Mental health and addiction quality improvement programme update June 2021

Members of the Health Quality & Safety Commission’s (the Commission’s) MHA team are encouraged by their engagement with senior district health board (DHB) leadership.

Over the past month, members of the MHA quality improvement programme have visited Lakes, MidCentral, Southern, South Canterbury and Whanganui DHBs.

The visits focused on updating DHB teams on key projects including; Zero seclusion: safety and dignity for all | Aukatia te noho punanga: Noho haumanu, tū rangatira mō te tokomaha, Connecting care: Improving service transitions | Te tūhono i ngā manaakitanga:Te whakapai ake i ngā whakawhitinga ratonga, and Learning from adverse events and consumer, family and whānau experience | Te ako mai i nga pamamae taumaha me te wheako tangata whaiora me te whānau. They were also a chance to hear from leadership about the challenges their teams face and achievements to date.

It was fantastic to hear unanimous support from leadership about eliminating seclusion, MHA quality improvement programme’s clinical lead, Dr Clive Bensemann said.

‘It’s heartening to see an emerging belief that achieving zero seclusion is possible. Progress is being made by most DHBs in reducing the duration of seclusion, and within services there are champions quietly leading this work with their colleagues.’

Wi Keelan, the programme’s Māori cultural advisor and kaumātua was also encouraged by the number of DHBs showing a reduction in their use of seclusion and restraint for Māori consumers.

‘It is noticeable that this improvement has been accompanied by an increase in the use of Māori models of practice, and cultural interventions enhancing clinical practice. South Canterbury DHB for example has had no Māori seclusion events since March 2020.’

Clive says the ‘Connecting care’ project has resulted in gains through innovative practice within specific teams, and services visited are now focused on scaling these up across their wider service and sustaining the gains made.

The ‘Learning from adverse events consumer family and whānau experience’ project has seen most project teams focusing on greater involvement of family and whānau in the response to and review of adverse events which have significant impact on them as well as on staff.

A schedule of further DHB visits to take place over the coming months is currently being developed.

When Kolini Baker’s partner died, her world fell apart. She became depressed, addicted to methamphetamine, lost custody of her children, and lost her home.

While trying to access support to stop taking drugs, Kolini found it very difficult to get into a MHA service and says there was little formal assistance available for those who were using methamphetamine and/or other drugs.

Her mother brought her home to Whanganui and, after a time in Whanganui DHB MHA services, Kolini transitioned to the support of a kaupapa Māori community provider, Te Oranganui. There, with the help of her whānau, Kolini has managed to get further help with her depression and addiction, and to stay off drugs. Kolini has been drug-free for three years and supported by her key worker who became ‘like a second mother’ to her along the way.

The value of a kaupapa Māori community support organisation like Te Oranganui has resulted in Kolini being able to ‘self-refer’ if she feels she is becoming unwell and this, in turn, allows her to get help before her condition deteriorates.

The mission statement for Te Oranganui is ‘Korowaitia te puna waiora, hei oranga Motuhake mō te iwi – Empowering whānau into their future’.

Te Oranganui was established in 1993 to improve access and service delivery of health services to Māori in the Whanganui region.

As Kolini says, ‘[It] made me safe from the world, like I was someone… there was help for people like me, I wasn’t alone.’

Kolini has shared her story as part of the Health Quality & Safety Commission-led project Connecting care: improving service transitions project | Te tūhono i ngā manaakitanga, te whakapai ake i ngā whakawhitinga ratonga.

The project’s objectives are to: improve outcomes for consumers of MHA and their families and whānau; reduce unwarranted variation and achieve more equitable outcomes across New Zealand; and build quality improvement capability in the MHA sector.

The Commission offered a MHA Quality in action / Mahia te mahi-hikina te kounga course from September 2020 to March 2021.

The course was delivered via Zoom and provided participants with the opportunity to learn foundational level quality improvement (QI) concepts and practice, including co-design QI methods and tools. Participants were expected to use a practical project that would be of benefit to their work, role, or organisation to apply the course content to.

A total of 43 participants completed the course, with representation from across DHBs, non-governmental organisations (NGOs) and other agencies. Participants were supported at a local level by regional course supports, and this was a pivotal success factor in the acquisition and implementation of learning.

Evaluation of the course was completed both internally and through an externally-commissioned report. The external evaluation was designed to capture both the experience of the course and the degree to which learning had been acquired and implemented.

Data was drawn from three sources: participant survey responses, course support survey responses and participant face-to-face interviews. As a result of the course, 57 percent of respondents rated their average skills as high or very high and 91 percent felt confident in applying the learning from the course.

The survey respondents and interviewees were able to describe and articulate their learning, they reflected on the tools, techniques and methodologies taught and the impact experienced on themselves and their organisations. Familiarity with QI had a strong influence on the speed and degree to which participants could acquire and consolidate knowledge.

The innate challenges related to undertaking QI work were experienced as barriers for some, including project readiness, stakeholder engagement and maintaining progress, however a sense of trust in the frameworks and methodologies taught was retained as a result of greater understanding of the QI process.