What do we want? - An Integrated System When do we want it? - NOW! Jane Kinsey (GM) & Dr Heather McPherson (CD) NMH – March 2018

Ages & Stages MH&A (Ref: On track) Past Current Future Disease focus Illness Wellbeing Hospitals Community-based care Health and social systems Volume Outputs and outcomes Value Fragmented Coordinated Integrated Singular response Joined-up actions Collective impact Command and control Collaboration Co-production Simple Complicated Complex Low adaptability Innovative Agile and adaptive Patients Service users People Medical model Recovery Social determinants model 14 contracted NGOs 17 individual services in MH&A – separate management, referral criteria

Current pressures Demand for PMHI outstrips supply PMHI focus is mild to moderate – What about capacity for moderate to severe? Addictions and other co-morbidities Distress / stress increased presentations Disconnect with specialist services – D/C Physical health outcomes Social pressures - Housing and employment

Integration Framework Leadership and culture Building Trust Maori models of care Leadership and culture Model of care – getting the basics right Improvement

Integration – what does it mean? What is the challenge? Meeting people’s Physical, Mental and Social Needs What does it mean? Integration of health and social care, primary and specialist care, and physical and mental health care https://www.kingsfund.org.uk/publications/physical-and-mental-health

Integration for us: Within and across specialist MH&A services Across service continuum – NGO, primary, secondary and tertiary Holistic care – mental and physical health Across sectors – social and education

Ages & Stages of health care

Challenges to MH&A integration Workforce Ageing workforce Training and education Population diversity Recruitment and retention Collaboration and integration One team across continuum and sectors Shared care / Info sharing Top of scope / Role clarity Increasing Demand on services Complexity Co-existing

Current initiatives Psychiatry liaison in primary care Nurse Practitioner in primary care Primary care – credentialing programme GP CD for Mental health SPOE and Joint primary/secondary triage and MDT discussion complex cases. Equally Well / wellness focus Health improvement practitioners Supported discharge to primary care PMHI – counselling / psych Locality focused teams (iLoc teams) IPS employment support Group intervention e.g. refugee population Targeted programmes e.g. corrections Peer & community support workforce MH Pharmacist IT tool for primary and secondary metabolic monitoring