Integrated Care Within New Zealand’s Specialist Mental Health and Addiction Services: Qualitative Research to Inform a New Model

Internationally, and within New Zealand (NZ), specialist mental health and addiction service-users (SMHAS-users) experience increased risks of comorbidities and premature mortality, and poorer health outcomes, compared to the general population. In particular, Indigenous Māori SMHAS-users face significant inequities compared to non-Māori. Integrated care has been found to improve outcomes by improving quality and coordination between services. This research aimed to develop a model of integrated care relevant to SMHAS-users in a NZ context, to inform the development of a questionnaire intended to assess SMHAS-users experiences of integrated care, support SMHAS to improve their services, and in turn, improve outcomes for SMHAS-users. Key informants working for, and/or with lived experience of, SMHAS were interviewed about existing integrated and people-centred care concepts. Barriers to integration were identified. The team met frequently to review and discuss coding, themes, and model development. Ten informants from across NZ were recruited, including five with lived experience of mental distress, and three who were Māori. Singer et al.,’s (Medical Care Research and Review, 68(1), 112–127, 2011) integrated patient care framework and the World Health Organization’s (2016) concept of people-centred care were found to be acceptable, although people-centred constructs were needed more clearly at a model’s core. SMHAS-user controlled funding and participation in multi-disciplinary team meetings were identified as key opportunities alongside other concepts such as cultural responsiveness, de-centralising services (to re-centralise people), and peer navigators. The resulting People-Centred Joined Up Care (PCJUC) model is proposed to convey a paradigm shift from a service-centric system, organised around the efficiencies and needs of services, to a people-centred system. Irrespective of the health workforce’s best intentions, the current service-centric orientation does not empower SMHAS-users. A people-centred model requires power structures to be inverted and the paramount authority of health professionals as the ‘decision-making experts’ to be challenged. Research is now underway exploring the use of a questionnaire developed to measure the concepts within the PCJUC model, to inform service improvements.