The best way to combat rumours and scaremongering is by providing evidence to the contrary. And if there’s one controversial programme that could do with such treatment, it’s social impact bonds (aka social bonds in NZ). The Story piece that ran last night only reinforced that impression.
The New Zealand Initiative released our report on SIBs in May this year, and our position has been that it is a promising model worth considering. It’s a model that incentivises achieving outcomes, rather than just funding outputs, and there are potential benefits for all parties involved. During our research, we did not come across anything inherent in the model that would indicate it was doomed from the start.
When the subject of the first NZ SIB was released on mental health, we refrained from commenting too much on it. The pilot would be based around providing employment services to those with mental health issues. Rather, ours was a “we’ll wait and see” approach, until further details of the pilot were released. Again, while acknowledging there was great potential in the model, we were interested to see how risks such as gaming and cherry picking would be handled in the contract.
The problem is, those details are still not publicly known (or if they are, my Google Alert on the subject has failed me).
However, even without those contractual details, I’d still argue that SIBs have been inaccurately framed in The Story piece. Here’s some of the things I’d quibble with:
- The piece gave the impression SIBs would be this scary government roll-out of an experimental and controversial programme. Worse, it’s at the same time funding is being cut for valued and proven services like Lifeline. Actually, SIBs are designed to be small-scale, focussed on a small population whose outcomes can be carefully monitored. If – and only if – the programme proves to be successful, services can then be rolled out further.
- The idea that SIBs will take money away from other services is also deceptive. Health Minister Jonathan Coleman has stated that the total cost to date is $1.35 million over 3 years, which is approximately 0.0015 percent of the total social spend over that period. (In the interests of not being labelled as “deceptive’ myself, I’ll note those are just the costs to date, not the impending costs).
- “Mentally unwell” people will not be forced into work. First, because the SIB is a voluntary opt-in service. It is for people who have suffered from mental illness or are facing mental health issues, who have decided the want to work but require extra help in doing so. They’ll be participating in the SIB under the supervision of their current GP, and an independent assessor who will be measuring outcomes and overseeing programme delivery.
- The service providers, the Wise Group, aren’t just your everyday employment consultants either. They have experience providing specialised services for the intended population: people suffering mental illnesses. They have experience not just in employment services, but holistic support.
- Finally, critics of SIBs argue that it creates incentives to get the outcome (pushing people into employment), rather than ensuring they are getting well. I’d challenge the dichotomy that employment is always at odds with mental health recovery for everyone. Also – and this is where further details of the NZ pilot would be useful – SIBs overseas often use a range of targets and proxy indicators. Employment will certainly be one target in the NZ model. But it is possible, and would certainly be desirable, to measure and reward improvements in mental wellbeing too.
Finally, and most importantly, has it occurred to the critics of SIBs that some people suffering from mental illness may even welcome the model, and want these services for themselves? I don’t think any proponents of SIBs have argued that it will be appropriate for all people, but for people who do seek out these services, surely it is a good thing. I’d encourage sceptics to check out this piece in the Bay of Plenty Times, which has not received nearly as much coverage as it deserves.
The SIB pilot for enabling people with mental illness into work won’t be for everyone. But as an opt-in service, are sceptics really willing to deny this service to those who do feel they could benefit?
End Note: I hope these quibbles (and I promise I will never use the word quibble again because it’s awful) don’t take away from the fact I actually think The Story and Jimi Hunt are doing excellent work on mental health. Much respect!