Authors: Carole Koha, Kristina Sofeie, Bron Poad, Shaun McNeil, Pauline Morrison, Kym Park
Event: 2016 TheMHS Conference
Subject: Wellness and Phsyical Health, advocacy, attitudes, stigma, discrimination, challenges, communities, culture & society, innovation, quality, new pathways to care, service delivery, implementation, Te Waka Whaiora Trust wellington new zealand, emerge aotearoa, capital & coast district health board, pathways, vaka tautua, Te Ara Pai , Maori and Pacific Peoples, person centred
Type of resource: Conference Presentations and Papers
Abstract: People achieve wellness and connections with their communities in different ways. Change does have an impact not just on those using the services but also all the services involved in developing a people-centred streamless service. Change is frightening and instead of looking at what the gains could be, we continue to look at what are our losses.
Capital & Coast District Health Board invested in Marciano Lim Work stream to complete a literature review that would look at providing better services for people who have high, complex and chronic mental health needs that was evidenced based. The purpose for gathering evidence based practice was to seek best-practice research that adequately addresses the effectiveness of service delivery models for adults with low prevalence, high severity mental health conditions in a number of areas. The material and findings contributed to a proposal that developed a service delivery framework and person centred models of support, Te Ara Pai.
Introducing what evidence based best practice literature informs us of:
The literature describes the target population as individuals who are difficult to discharge due to severe and long-term mental illness (Butterill, Lin, Durbin, Lunsky, Urbanoski & Soberman, 2009), taking into account the following areas:
- Consumer perspective that identifies their needs, service configurations and the effectiveness and efficiency of these.
- Considers location of services for adults with low prevalence, high severity and support needs.
- Consideration of what and how services should be delivered to Maori, Pacific and other minority communities.
- Best practice for working with families/whānau and support networks while adults are receiving mental health support.
The review included national and international research which included prevalence data, safe care management, assessment processes and tools, effective evidence based interventions, family and community support, models of service delivery, effective interventions identified to support adults with low prevalence, high severity mental health conditions in the community. This sub group of people are known as the revolving door clients who remain in services because of their severity of mental and physical health, behavioural issues and an aging population with alternative community placement. The most common mental health disorders were: depressive disorders, bipolar disorder and schizophrenia (Ministry of Health 2004, McGeorge, 2004).
Some of the key features of people with multiple and complex needs have combinations of: mental health concerns; physical disability; substance abuse; contact with criminal justice system; lack of access to secure or stable accommodation; chronic problems and social isolation.
Maori and Pacific Peoples showed a higher prevalence of mental health disorder including addiction than other ethnic group (Oakley Browne et al., 2006).
Consumers’ concerns were around: stigma; lack of access to clinical treatment options; insufficient involvement in treatment decision; lack of access to a wide range of community support services like accommodation, vocational and employment options, family education, employment, support and participation (Mental Health Commission, 1998), family and peer support, relationships, alternative options to treatment, accessibility and availability of mental health services, which affects the individual’s recovery. People with severe mental illness also wanted access to a broader range of services that look at gender, culture, ethnicity and self- management programmes (Sainsbury Centre, 2006, Ministry of Health, 2005), self-management and peer support. The lack of knowledge of mental disorders, social isolation and beliefs hinders positive outcomes for people with mental illness.
Te Ara Pai provides a direction to a more ‘whole of system approach’ or an integrated approach between NGO, primary care and specialist services to support people with severe mental health illness (Mental Health Commission, 2012).
This integration of mental health into NGO healthcare led to the development of a model such as Te Ara Pai, which has ten different services.
Capital Coast District Health Board has developed community-based alternatives to inpatient treatment including community mental health team interventions and formal peer support, support community-based self-care, prevention and early intervention, developments outside the health sector – including integrated multi agency solutions and the role of mental wellbeing generally – and consumer involvement.
Te Ara Pai services are person-centred. This means organisations will work with you to meet your needs. They will also work alongside your family/whānau or the support people you choose, as well as any of your treatment providers (e.g. mental health and addiction clinicians or GP) to support you to regain wellness.