Hinapōuri ki Hīnātore: Improving mental health services and outcomes via integrated care in New Zealand

Background: Mental illness/distress or addiction affects 16% of the world’s population. In New Zealand (NZ), people accessing specialist mental health or addiction services (PA-SMHAS) experience reduced life expectancy and greater morbidity than the general population. Māori (Indigenous population) experience disproportionate inequities. Consequently, there are calls for integration within, and between, SMHAS and other health/community providers, to improve outcomes but we must be able to measure integration to do so.

 

Approach: Our study of PA-SMHAS and SMHAS Staff in NZ’s Southern region (population=320,000) has been designed in partnership with people with lived experience of mental distress as advisors and research team members.

 

Our study aims to: 1) describe integrated care reported by PA-SMHAS (aged ≥18 years) and Staff, and 2) understand relationships between integrated care and health of PA-SMHAS and Staff. This presentation includes findings from surveys of PA-SMHAS and Staff in 2022 and 2024. Questionnaires included measures of integrated care developed by team members: a 25-item measure for PA-SMHAS, and a 21-item measure for Staff (scores can range from 0, lowest integration, to 100 highest integration); and factors potentially associated with integrated care, such as quality of care, health; and for Staff – burnout and job satisfaction.

 

Results: Following a carefully planned confidential recruitment approach, we strove to recruit the same number of Māori and non-Māori PA-SMHAS who had accessed SMHAS in the past 3 months. Over the two surveys, 532 PA-SMHAS and 481 Staff participated.

 

Provisional analyses indicate that slightly over half PA-SMHAS and 73% of Staff were female; 48% of PA-SMHAS were Māori. Two-thirds of PA-SMHAS reported inadequate household income. PA-SMHAS had a range of diagnoses including depression, anxiety, PTSD and  intellectual disability, and accessed a range of SMHAS including inpatient, community and day programmes. PA-SMHAS had a mean age of 42 years; staff 49 years. Approximately half PA-SMHAS had been in contact with SMHAS for ≤5 years. Half the Staff had worked in SMHAS for ≥10 years, most worked in urban locations; ~20% in rural or mixed locations. Staff had a range of roles including nursing, allied health, administration and medical.

 

Integrated care scores from PA-SMHAS ranged from 4 to 100 (mean=65) and from 20 to 100 for staff (mean=64). Analyses show strong relationships between integration and PA-SMHAS and Staff perceived overall quality of care. There are considerable differences between mean integrated care scores for PA-SMHAS reporting excellent/good quality of care compared to PA-SMHAS reporting fair/poor quality (74 compared to 45, respectively; P<0.01).

For Staff, those reporting excellent/good compared to fair/poor quality of care the mean integrated care scores were 68 and 53, respectively (P<0.01). This presentation will also present associations between integration and the health of PA-SMHAS.

 

Implications: Hinapōuri ki Hīnātore appears to be the largest NZ cohort study collecting data directly from both PA-SMHAS and Staff. Our research has collected PA-SMHAS and Staff perspectives of integrated care (using measures developed previously by team members), identifying where and why integrated care is working well, and relationships between levels of integration and quality of care, and health.