Making Mental Health a priority

“There needs to be compassion and humanity – professionals need to think about the impact of their words and actions.” Mental Health Service user

shutterstock_84846199A wise man once told me told me, you can’t have health without mental health, and I’m a firm believer that we should prioritise mental health alongside physical health, and not treat them as separate issues.   In New Zealand, an estimated one in three people cope with a mental health condition at any one time – of that number, approximately one in five people in Counties Manukau seek support and care for their mental health needs. Many of these people also suffer from chronic health conditions such as diabetes or heart failure, and if you have a mental health condition, you are three times more likely to experience an avoidable hospital admission.

In terms of addictions, it is estimated that one in ten people use drugs and/or alcohol, with approximately 10,000 people in Counties experiencing harmful effects as a result, and in need of treatment.

We know the current mental health and addictions system is fragmented – that’s why the Mental Health Service at CM Health is embarking on a programme of work to transform the MH&A (Mental Health and Addiction) system. Through better integration and intervening early to keep people well, people using MH&A services will have an improved experience and better health outcomes. We will also continue to ensure a focus on supporting people with severe and enduring mental health needs.

I’m joined by Pete Watson, Clinical Director Mental Health and Tess Ahern, GM Mental Health to tell us about their approach.

Over the past few months, we’ve taken the time to learn about the needs of our communities.   We’ve talked to a cross-section of people through a process of co-design engagement to hear their thoughts and ideas and to work together on what some of the solutions may be.

If you are not familiar with the term ‘co-design’, it means working with service users and their family/whaanau, together with a wide range of stakeholders, to design a system that truly meets people’s needs. We’ve successfully used co-design to inform the planning processes for the new inpatient unit at Middlemore Hospital and have seen how valuable it is.

To inform our integration agenda, we have used co-design to engage with people living and working in our localities, i.e. Mangere, Otara, Franklin, Manukau and Eastern. While there are certain things that are important for MH&A no matter where you live or work within Counties, there may also be different approaches and priorities for our different communities. It is important these are acknowledged and acted upon. Through this process we have heard from a wide range of stakeholders including service users, family/whaanau, GPs and practice nurses, specialist MH&A services, broader health partners such as midwives and pharmacists, and NGO providers as well as people such as school principals, guidance counsellors, the police, CYFS and MSD. It has been fantastic to see how many people are interested in being involved in effectively supporting our communities’ mental wellbeing.

“The benefits of the Locality Leadership Team working together with mental health team members in the co-design process included the building of trusting relationships leading to new learnings for us all. In a context of high trust, integrated models of health and social care can be designed, actions planned and new services implemented quickly to bring new solutions to service users and communities in need. To this end, co-design is in everybody’s best interests.” Sarah Marshall, General Manager, Otara-Mangere Locality Clinical Partnership.

The questions we have been asking people, through a series of workshops and online survey include: What matters to people? What is working well at the moment? What they think the issues and challenges are? And what they think the priorities are to improve the mental well-being of our population?

This has generated some great feedback, and people have told us we need to empower the individual and their whaanau so that they can take control of their overall health.

“Help my family help me, by letting my family help you” Mental Health service user

People have also said we should treat physical and mental health equally, and that good relationships and communication between service users/family/whaanau and professionals were important.   People also spoke of the importance of access to good information and the need for professionals across the health system to have knowledge and confidence in dealing with mental health. The resounding feeling was that we need to be doing all of these things consistently well, all of the time.

We couldn’t have got this far without the knowledge and expertise from across the sector and collaboration with our primary, specialist and NGO partners. Our community mental health professionals are committed to working alongside colleagues in primary care and localities and are keen to work collaboratively to determine how this can be taken forward. There are already wonderful examples of collaboration taking place in our community. For example, professional relationships have been developed in Mangere/Otara between GPs and The Cottage Community Mental Health Centre based in Otahuhu.   This has resulted in regular mental health clinics in three GP practices, with a psychiatrist and mental health nurse available to discuss and update plans for people who access both primary care and mental health services, and to provide information, resources and advice for general mental health queries.

“Ready access to specialised mental health expertise by forming networks and relationships, and sharing knowledge, can only help improve the care for patients…and better support both their physical and mental well-being.” Tim Hou, GP, Mangere Health Centre

An Integrated MH&A Leadership Group oversees and drives the programme. This group includes representatives across primary/secondary/NGO, as well as cultural representation. The group’s overarching vision for the MH&A system in Counties is to be the very best that it can be, with our population confident that the system will be responsive and effective at protecting and promoting mental wellbeing. While the group is leading and overseeing the programme, it will be important for others to continue to be involved in the co-design process as we move from design to implementation and delivery. If you are interested in being involved, please contact Wendy Brown via email:  Wendy.Brown@middlemore.co.nz, Service Development Manager, Integrated Mental Health and Addictions.

Tess, Pete and Geraint

  • Photo:  The person shown in the photo was not part of the co-design session

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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