Equally Well framework for collaborative action

Equally Well framework for collaborative action How we work and what actions we can take to improve the physical health of people who experience mental health and addiction problems Phase 3: 2015

Contents Contents... 2 Introduction... 3 Phase One: Evidence review... 3 Phase Two: Stakeholder engagement and consensus... 3 Phase Three: Proposed framework for collaborative action... 4 The five conditions of collective impact... 6 Underpinning principles of the collaborative... 7 Equally Well Collaborative Action Framework... 8 Programme of collaborative action... 9 1. Improve the quality of physical health care... 9 2. Reduce exposure to risk factors... 12 3. Promote prevention and early intervention... 13 Appendix one: Organisations who endorse the consensus statement (as at January 2015)... 14 2

Introduction The associations between mental health and/or addiction problems and relatively poor physical health outcomes have been well-established over many decades. Equally Well attempts to address this longstanding and unacceptable inequity through a programme of collaborative action, involving a wide range of individuals and organisations willing to work together for change. Phase One: Evidence review Platform 1 and Te Pou 2 initiated the response during 2013, and began by defining the extent of the problem. International and New Zealand literature was analysed 3, and information about New Zealand health sector initiatives were brought together through a call for evidence. This material was used to inform discussions with health sector leaders and gain support for action. Equally Well aims to draw on expertise and knowledge across the health and related sectors to translate the available evidence and sector knowledge into individual and collective action. Phase Two: Stakeholder engagement and consensus A consensus position paper calling for a concerted and sustained effort by all those who can effect change was developed in consultation with a range of interested stakeholders during 2014. This paper has now been signed by a wide range of professional peak bodies and health and health related agencies. Leaders in health policy and professional development, funding and planning, universities, primary care and mental health and addiction treatment services have agreed to work in partnership with people with lived experience 4 of these challenges to effect change. Changes are needed at both policy and service delivery levels. The signatories to the consensus statement recognise the urgent need for coordinated action that will contribute to improved physical health and increased life expectancy. Equally Well collaboration members have agreed that people who experience mental illness and/or addiction need: to be identified as a priority group at a national policy level based on significant health risks and relatively poor physical health outcomes to 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 to be offered support and guidance on personal goals and changes to enhance their physical wellbeing. 1 (www.platform.org.nz) The peak body for mental health and addictions non-government organisations 2 (www.tepou.co.nz) A national mental health workforce development centre which incorporates Matua Raki, national addictions workforce development centre 3 Te Pou o Te Whakaaro Nui. 2014. The physical health of people with a serious mental illness and/or addiction: An evidence review. Auckland: Te Pou. 4 The definition used in the evidence review of people who experience serious mental illness and/or addiction includes those who have been diagnosed with schizophrenia, major depressive disorder, bipolar disorder, schizoaffective disorder and/or addiction with the primary focus on alcohol, cannabis and methamphetamine addiction. However, it is likely that many people with other mental health conditions and/or addiction face similar challenges. Equally Well will also benefit this wider group of people who are affected. 3

More than 100 Equally Well stakeholders met in Wellington on 10 November 2014 to take the first step in planning collaborative action. The summit provided an opportunity for a wide range of people who had been engaged with the project for the previous six months or more to come together and share experience and ideas. Prior to the meeting itself, an online conversation between stakeholders was generated using Loomio, open access software developed in New Zealand, to facilitate collaborative activities. This process generated a number of proposals for collaborative action, in addition to those that had emerged through the evidence review process. The evidence review, online conversations, meetings with stakeholders and the summit itself resulted in a whole range of possible activities. More than 40 proposals were generated and these have been brought together in the following draft framework which takes into account the multi-dimensional nature of the problem. Phase Three: Proposed framework for collaborative action A number of models of collaborative action were identified as possibilities for the next stage of Equally Well. The one most closely fitting what we are trying to achieve appears to be the constellation model of collaborative social change developed by the Centre for Social Innovation 5 in Toronto, Canada. It is proposed that this model (see below) is adapted as outlined. The constellation model was designed to serve a partnership of organisations wishing to collaborate to achieve a desired outcome. It utilizes a lightweight governance framework, a stewardship group, action-focused groups referred to as constellations, and a support team for co-ordination. 6 The model is held together by shared commitment to achieving the desired outcome, and recognition that this will require working together. In adapting this model we have changed some of the language and design features (see following illustrative model). 5 Retrieved from http://socialinnovation.ca/constellationmodel on 28 November 2014. 6 From material on the Centre for Social Innovation website, retrieved 28 November 2014. 4

Features of the adapted model are as follows: 1. Funding adding value to existing services The proposed model assumes minimal additional funding. Partner organisations will need to utilise their existing resources for working together on Equally Well projects, and this may require negotiating with their current funders on variations to existing contractual agreements, or in some cases applying for additional funding from external sources. The intention of Equally Well is to improve the quality of existing services and incorporate additional activities into business as usual for all participating agencies, to provide for long-term, sustainable change. For some people already working in this area it might just mean linking up to others doing similar work, sharing experiences and building on what s already in place. 2. Backbone team Another model that has been drawn from for Equally Well is outlined in a Stanford Social Innovation Review paper 7 which identified five success factors (see Table One below) for collaborative action, by looking at examples of such efforts which had been effective in achieving substantial impact. Backbone support is identified as one of the most important pre-requisites for successful collaborative effort, and to date this function has been provided by Te Pou, in consultation with a group of sector leaders who initiated the project. With agreement and support from the Ministry of Health, Te Pou has funded part-time project management (Helen Lockett), analyst 7 Hanleybrown F., Kania J, & Kramer M. (2012) Channeling Change: Making Collective Impact Work. Stanford Social Innovation Review. 5

input (Candace Bagnall), communications and administrative support, and input from Carolyn Swanson, Te Pou s service user lead. For Phase Three, it is envisaged that the backbone group will: provide overall direction and maintain momentum facilitate dialogue between stakeholders manage online (Loomio) stakeholder engagement and decision-making processes monitor, analyse and incorporate online discussions into activities analyse and disseminate research data and support outcome measurement manage communications including web presence provide accountability back to organisations that have signed the consensus paper identify leads and champions for areas of work, and encourage leadership identify and share models of good practice from across the country encourage more organisations to endorse the position paper and make commitment to taking action. The five conditions of collective impact Common agenda Shared measurement Mutually reinforcing activities Continuous communication Backbone support 3. Stewardship group All participants have a shared vision for change including a common understanding of the problem and a joint approach to solving it through agreed upon actions. Collecting data and measuring results consistently across all participants ensure effects remain aligned and participants hold each other accountable. Participant activities must be differentiated while still being coordinated through a mutually reinforcing plan of action. Consistent and open communication is needed across the many players to build trust, assure mutual objectives, and create common motivation. Creating and managing collective impact requires a separate organisation(s) staff and a specific set of skills to serve as the backbone for the entire initiative and co-ordinate participating organisations. Equally Well was initiated by a small group of individuals who have been guiding the project now for more than a year. It is intended that this group will be expanded to include more people with lived experience, and other people who agree to lead and champion Equally Well projects. Membership of the stewardship group will be as flexible as possible. Organisations participating in Equally Well will have their own governance arrangements and internal accountabilities and therefore the backbone group does not envisage organising and servicing regular formal meetings. Rather, the collaboration and the Stewardship group will function as a network, with agreed communication mechanisms. 4. Projects and activities The Equally Well projects and activities that have been identified (and more will evolve) are described in the Canadian model as self-organising action teams that operate in co-operation 6

with a broader strategic vision. We acknowledge that a lot of work is already under way, and many systems already in place are aligned with the purpose of Equally Well, which may or may not come under the collaboration. A lead partner, what we have termed activity lead will be needed for each project/activity, along with any person or organisation with an interest in the action area to form a team focused on taking action on this issue. The idea is that projects and activities teams are relatively loose arrangements relying on success through influential and committed champions, whereas the co-ordination and stewardship group functions are more formal and provide the accountability needed for keeping the overall momentum going on this work. In addition, we have added action pushes, and described these as windows of opportunity for action where there is a focused set of activities on a specific issue and the timing is right. Examples might be the opportunity to influence the development of DHB s district annual plans, or a one-off consultation process on new clinical guidelines. It is envisaged that many of the actions identified in the Equally Well framework will become project teams. Through identifying the project teams activities as part of Equally Well, their progress will continue to be visible and projects supported in various ways through the coordination function and wider network. The model allows for a creative, flexible and dynamic set of relationships between agencies and individuals committed to the common goal of improving physical health outcomes. It relies on collaborative leadership based on mutual respect, organisational autonomy and a shared vision. Underpinning principles of the collaborative 1. Partnership between health professionals, people with lived experience of mental illness and addiction and their families and whānau. 2. Stigma and discrimination will be addressed wherever it occurs. 3. Where possible good quality research evidence will inform activities and improve services. 4. Sustainable changes will be made by incorporating new approaches into business as usual. 5. People who experience mental health and addiction problems have a right to be wellinformed about treatment options and wellness opportunities. 6. Different perspectives and world views are accepted and welcomed. 7. Quality of life is as important as extending lives. On the following page is a conceptual framework for Equally Well, which attempts to give a single page overview of the programme of collaborative action which is then outlined in more detail in the table of priority areas of action that follows it. 7

Equally Well Collaborative Action Framework All activities informed by Treaty of Waitangi principles Partnership with people with lived experience Reducing inequities VISION: Improving the physical health of people who experience mental health and addiction problems GOAL GOAL GOAL Improve the quality of physical health care Reduce exposure to risk factors Promote prevention and early intervention Some specific actions Some specific actions Some specific actions MH&A training for health professionals - building capability and confidence Communicate side effects of medication, and different treatment and recovery options to service users Routinely offered effective smoking cessation support Address stigma and discrimination in health services Support better access to employment and suitable housing Promote self-control skills training in early childhood settings Endorse the HeAL Declaration for young people with psychosis, and put the goals into practice in New Zealand Promote routine metabolic screening & CVD risk assessment & follow-up Develop recoveryfocused guidelines for the prescribing of psychotropic medication Develop Recoveryoriented Systems of Care led by service users Improve access to dental health services for mental health and addiction service users Investigate including psychotropic medication as a risk factor for CVD and type 2 diabetes in PREDICT Reduce access to alcohol in communities Adapt the HeAL Declaration for people of all ages using mental health and addiction services Trial complementary treatment options to minimise the impact of psychotropic medications Promote recognition as priority group in national and regional policies Support communities of practice with good quality research, evaluation and monitoring 8

Programme of collaborative action The following themes and possible actions have emerged through the Equally Well process so far. The lead agencies and partners column has deliberately been left blank so that people volunteer for areas they d like to get involved in and/or take a lead on. We would like your input to this process, so please feel free to make a copy of this template, add any other possible projects we have missed, and nominate yourself or other agencies as leads or partners for any particular action. Some examples of measure of success have been identified, but we d expect the groups themselves to develop and agree these for each project. Please email your feedback to us directly, via Chelvica.Ariyanayagam@tepou.co.nz as soon as possible, preferably by 16 March 2015. We ll then update the template and re-circulate it in the next email update. 1. Improve the quality of physical health care Themes Actions Possible measures of success Lead agency and partners Increase visibility as a priority group in policies impacting on physical health outcomes Identify, develop and share examples of good practice Strengthen mental health and addiction service requirements of DHBs to improve their response to physical health in District Annual Plans (DAPs) Strengthen requirements for all health services to respond to the physical health of people who experience mental health or addiction problems Work with DHB funders and planners to prioritise funding for services likely to impact on better health outcomes for this group, and include in DAP and PHO alliance contracts Consider review of the use of the Mental Health (Compulsory Assessment and Treatment) Act 1992, to take into account concerns raised by people with lived experience and their families Identify models of good practice and share stories. E.g. Bay of Plenty model using physical health check KPIs in contracts and establishing free nurse-led clinics Encourage evaluation of models for effectiveness and share results Changes to Service Coverage Schedule for 2015/16 and out-years Changes to DAPs for 2015/16 and out-years An increase in local initiatves which build on others success stories MH&A provider contracts all have KPIs around physical health Number of SPARK 8 projects 8 SPARK stands for Supporting the Promotion of Activated Research and Knowledge NZ training based on a Canadian model. 9

Themes Actions Possible measures of success Lead agency and partners Evaluation reports disseminated Models of good practice initiated as a result Promote metabolic screening guidelines and improved routine screening practice in mental health and addiction services Improve consistency in routine monitoring of the physical health of people using MH&A services & physical health screening Adapt International models on pathways and algorithms for physical health screening and action Promote routine checks in primary care for CVD and diabetes risk for any person on psychotropic medication Numbers of people screened? Numbers of people screened? Evidence of use of algorithm and increased percentage of health checks completed PHOs reporting percentage of people checked Formal recognition in the IPIF 9 as an eligible population Ensure access to routine breast and cervical cancer screening for mental health service users Promote shared care models of strengthening links between mental health and primary care to support physical and mental health Investigate linkage of PREDICT across both mental health and primary care services Communicate effects and potential impacts of medication on physical health to service users, as well as the different treatment and recovery options Formal recognition in the IPIF as an eligible population Evaluate effectiveness of current shared care initiatives and disseminate learnings Recovery-focused prescribing guidelines developed 10? IPIF stands for the Integrated Performance and Incentive Framework. More details on the IPIF can be found on the Ministry of Health s website 10 This action area is strongly linked to the action area in the quality improvement section below 10

Themes Actions Possible measures of success Lead agency and partners Reduce stigma and discrimination Research and evaluation Promote effective psychological therapies and family interventions as alternatives to and/or alongside medication MH&A training and supervision for health professionals in primary care - building capability and confidence in working with mental health and addiction issues Physical health assessment training and supervision for health professionals working in mental health and addiction services Promote the use of peer support workers 11 and educators across the health sector, particularly primary care Support research that leads to better understanding of how to manage the side effects of psychotropic medication Quality improvement Undertake qualitative research to include the perspectives of people with lived experience in finding solutions Develop recovery-focused guidelines for the prescribing of psychotropic medication Develop Recovery-oriented Systems of Care led by service users Encourage open dialogue, transparency, and reflective practice, with a view of recovery and treatment choice across MH&A services Increase access to funded extended primary care consultations Increase use of patient-held records across all health services including MH&A services Increased numbers of extended consults 11 Peer support workers work alongside people who experience addiction or mental distress to inspire them to move forward with their lives. Other peer roles include peer educators, peer advocates, peer researchers, peer supervisors, peer consultants and consumer auditors. 11

2. Reduce exposure to risk factors Themes Actions Possible measures of success Lead agency and partners Increase visibility as a priority group in policies impacting on physical health Ensure that smoke-free policies are in place in all mental health and addiction services and that personalised support is provided to heavy smokers who want to quit (while ensuring this doesn t create more stigma/discrimination) Support public health advocacy to reduce access to alcohol, including supporting all the 2013 recommendations of the Law Commission. Develop and share examples of good practice Reduce stigma and discrimination Identify good models of wellbeing programmes through call for evidence network, promote through newsletters and online networks Ensure that people who experience mental health and addiction problems are provided appropriate access to screening for CVD and cancers Reduce the impact of lowered socioeconomic status through supporting better access to employment support and suitable housing Develop awareness in the health workforce of how to address the stigma, especially self-stigma, that can prevent people from engaging in wellness programmes Research and evaluation Analyse NZ data to inform the possible inclusion of additional risk factors related to mental health in the PREDICT CVD assessment tool widely used in primary care Review smoke-free practices in inpatient units around the country and how to provide more effective support for people who want to quit smoking, with a particular focus on Māori Trial alternative and complementary treatment options to minimise the side effects and provide viable alternatives to psychotropic medication 12

Quality improvement Improve access to oral health services for mental health and addiction service users Advocate for monitoring, screening and management of physical health problems in quality frameworks for MH&A services (and a physical health KPI) Ensure people have access to good information and support on the importance of nutrition to physical and mental health 3. Promote prevention and early intervention Themes Actions Possible measures of success Lead agency and partners Increase visibility as a priority group in policies impacting on Strengthen requirements of DHBs to prioritise early intervention services through DAP processes Endorse the HeAL Declaration for young people with psychosis, and put the goals into practice in NZ Adapt the HeAL Declaration for people of all ages using mental health and addiction services Develop and share examples of good practice Reduce stigma and discrimination Research and evaluation Quality improvement Promote self-control skills training in early childhood and health curriculum in schools Addiction performance target screening and brief intervention in primary care for alcohol Comprehensive annual wellness check and screening for everyone in contact with secondary and primary MH services Support ongoing funding and delivery of Like Minds Like Mine programme to address stigma and discrimination at a population level Trial complementary treatment options to minimise impact of psychotropic medications Training all health professionals (comorbidity, reduce stigma and discrimination) 13

Appendix one: Organisations who endorse the consensus statement (as at January 2015) 14