Concerns are growing among clinicians in Aotearoa New Zealand over the “severe and adverse” impacts of recent government funding cuts affecting individuals with intellectual disability (ID) and their carers.
A group of five clinicians, including University of Otago, Christchurch’s, Department of Psychological Medicine Head, Professor Richard Porter, have expressed their concerns in this week’s New Zealand Medical Journal editorial, outlining the negative effects of these changes on the “vulnerable people” they are currently treating day to day in their clinical practice.
“We have observed significant adverse consequences due to the current disability funding cuts and believe these impacts will both worsen over time and cause long term harm,” Professor Porter says.
Professor Richard Porter
“We suggest there is no justification to freeze residential funding while reviewing the funding system and that doing so is causing unnecessary, severe harm to those with ID and their families and carers. Already, a reconfiguration of services is taking place, returning individuals with ID to a situation of non-personalised care, accompanied by reduced community involvement and chemical restraint.“
In March 2024 the Government reported a forecasted budget overspend of $50 to $60 million in Disability Support Services (DSS) and announced a “temporary pause” that narrowed the scope of what carers could purchase to support the approximately 50,000 individual clients in New Zealand with disabilities.
In August the Government announced that Whaikaha – the Ministry of Disabled People would be restructured as a policy and advisory department with DSS functions taken over by the Ministry of Social Development (MSD), and that there would be no financial uplift for the care and support of people with disabilities. It was recommended “to freeze current levels of funding for residential facility-based care for 2024/25 pending commissioning and completion of a detailed and urgent review of the contract and pricing models”.
The authors says as a result of this Government decision, people with intellectual disabilities can no longer access residential care; that the levels of support many are receiving in residential care is now reduced; and that additional funding cuts for those receiving care at home and in the community is resulting in significant distress and mental health harm for people with disabilities and their carers/whānau.
“Effectively, no new residential places are being funded and some that were planned but not yet commenced have been withdrawn. This has been devastating for all concerned as people with intellectual disabilities are forced to return to an untenable situation at home, with carers and whānau often unable to cope,” Professor Porter says.
“We are also seeing individuals admitted to hospital with severe difficulties unable to be transitioned back to the community, leaving them in an inappropriate hospital ward environment where they are vulnerable, ‘blocking’ scarce mental health beds. Residential services won’t consider taking these individuals into care because of the likelihood they may require higher levels of care for which funding is now unavailable.”
The authors argue that funding cuts to services which specialise in community care for ID patients with dementia are leaving many vulnerable to closure, increasing the likelihood that individuals will now be admitted to general psychiatric wards since they are not suitable for dementia-level care.
“As funding is reviewed, some individuals have had their existing packages of care reduced, with providers now beginning to ‘rationalise’ by amalgamating houses and closing houses with fewer residents. Not only are larger homes often less suitable, but enforced moves away from familiar long-term housemates and staff are causing undue stress and altered mental wellbeing for those involved,” Professor Porter says.
The authors argue funding cuts are also increasing pressure on psychiatrists and other prescribers to increase sedative and anti-psychotic medication to ‘medicate’ behaviour disturbance, to mitigate the effects of inappropriate patient placements and low staffing levels.
“A combination of factors related to these funding cuts is leading to an increase in high-risk suicidal and violent behaviour, resulting in higher rates of presentation of individuals with ID to mental health services, emergency departments and police,” Professor Porter says.
He and his colleagues are calling for the Government to reinstate funding – before more harm is caused.
“We urge the Government to re-think a policy that was based on a report, produced in 6 weeks, without clinical or community engagement, which essentially had minimal consideration of the effects, other than supposed financial benefits.”