Changing Services in New Zealand

Transcription

1 Changing Services in New Zealand NGOs dialectic stance

2 An Introduction Who am I? My great -grandparents my turangawaewae dad mum Two inspirational kids! 2

3 What I Am Going To Talk About Introduction New Zealand and New Zealand mental health services The role of NGOs Challenges Drawing inspiration from Basaglia and others. transforming services

4 About New Zealand Size = 270,000sq. km (a little smaller than Italy 301,000sq. km) When the Europeans arrived in New Zealand, it was already inhabited by the Maori people Eastern polynesian settlers who arrived some time between 800 and Population = 4 million (40 million sheep!) Maori comprise around 15% of the population; Pacific Island people s, 8%, Asian people, 9%.

5 About New Zealand Mental Health Services All psychiatric hospitals / asylums closed during the late 1980s Acute inpatient wards established on grounds of General Hospitals Residue of culture, attitudes and practices from the institution remains

6 About New Zealand Mental Health Services Psychiatric patients have again become people Strong emphasis from Government on value for money 153,378 people used services in Recovery is emphasised as a service priority - from national policy to job descriptions Hospitals (20) provide and purchase / contract for mental health services Nearly 300 NGOs are contracted to provide services

7 We can work together!

8 Non Government Providers of Mental Health Services Emerged as a community response to the closure of institutions in the late 1980s Provide a direct connection to community voice, needs and supports Contracted by and partner with hospital services NGO / community sector now receive around 28% of mental health funds Now employ clinical staff; provide sub acute and alternatives to acute inpatient care Provider of services and protagonist / change agent

9 WALSH Trust An NGO established in Auckland 1988 Governed by a Board of Trustees who are members of the West Auckland community s They include service users, family, accountant, lawyer, psychiatrist, Pacific people s consultant, kuia, neighbour s. Provides a range of mental health support services, including: Peer support Home based support Residentially based support Older person s sub-acute, respite / short term support Employment

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11 WALSH Trust Staff Experience Mental Ill-health 2014 Within the last 12 months 12% Within the last 6 months 8% Never 31% Serious 17% None at all 31% Within the last 2 years 12% Moderate to serious 17% More than 2 years ago 37% Moderate 21% Mild 14%

12 Cumulative % Change Our Challenges Health spending in NZ 417% GDP 133%

13 Cumulative % Change Our Challenges Demand For Health Services 100% Increase In Health Spending 40%

14 Our Challenges 400% 350% 300% 250% 200% 150% Mental Health Spending Increased by 344% All Of Health Spending Increased by 184% 100% 50% 0%

15 Looking Forward Improving people s access to appropriate services of an acceptable quality. Access Moving Forward improve access to primary healthcare for those with or at risk of developing mental disorders 1998 Blueprint Service users need to be able to move easily from one service to another, whether they be general health or mental health services, or services provided by other sectors Meeting the challenge: New models of care that put the person, rather than the service at the centre of service delivery Blueprint II Access that is quick and easy Rising to the challenge Improve access / reduce waiting times 2013 WHO Mental Health Action Plan integrated mental health and social care services in community-based settings.

16 Why? How? What?

17 A Medical Approach WHY? Everything we do is based in the belief that mental illness, and associated risks, are best identified, understood and treated through diagnosis and medical technology. HOW? We achieve this within the safety of a hospital environment, through the diagnosis and treatment of mental illness, by trained clinicians. WHAT? We provide a range of diagnostic services, pharmacological treatment and other interventions that respond to the symptoms of mental illness, and the risks such illness might present to the patient and/or to others

18 Trieste WHY? Everything we do is based in the belief that we need to free patients and staff from the beliefs, attitudes, hierarchies and culture of the asylum. HOW? We employ people who are psychiatrists, nurses, and social workers committed to the restoration and enjoyment of a person's citizenship and well-being. WHAT? We provide a range of integrated, community based mental health services.that enables citizenship and participation

19 WALSH trust WHY? Everything we do is based in the belief that all people have a right to a sense of self-worth, and the potential to live a rich and fulfilling life that holds personal meaning and purpose. HOW? We achieve this through communicating and supporting people s worth and potential so clearly that they are inspired to see it in themselves. WHAT? We provide a range of community-based services that are responsive to, and support people s mental health and wellbeing in the community.

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22 Summary De-institutionalisation a work in progress; buildings may have disappeared, but attitudes can remain and can be powerful barriers to change Status quo is no longer sustainable neither as an effective delivery model, nor financially Transformative change will not occur just by changing what and how you do things you must change why (eg. Basaglia democratisation of mental health - and Dietz, design shaped by empathy with the experience of the service user) NGOs can be a pivot for transformation and sustainability But with all this talk of transformation and revolution, we need to remember our own role and potential complicity

23 When you change the way you look at things the things you look at change.

24 HAD I the heavens embroidered cloths, Enwrought with golden and silver light, The blue and the dim and the dark cloths Of night and light and the half light, I would spread the cloths under your feet: But I, being poor, have only my dreams; I have spread my dreams under your feet;