Linda Smith is one of the Consumer Advisors within Canterbury DHB. It is Linda’s role within the Specialist Mental Health Services of the DHB to work with managers to improve the services provided for people with experience of mental health issues. Here Linda shares her observations on some of the Equally Well initiatives the DHB is involved with to improve information, access and outcomes for people with mental health issues. She is a passionate advocate for Equally Well action. 

Clozapine-induced gastrointestinal hypomotility

Linda returned from the Equally Well Summer School in February this year well-motivated by Suzanne Every-Palmer’s research presentation on clozapine-induced gastrointestinal hypomotility. The result has been further work on adopting the Porirua Protocol 1 (guidance to prevent clozapine-related constipation) within the Mental Health Services, and work on providing information for consumers using this medication. The group working on the initiative has chosen to go with information from Best Practice Advocacy Centre New Zealand (bpac), which Linda particularly likes because the information provided is given in a clear, succinct and non-judgemental way. Here's a link to the site.


Linda has also been instrumental in getting further information for people with mental health issues available on the Canterbury DHB’s HealthInfo website. This fact sheet covers possible comorbidities for people with mental health issues and includes topics such as cancer screening, oral care, breast care, diabetes, feet care, medication, lifestyle, GP visits and physical health check-ups. This fact sheet will soon be available on the HealthInfo website, with embedded links to specific care information for people to explore issues further. 

They need to be prepared to work with people with mental health issues and be involved with their ongoing physical wellbeing. To this end, they need to read the evidence around Equally Well.

Education for medical staff

Education for medical staff is also important.  Another initiative is a presentation being developed for Canterbury DHB fifth year medical students or trainee interns. Linda comments, “The new doctors need to understand the comorbidities which accompany a mental health issue – to help them identify that the people presenting to Health services are not just there because they have a mental health issue. We are especially looking at educating them about the health disparities for those with a serious mental health issue and to understand that the 25-year decrease in life expectancy is having an impact on the consumer’s life. We need them to understand the complexities around diagnostic overshadowing and the likes of Cardiovascular disease at a much earlier stage than you would expect in the general population”. 

Linda also has a similar comment about GPs, “They need to be prepared to work with people with mental health issues and be involved with their ongoing physical wellbeing. To this end, they need to read the evidence around Equally Well”. 

Linda is looking for improvement in the communication of information around funded Equally Well GP visits and CarePlus with Pegasus PHO  to the Canterbury DHB mental health service case managers. Linda says, “The funded GP visits are successful for those who have accessed them, but more people need to know about this service”. Linda comments on feedback from a consumer on the funded GP visits, “It was a very good appointment as her baseline physical testing was done, which actually raised a Cardiac issue which otherwise may not have been picked up”.   

Patient Safety Week

One of the national initiatives Linda is excited about is Patient Safety Week (PSW) from 5-11 November. PSW has a focus on medication safety in line with the World Health Organization’s five-year medication safety challenge. The Health Quality and Safety Commission, with input from ACC and Pharmac, have produced resources to encourage conversations between consumers and health professionals. Linda is impressed that consumers are being encouraged to ask: What is my medicine called? What is it for? When and how should I take it? Linda is particularly impressed with this initiative as “people need to know about their medication, for example, the weight gain associated with some medications, so they can be aware and address the issue”. For further information and to access the suite of resources click here.

Suggested algorithm to prevent clozapine-induced gastrointestinal hypomotility (Every-Palmer, 2014). The Porirua Protocol: Guidance to prevent clozapine-related constipation)