Zealand Mental Health Research Articles

"I don't think we've quite got there yet": The experience of allyship for mental health consumer researchers.

Consumer participation in mental health services is an expectation articulated through mental health policy. Consumers as researchers could contribute significantly to mental health services. Barriers to participation are significant and limit consumer involvement. Enhanced understandings of collaborative relationships between consumer and nonconsumer researchers. Researchers from the health disciplines find value in consumer involvement in mental health research. These researchers can support and facilitate consumer research by being allies to consumer researchers. Understanding the role of allies is necessary to strengthen their capacity to support consumer researchers. Involving consumers in mental health research is likely to lead to improved practice. Introduction Australia and New Zealand mental health policy requires consumer participation in all aspects of mental health services. Systemic participation informs and improves the quality of mental health services. Collaboration with consumer researchers should be similarly required. Enhanced understandings of collaborations are needed. Aim To enhance understanding of the perspectives and experiences of nonconsumer researchers in working collaboratively with consumers as researchers. Method This qualitative exploratory study involved interviews with nonconsumer mental health researchers who have worked collaboratively with consumers in research. Interviews were conducted with participants from Australia and New Zealand. Results "Allyship" emerged as a major theme. This describes nonconsumer researchers playing an actively supportive role to facilitate opportunities for the development and growth of consumer research roles and activities. Seven subthemes were identified: establishing and supporting roles, corralling resources, guiding navigation of university systems, advocacy at multiple levels, aspiring to coproduction and consumer-led research, extending connections and partnerships, and desire to do better. Discussion Allyship may have an important role to play in the broader consumer research agenda and requires further consideration. Implications for practice Embedding meaningful consumer participation within mental health services requires active consumer involvement in research. Allies can play an important facilitative role.

Transitions Through Stages of Alcohol Use, Use Disorder and Remission: Findings from Te Rau Hinengaro, The New Zealand Mental Health Survey.

To understand transitions from alcohol use to disorder, we examine timing of transitions between stages of alcohol use and associations between transitions and socio-demographic factors. Using nationally representative data, we found that the majority of alcohol use disorders develop by age 25. Increased alcohol use within a participant's cohort was associated with subsequent transition across all stages of alcohol use and disorder. Fifty percent of dependence cases had not remitted after 9 years. A nationally representative sample with a 73% response rate included 12,992 participants aged 16 and older. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess age at initial alcohol consumption, commencement of regular consumption, symptoms of alcohol abuse and dependence, and year-long remission. Alcohol consumption in an age- and gender-matched cohort, education, gender and age at commencement of use were investigated as covariates. Among all respondents, 94.6% used alcohol, 85.1% used alcohol regularly, 11.4 and 4.6% had developed alcohol abuse and dependence disorders, respectively. Of those with an abuse or dependence disorder, 79.9 and 67.2% had remitted, respectively. Increased alcohol use within a participant's cohort was associated with subsequent transition across all stages. The majority of disorders had developed by age 25. Considerable time was spent with disorder; 50% of dependence cases had not remitted after 9 years. Men were at greater risk of disorder and less likely to remit. Interventions should target young people and cohort-specific consumption with resources also allocated to long-term treatment provision for alcohol dependency.

Is Pacific language ability protective of prevalence of mental disorders among Pacific peoples in New Zealand?

Aims: To explore associations between experiences of mental illness, migration status and languages spoken among Pacific adults living in NZ.
 Methods: SURVEY FREQ and SURVEY LOGISTIC procedures in SAS were applied to data from Te Rau Hinengaro: The New Zealand (NZ) Mental Health Survey, a survey of 12,992 New Zealand adults aged 16 and over in 2003/2004. Pacific people were over sampled and this paper focuses on the 2374 Pacific participants but includes, for comparison, 8160 non-Maori-non-Pacific (NMNP) participants.
 Results: Pacific migrant respondents had the lowest prevalence of mental disorders compared to other Pacific peoples. However, Pacific immigrants were also less likely to use mental health services, suggesting an increased likelihood of experiencing barriers to available mental health care. Those who were born in NZ and who were proficient in a Pacific language had the lowest levels of common mental disorders, suggesting a protective effect for the NZ-born population. Additionally, access to mental health services was similar between NZ-born people who spoke a Pacific language and those who did not.
 Conclusions: We conclude that, given the association between Pacific language and reduced mental disorder, there may be a positive role for Pacific language promotion in efforts to reduce the prevalence of mental health disorder among Pacific communities in NZ.

Patient-Targeted Googling by New Zealand Mental Health Professionals: A New Field of Ethical Consideration in the Internet Age.

Patient-targeted Googling (PTG) describes the searching on the Internet by healthcare professionals for information about patients with or without their knowledge. Little research has been conducted into PTG internationally. PTG can have particular ethical implications within the field of mental health. This study was undertaken to identify the extent of PTG by New Zealand mental healthcare professionals and needs for further guidance regarding this issue. All (1,850) psychiatrists, clinical psychologists, and psychotherapists working in New Zealand were electronically surveyed about their experience of PTG and knowledge about the associated practice of therapist-targeted Googling (TTG) using a questionnaire that had previously been developed with a German sample. Due to ethics and advertising restrictions, only one indirect approach was made to potential participants. Eighty-eight clinicians (5%) responded to the survey invitation. More than half (53.4%, N = 47) of respondents reportedly being engaged in PTG, but only a minority (10.3%, N = 9) had ever received any education about the subject. Reasons for undertaking PTG included facilitating the therapeutic process, information being in the public domain, and mitigating risks. Reasons against undertaking PTG included impairment of therapeutic relationship, unethical invasion of privacy, and concerns regarding the accuracy and clinical relevance of online information. Two-thirds of participants reported being the subject of TTG. New Zealand psychiatrists, clinical psychologists, and psychotherapists are engaging in PTG with limited education and professional guidance. Further discussion and research are required, and so, PTG is undertaken in a manner that is safe and useful for patients and health practitioners.

Resituating Aotearoa New Zealand mental health legislation in the context of social and occupational justice

INTRODUCTION: Social work and occupational therapy mental health practitioners face a range of tensions in relation to statutory obligations in the context of maintaining a focus on the ideals of social or occupational justice.APPROACH: The aim of this article is to highlight some of the complexities for social work and occupational therapy practitioners in an environment dominated by a medico-legal worldview. Those complexities include creating and maintaining a therapeutic relationship, adhering to legal obligations; and staying focused on professional values and beliefs. We have explored notions of social justice and occupational justice and undertaken a descriptive chronological review of Aotearoa New Zealand mental health legislation.IMPLICATIONS: We have provided an insight in to some of the key factors that have influenced the development of mental health legislation in this country in relation to social and occupational justice. We have considered how the medico-legal worldview influences staying true to the notions of social and occupational justice and have made suggestions for change relative to practice and the legislation.

New College Literature Review: Powers and duties of psychiatrists in Australia and New Zealand Mental Health Acts

New College Literature Review: Powers and duties of psychiatrists in Australia and New Zealand Mental Health Acts

Considerations of response bias and value in linking an existing longitudinal cohort study with national health record data

ABSTRACTObjectiveLongitudinal cohort studies remain important sources of information in health and epidemiological research and represent a significant investment of resources. The maintenance of these cohorts over time and the representativeness of retained participants are important considerations for researchers. For those weighting the benefits of augmenting a longitudinal cohort study with data linkage to national health records, the potential for bias in consent and match rates and the utility of the newly obtained data are also key considerations. This study presents an analysis of bias associated with consent to participate and record matching in an established longitudinal cohort of older persons. We present the unique outcomes generated from this national health record data linkage project and the opportunities such variables present for longitudinal cohort studies.ApproachThe New Zealand Health, Work and Retirement study is a biennial survey of persons aged 55-85 which commenced in 2006. Over the past decade, additional cohorts have been recruited to the study, with n = 9003 older New Zealand residents participating to the year 2015. In 2013 the study began an approach to active survey participants for consent to link their longitudinal survey data to national health record data held by the New Zealand Health Information Service, including data related to hospital events, the New Zealand Cancer Registry, pharmaceutical data and mental health data. We compare self-reported longitudinal health trends associated with consent/declination to participate as well as for record match success and failure. Key outcomes derived from these national datasets for the purposes of the Health, Work and Retirement Study are described.ResultsConsent (62.5%) and declination (8.9%) to participate in the data linkage project are described in terms of the corresponding longitudinal self-reported health and socio-demographic trends for these groups. Successful and unsuccessful matches of participants to national health record data are also described. The calculation of outcomes from each of the linked datasets obtained and their potential utility in building upon existing longitudinal cohort data are also presented.ConclusionsNational health record data linkage presents a potentially valuable source of data to supplement and replicate findings related to health outcomes and expenditure derived from longitudinal cohort surveys. The challenges and successes of the New Zealand Health, Work and Retirement survey data linkage project touch upon considerations pertinent to evaluating the value of augmenting existing and ongoing longitudinal survey cohort for other researchers.

Are mental health services getting better at responding to abuse, assault and neglect?

To determine whether staff responses to abuse disclosures had improved since the introduction of a trauma policy and training programme. The files of 250 clients attending four New Zealand mental health centres were audited. There was a significant improvement, compared to an audit prior to the introduction of the policy and training, in the proportion of abuse cases included in formulations, and, to a lesser extent, in treatment plans. There was no significant improvement in the proportion referred for relevant treatment, which remained at less than 25% across abuse categories. The proportion of neglect disclosures responded to was significantly lower than for abuse cases. Fifty percent of the files in which abuse/neglect was recorded noted whether the client had been asked about previous disclosure, and 22% noted whether the client thought there was any connection between the abuse/neglect and their current problems. Less than 1% of cases were reported to legal authorities. People diagnosed with a psychotic disorder were significantly less likely to be responded to appropriately. Future training may need to focus on responding well to neglect and people diagnosed with psychosis, on making treatment referrals, and on initiating discussions about reporting to authorities.

Service user and clinical perspectives of psychiatric advance directives in New Zealand.

Advance care planning is becoming an increasingly important feature of health service provision. Although the New Zealand Mental Health Commission has advocated strongly for the provision of advance directives in mental health services, little is known about clinician or service user views on advance directives. The aim of the study was to survey the perspectives of service users and clinicians on the use of psychiatric advance directives. The study used an anonymous online survey to collect data from 110 mental health service users and 175 clinicians. Survey items included existing knowledge, preferred content and potential benefits of advance directives. Descriptive statistics and intergroup comparisons were conducted. Over 90% of service users and clinicians agreed that they support advance directives in mental health. There were similarities in the preferred content of an advance directive across the two groups, particularly regarding the notification of support persons, cultural support and preferred methods of de-escalation. Significant differences in opinion were found regarding the use of coercive measures and the ability of mental health legislation to override advance directives. The results indicate strong support for the use of advance directives within New Zealand mental health services, as well as for further research in the area.

Checking and Balancing New Zealand's Mental Health Review Tribunal: Perspectives of Forensic Patients

The aim of the study was to examine perspectives of forensic patients who applied for Mental Health Review Tribunal (MHRT) hearings regarding their compulsory detention in New Zealand. Ten participants were identified; semistructured interviews were completed; and a thematic analysis was performed. The participants described variable understanding of the process and scope of the MHRT. They explained why they applied for hearings, including to resolve disputes with clinicians regarding aspects of their care and the desire to expedite examination of their compulsory status. In some instances, the participants described feelings of distress and powerlessness regarding the process and outcome of the hearings. They also discussed the impact of the process upon the therapeutic relationships with their treatment teams. It emerged as important for patients to understand the limited functions of the MHRT. Written and other accessible forms of information may be helpful in this regard. For participants, the application process and hearing had variable value and utility, although some participants reported that the MHRT afforded them dignity because they had the right to challenge their compulsory detention.

Past Year Alcohol Consumption Patterns, Alcohol Problems and Alcohol-Related Diagnoses in the New Zealand Mental Health Survey

Background: Criteria for the diagnosis of alcohol abuse or dependence in DSM-IV or ICD-10 do not include measures of alcohol consumption. However the Alcohol Use Disorders Identification Test (AUDIT) contains three consumption questions (AUDIT-C) plus seven problem questions. The AUDIT-C has often been used as a short screening questionnaire. Here drinking patterns in the past year are analysed, and the AUDIT-C and other combinations of those three questions are related to alcohol problems or diagnoses in the same period.

New Zealand Mental Health Review Tribunal characteristics and outcomes 1993-2011.

This paper provides a descriptive statistical overview of Mental Health Review Tribunal outcomes from 1992 to 2011. A database used by administrators of the Mental Health Review Tribunal to store information on applicants and their hearing outcomes was subjected to basic descriptive analysis. A total of 3117 applications were received, with most applications received from males (n=2039, 65%) of New Zealand European ethnicity and a mean age of 49 years. A similar number of applications were received from inpatient and community patients (35%, 28% respectively). There was only a small percentage (7%) of applicants who were released and the number of applications withdrawn before a hearing took place was high, at 45%. The success rates of New Zealand Mental Health Review Tribunal applicants is low compared with some international jurisdictions, while at the same time withdrawals are high, warranting further investigation. Applicants in the community are underrepresented, which is of concern in the context of rising use of community treatment orders. Future research focused on service users' experiences of using the Mental Health Review Tribunal and improvements to the existing data stored on applicants are also suggested.

When the mandatory second opinion fails to approve compulsory treatment.

To examine situations in which compulsory treatment was not approved by the second opinion required under New Zealand's Mental Health Act. Qualitative and quantitative analysis of 11 index cases where full approval of treatment was not given and of 33 matched controls. The reasons for non-approval of treatment were diverse. Following non-approval, intensive consultation occurred, reflecting significant disagreement between clinicians. The process of resolution included discharge from the Act, patients consenting to treatment and alternative treatment plans. Compared with controls, index cases had significantly lower rates of being mentally well in the community over the subsequent year. Non-approval marks a group of patients with very poor clinical outcome. Explicit processes are needed to manage non-approval of compulsory treatment plans.

Eighteen months of depression: examining the chronic care management of depression with particular reference to Pacific people

Primary care is responsible for the 17% of the population with mild to moderately severe mental illness. Total Healthcare Otara (THO), with 49% of its patients of Pacific ethnicity, presents an opportunity to study the primary care management of depression, inclusive of Pacific people. While it had been assumed that Pacific people in New Zealand suffer less mental illness, Te Rau Hinengaro: The New Zealand Mental Health Survey showed this is not the case. The aim of the study was to examine a Chronic Care Management (CCM) programme for depression in a predominantly Pacific practice. A clinical audit of the CCM depression programme used by THO between 31 March 2009 and 30 September 2010. Participants were patients aged 18-64 years who scored ≥15 on the Patient Health Questionnaire-9 (PHQ-9). Computer templates completed for each consultation, including serial PHQ-9s, were analysed over time and across different ethnic groups. Cook Island Maori patients participated in the CCM depression programme in proportionally greater numbers than their enrolment in THO, while Samoan and Tongan patients participated significantly less. The mean PHQ-9 score fell rapidly over the first few visits and then levelled off, without reaching the normal range. Dropout rate was 60% after the third consultation irrespective of ethnicity or gender. There is a need for ethnic-specific research into depression in Pacific ethnic groups. A significant immediate improvement in PHQ-9 on entering the CCM depression programme suggests enrolment is therapeutic. However, further research into the CCM depression programme is needed, particularly the reasons for non-attendance.

Compulsory Community Care in New Zealand Mental Health Legislation 1846-1992

Community treatment orders are considered a new development in mental health care and are consistent with current New Zealand mental health policy of care in the community. However, since its first adoption in 1846, New Zealand mental health legislation has always made provision for compulsory mental health care out of hospital. Analysis of the text of each of the five iterations of mental health legislation shows that an initial (1846) provision for a friend or relative to take a committed patient into his or her care, as an alternative to committal to hospital, continued though various revisions until its current expression as a community treatment order. Using Rochefort’s model of change in mental health policy, we argue that a long static period until 1911 was followed by progressive change throughout the 20th century, although provision for compulsory out-of-hospital care has been continuous over the life of New Zealand’s legislation. In the late-20th century, compulsory mental health care is tied to medical treatment and mental health service surveillance of the patient’s social circumstances. We conclude with recommendations for how reformed legislation may contribute to future mental health policy by giving effect to agendas of positive rights and social inclusion.

The life cycle, achievements and transformation of the New Zealand Mental Health Commission: opportunities and risks

PurposeThe aim of the paper is to describe the “organisational lifecycle” of the New Zealand Mental Health Commission (NZ MHC) including factors that led to it being established, the evolving phases of the work it undertook and its key achievements, the critical success factors, the rationale behind its disestablishment and transfer of its core functions to another entity.Design/methodology/approachThe methodology is a review of relevant documents and interviews of previous Commissioners, and insights of the final two Chair Commissioners and authors.FindingsThe NZ MHC was established to provide government with independent advice on how to develop the capacity and capability of mental health and addictions services for those people with the highest and most complex needs, estimated to be approximately 3 percent of the population. Having successfully led changes to achieve this goal as set out in The Blueprint of 1998 it is now influencing government policy and services to achieve better mental health and well‐being for the whole population as per Blueprint II, published in 2012. The NZ Government clearly values the role of Mental Health Commissioner which has been transferred to the Office of the Health and Disability Commissioner from July 2012 at the time the Commission is disestablished.Research limitations/implicationsThe paper relies on insights of those in Commission leadership roles.Practical implicationsOther Commissions may gain insight into their own evolutionary pathways and proactively manage them.Social implicationsOptimal mental health and wellbeing for society requires policy that simultaneously takes a “whole of society” approach and focuses on responding to people with the highest needs.Originality/valueThe paper shows that there are significant concerns about the disestablishment of the Mental Health Commission in New Zealand and little understanding of the underlying rationale for the organisational changes.

Chaplaincy and Mental Health Care in Aotearoa New Zealand: An Exploratory Study

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.

The emperor’s edicts stop at the village gate

To present an overview of policy implementation, and develop principles for effective policy development and implementation. An overview of literature on policy implementation, and analysis of lessons from some recent experiences in Australian and New Zealand mental health services. Effective development and deployment of policy is much more complex than the commonly held, simplistic compliance model. There are principles that can guide effective policy development and implementation. Future areas of study include the policy implementation systems and change management processes in the health service setting.

Social deprivation and use of mental health legislation in New Zealand

Low socioeconomic status has consistently been associated with poorer health outcomes. Few studies have used ecological analysis to explore relationships between area measures of deprivation and use of mental health legislation. We used an ecological design to explore associations between two area measures of relative deprivation and the two most commonly used sections of New Zealand mental health legislation. High levels of relative deprivation were positively correlated with use of both acute and long-term community care provisions of mental health legislation with the correlation with long-term care achieving significance (r = .518, p = .016). Low levels of relative deprivation showed negative correlations with use of both provisions. The correlation of -.493 between low levels of relative deprivation and acute care provisions was significant at p = .023. In stepwise regression, the proportion of the population aged 15-64 contributed to the model for section 11, but ethnicity contributed to neither model. Mental health legislation is used disproportionately in areas with high levels of relative deprivation. The results have implications for regional allocation of funding for mental health and social services to support community-based care. Further research is needed to explore other factors that may account for the regional variation.

Collaborative prescribing: A qualitative exploration of a role for pharmacists in mental health

BackgroundCollaborative prescribing has been proposed as an extension of practice for advanced pharmacist practitioners. A lack of research investigating how pharmacists might be most effective as prescribers in mental health was identified. ObjectiveTo explore health professionals’ and consumers’ attitudes and beliefs that relate to the role of specialist mental health pharmacists working as collaborative prescribers within their advanced scope of practice in secondary care. MethodsSemistructured interviews were conducted with key informants in the New Zealand mental health sector. Participants were selected via a purposive sampling method, including health professionals (n=9) and consumers (n=3). NVivo software was used to analyze data, using a thematic analysis approach to develop a series of key themes from the interviews. Common themes were extracted, which were used to gather results and draw conclusions. ResultsThe key findings include a widespread acknowledgment of the role of specialist pharmacists as collaborative prescribers in mental health and as integral members of the multidisciplinary team; however, consumers were unaware of pharmacists’ role in secondary care. The role was seen to extend current practice particularly in medication management after assessment and diagnosis by a medical practitioner. Concerns regarding demonstrating competence, practitioner role/boundary confusion, insufficient training and workforce development, hesitancy by pharmacists to extend role, consumer awareness, and public perception of the traditional pharmacist role were identified. Solutions discussed included education by the profession; relationship building, training, and robust competency assessments; and a structured framework for implementing a collaborative prescribing model. ConclusionsThis study suggests there was recognition and acceptance of the role that specialist pharmacist practitioners could play in contributing to the care of mental health consumers as collaborative prescribers; their medication expertise being regarded highly. Further research is necessary to investigate how current resource constraints will allow for collaborative prescribing to be implemented within the context of mental health practice.