic distribution (urban vs. regional/rural)
