Equally Well and COVID-19

General practices are still available for the usual health support and services at all Alert Levels. People are encouraged to use phone and the internet in the first instance, to contact their GP or Healthline. Do not feel because of the pandemic you have to wait. All general practices have processes in place to keep people safe if you do need to visit in person, whether unwell or for routine medications and tests, so do contact your GP if needed.

“How lovely it was the other day when I had a telephone consult with my GP around a physical health issue, and they also took the time to ask me how my mental health is at the moment too” - Linda Smith, Consumer advisor, Canterbury DHB.

The flu vaccine is recommended and free for some groups of the population, particularly people who are most likely to get more severe symptoms. If you are unsure if you are eligible, please contact your general practice or pharmacy to discuss. The priority groups are:

• People aged 65 and over
• Pregnant women
• People with certain long-term conditions and illnesses including:

1. cardio-vascular disease
2. chronic respiratory disease
3. diabetes
4. chronic renal disease
5. most cancers
6. autoimmune disease
7. HIV
8. Transplant recipients
9. Neuromuscular disorders
10. Haemoglobinopathies
11. Down syndrome
12. Error of metabolism

• Children aged 4-years or under who have needed to stay in hospital for severe respiratory illness or children aged 5-years or under who have needed to stay in hospital with measles.

For a full list of who is eligible for a free flu vaccine see: Fight Flu website.

Also don’t forget that Green Prescriptions are still available if you want to access additional support for looking after your physical health.

At the end of 2020 the Equally Well backbone team convened a group of expert advisors, chaired by strategic advisor, Dr Helen Lockett, to consider the available evidence in relation to people with mental health and addiction issues and COVID-19 and to make recommendations to the Ministry of Health’s policy team developing the Vaccination Sequencing Framework.

The research team at Te Pou undertook the evidence review to inform this work.

The advisory group were clear that there is strong evidence to support adults with mental health and addiction issues being prioritised for the vaccination. The Group developed a position statement summarising the evidence and their recommendations. The position statement was sent to the Ministry of Health on 25 January 2021 for their consideration.

You can download the position statement here.

A new resource is now available with questions and answers that people with experience of mental health and addiction challenges may have about the COVID-19 vaccination including:

• How the vaccination was developed
• How it works
• Addressing misinformation, overcoming fear and engendering trust
• Information for the lived experience workforce

A resource for tāngata whai i te ora, tāngata mātau ā-wheako and their whānau, as well as people working in mental health and addiction services, it is informed by a survey carried out by Changing Minds, a Whāriki o te Ara Oranga he aka hui in July 2021 hosted by Dr Edwin Reynolds from the Immunisation Advisory Centre (IAC) and with extensive support from Equally Well champions, Te Pou and the IAC team.

Te Rōpū Whakakaupapa Urutā is a national Māori pandemic group with resources specifically for whānau and iwi during the current Rāhui. The rōpū are leading Māori medical experts understanding the multiple layers of health inequities for Māori and identifying resources to assist: find out more on their website.

Te Rau Ora (formerly Te Rau Matatini) is Aotearoa New Zealand’s lead indigenous Māori organisation in national health workforce development mental health and addiction and mental wellbeing across the lifespan. Te Rau Ora have a number of resources on their website to support people during the Rāhui and beyond, #RespectTheRāhui. These resources include:

• Helping frontline workforces with stress
• Helping our tamariki deal with stress
• Preventive measures for yourself and whānau
• What physical distancing to COVID-19 means for Māori
• Be prepared
• Supporting a colleague

• Le Va have developed a resource, 'Catch yourself', to help us maintain respectful relationships in our bubbles
• Le Va have also developed a ‘Budgeting in your bubble’ resource which includes ten tips on living on a budget during COVID-19

Staying at home and dealing with the pressures that are around at the moment can mean mental health and addiction needs increase, and it can be harder to maintain general wellbeing. The Mental Health Foundation has a number of helpful resources on their website including some top tips based on the ‘Five ways to wellbeing’ and Te Whare Tapa Whā.

Mental health or addiction medication

The situation for people on clozapine may be different at the moment. Some of the information that may be useful is:

1. Waitematā DHB Specialist Mental Health and Addictions Service guidelines recommend that during the COVID-19 Alert Level Four response routine monthly full blood counts are deferred due to safety risks in people attending their local testing lab. Waitematā were reviewing this policy towards the end of week four of COVID-9 Lockdown.
2. An article aimed at clinicians, and published in a peer-reviewed journal in April: A consensus statement developed in Australia on the use of clozapine during the COVID-19 pandemic
3. A UK website also provides information on clozapine use during the COVID-19 pandemic based on frequently asked questions:

The Ministry of Health advise that under the Level Four restrictions, pharmacies can only supply sufficient Pharmac funded medication for one month at a time, except for oral contraceptives. All recommendations are being constantly reviewed: see here.

Opioid Substitution Treatment (OST) medications have continued to be provided by community pharmacies. As controlled substances, the medications are usually dispensed to people receiving OST 2-3 times a week, with some people picking up medication on a daily basis. Each OST service has made decisions about the frequency of medication pickups on an individual basis balancing risks of potential exposure to COVID-19 and risks of diversion or nonprescribed used of medications, including overdose. Guidance for pharmacies on dispensing OST medications have been provided.

Accessing mental health and addiction support

For people who are currently accessing mental health and addiction services, consider what coping mechanisms have worked successfully for you in the past, and whether this may also support you now. Continue to do the things that are helpful for your mental health and wellbeing.

You may need to find different ways of doing some of those things, like meeting people over Zoom rather than in person. Keep reaching out.

Do reach out to the health professionals you are connected to as you need to, whether that is your GP or a specialist mental health and addiction team.

Don’t feel you can’t because of the pandemic or that health services are dangerous places at the moment. They are doing everything to ensure people are safe and have their needs met.

The Ministry of Health’s pandemic website provides information and tools available to support mental wellbeing, help with substance use concerns, and lists of online and phone support services, including Just a Thought’s online course for supporting your wellbeing during the pandemic:

The New Zealand Drug Foundation has developed web and downloadable resources to support people impacted by their own or others substance use during lockdown.

While the past few weeks have been a time of reflection, some people might be thinking about reducing their alcohol use or stopping. This is a great opportunity for some, but for others who stop drinking suddenly it can have significant negative consequences. If you're unsure contact the alcohol drug helpline.

Platform Trust is providing regular updates on COVID-19 information relevant to community NGOs, on their website.

It is a very important time to consider the needs of people who are already experiencing significant mental health and addiction issues. People with lived experience have higher levels of co-occurring physical health issues, and at an earlier age than people without mental health and addiction issues. This can mean some people are more susceptible to contracting respiratory illnesses and experiencing symptoms at a more severe level. In addition, many people with lived experience are living in situations with increased levels of social and economic hardship. This may be due to lack of employment, low incomes, access to affordable quality housing and food supplies, and unaffordable health costs thereby impacting on the health and wellbeing of their whānau. Furthermore, many people with lived experience belong to whānau and Māori communities and can live with disproportionate levels of cancer, diabetes, and cardiovascular and respiratory disease. This can be on top of food supply insecurities and low access to healthy kai.

The COVID-19 pandemic further exacerbates these issues by:

• Further reducing access to affordable and healthy food supplies.
• Reduction in job security and growing unemployment in general.
• Not having long-term physical health needs met due to the current halt on some hospital and medical interventions.
• Phone contact only with some primary health services.
• Barriers to healthcare such as no internet or phone connections further isolating people, particularly those living in remote coastal and rural locations.
• Isolation due to social distancing and level restrictions