Tū pakari tonu mai e te Whare Tapawhā!
Let the house of health and wellbeing stand strong!
Earlier this month the University of Auckland hosted a two-day Equally Well summer school in partnership with Te Pou o te Whakaaro Nui and Platform Trust. The summer school brought together people with lived experience, academia, medicine, community-based service providers and others to collectively address the physical health disparities for people who experience mental health problems and/or addiction issues.
The Equally Well collective impact model
Equally Well represents purposeful action being taken by people across all parts of society to address a serious issue potentially facing people who experience mental health and/or addiction issues. The Equally Well collective impact model is at the leading edge of innovation designed to create change in complex systems, with creative solutions driven by people who care and are able to influence change.
Ngāti Whātua Kaumātua George Hill opened the summer school and Changing Minds chief executive Taimi Allan welcomed the participants. The theme of the first day was ‘Evidence-based practice and practice-based evidence – published, lived, service.’
Taimi Allan discussed the Evidence Update: December 2017 and commented, “it was good to have the evidence in one place. My highlighter almost ran out!”
“We won’t make any inroads unless we collaborate in the fight together,” she said.
Finding the right solutions to systemic problems
Guest speaker Dr David Codyre and his team from East Tamaki Healthcare debunked the myth that people with longer-term experience of mental health problems and/or addiction issues don’t access their GPs. Data from Waitematā and Auckland DHBs told a different story. “94% of patients are enrolled in GP care and see their GPs more often. The issue is we don’t talk to each other,” he said.
Dr Codyre discussed how 12 – 18% of people living with long-term conditions are likely to also have severe mental illness. So, finding the right solutions to the systemic problems impacting on people’s health outcomes and quality of life is key. The ‘Kia Kaha – Manage Better Feel Stronger’ programme at Tamaki Healthcare is an example of integrated healthcare. The team working in this mental health and wellbeing programme know the three tenants of good outcomes are:
- early access
- learning about the condition
- learning how to manage.
Initial findings tell a story of the value of peer support, patient choice, patient voice.
Registered nurse Reny Abraham followed with a presentation about her Master's study – Metabolic Screening at Southern DHB, that incorporates a three-year plan. “No one ever said this issue of disparity is going to be a quick fix.”
Peer leaders Caro Swanson (Te Pou), Suzy Morrison (Matua Raḵi), and Brody Runga (Odyssey) discussed collaboration and co-design and the importance of understanding each other’s values to be able to work well together.
Helen Lockett from the Wise Group gave an update on the Cardiovascular Disease Risk Assessment and Management for Primary Care guidelines recently published by the Ministry of Health. This came about as a result of the Equally Well collaboration with the Heart Foundation, starting in May 2014. Important changes include the message “start earlier”. That is, for Māori, Pasifika and South Asian populations, and individuals with known significant CVD risk factors, screening should begin at age 30 years for men and 40 years for women, fifteen years earlier than other populations. People with severe mental illness (schizophrenia, major depressive disorder, bi-polar disorder, schizoaffective disorder) are a high-risk group and screening from 25 years is recommended.
Helen challenged the audience to think about how we turn this policy and guidance into better experiences and outcomes for individuals.
Emerging insights from the Equally Well evidence update
The afternoon sessions proved to be just as stimulating as earlier in the day. Café-style discussion groups looked at the emerging key messages from the Equally Well evidence update and shared the following insights:
- For Māori: the use of groups, peer support and telling stories are key. “Māori are very anecdotal”. With reference to the hierarchy of evidence, there was a suggestion of the need to turn it upside down for Māori, putting anecdotal evidence at the top.
- From people with lived experience: Peer work is “soul work”, peer leadership utilising knowledge and skills in motivational interviewing has great outcomes.
- From the addictions sector: Meeting people “where they are at” is important for engagement; knowledge can add to someone’s distress – unless there is someone they can access to support the processing required when someone is on the journey of discovery about themselves.
- From people with experience and knowledge of stigma and discrimination: “People only wear stigma because of the discrimination they face or are going to face;” issues of institutional and system discrimination (eg. insurance cover); barriers to access through being disadvantaged by limited opening hours and funding.
Focusing on solutions
The discussion turned to focus on the solutions. The consensus was we need to start by adopting an ideology of health equity for people with lived experience of mental health problems or addiction – this is key to achieving change.
Debby Sutton from the Addictions Collaborative, Suzy Morrison from Matua Raḵi and Tipene Pickett from Te Atea Marino, the kaupapa Māori service within CADS Auckland WDHB, presented on the current approaches supporting Equally Well in the addictions sector, reminding the audience that 12% of New Zealanders have a substance use problem in their lifetime. There are, however, always opportunities for enhancements and the “how" is key. Tipene left the audience with the take-home thought that “empathy is a big predictor of change”.
Marion Blake from Platform Trust facilitated a very interactive second day, themed "Applying the principles of collective impact to the Equally well collaborative". She encouraged the particpants to think and talk about issues of discrimination and how “activism is different these days and needs to be”. Reclaiming language, functional medicine and systems thinking are areas to focus on to bring about the change needed.
The organisers wish to express their thanks to the host organisations and the people who supported this event by attending and participating so passionately. Special thanks to Matua George Hill, Taimi Allan and Marion Blake. Presentation slides will be available on the University of Auckland website. For further information about the summer school, please contact Tony O’Brien.