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Guest Blog: Robert Miller on the Social Bonds Pilot for NZ Mental-Health Services

Commentary on Latest Move of New Zealand Government Over Mental Health Care

UntitledLike many Kiwi’s, Robert Miller from the NZ Schizophrenia Research Group recently received a message from Annette King, health spokesperson for the Labour Party, asking him to sign a petition against the government proposal to trial funding mental-health services with Social Bonds. Here, Robert shares a few of his thoughts on this controversial new move to fund mental-healthcare. Social Bonds involves using a private investment model where companies put up their own funds and are reimbursed (with interest) only if certain outcomes are met. The process of ‘procurement’ is now well under way. By March 2015, seven potential partnerships were being assessed, with a view to ‘moving to implementation in the second half of 2015.’ The Government document mentions ‘NGOs, retail banks, and specially created partnerships’, but provides no details of which organisations are to be involved. The first four Social Bonds contracts have been announced and they all have work targets as the defined outcomes.

Greetings from Masterton!

Yesterday, I received two messages on the same topic – the government’s latest initiative for funding mental health care in New Zealand by what it calls ‘Social Bonds.’ One came from Annette King asking me to sign a petition, which I did. The other came from my good friend Julie Leibrich (former Mental Health Commissioner) expressing her serious concern about the government move. Here is her message –

‘National is planning to use Social bonds to fund mental health services.  Social bonds allow Government to contract out services and funding to non-government or private organisations, with agreed targets and timeframes. If the targets are met, Government pays back the investors, and also pays a return on their investment. The return depended on the level of results, up to an agreed maximum. Labour says that the risks of the policy are huge, because in order to meet targets providers are likely to focus on “easier-to-help” clients and not difficult and expensive ones. The Department of Internal Affairs warned that New Zealand should not “engage in trials or implementation of a social impact bond”. There is a good article about the dangers. I think that people with mental illness struggle enough as it is to get good care, and the idea of them becoming Guinea pigs in a social experiment is appalling. So I would be grateful if you would consider the petition, and if you want to, then sign it.’
~ Julie Leibrich, former Mental Health Commissioner

Since the pilot was announced, there has been much comment on the Social Bond scheme for mental health funding, in newspapers, generally highly critical. Let me make a few of my own comments, briefly, because there is urgency here.

(i) Mental health is probably one of the hardest areas of health policy to get right, and this government seems to think it is just about money. It IS about money, of course, but just as important (perhaps more important), it is about organisational culture, sensitive responsiveness to needs of clients, and morale in mental health services. It is quite possible for dedicated, highly trained and skilled staff to deliver a first class service when physical aspects of the service (buildings etc,) are distinctly below par. It is the ‘human capital’ as much as the funding available which matters. These aspects of a good service cannot be measured in the usual way in which profit and loss are computed.

Nowhere, it seems, does one sense that actual persons with their own hopes and dreams are involved. Collectively, they are just ‘a problem’ to be reduced

(ii) The nature of funding streams IS an important factor in delivery of mental health care. In something as complex as setting up an effective mental health service, with its community outreach, it would help if funding (especially of NGOs for mental health care) were not administered in such a way that different agencies who should collaborate, are forced to compete for funds.

(iii) Earlier this year I learned of someone writing a report about mental health for Treasury, found her e-mail address, wrote to her, but never received a reply. Maybe this government move is related to that report, although it has clearly been under development already for some years. In this case the government seems to be moving to get this inconvenient burden off its shoulders. The un-named banks and financial institutions are likely to have their bases outside New Zealand, have no responsibility to the New Zealand electorate, only to their shareholders. Apart from maximizing profits, mental health is an area which is not a money-making business, is not, and never has been capable of really generating a profit, except in a highly distorted sense of market discipline. In addition, I ask: What would be the ‘quid pro quo’ demanded by those private investors? If it seems that targets are not being met, and the return on investment therefore not likely to be forthcoming, what pressures will be put on services to meet the targets? What corners will be cut on ethical aspects of service delivery? What style of healthcare delivery would they require? Would delivery of mental health services become hostage to multinational enterprises, with agenda quite out of line with our own philosophy of healthcare?

(iv) There may be some merits in the social bond scheme as a way to bring about public/private partnership. However, if so, it would be better to test this particular model of such partnership in an easier area than mental health care. It seems as if this is being tried out in the mental health area first because ‘no one really cares too much about this anyway’. Government policy makers should reconsider the choice of mental health as the first place to try out this approach.

(v) In terms of ‘meeting targets’, the devil is in the detail. The main target appears to be getting people with mental health problems into paid employment; but this depends on many factors beyond control of any mental health service. In addition, for many service users, obtaining employment is the end of a long journey. It might be better to emphasize earlier stages of that journey, namely helping to rebuild personal resources of people whose normal development has been undermined by mental disorders. This might include entering and succeeding in higher education. Entry into paid employment would be a natural flow-on from this, which is a more fundamental form of assistance.

Immense flexibility is needed to cope with the individuality and idiosyncrasies of each client… Target-driven systems are unlikely to achieve this

(vi) In any case, this appears to be setting up a ‘pseudo-market’, possibly a subterfuge for covert administrative and government control. It also seems to imply that the government admits that devising a good mental health system is beyond its capability; and somehow, by offering financial incentives, the market in mental health care will somehow magic up a level of intelligence in this area, which is superior to the government’s own. This stretches credibility.

(vii) Administrators do like to set targets, as if the matter of concern is one where commands can be given, and outcomes/outputs delivered according to plan (but, in today’s world, using the ‘invisible hand’ of market forces as an intermediary). Those at the front line of any human services, especially mental health services, know better. In their practice, immense flexibility is needed to cope with the individuality and idiosyncrasies of each client, for instance in matching each client to the most suitable practitioner of counselor. Target-driven systems are unlikely to achieve this. Such flexibility is one of the features that make for a good organizational culture and good morale in those services.

(viii) The government’s plan is one more move – perhaps more dangerous than others so far – to move small aspects of our social services to enterprises based offshore. Others we know about include setting up private prisons, or catering services in hospitals, to name a couple. Who are the movers of this international trend? What are their real objectives? Early in 2014, as part of a resignation document I wrote, when I left committees of RANZCP, I shared a paragraph expressing my concerns, which contained hints of answers to those questions:

“…that entrusting mental health issues to untrained community people has encouraged re-uniting two policy areas which had been painfully separated in the second half of last century. The two areas are mental health and justice. In the nineteenth century in Western countries (and in many other countries still today), the two were not separated. Authorities who could put you away in an asylum were either medical people or JPs. Since 1950, there has been steady progress in prizing these two apart, so that the area where, inevitably, the two overlap, becomes a difficult and highly specialized discipline of its own – forensic psychiatry. I fear there are now accelerating moves to bring these two back together again. With international consortiums now running both private prisons in many countries, and some mental health NGOs, I fear that merging of the two policy areas is gaining momentum internationally, led by those whose ethical perceptions are quite different from most of those who will be reading this document.”

(ix) I have just sent in an abstract to the New Zealand branch of RANZCP for their forthcoming meeting in Hamilton in September. Basically this is about the history of psychiatry. Sadly I conclude that, over the last century a specialty, which, in the 1890s, had the promise to become a respected branch of personal health care, at least on the continent of Europe, was largely taken over by those who sought the most efficient way to administer a ‘social problem’. This emphasis is quite explicit in the Government document: Under the section titled “What is the Government looking for the Pilot to do? we read in its first bullet point “test the concept within the New Zealand context to see whether this is an effective and efficient way for government to reduce social problems” [emphasis added]. Nowhere, it seems, does one sense that actual persons with their own hopes and dreams are involved. Collectively, they are just ‘a problem’ to be reduced. Mental health care has insidiously become linked in the public mind to other ‘nasties’ of social policy, including (from 1834), workhouses and asylums, and then prisons, together with legal sanctions on prostitution, suicide, sexual orientation, street drugs, ‘welfare dependents’ and so on, all those areas that ‘nice people’ do not want to know about. The battle between these two has been raging for the last century, and more. I fear that parts of that battle are now being waged by international corporations, unaccountable to any electorate, probably in denial about the personal aspects of healthcare, or the person-centred ethical precepts, which should guide healthcare.

(x) Now is the time to challenge this outrageous government move.

Robert Miller

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About the author: Robert Miller was educated in Britain, originally a medical student, until he was overwhelmed by a psychotic disorder. Later he retrained as a neuroscientist and came to New Zealand in 1977 to a position in the Department of Anatomy at Otago Medical School. His research objectives have been to explore the theory of brain function and its relation to mental disorders. He founded and continues to lead the NZ Schizophrenia Research Group in 1994. From 2009-2014 he served as community representative on committees of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) where he learned that one of the biggest problems in mental health is to get different players to listen to one another. Robert tries to stay independent of all organisations, so as best to encourage them to work together. He is not a member of the Labour Party.

Toi Ora Performing Arts Group Wins Awards for Short Films

After some years of working their craft the Toi Ora Live Art Trust’s Performing Arts group have come up trumps with two out of their four entries winning awards at the 48th Annual WorldFest International Film Festival in Houston.

With over 4700 entries and just 15% of entries receiving awards, they entered in the Dark Comedy category and won a Silver Remi Award for “Walter out of the Blue” and a Bronze Remi Award for “Walter Satyricon”

Congratulations to the Performing Arts group for this brilliant success and a big thanks to the support from our tutors Stephen Ure, Mick Innes and Greg Callinan,” says Toi Ora director Erwin van Asbeck, “The team kept working away at their ideas and kept it light with obvious humour and fun. Well done, onwards and upwards, you never know what lies round the corner.”

Mind and Body Consultants: upcoming workshops

Mind and Body is running some of its most popular workshops across the country, and they thought your networks may be interested in these upcoming professional development opportunities in Auckland, Christchurch, Raumati, Hamilton and New Plymouth.

The interactive ‘reTHiNK Madness’ one-day workshop is useful for anyone wanting to gain a broader, destigmatised, understanding of mental ‘illness’. Previous attendees have come from a variety of industries including film, manufacturing, health, professional services, sports, retail, and the arts, and been family/whanau, colleagues, friends and people with personal experience of mental ‘illness’. This workshop sold-out within 3 days of promoting it last time so please don’t wait to book.

The ‘Introduction to Peer Support’ two-day workshop is popular with people who have lived experience of mental ‘illness’ and/or addictions and recovery, who are interested in learning about peer support. Peer support involves using your own experience of mental health challenges and recovery positively, to walk alongside others who are struggling with their mental health. This workshop gives participants a good overview of the topics and subjects covered in the Certificate of Peer Support (Mental Health) NZQA level 4 should you wish to further your studies.

Tickets for these events can be booked via Eventfinda by clicking on this link and selecting the workshop you are interested in.

The full Mind and Body training calendar for 2015 is now available on their website.

Nāku noa, nā
Taimi Allan – Communications – Mental Health Promotion Lead
Mind and Body Consultants
Ph: (649) 630 5909
Mob: 0224 TAIMI A (82464 2)
Fax: (649) 630 5944
www.mindandbody.co.nz
www.rethink.org.nz

Call for abstracts: 2015 Service User Academia Symposium

“Creating Connections & Building Bridges Together One Step Closer” will take place on the 30th of November and the 1st of December 2015 in Auckland.

Presentations will be about any and all aspects of service users involved in mental health education and research, but this year there will be a particular focus on hearing about co-produced work – where service users and others are working as equal partners in all aspects of a mental health research project or teaching programme.

Abstracts are welcome from service users holding academic, education or professional development positions or aspiring to do so, and those (usually non-service users) who promote, support and advocate for these roles in academia and service settings. To submit an abstract please complete the attached form and send to: Dr Sarah Gordon (sarah.e.gordon@otago.ac.nz) by June 12th, 2015.

For further information please contact:
Dr Sarah Gordon, Service User Academic, Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington, New Zealand,
ph. 0064 7 8235025/0064 21 134 6816

Toi Ora ‘Outsider Art’ Exhibition

Mark your calendars for Toi Ora’s Outsider Art exhibition opening on Tuesday 10 March 2015.

Toi Ora Live Art Trust is a unique shared creative space in the heart of Auckland city where people can find support for their mental health and well-being.  Toi Ora Live Art Trust provides an array of visual arts, writing, music and recording classes and workshops that are tutored by professional practitioners with experience and/or an understanding of the issues surrounding mental health.

Studio space is available for people wishing to work on individual or collaborative projects. A range of art materials and resources are available. Members are able to explore their creative ideas and potential in this supported environment.

If you would like to know more about Toi Ora click here.

If you would like to see our artists and their work click here.

The ‘Outsider Art’ exhibition will feature art from outside the boundaries of official culture. It will run from 10th March to 30 April at Toi Ora Gallery, 6 Putiki Street, Grey Lynn.

Contact: Faye: faye@toiora.org.nz; or Erwin: erwin@toiora.org.nz
Phone: 09 360 4171

New Poetry Book Charts Trauma Recovery Journey

Engage Aotearoa’s service director can most often be found sharing other people’s recovery stories and experiences. But in her spare time she is a poet, and writing under her maiden name, Miriam Barr, she recently had her first major collection of poetry published by Steele Roberts Aotearoa, one of New Zealand’s leading publishers of home-grown poetry.

Bullet-hole-riddle-FRONTcoverThe book features cover art by Elke Finkenauer and interior art from Andrew Blythe‘s untitled ‘No’ series. The back-cover reads, “Bullet Hole Riddle is a three-part narrative sequence charting one person’s journey to make sense of an unwanted history. Framing personal experience as a series of collective acts, Miriam Barr’s first major collection of poetry tells a story about the human psyche and the spaces between us.”

Those familiar with Engage Aotearoa will know what Miriam means when she comments on the Engage Facebook page, “I guess this [Bullet Hole Riddle] is kinda like my Butterfly Diaries story in a way. In poetry form.”

An Auckland Women’s Centre article by Sabrina Muck goes on to say, “Tied into the overall message of the book, it is worth noting its dedication, which tells us this is for the untold stories. Speaking with Miriam in the week following the announcement of the Roastbusters outcome, she felt this was particularly relevant in light of the young women’s experiences in that case, and the voices of too many survivors which continue to go unheard. Steele Roberts is to be commended for supporting this book on its journey and bringing Miriam’s voice into the public sphere.”

The CMHRT Board of Trustees and the volunteer team at Engage Aotearoa would like to congratulate Miriam for her poetic achievement and wish her all the best for Bullet Hole Riddle’s journey into the world.

Bullet Hole Riddle can be ordered online at www.steeleroberts.co.nz or from your local bookseller. Copies are available to borrow at Auckland City Libraries and the Auckland Women’s Centre Library. Check out reader reviews and share your own at GoodReads.com. Find out more about the book at www.miriambarr.com/bulletholeriddle.

Te Pou: Peer support competencies ‘sandstone to sharpen practice on’

The following is a press release from Te Pou, from their website:

The resource Competencies for the mental health and addiction service user, consumer and peer workforce were launched on November 11 at Te Pou in Auckland.

Dr John Crawshaw, director of mental health, gave an opening address to the mental health and addiction sector people from across the North Island. He acknowledged the pivotal role the service user, consumer and peer workforce has in informing service development and working alongside clinical services, supporting people to self manage and drive their own recovery.

Dr Crawshaw was followed by two peer support workers who spoke about their experience and what peer work meant for them. Elton Hakopa, addiction peer support worker from the drug court, gave a stirring and entertaining outline of his experiences. Elton gave the quote of the day, or even the year when he said “these competencies are the sandstone I will sharpen my practice on”.

Ahmad Al-Ali, mental health peer worker from Mind and Body, also entertained the crowd with his self-deprecating wit and story of courage. Both exemplified the state of gratitude they were in to be able to use their powerful experiences to support other people’s self-determination and wellbeing.

Robyn Shearer, Te Pou chief executive, talked about the power of people from across mental health and addiction co-designing and co-developing the competencies.

Two documents created to support the competency framework were also launched: The Service user, consumer and peer workforce guide for managers and employers and the Service user, consumer and peer workforce guide for planners and funders. These are available to download alongside the competencies. These documents provide information and sound direction for people managing and employing peer workforce members and for planners and funders investing in this exciting growth area in the mental health and addiction workforce.

To contact Te Pou or for further information:

http://www.tepou.co.nz/

Email: info@tepou.co.nz

Te Pou phone numbers online here.

Exhibition at Studio One Toi Tu explores Mindfulness | Auckland 26 Nov – 18 Dec 2014

A new exhibition opens this week on Ponsonby Road with relevance to mental well-being and creative thinking.

NOW
Opens Wednesday 26 November, 5-7 PM

Studio One Toi Tu (Formerly Art Station)
1 Ponsonby Road, Auckland
Exhibition runs until December 18th.

To quote the artists’ statement: “The concept of Mindfulness, which is rooted in Buddhism, is the cornerstone of this exhibition by photographic artist Faye Norman and poet Miriam Barr. In contemporary society Mindfulness has been expanded into psychotherapy, and as an everyday tool for people to apply to deal with issues such as stress. Now presents works that are the result of collaborative investigations by the two artists involving the integration of mindfulness and creative process.”

StudioOne_NOW_Postcard

Gallery Opening Hours :

Mon – Thu 9am – 7pm
Fri 9am – 5pm
Sat 9am – 4pm
Sun Closed

Gallery Contact:

studioone@aucklandcouncil.govt.nz
09 376 3221
www.studioone.org.nz
facebook.com/studioonetoitu

DRIVE Update: Christmas Special Hui & Notices

DRIVE announces the final hui date for the year, featuring guest musician Sam RB and a chance for you to perform.

Date: Thursday 18 December
Time: 10.45 for an 11am start
Place: Pacific Business Trust, 733 Great South Road, Papatoetoe

RSVP’s are essential as lunch will be supplied. DRIVE may not be able to cater for all needs, but please get in touch if you have any dietary requirements.

The October Hui was a productive day of brainstorming what was important to consumers, and what they wanted from services. Drive hopes to give you further feedback about this soon. They also have a list of events that are happening in the next couple of weeks that may be of interest. These include several art events, training opportunities and some chances for you to use your experiences to give some feedback around parenting and mental illness, and the Auckland Council psychoactive substances policy.

Contact DRIVE via:

Email: sheree.veysey@connectsr.org.nz

Mailing address: DRIVE Network, PO Box 102 149, North Shore Mail Centre, Auckland, 0745, New Zealand

AUT and Changing Minds: Quality of Life Issues During Mental Health Recovery

AUT and Changing Minds are interested in hearing what people think and feel about Quality of Life and mental health recovery.

AUT and Changing Minds are seeking interested people with lived experience of mental health recovery to take part in a focus group and some exercises to help answer this question.

Answers will help them to identify the most important life issues for people living with and recovering from mental illness.

Feel free to pass on this invitation to others who could also be interested in participating. A voucher for your time and refreshments will be provided. Thank you!

For further information or if you would like to participate, please contact Margaret, so she can arrange a suitable time to meet. Email or text on:

margaret@changingminds.org.nz

Phone: 021 2177 377

http://changingminds.org.nz/