Issue 26 - Summer edition - March 2014Mental health & addiction nursing newsletter

In this issue: Nurse Practitioner journeys • The invisible AOD problem • and much more...

Sarah Barkley and her two girls

Continues on page 4

Left to right Catherine Fuller, Juliana Korzon, Katie Owen, Wendy Trimmer (seated)

Sensory modulation is an approach that uses environment, equipment and activities to regulate a person’s sensory experience and optimise wellbeing (Sutton & Nicholson, 2011). It’s being used nationally to varying degrees within mental health settings (both inpatient and community), in medical/surgical areas and in aged care facilities. Explorative research undertaken by Sutton and Nicholson noted service users found sensory modulation created a sense of safety, a sense of control, positive associations, and that it ‘grounded’, soothed and aided in distraction from distressing thoughts or emotions.

Sensory modulation in nursing programmes at Whitireia New Zealand – a teaching initiative

Teaching staff at Whitireia have recognised the opportunity to integrate sensory modulation into their nursing programmes at both undergraduate and graduate level. During 2012 conversations began with key sensory modulation drivers from Te Pou. These discussions initiated the planning of a sensory room.

Academic leader Wendy Trimmer then attended sensory modulation familiarisation training delivered by MidCentral District Health Board. The purpose of this workshop was to support application of sensory modulation into practice. The workshop was closely aligned to Let’s get real (Ministry of Health, 2008), strengths-based practice, and trauma informed care. Following the 2013 workshop, undergraduate and postgraduate nursing lecturers within the Faculty of Health had a series of meetings to develop a sensory modulation room as part of the simulation suite established at Whitireia’s Porirua campus.

A sensory starter kit was sourced from SensoryCorner.co.nz, which included weighted blankets, a lycra wrap, relaxation CDs, weighted dogs, soft squeeze balls, ‘tapping’ bags, and other assorted equipment which could be used for demonstration to the students. Staff also visited local providers who had established sensory rooms to learn about and understand their experience in the practice setting.

By Wendy Trimmer, Juliana Korzon, Katie Owen and Catherine Fuller

The national centre of mental health research, information and workforce development

Welcome to the Summer edition

of Handover, our first for 2014.

Welcome to nurses new to the

mental health and addiction

sector – it is full of opportunities

for you to learn and grow. We

trust this edition will encourage

and inspire you.

We open with a superb initiative, a new sensory room, created by nurses working at Whitireia New Zealand. The sensory room enables undergraduate nurses and other students to learn more about how sensory modulation can be used to support people in distress.

We profile two pioneering Wellington-based nurses on the journey towards becoming nurse practitioners with a focus on primary care – Lynley Byrne and Wendy Tait. Our feature story highlights the interesting work of Suzy Morrison about alcohol use among older people. We also bring you an article from Mark Smith about the HoNOS 65+ outcome measure.

In our regular family column, Leigh Murray provides useful insights into many of the terms used to describe families. Klare Braye brings us highlights from the recent addiction nurses’ symposium held in Whangarei in the addiction nursing update column.

Anne Brebner discusses the final strategy in the Six Core Strategy Series©: Strategy six – debriefing techniques. She reminds us so much can be learned by reflecting on what has occurred and identifying key learnings to inform our future practice.

The value of taking incremental steps to make sustainable life changes is discussed in the service user perspective column by Carolyn Swanson.

In the professional supervision column I prompt us all to think about the different forms of supervision we may need to support our practice at various stages in our careers.

Don’t forget to check out the journal articles in the Nursing Digest section, this edition includes an article co-authored by Debra Lampshire about consumer involvement in tertiary-level education of mental health professionals.

We hope you enjoy the issue.

Kindest regards Suzette

to subscribe to the handover newsletter, go to the te pou website at www.tepou.co.nz and select sign up for e-news

if you would like to submit an article to handover, or you just have an idea for one, please feel free to contact me as i would be delighted discuss this with you. we welcome your articles which can be 300-800 words and we encourage you to send in a photo to accompany your story. articles submitted are reviewed before publication and if any major changes are needed we will work with you to ensure the content reflects your story. email submissions to suzette.poole@tepou.co.nz.

clinical lead

email: suzette.poole@tepou.co.nz

issn: 2324-3821

Suzette Poole - Editor

Contents1 Sensory modulation in nursing programmes at

Whitireia New Zealand – a teaching initiative

5 Profile: Lynley Byrne –The journey towards nurse practitioner status in primary mental health care

7 Profile: Wendy Tait – Diversity and opportunity

8 Feature story: The invisible AOD problem

Regular features:

3 Nursing notes

10 Information alive

11 Family column

12 Addiction nursing update

13 Acutes project

14 Service user perspective

15 Professional supervision

16 Latest publications

17 Nursing digest

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Nursing notes By Anne Brebner, clinical advisor

I write this as I enter my fifth year at Te Pou and the second month of 2014. I have been reflecting on the changes within the mental health and addiction workforce that have occurred in this time.

The impact of Rising to the challenge, the mental health and addiction service development plan 2012- 2017 is already beginning to show. There is a real emphasis upon and need for specialist services to support people working in primary health to develop and maintain the skills required to meet varied mental health and addiction needs at an earlier stage.

At Te Pou we are working with multiple organisations around talking therapies (psychological therapies) to enable the primary workforce to appropriately meet the needs of those who require first line mental health and addiction support. Acute mental health and addiction specialist support needs to have a more stringent focus that enables service users to have brief, high level support with easy discharge procedures to their health hub (preferably their GP).

An easy way of having further specialist input only when it is needed needs to follow. It is no longer feasible, nor is it in the interests of service users, to remain with specialist services for prolonged periods of time. The majority of their needs would be better served by a wider group of health and social service professionals, with a focus on doing more at an earlier stage.

This focus does have workforce implications. There is a definite need to develop screening, brief intervention counselling and an awareness of how and when to appropriately refer to specialised support. Mental health and addiction nursing has adapted to this model well already. In the previous edition of Handover we profiled primary health organisations that have taken steps to grow this expertise with the help of professional colleges such as Te Ao Māramatanga New Zealand College of Mental Health Nurses Inc. In this edition we profile two primary health-based mental health nurses who are on the pathway towards becoming nurse

practitioners.

The Service Delivery Plan also reminds us that changes need to occur at the other end of the mental health spectrum of care, inpatient acute mental health services. There is a call to reduce and eliminate the use of seclusion and restraint. Te Pou has been actively involved with supporting district health boards for several years now, and in the Annual Mental Health Report by Mental Health Directorate director Dr John Crawshaw (www.health.govt.nz/publication/office-director-mental-health-annual-report-2012) a decline in reported numbers using seclusion was noted. Those services that have made considerable impact were congratulated.

The reduction is encouraging, but the rates for seclusion for Maori remain higher than for non-Maori and considerable work will be focussed on this area in the coming year. To further support reduction, we are developing national guidelines for the practice of restraint. This work is well underway and we look forward to keeping you informed on progress.

I look forward to a busy and eventful year in workforce development. There will be lots of opportunities for nurses to demonstrate leadership and innovation. We love to showcase these innovations in Handover, so please call, email or discuss with Suzette or me.

Warm regards Anne

Update: Farewell AlisonAlison Forshaw has returned to her passion of working in the clinical frontline. We wish her well and applaud her commitment to supporting people in crisis.

The new year is a time of reflection about what we have achieved, and a time to consider our future aspirations. Although not every nurse may have had the opportunity for a decent break over Christmas I am sure many of you will have had opportunities to catch up with friends and family and make a few year resolutions.

At a symposium for mental health nurses in Wellington late last year, I was pleasantly reminded of exactly how nurses can achieve goals. I learned more about how nurses can transform inpatient services by using a ‘productive ward approach’ and how nurses were improving their responses to meet the physical health needs of adolescent services users. I was enlightened by nurse researchers and learned about the

gaps in crisis interventions as perceived by service users, families, mental health nurses and the police – and also about the experiences of people who present to emergency departments with intentional self-harm behaviours and physical and/or social needs.

Making resolutions by setting goals for our professional development is an inherent part of our nursing practice. Hearing how others nurses have achieved their professional goals is often encouraging. I would like to invite nurses to share their stories of success in achieving goals

Anne Brebner

Suzette Poole

Continues on page 4

By Suzette Poole, clinical leadNursing notes continued:

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Other students have reported their thoughts about observing the use of PRN (pro-re-nata) medication in environments that are not equipped with sensory rooms.

Whitireia staff are pleased with the response from students who are demonstrating integrating the new knowledge into their practice settings. The teaching team also provided the opportunity for all faculty staff to be introduced to the equipment and are engaged with other programmes to assist with use and teaching of sensory modulation approaches.

References:Ministry of Health. (2008). Let’s get real: Real skills for people working in mental health and addiction, Wellington: Ministry of Health.

Sutton, D., & Nicholson, E. (2011). Sensory modulation in acute mental health wards: A qualitative study of staff and service user perspectives. Auckland, New Zealand: Te Pou o Te Whakaaro Nui

The teaching plan included

emphasising the connection

between sensory modulation

and how it can help

support recovery, building

connections, rapport, and

therapeutic relationships.

Sensory modulation in nursing programmes at Whitireia New Zealand – a teaching initiative Continued from page 1

Teaching sessions began in September 2013 with second year Bachelor of Nursing students. These practical sessions focused on responding to people with heightened distress and gaining an understanding of sensory modulation as a tool for de-escalation. The teaching plan included emphasising the connection between sensory modulation and how it can help support recovery, building connections, rapport, and therapeutic relationships.

Undergraduate staff have noted that exposure to sensory modulation approaches has enabled students to reflect on using it in their practice settings and to recognise it in practice. Staff have had positive feedback from students about the integration of this new knowledge base into their learning and practice.

One example has been a student who has helped introduce sensory modulation whilst on placement as part of the planning for discharge for a person within an acute environment.

they believe have made a difference to their professional practice. Or, if you are a nurse who has set a goal for the year and would like to share snippets of your journey, feel free to contact me so we can talk some more.

One of my major goals for many years has been to complete my Masters in Nursing. The journey has taken some time but the end is in sight and this is the year to finish it! I can now fully appreciate the hard work, time, energy and perseverance it takes to travel this path, which has been traversed by many nurses before me. What encourages me most is the sense of relief and achievement I have seen in my colleagues when they reached their goal – I can’t wait to experience it for myself this year!

I am looking forward to a very productive year and meeting more nurses who are determined to keep developing their professional practice and who are committed to improving the services that respond to people with mental health and/or addiction problems.

Warm regards Suzette

Nursing notesContinued from page 3

Mental health webinar seriesThe Mental Health Professionals’ Network is a unique initiative targeted at improving interdisciplinary mental health practice and collaborative care within Australia. It supports primary mental health practitioners through local networks and their webinar programme.

Mental health practitioners from New Zealand have free access to view past webinars. There are currently 28 webinars in the series, featuring panel discussions by leading Australian-based experts from a range of disciplines about topical mental health issues such as:• collaborative mental health care to support a young person

from a refugee background• supporting families living with maternal bipolar mood disorder• chronic pain and mental health issues• sleep disorders and mental illness: insomnia, depression and

anxiety• supporting a young woman struggling with bulimia and

depression• collaborative care in mental health and substance abuse.

To access the webinar series, visit the Mental Health Practitioners Network website, www.mhpn.org.au/webinars

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As mental health nurses, we need to increase the integration of mental health into primary care by using our unique skills and by working towards nurse practitioner status, says Lynley Byrne.

A mental health liaison nurse working across primary practices for the Capital & Coast District Health Board (CCDHB), Lynley has fulfilled the academic requirements of her Masters of Nursing, including the prescribing practicum. By mid-2014 she intends to have completed her portfolio and will be ready to apply to the Nursing Council for nurse practitioner status.

Mental health liaison roleIn her mental health liaison nurse role Lynley brokers people’s pathways into primary care from mental health services in the CCDHB. This is a funded programme providing free GP visits to help people access primary care for both their physical and mental health needs. Lynley is one of two mental health liaison nurses working in primary care in the CCDHB. She covers the northern area from Tawa to Waikanae while her colleague Deb Glenn covers Wellington City.

Their work is predominantly with people using primary care who have previously had moderate to severe mental health problems including addiction. They also offer advice, when asked, to GPs with people who have less severe mental health problems.

Nurse practitioner motivationLynley’s motivation to gain nurse practitioner status came from the “potent realisation” seven years ago that prescribing medication would make a huge difference in her ability to help people with mental health issues in primary care.

“Mental health nurse practitioners are experts in their field and can offer medication advice to primary health staff, some of whom do not feel confident prescribing mental health medication,” she says.

She aims to work as a mental health nurse practitioner with people from 18 years to older adults.

“My goal is to enable those with mental health issues to remain in primary care while receiving specialist mental health treatment. If they don’t

have to enter mental health services they avoid the stigmatisation often associated with those services,” she says.

“It is normalising to receive specialist mental health services within a GP clinic. It also demystifies mental health treatment to primary care staff and complies with the Ministry of Health vision of integration of health services.”

Moving to primary careLynley says the process of moving people out of the mental health system and into primary care in the community often takes time, especially for those who have had extended treatment within community mental health teams. This is because there is a distinct change of focus required by those people with enduring mental health problems.

“It takes time and support for people to develop the confidence they need to move on with their recovery, especially when they are coming out of an all-inclusive community mental health team and are being asked to take individual responsibility for their health within the primary care system.”

However, she says it is often a powerful experience to have the final meeting with someone who may have received treatment from community mental health for many years and is now ready to be responsible for their own health outside the mental health system.

“At times there are tears of joy.”

Lynley says the liaison team also provides a consultative service in primary care for GPs and practice nurses regarding queries about

Profile: Lynley ByrneThe journey towards nurse practitioner status in primary mental health care

“My goal is to enable those

with mental health issues to

remain in primary care while

receiving specialist mental

health treatment.”

Lynley Byrne

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medication or when people’s needs change and other professionals may need to be involved.

Journey with studyLynley’s academic journey was long – and often stressful – but it is a journey she hasn’t regretted. Her postgraduate pathway began with a certificate in mental health nursing at Victoria University in 2007. She says she was cajoled into undertaking this study by the mental health nurse leader Eileen Weekly, shortly after beginning her GP Liaison role at CCDHB.

On completing the one year certificate, Lynley decided that was the end of postgraduate study, but was quickly drawn back by the opportunity to do a postgraduate certificate in cognitive behavioural therapy (CBT) through Otago University, Wellington.

“The thought of a postgraduate certificate in a therapy that I could use in my practice was what made me apply.”

She then took a year off ‘to smell the roses’. Having that space away from study made her decide she wanted to continue and work towards nurse practitioner status.

“I could see it really working in this area that crosses primary and mental health services.”

Challenges of studyLynley signed up to the first clinical paper, pathophysiology, at Massey University with much trepidation. As a psychiatric hospital-trained nurse, she was worried about the large physical health component involved.

The underpinning educational background in physical health was somewhat lacking in mental health training in 1987 and the science of the nursing component within nursing education has increased exponentially over that time, she explains.

“It was like baptism by fire. As well as learning the science of nursing at an advanced level, I also had to develop my undergraduate knowledge so I could make sense of the advanced learning. I really thought I would never finish it in one piece. However, I did and went on to a clinical assessment and diagnosis paper – again all physical health based.”

The following year, Lynley did a research design paper and developed a research proposal about metabolic monitoring within the mental health setting.

“By the time I got to the clinical pharmacology paper I had gained confidence that I could do it and believed I was well on the way to becoming a nurse practitioner.”

She went on to do her prescribing practicum at The University of Auckland because that university had a larger postgraduate mental health presence within the university staff.

Along with the academic demands, the next biggest challenge with postgraduate study was managing time, she says.

“Working full-time while full-time parenting has added to the challenge of completing these papers and undertaking the practical work involved, so it is a very real sense of achievement to have completed the Masters of Nursing as well as working on my nurse practitioner portfolio, which I hope to have done by mid next year.”

Being organised was the key to getting through, says Lynley. She set up a dedicated office at home, and a year planner that was full of goals and assignments to be achieved, as well as school commitments.

“An understanding daughter who had been given large headphones for the TV, computer and stereo to use while mother was studying really helped too. I had to keep social events to a minimum to keep my sanity and stay ultra-organised.”

Support of colleaguesHaving supportive and collaborative team leaders, colleagues, directors of nursing and psychiatrists makes a big difference, she says.

“Nurse practitioners are still a very new

concept, despite being 10 years down the track.

We are still seen as trail blazers – there are very

few in mental health. It was important that

colleagues, like my supervising psychiatrist,

could see how I could add value to the mental

health service and were supportive of my goals

and vision.”

Goal in sightReflecting back over the eight years she has

spent across primary and mental health

services, Lynley is excited she will soon reach

the goal of becoming a nurse practitioner.

“I can see having this status really will make

a big difference to how I can help the mental

health of people accessing primary health

services. Instead of suggesting medication or

treatment changes to GPs I can provide the

entire service, including cognitive behavioural

therapy (CBT) skills.”

Consultant psychiatrist perspectiveDr Laurie Thomson, consultant psychiatrist for

community mental health teams in Porirua,

was Lynley Byrne’s supervising psychiatrist

for her prescribing practicum paper last year.

He says it has been a privilege to provide

supervision to Lynley in this transition

phase, whilst there are no mental health

nurse practitioners within the CCDHB to provide supervision. When she has gained

nurse practitioner status she will be able to

supervise the next generation of mental health

nurse practitioners.

“It was very rewarding to supervise a clinician

with vast experience of mental health and

psychosocial issues, compared to medical

students who are medical model orientated

with little psychosocial orientation or mental

health experience. It was also rewarding to

supervise the integration of bio-medical

knowledge into Lynley’s prescribing practice.”

Dr Thomson believes nurse practitioners are

a valuable addition to mental health services

because they provide a more flexible delivery

of services in the community and have closer

links to primary practices.

“Nurse practitioners are still a very new concept, despite being 10 years down the track. We are still seen as trail blazers – there are very few in mental health.”

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Profile: Wendy Tait

The diversity in this job is unique, says Wendy Tait, the nurse practitioner candidate (mental health) and primary care mental health nurse at Te Aro Health Centre and Evolve Youth Service.

A not-for-profit charitable organisation, Te Aro is a nurse-led service working with people who have complex needs and high service use. This includes people experiencing mental health, addiction and physical issues.

Wendy, who has been at Te Aro since January 2012, runs two clinics for the general population of Te Aro each week, as well as spending one and a half days a week with Evolve Youth Service working with young people. She also provides outreach services, including street outreach, for Te Aro. This involves proactively engaging with hard to reach people who may be homeless or vulnerable and encouraging them to access health care and services within the sector. These include initiatives such as The Soup Kitchen, Downtown Community Ministry and Night Shelter.

Nurse practitioner candidateIn her nurse practitioner candidate role Wendy provides guidance and advice concerning mental health diagnosis and medication to other nurses and general practitioners (GPs) at Te Aro and Evolve.

“Clinicians, including doctors, present issues to me and I give recommendations and advice. I also do medication reviews. I usually see the person and do a comprehensive assessment including diagnosis, formulation and treatment recommendations, which may include advising the GP or nurse practitioner on what medications to prescribe.”

She says having nurse practitioner candidacy status, which is like an internship, is a major bonus of the role. It enables her to utilise her skills and work at an advanced level which has meant she has been able to work on her nurse practitioner portfolio and consolidate her learning while also completing her Masters, which she finished in November 2012.

“Many nurses on the pathway to nurse practitioner have to complete their Masters and then make a business case proposal to obtain a candidacy position. Not everyone working towards nurse practitioner status has their organisation supporting them which doesn’t make sense to me.”

Working alongside two experienced nurse practitioners, Angela Bates at Te Aro and Rebecca Zonneveld at Evolve, has also been of considerable help in advancing Wendy’s skills.“I’m very lucky to have that experience,” she says.

She also accesses support from psychiatrists, including Dr Tom Flewett, consultant psychiatrist/addiction specialist, who was her prescribing mentor during her prescribing practicum.

“It is essential to have good networks with primary and secondary providers because, once endorsed, you are still a novice prescriber and need that support and experience around you.”

Gaining nurse practitioner statusWendy decided to become a nurse practitioner because she wanted to practice at an advanced level, building on skills she has developed over the years.

“Nurse practitioner status means I can provide seamless care, continuous service and an integrated approach in my nursing practice. It gives me the opportunity to provide for a wider segment of the population and increase my understanding of physical health, alongside my mental health knowledge and experience.”

After four years Wendy is close to applying for endorsement. She is currently drafting up her portfolio, which has to contain in-depth evidence of advanced nursing skills, including prescribing.

Career in mental health Mental health nursing was not Wendy’s first career choice. When she left school in her native Scotland she trained as a beauty therapist specialising in therapeutic massage. After taking a number of sessions with people who were intellectually and physically impaired, she decided she wanted to change careers and work with that particular group. This was in the early nineties when changes were happening in Scotland and it was hard to obtain employment in this area of nursing, so Wendy decided to train as a mental health nurse instead.

It was during her training that Wendy got an early taste of the area that has become her passion; co-existing problems (mental health and addiction).

“I don’t see these conditions as separate issues; I see addiction as part of mental health. I believe strongly in the philosophy that ‘no door is the wrong door’.”

Move to New Zealand After moving to New Zealand 10 years ago, Wendy initially worked with the crisis team on Auckland’s North Shore before moving to Wellington in 2006 to join the addiction service. She worked with the opioid treatment service and then the co-existing disorder service where she developed, implemented and evaluated the CEP skills assessment framework for co-existing disorders clinicians which has become the basis of Te Whare o Tiki: Co-existing problems knowledge and skills framework.

Diversity and opportunity Left to right: Lynley Byrne and Wendy Tait

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“There is a widely held view that problematic alcohol and other drug (AOD) use mainly happens among young people. However, another generation of people is just as vulnerable – people 65 years of age and over,” says Suzy Morrison, consumer project lead for Matua Raki, the national addiction workforce development centre.

A 2001 Christchurch study, Drinking patterns among older people in the community: hidden from medical attention, interviewed general practitioners (GPs) and 108 of their patients (Khan, Davis, Wilkinson & Sellman 2002: http://journal.nzma.org.nz/journal/115-1148/2226/content.pdf).

Of those patients, 26.9 per cent reported alcohol dependence in their lifetime. The GP assessments/medical records only identified 3.7 per cent, says Suzy.

Stigma around ageing

Older people often carry personal stigma about

ageing and retirement, says Suzy.

“There are unique challenges, including

ageism, bereavement, loss of status, mobility

and independence. For many, alcohol appears

to help manage emotions and for some people

a dependency can quickly develop, especially

when combined with some commonly

prescribed medications.”

AOD problems can remain undetected and

undiagnosed with older people because

a different standard of quality of life is

often assigned to them due to societal pre-

conceptions and attitudes.

For example, if a young person was forgetful

or falling over at home or in the street there

She believes strongly in taking a holistic view, which is why she enjoys the outreach aspect of her role at Te Aro.

“I’m helping address people’s health care needs, while working alongside agencies, helping with physical and social needs as well as mental health and addiction needs.”

Strategic involvementWendy is also involved at a strategic level in a number of areas. She is a board member for the Wellington Homeless Women’s Trust and is involved in various steering groups, including the Addiction Stakeholder group and Te Mahana, Ending Homelessness in Wellington by 2020 steering group. She also works on two pilots for Te Aro. One is collaboration with the Hepatitis Foundation on a hepatitis C pilot that involves screening and referral. Another involves Te Aro and other key agencies piloting transition visits to people who were previously homeless and have recently been housed. The visits are to ensure continuity of care, engagement with services and sustainability of tenancies.

Continuity and networkingOne of the biggest challenges overall in the job, says Wendy, is maintaining

continuity between services to avoid a person getting a range of treatment across agencies for the same issues, particularly if the treatment is inconsistent and there is a lack of communication. It is paramount that individuals are provided with integrated treatment which prevents them falling through the cracks, she explains. Her past work in secondary mental health services with the co-existing disorders service is a big help with creating better communication and seamless provision of services.

“Networking with various individuals, teams and agencies is the key.”

Wendy also continues to build up her skills across non-traditional theories and approaches to avoid a solely medicinal approach.

“I’ve just completed an eight-week introductory yoga training course for mental health professionals and now provide group sessions at one of our outreach facilities. I am a Reiki master and I have a keen interest in complementary therapies and introducing these in our clinic.”

Having the freedom to continue to develop keeps work exciting, she says.

“The opportunities have been magnificent and the ongoing experience of working with such a network of different individuals, from client groups to colleagues and agencies is just wonderful.”

“Networking with various individuals, teams

and agencies is the key.”

The invisible AOD problem

Suzy Morrison consumer project lead for Matua Raki.

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would be questions asked about what is going on and possibly an assumption that AOD use was present. With older people it is different. Family and observers think, ‘Oh this is what happens to old people. They forget; they fall over’.

She says a conversation about AOD use may not take place at all even though people 65 and older may be seeing a GP on a regular basis. Consequently, assessment and treatment is often not offered to this ‘invisible generation’. Some AOD and mental health services aren’t even funded to treat people 65 and over.

“However, older people have a lot of respect for doctors and nurses so primary health organisations are in a good position to begin conversations about AOD use. A blood test result showing changes to liver function and subsequent assessment of AOD use can be easier to hear from a health professional with whom there is already a relationship of trust.”

Physiological change

It is not just those diagnosed as AOD dependent that have problems. Recommended ‘safer’ alcohol limits for older people are less than the general population. In 2011, the United Kingdom Royal College of Psychiatrists set no more than 1.5 units per day or 11 units per week for older men and 1 unit a day or 7 units per week for older women, says Suzy.

Due to the physiological and metabolic changes of ageing, alcohol can start to impact more. So someone who may have been drinking the same amount, say two drinks a night, for many years with no apparent negative impact, could find they begin to experience intoxication, forgetfulness or falls.

“These changes may mirror early signs of dementia and this is really frightening for the people involved who are often reluctant to speak of their fears in case it is dementia.”

Therefore, hearing about the effects of alcohol on older bodies is often met with relief, says Suzy, who recalls one client who knew something wasn’t right. He realised he was becoming forgetful – leaving things on the stove, forgetting to eat, forgetting to take prescribed medication, sleeping more during the day. He feared he was developing dementia and was alone with the fear. He didn’t speak

about it because he was scared he would be taken from his home and placed in a care facility.

“Consequently he’d get really angry when his daughters talked to him about his apparent intoxication. These angry outbursts were out of character and his daughters were worried. After visiting 65+ Auckland Community Alcohol and Drug Service he was hugely relieved to realise alcohol may have been the problem.”

Art of engagement

In 2012 Matua Raki contracted Suzy to develop and deliver AOD and older people workshops to the addiction and mental health workforce. The day-long workshop begins by examining values, attitudes, stigma, shame and losses that may be present for participants, and outlines how prescribed and/or over the counter medications can be affected by alcohol.

It then focuses on the art of listening and engaging with older people because discussions about drinking or using prescription drugs are not necessarily easy, says Suzy. People may feel disrespectful or believe drinking could be the older person’s only pleasure, so they shouldn’t interfere.

She adds the emphasis needs to be on listening so engagement is conversational rather than a formal assessment process.

“Something changes when people feel heard. Any information should be discussed in a warm, non-shaming way and literature volunteered, not forced. At the end of the day, it is the relationship between the worker and person that is most important.”

She adds that the workshop also points out the importance of allowing older people to come to their own decision about not drinking. “You can’t MAKE someone stop.”

The initial workshops were so well received Suzy has delivered another six in various locations throughout the country.

“It is heartening to see this awareness and interest in supporting older people,” says Suzy, who believes it is essential the mental health and addiction workforce is supported in its work with people 65 and older.

“With Statistics New Zealand predicting almost one quarter of New Zealanders will be 65 and older by 2031, our challenge is to improve detection and offer treatment to this often invisible part of our society.”

Background in AOD support

Suzy has many years of lived experience of active addiction and recovery. In the early nineties she trained as a social worker, keen to be a voice and advocate for the invisible sectors in the AOD community.

She began working with the Auckland District Health Board as part of the Community AIDS Resource Team (CART) supporting people infected with or affected by HIV, with a focus on women living with HIV. During her seven years at CART Suzy also trained as a counsellor and then worked as an addiction counsellor for 15 years in therapeutic community and outpatient settings.

Nine years ago, Suzy and another addiction counsellor, set up the Auckland Community Alcohol and Drug Services (CADS) 65+. This mobile service works with people 65 and older who may be concerned about their own or someone else’s AOD use. It is one of only two addiction services that work specifically with older people in New Zealand; the other is 65 Alive, a seniors CEP and AOD service funded by Odyssey House in Christchurch.

Suzy worked for 65+ for two years before taking over the CAD Family services co-ordinator role. She moved to her current role at Matua Raki in August 2013. “Each role has given me opportunities to support and advocate for the people who don’t have a voice in our community.”

Safer alcohol limits for people aged 65 and olderEvidence suggests the upper safer limit for older men is 1.5 units per day or 11 units per week, and for women 1 unit per day or 7 units per week (Royal College of Psychiatrists UK 2011).

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The Ministry of Health’s strategy document Rising to the Challenge emphasises older people’s mental health.

Explicitly it mentions ‘delivering increased access for our growing older population while respecting and protecting their positive contribution.’ This is well phrased, capturing both the demographic bulge which we are likely to experience in the next few decades and the need to improve access to services while valuing the contribution of older people. For people already using services this equates to improving recovery and service performance.

For those older people already in services we have an outcome measure which could help with recovery and service performance. That is the HoNOS 65+ outcome measure (www.tepou.co.nz/outcomes/measures/honos).

This measure has been mandated by the Ministry of Health for mental health services for inclusion in the national mental health collection. This simple outcome measure collects scores from 0 (no problem) to 4 (severe problem) on 12 items. It is rated by clinicians.

There are a number of ways in which this measure could be useful.

Firstly, at the individual level of clinician and service user, HoNOS 65+ information can be used to develop individual plans and provide a platform for shared problem identification and solution finding. This will help service users assess their own recovery by setting personal goals.

Clinicians will be able to identify and plan around the areas which need

attention in a systematic manner.

Secondly, the team can use the information to allocate referrals based on

the severity of cases rather than numbers on caseloads. Aggregated team

information will enable the team to determine recruitment priorities.

Thirdly, the service can benchmark their performance against other

services. This can be a positive experience of learning what works well in

your own service and what works well elsewhere that could be transferable.

Fourthly, this information can be used nationally to determine trends

and patterns over time which will ultimately enable New Zealand to

plan services, workforce development and resources more accurately.

One of the powerful factors about outcome information is that it is most

useful when the information is shared between clinician and service user.

This can provide an opportunity for therapeutic discussions between

clinicians and service users. This in turn will assist with the development

of the therapeutic alliance and rapport.

Obviously, if this information is simply seen as an administrative chore

that is sent on to the ministry, this powerful potential is lost and it becomes

a compliance issue only. It is easy to see how sharing this information

contributes to ‘respecting and protecting their (that is older people’s)

positive contribution’.

Useful resources

Suzy recommends two New Zealand resources to help people working with older adults and AOD issues; both of which are available on the Te Pou website.

“Te Pou has published an excellent resource Talking therapies for older adults (www.tepou.co.nz/library/tepou/talking-therapies-for-older-adults) that has helpful

information about engaging and

communication, including an

overview of stigma and ageism.

Another lovely resource is the Let’s

get real Principles for Engagement

(www.tepou.co.nz/library/tepou/

principles-for-engagement) which

explores the values and attitudes

which are the foundation of good

engagement.”

Tip for family members When working with concerned family members encourage them to not have conversations about AOD when the other person is intoxicated because it doesn’t work. Arguments generally ensue and chances are the intoxicated person will not remember the next day.

Information Alive by Mark Smith

Older people’s outcomes information

Information Alive is a regular feature in Handover written by Mark Smith. Mark is a clinical lead at Te Pou and an independent registered nurse practitioner. mark.smith@tepou.co.nz

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Many have questioned the various terms and labels ascribed to people who experience mental health and addiction problems such as ‘consumer’, ‘service user’, ‘patient’, ‘client’, ‘tangata whaiora’.

This family column discusses some terms used in mental health and addiction services to describe families and whanau. Being able to identify the family, whanau and friends of a service user is a key performance indicator for the Let’s get real skill ‘Working with families, whanau’ (Te Pou, 2008).

Family, whanauOver the last 10 years most New Zealand mental health and addiction policy and strategic documents have used this term when referring to family members of people accessing services.

“Family, whanau is not limited to relationships based on blood ties. Family, whanau can include a person’s extended family, whanau, their partners, friends, advocates, guardians or other representatives. In the area of mental health and addiction, the person receiving the service decides who their family, whanau is.” (Mental Health Commission: Guide for family, whānau and friends, 2011).

However, staff need to be mindful that cultural and legal priorities and processes may sometimes override individual choices.

Partner, mother, father, brother, sister, friendMany of us who are family refer to ourselves by the relationship we hold with the person we are supporting. If you are someone’s partner it can

be embarrassing or distressing to be called their mother (or vice versa) by a nurse. Accurately recording the name and relationship of a close family member can help nursing staff prevent this kind of situation from arising.

Natural supportsNatural supports are “sources of support that come directly from people and communities rather than being provided through formal ‘paid’ forms of support” (Michael Kendrick, ww.kendrickconsulting.org).

This phrase encompasses a range of supports available to people including neighbours and pets which are probably not covered by other terms.

Next of kinIn New Zealand there is no legal definition of the expression ‘next of kin’ despite its wide use. The online dictionary meaning is ‘the person or persons most closely related by blood to another person’. Spouses or partners are also generally accepted by services as a person’s next of kin.

In mental health services who you list as your ‘next of kin’ generally has more implications than in other health areas, as that person can end up becoming your ‘principal caregiver’ when Mental Health Act processes come into play. Finding out next of kin contact details and updating these on a regular basis is therefore an important process for nursing staff.

Principal caregiverThe Mental Health Act defines the ‘principal caregiver’ as ‘the friend of the patient or the member of the patient’s family group or whanau who is most evidently and directly concerned with the oversight of the patient’s care and welfare’. This role is deemed by the law to be necessary when someone lacks capacity due to their mental unwellness.

Significant otherThis term is still commonly used in addiction services. The online dictionary definition of ‘significant other’ is:

• a person, such as a spouse or lover, with whom one shares a long-term sexual relationship

• a person, such as a family member or close friend, who is important or influential in one’s life.

CarerThis term is widely used in the disability and older persons sector in New Zealand. Carers UK has defined carers as people who “provide unpaid care by looking after an ill, frail or disabled family member, friend or partner”(www.carersuk.org). At a national and policy level the word ‘carer’ has recently been used generically across health and disability sectors to develop strategies for supporting family members in a caring role (www.carers.net.nz).

However, within a mental health and addiction context the word ‘carer’ is considered to not fit well within a recovery framework. Having a family member care for someone with lived experience of mental health or addiction problems in a fixed ‘carer’ role can make it more difficult for that person to take personal responsibility for their recovery. Service users have indicated that it may be an appropriate term for children/younger adolescents accessing CAMHS (child and adolescent mental health services), but when someone is an adult it does not foster respectful, reciprocal relationships within the family/whanau.

Considering the different terms we all use within mental health and addiction, a recent blog on Changing minds, the service user run organisation’s website, provides some excellent guidance.

“We need more conversations and more flexibility in the terms we use about ourselves and other people… we need to recognise that we are all human and that we all have mental health that needs to be nourished and protected by systems and by our family, whanau, friends, and peers,” (http://changingminds.org.nz/cword-blog/c-word-consumer).

Family Column

Family, whanau terms in mental health and addiction

“Call it a clan, Call it a network,

Call it a tribe, Call it a family.

Whatever you call it, Whoever

you are, You need one.”

– Jane Howard

By Leigh Murray - co-chair National District Health Board (DHB) Family Whanau Advisors and Auckland DHB Mental Health Services family advisor

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Matua Raki update I would like to acknowledge all the addiction nurses who have continued to work tirelessly throughout the Christmas/summer period in helping to keep their services going, providing support for their clients and juggling leave or time away with their colleagues, families and friends. Your contributions are valued.

Prior to Christmas, and since being back at Matua Raki, a number from among the Addiction Nurses’ Stakeholder Group has been working to bring together the next Addiction Nurses’ Symposium. By the time you read this newsletter, the symposium will have been and gone and, if previous symposia are to go by, it will have been a great success.

Whangarei, notably Northland District Health Board and Manaia PHO, worked together as hosts, ensuring these events are easily accessible for nurses in the provinces and not just for those in the main centres. We will continue to use both the provinces and the main centres for these events so keep an eye on the Matua Raki website event calendar www.matuaraki.org.nz/events.

Once again, there were core presentations from Daryle Deering (National Addiction Centre, Otago University, Te Ao Māramatanga New Zealand College of Mental Health Nurses), reflecting on the Addiction specialty nursing knowledge and skills competency framework and the Implementation of advanced practice roles (nurse specialist and nurse practitioner) in addiction treatment: Guidance for service managers and directors of mental health nursing; Louise Leonard (Waikato District

Health Board, DANA) reporting back on the new DANA certification pathway as well as the nurse practitioner pathway; and Sarah Barkley (Lakes District Health Board) on wellbeing theirs and ours (the interaction and implications of the two).

In addition we had local speakers presenting, including:

• nursing supervision by Henriette de Vries and Bart Van Gaalen (Northland District Health Board, Te Ao Māramatanga)

• practice nurse –mental health and addiction credentialing programme by Mary Carthew and John Hartigan (Manaia Health PHO)

• video-conferencing as a training and treatment access tool by Jewel Reti (Northland District Health Board)

• the ABC model for general practice by Agnes Hermans (Manaia Health PHO).

I will report back on this forum in the next edition of Handover.

There is one more thing to note for those considering heading down the nurse practitioner pathway, or who are currently on it. We are reviewing the collegial and peer support that can be offered and would like to set up a regular network for doing this. If you are interested or have some idea about how it may function please email me, klare.braye@matuaraki.org.nz.

Addiction nursing update by Klare Braye, project leader

Mental health, addiction and disability job vacanciesYou’ll find Te Pou and Matua Raki job vacancies on the Te Pou website – alongside a wide range of job ads from the mental health, addiction and disability sectors, updated daily.

There are currently more than 50 vacancies listed, from peer support workers to psychiatrists, leadership roles, nursing positions and other relevant jobs across New Zealand.

www.tepou.co.nz/vacancies

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Acutes project is a regular feature in Handover. Anne Brebner is the clinical advisor at Te Pou. anne.brebner@tepou.co.nz

Acutes project by Anne Brebner

This is the final column in this series about Six Core Strategies© (www.nasmhpd.org/docs/publications/docs/2008/Consolidated%20Six%20Core%20Strategies%20Document.pdf ) which supports reducing seclusion and restraint practices in New Zealand. In the last five editions of Handover I have described each of the six strategies in detail. This column focuses on one of the most difficult of the strategies, debriefing.

As we visit district health boards we discuss the need to focus on debriefing as a chance to rigorously look at what preceded either a restraint or seclusion event, and use that knowledge to try to avoid repeats in the future. Debriefing also gives the staff, service user and family and/or witnesses the chance to mitigate against possible adverse effects of the event.

You will find our newly adapted checklist at www.tepou.co.nz/library/tepou/six-core-strategies-for-reducing-seclusion-and-restraint-checklist. This New Zealand adaptation of the great work done by Kevin Ann Huckshorn at the National Association of State Mental Health Programme Directors allows you to review how your service might be doing in this area, and find some examples of how to implement this strategy.

Like the other strategies, there is emphasis on the involvement of senior management, clinical members and the clinical director in the debriefing sessions. The value is in reviewing without blame and ascertaining where the service can make improvements. Diligence in following up on system changes that can influence a change in practice is a must.

It is worth noting that debriefing on a ‘near miss’ – or an event that previously may have ended in seclusion or restraint but didn’t – is valuable for all staff and

provides useful information to inform improvement initiatives.

Some acute mental health inpatient units have been able to refine this debriefing strategy by using service user leads to debrief service users and then provide feedback to staff. This emerging practice demonstrates considerable innovation and commitment to change.

Reflective practice that allows for growth and change, not blame, will enable staff involved in a restraint or seclusion event to review what

happened. This allows reflection and discussion on what they might do differently next time, what the service may do differently and ultimately how service users may have a different, less restrictive or traumatic experience.

We suggest you download the checklist, have a look at how and where changes can be initiated and begin to work through them.

If you are looking for policies and procedures, please contact us. We can put you in touch with those services that have already developed them and are happy to share. It’s much easier to adapt than develop from scratch.

As we visit services, I often hear about times when seclusion has been avoided using all kinds of innovations. These include excellent de-escalation, use of sensory modulation, use of cultural approaches, ‘fitting’ staff with service user needs and being flexible and responsive to service users.

I hope to compile these into a future column in Handover, so please email me any other stories or even anonymous reflections so I can showcase some of the fabulous acute care we hear about.

Six Core Strategies series©: Strategy six – debriefing techniques

Diligence in following up on system changes

that can influence a change in

practice is a must.

Reflective practice that allows for

growth and change, not

blame, will enable staff involved

in a restraint or seclusion event to review what

happened.

Leadership toward organisational change

Using data to inform practice

Workforce development

Use of seclusion and restraint reduction tools

Service user/consumer involvement in restraint and seclusion reduction.

1. 2. 3. 4. 5.

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The discrepancy between the length of life for people who experience mental health and/or addiction problems and people who don’t has prompted a lot of interest in how we support people to manage their physical health.

I must admit, some of this has had me worried. So much of service users’ lives are lived under observation and analysis already and to subject us to more seemed too much. No other group has as much scrutiny, behaviour or action analysis and judgement as we do. Given that the medications we need also create some of the physical health challenges we end up with I wish there had been more research, information and emphasis on this area when I started taking medication all those years ago.

This new more holistic way of working must be done with sensitivity and practical, do-able and affordable solutions. A lot of people feel a level of shame, humiliation and stigma about things like weight gain, lack of physical motivation, smoking tobacco and high caffeine use alongside what they already feel about having mental health and/or addiction problems. There is often also a lack of understanding that some of these traits are side effects of medication or self-management strategies for dealing with side effects or the mental health and addiction issues.

I recently attended the ‘From treatment silos to a healthy lifestyle approach for comorbidity’ research symposium at the University of Auckland Centre for Addiction Research.

Professor Amanda Baker (University of Newcastle, NSW, Australia) and Dr Peter Kelly (University of Wollongong, NSW, Australia) talked about some initiatives they had trialled with some success using tobacco use reduction as a way of addressing a wider set of health issues for people with mental health and or addiction problems. The session was recorded and will be available on their website, www.fmhs.auckland.ac.nz/faculty/cfar/centre/.

I was really struck with the simplicity and practical nature of their programme. What

stood out for me was how non-judgemental

and easily achievable it was for any person.

It targeted harm reduction for tobacco use

initially rather than overwhelming people with

the expectation of being smokefree. It also

included really simple things like increasing

vegetable and fruit intake and reducing leisure

screen time rather than the D and E words

(diet and exercise) all done in increments

directed by the person. Daily log sheets were

used by people participating to record their

own progress.

The reason I was taken by this so much as I

listened and looked at the presentation was I

found myself thinking, “I could do that, it’s not

scary or overwhelming and it doesn’t feel like a

punishment”. It felt affirming and induced hope.

Less is more it seems. Small incremental steps

to make sustainable life changes are simple,

have quick success and satisfaction rewards and

these can apply to anyone at all; all normal stuff.

The areas that could be added, in my opinion,

were sleep and hydration.

Anyway. I went home, added a couple more

veges to my dinner plate, drank an extra glass

of water and went to bed half an hour earlier

(reducing screen time and increasing relaxation

time) – and felt very smug!

Less is more it seems.

Small incremental steps

to make sustainable

life changes are simple,

have quick success and

satisfaction rewards and

these can apply to anyone

at all; all normal stuff.

Service user perspective by Carolyn Swanson

Isn’t managing my mental health issues, medication and side effects enough? You also want me to diet, exercise and give up tobacco?

Service user perspective is a regular feature in Handover. Carolyn Swanson is a service user lead at Te Pou. carolyn.swanson@tepou.co.nz.

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Professional supervision

Personal view and project update

Developing nursing’s professional practice to respond to changes in how we provide services will require support from both our managers and professional peers.

Supervision plays a key role in nursing practice development and different types of supervision may be required during various stages in our careers. I have come to think more about this lately, during our work on improving service responses to people experiencing co-existing problems, and also about developments to enhance nurses’ knowledge and skills in talking therapies.

To illustrate: if I was returning to clinical practice as a nurse in a new area, which included providing services for people with addiction problems, I would have to consider what types of support and supervision I would need. I may already be engaged in professional nursing supervision which aligns with the Standards of practice for mental health nursing in Aotearoa New Zealand Te Ao Māramatanga (www.nzcmhn.org.nz/Publications/Standards-of-Practice-for-Mental-Health-Nursing).

However, there may also be a need for me to engage in some other type of supervision with a health professional who has experience in addiction work and talking therapies to provide me with more focused supervision to support my practice development. The next step would be for me have a discussion with my manager about how I can access the right types of supervision support to develop my practice and thus have the greatest chance of success in supporting people to achieve recovery and resilience.

This example shows that when we are developing our practice it is useful to identify, adapt and fine tune the support systems we need to enable us to practise professionally.

Access to regular, quality supervision will play a vital role in developing a mental health and addiction workforce with the capabilities and motivation to implement Rising to the Challenge.

The plan explicitly states: “Achieving this will only be possible if staff have the appropriate education, training and supervision to deliver the future services described in the plan and are valued and supported, and if the jobs that people do are sufficiently rewarding to make them want to stay.”

• Supervision is specifically mentioned in the two key workforce development priorities in the plan.

» Primary mental health and addiction workforce: “specify workforce supervision and support requirements along with credentialing expectations for roles specific to mental health.”

» Specialist mental health and addiction (within DHBs and NGOs) workforce development: “developing other roles that require briefer training periods for specific functions, and providing supervision for these from the existing workforce (substitution).”

Te Pou has a number of resources currently available, and some in the pipeline, that support supervision of the mental health and addiction workforce.

Current resourcesThe professional supervision guides for nurses developed by Te Pou in 2011 (www.tepou.co.nz/supporting-workforce/professional-supervision)

continue to be widely used by nurses and services in the sector. The guides provide information for nurse supervisors, supervisees and managers/leaders.

A publication released in 2013, Position paper: The role of supervision in the mental health and addiction support workforce (www.tepou.co.nz/library/tepou/position-paper-the-role-of-supervision-in-the-mental-health-and-addiction-support-workforce) describes how supervision can help the workforce provide safe, effective, quality support for people using mental health and addiction services. This

resource provides examples of supervision programmes among nine services and includes a diagram describing the types of supervision and other professional development activities.

Resources in development Supervision guide for the addiction workforce

Te Pou, Matua Raki and dapaanz are collaborating together to develop a supervision guide to support the particular requirements of the addiction workforce. Paula Parsonage is contracted by dapaanz to lead this project and the new guide will be available later this year.

Mental health and addiction managers’ supervision toolkit – Implementing, reviewing and enhancing your supervision

The toolkit will provide a professionally neutral resource for leaders and managers of interdisciplinary teams and will include tools (such as templates) and recommendations about how to implement review and/or evaluate a supervision programme in the mental health and addiction sector. Anna Nelson from Matua Raki leads this project, which is due for release later this year.

In the next edition of Handover the supervision column will include an article about the role of supervision in a mental health and addiction credentialing programme (www.nzcmhn.org.nz/Credentialing) for primary care nurses in Northland.

“…when we are developing our practice it is useful to identify, adapt and fine

tune the support systems we need to enable us to practice

professionally.”

By Suzette Poole, project lead for professional supervision project

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Le VaNational suicide prevention programme for Maori and Pacific communities launchedwww.leva.co.nz/news/2014/02/05/national-suicide-prevention-programme-for-maori-and-pacific-communities-launching

Waka Hourua is a partnership between Le Va and national Maori health organisation, Te Rau Matatini. It will provide a national voice for suicide prevention in Maori whanau, hapu, iwi, Pacific families and communities.

Le Va feature in Pacific Peoples Health magazine www.pacificpeopleshealth.co.nz/#!about/galleryPage

Le Va was recently profiled in Pacific Peoples Health magazine, where chief executive Monique Faleafa talked about how a strengths-based approach to embracing Pacific solutions and collective responsibility will lead to a greater positive state of mental health among families.

Taeo o Tautai: Pacific public health workforce development implementation plan, 2012-2017. Le Va and the Ministry of Health (2013). www.tepou.co.nz/library/tepou/taeo-o-tautai-pacific-public-health-workforce-development-implementation-plan-2012-2017

In 2007 the Ministry of Health published Te uru kahikatea: The public health workforce development plan which provided a national

strategic approach to public health workforce development from 2007 to 2016. The vision is that inequalities will be reduced and the health of all peoples in New Zealand will be improved through public health and societal strategies.

The more recent Taeao o tautai outlines how the ministry will implement actions to contribute to better health outcomes for Pacific peoples. In particular, Taeao o tautai lists the specific priorities, workforce outcomes, action points, and milestones necessary to achieve this. This plan should be considered in the context of other public health workforce development activities, as it aligns with and complements a range of other actions which are being promoted by the ministry to implement all the objectives of Te uru kahikatea.

Latest publicationsMinistry of Health One way for nurses to keep up with the developments in national policy and health related matters is to link into the Ministry of Health (MOH) website www.health.govt.nz.

Since the last publication of Handover there have been a number of publications released by the MOH which have particular relevance to nurses working in the area of mental health and addiction. These include:

Gambling resource for local government

www.health.govt.nz/publication/gambling-resource-local-government

The Gambling resource for local government assists territorial authorities with their Class 4 (‘pokie machine’) and Totalisator Agency Board (TAB) gambling venue policy reviews.

Suicide facts: Deaths and intentional self-harm hospitalisations 2011

www.health.govt.nz/publication/suicide-facts-deaths-and-intentional-self-harm-hospitalisations-2011

This publication focuses on suicide deaths and self-harm hospitalisations in 2011 and also contains time trend analyses of suicide deaths from 1948 and intentional self-harm

hospitalisations from 1996.

Psychoactive substances: Code of Manufacturing Practice – implementation plan

www.health.govt.nz/publication/psychoactive-substances-code-manufacturing-practice-implementation-plan

The code focuses on making sure all psychoactive products on the market in New Zealand are made to a consistently high standard in clean, controlled environments, and details the quality control requirements for psychoactive substances and products.

Te PouTe Pou publications are available from www.tepou.co.nz/library.• Outcomes and experiences of participants

of the Activity Based Experience (ABE) programme at Richmond Services Limited by Arno Grueber - www.tepou.co.nz/library/research/944.

• ‘Where is my home?’ Exploring perspectives of mental health social workers about homelessness among tangata whaiora in urban Auckland by Shoichi Isogai – www.tepou.co.nz/library/research/942.

Latest editions to ‘Your Stories’ - inspiring initiatives from the mental health, disability and addiction sector

Qualification is just the beginning for Trish McQueen www.tepou.co.nz/story/2013/12/09/qualification-is-just-the-beginning-for-trish-mcqueen

Trish McQueen has just completed the National Certificate in Health Disability and Aged Support (Foundation Skills) and is already aiming for more.

Successful self-advocacy training for people with Down syndrome www.tepou.co.nz/story/2013/12/09/successful-self-advocacy-training-for-people-with-down-syndrome

The New Zealand Down Syndrome Association supported 11 people with Down syndrome to undertake self-advocacy training, funded through Te Pou’s consumer leadership development grant. The training was hugely successful and the participants have now been appointed to the self-advocacy group STRIVE.

More at www.tepou.co.nz/stories

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Mental Health Nursing, Vol. 34, No. 12, December 2013

Participant satisfaction with Wellness Recovery Action Plan (WRAP). Jessica M Wilson, Sadie P Hutson and Ezra C Holston.

Physical health inequities in people with severe mental illness: Identifying initiatives for practice change. Colleen Cunningham, Kathleen Peters and Judy Mannix.

Abused South Asian women in westernized countries and their experiences seeking help. Deborah Finfgeld-Connett and E Diane Johnson.

Journal of Mental Health, Vol. 22, No. 6, December 2013: 467-47

Physical activity and mental disorders: A case-control study on attitudes, preferences and perceived barriers in Italy. Bernardo Carpiniello, Diego Primavera, Alessandra Pilu, Nicola Vaccargiu and Federica Pinna.

Life satisfaction in people with post-traumatic stress disorder. Thanos Karatzias, Zoë Chouliara, Kevin Power, Keith Brown, Millia Begum, Therese McGoldrick and Rory MacLean.

Mental health service use one year after China 5.12 earthquake: Relationship with post-traumatic stress disorder among survivors. Jiuping Xu and Yanfei Deng.

The impact of exercise projects to promote mental wellbeing. Estelle Malcolm, Sara Evans-Lacko, Kirsty Little, Claire Henderson and Graham Thornicroft.

Carers of forensic mental health in-patients: What factors influence their satisfaction with services? Douglas Macinnes, Dominic Beer, Kelly Reynolds and Catherine Kinane.

A survey of mental health professionals’ knowledge, attitudes and preparedness to respond to domestic violence. Sarah Nyame, Louise M. Howard, Gene Feder and Kylee Trevillion.

Journal of Psychosocial Nursing and Mental Health Services e-contents December 2013

The choking game: A risky behavior for youth. Brandy Mechling, Nancy R Ahern and Teena M McGuinness.

Journal of Psychiatric and Mental Health Nursing Volume 21, Issue 1 Pages 1 - 96, February 2014

Mental health nurse prescribing: Using a constructivist approach to investigate the nurse–patient relationship (pages 1-10). J D Ross, A Clarke and A M Kettles.

A systematic review of nurse physical healthcare for consumers utilizing mental health services (pages 11–22). B Happell, C Platania-Phung and D Scott.

Recovering from childhood sexual abuse: A theoretical framework for practice and research (pages 69-78). Z Chouliara, T Karatzias and A Gullone.

Nursing care complexity in a psychiatric setting: Results of an observational study (pages 79-86). C Petrucci, G Marcucci, A Carpico and L Lancia.

Mental Health Nursing Vol. 35, No. 1, January 2014

A recovery-oriented alternative to hospital emergency departments for persons in emotional distress: “The living room”. Mona M Shattell, Barbara Harris, Josephine Beavers, Stella Karen Tomlinson, Lauren Prasek, Suja Geevarghese, Courtney L. Emery and Michelle Heyland.

Mental health nursing in Australia: Resilience as a means of sustaining the specialty. Michelle Cleary, Debra Jackson and Catherine L Hungerford.

It’s the anxiety: Facilitators and inhibitors to nursing students’ career interests in mental health nursing. Brenda Happell, Chris Platania-Phung, Scott Harris and Julie Bradshaw.

Patients’ and family members’ experiences of a psycho-educational family intervention after a first episode psychosis: A qualitative study. Liv Nilsen, Jan C Frich, Svein Friis and Jan Ivar Røssberg.

International Journal of Mental Health Nursing Volume 23, Issue 1 Pages 1 - 98, February 2014

Consumer involvement in the tertiary-level education of mental health professionals: A systematic review (pages 3-16). Brenda Happell, Louise Byrne, Margaret McAllister, Debra Lampshire, Cath Roper, Cadeyrn J Gaskin, Graham Martin, Dianne Wynaden, Brian McKenna, Richard Lakeman, Chris Platania-Phung and Helen Hamer.

Released potential: A qualitative study of the Mental Health Nurse Incentive Program in Australia (pages 17-23). John Hurley, Graeme Browne, Richard Lakeman, DoRhen Angking and Andrew Cashin.

Perceptions from the front line: Professional identity in mental health nursing (pages 24-32). Gylo Hercelinskyj, Mary Cruickshank, Peter Brown and Brian Phillips.

Treatment of post-traumatic stress disorder in patients with severe mental illness: A review (pages 42-50). Linda Mabey and Gwen van Servellen.

Trauma-informed care in inpatient mental health settings: A review of the literature (pages 51–59). Coral Muskett.

Psychosocial Nursing and Mental Health Services e-contents, January 2014

Users of mental health services as peer support providers and research collaborators. Richard Humm and Alan Simpson.

Adding SUGAR: Service user and carer collaboration in mental health nursing research. Alan Simpson, Julia Jones, Sally Barlow, Leonie Cox, Service User and Carer Group Advising on Research (SUGAR).

Evaluating the selection, training, and support of peer support workers in the United Kingdom. Alan Simpson, Jody Quigley, Susan J Henry and Cerdic Hall.

Promoting wellness of peer providers through coaching. George H Brice, Margaret A Swarbrick and Kenneth J Gill.

Journal articlesNursing digest:

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