How does this change proposal fit within the overall MH&A change programme?
There are four workstreams in the Mental Health and Addiction Change Programme, which complement one another but are able to progress independently.
The Community Mental Health and Addiction workstream covers several projects which collectively strengthen community-based mental health and addiction services. This includes work to improve integration across the continuum of care and provide more options and choices closer to home. Like the workstreams, these projects complement one another but can progress independently.
This change proposal relates to the Local Adult Specialist Mental Health and Addiction Service project.
Who was involved in the development of this change proposal?
The proposal represents the culmination of a design process, involving MHAIDS kaimahi, stakeholders, and priority partners including Māori, Pacific, those with lived experience, and people with disabilities.
In January 2023, a concept paper was shared for feedback, which broadly outlined our vision for the service. This was itself the culmination of earlier stakeholder engagement sessions and feedback, which began in 2021.
Following this, a series of three design workshops were held in March 2023, attended by around 80 internal and external stakeholders, including but not limited to:
- Primary care and GP practices
- Key local non-government organisations
- People with lived experience, including tāngata whaikaha
- Māori kaimahi
- Pacific kaimahi
- Leadership and kaimahi within MHAIDS
- NZ Police
- Wellington Free Ambulance
The views captured in this process were used as the basis for a proposal for how a redesigned service could look. We have also looked at the data relating to service access, ethnicity and demand across the within localities as well as both feedback from tāngata whaiora and other agencies to inform the development of the model.
The proposal lacks detail, and it is difficult to provide feedback without this information. Why is this?
The intention of the proposal is to describe the vision, principles and model of care for the future of Local Adult Specialist Mental Health and Addiction services – the ‘what’. It seeks to establish a leadership structure that aligns to the proposed model.
We will work with the teams and kaimahi on the detail of how these changes would be implemented – the ‘how’.
How are external stakeholders / the public being made aware of these changes, given it affects them?
Stakeholders have been involved with work on the Local Adult Specialist Mental Health and Addiction Service since its inception, including through representation on the wider programme leadership group. We also communicate stakeholder updates from across the programme regularly via face-to-face meetings, email newsletters (which are also sent to MHAIDS kaimahi) and with information on the MHAIDS website.
A summary document outlining the change proposal following discussions that were held at a series of design workshops and the feedback from the local concept paper was released to external stakeholders in late June 2023. This summary document is available here.
We also wanted to make sure that those who attended the design workshops had an opportunity to review the outcomes and to make people aware (including the public) of the key changes we are proposing to work towards an integrated Local Adult Specialist Mental Health and Addiction Service.
Will I be expected to work longer hours?
Firstly, we want to acknowledge the hard work that staff in all the teams are currently doing. The flexible hours suggestion in the proposal is around extending service provision hours in localities, rather than individual staff working longer hours. Extended hours might look different across the home bases - and might not be every day.
We know tāngata whaiora want more flexibility in the times available for them to access services, such as those who work full-time, and that some teams already provide group therapy after hours. We know that some of our community mental health staff are already providing services outside of 8.30am to 5pm, Monday-Friday. We want to strengthen these activities already happening, make sure that staff are appropriately reimbursed as per their employment agreement, and we need to consider safety of our staff, tāngata whaiora and whānau.
The terms and conditions of staff employment agreements remain unchanged – i.e., staff contracted for 40 hours of work per week under those conditions.
How will you manage the rapid response for young people?
We will still provide a rapid response for young people. We are actively seeking feedback in this area, as we are aware that young people often present to our services in crisis. We will work alongside the Younger Persons sector to design and implement a response that best meets the needs of young people and their whānau who present and need care for acute mental health distress.
Will we still provide support to ED and police for people who present in crisis?
Yes, the proposal is looking to strengthen the crisis response to ED rather than diminish it. Even if the proposal goes ahead and the crisis response function is de-centralised to the localities, we will continue to provide a crisis response or 'rapid response' function to all the places we do now.
We have the Mental Health Addiction Crisis Support (MHACS) project that continues to look at the provision of acute response to the Emergency Departments.
We also know that there are other peer-led community-based alternatives for people experiencing mental distress (safe haven cafes). These approaches provide other options for tāngata whaiora and can reduce people presenting to the emergency department.
We spend a lot of time doing work that could be better done elsewhere – e.g., picking up tāngata whaiora for appointments or providing ‘watches’ while waiting for inpatient admissions. How will this change?
As part of the engagement process, we have heard from both staff and stakeholders that often they feel that they are doing work that might be better done by someone else. Community providers have indicated that they want to be able to do the work that they are good at, as do the staff.
This proposal recognises that specialist MH&A services are part of a continuum of care that intends to strengthen local partnerships and remove the barriers to allowing this work to happen. We have seen excellent results from the integration of Workwise into the local community mental health and addiction teams and the change proposal would look to further explore how the localities can build on these types of partnerships.
Proposed functions such as the Community and Primary Transition Service aims to strengthen consultation and liaison functions aiming to reduce the barrier between specialist and primary care services.