mental health & wellbeing outcome framework · mental health & wellbeing outcome framework...

Mental Health &

Wellbeing

Outcome Framework Work in progress – for discussion only at Reference and

Steering Group

1

Results for

people in New

Zealand

2

You can’t be

sure you will all

end up in the

same place

Creating a

unifying tool

Our Approach

“Our methodology

is designed to

reveal the

strengths and

wisdom that exist

within the system

whilst creating

spaces for new

things.”

3

Information as a flashlight4

Turning

information into

intelligence

Create a

shared

performance

storyCreating

evidence about

what works

Summarised overview of

development to date5

6

‘He Tangata’

Everyone in New Zealand is thriving

‘Reducing the impact of mental distress, illness and addiction

contributing to people in New Zealand to participate in their

community ensuring equity and improved life outcomes’

Macro target populations

Life stage and cultural identity

Attribute clusters

Cluster Cluster Cluster Cluster Cluster Cluster



Healthy, safe and secure

homes

Security of tenure

Healthy homes

Safe homes

Quality residential care

Financial security

Income security

Financial stressors

Living in hardship

Employment, education & participation

Paid & unpaid work

Education & training

Social, cultural and

spiritual connection

Friends & social networks

Cultural connection

Spiritual wellbeing

Wellbeing and respect

Reported wellbeing

Stigma, discrimination &

racism

Mental distress, illness & addiction

Suicide & self harm

Mental health

Mental health & LTC

Physical health

Physical health

Hazardous behaviour

Life expectancy

Outcome

Goal

Key result

areas

Population

groups

Services and activities for population groups

Structural measures

Process measures

Impact measures

Service

activity

The outcome framework

The Goal – the reason for creating this outcome framework

The ‘Quality of Life Outcome’

The key result areas that matter to achieve the goal

The indicators in each result area that measure success

The target populations so we can create equity and support the right people

Activities matrix – to organise existing service interventions and plan for new ones

Service performance measures to ensure we measure the things that matter

7

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W/shop 2

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Definition for a health and

wellbeing outcome

framework8

Scope and definition9

Incorporation of the health promotion and prevention strategies

Mental distress and mental illness – the medicalisation

Tangata whaiora – people seeking wellbeing.

Protect - to defend or guard

Promote mental health and wellbeing for people in New

Zealand

Prevent the onset and development of mental distress, illness &

addiction

Protect life outcomes for tangata whaiora

Protect the well-being of family, friends & whanau of tangata

whaiora

Social

Equity of

outcome

Social & Economic

Policy Setting

Personal &

Community

Factors

Participation &

Contribution

Housing

Education

Health services

Alcohol& drug policy

DebtRacism

Dysfunctional family life

Social isolation

Failing education

Child incare

Pregnancy

Communityresources

LGBT

Discrimi-nation

Parents unwell or addicted

GenderEmployment

Poverty

Welfaresupport

WorkTraining

Poor healthDisability

Aged care

Mental Health Act

Strategic Alignment Framework

The proposed Goal and the Outcome11

‘He Tangata’


‘Reducing the impact of mental distress, illness and

addiction contributing to people in New Zealand

being able to participate in their community,

ensuring equity and improving life outcomes’

Key result areas for

populations12

Organise the:

population level indicators of the

outcome

the focus of interventions for target

population groups

Key result areas

Healthy, safe and secure homes

Financial security


Social, cultural and spiritual connection


Physical health


13

Healthy, safe and secure homes

Security of tenure

• Emergency housing support required

• Lengths of tenancy/Home ownership

• Homelessness and temporary accommodation

Healthy homes

• Levels of crowding

• Quality of homes - star rating

Safe Homes

• Interpersonal violence and domestic assaults

• Reported child abuse


• CYF care

• Prisons

• Residential care

14

Financial security and living standards15

Income enables

• Individual income levels

• Household income levels

• Benefit & subsidy utilisation & time on benefit

Financial stresses

• Households able to meet every day needs

• People requiring emergency assistance grant

• Sources of debt greater than 3

Hardship measures

• Living in hardship (ELSI metrics)

• Ability to meet bills

• Proportion of children living in a household dependent on a main benefit

Education, employment and

participation16

Meaningful work

• Working age people in employment

• Households with at least one person employed

• Volunteering and whanau support

Education/Training

• Children leave school able to read and write – national standards

• 18 year-olds with NCEA Level 2, Level 3

• Literacy and numeracy rates at Level 2 or above

• Qualifications at level 5-7 in the working age population

Healthy work environments

• To be developed

Social, cultural and spiritual connection17

Family, friend and whanau networks

• Access to support

• Participation in social networks

Cultural connection

• Language skills

• Cultural participation & support

Spirituality

• Yet to be determined

Wellbeing & respect

Reported wellbeing

• National health survey

• Self reported wellbeing

Suicide and self harm

• Suicide rate

• Self harm /suicide behaviour rate

Stigma, discrimination and racism

• Knowledge in community

• Experience of discrimination

18

Physical health19

Physical health

• People within each household with average or above physical health self-rating overall life satisfaction

• People with good/very good/excellent health rating

• Reported levels of physical activity and nutrition

• Obesity rates

• Smoking rates

• Incidence of long term conditions

Life expectancy

• Low prevalence (serious) mental health conditions

• High prevalence mental health conditions

Mental distress, illness and addiction

Mental distress, illness and addiction

• Incidents and rates of illness and addiction

• Compulsory treatment orders?

Mental health of those with long term conditions & disability

• Incidence of mental distress, illness and addiction

Hazardous behaviour

• Drug & alcohol misuse

20

Knowing the

peopleDeveloping target populations

21

Population Filters22

Major target population segments

• These are the four groups linked to the purpose of the outcome framework

Life course and cultural identity

• Within the target populations life course, and cultural identity influence the distribution of need within the target populations

Clusters of attributes

• These are the social determinants and personal stressors that can cluster in groups of people generating greater challenges to

resilience


People experiencing challenges to

their wellbeing.

Family, friends and whanau of tangata whaiora.

People who are

experiencing ill-health and, or addictions.

23

People with

challenges to

wellbeing

Tangata

Whaiora

Family, friends

and whanau

All people in New Zealand

Life course and cultural identity

Families with young

children

Children Tamariki

Young adults

Rangatahi

Adults Pākeke

Older adults

Kaumatua

24

Māori

Pacific Island

Asian

European

Other

Inclusion of children

as a life course group

Ethnicities can

be sub-setted

Locality

Geocoding

quality

Attribute clusters25

Attribute clusters that create

challenges to wellbeing

Examples of attributes only

Experiencing distress

Social determinantsIsolation

Low incomeEducation levels

Housing stressCrowding

Discrimination

Individual stressorsAdverse childhood

events

Poor health

Death of a

loved one

Relationship

breakdown

Job loss

Trauma RefugeePersonal debt

Representing populations26

Tangata whaioraTangata

whaiora

Challenges to

wellbeing

All people

in New Zealand

Family, friends and whānau

Young adultsRangatahi

AdultsPākeke

ChildrenTamariki

Whānau with

tamariki

Older adultsKaumatua

Cultural identity

within each wedge

Population GroupsHow we find target groups

27

Why segment our populations

To understand who we are planning service / Are we designing services that:

• Contribute to the outcome

• Provide population coverage

• Change the result

To measure population indicators to know that it works creating knowledge about

• Life outcomes for people

• The impact services may be having on these key result areas

• The gaps and opportunities in service delivery

28

Tangata WhaioraThese populations are likely to be service users, or

should be service users.

29

Who are the clusters of

people we are planning

services for in addiction?30

Tangata Whaiora development

•Chronic poor health

•Alcohol and drug addictions

•High prevalence and low need conditions also known as the ‘Big 5’

•Low prevalence and high need conditions

•Forensic youth

•Youth with emerging mental ill-health & addictions

•Youth with early onset low prevalence disorders

•Forensic adults

•Drug & alcohol addictions

•Co-morbid with chronic and serious ill health

•Low prevalence and high need conditions

•High prevalence and low need conditions also known as the ‘Big 5’

•Pregnancy related

•Child related with emergent conditions

•Infant and child attachment

•Child with high prevalence disorders

Families with

young children

Adults Pakeke

Older adults

Kaumatua

Young adults

Rangatahi

31

Populations with

Challenges to Wellbeing32

Who are the clusters of

people we understand are

at greater risk of addiction?33

Challenges to wellbeing34

Organising and

understanding activities and

servicesThinking about activities and services

35

Key concepts36

The activity matrices are for clearly defined people groups within a cluster:

Challenges to wellbeing

Tangata whaiora

Family, friends and whanau

Activities could be supplied by anyone:

Other Agencies

DHBs

NGOs/PHOs

Community organisations

Information (natural) supports

It is all about contribution not attribution

Is it likely to contribute to the key result area

At what level do interventions occur

Interventions designed to work with the individual and their whanau

Interventions for social groupsthat individuals may be connected

Interventions that occur within community / hāpu that people live

The whole of society / Iwiinterventions such as policy or public health strategies

37

Quit

smoking

services

Smokefree

sports

sponsorship

Smokefree

public

spaces

Cigarette

tax

Service activity matrix38

Healthy, safe

& secure

homes

Financial

security

Participation

in society

Social &

cultural

connection

Physical

health

Mental health

Individual & whanau

Social groups

Community

& Hapu

Society & Iwi

For a population group e.g. Maori Rangatahi engaged with justice

The matrix is

populated by services

and activities

designed to

contribute to the ley

result area for target

populations

Service performance measurement

Structural measures

Inputs

Competence & compliance

Process measures

Evidence markers

Quality & completion

Impact measures

Change in circumstance

People impact

Coverage

Change of circumstance

Person/community experience

39

Service performance measurement

Nationwide consistent service performance measurement requires:

Consistent service description

Consistent service performance measurement

Know the target population

Understand eligibility

Consider coverage

Stream-lined contracting requires

Agreement on service user population

Agreement on service purpose

Contribution to key result areas

Performance measurement

How much?

How well?

Did it work?

40

41

‘He Tangata’


‘Reducing the impact of mental distress, illness and addiction

contributing to people in New Zealand to participate in their

community ensuring equity and improved life outcomes’


Life stage and cultural identity

Attribute clusters




Healthy, safe and secure

homes

Security of tenure

Healthy homes

Safe homes


Financial security

Income security

Financial stressors

Living in hardship


Paid & unpaid work

Education & training

Social, cultural and

spiritual connection

Friends & social networks

Cultural connection

Spiritual wellbeing


Reported wellbeing

Stigma, discrimination &

racism


Suicide & self harm

Mental health

Mental health & LTC

Physical health

Physical health

Hazardous behaviour

Life expectancy

Outcome

Goal

Key result

areas

Population

groups

Services and activities for population groups

Structural measures

Process measures

Impact measures

Service

activity

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