Co-existing problems

Te Pou supports the development of person-centred, wellbeing oriented integrated care for co-existing mental health and addiction issues (CEP). The aim of integrated care is to ensure that ‘any door is the right door' for tāngata whai ora with co-existing mental health and addiction issues wherever they make contact with a service.

In April and May 2026, Te Pou surveyed addiction and mental health kaimahi to understand their confidence in knowledge and skills for working alongside tāngata whai ora with co-existing problems, use of co-existing problems frameworks, and their workforce and organisational development needs. One hundred and fifty-two kaimahi completed the survey.

The survey found:

• kaimahi often work alongside tāngata whai ora with co-existing problems
• about 1 in 5 kaimahi are not confident in screening and assessment, and maintaining their own learning
• they use a mix of approaches to respond to tāngata whai ora with co-existing problems including Māori models of health like Te Whare Tapa Whā, co-existing problems frameworks, tools and resources, and collaborative and integrated practice approaches
• some kaimahi reported no prior training and many stated they want more training and development relevant to their roles
• organisational and systems development opportunities are also needed to enable kaimahi to upskill in their practice to better support tāngata whai ora to meet their hauora aspirations.

A range of specific resources and material are available to support the process of raising awareness and skills to work with co-existing issues, such as e-learning modules and online assessment tool - Real Skills.

Te Whare o Tiki: the Co-Existing Problems (CEP) knowledge and skills framework describes the knowledge and skills required by the mental health and addiction workforce to effectively respond to the needs of people, and their whānau, with co-existing problems.

It was developed to align with the seven key principles of Te Ariari o te Oranga (Cultural Considerations, Wellbeing, Engagement, Motivation, Assessment, Management, and Integrated Care) and is underpinned by the values and attitudes outlined in Let's get real.

Each key principle encompasses a set of knowledge and skills with performance indicators at three levels of practice: Foundation, Capable, and Enhanced.

There are two guiding documents for the development of CEP responsive mental health and addiction services in New Zealand.

• Te Ariari o te Oranga: The Assessment and Management of People with Co-existing Mental Health and Drug Problems (Ministry of Health, 2010). This is a clinical framework to assist health professionals working with co-existing substance use and mental health problems.
• Service Delivery for People with Co-existing Mental Health and Addiction Problems: Integrated Solutions 2010 (Ministry of Health, 2010). A service delivery guidance and companion document to Te Ariari O te Oranga that supports more integrated care for people with co-existing mental health and addiction problems.
• Integrated competencies for co-existing issues: Holistic support for people accessing mental health and addiction services. A literature review summarising required competencies and a comparison to existing competency frameworks like Let’s get real and Te Whare o Tiki.