Engage Aotearoa

Sign up for the Mental Health Foundation’s E-Bulletin

The Mental Health Foundation of New Zealand’s latest weekly E-Bulletin was delivered to inboxes on the 24th of June. Delivered weekly, the E-Bulletin provides links to resources for researchers, academics, mental health workforce, people interested in new research, information and developments in the field of mental health and wellbeing.

Follow this link to subscribe to the E-Bulletin.

Support Group for Women to Talk about Same Sex Attraction; Auckland

Questioning?

Would you like a supportive women’s space to talk about same sex attraction?

This group is participant directed, a space to explore topics like:

  • What does same sex attraction mean to you?
  • Identity labels…e.g.  Bi, Queer, Lesbian, Dyke
  • Stereotypes and gender stereotypes
  • Being in an opposite sex relationship and having same sex attraction
  • Finding community and dating
  • Being out in society
  • If you want to come out, how to tell family, friends, work colleagues
  • Relationships with women
  • You, your children and a new relationship

This six-week group is facilitated by Cissy Rock and Ellie Lim.  Cissy is a prominent contributor to the Auckland Lesbian scene creating events and support groups.  She enjoys getting alongside people and sharing her experience as a mother, feminist, lesbian, friend and partner.  Ellie works for the Auckland Women’s Centre and has had extensive involvement with rainbow organisations.  She is passionate about enabling women to live the lives they dream of living.

Comments from previous participants:  (I enjoyed) “Being able to connect with people and talk to people who were experiencing similar things to me.  Having experienced people to help us and cheer us on.”  “Really enjoyed (it) and appreciated the professional delivery. Thanks! :-)”

Date: Tuesdays 7 July – 11 August, 2015
Time: 7.00pm-9.00pm
Venue: Auckland Women’s Centre, 4 Warnock Street, Grey Lynn
Cost: FREE
Contact: Ellie on 376 3227 ext 1 or email her on womensservices@womenz.org.nz
Come along, ask questions, share, this is a safe, non-judgemental environment. (6 weeks)

Free Primary Healthcare for Kiwi Kids from 1 July 2015

FreeDocsforKids

To find out more

Ask your GP or nurse

Talk to your pharmacist

Call Healthline on 0800 611 116

Visit www.health.govt.nz/visiting-a-doctor

 

Research Evidence on Peer Support Work

In light of the recent media attention on Peer Support Work, the team at Engage Aotearoa thought it timely to share some research on peer support, should members of the community want to get some more information on the topic.

In a review published last year researchers cite a meta-analysis of 11 studies evaluating peer support against case management and clinical professionals in support roles, which concluded “No significant differences in symptoms, hospital admissions, service use, psychosocial functioning or client satisfaction were found. In a second category, six trials compared usual care with services with PSWs in adjunct roles, four with PSWs in mentoring or advocacy roles. There were no significant differences in quality of life, social relations, client satisfaction, hospital admissions, but a small reduction in emergency service use and a larger number of met needs. With these small benefits and no adverse effects found for PSW, Pitt et al. conclude in their review that PSW’s support was noninferior to support by mental health professionals” (emphasis added).

Reference: Mahlke C, Krämer UM, Becker T, Bock T, (2014). Peer support in mental health services. Current Opinion in Psychiatry, 27/4, 276-81. doi: 10.1097/YCO.0000000000000074

In a 2011 review researchers noted that “it seems prudent to mention that a result of no difference demonstrates that people in recovery are able to offer support that maintains admission rates (relapse rates) at a comparable level to professionally trained staff” (emphasis added). They also point to several studies that reported improvements in empowerment, sense of independence,  self-esteem,  hope and community integration along with reduced internalised stigma.  Authors outline several challenges that face peer support workers in the execution of their roles, which require training and organisational support and go on to conclude that peer support workers “have the potential to drive through recovery-focused changes in mental-health services.”

Reference: Repper, J., & Carter, C., (2011). A review of the literature on peer support in mental health services. Journal of Mental Health, 20/4, 392-411.

A 2012 study of peer support worker perspectives of their work, showed that peer support workers are aware of the many challenges they face and highlight the value of their training in enabling them to deal with such challenging issues as self-disclosure and managing boundaries.

Reference: Kemp, V., & Henderson, A.R., (2012). Challenges faced by mental health peer support workers: peer support from the peer supporter’s point of view. Psychiatric rehabilitation journal, 35/4, 337-40.

There is a notable lack of evidence to suggest that peer support work carries risks that are not inherent to any work in the mental-health field and which cannot be overcome without adequate training and supervision. In 2014, Te Pou launched a set of core competencies for peer support workers in New Zealand, to help define the role and help regulate who is able to practice as a peer support worker in mental-health and addictions services. Importantly, in Mary O’Hagan’s 2010 paper, we hear service-users’ own answers to the question “What are the benefits of peer support to you?
  • Knowing you are not alone. Seeing that you are able to live with a mental health diagnosis and still go to school, get degrees, have a job, have a relationship and family. Feeling you are more ‘normal’ or ‘okay’.
  • If it were not for peer support, I wouldn’t be alive.
  • My life was turned around.
  • It was my passage way to getting better, pretty much the only one.
Reference: O’Hagan, M., Cyr, C., McKee, H., & Priest, R. (2010). Making the Case for Peer Support. Mental Health Commission of Canada. Cited in O’Hagan (2011). Peer Support in Mental Health and Addictions: A Background Paper Prepared for Kites Trust.

Find out more about Peer Support in NZ at Kites Trust, the Peer Workers Association or Mind and Body Learning and Development.

Have You Seen the Target Zero Documentary Yet? Watch Online

A very special documentary aired on Maori Television on the 15th of June. Target Zero highlights the need for suicide prevention strategies in NZ, Key to Life Charitable Trust‘s grassroots work across NZ, what gets people through and the solutions whanau and youth themselves are enacting in their schools and towns. IMG_0168

 

Engage Aotearoa would like to congratulate Mike King, Jo Methven, Tai Tupou and the rest of the Key to Life team on  the messages they have brought together in Target Zero. This is an inspiring example of what can come about when genuine people, with genuine passion, collaborate with their communities to fill community needs.

Watch Target Zero online here and share it on social media.

These are the kinds of ideas we need to be spreading.

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

Learn More

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.

Towards Restraint Free Mental Health Practice

In case you missed it, Te Pou have launched a new resource called Towards restraint free mental health practice: Supporting the reduction and prevention of personal restraint in mental health inpatient settings. This resource is the latest in a suite of work from Te Pou that is aimed at reducing and preventing the use of seclusion and restraint in New Zealand mental-health services. According to the Te Pou website “Every mental health inpatient unit in New Zealand is engaged in some form of practice based activity that promotes least restrictive practice.” This latest resource is intended to assist services to put ‘least restrictive practices’ in place and reduce the use of seclusion and restraint.

Find out more and download the resource here

 

Health Promotion Agency Launches “Don’t Know? Don’t Drink” Campaign

The Health Promotion Agency launched a new campaign called “Don’t Know? Don’t Drink” on the 14th June. The Campaign, which will run until September, aims to raise awareness about the effects of alcohol during early pregnancy and ultimately reduce rates of Foetal Alcohol Spectrum Disorder (FASD) in New Zealand.

“Don’t Know? Don’t Drink” encourages women to stop drinking alcohol if there is any chance they could be pregnant because alcohol can affect a developing baby throughout pregnancy, including before a woman knows she is pregnant. There is no known safe amount and no known safe time to drink alcohol during pregnancy.

Watch the first “Don’t Know? Don’t Drink” video here

Learn more about the signs and symptoms of FASD here

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.”

Survey on Plans for an International Peer Leadership Academy at Yale University

An international steering group is planning an international ‘peer leadership academy’ at Yale University. They are seeking the views of people who are involved in mental health systems in any role on the proposed academy.

The International Initiative for Mental Health Leadership and Mind Australia are supporting the development of a proposal for an international peer leadership Academy to be based at Yale University and collaborating centers in other countries. The purpose of the Academy will be to train and support emerging and established peer leaders in mental health, from low income and high income countries, to advocate or manage system transformation from a lived experience perspective.

Please take part in this survey if you have an interest in this issue or share it with relevant  friends and contacts via email or social media.

To take part in the survey go to the Peer Leadership Academy Survey

 The deadline for participating is Saturday 20 June 2015.