hawke's bay dhb - te pou · results provided by services in the hawke’s bay dhb district for...

Hawke’s Bay DHB

district adult

mental health and

addiction services Profile of the 2014 Vote Health

funded workforce

2 Hawke’s Bay DHB district 2014 mental health and addiction workforce

Published in May 2015 by Te Pou o Te Whakaaro Nui

PO Box 108-244, Symonds Street, Auckland, New Zealand.

ISBN 978-0-908322-22-0

Web www.tepou.co.nz

Email [email protected]

Recommended citation:

Te Pou o Te Whakaaro Nui. (2015). Hawke’s Bay DHB district adult mental health and addiction

services: Profile of the 2014 Vote Health funded workforce. Te Pou: Auckland.

Hawke’s Bay DHB district 2014 mental health and addiction workforce

3

Executive summary

In 2014 Te Pou and Matua Raki led an organisation workforce survey of the adult mental health and

addiction services. The survey aimed to describe the size, configuration, roles and ethnicity of the

workforce by DHB area and region. It also aimed to generate greater knowledge about current and

future workforce challenges, knowledge and skill needs, and the strength of cross-sector relationships.

The survey sample included both DHB and NGO organisations receiving Vote Health funding to

deliver adult mental health and addiction services during 2012/13.

The survey results are reported in a number of

companion documents including three national

reports; four regional reports, local DHB reports

and a number of specialist reports on segments of

the workforce. This report summarises the survey

results provided by services in the Hawke’s Bay

DHB district for both mental health and addiction

services. Total FTEs reported in the text and

graphics may differ by up to one FTE due to

rounding.

As at 1 March 2014, the reported Hawke’s Bay

DHB district’s adult mental health and addiction

workforce consisted of 249 FTE positions,

including 25 (10 per cent) vacant FTE positions.

As shown in Figure A, 30 per cent of the Vote

Health funded mental health and addiction

workforce in the Hawke’s Bay DHB district were

located in addiction services and 70 per cent were

located in mental health services.

Overall, for the workforce across mental health and addiction services:

• DHB services reported 62 per cent of the workforce (155 FTE positions)

• NGO services reported 38 per cent of the workforce (94 FTE positions)

• more than half the workforce (51 per cent) were in clinical roles

• non-clinical roles made up 31 per cent of the workforce

• administration and management roles made up 18 per cent of the workforce.

The breakdown was slightly different for addiction services relative to mental health services. A

summary of the breakdown of clinical and non-clinical workforce by provider type (DHB and NGO)

and sector (mental health and addiction) is provided in Figure B.

Figure A. Hawke’s Bay DHB district

workforce by sector


Figure B. Proportion of the workforce in clinical, non-clinical and administration and

management roles by provider type and sector

Support workers made up 30 per cent of the workforce and the majority were reported by NGO

mental health services. Nurses were the next largest occupation group and the majority of these roles

were reported by DHB mental health services. Figure C provides an overview of the primary provider

and sector where key occupational group positions are located.

Figure C. Size of each main occupational group by provider type and sector


5

When asked to report which knowledge and skills needed some or a large improvement:

• co-existing problems capability received the highest proportion of responses indicating some

or large need for improvement (95 per cent)

• 81 per cent of respondents indicated the need for some or a large improvement in risk

assessment

• 81 per cent of respondents indicated the need for some or a large improvement in physical

health assessment

• 76 per cent of respondents indicated the need for some or a large improvement in using

strengths based approaches to enhance resiliency and recovery with service users.

When asked about knowledge and skills related to cultural competency and working with other

groups, respondents commonly identified that the following needed some or a large improvement:

• 67 to 100 per cent of respondents indicated that their workforce needed some or large

improvement in cultural competence skills for working with Māori, particularly in Māori

health outcome measurement and working in te reo Māori

• 90 to 95 per cent of respondents indicated that their workforce needed some or large

improvement in cultural competence skills for working with Pasifika, particularly in Pasifika

concepts of family values, models of health and languages (67 to 86 per cent indicated large

improvements are needed)

• 86 per cent of respondents reported a need for improvement in skills for working with Asian

ethnic groups.

When asked to rank the top four challenges facing their workforce:

• 67 per cent of respondents ranked managing pressure on staff due to increased complexity in

their top four (12 of 18 responses)

• 67 per cent of respondents ranked managing pressure due to changing service delivery models

in their top four (12 of 18 responses)

• 50 per cent of respondents ranked managing pressure on staff due to increased demand for

service in their top four (9 of 18 responses), and was also ranked as the biggest challenge by 33

per cent of respondents (6 of 18 responses).

When asked to report whether relationships with other sectors or agencies were working adequately,

well or needed improvements:

• mental health services reported their relationships with other addiction services, disability

sector and family violence needed to improve

• some addiction services reported their relationships needed to improve with other mental

health services and other addiction services.


Table of contents

Executive summary ....................................................................................................................................... 2

Glossary .......................................................................................................................................................... 8

1.0 Introduction ........................................................................................................................................... 10

The survey data in context ...................................................................................................................... 11

2.0 Adult mental health services’ workforce .............................................................................................. 13

2.1 Overview ............................................................................................................................................ 13

2.2 Workforce size and service delivered ............................................................................................... 13

2.3 Mental health occupational groups .................................................................................................. 15

2.4 Roles employed and vacant ............................................................................................................... 16

For employed roles .............................................................................................................................. 16

For vacant roles ................................................................................................................................... 18

2.5 Ethnicity of the mental health services’ workforce .......................................................................... 21

3.0 Adult addiction services’ workforce ..................................................................................................... 22

3.1 Overview ............................................................................................................................................ 22

3.2 Addiction workforce size and service delivered .............................................................................. 23

3.3 Addiction occupational groups ........................................................................................................ 24

3.4 Roles employed and vacant ............................................................................................................... 25

For employed roles .............................................................................................................................. 25

For vacant roles ................................................................................................................................... 26

3.5 Ethnicity of the addiction services’ workforce ................................................................................. 28

4.0 Mental health and addiction workforce, service and cross-sector relationship challenges .............. 30

4.1 Knowledge and skill levels ................................................................................................................ 30

General knowledge and skills ............................................................................................................. 30

Cultural competence and working with other groups ...................................................................... 32

4.2 Workforce planning and development challenges .......................................................................... 34

4.3 Cross-sector relationships ................................................................................................................. 35

5.0 Summary of the DHB district mental health and addiction workforce results ................................. 38

6.0 References .............................................................................................................................................. 40

Appendix A: Survey method ....................................................................................................................... 41

Appendix B: Mental health services’ and addiction services’ workforce combined ................................ 42


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List of Figures

Figure 1.Hawke’s Bay DHB and NGO services’ adult mental health services’ workforce (n= 176 FTE

positions)...................................................................................................................................................... 13

Figure 2. Proportion of adult mental health services’ workforce located in community,

inpatient/residential and other/unknown locations by NGO and DHBs ................................................ 15

Figure 3. Workforce FTE positions (employed plus vacant) for each main occupational grouping for

DHB and NGO services .............................................................................................................................. 16

Figure 4. Hawke’s Bay DHB and NGO services’ adult addiction workforce (n = 74 FTE positions) ..... 22

Figure 5. Proportion of adult addiction services’ workforce located in community,

inpatient/residential and other/unknown locations by NGO and DHB services. ................................... 24

Figure 6. Addiction services’ workforce (FTE positions employed plus vacant) for each main

occupational grouping by DHB and NGO services................................................................................... 25

Figure 7. Proportion of respondents needing to improve other knowledge and skills (n=21 responses)

...................................................................................................................................................................... 31

Figure 8. Proportion of respondents perceiving a need to improve knowledge and skills for working

with Māori, Pasifika and other groups (n=21 responses) ......................................................................... 33

Figure 9. The biggest workforce challenges for DHB and NGO services (n=18 responses) ................... 35

Figure 10. Strength of DHB and NGO services’ cross-sector relationships (n=21 responses) ............... 37

Figure 11. Mental health services’ and addiction services’ workforce FTE positions (employed plus

vacant) for each main occupational grouping for DHB and NGO services ............................................ 42

List of Tables

Table 1. Population, mental health and addiction consumer and workforce for the Hawke’s Bay DHB

district and Central region as a percentage of regional and national totals ............................................... 11

Table 2. Total Vote Health-funded workforce (FTE positions employed plus vacant) reported in the

survey for the Hawke’s Bay DHB district .................................................................................................... 12

Table 3. DHB and NGO mental health services’ workforce (FTE positions) by service type ..................... 14

Table 4. Adult mental health service workforce FTE positions employed and vacant by roles ................. 18

Table 6. DHB and NGO services’ workforce by service type ....................................................................... 23

Table 6. Adult addiction services’ workforce FTE positions by role............................................................ 26

Table 7. Total number of responses for the Hawke’s Bay DHB district ...................................................... 41

Table 8. Adult mental health services’ and addiction services’ FTE positions employed and vacant by

roles ............................................................................................................................................................... 43


Glossary

Addiction services Alcohol and other drug (AOD) and problem gambling services (PG).

Clinical staff

‘Professionals who are qualified and competent to provide intervention and or

treatment independently, albeit while part of a team’. The above definition was

offered as guidance in Section B of the survey.

Consumers

Within this report the term ‘consumer’ is used to identify people accessing

mental health or addiction services. It is used synonymously with mental health

services’ use of the term ‘service user’.

Community-based

services (home,

community)

Services based within the community that may be delivered in the community

or in hospital outpatient settings.

Dual diagnosis/co-

existing problems

(CEP) services

Services focused on the interaction of substance use and mental health

problems. Also known as dual diagnosis, co-occurring substance use and

mental health disorders, co-existing disorders and comorbidity.

Health funding

Funding associated with Ministry of Health or DHB mental health and

addiction service delivery contracts. This definition of health funding does not

include Ministry of Health whānau ora or primary care funding.

Inpatient services

Services in a medical environment such as a hospital for eligible persons who

are in need of a period of close observation, intensive investigation or

intervention.

Kaupapa Māori

services

Services developed and delivered by providers who identify as Māori. Providers

and teams are expected to use a Māori framework and models of care that

encompass a holistic approach to health, and are cognisant of the health and

wellbeing aspirations of Māori.

Management,

administration and

support services

The management service type provides support and oversight for the

organisation. Some staff employed in management services may do non-

management ‘roles’, eg cultural supervisor, and some management roles may

not be employed within management services.


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Pasifika services or

teams

Services or teams that provide a holistic approach that recognises Pasifika

frameworks as necessary to increase the service access rates of Pasifika people

and engage them within a service for the duration of treatment. Services and

teams recognise the significance of the family for wellbeing. Key values for

Pasifika people are acknowledged in the delivery of services: love, respect,

humility, caring, reciprocity, spirit quality, humour, unity and belief in the

importance of family.

Region

The four regions in New Zealand include the following DHB districts of;

Northern region (Northland, Waitematā, Auckland and Counties Manukau

DHBs), Midland region (Waikato, Bay of Plenty, Lakes, Tairāwhiti and

Taranaki DHBs), Central region (Hawke’s Bay, Whanganui, MidCentral, Hutt

Valley, Wairarapa and Capital & Coast DHBs), South Island region (Nelson

Marlborough, West Coast, Canterbury, South Canterbury and Southern DHBs.

Residential services

Accommodation, rehabilitation and support provided in a community

residence to eligible consumers/tangata whaiora with mental health issues eg

supported accommodation, respite.

Respondents

Organisation managers, team leaders and staff working at organisations invited

to complete the survey, who completed and returned valid organisation

workforce survey sections.

Non-health

funding Funding received from sources other than the Ministry of Health or DHBs.

A full list of service and role type definitions are provided in the data dictionary available on the Te

Pou website: http://www.tepou.co.nz/library/tepou/more-than-numbers-organisation-workforce-

survey-data-dictionary


1.0 Introduction

Workforce planning approaches support organisations

and managers to plan for the future service delivery,

anticipate change, manage their workforce, and ensure

that mental health and addiction services provide

consistent, quality services through an appropriately

staffed and skilled workforce (Te Pou o te Whakaaro Nui,

2014b). Profiling the existing workforce, analysing it in

relation to organisational and national strategy, and

identifying gaps between current workforce and future

needs are key components of a workforce planning

approach (Te Pou o te Whakaaro Nui, 2014b, Step 4).

This report profiles the Hawke’s Bay DHB district’s adult mental health and addiction services’

workforce. It presents the 2014 Te Pou and Matua Raki organisation workforce survey results for the

Vote Health funded workforce delivering adult mental health and addiction (alcohol and other drug

and problem gambling) services across the district health board (DHB) provider arm and the non-

government organisation (NGO) sector1. Service respondents were asked to describe their workforce

as at 1 March 2014. The survey aimed to describe the size, configuration, roles and ethnicity of the

workforce by DHB district and New Zealand region. It also aimed to generate greater knowledge

about current and future workforce challenges faced by service providers, their workforce knowledge

and skill needs, and the strength of relationships within and across sectors.

In the Hawke’s Bay DHB district, mental health services provided 13 survey responses identifying a

total of 176 FTE positions (including 20 FTE positions working in combined mental health and

addiction services2). This comprised of five responses from DHB services (104 FTE positions

reported) and 8 responses from NGO services (72 FTE positions reported).

The Hawke’s Bay DHB district also provided 8 responses from addiction services identifying a total of

74 FTE positions. These comprised of four responses from DHB services with a total of 51 FTE

positions reported and four responses from NGO services with a total of 23 FTE positions reported.

Of the four NGO responses, one was received from a problem gambling service with 4 FTE positions.

1 Organisations were excluded from the survey sample if their contracts (identified using the Price Volume Schedule purchase unit codes

and descriptors) were limited to the following: Ministry of Health Te Kete Hauora and Te Ao Auahatanga contracts (whānau ora), mental

health services for older people and aged-care services, primary health services, youth services, disability support services, health promotion

activities, policy and workforce development, telephone helplines, parenting programmes, quality and audit activities. 2 The combined mental health and addiction services FTE have been included in the mental health group


11

A summary of the survey method is provided in Appendix A of this report. More information about

the survey and its results are reported in six companion reports that describe at national and regional

level the survey method, questions and results, and link the information back to workforce

development and planning principles.3

The survey data in context This section describes the population and service use context for the Hawke’s Bay DHB district in

conjunction with a summary of the Vote Health funded workforce.

• The 2013 NZ population census identified 83,049 adults living in the Hawke’s Bay DHB

district which is 17 per cent of the population in the Central region and 3 per cent of the

national adult population.

• Mental health and addiction services in the Hawke’s Bay DHB district saw 4,278 unique

consumers4, which is 21 per cent5 of the total consumers seen in this region and 4 per cent of

consumers seen nationally.

• Hawke’s Bay DHB district mental health and addiction services surveyed reported their

workforce totalled 249 FTE positions employed plus vacant. This is 16 per cent of the Central

region’s workforce and 29 per cent of the national mental health and addiction workforce

identified by the survey.

Table 1. Population, mental health and addiction consumer and workforce for the Hawke’s Bay DHB

district and Central region as a percentage of regional and national totals

Hawke’s Bay DHB district

Total Proportion of

regional total (%) Proportion of

national total (%)

Population 83,049 17.1 3.4

Unique consumers2 4,278 20.8 4.3

Total workforce reported 249.3 16.1 2.9

Notes:

a The unique consumer numbers are not directly comparable to the workforce numbers because the consumer numbers are based on

consumer’s home location rather than the DHB area where they received services and workforce numbers underestimate the total number of

FTEs due to underreporting in the survey. The percentage of the consumers in the regional and national total will be slightly inflated

because some consumers are included once in the total regional and national figures but are seen by multiple DHBs. See also footnote 4.

3 Survey results in detail with explanation of survey questions, responses received and limitations are explained in the six survey reports

available on Te Pou’s website at: www.tepou.co.nz/more-than-numbers 4 The number of unique consumers is collected from the PRIMHD 2012/2013 dataset of mental health and alcohol and other drug services

and does not include unique problem gambling consumers. 5 This number is inflated, see the note below Table 1.


Table 2. Total Vote Health-funded workforce (FTE positions employed plus vacant) reported in the

survey for the Hawke’s Bay DHB district6

Provider type Mental health

services

Mental health

and addiction#

services

Addiction

services

Total

workforce

DHB 85.9 18.0 51.0 154.9

NGO 69.9 2.0 22.5 94.4

Total 155.8 20.0 73.5 249.3

Notes:

# Combined mental health and addiction FTE have been included in the mental health chapter.

^ Total problem gambling workforce team comprises 4 FTE positions.

Survey respondents identified 5 FTE positions that were funded through sources other than Vote

Health in this DHB district. Of the non-health funded workforce:

• DHB mental health services reported 3 FTE position and NGO mental health services had 1

FTE positions

• NGO AOD and PG services reported a total of 1 FTE positions

• DHB AOD services did not report any non-health funded workforce in their responses.

6 The figures do not include workforce employed in service who report other DHB districts as their main focus but also allocate some time

to this DHB or who work across regions.


13

2.0 Adult mental health services’ workforce

This section describes the survey results for the Vote Health funded adult mental health services,

including those providing combined mental health and addiction services.7 Information about the

adult addiction services’ workforce including dual diagnosis and co-existing problems services is

provided in Chapter 3 of this report.

2.1 Overview

The majority of the workforce were reported by DHB services (59 per cent) compared to NGO

services (41 per cent). This split is more evenly divided compared to the Central region result and

differs from the national average, where 66 per cent of the national workforce were reported by DHB

services and 34 per cent were reported by NGO services.

Figure 1.Hawke’s Bay DHB and NGO services’ adult mental health services’ workforce (n= 176 FTE

positions)

2.2 Workforce size and service delivered

The adult mental health services’ workforce in both DHB and NGO services who responded to the

survey comprised of 176 FTE positions:

• a total of 154 FTE positions employed (87 per cent)

• a total of 22 FTE positions vacant. Of which:

o DHB services had 20 FTE positions vacant (11 per cent of all positions)

o NGO services had 2 FTE positions vacant (1 per cent of all positions).

7 Tables presenting information about mental health and addiction services’ workforce are provided in Appendix B.

DHB

59%

NGO

41%


For the DHB and NGO mental health services’ workforce:

• 41 per cent of the workforce were reported by inpatient services (73 / 176 FTE positions)

• 32 per cent by community services (56 / 176 FTE positions)

• 17 per cent by residential services (29 / 176 FTE positions)

• 10 per cent by administration and management (18 / 176 FTE positions).

For DHB provider arm mental health services:

• 70 per cent of the workforce were employed in inpatient services (73 / 104 FTE positions)

• 17 per cent by administration and management (18 / 104 FTE positions)

• 13 per cent by community services (13 / 104 FTE positions).

For NGO mental health services:

• 59 per cent of the workforce were reported by community services (43 / 72 FTE positions)

• 41 per cent by residential services (29 / 72 FTE positions).

Table 3 shows Hawke’s Bay district DHB and NGO services’ FTE positions employed, vacant and total

for each main service type. The last column shows the total FTE positions as a proportion of the total

workforce of responding mental health services in this DHB district.

Table 3. DHB and NGO mental health services’ workforce (FTE positions) by service type

Service type

DHB services NGO services

Total workforce

Proportion of total FTE

positions (%)

Employed Vacant Total Employed Vacant Total

Inpatient 65.2 7.5 72.7 - - - 72.7 41.4

Residential - - - 29.3 - 29.3 29.3 16.6

Community 8.7 4.5 13.2 40.6 2.0 42.6 55.9 31.8

Forensic - - - - - - - -

Management 10.0 8.0 18.0 - - - 18.0 10.2

Other - - - - - - - -

Total 83.9 20.0 103.9 69.9 2.0 71.9 175.8 100.0

Note:

The management service type provides support and oversight for the organisation. Some of the staff employed in management services may

do non-management ‘roles’, eg cultural supervisor, and some management roles may not be employed within management services.

Figure 2 summarises the survey responses received from DHB and NGO services in the Hawke’s Bay

DHB district, showing the proportion of FTE positions (employed plus vacant) located in community

settings, inpatient and residential settings and other or unknown locations. The data on location of

services differs from the data about service type because some of the forensic workforce is located in

community settings and some of the forensic workforce is located in inpatient/residential settings.


15

Figure 2. Proportion of adult mental health services’ workforce located in community,

inpatient/residential and other/unknown locations by NGO and DHBs

2.3 Mental health occupational groups

For mental health services in the Hawke’s Bay DHB district, the largest occupational group was

support workers (38 per cent) followed by nursing (27 per cent). The percentage of the mental health

workforce positions (including vacancies) that were support worker roles is higher than the national

figures (32 per cent) and the Central regional figures (33 per cent).The percentage of the workforce

that were nursing roles is lower than that of the mental health workforce positions for nursing roles

nationally (32 per cent) and in the Central region (33 per cent).

DHB mental health services reported:

• 92 per cent of the medical and other professional support workforce (6 / 7 FTE positions)

• 87 per cent of the nursing workforce (42 / 48 FTE positions)

• 71 per cent of the administration and management workforce (27 / 38 FTE positions).

NGO mental health services reported:

• 70 per cent of support workers (47 / 67 FTE positions)

• 47 per cent of the allied health workforce (7 / 15 FTE positions).

Figure 3 summarises the occupational grouping of the workforce reported by survey respondents by

cultural workers, medical and other professionals, allied health, administration and management,

support workers and nursing.

59

13

41

70 17

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

NGO

DHB

Community Inpatient/residential Other


Figure 3. Workforce FTE positions (employed plus vacant) for each main occupational grouping for

DHB and NGO services

2.4 Roles employed and vacant

This section describes the size of the mental health services’ workforce employed and vacant positions

by workforce roles. Survey respondents were asked to report the role that each person was currently

employed in, rather than their qualification. For example, a registered social worker employed as a

‘family support worker’ would be reported as a ‘family support worker’.

Table 4 shows the FTE positions for each role employed and vacant by DHB and NGO services and

the total workforce (employed plus vacant). A summary of key statistics are reported in the text below.

For employed roles

Clinical roles comprised 38 per cent of the FTE positions employed across the district (58 / 154 FTE

positions). This compares to clinical roles comprising 52 per cent of the total national mental health

FTE positions. Key points in relation to clinical role FTE positions employed are:

• 67 per cent of total clinical roles were nursing (39 / 58 FTE positions)8

• 22 per cent were allied health (13 / 58 FTE positions)

• 11 per cent were medical and other professionals (7 / 58 FTE positions)

8 The nursing occupation group excludes nurse managers

1

6

8

27

42

20

1

1

7

11

6

47

2

7

15

38

48

67

10 20 30 40 50 60 70 80 90 100

Cultural advice and support

Medical and other professionals

Allied health

Administration and management

Nursing

Support workers

DHB NGO Total FTE positions


17

• DHB services comprised 80 per cent of FTE positions employed for the clinical workforce (46

FTE positions);

o registered nurses comprised 62 per cent of DHB clinical roles(29 / 46 FTE positions)

o nurse practitioner/specialist/educators comprised 11 per cent (5 / 46 FTE positions)

o social workers, 6 per cent (3 / 46 FTE positions)

• NGO services employed 20 per cent of the clinical roles (12 FTE positions);

o registered nurses were the largest clinical role employed by NGO services (5 / 12 FTE

positions)

o clinical psychologists comprised 26 per cent (3 / 12 FTE positions).

Non-clinical roles comprised 42 per cent of the total mental health services’ workforce in the district

(65 FTE positions). Key points in relation to the non-clinical workforce include:

• 97 per cent of the non-clinical workforce were support workers (63 / 65 FTE positions)

• DHB services employed 27 per cent of non-clinical workforce (18 / 65 FTE positions);

o healthcare assistants were 87 per cent of DHB non-clinical roles (15 / 18 FTE

positions)

o the cultural advice and support occupational group comprised 7 per cent (1.3 / 18

FTE positions), in which cultural supervisors had 1 FTE position

o there were no peer support workers (n = 0 / 18)

• NGO services employed 73 per cent of the non-clinical workforce (48 / 65 FTE positions);

o community support workers comprised 40 per cent of NGO services’ non-clinical

workforce (19 / 48 FTE positions)

o residential support workers, 29 per cent (14 / 48 FTE positions)

o peer support workers – consumer/service user, 18 per cent (8 / 48 FTE positions)

o NGO services reported having only 0.6 FTE position in cultural advice compared to

1.3 FTE positions for DHB services. However, as a number of NGO survey

respondents from around the country indicated, these roles were usually unpaid

(volunteers were excluded from the survey) there is likely to be significant

underreporting of this group.

The administration and management occupational group comprised 20 per cent of the mental health

services’ workforce in the district (31 FTE positions). Key points in relation to this workforce include:

• administrators comprised 29 per cent (9 / 31 FTE positions)

• service/team managers, 29 per cent (9 / 31 FTE positions)

• senior managers, 11 per cent (4 / 31 FTE positions).


For vacant roles

There were 22 FTE positions vacant (13 per cent) in this DHB district and the majority of these

vacancies were located in DHB services. As expected, the larger occupational groups had more vacant

FTE positions than the smaller groups:

• For clinical roles, registered nurses had the largest number of vacant FTE positions (8 FTE

positions vacant, 20 per cent).

• For non-clinical roles, the healthcare assistant role had the largest number of vacant FTE

positions (3 FTE positions vacant, 15 per cent).

Family/whānau advisors had a relatively small workforce (6 FTE positions) with a high proportion of

these being vacant (3 FTE position vacant, 50 per cent).

Table 4 shows the FTE positions for each role employed and vacant by DHB and NGO services and

the total workforce (employed plus vacant). The second to last column shows the vacancy rate. The

final column shows the total workforce for each role as a proportion of the total workforce for the

DHB district (FTE positions employed plus vacant).

Table 4. Adult mental health service workforce FTE positions employed and vacant by roles

Roles

DHB services NGO services Total

workforce

(FTE

positions)

Vacancy

rate (%)

Proportion

of total FTE

positions (%)

Employed

Vacant

Employed

Vacant

Clinical roles

Allied health

Addiction practitioner/clinician - - 1.0 - 1.0 - 0.6

Dual diagnosis practitioner/CEP

clinician - - - - - - -

Counsellor - - - - - - -

Educator/trainer 1.0 - 1.0 - 2.0 - 1.1

Occupational therapist 1.0 - - - 1.0 - 0.6

Clinical psychologist 1.0 - 3.0 1.0 5.0 20.0 2.8

Other psychologist 1.0 - - - 1.0 - 0.6

Social worker 2.8 1.0 1.0 - 4.8 20.8 2.7

Other allied health - - - - - - -

Total (allied health) 6.8 1.0 6.0 1.0 14.8 13.5 8.4

Medical and other

professionals

General practitioner - - 0.5 - 0.5 - 0.3

House surgeon 1.0 - - - 1.0 - 0.6


19

Roles


workforce

(FTE

positions)

Vacancy

rate (%)

Proportion

of total FTE

positions (%)

Employed

Vacant

Employed

Vacant

Consultant psychiatrist 2.0 - - - 2.0 - 1.1

Medical officer special scale - - - - - - -

Psychiatric registrar 1.0 - - - 1.0 - 0.6

Liaison/consult liaison 2.0 - - - 2.0 - 1.1

Other medical professionals - - - - - - -

Total (medical and other

professionals) 6.0 - 0.5 - 6.5 - 3.7

Nursing

Registered nurse 28.6 7.4 5.0 1.0 42.0 20.0 23.9

Enrolled nurse - - - - - - -

Nurse practitioner/nurse

specialist/nurse educator 5.0 1.0 - - 6.0 16.7 3.4

Other nursing professional - - - - - - -

Total (nursing) 33.6 8.4 5.0 1.0 48.0 19.6 27.3

Other clinical roles - - - - - - -

Total (clinical roles) 46.4 9.4 11.5 2.0 69.3 16.5 39.4

Non-clinical roles

Support workers

Community development

worker - - - - - - -

Employment worker - - 0.2 - 0.2 - 0.1

Community support worker - - 19.2 - 19.2 - 10.9

Te whānau tautoko /family

support worker - - - - - - -

Healthcare assistant 15.2 2.6 - - 17.8 14.6 10.1

Peer support - consumer and

service user 8.4 - 8.4 - 4.8

Peer support - family and

whānau 1.5 - 1.5 - 0.9

Psychiatric assistant - - - - - - -

Residential support worker - - 14.0 - 14.0 - 8.0

Other support workers 1.0 1.0 3.6 - 5.6 17.9 3.2

Total (support workers) 16.2 3.6 46.9 - 66.7 5.4 37.9


Cultural supervisor 1.0 - 0.4 - 1.4 - 0.8

Poua / kaumātua - - 0.2 - 0.2 - 0.1

Taua / kuia - - - - - - -


Roles


workforce

(FTE

positions)

Vacancy

rate (%)

Proportion

of total FTE

positions (%)

Employed

Vacant

Employed

Vacant

Pukenga atawhai / kaiāwhina 0.3 - - - 0.3 - 0.2

Traditional Māori health

practitioner - - - - - - -

Matua - - - - - - -

Pasifika cultural advisor - - - - - - -

Other cultural advisor - - - - - - -

Total (cultural advice and

support) 1.3 - 0.6 - 1.9 - 1.1

Other non-clinical roles - - - - - - -

Total (non-clinical roles) 17.5 3.6 47.5 - 68.6 5.2 39.0

Administration and

management

Administrative and/or technical

support 6.0 1.0 3.0 - 10.0 10.0 5.7

Senior manager 2.0 1.0 1.5 - 4.5 22.2 2.6

Clinical director 2.0 1.0 - - 3.0 33.3 1.7

Professional leader 1.0 - 1.0 - 2.0 - 1.1

Service manager/team leader 5.0 1.0 4.0 - 10.0 10.0 5.7

Consumer advisor/consumer

leader 1.0 - 1.4 - 2.4 - 1.4

Family/whānau advisor 3.0 3.0 - - 6.0 50.0 3.4

Other administration and

management - - - - - - -

Total (administration and

management) 20.0 7.0 10.9 0.0 37.9 18.5 21.6

Total (all roles) 83.9 20.0 69.9 2.0 175.8 12.5 100.0

Note:

Definitions of each role type are provided in the data dictionary available on the Te Pou website:

http://www.tepou.co.nz/library/tepou/more-than-numbers-organisation-workforce-survey-data-dictionary.


21

2.5 Ethnicity of the mental health services’ workforce

Rising to the Challenge’s (Ministry of Health, 2012) priority actions include improving service

responsiveness to Māori, Pasifika, and Asian and refugee populations. An ethnically diverse workforce

that reflects the population served is one aspect of culturally responsive services.

Of the 13 mental health service respondents, 12 provided information about staff ethnicity:

• DHB services contributed four responses

• NGO services contributed 8 responses

• the total workforce reported for these responses was 144 FTE positions employed.

Of the 12 responses, four respondents reported that they had no staff members in the specified groups.

The following information is an approximate estimation of the ethnic makeup of the workforce based

on the information provided by the person completing the survey in each service.9

There were 56 FTE positions employed in clinical roles for whom staff members’ ethnicity was

reported:

• Māori staff members made up 25 per cent of this workforce (14 / 56 FTE positions)

• Pasifika staff members made up 2 per cent (1 / 56 FTE positions)

• Asian staff members made up 2 per cent (1 / 6 FTE positions).

There were 88 FTE positions employed in non-clinical, administration and management roles for

whom staff ethnicity was reported:



• Asian staff members made up 1 per cent (1 / 88 FTE positions).

The ethnic makeup of the workforce is important but is not necessarily a reflection of the cultural

competence of the workforce. These broad ethnic groups are comprised of a number of cultures,

customs and languages and some people may not work from the cultural perspective or work in

contexts that support that perspective. Section 4.1 Knowledge and skill levels indicates there are a

number of cultural competency development needs for the mental health services’ workforce.

9 The survey asked people not to guess people’s ethnicity however we cannot ascertain whether this occurred. Services were asked to leave

this question blank if they could not ascertain information on ethnicity which led to an underreporting of ethnicity information. This means

that the following information is an approximate estimate of the ethnicity of the workforce.


3.0 Adult addiction services’ workforce

This section describes the survey results for the Vote Health funded adult addiction services (ie

alcohol and other drug (AOD) and problem gambling services). The following information does not

include any of the addiction services’ workforce funded through non-health sources or working in

services that receive funding to provide combined mental health and addiction services.10

3.1 Overview

The adult addiction services’ workforce reported by services responding to this survey comprised 74

FTE positions:11

• DHB services had 51 FTE positions employed plus vacant (69 per cent)

• NGO services had 23 FTE positions employed plus vacant (31 per cent).

The proportion of the addiction services’ workforce reported by NGO services in the Hawke’s Bay

DHB district (31 per cent) is smaller than the proportion of the addiction services’ workforce located

in NGOs regionally (44 per cent) and nationally (52 per cent).

Figure 4. Hawke’s Bay DHB and NGO services’ adult addiction workforce (n = 74 FTE positions)

There was one problem gambling service identified by the survey, which had a workforce of 4 FTE

positions. In addition there may be problem gambling staff employed in AOD services that are not

identified here and a number of problem gambling services are not funded by health and thus will not

be included in this summary.

10 The mental health service workforce including combined mental health and addiction service workforce is described in Chapter 2 of this

report. Tables presenting mental health services’ and addiction services’ combined workforce is provided in Appendix B. 11 The remainder of this report describes survey responses relating to these FTE positions.

DHB

69%

NGO

31%


23

3.2 Addiction workforce size and service delivered

For the DHB and NGO addiction services’ workforce:

• 81 per cent of the addiction workforce was located in community services (59 / 74 FTE

positions)

• 19 per cent was in residential services (14 / 74 FTE positions).

For DHB provider arm services:

• 85 per cent of DHB addiction services’ workforce was located in community services (43 / 51

FTE positions)


For NGO services:

• 72 per cent of NGO addiction services’ workforce was located in community services (16 / 23

FTE positions)


Of the 23 FTE positions in NGO services, 4 FTE positions (16 per cent) were located in problem

gambling services and the rest were in AOD services.

Table 5 shows the DHB and NGO services’ workforce (FTE positions employed, vacant and in total)

for each main service type. The last column shows the total FTE positions as a proportion of the total

addiction services’ workforce in this DHB district.

Table 5. DHB and NGO services’ workforce by service type

Service type


Total

workforce

Proportion of total

FTE positions

(%)

Employed

Vacant

Total

Employed

Vacant

Total

Inpatient - - - - - - - -

Residential 7.8 - 7.8 6.3 - 6.3 14.1 19.2

Community 41.0 2.2 43.2 15.6 0.6 16.2 59.4 80.8

Forensic - - - - - - - -

Management - - - - - - - -

Other - - - - - - - -

Total 48.8 2.2 51.0 21.9 0.6 22.5 73.5 100.0

Note:

Here ‘management’ relates to services providing management support and does not necessarily correspond with the number of people in

management-specific roles across all organisations.


Figure 5 summarises the survey responses received from DHB and NGO addiction services in the

Hawke’s Bay DHB district, showing the proportion of FTE positions (employed plus vacant) located

in community settings, inpatient and residential settings and other or unknown locations.

Figure 5. Proportion of adult addiction services’ workforce located in community,

inpatient/residential and other/unknown locations by NGO and DHB services.

3.3 Addiction occupational groups

For DHB and NGO addiction services the largest occupational group was allied health12 (48 per cent

of the total addiction services’ workforce) followed by nursing (25 per cent of the total addiction

services’ workforce). This is similar to the Central region (allied health 45 per cent, nursing 17 per

cent) and to the addiction services’ workforce nationally (allied health 46 per cent, nursing 16 per

cent).

DHB AOD services reported:

• 95 per cent of addiction services’ nursing workforce (17 / 18 FTE positions)

• 62 per cent of addiction services’ allied health workforce (22 / 35 FTE positions)

• 95 per cent of all addiction services’ medical and other professional support workforce (3.5 /

3.7 FTE positions).

NGO addiction services reported:

• 54 per cent of addiction services’ administration and management workforce (4 / 7 FTE

positions)

• 42 per cent of addiction services’ support worker workforce (3 / 8 FTE positions).

12 Common roles in the allied health group were addiction practitioner/clinician, counsellor and clinical psychologist.

72

85

28

15

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

NGO

DHB

Community Inpatient/residential Other


25

Figure 6. Addiction services’ workforce (FTE positions employed plus vacant) for each main

occupational grouping by DHB and NGO services13

3.4 Roles employed and vacant

This section describes the size of the addiction services’ workforce employed and vacant positions by

workforce roles. Survey respondents were asked to report the role that each person was currently

reporting, rather than their qualification. For example, a registered social worker employed as a

‘family support worker’ would be reported as a ‘family support worker’.

For employed roles

Clinical roles comprised 77 per cent of the total addiction services’ workforce across the district (55 /

71 FTE positions). Key points in relation to clinical workforce employed are:

• DHB services employed 74 per cent of clinical roles (41 FTE positions):

o 42 per cent of DHB clinical roles were registered nurses (17 / 41 FTE positions)

o 23 per cent were social workers (9 / 41 FTE positions).

• NGO services employed 26 per cent of clinical roles (14 FTE positions):

o addiction practitioners were the largest clinical role employed by NGO services (10 /

14 FTE positions)

o 18 per cent were social workers (3/ 14 FTE positions)

o registered nurse roles had 1 FTE position in NGOs.

13 There was no workforce in other clinical and other non-clinical roles.

1

4

3

5

17

22

1

4

3

1

14

2

4

7

8

18

35

5 10 15 20 25 30 35 40




Support workers

Nursing

Allied health



Non-clinical roles comprised 13 per cent of the total workforce in the district (10 FTE positions). Key

points in relation to the non-clinical workforce include:

• DHB services employed 56 per cent of the non-clinical roles (5 FTE positions):

o 85 per cent were community support workers (4.5 / 5 FTE positions)

o kaiāwhina roles had 1 FTE position in the district.

• NGO services employed 44 per cent of non-clinical roles (4 FTE positions):

o 79 per cent of NGO non-clinical roles were residential support workers (3 / 4 FTE

positions)

o kaumātua roles has 0.2 FTE positions in the district.

The administration and management occupational group comprised 9 per cent of the total addiction

services’ workforce in the district (7 FTE positions). Key points in relation to the administration and

management workforce include:

• administrators comprised 2 of 7 FTE positions

• service/team managers, 5 of 7 FTE positions.

For vacant roles

There were 3 FTE positions (4 per cent) vacant in this DHB district. Clinical psychologists had 2 FTE

positions vacant (30 per cent).

Table 6 shows the FTE positions for each role reported by responding addiction services. The FTE

positions are grouped into employed and vacant by DHB and NGO services. The second to last

column shows the vacancy rate. The final column shows the total workforce for each role as a

proportion of the total workforce for the DHB district (FTE positions employed plus vacant).

Table 6. Adult addiction services’ workforce FTE positions by role

Roles


workforce

(FTE

positions)

Vacancy

rate (%)

Proportion

of total FTE

positions (%)

Employed

Vacant

Employed

Vacant

Clinical roles



clinician - - - - - - -

Counsellor 3.8 0.3 - - 4.1 7.3 5.6

Educator/trainer - - - - - - -

Occupational therapist 3.0 0.1 0.5 - 3.6 2.8 4.9

Clinical psychologist 3.8 1.0 - 0.6 5.4 29.6 7.3

Other psychologist - - - - - - -

Social worker 9.4 0.4 2.5 - 12.3 3.3 16.7


27

Roles


workforce

(FTE

positions)

Vacancy

rate (%)

Proportion

of total FTE

positions (%)

Employed

Vacant

Employed

Vacant



House surgeon - - - - - - -



Psychiatric registrar - - - - - - -

Liaison/consult liaison - - - - - - -


Registered nurse 17.0 0.4 1.0 - 18.4 2.2 25.0



specialist/nurse educator - - - - - - -

Other nursing professional - - - - - - -


Total (clinical roles) 40.5 2.2 14.2 0.6 57.5 4.9 78.2

Non-clinical roles

Community development worker - - - - - - -

Employment worker - - - - - - -

Community support worker 4.5 - - - 4.5 - 6.1

Te whānau tautoko /family support

worker - - - - - - -

Healthcare assistant - - - - - - -

Peer support - consumer and

service user - - - - - - -

Peer support - family and whānau - - - - - - -



Other support workers - - - - -

Cultural supervisor - - - - -

Poua / kaumātua - - 0.2 - 0.2 - 0.3

Taua / kuia - - - - - - -

Pukenga atawhai / kaiāwhina 0.8 - - - 0.8 - 1.1

Traditional Māori health

practitioner - - - - - - -

Matua - - - - - - -


Other cultural advisor - - 0.7 - 0.7 - 1.0


Total (non-clinical roles) 5.3 - 4.2 - 9.5 - 12.9


Roles


workforce

(FTE

positions)

Vacancy

rate (%)

Proportion

of total FTE

positions (%)

Employed

Vacant

Employed

Vacant



support - - 2.0 - 2.0 - 2.7

Senior manager - - - - - - -

Clinical director - - - - - - -

Professional leader - - - - - - -

Service manager/team leader 3.0 - 1.5 - 4.5 - 6.1

Consumer advisor/consumer

leader - - - - - - -

Family/whānau advisor - - - - - - -



Total (administration and

management) 3.0 - 3.5 - 6.5 - 8.8

Total (all roles) 48.8 2.2 21.9 0.6 73.5 3.8 100.0

Note.

Definitions of each role type are provided in the data dictionary available on the Te Pou website:

http://www.tepou.co.nz/library/tepou/more-than-numbers-organisation-workforce-survey-data-dictionary

3.5 Ethnicity of the addiction services’ workforce

Of the eight addiction service respondents, seven provided information about staff ethnicity:

• DHB services contributed four responses

• NGO services contributed three responses

• the total workforce reported for these responses was 64 FTE positions employed.

The following information is an approximate estimation of the ethnic makeup of the workforce based

on the information provided by the person completing the survey in each service.14

There were 52 FTE positions employed in clinical roles for which staff members’ ethnicity was

reported:

14 The survey asked people not to guess people’s ethnicity however we cannot ascertain whether this occurred. Services were asked to leave

this question blank if they could not ascertain information on ethnicity which led to an underreporting of ethnicity information. This means

that the following information is an approximate estimate of the ethnicity of the workforce.


29



• there were no FTE positions occupied by Asian staff (0 / 52 FTE positions).

There were 12 FTE positions employed in non-clinical, administration and management roles for

which staff members’ ethnicity was reported:


• there were no FTE positions occupied by Pasifika staff (0 / 12 FTE positions)

• there were no FTE positions occupied by Asian staff (0 / 12 FTE positions).

The ethnic makeup of the workforce is important but is not necessarily a reflection of the cultural

competence of the workforce. These broad ethnic groups are comprised of a number of cultures,

customs and languages and some people may not work from the cultural perspective or work in

contexts that support that perspective. Section 4.1 Knowledge and skill levels indicates there are a

number of cultural competency development needs for the mental health services’ workforce.


4.0 Mental health and addiction workforce,

service and cross-sector relationship challenges

This section describes responses to survey questions about workforce and service challenges facing

adult mental health and addiction services in the Hawke’s Bay DHB district. The responses reflect the

opinions of respondents, in most cases team leaders and managers, including any input they sought

from others. The main analyses in this chapter combined the responses from mental health and

addiction services. The responses from addiction services are highlighted in the text following the

graphs because they may not be well represented by the combined responses.

4.1 Knowledge and skill levels

All 21 responses received to the survey answered this question (100 per cent of the respondents to this

survey).

• DHB services provided 9 responses, of which four were from mental health services, one was

from a combined mental health and addiction service and four were from addiction services.

• NGO services provided 12 responses, of which 7 were from mental health services, one was

from a combined mental health and addiction service, and four were from addiction services

Respondents were asked to indicate if they thought their staff needed to increase knowledge and skill

levels around key policy and service areas. At least 75 per cent of mental health and addiction service

respondents identified that their workforce needed improvement in 17 out of 31 pre-identified

knowledge and skill areas. Responses indicating low need for improvement cannot be read as an

indication of high levels of workforce competence; such responses may reflect other factors such as a

lack of demand for the particular skill outside specialised services.

Responses to general knowledge and skills are presented first, followed by knowledge and skills related

to cultural competency and working with particular groups. Figure 7 and Figure 8 present combined

responses from DHB and NGO services.

General knowledge and skills

The general knowledge and skill areas most commonly reported as needing some increase or a large

improvement were:

• co-existing problems capability (95 per cent)

• risk assessment (81 per cent)

• physical health assessment (81 per cent)

• using strengths based approaches to enhance resiliency and recovery with service users (76

per cent).


31

DHB mental health and addiction services reported the need to improve a number of knowledge and

skills. Key needs were in the following areas:

• co-existing problems capability (9 of 9 responses)

• risk assessment (8 of 9 responses)

• physical health assessment (7 of 9 responses).

NGO mental health and addiction services reported the need to improve a number of knowledge and

skills (n= 12 responses). Key needs were in the following areas:

• co-existing problems capability (92 per cent of NGO respondents)

• working with new technologies and IT (83 per cent)

• using strengths based approaches to enhance resiliency and recovery with service users (83

per cent).

Figure 7. Proportion of respondents needing to improve other knowledge and skills (n=21 responses)

29

43

24

48

43

43

48

43

43

48

67

62

57

62

10

5

29

10

19

19

14

24

24

19

10

19

24

33

38%

48%

52%

57%

62%

62%

62%

67%

67%

67%

76%

81%

81%

95%

0 20 40 60 80 100 120

Promotion of restraint and seclusion reduction

initiatives

Knowledge of community resources available in your

area

Screening and brief interventions eg use of AUDIT

tool, sleep hygiene education

Able to respond readily to changes in type of work

Psychological interventions eg cognitive behavioral

therapy, social network, mindfulness

Using outcome measures eg HoNOS, Hua Oranga

Knowledge and use of relevant legislation, regulations,

standards, codes and policies

Working with new technologies and IT

Supporting self-managed care (including on-line

options, 12-step programmes)

Supporting use of peer support

Using strengths-based approaches to enhance

resiliency and recovery with service users

Risk assessment (including suicidality)

Physical health assessment

CEP (co-existing problems) capability

Some increase (%) Large increase (%) Total needing increase


The addiction sector provided 8 of the 21 services that provided information about their knowledge

and skill needs. Outlined below are results specific to the addiction services’ responses.

Most addiction services reported needing to improve workforce knowledge and skills in the following

areas:

• co-existing problems capability (7 of 8 responses)

• supporting use of peer support (7 of 8 responses)

• physical health and risk assessments (7 of 8 responses).

Cultural competence and working with other groups

A number of questions were specifically focused on cultural competency and skills and knowledge

working with other groups.

The cultural competency areas most commonly reported to need some increase or a large increase

were:

• cultural competence for working in te reo Māori me ona tikanga (100 per cent)

• Māori health outcome measurement and assessment e.g. Hua Oranga (100 per cent)

• knowledge of Pasifika cultural models of health (95 per cent)

• confidence in one or more Pasifika languages (95 per cent).

DHB mental health and addiction services reported the need to improve a number of knowledge and

skills. Key needs were in the following areas:

• all knowledge and skill areas for working with Māori (between 7and 9 of 9 responses)

• all knowledge and skill areas for working with Pasifika (9 of 9 responses)

• cultural competence for working with Asian ethnic groups (9 of 9 responses).

NGO mental health and addiction services reported the need to improve a number of knowledge and

skills (n= 12 responses). Key needs were in the following areas:

• Māori health outcome measurement and assessment e.g. Hua Oranga (100 per cent of NGO

respondents)

• cultural competence for working in te reo Māori me ona tikanga (100 per cent)

• knowledge of Pasifika cultural models of health, languages and family values (92 per cent).


33

Figure 8. Proportion of respondents perceiving a need to improve knowledge and skills for working

with Māori, Pasifika and other groups (n=21 responses)

Most addiction services reported needing to improve workforce knowledge and skills in the following

cultural competency areas:

• Māori health outcome measurement (8 of 8 responses)

• cultural competence for working in te reo Māori me ona tikanga (8 of 8 responses)

• cultural competence for working with Asian ethnic groups (8 of 8 responses).

43

48

57

71

19

24

19

10

29

29

29

48

67

76

81

76

71

5

5

5

5

67

67

71

86

67

67

67

19

14

10

10

24

29

48%

52%

62%

76%

86%

90%

90%

95%

95%

95%

95%

67%

81%

86%

90%

100%

100%

0 20 40 60 80 100 120

Working collaboratively with other services and

agencies

Working with families

Working with children and young persons

Working with older people

Cultural competence for working with Asian ethnic

groups

Knowledge and skills in the engagement process when

working with Pasifika ethnic groups

Knowledge of the basic concepts of tapu across a range

of Pasifika cultures

Confidence in one or more Pasifika languages

Cultural competence for working with Pasifika ethnic

groups

Knowledge of Pasifika cultural models of health

Knowledge of Pasifika family values, structures and

concepts

Knowledge and skills in Māori models of health eg Te

Whare Tapa Whā, Te Pae Mahutonga, Te Wheke

Knowledge and skills in Māori models of engagement

eg pōwhiri process

Cultural competence for working with Māori

Knowledge and skills in whānau-centred practice

(Whānau ora)

Cultural competence for working in te reo Māori me

ona tikanga (language and custom)

Knowledge and skills in Māori health outcome

measurement and assessment eg Hua Oranga

Some increase (%) Large increase (%) Total needing increase


4.2 Workforce planning and development challenges

Respondents were asked to rank from one (highest) to four a list of workforce planning and

development challenges.

Of the 21 responses received to the survey, 18 (86 per cent) answered this question. These included:

• DHB services provided 9 responses, of which four were from mental health services, one was

from a combined mental health and addiction service, and four were from addiction services

• NGO services provided 9 responses, of which six were from mental health services, one was

from a combined mental health and addiction service and two were from addiction only

services.

Figure 9 displays combined responses from DHB and NGO services. When asked to rank the top four

challenges facing the workforce:

• 67 per cent of respondents ranked managing pressure on staff due to increased complexity in

their top four (12 of 18 responses)

• 67 per cent of respondents ranked managing pressure due to changing service delivery models

in their top four (12 of 18 responses)

• 50 per cent of respondents ranked managing pressure on staff due to increased demand for

service in their top four (9 of 18 responses), and was also ranked as the biggest challenge by 33

per cent of respondents (6 of 18 responses).

The challenges most identified by DHB services were:

• managing pressure due to changing service delivery models (89 per cent, 8 of 9 DHB

responses)

• managing pressure on staff due to increased complexity (67 per cent, 6 of 9 DHB responses)

• managing pressure on staff due to increased demand for service (67 per cent, 6 of 9 DHB

responses).

The challenges most identified by NGO services were:

• static or reduced funds (89 per cent, 8 of 9 NGO responses)

• managing pressure on staff due to increased complexity (67 per cent, 6 of 9 NGO responses)

• cost of training and other professional development (56 per cent, 5 of 9 NGO responses).

Figure 9 shows the percentage of respondents giving rankings of one to four for each challenge. The

percentage at the end of the bar represents the proportion of all respondents who included this

challenge in their top four.


35

Figure 9. The biggest workforce challenges for DHB and NGO services (n=18 responses)

The addiction sector made up six of the 18 responses to this question. This means that the addiction

sector responses are not necessarily well represented when combined with mental health responses.

Outlined below are results specific to addiction responses relating to service and planning challenges.

The challenges most identified by addiction services were:

• recruiting qualified and experienced staff (5 of 6 responses)

• retaining qualified and experienced staff (4 of 6 responses).

4.3 Cross-sector relationships

Respondents were asked to indicate the strength of their relationships with other sectors and agencies.

Overall the responses indicated that more relationships were working adequately or well than needed

improvement.

All of the 21 responses received to the survey answered this question, these included:

• DHB services provided 9 responses, of which four were from mental health only services, one

was from a combined mental health and addiction service and four were from addiction

services

17

6

6

17

33

6

17

11

6

22

6

22

28

6

6

22

11

6

17

17

6

28

17

6

22

6

39%

44%

44%

50%

50%

67%

67%

0 10 20 30 40 50 60 70 80

Retaining qualified and experienced

staff

Cost of training and other professional

development

Recruiting qualified and experienced

staff

Static or reduced funds

Managing pressure on staff due to

increased demand for service

Managing pressure due to changing

service delivery models

Managing pressure on staff due to

increased complexity

Ranked highest (%) Ranked 2nd (%) Ranked 3rd (%) Ranked 4th (%) Total ranked 1-4 (%)


• NGO services provided 12 responses, of which 7 were from mental health only services, one

was from a combined mental health and addiction service and four were from addiction

services

• some of these services did not report the strength of relationships with every sector or agency.

Figure 10 presents combined responses from DHB and NGO services. Relationships working

adequately or well for mental health and addiction DHB and NGO services were with:

• primary health practices (100 per cent of respondents, 20 of 20 responses)

• relationship services (100 per cent of respondents, 12 of 12 responses)

• Work and Income (100 per cent of respondents, 19 of 19 responses).

Relationships needing improvement for mental health and addiction DHB and NGO services were

with:

• other addiction services (48 per cent of respondents, 10 of 21 responses)

• other mental health services (33 per cent of respondents, 7 of 21 responses)

• family violence (33 per cent of respondents, 6 of 18 responses).

Key points for DHB respondents:

• the relationships working adequately or well were with;

o primary health practices (100 per cent of respondents, 9 of 9 DHB responses)

o Work and Income (100 per cent of respondents, 8 of 8 DHB responses)

o Child and adolescent mental health services (100 per cent of respondents, 8 of 8 DHB

responses)

• relationships needing the most improvement were with;

o other addiction services (33 per cent of respondents, 3 of 9 DHB responses)

o other mental health services (33 per cent of respondents, 3 of 9 DHB responses).

Key points for NGO respondents

• the relationships working adequately or well were with;

o primary health practices (100 per cent of respondents, 11 of 11 NGO responses)

o Work and Income (100 per cent of respondents, 11 of 11 NGO responses)

o Police (100 per cent of respondents, 11 of 11 NGO responses)

• relationships needing the most improvement were with;

o other addiction services (58 per cent of respondents, 7 of 12 NGO responses)

o family violence (56 per cent of respondents, 5 of 9 NGO responses).

Figure 10 shows the distribution of responses to this question for each sector. To the left of the zero

axis, the bar shows the proportion of respondents (in percentages) needing to improve relationships

with this sector or organisation. On the right hand side, the first part of the bar shows the proportion

of respondents who thought the relationship was working adequately, and the second part is the

proportion for which relationships were working well. The total responses received for each sector


37

(excluding those who did not select an option or selected not applicable) is printed on the right side of

the graph.

Figure 10. Strength of DHB and NGO services’ cross-sector relationships (n=21 responses)

The addiction sector made up 8 of the 21 responses to this question. Outlined below are results

specific to the addiction services’ responses relating to cross-sector relationships.

Addiction service respondents reported a number of cross-sector relationships were working

adequately or well, including:

• primary health practices (8 of 8 responses)

• relationship services (8 of 8 responses)

• Police (8 of 8 responses).

Addiction services reported needing improved cross-sector relationships with:

• other addiction services (3 of 8 responses)

• other mental health services (3 of 8 responses).

5

17

21

21

21

21

25

29

29

33

33

48

45

75

53

65

67

42

50

64

64

50

65

53

33

38

33

55

25

47

30

17

37

29

14

14

25

6

18

33

29

19

20

12

19

20

18

19

14

14

14

16

17

17

18

21

21

60 40 20 0 20 40 60 80 100

Primary health practices

Relationship services

Work and Income

Police

Corrections department

General hospitals/emergency departments

Child and adolescent mental health services

Child Youth and Family

Education

Housing New Zealand/accommodation providers

Disability sector

Mental health services for older people

Family violence

Other mental health services

Other addiction services

Needs improvement (%) Working adequately (%) Working well (%) Total responses


5.0 Summary of the DHB district mental

health and addiction workforce results

This report has described the survey results for the adult mental health and addiction services’

workforce in the Hawke’s Bay DHB district. This summary largely duplicates the summary of results

provided in the executive summary but is included again here for completeness.

As at 1 March 2014, the DHB district’s mental health and addiction workforce consisted of 249 FTE

positions, including 25 vacant FTE positions.

Mental health services’ workforce comprised 156 FTE positions (62 per cent of the total workforce

identified). Combined mental health and addiction services workforce comprised 20 FTE positions (8

per cent). The AOD services’ workforce comprised 70 FTE positions (28 per cent) and problem

gambling services’ workforce comprised 4 FTE positions.

DHB services reported 62 per cent of the mental health and addiction workforce in the DHB district

(155 FTE positions) and NGO services reported 38 per cent of the workforce (94 FTE positions). More

than half the workforce (51 per cent) were in clinical roles and 31 per cent were in non-clinical roles.

Administration and management roles made up 18 per cent of the workforce. The breakdown was

slightly different for addiction services relative to mental health services.

For the mental health services’ workforce clinical roles comprised 39 per cent of the FTE positions

(employed plus vacant) and non-clinical roles comprised 39 per cent of the FTE positions (employed

plus vacant). Administration and management roles comprised 22 per cent of the mental health

services’ FTE positions (employed plus vacant). Most of the clinical positions were reported byDHB

services (81 per cent) and most of the non-clinical roles were reported byNGO services (69 per cent).

Support workers and nurses were the two largest occupational groups for mental health services in

this DHB district.

For the addiction services’ workforce clinical roles comprised 78 per cent of the FTE positions

(employed plus vacant) and non-clinical roles comprised 13 per cent of the FTE positions (employed

plus vacant). Administration and management roles comprised 9 per cent of the addiction services’

FTE positions (employed plus vacant). Most of the addiction services’ clinical roles were reported by

DHB services (74 per cent) and most of the non-clinical workforce were in DHB services (56 per

cent). Allied health and nurses were the two largest occupational groups for addiction services in this

DHB district.

Services were asked to report on the degree of improvement they needed in a range of knowledge and

skills. Co-existing problems capability was commonly rated as needing some or a large need for


39

improvement (95 per cent) as was risk assessment (81 per cent), physical health assessment (81 per

cent) and using strengths based approaches to enhance resiliency and recovery with service users (76

per cent).

Sixty-seven to 100 per cent of respondents indicated that their workforce needed some or large

improvement in cultural competence skills for working with Māori, particularly in Māori health

outcome measurement and working in te reo Māori. Ninety to 95 per cent of respondents indicated

that their workforce needed some or large improvement in cultural competence skills for working

with Pasifika, particularly in Pasifika concepts of family values, models of health and languages.

Cultural competency for working with Asian ethnic groups was also a key need: 86 per cent of

respondents needed improvement in skills for working with Asian ethnic groups.

Managing pressure on staff due to increased complexity (67 per cent of respondents) and managing

pressure due to changing service delivery models (67 per cent of respondents) were commonly rated

as key workforce planning and development challenges. Managing pressure on staff due to increased

demand for service was ranked as the biggest workforce challenge by 33 per cent of respondents.

Both mental health services and addiction services commonly reported that relationships with the

primary health services, relationship services and Work and Income were working adequately or well.

However mental health services reported their relationships with other addiction services, disability

sector and family violence needed to improve. Some addiction services reported their relationships

needed to improve with other mental health services and other addiction services.


6.0 References

Matua Raki. (2011). Addiction services: Workforce and service demand survey 2011 report. Wellington:

Matua Raki.

Ministry of Health. (2012). Rising to the challenge: The mental health and addiction service

development plan 2012-2017. Wellington: Ministry of Health.

Platform Trust. (2007). NgOIT Workforce Survey. Wellington: Platform Trust.

Statistics New Zealand. (2013).New Zealand Census of Population and Dwellings. Wellington:

Statistics New Zealand.

Te Pou o Te Whakaaro Nui. (2014b). The mental health and addiction workforce planning and

forecasting literature review. Retrieved from http://www.tepou.co.nz/library/tepou/mental-

health-and-addiction-workforce-planning-guide


41

Appendix A: Survey method

Nationally, the organisation workforce survey was sent to the 20 district health boards (DHBs) and

231 non-government organisations (NGOs) that had contracts to provide adult mental health and

addiction services funded by Vote Health in 2012/13.15 Development of the survey questions was

supported by a review of previous workforce surveys and stocktakes including the NgOIT 2007 survey

of the NGO workforce delivering mental health and addiction services (Platform Trust, 2007) and the

2011 Matua Raki survey of addiction services’ workforce and service demand (Matua Raki, 2011).

The survey period ran from 28 March to 15 June 2014. During this time the regional workforce

planning leads, Matua Raki and Te Pou supported survey participants to complete and return their

surveys. Nationally, all 20 DHBs and 169 NGOs completed the survey, giving an overall response rate

of 75 per cent of services. In the Hawke’s Bay DHB district the DHB service and 8 NGOs working in

the district completed the survey.

Table 7. Total number of responses for the Hawke’s Bay DHB district

MH only MH&A Addiction Total

Organisa

tions

Responses

Organisa

tions

Responses

Organisa

tions

Responses

Organisa

tions

Responses

DHB 1 4 1 1 1 4 1 9

NGO 4 7 1 1 4 4 8 12

Total 5 11 2 2 5 8 9 21

The method and limitations of the organisational workforce survey used to generate this data and

detail on population, funding and service access data can be found in the Central regional report

available on the Te Pou website.

15 The survey sample did not include all the organisations working to provide adult mental health and addiction services in New Zealand.


Appendix B: Mental health services’ and

addiction services’ workforce combined

Figure 11 and Table 8 present a summary of the mental health services’ and addiction services’

workforce combined.

Figure 11. Mental health services’ and addiction services’ workforce FTE positions (employed plus

vacant) for each main occupational grouping for DHB and NGO services16

16 Other clinical and other non-clinical FTE are not included in this graph.

2

10

30

30

59

24

2

1

14

21

7

50

4

10

44

50

66

74

0 10 20 30 40 50 60 70 80


Medical


Allied health

Nursing

Support workers



43

Table 8. Adult mental health services’ and addiction services’ FTE positions employed and vacant by

roles

Roles


Total Vacancy rate (%)

Role as % of total FTE

Employed

Vacant

Employed

Vacant

Allied health



clinician - - - - - - -

Counsellor 3.8 0.3 - - 4.1 0.1 1.6

Educator/trainer 1.0 - 1.0 - 2.0 - 0.8

Occupational therapist 4.0 0.1 0.5 - 4.6 - 1.8

Clinical psychologist 4.8 1.0 3.0 1.6 10.4 1.0 4.2

Other psychologist 1.0 - - - 1.0 - 0.4

Social worker 12.2 1.4 3.5 - 17.1 0.6 6.9


Total (Allied health) 26.8 2.8 19.0 1.6 50.2 1.8 20.1



House surgeon 1.0 - - - 1.0 - 0.4



Psychiatric registrar 1.0 - - - 1.0 - 0.4

Liaison/consult liaison 2.0 - - - 2.0 - 0.8


Total (Medical and other

professionals) 9.5 - 0.7 - 10.2 - 4.1

Nursing

Registered nurse 45.6 7.8 6.0 1.0 60.4 3.5 24.2



specialist/nurse educator 5.0 1.0 - - 6.0 0.4 2.4

Other nursing professionals - - - - - - -

Total (Nursing) 50.6 8.8 6.0 1.0 66.4 3.9 26.6


Total (Clinical roles) 86.9 11.6 25.7 2.6 126.8 5.7 50.9

Support workers

Community development worker - - - - - - -

Employment worker - - 0.2 - 0.2 - 0.1

Community support worker 4.5 - 19.2 - 23.7 - 9.5

Te whānau tautoko/family support

worker - - - - - - -


Roles


Total Vacancy rate (%)

Role as % of total FTE

Employed

Vacant

Employed

Vacant

Healthcare assistant 15.2 2.6 - - 17.8 1.0 7.1

Peer support - consumer and service

user - - 8.4 - 8.4 - 3.4

Peer support - family and whānau - - 1.5 - 1.5 - 0.6



Other support workers 1.0 1.0 3.6 - 5.6 0.4 2.2

Total (Support workers) 20.7 3.6 50.2 - 74.5 1.4 29.9


Cultural supervisor 1.0 - 0.4 - 1.4 - 0.6

Kaumātua - - 0.4 - 0.4 - 0.2

Taua/kuia - - - - - - -

Pukenga atawhai/kaiāwhina 1.1 - - - 1.1 - 0.4

Traditional Māori health practitioner - - - - - - -

Matua - - - - - - -


Other cultural advisor - - 0.7 - 0.7 - 0.3

Total (Cultural advice and support) 2.1 - 1.5 - 3.6 - 1.4


Total (Non-clinical roles) 22.8 3.6 51.7 - 78.1 1.4 31.3



support 6.0 1.0 5.0 - 12.0 0.4 4.8

Senior manager 2.0 1.0 1.5 - 4.5 0.4 1.8

Clinical director 2.0 1.0 - - 3.0 0.4 1.2

Professional leader 1.0 - 1.0 - 2.0 - 0.8

Service manager/team leader 8.0 1.0 5.5 - 14.5 0.4 5.8

Consumer advisor/consumer leader 1.0 - 1.4 - 2.4 - 1.0

Family/whānau advisor 3.0 3.0 - - 6.0 1.2 2.4



Total (Administration and

management) 23.0 7.0 14.4 - 44.4 2.8 17.8

Total (All roles) 132.7 22.2 91.8 2.6 249.3 9.9 100.0


45

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