Taking our pulse survey 2019 November 2019

www.tepou.co.nz/equallywell @EquallyW

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Acknowledgements We would like to thank everyone who took the time to fill out the survey.

This report has been written by Te Pou o te Whakaaro Nui (Te Pou). The authors include Talya Postelnik, Dr Angela Jury and Dr Helen Lockett. Input and review was provided by Equally Well backbone team members Wendy Donaldson, Ashley Koning, Rachel Kapeli, Paulien Fa'atafa and Reena Kainamu.

Contact Rachel Kapeli (Equally Well backbone team coordinator, rachel.kapeli@tepou.co.nz) for more information about Equally Well, if you’d like to share resources or initiatives, or be connected with others.

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Published in November 2019 by Te Pou o te Whakaaro Nui.

ISBN: 978-1-98-855134-0

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

Email: info@tepou.co.nz

Website: www.tepou.co.nz

Te Pou o te Whakaaro Nui is a national centre of evidence-based workforce development for the mental health, addiction and disability sectors in New Zealand.

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Contents

Acknowledgements ........................................................................................................................................................................ 2

Summary ............................................................................................................................................................................................ 5

Introduction ...................................................................................................................................................................................... 8

Results ................................................................................................................................................................................................. 9

Who took part in the survey? ........................................................................................................................................................................ 9

What is happening?........................................................................................................................................................................................ 11 Identifying and providing support to help manage physical health issues.................................................................... 12 Supporting people to improve their physical health by reducing risk factors ............................................................. 15 Increasing people’s access to primary care services ................................................................................................................ 16 Working together with others to achieve physical health equity ...................................................................................... 16 Enhancing workforce capability & capacity ................................................................................................................................. 17

Taking action at an organisational level – Equally Well action plans ...................................................................................... 18

Planned actions ............................................................................................................................................................................................... 19

The identified challenges ............................................................................................................................................................................. 20

How can the Equally Well collaborative use these findings? ....................................................................................... 21

What this survey tells us about Equally Well in Aotearoa New Zealand .................................................................................. 21

Implications for all of us ............................................................................................................................................................................... 21

Conclusion .......................................................................................................................................................................................................... 22

Appendices ..................................................................................................................................................................................... 23

Appendix A: Framework for collaborative action .............................................................................................................................. 23

Appendix B: Equally Well development overview .............................................................................................................................. 24

Appendix C: Methodology ............................................................................................................................................................................ 25

Appendix D: Comparison with the 2015 Taking our pulse survey .............................................................................................. 27

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Summary

Introduction

Equally Well is a nationwide collaborative of people and organisations taking action in various ways and at different levels of the health and health-related systems to achieve physical health equity for people who experience mental health and addiction issues. Equally Well is about taking initiative and working together for change.

Project aim

The Taking our pulse 2019 survey was undertaken to provide a snapshot of Equally Well initiatives over the last 12 months in Aotearoa New Zealand. The survey is not an evaluation of the Equally Well collaborative. The survey findings will help to share initiatives and learnings, facilitate collaborations, and can also provide inspiration for people and organisations facing implementation issues.

Results

Who took part in the survey?

In total, 174 people responded to the survey. Of these, 76 people provided information about their role, sector and organisation. These 76 people represented organisations and services from around New Zealand in 15 out of 20 district health board (DHB) areas.

Most people were working in the mental health and addiction sectors (70 per cent and 41 per cent respectively – more than one sector could be chosen). Just over one-third of people worked for non-government organisations (NGOs, 38 per cent), another third for district health boards (37 per cent) and 20 per cent for primary health organisations (PHOs). Almost one-third of people were health practitioners (30 per cent), 21 per cent were managers, and 16 per cent were educators or trainers. A range of people in other roles took part in the survey, including medical professionals (eg GPs), project leads, pharmacists and peer support workers.

What is happening?

Actions in the last 12 months There were 140 responses providing one or more examples of actions undertaken in the past year to achieve physical health equity. It was great to see a wide range of actions across the country that align with Equally Well goals. Initiatives mainly focussed on:

• identifying and providing support to help manage physical health issues (eg routine physical health checks and metabolic monitoring, developing screening tools and resources, and providing physical health information tailored to people and whānau)

• supporting people to improve their physical health by reducing risk factors (eg supporting smoking cessation, helping with diet and exercise, supporting or funding dentist visits, and offering support to have a safe affordable home and stable employment)

• increasing people’s access to primary care services (eg funding GP visits or offering extended consultations)

• working together with others to achieve physical health equity (eg collaborative or working groups, or shared care arrangements between specialist and primary care teams)

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• enhancing workforce capability and capacity (eg education and training sessions on Equally Well for health professionals and students, developing tools for the health workforce, and recruiting dedicated new roles to work within mental health and addiction services, such as dietitians).

Taking action at an organisational level Fourty-three of the 174 people who responded said their organisation had an Equally Well action plan. Additionally, some people were currently developing a plan, or were planning to soon.

Planned actions Almost one-quarter of people who responded (38 people, 22 per cent) reported planning at least one future initiative. Planned initiatives reflected a range of areas including screening and monitoring, supporting people to improve their physical health, wider collaborations and workforce development.

The identified challenges

Some challenges that emerged for implementing Equally Well initiatives included a lack of resources such as time, people or money, or workplace support. Some examples reinforced the need for good organisational change management and leadership support of Equally Well to support individual champions and get health practitioners on board with screening for physical health issues. The challenges also reflected the recognition of the time commitment and other resources required for some initiatives. Throughout the survey there were examples of how some people or organisations had overcome certain challenges.

How can the Equally Well collaborative use these findings?

What this survey tells us about Equally Well in Aotearoa New Zealand

This survey tells us the Equally Well movement is active and enthusiastic in pursuing physical health equity. A wide range of activities were captured taking place in different locations and organisations, and across different roles and sectors. Many initiatives have been embedded into usual practice. It is clear there is a strong network of individuals that are active in creating change.

The survey also highlighted that among the great work, the Equally Well movement is a work in progress and there is still more to be done. Though many people who responded had active initiatives, greater awareness and visibility of Equally Well actions plans may be required given some people were unaware of these. While this may reflect the mix of people who answered the survey, to ensure sustainability of the programme we need to find ways to embed Equally Well into organisations with resources to support this.

Implications for all of us

Everyone in the Equally Well collaborative should be encouraged to keep taking action, sharing actions, and collaborate with people and organisations who are working on similar initiatives.

The Equally Well backbone team reviewed the results of the Taking our pulse survey and took a number of actions points from it. Whilst we recognise that Equally Well champions will use these survey findings in different ways to continue to create change, below are some recommendations for actions arising from this survey.

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Sustainability and Equally Well action plans

• If you are unaware of your organisation’s Equally Well action plan, find out more. If your organisation does not have one, encourage your workplace to develop one. For those who already have a plan, consider whether it is widely known, how to better promote it to increase awareness, and whether it needs a refresh.

• Consider how your organisation can use the range of Equally Well resources to create change and take action.

• Consider the sustainability of Equally Well in your organisation. If you left tomorrow, who would take over? Is there support from organisational leadership and commitment to resourcing initiatives?

Spread the word and connect with others

• Share the findings of this survey with your colleagues, workplace and managers, as well as the wider collaborative. In particular, how your Equally Well initiatives and those of others are having an impact on people and services, or issues and learnings about how to support effective implementation.

• Contact us. The backbone team are always pleased to hear from you, and to assist where they can to profile your work in the Equally Well e-news or connect you with others. If you didn’t fill out the survey, get in touch if you have initiatives or stories that you’d like to share - it’s not too late as this is an ongoing process.

Conclusion

The Equally Well collaborative can be encouraged and inspired by the many actions undertaken to achieve physical health equity. This survey shows that everyone, regardless of role or sector can get involved and make a contribution.

For many people and organisations, physical health now appears to have a high priority as we work together to address the unacceptable disparities in health outcomes. This snapshot will help to inform planning and priorities for the Equally Well collaborative in 2020 and beyond.

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Introduction Equally Well is a collaborative of people and organisations who are committed to achieving physical health equity for people who experience mental health and addiction issues.

Equally Well was launched in 2014 with a comprehensive evidence review and a summit in Wellington, New Zealand hosted by Te Pou o te Whakaaro Nui (Te Pou) and Platform Trust. More than 100 health service leaders, academics, people with lived experience of addiction and mental health issues, and health practitioners attended the summit. Development of a framework for collaborative action (see Appendix A) followed, outlining 40 areas for priority action and underlying principles identified by summit stakeholders.

Equally Well now has 124 endorsing organisations, 1,281 e-news subscribers, 384 Loomio group members, and 648 Twitter followers.1 The Equally Well collaborative includes many people committed to bringing about change. An overview of the development of Equally Well is outlined in Appendix B.

The previous Taking our pulse 2015 survey provided a snapshot of Equally Well initiatives. It helped to increase awareness and understanding of activities taking place across New Zealand one year after the launch of Equally Well.

It is timely to gain an up-to-date understanding of current initiatives in New Zealand.

Project aim

The Taking our pulse 2019 survey was undertaken to provide an up-to-date understanding of Equally Well initiatives in Aotearoa New Zealand. The survey findings are intended to help share initiatives and learnings, facilitate collaborations and can also provide inspiration for people and organisations facing implementation issues.

The survey is not an evaluation of the Equally Well collaborative, rather it is a way of capturing activities taking place across the country and synthesising this information so it can be shared and used by the collaborative to stimulate further action.

Methodology

An online survey was developed - adapted from the 2015 Taking our pulse survey - and distributed to members of the Equally Well collaborative via Survey Monkey in August 2019. Open ended feedback was analysed to identify key emerging themes. See Appendix C for further details.

1 Loomio is an online member-only discussion and information sharing forum which can also be used to support collaborative decision making.

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Results The number of responses varied for each question. The following subsections describe:

• who took part in the survey

• what is happening around Equally Well

• organisation action plans

• planned actions

• identified challenges.

Comparisons are made with 2015 survey results, where relevant. More information comparing the two surveys is provided in Appendix D.

Who took part in the survey?

Of the 174 people who took part in the survey, almost half (76 people, 44 per cent) provided information about their role, organisation and sector as summarised in Table 1.2 People were able to choose more than one answer option.

Roles

Of the 76 people who reported their role, most were:

• health practitioners (30 per cent)

• managers (21 per cent)

• educators or trainers (16 per cent).

This was similar to the Taking our pulse 2015 survey. A larger proportion of people responding to the 2019 survey were medical professionals (eg GPs and psychiatrists, nine per cent in 2019 compared to two per cent in 2015). In contrast, a smaller proportion of people responding to the 2019 survey had lived experience (eight per cent compared to 16 per cent in 2015) or worked as a pharmacist (one per cent compared to 12 per cent in 2015).

Organisation type

More than one-third of the 76 people identifying their organisation type worked in non-government organisations (NGOs, 38 per cent) with another third in district health boards (DHBs, 37 per cent).

In 2019, the proportion of people who reported working in primary health organisations (PHOs) was four times higher than the 2015 survey (20 per cent compared to five per cent in 2015).

Sector

Most of the 76 people identifying their sector worked in mental health (70 per cent), followed by addiction (41 per cent), then primary care (17 per cent). These results were similar to the 2015

* This was an encouraging response but because the survey link was sent out through a number of electronic networks with potential for duplication, it was decided not to estimate a response rate. 2 Given that the demographic questions were not mandatory, the response rate (76/174 people) was good.

174 people responded to all or

part of the survey*

76

people provided information about their role,

organisation and sector

140 people provided at least one

example of Equally Well initiatives

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survey. In comparison to the 2015 survey, more people in the education sector completed the survey in 2019 (15 per cent compared to three per cent in 2015).

Table 1: Role, Organisation and Sector of 76 People who Responded

Number (%)*^

Roles

Health practitioner (eg nurse, midwife, allied health) 23 (30%)

Manager 16 (21%)

Educator or trainer 12 (16%)

Programme or project lead 10 (13%)

Medical professional (eg GP#, psychiatrist) 7 (9%)

Person with lived experience/tāngata whai ora or family/whānau 6 (8%)

Support worker 4 (5%)

Peer support worker 4 (5%)

Other 15 (20%)

Organisation type

Non-government organisation (NGO) 29 (38%)

District health board (DHB) 28 (37%)

Primary health organisation (PHO) 15 (20%)

Education or training 7 (9%)

Māori health service 4 (5%)

Other 9 (12%)

Sector

Mental health 53 (70%)

Addiction 31 (41%)

Primary care 13 (17%)

Education 12 (16%)

Disability 8 (11%)

Public health 7 (9%)

General health 4 (5%)

Other 2 (2%)

* More than one option could be chosen. ^Percentage is based on 76 people who responded. # General practitioner.

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Location

Seventy-one people reported the DHB locality where they worked. They were located in 15 out of the 20 DHB areas. One-third (32 per cent) of people worked in one of the three Auckland DHB areas (Auckland, Waitematā, Counties Manukau). Fifteen per cent worked in Canterbury and eight per cent in Capital & Coast DHB areas. A few people worked at a national level (three per cent). Compared to the Taking our pulse 2015 survey, responses from Capital & Coast, Hutt Valley, Wairarapa, Waikato and Northland DHB areas were lower than expected. So too were people who worked nationally. In 2015, all DHB areas were represented.

Figure 1. Breakdown of location by DHB area among 71 people who responded.

What is happening?

We asked people to tell us about any Equally Well initiatives undertaken in the last 12 months. The 140 people who responded described a wide range of initiatives with about half of responses reporting more than one initiative.

Equally Well initiatives focussed on:

• identifying and providing support to help manage physical health issues (eg routine physical health checks and metabolic monitoring, developing screening tools and resources, and providing physical health information tailored to people and whānau)

1%

3%

25%

4%

6%

6%

4%

6%

3%

6%

8%

3%

15%

1%

4%

3%

Northland

Waitematā

Auckland

Counties Manukau

Waikato

Bay of Plenty

Tairāwhiti

Lakes

Hawke's Bay

Taranaki

Whanganui

MidCentral

Wairarapa

Hutt Valley

Capital & Coast

Nelson Marlborough

West Coast

Canterbury

South Canterbury

Southern

NationalPer cent of people who responded

DH

B a

rea

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• supporting people to improve their physical health by reducing risk factors (eg supporting smoking cessation, helping with diet and exercise, supporting or funding dentist visits, and offering support to have a safe affordable home and stable employment)

• increasing people’s access to primary care services (eg funding GP visits or offering extended consultations)

• working together with others to achieve physical health equity (eg collaborative or working groups, or shared care arrangements between specialist and primary care teams)

• enhancing workforce capability and capacity (eg education and training sessions on Equally Well for health professionals and students, developing tools for the health workforce, and recruiting dedicated new roles to work within mental health and addiction services such as dietitians).

Identifying and providing support to help manage physical health issues

The most frequently reported Equally Well activities related to identifying and helping people experiencing mental health and addiction issues to manage their physical health needs. Reported activities included routine physical health checks and metabolic monitoring, developing screening tools or resources, providing information to people regarding physical health, and workforce development related to screening.

Routine physical health checks and metabolic monitoring In total, 108 of 128 (84 per cent) people who responded reported at least some routine screening for physical health issues.

Figure 2. Routine screening for physical health issues reported by 128 people.

Many people who responded gave examples of how they or their service were active in screening for physical health issues. This included routine physical health checks and regular metabolic monitoring, monitoring medication use, and referrals to other services. People reporting their service regularly screened for physical health appear to have integrated the process into routine

53

20

35

20

Yes

Most of thetime

Sometimes

No

Number of people who responded

Scr

ee

nin

g

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practice. It is encouraging to see screening taking place across both mental health and addiction services. Examples of initiatives are presented below.

Metabolic screening was a special project and clinical indicator work, now [both are] business as usual [and are] monitored through caseload management. (Manager, NGO service)

We are working on implementing mandatory screening for all people who enter the service (if they consent). (Health practitioner, DHB)

Now [we] have GP and nursing reviews of people entering our residential addictions recovery programme, so that remediable conditions can be addressed and other risks identified. (Project or programme lead, NGO, addiction service)

Strict guidelines around medication prescribing and management, including auditing. (Health practitioner, DHB)

On our GP Appointment form we have a statement that [people] who are on antipsychotics are eligible for a yearly cardiovascular disease (CVD) screen - as a prompt for GP's. (Health practitioner, NGO)

Have recently introduced more comprehensive screening for [people accessing] addiction [services]. (Unknown)

Regularly look at medications people are on and help to optimise these (I am a pharmacist), referral to respiratory services for spirometer, green prescription, sexual health clinic, GPs, NGOs. (Pharmacist, and working in an education institute)

Hepatitis C clinics are here, good relationship with liver clinic, with visiting nurses doing screening. Harm reduction with provision of naloxone kits for overdose on opioids. (Medical professional and manager, DHB, addiction services)

The responses from medical professionals and health practitioners in PHO settings included examples of how physical health support for people who experience mental health and addiction issues have been integrated into their day-to-day work.

My [general] practice has set up annual screening Equally Well appointments for [people] enrolled. (GP)

As a GP being aware of metabolic impacts of medications increasing weight gain and maybe causing diabetes? (GP)

The nurses also play a role in picking up problems as they arise, and advocate for [people], many of whom cannot afford to see a GP, and may not have had a health check of any kind for some time. (Unknown)

I incorporate full medical assessments and histories as part of my initial assessment as a Nurse Practitioner, discuss physical impacts of medication side effects, screen for metabolic issues etc. (Primary care nurse)

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Physical health tools and resources Responses from people relating to screening for physical health issues discussed the use or development of standardised physical health assessment processes or tools, both for health professionals and people accessing services.

Cardiometabolic screening and intervention tool developed and rolled out to all [people accessing] secondary services on antipsychotics. (GP)

At the PHO I have been involved in rolling out our updated EdGE D diabetes/cardiovascular disease (CVD) assessment tool with strong focus on medication impacts. Focus is on incorporating CVD and glycaemic meds. (Manager, health practitioner and educator, PHO)

Developing a physical health self-assessment tool for service users. Developing a booklet for service users, with a range of local health services in categories. (Project or programme lead, NGO, addiction services)

Develop resources for staff to respond to screening in a standardised way. (Manager, NGO, addiction services)

Providing physical health information to people One-quarter of the initiatives described in the survey about identifying and helping people to manage their physical health needs involved sharing information with people regarding physical health or the impacts of psychotropic medications. Examples were shared from people working in both DHBs and NGOs. Peer support workers described how they were active in sharing information with people.

I have contributed to a pamphlet designed to warn [people] on clozapine about the risk of constipation. (Clinical Lead and educator, DHB)

I am involved with the screening health team and try and get the information out to [people] to help bring awareness about bowel screening, smear checks, cancer checks, mammograms etc and I work in Mental Health as an advisor. Going through [people’s] rights. (Peer support worker, NGO)

Weekly awareness notes about research and how it impacts our peers, so we can draw the attention of our peers to these issues and promote their own physical health needs with their medical teams and [help them] advocate for themselves. (Peer support worker and manager, NGO)

Communicating the physical health impacts of medications. (Project or programme lead, DHB) Encouraging medication literacy. (Manager, NGO)

Workforce development related to screening Several people who responded described Equally Well initiatives specifically focused on workforce development relating to screening initiatives. This included teaching students about the

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importance of physical health screening, as well as providing advice and training on screening to current health professionals working in mental health and addiction services.

Teaching new graduates about the importance of undertaking physical health assessments. (Educator/Trainer, DHB and education institute)

A specialist mental health service mandatory training package for all staff around Equally Well. (Health practitioner, DHB)

I run Equally Well Sessions with staff to address issues around Equally Well health and diagnostic overshadowing. I routinely do medication reconciliations at all residential sites and discuss issues with our GP practices. (Heath practitioner, NGO)

Supporting people to improve their physical health by reducing risk factors

Some people reported initiatives aimed at supporting people to improve their physical health and wellbeing by reducing physical health risk factors. These initiatives covered a wide range of areas such as supporting smoking cessation, helping with diet and exercise, supporting or funding dentist visits, and offering support to have a safe affordable home and stable employment. These initiatives were described by people working for a range of organisation types, mainly PHOs, DHBs and NGOs. A few initiatives included system changes such as the introduction of specialist roles like dietitians within mental health and addiction services.

A big focus on supporting tāngata whai ora to access housing. Smoking cessation groups eg Kick the Butt in Auckland. (Manager, NGO)

Looking into use of varenicline among [people accessing services] to identify possible inequity in/barriers to prescribing for smoking cessation. (Project or programme lead, PHO)

Reducing/stopping unnecessary medication currently prescribed that may have metabolic side effects, working on improving knowledge about impact of diet and exercise on health and mental health. (Primary care nurse)

New physical activity group for people with high and complex needs. (Clinical lead, DHB)

Looking at engagement with "Byte" charity to distribute toothbrushes/toothpaste and advice to people with mental health and addiction issues in Primary Care via Partnership Community Workers (PCW). (GP)

Healthy cooking and education in day activity service. [People accessing] residential [care] all to dentist. (Manager, Māori health service NGO)

In my role as a dietitian in a mental health service my job is to provide practical nutrition advice and support for [people] who want to learn about how they can help [people they work with]. (Clinical lead, DHB and education institute)

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A few people demonstrated ways of working around system barriers, such as payment plans or informal arrangements with other services to increase access to oral health care, employment support, and support to stay active.

Informal arrangement with DHB dental services to help our most vulnerable. There is NO formal funding for this so far as I know. (Medical professional, DHB)

[People] are linked to green prescription services. We provide mental health supported living and landlord services for [people] who are having difficulty living in the community and [provide disability support] services also to [people] in Northland, Auckland and Bay of Plenty. We link with [a community organisation] for employment and skills development, and have found employment for [people] that suits their skills development. We have a number of dental services who provide care for [people] with payment plans to enable them to pay for treatment, over months rather than up-front payment. We pay for all [people in] residential [care to visit a] GP. And pay for any ambulance callouts for medical/health issues. (Health practitioner, NGO)

Increasing people’s access to primary care services

Some people who responded described actions to improve access to primary health services, in particular GP services. As cost was a commonly identified barrier for people, free consultations were a key initiative used to improve access.

We provide up to four free consultations for people with mental health concerns and physical health issues. The focus of the consults is on addressing physical health needs. We also provide free consults for youth who have mental [health] concerns and barriers to accessing doctors. This funding is limited and up to the clinician’s discretion and if no other funding streams are available. The consults can be used in conjunction with extended general practice mental health consultations. We also have a suite of mental health services including BICs [Brief Intervention Counsellors] and they work closely with our funded social worker who are aware of funding streams available to enrolled [people]. We are looking at utilising our mobile nurse to actively identify and target people who would benefit from more assistance and providing more in-depth guidelines for our clinicians on Equally Well. (PHO)

All [people accessing our service] to have a GP and attend GP follow up clinics with support. (Peer support worker, Māori health service)

Working together with others to achieve physical health equity

Some people who responded reported initiatives or plans to better connect with other health services that can support more effective and efficient services. This included collaborative or working groups, mapping initiatives, and shared care arrangements between primary and secondary care.

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Developed Primary Care Equally Well working group. Produced a paper identifying Equally Well population enrolled with our PHO and identified inequities in a number of areas. (Project or programme lead, PHO)

Discussions with Public Health about strategies to address specific movement dysfunctions in children, which we observe to be co-existent with many diagnoses (eg ADHD, ASD, anxiety). Currently setting up a collaborative cross-sector workshop to resource exercise professionals in the community with more understanding to enable more effective interventions for people with mental health conditions. Bringing an author of the 'Blueprint' article (Dr Simon Rosenbaum) as keynote speaker. (Clinical lead, DHB)

The Dietetics and the Physiotherapy Services within our mental health service work collaboratively. By working together, we have broadened our reach as physical clinicians and have been able to provide more effective services. (Clinical lead, DHB and education institute)

Mapping Equally Well initiatives in the Canterbury region. (Medical professional, PHO)

Introduction of AOD to peer support service. (Manager, NGO and Māori health service)

Communicating follow up with GP to ensure registration and ongoing physical care are monitored regularly with GP. (Health practitioner, DHB)

Enhancing workforce capability & capacity

Almost one-quarter of people who responded described activities related to enhancing the capacity and capability of the workforce to better support the physical health needs of people experiencing mental health and addiction issues. This included education and training sessions on Equally Well for health professionals and students, developing tools for the health workforce and the creation of new roles. As well as education institutes, initiatives were reported by NGOs, DHBs and PHOs.

The examples below illustrate some of these responses related to supporting workforce development.

Developing the knowledge and skills of mental health and addiction practitioners to support physical health. (Manager, NGO, addiction services)

Teaching sessions on stigma and discrimination run by people with lived experience. More emphasis on trauma informed care. Teaching including discussion on equity/inequity for [people accessing] mental health services. Key findings of mental health inquiry, more people with lived experience in teaching and assessment - addressing stigma and discrimination. (Educator, education institute)

Delivered Equally Well education to primary care practitioners. (Project or programme lead, PHO)

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Supporting mental health staff to become phlebotomy trained to ensure that physical concerns are addressed in a timely manner. (Health practitioner, DHB)

Developing leaflets in plain English re medications and mental health diagnosis. Education via MOH and GP conferences. Teaching GPEP [general practice education programme] 1 registrars. Primary Mental Health Nurse credentialing programme. Outreach psychologist within General Practice. (Medical professional, DHB and PHO)

Some initiatives were aimed at training to enhance capability for students around Equally Well.

Building workforce capability - student nurses are informed about Equally Well initiative and links to theory. This included information on psychopharmacology and impact on health, metabolic syndrome and students' own physical wellbeing with a focus on positive mental wellbeing throughout their studies. Indirectly through training and education. Students experience different levels of implementation of Equally Well in clinical placement learning environments. In teaching the Mental Health practice paper (undergraduate level) it is important to integrate Equally Well key messages both in the teaching and learning, and application to individual students’ situations and their families where this may be required. (Health practitioner and educator, education institute)

Developing lab-based simulation exercise for students focused on linking physical and mental health. (Educator, education institute)

Teaching nursing students about the Equally Well campaign. (Educator, education institute)

A few initiatives involved the development of new roles to increase capacity.

Employment of myself (primary care nurse) at community mental health setting to address Equally Well initiatives. (Health practitioner, DHB)

Taking action at an organisational level – Equally Well action plans

In total, 43 of the 174 people who responded reported that their organisation had a current Equally Well action plan. The remainder either reported their organisation didn’t have a plan, or they were unaware of such a plan. People reporting plans were primarily working in five DHB areas (Canterbury, Auckland, Counties Manukau, Capital & Coast and Nelson Marlborough), and were mainly from DHBs and NGOs.

Developing service specific Equally Well plans where each service focuses on three key areas related to physical health and then reviews them, eg GP visits, smoking cessation initiatives, growing vegetable initiatives, sensory modulation workshops. (Manager, NGO)

An audit of what is currently happening (Equally Well activity) in our service to try and understand any gaps (the gaps were vast!!). (Health practitioner, DHB)

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In addition, some people who responded reported they were currently developing an action plan or were planning to do so in the near future.

Develop an action plan from a mapping report done to identify gaps in primary care for address Equally Well service needs. (Project or programme lead, PHO)

Developing proper Equally Well Plan including promoting more physical activity amongst staff and people using services. (Manager, NGO)

I am involved in the Clinical Advisory Group working on an Equally Well Action Plan with the Practice Nurse Leader. (Health practitioner, DHB and PHO)

Planned actions

Thirty-eight people reported having Equally Well initiatives planned for the next 12 months. Many of these reflected ongoing or evolving Equally Well initiatives. Overall, planned initiatives covered a broad range of areas. Most commonly, they related to screening, monitoring or supporting people to reduce their physical health risk factors.

We continue to focus and advocate for the need to be vigilant about our physical health needs. (Peer support worker and manager, NGO)

Overall, we seem to be getting more consistent, but the next step is taking appropriate action when results indicate a need for change. The primary-secondary care interface and GP costs contribute to this. (Unknown)

New health passport being created. New policies in place and improved currently. (Manager, disability sector)

Increased focus on smoking cessation. Increased focus on cultural support. (Manager, NGO)

[Extending] cardiometabolic monitoring to alcohol and other drug services. Greater involvement of pharmacy in cardiometabolic monitoring. Cardiology direct access for [people accessing] mental health and addiction [services]. Advocate for revised cardiovascular risk calculations for people on antipsychotic medication. Education anywhere and everywhere, whānau, [people accessing services], NGO primary secondary care settings. (Medical professional, DHB and PHO)

A few initiatives were also aimed at building the capacity and capability of the workforce, including students in tertiary education courses.

More of what we are doing to ensure Equally Well initiatives are included in under-graduate nursing education. (Educator, education institute)

Provide workshops for the mental health and addiction workforce about Equally Well and how to use the self-assessment tool and health service brochure with the people who access their services. Gather feedback on these two resources

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from services users and staff, and adjust them as needed. (Project or programme lead, NGO, addiction services)

A major collaborative initiative was also planned for the next 12 months.

A major collaborative project with all 20 DHBs related to maximising the physical health of mental health and addiction consumers. (Government agency)

The identified challenges

While people who took part in the survey were not specifically asked about barriers or challenges for taking action on Equally Well initiatives, some examples emerged.

The most commonly reported challenge related to resources – either time, staff or money. A few people commented on how they would be retiring or reducing their hours, and therefore potentially reducing their capacity to continue Equally Well activities.

Time allocated to undertake is hit and miss. (Unknown)

Currently our service is not funded to address any physical health needs. I believe that having more GPs working in addiction services and fund[ing] those services is one of the most important strategies to improve health outcomes in [substance use disorder] (SUD) populations. (Medical professional, DHB, addiction services)

Where is the money? (Medical professional, DHB)

Initiatives and potential is limited by available staffing resource and current vacancy. (Clinical lead, DHB)

I will be retiring early next year. (DHB)

Attitudes towards screening and a lack of organisational support were commonly reported challenges. Some people commented that support for screening for physical health issues was variable depending on the attitudes of other staff.

Does not seem to take priority most of the time. Psychiatrists are not so supportive. (Health practitioner, DHB)

Very much dependent on individual clinician’s motivation. (Unknown)

I believe in what Equally Well is about but my workplace is not fully on board. (Health practitioner, DHB)

The challenges identified reinforced the need for good organisational change management and leadership support of Equally Well to support individual champions and get health professionals on board with screening for physical health issues. The challenges also reflected the recognition of the time commitment and other resources required for some initiatives. Learnings from successful initiatives may be useful in understanding how others have addressed these challenges.

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How can the Equally Well collaborative use these findings? The Taking our pulse 2019 survey was undertaken to provide an up-to-date understanding of current initiatives in New Zealand. It provides a broad snapshot of some Equally Well initiatives that have recently happened, are currently happening, or will take place in the next 12 months. The survey is not an evaluation of the collaborative.

What this survey tells us about Equally Well in Aotearoa New Zealand

This survey tells us the Equally Well movement is active and enthusiastic in pursuing physical health equity. From the 174 people that participated in the survey, a wide range of activities and actions were captured that were taking place in different locations and organisations, and across different roles and sectors.

Many initiatives have been embedded into usual practice. It is clear there is a strong network of individuals that are actively making things happen.

The survey also highlighted that among the great work, the Equally Well movement is a work in progress and there is still more to be done. Though many people who responded had active initiatives, greater awareness and visibility of Equally Well actions plans may be required given some people were unaware of these. While this may just reflect the mix of people who answered the survey, to ensure sustainability of the programme we need to find ways to embed Equally Well into organisations with adequate resources. This supports sustainability by making Equally Well the responsibility of everyone in an organisation, not just one or two champions. Identifying priorities and developing plans is a key part of taking action.

Implications for all of us

The Equally Well collaborative in Aotearoa New Zealand is active and everyone should be encouraged to keep taking action, sharing actions, and collaborate with people and organisations who are working on similar initiatives.

The Equally Well backbone team reviewed the results of the Taking our pulse 2019 survey and took a number of actions points from it. Whilst we recognise that Equally Well champions will use these survey findings in different ways to continue to create change, below are some recommendations for actions arising from this survey.

Sustainability and Equally Well action plans

• If you are unaware of your organisation’s Equally Well action plan, find out more. If your organisation does not have one, encourage your workplace to develop one based on where you can have the best impact.3

• If you already have an Equally Well action plan, consider if it is widely known and whether it needs a refresh. Consider also how you can promote your action plan within your organisation to increase awareness and uptake.

3 Contact Equally Well backbone team coordinator Rachel Kapeli (rachel.kapeli@tepou.co.nz) to get the Equally Well action plan template, or to promote your action plan on the website (https://www.tepou.co.nz/initiatives/action-

plans/246).

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• There are plenty of Equally Well resources - consider how your organisation can use these to create change and take action.4 If you develop your own, or adapt these, please share these on Loomio.

• Consider the sustainability of Equally Well in your organisation. If you left tomorrow, who would take over? Is there support from organisational leadership and commitment to resourcing initiatives?

Spread the word and connect with others

• Share the findings of this survey with your colleagues, workplace and managers, particularly how your Equally Well initiatives and those of others are having an impact on people and services.

• Keep sharing what you are doing with the collaborative, including key issues and learnings about how to support effective implementation. This could be through Loomio, Twitter, or when presenting to colleagues or others in the sector.

• Contact us. The backbone team are always pleased to hear from you, and to assist where they can to profile your work in the Equally Well e-news or connect you with others.

• If you didn’t fill out the survey, get in touch if you have initiatives or stories that you’d like to share - it’s not too late as this is an ongoing process.

Conclusion

The Equally Well collaborative can be encouraged and inspired by the many actions undertaken to achieve physical health equity. This survey shows that everyone, regardless of role or sector can get involved and make a contribution.

For many people and organisations, physical health now appears to have a high priority as we work together to address the unacceptable disparities in health outcomes. This snapshot will help to inform planning and priorities for the Equally Well collaborative in 2020 and beyond.

4 https://www.tepou.co.nz/initiatives/equally-well-resources/134

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Appendices

Appendix A: Framework for collaborative action

Some specific actions

• MH&A training for health

professionals - building

capability and confidence

• Communicate side effects

of medication, and

different treatment and

recovery options to

service users

• Promote routine

metabolic screening &

CVD risk assessment &

follow-up

• Develop recovery- focused

guidelines for the

prescribing of

psychotropic medication

• Develop ‘Recovery-

oriented Systems of Care’

led by service users

Some specific actions

• Routinely offered effective

smoking cessation support

• Address stigma and

discrimination in health

services

• Support better access to

employment and suitable

housing

• Improve access to dental

health services for mental

health and addiction

service users

• Investigate including

psychotropic medication as

a risk factor for CVD and

type 2 diabetes in PREDICT

• Reduce access to alcohol in

communities

Some specific actions

• Promote self-control

skills training in early

childhood settings

• Endorse the HeAL

Declaration for young

people with psychosis,

and put the goals into

practice in New Zealand

• Adapt the HeAL

Declaration for people of

all ages using mental

health and addiction

services

• Trial complementary

treatment options to

minimise the impact of

psychotropic

medications

Promote recognition as priority group in national and regional policies

Support ‘communities of practice’ with good quality research, evaluation and monitoring

Treaty of Partnership with

Waitangi principles

people with lived experience

Reducing

inequities

All activities informed by

VISION: Improving the physical health of people

who experience mental health and addiction problems

GOAL

Improve the quality of physical health care

GOAL

Reduce exposure to risk factors

GOAL

Promote prevention and early intervention

Reducing inequities

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Appendix B: Equally Well development overview

Equally Well is a group of people and organisations committed to physical health equity for people who experience mental health and addiction issues.

The evidence review and a consensus position paper are published. The Equally Well collaborative is formally launched at a

stakeholders’ summit.

A Taking our pulse survey maps all the actions being taken across the country. The collaborative

wins two international awards We reach 100 endorsing organisations.

A BRIEF HISTORY OF

Platform Trust and Te Pou o te Whakaaro Nui call for urgent action and undertake an evidence review.

2013

2014

2015 The Framework for Collaborative Action outlines the underlying principles of the collaborative and the priority areas for action. A wicked issues think tank brings primary care and lived experience leaders together to plan system-level changes. Through stakeholder engagement organisations endorse the consensus paper and commit to action.

2016

2017 A second evidence review is published by Te Pou o te Whakaaro Nui. A champions network strengthens distributed leadership. Australia launch their Equally Well collaborative.

2018

The UK launch their Equally Well collaborative For the first time New Zealand’s cardiovascular

disease risk management guide prioritises the heart health of people with mental health and

addiction issues.

2019 New Zealand’s mental health and addiction inquiry recognise Equally Well as a good example of collective impact. Te Pou o te Whakaaro Nui evidence review 2017 cited as a key resource by the Lancet Psychiatry Commission. A strategic leadership group is formed to grow and sustain the collaborative.

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Appendix C: Methodology

Survey

An online survey was developed and adapted from the 2015 Taking our pulse survey. Equally Well e-newsletter subscribers and Loomio group members were invited to take part in the survey administered via Survey Monkey in August 2019. Participants were given three weeks to take part in the survey, and sent two reminders during this time, along with promotion on Twitter and Loomio.

Analysis

Open ended feedback was analysed to identify key themes that emerged as listed below.

• Identifying physical health issues and providing support to help manage physical health.

• Supporting people to improve their physical health by reducing risk factors.

• Increasing people’s access to primary care services.

• Working together with others to achieve physical health equity.

• Enhancing workforce capability and capacity.

Survey questions

1. Does your organisation have a current Equally Well action plan? a. Yes b. No c. Don’t know

2. How often does your organisation review the Equally Well action plan? a. Monthly b. Quarterly c. Six-monthly d. Annually e. No regular review f. Don’t know

3. If you are working in a health service, does your service routinely screen and monitor people who experience mental health and addiction needs for a range of physical health problems?

a. Yes b. Most of the time c. Sometimes d. No e. Not applicable

4. Any other comments about screening? 5. Describe any Equally Well initiatives you have been part of in the past 12 months aimed at

improving the quality of physical healthcare. 6. Describe any Equally Well initiatives you have been part of in the past 12 months aimed at

reducing exposure to known risk factors for physical health issues. 7. Describe any Equally Well initiatives you have been part of in the past 12 months aimed at

promoting prevention and early intervention.

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8. Describe any other Equally Well initiatives you have been part of in the past 12 months that are not already described above.

9. Please briefly describe any Equally Well initiatives you have planned for the next 12 months.

10. Where in New Zealand are you located? 11. Which of the following best describes your role?

a. Manager b. Programme or project lead c. Pharmacist d. Medical professional e.g., GP, psychiatrist e. Health practitioner e.g., nurse, midwife, allied health f. Support worker g. Peer support worker h. Person with lived experience or family/whānau i. Planner and funder j. Researcher/evaluator/policy advisor k. Educator/trainer l. Other (please specify)

12. Which sector do you mainly work in? a. Mental health b. Addiction c. Disability d. Primary care e. General health f. Public health g. Education h. Other (please specify)

13. Organisation type a. Non-government organisation (NGO) b. DHB c. Education/training d. Primary health organisation (PHO) e. Māori health service f. General Practice g. Pharmacy h. Other (please specify)

14. What is your name? 15. What is your email address? 16. What is your phone number? 17. Do you prefer to be contacted via email or phone? 18. Any other comments or feedback related to Equally Well or this survey?

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Appendix D: Comparison with the 2015 Taking our pulse survey

In total, 167 people, identified through Equally Well networks, responded to the electronic survey carried out in 2015 (compared to 174 in 2019).

DHB area In 2015, 160 people answered the question regarding DHB locality, compared to 71 in 2019. In 2015, all DHB areas were represented by people who responded, compared to 15 out of the 20 DHBs in 2019.

Table 2. DHB Area in 2015 and 2019

2015 2019

DHB area Number Percentage Number Percentage

Capital & Coast 33 21% 6 8%

Auckland 28 18% 18 25%

Counties Manukau 23 14% 3 4%

Canterbury 22 14% 11 15%

Waikato 22 14% 4 6%

Hutt Valley 20 13% 0

Waitematā 20 13% 2 3%

Southern 14 9% 3 4%

Bay of Plenty 13 8% 4 6%

Wairarapa 11 7% 0

Northland 11 7% 1 1%

Taranaki 10 6% 4 6%

Lakes 8 5% 0

Nelson Marlborough 7 4% 2 3%

MidCentral 7 4% 4 6%

West Coast 6 4% 0

South Canterbury 5 3% 1 1%

Hawke's Bay 5 3% 3 4%

Tairāwhiti 4 3% 0

Whanganui 4 3% 2 3%

National 20 13% 2 3%

Other (e.g. international) 3 2% 1 1%

Total people responded 160 71

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Sector In 2015, 162 people answered the question regarding their work sector (compared to 76 in 2019). Similar to 2019, the majority of respondents for the 2015 survey worked in mental health and addiction sectors. Half (51 per cent) worked in mental health and addiction, 33 per cent in mental health and two per cent in addiction (compared to 70 per cent mental health and 41 per cent addiction in 2019 – people could choose more than one option). There was an increase in the percentage of respondents working in the education sector, rising from three per cent in 2015 to 16 per cent in 2019.

Table 3. Work Sector in 2015 and 2019

2015 2019

Sector Number Percentage Number Percentage

Mental health and addiction 83 51% N/A N/A

Mental health 53 33% 53 70%

Addiction 4 2% 31 41%

Primary care 25 15% 13 17%

Education 5 3% 12 16%

Disability 7 4% 8 11%

Public health 10 6% 7 9%

General health N/A N/A 4 5%

Other 20 12% 2 3%

Total people responded 162 76

Roles In 2015, 163 people answered the question regarding roles (compared to 76 in 2019). As in 2019, most respondents were health practitioners (31 per cent 2015, 30 per cent 2019), and there was a slight increase from 2015 for educator/trainers (11 per cent 2015, 16 per cent 2019). There was a greater percentage of respondents who were programme or project leads in the 2019 survey, compared to 2015 (<1% 2015, 13% 2019).

Table 4. Roles in 2015 and 2019

2015 2019

Role Number Percentage Number Percentage

Health practitioner (eg nurse, midwife, allied health)

50 31% 23 30%

Manager 42 26% 16 21%

Educator/trainer 18 11% 12 16%

Programme or project lead N/A N/A 10 13%

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Medical professional (eg GP, psychiatrist) 4 2% 7 9%

Person with lived experience/tāngata whai ora or family/whānau

26 16% 6 8%

Support worker 8 5% 4 5%

Peer support worker 2 1% 4 5%

Pharmacist 20 12% 1 1%

Addiction worker 9 6% N/A

Social worker 8 5% N/A

Planner and funder 7 4% 3 4%

Researcher/evaluator/policy advisor 12 4% 2 3%

Consumer lead/advisor 6 3% N/A

Psychologist 3 2% N/A

Other 16 10% 9 12%

Total people responded 163 76

Organisation type In 2015, 162 people answered the question regarding their organisation type (compared to 76 in 2019). As in 2019, most respondents worked for NGOs (43 per cent 2015, 38 per cent 2019) or DHBs (53 per cent 2015, 37 per cent 2019). There was a greater percentage of people who responded from PHOs in 2019 (five per cent 2015, 20 per cent 2019).

Table 5. Organisation Type in 2015 and 2019

2015 2019

Organisation type Number Percentage Number Percentage

Non-government organisation (NGO)

69 43% 29 38%

District health board (DHB) 79 53% 28 37%

Primary health organisation (PHO) 8 5% 15 20%

Education/training 14 9% 7 9%

Māori health service 6 4% 4 5%

DHB other 6 4% N/A

General Practice (GP) 3 2% 5 7%

Pharmacy 5 3% 1 1%

Other 13 8% 3 4%

Total people responded 162 76