Hon Peter Dunne

Associate Minister of Health
Speech

Opening Address to International Initiative
for Mental Health, Addictions & Disability Leadership Network Meeting

Langham Hotel, Auckland

Thursday, 7 March 2013

Tena Koutou Tena Koutou Tena Koutou Katoa.

I am delighted to be here with international colleagues who are passionate about delivering excellence in mental health and addiction services.

Firstly, welcome to Pam Hyde from the United States, Louise Bradley from Canada and Eddie Bartnik from Australia and other distinguished participants and contributors to this Network programme.

I understand this is the second time that New Zealand has been honoured to host a Network programme and it is the third time IIMHL participants have been to Australasia.

Last time it was in Wellington in March 2005.

This year it is in the City of Sails, Auckland.

The theme for this week’s Leadership Exchange and this Network Programme starting today is “Service Innovation across the Lifespan – What does it take to make an impact?”

In this global age it is critical that we learn from each other’s successes and share innovation.

Such learning is the hallmark of IIMHL.

The World Health Organisation (WHO) has identified that mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all countries.

14% of the global burden of disease is attributed to these disorders, surpassing both cardiovascular disease and cancer.

Depression is the third leading contributor to the global disease burden, and alcohol and illicit drug use account for 5%.

Mental health is an integral part of health and well-being.

Like other aspects of health, it is influenced by a range of socioeconomic factors, such as income, employment, housing, education, political and environmental including national policies, social protection and community social supports among others.

To tackle these factors Governments internationally show leadership through developing and implementing comprehensive actions and responses for promotion, prevention, treatment and recovery across the Lifespan and through a whole of government approach.

In 2011, the Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, United States identified a series of principles to guide the way Government should respond.

They suggested they

• use a life course approach,

• use system wide approaches to addressing suffering or need

• use evidence based interventions and

• understand environmental influences.

These principles are also relevant to policy makers, service planners, funders, clinical leaders, people with lived experience of mental health and/or addiction issues who work in services, family/ whānau supports and providers of services.

Here in New Zealand, research tells us one in five of us have experienced a diagnosable mental health or addiction issue over the past 12 months.

We know that young people, Māori and Pacific peoples may experience these issues more than others.

For people with mental health and addiction issues and their families/ whānau, the impacts are very real and personal.

That is why improving mental health is a high priority for the Government because it affects so many people.

In recognition of all these issues, our Government has shown leadership and recently released – Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012-2017, which is strongly underpinned by the principles identified by the Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, United States.

This plan, builds on previous strategies and action plans, and has at its core, the globally accepted principle that there is “no health without mental health”.

The results we wish to see in years to come as this Plan is implemented are:

o increased value for money

o enhanced integration,

o improved mental health and wellbeing, physical health and social inclusion, as well as address disparities in health outcomes for people with low prevalence conditions

o expanded access and decreased waiting time in order to:

avert future adverse outcomes in infants, children and youth,

improve outcomes for people with high prevalence conditions (common mental health problems like depression, anxiety, medically unexplained symptoms);

and for our growing older population, support their positive contribution in the home and community of their choice.

To deliver on these results the expectation is that the health sector, and more specifically the mental health and addictions sector, will become innovative, efficient and focussed on delivering what New Zealanders really want and expect.

The plan also challenges government services to think innovatively about how they can work together so that communities we service can be guaranteed consistent and seamless services.

Over two decades there has been significant investment in mental health and addiction services, $270 million per annum in 1993/94 to a projected $1.3 billion for the year 2012/13.

This funding has supported and will continue to support important service developments in the Plan like:

• mental health and addiction sector capacity and infrastructure, including the development of a specialist mental health and addiction workforce

• continuing to increase access rates to specialist services – over 3 percent of the total population now have access to specialist services – a goal of the 1994 national strategy

• Non-governmental (NGO) sector service provision including Māori and Pacific providers

• using information and outcomes to improve system performance and ensuring quality and safety of services

• Policy makers, funders, mental health and addiction professionals and providers partnering with service user, family/ whānau in how services are planned and developed.

Let me illustrate some of the developments that have taken place to date:

• In 2011/12, over 3 percent of the population accessed specialist mental health and addiction services.

• 94 percent of people who access specialist mental health services are seen only in community settings (both DHB and NGO provided services), while the remainder are seen in both inpatient services and community services.

• The national total acute inpatient bed days used has reduced from 233,103 in 2004/05 to 184,515 in 2011 – a reduction of 21 percent in eight years.

• The National Mental Health Consumer Satisfaction Survey in 2010/11 told us that 81 percent of people who used specialist services were satisfied with the services they received.

• We are capturing outcome data on the severity of mental health or addiction issue at admission and discharge of people using DHB specialist inpatient and community services.

• This data has the potential to identify the most effective services and therefore inform future service development.

• We have about 350 NGO providers of community mental health and alcohol and drug services, of these we have good information from 250, with about 26% percent of DHBs’ funding of specialist service allocated to NGO-provided services.

• We have a public awareness and education campaign “Like Minds Like Mine” to address public attitudes and difficulties created by negative stereotyping of people experiencing mental health and addiction issues.

• We have the National Depression Initiative fronted by Sir John Kirwan which provides to the public information about depression and anxiety, encourages help seeking behaviours, including where to seek help as well as offer an on line self-help management programme called the ‘Journal’.

• For young people we have the ‘Lowdown’ a website that provides information on how they can understand and deal with depression.

The Government’s leadership on mental health and addictions service developments and innovation extends through working with other social sector agencies on a number of service initiatives. These include;

• Drivers of Crime, specifically the conduct disorders and alcohol work streams.

• The Prime Minister’s Youth Mental Health Project for 12 to 19 year olds with common mental health problems such as depression and anxiety as well as substance misuse.

• Development of youth forensic services for youth with mental health and addiction problems who are in contact with the youth justice system.

• Implementing the Child Action Plan by deliberately targeting resources, intervention and support to at risk and vulnerable children.

• “Tackling Methamphetamine” – the health sector is responsible for improving routes into treatment for people with methamphetamine-related issues.

• Whānau ora - social and health sectors working together to provide better, more effective ways of working with whānau

• Welfare reforms to increase the work focus of the benefit system – the health sector’s role in assisting people with mental health and addiction issues to realise their work potential and capacity aiding their further recovery.

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• The development of New Zealand’s all age cross agency suicide prevention strategy.

Here in New Zealand we have a lot to learn, and much to share.

We are proud of the advances we have made in several areas as a result of IIMHL initiatives, learning exchanges and network programmes.

o Peer support services – around 300 people have been trained in peer support best practice which emerged through IIMHL.

o Counties Manukau District Health Board in Auckland has the most advanced development of peer support services in New Zealand.

o Peer support is being used to supplement expensive clinical services with very good outcomes for service users.

o At risk youth innovation – we are working towards implementation of the award-winning ‘Milwaukee Wraparound’ system of working with multiple agencies for young people with complex mental health and other needs.

o This fits completely with our Governments ‘Whānau Ora’ policy.

o People with acute illness – best practice in acute care units has resulted in significantly reduced rates of seclusion for people with acute illness.

o We have over 400 staff now trained in the use of sensory modulation and other methods to reduce the use of seclusion.

o There are 35 trainers now across seven District Health Boards.

o Again this training for this system of best practice came through our collaboration with the US through IIMHL.

o Knowing the People Planning –Knowing the People Planning (KPP) is a practical approach that assists mental health services plan for and meet the needs of long-term service users.

o KPP is based on an easy-to-use survey to evaluate the experience of service users.

o This allows us to assess how well local mental health systems are working and to identify where improvement is needed.

o Primary mental health care – through IIMHL we gained best practice knowledge on collaborative practices between primary care and mental health services.

o In New Zealand this early work paved the way for our Governments policies in strengthening primary mental health care so that we can intervene earlier for people with developing and existing mental health problems.

o Key Performance Indicators - the national Key Performance Indicator (KPI) process is a good example of using information to understand service and quality improvements required at local, regional and national levels.

o DHBs and NGOs use KPIs (key performance indicators) to bench mark themselves against one another.

o The major goal being to understand and address variations that may impact on outcomes for consumers.

o Through the IIMHL Clinical Leader’s Group we will move forward to see how we may align our indicators with those of partner countries so we may be able to compare system improvements and outcomes for people.

I know that you have already enjoyed the 2013 Leadership Exchange held on Monday and Tuesday.

I hope you enjoy and take a lot out of the Network Programme during the next two days.

The aim is to ensure you get the best learning and practice development opportunities.

To take away important ideas to put into practice about the kind of organisational changes and capability necessary to make a difference when implementing innovative service changes across the lifespan.

ENDS

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