NZ’s mental health care in crisis, research reveals ways to reduce waiting times and retain staff

Mental health care for young people in New Zealand continues to be in crisis, with long waiting times for services. There is a need to expand the mental health workforce and diversify the range of services available.

But improving the quality of mental health care is also a key priority. As our research shows, it helps shorten bloated waiting lists and retain employees.

Better implementation of proven treatments is a key element in delivering quality care that is effective, safe, human-centered, culturally responsive, and promotes equity. , leading to improved patient outcomes.

This has obvious direct benefits, but it also has indirect benefits. Quality care reduces the time people spend in treatment and services, increases capacity and reduces waiting times. It can also increase clinician satisfaction and reduce burnout and employee attrition.

Training is necessary but not sufficient

Most mental health clinicians are trained in evidence-based treatments. These are often talking therapies that have been proven to be effective for most people through research studies such as clinical trials.

However, internationally, there is often a gap between what clinicians are trained to do and what they actually do at the bedside or in the treatment room.

Large-scale studies of treatments in general medicine across multiple conditions and age groups show that only about 60% of treatments currently follow evidence-based guidelines. According to the study, 30% are “waste, duplication, or of low value” and 10% are actually harmful.

There are countless examples of this ‘knowledge’ gap in Aotearoa. Many mental health services offer therapy based on dialectical behavior therapy to help young people and adults improve their emotional regulation. But few can deliver these as designed.

National autism guidelines have been in place for about 20 years, but compliance is patchy as clinicians question their usefulness. Finally, although parent-child interaction therapy is an effective treatment for childhood conduct problems, some areas, particularly the ease and acceptability of the use of “time-outs”, remain difficult for clinicians to use. It can be uncomfortable.

As clinicians working in mental health services, we see good people trying to do good for those in need. Thanks to decades of research, we now know quite a bit about what works to improve mental health.

There will always be a need to develop and adapt treatments, but a central challenge is to better implement existing treatments.

Better implementation of proven treatments

Implementation science is a relatively new field. We research ways to strengthen the adoption, implementation, and sustained delivery of evidence-based practices to improve the quality of everyday care.

Rather than asking tired clinicians to put in more effort, implementation science can identify the impact on clinician behavior and target support accordingly. Implementation science tells us that providing evidence-based treatment guidelines and training is necessary but often not sufficient to achieve quality care.

Complex factors such as clinicians’ own beliefs about their abilities, attitudes, intentions, and emotions can have a significant impact on how well treatment can be implemented. So are factors related to the team or service, such as leadership, broader organizational culture and climate, policies, priorities, and resources.

To improve the implementation of evidence-based treatments, it is important to first understand and prioritize the enablers and barriers that clinicians experience in their daily work. It is then important to carefully select implementation supports and strategies to address these barriers.

Our research shows that clinicians trained in parent-child interaction therapy often lacked the necessary equipment.

An international example of implementation support comes from a large-scale project delivering over 70 strategies to improve care. These include identifying local opinion leaders and quality champions, auditing care delivery, providing oversight and feedback to clinicians, and building professional learning collaborations.

Quality in action

There is an encouraging example of better implementation already underway in Aotearoa New Zealand. Health New Zealand-Te Whatu Ora operates a national clinical network, including a specialist mental health network. Their aim is to work with whānau, consumers and communities to promote national standards for quality of care.

Beyond mental health, seemingly simple solutions such as surgical checklists have been shown to significantly improve quality, even in resource-limited settings.

Inspiring work in the neighborhood health field can also inform mental health practice. The new equity-focused implementation framework, based on Te Tiriti o Waitangi, is designed to support mainstream services and provides guidance for implementation planning, monitoring and evaluation.

People have a right to effective mental health care. Unless we urgently prioritize quality, we risk developing an ill-equipped workforce with rapid turnover or creating a situation where well-staffed teams provide low-value care.

We live in times of limited resources, so we need to ensure that care is the best possible. Service leaders, funders and policy makers urgently need to consider how to best equip existing and new staff to deliver quality care, drawing on insights from implementation science. there is.

Postponements cannot be made until the service is fully staffed and the waiting list is cleared.

This article is republished from The Conversation under a Creative Commons license. Read the original article.