Midland Regional Forensic Psychiatric Service Stakeholders Report
1
Whitiwhiti mai te ra
Poro poro mai te ra
Tihei mauri ora
Ko te korowai aroha ko Te Kaihanga
Te timata-tanga
Me te whaka-otinga
O nga mea katoa
Kia whai kororia ki Toona Ingoa Tapu
E te kiingi ariki Tuheitia kiingi
O te ataitai tangata kiingi Maori
He mihi hoonore kia koe heke iho
Ki to hoa Atawhai to paapaa ra
Whatumoana heke iho ki te whare
Kahui ariki nui tonu paimarire.
E mihi atu ana kia raatou, kua mene atu ki te poo
No reira, haere atu raa, haere atu raa,
Moe mai raa
No reira, teena koutou, teena koutou,
Kaati raa
Teena raa koutou katoa
Midland Regional Forensic Psychiatric Service Stakeholders Report
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Table of contents
Pages
Table of contents
1. Introduction
1.1. Background
3
4
5
2.
6
Staffing and Facilities
2.1. The Waikato District Health Board Provider Arm Services (Health
Waikato)
2.1.1. Inpatient Services
2.1.2. Community Services
2.2. Hauora Waikato Forensic Mental Health Services
2.2.1. Toka Tu Mataara Forensic Services
2.2.2. Tamahere Hospital and Healing Centre and Mahoe Hospital
2.2.3. Kohi Maara Programme
6
6
8
9
9
9
9
3.
Rebranding and Future Service Structure
10
4.
Service Utilisation/Activity Data (2008)
4.1. Seclusion Data
4.2. Bed utilisation
4.3. Length of stay
4.4. Re-admission
4.5. Referral data
4.6. Admissions
12
12
13
14
14
15
16
5.
Forensic Futures Implementation
5.1. Forensic Futures-Strategic Direction
5.2. Department of Corrections Prison Muster Projections
5.2.1. Model of care in the Correctional Setting
5.3. Springhill Correctional Facility
5.4. Auckland Liaison/Protocols
5.5. Youth Forensic Service Development
5.6. Regional Consultation/Liaison
17
17
17
17
18
19
19
20
6.
Facilities Redesign
6.1. Waikato DHB Provider
6.2. Tamahere Hospital and Healing Centre
21
21
22
7.
One Service Two Providers
7.1. Needs Assessment Service Co-ordination (NASC) Panel
7.2. Clinical Governance Structure
23
23
23
8.
Workforce Development and Training
24
9.
Forensic Futures - The Next Steps
25
Midland Regional Forensic Psychiatric Service Stakeholders Report
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1. Introduction
The Midland Regional Forensic Psychiatric Service is one of five regional forensic services across
New Zealand providing forensic mental health services to people within their respective regions.
The others are Auckland, Central, Canterbury and Otago. Whilst each of these services are very
similar in terms of the services they provide, they also have a unique set of challenges and meet
them in a range of different ways.
The particular challenges faced by the Midland service include:

the rural nature of the region, serviced by small urban centres

the high proportion of Maori in particular areas across region

the lack of consistency between iwi Maori boundaries and Midland boundaries

the projected growth in the prison muster

the lack of any inpatient based semi-secure inpatient facility for patients within general mental
health services with ‘high and complex needs’

the differing distances from Hamilton where we provide the majority of forensic mental health
services.
The Midland service, funded by Waikato District Health Board’s Planning and Funding, provides
forensic mental health services to people of the Bay of Plenty, Lakes, Taranaki and Waikato
district health boards.
Waikato DHB’s provider arm, Health Waikato, and Hauora Waikato,
provide the service.
Following consultation around the region, the Midland service published the Midland Forensic
Futures Plan in April 20081. This plan was developed as a response to a review of mental health
services conducted by the Ministry of Health (MoH) 2 and laid out the major strategic challenges
and how they will be met, through until 2012. The MoH will collate all of the region’s forensic
‘Futures Futures’ responses and publish them in a national plan. Whilst we have seen a draft of
this plan, we await publication of the final version. This report is the first in a series of reports to
key stakeholder of the Midland service. As such, this report includes a brief description of the
service and its constituent parts. It also includes a very rudimentary analysis of service
activity/utilisation.
Later reports may include less descriptive information about the service but rather concentrate on
reporting service activity, utilisation data, an update of implementation of the Forensics Future
plan and any emerging issues that might be of interest to the region. We issued an invitation to all
stakeholders to identify any aspects of purchased service activity that they might wish to be
reported in future reports of this sort, which we anticipate, will be completed twice yearly.
1
Forensic Futures Document-Final Forensic Futures Response (Midland Region) April 2008.
Review of Forensic Mental Health Services-Future Directions. 2007. Ministry of Health.
Midland Regional Forensic Psychiatric Service Stakeholders Report
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1.1.
Background
The Waikato Regional Forensic Psychiatric Service was initially established in early
1990, initially in Tokanui Hospital, transferring to the Waikato Hospital site with the
opening of the Henry Rongomau Bennett Centre on 13 December 1997. It comprises
a spectrum of psychiatric (assessment, treatment and rehabilitative) services
provided in the courts, the region’s prisons, hospital (within the Henry Rongomau
Bennett Centre - Waikato Hospital campus) and community settings, across the
Midland region.
Hauora Waikato, a non government kaupapa Maori mental health provider was also
established in 1999 and evolved out of the first kaupapa Maori psychiatric unit (Whai
Ora) situated within Tokanui Hospital. Hauora Waikato enjoys the mandate of iwi
Tainui and over subsequent years has grown to be one of the largest non
government providers of psychiatric services and the largest non government
provider of forensic psychiatric services. Hauora Waikato provide forensic psychiatric
services to the courts across the Midland region (both adult and youth courts) and
minimum secure kaupapa Maori inpatient forensic psychiatric rehabilitation in both
hospital (Tamahere Hospital and Healing Centre and Mahoe Hospital) as well as
within community settings.
Over the years, the two providers have had difficulties in forming a collaborative
working relationship. In 2006 the ‘business case,’
was developed, outlining a
service redesign and facilities development for the Midland Regional Forensic
Psychiatry Service. The business case enunciated a new service model of ‘one
service-two providers’. It outlined a new model of care across services and it
identified a set of shared service values and principles. This shared approach to the
provision of forensic mental health services was further cemented by the
establishment of a joint (and independent) governance entity for forensic services
across both organisations. The governance group is made up of the representatives
from both providers and the region’s DHBs and has an independent chair with
extensive forensic experience.
The governance group subsequently advertised and appointed an executive clinical
director sitting across both providers.
The executive clinical director is assisted by a service development group made up of
Kaumatua and Whaea, representatives of each of the provider organisations, an
academic from the Waikato Clinical School of Medicine and the Waikato DHB mental
health portfolio manager. In February 2009 a clinical governance group was
established across both providers and is working well.
Midland Regional Forensic Psychiatric Service Stakeholders Report
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2. Staffing and Facilities
2.1.
The Waikato District Health Board
Provider Arm
Services (Health Waikato)
The Health Waikato forensic mental health service has two main bases.
The
inpatient services are all based on the Waikato Hospital campus and the community
services are based at 40 Clarence Street, Hamilton.
2.1.1. Inpatient Services
The inpatient services are based at the Henry Rongamau Bennett Centre
situated at Waikato Hospital, Hamilton. Inpatient services are delivered in a
mixture of medium and minimum secure environments. Long term secure
care beds are currently provided by the Mason Clinic and Stanford House (it
is anticipated that these beds will return to the Henry Rongomau Bennett
Centre at the end of 2010).
Through the ‘top-slice’
purchasing mechanism
twenty five medium and
twenty minimum secure
beds
are
purchased.
The 25 medium beds
are located at the Henry
Rongamau
Bennett
Centre, along with five
minimum secure beds.
The other 15 minimum
beds are provided by
Hauora Waikato at Tamahere Hospital and Healing Centre and Mahoe
Hospital.
Wards 33 and 32 provide care for individuals requiring medium secure care
and these clinical areas also provide services under a separate direct
Ministry of Health contract for secure services to individuals with an
intellectual disability and are predominantly under the Intellectual Disability
(Compulsory Care & Rehabilitation) Act 2003. Wards 33 and 32 currently
operate 12 and 13 beds, respectively. Ward 33 is the acute admission and
assessment ward. This unit predominantly admits individuals from the prisons
that require assessment for mental disorder.
Midland Regional Forensic Psychiatric Service Stakeholders Report
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This ward also accepts individuals who have come via the court and have
been made subject to a Section 38(2)(c) of the Criminal Procedure (Mentally
Impaired Persons) Act 2003 report as well as a small number of individuals
from general mental health services who are deemed to pose an
unacceptable level of risk and require secure care. This ward typically admits
40-50 individuals per year. Individuals in ward 33 who have been transferred
from the prison and are mentally well and not in need of rehabilitation are
transferred back to the prison, where they receive follow up from the Forensic
Prison Team. When individuals (who are not returning to prison) have
become more engaged in their rehabilitation they can be referred and
transferred to ward 32, which focuses on rehabilitation and preparing for the
process of gradual re-integration into the community.
The focus of ward 32 is to
offer rehabilitation within the
confines of a medium secure
environment.
In
this
environment there is a greater
focus on programme based
rehabilitation; strengths based
approach
to
individualised
rehabilitation and for a few
individuals longer term care
and
a
slower
rate
of
rehabilitation and re-integration. Individuals from here typically return back to
their DHB of origin, or to minimum secure rehabilitation either within Health
Waikato or with Hauora Waikato.
Health Waikato minimum secure beds are based in the Transition House,
which is in the grounds of Waikato Hospital, opposite the Henry Rongamau
Bennett Centre. This is a five bed rehabilitation house, focusing on building
the individuals skills and capabilities to be able to live in the community. The
rehabilitation focuses on building life skills and on increasing independence
from hospital provided services. Individuals typically increase work skills,
complete courses and/or begin work whilst in the house.
Individual service users who chose to access Kaupapa Maori rehabilitation
(and are deemed likely to benefit from such an approach) do so through the
services offered by Hauora Waikato, either at Tamahere Hospital and
Healing Centre (ten beds) or Mahoe Hospital (five beds).
Midland Regional Forensic Psychiatric Service Stakeholders Report
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Due to the extensive refurbishment and re-build occurring within the Health
Waikato forensic unit, five additional minimum secure beds have been
temporarily sited at Tamahere Hospital until May 2010 allowing work to
progress on Ward 31. A small number of staff from Health Waikato nursing
staff are seconded to work with Tamahere Hospital during this period.
2.1.2. Community Services
The Community Forensic Team is essentially divided into three subspecialties and operates in the areas of Court and General Mental Health
Liaison Team, Forensic Prison Team and Community Team.
The Court Liaison Team provide assessments and advice to the courts
relating to options for individuals presenting before the court where there may
be a mental health concern. The Court Liaison Team is present in the
Hamilton, Tauranga, Whakatane, Rotorua, Taupo, New Plymouth and
Hamilton satellite District Courts. As part of this team, approximately one
hundred and seventy court reports are prepared by forensic psychiatrists and
psychologists each year.
The Forensic Prison Team is the largest of the community based subspecialties, delivering services into Waikeria, Tongariro-Rangipo, New
Plymouth and Springhill prisons. A multi-disciplinary team is responsible for
the assessment and treatment of individuals with mental health problems in
the prisons. The current prison muster is approximately 2000. The Forensic
Prison team receives approximately 117 referrals per year and the current
caseload across all prisons is 75 (and growing). Individuals who are released
from prison and require ongoing mental health treatment are generally
referred in advance of their release to general mental health services.
The community team cares for individuals in the community who have usually
come through the inpatient services and, following discharge, live in
supported accommodation or with family, in the Waikato area. Typically these
are Special3 patients or occasionally patients subject to civil commitment4
judged to present an unacceptable risk to district general mental health
services (GMHS). Optimally, individuals without a legal status or identified
level of risk requiring them to be with the forensic service are referred back to
GMHS in their area of origin.
3
Special patients as defined in Sections 24 and 25 of the Criminal Procedures (Mentally Impaired Persons) Act 2003
Patients subject to a Compulsory Treatment Order as defined in Sections 29 and 30 of the Mental Health (compulsory
Assessment and Treatment) Act 1992
Midland Regional Forensic Psychiatric Service Stakeholders Report
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2.2.
Hauora Waikato Forensic Mental Health Services
2.2.1. Toka Tu Mataara Forensic Services
Toka Tu Mataara forensic mental health services are purchased to provide a
kaupapa Maori court liaison and court reporting service to the Hamilton and
Waikato satellite courts.
Established in 1999 it offers the opportunity for
defendants to be assessed within a Kaupapa Maori framework.
Toka Tu
Mataara has 2.25 purchased FTEs.
2.2.2. Tamahere Hospital and Healing Centre and Mahoe
Hospital
Tamahere Hospital and Healing Centre (Tamahere Hospital) was established
in 1999.
It offers inpatient assessment, treatment and rehabilitation for
patients within a kaupapa Maori context in a tranquil rural setting within the
rohe (tribal group) of Ngati Haua5, in Tamahere. Tamahere Hospital has ten
minimum security forensic beds and five beds sub-contracted by Health
Waikato to allow work on the facilities redesign process.
Mahoe hospital was established in 2003. It is a five bedded hospital, situated
in residential Hamilton but still very closely connected to Tamahere hospital.
This small hospital offers patients more freedom, independence and access
to Hamilton city and its resources. Patients move freely between Tamahere
and Mahoe hospitals, dependant on their clinical needs.
Tamahere and Mahoe Hospitals are staffed by a range of pou (staff) of a
range of different disciplines.
2.2.3. Kohi Maara Programme
Kohi Maara is a kaupapa Maori education, skills and rehabilitation
programme. Dependant on their individually identified needs, patients from
Tamahere and Mahoe Hospitals attend the Kohi Maara programme which
runs on four full days per week.
5
Ngati Haua-A hapu of the iwi Tainui
Midland Regional Forensic Psychiatric Service Stakeholders Report
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3. Rebranding and Future Service Structure
The MRFPS has historically been perceived as a Waikato service. Indeed, it was named the Waikato
Regional Forensic Psychiatric Service. With the move towards developing more of a regional identity
and focus the service accepts that it could do more to inform and involve its stakeholders about its
role and functions.
This has been a key focus in the Forensic Futures Plan and lead to:
 The writing of this report to key stakeholders and a commitment to regular reporting thereafter;
 A focus on liaison with district GMHS and the interface with the MRFPS;
 An increased transparency around the processes for admissions and discharges between
services and;
 A focus on moving the MRFPS to having more of a regional identity.
Re-branding of a service and establishing a new and common
identity is not a straight forward exercise, particularly when it
involves two independent provider organisations who have not
always seen eye to eye. The establishment of the ‘one servicetwo provider’ model, with its independent governance and
executive clinical leadership structure, the adoption of a new
model of care across both services and a major facilities
redevelopment present a prime opportunity to do this. Such a
re-branding requires the development of a service metaphor
which has its origins in the Midland region and its people and
which capture the work which the service does and the context
within which it does it.
From this metaphor must come an
appropriate name for the service (incorporating both providers),
names for each of the constituent units within the service and
stories about the functioning of each, which have their origins in
the metaphor.
An appropriate process iwi consultation, conducted across the Midland region was undertaken by
Tainui kaumātua, Tom Moana, with the assistance of Jonas Hapuku, operations manager with Te
Puna Oranga, the Maori health unit within the Waikato DHB.
From this consultation came iwi
endorsement for the proposed service changes and support for the service metaphor, unit names and
new model of care.
Midland Regional Forensic Psychiatric Service Stakeholders Report
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Having agreed the new service metaphor and service names and acknowledging the new service
values, principles and model of care, as enunciated in the original business case for facilities
redesign,6 we must seek organisational agreement from both the Waikato DHB and governing board
of Hauora Waikato to endorse a rebranding and the launching of a new service, with an independent,
regional identity.
An exercise must then be undertaken to inform key stakeholders of the new service identity and its
‘whakapapa’ (origins) and to cement that identity within the services and in the minds of its staff and
all of its key stakeholders.
The re-branding project will culminate in the launching of the new service, with its new identity in mid
2010.
Waikato Regional Forensic and Rehabilitation Service Redesign and Facilities Development, Joint working group, compiled by
Andrew Higgins, 1 December 2006.
Midland Regional Forensic Psychiatric Service Stakeholders Report
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4. Service Utilisation/Activity Data (2008)
This section describes some of the service utilisation/service activity data for forensic mental health
services purchased by the Waikato DHB for the 2008 year. In the case of Hauora Waikato this does
not capture all services provided. As this report records data that has been gathered for a novel
purpose we are aware that it does not gather all of the utilisation data accurately.
An example of this is the legal requirement to retain a bed for special patients subject to specific leave
requirements where the patient is still recorded as having occupied the bed (for legal purposes) for a
lesser period than is reflected in this data. Another example is where an individual transferred from
Waikeria Prison has a default address of origin as Waikato (as opposed to their actual DHB of origin).
In order to maximise the accuracy of data we have limited data to the 2008 year. As this data was
gathered from two separate services which have quite different information technologies and reporting
frameworks it presented challenges in terms of ensuring that the data was accurate and consistent.
For future reporting we have begun to set up mechanisms for capturing this data accurately and
consistently across providers and services prospectively. We invite stakeholders to engage in
discussions with us about data that may be of interest to them in future.
4.1.
Seclusion Data
Seclusion data reflects Health Waikato forensic mental health service only as
seclusion is not practiced within the kaupapa of Hauora Waikato.
The general trend for seclusion is down as shown in the graphs below which
represent the number of incidents per month and the total hours per month over the
08/09 calendar year.
Number of seclusion
incidents
Number of incidents - Forensic
Number of incidents - Forensic
Linear (Number of incidents - Forensic)
80
60
40
20
0
Jan/08
Feb/08
Mar/08
Apr/08
May/08
Jun/08
Jul/08
Aug/08 Sep/08
Oct/08
Nov/08
Dec/08
Month
Midland Regional Forensic Psychiatric Service Stakeholders Report
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Hours of seclusion per month
Hours in seclusion Forensic
Linear (Hours in seclusion Forensic)
600
Hours
500
400
300
200
100
0
Jan-08
Feb-08
Mar-08
Apr-08
May-08
Jun-08
Jul-08
Aug-08
Sep-08
Oct-08
Nov-08
Dec-08
Month
4.2.
Bed utilisation
The table below shows the number of bed days occupied per region for the 2008
calendar year. This represents both service users who have been admitted and
discharged in the 2008 year plus those service users who have been an inpatient for
the entire year.
DomDHB
Total
Percentage
D011 Northland
21
0.14%
D022 Auckland
105
0.72%
D023 Counties Manukau
213
1.46%
D031 Waikato
7930
54.50%
D042 Lakes
1547
10.63%
D047 Bay of Plenty
2562
17.61%
D071 Taranaki
1762
12.11%
D081 MidCentral
250
1.72%
D082 Whanganui
4
0.03%
156
1.07%
144550
100%
D091 Capital and Coast
Grand Total
Midland Regional Forensic Psychiatric Service Stakeholders Report
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4.3.
Length of stay
The table below shows the average length of bed occupancy by region including
those service users who have been an inpatient for the full 2008 calendar year
DomDHB
Average Occupied bed days
D011 Northland
21.00
D022 Auckland
105.00
D023 Counties Manukau
106.50
D031 Waikato
130.00
D042 Lakes
91.00
D047 Bay of Plenty
197.08
D071 Taranaki
352.40
D081 MidCentral
250.00
D082 Whanganui
4.00
D091 Capital and Coast
4.4.
78.00
Re-admission
During the 08 calendar year there was only one readmission which occurred within
28 days of the previous discharge from inpatient services.
Midland Regional Forensic Psychiatric Service Stakeholders Report
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4.5.
Referral data
The tables below show the number of referrals per team, from the Health Waikato
forensic mental health service during the 2008 calendar year. In addition this is
displayed as the number by referral source and a breakdown of referrals by ethnicity.
Team
Total
Team:- Forensic Prison Team
117
Team:- Forensic Court Liaison Team
230
Team:- Forensic General Community Team
21
Grand Total
368
Count of Referral Source
Team
Referral Source
Prison
Team
Community Health Services
1
Court Liaison
Team
1
Community Mental Health
Courts And Criminal Justice System
3
1
Internal
1
107
3
Police
Psychiatric Inpatient
188
2
Count of Ethnicity
1
41
3
10
305
2
2
3
8
1
1
117
1
2
1
1
Psychiatric Outpatients
Grand Total
1
1
Other DHB
Other Referral Source
3
1
Family
Grand Total
1
38
Emergency Department
Justice Department
Community
Team
230
1
1
21
368
Team
Midland Regional Forensic Psychiatric Service Stakeholders Report
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Prison
Team
Ethnicity
Court Liaison
Team
African (or cultural group of African origin)
Cook Island Maori
3
European No Further Definition
2
Fijian
2
1
4
2
3
3
2
1
1
Maori
59
105
Not Stated
NZ European / Pakeha
Other
Grand Total
2
Indian
Middle Eastern
Community
Team
10
174
1
1
6
10
16
42
86
9
137
3
5
1
9
10
1
11
Other European
Pac People No Further Definition
1
1
Samoan
1
1
1
4
5
117
230
Tongan
Grand Total
4.6.
368
21
Admissions
During the 2008 calendar year there were 45 admissions to the acute admission ward
of the Health Waikato forensic mental health service.
Midland Regional Forensic Psychiatric Service Stakeholders Report
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Forensic Futures Implementation
4.7.
Forensic Futures-Strategic Direction
We still await the final Forensic Futures plan from the Ministry of Health (MoH),
following significant feedback on the first draft of this report by the New Zealand
Forensic Advisory Group (NZFAG-the national group of forensic service providers),
The document has been agreed, in principle but has been held up by the political
processes surrounding the recent change in government.
The MoH identified six new FTEs for the Midland region, the 2008/09 year.
A
prioritisation process was undertaken and these FTEs were allocated according to
priorities outlined in our original forensic futures plan and the expectations of the
MoH.
Four FTEs have been allocated to the prison liaison team of the Health
Waikato forensic mental health service and two will go to the youth court liaison team
at Hauora Waikato to provide services to courts across the Midland region.
Any and all new funding for forensic services has been put ‘on hold’, pending a
general review of all health funding by the new government.
4.8.
Department of Corrections Prison Muster Projections
The change of government brought a change to national policies regarding the
imprisonment of offenders.
Consistent with these changes, the Department of
Corrections reviewed its prison muster projections. There are currently (March 2009)
9000 prison beds in use. It is estimated that by 2018 we will require 12,500 beds
nationally and 3500 extra beds for Midland. Immediately, it is estimated that there is
a need for 900 more beds by 2011, 500 by 2010 and the rest by March 2011.
It is
further estimated that most of these beds will be required in the northern region
(involving the Auckland and Midland forensic service areas). As there is no ability to
rebuild in this time, immediate needs will be addressed by ‘double bunking’ prisoners
with Springhill Correctional Facility (SCF) increasing by another 377 prisoners to a
total muster of 1027 by February.
This increase in actual muster growth in the Midland region is further compounded by
a number of planned refurbishments within the northern prisons with a number of
inmates likely to be transferred from prisons in that area to Springhill. Accordingly the
acuity and complexity (as well as the actual number) of prisoner held in Springhill will
increase.
4.8.1. Model of care in the Correctional Setting
Nationally, there is agreement that prisoners within correctional settings
should have access to the same standards of mental health care as provided
Midland Regional Forensic Psychiatric Service Stakeholders Report
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within community settings. This is the argument of ‘equivalency’. The FF7
plan commits to a mixed model estimating that 50% of the 12% of prisoners
under the care of forensic mental health services will require an intensive
case management approach and 50% will require standard outpatient care
and treatment.
Delivering such a model of care in an environment of growing demand has
required a review of the model of care provided by the prison team and a
focus on: what sorts of care and treatment the team is providing, to whom,
and with what resources.
4.9.
Springhill Correctional Facility
We have agreed a Service Level Agreement and operational protocols for the
provision of services into Springhill. A full range of services are now being provided
to Springhill and the case load is steadily increasing.
Our relationships with Springhill staff, Auckland Regional Forensic Psychiatry
Services (Mason Clinic) and the intensive community team in Counties Manakau
District Health Board are very good and we are working with them to address issues
such as training and operational protocols necessary for increasing the quality of
prison based services and the strength of our liaison with community based mental
health services (particularly within the Auckland and Waikato regions) following the
release of prisoners into the community.
We are in the process of recruiting new staff to the Springhill Prison liaison team.
Following discussions between funding and planning managers from across the
region a letter was sent to the Ministry of Health seeking clarification of how the
additional six medium secure inpatient forensic beds ( identified as necessary by the
regions DHBs in the FF plan) might be funded.
7
Forensic Futures Document-Final Forensic Futures Response (Midland Region) April 2008
Midland Regional Forensic Psychiatric Service Stakeholders Report
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4.10.
Auckland Liaison/Protocols
There has been some discussion with both the Auckland Regional Forensic
Psychiatry service and the Intensive Community Team (Counties Manukau District
Health Board) (ICT) around protocols for interaction around prisoners within
Springhill.
A representative of the ICT regularly attends the liaison meetings at Springhill and is
the conduit to services in South Auckland.
Liaison with other Auckland based services is through the appropriate community
mental health teams and contacts have been made and protocols established (based
on the Mason clinic protocols) for communication and planning for the transfer of care
for prisoners returning to the greater Auckland area.
The Needs assessment and service Co-ordination screening panel have discussed
and agreed protocols for the assessment and eventual repatriation of patients
currently occupying the ‘Mason beds’ and plans for their repatriation will be discussed
with the Auckland services towards the time of completion of the facilities redesign.
We also have good protocols for the repatriation of other patients from out of our area
and this has gone well.
4.11.
Youth Forensic Service Development
Te Ara Kaupare Youth Forensic Mental Health Service continues to develop with the
most significant recent news being the addition of 2.0 FTE regional Youth Court
Liaison positions. This funding has come from the Forensic Futures new FTE’s
process, via the Regional Forensic Psychiatric Service and Planning and Funding,
Waikato DHB. It will allow Youth Court Liaison Services to be developed into the
Tauranga Youth Court and satellites (Waihi and Whakatane), as well as consolidating
services in the Rotorua Youth Court and providing service to Rotorua satellites
Tokoroa and Taupo. Consultation and Liaison services, as well as report writing
services will be provided to the Taranaki region Youth Courts. This will effectively
establish a regional youth forensic service provided by Hauora Waikato/Ngaa Ringa
Awhina. The new positions will be implemented in January 2009.
The current Youth Court Liaison Service remains very busy and has been well
supported by the Judiciary, Child, Youth & Family Service Youth Justice, Hamilton
Youth Offending Team and Police Youth Aid. Reporting for the last quarter included
120 completed screenings with assessment, and 32 section 333 reports.
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A new database is being developed, along with a teaching program (to NZQA level 4
certificate standard) in Kaupapa Maori Youth Forensic Mental Health. This course will
begin in March 2009. Development of the screening tool is ongoing.
Te Ara Kaupare Pou (staff) have also been involved with national developments
including the editorial team of the Werry Centre literature review on YFMH, and on
the expert advisory group for the development of the National Strategic Framework
for YFMH at the Ministry of Health.
Development of the national youth forensic
service framework by the MoH progresses slowly.
We await release of this
framework.
It has been agreed that Youth Court Liaison Services will operate under their own
governance structure and will not be reported within the MRFPS report in future.
4.12.
Regional Consultation/Liaison
Ms Rachael Aitchison and Dr Rees Tapsell (as representatives of the Midland
Regional Forensic Psychiatric Service) have now completed consultation meetings
with the Lakes and Bay of Plenty DHBs.
An attempt to meet with the Taranaki
services was thwarted by the weather. This meeting will be rescheduled. In general,
these meetings have gone well and have centred on the Forensic Futures document
and ways in which the MRFPS can better support district GMHS to manage difficult
and risky individuals.
We continue to have discussions with the region’s GMHSs about a range of issues.
These include:

ways in which we can best support GMHS with difficult and risky individuals;

protocols for admission and discharge of patients to/from the MRFPS;

the interface between the MRFPS and district GMHS and the protocols for
referring patients between services;

the interface between services for those with ‘high and complex needs’ and those
requiring forensic mental health care.
We have a number of meetings planned with key stakeholders from around the
region to try and clarify some of these issues.
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5. Facilities Redesign
5.1.
Waikato DHB Provider
In general the facilities re-design is progressing to plan. The Transition house has
been opened and work is well under way on Wards 30 and 31. Ultimately these units
will house 20 patients (10 in each) with needs for minimum secure rehabilitation.
Following this, work will begin to renovate wards 33 and 32. These units will reduce
the number of patients housed within them (12 each) providing extra space for
therapeutic activity and to cater for those patients requiring longer term secure care.
Ward 32 will also change its configuration to a modular design allowing the ability to
cater for sub-populations with particular and specific needs (e.g. women, those with
intellectual disability etc).
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The secure entrance to the service will be re-sited consolidating the feeling of an
independent and truly regional identity for the service and forming a formal entrance
and exit to and from the services and a natural flow through the service, starting at
the whare. The final stage of the redesign will see the building of the ‘whare’ (a Maori
cultural centre with multi-purpose therapeutic opportunities) and a ‘kokiri centre’
(occupational therapeutic and activities space).
Although we have realized slight
slippage in time, the project is going well and to budget.
5.2.
Tamahere Hospital and Healing Centre
Work on the new build at the Tamahere Hospital and Healing centre is all but
complete. The nine bed women’s wing is now complete, occupied and is working very
well. The hospital has a new roof, all rooms at the hospital now have en suite
bathrooms and there is air conditioning and central heating throughout. The ‘manuhiri
room’ offers family the opportunity of staying overnight and the chance to spend time
together with loved ones, often for the first time in a long while. The self contained
units, Ranea and Karapotea, have been extensively renovated and offer whanau the
opportunity to have a little more freedom and independence as they transition back to
the community. Work has begun on the wharenui, the landscaping and the whanau
swimming pool.
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6. One Service Two Providers
6.1.
Needs Assessment Service Co-ordination (NASC) Panel
We have established a single point of entry to the service (both providers) called the
NASC Panel. This panel is made up of staff from each service and meets regularly to
consider referrals made from GMHS or forensic services outside of the Midland
region. The panel also serves as a mechanism for bringing a degree of external
scrutiny to the care and clinical pathways of patients within the Health Waikato
forensic mental health service units identifying patients for referral to Tamahere
Hospital and Healing Centre.
The focus of discussions is always the assessment of patient needs, the identification
of a clear clinical pathway and the identification of services required to meet that
need and facilitate progress along that pathway. This Panel is a collaborative forum
and an opportunity to bring a number of different perspectives to discussions about
the care and treatment of patients.
6.2.
Clinical Governance Structure
Significant discussion and planning has gone into the establishment of a clinical
governance framework for the MRFPS (across both providers). There is general buy
in to this concept and it is seen as a pilot project for the wider Waikato DHB mental
health services. We, in the process of implementing this process, have had three
meetings. Meetings occur monthly and are attended by key clinical and management
staff from both services.
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7. Workforce Development and Training
The Health Waikato forensic mental health service has recently completed a workforce
development plan.8
An exercise was completed of SMO job sizing within the Health Waikato forensic mental health
service and identified areas of additional need both in the short and intermediate (two years) term.
We have agreed a process of SMO performance review and the first of these meetings are due to
be held in mid February.
We have commenced a series of ‘SMO Core Forensic Skills Seminars’, open to SMOs across
both providers. We have had three such seminars and attendance, participation and feedback is
very good.
The Health Waikato forensic mental health service is currently undertaking a review of the
utilisation of psychological resources within forensic services, building on work done within
Hauora Waikato. The Waikato DHB is also planning similar exercises with each of the other
‘paramedical’ disciplines (e.g. OTs, social workers, etc) across the service.
The recruitment of well trained, qualified nurses with appropriate skills continues to be a challenge
for the DHB in the current environment.
With her team, Rachael Aitchison is looking at all
possible options for recruitment and retention of staff.
Across both services, we have discussed options for ongoing skills development for staff, as
deemed necessary. This involves programmes such as the Wanaanga (provided by Rapu ki Rua)
the Diploma in Forensic Psychiatry (offered by the Auckland Medical school).
The Health Waikato forensic mental health service has identified two main foci for training for the
2009 year. These are:
 risk assessment and management and;
 cultural competence.
Whilst not exclusive of other training opportunities, a particular focus will be put on these areas
over the next year.
8
Forensic and Rehabilitation Workforce Development Plan- Health Waikato Forensic and Rehabilitation Services.
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8. Forensic Futures - The Next Steps
The main priorities for 2009 remain:
1. the facilities re-design process (both Hauora Waikato and the Health Waikato) and
implementation of the new model of care
2. the re-branding of the MRFPS
3. developing capacity to manage the increasing demands of a growing prison muster
4. attempting to get more regional transparency around the boundary between the MRFPS and
local GMHS and how it should be negotiated
Finally, again, I would remind readers that this is the first MRFPS regional report and that we
have tried to give you a summary of the service and its activities over the past year. I reiterate
our invitation for you to advise us of any other information you might like to be included in our next
report, which we will publish in December 2009.
If you have feedback or would like to discuss other information/data. please email Colleen
McKenzie on: mckenzic@waikatodhb.govt.nz
Naku iti Noa
Na
Dr Rees Tapsell
Executive Clinical Director
Midland Regional Forensic Psychiatric Service
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