No:4
SEPTEMBER 2003
Homicide rate falls with
community mental health care
* Defined in the report as not guilty by reason of insanity, unfit to stand trial, Section 118
of the Criminal Justice Act and infanticide.
Be a Pacific person with a difference
Encouraging Pacific people to train and work in mental health services is the
aim of the Commission’s most recent Pacific project.
Commission chair Jan
Dowland says that more
Pacific people are desperately
needed to train and work in
Pacific mental health services.
INSIDE: “Pacific mental health
services provide support and
treatment for Pacific people
who are mentally unwell.
They are based on Pacific
models of health and Pacific
beliefs and values. They focus
The arguments for a return to
institutional-type care in the interests of
public safety have been blown out of
the water by a New Zealand report on
mental illness and homicide, according
to Commission Chair Jan Dowland.
The report shows that personal or public safety with
there was a decline in the the move to community
proportion of homicides care,” says Jan.
committed by people with a
serious mental illness in the The report called
30 years since the transition “Myth and Reality: the
from institutional care to Relationship Between Mental
community care in New Illness and Homicide in New
Zealand. Zealand”, was produced by
Auckland Uniservices for the
“The report confirms what Mental Health Research and
the mental health sector has Development Strategy.
suspected for many years –
that there is no need for the » continued over
public to be concerned for
on providing for Pacific using Pacific networks, and
people in culturally working with training and
appropriate ways,” says Jan. education providers.
To encourage Pacific people The most recent survey of
to consider training, the Pacific mental health workers
Mental Health Commission was undertaken in 1999.
is running advertisements It showed that around 175
on Radio 531PI and NiuFM Pacific staff from various
for a month starting in mid ethnic groups worked in
September. The campaign mental health services. At 2.5
also involves advertising percent of the mental health
in Pacific publications, workforce, Pacific people are
» continued over
 Editorial
by JAN DOWLAND, Chair, Mental Health Commission
It is invaluable to have the
opportunity to look at how other
nations are responding to the
challenges in mental health and
to use those learnings to reflect on
where we are going in New Zealand.
I was privileged to attend the
inaugural conference of the
International Institute of Mental
Health Leaders (IIMHL) in the UK
in June. As part of that event Mary
O’Hagan and I spent several days with
the team at the London Development
Centre. The London Development
Centre is one of eight regional
development centres established as
part of the new National Institute for
Mental Health in England (NIMHE).
The aim is to help those involved in
mental health to implement change
and provide a vehicle for supporting
learning and development. The idea
is to create a strong and focused
approach to service improvement
over and above that which a single
organisation or agency could achieve.
« Homicide rate falls with community mental health care/continued
Every solved homicide in New
Zealand between 1970 and 2000 was
investigated in the study.
“This report gives us hard evidence
for the first time in New Zealand that
over a 30-year period the proportion
of homicides committed by people
with a serious mental illness has
fallen,” says Jan.
This work is also internationally
significant as it is only the second
study in the world that examines a
comprehensive range of data showing
time-trends on this issue. Some of the
key findings were:
2
Projects are generated in response to
needs identified by stakeholders and are
carried out in collaboration with them.
The focus is on practical interventions
that give front line staff the time and
tools to improve things. One of the
major projects is looking at acute
inpatient services and identifying
with front line workers what needs to
happen to ease the current crisis.
In New Zealand we currently have
a number of national and regional
organisations with some responsibility
for development and service
improvement in mental health.
There are the Regional Networks and
while they have had a predominantly
planning function it is interesting to
see how, in some places, the work
programme is evolving to include
development projects directed at
supporting services in practical ways.
Platform is a key player in the NGO
sector and plays a critical role in
supporting the development of
the NGO sector. Its standards in
action project is a good example of a
development initiative directed towards
service improvement.
In New Zealand we have a Mental
Health Research and Development
Strategy (MHRDS), which is action
– mentally abnormal homicides
comprised 8.9 percent of all
homicides in the 30-year period
– across the period studied, mentally
abnormal homicides fell as a
proportion of total homicides from
around 20 percent in 1970 to six
percent in 2000.
“The research undertaken for this
report is very important research. While
the homicide rate in New Zealand has
increased, the rate of homicide by those
with serious mental illness has remained
static at 0.13 per 100,000 population
per year,” says Jan.
and development orientated. More
recently we have seen a Workforce
Development Programme (MHWD)
established.
The Commission itself, while charged
primarily with a monitoring role, also
aims to make a contribution to sector
development and service improvement.
Last but not least there is significant
amounts of service development work
carried out locally in DHB and NGO
services.
It has been good to see, in recent
times, much greater sharing between
all these players and much closer
alignment of work programmes. In a
small country like New Zealand we do
not need to create the bureaucracies
and structures favoured by our
larger neighbours to achieve goals of
consistency and coordination. It is
easy for us to all talk to each other
and achieve the same goals through a
strong working relationship.
However, it might be worth thinking
about a development model for mental
health that links national, regional
and local initiatives and start talking
about how the central players (MHC,
MHRDS and MHWD) fit into that
framework – just a thought!
Jan Dowland
“Every homicide is a tragedy.
However, it is good to have research
that sets out the facts and dispels
myths and anxieties around those with
mental illness.”
The authors of the report were
Dr Sandy Simpson, Brian McKenna,
Dr Andrew Moskowitz, Dr Jeremy
Skipworth and Dr Justin Barry-Walsh.
A full copy of the 72-page report
can be downloaded from the
Health Research Council’s website
www.hrc.govt.nz.
« Be a Pacific person with a difference/continued
significantly under-represented in the
mental health workforce compared to
their representation in the population
as a whole,” says Jan.
Jan says that a relatively new role in the
mental health sector, the mental health
support worker, requires just one year’s
full time training and is a good way to
get into mental health services.
Mali Erick, Senior Community
Support Worker with Lotofale, agrees
that more Pacific mental health
workers are needed and that training
as a Community Support Workers is a
good way to start.
“It provides opportunities to work
in other areas such as counselling,
nursing, management, health
education or health promotion,” says
Mali.
“The Pacific mental health service
is very different to mainstream
services. Being a Pacific CSW makes
a difference to consumers because we
focus on the total wellbeing of the
individual and their families, rather
than on the mental illness. I love being
able to make a difference to the lives of
Pacific people. It’s a great job.”
Mali says that Pacific CSW will often
sit down and meet the family.
Tribute to Maria de Silva
Maria de Silva made a big
contribution towards raising
awareness and understanding
of borderline personality
disorder, according to Mental
Health Commissioner
Mary O’Hagan.
“Maria’s contribution to raising
awareness of BPD was immense. We
have a great deal to thank her for.”
Mary says that she met Maria
through her work in establishing the
Christine Whittle Memorial Charitable
Trust. This trust aimed to support
people suffering with borderline
personality disorder (BPD) and was
named after a woman with BPD who
died last year.
“It’s about working together. During
family meetings we give the family
the opportunity to decide how they
want the meeting to be conducted,
for example, opening and closing it
with a prayer. If a person wants to be
connected to the church again we will
take them to church and support them
until they can manage going on their
own.”
The theme of the Commission’s
campaign is “Be a Pacific Person
with a difference….Work in mental
health services with our people, our
community and make a difference.”
If you are interested in information
on education and training for mental
Maria was setting up a network of
BPD support groups offering weekly
gatherings and featuring guest speakers
such as doctors, pharmacists and
psychologists, as well as input from
BPD sufferers. She had put enormous
effort into publicising the Trust and
raising funds.
Maria had spent many years helping
other people, some of that time with
Bosnian and Croatian refugees in the
former Yugoslavia. She spoke several
languages and was studying for a
degree in psychology and philosophy at
Auckland University.
“With Maria’s death we have lost
a very caring and talented New
Zealander,” says friend and chairperson
of the Trust, Raewyn Biel.
health services phone the Commission’s
information line 0800 30 4444.
It falls at the same time as the Pacific
Mental Health Workforce Awards,
established by the Ministry of Health
and administered by the Health
Research Council. These awards
are open to Pacific people enrolled
in a qualification such as health
management, mental health nursing,
occupational therapy, psychology and
mental health research.
Applications close on 1 October 2003.
Information is available from
the Health Research Council,
www.hrc.govt.nz, PO Box 5541,
Auckland.
“Maria was definitely a person on a
mission. Since being diagnosed, Maria
had many ups and downs, however
in helping to form the Trust she was
trying to fill a huge gap for herself and
many fellow sufferers.
“As the chairman of the CW Trust,
along with my fellow board members,
we will miss Maria’s drive and input
tremendously. The trust is even more
determined now to get these support
groups up and running as soon as
possible,” says Raewyn.
3
CONFERENCE
UPDATES
The Psychology of Psychosis – this
is a satellite conference following on
from the International Symposium
for the Psychological Treatment of
Schizophrenia and other Psychoses.
It will be held at the University of
Auckland on 29 and 30 September
2003 and includes speakers from the
United Kingdom, the United States
and others who made presentations
to the Melbourne conference. The
Commission is sponsoring Courtenay
Harding’s presentation. Contact: John
Read, j.read@auckland.ac.nz. The cost
is $150 for one day and $250 for two
days.
Acute mental illness – specialised
treatment in the in-patient setting
– this national conference is for
professionals working in or interested
in the area of adult in-patient acute
care. It runs on 1 and 2 December
2003 in Christchurch. For more
information contact Georgina Brooks,
Christchurch School of Medicine and
Health Sciences, ph: 03 372 0402, or
email georginabrooks@chmeds.ac.nz.
Borderline personality disorder
national conference – November
6 and 7, 2003. To be held in
Christchurch, the conference aims
to build on the achievements already
gained and further improve treatment
of BPD. The theme is Gathering
Momentum: developing effective services
for BPD. For information contact
Lynley Coburn at Canterbury DHB
phone (03) 363 1950.
Cross-cultural counselling
– an Asian perspective – 23 and 24
October 2003. One of the keynote
speakers for this conference is
Beven Yee, a Commission policy
analyst. The organisers say that
many of the issues canvassed in the
Commission’s Mental Health Issues
for Asians in New Zealand will be
addressed at the conference.
For information contact
Assured Directions, admin@AssuredD
irections.co.nz or phone 09 638 3463.
4
Being culturally appropriate
the deaf way
Auckland’s Deaf Mental Health Service is leading
the way in making mental health services culturally
appropriate for deaf people.
A recent New Zealand Health
Innovations Awards finalist, the service
is the first in New Zealand to provide
mental health services specifically
for deaf people. They are currently
contracted to service a region that
stretches from Auckland to Tauranga,
according to team leader, Linda Hall.
The need for the service was first
identified in research undertaken
amongst the deaf community in 1999.
This research was lead by psychologist,
Dr Jeff Bridgman, who assembled a
team of deaf people to research their
mental health needs.
“Through this research it was found
that there was a greater need than in
the hearing community for mental
health services. The Deaf Association
had set up a Mental Health Steering
Committee to lobby on this particular
issue and this research helped them
in their lobbying with the Ministry of
Health for the contract that our service
now has,” says Linda.
It is estimated that there are 8,000
people in New Zealand who were
born profoundly deaf or who became
deaf before the age of five. The rate of
mental illness amongst them is very
high with 45–49 percent of deaf people
at risk of mental illness.
The fact that deaf people need more
mental health support than other
sectors of the population is partially
due to the social isolation they face
within the hearing world.
However, deaf people have traditionally
faced barriers in accessing mainstream
mental health services – the main one
being the cultural inappropriateness of
mainstream services.
–
BY Chris Ford
This is because New Zealand
Sign Language (NZSL) is the deaf
community’s first language. As a
result, deaf people may use English as
a second language and as most health
services are delivered in the primary
language of the hearing world, many
are not able to access them without
interpreter support. This extends to
mental health services where the ability
of a deaf person to be understood
when seeking treatment is not aided
by the fact that there are few, if any,
signing mental health professionals.
Even form filling can be difficult as
Linda states that many deaf people
“cannot read to the same level as
hearing people. Some of our clients
can’t read at all.”
This is as a result of over 100 years of
“Oralism” from 1880 – 1990 where
deaf children were banned from using
sign language and had to try and lip
read and speak in parrot fashion. As
a consequence most left school with
minimal education.
It was these and other issues that lead
to the formation of the Deaf Mental
Health Service in 2001. The service
currently employs four staff – two
fulltime deaf mental health support
workers, one community and team
support worker, and Linda as team
leader.
The service aims to make it easier for
deaf people to access mental health
services through, amongst other things,
ensuring that the service only employs
staff who are fully fluent in NZSL and
have a strong understanding of deaf
history and culture. This cuts out the
need for interpreters, as deaf people are
often reluctant to talk about their
feelings when a third person is present.
Therefore, the ability for clients to
also express themselves in their own
language and to be able to complete
forms written in simple language has
enabled staff to more clearly identify
what their issues are.
Linda explains that through working
alongside clients towards this end, they
often find that “after three months
they may not have a psychiatric
diagnosis but during those months
working with people, we can explain
what mental illness is . . . as they don’t
have the destigmisation literature
(such as the ‘Like Minds, Like Mine’
campaign) available to them in
accessible language formats. They
simply don’t have access to this kind of
information.”
For those who either acquire a
diagnosis or need further counselling,
the Deaf Mental Health Service can
assist people to access psychiatric
assessment services. They can
Advance Directives Workshops
Ten workshops for service users on
advance directives, crisis plans and
powers of attorney were held in
June.
Delivered by Treena Martin (through
Case Consulting), and funded by
the Mental Health Commission, the
workshops covered issues such as how
to develop advance directives, crisis
plans and powers of attorney, what
are the differences between them, and
what are their pros and cons.
Case Consulting Director Sarah
Gordon says that the workshops
aimed to provide participants with
the opportunity and support to begin
work on the development of their
own advance directive, crisis plan and
power of attorney material.
“These types of documents can be of
huge value to consumers in terms of
having a sense of control over their
treatment. Forward planning and
anticipation of potential difficult issues
also assist clients to investigate
community employment/training
options or reconnect them to the deaf
community.
Overall the service has been successful
in achieving positive outcomes for
clients and their families.
“We’ve exited a lot of people from the
service but from surveys, the most
common theme is that for deaf people also a recipient of a Mental Health
and their families, communicating Award at the recent Building Bridges
with a support worker has been really Conference as promoting the idea that
therapeutic. It’s been a really positive the Deaf Mental Health Service “is
step for that person to communicate something unique.”
with a support worker, explain their
frustration, and what their support After all this success, the Deaf Mental
needs are and get them met. For Health Service is looking outwards
families, it was brilliant to have a with hopes for a national service.
service for them to communicate This has moved one step closer with
with the deaf client and hear what the recent awarding of a Wellington
they were trying to say for a long contract.
time.”
With the service now established, deaf
Linda sees being a finalist in the people can now look forward to a
Health Innovation Awards and better deal from the sector.
well received
can help people to feel more relaxed
and in control of situations where
previously they may have had little
input,” says Sarah.
“A couple of people have already
spoken to me about developing and
implementing their own advance
directive. Just going through that
process can provide people with a
feeling of taking charge of their own
direction and treatment.”
The workshops were attended by
126 service users from around New
Zealand. The majority said that the
workshops were very helpful and well
presented.
The Commission has received requests
from clinicians for a workshop on how
they can assist service users to prepare
advance directives, crisis plans and Commissioner have produced a
power of attorney. The Commission is brochure about advance directives,
investigating the best way to do this. which can be downloaded from
www.mhc.govt.nz.
The Mental Health Commission
and the Health and Disability
5
 ‘Recovery through partnership’ –
Framework’s Personal Development Service
The Auckland-based Framework Trust’s Personal Development
Service aims to deliver “recovery through partnership.”
It was this philosophy that recently
drove the trust to nominate itself for a
Health Innovation Award, according
to Service Training and Development
Coordinator, Heather Menzies.
The origins of the Service are that it
“grew out of a desire for service users
to further their own personal and
professional development. Initially
it was under a social and recreation
contract and, therefore, it covered
a variety of activities and initiatives
for mental health service users,” says
Heather.
The sense of consumer ownership
of the Service is reflected in the fact
that it was the consumers themselves
who chose to call it a ‘Personal
Development Service’ rather than
the ‘Social and Recreational Service’,
says Heather. The need for personal
development is reflected on the
ground where staff work alongside
service users “who are on their
recovery journey.”
Underpinning all programmes is the
‘Progressive Pathway’ model. As the
Framework website states it “promotes
collaborative learning needs profiling,
self-assessment and evaluation and
meaningful progression,” for all
service users.
6
The progressive pathways model assists
clients in three key areas of social
recreational rehabilitation – their life
skills, personal development and pre
vocational skills –- and potentially
gaining employment and further
education as well.
The Service chose this model “after
much reflection that the Service wasn’t
really hitting the mark. The bottom
line is that Framework Trust always
asks ‘what can we do better?’” Heather
admits that the change to the model
involved some risks as they were
closed for two weeks before the new
programmes were introduced.
The risk seems to have been well
worth taking as the new approach
offers service users something better
in terms “of ensuring that social
and recreational pursuit provides for
meaningful (personal) progression as
the Service is outcome focused and
forward looking. It looks at how the
Service is going to support users to live
in their communities of choice – that’s
what we’re about.”
In practice, this means that clients
begin their learning journey by
completing a Learning Needs Profile
where they talk with staff about their
“lived experience with learning and
change.” The whole process is designed
around identifying what the learning
interests and needs of the client are, as
expressed in their own words.
From there, they choose the “learning
path” of their choice. This may
mean, for example, that if there
is the demand, a programme co-
ordinator is contracted to conduct
an “Introduction to Floristry” course
by Chris Ford
for those who are interested in flower
arranging. This course (as are others)
can be aligned to New Zealand
Qualifications Authority (NZQA)
Units giving clients the option of
earning some credits towards a
National Certificate. However, the
courses offered are still viewed as social
and recreational programmes as the
Personal Development Service is not
officially recognised as a training or
education provider.
The Service is always seeking out
partnerships with mainstream training
providers, as it has been doing
recently with Auckland University of
Technology (AUT), to work towards
placing service users in open learning
environments, if they choose.
Throughout this whole process, service
users can measure their learning
achievements. They undergo a pre-
test to examine what prior knowledge
they have about a certain area and
then at the end of each course a post-
test is conducted to ascertain what
further knowledge and skills they have
acquired. The programmes offered by
the Service are delivered on a school
term basis and each person’s profile is
evaluated after every term of learning.
As Heather emphasises, this process
“enables clients to feel that they’re
succeeding.”
Therefore there have been “some
fantastic outcomes” for clients who
have gone through the Service. “One
young woman went out and gained a
Skill Enhancement Scholarship from
the Tertiary Education Commission
and is now undertaking a bachelor
degree course. Other service users
have gone on to do National
Certificates in Mental Health while
others have moved into outside full
time employment. Even some former
service users have been contracted

back to Framework to deliver programmes. In fact, we intend
to employ more service users as that’s the direction we want to
head.”
These and many other success stories have spurred the Service
forward. This has meant that the Service has been happy
to share its experiences with other mental health providers.
This information sharing has occurred at forums such as the
2003 Building Bridges conference. According to Heather, the
interest shown by other service providers in their pioneering
approach has been “very pleasing.”
As a result, there could soon be more service users taking the
road to “recovery through partnership” around the country.
For more information contact Heather Menzies, Framework
Trust Training and Personal Development Team Leader,
09 815 5126, 8–14 Kingsland Terrace, Kingsland, Auckland.
Introducing the people that keep
the Mental Health Commission
ticking over – the admin team.
From left to right – Iona Collin the office assistant,
Evelyn Kupenga, receptionist, Salevasa Faifai
executive assistant to the programme manager,
Mey Chan who manages the accounts and
Sue Shotter the administration manager.
SNIPPETS
Commission website keeps growing
Look on www.mhc.govt.nz. These papers have been added
to the Commission’s website in the last couple of months.
Stakeholder Dialogue Report: One of the many barriers that
mental health service users face in their journey to reclaim
their lives is the attitudes, values and beliefs of the people
who work with them. Stakeholder dialogues are intended
to improve the quality of services by developing a shared
understanding between key stakeholders of the points of
view and experiences of each of them within the current
mental health system.
The Stakeholder Dialogue Report describes dialogues held
in Nelson and Auckland. It explains how to run a dialogue,
the key messages from the dialogues and feedback from
family/whanau, clinicians and service users. Download it
from www.mhc.govt.nz
Occasional Paper 3 - Asian Mental Health Recovery
– Follow-up to the Asian Report: This occasional paper
analyses government initiatives and Asian community
responses to the recommendations in the full report. It
introduces an Asian cultural perspective on recovery.
The experience of four women
A thesis has been written that present the findings of a
study into the experiences of four women inpatients at
the Mental Health Unit in Invercargill. Called “And there’s
the Likes of Me” it was prepared by Jude Vermeulen,
Nurse Researcher at Southern Institute of Technology. The
completed thesis is available in the libraries of Victoria
University of Wellington and the Southern Institute of
Technology.
Mark Smith
In the last issue we incorrectly said that Mark Smith, New
Zealand’s first mental health nurse practitioner, worked for
Waitemata DHB. In fact, he works for Waikato DHB.
Depression gene
A ground-breaking Otago-based study provides new
evidence of how genes and environments interact. A team
of researchers from the University of Otago, Kings College
London and the University of Wisconsin have found that a
variation in a specific gene can be used to predict whether
major life stress will lead people to develop depression.
The study found that only 17 percent of participants with
the long version of the gene developed depression despite
experiencing multiple events over a five-year period such
as a death in the family, losing a job or breaking up with a
partner.
This contrasts with the 43 percent of participants with the
short version who went on to develop depression.
For more information go to www.otago.ac.nz/dmhdru/
7

UPDATE on
translating the
Blueprint resource
guidelines
The Blueprint project is
focusing on two DHBs,
Tairawhiti and Taranaki, in
order to provide the sector
with practical advice on the
Blueprint’s application in the
DHB environment.
Project Manager Gaylia Powell
says that for Tairawhiti the
initial desktop assessment
and on-the-ground work
are complete. Two open
meetings, attended by more
than 30 people, were held
to check out the findings of
these assessments with the
stakeholders.
“As part of this exercise we are
tackling two questions. What
does implementation of the
Blueprint mean in a small
DHB like Tairawhiti? And how
can the mental health services
of a small DHB serve 3% of its
population?
“We are now completing the
analysis and writing up our
findings and observations from
Tairawhiti. We expect a report
to be completed by the end of
September,” says Gaylia.
The Taranaki work is being
undertaken in tandem with the
Tairawhiti work. A draft report
is due in September.
“We may need to talk with
some of the stakeholders
in Taranaki, as we did in
Tairawhiti, particularly looking
for implications of the greater
population size and different
population mix.”
Keeping the sector up to date on
what’s happening at the Mental
Health Commission ...
The overall objective of workplan is to contribute to the
Mental Health Commission’s strategic goals:
– Strong inclusive communities
– Strong mental health workforce
Objective:
To fulfil MHC’s primary function of advising
the Minister on the performance of the mental
health sector.
Key activities:
– DHB and other service visits
– Annual report on progress
– Expenditure review
– Quarterly vacancy and access monitoring
– Privacy review
– Audit and advice on Maori cultural
assessment
– Follow-up of ringfence project
– Consumer and family focus groups
– PHO developments
– Uptake of recovery competencies
– Initiatives for Asian people
– Monitoring Ministry of Health
• Stocktake of anti-discrimination activities
• Personal costs of participation in
anti-discrimination programmes
• Identifying systemic features of recovery
• Research into the use of seclusion
• Evaluation of home-based treatment
• Compulsory interventions in mental
health services
• Workplan for Maori
• Workplan for Pacific people
• Workplan for families
– Strong effective mental health system
– Strong service users
Objective:
To facilitate greater understanding of the
experience of mental illness, and of the mental
health sector, to diverse audiences from
perspectives of all key players.
Key activities:
– Producing fact sheets, occasional papers,
newsletters and other resources
– Anti-discrimination CD Rom
– Pacific people workforce project
– Booklet “Getting the most out of services”
– Media training for service user spokespeople
– Ongoing media monitoring/liaison
– Website maintenance and development
– Briefing a range of stakeholders
• Making the case for consumer-led services
• Strategic overview of vocational/
employment policy
• Impact of macro labour market environment
• Translating the Blueprint
• Alcohol and other addiction services
• Older persons with mental illness
• Maternal mental health
• Acute inpatient units
• Child and youth services

How to contact us
Phone: 04 474-8900 from within New Zealand PO Box 12479, Wellington, New Zealand
0064 4 474-8900 from outside New Zealand
6th Floor, Lumley House,
Fax: 04 474 8901 93 The Terrace,
Email: info@mhc.govt.nz Wellington, New Zealand
Website: www.mhc.govt.nz