Lack of data about
people who have
co-existing problems
Let’s discuss
problems, consequences and
solutions
Ashley Koning- Project Lead- Matua Raki
Suzette 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
Finances
Employment
Physical
health
Relapse
/admissions
Quality of life
Recovery
Risk to self
and others
Housing
offending
Relationships
Mental health and addiction
• 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
Substance use and mental health
• 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
PRIMHD Diagnostic Data 2012-14
18,000
16,000
14,000
12,000
42-44% of people
accessing a service have
any diagnosis
10,000
8,000
$$
6,000
4,000
2,000
3-4% have both
MH and A diagnoses
0
Drug and Alcohol
Drug and Alcohol and
Mental Health
2012
Mental Health
2013
Other
2014
No Diagnosis
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
Primary, secondary and provisional
(5) diagnoses recorded in all clinical files and
PRIMHD
(4)
Primary diagnoses entered on all clinical
files and also recorded in PRIMHD
Primary, secondary and provisional
(3) diagnoses recorded in the majority of
clinical files
DHB
NGO
Total
3
2
5
2
3
5
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
More Than Numbers
DHB
NGO
Service design
Effective workforce planning has the
population and the service user group
at the heart of the process
(Golden, Hillier & Bosma, 2004).
Population
needs ?
Improved
health and
wellbeing
outcomes
Model
of care
Workforce
planning
Workforce
capability
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 Poole
suzette.poole@tepou.co.nz