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Special 40th issue - September 2017
Mental health and addiction nursing newsletter
Celebrating Reflections from
Anna Schofield,
10 years
founding editor of
Handover
Page 2
Mental Health
Nursing Framework –
Helen Hamer reflects
Page 16
We introduce our
editorial board
Page 5
Meet the nurses at
Te Oranganui
Page 25
Complete 10-year index
of Handover articles
Page 34
Get Handover delivered to your inbox: Sign up at www.tepou.co.nz/subscribe
LEAD STORY 4 S
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Founding editor of
Handover looks back
As the founding editor of
"I was keen to get something out there about
Handover, Anna Schofield finds
it remarkable and extremely the mental health nursing craft.”
satisfying that the e-publication
has survived 10 years and is still Getting started
going strong.
Starting a publication from scratch is a big project, especially as Anna had
Anna was new in the role as never done anything like it before. “We decided it needed to be electronic
workforce development nursing so it had multifaceted use and could be printed off, put on noticeboards,
Anna Schofield leadership manager at Te Pou or read and stored electronically. We set up an archive on Te Pou’s website
when she came up with the idea to store each edition so it could be a resource for people to access and
of a publication for communicating the good work nurses were doing in read about services or profiles at a later date.”
mental health and addiction, including primary care services.
“Handover became a place to demonstrate the initiatives and innovative
“We wanted Handover to be a publication where we could share, profile practice of individuals in finding solutions for what could be tricky situations
and celebrate the innovative approaches, solution focused nursing and and gaps in services. This is still a strong theme in Handover today.”
nursing partnerships occurring around the country that have had a
Anna says it was a busy project. As soon as one edition had gone to press
positive impact on service user outcomes. It also needed a national reach
she had to start planning the next one, keep people to deadlines and
to develop national and regional networks,” says Anna.
ensure enough appropriate and interesting material was coming through.
She says Handover aimed to give people accessing services, family and
“It was all about making sure we captured and profiled the diversity
whānau a platform to share their experiences and tell their stories – a
of the sector across the four editions each year, in a compelling and
very powerful process for nurses to hear about. “That kind of story telling
interesting way.”
continues to grow.”
“The longevity of Handover is due to ongoing commitment from the
"It was a great way to overcome a lack nursing leader editors who have succeeded me,” says Anna. “They continue
to be passionate about it and they keep it contemporary and relevant.
of information about mental health and It is important too that the focus has now expanded to include other
addiction nursing within regular nursing initiatives of interest for nurses.”
publications.” As a reader, not an editor, Anna still looks forward to receiving Handover as
a vehicle for facilitating dialogue and unifying the sector. “You become so
Handover also set out to support recruitment by highlighting the work focused on your own organisation, it is good to share approaches and have
nurses do in a real and authentic way, from chief nurse to community care, a reminder of what others are doing, including the amazing consumer
to help overcome the stigma surrounding mental health and addiction. lead work across the country.”
Anna says it was a great way to overcome a lack of information about mental
health and addiction nursing within regular nursing publications. “I was
Moving on - 10 years later
keen to get something out there about the mental health nursing craft.” After three years as workforce development nursing leadership manager,
Anna took up the position of nurse director of mental health at Auckland
2 Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
“You become so focused on your
own organisation, it is good to share
approaches and have a reminder of what
others are doing, including the amazing
consumer lead work across the country.”
District Health Board (ADHB). More recently she became director of
mental health at ADHB.
As the only nurse currently in the position in New Zealand, Anna sees it as
a great privilege and responsibility to be accountable for overall delivery
She sees huge opportunities for the workforce over the next 10 years,
of the Mental Health Directorate.
including nursing, with where and how care will be delivered. “For example,
As nurse director, Anna was part of the directorate leadership senior the nurse practitioner role and designated registered nurse prescribing,
team and accountable for all aspects of nursing practice and patient what that means for advanced nursing practice and how and where service
safety, professional and workforce development. As the mental health users can receive their care. It is pretty exciting for our nursing leaders to
director, her role is focused on strategy development and delivery, with a be part of leading and influencing some of that change.”
directorate-wide focus on professional governance, quality care delivery
and ensuring the workforce are effectively equipped to do the best they can. Mental health and addiction careers
“People are coming into mental health and addiction services with “Career opportunities and pathways are endless in the mental health
increasing complexities and that creates another set of challenges for and addiction sector,” says Anna. “It is exciting to see the enthusiasm and
the sector,” says Anna. passion of our New Entry to Specialist Practice Nursing (NESP) programme
nurses coming into Auckland DHB. These include specialties across age
“A big part of my job is around making sure the workforce, including all
groups, inpatient and community services, and pathways into leadership,
the leaders, are well supported to do their role but also able to talk about
tertiary education and nurse practitioner roles.
their challenges openly and find a range of solutions.”
“Where and how they will be delivering care in 20 years will be very different
She was attracted to the role because she wanted to participate in setting
to now, and for a traditional role like nursing that’s really inspiring. I’ve
strategic direction about where and how care is delivered. “It is about
been nursing for 21 years and have seen many colleagues and peers move
ensuring care across the sector is of high quality, supporting a range
down very diverse pathways within the mental health and addiction sector.
of leaders to lead within their service group, as well as setting strategic
That is a fabulous thing about mental health nursing.”
intent and developing services around that.”
Anna’s own journey along the leadership pathway has been partly
Anna believes her mental health nursing background brings a unique
serendipitous but also driven by a desire to be in a leadership role, taking
philosophy and perspective to the role.
a system view of services and the sector. “I enjoy being able to influence
“The way we are trained to think and use our skills as mental health systems to enhance the experiences and health outcomes of people
nurses enables us to influence, in a different way, the aims of what we accessing services, and the experiences of the workforce.”
strive to do in the directorate.”
10 th anniversary special issue
3
4 S
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Co-editorial
S S
Contents
Welcome to our 40th issue of Handover. We mark this occasion with a 10-year birthday celebration Founding editor of
Handover looks back .........................................2
issue that includes an index of all our articles since Autumn 2007. The index brings to light our
Co-editorial.........................................................4
collection of stories about mental health, addiction and disability nurses along with stories from
Meet the Handover editorial board..................5
our regular column writers which have evolved over time.
Next issue...........................................................5
We lead out with a reflection from Anna Schofield, the creator of Handover, and hear about how Meet the team of nurses at
this national mental health and addiction nursing newsletter came to be and her career pathway Te Pou o te Whakaaro Nui.................................6
since leaving Te Pou in 2009. Patrick Au, A face of Handover, 2007................7
Mental Health
Patrick Au, one of the nurses who kindly agreed to have his picture on the masthead of several issues – the time to act is now!.....................................8
of Handover, discusses his thoughts about a decade of working in an Asian mental health service. Taking a holistic approach to
mental health and addiction...........................10
Building the capacity and capability of the nursing profession to support global efforts to promote The DOMHNs
good mental health throughout the life-course, is just one of the key messages in the ICN update reflect on the decade ........................................11
from Annette Kennedy (president). Addiction nursing
– reflecting on the past decade....................... 12
Jane Bodkin from the Office of the Chief Nursing Officer, Ministry of Health, notes the growing Matua Raki update........................................... 14
recognition of the bi-directional nature of mental health services and a need for a cross sector Introduction to
approach towards mental health. It is not a problem the health sector can address alone. the framework.................................................. 15
Helen Hamer - reflections on
In the regular directors of mental health nursing column reflections on Handover and the mental the mental health nursing framework........... 16
health nursing framework are shared. Daryle Deering reflects on the development of addiction Leadership........................................................ 18
nursing over the past decade and Klare Braye updates us on Matua Raki’s work. Mark Smith comments Professional supervision.................................. 19
on trends in information over the last decade. Education .........................................................22
Making a difference
Our special feature is focused on Mental Health Nursing and its Future: A Discussion Framework in primary care.................................................25
(Ministry of Health, 2006). Helen Hamer reflects on the development of the framework and her Nurses supporting kaituhauora......................26
professional career. We focus on recommendations related to leadership, professional supervision
Developing workplace wellbeing practices....28
and education. Information about the newly updated suite of professional supervision guides for
Whitireia equipping nurses
nurses is shared. Future issues will include more articles about the mental health nursing framework. to work with people who
experience co-existing problems...................29
Our nurse profiles feature four NGO nurses from Te Oranganui, an iwi health and social service for pēpe, Reflections on the past decade.......................32
tamariki, paheke and kaumātua in the Whanganui region and a nurse practitioner Meg Robertson, Creating the nursing digest............................. 33
whose role focuses on supporting people who experience depression and/or anxiety. Handover index of articles...............................34
Stacey Wilson from Massey University encourages us to consider developing workplace wellbeing
practices.
Catherine, Loma-Linda, Dianne, Wendy and Vicky from Whitireia New Zealand reveal how they are
issn: 2324-3821
equipping nurses to support people who experience co-existing problems.
Barry Kennedy and Shivika Singh share how they prepare the quarterly nursing digest, and our To subscribe to the Handover
index of Handover articles concludes this special celebratory issue. newsletter, go to the Te Pou website:
www.tepou.co.nz/subscribe
Nga mihi, Suzette and Caro Te Pou is now on Twitter and LinkedIn,
connect with us:
Suzette Poole Caro Swanson
twitter.com/TePouNZ
Editor Editor
(RN-MH, MN) SERVICE USER LEAD linkedin.com/company/te-pou
– CLINICAL LEAD caro.swanson@tepou.co.nz
suzette.poole@tepou.co.nz
4 Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
Meet the Handover editorial board
The editorship of Handover since its inception in 2007 has sat with the
nursing leader at Te Pou. Throughout the life of this publication service
user lead Caro Swanson has contributed to the editing of each edition. Her
attention to grammar and focus on using language that is less stigmatising
makes the style of Handover unique.
In July 2016, Issue 36, Caro joined Suzette Poole, mental health nurse and
clinical lead, to become the co-editor of Handover. Caro and Suzette work
Suzette Poole Caro Swanson
with the Handover editorial board.
• Angela Gruar, manager of the practice and leadership portfolio, Te
Pou, has keen eyes for detail and is the one who signs off the final
proof of each issue.
• Mark Smith, principal advisor, Te Pou; is our regular ‘Information
Alive’ column writer.
• Rachel Kapeli, project co-ordinator, Te Pou; is the key person in
keeping timeframes, making her an instrumental part of the team!
Mark Smith Heather Casey
• Heather Casey, director of mental health nursing representative,
brings in sector leadership knowledge. Heather is the director
of nursing of mental health, addiction and disability services for
Southern District Health Board. She is a past president and fellow
of Te Ao Māramatanga – New Zealand College of Mental Health
Nurses.
The Wise Group communication and design teams provide the talent
and skills to bring the content to life.
Angela Gruar Rachel Kapeli
Sima Clarke, Te Pou team support co-ordinator, is the logistics queen who
ensures hard copies of each issue of Handover reach our valued readers.
It’s a real team effort and a project that we are all proud of!
Next issue Sima Clarke
Our readers want to know about solutions and innovations Issue 41 will be our final issue for 2017 and we welcome stories about the
highlights for mental health and addiction nurses and thoughts about
to improve services for people experiencing mental health
what 2018 may hold.
and addiction problems. They also want to know how to
Issue 41 will be released in early December and articles are due by Friday,
support the workforce to develop the values, attitudes,
27 October 2017.
knowledge and skills that best support a person with their
Articles can be 300-800 words and photos are welcome. Please send
recovery. So if you have a story like this, please get in touch.
to either suzette.poole@tepou.co.nz or carolyn.swanson@tepou.co.nz.
10 th anniversary special issue
5
4 S
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Jo van Leeuwen Lois Boyd Mark Smith Suzette Poole
Meet the team of nurses at
Te Pou o te Whakaaro Nui
The first nurse to be employed by Te Pou was Anna Schofield in 2006. Dr Mark Smith, principal advisor, providing strategic clinical leadership
Eleven years on we now employ four nurses who take leadership roles in and advice about research and evaluation. Mark leads work on mental
delivering and contributing to many of our initiatives, drawing on their health outcomes measurement, mental health information use and
extensive nursing experience. the early intervention in psychosis project. He is a registered psychiatric
nurse and qualified as a registered nurse practitioner in 2002. He has
Introducing: an interest in academic philosophy, particularly philosophy of mind and
ethics, in which he holds a PhD. Mark has worked in a range of clinical
Jo van Leeuwen, programme lead. Her projects include: Equally Well, talking
roles and as a lecturer at the University of Auckland. He is a Fellow of Te
therapies, working with families and whānau, primary mental health and Let’s
Ao Māramatanga, NZCMHNurses.
get real. Jo provides leadership for a range of workforce development initiatives
to assist district health board (DHB) and non-government organisation (NGO) Suzette Poole, clinical lead. Suzette’s projects include supervision; trauma
services bring about service and workforce change, through planning and informed care; women in secure care; co-existing problems; and she is co-
enhancing practice. Jo is a registered nurse with a career that has spanned the editor of Handover alongside Caro Swanson. Suzette qualified as a psychiatric
specialist adult and NGO Kaupapa Māori mental health sectors; workforce nurse in 1985 and has worked in a range of clinical and leadership roles,
education; and clinical and service management within DHB mental health including clinical nurse educator, clinical nurse director and nurse advisor –
and addiction services. Jo is a member of Te Ao Māramatanga, New Zealand health (Nursing Council of NZ). Suzette specialised in forensic mental health.
College of Mental Health Nurses (NZCMHNurses). Her Masters of Nursing thesis was about workplace empowerment among
New Zealand mental health and addiction nurses. Suzette is an honorary
Lois Boyd, contracted co-leader of the least restrictive practice initiative alongside
lecturer at the University of Auckland, a Fellow of Te Ao Māramatanga,
Caro Swanson. Lois has worked in a wide variety of mental health settings
NZCMHNurses and a member of New Zealand Nurses Organisation.
including acute inpatient care; community mental health; early intervention;
supported housing; nursing research; and was the nurse consultant for Nelson/
Marlborough DHB. Lois is a member of Te Ao Māramatanga, NZCMHNurses.
6 Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
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Patrick Au, a face of Handover, 2007
I feel somewhat emotional when I been expanded. Over the years, other than
look back on my professional journey providing consultation and liaison work, I
over the last 10 years. Looking at have gradually become more involved in
my photo on the front page of the providing therapy to work with Asian
first issue of Handover in 2007, my families. On top of my Master’s degree
first impression is that I have aged. in counselling, which I obtained in
1999, I have attended various training
I continue working in the same
workshops on family therapy both
district health board and running
Patrick Au in New Zealand and China.
the same Asian mental health
service. The change of my role from clinical co-ordinator to nurse specialist On average, I present at mental
has been a highlight, as it has helped to reflect and recognise the nature health conferences every few years and
of the work I am engaged in. provide guest lectures at universities. My recent
co-authored book Broken dreams? Chinese migrant families at risk: The New
Over the last 10 years, the Asian mental health service delivery model has
Zealand experience (Au & Ho, 2015) summarised my clinical experience in
not changed, and the number of staff working within the service has not
the last 10 years. In 2016, I was also involved in two Asian suicide studies
changed. But the number of Asian people residing, studying and working in
with the University of Auckland, one of which was funded by ADHB. We
the Auckland District Health Board (ADHB) area has increased considerably,
are about to publish the second suicide study in a journal.
as evidenced by the 2013 Census figures and recent government statistics.
Supporting and meeting the mental health needs of this third largest Overall, the past decade has been challenging but rewarding. I am ready
ethnic group in central Auckland has been keeping our team very busy. to meet any future challenges in the next 10 years, provided that I have
not retired earlier.
In terms of my career pathway, the scope of practice as a nurse specialist has
10 th anniversary special issue
7
ICN UPDATE
Mental Health
– the time to act is now!
Collaborators, 2016). According to the WHO (World Health Organization,
Annette Kennedy 2015), one in four people will experience an episode of mental illness in their
President lifetime. Mental disorders are also the leading cause (25%) worldwide of
International Council of Nurses years lived with a disability. This is the single biggest cause and is more than
cardiovascular disease and cancer combined (DALYs & Collaborators, 2016).
In high income countries, men with mental health problems die 20 years
Earlier this year the International Council of Nurses (ICN) hosted our
earlier and women 15 years earlier than people without mental health
2017 ICN Congress in Barcelona, Spain. This four-day event saw over
problems. In Low-Middle Income Countries (LMIC) the gap is considered
8000 nurses from all over the world come together and share their
much wider.
knowledge, experiences and discoveries under the theme Nurses at the
Forefront Transforming Care. There are strong links between mental health problems and chronic
health problems. This is not only related to their causes and consequences,
At this Congress, we highlighted one of our priority areas, mental health,
but also their prevention and management. Despite clear evidence that
including a main session address by Heather Casey, Past President and
there can be no health without mental health, nowhere in the world does
Fellow of Te Ao Māramatanga, College of Mental Health Nurses New
mental health enjoy parity with physical health in national policies and
Zealand and Dr Daryle Deering (Senior Lecturer, University of Otago). The
budgets or in medical education and practice (United Nations, 2017).
fact remains that mental health continues to be a global health issue. In
many parts of the world, people with mental health problems experience Globally, health systems have not been sufficiently resourced to meet the
discrimination and so-called treatments such as being chained, isolated mental health burden of disease. There is a significant gap in the need for
and physically abused. There are gross human rights violations occurring treatment and services offered. The WHO estimates that between 76-85%
and this should be considered a travesty of justice. of people with severe mental disorders receive no treatment in LMIC.
Health systems are so under-resourced that they are unable to provide
This is why ICN is committed to the delivery of the United Nations
even the most basic health care, including essential medicines to treat
Sustainable Development Goals (SPGs), adopted by world leaders in
mental disorders (World Health Organization, 2013). Most investment is
September 2015 at an historic UN Summit.
focused on long-term institutional care and psychiatric hospitals, resulting
This was the first time that mental health has been included in a global in a near total policy failure to promote mental health holistically for all
health agenda - an historic step in recognising the cost of mental health (United Nations, 2017).
problems. The SDGs define mental health as a priority area for action
Now is the time to advocate for change. It is time for all governments and
over the next 15 years. Goal 3 seeks to ensure healthy lives and promote
decision makers to invest in nursing with a particular focus on investment
wellbeing at all ages and target 3.4 includes the promotion of mental health
into specialist mental health workforce. We know now that mental health
and wellbeing in reducing mortality from non-communicable diseases.
is a priority for the UN and WHO. We know that there are gross inequalities
The UN placing such emphasis on the issue of mental health is a good start, between the supply and demand of specialised and general health workers
but there is still much to be done. Mental health is a high cost problem. It supporting people with mental health problems. However, we also know
is one that does not discriminate in gender, race or socio-economic status. that nurses play many vital roles in supporting people with mental health
The issues pertaining to mental health disorders can happen to anyone problems, including that of advocate, and are also often in the best position
at any time and for this reason it could be argued that the entire way in to act as the liaison between the patient and family as well as other team
which the global community engages with mental health needs reform. members and departments. Nurses are often the professionals ensuring
that a patient’s human rights are maintained. Performing these roles
The facts are that mental health problems are responsible for a significant
means that nurses must be knowledgeable and involved in all aspects
proportion (7.4%) of the total global burden of disease (DALYs &
of the patient’s care as well as have a positive working relationship with
8 Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
ICN UPDATE
to
u nity y.
o p po r t
b i r thda
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et o ry h ta
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o u o m i tme
ow i Te P ing com e
I als ver and aver th
a n d o
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N lh al.
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ette oun
Ann tion
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other team members. Without nursing, we have no universal health
care (UHC), we have no primary health care (PHC). Specialist mental References
health nursing ensures not only mental health delivers what it should to
DALYs, G. B. D., & Collaborators, H. (2016). Global, regional, and national
consumers but, through their specialist knowledge and skills, provides disability-adjusted life-years (DALYs) for 315 diseases and injuries and
services to the whole health system. And nurses are the largest group of healthy life expectancy (HALE), 1990-2015: a systematic analysis for the
health care providers worldwide! Colleagues, the time is now! Global Burden of Disease Study 2015. Lancet, 388(10053), 1603-1658.
doi:10.1016/S0140-6736(16)31460-X
It is the vision of ICN to build the capacity and capability of the nursing
World Health Organization. (2013). Mental Health Action Plan 2013-2020.
profession to support global efforts to promote good mental health Retrieved from Geneva:
throughout the life-course, and support improved prevention, treatment
World Health Organization. (2015). Mental Health Atlas 2014. Retrieved
and management of services for populations with compromised mental
from Geneva:
wellbeing; to promote the role of patients and consumers’ in their recovery.
The right to mental health requires care and support facilities, goods and World Health Organization. (2017). Social Determinants of Mental
Health. Retrieved from http://www.who.int/mental_health/publications/
services that are available, accessible, acceptable and of good quality.
gulbenkian_paper_social_determinants_of_mental_health/en/
Rights-based care and support for mental health is an integral part of
health care for all (United Nations, 2017). United Nations. (2017). Report of the Special Rapporteur on the right
of everyone to the enjoyment of the highest attainable standard of
As a nurse, your ability to effect change is just as important as the technical physical and mental health http://www.ohchr.org/EN/Issues/Health/
Pages/SRRightHealthIndex.aspx
ability to deliver safe and effective care. Nurses’ sphere of influence as
health care professionals goes beyond the individuals, families, groups www.un.org/sustainabledevelopment
and communities with whom they work. It extends throughout the
health sector to nursing and midwifery colleagues, medical colleagues,
allied health colleagues, and those with policy, management and fiscal
responsibilities. Nurses are both needed and wanted around the policy
and decision-making tables.
I encourage you all to visit the ICN International Nurses’ Day website, (www.
icnvoicetolead.com), to read about some of the changes your colleagues
are making all over the world and share your own story.
10 th anniversary special issue
9
OFFICE OF THE CHIEF
NURSING OFFICER UPDATE
Taking a holistic approach to
mental health and addiction
Corporation; and others, are considering mental health issues in their
Jane Bodkin work. Social sector agencies are working with the Ministry of Health to
Chief Advisor develop work programmes that address mental health and addiction issues.
Office of the Chief Nursing Officer
Ministry of Health
Social investment
Social investment is a platform of this government. Social investment is
Mental health is an enormously important and complex area. Everyone
about understanding and sharing data, understanding what works and
who works in the health system, whether they work in mental health and
who to target. For example, there is growing evidence from sources, such
addiction services or not, are involved in work that includes and inevitably
as the Dunedin Longitudinal Study, that mental health issues typically
relates to mental health. Therefore, it is important that we don’t silo off
develop in an individual’s early years.
mental health as a separate part of the health system, in part because
the body and mind are so interconnected. We need a holistic approach. Therefore, we need to focus on mental health early in people’s lives. Of
Mental health is everybody’s business. Nurses, midwives, allied health course, the social investment approach needs to be balanced by connecting
and doctors – the whole workforce has a role to play in this. with people and understanding their needs and wants.
People with mental health and addiction problems are also more likely to On 14 August, the government announced a package of 17 mental health
have poor physical health outcomes. A good example of work underway initiatives aimed at helping New Zealanders experiencing mental health
in this area is Equally Well. https://www.tepou.co.nz/initiatives/equally- problems as well as focusing on improving services and earlier intervention.
well-physical-health/37 http://www.health.govt.nz/our-work/mental-health-and-addictions/
mental-health/new-mental-health-care-initiatives
Good mental health and resilience
These include:
There is an increasing focus and realisation of the importance of building
resilience and keeping ourselves well. ‘Staying well’ features strongly in the Distance and electronic therapies package
New Zealand Health Strategy. Building wellbeing and resilience occurs at • Enhanced e-therapy options for pre-teens, adolescents and young
an individual, community and organisational level. At the same time, there adults
are increasing demands on mental health and addiction services, which is a • E-therapy for young prisoners
challenge. Our focus on existing mental health services needs to continue.
• Package of tailored telehealth pilots
• Ensuring support and follow-up for those who attempt suicide
Cross-agency approach
• Expanding and enhancing primary and community mental
There is a growing recognition of the bi-directional nature of mental health and addiction care
health services. This means a person’s circumstances affect their mental
health and mental health affects their circumstances. For example, Step-up/step-down support for people experiencing acute and emergency
housing, education and employment status affect mental health, and it mental health needs package
is equally true that mental health affects your ability to work and other • Support service for people in acute mental health crisis to sustain
aspects of your life. This is a key thing to understand and is why a cross- tenancies
agency approach makes sense. Mental health is too complex to be solved • Wraparound step-up/step-down care trial
by psychiatry, mental health services or even the health sector. It needs
• Multi agency co-response service for people who ring 111 for Police
a whole of government and whole of society approach. Many agencies, or Ambulance requiring a mental health response
such as the ministries of social development, justice and education; the
• Strengthening self-regulatory skills in early childhood
Corrections Department, New Zealand Police; Accident Compensation
10 Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017Schools package experiences of family and/or sexual violence
• Pilot frontline mental health input to schools • Enhancing mental health and neurodevelopmental capacity in
Gateway assessment teams and associated service pathways
• Improve learning environments and build resilience
• Improving the evidence base about New Zealanders’ mental
• Electronic HEEADSSS assessment and brief intervention for
health and interventions that work.
young people
• Supportive housing models for youth with a mental health condition “There is a growing recognition of the
• Strongest Families pilot
bi-directional nature of mental health
• Culturally responsive trauma-focused CBT for children following
services.”
DIRECTORS OF MENTAL
HEALTH NURSES UPDATE
The DOMHNs
reflect on the decade
Ten years of Handover publications! Hard to believe it has been that long “Handover shines a light on local mental
and also how the content and circulation has developed over these years.
Handover is a really important tool for sharing mental health nursing
health nursing innovation, highlights topics
innovation and practice development, showcasing new roles and has relevant within mental health, addictions
been a real enabler for the mental health nursing framework. Handover and disability and provides an opportunity to
shines a light on local mental health nursing innovation, highlights topics
relevant within mental health, addictions and disability and provides an
read about local topical issues.”
opportunity to read about local topical issues. It provides a close practice The directors of mental health nurses (DOMHNs) network has been
to publication link, mirrors what is coming out of regulatory and statutory operating for approximately 20 years and is an essential network for
bodies, and maintains relevance for the readers. Te Pou o te Whakaaro Nui sharing information and innovation. Nursing leadership within services
has shown real leadership in maintaining this publication. We congratulate is key to supporting and sustaining the nursing workforce and mental
them on this and hope to see this wonderful celebration of mental health health nursing practice. The DOMHNs structure offers new nursing
and addiction nursing remain! leaders the support to develop their leadership capabilities and to work
through many of the difficult challenges facing mental health services
It is also just over 10 years since the mental health nursing framework was
by utilising the experience of the group.
released in 2006 and it has been an interesting process for district health
board (DHB) nursing leaders to reflect on the recommendations under DOMHNs have key strategic relationships with all organisations and
the categories of leadership, nurse practitioners, standards, skill mix and agencies who intersect with either mental health, addictions and
clinical career pathways. Progress in each of these areas can be dependent intellectual disability sectors or nursing, such as the Nursing Council and
on the DHB governance structures, the financial state of DHBs and the the Office of the Chief Nursing Officer. Key people from these agencies
personalities of people in leadership positions. The one area that has some regularly attend our quarterly meetings to hear our views on what is
consistency in progress is clinical career pathways or as we know them happening in the sector and share their own. Each year our work plan is
now, professional development and recognition programmes (PDRP). refreshed. This plan reflects priorities in the sector and also proactive work
The national consistency comes from Nursing Council expectations of to ensure nurses are well prepared for future practice or service delivery
PDRPs. Local variation may be more about uptake by nurses, but it isn’t initiatives, such as registered nurse prescribing.
about content and processes as the expectations are clear and audited.
However, some more thinking about who sets expectations for nurses
practising in mental health settings is needed.
10 th anniversary special issue
11addiction nursing update
Addiction nursing – reflecting
on the past decade
competencies for registered nurses and Te Ao Māramatanga - New
Dr Daryle Deering Zealand College of Mental Health Nurses Standards of Practice (Te Ao
National Addiction Centre Māramatanga, 2012).
University of Otago
The opportunity to be recognised as an advanced certified addiction nurse
was then established. DANA members and non-members can apply for
advanced certification to the DANA Credentialing Advisory Committee
In the past decade, government policy has emphasised greater integration
via a process outlined on the DANA website http://www.danaonline.
of care for people affected by addiction and mental health issues (Ministry
org/credentialling.
of Health, 2010; Todd, 2010), greater integration of care between primary
and community services and secondary care services, accessible community Symposia for addiction and related sector nurses were introduced and
services and early intervention (Ministry of Health, 2012). supported at least annually by Matua Raki. The symposia are hosted
in different regions by addiction nurses and provide opportunities for
Nursing workforce implications have included a broadening of work
nurses to hear about national nursing trends, develop networks and
settings from practicing mainly in specialist services, to opportunities to
share innovations/developments in practice.
practice within primary care, non-governmental organisations, community
services and other sectors; while specialist nurses are to have an increasing Addiction nurses have also supported the Te Ao Māramatanga credentialing
consultation liaison role in supporting/supervising other practitioners project for enhancing primary care practice nurses’ mental health and
to provide assistance to people affected by mental health and addiction addiction competencies.
problems within primary care and community services (Health Workforce
New Zealand, 2011). Addiction nurses now have roles that extend across an increasing range
of settings including primary care, non-government organisation (NGO),
In addition, the urgent need to address the physical health of people education and workforce development. Increasing numbers of addiction
with significant mental health and addiction issues has been highlighted nurses are gaining postgraduate qualifications and undertaking master’s
(Te Pou o te Whakaaro Nui, 2014), thereby requiring mental health and level research projects.
addiction nurses to enhance their physical health knowledge and skills.
Aligned with these trends, developments within the broader nursing Two nurse practitioners, Louise Leonard and Sarah Barkley, have an
sector have included the embedding of nurse practitioner roles and the addiction focus within their scope of practice and many other nurses are
introduction of registered nurse prescribing. on a nurse practitioner pathway. Recent legislative changes have enabled
a wider range of health practitioners to undertake certain functions
Within this context several developments have occurred within addiction which were restricted to medical practitioners. Nurse practitioners and
nursing in New Zealand, supported particularly by Matua Raki (national specialist registered nurse prescribers working in addiction services are
addiction workforce development centre). now able to prescribe controlled drugs to treat addiction. Such changes
should promote accessible and responsive care, for example, to people
A strategy discussion document on advanced practice nursing in the
with opioid dependence, and greater capacity for care provision within
addiction specialty (Deering, 2008) was developed with regional input
specialist and primary care, NGO and community services as well as in other
from addiction nurses. This national network of nurses provided a basis for
sectors. Opportunities are also likely to present for nurse practitioners and
input to the development of the Drug and Alcohol Nurses of Australasia
other addiction specialist nurses with the introduction of the Substance
(DANA), Addiction Specialty Nursing Competency Framework for Aotearoa
Addiction (Compulsory Assessment and Treatment) Act in 2018.
New Zealand (Matua Raki, 2012). The framework describes the continuum
of nursing practice and the role of the specialist level addiction nurse. With increasing opportunities for addiction nurses to be employed across a
It was designed to be congruent with Nursing Council of New Zealand range of health and other sectors, practice networks and addiction nursing
12 Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017addiction nursing update
leadership become increasingly important. Recruitment of nurses with
addiction expertise will remain an important focus, as will supporting References
nurses to gain broad addiction nursing experience and postgraduate Deering, D. (2008). Development of the advanced practice nursing strategy
qualifications. It is essential that the needs of people with complex addiction for the addiction treatment sector: A discussion document. Matua Raki
and mental health issues are responded to by nurses with the required Report: Wellington.
level of knowledge and skills. A specialist competency framework aligned Drug and Alcohol Nurses of Australasia. (2012). Addiction specialty nursing
with advanced certification is likely to become of increasing importance competency framework for Aotearoa New Zealand. Wellington: Matua Raki.
in this context, particularly given the potential for the establishment of Health Workforce New Zealand. (2011). Towards the Next Wave of Mental
nurse-led services. Health & Addiction Services and Capability: Workforce Service Review
Report. Wellington: Health Workforce New Zealand.
Strong professional bodies that can attract addiction nurses have an
Ministry of Health. (2010). Service Delivery for People with Co-existing
important role to play in:
Mental Health and Addiction Problems: Integrated Solutions. Wellington:
• promoting contemporary competencies and learning outcomes Ministry of Health.
within nursing undergraduate education programmes
Ministry of Health. (2012). Rising to the Challenge. The Mental Health and
• advocating for the implementation of a framework for specialist Addiction Service Development Plan 2012– 2017. Wellington: Ministry of Health.
addiction nursing practice as the basis for practice
Te Ao Māramatanga New Zealand College of Mental Health Nurses Inc.
• supporting increased nurse practitioner positions and registered (2012). Standards of Practice for Mental Health Nursing in Aotearoa New
nurse prescribing Zealand (3rd Ed.). Auckland: Te Ao Māramatanga New Zealand College
of Mental Health Nurses Inc.
• advocating for accessible postgraduate education and skills
development options 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.
• supporting input from nursing, consumer and other stakeholders
to national policy and service development. Todd, F.C. (2010). Te Ariari o te Oranga: the Assessment and Management
of People with Co-existing Mental Health and Substance Use Problems.
Ministry of Health: Wellington.
o
a R a k i tēnei tin
atu na
ana e M nei ki tō
E mihia ver k u a e k e
i te
u e m i a Hando k a u t ia nuitia a
ra Kaing ā a
u t u a n gahuru. g ā t a p u hi hauor
ta er i n
t o k o a Handov i w aranga.
Kia
tau āt a p u h
ro me ng ui!
hinenga , k ia m anawan
māia
kaha, kia
aki
Matua R
hānau o
Nā te w
10 th anniversary special issue
134 S
0 E
* I S S U
Matua Raki update
Raki. Matua Raki has recently completed a series of workshops designed
Klare Braye to support addiction, allied services and workforces to develop plans,
Project Lead protocols, new roles and models of care in preparation to respond to
Matua Raki requests on how to use the Act from that date. The SA(CAT) Act introduces
new addiction sector roles, processes and models of care for which nurses
can offer a significant contribution. An e-learning module providing a
As the year progresses it is encouraging to see the ongoing achievements brief overview of SA(CAT) Act is available on the Matua Raki website
and activities of nurses working in the addiction sector. Moira Gilmour, https://www.matuaraki.org.nz/initiatives/introduction-to-the-substance-
Capital and Coast District Health Board, is currently leading a small but addiction-compulsory-assessment-and-treatment-act-2017/183.
very important project for us, prompting access and support for nurses
Knowing the enormous amount of work and preparation going into the
who may be using substances in a problematic way, and what they and/
upcoming 5th International Conference of Te Ao Māramatanga – New
or their colleagues can do to get support.
Zealand College of Mental Health Nurses, this is shaping up to be a
We have a small working group who are refreshing the Addiction Specialty great event. This year the conference is titled Surfing the Waves – mental
Nursing Competency Framework for Aotearoa New Zealand https://www. health and addiction nurses responding in new and innovative ways.
matuaraki.org.nz/resources/addiction-specialty-nursing-competency- With sponsorship from Matua Raki; keynote speaker Dr Daryle Deering;
framework-for-aotearoa-new-zealand/377. The framework, published in workshops by Michelle Fowler and Ashley Koning about screening and
2012 and endorsed by the New Zealand National Nursing Consortium stands brief interventions for substance use disorders across the age span and
alongside relevant nursing and other professional codes of ethics, legislative theories of addiction and treatment; as well as several concurrent addiction
and policy frameworks, accepted best practice guidelines and compliments focused sessions – it is exciting to see the strength of the addiction content.
the Standards of Practice for Mental Health Nursing (Te Ao Māramatanga – Please make yourselves known to us at our stand.
New Zealand College of Mental Health Nurses). It provides guidance on the
Visit the Te Ao Māramatanga
clinical career pathway for nurses from foundation to advanced specialist;
– New Zealand College of
a description of the levels of practice of nurses; clarification of the specialist
Mental Health Nurses website
level of nursing practice for nurses, other professionals, peer support
for more information about
workers, consumers, consumer advisors, employers, funding and planning
the conference http://www.
personnel; and guidance for education providers in designing curricula.
nzcmhn.org.nz/News-
Consideration for the Substance Addiction (Compulsory Assessment and Events/2017-Conference.
Treatment) Act 2017, SA(CAT) due to come into force in February 2018
is well underway with the Ministry of Health and supported by Matua
14 Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017MENTAL HEALTH
NURSING FRAMEWORK
Introduction to
the framework
Mental Health Nursing and its Future: A Discussion Framework – Report from the Expert Reference Group to the Deputy
Director-General, Mental Health Dr Janice Wilson, was published in 2006 by the Ministry of Health.
Dr Frances Hughes chaired the development of the report and Helen Hamer led the project. The final report was authored
by Helen Hamer, Mary Finlayson, Katey Thom, Frances Hughes and Sharon Tomkins.
http://www.moh.govt.nz/NoteBook/nbbooks.nsf/0/12CBFAC7FCA3C1F0CC2576DF007B1AC2/$file/mental-health-nursing.pdf
The framework provided a strategic direction for the future of mental health nursing to strengthen both nursing leadership
and practice within the multidisciplinary clinical environment. The overall goal was to provide strategies to move the
profession of mental health nursing forward. Several recommendations were made about leadership, mental health nurse
practitioners, standards, skill mix, clinical career pathways, professional supervision, education, research, recruitment and
retention. We invited key stakeholders to revisit the framework and comment on progress and their thoughts on what
more is needed to support mental health and addiction nurses. We received a lot of feedback and over the next few issues
of Handover will share a summary of this with you on each of the recommendations.
In this issue Helen Hamer reflects on the framework and we focus on leadership, professional supervision and education.
Nga mihi, Suzette Poole
Suzette Poole
Editor
(RN-MH, MN)
– CLINICAL LEAD
10 th anniversary special issue
15MENTAL HEALTH
NURSING FRAMEWORK
Helen Hamer - reflections on the
mental health nursing framework
Dr Helen Hamer, project lead and report author of the 2006 framework, documentation was written and
recalls great optimism in the sector about the framework development placed in Te Pou’s resources;
as it got underway – and she was very excited to be involved. documentation that is still current
and available to guide managers,
Creating a framework opened up the opportunity to do two things, she
nurses and professional leads on
explains. “One was to develop the workforce of mental health nursing by
providing a supervision structure.
giving managers and leaders recommendations to help them provide
a workforce environment that promoted the maximum leadership, “Momentum quickly grew,” says
governance, professional and clinical best practice from the mental Helen. “The new graduate nursing Helen Hamer
health nursing workforce. It was also to describe and clarify the role and programme was strengthened and
function of the mental health nurse in the post-institutional environment.” developed nationally through the Skills Matter programme.” Postgraduate
funding was allocated for experienced mental health nurses to match
At the time Helen was working in a joint role as clinical nurse consultant
their peers in physical health settings by developing academic and
for Auckland District Health Board and senior lecturer at the University
research pathways that complimented their clinical expertise, such as
of Auckland, where she was leading the mental health component of the
the nurse practitioner endorsement in mental health and intellectual
new Bachelor of Nursing programme.
disability settings.
“Writing the framework was also a great opportunity to articulate my thoughts
As well, Te Ao Māramatanga – New Zealand College of Mental Health
and those of other nurses, and to incorporate what research was telling me
Nurses and New Zealand Nurses Organisation (NZNO) also reviewed
and say: this is what we do as nurses, and here are the recommendations
the standards for mental health nurses.
that will support the profession to articulate the role as well as we can.”
“Such initiatives sent a signal to the mental health sector that there were
Over a period of 18 months, she talked to many different sector groups,
a variety of roles and career pathways available for mental health nurses,
including nurses, nurse leaders, educators and unions to ensure the
including a leadership programme.”
framework truly represented what the sector was saying.
“The framework was supported from inception to implementation by
“The reference group didn’t want the report to sit on a shelf and never see
Frances Hughes who was the Ministry of Health’s chief nurse advisor,
the light of day. We wanted to make sure it was a living document that
and embraced by the Directorate of Mental Health Nurses’ group, who
nurses would read, a snapshot of mental health nursing and of the things
continue to support it,” says Helen.
we needed to have in place for the future of the profession.”
Looking forward
How did it impact?
Whilst these successes are making a huge difference to the mental
After publication, there was a desire to quickly implement tangible changes,
health nursing sector, at times, Helen feels some momentum has been
says Helen. The Ministry of Health convened a meeting of key stakeholders
lost; possibly due to funding and election cycles, making it important to
to advise and help determine the next steps, including prioritising
revisit the framework.
recommendations. Part of that involved developing a specific nurse-led role
at Te Pou, to lead the implementation of the framework recommendations. “When I began this framework project, my commitment was to consult
widely and listen to the sector. I think it’s time to hear their views and
Professional supervision was the first recommendation to be implemented,
voices again. The review needs to consider contemporary national and
as advised by Helen. A literature review and recommendations on
tepou.co.nz/jobs
supervision practice were undertaken by the Centre for Mental Health
international changes, and the direction for nursing as a whole.”
at the University of Auckland’s School of Nursing. Substantial supervision
16 Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017MENTAL HEALTH
NURSING FRAMEWORK
"We wanted to make sure it was a living
Other gains over the last 10 years include:
document that nurses would read, a
• salary incentives for mental health nurses to work in snapshot of mental health nursing and of
under-served geographical areas
the things we needed to have in place for the
• successes in the role of mental health nurses in the
primary care arena, such as shared care approaches
future of the profession.”
• increased physical health screening by mental health Her PhD thesis led to an honorary appointment at Yale University which
nurses for people presenting to secondary services with she took up in 2015. She is now completing further research at Yale
mental health problems
University, exploring the practices of social inclusion by mental health
• continued growth in some DHBs for the role of clinical staff in everyday clinical practice settings. These acts of citizenship by
nurse specialists and educators
mental health staff make a claim for justice, and support the rights of
• extending the mental health nurses role into people in their care.
new services such as home-based treatment
approaches, non-government organisation settings “They are often small gestures, embedded in practice, that have enormous
and as responsible clinicians within the legislative positive impact on people’s recovery journeys and are sometimes described
requirements of the Mental Health (Compulsory as ‘turning points’ on their journey, that foster their sense of social inclusion
Assessment and Treatment) Act 1992. as full citizens.”
Primary care and mental health
Life after the framework Now an independent practitioner, Helen also contracts to DHBs, primary
health organisations and other health and education providers. She is
After the framework was completed, Helen turned her sights to PhD
currently contracted to Counties Manukau Health as nurse lead for a
study. She completed this in 2012 while still working in her clinical nurse
project dear to her heart – primary care integration.
consultancy and university teaching roles. Her PhD topic ‘What does
citizenship mean for people who have serious mental illness?’, explored Helen has a long-standing interest in promoting closer relationships
the structures in society that marginalise some citizens and privilege between DHB mental health and addiction staff and primary care general
others, which leads to social exclusion particularly for people labeled practice clinicians, to increase prevention and provide earlier intervention
with a mental illness. for people presenting with mental health and addiction problems.
“When you feel included in the dominant group you don’t question your “These partnerships will help to reduce the health disparities and earlier
citizenship – it is often taken for granted because ‘you don’t know what mortality for people accessing services and help to reduce stigma and
you’ve got ‘til it’s gone’. It isn’t as easy to express its deeper meaning discrimination.”
unless you have experienced exclusion and marginalisation,” says Helen.
Helen regards such initiatives as, “The third decade, and hopefully final
After completing her PhD, Helen worked on Stories of Successful Social stage of the deinstitutionalisation of our mental health services, and
Inclusion, a Like Minds, Like Mine research project that was published in the opportunity to future-proof mental health nursing as we extend
2014. The study found that many of the people accessing services whom our practice to embrace a primary care approach to our specialist roles.”
were interviewed described mental health professionals as champions
who fostered their inclusion.
10 th anniversary special issue
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