Lack of data about people who have co-existing problems · 2015. 12. 3. · The Co-existing...
Transcript of Lack of data about people who have co-existing problems · 2015. 12. 3. · The Co-existing...
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