Mental Notes No. 4 (March 1998)

The Blueprint for Mental Health Services: Fast-Forward Action Report

The Blueprint is our baseline tool for encouraging and monitoring positive change to all aspects of mental health services in New Zealand. It sets out the resources needed for the implementation of the ten-year strategy. We don’t expect everything in the Blueprint to happen at once, but we do expect to see progress in the direction of the Blueprint’s goals.

The Blueprint is specific about the need for more and better services. Getting the Blueprint implemented is now the challenge, and the responsibility lies with every single part of the mental health system.

‘More Services" ...

The Ministry of Health’s access targets for mental health services are 3 percent of adults and 5 percent of children and young people. The Blueprint is explicit about the levels of service required to meet these targets.

Service Requirements

The Commission is currently working with the sector to review the benchmarks and make sure they are as sound as possible. The Commission has done extra work on some of the specialty services and consulted more widely with those working in these areas.

The Commission is working with the HFA to:

find out present levels of service across all service areas and for all priority groups

determine the service gap between what is, and what should be, and resources required to fill the gap

decide what is needed in terms of ongoing funding, staffing and service configurations.

Getting more means making sure the HFA plans are in line with the Blueprint. It also means making sure that every provider is efficient and effective.

‘Better Services’ ...

The Commission is concentrating on getting four things happening:

discharge and care plans for everyone

good risk assessment and management procedures in all services

care pathways in all CHEs for those who have alcohol/drug disorders and mental illness

safe and appropriate use of the Privacy Act

There are no excuses for the above four things not happening and every service provider must take greater responsibility for keeping people who use their services safe.

The Commission has asked providers, what’s happening now, and what their plans are for improvement in the four very critical quality areas:

Discharge planning

When a person who has, or has had, a mental illness is discharged from care they are often still very vulnerable. Recent events have plainly and painfully shown that the discharged patient’s needs are too often woefully neglected and in too many cases, the result has been tragedy for the patient and other people. Despite the fact that there is a national requirement for discharge plans, few providers consistently use good discharge plans.

Risk management and safety

All providers need to have processes that identify risk for individuals and then need to take appropriate steps to cover these risks.

Care for people with alcohol/drug disorders and mental illness

Too many of these people are falling through the gaping cracks in the system. There has to be an end to the endemic Catch 22 situation where people are shunted between mental health services and alcohol and drug services, being told at both places that they can’t be treated until they have the other problem fixed first. All services must have clear pathways of care for these people.

Privacy Act guidelines

Some mental health service providers have been accused of hiding behind the Privacy Act to cover up their inadequacies when they refuse to give out information. The Privacy Act must be used to the patient’s advantage. Guidance Notes for the Mental Health Sector has been widely distributed in the sector and clearly indicates that the Privacy Act should keep people safe.

The Commission is completing a comprehensive analysis of the current protocols and policies to address these critical service issues. We’ll provide feedback to the CHEs in April or May.

Swinging on the NZQA Framework - Qualifications for Support Workers

"No discussion on Mental Health services makes sense if attention is not paid to workforce, employment and training issues. This is probably the most significant concern in the Mental Health sector"

Quote from: Mason Report 1996

Support for the Supporters

With considerable delight the Mental Health Commission and the Health Funding Authority (HFA) launched the registration of the new Mental Health (Support Workers) Qualification and Unit Standards at the Beehive on 19 February.

Establishing support worker qualifications has been one of the Commission’s high priorities. This was a joint goal, achieved with the tremendous support and commitment of the HFA, the Ministries of Health and Education, the New Zealand Qualifications Authority and the Education and Training Support Agency.

Talk about "WIN:WIN"!

The qualification will provide a uniform approach to training support workers. The development of the qualification and unit standards has made us take a look at the variety of existing approaches to training, and select the best in terms of both content and process. Mental health clients will benefit from having a trained support worker and employers of mental health support workers will have a transparent minimum qualification. Support workers will have more confidence in their working decisions and, equally important, the qualification will clearly recognise a person with expertise.

The Role of Support Workers

Mental Health Support Workers, paid and unpaid, assist people who have, or have had, a mental illness or disability. They work alongside the person, and frequently their families, to support them to achieve individual life goals. The people they support may be living in their own homes, supported accommodation or full care facilities.

Graduates Expected This Year

UNITEC, Manakau, Tairawhiti, Whitirea, Manawatu, Nelson and Southland polytechnics are working towards offering the full-time course this year. Students will spend four days a week gaining practical experience in the workforce and one day a week on theory.

Graduates will have the National Certificate in Mental Health (Mental Health Support Work).

More Programmes for Support Workers

Now that the Unit Standards are on the NZQA Framework we want to see them used. An advisory group is working with the health and education sectors to encourage additional programmes to increase access to the qualification. The advisory group will also develop quality management systems for the training programmes.

That Old Devil called Funding Again

The lack of education funding earmarked for mental health has been a significant barrier to increasing accessibility to the programme. A major challenge for the mental health sector this year is to increase the allocation of full-time tertiary student funding so that more programmes can be offered in 1999.

Maori Mental Health Services

Kaupapa & Mainstream: Nothing But the BEST for BOTH

"Maori, as Treaty partners are entitled to choice of access to both the full range of mainstream services (all of which should acknowledge Maori culture), and wherever possible, separate kaupapa Maori services."

Blueprint for Mental Health Services in New Zealand

With the release of the Blueprint the Mental Health Commission made a firm commitment to go out and seek input from Maori on what they want and need in the way of mental health services and how those services should be provided.

Quality & Access

At present, some Maori have access to kaupapa Maori mental health services, others have no choice but to use mainstream services. Both kaupapa and mainstream services must provide quality mental health care and it is very important for mainstream services to offer Maori, care, that is as sensitive to their needs as a kaupapa service would be.

Issues Hui

Commissioner Bob Henare, supported by Kaumatua Denis Simpson and Lyn Harrison, have attended eight hui in February and March to find answers to these pivotal questions.

What are the most effective ways for kaupapa Maori services to operate?

What do mainstream services need to do to be more effective for Maori?

How do we address the under-representation of Maori in the mental health workforce?

The ultimate aim for Maori mental health is to provide the best possible services, whether the service is kaupapa or mainstream. When Bob, Denis and Lyn have completed the round of hui, the Commission will incorporate the information gained in the next edition of the Blueprint.

Turning Ideas into Action ...

Maori already have a philosophy and whole range of practices for the care and rehabilitation of people with mental illness. They know that they want to take care of their own health. The overall vision is there and now they are intent on actioning the vision in a credible and flexible manner which allows for the different needs of different groups and individuals.

Maori culture tends to view life and existence, sickness and health, more holistically. For Maori, the physical, material, social, spiritual and mental are not separated. At present, our mental health services are resourced to treat only "the illness" under the assumption that the illness is relatively isolated from the rest of a person’s life. Maori want to find ways to treat the whole person.

... and Righting the Wrongs

Time and again, Waitangi Tribunal research has linked historical land alienation and the resulting social and cultural disruption, to problems faced by Maori today. A disproportionate number of Maori people use mental health services and the Commission is working to ensure that resources are available for appropriate care and treatment.

Working For the Workforce

The sector takes up the challenge

Last year, we chaired a steering group with the Ministry of Health and the four (now dissolved) regional health authorities, which developed a vision and strategy for a fully functional mental health workforce in New Zealand.

A new committee, the Mental Health Workforce National Co-ordinating Committee, has been formed to develop and implement a workforce plan which will meet the requirements of the HFA’s strategic service plan.

As the national leader for mental health workforce development the Committee will:

find out the investment required to match the workforce with service needs

ensure that the consumer is the primary beneficiary of all its plans

set goals for the workforce

develop plans and influence the allocation of resources for achieving those goals

monitor the national workforce to identify key issues that influence the delivery of services

promote solutions between, for example, the health and education sectors

encourage the development of a national information bank to assist managing mental health workforce issues.

The HFA is funding the Committee for a year after which it will make a decision on further funding, dependent on the effectiveness of on-going work. Further revenue is being actively sought from other stakeholders.

Providers to the fore

At its first meeting the Committee agreed that provider leadership is crucial to its success. Providers know best the skills and numbers of people needed to deliver the services required. They know which factors influence the recruitment and retention of staff with the required skills and attitudes.

Guiding Principles

The guiding principles for the Committee’s activities and decisions are:

to include

the diverse stakeholders involved in mental health

to improve

cost effectiveness

to encourage

partnerships between health and education providers at local, regional and national levels

local innovations

improved workforce stability and performance.

Committee Members

While Committee membership is balanced to represent the sector, it will be the skills and commitment of the individual members that will determine its success.

The members are:

Margot Mains (CEO Midland Health) (Chair)
Murray Johnson (Manager, Mental Health Services, Capital Coast Health) Interim representative of CHE mental health managers Barbara Anderson (Chairwoman HOMES)
Jacquie Graham (Director, Pathways Trust)
Bob Henare (Mental Health Commissioner)
Kath Fox (National Director of Mental Health Services, HFA)
Megan Purvis (Acting Manager, Clinical Training Agency)
Karl Pulotu-Endemann (Pacific Islands member)
Mason Durie (Maori member)
Madeleine Heron and Mike Sukolski (Consumer Advisor to the HFA, Central Division) Interim consumer representatives

Consumer Advisor - A New Position at the Commission

It’s become evident over the months since our establishment in September 1996 that we need someone to work at the Commission whose sole responsibility is to ensure that mental health consumers are at the centre of all our programmes. The Commission’s raison d’être is to improve the lot of people with mental health disabilities. While all our programmes are consumer oriented, it takes time to consult with consumer groups as well as all the other groups in, and outside of, the health sector. We want to get the consumer perspective right.

The position was advertised nationally at the end of February, with applications closing on 13 March. By the time you are reading this we will either be selecting, or will have appointed, a Consumer Advisor.

The Anti-discrimination Journey - On the Road to Equality, Respect and Rights for People with Mental Health Problems

The Anti-discrimination Team at the Commission has taken time out to review its plan and clarify its role.

What Have We Done So Far?

To get a grasp of what needs to happen overall, we’ve been mapping the territory, guided by four key processes:

Consult Understand Define Discover Solutions

We’ve held forums and workshops, distributed a discussion paper which produced good feedback, worked with the Ministry of Health and then the HFA on their campaign and brought the media on board.

The team has begun work to clarify the legal rights of people with mental health problems. We’re also writing a book which, through telling the stories of people who have faced mental health problems, shows the incredible strength and wisdom that can come from that experience.

We’ve Drawn the Map It’s Time to Hit the Road

Our task for the 1998/1999 period is to strengthen the relationships amongst all the travellers, that is, all the agencies and organisations on the anti-discrimination pathways. We must also support the travellers to maintain impetus and enthusiasm.

We have two goals for the next year:

Goal 1. To make sure the HFA anti-discrimination/de-stigmatisation programme is sound and strong

Previous confusion over our, the Ministry of Health’s and the HFA’s roles, has now been cleared up.

The HFA makes all decisions about the programme it funds- what it does and how it operates.

The Mental Health Commission, the HFA and the Ministry of Health all decide what the performance indicators for the programme will be.

The Ministry of Health monitors the HFA.

The Mental Health Commission checks that the Ministry of Health is doing this. (We monitor the monitor!)


To Be a Thorough Monitor and Set Useful Performance Indicators, We Must:

have an in-depth understanding of all aspects of the programme, so that we can:

advise when something is on track, or isn’t,

share information with the Ministry of Health and the HFA, and

warn of the consequences of the programme, or parts of it, going off track.


The Commission will carry out its monitoring role through regular meetings with the Ministry of Health and the HFA. The Commission intends to give as much help as it can to HFA staff to maintain the programme.


Goal 2. To Sow Seeds in Areas Not Covered by the HFA Programme

We will build relationships outside the HFA programme encouraging other sectors to put discrimination and mental health on their agendas and begin the journey.

We will help the people working on workforce development address anti-discrimination.

We will work with other agencies to establish and protect legal rights of people with mental health problems.

The Map

The journey to end discrimination against people with mental illness is new. It covers uncharted territory. All the people embarking on pathways are trail-blazers. No one can know for sure the right direction to take, but we’ll get there as long as we record our findings, keep our destination in mind and make sure we do no harm along the way.

We devised the map so that while we are bogged down in the detail, we can maintain an overview of the territory and record our understanding to date.

We’ve consulted widely on the Blueprint version of the map and a new version will be out soon. While the HFA is treading the map’s many paths, we will be concentrating on introducing other travellers to the journey.



Tackling Youth Suicide

New Zealand’s youth suicide rate is tragic and shameful; we all know that. Our Blueprint states that the number of young people our mental health services can treat is far too low. It’s pretty obvious that if we had more youth services we would be able to help more young people with the causes of suicide: depression, feelings of worthlessness and alienation from society.

Youth suicide is an extremely complex issue and the Commission welcomes the overall strategy for prevention of suicide that has been developed by the Ministry of Youth Affairs. It is supporting the Ministry of Education’s guidelines for schools on what to do when faced with students who are at risk.

We believe that the youth suicide rate can only be lowered if New Zealand families and communities have access to support and knowledge when they need it. Making sure that there are more youth mental health services and more effective crisis intervention and follow-up procedures that really work for disaffected young people, is a priority. This will mean more training places in existing services, more youth mental health services and better sharing of information and ideas.

Keeping Track of Mental Health Spending

In the last issue of Mental Notes (December 1997) we gave you a run-down of the main findings of our financial tracking exercise. At the beginning of February we released a copy of our findings to the sector. We plan to continue monitoring how much money is spent on the provision of mental health services.

The Health Funding Authority’s Five Year Plan

We have received, and commented in detail, on the HFA’s draft five year funding plan for mental health.

The Commission wants to see substantial progress towards the benchmarks set down in the Blueprint. We are pleased to see that service increases over the five years will go some way to bridge the gaps.

For the first time, clear forward plans have been made which flag directions and priorities. The plans do need to emphasise the standards and improvements required.

We are now working with the HFA and the Ministry of Health to ensure that the plans do as much as possible for mental health services and to ensure that an effective monitoring process is in place.

News from the Pacific People’s Advisory Committee

The Minister of Health, the Hon Bill English and Peter Carter (Strategic Planning) from the HFA attended the February meeting of the Pacific People’s Advisory Committee.

The Committee has now drafted its priorities for the development of Pacific peoples’ mental health services. They are:

more Pacific mental health services provided by Pacific people

more Pacific Islands people in the mental health workforce

real jobs for real money for people working with Pacific mental health consumers

more funded research into Pacific peoples’ understanding of mental illness, their mental health needs and how best to meet these needs.

The Committee is organising talk-back radio shows to promote a two-way dialogue between Pacific communities and the Mental Health Commission. The Committee base all its recommendations to the Commission on extensive consultation with Pacific people.

There’s Been a Bit of a Shuffle at the Commission

Until recently, the commissioners divided the national workload into three regions, with Barbara Disley focused on the northern and middle regions, Bob Henare looking after the central region and Julie Leibrich responsible for the southern region.

Now, because discrimination has emerged as a big workload issue, Julie will be dealing with discrimination issues nationally. Barbara and Bob will jointly look after the southern region.