Local Mental Health and Addictions Group

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Local Mental Health and Addictions Group

• Summary and update for DSAC
• 12 June 2007 (continued in August)

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Contents

• HHS Current Issues
• HHS Enhancing Crisis and Acute Services
• The Journey Forward
• NGO Development
• Services for Maori
• Primary Mental Health
• Information and Analysis
• Acute Service Spectrum Development

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HHS Mental Health Issues

• Vehicles
• Electronic Health Record
• Access targets
• Enhanced Responsiveness Project (CATT Review)

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Targets
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Enhancing CC DHBs Crisis Acute Mental Health
Services
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• Align with
• The Journey Forward
• The Acute and Crisis Workstream
• Improving Access to Primary Health and Mental
  Health Services.
• The Crisis Review Project

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Enhance service response by

• Lowering threshold for accepting people for
  assessment
• Increasing threshold for entry to (on-going)
  case-management
• More purposeful engagement focused on expected
  outcomes
• More proactive discharge planning with ease of re
  - entry into the service if required
• More standardisation of processes for the
  predictable
• Improve access to the right staff and services

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Enhance service response by

• Improving relapse prevention and more use of
  advanced
• directives for those consumers who already
  have a
• relationship with services
• Increasing collaboration between MHS, PHOs,
  NGOs,
• other health care services and community
• organisations. Including more availability
  of MHS for
• consultation and advice
• Improving ability of current silos to pool
  resources in
• order to maximise coverage and efficiencies

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A Proposed New Model
CMHT

Crisis Resolution
Assessment Clinic

Community Consultation
Case Management/ key work/ other
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Access Assessment Model 1

• crisis referrals

Mental Health Line
Kapiti
South
Porirua
Wellington

• All other referrals

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Combined Functions
CMHT
CMHT
Care Management
Crisis Resolution
Care Management
Community Consultation
Community Consultation
Assessment Clinic
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Access Assessment Model 2

• crisis referrals

Mental Health Line
Kapiti
Porirua
Wellington
South
Combined Functions

• All other referrals

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Access Assessment Model 3

• crisis referrals

Mental Health Line
Kapiti
Porirua
Wellington
South
Combined Functions
Combined Functions

• All other referrals

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Access Assessment Model 4

• crisis referrals

Mental Health Line
Other

Some Combined Functions
South
Wellington
Kapiti
Porirua

• All other referrals

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Acute Resource Coordination
Service Coordination

Kapiti
Wellington
Acute resource Coordination 24/7

Acute resource Coordination 24/7
Porirua
South
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Key areas to support for improved integration and
access/response

• Emergency Dept General Hospital
• Maori Mental Health
• Health Pasifika
• Older persons
• CADS
• Children Youth
• RFRIDS
• Consumer Run Services
• Other?

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The Journey Forward

• Workforce linking with national and regional
  developments
• Addictions workstream now being established
• Child and Youth strategic population approach
  being agreed

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Addictions Service Development

• Improve the availability of and access to quality
  addictions services, and strengthen the alignment
  between addiction services and services for
  people with mental illness

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Addictions Service Matrix
Inpatient Detox Social detox Early On-set of Dementia Residential Facilities
Methodone Clinic Community Alcohol and Drug Team Community Alcohol and Drug Team Wet Shelter
General Practice Regional Residential Rehabilitation TACT team Wet Shelter
Information Services Counselling Services Longer Term Residential DCM Outreach
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Maori

• Community and Inpatient Numbers
• Te Puwaitanga Review
• Initiatives

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Te Puawaitanga Goals

• Goal 1 Provide comprehensive clinical, cultural
  and support services to at least 3 percent of
  Maori, focused on those who have the greatest
  Mental Health needs
• Goal 2 Ensure that active participation by Maori
  in the planning and delivery of Mental Health
  services reflects Mäori models of health and
  Mäori measures of Mental Health outcomes
• Goal 3 Ensure that 50 percent of Maori adult
  Tangata Whaiora will have a choice of a
  mainstream or a Kaupapa Maori community Mental
  Health service
• Goal 4 Increase the number of Maori Mental
  Health workers (including clinicians) by 50
  percent over 1998 baselines
• Goal 5 Maximise opportunities for intra and
  intersectoral co-operation

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Areas for Further Development by DHB
Score out of 5
Te Puawaitanga goals
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Maori Initiatives (update)

• Matatini (4 place Recovery House)
• Te Upoko Nga Oranga o te Rae (regional
  development service)
• Maori Consumer Consultant (HHS services)

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Primary Care Initiatives

• Existing GP Liaison Scheme
• MoH Pilots

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Needs of the Population
Acute care and protection
Long term support for high and complex needs
CMHT
NGOs
Primary Care
Prevention and Promotion in Communities
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Funding Paradox
Services
Funding
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Assumptions

• Mental health problems for individuals will
  generally get worse if left untreated
• Major mental health problems dont just occur out
  of the blue/occur overnight they build up over
  time
• Most people, if given good information for self
  management, can take steps to remain more
  mentally healthy than if they are uninformed or
  subject to internalized stigma
• Many people who live in difficult social
  circumstances will experience these as a negative
  impact on mental health - therefore an
  improvement in social circumstances will
  generally mean an improvement in mental health

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Current Access Inertia
Acute
NGOs
CMHTs
Primary Care
Prevention and Promotion
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High Level Process map stepped approach to care
Acute
Recovery / Long Term
Primary Care
Prevention
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Targeted Prevention and Promotion and Social
Supports
Resources
Managing the Effects of institutionalisation,
stigma and delayed support and services
Time
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The Way We Organise Services
?
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The way we should integrate services
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People with high behavioural and low social needs People with high behavioural and high social needs
People with low behavioural and low social needs People with low behavioural and high social needs
Increasing Behavioural Needs
Increasing Social Needs
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Specialist Clinical Services
Primary Care
Coordination
Increasing Behavioural Needs
Self Help
NGOs
Increasing Social Needs
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Information and Analysis

• NGO data project
• PRIMHED
• Senior Analyst Position
• System Reorientation

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NGO Data
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NGO Data
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NGO Data
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NGO Data
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NGO Data Project Purpose

• Promote effective integrated care and support
  for mental health service users by
• Increasing the information available for NGO
  providers to better manage their business and
  help them develop a culture of continuous quality
  improvement.
• Enhancing coordinated health care and service
  integration between NGO and DHB clinical services
  so that each party is aware of the others
  contribution to the process of recovery by the
  service user.
• Enabling Funding and Planning to monitor and
  evaluate service performance and to have better
  information to inform service planning.

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NGO Data Project

• The goal of the project is to develop a
  mechanism for the effective reporting of good
  quality information about the utilisation of
  mental health NGO services by consumers.

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Counties Manukau DHB CLS - an example of
information use by NGOs
Counties Manukau DHB Capital Coast DHB Hutt Valley DHB
Total population 440,600 272,400 139,000
Maori 17 10.5 17
Pacific 21 8 8
No. of MH NGO providers 10 29 11
Sources DHB DAPs for 2006/07 and the NGO-IT
report (2006)
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Community Living Services (CLS)

• Community Living Services (CLS) were established
  in CMDHB in 2004 in response to a shortage of
  individualised community living options.
• Six NGO providers work in close partnership with
  a CMDHB clinical team.
• CLS emphasises a strength based and
  person-centred recovery orientation.
• CLS service specification includes information
  that providers report on a monthly basis to the
  DHB.
• Routine data is used as the basis for generating
  regular provider reports and for the purposes of
  evaluating CLS.

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Counties Manukau DHBCLS evaluationSummarised
quantitative reports
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CLS Evaluation Framework
Consumer profile (who used the service?) Outcomes (impact of service?)
Services (what was done?) Quality (how good was it?)
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Number of service users enrolled in CLS
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Diagnosis breakdown
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Outcomes of CLS use
Outcomes for clients served in September 2006 vs
registration
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Service User FTE ratio
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time in direct service delivery
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Impact on costs of mental health services
Average monthly per person costs
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Overall savings by service type
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Benchmarked CLS Provider ReportsNB These next
graphs are based on dummy data and bear no
relation to the actual CLS provider benchmarked
reports
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Housing Outcomes example only
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Inpatient Admissions example only
Change from 6 months prior to past 6 months
  Bed Nights   Bed Nights
Yellow -2.3
Green -1.7
Orange -1.6
Violet -1.2
White -0.9
Blue -2.2
Purple -1.1
Indigo -0.2
Red -1.2
AVERAGE -1.4
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FTE Utilisation example only
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Average Delay To First Contact example only
based on dummy data
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Average Duration Of Care For Clients Exited
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Acute Services Spectrum Development

• Te Whare Matairangi numbers
• Recovery Houses
• STARS development

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The proposed acute service spectrum
Acute Service Community Needs/Situation Predicted ALOS Places
Home Based Treatment Works with individuals in their own home, and/or being supported by other services 20 Days 15
Crisis respite Used to prevent exacerbation of acute symptoms Up to 3 days 8
Acute Service Residential Needs Situations Predicted ALOS Places
Community Based Enhanced Mental Health Recovery Services An alternative to inpatient services or support post discharge 21 days 10 to 12
STARS (Two services planned) Residential Services for people requiring significant levels of medical, nursing and therapeutic support. Acute and planning admissions 21 days 16 to 18
Acute Service Inpatient Needs/Situations Predicted ALOS Places
Acute Assessment Unit For people requiring significant levels of medical and nursing assessment and treatment 3-21 Days 20
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Why do we want to purchase a STARS service?

• Flexibility of services as community needs and
  expectations change over the coming years
• To develop a range of recovery orientated
  services inline with objectives of The Journey
  Forward

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Why do we want to purchase a STARS service?

• Provide a more home-like environment
• Care is provided closer to the community for less
  disruption to the persons natural support systems

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Why do we want to purchase a STARS service?

• Opportunity to further develop a collaborative
  and recovery orientated workforce
• Part of the range of solutions to reduce the
  bottleneck experienced by having just one fixed
  capacity acute ward

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Why purchase from an NGO?

• NGOs have wide ranging experience in establishing
  and maintaining comfortable and community based
  services
• Fits with an overall strategy of encouraging NGOs
  to take more responsibility for sharing the acute
  end of the service spectrum

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Why purchase from an NGO?

• Allows for more flexible working relationships
  and structures
• Collaboration of knowledge and experience

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Selecting an NGO Partner with

• Strong recovery values and recovery orientated
  employees at all levels
• Proven ability in innovation, staff motivation
  and good working conditions
• Advanced abilities to engage and involve
  consumers in service design and delivery