Helen Lockett reflects on last month’s cracking Equally Well workshop at the Ministry of Health’s Making it Real: working with long-term conditions conference.

A surfer does not always ride the first wave but watches the horizon for opportunities for larger waves.  The surfer dodges and dives through the water and waves, carving a path forward while being drawn by the current towards the shore.  This analogy suits an agile approach, leaders need to move forward at the same time as keeping their view to the horizon of possibilities.

These words are from Liz Weaver from the Tamarack Institute, whose thoughtful piece Disruptive Times require Skilled Changemakers, I’ve been reading as I reflect on how to enable systems change. 

The need to keep agile and scan for possibilities feels very apt at the moment. I keep taking action where I can on Equally Well issues, whilst at the same time I am looking for the opportunities which are opening for taking further action, as we wait for the Government’s response to He Ara Oranga in particular, and also to the other systems reviews that are currently underway. 

At the end of February, I had the privilege to convene and chair a session at the Ministry of Health’s Making it Real: Working with long-term conditions conference. Our Equally Well workshop was titled Working with the whole person: mental health, addiction and physical health

Five years ago, if I had been asked, I would probably have struggled to find people outside the mental health sector to ask to present. My networks were certainly more limited then and they really did not even span into the addiction sector much either. I might have gone along and presented the findings from the Te Pou 2014 evidence review, perhaps feeling a lone voice and a little uncomfortable in a setting of people operating in a different part of the health sector. I was likely to be sharing information people were hearing for the very first time. 

In contrast, earlier this year on receiving the request from the Ministry of Health to convene some speakers who could talk to a primary care audience about mental health, addiction and physical health - we (the Equally Well backbone team) opened our Equally Well partners’ list for the collaborative. It is now abundant with people who have put their hands up to be Equally Well champions. One email later, Janet Peters, Jocy Wood and Fran Cook had agreed to speak and we had a great complementary set of presentations planned. 

I opened the session to set the scene. The room was full of around 50 primary care practitioners and managers. I talked about co-occurring issues being the rule not the exception, drawing on the NZHS analysis by Te Pou, the Matua Raki CEP project and the 2017 Equally Well evidence review on co-morbidities.   

Kevin Harper of the Ministry of Health led us into the session speaking to He Ara Oranga, and how he felt it opened the way for new thinking and new ways of working, with a particular focus on addressing inequities in physical health outcomes.  

Janet Peters spoke about the evidence on the association between additive adverse childhood experiences (ACEs) and later physical health, mental health and addiction issues. She discussed the importance of trauma-informed care and examples of what this means for primary care, challenging the audience to take action. Janet also talked about what other countries were doing and provided a number of useful links to examples of good practice, such as Warren Larkin’s REACh programme in primary care and a 2019 UK government report on the issues.

Jocy Wood as a practising GP and also the clinical director of community mental health at Nelson Marlborough DHB, led by example from her own general practice. Jocy’s particular interest is the need to create better cardiometabolic pathways of care for people with mental health and addiction needs. She highlighted the new Ministry of Health guidance for CVD screening and assessment in primary care and the need for risk assessments from the age of 25. She also pointed out how the current risk assessment tools underestimate the risk and what this means for GPs. Jocy has established a process within the general practice patient management system that prompts GPs and practice nurses to carry out the recommended checks, and she shared how this can improve pathways of care.  

Fran Cook is the service manager for Pegasus Health PHO, with a background in nursing. Fran presented some of Pegasus’ Equally Well actions including how Pegasus are building a better understanding of how people with mental health and addiction issues experience primary care. This includes regular reporting on rates of cancer screening, CVD risk assessment, diabetes care and use of the smoking cessation ABC, and ensuring this information is rapidly shared with general practices so that they can address inequities of care. 

It was a great session. Each person spoke authentically, knowledgably and passionately about Equally Well issues and walked the talk, giving example after example of the actions that they were taking. There was a real buzz in the room throughout the session. Jo Scott-Jones, a leading rural GP from Pinnacle Health Network, raised his hand to help when Janet called for a national movement to raise awareness of the impacts of adverse childhood experiences and the importance of delivering trauma-informed care. People smiled and nodded with agreement when Jocy spoke about how she takes time to have conversations with all her patients who are experiencing mental health and addiction issues, and then carries out cardiometabolic screening and checks. When a participant asked Jocy how we get primary care data to be able to understand how we are performing with patients with mental health and addiction issues, the question was the perfect lead in for Fran to explain how Pegasus can now better understand the needs and experiences of patients with mental health and addiction issues. 

Kevin, Janet, Jocy and Fran are Equally Well champions, and they are typical of many I meet every week, and many others who I have not met yet, who are taking action right now to address the physical health inequities for people who experience mental health and addiction issues. The Equally Well collaborative promotes distributed leadership, and this was certainly what we achieved that day - it was a pleasure to be part of it. 

He Ara Oranga encourages us to bring change through collective impact, citing pockets of good examples like Equally Well and Waka Hourua [He Ara Oranga, p. 120]. Collective impact initiatives are by definition community-led, addressing national issues with local solutions.  

Community change doesn’t just happen. Change occurs when a leader invites others to join them or a group of leaders come together because they want to build something new or are dissatisfied and want to shift the status quo.

(Liz Weaver, Tamarack Institute) 

This year Equally Well aims to strengthen its distributed and diverse leadership and is calling on all endorsing organisations to publicly share their Equally Well action plans. Shared action plans can strengthen the networks and connections across the collaborative and help to maximise individual and collective action.