1. Access and Choice
Expanding access and choice for primary mental health and addiction supports
Jo Chiplin Programme Manager, Access and Choice Mental Health and Addiction Directorate 1

3. Purpose
Increase access, equity of access
Increase choice
Provide more timely support
Positive health outcomes
Equitable health outcomes

4. Funding Overview 7

6. Where Are We Heading? 7

7. People and their whānau
Secondary Services
Primary Services
Other?
Communities
Maternal
& Child
Peer
Support
People and their whānau
Youth
Services
Virtual /
Digital
Church
Ministers
Māori
Wardens
Pacific
Services
NGO
Services
Pharmacists
Aunties
Māori
Services
General
Practices
School-based
Services

8. Key Features
Free access to primary mental health & addiction supports
No entry criteria/barriers
Choice of settings
Easy Access
What you need now – no pre-defined packages
Individuals/Whānau/Groups
All Ages
National consistency with local flavour
Coordination & collaboration

9. Priority Groups
Māori, Pacific and Youth are priority groups within general services
AND
Funding directed for services specifically for these groups

10. Year One 7

11. Funding Approach
Existing Primary Mental Health Initiatives to continue
Expansion of existing pilots
Collaborative design process for new programmes /services

12. Expansion of Existing Programmes
Procurement Process for integrated general practice services-
Collaborative responses – DHBs, PHOs, NGOs
District or Regional Level
Other –
Māori Services
Youth Focussed Services

13. Integrated General Practice Services
Core components with local implementation:
Self-management support using peer health coaching model
NGO supported access to natural community supports
Confident and Competent GPs and Practice Nurses
Mental Health professionals – Health Improvement Practitioner model.
Close coordination and collaboration between general practice and specialist mental health services

14. Collaborative Design – Initial Priorities
Māori Services
Youth Services
Pacific Services
Services for Rural & Remote communities

15. Key Enablers
Workforce
Ensuring the voice of people with lived experience is front and centre in all of this work.

16. Kia ora Thank You 7

18. Kaupapa Māori primary mental health and addiction services
Maraea Johns Principal Advisor Māori Mental Health and Addiction Directorate 1

19. Whakapapa – acknowledgement and context
Many voices in He Ara Oranga identified that the system is not working for Māori
Mātanga Mauri Ora Advisory Group
Māori health strategy – He Korowai Oranga
Waitangi Tribunal Claim WAI2575
Important to acknowledge the many voices in He Ara Oranga who identified that the system is not working for Māori
Acknowledge the people and whanau who have suffered or continue to suffer with the impact of mental illness or addiction.
Acknowledge the people who have come before, and who continue to strive for improved services for Māori.
Mātanga Mauri Ora is a group of Māori mental health and addiction leaders who have come together as an advisory group to the MHA Directorate. They will guide and inform our work to improve MHA outcomes for Māori, and overall system change.
Inform that we are working with the Māori Health Directorate – with the refresh of He Ara Oranga.
Stage One report of WAI 2575 provides the direction to do better, as we prepare for stage two which will examine the how the Crown has provided for Māori with disabilities, mental illness and addiction (including tobacco).

20. Priority Group – Māori directed approach
Māori priority group in the general population approach, and a directed approach.
The directed approach seeks to support and grow Kaupapa Māori mental health providers to deliver a primary mental health and addiction service.

21. Primary Kaupapa Māori mental health and addiction service?
What might this look like from a Māori lens?
Is it a Māori response within a primary care service? Yes – but that is what the general population approach will deliver.
Māori mental health services have developed over the years within or for referral from secondary/ specialist services for follow-up care, or early intervention.
Some thinking is needed to identify and define what a “primary” Kaupapa Māori mental health service is.

22. What is a primary Kaupapa Māori mental health and addiction service?
Ministry MHA Directorate working together with Mātanga Mauri Ora
We should return to kupu (words) that expresses us better e.g Oranga Hinengaro - Oranga Wairua - Oranga Whānau
It is about wellbeing
It is about establishing, designing, developing and delivering a by Māori with Māori for Māori kaupapa.
Lived experience is key. Autonomy to stand in our own mana.
Informed by Mātauranga Māori
Whānau focussed – this is the manawa (heart) of it.
Evaluated through a Māori lens.
Eliminating racism, stigma & discrimination.
At a recent hui with Mātanga Mauri Ora we had a short brainstorming session – the graphic represents the thoughts that came from the session and was drawn live as the kōrērō was happening. The key themes that emerged are listed here.

23. Year One directed approach – Māori
Identify existing Kaupapa Māori services that provide Māori primary mental health and addiction service and includes elements of:
- alignment to the direction of expanding access and choice
- co-design
- evaluation
Establish, build and/or strengthen Relationships and support Māori to determine, design, develop and deliver primary mental health and addiction services. (Collaborative design process for new services)

24. Next steps
Aug – Nov Host (or attend existing) hui to workshop a new Māori primary mental health and addiction model of care.
Nov – Feb Based on workshops, develop the new model of care and write service specifications.
Determine commissioning framework for new services.
Mar – Apr Commission new services.
July New services commence (roll out sequence tbd)

25. Kia ora Thank You 7

27. Shaping the Future for Recovery
Budget 2019 initiatives and developing a national model of care
Richard Taylor Manager, Addictions

28. Gaps and Opportunities
Alcohol and drug addiction recovery services are under pressure.
There are great models and initiatives around the country, but these are inconsistently applied, and there are gaps.
Budget 2019 provides us with an opportunity to begin filling those gaps now.
Work has also begun to shape the future.
If we invest heavily now, we will be investing in and solidifying the status quo.
Two parts to our approach – what we are trying to get out the door now where there are things we know need support or that are working and can be boosted, and what we are working on to prepare for the future.

29. Budget 2019
Specialist Services
Funding of $44 million over four years.
Supporting the services already in place, focused on residential care, managed withdrawal, and continuing care/aftercare
Funding to DHBs on a regional basis, with a strong expectation that funding will support NGO contracts.
Includes some funding to develop promising models of continuing care.

30. Primary / Community Interventions
Budget 2019
Primary / Community Interventions
Funding of $14 million, phased up over four years.
Filling a known gap in the existing model of care.
Co-developed approach locally.
There are also existing models around the country that show promise and can be learnt from.
Considering how it can support potential amendment to the Misuse of Drugs Act.
Phased from $2m in year 1 to $5m per annum in year 4.
Access and Choice (Jo’s initiative) is more focused on low threshold. These initiatives could be an escalation point from those services, but will also focus on people who have identified (or have been identified) as having an AOD issue.
Assertive outreach with lived experience something that services are increasingly doing well – let’s build on it.

31. Pregnancy and Parenting Service
Budget 2019
Pregnancy and Parenting Service
Currently in place at Waitemata, Northland, Tairawhiti and Hawke’s Bay DHBs.
Expansion to two more pilot sites.
Using the same process and criteria as previous pilot roll out.
Locations for sites determined based on child wellbeing risk factors identified in the IDI.
1. CYF finding of abuse or neglect
2. Long term benefit receipt (at least 75% of child's life, or child included in the benefit for at least 1 month if the child is less than 1 year old)
3. Caregiver with a corrections history in the 5 years prior to birth
4. Mother with no formal qualifications.

32. Developing a National Model of Care
We can build off work already happening on a regional basis to develop models of care.
Ministry leading a process nationally to develop what a good addiction treatment system in Aotearoa should include and the principles that should underpin it.
National framework but flexible to allow for local approaches.
Inform future funding decisions.
Engagement already begun, but will include full health sector, lived experience and Māori.
A bird’s eye view of the system.
Not pre-determining – Māori will develop Māori frameworks.
Needs to respond to the issues we know are happening now: trauma, cognitive impairment.
How can general services become more and more responsive to Māori and enhance the mana of everyone they support.

33. Strategy to Prevent and Minimise Gambling Harm $60m over three years.
Budget 2019
Strategy to Prevent and Minimise Gambling Harm
$60m over three years.
Developed after public consultation process.
Includes funding for piloting new services, peer support and residential care.
Develop a lived experience network
Available on Ministry website:
and-minimise-gambling-harm
Opportunities to align sectors more.
Please get involved in this kaupapa, even if you’re not delivering the service.

34. Kia ora Thank You

36. Supporting innovation
Enabling implementation of the Government’s response to He Ara Oranga
Sue Hallwright Programme Manager, Innovation and Change Mental Health and Addiction 1

37. Pockets of excellence exist
He Ara Oranga Found
Pockets of excellence exist
Ad hoc funding, ‘letting a thousand flowers bloom’, and encouraging innovation without clear pathways to evaluate and scale up. 2

38. He Ara Oranga Recommended
Funding support for change – national, regional and local
Using implementation science to bridge the gap between strategy and practice 3

39. He Ara Oranga Rationale for Funding Support for Change
No implementation support
With implementation support
80% uptake of new practice in 3 years
14% uptake of new practice in 17 years 4

40. Active and planned efforts to “mainstream” an innovation
How change happens
Diffusion
Dissemination
Implementation
Letting it happen
Passive spread
Helping it happen
Active and planned efforts to persuade target groups to adopt an innovation
Making it happen
Active and planned efforts to “mainstream” an innovation
Greenhalgh et al, 2004 5

41. What is “Implementation Support”?6

42. Implementation support
Deliberate, systematic implementation to scale up effective innovations
Uses “implementation science” approach
Done in partnership with agencies and communities including people with lived experience and their whānau
Meaningful buy-in, community ownership, and capacity-building 7

43. Implementation support teams
Define ‘success’ and the way to measure the outcomes we want to achieve
Identify known successful approaches – core elements for all services
Co-design locally relevant responses with those involved: people who will use services, families, providers, communities
Plan the implementation: to guide actions that ensure funding gets to the right services and the right people
Ensure development of workforces to deliver the initiatives
Routinely review data and share learning between sites
Provide feedback to refine policy 8

44. Skills / experience needed by people working in implementation support:
Collaboration, facilitation, coaching
Collaborative design
Implementation/project management
Knowledge brokering and exchange
Data / evaluation
Cultural capability
Focus on equity for Māori
Lived experience 9

45. Preliminary Ministry Ideas10

46. Immediate need:
Establish an interim infrastructure to support active implementation of innovations
Use this infrastructure to support implementation of “access and choice” initiative 11

47. Potential initial structure
NATIONAL TEAM
Source evidence
Collaboratively define core components
Develop national plan
Support /coach regional teams
Coordinate national knowledge exchange
Provide feedback to shape policy
National team/s
initially located within
MoH Mental Health Directorate
Regional MoH Lead
Regional MoH Lead
Regional MoH Lead
Regional MoH Lead
Regional team
Sector-based
Regional team
Sector-based
Regional team
Sector-based
Regional team
Sector-based
REGIONAL TEAMS
Identify promising practice
Facilitate local collaborative design
Develop local implementation plan
Support/coach provider project teams
Coordinate knowledge exchange between sites 12

48. What next? Convene an interim national team
Regional hui to progress co-design of structure over three – four months
Preliminary national work to support Access and Choice initiative 13

49. Kia ora Thank you 14

50. QUESTIONS

51. What is missing from this picture?
How do we define lived experience in the primary and community wellbeing space?
3. How do you see your role in developing communities of recovery outside treatment settings?