Mental Health Services Review - Auckland
20 December 2002
Review of the continuum of mental health services funded by the District Health Boards in the Auckland region
Agreement on way forward for Auckland mental health services
The three Auckland District Health Boards, the PSA, the Ministry of Health, the Minister of Health and the Mental Health Commission have contributed to an action plan that will improve mental health services for service users and their families and staff.
The action plan, prepared as part of the review of Auckland’s mental health services, will enable better management of the contracting and co-ordination of mental health services and inform the planning across the three DHBs in Auckland.
“When the review team visited Auckland they found significant difficulties with mental health services not able to meet the needs of service users. They were not co-ordinated and service users couldn’t access the care they needed as their illness changed,” say Mental Health Commissioner Bob Henare.
“The team found highly committed and caring staff who were frustrated because they couldn’t provide the best quality of care to those who needed it,” says Mr Henare.
“The review team talked to around 400 people and examined reports from DHBs, other agencies and the Mason Report. The consistent messages coming from Auckland were that the system was struggling, that people were not receiving the services they needed, and that staff did not feel part of an effective, co-ordinated system.”
“While Auckland’s funding is not commensurate with its population and needs, funding alone won’t solve Auckland’s problems,” says Mr Henare.
“I would like to commend the three Auckland DHB’s for their assistance with this review and their willingness to find a way forward, as well as the many, many people who took the time to talk to us and write down their views.”
(A copy of the full report can be downloaded from www.mhc.govt.nz)
REVIEW OF THE CONTINUUM OF MENTAL HEALTH SERVICES FUNDED BY THE DISTRICT HEALTH BOARDS
IN THE AUCKLAND REGION
QUESTIONS AND ANSWERS
Why was the review undertaken?
The Mental Health Commission became increasingly concerned over a period of time about service issues in Auckland. Service users were not getting the best possible care. Concerns brought to our attention by staff, service users, mental health service providers and others in Auckland suggested that the system was in crisis. Staff morale was low. The situation came to a head with industrial action by acute inpatient ward staff within Auckland. The Minister asked the Mental Health Commission to investigate the issues and come up with an action plan.
Why was the timeframe extended?
The review team talked with over 400 people - in itself a time consuming exercise. Time and care was taken to develop an action plan that was achievable.
What about the ringfence project?
The ringfence project is separate from this review of the continuum of mental health services in the Auckland region. The Commission and the Ministry of Health has gathered and analysed information on the ringfence from the six DHBs and has compiled a draft report. That report has been forwarded to CEOs of the DHBs for final comment. The report will be finalised late January/early February.
Why will this review make a difference?
Considerable effort has been directed towards providing a review with outcomes that are achievable. Because of the time and care taken to present an action plan that can be implemented, this review has the potential to make a significant difference to service users in Auckland.
What did the Review Team find in Auckland?
1. mental health services in Auckland didn’t adequately meet the needs of people with mental illness
2. a workforce that was extremely hardworking and committed, but was frustrated as it couldn’t deliver the services needed by the people it was supposed to help
3. an urgent need for intensive rehab packages for people able to be moved from acute inpatient care, and respite facilities for people who need temporary relief without having to use the acute wards
4. a lack of engagement and co-ordination of providers in the planning and delivery process which resulted in the knowledge of staff and management not being fully utilised
5. a lack of leadership and shared vision for the region
6. different service approaches between DHBs
7. failure to balance resources across DHBs
8. pockets of extremely good practice, especially amongst Maori and Pacific providers
9. funding was an issue - Auckland’s mental health funding was not commensurate with its needs.
How did the Review Team gather information?
The Review team talked to more than 400 people, including staff, service users, families, NGOs and management. It reviewed all of the major reports on mental health services since the Mason Report. It reviewed management documents from the three DHBs. However, it was the voices of staff and service users that provided the most compelling case for change.
Are the problems unique to Auckland?
Auckland’s mental health sector faces a number of issues, some of which are unique to the region and some are national issues. The issues unique to Auckland include:
- a large ethnically diverse and growing population
- Auckland has three large DHBs side by side each charged with meeting the needs of their populations. This generates significant cross boundary issues
- Auckland’s funding is not commensurate with its population. The Blueprint for Mental Health Services shows that Auckland is behind other regions
But good links between services are important and relevant nationwide.
What are the lessons for the rest of New Zealand’s mental health sector?
- The importance of a balanced and integrated continuum of service to the effective functioning of the mental health sector
- The need to look at the current funding path for mental health and reassess the timeframe for achieving Blueprint targets, and whether this can be accelerated
- The need to better look after the workforce we have got. Exit rates are too high in an environment of scarce resources. Workforce shortages are a problem locally and internationally which puts pressures on the existing workforce.
- The importance of ensuring the knowledge and experience of providers (DHB providers, NGOs and primary practitioners) are better used to inform planning and address service gaps and priorities
- The contracting and service specification framework needs to be reviewed to ensure greater flexibility and to minimise the tendency for contracted services to operate in silos
- The importance of primary care practitioners as a vital part of the services continuum.
Is anyone to blame for Auckland’s problems?
No, the problems have been accumulating over a number of years. Twenty-five years ago the majority of mental health services in the Auckland region were delivered from hospitals that provided inpatient facilities and attached outpatient clinics. Home based and community care is now accepted practice for most people. This has necessitated a significant change in skills and expertise.
Will this mean police cells will no longer be used to accommodate the mentally ill?
Waitemata DHB has already announced three additional packages of acute care which will ease some of the pressure on acute services. In addition, policy changes have been made within the DHBs to avoid the use of police cells.
The review recommends the immediate provision of 20 additional intensive rehabilitation packages of care for the Auckland region. This will make a difference.
What is the role of the proposed Regional General Manager Mental Health?
The Regional General Manager Mental Health will provide overall clinical direction, leadership and oversight of the services in metropolitan Auckland. This will ensure the provision of a co-ordinated mental health service and a seamless continuum of care for service users.
20 December 2002