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

2. 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.

3. 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

4. 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?

5. 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

6. 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.

7. 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….

8. 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 

10. 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:

11. 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

12. 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?

13. 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?

14. 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

15. Distributed leadership
Contact:

16. Stories of change
Connect Supporting Recovery

17. 3 minutes

18. 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
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