OTAGO DISTRICT HEALTH BOARD

OTAGO DISTRICT HEALTH BOARD BOARD MEETING Thursday, 5 November 2009 10.00 am Board Room, First Floor, Dunedin Hospital TIME INDEX 10.00 am Welcome Apologies 10.05 am Presentation: OPJ2 Year of Care Interests Registers 1 Minutes of Previous Meetings 2 Matters Arising Chairman s Report 3 Regional CEO s Report 4 Financial Report 5 Advisory Committee Minutes & Reports Disability Support Advisory Committees 6 Community & Public Health Advisory Committees Hospital Advisory Committee 8 7 Contracts Register 9 Review of Action Sheet 10 Proposed Meeting Schedule for 2010 11 General Business

Confidential Session: RESOLUTION: That the Board move into committee to consider the agenda items listed below. The general subject of each matter to be considered while the public is excluded, the reason for passing this resolution in relation to each matter, and the specific grounds under section 32, Schedule 3 of the NZ Public Health and Disability Act 2000 for the passing of this resolution are as follows: General subject: 1. Confidential Board Meeting Minutes 01.10.09 2. Confidential CEO Report Sentinel Events Report Joint National Pricing Programme 3. Confidential Audit, Finance & Risk Management Committee Minutes 28.09.09 4. Confidential Community & Public Health Advisory Committees Minutes 20.10.09 5. Confidential Hospital Advisory Committee Minutes 27.10.09 6. Risk Registers 7. Review of Action Sheet Reasons for passing this resolution: To allow negotiations and activities to be carried on without prejudice or disadvantage Commercial Sensitivity Grounds for passing the resolution: S 32(a), Schedule 3, NZ Public Health and Disability Act 2000 that the public conduct of this part of the meeting would be likely to result in the disclosure of information for which good reason for withholding exists under sections 9(2)(i), 9(2)(j) of the Official Information Act 1982, that is withholding the information is necessary to enable a Minister of the Crown or any Department or organisation holding the information to carry on, without prejudice or disadvantage, commercial activities and negotiations.

Our Community, Our Health, Mental Health South Island Regional Mental Health Strategic Plan 2009-2012 March 2009 Prepared by: Faye Logan Mental Health Team Leader South Island Shared Service Agency Limited South Island Shared Service Agency Limited Page 1 of 62

1 Foreword... 6 2 Introduction... 7 2.1 Achievements against the 2005-2008 plan... 7 2.2 Principles...8 2.3 Assumptions... 8 2.4 How this plan was developed... 9 3 Strategic Context... 11 3.1 3.1 Policy Context... 11 3.1.1 3.1.1 Key Mental Health Strategies... 11 3.1.2 3.1.2 South Island Regional Mental Health Documents... 12 3.2 Organisational Context... 13 3.2.1 Ministry of Health... 13 3.2.2 Mental Health Commission... 13 3.2.3 District Health Boards... 14 3.2.4 Specialist Mental Health Services... 14 3.2.5 Primary Mental Health... 14 3.2.6 South Island Regional Mental Health Network... 15 3.2.7 South Island Planning and Funding Network... 15 3.2.8 Mental Health stakeholders... 16 3.2.9 Regional Resources... 17 4 The Environment... 18 4.1 Demographic Profile... 18 4.1.1 Population... 18 4.1.2 Age profile... 18 4.1.3 Ethnic groups (total responses)... 19 4.1.4 Urban verses Rural Residence... 21 4.1.5 Population Projection... 23 4.2 The South Island Population and Te Rau Hinengaro: The New Zealand Mental Health Survey... 24 4.2.1 Limitations... 27 4.3 Access to Secondary and Tertiary Mental Health Services... 29 4.3.1 Domicile... 29 4.3.2 Age, Gender and Ethnicity... 29 5 Strategic Challenges and Goals... 30 5.1 Strategic Challenge One Promotion and Prevention... 30 5.1.1 Current State... 30 5.1.2 Strategic Goal... 31 5.1.3 Strategic Activities... 31 5.2 Strategic Challenge Two Building Mental Health Services... 31 5.2.1 Current State... 31 5.2.2 Strategic Goal... 32 5.2.3 Strategic Activities... 32 5.3 Strategic Challenge Three Responsiveness... 33 5.3.1 Current State... 33 5.3.2 Strategic Goal... 33 South Island Shared Service Agency Limited Page 2 of 62

5.3.3 Strategic Activities... 33 5.4 Strategic Challenge Four Workforce and Culture for Recovery... 34 5.4.1 Current State... 34 5.4.2 Strategic Goal... 35 5.4.3 Strategic Activities... 35 5.5 Strategic Challenge Five Māori Mental Health... 36 5.5.1 Current State... 36 5.5.2 Strategic Goal... 39 5.5.3 Strategic Activities... 39 5.6 Strategic Challenge Six Primary Health Care... 40 5.6.1 Current State... 41 5.6.2 Strategic Goal... 41 5.6.3 Strategic Activities... 41 5.7 Strategic Challenge Seven Addiction... 42 5.7.1 Current State... 42 5.7.2 Strategic Goal... 42 5.7.3 Strategic Activities... 42 5.8 Strategic Challenge Eight Funding Mechanisms for Recovery... 43 5.8.1 Current State... 43 5.8.2 Strategic Goal... 44 5.8.3 Strategic Activities... 44 5.9 Strategic Challenge Nine Transparency and Trust... 44 5.9.1 Current State... 45 5.9.2 Strategic Goal... 45 5.9.3 Strategic Activities... 45 5.10 Strategic Challenge Ten Working Together... 45 5.10.1 Current State... 46 5.10.2 Strategic Goal... 46 5.10.3 Strategic Activities... 46 6 References... 48 Appendix One Strategy Map... 50 Appendix Two - Blueprint Analysis... 55 Appendix Three South Island Regional and Inter-District Mental Health Services... 58 Appendix Four Related legislation, strategies and documents... 60 Legislation Relating to Mental Health Service Provision... 60 Other mental health documents... 60 6.1.1 Key Mental Health Strategies... 61 South Island Shared Service Agency Limited Page 3 of 62

List of Tables Table 1: 2006 Usually Resident Population, by gender...18 Table 2: Urban/Rural distribution by DHB, 2006 usually resident population...22 Table 3: Population Density by DHB, 2006 usually resident population...23 Table 4: 2011 South Island Projected Population by DHB...23 Table 5: 12-month prevalence of any disorder by age, Mental Health Survey and estimated results for the South Island 25 Table 6: 12-month prevalence of any disorder by prioritised ethnicity, Mental Health Survey and estimated results for the South Island...26 Table 7: 12-month prevalence of any disorder by severity, Mental Health Survey and estimated results for the South Island...26 Table 8: 12-month prevalence of any disorder by Disorder Group, Mental Health Survey and estimated results for the South Island...27 Table 9: Number of clients seen by mental health services in 2007 by Domicile...29 Table 10: Percentage of clients seen by mental health services in 2007 Age, Gender, Ethnicity...29 Table 11: Twelve Month Prevalence Rates...38 List of Figures Figure 1: Relationship Diagram...16 Figure 2: Comparison of age between South Island and New Zealand Population, 2006 Census...19 Figure 3: Comparison of Ethnic Group between South Island and New Zealand total ethnicity Population...20 Figure 4 Comparison of Ethnic Groups (Prioritised) between the South Island New Zealand...21 Figure 5: Comparison of Urban/Rural between South Island and New Zealand usually resident population, 2006...22 This report should be referenced as follows: Logan, F (2009) South Island Regional Mental Health Strategic Plan 2008 2011. South Island Shared Service Agency Ltd, Christchurch, NZ, January 2009. South Island Shared Service Agency Limited Page 4 of 62

Acknowledgements Thank you to the South Island Regional Mental Health Network members who gave their knowledge, expertise and skills to the development of this document. Chris Nolan (Southland DHB) Dan Mustapic (Otago DHB) Hecta Williams (West Coast DHB) Lorraine Eade (Nelson Marlborough DHB) Margaret Hill (South Canterbury DHB) Toni Gutschlag (Canterbury DHB) Thank you to Tony MacDonald and Claire Worsfold from the South Island Shared Service Agency Limited, Information and Analysis team for writing Section 4: The Environment. Thank you to Lorraine Eade, Mental Health Portfolio Manager at Nelson Marlborough District Health Board for writing Section 5.5: Strategic Challenge Five Maori Mental Health. Thanks also to Dr Rob Weir (South Island Shared Service Agency Limited General Manager) for advice, and the valuable feedback and input from Alan Lloyd, Catherine Ledingham and Leanne McTear the South Island Shared Service Agency Limited (SISSAL) mental health team members. Abbreviations 95% CI 95% Confidence Interval ADANZ Alcohol and Drug Association New Zealand AOD Alcohol and Other Drug CEO Chief Executive Officer DHB District Health Board DSM Diagnostic and Statistical Manual of Mental Disorders HBSS Home Based Support Service IDF Inter District Flow MHINC Mental Health Information National Collection MOH Ministry of Health NGO Non-Government Organisation NZ New Zealand PHO Primary Health Organisation SCNT Southern Consumer Network Trust SISSAL South Island Shared Service Agency Limited StatsNZ Statistics New Zealand South Island Shared Service Agency Limited Page 5 of 62

1 Foreword This is the second Regional Mental Health Plan developed by the South Island District Health Boards (DHBs) and the South Island Regional Mental Health Network. The first plan reflected the strategic direction and outlined key national policy including national policy developments in mental health, documented in Looking Forward (1994), Moving Forward: The National Mental Health Plan for More and Better Service (1997) and the 1998 Mental Health Commission Blueprint for Mental Health Services. This second plan builds on those key national policies and emulates Te Tahuhu: Improving Mental Health 2005 2015 and Te Kokiri: The Mental Health and Addiction Action Plan 2006 2015. Together these documents draw together the Government s priorities for the mental health and addiction sector, and builds on previous successes. They set out clear outcomes that the Government expects agencies to pursue. It also defines the priorities or challenges that must be tackled collaboratively and implemented collectively if they are to be achieved. It is these collaborative priorities that this plan addresses. The South Island Regional Mental Health Network provides a mechanism for progressing regional collaboration and for achieving the overall purpose identified in the terms of reference: To provide effective regional mental health planning and funding advice and recommendations to the South Island Regional General Managers Network. To develop, prioritise, monitor and implement the regional mental health planning and funding work programme. To promote effective and appropriate sharing of information that supports a regional perspective on Mental Health Planning and Funding, influences changes, and progresses the implementation of National Mental Health Strategy. This plan has also taken into account the district annual planning process and the directions and activities at a district level, and their alignment to the regional plan. The South Island Shared Service Agency Limited Page 6 of 62

2 Introduction Since the launch of the South Island Regional Mental Health Network in 2001 and the development of the South Island Regional Mental Health Plan 2005-2008, the South Island has achieved significant progress in the majority of areas identified in the plan as regional priorities. The plan had specific objectives to achieve in each of the three years. Within the context of a dynamic and evolving health environment, wider societal changes and expectations of Government, the plan was reviewed annually and the work plan adjusted to meet these changing demands. 2.1 Achievements against the 2005-2008 plan Achievements made by the South Island Regional Mental Health Network against the South Island Regional Strategic Mental Health Plan 2005 2008 include: Agreed entry and exit criteria for regional inpatient and consult liaison services. Agreed service provision and interface relationships for regional inpatient and consult liaison services. Established an audit programme to measure achievement against the standards set for these regional inpatient services in relation to entry, exit, service provision and interface relationships. Upgraded and extended the videoconference facilities and network. Usage of videoconferencing for clinical, administrative, management and educational purposes has continued to increase. Promoted greater consistency in clinical practice through the ongoing development of common service provision frameworks for mental health services across all South Island DHBs. A common South Island Opioid Substitution Treatment Programme service provision framework was developed. Supported South Island mental health and addiction staff to develop a leadership role in the sector, by providing scholarships for recognised leadership and management programmes. Supported the national initiative on risk assessment and management strategy by conducting a series of Train the Trainer workshops in December 2006 to roll out the strategy and tools. Established a Regional Kaupapa Māori residential Alcohol and Other Drug (AOD) day programme. Evaluated the implementation of the 2004 South Island AOD review, celebrated the successes and continue to work towards key outstanding actions. Evaluated the implementation of the Te Waipounamu Māori Mental Health Strategy. Reviewed models of care and service user pathways across districts for recidivist substance dependents under the Alcoholism and Drug Addiction Act 1966. Reviewed and provided clarity around funding boundaries for Corrections clients requiring AOD treatment services. Participated in both the first and second round initiatives for Primary Mental Health. Drafted the South Island Regional Forensic Strategic Plan. Achievements from the Te Waipounamu Māori Mental Health Strategy include: o Increase Kaupapa Māori health spend of 61% between the financial years 2003/04 and 2006/07- exceeding the expected 50 percent increase. South Island Shared Service Agency Limited Page 7 of 62

o Access levels improved from 2002 levels of 2.26 percent to 3.40 percent in 2006, but did not achieve the projected access rate of 3.96 percent. It is noted, however, that the projected rate was based on a 6 percent access rate rather than a 3 percent access rate. o The development of new services (i.e. a new Kaupapa Māori Day Activity Programme based in Nelson and a regional AOD Kaupapa Māori Day Programme based in Christchurch). Achievements identified from the Review of AOD Services include: o increased screening and brief intervention in primary settings o improved access to assessment, referral and counselling services o reduced or have no waiting times for methadone treatment post-assessment o established AOD sector planning groups in each district 2.2 Principles Seven overarching principles guide the plan: Strive to provide services that are trusted and high performing, so that people will have confidence that if they need them, they can access high-quality mental health and addiction services. Recovery-focused mental health services provide choice, promote independence, and are effective, efficient, responsive and timely. Work across boundaries and enable service users to lead their own recovery. Strive to continuously improve the quality of our services, which are outcome focussed and based on best practice. Collaborative planning and teamwork will enable the implementation of regional sustainable strategies to improve health outcomes. Promote innovation in the mental health and addiction sector and the sharing of good ideas. Value diversity and support and enable all people with experience of mental illness and addiction to fully participate in society and in the everyday life of their communities and whānau. 2.3 Assumptions Mental health services are funded from government revenue and allocated to DHBs on a Population Based Funding Formula model designed to distribute available funding fairly between DHBs, according to the relative needs of their populations and the cost of providing health services to meet those needs. South Island Shared Service Agency Limited Page 8 of 62

The Mental Health Commission s Blueprint document was developed in 1998 and is outdated in the current environment. DHBs can no longer expect that mental health services will be fully funded to the Mental Health Commission blueprint level. There is no specific funding for implementing the Regional Mental Health work plan. The six South Island DHBs contribute to SISSAL, and the SISSAL Mental Health Team is charged with the responsibility of implementing the plan within available resources. Funding for specific projects may be sought on a case by case basis. The South Island Regional Mental Health Network will endeavour to be responsive to changing needs within the context of a dynamic and evolving health environment, wider societal changes and expectations of Government. This plan supports Te Tahuhu in broadening the interest in mental health from people who are severely affected by mental illness and addiction to all New Zealanders while continuing to place an emphasis on ensuring that people with the highest needs can access specialist services. 2.4 How this plan was developed The South Island Mental Health Regional Strategic Plan 2008-2011 was developed by the South Island Regional Mental Health Network, with input from the South Island Shared Services Agencies Information and Analysis team for The Environment section. It provides strategic, high level goals for the region that support the implementation of Te Tahuhu and Te Kokiri. South Island Regional Mental Health Network identified all actions within Te Kokiri with a DHB or regional lead responsibility. The DHBs Strategic Plans and District Annual Plans were also considered and District priorities taken into account, resulting in identified strategic goals for which a regional approach is most appropriate. The plan provides a regionally agreed framework which will inform district annual plans. DHBs in the Southern region can choose to use the plan either as a template for developing their own local mental health plans or as a strategic framework during their local prioritisation of funding for mental health services. Either way, DHBs District Annual Plans will reflect the goals and objectives of the regional strategic plan. Consultation As is standard practice for South Island DHB regional processes, each DHB was responsible for engaging with key stakeholders at a District level within the given timeframe. Sign Off Process Within the region, sign off is gained through the South Island Regional Mental Health Network, South Island Planning and Funding Network, the South Island Chief Executive Officers (CEOs), and then submitted to the Ministry of Health (MOH). South Island Shared Service Agency Limited Page 9 of 62

Implementation Implementation of the regional strategic plan will occur in the form of an annually agreed work plan which will outline the deliverables against the strategic goals. Initiatives within the work plan will be resourced on a task by task basis by a combination of South Island Shared Service Agency staff and nominated DHB staff. To support carrying out major tasks, time limited regional project teams and reference groups will be established as required. South Island Shared Service Agency Limited Page 10 of 62

3 Strategic Context The South Island Regional Mental Health Network, alongside three further Regional Mental Health Networks (RMHNs) that support the North Island DHBs, were initially mandated by the Minister of Health in 2001, to undertake regional planning, and to ensure further development of the mental health sector. This structure was developed to support regions to share expertise and knowledge and collaborate on sector wide issues. These RHMNs are cognisant of the New Zealand policy context, and operate within the frameworks and guidelines provided by national strategies. 3.1 3.1 Policy Context 3.1.1 3.1.1 Key Mental Health Strategies In 1994 the New Zealand government set the direction of the national mental health strategy with Looking Forward, Strategic Directions for the Mental Health Services (Ministry of Health 1994), outlining the principles and objectives developed to reshape mental health services in New Zealand. This document identified two major goals: Decrease the prevalence of mental illness and mental health issues in the community. Increase the health status and reduce the impact of mental disorders on service users, families/whanau and communities. The second element of the mental health strategy published in 1997, Moving Forward: the National Mental Health Plan - for More and Better Services (Ministry of Health 1997b), linked the goals and strategic direction of the Looking Forward document to measurable objectives and targets. As global recognition highlighted a need, with the World Health Organisation estimating that up to 20 per cent of adult populations were likely to experience some form of mental illness during their lifetime, New Zealand began developing its psychiatric service provision. This resulted in one of the new Mental Health Commissions first actions, the Blueprint for Mental Health Services in New Zealand: How things need to be (Mental Health Commission 1998). The Blueprint document described the services required to meet the needs of people who experience severe mental health issues (approx 3% of the population), and is still valued today, by the mental health sector both nationally and internationally. Improving mental health continues as a priority health area for the New Zealand Government, as reflected in both the New Zealand Health Strategy (2000) and the New Zealand Disability Strategy (2001). He Korowai Oranga (2002), the Maori Health Strategy identifies whanau as the foundation of Maori society, acknowledging the interdependence of people, and the importance of viewing people within their social context. The aim of this document is to achieve whanau ora, with Maori families supported to achieve maximum health and well being. Whanau is viewed as the foundation of Maori society, providing a vital source of strength, support, security and identity, with the whanau recognised as playing a central role in the individual and collective wellbeing of Maori. South Island Shared Service Agency Limited Page 11 of 62

These three leading health documents underpin Te Tahuhu: Improving Mental Health 2005-2015: The Second New Zealand Mental Health and Addiction Plan (Minister of Health 2005). Te Tahuhu sets the strategic direction and government priorities in mental health and addictions and establishes people and service focussed outcomes. This document more importantly highlighted 10 challenges that were identified as necessary to support the development of the sector. Te Tahuhu also broadens the focus of the existing mental health strategies to include prevention, promotion and primary care. The most recent addition to the growing national mental health strategy, Te Kokiri: The Mental Health and Addiction Action Plan 2006-2015 (Minister of Health 2006), describes specific actions required, including: Strengthening linkages between mental health services and primary health care. Developing and contributing to inter-sectoral activities that support recovery. Implementing initiatives that acknowledge and meet the needs of the family/whanau. This document places a strong emphasis on services provided by other government agencies and their role in contributing to mental health and wellbeing. To support a sector that is coordinated, that utilises common approaches and consistent practice, Te Hononga (Mental Health Commission 2007), complements and supports both Te Tahuhu and Te Kokiri in guiding service providers to develop the tools and practice necessary for service users, family/whanau, service providers and the community. The goal being to support a sector that is coordinated, that utilises common approaches and consistent practice. The document Te Puawaiwhero The Second Maori Mental Health and Addiction National Strategic Framework 2008-2015, provides current focus, updating Te Puawaitanga (2002), which directly implements the documents, Te Tahuhu, Te Kokiri and He Korowai Oranga. Te Rau Hinengaro: The New Zealand Mental Health Survey (2006) provides information about the prevalence of mental disorders, patterns of onset and the impact on New Zealanders. This survey provided for the first time a true indication of mental health issues in New Zealand, of particular note were the acceptable estimations of prevalence of mental health issues for Maori and Pacific people. 3.1.2 3.1.2 South Island Regional Mental Health Documents The South Island Regional Mental Health Network used the New Zealand policy context and learning s of the previous SIRMHN documents to shape the development of this strategic plan. The South Island specific documents included the Review of Progress (April 2008), which reviewed the progress made by each South Island DHB s in the implementation of the Strategic Framework for Service Development (May 2004) according to 21 Service Need areas and 106 Service Development Objectives. A Review was conducted in 2007 to identify progress made in implementing each of the Objectives. This Review also provided recommendations to the SIRMHN in regards to objectives not achieved over the 3.5 year implementation period. Progress made included: South Island Shared Service Agency Limited Page 12 of 62

Increased screening and brief intervention in primary settings. Improved access to assessment, referral and counselling services. Improved access to Medical Detoxification through reduction of waiting times. Improved integration and flexibility of service delivery. Also identified were objectives that had not been achieved and gaps, and issues, in AOD service provision within individual DHBs and across the South Island, including: Issues regarding Medical Detoxification services. Issues regarding AOD residential care beds. Lack of mental health planned respite resources for people with co-existing disorders. Lack of aftercare/reintegration services. The Review of Forensic Mental Health Services Future Directions (Ministry of Health, 2007) sets out to challenge the South Island Forensic Psychiatry Services for the 5 year period 2008-2013. Implementation of the recommendations in the South Island Regional Forensic Strategic Plan (2007) will lead to a forensic mental health system that offers services which reflect the values inherent in the policy documents, Te Tahuhu, Te Kokiri, and Te Hononga. The services will be culturally relevant, gender sensitive, and offer flexible opportunities for least restrictive care. Further related legislation, strategies and documents, that influenced the development of this strategic document have been identified in Appendix Four. 3.2 Organisational Context 3.2.1 Ministry of Health The MOH is the Government s principal agent and advisor on health and disability. It develops policy advice for the Government on health and disability issues, administers health regulations and legislation, funds health and disability support services, plans and maintains nationwide frameworks and specifications of services, monitors sector performance, and provides information to the wider health and disability sector and the public. The Mental Health Group as part of the Ministry provides policy advice to the Minister of Health. It is responsible for implementation of government policy through collaborative efforts with DHBs, and for the administration of mental health legislation. The Mental Health Group is part of the Ministry's Population Health Directorate. Its focus is on leading the implementation of Te Tāhuhu Improving Mental Health 2005-2015. 3.2.2 Mental Health Commission The Mental Health Commission was established as a ministerial committee in response to the recommendations of the 1996 Mason Inquiry into mental health services. Following the enactment of the Mental Health Commission Act 1998, the Commission was established as an autonomous crown entity providing independent advice to the Minister of Health on matters relating to mental health. South Island Shared Service Agency Limited Page 13 of 62

The Commission's term has been extended three times, most recently in August 2007 when its term was extended to 2015 and its functions were reframed to align with the future direction of the mental health and addiction sector. The Commission s day-to-day functions include monitoring the implementation of the second mental health strategy and acting as an advocate for the interests of service users and their families. 3.2.3 District Health Boards DHBs were established on 1 January 2001 when the New Zealand Public Health and Disability Act 2000 came into force. They are responsible for providing, or funding the provision of, health and disability services in their district. The statutory objectives of DHBs include improving, promoting and protecting the health of communities, promoting the integration of health services, especially primary and secondary care services, promoting effective care or support of those in need of personal health, mental health or disability support services. 3.2.4 Specialist Mental Health Services Specialist Mental Health Services are provided in the South Island by the six DHBs through the provider arm of the DHB and the Non-Government Organisation (NGO) sector. The provider arm of each DHB provides secondary hospital and community based mental health care services to the people of their District or in some cases the whole of the Southern region. New Zealand has one of the largest NGO mental health sectors in the world, with over 30% of mental health funding directed to purchasing from this source. The NGO sector is considered by many New Zealanders as trustworthy and to have a vital role in the social and civil life of communities (Te Pou 2008). 3.2.5 Primary Mental Health Primary health care covers a broad range of out-of-hospital services, although not all of them are Government funded. It aims to improve the health of the people in communities by working with them through health improvement and preventative services, such as health education and counselling, disease prevention and screening. Primary health care includes first level services such as general practice services, mobile nursing services and community health services targeted especially for certain conditions, for example maternity, family planning and sexual health services, mental health services and dentistry, or those using particular therapies such as physiotherapy, chiropractic and osteopathy services (Ministry of Health 2007a) South Island Shared Service Agency Limited Page 14 of 62

3.2.6 South Island Regional Mental Health Network The South Island Regional Mental Health Network is a South Island DHB Planning and Funding forum. One representative from each of the six South Island DHBs with requisite knowledge and expertise to ensure effective input from both a district and regional perspective is appointed by the respective General Manager Planning and Funding. The South Island Regional Mental Health Network is accountable to the South Island Planning and Funding Network, with each Network member also being accountable through their own organisations accountability framework. It is the responsibility of each DHB to ensure that mechanisms are in place for effective communication and consultation internally within their DHB. This bottom-up model is the usual mechanism for formal consultation and involvement by stakeholders in the Network, and the one by which the regional decision making process is visible to the sector. On this basis it is the responsibility of each Network member to represent the interests of all stakeholders in their respective DHB and to use their district based mechanisms to ascertain the views of specific stakeholder groups and to inform them of regional developments. The network is consultative and its structure provides or should provide linkages for stakeholder groups and, through projects, key services, to be represented. The network also provides an interface on behalf of the districts, for regional issues, with the MOH, and other intersectoral agencies or services. In particular the network assists the districts in meeting the goals in the national strategic plan, by coordinating information flow, and linkages and representation with key national projects. The South Island Shared Services Agency co-ordinates and provide the resources to support the Network in achieving the purpose and objectives of the Network. 3.2.7 South Island Planning and Funding Network The South Island Planning and Funding Network is a South Island DHB Planning and Funding forum accountable to the South Island CEOs Group. Membership consists of General Managers Planning and Funding, from each of the South Island DHBs (or their nominated representatives). Members maintain their individual accountability for the planning and funding of health services in their DHBs. This group provides planning and funding advice on regional issues to the South Island CEOs group. All recommendations or endorsements on regional decisions from other South Island regional networks, e.g., mental health network will be referred to the SIRGMN for approval. Where necessary the South Island Planning and Funding Network will advise the SISSAL Board/CEO group of its decision. Figure 1 shows the relationship between the South Island Regional Mental Health Network and the South Island Planning and Funding Network. South Island Shared Service Agency Limited Page 15 of 62

Figure 1: Relationship Diagram 3.2.8 Mental Health stakeholders Family/Whanau Funding that had been regionally provided for family/whanau support and advisors have been devolved to the Districts. The South Island Regional Mental Health Network endorses an approach which sees the Districts support local family/whanau and advisors working together in a regional forum. Consumers/Tangata Whaiora The South Island DHBs currently hold regional contracts with Southern Consumer Network Trust (SCNT) and Alcohol and Drug Association New Zealand (ADANZ). The SCNT supports existing and emerging DHB, NGO and independent consumer advisory, advocacy and peer support groups and individual consumers in the South Island through: Facilitating safe and effective consumer participation in service planning, funding, monitoring and evaluation. Provision of information, training, supervision, resources and other support to consumers and consumer groups. ADANZ undertake tasks which aim to improve: Co-ordination and integration among and between AOD services in a cost effective way. Continuity of care for consumers of AOD services. Consumer and family input and involvement in the further development of AOD services. Support and advice around funding highlighting the important work of this field. Knowledge in the community regarding the role of AOD services. Quality of care and AOD service delivery. South Island Shared Service Agency Limited Page 16 of 62

A review of regional mental health services is currently underway to determine recommendations regarding these stakeholder groups. Māori Te Roopu Awhiowhio was established as a Māori reference group to support the development of Te Waipounamu Māori Mental Health Strategy 2003 2006 and subsequently the implementation of the strategy. Te Roopu Awhiowhio had strong links with the South Island Regional Mental Health Network, but the term of this group expired at the end of the fixed term contract of the Māori Mental Health Project Manager in October 2006. Te Whare Tukutuku was established in late 2004 as a regional Mental Health and AOD Network. Whilst still in existence Te Whare Tukutuku now has an AOD only focus and does not have a formal linkage with the South Island Regional Mental Health Network. As part of the development of this Regional Strategic Plan the South Island Planning and Funding Network have supported the establishment of regional expert reference groups (e.g. Māori mental health reference group) to provide advice and recommendations to the South Island Regional Mental Health Network in the development and implementation of the South Island Regional Mental Health Strategic Plan. 3.2.9 Regional Resources A range of specialist services are currently provided regionally (see Appendix Three). Provision has been based on historical arrangements with the configuration of these services developed prior to the establishment of the DHBs. With the development of DHBs the funding of these has been through Inter District Flow funding (IDFs) which are calculated on a population based share of costs. During 2002-2005 the South Island Regional Mental Health Network led a project to develop common processes and protocols for access to regional specialist services. The project noted that: There is a range of regional services that are highly specialised and characterised by very low volumes. For these services to be delivered in a manner that optimises skill, best practice and economy of scale a regional approach is the most effective. This project aimed to improve access to these services. A monitoring system was established to report quarterly on access levels, with a review of these services after a minimum of two years. This review of the South Island Regional Mental Health Services has commenced and looks to identify mental health services for which specialist regional service provision would be appropriate. It will also facilitate an agreement between South Island DHBs as to the overall purchase volumes and funding allocations from each district for regional specialist services. South Island Shared Service Agency Limited Page 17 of 62

4 The Environment 4.1 Demographic Profile There are key factors that influence demand for mental health services including population size, age, ethnicity and gender of a population. Section 4.1 provides an overview of the population structure of the South Island. The information in this profile is based on the 2006 Census of Population and Dwellings. All population statistics are for the usually resident population count and have been randomly rounded to base three to preserve confidentiality. Percentages have been calculated against complete responses; that is, they exclude cases where no answers were provided and have been calculated on the rounded data so do not always total 100% (Public Health Intelligence 2007). 4.1.1 Population The census usually resident population count for the South Island was 967,293 in 2006, representing an increase of 6.7 percent since 2001, being 60,559 residents. In comparison, the population for New Zealand as a whole has increased by 7.7 percent since 2001. Table 1: 2006 Usually Resident Population, by gender Numbers of people counted South Island New Zealand Males 473,991 1,964,253 Females 493,302 2,061,606 Total 967,293 4,025,859 Increase since 2001 Census 60,559 288,582 Data analysis shows no significant differences for males and females compared to national figures. The South Island usually resident population in the 2006 Census included 49.0% males compared with 48.8% in New Zealand as a whole. Within the South Island, the West Coast DHB is different, showing a slightly greater number of males than females. 4.1.2 Age profile In comparison to the New Zealand population, the South Island has a higher proportion of people over 44 years, while New Zealand as a whole has a higher proportion aged less than 16 years. Figure 2 South Island Shared Service Agency Limited Page 18 of 62

illustrates the age distribution for the South Island compared to the age distribution for New Zealand as a whole. South Canterbury had a significantly higher proportion of people aged 65 years and over than the South Island as a whole (18.0% in South Canterbury versus 14.0% in the South Island). Figure 2: Comparison of age between South Island and New Zealand Population, 2006 Census 30% 25% Percentage of population 20% 15% 10% 5% 0% 0 to 15 16 to 24 25 to 44 45 to 64 65+ Age South Island New Zealand 4.1.3 Ethnic groups (total responses) Ethnicity is presented by both total and prioritised ethnicity. Total ethnicity counts every ethnic group that a person identified with. Because individuals who indicate more than one ethnic group are counted more than once, the sum of the ethnic group populations will exceed the total population. In prioritised ethnicity each respondent is allocated to a single ethnic group using the priority system. The prioritised order is Māori, Pacific peoples, Asian, other groups except New Zealand (NZ) European and NZ European (Ministry of Health 2004).. Based on total ethnicity from the 2006 Census, there are 73,197 Māori, 17,436 Pacific people, 40,758 Asian and 134,304 people from Other ethnic group in the South Island. The distribution of ethnicity differs somewhat from the national figures: 73.1 percent of people in the South Island self identified as European compared with 61.2 percent for all of New Zealand. 7.3 percent of people in the South Island self identified as Māori compared with 13.3 percent for all of New Zealand. 1.7 percent of people in South Island self identified as Pacific peoples compared with 6.2 percent for all of New Zealand. South Island Shared Service Agency Limited Page 19 of 62

4.0 percent of people in South Island self identified as Asian compared with 9.3 percent for all of New Zealand. Within the South Island, the South Canterbury DHB showed a higher proportion of European people compared to the rest of the South Island. Figure 3 illustrates the ethnicity distribution for the South Island compared to the ethnicity distribution for New Zealand as a whole. Figure 3: Comparison of Ethnic Group between South Island and New Zealand total ethnicity Population Percentage of population 80% 70% 60% 50% 40% 30% 20% 10% 0% European Mäori Pacific Peoples Asian Middle Eastern/Latin American/African Other Ethnicity Not Elsewhere Included Ethnic Group (grouped total responses) - 2006 usually resident population South Island New Zealand Figure 4 illustrates the prioritised ethnicity distribution for the South Island compared to the ethnicity distribution for New Zealand as a whole. Statistics New Zealand (StatsNZ) utilises a confidentiality assurance technique of randomly rounding census statistics to base three. This enables the greatest possible amount of census data to be published, without compromising the privacy of individual responses. The effect of this rounding on the accuracy of census statistics for practically any proposed use is insignificant. This however may result in totals disagreeing slightly with the totals of the individual items shown in tables. South Island Shared Service Agency Limited Page 20 of 62

Figure 4 Comparison of Ethnic Groups (Prioritised) between the South Island New Zealand 100% Percentage of population 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Other Maori Pacific Ethnic Group (prioritised) - 2006 usually resident population South Island New Zealand 4.1.4 Urban verses Rural Residence In comparison to the whole of New Zealand, the South Island has a similar distribution of population living in urban centres. Urban and rural can be described as follows: Categories Definition Main Urban Centres with a population of 30,000+ Secondary Urban Urban area with a population of 10,000-29,999 Minor Urban Rural Centre Urban area with a population of 1,000-9,999 or a notable suburb within a main urban area Settlement or town with a population of 300-999, small settlement, not population specific When calculating the rural adjuster, the Ministry uses a number of definitions for calculating the allocation methods. There is currently no sector accepted rule for the rural adjuster. This plan has used the New Zealand Statistics definition which is consistent with the New Zealand Health Information Service. Figure 5 compares the urban and rural distribution for the South Island compared to the urban and rural distribution for New Zealand as a whole. South Island Shared Service Agency Limited Page 21 of 62

Figure 5: Comparison of Urban/Rural between South Island and New Zealand usually resident population, 2006 80% 70% Percentage of population 60% 50% 40% 30% 20% 10% 0% Main Urban Secondary Urban Minor Urban Rural Centre Categories - 2006 usually resident population South Island New Zealand Within the South Island, DHBs are significantly different in urban and rural population structures. Table 2 shows the urban and rural distribution for each of the South Island DHBs. In this table, urban includes the main urban, secondary urban and minor urban groups. Table 2: Urban/Rural distribution by DHB, 2006 usually resident population DHB Area Urban Rural Nelson Marlborough 77.69% 22.31% West Coast 58.05% 41.95% Canterbury 87.07% 12.93% South Canterbury 70.96% 29.04% Otago 79.80% 20.20% Southland 71.44% 28.56% South Island 80.91% 19.09% New Zealand 86.01% 13.99% Another feature of the South Island is how geographically spread the population is. Table 3 shows the population density for New Zealand as a whole, South Island and South Island DHBs. South Island Shared Service Agency Limited Page 22 of 62

Table 3: Population Density by DHB, 2006 usually resident population 2006 Population Land Area (sq kms) Pop per sq km DHB Area Nelson Marlborough 129,933 20,517 6.33 West Coast 31,149 23,283 1.34 Canterbury 466,404 26,881 17.35 South Canterbury 53,817 13,450 4.00 Otago 179,163 30,909 5.80 Southland 106,827 35,747 2.99 South Island 967,293 150,787 6.41 New Zealand 4,025,700 265,044 15.19 4.1.5 Population Projection The following table shows the 2011 South Island projected population by DHB area. The figures were prepared for the Ministry of Health by StatsNZ. The information is based on the 2006 Census and assumes medium growth rates. The largest percentage increase in population is expected in the Canterbury DHB area, a similar projected increase in population for New Zealand as a whole, 9%. The populations of South Canterbury and the West Coast are projected to increase the least, at 3%. Table 4: 2011 South Island Projected Population by DHB 2006 Population 2011 Projected Population Percent Increase DHB Area Nelson Marlborough 129,933 138,530 6.6% West Coast 31,149 32,145 3.2% Canterbury 466,404 509,440 9.2% South Canterbury 53,817 55,455 3.0% Otago 179,163 187,390 4.5% Southland 106,827 111,170 4.1% South Island 967,293 1,034,130 7.0% New Zealand 4,025,700 4,401,460 9.3% South Island Shared Service Agency Limited Page 23 of 62

4.2 The South Island Population and Te Rau Hinengaro: The New Zealand Mental Health Survey Using the South Island population data above, the 12 month prevalence rates of mental disorders for South Island residents were estimated using prevalence estimates and 95% confidence intervals from Te Rau Hinengaro: The New Zealand Mental Health Survey. The survey s methodology involved trained interviewers administering a structured psychiatric diagnostic interview to a random sample of 13,000 respondents. This door-to-door survey was conducted in 2003/2004 to describe the one-month, 12- month and lifetime prevalence rates of major mental disorders among those aged 16 and over living in private households. The survey estimated 21.5% (95% confidence interval: 19.1-24.1) had a DSM-IV diagnosable disorder. Applying the 95% confidence intervals to the South Island usually resident population at the 2006 Census means we would expect between 185,000 and 233,000 people in the South Island to meet DSM-IV criteria for a mental disorder at the time the survey was undertaken. The results showed females were more likely than males to experience any 12-month disorder (24.0% compared with 17.1%). Applying this result to the South Island means we would expect between 110,500 and 126,285 females and 73,470 and 89,110 males had experienced a DSM-IV disorder over a 12 month period. This was calculated using the 95% confidence intervals for gender of 17.1% (15.5-18.8) for males and 24.0% (22.4-25.6) for females. The study s 95% confidence intervals were also applied to other population groupings, age, ethnicity, severity of disorder and disorder group. Te Rau Hinengaro shows a clear gradient for age from the group aged 16 24, who had the highest prevalence of any disorder, down to the oldest age group (aged 65 years and over), who had the lowest prevalence s (Oakley-Browne et al. 2006b)., Table 5 shows the 16-24 age bracket had the highest prevalence meeting criteria for a DSM-IV mental disorder, but because of the South Island age distribution, the largest number of people identifying with a disorder were aged between 25 and 44 years. South Island Shared Service Agency Limited Page 24 of 62

Table 5: 12-month prevalence of any disorder by age, Mental Health Survey and estimated results for the South Island Age Mental Health Survey results % 95% CI South Island population (2006 Census) South Island population expected to have DSM-IV diagnosable disorder, 12-month period 16-24 28.6 (25.1-32.3) 122,034 30,630 39,420 25-44 25.1 (23.2-27.1) 263,211 61,065 71,330 45-64 17.4 (15.7-19.2) 244,737 38,425 46,990 65+ 7.1 (5.7-8.8) 135,438 7720 11,920 The 12-month prevalence rates from Te Rau Hinengaro show the burden of disorder is generally highest for Māori, intermediate for Pacifica people and lowest for the Other composite ethnic group (Oakley-Browne et al. 2006a) Expected numbers with a DSM-IV diagnosable disorder within the South Island are shown by prioritised ethnicity in Table 6. Applying these prevalence rates to the South Island population means we would expect approximately 20,000 Māori, 4000 Pacifica people and in excess of 160,000. Other people would meet the criteria for a diagnosable mental disorder in the 12 months preceding the research study. South Island Shared Service Agency Limited Page 25 of 62

Table 6: 12-month prevalence of any disorder by prioritised ethnicity, Mental Health Survey and estimated results for the South Island Prioritised Ethnicity Mental Health Survey results % 95% CI South Island population (2006 Census) South Island population expected to have DSM-IV diagnosable disorder, 12-month period Māori 29.5 (26.6-32.4) 73,233 19,480 23,727 Pacific 24.4 (21.2-27.6) 14,685 3113-4053 Other 19.3 (18.0-20.6) 879,984 158,397 181,277 The study classified disorder by severity. Severity was categorised into serious, moderate or mild. Expected numbers with a DSM-IV diagnosable disorder within the South Island are shown by illness severity in Table 7. The prevalence of serious disorder was 4.7%, moderate disorder 9.4% and mild disorder 6.6%, with the remaining 79.3% of the population not diagnosed with a disorder. For South Islanders it would be expected between 40,000 and 50,000 people would be classified as having a severe disorder, between 84,000 and 99,000 with a moderate disorder and between 58,000 and 70,000 with mild symptoms in the 12 months preceding the research study. Table 7: 12-month prevalence of any disorder by severity, Mental Health Survey and estimated results for the South Island Severity Mental Health Survey results % 95% CI South Island population expected to have DSM-IV diagnosable disorder, 12- month period Serious 4.7 (4.2-5.2) 40,626 50,300 Moderate 9.4 (8.7-10.2) 84,155 98,665 Mild 6.6 (6.0-7.2) 58,040 69,645 South Island Shared Service Agency Limited Page 26 of 62

Te Rau Hinengaro studied four groups of mental disorders: anxiety disorders (panic disorder, agoraphobia without panic, specific phobia, social phobia, generalised anxiety disorder, post-traumatic stress disorder and obsessive-compulsive disorder), mood disorders (major depressive disorder, dysthymia and bipolar disorder), substance use disorders (abuse of or dependence on alcohol or other drugs) and eating disorders (anorexia and bulimia) (Oakley-Browne et al. 2006a). Expected numbers with a DSM-IV diagnosable disorder within the South Island are shown by disorder group in Table 8. Estimated total numbers with disorder are higher in this table than other tables as some study participants fulfilled criteria for more than one disorder. For South Islanders it would be expected over 130,000 people met criteria for at least one anxiety disorder symptom in the last 12 months preceding the research study. Likewise, between 70,000 and 84,000 would be expected to meet the diagnostic criteria for a mood disorder, between 29,000 and 39,000 for a substance disorder and eating disorders between 2900 and 6000 in the 12 months preceding the research study. Table 8: 12-month prevalence of any disorder by Disorder Group, Mental Health Survey and estimated results for the South Island Disorder Group Mental Health Survey results % 95% CI South Island population expected to have DSM-IV diagnosable disorder, 12- month period Any Disorder Anxiety 14.8 (13.9-15.7) 134,455 151,865 Any Disorder Mood 7.9 (7.3-8.7) 70,612 84,155 Any Substance Disorder 3.5 (3.0-4.0) 29,020 38,695 Any Disorder Eating 0.5 (0.3-0.6) 2,900 5,805 4.2.1 Limitations The survey s key limitations are as follows: The survey does not provide useful prevalence rate estimates for people with a severe lowprevalence disorder, because the: o Diagnostic interview used does not generate diagnoses for specific psychotic disorders such as schizophrenia or schizoaffective disorder. South Island Shared Service Agency Limited Page 27 of 62

o Sample frame does not include people within institutions, so people with such severe but uncommon disorders are likely to be under-represented. The survey does not provide estimates of rates of dementia and associated cognitive impairment in older people (for similar reasons as above). While an initial attempt was made to translate the survey questionnaire into languages other than New Zealand English, for reasons of cost and logistics this was not possible. People living in institutions (such as rest homes, hospitals, sheltered accommodation, university colleges, prisons and armed forces group accommodation) and homeless people were not included in the sampling frame. The diagnostic instrument used does not incorporate Māori or Pacific peoples beliefs about health, as the systems of disease classification it follows are the American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, reflecting Western or Eurocentric conceptualisations and beliefs about mental disorder. The study is quantitative and aggregates information across individuals to arrive at estimates for the population and subgroups within the population, so it does not capture each person s unique experience (Oakley-Browne et al. 2006a). South Island Shared Service Agency Limited Page 28 of 62

4.3 Access to Secondary and Tertiary Mental Health Services In addition, data from the Mental Health Information National Collection (MHINC) for the 2007 calendar year was extracted to gauge the actual numbers of people seeking help for mental disorders. It showed there were 24,132 clients living in the South Island who sought help from mental health services in 2007. 4.3.1 Domicile Table 9 shows how these 24,132 clients accessed secondary and tertiary mental health services by DHB of domicile. Table 9: Number of clients seen by mental health services in 2007 by Domicile DHB Domicile Number of Clients Nelson/Marlborough 4259 West Coast 1337 Canterbury 9073 South Canterbury 947 Otago 5527 Southland 3260 TOTAL 24403 Note: 250 clients have more than 1 domicile, i.e. lived in more than one South Island DHB region during 2007. 4.3.2 Age, Gender and Ethnicity Table 10 shows how these 24,132 clients are distributed on age, gender and ethnicity. The gender breakdown shows equal number of males and females are receiving help. The ethnicity profile from MHINC shows 11.4% of clients identified as Māori and 1.4% as Pacific. The age profile shows very low impact on services for clients aged 65 and over. Table 10: Percentage of clients seen by mental health services in 2007 Age, Gender, Ethnicity Māori Pacific Other TOTAL Female 0-19 1.4 0.2 10.2 11.8 20-64 3.3 0.5 31.0 34.8 65+ 0.0 0.0 2.0 2.0 Male 0-19 2.2 0.2 12.0 14.4 20-64 4.3 0.6 31.0 35.9 65+ 0.0 0.0 1.5 1.5 TOTAL 11.2 1.5 87.7 100% South Island Shared Service Agency Limited Page 29 of 62

5 Strategic Challenges and Goals This section of the strategic plan outlines the ten strategic challenges identified in Te Kokiri and provides the South Island DHB s strategic activities in order to achieve these challenges. A summary of all strategic activities is illustrated in the strategic map (Appendix one). These high level activities support the implementation of Te Tahuhu and Te Kokiri. The South Island Regional Mental Health Network identified all actions within Te Kokiri with a DHB or regional lead responsibility; they considered DHBs Strategic Plans, District Annual Plans and District priorities. Strategic activities were then identified for which a regional approach is most appropriate. The strategic activities are listed under each strategic challenge and include the expected outcome i.e. what the South Island DHBs hope to achieve by addressing the strategic activities. The strategic activities will inform the development of the annual work plan, identifying projects that will contribute towards achieving the expected outcomes. 5.1 Strategic Challenge One Promotion and Prevention Public health makes a difference when society moves collectively on an issue. The basis of effective public health action is not a single service or intervention, but the organised efforts of society itself (Ministry of Health 2007c). 5.1.1 Current State Responsibility for Mental Health Promotion and Prevention currently sits within the Public Health Directorate of the Ministry of Health. Primary Health Organisations (PHOs) are charged with promoting good community health, and in the South Island mental health sector, several NGOs are focussed on Mental Health Promotion and Prevention at both a district and regional level. Te Rau Hinengaro, the New Zealand Mental Health Survey, shows there is a high prevalence of common mental health problems such as anxiety, depression, drug and alcohol problems. Currently, most mental health services only treat people with the most severe mental health problems (approximately 3% of population). There is a gap in mental health service delivery for people with mild to moderate mental health problems. The development of primary mental health initiatives within Primary Health Organisations is going someway to address this service gap. The Healthy South Strategy 2008-2012 aims to build South Island-wide capability to improve the health of populations. This plan was commissioned by the Ministry of Health and the South Island District Health Boards (DHBs). It sets out actions that will improve the health and wellness of whole populations and sub-groups within populations. South Island Shared Service Agency Limited Page 30 of 62

5.1.2 Strategic Goal Promote mental health and wellbeing, and prevent mental illness and addiction. 5.1.3 Strategic Activities The strategic activities and their outcomes are: Strategic Activity Outcome Measure Encourage PHOs to include health promotion education and prevention components in the mental health and addictions section of their annual plans. PHOs have consistent, clear and transparent goals in their annual plans that meet the mental health needs of their enrolled populations. SIRMHN have promoted the inclusion of health promotion education and prevention components in the mental health and addictions section of the PHOs annual plans. SIRMHN members report progress. Engage with Public Health in their implementation of Public Health strategies that impact on the mental health and addiction sector. Public Health strategies that impact on the mental health and addiction sector are supported by SIRMHN. SIRMHN have engaged with Public Health on strategies that impact on the mental health and addiction sector. 5.2 Strategic Challenge Two Building Mental Health Services Service responses must match need and address the issues relevant for each person and their families/whānau. In 2015 there will be a variety of responses tailored to suit individual and family/whānau needs (Mental Health Commission 2007). 5.2.1 Current State The six South Island DHBs are in different positions in terms of Population Based Funding and their ability to accept blueprint money which in turn affects their ability to build mental health services. Both the ability to accept blueprint funding and the proposed changes in the national pricing framework, which will impact on the way money is allocated, has created an environment and an impetus for innovation in the way services are planned, funded and delivered. There is a commitment by the South Island DHBs to provide treatment and support in the least restrictive environment and investment has gone into building community services, primary mental health services, expanding on existing services and a move away from traditional residential care to caring for people in their own homes. An example of this can be seen in the mobile medication service developed in Canterbury DHB. South Island Shared Service Agency Limited Page 31 of 62

5.2.2 Strategic Goal Build and broaden the range and choice of services and supports, which are funded for people who are severely affected by mental illness. 5.2.3 Strategic Activities The strategic activities and their outcomes are: Strategic Activity Outcome Measure Assist regional mental health services to continue to meet the populations needs. The South Island population has access to quality regional mental health services that meet their needs. The regional mental health services, service provision framework are reviewed annually. Continue to build relationships with other agencies to support recovery and contribute to intersectoral projects which have mental health goals. Work collaboratively with other agencies that have mental health goals. SIRMHN have engaged in work with other agencies that have mental health goals. Actively participate in the Ministry led development and implementation of national service provision frameworks. South Island services reflect national guidelines. South Island has plans in place to implement national service provision frameworks. To be better informed about mental health by sharing information within the South Island and nationally to improve: Range of services for people with high and complex needs. Acute emergency response services. Models of care. Shared information informs and improves service delivery. SIRMHN members are informed of South Island mental health services, and DHB specific information is available to be shared. Support the further development and implementation of specific population regional planning Regional planning frameworks inform local and regional planning. Regional frameworks implemented. planning are South Island Shared Service Agency Limited Page 32 of 62

frameworks. Continue to improve access to regional mental health clinical services. Facilitate the dissemination and discussion of best practice guidelines as they become available. The South Island population has access to quality regional mental health services to meet their needs. Shared information informs and improves service delivery. Utilisation data shows access to regional mental health services. Best practice resource guidelines are disseminated. 5.3 Strategic Challenge Three Responsiveness Te Hononga places service users and a whānau ora/recovery focus at the heart of the delivery of mental health and addiction services, with service users being the drivers of their own recovery (Mental Health Commission, 2007). 5.3.1 Current State The South Island DHBs operate within the context of a dynamic and evolving health environment, where wider societal changes and expectations of Government, demand that services and plans are reviewed regularly to ensure responsiveness to meet changing demands. At a regional level there are processes in place to monitor regional services and receive feedback. At a local level the South Island DHBs demonstrate responsiveness to local demand and local needs and priorities, contracts with providers provide flexibility for providers to be responsive to the needs of individuals, forums have been developed to provide better communication channels and there is more robust data collection and information analysis to support a continuous quality improvement approach. The South Island can demonstrate a match between the mental health and addiction needs of the South Island and the services provided as evidenced in the blueprint analysis in Appendix Two. 5.3.2 Strategic Goal Build responsive services for people who are severely affected by mental illness and/or addiction. 5.3.3 Strategic Activities Many of the goals under this section as described in Te Kokiri will be achieved locally by the six South Island DHBs. The Regional Mental Health Network provides a vital link in terms of sharing information to support local delivery. The strategic activities and their outcomes are: South Island Shared Service Agency Limited Page 33 of 62

Strategic Activity Outcome Measure Support local initiatives to engage with Pacific people to encourage participation in service planning and development by sharing best practice. Pacific people contribute to local service planning and development. Local initiatives are supported. Support initiatives of Le Va, the Pacific mental health workforce development unit within Te Pou, as appropriate to the regional context. The needs of Pacific families are met through leadership in mental health workforce development, information, knowledge and research. SIRMHN have supported initiatives to develop pacific leadership. Establish a regional mechanism for engaging with tangata whaiora and whanau in regional mental health service planning and development. Regional mental health service planning and development meets the needs of tangata whaiora and whanau. SIRMHN has involved tangata whaiora and whanau in regional mental health service planning and development. Facilitate the dissemination and discussion of best practice guidelines as they become available. Shared information informs and improves service delivery. Best practice guidelines are disseminated. 5.4 Strategic Challenge Four Workforce and Culture for Recovery Simply put, the ultimate goal of workforce development in the mental health and addiction sector is to ensure that we have the right mental health and addiction practitioners and staff in the right place, at the right time, to treat, support and care for the users of mental health and addiction services (Ministry of Health 2005). 5.4.1 Current State The South Island DHBs are committed to maximising efficiency by working together on workforce development activity. Workforce development continues to be a key focus for the Southern Region and there remains a strong commitment to the needs of the South Island. The South Island Regional Mental Health Network in consultation with the SISSAL Mental Health Team determines the regional workforce development priorities for the South Island. Some of the success of this commitment has been demonstrated through: South Island Shared Service Agency Limited Page 34 of 62

Strengths model training has been provided to over 400 staff throughout the six SI DHBs, three of which are looking to adopt the Strengths model. Five consumers underwent audit training through SISSAL and three are being utilised to conduct audits. Twenty seven videoconference units were installed throughout the South Island. Department of Psychological Medical Clinical Meeting available to all South Island DHBs via videoconferencing. Thirty two introductory workshops on cognitive behaviour therapy across the six South Island DHBs took place in 2008. The Assessment and Management of Risk to Others Guidelines were rolled out taking a train the trainer approach. The role of regional workforce coordinator was established in May 2004 by the Mental Health Directorate of the Ministry of Health to provide a continuous and systemic response to mental health workforce development. As of 1 July 2007, funding for the regional workforce development coordinators transferred to Te Pou. All the regional coordinators provide the same service throughout the country, although are funded differently. The Southern Regional coordinator is employed by Te Pou to ensure better alignment of regional projects, national policy and broader DHB health workforce networks and initiatives by: Building strong relationships within and across the mental health sector. Facilitating the uptake of national mental health workforce development opportunities. Increasing regional feedback on, and participation in, national, regional and district mental health workforce development planning. Ensuring national centres and programmes are responsive to the needs of the mental health sector. 5.4.2 Strategic Goal Build a mental health and addiction workforce and foster a culture among providers that supports recovery, is person-centred, is culturally capable and delivers an ongoing commitment to assure and improve the quality of services for people. 5.4.3 Strategic Activities The strategic activities and their outcomes are: Strategic Activity Outcome Measure To be familiar with the four Increase awareness and SIRMHN are aware of national mental health knowledge of the national the national workforce workforce development workforce development work development work centres/programmes to plans. plans. South Island Shared Service Agency Limited Page 35 of 62

inform regional planning. National workforce development centres work plans are supported for those activities that meet the needs of the South Island. To encourage skill development of the workforce To continue to utilise videoconference as a key tool for delivering regional specialist services and workforce development throughout the South Island mental health sector. Workforce has opportunities to upskill. Increased opportunities to participate in workforce development. Increased opportunities to actively engage with the regional specialist services. SIRMHN have promoted initiatives that meet the needs of the South Island. Mental health staff are aware of opportunities to upskill. Statistics form Vivid Solutions show an increase in videoconference utilisation. 5.5 Strategic Challenge Five Māori Mental Health Whanau Ora: Māori families are supported to achieve their maximum health and wellbeing, which provides the overarching principle for recovery and maintaining wellness (Ministry of Health 2008b). 5.5.1 Current State Te Waipounamu Māori Mental Health Strategy was first developed for the period 2003-2006. An evaluation of the implementation of the strategy has been completed, and gains for Māori mental health in the South Island have included: Between the financial years 2003/04 and 2006/07 the Kaupapa Māori health spend in Te Waipounamu increased by 61 percent from $5,730,922 to $9,235,327 - exceeding the expected 50 percent increase by $638,943. Access levels improved from 2002 levels of 2.26 percent to 3.40 percent in 2006, but did not achieve the projected access rate of 3.96 percent. It is noted, however, that the projected rate was based on a 6 percent access rate rather than a 3 percent access rate (He Oranga Pounamu 2008). A Māori Mental Health and Addiction network was established and a coordinator was appointed jointly funded by the Alcohol Advisory Council and Nelson Marlborough DHB (through South Island Māori Provider Development Fund underspend one years funding). The rationale being that the majority of Māori mental health providers also held addiction service agreements, therefore a separation of a Māori Mental health network, and Māori addiction network was in essence an ineffective use of resources. The network continues, however it predominantly has an addictions focus. South Island Shared Service Agency Limited Page 36 of 62

Te Herenga Hauora te waka o Aoraki (South Island DHB Māori Health Managers Network) completed Te Waipounamu Māori Health and Disability Workforce Development Plan 2006-2011. A report completed in September 2006 considered the issues involved with the establishment of a regional Kaupapa Māori inpatient unit, and made conclusions on the viability and feasibility of such a service. The South Island Regional Mental Health Network requested that the report be refocused to the regional context. A report was completed, dated October 2006 in relation to the establishment of a more appropriate qualitative NGO reporting framework. Several DHBs have subsequently developed their own NGO reporting framework until the National Mental Health Service Framework review and Whanau Ora project work is completed. Tangata Whaiora me Whanau Regional Training packages are now in the process of being developed and implemented. The development of a cultural training package for mainstream services was replicated in the Te Waipounamu Māori Health and Disability Workforce Development Strategy Plan 2006-2011. In addition, several DHBs have initiated their own cultural training package, suited to local need. A report completed in October 2006 proposes a five-year collaboration plan for the six DHBs, to share information pertaining to the development, implementation and measurement of their ethnicity data collection. DHBs were responsible for implementing recommended guidelines at the local level. However, there have also been some lessons learnt from the strategy. These have assisted in the development of this regional strategic plan. Key lessons learnt have included: Having a dedicated, passionate and committed advisory group through the development and implementation of the strategy is vital. Difficulty in awareness and implementation of the strategy if it is a separate document to the South Island Regional Mental Health Plan. Difficulty in awareness and implementation of the strategy as key personnel within DHBs change. Health resources are limited and prioritized. Any strategy requires confirmation of financial and human resources prior to its implementation. Implementation of this strategy was impeded for some time by the inability to secure funds for a Māori Project Manager. Māori mental health development and celebrations at an individual DHB level need to be shared regionally on a more regular basis with the aim of building on leading edge developments (He Oranga Pounamu 2008). What does the research tell us about Māori Mental Health Aligned to Te Puawaiwhero, there is a need to prioritise Māori in regional planning processes, evidenced by the following research findings: (i) Māori have a higher prevalence of mental disorder, than any other ethnic group. Over a twelve month period, we can expect 29.5% of Māori (over the age of 16 years) to experience a mild to serious mental health disorder. This is in comparison to 24.4% in Pacific people and 19.3% in the Other ethnic group (every ethnic group other than Maori and Pacific),(Oakley-Browne et al. 2006b). South Island Shared Service Agency Limited Page 37 of 62

(ii) Māori and Pacific have higher rates of suicide ideation, planning and attempts in comparison to the other population (Oakley-Browne et al. 2006b). Table 11: Twelve Month Prevalence Rates Twelve Month Prevalence Rates Ethnic group Suicide Suicide Suicide Total ideation Plan attempts Other 2.8% 0.8% 0.3% 3.9% Māori 5.4% 1.8% 1.1% 8.3% Pacific 4.5% 2.6% 1.2% 8.3% (iii) Pacific people, and to a lesser extent, Māori are less likely than Others to make contact for mental health reasons with services. For those with a disorder in the past 12 months, 25.4% of Pacific people, 32.5% of Māori and 41.1% of Others made a mental health visit (Oakley-Browne et al. 2006b). (iv) Of Māori with serious disorder, 52.1% had no contact within the health sector for their mental health needs. Additionally 74.6% of Māori with moderate disorders and 84% of Māori with a mild disorders also had no contact within the health sector for their mental health needs (Oakley- Browne et al. 2006b). Māori have significant health disparities when compared with non-māori (Baxter 2008): Māori life expectancy is 8 years less than non-māori. Māori are 1.6 times more likely to be hospitalized due to avoidable and ambulatory sensitive hospitalizations but were 2.8 times more likely to die due to avoidable or amendable mortality when compared with non-māori. Māori had increased rates of disability (24%) when compared with non-māori (17%). non-māori had higher self-rated health than Māori across all domains except vitality in Māori men. Māori men and women had higher rates of all heart disease and cancer mortality. the prevalence of diabetes is 2½ times higher among Māori than non-māori; however access to the Get-Checked programme was lower in Māori (37%) compared with non-māori (65.5%). mortality rates for suicide among Māori were 1.6 times higher (Oakley-Browne et al. 2006b). One of the limitations of Te Rau Hinengaro is that it did not include people living in institutions. This includes hospitals, rest homes, university colleges, sheltered accommodation, prisons and armed forces groups accommodation). Māori comprise 48% of forensic inpatients (and 47% of this population has a chronic disease (Ministry of Health 2008a)) and 45% of community-based service users, whereas New Zealand Europeans made up 39% of inpatients and 43% of community-based service users, while Pacific peoples made up 8% and 11% of inpatient and community based services respectively. Given the high proportion of Māori in these settings, it is expected that Te Rau Hinengaro will have underestimated the prevalence of mental disorders more than occurred in other ethnic groups, given the sampling approach used. South Island Shared Service Agency Limited Page 38 of 62

Given the research findings, there is a demonstrated need to prioritise Māori in regional mental health service planning. What existing regional services are specifically Kaupapa Māori There is one Kaupapa Māori regional service delivered by He Waka Tapu, which is the AOD Treatment Day Programme with supported accommodation. Māori however, have access to a full complement of regional services including forensics, child youth inpatient, eating disorders unit, AOD residential facilities including detoxification services. 5.5.2 Strategic Goal Continue to broaden the range, quality and choice of mental health and addiction service to Māori. 5.5.3 Strategic Activities At a local level each DHB is responsible for meeting the needs of tangata whaiora, with alignment to He Korowai Oranga Māori health strategy, Te Kokiri Mental Health and Addiction Plan, and Te Puawaiwhero Second Māori mental health strategy. South Island Regional Mental Health Network can play a pivotal role in terms of regional Māori mental health development that can support both local and regional initiatives. The strategic activities and their outcomes are: Strategic Activity Outcome Measure Promote Māori mental health and wellbeing and prevent mental illness and addictions through the development of programmes that are effective for diverse Māori communities. Ensure that primary mental health and addictions service models and funding arrangements reflect Māori mental health need and strategies. Improved access and earlier intervention for Māori in primary care settings. Improved access and earlier intervention for Māori in primary care settings. Improved regional collaboration and support for programmes such as Māori Like Minds Like Mine development. Collate and analyse South Island Maori statistical data for whanau who have accessed services through the Primary Mental Health Initiatives. A regional increase in the number of Māori presenting to Primary Mental Health Initiatives. Tangata whaiora requiring A regional increase in All regional mental health South Island Shared Service Agency Limited Page 39 of 62

regional specialist clinical services, experience services that provide choice, promote independence and are effective, efficient, timely and responsive to their needs. Build a regional mental health workforce across all levels of the continuum that responds to the cultural and clinical needs of Māori whanau. the number of Māori accessing regional specialist mental health services. Workforce is responsive to cultural and clinical needs of Māori. services, can clearly demonstrate that they provide a culturally effective service, meeting the needs of Maori. Increased number of Maori clinical staff within regional specialist mental health services, that are responsive to cultural and clinical needs of Māori. Consolidate our research and development foundation and build and share our knowledge base to achieve better outcomes for tangata whaiora and whanau. Commence the development of a best practice repository. Improved understanding of Māori mental health research, that supports the integration of knowledge into regional mental health and addiction services. Māori mental health data/information is distributed. Support initiatives to engage with Māori at a regional level to grow the participation in regional planning and development. More Māori participate in regional mental health services, planning and decision making processes. Māori have participated in regional mental health service planning and decision making processes. 5.6 Strategic Challenge Six Primary Health Care People will be part of local primary health care services that improve their health, keep them well, are easy to get to and co-ordinate their ongoing care. Primary health care services will focus on better health for a population, and actively work to reduce health inequalities between different groups (Ministry of Health 2007b). South Island Shared Service Agency Limited Page 40 of 62

5.6.1 Current State In 2004, to support the Primary Health Care Strategy, DHBs and PHOs were to establish primary mental health initiatives. These initiatives targeted people with mild to moderate mental health problems. It was of particular interest to identify effective primary mental health service delivery models and components that could potentially be expanded and implemented across New Zealand. Twenty-six Primary Mental Health initiatives, involving 41 PHOs, have been funded of which two are South Island initiatives (West Coast and Otago). A further 16 initiatives, involving 20 PHOs received funding in October 2007 to begin their own primary mental health initiatives this year, of which six are South Island initiatives. These are being conducted in Nelson, Otago and Southland. The outcomes of the first 26 initiatives are being evaluated by the Wellington School of Medicine and Health Sciences, University of Otago. Despite their limitations, the new initiatives are shown to be making a positive impact in the sector. Additionally three South Island DHBs funded their own primary mental health initiatives, taking the total number of South Island primary mental health initiatives to twelve. A Primary Mental Health Team has been established as part of the Mental Health Policy and Service development team, Population Health Directorate, Ministry of Health. The South Island support regional representation to work closely with the Primary Mental Health Team. Regional involvement has assisted to evaluate primary mental health proposals, organise network meetings, and communicate with the sector. 5.6.2 Strategic Goal Build and strengthen the capacity of the primary health care sector to promote mental health and wellbeing and to respond to the needs of people with mental illness and addiction. 5.6.3 Strategic Activities The strategic activities and their outcomes are: Strategic Activity Outcome Measure Continue to support the primary mental health initiatives across the Southern region. Improved access and earlier intervention in primary care settings. Better integration between primary services and secondary services. SIRMHN continue to support primary mental health initiatives across the Southern region. South Island Shared Service Agency Limited Page 41 of 62

5.7 Strategic Challenge Seven Addiction Addiction imposes a high cost on individuals, whänau and the wider community. Substance abuse and problem gambling are increasing problems for many young people, and there are also significant issues for people who have contact with the criminal justice system. It is vital that any door is the right door with close alignment between mental health and addiction services and between problem gambling services and alcohol and other drug services, and that individuals and families have clear recovery pathways (Minister of Health 2005). 5.7.1 Current State The South Island Alcohol and Other Drug (AOD) Services Review, completed in May 2004, was undertaken by the South Island Regional Mental Health Network on behalf of the six South Island DHBs. The review examined the inter-relationship and integration of services within the AOD treatment system, and with other sectors. It sought to identify AOD service needs of specific population groups, including Māori, Pacific, adolescents, women, people with co-existing disorders, older people, opioid users, offenders with AOD problems and family/whanau of AOD dependent people. Twenty one different Service Need areas and 106 Service Development Objectives were developed to address the Service Need areas that were identified. Since the framework was published South Island DHBs and the region as a whole have worked towards implementing the Framework. Implementation of the framework was reviewed in 2008 and identified that the majority of Service Development Objectives had been achieved and continue to be addressed by the DHBs and AOD Service Providers. Also identified were Objectives that had not been achieved and gaps and issues in AOD service provision within individual DHBs and across the South Island. It is these areas that have formed the development of the strategic goals identified below. 5.7.2 Strategic Goal Improve the availability of and access to quality addiction services, and strengthen the alignment between addiction services and service for people with mental illness. 5.7.3 Strategic Activities The strategic activities and their outcomes are: Strategic Activity Outcome Measure Support reviews of service need versus service provision for identified service areas and user groups. Service provision for specific service areas meets the needs of consumers. Service provision is documented. Support regular forums that enable tangata whaiora to participate in the AOD services meet the needs of tangata whaiora. Tangata Whaiora have participated in service development, South Island Shared Service Agency Limited Page 42 of 62

development, implementation and evaluation of AOD services. Support DHBs to align service delivery for people with co-existing mental health and substance use/abuse disorders. Support local DHB initiatives to strengthen linkages between primary health, mental health and AOD services. All South Island patients with co-existing disorders have access to mental health and alcohol and other drug clinicians who have the skills to assess, formulate and implement treatment plans for patients with co-existing disorders. All South Island patients with co-existing disorders have access to mental health and alcohol and other drug clinicians who have the skills to assess, formulate and implement treatment plans for patients with co-existing disorders. implementation and evaluation of regional mental health and addiction AOD services. SIRMHN support DHBs to align service delivery. SIRMHN support local initiatives. 5.8 Strategic Challenge Eight Funding Mechanisms for Recovery Funding mechanisms are instrumental in shaping the services that are purchased and delivered (Minister of Health 2005) 5.8.1 Current State The South Island Regional Mental Health Network is a planning and funding forum that has as one of its key objectives: To promote effective and appropriate sharing of information that supports a regional perspective on Mental Health Planning and Funding, influences changes, and progresses the implementation of National Mental Health Strategy. Network members share information and provide support for each other in regard to planning and funding. Network members also participate in national mental health planning and funding forums and are connected via the Te Pou workforce development initiative for planners and funders. The South Island mental health planners and funders understand the need for funding mechanisms that are flexible, responsive and built on genuine respect. More and more funding mechanisms are being South Island Shared Service Agency Limited Page 43 of 62

linked to outputs and outcomes, and are being informed by increased monitoring of data to provide meaningful analysis and understanding. 5.8.2 Strategic Goal Develop and implement regional funding mechanisms for mental health and addiction that support recovery, advance best practice and enable collaboration. 5.8.3 Strategic Activities The strategic activities and their outcomes are: Strategic Activity Outcome Measure Utilise national forums and the South Island Regional Mental Health Network to increase the capacity and capability of the mental health and addiction funding and planning roles in DHBs. South Island Mental Health planners and funders are upskilled. South Island Mental Health planners and funders have taken opportunities to upskill. Share information around funding models that best encapsulate an outcomes approach. Liaise with other government agencies to share information on funding models. Increase awareness and knowledge of outcomes based funding models. Increase awareness and knowledge of funding models to improve interfaces with other agencies. SIRMHN are aware of outcomes based funding models. Interfaces with other agencies is improved. Support NGOs through sustainability and growth guidelines and striving for consistency. Increase awareness and knowledge about NGO sustainability to support NGOs and the planning and funding interface. Sustainability and growth guidelines are considered. 5.9 Strategic Challenge Nine Transparency and Trust The dictionary defines these terms as: Transparency is being open; frank; candid (transparent 2008). Trust is the reliance on the integrity, strength, ability, surety, etc., of a person or thing; confidence (trust. 2008). South Island Shared Service Agency Limited Page 44 of 62

This challenge recognises the importance of the public seeing a trusted and high-performing mental health and addiction sector (Minister of Health 2005). 5.9.1 Current State In addition to the South Island Regional Mental Health Network sharing information, all South Island DHBs have forums to share information with their local sector in order to improve transparency and trust. A good example of this is the Southland DHBs Future Directions Mental Health Network, a representative group of Mental Health Service Users, Families, Providers and Stakeholders in Southland. The Network was developed to improve how the Mental Health sector in Southland works. It adds value and capacity to the good work already going on by improving the quantity and quality of consultation, communication, coordination and collaboration between the Southland DHB, service providers, stakeholder groups, service users and families. For more information go to www.futuredirections.org.nz 5.9.2 Strategic Goal Strengthen trust. 5.9.3 Strategic Activities The strategic activities and their outcomes are: Strategic Activity Outcome Measure Use available data and information to better inform regional and local planning Support the New Zealand National Mental Health Information Strategy. Data and information informs regional and local planning. Information-gathering is carried out in the most effective way to improve health outcomes for mental health consumers and to increase accountability for expenditure on mental health services. Data and information has been used to inform regional and local planning. National Mental Health Information Strategy guidelines are implemented as required. 5.10 Strategic Challenge Ten Working Together Improving outcomes for service users and tangata whaiora will not be achieved by the mental health sector alone. Strong, proactive, intersectoral partnerships will need to be forged with justice, corrections, education, housing, employment and social service agencies (Minister of Health 2006) South Island Shared Service Agency Limited Page 45 of 62

5.10.1 Current State The South Island Regional Mental Health Network endeavours to improve efficiency and effectiveness by collective problem solving and sharing of information. The SISSAL mental health team is tasked with supporting the Network to achieve these goals. The individual South Island DHBs are responsible for the development of intersectoral partnerships across social agencies, and are at different places in relation to the development of these. Many South Island DHBs have integrated funding agreements across multiple agencies to improve outcomes for service users and tangata whaiora. At times activities to inform and strengthen these relationships have been undertaken on a regional basis, for example the AOD - Funding Interface with the Ministry of Justice and Related Agencies - Stocktake and Analysis report completed in August 2007. 5.10.2 Strategic Goal Strengthen cross-agency groups working together. 5.10.3 Strategic Activities The strategic activities and their outcomes are: Strategic Activity Outcome Measure Participate in the Ministry led project to clarify the role of regional networks. Develop infrastructure which supports South Island Regional Mental Health Network linkage and collaboration with key stakeholder and provider groups. The South Island Regional Mental Health Network meets the requirements of the Ministry of Health and the needs of the southern region. The SIRMHN is cognisant of key stakeholders needs SIRMHN have participated in the Ministry led project. Key stakeholders have input into the SIRMHN. Participate in cross-agency initiatives that promote working together with other government agencies. Mental health outcomes are improved for the population. South Island Mental Health Service have worked with other agencies. Support the engagement with the Disability Support Mental Health outcomes are improved for service users Interface guidelines are developed. South Island Shared Service Agency Limited Page 46 of 62

Service sector to develop interface guidelines that improve outcomes for all service users. who utilise both Mental Health and Disability Support services. Develop an integrated service framework that addresses the needs of older people in terms of mental health and addictions. Mental Health outcomes are improved for older age service users. SIRMHN participate in the development of an integrated service framework for older people. South Island Shared Service Agency Limited Page 47 of 62

6 References Baxter, J. (2008). Maori Mental Health Needs Profile. A Review of the Evidence. Palmerston North: Te Rau Matatini. He Oranga Pounamu (2008). Implementation of Te Waipounamu Maori Mental Health Strategy 2003-2006: He Oranga Pounamu. Health Information Strategy Steering Committee (2005). Health Information Strategy for New Zealand. Wellington: Ministry of Health. Mental Health Commission (2007). Achieving Mental Health and Wellbeing for All. Wellington: Mental Health Commission. Minister of Health (2005). Te Tahuhu - Improving Mental Health 2005-2015: The Second New Zealand Mental Health and Addiction Plan. In Wellington (Ed.): Ministry of Health. Minister of Health (2006). Te Kokiri: The Mental Health and Addiction Action Plan 2006-2015. In Wellington (Ed.): Ministry of Health. Ministry of Health (2000). The New Zealand Health Strategy: Ministry of Health. Ministry of Health (2001). The Primary Health Care Strategy. Wellington: Ministry of Health. Ministry of Health (2002). He Korowai Oranga: Maori Health Strategy. In Wellington (Ed.): Ministry of Health Ministry of Health (2004). Ethnicity Data Protocols for the Health and Disability Sector. Wellington: Ministry of Health. Ministry of Health (2005). Tauawhitia te Wero - Embracing the Challenge: National mental health and addiction workforce development plan 2006-2009. In Wellington (Ed.): Ministry of Health. Ministry of Health (2007a). The New Zealand Health and Disability System. Wellington: Ministry of Health. Ministry of Health (2007b). Primary Health Care: Ministry of Health. Ministry of Health (2007c). Public Health: Ministry of Health. Ministry of Health (2008a). The Health Status of Maori Male Prisoners. Key Results from the Prisoner Health Survey 2005. In Wellington (Ed.): Ministry of Health. Ministry of Health (2008b). Te Puawaiwhero: The second Maori mental health and addiction national strategic framework 2008-2015: Ministry of Health. Oakley-Browne, M. A., Wells, J. E., & Scott, K. M. (2006a). Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington: Ministry of Health. Oakley-Browne, M. A., Wells, J. E., & Scott, K. M. (2006b). Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington: Ministry of Health. South Island Shared Service Agency Limited Page 48 of 62

Parliamentary Counsel Office (2000). New Zealand Public Health and Disability Act 2000. In P. C. Office (Ed.): Parliamentary Counsel Office. Public Health Intelligence (2007). Charting Our Health. Wellington: Ministry of Health. Te Pou (2008). NGO Workforce Development. Auckland: Te Pou. transparent (2008). Dictionary.com website, Dictionarycom Unabridged (v 11). trust. (2008). Dictionary.com website. South Island Shared Service Agency Limited Page 49 of 62

Appendix One Strategy Map To support efficient and effective planning and funding of South Island mental health services in order to provide quality services that focus on wellness, dignity, safety, independence and respect. Strategic Challenge One: Promotion and Prevention Strategic Activity Outcome Measure Encourage PHOs to include health promotion education and prevention components in the mental health and addictions section of their annual plans. PHOs have consistent, clear and transparent goals in their annual plans that meet the mental health needs of their enrolled populations. SIRMHN have promoted the inclusion of health promotion education and prevention components in the mental health and addictions section of the PHOs annual plans. Engage with Public Health in their implementation of Public Health strategies that impact on the mental health and addiction sector. Public Health strategies that impact on the mental health and addiction sector are supported by SIRMHN. SIRMHN members report progress. SIRMHN have engaged with Public Health on strategies that impact on the mental health and addiction sector. Strategic Challenge Two: Building Mental Health Services Strategic Activity Outcome Measure Assist regional mental health services to continue to meet the populations needs. The South Island population has access to quality regional mental health services that meet their needs. The regional mental health services, service provision framework are reviewed annually. Continue to build relationships with other agencies to support recovery and contribute to intersectoral projects which have mental health goals. Work collaboratively with other agencies that have mental health goals. SIRMHN have engaged in work with other agencies that have mental health goals. Actively participate in the Ministry led development and implementation of national service provision frameworks. South Island services reflect national guidelines. South Island has plans in place to implement national service provision frameworks. To be better informed about mental health by sharing information within the South Island and nationally to improve: Range of services for people with high and complex needs. Acute emergency response services. Models of care. Shared information informs and improves service delivery. SIRMHN members are informed of South Island mental health services, and DHB specific information is available to be shared. South Island Shared Service Agency Limited Page 50 of 62

Support the further development and implementation of specific population regional planning frameworks. Regional planning frameworks inform local and regional planning. Regional planning frameworks are implemented. Continue to improve access to regional mental health clinical services. Facilitate the dissemination and discussion of best practice guidelines as they become available. The South Island population has access to quality regional mental health services to meet their needs. Shared information informs and improves service delivery. Utilisation data shows access to regional mental health services. Best practice resource guidelines are disseminated. Strategic Challenge Three: Responsiveness Strategic Activity Outcome Measure Support local initiatives to engage with Pacific people to encourage participation in service planning and development by sharing best practice. Pacific people contribute to local service planning and development. Local initiatives are supported. Support initiatives of Le Va, the Pacific mental health workforce development unit within Te Pou, as appropriate to the regional context. The needs of Pacific families are met through leadership in mental health workforce development, information, knowledge and research. SIRMHN have supported initiatives to develop pacific leadership. Establish a regional mechanism for engaging with tangata whaiora and whanau in regional mental health service planning and development. Regional mental health service planning and development meets the needs of tangata whaiora and whanau. SIRMHN has involved tangata whaiora and whanau in regional mental health service planning and development. Facilitate the dissemination and discussion of best practice guidelines as they become available. Shared information informs and improves service delivery. Strategic Challenge Four: Workforce for Culture for Recovery Strategic Activity Outcome Measure To be familiar with the four national mental health workforce development centres/programmes to inform regional planning. To encourage skill development of the workforce Increase awareness and knowledge of the national workforce development work plans. National workforce development centres work plans are supported for those activities that meet the needs of the South Island. Workforce has opportunities to upskill. Best practice guidelines are disseminated. SIRMHN are aware of the national workforce development work plans. SIRMHN have promoted initiatives that meet the needs of the South Island. Mental health staff are aware of opportunities to upskill. To continue to utilise videoconference as a key tool for delivering regional specialist services and workforce development throughout the South Island mental health sector. Increased opportunities to participate in workforce development. Increased opportunities to actively engage with the regional specialist services. Statistics form Vivid Solutions show and increase in videoconference utilisation. South Island Shared Service Agency Limited Page 51 of 62

Strategic Challenge Five: Maori Mental Health Strategic Activity Outcome Measure Promote Māori mental health and wellbeing and prevent mental illness and addictions through the development of programmes that are effective for diverse Māori communities. Ensure that primary mental health and addictions service models and funding arrangements reflect Māori mental health need and strategies. Improved access and earlier intervention for Māori in primary care settings. Improved access and earlier intervention for Māori in primary care settings. Improved regional collaboration and support for programmes such as Māori Like Minds Like Mine development. Collate and analyse South Island Maori statistical data for whanau who have accessed services through the Primary Mental Health Initiatives. A regional increase in the number of Māori presenting to Primary Mental Health Initiatives. Tangata whaiora requiring regional specialist clinical services, experience services that provide choice, promote independence and are effective, efficient, timely and responsive to their needs. Build a regional mental health workforce across all levels of the continuum that responds to the cultural and clinical needs of Māori whanau. A regional increase in the number of Māori accessing regional specialist mental health services. Workforce is responsive to cultural and clinical needs of Māori. All regional mental health services, can clearly demonstrate that they provide a culturally effective service, meeting the needs of Maori. Increased number of Maori clinical staff within regional specialist mental health services that are responsive to cultural and clinical needs of Māori. Consolidate our research and development foundation and build and share our knowledge base to achieve better outcomes for tangata whaiora and whanau. Commence the development of a best practice repository. Improved understanding of Māori mental health research that supports the integration of knowledge into regional mental health and addiction services. Māori mental health data/information is distributed. Support initiatives to engage with Māori at a regional level to grow the participation in regional planning and development. More Māori participate in regional mental health services, planning and decision making processes. Māori have participated in regional mental health service planning and decision making processes. Strategic Challenge Six: Primary Health Care Strategic Activity Outcome Measure Continue to support the primary mental health initiatives across the Southern region. Improved access and earlier intervention in primary care settings. Better integration between primary services and secondary services. SIRMHN continue to support primary mental health initiatives across the Southern region. South Island Shared Service Agency Limited Page 52 of 62

Strategic Challenge Seven: Addiction Strategic Activity Outcome Measure Support reviews of service need versus service provision for identified service areas and user groups. Service provision for specific service areas meets the needs of consumers. Service provision is documented. Support regular forums that enable tangata whaiora to participate in the development, implementation and evaluation of AOD services. Support DHBs to align service delivery for people with co-existing mental health and substance use/abuse disorders. Support local DHB initiatives to strengthen linkages between primary health, mental health and AOD services. AOD services meet the needs of tangata whaiora. All South Island patients with coexisting disorders have access to mental health and alcohol and other drug clinicians who have the skills to assess, formulate and implement treatment plans for patients with coexisting disorders. All South Island patients with coexisting disorders have access to mental health and alcohol and other drug clinicians who have the skills to assess, formulate and implement treatment plans for patients with coexisting disorders. Strategic Challenge Eight: Funding Mechanisms for Recovery Strategic Activity Outcome Measure Utilise national forums and the South Island Regional Mental Health Network to increase the capacity and capability of the mental health and addiction funding and planning roles in DHBs. South Island Mental Health planners and funders are upskilled. Tangata Whaiora has participated in service development, implementation and evaluation of regional mental health and addiction AOD services. SIRMHN support DHBs to align service delivery. SIRMHN support local initiatives. South Island Mental Health planners and funders have taken opportunities to upskill. Share information around funding models that best encapsulate an outcomes approach. Liaise with other government agencies to share information on funding models. Increase awareness and knowledge of outcomes based funding models. Increase awareness and knowledge of funding models to improve interfaces with other agencies. SIRMHN are aware of outcomes based funding models. Interfaces with other agencies are improved. Support NGOs through sustainability and growth guidelines and striving for consistency. Increase awareness and knowledge about NGO sustainability to support NGOs and the planning and funding interface. Strategic Challenge Nine: Transparency and Trust Strategic Activity Outcome Measure Use available data and information to better inform regional and local Data and information informs regional and local planning. Sustainability and growth guidelines are considered. Data and information has been used to inform regional and South Island Shared Service Agency Limited Page 53 of 62

planning Support the New Zealand National Mental Health Information Strategy. Information-gathering is carried out in the most effective way to improve health outcomes for mental health consumers and to increase accountability for expenditure on mental health services. Strategic Challenge Ten: Working Together Strategic Activity Outcome Measure Participate in the Ministry led project to clarify the role of regional networks. Develop infrastructure which supports South Island Regional Mental Health Network linkage and collaboration with key stakeholder and provider groups. The South Island Regional Mental Health Network meets the requirements of the Ministry of Health and the needs of the southern region. The SIRMHN is cognisant of key stakeholders needs local planning. National Mental Health Information Strategy guidelines are implemented as required. SIRMHN have participated in the Ministry led project. Key stakeholders have input into the SIRMHN. Participate in cross-agency initiatives that promote working together with other government agencies. Mental health outcomes are improved for the population. South Island Mental Health Service has worked with other agencies. Support the engagement with the Disability Support Service sector to develop interface guidelines that improve outcomes for all service users. Mental Health outcomes are improved for service users who utilise both Mental Health and Disability Support services. Interface guidelines are developed. Develop an integrated service framework that addresses the needs of older people in terms of mental health and addictions. Mental Health outcomes are improved for older age service users. SIRMHN have participated in the development of an integrated service framework for older people. South Island Shared Service Agency Limited Page 54 of 62

Appendix Two - Blueprint Analysis Blue print Code 07/08 South Island Blueprint SISSAL Analysis - Feb 08 Update Nelson Marlborough West Coast Blueprint Description Unit of Measure Blueprint Volumes 07/08 Indicative Volumes Blueprint Volumes 07/08 Indicative Volumes 1.1 Acute Inpatient Bed days 20.3 24.0 4.8 10.0 1.2 Community Mental Health Teams FTE 56.3 66.8 13.4 32.1 1.3.1 Community Residential Level I/II Bed days 40.5 10.0 9.6 0.0 1.3.2 Community Residential Level III+ Bed days 54.0 75.4 12.8 20.0 1.5 Home Based Support Services FTE 20.3 43.5 4.8 10.0 1.6 Residential Intensive Long Term Bed days 2.2 0.0 0.5 0.0 1.7 Medium Term and Extended Inpatient Services Bed days 16.2 13.0 3.9 8.0 1.8 Employment and Education Support FTE 13.5 6.5 3.2 0.0 1.9 Support and Education Recovery FTE 12.2 14.8 2.9 7.7 1.10 Outreach (Rural) FTE 2.0 0.0 0.5 0.0 1.11 Consumer Advisory Services and Consumer Run FTE 5.4 4.4 1.3 1.6 1.12 Family Advisory Service and Family Run Initiatives FTE 3.4 3.8 0.8 1.5 1.13 General Hospital Liaison FTE 2.7 0.0 0.6 0.0 1.14 Primary Service Liaison FTE 3.4 0.0 0.8 0.0 1.15 Early Intervention FTE 6.1 4.5 1.4 0.0 5.1 A&D - Community Assessment and Treatment FTE 20.9 27.2 5.0 5.9 5.2.1 A&D - Methadone Specialist Place 121.6 160.0 28.9 34.0 5.2.2 A&D - Methadone GP Place 81.0 57.0 19.3 7.0 5.3 A&D - Residential Treatment Bed days 7.4 17.3 1.8 4.1 5.4 A&D - Supported Living Client 2.7 1.7 0.6 0.4 5.5 A&D- Home and Community Detoxification FTE 1.0 0.5 0.2 0.0 5.6 A&D- Social,Medical,Dedicated Inpatient Detox. Bed days 4.1 0.9 1.0 0.2 6.1 Mental Health and A&D Service - Specialist Exp. FTE 2.7 0.0 0.6 0.0 6.2 Mental Health and A&D Service - Residential Bed days 3.4 0.4 0.8 0.0 6.3 Mental Health and A&D Service - Com Teams FTE 2.0 0.0 0.5 0.0 7.1 Mental Health and ID - Specialist Expertise FTE 1.4 0.0 0.3 0.0 2.1 Acute Inpatient - Child & Youth Bed days 2.7 4.6 0.6 0.7 2.2 Secure Inpatient - Child & Youth Bed days 0.5 0.0 0.1 0.0 2.3 Community Mental Health Teams - Child & Family FTE 38.6 27.9 9.2 8.2 2.4 Respite Services - Child and Youth Care pkg 1.1 1.6 0.3 0.0 2.5 Day Programmes - Child and Youth Care pkg 5.4 1.0 1.3 0.0 2.6 Community Residential Services - Child and Youth Bed days 2.7 5.0 0.6 0.0 4.1 Forensic - Acute Medium Secure Inpatient Bed days 5.1 4.2 1.2 1.1 4.2 Forensic - Long Stay, Maximum Secure, Inpatient Bed days 1.7 1.0 0.4 0.3 4.3 Forensic - Minimum Secure Bed days 1.7 0.0 0.4 0.0 4.4 Forensic - Community Residential Recovery Support Bed days 1.0 0.0 0.2 0.0 4.7 Forensic - Community, Prison and Court Liaison FTE 0.7 4.5 0.2 1.2 9.1 Mothers and Babies Service Bed days 0.7 0.7 0.2 0.2 9.2 Mothers and Babies Service - Community Staff FTE 2.4 0.2 0.6 0.0 9.3 Mothers and Babies - Respite Services Care pkg 1.0 0.0 0.2 0.0 8.1 Head Injury or Neur. Disorder with Behav. Problems Bed days 2.7 0.0 0.6 0.0 8.2 Head Injury or Neur. Disorder - Community Staff FTE 0.3 0.0 0.1 0.0 10.1 Eating Disorders - Community Teams FTE 3.2 0.2 0.8 0.0 10.2 Eating Disorders Bed days 0.7 1.1 0.2 0.3 10.3 Services for the Profoundly Deaf Community FTE FTE 0.2 0.0 0.0 0.0 10.4 Services for Refugees - Community Staff FTE 0.3 0.0 0.1 0.0 10.5 Disabling Personality Disorders - Community Staff FTE 0.4 0.0 0.1 0.0 10.6 Severe Anxiety Disorders - Community Teams FTE 0.4 0.0 0.1 0.0 11.2 Mental Illness Prevention - Community Staff FTE 13.5 0.0 3.2 0.0 12.0 Services outside the Blueprint 0.0 N/A N/A South Island Shared Service Agency Limited Page 55 of 62

07/08 South Island Blueprint SISSAL Analysis - Feb 08 Update Canterbury South Canterbury Blue 07/08 07/08 Indicativ print Code Blueprint Description Unit of Measure Blueprint Volumes Indicative Volumes Blueprint Volumes e Volumes 1.1 Acute Inpatient Bed days 73.7 69.9 8.3 26.1 1.2 Community Mental Health Teams FTE 204.9 156.7 23.0 37.9 1.3.1 Community Residential Level I/II Bed days 147.4 0.0 16.6 0.0 1.3.2 Community Residential Level III+ Bed days 196.5 247.4 22.1 7.8 1.5 Home Based Support Services FTE 73.7 111.1 8.3 18.8 1.6 Residential Intensive Long Term Bed days 7.9 0.0 0.9 0.0 1.7 Medium Term and Extended Inpatient Services Bed days 59.0 77.6 6.6 4.3 1.8 Employment and Education Support FTE 49.1 1.0 5.5 1.8 1.9 Support and Education Recovery FTE 44.2 32.4 5.0 3.7 1.10 Outreach (Rural) FTE 7.4 1.3 0.8 0.0 1.11 Consumer Advisory Services and Consumer Run Initi. FTE 19.7 31.0 2.2 6.7 1.12 Family Advisory Service and Family Run Iniatives FTE 12.3 6.8 1.4 5.4 1.13 General Hospital Liaison FTE 9.8 5.0 1.1 0.0 1.14 Primary Service Liaison FTE 12.3 0.0 1.4 0.0 1.15 Early Intervention FTE 22.1 0.0 2.5 0.0 5.1 A&D - Community Assessment and Treatment FTE 76.2 60.5 8.6 14.6 5.2.1 A&D - Methadone Specialist Place 442.2 503.9 49.7 4.1 5.2.2 A&D - Methadone GP Place 294.8 194.3 33.1 0.9 5.3 A&D - Residential Treatment Bed days 27.0 51.0 3.0 4.6 5.4 A&D - Supported Living Client 9.8 6.5 1.1 0.6 5.5 A&D- Home and Community Detoxification FTE 3.7 1.0 0.4 0.0 5.6 A&D- Social,Medical,Dedicated Inpatient Detox. Bed days 14.7 2.8 1.7 1.4 6.1 Mental Health and A&D Service - Specialist Exp. FTE 9.8 1.3 1.1 0.0 6.2 Mental Health and A&D Service - Residential Bed days 12.3 0.9 1.4 0.0 6.3 Mental Health and A&D Service - Com Teams FTE 7.4 0.0 0.8 0.0 7.1 Mental Health and ID - Specialist Expertise FTE 4.9 5.5 0.6 0.0 2.1 Acute Inpatient - Child & Youth Bed days 9.8 8.3 1.1 5.1 2.2 Secure Inpatient - Child & Youth Bed days 2.0 0.0 0.2 0.0 2.3 Community Mental Health Teams - Child, Youth and Fa FTE 140.5 81.4 15.8 17.2 2.4 Respite Services - Child and Youth Care packages 3.9 6.2 0.4 0.0 2.5 Day Programmes - Child and Youth Care packages 19.7 5.8 2.2 0.0 2.6 Community Residential Services - Child and Youth Bed days 9.8 17.0 1.1 0.0 4.1 Forensic - Acute Medium Secure Inpatient Bed days 18.4 13.4 2.1 9.5 4.2 Forensic - Long Stay, Maximum Secure, Inpatient Bed days 6.1 3.2 0.7 2.5 4.3 Forensic - Minimum Secure Bed days 6.1 11.0 0.7 0.0 4.4 Forensic - Community Residential Recovery Support Bed days 3.7 0.0 0.4 0.0 4.7 Forensic - Community, Prison and Court Liaison Services FTE 2.5 14.5 0.3 4.3 9.1 Mothers and Babies Service Bed days 2.5 2.4 0.3 1.5 9.2 Mothers and Babies Service - Community Staff FTE 8.6 6.8 1.0 0.2 9.3 Mothers and Babies - Respite Services Care packages 3.7 0.0 0.4 0.0 8.1 Head Injury or Neur. Disorder with Behav. Problems Bed days 9.8 0.0 1.1 0.0 8.2 Head Injury or Neur. Disorder - Community Staff FTE 1.0 0.0 0.1 0.0 10.1 Eating Disorders - Community Teams FTE 11.8 5.6 1.3 0.2 10.2 Eating Disorders Bed days 2.5 3.6 0.3 2.2 10.3 Services for the Profoundly Deaf - Community Staff FTE 0.6 0.0 0.1 0.0 10.4 Services for Refugees - Community Staff FTE 1.0 2.0 0.1 0.0 10.5 Disabling Personality Disorders - Community Staff FTE 1.5 0.0 0.2 0.0 10.6 Severe Anxiety Disorders - Community Teams FTE 1.5 0.0 0.2 0.0 11.2 Mental Illness Prevention - Community Staff FTE 49.1 0.0 5.5 0.0 12.0 Services outside the Blueprint N/A N/A South Island Shared Service Agency Limited Page 56 of 62

Blue print Code 07/08 South Island Blueprint SISSAL Analysis - Feb 08 Update Otago Southland 07/08 Indicative Volumes 07/08 Indicative Volumes Blueprint Description Unit of Measure Blueprint Volumes Blueprint Volumes 1.1 Acute Inpatient Bed days 27.82 31.0 16.55 23.1 1.2 Community Mental Health Teams FTE 77.34 110.3 46.01 56.9 1.3.1 Community Residential Level I/II Bed days 55.64 33.0 33.10 1.0 1.3.2 Community Residential Level III+ Bed days 74.19 103.0 44.14 29.0 1.5 Home Based Support Services FTE 27.82 42.5 16.55 28.1 1.6 Residential Intensive Long Term Bed days 2.97 0.0 1.77 0.0 1.7 Medium Term and Extended Inpatient Services Bed days 22.26 24.0 13.24 0.0 1.8 Employment and Education Support FTE 18.55 5.6 11.03 3.3 1.9 Support and Education Recovery FTE 16.69 14.2 9.93 7.8 1.10 Outreach (Rural) FTE 2.78 0.0 1.66 0.0 1.11 Consumer Advisory Services and Consumer Run Initi. FTE 7.42 9.3 4.41 4.0 1.12 Family Advisory Service and Family Run Iniatives FTE 4.64 4.6 2.76 3.0 1.13 General Hospital Liaison FTE 3.71 2.5 2.21 0.0 1.14 Primary Service Liaison FTE 4.64 0.0 2.76 0.0 1.15 Early Intervention FTE 8.35 0.0 4.97 0.0 5.1 A&D - Community Assessment and Treatment FTE 28.75 28.2 17.10 18.9 5.2.1 A&D - Methadone Specialist Place 166.92 238.0 99.31 65.0 5.2.2 A&D - Methadone GP Place 111.28 85.0 66.20 10.0 5.3 A&D - Residential Treatment Bed days 10.20 21.2 6.07 11.9 5.4 A&D - Supported Living Client 3.71 2.3 2.21 1.3 5.5 A&D- Home and Community Detoxification FTE 1.39 2.1 0.83 0.0 5.6 A&D- Social,Medical,Dedicated Inpatient Detox. Bed days 5.56 1.1 3.31 0.6 6.1 Mental Health and A&D Service - Specialist Exp. FTE 3.71 0.0 2.21 0.0 6.2 Mental Health and A&D Service - Residential Bed days 4.64 0.6 2.76 0.2 6.3 Mental Health and A&D Service - Com Teams FTE 2.78 0.0 1.66 0.0 7.1 Mental Health and ID - Specialist Expertise FTE 1.85 0.0 1.10 0.5 2.1 Acute Inpatient - Child & Youth Bed days 3.71 3.4 2.21 1.9 2.2 Secure Inpatient - Child & Youth Bed days 0.74 0.0 0.44 0.0 Community Mental Health Teams - Child, Youth and 2.3 Fa FTE 53.04 38.5 31.56 24.8 Care 2.4 Respite Services - Child and Youth packages 1.48 0.4 0.88 0.1 2.5 Day Programmes - Child and Youth Care packages 7.42 0.0 4.41 2.0 2.6 Community Residential Services - Child and Youth Bed days 3.71 7.0 2.21 5.0 4.1 Forensic - Acute Medium Secure Inpatient Bed days 6.95 5.5 4.14 3.1 4.2 Forensic - Long Stay, Maximum Secure, Inpatient Bed days 2.32 1.3 1.38 0.8 4.3 Forensic - Minimum Secure Bed days 2.32 0.0 1.38 0.0 4.4 Forensic - Community Residential Recovery Support Bed days 1.39 0.0 0.83 0.0 4.7 Forensic - Community, Prison and Court Liaison Services FTE 0.93 5.9 0.55 3.4 9.1 Mothers and Babies Service Bed days 0.93 1.0 0.55 0.6 9.2 Mothers and Babies Service - Community Staff FTE 3.25 0.3 1.93 0.2 9.3 Mothers and Babies - Respite Services Care packages 1.39 0.0 0.83 0.0 8.1 Head Injury or Neur. Disorder with Behav. Problems Bed days 3.71 0.0 2.21 0.0 8.2 Head Injury or Neur. Disorder - Community Staff FTE 0.37 0.0 0.22 0.0 10.1 Eating Disorders - Community Teams FTE 4.45 0.3 2.65 0.2 10.2 Eating Disorders Bed days 0.93 1.5 0.55 0.8 10.3 Services for the Profoundly Deaf - Community Staff FTE 0.22 0.0 0.13 0.0 10.4 Services for Refugees - Community Staff FTE 0.37 0.0 0.22 0.0 10.5 Disabling Personality Disorders - Community Staff FTE 0.56 0.0 0.33 3.0 10.6 Severe Anxiety Disorders - Community Teams FTE 0.56 0.0 0.33 0.0 11.2 Mental Illness Prevention - Community Staff FTE 18.55 0.0 11.03 0.0 12.0 Services outside the Blueprint N/A N/A South Island Shared Service Agency Limited Page 57 of 62

Appendix Three South Island Regional and Inter-District Mental Health Services Provider Purchase Description Unit Forensic CDHB MHIS05 Medium Secure Forensic CDHB MHIS04 Long Term Secure Forensic CDHB MHCS11 Community Forensic Service CDHB MHCS12 Prison/Court Liaison NMDHB MHCS11 Community Forensic Service NMDHB MHCS12 Prison/Court Liaison WCDHB MHCS11 Community Forensic Service WCDHB MHCS12 Prison/Court Liaison ODHB MHCS05 Medium Secure Forensic ODHB MHCS11 Community Forensic Service ODHB MHCS12 Prison/Court Liaison SDHB MHCS11 Community Forensic Service SDHB MHCS12 Prison/Court Liaison Adult Specialty Service CDHB MHIS13 Mother and Baby Inpatient CDHB MHCS28 Specialist Maternal Mental Health Service (Service intended to support service users outside of CDHB) CDHB MHIS12 Eating Disorder Service Inpatient CDHB MHIS09 Eating Disorders Clinical Community FTE (Service intended to support service users outside of CDHB) Child and Youth CDHB MHIS07 Child and Youth Inpatient Beds ODHB MHIS07 Child and Youth Inpatient Beds Alcohol and Drug Salvation Army MHCR07 Residential Service Salvation Army MHCR07 Residential Service Salvation Army MHCR07 Residential Service Salvation Army MHCR07 Residential Service (Women s Rehab) He Waka Tapu MHCR07 Residential Service Nova Trust MHCR07 Residential Service (Level 1) Nova Trust MHCR07 Residential Service (Level 2) Nova Trust MHCR07 Residential Service (level 3) Odyssey House AK MHCR07 Residential Service (Dual Diagnosis) Odyssey House CH MHCR07 Residential Service Odyssey House CH MHCR07 Child and Youth Community Residential Services Odyssey House CH MHCR07 Child and Youth Community Residential Services Odyssey House CH MHCR07 Child and Youth Community Residential Services Vincentian Trust MHCR07 Residential Service (Level 1) Vincentian Trust MHCR07 Residential Service (Level 3) South Island Shared Service Agency Limited Page 58 of 62

Vincentian Trust MHCR07 Residential Service (Level 2) CDHB MHIS10 Detoxification - Medical Inpatient St Marks MHCR07 Residential Service Downie Stewart MHCR07 Residential Service Advocacy and Peer Support ADANZ MHCS21.8 Advocacy/Peer Support Consumers A & D ADANZ MHCS21.8 Advocacy/Peer Support Consumers A & D Regional Support Resourcing. Southern Consumer Network Trust MHCS21.1 Advocacy/Peer Support - Consumers Southern Consumer Network Trust MHCS21.1 Advocacy/Peer Support - Consumers Workforce Development ADANZ MHWD01 Workforce Development Quarterly A&D Newsletter ADANZ MHWD01 Workforce Development A&D Consuming networking ADANZ MHWD01 Workforce Development Load Network Meeting Southern Consumer Network Trust MHWD01 Workforce Development South Island Shared Service Agency Limited Page 59 of 62

Appendix Four Related legislation, strategies and documents Legislation Relating to Mental Health Service Provision The provision of mental health and addictions services in New Zealand is subject to the statutory requirements of the: Criminal Justice Act 1985 Health and Disability Commissioner Act 1994 (Health Disability Code of Rights) Health and Disability Services Safety Act 2003 Health Information Privacy Code 1994 (amendments of 1995, 1998 and 2000) Health Practitioners Competency Assurance Act 2003 Mental Health (Compulsory Assessment and Treatment) Act 1992 New Zealand Public Health and Disability Act 2000 Public Finance Act 1989. Forensic Services are also subject to the following legislation: Criminal Procedure (Mentally Impaired Persons) Act 2003, which replaces Part VII of the Criminal Justice Act 1985 Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 Victims Rights Act 2002. Other mental health documents The following list of other mental health documents was sourced from the MOH website http://www.moh.govt.nz/moh.nsf/indexmh/mentalhealth-resources-publications on the 17th September 2008. 2008 Raising the Odds? Gambling behaviour and neighbourhood access to gambling venues in New Zealand This report presents the key results of a study that investigated whether people's gambling behaviour was associated with their local gambling environment. Future Directions for Eating Disorders Services in New Zealand (01 April 08) The MOH anticipates that DHBs will use this document to help guide planning for, and implementation of, improvements in the provision of eating disorders services. Evaluation of the Home Based Support Service (HBSS) Training Initiative (Jan 08) An independent evaluation of the HBSS Training Initiative identified value for support workers, employers, and the sector in general. Refinements were recommended that would further strengthen infrastructure to make training more sustainable. 2007 Suicide Facts: 2005 2006 data (Nov 07) This report presents a summary of 2005 suicide mortality data and 2006 hospitalisation for intentional self-harm data by total population and key population groups (sex, ethnicity, life cycle stages, deprivation and DHB region). South Island Shared Service Agency Limited Page 60 of 62

Problem Gambling Intervention Services in New Zealand: 2006 Service-user statistics This presents an overview of clients who have sought help via Gambling Helpline Ltd and face-to-face problem gambling services in 2006. Preventing and Minimising Gambling Harm: Three-year service plan 2007 2010 The three-year service plan 2007 2010 outlines funding primary (public health), secondary and tertiary prevention services and research, to progress the goals in the Strategic Plan for Preventing and Minimising Gambling Harm 2004 2010. Service Audit and Review Tool: Opioid Substitution Treatment in New Zealand The Service Audit and Review Tool is to be used as a quality tool for opioid treatment services and auditors. Census of Forensic Mental Health Services 2005 In 2001 the MOH published Services for People with Mental Illness in the Justice System: Review Findings. This presented a picture of the forensic mental health service in New Zealand at that time, and made recommendations for future service requirements. Since this, in 2005, the Ministry has conducted this census. The census data compares results with the 2001 Review Findings. 6.1.1 Key Mental Health Strategies The following list of key mental health strategies was sourced from the MOH website http://www.moh.govt.nz/moh.nsf/indexmh/mentalhealth-resources-publications on the 17th September 2008. 2008 Let s get real Real Skills for people working in mental health and addiction A national project identifying the knowledge, skills and attitudes people need to deliver effective mental health and addiction services in New Zealand. The project was lead by the MOH and developed with sector stakeholders. Te Puāwaiwhero - The Second Maori Mental Health and Addiction National Strategic Framework 2008-2015 This document has been developed to update Te Puawaitanga, the first Māori Mental Health National Strategic Framework, published in 2002 and directly implement Te Tāhuhu, Te Kōkiri and He Korowai Oranga. New Zealand Suicide Prevention Action Plan 2008-2012 The New Zealand Suicide Prevention Action Plan 2008-2012 outlines the actions required to implement the New Zealand Suicide Prevention Strategy 2006-2016. Te Raukura: Addressing the mental health and alcohol and other drug needs of children and youth Te Raukura: Addressing the mental health and AOD needs of children and youth describes the key issues the child and youth mental health and AOD sector faces and identifies priorities for action over the next three to five years. South Island Shared Service Agency Limited Page 61 of 62

Like Minds, Like Mine: Work Plan to 30 June 2009 Outline of planned activities for New Zealand programme to counter stigma and discrimination associated with mental illness. 2007 Like Minds, Like Mine National Plan 2007-2013 Like Minds, Like Mine national plan providing an opportunity to look to the future and to also acknowledge the programme s successes over the past ten years. 2006 Te Kōkiri: The Mental Health and Addiction Action Plan 2006-2015 Te Kōkiri: The Mental Health and Addiction Action Plan has been developed to directly implement Te Tāhuhu Improving Mental Health 2005-2015: The Second New Zealand Mental Health and Addiction Plan. 2005 Te Tāhuhu: Improving Mental Health 2005-2015: The Second New Zealand Health and Addiction Plan Te Tāhuhu: Improving Mental Health outlines Government policy and priorities for mental health and addiction for the 10 years between 2005 and 2015, and provides an overall direction for investment in mental health and addiction. It builds on the current Mental Health Strategy contained in Looking Forward (1994) and Moving Forward (1997), and the Mental Health Commission s Blueprint for Mental Health Services (1998). 2002 Te Puawaitanga - Māori Mental Health National Strategic Framework The purpose of this Māori Mental Health Strategic Framework is to provide DHBs with a nationally consistent framework for planning and delivery of services for tāngata whaiora and their whānau, so they can meet the Government s mental health policy objectives for Māori over the next five years. 1998 Blueprint for Mental Health Services in New Zealand: How things need to be This Mental Health Commission document builds on the initial July 1997 Blueprint working document which was widely distributed and includes changes as a result of feedback received from many people and organisations. 1997 Moving Forward: The National Mental Health Plan - for More and Better Services Moving Forward is the National Mental Health Plan for New Zealand. The Plan is based on the National Mental Health Strategy Looking Forward, which was released in 1994 and which outlined the goals and strategic directions for the development of mental health services over the next ten years. 1994 Looking Forward: Strategic Directions for the Mental Health Services The Government has decided to develop a set of strategic directions for New Zealand s mental health services. This document outlines the goals, principles and national objectives that will reshape New Zealand s mental health services. South Island Shared Service Agency Limited Page 62 of 62