*Population in 2020、GNI and life expectancy are updated based on UN's 2019 data.

 *Medical information is based on WHO's report of 2017 Mental Health Atlas-country profile.

I.        Overview

　　New Zealand is an island country in the southwestern Pacific Ocean with a total area of 270,534 square kilometers, it is mainly composed of two large islands, namely, the North Island and the South Island, as well as some scattered islands around. North Island and South Island are separated by the Cook Strait. The capital Wellington is located at the southern end of the North Island, while the largest city, Auckland, is at the northern end of the North Island. The country and Australia are all the members of the Commonwealth of Nations and realm, and it is also a parliamentary and constitutional monarchy.

　　Christianity is the main religious belief in New Zealand, and the rest still have traditional Maori Animism, and a minority of Buddhists and Muslims. New Zealand's population, in 2020, is 4.82 million, and about 1/3 of the people live in the area of Auckland, and more than 70% are in the metropolitan cities. The composition of the national population is diverse and is dominated by the descendants of immigrants, of whom 74% are mainly Europids and indigenous locals Maori (14.9%), some minorities of Asians (including Chinese) and other Pacific Islanders. The life expectancy of women and men at birth is 83.6 and 80.2 years, respectively. According to the statistics of the World Bank in 2019, the average national income (GNI) is US$42,220, and the psychiatric-related budget accounts for 9% of its total medical expenditure.

　　Nowadays, New Zealand is divided into 16 primary regions at the north and south main island, the Chatham Islands Territory, and many extraterritorial territories, including the Cook Islands, Niue, Tokelau and Antarctic Ross. There are 67 districts and cities under the 16 regions and the Chatham Islands, which are called Territorial Authority and considered as the secondary administrative local governments.

　　The Ministry of Health (hereinafter called MoH) is in charge of the overall public medical health service in New Zealand and is responsible for overseeing the provision and development of health services. It is to implement the government policies and statutorily supervise the enhancement of the Mental Health Act which was enacted in 1992. Health Workforce New Zealand (HWNZ) is fully responsible for planning and developing the health workforce, and it also manages voluntary funding for post-employment clinical training and integration programs for psychiatry, nursing, psychology and other health professionals.

II.       Mental health policy and system

　　New Zealand's mental health-related bills and policies cover a wide range, such as the current Mental Health Act, which passed 1992 and revised in 1999, it also stipulates the Compulsory Assessment and Treatment and accepts the legal measure for driver’s license suspension during the assessment period (section 19, Land Transport Act 1998). The relevant laws and regulations also include the mental state of the crime (section 23, Crimes Act 1961), Criminal Procedure for the Mentally Impaired Persons (Act 2003), Compulsory Care and Rehabilitation for the Intellectual Disability (Act 2003), etc.

　　In 1994, the New Zealand MoH formally proposed the National Mental Health Policy, emphasizing the provision of mental health services and promising to develop a community model. The first phase of the National Mental Health Plan began in 1997, with the goal of improving the quality of services, the Mental Health Advisory Committee supervised the effectiveness of the implementation of the plans. From the period 2006 to 2015, the mental health and addiction prevention plan would be implemented with the theme of improving mental health, its main aspects included:

(1). Promotion and prevention: Improve mental health and well-being, and prevent disease and substance abuse.

(2). Establish mental health services

(3). Provide immediate services

(4). Cultivate human resources related to mental health and substance abuse prevention

(5). Expand the scope, quality and choice of mental health services for  indigenous people.

(6). Improve the ability of primary medical care to provide mental health and addiction services

(7). Improve the accessibility of addiction services and strengthen the connection with mental health services

(8). Formulate and implement a funding allocation mechanism for related mental health and addiction treatment services

(9). Strengthen inter-ministerial coordination and cooperation

(10). Improve people's trust in services, information systems, etc.

　　In addition, the government also targeted the use of alcohol and other substances for children, adolescents, and to take care of the aboriginal psychological well-being in 2007. In 2008, the second phase of national strategic framework (2008-2015) for the Indigenous Mental Health and Addiction Prevention and Treatment was proposed. In 2010, a plan was issued to integrate services for people with both mental health and substance addiction problems, including evaluation and management. In 2011, it developed the youth justice services for young people involved in judicial issues. In 2012, it proposed to develop the mental health services for the duration of pregnancy and infants.

　　The central government is in charge of the management of New Zealand's Universal Healthcare System. However, the government does not assume the responsibility for providing medical services, it is in the scope of the regional and private medical centers in the system. The relatively extensive and high-quality system of public hospitals provides free treatment to citizens or permanent residents and is managed by the district health committee.

　　New Zealand provides public-funded medical services for citizens, permanent residents, and those who have a working visa for more than two years, which includes free inpatient medical care, outpatient fee subsidy, fee subsidy for prescription in public hospitals, and free maternal and child health services during pregnancy and childbirth. The medical costs are quite high, if not eligible for public medical care, it will be very expensive to receive the public or private medical services, therefore, it is better to purchase a private insurance in advance for the expense saving. New Zealand adopts the British General Practitioner (GP) system, generally, it needs to see a GP first when unwell. The GP will diagnose the condition, if it's complicated and needs further treatment, the referral from the GP is necessary for going to a specialist or apply for hospitalization. Only in the event of a sudden illness or serious trauma, it accepts the direct emergency treatment in the hospital. The government provides more medical subsidies (or free) for children under the age of 14, such as the service of GPs, pharmacist's prescriptions, and dentists (under 18).

III.   Human Resources

　　WHO points out that there are 28.54 psychiatrists and 75.13 nurses in New Zealand for every 100,000 population, but there are no data for psychologists, social workers and occupational therapists.

　　To become a qualified psychiatrist in New Zealand, after completing a five-year Bachelor of Medicine and Bachelor of Surgery (BMBS) degree at the University of Otago or Auckland University, and served as a Supervised Junior Doctor in the hospital for 1~2 years, then complete six years of professional training and examinations at the Royal Australian and New Zealand College of Psychiatrists (RANZCP). It finally can be registered as a member of the Medical Council of New Zealand.

IV.    Mental health system and promotion

　　Mental health services in New Zealand need to be referred through a GP. If there is an emergency case involved with personal safety, it has the following treatment methods:

(1). Make a report or directly take the patient to the emergency room of the nearest hospital；

(2) Call the nearest hospital, or emergency psychiatric service, or the  psychiatric crisis assessment team in the district/city.

　　In addition, there are various consultation hotlines (including lifeline, depression hotline, alcohol and drug abuse assistance hotline, youth hotline, etc.) and online resources (such as how to choose counselors from the Mental Health Foundation, how to seek services from the Health and Disability Committee, etc.), which can be used anyway.

　　To support New Zealanders to experience positive mental health and well-being, the National Mental Health Department and a health promotion organization named Oranga Hinengaro (in Maori, meaning mental health) have committed to promote the current mental health plan by the following two activities: One is "National Depression Initiative" which is to focus on the early recognition, appropriate treatment and rehabilitation to reduce the impact of depression onto the adults and young people, while another is the "Like Minds, Like Mine" public awareness plan. It aims to increase social inclusiveness and end the discrimination against people with mental illness or suffering. In addition, the government conducted an investigation for mental health and addiction issues in early 2018, the goal was to determine a clear direction for the government, mental health and addiction departments, and the entire community in the next five to ten years, which include and focus on how to prevent mental health and addiction problems, how to intervene early and respond better to those in need and how to promote well-being, etc..

V.       Major issues, challenge, and opportunities

　　In response to the recommendations made by the New Zealand Government Expert Meeting on the status of mental health and addiction treatment in November 2018, which was the Report of the Government Inquiry to Mental Health and Addiction, the most important priorities for the MoH included suicide prevention, revision of the mental health act, and the establishment of a mental health and well-being committee. These tasks were expected to be carried out through the MoH to promote mental health reforms in 2019. Nowadays, suicide is a serious concern for the New Zealand community.

　　According to New Zealand Health Survey report in Mental Health 2016/2017, it stated that 19% of adults had mild or higher anxiety symptoms, 20% with depressive symptoms, and 39% having that of physical symptoms (such as pain and shortness of breath) in the 4 weeks before the survey, and women indicated higher rate than men. Among children, boys (11%) were more likely to have emotional or behavioral problems than girls (6%). Maori adults were 1.1 times more likely to have mild or greater anxiety, depression, or physical symptoms than non-Maori adults, while Maori children are 1.5 times more likely than those of non-Maoris.

　　For adults and children, those who live in socioeconomically impoverished areas have a higher incidence of mental health-related problems.

　　32% of adults are at moderate or high risk of substance abuse. This is mainly due to heavy use of tobacco and alcohol. Men (36%) are at higher risk of medium or high-risk substance use than those of women (27%). Adults with mild or severe anxiety, depression, or physical symptoms (38%) have a higher risk of substance use than those of the general adult population.

　　In New Zealand, at least 44% of adults will try illegal drugs at some moment in their lives, and 93% will try alcohol. Almost 80% of New Zealanders drink once at least in the past year, while 20% of them drink by the harmful way to their bodies or mentalities somehow.

　　Cannabis is the most commonly used illegal drug, 15% of adults have used it in the past year, and 8.5% (i.e., 330,000 adult New Zealanders) smoke marijuana (cannabis) every month. The usage rate is even higher by Maori, young people and people in some poor communities.

　　The use of methamphetamine has remained relatively stable over the past 5 years, but some communities are facing greater harm anyway. In the past 5 years, the total number of people using amphetamines, including methamphetamine, accounts for about 1% of the total population.

VI.    Potential exchange issues

　　New Zealand's mental health work is highly developed, and it is effectively integrated with legal education and other fields, and worthy of being used as a reference for policy and practice exchanges. For example, recent work has focused on suicide prevention, addiction treatment, increasing primary mental health services, campus mental health promotion, etc. Furthermore, there are some possible issues for the future cooperation, which include the suicide prevention extends the scope to include those who are in crisis and the bereaved, the improvement of the accessibility to primary medical care and community services, the enhancement of the specialized services for drug and alcohol addiction, the provision of education assistance for the addicts with children, etc. Moreover, the school health services at all levels can be early intervened and evaluated, and the primary and secondary school teachers and students are the targets for intervention. All of the above can be used as a project for future exchanges, consultation and cooperation between the two parties.