Helen Lockett, Strategic Lead Equally Well – using research to inform the actions of the Equally Well collaborative: an evidence update Helen Lockett, Strategic Lead

The beginnings: this is not acceptable Leaders from the non-government mental health and addiction sector found themselves discussing the number of untimely and unexpected deaths of people using their services.

The beginnings: dying for a life, should we have to? “Many people are spending years living with undetected but treatable physical health problems needlessly and also some people are losing their lives because things have been picked up too late” Caro Swanson

Understanding the issues Phase 1 (from mid 2013) Evidence collection and initial stakeholder discussions The literature review asked: What is the mortality and morbidity gap? What’s contributing to it? What can be done to improve physical health outcomes and reduce the disparity?

Equally Well: evidence-based practice Best research evidence Informing both What we do and How we do it Practitioner Expertise Service user expertise and values EBP

A call to action Be identified as a priority group at a national policy level based on significant health risks and relative poor physical health outcomes. Have access to the same quality of care and treatment for physical illnesses as everybody else, and in particular to have a right to assessment, screening and monitoring for physical illnesses. Be offered support and guidance on personal goals and changes to enhance their physical wellbeing.

The drivers of inequities Health systems Workforce issues Exposure to known risk factors Psychotropic Medication Socio-economic status Adverse childhood experiences These are all the contributing factors Yes, socio economic status is contributing, but studies that have controlled for this have still found a disparity Many interventions focus on the bottom two – risk factors and medication We must focus on the top too as well In my reading, it got so awful and so complex I did think about putting the ‘lid back on’ and walking away….

September 2014, consensus paper launched Hawkes Bay District Health Board mental health and addictions services Te Menenga Pai Nga Whare Hauora Fairleigh Lodge September 2014, consensus paper launched June 2016 – 69 endorsing organisations Oct 2016 over 80 Dec 2016 over 100 15 out of 20 DHBs (75%) Most of the large PHO organisations and peak bodies A number of medical colleges, but also the Council of Medical Council (So all 14 of the medical colleges) You may wish to point out that we have the Royal College of Psychiatrists, London (as well as the Australasian College) and the Australian MH Commission! More than 250 on Loomio 

Backbone function Six functions of a backbone organisation: Guide vision and strategy Support aligned activities Establish shared measurement practices Build public will Advance policy Mobilize funding Source: www.collaborationforimpact.com

Backbone support function Collective impact Research and data analysis Advocacy District Health Board annual plans Workforce development Increasing access to primary care Backbone support function

Sustaining the impact The literature review asked: What is the mortality and morbidity gap? What’s contributing to it? What can be done to improve physical health outcomes and reduce the disparity?

Evidence update (Te Pou, in press) To continue to inform the actions of the Equally Well collaborative Evidence update, in press The literature review asked: What is the mortality and morbidity gap? What’s contributing to it? What can be done to improve physical health outcomes and reduce the disparity?

Action pushes for service improvement Improve service user leadership and participation Include people who experience mental health conditions and addiction in the planning and delivery of Equally Well initiatives across the DHB and in awareness and education sessions on Equally well issues across the DHB Let's get clear about roles and responsibilities Shared care agreements between mental health and addiction services and primary care are reviewed and reported annually to enable tracking of improvements Increase access to primary care Reduce cost of access for MH&A service users Make funded as well as extended consultations available Promote successful NZ approaches e.g. Tāirawhiti and Canterbury DHBs Improve compliance with clinical guidelines Monitor adherence to clinical guidance relating to physical health impacts of psychotropic prescribing (eg problematic polypharmacy) Be Equally Well champions Make the physical health of people with mental health conditions and addiction a reportable health equity issue across other parts of the health system Make sure cardiometabolic and cancer screening and monitoring happens DHBs report annually on % of MH&A service users in primary and secondary care who are screened and monitored Outcomes of screening and monitoring are also reported Equally Well: Improving physical health outcomes and reducing premature mortality

Distributed leadership Contact: Wendy.Donaldson@tepou.co.nz

Stories of change Connect Supporting Recovery

3 minutes

Ngā mihi ki a koutou Everything you do DOES make a difference Join the Equally Well collaborative and take action today. Everything you do DOES make a difference Visit: