It’s entirely possible for the 13,000 residents of Wānaka District to have an advanced modern mental health service. The population justifies a staff role of about 25. Those staff
positions exist now, they are just in the wrong locations and roles. Modern practice responds to the clients need as it presents, not limiting itself to set professions and techniques.
Wānaka people would see a physical centre they easily recognise and self refer to. They will see little difference between using the service and using their primary health (GP) service. The two would be closely associated with an easy flow between them. Using mental health support will become an ordinary thing.
Users of the service could expect to see workers they know and who know them well. They won’t have to explain their story multiple times. The story and plan that is formulated between the user and worker would recognise the families and local situation of the client as much as diagnosis.
Solving a housing issue may help the mental health issue greatly for example. For children there are often multiple agencies involved such as the school. Close work with agencies in education housing and welfare will be a common technique. Services in smaller areas already do that much better than city services.
The user can expect a generalist flexible response, driven by their particular need. Rather than confined to narrow professional roles, workers and the team can adapt what they do to the client situation. Within a small team approach, staff seek to provide solutions directly, limiting referrals to the bare minimum. Multiple referrals have high costs in communication time and the personal story can be lost in the translation.
In the new service users will experience contact with a small number of people they get to know, and not experience much of the confusion around referral, wait, seeing new and multiple people, and the confusion that process creates.
Twenty five staff seems an amazing number to those used to the current situation. But it’s
perfectly justified as Wanaka’s valid share of the 800-900 workers the Southern DHB now
employs directly or funds. But remember also that it’s a complete service aiming to keep people in the district. Alcohol and drug work is included. Some mobile service is necessary and Wānaka district is geographically large. Children and young people will access the service in significant numbers. The talking therapies take time. There are also very disabled people requiring daily care and attention.
The service still has a mental health focus and while recognising the complex lives of the people it sees it can’t be all things to all people. Some may be advised to go elsewhere.
It does not matter so much who owns and operates the service, but local ownership and control would ensure local needs are recognised.
These are very well established ways of organising a service. The basic framework comes from my 30-year contact with the famous mental health services of Trieste Italy. They have used this approach for 40 years now. Trieste, a World Health Organisation site, is often described as the best place in the world to be ill.
Kerry Hand is a psychiatric nurse who lives in both Dunedin and Central Otago. He is sceptical about claims for more funding and believes better service arrangement can be highly productive. He has long-established connections with the mental health services of Trieste Italy and the Milwaukee Child and Youth Wraparound Mental Health Service. He can be contacted at email@example.com