Northern region mental health and addiction services - workforce summary

Transcription

1 Northern region mental health and addiction services - workforce summary More than numbers organisation survey results This summary presents the Northern region results from the 2014 Te Pou and Matua Raki organisation workforce survey. The survey aimed to describe the size, distribution and configuration of the adult mental health and addiction services workforce as at 1 March 2014 and to understand current and future workforce challenges, knowledge and skill needs, and the strength of relationships within and across sectors. Survey results are complemented by images from the published visual summary for the region. 1 Four district health board (DHB) organisations and 45 Vote Health funded non-government organisations (NGOs) based in the Northern region were invited to participate in the survey. 2 All DHBs (100 per cent) and 78 per cent of NGOs returned completed surveys. The overall response rate was 80 per cent. NGOs completing the survey received 90 per cent of the Vote Health funding for NGOs in the region. About the Northern region The Northern region s adult population consists of 943,665 people, which is 38 per cent of the national adult population. Adults identifying as Māori are 10 per cent of the region s adult population, and those identifying in Pasifika and Asian ethnic groups comprise 11 per cent and 22 per cent of the adult population respectively. Organisations working in the Northern area receive 37 per cent of Vote Health funding for the delivery of adult mental health and addiction services. The access rate for mental health services in the region (2.7 per cent) was lower than the national average of 2.9 percent, and the access rate for alcohol and other drug (AOD) services (1.6 per cent) was higher than the national average of 1.5 per cent (see Figure 1). Figure 1. Consumers accessing adult mental health and addiction services 2012/13 Note: ^ Mental health service and AOD service consumer numbers will include people seen by both sectors 1 Visual summaries are available from the Te Pou website 2 Organisations surveyed included DHB provider arm services and NGOs contracted to deliver adult mental health and addiction services during the 2012/2013 year. The survey did not collect information from services whose primary focus was whānau ora, aged care, primary health, youth, disability support, health promotion, policy, quality improvement, research or workforce development.

2 Workforce results For the purposes of this report, mental health services includes those providing combined mental health and addiction services (excluding dual diagnosis and co-existing problems services), and addiction services includes AOD and dual diagnosis and co-existing problems services, and problem gambling services. Size and distribution Northern region services that returned surveys reported a total workforce of 3,955 people, with 3,409 full-time equivalent (FTE) positions including vacancies of 145 FTE positions. Ninety-four per cent of the workforce identified was funded by Vote Health (3,219 FTE positions). The remainder of this summary describes the Vote Health funded workforce. The total workforce in the region s adult mental health and addiction services was the largest in the country and is consistent with the region s share of the national adult population. The region s workforce comprised 37 per cent of the national mental health services workforce and 27 per cent of the national AOD services workforce and 48 per cent of the national problem gambling workforce. Figure 2 shows the total workforce for each sector and the proportion in DHB and NGO services, and describes their vacancy rates. Figure 2. Proportion of the Vote Health funded workforce (FTE positions employed plus vacant) in DHB and NGO services for each sector. Within the Northern region, services in the Waitematā DHB area had the largest workforce followed by the Auckland DHB area. The Counties Manukau DHB area had a large mental health workforce and a very small addiction workforce. The Northland DHB area had the smallest workforce in the region. Figure 3 shows the workforce reported by mental health services and by addiction services by DHB area where the service is provided.

3 WORKING NATIONALLY^ Mental health 52 FTEs (2%) Addiction 13 FTEs (3%) NORTHLAND Mental health 217 FTEs (8%) Addiction 10 FTEs (3%) WAITEMATĀ Mental health 1,057 FTEs (37%) Addiction 212 FTEs (56%) AUCKLAND Mental health 730 FTEs (26%) Addiction 102 FTEs (27%) COUNTIES MANUKAU Mental health 785 FTEs (28%) Addiction 40 FTEs (11%) Figure 3. Mental health and addiction services workforce for each DHB area of service delivery Notes: The percentages shown describe the DHB area s proportion of the region s workforce for that sector. For example, the Auckland area mental health workforce of 730 FTE positions is 26 per cent of the region s mental health workforce. ^There were 65 FTE positions working across multiple regions or nationally. Services delivered DHB provider arm mental health services reported that 19 per cent of their workforce was in forensic services, with 27 per cent in inpatient or residential services, and 52 per cent in community services. The region s NGO services reported 40 per cent of their mental health services were in residential services and 45 per cent in community services. The workforce in DHB provider arm addiction services all provided AOD services and was mostly community-based (85 per cent). For NGO addiction services 56 per cent of the workforce was in community services and 42 per cent in residential or inpatient services.

4 Occupational groups and roles Seventy-four percent of the DHB mental health services workforce was in clinical roles, with their largest occupational group being nursing. Nonclinical roles comprised 73 per cent of the NGO workforce, with the largest occupational group being support workers. In contrast, 63 per cent of the AOD services workforce was in clinical roles, and 19 per cent was in non-clinical roles. DHB AOD services reported 83 per cent of their workforce was in clinical roles, most of which were nursing and addiction practitioner roles; whereas 42 per cent of the NGO-based AOD services workforce was in clinical roles, most of which were addiction practitioners. Figure 4. Total adult mental health and addiction services workforce (FTE positions employed plus vacant) by role type and provider. Three-quarters of the problem gambling services workforce was in clinical roles, mostly comprised of addiction practitioners or counsellors (see Figure 5). Figure 5. Workforce (FTE positions employed plus vacant) for mental health services and addiction services by main occupational groups Note: ^ These graphics do not include 15 FTE positions in mental health services other roles and 15 FTE positions in addiction services other roles.

5 Ethnicity of the workforce Figure 6 describes the ethnicity of the adult mental health and addiction services workforce reported to the survey in total and by clinical and non-clinical roles. In NGO mental health services, 22 per cent of the workforce positions were filled by Māori staff members, with slightly higher representation of Māori in non-clinical roles, compared to clinical roles. Staff from Pasifika and Asian ethnic groups comprised 13 per cent and 14 per cent of the workforce respectively. Figure 6. Adult mental health and addiction services workforce ethnicity by role type Note: ^ Other comprises of all other ethnic groups including Pākehā/New Zealand European In DHB mental health services, Māori staff members filled 17 per cent of the workforce positions, with three time s higher representation of Māori in non-clinical roles compared to clinical roles. Staff from Pasifika and Asian ethnic groups comprised 8 per cent and 10 per cent of the workforce respectively. NGO addiction services had 18 per cent of their workforce positions filled by Māori staff members with higher representation in clinical roles than non-clinical. DHB addiction services did not report any Māori staff members. Staff from Pasifika and Asian ethnic groups comprised 18 per cent and 10 per cent of the total AOD services workforce respectively. Workforce and service challenges Recruitment and retention Mental health services reported they perceived future recruitment and retention issues for registered nurse, consultant psychiatrist, psychiatric registrar and community support worker roles. Mental health respondents were also concerned about potential shortages of Māori and Pasifika staff to fill non-clinical roles. AOD services were concerned about shortages of staff to fill consultant psychiatrist and addiction practitioner roles, and Māori staff to fill non-clinical roles. Problem gambling services were concerned about large shortages of addiction practitioner roles and Māori staff to fill clinical roles.

6 Knowledge and skills Sixty-three to seventy-six per cent of respondents from mental health services indicated a need to improve all the workforce knowledge and skill areas described in the survey that related to cultural competency for working with Māori, Pasifika and Asian ethnic groups. In addition to the competencies described in Figure 7, respondents identified working with new technologies and IT, psychological interventions and supporting self-managed care as areas needing improvement. Fifty to ninety-four per cent of respondents from AOD services indicated a need to improve all the workforce knowledge and skill areas described in the survey relating to cultural competency for working with Māori, Pasifika and Asian ethnic groups. In addition to the competencies described in Figure 7, respondents identified working with Māori health outcome measurement, working with families, risk assessment and working with new technologies and IT as areas needing improvement. Problem gambling services were concerned about cultural competencies for working with Pasifika ethnic groups, as well as working collaboratively with other services and ability to respond readily to changes in types of work. Figure 7. Areas identified as needing improvement in workforce knowledge and skills by sector Workforce planning and development challenges Figure 8 shows the top four challenges identified by adult mental health and addiction service respondents. Mental health services most commonly identified managing pressure on staff due to increased complexity as one of their top four challenges. This was followed by static or reduced funds, managing pressure on staff due to increased demand for service, and recruiting qualified and experienced staff. Funding was the challenge most often ranked first. DHB services were less concerned about funding than NGOs and instead identified managing pressure on staff due to increased complexity as a challenge. Figure 8. Top four challenges ranked by all respondents (proportion of respondents shown as percentage)

7 AOD services highlighted concerns about retaining qualified and experienced staff, and managing pressure on staff due to increased demand for service and changing service delivery models. NGO AOD services and problem gambling services also highlighted static or reduced funds as a key challenge. Cross-sector relationships Figure 9 describes the total responses for the relationships most often identified as in need of improvement by adult mental health and addiction service respondents. Mental health services reported the need to improve relationships with the disability sector, Child Youth and Family Services, and general hospitals and emergency departments. Figure 9. Proportion of all respondents identifying strength of relationships AOD services reported needing to improve relationships with mental health services for older people and Housing New Zealand and other accommodation providers. DHB AOD services also needed to improve relationships with the education sector and general hospitals and emergency departments. NGO AOD services identified relationships with the family violence sector and other mental health services. Problem gambling services needed to improve relationships with child and adolescent mental health services and the disability sector. Wait list management Addiction services were asked about wait list management and the actions they took to prevent, manage or reduce wait lists. More than half of NGO services managed a wait list, whereas all DHB services and problem gambling services did not manage a wait list. However, most respondents identified that actions were taken to address wait lists, suggesting these prevented the need to have a wait list in some cases. The most common actions taken by DHB services to address wait lists were internal triage, and prioritisation in a multi-disciplinary team meeting. NGO services reported provision of information, referral to self-help and peer support, and internal triage. Problem gambling used prioritisation in a multi-disciplinary team meeting, referral to self-help groups or the peer support workforce, and referral to helplines.

8 Conclusions Information in this report provides a foundation for future workforce planning and development for mental health and addiction services for the Northern region. In the full report, the conclusions are preceded by a discussion section that describes the key survey findings in relation to a workforce planning approach and Ministry of Health future strategic directions. Northern region DHBs and NGOs completing the survey reported that: their total workforce comprised 3,955 people these people were working in 3,409 FTE positions (employed plus vacant) 145 FTE positions were vacant 94per cent of the total workforce was Vote Health funded (3,219 FTE positions). For the adult mental health services Vote Health funded workforce: 3 there were 2,842 FTE positions (employed plus vacant) 124 FTE positions were vacant DHB services had 65 per cent of the workforce NGO services had 35 per cent of the workforce. For the adult addiction services Vote Health funded workforce: there were 377 FTE positions (employed plus vacant) 13 FTE positions were vacant DHB services had 45 per cent of the workforce NGO services had 55 per cent of the workforce. Northern region respondents identified recruitment and retention issues. Mental health services identified registered nurse, consultant psychiatrist, psychiatric registrar and nurse educators, community support worker, residential support workers and peer support roles. AOD services identified dual diagnosis practitioner and co-existing problems clinician, consultant psychiatrist and administrative or technical support roles, as well as addiction practitioner and service manager roles and Māori staff for non-clinical roles Information is unable to be reported for problem gambling services. Respondents in mental health and AOD services identified skill development needs in the following areas: 3 Including the workforce in combined mental health and addiction services (183 FTE positions).

9 cultural knowledge and skills for working with Māori, Pasifika and Asian ethnic groups, particularly for the AOD services workforce co-existing problems capability skills for working with new technologies and IT psychological interventions AOD services also identified the need to increase knowledge around policy and regulations and using strengths-based approaches problem gambling services key needs were working collaboratively with other services, being able to respond to changes in types of work and knowledge of community resources. Respondents identified key challenges in the area of team management. For both mental health and AOD services key challenges were managing pressures on staff due to increased demand for services and increased complexity, static or reduced funds and recruiting experienced staff. AOD services also identified cost of training and professional development. Both mental health and addiction services identified cross-sector relationships that needed to improve were with: child and adolescent mental health services Housing New Zealand and accommodation providers general hospitals and emergency departments Corrections Department the disability sector. Information about a number of workforce development strategies and tools can be found on the websites of Te Pou, Matua Raki and other workforce development centres. Northern region Workforce Planning Governance group recommendations This report provides useful information for planning future service delivery configuration and workforce planning and development in the Northern region that aligns with national strategies and policy. In the process of finalising this report Te Pou and Matua Raki have consulted with the Northern Region Workforce Planning Governance group to identify and agree relevant recommendations arising from the report. The Northern Region Workforce Planning Governance group includes representatives from the following:

10 DHB and NGO planners and funders DHB general managers and clinical directors NGO addiction services NGO mental health services the consumer network national workforce centres regional portfolio managers Māori primary health As a result of the consultation, a set of recommendations relevant to the Northern region, have been identified and agreed. These recommendations are set out below. The Northern Regional Alliance will now develop a regional workforce plan that details the direction, plans and strategies that it intends to adopt to support workforce development in the region. Workforce Assess whether the distribution of roles across DHB and NGO services reflects the needs of the population now, and in the future, taking into account future anticipated needs. This work should include assessing the impact that vacancies have on service delivery. Ethnicity of the workforce Develop a standardised approach to the identification of workforce ethnicity across all DHBs. Collect ethnicity data from the four DHB s which includes current staff and provides for new staff data collection. Focus systemic data collection on: o ensuing all DHB s are asking the right question o ensuring ethnicity data collection is not optional o collecting data of current staff for who this information is current missing o processes for extending data capture into primary and community care settings. Workforce and service challenges Identify specific recruitment and retention issues relating to Māori and Pasifika staff in clinical roles. Support all Northern Region DHB s to have a strategic Māori and Pacific strategic recruitment strategy.

11 Knowledge and skills Assess whether the workforce and service challenges reported in the survey have a negative impact on service delivery. Apply the skills and knowledge analysis to individuals to ascertain whether the organisational management perspective reflected in the survey is also an on-the-ground perspective. Work towards reporting on staff competency levels for mental health and AOD services: o Support the 2015 Te Pou and Matua Raki workforce census to assess these levels. Peer support Develop a regional strategy to build the peer support workforce. Develop and support a regional approach to the utilisation of the Peer Workforce Competency Framework.