Questions and answers about the mental health and addiction (MHA) quality improvement programme

Last updated 23 August 2017

Why do we need a mental health and addiction quality improvement programme?

Service providers work hard to give New Zealanders the best possible mental health and addiction services. However, these services need to continue to evolve and improve.

There are opportunities to improve the quality and safety of mental health and addiction services in New Zealand with benefits to consumers, family and whānau and the wider community. These include the opportunities to:

  • reduce the variability in access to and quality of the mental health services and care people receive
  • improve the performance of services (eg, by providing more timely follow-up when patients are discharged from hospital) 
  • provide more open and less restrictive environments, while still ensuring appropriate management of risk and harm
  • develop mechanisms to support services to coordinate and share their lessons and improvements. 
What is the aim of the programme?

The aim of the programme is to use quality improvement methodology to improve mental health and addiction services. This will result in significant benefits for consumers, including better outcomes. Ultimately, this will result in fewer people harmed, more lives saved, and more effective use of health care funding.

In particular, the programme will focus on improving the quality of services by:

  • reducing unwarranted variation
  • boosting performance across the sector
  • foster a recovery approach and philosophy
  • creating a culture of quality improvement and learning within MHA services. 
What will the programme do?

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 programme will sit alongside and complement other initiatives being undertaken in the sector.

It might take some time for small improvements to achieve significant and sustained change to MHA services.

Who is leading the programme?

The Health Quality & Safety Commission is leading the programme. The Commission is a Crown entity that works with clinicians, service providers and consumers to improve health and disability services. Quality and safety improvements mean fewer people harmed, more lives saved and more effective use of health care funding.

Dr Clive Bensemann is the programme’s clinical lead. Dr Bensemann is a psychiatrist at Counties Manukau DHB and an experienced clinical leader and director of DHB services. Mr Wi Keelan is the programme’s kaumātua and clinical advisor. Mr Keelan is affiliated with Ngāti Porou, Ngāti Kahungunu and Ngāpuhi and has experience in senior roles as a Māori health leader, specifically Māori mental health.

A sector leadership group is chaired by Dr Rees Tapsell, Director of Clinical Services, Mental Health and Addiction Services, at Waikato District Health Board. Dr Rees Tapsell is affiliated with Te Arawa.

A stakeholder group is chaired by Commission Chief Executive Dr Janice Wilson.

How did this programme begin?

Senior leaders in the mental health and addiction area approached DHBs in July 2016 about the need for a mental health and addiction improvement programme. The Ministry of Health and DHBs requested a proposal from the Health Quality & Safety Commission for such a programme, and a draft proposal was presented to DHB chief executives (CEs) in November 2016. Following the meeting of DHB CEs and Chairs in March 2017, the Commission was advised that the proposal for a mental health and addiction quality improvement programme had been successful. The programme began in July 2017.

What are the programme’s priorities and how were they established?

In 2016, the Commission hosted a workshop for MHA sector leaders. The workshop participants identified five potential priority areas:

  1. 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.
  2. 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.
  3. 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.
  4. 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. 
  5. 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.
What happens if other areas need attention?

These five priority areas are not exclusive; the programme will also support people to work on other areas of mental health and addiction.

How are consumers being involved?

The Commission supports consumer engagement and participation in health and disability services at every level, including governance, planning, policy, setting priorities, and highlighting quality issues. As such, consumer and family and whānau engagement, and co-design are key components of the programme.

Partnerships with consumers will be an overarching theme in all priority areas. This will include consumer participation at all levels, including the leadership group, regional and national workshops, and networks.

We will appoint a dedicated consumer engagement advisor as a member of the core programme team. The appointed person will provide consumer engagement and co-design expertise, and will ensure appropriate consumer input throughout the programme.

How does the programme differ from the Ministry of Health’s work on mental health?

The Ministry of Health is developing a new mental health and addiction strategy, which will set out the Government’s overarching plan and approach to deal with mental health and addiction issues. The strategy will set out a plan for the whole mental health and addiction sector in New Zealand, and will identify priorities for DHBs to focus on. The Strategy will inform the Ministry’s funding and planning decisions, for example, where they should focus their investment, and what services they should purchase.

The Commission’s national MHA quality improvement programme will not focus on changing the whole MHA system or the approach to providing care. Instead it will work within the current system, and is about doing better with what we already have.

Will the programme reduce suicides?

The aim of the programme is not just to prevent suicide, but to improve the quality of mental health and addiction services available to all New Zealanders. Better quality services will directly or indirectly impact a range of outcomes, including self-harm and suicide.
Suicide is a complex social issue and no one person or organisation can prevent it. Suicide prevention requires a cross-sectoral, cross-government approach. The MHA quality improvement programme will support the work that is underway in the MHA sector and across government to help prevent suicide in New Zealand.

How will the programme improve access to mental health services?

Addressing the increasing demand for mental health services is outside the scope of the Mental Health and Addiction Services Quality Improvement programme. The programme 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.

However, by improving the quality of services, they may become more effective and efficient, which may help to improve access.

How long will the programme run and what will it cost?

The programme, which is funded by DHBs, will be run for the next five years at a cost of $7.5 million, with a review after three years.

How will the programme’s success be measured?

Each priority area will have a measurement plan to show changes and improvements. These plans will include measures relating to equity, consumer experience, and outcomes. 

Last updated 24/08/2017