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6/10 mentally ill people have crisis plan

Mental Health Services Target: Six out of 10 mentally ill people have crisis prevention plans

Bobby (name changed to protect privacy) has bipolar affective disorder but has developed a plan to cope with alternating periods of mania and depression.

In the past, when she was in a manic state, she went on spending sprees and had sex with strangers, causing her huge debts and loss of dignity and self-esteem.

But with the help of her partner and a mental health worker, Bobby has written her own relapse prevention plan to avert similar crisis situations. The document identifies the early warning signs of mania and depression, authorises her partner to seek help at the onset of the symptoms and outlines a plan to help her avoid a relapse.

Guided by the plan, Bobby and her partner have been able to get help in the earlier stages, preventing her from engaging in risky sexual behaviour like she did in the past. It has also helped reduce the length and frequency of her hospitalisations.

“People with relapse prevention plans are alerted to the first signs of trouble and so they are able to seek help and prevent a crisis,” explained Dr David Chaplow, Director of Mental Health.

“With a relapse prevention plan, clients know what they can do for themselves and what services they can rely on. It is essentially a lifeline so the more lifelines we have in place, the better.”

Most importantly, the process of developing a relapse prevention plan encourages the individual to be the driver of their own care.

“The knock-on effect from having a crisis plan is that as the person becomes more self-managing, they will progressively be able to reduce the need for acute pyschiatric services,” said Lee Cordell-Smith, Acting Service Manager of Timaru Psychiatric Service.

Nationally, about 8500 people (64 per cent) with long-term mental illness have treatment and relapse prevention plans as of December 2007, up from 2804 (35 per cent) the year before.

The threefold increase came as a result of concerted action by district health boards. Eight DHBs - Canterbury, Capital and Coast, Hawkes Bay, Hutt, MidCentral, South Canterbury, Tairawhiti and Wairarapa - have achieved the national target of having relapse prevention plans for at least 90 per cent of clients with long-term mental illness.

Another four – Bay of Plenty, Counties Manukau, Nelson Marlborough and Otago – are close to achieving the target.

The target is important as one in five New Zealanders experience a mental health problem in the course of a year, and almost half of the New Zealand population will be affected by a mental health problem or addiction at some point in their lives.

Data collected from DHBs appears to back the benefits of the crisis prevention plans showing that as the percentage of people with these plans rises, there has been a corresponding drop in admission rates (by up to 26 per cent nationally).

Launched in July, the ten health targets represent priority areas for health improvement. These targets include improving immunisation coverage, reducing cancer waiting times, improving nutrition, increasing physical activity and reducing obesity, and reducing the percentage of the health budget spent on the Ministry of Health.

The second quarterly report showed that all DHBs are on track to achieve the annual goal for the ten targets except in diabetes services. Although the number of people availing of the free annual diabetes checks continues to increase, there are persistent challenges in increasing access to the Get Checked programme.

“The Ministry and DHBs are working on a number of initiatives to get us all back on track towards meeting the national target by the end of the year,” said Dr Sandy Dawson, Chief Advisor, Clinical Service Development.

Diabetes can cause damage to all parts of the body, but the greatest harm results from complications including stroke, heart attack, amputation, kidney failure and blindness.

“This harm can be minimised through good medical treatment and lifestyle changes," Dr Dawson noted.

"At a very fundamental level, all people with diabetes should understand the importance of checking with their GP or nurse at least once a year to ensure that all appropriate investigations have been completed and their treatment and care plans have been adjusted, if required. Many Primary Health Organisations and DHBs have fantastic programmes to support this but all need to deliver improvements if these demanding targets are to be met.”

In elective services, 15 of the 21 DHBs are on track, at this point, for appropriately managing patients referred to them for elective assessment or treatment. Ten DHBs were also able to deliver the agreed increase in the level of elective service patient discharges. However, delays in reporting discharges and capacity constraints in some DHBs continue to affect the results in this target area.

The second quarterly report on progress towards the health targets is available here: (


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