Key Ministry & Government Initiatives

Transcription

1 Key Ministry & Government Initiatives Dr John Crawshaw Chief Advisor & Director of Mental Health PREPARED BY Director of Mental Health September 2012

2 Overview Role of Chief Advisor & Director of Mental Health Opiate Substitution Treatment Suicide Youth Mental Health Co-existing Problems COPMIA (Children of Parents with Mental Illness and Addictions)

3 Role of Director of Mental Health Director of Mental Health has dual roles: o Clinical leadership as Ministry s chief advisor on mental health and addiction issues Policy and service development and oversight Mental health and addiction leadership within the Ministry Mental health and addiction sector leadership o Statutory, Protection and Regulatory Functions in mental health and addition services

4 Role of Director of Mental Health contd Statutory, Protection and Regulatory Functions in mental health and addition services o Protection of compulsory patients interests and regulation of mental health services Appointments and administration of statutory actors under the Mental Health (Compulsory Assessment and Treatment) Act 1992 Monitoring and regulating service quality Treatment and rehabilitation of special patients and restricted patients o Opiate Substitution Therapy and gazetting of prescribers under the Misuse of Drugs Act (MODA) o Other related legislation

5 New alcohol and drug addiction legislation New substance addiction legislation is scheduled to be introduced to Parliament this year. The new legislation will be a long-awaited replacement for the current Alcohol and Drug Addiction Act. It includes a strong focus on protecting the rights of people subject to compulsory treatment for serious substance addiction. The new legislation provides for a Director of Addiction Services and it is likely that it will become part of the duties of the Director of Mental Health. The Office of the Director will be responsible for much of the implementation of the new legislation and for the administration of the rights and protection structure contained therein.

6 Statutory appointees under the MH(CAT) Act Director of Mental Health is chief statutory officer; Deputy Director can exercise all the powers of the Director Director recommends appointment of a DAMHS for each mental health service to act as chief statutory officer at local level DAMHS appoints clinicians as DAOs to give advice and assistance, mainly in crisis situations Director recommends appointment of District Inspectors to maintain patient rights and check statutory procedures Director recommends appointment of a Mental Health Review Tribunal to review compulsory treatment Director of Mental Health Directors of Area Mental Health Services (DAMHS) District Inspectors Mental Health Review Tribunal Deputy Director of Mental Health Duly Authorised Officers (DAO)

7 Opiate Substitution Therapy Objectives Contribute to improving the health, psychological and social functioning and wellbeing of clients and their families, including dependent children Reduce the spread of infectious diseases associated with injecting drug use Reduce the mortality and morbidity resulting from the misuse of opioid drugs Assist individuals to achieve a successful withdrawal from opioids Reduce episodes of other harmful drug use Reduce crime associated with opioid use Assist with recovery from opioid dependence and withdrawal from methadone or other opioid substitution medicine, if appropriate by the client

8 Opioid Substitution Treatment (OST) Prescribing of opioid substitution therapy is governed by the provisions of s24 of MODA OST specialist services are funded and organised by DHBs o Some variations in some regions Guidance documents available of MOH website Clinical Network National Association of Opioid Treatment Providers (NAOTP) 6 monthly reporting on services to Office of the Director of Mental Health

9 Governance of the New Zealand Suicide Prevention Strategy Ministerial Committee on Suicide Prevention Inter-Agency Committee on Suicide Prevention Ministry of Health (lead) Ministry of Education Ministry of Social Development Department of Corrections New Zealand Police Ministry of Justice Ministry of Pacific Island Affairs Ministry of Women s Affairs Te Puni Kōkiri New Zealand Injury Prevention Secretariat

10 Risk and protective factors for suicide Individual Biological Mental health/illness Alcohol and other drug use Physical health/chronic pain or illness Sense of self Coping skills, outlook Feelings of meaning, purpose, sense of control in life

11 Risk and protective factors for suicide Individual Family Parent/child relationships Family conflict/harmony Parental separation Family history of suicide and mental illness Family violence

12 Risk and protective factors for suicide Poverty (Un)employment Individual Family Social/ Community Social connections Physical and emotional (in)security Peer relationships (eg. bullying) Educational experience

13 Risk and protective factors for suicide Economic (in)security Discrimination/acceptance Exposure to environmental stressors/supports Individual Family Social/ Community Society/ Environmental

14 Objectives of the New Zealand Suicide Prevention Strategy Promote mental health and wellbeing, and prevent mental health problems Improve the care of people who are experiencing mental disorders associated with suicidal behaviour Improve the care of people who make non-fatal suicide attempts Promote safe reporting and portrayal of suicidal behaviour by the media Support families, whanau, friends and others affected by a suicide or suicide attempt Expand the evidence about rates, causes and effective interventions Reduce access to the means of suicide

15 Youth Mental Health Project Initiated by Prime Minister Aims to improve services for young people aged 12 to 19 years with, or at risk of, mild to moderate mental health problems Has been informed by the report from the Prime Minister s Chief Science Advisor Improving the Transition; Reducing Social and Psychological Morbidity During Adolescence (May 2011) Is cross-government involving the Ministries of Health, Education, Social Development, Te Puni Kōkiri, the Department of Prime Minister and Cabinet (DPMC)and Treasury Requires a changed and collaborative way of working that pulls down the barriers and responds to the variable needs of young people Consists of a package of measures designed to build on strengths in current service provision and to address areas where there are gaps

16 YMH - Foci Achieving better mental health and well-being for young people, and particularly for those vulnerable groups at comparatively higher risk of mental health issues such as Maori and Pacific, by: o o o o o Building resilience and social connectedness Developing more responsive school environments Making available consistent, accessible and accurate information Intervening early and providing follow up care Connecting young people with youth-friendly support and treatment options.

17 YMH Expected Outcomes Better mental health and wellbeing for young people Increased resilience to support good youth mental health Better access to appropriate information for youth and their families/whanau Earlier identification of mild to moderate mental health issues in youth Improved access to support and treatment services for youth Effective assessment and referral pathways Improved knowledge about what works to improve youth mental health Connected and informed young people Collaborative agency responses

18 YMH - Settings In the health sector through: o primary care services being more responsive to youth o expanding current primary mental health services for youth o improving waiting times and follow-up care o reviewing referral pathways In schools with: additional nurses in decile 3 schools and Youth workers in low decile schools more HEEADSSS Wellness checks introduction of more student support programmes such as Positive Behaviour Schoolwide, FRIENDS and Check and Connect In communities with: o more information for families and friends o better youth engagement and social support for Youth One Stop Shops o Whanau Ora for mental health And online through E-therapy, social media and more youth friendly resources

19 Co-existing Problems CEP Working with people with co-existing mental health and addiction problems is one of our biggest challenges Yet CEP in our service users are common and not exceptional Failure to address both issues results in poorer outcomes, increased risks and frustration in our service users o CEP are associated with underachievement or failure across a number of key life domains o People with CEP experience greater involvement with the criminal justice system, higher rates of institutionalisation, more failed treatment attempts, poverty, homelessness and risk of suicide It is how we have organised and delivered our services and the artificial separation of mental health and addiction treatment services that has been the biggest barrier to addressing CEP

20 CEP the way forward Any door is the right door We must have capable systems that will support best practice o We need to focus on the client/service user and build our models of care to address his or her problem All practitioners should have some CEP capability some will have advanced capability We need to learn from the best models and how to apply them in wider areas good work is already occurring Collaboration and supporting each other in the process is key

21 Children of Parents with Mental Illness or Addiction (COPMIA) 50-70% of people affected by mental illness are parents All of family systemically & significantly affected by parental mental illness No national consistency despite pockets of good practice» MoH currently: o Establishing NZ statistics o DHB/NGO/workforce consultation o exploration of best practice interventions o eventual development of national framework