Let’s get talking is Te Pou’s psychological therapies project. It includes tools to support health services to deliver effective talking therapies for people with problems with mental health and addiction. Primarily it is concerned about better access using a stepped care approach and evidence-based therapies. It looks at outcome evaluation and optimising a skilled workforce. Treatment is directed at the best chance of delivering a positive outcome with the least restrictive intervention – in both primary and secondary care.
Stepped care is a way of getting a comprehensive approach to the delivery of talking therapies across the sectors because talking therapies are not always tied into a context. Stepped care gives you a way of knowing at which level you are practising and what is needed at that level. The point is to broaden the range of therapies and the range of people who can deliver them. So the more trained allied health professionals there are delivering this the better.
Te Pou’s online toolkit consists of seven tools to help people develop new services or expand existing ones. Individual practitioners can also use them in their therapy. Tools include: an introductory video; planning; surveying skills; assessment; evidence-based therapy; review; and practice support.
The experience at Southern DHB
Karen Ramsay (allied health director, mental health addictions and intellectual disability service, Southern District Health Board [DHB]) said leadership is her passion and that the work of leaders in the health system is to bring people along with them in the interests of providing the best possible care, and to involve service users in that care as well.
She said the problems Southern DHB faced in terms of talking therapies included: waitlists; non-recognition of therapies delivered by other allied health professionals; lack of clarity about who is delivering what; information systems not capturing what therapy is being delivered, by which profession and for how long; and training and delivery issues.
“So our starting vision was that there will be clear and available pathways to access evidence-based psychological therapies for all service-users in adult community mental health services,” Karen said.
The next step was gathering data and Karen surveyed the DHB’s adult teams to get baseline information about what talking therapy was delivered by which professional disciplines and for how long. The resulting data was quite variable and broad, so the next step in 2015 was an observational trip to Scotland, which has been introducing pathways to talking therapies for the last seven years.
In Scotland one of the things that had been found to make a real supportive difference was a Government mandated HEAT target (time into starting therapy), which, Karen said, is something we should really also have in New Zealand.
Allied health professionals in Scotland were very enthusiastic about progress there and Karen and her colleague brought that excitement back to New Zealand. To get the project underway they established a steering group and a project outline. Development workshops to engage staff and gain feedback were also held in Invercargill and Dunedin. Three multidisciplinary working groups that include consumer advisers are now developing specific recommendations that cover off the aspects of the Te Pou Talking Therapies tools.
Pathways and systems for increasing access to talking therapies will be rolled out across all the DHB's adult community multidisciplinary starting June 2017. Implementation will include monitoring and support systems for staff. Work will also be done to improve outcome data collection to inform evaluation.