Stories of change

Mana Mental Health Services

Ruia Mai Nga Kakano "Sowing the seed to recovery"

"This is about how much do you believe in yourself and who is there to support you." (Gavin Pike, Manager Mana Mental Health Services)

The profile

Mana Mental Health Services (MMHS) is a consumer-led organisation that provides peer support to mental health and dual diagnosis service users of the Lakes District Health Board (Lakes DHB).  MMHS is influenced by, but not working exclusively within, Kaupapa Maori.

The team also delivers recovery and educational workshops (awareness of mental illness and anti-discrimination presentations) to government agencies, the non-government organisation (NGO) sector and educational institutions. These are delivered by MMHS staff that have personal experience of mental illness.

MMHS consultancy services include audits of NGOs using the National Mental Health Sector Standards and Health & Disability Sector Standards.  The evaluated areas are Maori health, whanau ora, tamariki ora, tikanga practices, policy and procedures, consumer rights, organisational management, risk management, entry to services, clinical records and client records. Previously audited service providers include Runanga Iwi services, Kaupapa Maori, Child Youth and Family and mainstream mental health and addiction services, as well as GP practices.

The organisation employs six people, including manager, Gavin Pike. Each peer support specialist supports up to 12 service users.  The work hours are Monday to Saturday from 8.00am to 8.00pm to accommodate different needs of service users. The peer support service is funded by Lakes DHB, all other services are funded through external contracts of MMHS.

 "I've had a lot of people in my life that have been very supportive and cared about me and it's been a mixture of clinical and personal people.  So I want to give a lot of that back to other people that aren't receiving it." (Terry Dalzell - peer support specialist)

The beginnings

MMHS started in 2001 when Gavin Pike became known as "a one man band" to the police and crisis teams. At that time he was providing voluntary support to his fellow service users, as well as consumer-led consultancy services to government agencies.  Gavin used his own experience of mental illness and engagement with mental health services to address and close some of the "loop holes" in the system. Gavin strongly believed that if consumers and clinicians worked collaboratively and in a partnership, then it would be possible to achieve changes in individuals' lives and in the system's functioning.

In early 2005 Lakes DHB contracted MMHS to carry out a project called Nga Roopu Tangata. The project's goal was to assess how the region's mental health services had implemented standards 9 (consumer participation) and 10 (family/ whanau participation) of the Health and Disability Sector Standards, National Mental Health Standard (2001). Over a three-month period, MMHS engaged in 60 consultations with management and staff of mental health services, service users and their families/whanau. 

The outcome of the project highlighted a number of gaps within service delivery, mainly related to involvement of service users and their families/whanau in the process of recovery. It identified inadequate mechanisms for consumer advice, advocacy and peer support due to:

• the  limit to the number of services users in the local consumer support group
• no public advertisement of peer support organisations
• difficulty for providers and users to access consumer advocacy and peer support from outside their organisation. 

Capability building was identified as another area of improvement. Service users who were motivated to provide consumer services had insufficient opportunities for their development in the region.

At the end of 2005, not long after the report was made public, Lakes DHB and MMHS entered a contract to provide peer support services to service users in the region. Mind and Body Consultants from Auckland were appointed to provide supervision for the peer support service for a period of 12 months. MMHS became fully operational in May 2006 and became the first consumer-led organisation that was funded by Lakes DHB. 

Between 2006 and 2009 MMHS provided voluntary support to service users admitted to the hospital under Section 9 of The Mental Health Act (initial assessment in inpatient settings). Reluctantly the service, that in most cases took place at night in conjunction with the police and crisis team, stopped due to a lack of funding.  

Recruitment of new staff members involves a three-step process: CV selection, interview and a pre-induction half-day training session. Upon employment, new peer support specialists complete a four-week training course, consisting of 70 per cent theory and 30 per cent practice. In 2008 the MMHS renamed the role from peer support workers to peer support specialists, addressing the specific skills and knowledge of staff.

"Who would have thought a few years back that mental health/addiction providers would want to have a relationship with a consumer organisation. So it shows that things are changing. Things are improving, it's great." (Gavin Pike)

The process

MMHS peer support expands the involvement of service users from mental health only related services to general community activities and encourages them to work towards their personal goals. People are given the opportunity to attend events or visit facilities like the library or public swimming pool complex. This helps them improve their self-esteem and increase confidence in their abilities to live fulfilled lives in the community.

The peer support specialist identifies and informs the service user what is available within the community that will enable her or him to achieve their personal goal. People then carry out practical tasks, such as accessing appropriate agencies or organisations independently. Kiwifruit picking, taking salsa dancing lessons, and moving to Australia are some examples of what people have achieved using the MMHS service.

Another area of support is role modelling activities of daily living, from personal hygiene to shopping. For example, if support was needed for shopping, a peer support specialist will explain how to shop and will accompany the person to the store on their first trip. This assists people to start doing these tasks themselves.

People aged 20 years or over, residing in the Lakes DHB region, and having either mental health or a dual diagnosis, are eligible for peer support.

Step by step

1. MMHS information is available in inpatient and community mental health services. The decision whether or not to contact Mana Mental Health Services is the service user's personal choice, based on a collaborative discussion with their mental health care provider.
2. MMHS can be contacted by phone or in person. The administrator completes an initial contact sheet and clarifies what support is required.
3. The service manager reviews each contact sheet and determines which peer support specialist will meet face-to-face with the person who has enquired about the service.
4. Initial contact takes place in public, to provide a less threatening environment and to ensure everyone's safety. The peer support specialist presents an information pack which includes personal recovery stories of every peer support specialist and services offered.  
5. A peer support specialist is selected and a meeting is arranged.
6. The peer support specialist and the service user develop a plan of their collaborative work, based on a strengths profile, goal planning and Wellness Recovery Action Plan (WRAP).  Consent is sought for service coordination, family involvement and information sharing with other providers. The minimum frequency to meet is once a week. Areas of support range from daily living, finance management, education, health, social and spiritual support, leisure and recreation.
7. The length of time that MMHS provides support varies depending on the individual's needs and goals - this can range from a few weeks to more than two years (2 years 9 months is the longest support provided).

"They do what they say....it feels easy [with them] like with my family."(Service users supported by MMHS)

The unique approach

• MMHS is influenced by, but not working exclusively within, Kaupapa Maori. The service incorporates a Maori model of health in the provision of support to service users.
• Peer support specialists' personal stories send a strong message about recovery being achievable.
• Service users choose who they want to work with toward their recovery.
• For confidentiality and privacy reasons, each service user has a unique number that is used in discussions within the team or with external organisations.
• A thorough recruitment process to ensure diversity of background in skills and expertise.
• MMHS services strongly oppose commonly used terminology such as "our/my service users" and state that they do not "own" the people they support.  Members of the team believe that using possessives can be very demoralising for the people who use their service.

"They have an ear to listen to you...they make you think for yourself...these people save lives."(Service users supported by MMHS)

The results

Since the start of the service, MMHS has:

• supported 105 people
• been evaluated by Lakes DHB (in 2008)
• carried out ongoing internal audits
• been profiled widely in local newspapers and the Maori television programme Warrant of  Fitness.

Anecdotal evidence indicates that people using the MMHS service feel very supported to set and achieve personal goals. Key to this is the role modelling aspect of the service. This not only makes them believe they can do it, but also gives them strengths and tools to re-engage with the community.

An evaluation by Lakes DHB on the effectiveness of the service's delivery considered alignment between contracts, collaboration, integration and coordination of services. Factors such as choices, resources and service relationships were assessed. MMHS has met the service specifications in all areas. The report highlighted that:

• MMHS provide a focused peer support service and have remained clearly linked to the systems put in the establishment phase
• the volume of service users supported is appropriate for the type of service MMHS provides
• stakeholders in the area are supportive of the concept of peer support
• service users actively sought peer support
• Mana Mental Health Services has put in place ways to keep staff and the organisation on track and safe.

MMHS incorporates various approaches to insure the best service is provided through training and regular internal audits. These audits assess how well MMHS is meeting their contractual service specifications, and quality and efficacy of service delivery. Service users' feedback is included in the audits. The 2008 audit indicate that the service has met most of the audit criteria. For those that needed further improvement relevant, practical measures were suggested, such as developing contacts with the Pacific community; developing policies and procedures to prevent and remove abuse and neglect to service users, staff and visitors; quarterly internal monitoring of service users files; developing a procedure to feedback evaluation results to service users;  and developing infrastructure for better involvement of family/whanau.

"It's ... doing our best to create autonomy rather than co dependence."  Terry Dalzell

The lessons learnt

• People develop a "can do" attitude toward their recovery when they experience first-hand role-modelling by peer support specialists.
• Peer support services take an important place in the holistic approach to recovery.
• Diversity of staff background provides flexibility and creates good relationships between service users and peer support specialists because of the choices offered.
• Limiting the case load for peer support specialists leads to better options for service users and a psychologically safe environment for peer support specialists, being in recovery themselves.
• Peer support can only be provided with funding when section 9 of Mental Health Act is applied.
• A variety of funding sources are required to ensure sustainability of service, leading to individual and team success.

"It's reaffirmed everything I've always believed in.  That everybody is capable of change." (Alice Batkin - peer support specialist)

More information

Contact

• Gavin Pike at awhi4u@xtra.co.nz, or phone 07 343 9082, mobile 021 931384.

Website

www.manamentalhealth.co.nz

From left: Hui-Aroha Mareikura (company director/health promotions officer), Gavin Pike (company director/service manager), Alice Batkin (peer support specialist), Terry Dalzell (team leader/peer support specialist), Alison Lamberton (personal assistant)

Download this story in PDF format

The information on this page is also available for download in PDF format.

Mana Mental Health Services story (PDF)

Documents/links

• Company profile
• Mission statement 
• Peer support services 
• Leaflet for other services provided by MMHS

Audio

• A fragment of Waiata No one can do it but you, music by Hui-Aroha Mareikura, lyrics by Gavin Pike and Hui-Aroha Mareikura, from the disc Stand tall produced by Mana mental health Services, 2006 (duration: 50 sec.) To listen to the waiata please click the "play audio" link at the top of this page.

Browse   |   Search   |   Suggest a story

Page last updated: 7 November 2008