Co-existing problems

People with co-existing mental health and substance use problems often need to navigate both mental health and addiction services. The Ministry of Health’s co-existing problems (CEP) project aims to ensure services are designed and delivered in an integrated way.

Creating an ‘any door is the right door’ experience for people with co-existing problems (CEP) means we need to consider the knowledge and skills required by everyone working in mental health and addiction services, and make sure services are set up to assist collaboration, joint planning and support.

Understanding the service users’ experience when they access a service is essential to identifying areas for improvement.

Matua Raki is leading nationwide implementation of the co-existing problems project. Te Pou is supporting the project through some of its activities.

Let’s get real provides a framework for quality improvement across the sector. The seven Real Skills describe essential components for CEP practice, in particular identifying the importance of all staff having the essential knowledge and understanding of both mental health and addiction problems.

Te Pou has produced a number of resources to help services working with people who have co-existing problems. The position paper titled Using Let’s get real to support the co-existing problems project provides practical tips on how implementing Let’s get real will assist with CEP. It also demonstrates the similarities between the seven Real Skills and the seven principles of the Ministry of Health’s Te Ariari o te Oranga: The assessment and management of people with co-existing mental health and substance use problems 2010.

Building service responsiveness

In addition to individual workforce knowledge and skills, leaders need to ensure that services are designed to effectively respond to service users and their families with co-existing problems.

When considering how a service builds its CEP capability, there are a number of things that need to be taken into consideration. Understanding the service users' experience when they access a service is an essential component to identifying areas for improvement.

Process mapping is a mechanism to understand the service user journey when accessing a service. It identifies areas of excellence and areas of service improvement. The involvement of key stakeholders in service review and planning reflects the principles of the seven Real Skills of Let’s get real. Process mapping needs to involve a number of key stakeholders including service users, family and whanau, cultural advisors, managers and a variety of staff from across all services including community agencies.

Process mapping works by:

• focusing on the tangata whaiora/service user experience
• identifying the steps in delivering services
• understanding how the whole system works and how the different steps are connected
• identifying good practice and problems to tackle
• sharing team roles (identifying overlaps and gaps)
• defining service improvement work
• acknowledging complexity.

Te Pou is available to assist services map the service user journey to identify areas for service improvement.

Formulation workshops

Matua Raki delivers CEP formulation workshops. These are intended to introduce mental health and addiction practitioners from both DHB and NGO services to a conceptual framework that enhances the process of comprehensive assessment and treatment planning when working with people who have co-existing mental health and substance use problems.

Workshop content is based on material developed in Te Ariari o te Oranga and is delivered by Dr Joel Porter.
The workshop focuses on a practical tool that can be used by practitioners to consider co-existing problems in a more holistic way and will assist the process of integrating mental health and addiction assessment and treatment planning.

Although some workshop participants may not be routinely involved in carrying out comprehensive assessments, the workshop will nevertheless help to identify gaps in their CEP knowledge that can be addressed by future training and mentoring. Participants will also be encouraged to form peer supervision groups for ongoing development of knowledge and skills to work with co-existing problems.

For further information please contact Patricia Rainey at Matua Raki.

Using information to understand CEP responsiveness

When considering any area of service improvement, it is important to consider what information is being collected and how this might be useful to inform planning and to demonstrate change. Services that are collecting PRIMHD information can utilise some of this data to inform service delivery.

Team-based and diagnosis data can be used to inform CEP planning and responsiveness.

Team-based data

Service users often need to access both mental health and addiction services for support at the same time. The PRIMHD team-based data can be used to identify the number of service users that are accessing both mental health and addiction teams at the same time. This can be used to identify whether collaborative assessment, planning and support is occurring across the different teams.

Diagnosis

Te Rau Hinengaro identified that 20 per cent of the population will have some experience of mental health or substance misuse. The most commonly experienced mental health issues amongst substance users are anxiety and mood disorders with 30 per cent of these resulting in a visit to a mental health service. For workers it is essential that CEP is considered as part of the assessment process. Diagnosis is one component of what informs support planning. Primary and secondary diagnosis information is collected by services through PRIMHD. Identifying how this information is gathered and used in a service can contribute to CEP planning.

This is information that is available by any service collecting PRIMHD information. As it is being collected it is important to use it to inform any improvements that can be made to ensure that service users with co-existing problems receive the right support at the right time. For further information please see the April 2011 edition of Outcomes Matter.

Further information

The Te Pou website has a range of information available to support building the knowledge and skills for CEP capability. Check out the related publications towards the top right of this page.

For more information about the CEP project please contact Patricia Rainey, Matua Raki, email patricia.rainey@matuaraki.org.nz or phone 04 499 9340.

You may also be interested in…

• Counties Manukau DHB co-existing initiative
• Service Delivery for People with Co-existing Mental Health and Addiction problems - Integrated Solutions (Ministry of Health, 2010)
• Skills Matter funds places on the co-existing papers delivered through the National Addiction Centre (University of Otago) and Auckland University
• Let’s get real
• Alcohol and Drug Outcome Measure (ADOM)