issue 37 - december 2016 mental health and addiction ... winning graduates awards were presented to...
TRANSCRIPT
Mental health and addiction nursing newsletter
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Issue 37 - December 2016
Continued on page 3
Peter Blake (pictured walking with grey shirt on) acknowledges the 25 new graduates nurses
Waitematā DHB celebrates and embraces new graduates On 10 November Waitematā DHB held a graduation celebration for 25 nurses who had completed the mental health and addiction nursing new entry to speciality practice (NESP) programme surrounded by family, whānau, friends, mentors, supervisors, preceptors and nurse leaders. Angela Gruar and Suzette Poole from Te Pou were delighted to speak at this forum.
Matua Piripi Daniels and Whaea Tahana opened the day for the 100 guests with a celebration to embrace their new nurses. They imparted a wonderful feeling of being connected to family and whānau.
Alex Craig, head of division – nursing, has watched the programme evolve since she was first involved in 2002. She firmly believes the
programme is a key to attracting and retaining new nurses to work in mental health.
Peter Blake, newly appointed to the role of new graduate programme coordinator, was thrilled with the calibre of nurses in the programme. Feedback from students was positive and highlighted areas he is also keen to improve.
Graduates included: Aaron Smith, Ambi Cherian, Deb Cruickshank, Erica Park, Florence Alesana, Jenny Morris, Laurian Wheeler, Mansa Nti, Miriam Hughes, Netane Takau, Riley Smith, Tanya Arnesen and Tina Roberts.
It seems wrong to be just shy of the end of the year and the summer season – where did 2016 go? In the final edition of Handover for 2016 we start by celebrating endings and beginnings for Waitematā’s new graduates.
Our regular Chief Nurses Office update looks at improving access, enabling nurses and removing barriers.
Lois Boyd and Caro Swanson discuss the recent mental health nurse educator forum, picking highlights from the least restrictive practice point of view.
We meet Jo Rea who is doing wonderful work to build bridges between district health board mental health and addiction services and non-government organisation service providers.
We have a timely co-existing problems and solutions update – an issue that is coming up a lot, with many nurses reporting difficulties and a lack of confidence in this area.
Our physical health focus is on metabolic screening with a story from one DHB on addressing consistency, and Shivika Singh’s research – attitudes and beliefs of mental health nurses towards metabolic screening.
Our talking therapies toolkit has recently been launched and Tina Earl shares this exciting development and its potential for the sector.
Finally we have an update from the Care Capacity Demand Management (CCDM) programme - mental health, addiction and disability advisory group.
We wish you happy summer times with your loved ones, peace, happiness and fulfilment as this year ends and another begins. See you in 2017.
Nga mihi, Suzette and Caro
issn: 2324-3821
NEXT EDITION:
Issue 38 – articles welcome
Our readers want solutions and new innovations to improve services for people experiencing mental health and addiction problems. They also want ideas on how to support the workforce to develop the values, attitudes knowledge and skills that best support a person with their recovery. If you have a story like this then please get in touch!
Email your ideas to us – [email protected] or [email protected]
Issue 38 will be released in March. Articles are due Friday 17 February, 2017.
1 Waitematā DHB celebrates and embraces new graduates
4 Reflections: Hoping for the best
5 Least restrictive practice: Curiosity, challenges and preferences
5 Message from the CE
6 Chief nurses update
7 Nurse profile: Jo Rea
10 CEP and solutions update
13 Equally well: Metabolic screening
14 Nursing research: Masters thesis abstract
16 Equally well wins an award
17 Talking therapies: Let's get talking toolkit launch
18 Care Capacity Demand Management Update
19 Events and Training
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Mental Health and Addiction Nursing Newsletter - Issue 37 - December 20162
by Suzette Poole, clinical lead and Caro Swanson, service user lead
Co-editorial
(RN-MH, MN) – CLINICAL LEAD EMAIL: [email protected]
SERVICE USER LEAD EMAIL: [email protected]
Suzette Poole - Editor Caro Swanson - Editor
Award winning graduatesAwards were presented to the following graduates.• Angela Manigsaca Academic achiever award• Asuquo Asuquo Class representative award• Blake McCarthy Portfolio award• Emma Williamson Class representative award and Whitiki
Maurea cultural competence award• Giovanni Lolohea Recovery award• Mele Tuinukuafe Consumer responsiveness award• Natasha Barber Clinical excellence award• Rebecca Fort Reflective practice award • Riley Smith Whitiki Maurea cultural
competence award
Matua Piripi Daniels and Whaea Tahana presented Emma Williamson and Riley Smith with the Whitiki Maurea cultural competence award. This award recognises nurses who have demonstrated an understanding of and enacting of, the principles of cultural responsiveness and cultural safety in both their academic and clinical practice.
Acknowledging support from staff
The level of commitment and support from DHB staff for nurses on this programme is high. The preceptors, supervisors and mentors supporting this year’s group received certificates of acknowledgement from Peter Blake and were awarded at the ceremony.
New graduates enter forensic mental health services
As part of a wider nursing workforce development plan three new nurses were able to complete the programme within the forensic service. Carole Sneebelli, nurse advisor, facilitated this and was very positive about the outcomes which included Blake McCarthy receiving a portfolio award.
Developing cultural responsiveness
Cultural group supervision has been a unique feature of this programme for the past decade and continues to evolve. This form of support is led by Matua Piripi Daniels and Whaea Tahana from Whitiki Maurea services. Some feedback from this years’ group is shown below.• More therapeutic than supervision.• Beneficial to my learning and has made me more competent
culturally.• Very useful.• Informative and useful for my own personal professional
development.• Whaea and Piripi have described well the importance of Maori
health.• Was excellent, made me want to go back and learn Te Reo, which
I will in the future.
Group supervision
Professional supervision is a key requirement in this programme and nurses attend group supervision facilitated by experienced nurses. Although this form of supervision did not suit everyone, in general most found this type of support invaluable. Some comments are shared below.
• Walked in saying we did not have much to talk about, then spent whole hour sharing and talking.
• Helpful to discuss issues at work and to help own practice.
• Good to have a chat with an experienced nurse.
• Always left supervision feeling relieved.
Reflection
Feedback about the programme was gathered and graduates were asked to consider key messages to take forward in their nursing career. Rebecca Fort, received the reflective practice award, and this is her feedback.
“At the beginning of my placements I would find myself lying awake at night thinking about what I was going to do tomorrow, what I forgot to do today, what I should have done in one situation, what I shouldn’t have done in another. That’s a really fast way to burn yourself out. To solve this, so that I wasn’t still ruminating at 0300hrs, I began to write down whatever it was that was troubling me and those issues I would take with me to supervision. This allowed me to be able to ‘turn work off ’ and discuss issues with colleagues in supervision which benefited all of our learning - Win Win!”
Emma Williamson, Riley Smith, Whaea Tahana and Matua Piripi Daniels
Sarah Lubolanya, Vicky Totua, Morgan Timms, Lisa Collins and Barry Kennedy
3Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
cover story
Give it our allLets never give in,
to complaints nor fear.With our eyes on our goalsthe right direction we steer.
No matter the circumstances,with great effort we should always try.
We must pick ourselves up,when we get bruised and we cry.
Opportunities are plentiful, let’s just open our eyes.
Our dreams we shall nurture, as we stare to the skies.
The trick is to create value, that’s honest and real.
By following our passions, in our hearts, we shall feel
If we never hold back, and just give it our all.
No challenge or obstacle, shall ever be tall.
by anita poems.com
Hoping for the best by Caro Swanson and Suzette Poole
People accessing mental health and addiction services – and people working in them – often talk about the importance of hope. With the holiday season and the New Year just around the corner, this seems a good time to think about hope. What is hope and why does it matter?
This is a definition from Dictionary.com. Being both a noun and a verb means it is both a thing and something we do.
Most people feel some level of hope most of the time. Hope is the motivator that fuels dreams and aspirations and gives courage and strength to face challenges and expectations. Hoping, lets people imagine a future and gives meaning and purpose to what they do.
For many people experiencing mental health or addiction problems, losing the ability to hope and have hope is common. It’s a dire and lonely place to be. In an absence of hope, anything better than the now feels impossible and grief about a lost future is often a constant companion. Often this feels much, much, worse at celebratory times like Christmas and New Year.
Families, friends and whānau may also experience a loss of hope. Adjusting beliefs and dreams about the person they love, and their relationships with them to encompass this new challenge can be very intense.
People who work in mental health and addiction services become bastions of
hope, and can ‘hold hope’ for people and their families, friends and whānau. Holding hope for people definitely isn’t about pretending, or being relentlessly positive or not acknowledging the pain and distress someone is experiencing now, it is about confidence and belief.
Early recovery is one of the hardest times for people; a time that requires solid and consistent messages of belief and confidence from the people who support and work with them. Feeling glimpses of hope, touches of light and possibilities awakening and then losing that to slump back into the bad places is horribly painful and destabilising. Regaining hope can be like having pins and needles, as it flows back in, it’s both healing and painful, as it can also highlight some of the losses not yet recognised.
Having and articulating absolute confidence and belief that – no matter where someone is at this moment – things will get better, is essential and powerfully reassuring. It is possible for people to sit without hope for a time if someone they trust knows and believes in them, and holds confidence in their ability to have a future that matters to them. People only need to know it is possible, to be able to do it. Peer workers are wonderful examples of this.
To replenish reserves of confidence and belief, remember, notice and acknowledge the many times the people you have supported have achieved lives of meaning and resilience.
This is why you became a nurse – you had hope and hopes of helping people heal, you had belief that you could, and you have the confidence to do just that.
Hope: (noun) the feeling that what is wanted can be had or that events will turn out for the best.
(verb) to look forward to with desire and reasonable confidence.
Class representatives
Asuquo Asuquo and Emma Williamson acknowledged the support of Peter Blake, new graduate nurse programme coordinator, who was described by graduates as excellent, firm but fair, supportive, knowledgeable and approachable.
Asuquo Asuquo and Emma Williamson – class representatives
4 Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
reflections
Curiosity, challenges and preferences by Caro Swanson and Lois Boyd
We have been lucky enough to recently spend time amongst nurse educators at their biennial Mental Health and Addiction Nurse Educators forum in Dunedin. A well-chosen, professionally passionate and thought provoking line up of speakers gave us all plenty to think about. If a nurse educator from your service attended please make sure they share their highlights from the two days with you. There was so much we could talk about from this forum, but together we felt that the human rights perspectives presented were of most relevance to the goal of reducing seclusion and restraint.
Professor John Dawson discussed the least restrictive alternative and aspects of the Mental Health Act from a human rights perspective. He talked about the scope of powers under the Mental Health Act and the discretion and choice clinicians have in interpreting this to incorporate a human rights perspective. We were reminded even in situations where someone has been put under the Mental Health Act, there are opportunities to accommodate their preferences and choices at every step.
Professor Megan-Jane Johnstone spoke about advance directives and the importance of preserving autonomy and preferences. She talked about how upholding preferences doesn’t need to be a hard and fast, yes or no, legal aspect. Instead it should be about a person’s preferences being communicated and respected wherever possible, with preferences being treated as something tangible that nurses could recognise and uphold as a key component of an ethical perspective. Professor Johnstone talked about the Ulysses pact or contract, which neither of us had heard of. It is about the importance of preserving autonomy through planning and foresight. A Ulysses pact or Ulysses contract is a freely made decision designed and intended to bind oneself in the future. If you don’t know about the Ulysses contract we would encourage you to investigate further – it’s fascinating and thought provoking, as was most of this conference.
Gemma Griffin Dzikiewicz was a very compelling keynote speaker with a strong focus on human centred systems and human rights. Sharing her experience of representing New Zealand at the United Nations, Gemma made that world seem real and closer for a lot of nurses. Sometimes we hear about our international obligations and feel that is a long way away from New Zealand and what we do. It was really useful to hear about the large team of New Zealanders who work with the United Nations to monitor, report, review and strive to uphold human rights in New Zealand. More specifically, it was useful to be reminded about our accountabilities to the world, as a country that still uses restrictive measures such as seclusion and restraint.
Speakers encouraged us to be curious, human centred and consider human rights and our obligations to them more strongly in our work. Nurses especially are ideally placed to be advocates for human rights, for making space for preferences and choices and for reminding people they aren’t in this alone.
We are really looking forward to 2017 and working with you further on reducing and eliminating restrictive practices.
As we close another year it is important to reflect on our achievements for 2016 and what lies ahead. The mental health and addiction nursing workforce is one of our largest, alongside our support workers. The roles that nurses take are many – from leadership to community and primary care.
The policy direction for mental health and addiction services will align to the new health strategy. Services that are people powered, closer to home, high performing, team focused and using technology well. This will have an impact on the role of the nursing workforce.
This year we hosted the TheMHS conference. Our keynote speakers provided us some great perspectives that align to a positive future for people who use services. Dr Arthur C Evans spoke about taking a population/community approach to mental health, addiction and disability. Imagine if our local government invested in better services? This would enable many more local and accessible solutions that aren’t necessarily reliant on just health funding. Dr Robin Youngson spoke about the difference compassion makes to someone’s health outcomes and challenged us to bring this into our work more openly. Joe Macdonald talked about working with the transgender community and how we need to embrace diversity in our approaches with people. New perspectives are required to embrace better access to services for our LGBTI community.
These are all important reflections for the direction of the nursing workforce. Traditional roles and ways of working are changing. This will influence culture and direction for our services in exciting ways. We are doing lots of thinking about this at Te Pou as we consider ways to invest positively in the nursing workforce.
This time of year is one of reflection and contemplation. It is also a challenging time for many in our communities. Nurses will continue to provide service tirelessly over the Christmas period and this can be a life saver for many who don’t find the holidays a positive experience.
Thank you for your continued partnership with us and all the good work you do in the sector. We look forward to working with you in 2017.
Nga mihi,Robyn.
A message from the CE
5Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
LEAST RESTRICTIVE PRACTICE
Improving access, enabling nurses and removing barriers This article has been written by my colleague Alison Hussey – I’ve just added a little mental health specific detail. Alison has done some great work in the last few years in the Office of the Chief Nurse on reducing barriers to nurses working to the breadth of their scope, including legislative changes.
Improving access, enabling nurses and removing barriers – part one
We are all concerned about the growing burden of non-communicable diseases and inequity. Neuropsychiatric disorders (including mental illness, dementia and addiction) are now the leading cause of health loss in New Zealand. The Health Loss in New Zealand Study 1990-2013 has recently been published on the Ministry’s website, www.health.govt.nz/publication/health-loss-new-zealand-1990-2013.
The most obvious, and from a nursing point of view the most palatable, solution to poor health outcomes is to improve prevention and intervene at the earliest possible opportunity. The New Zealand Health Strategy (NZHS) emphasises a preventative approach where care is delivered in partnership with people and their families and as close as possible to where they live. In order to actualise the vision in the NZHS we need to make the best use of the available health workforce by ensuring they can work to the full extent of their scopes of practice and through innovative models of care.
For the past few years the Ministry of Health has had a programme of work designed to identify and remove barriers to innovation, and 2016 has seen considerable progress in this work. This includes:
• amendment of the Medicines (Standing Order) Regulations
• new regulations for registered nurse designated prescribers
• the omnibus Health Practitioners (Replacement of Statutory References to Medical Practitioners) (HPSR) Bill.
Standing orders regulations
The Medicines (Standing Order) Amendment Regulations 2016 came into force on 17 August 2016. The purpose of the amendment was to authorise nurse practitioners and optometrists to issue standing orders. The policy platform for the amendment was improving access to medicines through making best use of the scopes of practice and skills of the available workforce. The consultation documents and advice to the Government can be found online, www.health.govt.nz/our-work/nursing/developments-nursing/amendment-medicines-standing-orders-regulations.
Registered nurse prescribing
The Medicines (Designated Prescriber – Registered Nurses) commenced on 20 September. Under the new regulation the Nursing Council can set the educational, experience, competence and supervision requirements for registered nurse prescribers. The Gazette Notice published by the Nursing Council sets out the criteria for registered nurses in primary care and specialty teams. This group of designated prescriber registered nurses who must have a minimum of three years’ experience in the area they will be prescribing in, completed a Diploma in Registered Nurse Prescribing (including a prescribing practicum), and completed the required education can prescribe from a specified list of around 200 medicines. See the Gazette Notice at https://gazette.govt.nz/notice/id/2016-gs4683?year=2016¬iceNumber=gs4683. The Misuse of Drugs Regulations has also been amended and the new group of registered nurse prescribers will be able to prescribe a seven day supply of certain controlled drugs.
Of course medications are one mode of treatment in mental health alongside and complemented by others including therapy and psychosocial interventions. However, the regulations for registered nurse designated prescribers are part of policies to improve health, wellbeing and access to treatment. Registered nurse prescribers must work as part of a team with oversight from an authorised prescriber. Thinking about the population with mental health needs, in future for example registered nurses (suitably qualified and experienced) working in primary care teams might prescribe anti-depressants. Mental health nurses working in specialty teams, who meet the Nursing Council criteria to prescribe, will be able to provide continuity of care including by providing ongoing medication management.
Health Practitioners (Replacement of Statutory References to Medical Practitioners) (HPSR) Bill
The HPSR is now at the Committee of the Whole House stage in the parliamentary process. Proposed changes in the HPSR Bill include amendments to the Mental Health (CAT) Act as well as amendments to the Misuse of Drugs Act which will have significant implications for nurses working in mental health and addiction services. I will discuss the changes in more detail in a ‘part two’ of this article in a later edition of Handover when the Bill becomes law.
Jane Bodkin, senior advisor nursing, Office
of the Chief Nurse, Ministry of Health
6 Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
CHIEF NURSES OFFICE UPDATE
DHB-NGO bridge builder: Meet Jo ReaEffectively supporting people who may need to engage with more than one service, in particular a district health board (DHB) specialist mental health service and a non-government organisation (NGO), is a crucial aspect of person-centred-integrated-care. More importantly ensuring channels of communication operate effectively is vital to supporting the person with their recovery.
In early 2015, Canterbury DHB specialist mental health services (SMHS) and local NGOs embarked on a joint venture to improve the pathway between their services for people experiencing mental health and addiction problems. A clinical nurse specialist role for the NGO sector was created. The focus was on residential and non-residential NGO services. Stu Bigwood, Canterbury DHB director of mental health nursing, said it took some time to recruit the right person with proven ability to develop, mend and sustain cross-sector relationships. DHB and NGO leaders were confident the role was required and persisted in the need to find a person with DHB and NGO experience.
In April 2015 they appointed Jo Rea, a registered nurse with experience in a range of roles. Several people describe her as a real star, including Stu Bigwood, Dr Daryle Deering – clinical lecturer, Otago University, Rachel Wilson – clinical manager of Hoon Hay House and Kelly Marra – service manager of housing and recovery at Emerge Aotearoa.
She ticks all the boxes for the skills needed to develop a new role. ü Excellent interpersonal skills ü Effective communicator ü Work collaboratively with others ü Good judgement and problem solving ü Competent in time management ü Flexibility and initiative ü Experience in a range of specialist mental health services ü Experience in other areas of nursing ü Experience in primary care ü Overseas experience in nursing
Learning from NGO staff
The new role took time to develop. “Managing the scope of my role with NGO managers’ expectations was critical during the initial phase. The local NGO sector was huge. The relationships between NGOs and SMHS were variable which contributed to a fragmented system of care. Therefore I focused on organisations that were open to meeting with me and my attention turned towards seven residential NGOs,” explained Jo.
“NGO staff were quite sceptical about the new role at first,” said Jo. Therefore she decided to spend the first three months talking with NGO staff to find out what the issues were. Her focus was on building relationships with support workers who she believed really understood what was happening given they often spend the most time with the people in their service.
Jo said she learnt a lot from NGO staff about the challenges they faced regarding their relationships with many SMHS staff. These included issues such as:
• not feeling like their opinions mattered
• feeling very apprehensive about making calls to SMHS
• not feeling part of the team of people supporting the person experiencing mental health and/or addiction problems
• not feeling valued as they were seen as not ‘clinical’
• not always being communicated with before, during or after visiting a person in the service where they worked
• not always being invited to attend a visit or meeting with the person receiving care
• not always being involved in discharge planning
• on occasion only being given very short notice that a person is returning to their facility after being in the inpatient unit.
Through the time spent getting to know support workers Jo came to understand they had a focus on supporting the person to develop goals for their wellbeing. She also came to appreciate they were supporting people with many needs, including some people who harmed themselves or voiced the need to. Jo was impressed with the care provided by the NGO sector staff and their desire to work collaboratively with SMHS.
Jo Rea
7Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
NURSE PROFILE
Jo observed that many staff needed to know more about the medication people were prescribed which led to her designing and delivering a series of 90-minute education sessions for support workers. These were well received.
Jo realised many of the support workers had varying levels of training and not all had completed a mental health and addiction support work certificate. She noticed there was also a high turnover of support worker staff. It became clear many of the support workers needed more guidance and knowledge and they appeared to have an appetite for education and support.
Jo also spent time identifying the concerns of some of the SMHS staff such as variable ability of NGO staff to support people with complex needs, high staff turnover and perceived challenges with managing risk within the NGO sector.
Foot in both camps
Jo spends a lot of time in NGO services but her office is located in the community SMHS. She reports to a SMHS manager. She says “it feels like she has her feet in both camps but does not fit in anywhere”. She sees the value of having her office where it is as she can have both formal and informal (corridor) conversations with her SMHS colleagues. Jo has worked in the SMHS and has well established relationships with many of the staff. She understands both worlds and is able to confidently work and walk in both worlds.
Her goals are clear:
• to improve people’s experiences when they need to access more than one service
• to increase understanding of the challenges each sector faces
• support NGO sector staff to manage the increased complexities of the people they support.
Leadership support
Building bridges requires changes to happen at a systems level and at a ground level. Strong support from the leadership team enables Jo to develop the role and take the necessary actions to improve SMHS and NGO relationships. Developing high trust relationships with both SMHS and NGO leaders was crucial. “Staff in both camps needed to feel they could trust me to improve things. To speak up when I needed to and to help improve the services a person receives from both SMHS and NGOs.”
The role has both a clinical and an education focus. Working out ways to improve the one-to-one relationships between the key community support worker and the key SMHS workers was essential.
Jo says engaging in regular external supervision is vital to her when considering how to develop the role, and for finding solutions to overcome the barriers and challenges she is unveiling.
Here are some of Jo’s achievements.
• Encouraging people in both ‘camps’ to understand more about how their services work.
• Delivering education to highlight what the NGO sector looks like: the resource challenges they face and how services can work more collaboratively together. Audiences included inpatient staff, new graduate registered nurses, occupational therapists, social workers and registrars.
• Education on numerous topics to NGO staff including mental disorders, medication, depression, anxiety and physical health.
• Co-facilitating risk training to NGO staff to encourage uniformity between SMHS and NGO staff when discussing, describing and reporting risk.
• Facilitating numerous meetings between NGO’s and SMHS staff to develop understanding about individual NGO requirements.
• Assisting a residential NGO in recruiting a registered nurse.
• Developing a ‘transition envelope’ that travels with the service user between their residential NGO and inpatient wards. This improves communication between NGOs and inpatient wards during a person’s stay, and helps in preparation for discharge.
NGO leaders value new role
NGO leaders Rachel Wilson (clinical manager at Hoon Hay House) and Kelly Marra (service manager of housing and recovery at Emerge Aotearoa) see the value in this new role. They are quick to add Jo’s positive personality and professional knowledge are what makes this role work. Jo has taken the time to get to know the support workers and by doing so she understands the issues. She recognises NGO services support people who have many needs and often act in ways that mean they are at risk. Her education sessions have been invaluable. She has helped to improve things such as ‘the paper work systems’ – helping develop plans of care and recovery plans.
Some NGOs employ new registered nurses and Jo is able to provide support in the form of regular coaching sessions. Her ‘can do’ attitude means she can quickly problem solve and always does her best to help the people in our services and those supporting them.
Both NGO leaders agreed that Jo is a shining example of the statement “the person makes the job”. She is committed to making the role work and her many connections with multiple services enables her to navigate well through a system of care that is still learning to work together.
Jo’s next steps for 2017
• Complete my Post Graduate Diploma in Health Science (endorsed in Nursing).
• Continue to expand the support into other NGO providers within Canterbury.
8 Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
NURSE PROFILE
Career pathway – NGO clinical nurse specialist
Jo attended Christchurch Polytechnic and graduated with a Bachelor of Nursing in 2000. She then completed the New Entry to Speciality Practice – Nursing programme at Hillmorton Hospital, Canterbury DHB and upon finishing this worked within the forensic psychiatric inpatient service. Jo then moved to Sydney and completed another new graduate programme in general nursing where she spent time in a surgical ward, palliative care and recovery. In 2003, Jo returned back to Hillmorton Hospital and spent a couple of years working in one of the acute mental health inpatient wards before moving to Melbourne in 2005 where she worked at Albert Rd Private Clinic in an adolescent ward, often as the only nurse.
In 2006 Jo moved to Perth and worked within a private mental health clinic specialising in eating disorders and a post traumatic programme
for war veterans. In 2007 she returned to Christchurch and worked as a psychiatric district nurse. Following this role she assisted in the development and implementation of the brief intervention service within primary care for Pegasus Health until 2011. Jo then returned to the Canterbury DHB to work at the Clozapine clinic which involved both case management and transitioning people back to GP care. In April 2015 she took up her current role of clinical nurse specialist for the NGO sector.
Jo is currently completing her Post Graduate Diploma in Health Science endorsed in Nursing with the intention of completing a Masters’ programme.
If you would like to know more about this exciting new role please feel to email Jo, [email protected].
Successful launch of the national Safe Practice Effective Communication training programme While least restrictive practice is the aim of service delivery for people who are experiencing mental health and addiction problems there are times currently when a restraint may happen. To ensure this only happens as a last resort and with the highest degree of respect, safety and dignity for the person and staff, the Safe Practice Effective Communication (SPEC) training programme was developed.
SPEC was launched last month in Christchurch. The launch was a credit to many people who have worked hard to get to this point with the aim of achieving a national consistency of training that is pain free and prone free wherever possible. The strong emphasis on prevention and therapeutic communication skills and strategies supports inpatient staff to reduce the incidence of restraints. Essentially however, it is about how two human beings interact with each other, and the notion of doing no harm.
SPEC is a training programme for mental health clinicians who work in inpatient units. It is delivered through a ‘train the trainer’ model. DHBs are working in regional alliances to support the development and implementation of the programme.
Kathy Moore (Counties Manukau DHB), Michelle Atkinson and Dean Rangihuna (Canterbury DHB) spoke about delivering this training and the importance and strength of the clinical and service user trainer model. This aspect of training was evident throughout the two days.
Hearing Dean speak was a compelling reminder to us about why we need to do this work, and the need to “maintain the human face in the middle”. There was discussion through the two days around humanity, respect, human rights and the need to ensure service users are involved in all levels of the training.
SPEC is a new initiative in that it is a collaboration between all DHB’s, under the leadership of the National Directors of Mental Health Nursing. The initiative also involves a number of other key stakeholders including service user groups, Māori and Te Pou. These groups will be continuing to work together on the ongoing development and sustainability of the program via a SPEC governance board. The interim board had its first meeting immediately after the launch.
The ongoing focus will be maintaining national consistency and continuing to improve the program with best quality evidence based and innovative practice to reduce restrictive practices and ongoing support for trainer development.
Reflection time
Looking for evidence to reflect on and integrate into your practice then please check out our website, www.tepou.co.nz/initiatives/reducing-seclusion-and-restraint/102
9Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
NURSE PROFILE
Recognising and responding to co-existing problems (CEP) in acute care settings by Ashley Koning , project lead Matua Raki and Suzette Poole, project lead Te Pou o te Whakaaro Nui.
We often hear through our conversations with services that many of the people wanting and needing acute mental health services are experiencing co-existing mental and addiction problems (CEP). This aligns with what the evidence says - at least half of people receiving treatment from mental health services will have a co-existing addiction problem.
The ability of frontline staff to recognise, assess and respond to people with a co-existing addiction problem can greatly assist in reducing anxiety, distress, irritability and agitation and therefore reduce the likelihood of restrictive interventions being used. The focus of this article is on co-existing mental health and substance use problems, in particular alcohol, cannabis and amphetamine-type stimulant use and has been co-developed with Lois Boyd and Carolyn Swanson who co-lead the least restrictive practice programme of work at Te Pou.
Mental health and substance use
People experiencing CEP may have problems with:• depressive symptoms and depression • a brief psychotic episode that resolves after stopping substances• bipolar disorder, social phobia and post-traumatic stress
disorder • positive and active symptoms of psychosis.
Impact
We know people experiencing CEP are likely to have: • more frequent relapses and repeated admissions to hospital• poorer general physical health• financial and housing problems and increased risk of
homelessness• overall a poorer quality of life • greater risk of violence, both as perpetrator and as victim• higher rates of suicide• higher rates of offending• difficulties and tensions in relationships with family and
whānau.
These issues can contribute to problems engaging and remaining engaged in treatment.
Substance use and prescribed medication
The interaction between substances and prescribed medications can result in increased risk, distress and changes in behaviour. Interactions between substances and mental health medication can be discussed with the prescriber or pharmacist. Check for some potential interactions online, for example, at Medscape’s drug interaction checker, http://reference.medscape.com/drug-interactionchecker.
Mental health and alcohol use – key points• Withdrawal triggers anxiety and/or depression.• Alcohol use can be the sole cause of depression in some people
and if they stop drinking, and the withdrawal symptoms resolve, they can recover from depression.
• Use is associated with higher suicide risk.• Use by people with bipolar disorder is associated with higher risks
of suicide, instability of mood and medication non-adherence.• May worsen psychotic symptoms, increase the risk of tardive
dyskinesia and have greater effects on cognition (memory and attention).
Withdrawal symptoms include: risk of seizures (often peaks around 6-12 hours after last use and can be fatal), confusion, disorientation and extreme agitation (often peaks around 36-48 hours after last use).
Recognising signs of recent alcohol use and intoxication
Observing signs of recent alcohol use will inform a co-created plan of care. Signs include: strong smell of alcohol on breath or sweat, slurred speech, repetitive conversation, rapid and repetitive eye movements (nystagmus), flushed skin, irritable and reactive, short term memory loss, disinhibition (disregarding social conventions), impulsivity, poor judgement relating to risk, poor physical co-ordination.
Ashley Koning, project lead,
Matua Raki
10 Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
CEP AND SOLUTIONS UPDATE
11Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
CEP AND SOLUTIONS UPDATE
Recognise and respond to alcohol withdrawal symptoms
Diagram 1: Progress of alcohol withdrawal from time of last drink
Frank, L. and Pead, J. (1995), in (Matua Raki 2012)
Risk of Seizures
Severe Complications (medical emergency)VomitingConfusionDisorientationDehydrationHallucinationsExtreme agitationDelerium tremens
Mild WithdrawalsNauseaTremorSweatingAnxietyDisturbed SleepHypertensionTachycardiaHypothermia
Seve
rity
of s
igns
and
sym
pto
ms
Falli
ng B
lood
Alc
ohol
Lev
el
Time
Hours (over 5 days)
0 6 12 24 36 48 60 72 84 96 108 120
Adapted from NSW Health Detoxification Clinical Practice Guidelines 2000-2003
Mental health and cannabis use – key points• Cannabis use can trigger panic attacks.• Cannabis use by people with bipolar disorder is associated
with higher risks of suicide, mixed mania and medication non-adherence.
• Cannabis use can trigger more frequent episodes of psychosis in people with schizophrenia.
• Cannabis withdrawal can trigger anxiety and depressive symptoms when people who have used on a daily or near daily basis for a significant period stop or reduce use.
• Withdrawal symptoms include: • irritability, restlessness and anxiety, which often peak around
7 days after last use• anger and aggression, which often peak around 14 days after
last use.
Recognising signs of recent cannabis use
These include: bloodshot or heavy-lidded eyes, strong smell of cannabis on clothes and hair, smirking, distractibility, restlessness, poor concentration, irrelevant conversation, paranoid thoughts and behaviour.
Recognise and respond to cannabis withdrawal symptoms
Diagram 2: Progress of cannabis withdrawal
Reproduced with permission from NSW Dept. of Health (2008) in (Matua Raki, 2012).
Anger, Aggression
Irritability, restlessness, anxiety
Insomnia, shakiness, decreased appetite
Seve
rity
of s
igns
and
sym
pto
ms
0 7 14
Days
40
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CEP AND SOLUTIONS UPDATE
Mental health and amphetamine-type stimulant use – key points
Irritability, aggression and perceptual disturbance can be an issue for some people who use amphetamine-type stimulants. When trying to engage with a person you suspect has been using amphetamine-type stimulants, it is important to remember their judgement and perception may be impaired. Do not assume that they will understand your words or actions, as you intend them to be understood.
When supporting a person in this situation speak in a steady quiet manner, actively listen and ask for clarification if you need it, avoid humour and jokes, explain what you are doing and why, use short simple statements and avoid rapid movements towards the person. A low stimulus environment is helpful, if available.
Recognise and respond to amphetamine-type stimulant withdrawal symptoms
Table 3: Common methamphetamine withdrawal symptoms
Common methamphetamine withdrawal symptoms
Days since last use Symptoms
1-3 Days Crash:• exhaustion• many hours asleep• depression
2-10 Days
Common
Very uncommon
Withdrawal:• strong urges to use, cravings• mood swings; tearfulness, anxiety,
irritability, blah, feeling drained• agitation• sleep problems• poor concentration• aches, pains and headaches• diarrhoea, hunger• paranoia• hallucinations
7-28 days Most symptoms settle but most people could still be having:• mood swings• depression• sleep problems• cravings.
One to three months, sometimes much longer
Over time as brain chemistry adjusts• sleep patterns improve• energy levels get better• mood settles
Useful CEP resources and links
Substance Withdrawal Management: guidelines for addiction and allied practitioners (Matua Raki, 2012). www.matuaraki.org.nz/resources/substance-withdrawal-management-guidelines-for-addiction-and-allied-practitioners/373
Interventions and Treatment for Problematic Use of Methamphetamine and Other Amphetamine-Type Stimulants. (Matua Raki, 2010). www.matuaraki.org.nz/resources/interventions-and-treatment-for-problematic-use-of-methamphetamine-and-other-amphetamine-type-stimulants-ats/371
Te Ariari o te Oranga: The Assessment and Management of People with Co-existing Mental Health and Drug Problems (Todd, 2010). www.health.govt.nz/publication/te-ariari-o-te-oranga-assessment-and-management-people-co-existing-mental-health-and-drug-problems
Te Whare o Tiki, Co-Existing Problems knowledge and skills framework. (Matua Raki and Te Pou, 2013). www.matuaraki.org.nz/resources/te-whare-o-tiki-co-existing-problems-knowledge-and-skills-framework/437
The Queensland Network of Alcohol and other Drug Agencies suite of harm reduction resources, http://qnada.org.au/686/alcohol---health-professional-resources
CEP e-learningRecommended for all staff working in mental
health inpatient units, this resource provides
introductory, foundation level information about
co-existing mental health and addiction problems
and other complex needs (CEP).
Visit www.matuaraki.org.nz/initiatives/cep-e-
learning/170 to access the resource.
For further information please feel to check
out the CEP section of the Matua Raki website,
www.matuaraki.org.nz/initiatives/co-existing-
problems/141.
Sourced from P’d off: A guide for people trying to stop using meth/P/Ice/Speed (Matua
Raki, 2010)
Metabolic screening across mental health and primary care services by Candace Bagnall, senior policy analyst, Te Pou o te Whakaaro Nui
1 Laugharne, J., Waterreus, A. J., Castle, D. J., & Dragovic, M. (2016). Screening for the metabolic syndrome in Australia: a national survey of psychiatrists’ attitudes and reported practice in patients prescribed antipsychotic drugs. Australasian Psychiatry, 24(1), 62-66.
A recent study on metabolic screening practice in Australian mental health services1 concluded that it is, in a word, “inadequate”. Of the 955 psychiatrists who responded to the national survey (a 31 per cent response rate), 76 per cent reported that there was no reliable system in place to remind them when to monitor. Unsurprisingly, fewer than half routinely checked weight, fasting glucose or lipids in people who were on antipsychotics, and under 30 per cent checked blood pressure.
In the absence of similar New Zealand research it’s fair to say that we are probably no better at screening people for what’s known as ‘the metabolic syndrome’ (MetS) – a group of risk factors for cardiovascular disease and type 2 diabetes.
Equally Well members have been debating the issue online via Loomio lately, and it seems we have no current national standards or guidance for metabolic screening in mental health and addiction services here. District health boards (DHBs) have been developing their own clinical pathways for this and other areas, but it’s hard to know how many have done this, and whether it’s a priority for mental health services around the country.
Waitematā (WDHB) has been quite proactive over the last decade, especially during the previous couple of years, with a cardio-metabolic screening project led by Equally Well champion Anna Birkenhead getting real traction. Anna shares her experience in shifting organisational culture through system change at WDHB.
It started with an internal policy review, backed at a senior leadership level within the mental health service. The revised policy has been in place for a year now, and has doubled the number of screenings from the previous year. Anna posted the policy recently on Loomio in response to a request and invited others to use or adapt it for their own services.
She is the first to admit that there is still a long way to go, and while many people have elements of screening completed, only about 10 per cent of people are being screened at Waitematā using the cardiovascular disease (CVD) software tool PREDICT, which is being enhanced in functionality for mental health services. WDHB appears to be one of the few mental health services using the tool, which is often used in primary care to assess cardiovascular risk. A regional CVD tool is also being developed, led by Health Alliance.
Cardio-metabolic screening has been part of Anna’s professional life for many years. Since qualifying as a comprehensive (NZCpN) nurse
in 1990, she has been working in various mental health clinical roles with much time spent as a crisis team clinician, as well as in leadership roles – coordinator and team manager. Anna’s interest and passion in her current role developed when she was a clinic nurse for metabolic screening two years ago. She saw first-hand the significant difference that could be made to people’s lives, with ordinary approaches such as healthy lifestyle education and support. “Nearly every person I saw was interested and engaged in the process, and as a result, motivated to make positive change,” she said. Healthy lifestyle and CVD risk mitigation is relevant to everyone, but especially to people who use mental health services who have significant additional risk overall.
Supporting people to engage in primary care, is also important. “One other positive benefit I noticed was the interaction in a physical health setting seemed to be more comfortable for people who use our service. Many talked about other (important) aspects of their lives and health as a result,” Anna said.
The 2014 Equally Well summit was timely for Anna. She reflected again on the importance of improving the physical health of people at Waitematā, and was vocal in expressing concerns about how well WDHB mental health services were doing. Director of mental health, Dr Murray Patton, and then regional manager Helen Wood decided they would set up a project to improve their performance in cardio-metabolic screening, and Anna was appointed into the role on a half-time basis.
Her first task was to stocktake what was working and what wasn’t. She discovered screening numbers had been declining in the two to three years prior. This was disappointing, since draft policy had been in place since 2005 and screening started around then, initially with a small project involving Waitematā primary health organisation (PHO) and the University of Auckland. Following the stocktake, the policy was finalised and an implementation plan was put in place. This involved screening of all adults admitted to the service on entry if they had not been screened during the previous 12 months in primary care.
“We want clinicians to be supporting people to overcome barriers and engage with primary care,” Anna explains. For some people it’s difficult or impossible to get to primary health at that time, so they continue to be screened annually by mental health services until they can do so. “The idea is that every year an electronic reminder in our clinical record pops up, indicating the person is due for screening, so either we do it or they do it in primary care. We need to know what their
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EQUALLY WELL
CVD risk is so we can help support them mitigate the risk and understand how best to deliver treatment.”
The policy provides a clear summary of best practice including visuals explaining the screening pathways. It’s complemented by related guidance such as prescribing psychotropic medication, and use of metformin (for pre-diabetes), all in the same place on Waitematā DHB’s intranet. Guidance and professional support has also been made available for mental health staff on how to interpret and respond to electro-cardiograms (ECGs).
Training for 135 nurses has been undertaken, with plans for additional workforce development well under way. A “very streamlined and basic training package” has been developed which includes a section on educating people about lifestyle changes.
There is now an Equally Well champion group – including over 20 nurses across forensic and adult mental health services. At Waitematā this has resulted in the merge of smokefree and cardio-metabolic screening services. Three-monthly auditing will be part of new care standards so cardio-metabolic screening will be built into the system.
As part of the project, Anna managed a small point of care testing (POCT) pilot in the largely rural Rodney district. A portable device was used that enables a full lipid profile and HbA1c to be completed in 11 minutes using a finger prick blood test with no need for fasting or visiting a lab. Ten people considered to be at risk of metabolic syndrome or cardiovascular disease were offered the service, and encouraged to have their weight and blood pressure taken at the same time. The results were impressive and as a result the approach may be extended. Clinicians found that POCT enabled health education to be undertaken, where there would not otherwise have been an opportunity. The majority of people responded positively in terms of engaging in further follow-up or service.
Anna is clear the culture of the organisation and its core business has shifted. “We have to be clever and work smarter to get it done,” she says. “In the face of heavy caseloads and emergencies, people need to see the importance of physical health and understand the evidence about how intervening in lifestyle can reduce risk. It can be quite profound and motivating.”
Master’s Thesis AbstractAttitudes and beliefs of mental health nurses towards metabolic screening by Shivika Singh
Background
Metabolic syndrome is a combination of medical conditions that increases the risk of developing type 2 diabetes and cardiovascular disease. It is a globally prevalent and relatively common issue across all mental health diagnoses. Metabolic syndrome is further exacerbated due to prescription of second generation antipsychotic medications. Second generation antipsychotic medications provide significant benefits in reducing psychotic symptoms; however they are also linked with metabolic syndrome because atypical antipsychotics are associated with significant weight gain and increased appetite. People with metabolic syndrome are 2-3 times more at risk of having a heart attack or stroke and five times more likely to develop type 2 diabetes. Mental health nurses can play an important role in prevention of metabolic syndrome by increasing their knowledge of the syndrome and closely monitoring the person’s physical health.
Aims
To explore the level of knowledge of mental health nurses about metabolic syndrome, educational requirements for nurses to fully inform people of the risks of developing the syndrome and potential barriers that hinder nurses from addressing the risk of metabolic syndrome.
Methods
Quantitative data was collected by distributing a short questionnaire to a convenience sample of mental health nurses in inpatient units and community mental health centres in a DHB in Auckland. The identity of each participant was safeguarded by having an intermediary in each service. The intermediaries were nurse educators, charge nurses and team leaders in the respective areas. The completed survey questionnaires were returned by the intermediaries, who reported experiencing some difficulties getting the questionnaire completed. The intermediaries reminded the participants in some areas while other areas attached the questionnaires to nurses’ time sheets making it
Candace Bagnall, senior policy analyst, Te Pou o te Whakaaro Nui
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NURSING RESEARCH
more accessible for them. The completed survey questionnaire results were directly entered as raw data into a database using the Statistical Packages for Social Science (SPSS) version 20 programme.
Approval to conduct the research was sought and granted by University of Auckland Human Participants Ethics Committee, the National Health and Disabilities Ethics Committee and the district health board research office.
Findings
As evidenced by the results of this study, the participants who completed the survey questionnaire were able to make the link to increased mortality and morbidity and understood the importance of screening for metabolic syndrome. This supported the research hypothesis that all mental health nurses know what metabolic syndrome is and that antipsychotics and other medications can lead to people developing the syndrome. The results showed there was considerable variance amongst the responses from the participants.
Overall there was evidence of both positive and negative attitudes towards screening for metabolic syndrome. There was no major attitudinal difference between staff who had attained Bachelor of Nursing or were hospital trained or those who had a higher qualification. There was no major difference between the number of years participants have worked in mental health and the attitudes for the participants.
Some of the themes that emerged from the qualitative data contradicted findings from the quantitative data. This included nurses indicating that time was a barrier when the quantitative data did not indicate lack of time. Some nurses in the qualitative data suggested it was the person’s responsibility to manage their physical health. However, other findings supported results such as higher case load, not being confident with providing physical health treatment and advice and not having ample skills to perform screening were barriers.
This highlights the issue of the value and validity of the self-reported surveys on attitudes. The context of work environment and lack of ongoing education have an impact on metabolic screening. Ongoing education challenges negative attitudes amongst mental health nurses. Perceived barriers such as self-doubt, not having sufficient knowledge and skills to carry out metabolic screening can also be challenged by education that involves practicing these skills.
This study highlights nurses in inpatient units as well as community mental health centres believed metabolic screening was an important part of their role. The results have also indicated not all nurses believe that time is a barrier for them.
Key barriers to the implementation of metabolic screening in psychiatric settings include unclear responsibilities, competing demands on limited resources and liability issues. Ongoing education appears to be the key factor in challenging and changing negative attitudes. The results have clearly indicated a need for further education on the topic and
some skills training. Implementation of guidelines and policies may resolve the issue of not screening adequately.
Conclusion
This research has highlighted the crucial role of nurses in the identification, prevention and management of metabolic syndrome in people accessing mental health services. The nurses’ knowledge, skills, attitudes and their relationship with people allows for the opportunity to ensure ongoing regular physical health screening. I am hopeful that registered mental health nurses will find the findings and recommendations of this research useful in their practice as it has the potential to improve nursing practice and improve outcomes for a high risk population. Mental health nurses may recognise challenges and barriers that are similar to their work environment and be able to address these. There is also a need to undertake a qualitative study for further analysis of data to explore in detail the factors which influence the attitudes and beliefs of nurses. This will include ensuring nurses are aware of the different guidelines that exist within the DHBs for metabolic screening, such as physical health policies and guidelines. Also to raise awareness for nurses where there are gaps identified in practice settings and the recommendations to allow different work areas to develop some guidelines to work to.
Recommendations
In light of these findings I would recommend the following to ensure adequate screening and monitoring of metabolic syndrome in inpatient and community mental health settings.• Regular audits of current practice around metabolic screening
within the services.• Addition of prompting and monitoring tools within the electronic
clinical file system.• Training and education for all team members, not limited to
registered mental health nurses.• Periodic evaluation of protocols in place with contribution from
all members of the multidisciplinary team.• Having adequate reporting and handover systems within the
services.• Policy development in relation to ongoing monitoring and
screening.• Further research to determine how positive and negative attitudes
are linked to the quality of health care and outcomes for people with metabolic syndrome.
References available on request, please contact [email protected].
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NURSING RESEARCH
Equally Well wins top prize at the 4th World Congress on Integrated CareEqually Well, a New Zealand collaborative initiative to improve physical health for people experiencing mental health and/or addiction issues, was the topic of a presentation that won the International Foundation for Integrated Care (IFIC) Best Paper Award at the 4th World Congress on Integrated Care, last week in Wellington.
The Congress, opened by Health Minister, Dr Jonathan Coleman, brought together people working across the health care sectors from all over the world to exchange knowledge, experience and new ideas in the design and delivery of integrated health and social care, with over 150 papers presented over three days.
The top prize winning paper, “Equally Well – together we are making a difference” was based on the unique New Zealand initiative, Equally Well. Presented by Helen Lockett, from the Wise Group, the paper was written in partnership with Te Pou o te Whakaaro Nui, Platform Trust and the Royal New Zealand College of General Practitioners.
The presentation highlighted the ‘wicked issues’ in respect to physical health faced by people who experience mental health and addiction, and shared some of the best practice initiatives being undertaken in New Zealand, particularly around integrated care between specialist mental health and addiction services and primary care and how policy and strategy has been affected by the work of the Equally Well collaborative. “At the end of the presentation I challenged people to do at least one thing that day, such as endorsing the consensus position paper, raising awareness amongst peers, or changing the way they practice to recognise the physical health of people who experience mental health or addiction issues” said Helen.
Robyn Shearer, chief executive of Te Pou o Te Whakaaro Nui said, “We were really pleased to have the opportunity to highlight the health disparities of those experiencing mental health and addiction issues. To be announced as winners of the IFIC award is recognition of the great work of the more than 90 organisations that make up the Equally Well collaborative, and shows the wider health sector is taking these issues seriously”.
“A stellar example of how people-centred integrated care should look like.”
A scientific committee made up of international experts worldwide reviewed all the submitted papers and developed a shortlist for the award prior to the conference. The best paper was then chosen based on feedback from delegates after the presentation.
IFIC’s Head of the Integrated Care Academy, Dr Viktoria Stein said “the abstract and presentation ticked all the boxes in terms of the selection criteria for the Best Paper Award (quality of content/methodology, innovativeness, impact/relevance for integrated care, quality of presentation), but more importantly in terms of the key enablers and levels, which need to be addressed in order to create sustainable integrated care. The initiative managed to engage stakeholders from all sectors, including for example, housing, pharmacists, GPs, and across all levels, from system to local, in order to deliver holistic care to a group of people usually left out. Providing person-centred care for people with addiction and mental health issues, agreeing on a national strategy and then supporting bottom-up activities to co-design appropriate solutions in partnership with the clients and communities is a stellar example of how people-centred integrated care should look like.”
World Congress on Integrated Care
The Congress was convened by The International Foundation of Integrated Care (IFIC), in partnership with General Practice New Zealand (GPNZ), Health Quality and Safety Commission (HCQSC) and the Ministry of Health and was opened by the Health Minister, Dr Jonathan Coleman and closed by Minister Bill English.
Check out the winning presentation online, www.tepou.co.nz/resources/equally-well-presentation-to-4th-world-congress-on-integrated-care/767
Looking for a professional goal for 2017?
We encourage all our readers to do at least one thing to develop practices that recognise the physical health of people who experience mental health or addiction issues. We would be delighted to hear about your achievements.
Just imagine if every nurse working in mental health and addiction services made one practice change!
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EQUALLY WELL
Let’s get talking toolkit launchby Tina Earl, clinical lead, Te Pou o te Whakaaro Nui
Te Pou o te Whakaaro Nui is excited to announce the launch of the Let’s get talking toolkit. Three years in the making, the Let’s get talking toolkit is a suite of tools to support health services to deliver effective talking therapies for mental health and addiction.
To celebrate this milestone Te Pou hosted a successful launch event in October.
What’s in the toolkit?
Let’s get talking toolkit is a set of seven tools, available at www.tepou.co.nz/letsgettalking.
The Let’s get talking toolkit was developed in response to calls for better access to effective talking therapies from practitioners and people experiencing mental health and addiction issues.
Te Pou built on its previous work with talking therapies such as research from Talking Therapies: where to next? and the series of talking therapies guides for mental health and addiction, as well as on the strong international evidence base for the effectiveness of talking therapies.
This initiative also aligns with Rising to the Challenge, the Ministry of Health’s Mental Health and Addiction Service Development Plan 2012–2017, which encourages services to introduce a stepped care approach to meeting mental health and addiction needs. It was great to have Dr John Crawshaw, chief advisor and director of mental health at the Ministry of Health, in the audience to show his support for the toolkit and talking therapies.
Stepped care aims to match the right type and level of therapy to a person, to help them achieve the best health gain. It aims to optimise the effectiveness and cost-effectiveness of therapy.
The Let’s get talking toolkit enables services and health practitioners to plan and deliver talking therapies using a stepped care approach to promote:
• easier and fair access to therapies, particularly for high need populations and cultural groups
• efficiently delivering therapies to meet people’s needs
• effectively practising evidence based therapies
• evaluating therapy interventions to support best outcomes
• optimising a skilled workforce mix.
Services and practitioners can use the toolkit to help determine which talking therapies are best for the people they work with, plus what knowledge and skills are needed to deliver these. Increased access to talking therapies is supported by a trained and skilled workforce across all health professions.
Nurses are a key part of this workforce in both secondary DHB sector and in primary care GP practices and NGOs. They play an increasing role in the provision of therapy interventions for mental health and addiction problems.
“Earlier intervention in the community, through talking therapies, is part of a stepped care approach that will reduce health care costs for New Zealand. It also reflects the sector’s move from a primarily treatment focused system, to more recovery oriented system,” said Robyn Shearer, chief executive of Te Pou.
Talking therapies and the stepped care model are now underway in many DHB secondary services, and future work will see this expand into the primary care sector where there is a high need for early and brief interventions. Guest speaker at the launch, Dr David Codyre, psychiatrist working in primary care further supported the high need for effective evidence based therapies for mental health and addiction issues.
In response to requests from general practitioners (GPs) for an easy to use tool to support brief interventions, Te Pou is trialling the BIR (brief intervention resource). This can be readily used by GPs and practice nurses working with people who are experiencing early signs of mental health or addiction challenges.
Maurein Betts and Petite Nathan from Manaia PHO in Northland shared their experience of trialling the BIR in rural GP practices. They found it enabled nurses to “have a deeper conversation with people that went beyond the sore leg or other physical complaint,” and discovered that intervening early really does make a difference for people.
Where to next?
The next phase of Let’s get talking is to encourage and support services and practitioners to use the toolkit to implement talking therapies as a core part of service delivery and to use the stepped care approach as a robust co-ordinated model across sectors. This will provide more treatment options, for much better outcomes for people who access mental health and addiction services anywhere along the health continuum.
Tina Earl, Te Pou talking therapies lead, is excited to see the work come to life. “Completing the toolkit is a personal highlight for me and I’m looking forward to promoting the use of the tools in health.”
Get in touch
We would like to hear what is happening in your service to promote effective talking therapy delivery and stepped care. Get in touch with Tina by email, [email protected]
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TALKING THERAPIES
Mental health, addiction and disability advisory group updateThe Mental Health, Addiction and Disability Advisory Group (MHADAG) has made steady progress this year in ensuring that the Care Capacity Demand Management Programme’s staffing methodology is appropriate for New Zealand DHB mental health wards/units.
What the Safe Staffing Healthy Workplaces Unit found in their engagement with the sector is there can be challenges in capturing the therapeutic intent of many activities within the patient acuity tool. In the mental health setting where there is less focus on tasks and procedures than in medical and surgical settings, the work activity is not always visible. This is particularly so for work that contributes to maintaining a therapeutic environment that is safe for people and staff.
Within inpatient mental health settings, changes that impact on clinical practices, such as reducing the use of seclusion and restraint, has an effect on staffing requirements. This needs to be reflected when determining staffing numbers and the skill mix required.
The staffing methodology seeks to address this need through its dual components – work analysis and FTE calculation. Combined, these components enable a ward/unit to work out how many staff are normally needed and what numbers and skill mix are required to meet needs.
The work analysis has been fully reviewed by the MHADAG and the
amendments will be built into the Safe Staffing Healthy Workplaces Unit new staffing methodology software.
TrendCare is the primary patient acuity system used by DHBs and as such, much effort has gone into improving the quality of the data through promoting standardisation and consistent use. Trust in the system is a crucial element of its use and data accuracy. Several DHBs have undertaken TrendCare timing studies within their inpatient acute adult mental health units, and participation in this process has been key for ensuring that the patient type category times are reflective of the New Zealand context.
In order for a ward/unit to run a reliable FTE calculation, the data from the patient acuity system needs to be accurate. To support this, the MHADAG has developed a national TrendCare user guideline for the mental health, addiction and disability sector. This will support accurate and consistent use of the patient acuity system, through standardisation of components such as reasons for 1:1 care hours.
Having the right number of staff, who are appropriately skilled for the needs of that shift will promote a work environment that is therapeutic, safe and conducive to people and staff.
If you would like further information please contact Huia Swanson, secretariat for the MHADAG – [email protected].
18 Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
CCDM UPDATE
The ability and skill to purposefully pause and consider is not always easy, but it makes for great leaders. Taking the time to understand your role both personally and professionally, and the services you provide, can be both discouraging and enlightening, but is vital. This workshop will teach you how to pause using currently renowned best practice, and allow you to directly focus on a contribution to the wider sector that will both inspire and challenge.
Remember how excited you were as a child when your imagination meant that nothing was impossible? When rules were made up as you went along and you confidently tackled the greatest of battles without blinking an eyelid? This workshop will focus on regaining confidence in risk, innovation and trying new ways of working. You will learn methods to excite your team, introduce innovation and encourage thinking outside the square, and provide solutions to major sector issues along the way.
The sector is filled with best practice models and constantly changing focus based on national and international trends. Knowing how to navigate your way through these, and choose what it most relevant for you, is an issue all services face. Clinical governance, distributive leadership, collaborative practice, service integration… how do you attend to them all? This workshop will help you to learn how to distinguish the needs of your workplace with the best practice on offer, and help you to choose wisely in how your time as a service is spent.
PausePractice
Play
2017 Blueprint Leadership Series – Hamilton Worried you’re so busy being a manager that you’re not being a leader? Do you want to know how to be a leader in an environment that is time poor and task rich? Are you struggling to focus on and use your leadership abilities? Believe that you have more to give, but no time to give it?
The new Blueprint Leadership Series will allow you to leave every workshop with the skills you need to make a difference to yourself, your workplace and the wider sector. This leadership series will focus on removing barriers to reflective practice, increase your own knowledge about your own leadership abilities and challenge your day to day practice as a leader using reflection and innovation to bring about change.
For more information and application forms please visit the Blueprint website, www.blueprint.co.nz/learning/leadership or contact Sonja Eriksen on 04 381 6387 or [email protected].
TheMHS Summer forum: Choice and control – Personalising the mental health system23-24 February, 2017 | The Mercure, Sydney, Australia
The 19th TheMHS summer forum will guide, challenge and inspire you.
The drive towards a person centred mental health system changes many things - most critically the way that the system reacts to people's needs. How do we respond without losing sight of the individuals and communities in our system - clinicians, workers, consumers, managers, families and carers?
Challenged by concepts like "flexible funding", "self-directed support", "stepped care" and personalised packages", the summer forum will identify how mental health systems can achieve real citizenship for consumers.
Find out more on the TheMHS website, www.themhs.org.
19Mental Health and Addiction Nursing Newsletter - Issue 37 - December 2016
TRAINING AND EVENTS
Meri Kirihimeteand Season's Greetings from the team at
Mental Health and Addiction Nursing Newsletter
- Issue 37 - Dec 2016