Consumers, their families/whānau and service providers working together to continue to improve mental health and addiction services so people get the best care.
Service providers work hard to give New Zealanders the best possible mental health and addiction services. However, there are opportunities to improve the quality of those services by engaging consumers, learning from adverse events and reducing variation using quality improvement methods. Internationally, quality improvement methods have been effective, resulting in fewer people harmed, more lives saved and more effective use of health care funding.
The mental health and addiction quality improvement programme is led by the Health Quality & Safety Commission in partnership with the health service providers, consumers and their families/whānau. The five-year programme will identify, select and implement quality improvement initiatives and build quality improvement capability in the mental health and addiction sector.
This is an evidence-based approach that has international support. The programme is based on the successful Scottish Patient Safety Programme: Mental Health and work undertaken by the Institute for Healthcare Improvement.
The programme will:
- collect and deliver best practice MHA quality improvement information to the sector
- develop evidence-based, standardised quality improvement systems and processes within MHA services
- measure the impact and effectiveness of quality improvement initiatives
- support sector leadership to deliver quality improvement initiatives and build quality improvement capability within MHA services.
The problem being addressed
- concerns have been raised about the quality and safety of mental health and addiction services in New Zealand and the impact this is having on consumers, family/whānau and the wider community.
- there is variability in the access to and quality of the mental health services and care people receive. Consumers should be able to get the same high quality care no matter where they are in the country, but this is not currently always the case.
- some services are not showing expected improvements in performance, such as not providing timely follow up when patients are discharged from hospital.
- some services experience tension between providing a more open and less restrictive environment while ensuring appropriate management of risk and harm.
- some services are working in isolation with few mechanisms to coordinate or share learning in improvement.
Engagement with the sector has identified five priority areas:
- learning from serious adverse events and consumer experience. While New Zealand has high-quality health services, unfortunately things sometimes still go wrong, including in mental health services. It is important to learn from these events so systems can be changed to prevent them from happening again. We need to learn from data gathered about people’s experience in hospital and at their general practice to make sure we can provide the best possible care.
- maximising physical health. People with mental health issues have poorer physical health than other people and live for a shorter time. This programme will build on the evidence-based Equally Well programme that looks to improve the overall physical health of people with mental health and addiction issues.
- improving service transitions. People can find transferring in and out of services challenging. This programme will look at ways to improve the processes around transfers to ensure patients receive continued care and support.
- minimising restrictive care. Some services use restrictive practices such as seclusion and restraint to try and reduce harmful events. However, a recovery approach that includes a more open environment is central to the philosophy of care in mental health and addiction services. This programme will support service providers to use evidence-based practices to deliver care while ensuring appropriate management of risk and harm.
- improving medication management and prescribing. There is significant variation in prescribing and managing medications for people with mental health and addiction problems, which may worsen their physical health issues. This programme will support standardised, evidence-based processes and practices for prescribing and management.
These five priority areas are not exclusive; the programme will also support people to work on other areas of mental health and addiction.
The MHA quality improvement programme will sit alongside, complement and augment other initiatives being undertaken in the sector.
Addressing the increasing demand for mental health services is outside the scope of this programme. Rather it aims to help improve the quality of services by strengthening leadership, sharing learning across service providers and encouraging a culture of quality improvement and safety. It is about doing better with what we already have.
The programme focuses on quality improvement, not compliance. While some of the quality improvements may help to achieve Ministry of Health mental health targets, the focus is not about meeting those targets.
It will take time for the improvements put in place to make actual changes to services.