Lack of data about people who have

co-existing problemsLet’s discuss

problems, consequences and solutions

Ashley Koning- Project Lead- Matua RakiSuzette Poole- Clinical Lead- Te Pou o te

Whakaaro Nui

If ‘Any door is the right door’ which door did they use?

The Co-existing Problems (CEP) project

• Integrated solutions (MoH, 2010)• CEP service checklist

• Te Ariari o te Oranga: the assessment and management of people with co-existing mental health and substance use problems (Todd, 2010)

• Rising to the challenge: MH & A strategic plan• Joint workforce development project since 2010

- led by Matua Raki in partnership with Te Pou, the Werry Centre, Te Rau Matatini and Abacus

• Training- workshops, e- learning and fora• Champions/enhanced practitioners• Te Whare o Tiki- CEP knowledge and skills

framework

What do we mean by co-existing problems (CEP)?

Other terms:• Dual Diagnosis• Co Morbidity• Co-existing

Disorders

CEP means:Co-occurrence of

mental health and substance use or

gambling problems in the same person at the same time

Impact- when a person with CEP needs are not met

Quality of lifeRecovery

FinancesEmployment

Physical health

Housing

Relationships

Risk to self and othersoffending

Relapse /admissions

• About 30% of people with an anxiety disorder are likely to have a substance use disorder

• About 30% of people with a depressive disorder are likely to have a substance use disorder

• About 40-60% of people with bi-polar disorder are likely to have a substance use disorder

• About 18% of people with a mood disorder are likely to have a gambling disorder

• About 50% of people with psychosis are likely to have a substance use disorder

Mental health and addiction

• About 65% of people with a substance use disorder are likely to have an anxiety disorder

• about 50% of people with a substance use disorder are likely to have a mood disorder

• about 30% of people with a substance use disorder are likely to have PTSD

• about 30% of people with a substance use disorder are likely to have social phobia

• about 10% of people with a substance use disorder are likely to have bi-polar disorder

• about 70% of people on OST are likely to have a depressive disorder or social phobia

Substance use and mental health

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

Drug and Alcohol Drug and Alcohol andMental Health

Mental Health Other No Diagnosis

2012 2013 2014

$$

42-44% of people accessing a service have

any diagnosis

3-4% have both MH and A diagnoses

PRIMHD Diagnostic Data 2012-14

CEP evaluation

• Pockets of progress throughout NZ• Key to change is leadership

• Collection of information about people with co-existing problems is lacking overall

Primary, secondary and provisional diagnoses recorded in file notes and entered into PRIMHD for all tangata whai ora

Steps DHB NGO Total

(5)Primary, secondary and provisional diagnoses recorded in all clinical files and PRIMHD

3 2 5

(4)Primary diagnoses entered on all clinical files and also recorded in PRIMHD

2 3 5

(3)Primary, secondary and provisional diagnoses recorded in the majority of clinical files

2 7 9

(2)Primary and secondary diagnoses recorded on 50% of clinical files

3 0 3

(1)Only a primary diagnosis recorded in clinical files, if at all

2 3 5

Total 12 15 27

DHB

NGO

More Than Numbers

Service design

Effective workforce planning has the population and the service user group

at the heart of the process (Golden, Hillier & Bosma, 2004).

Model of care

Population needs ?

Workforce capability

Workforce planning

Improved health and wellbeing outcomes

Impact of poor data collection

• Commissioning: how can we expect complexity to be recognised in service funding if complexity is not captured by the data?

• How can CEP be recognised as a local issue?• How can care be integrated if problems not

acknowledged?• How do we know people are getting the help they

need?• Do we have more or less people with CEP than

other countries?• What are the most common CEP?• How does ethnicity impact on CEP?• How does CEP impact on premature mortality?

Problem

Lack of local data about people who have co-existing problems.

Barriers- your thoughts

Barriers -our experiences• Data entry limitations: e.g. NGOs can not

enter diagnosis data• Inconsistent data collection• Inconsistent data entry: some areas enter no

diagnosis information at all• Different expectations about who, i.e. what

profession, can ‘make’ a diagnosis • Philosophical objections to diagnosis • Lack of confidence in making out of scope

diagnosis• Lack of interest in data collection as too busy

and or have never seen any feedback or use of own data

Finding ways to overcome the barriers

Your thoughts

What can we do to improve data collection?

• ?Big stick• ?Incentives• ?Logic• ?Show the evidence

Thank you

Ashley Koning ashley.koning@matuaraki.org.nz

Suzette Poolesuzette.poole@tepou.co.nz