Survey of people who use mental health and addiction services offers insights for service improvement

A survey about people’s experiences using mental health and addiction (MHA) services has found many people felt they were treated with respect and things were well explained to them; but that their cultural and spiritual needs were not always met.

The Ngā Poutama consumer, family and whānau experience survey was carried out as part of the Health Quality & Safety Commission’s MHA quality improvement programme. The first national survey of its kind, it was completed by people recently discharged from district health board-provided inpatient or community MHA services.

The Commission coordinates the sector-led national MHA quality improvement programme. This work has a strong focus on partnership with people with lived experience, their families and whānau, and on Māori health advancement.

Programme kaumātua and clinical advisor Wi Keelan says the experience of consumers is an important indicator of health care quality, and a vital information source for quality improvement.

The survey gives us a snapshot of consumer, family and whānau experiences, which can be used to help providers improve the quality of MHA services. It complements the findings of the Ngā Poutama staff survey, which was conducted in August 2018 and focused on the quality and safety culture of these services. Together, the surveys allow for comparisons of staff and consumer perspective.

'Thank you to the consumers, families and whānau who participated in this survey, and to all the district health board staff who supported the fieldwork.'

The survey included 25 questions about people’s experience with MHA services, such as:

• whether consumers, family or whānau members were treated with respect
• whether their cultural needs were respected
• whether staff explained things in a way that was easy to understand, and
• whether consumers’ values and beliefs were incorporated into care/support plans.

It was carried out between September and November 2019 and responses were received from 267 people. Although the response rate was lower than desired, results align with similar surveys internationally as well as the He Ara Oranga report and have real value for quality improvement, Mr Keelan says.

Findings

The most people who responded to the survey gave a positive response for:

• being treated with respect (59 percent)
• staff explaining things in a way that was easy to understand (59 percent)
• being able to have a support person present during sessions with staff (53 percent).

The fewest people gave a positive response to questions about their cultural and spiritual needs being met:

• staff using te reo Māori during sessions, as appropriate (14 percent)
• access to traditional Māori healing practices, as appropriate (15 percent)
• access to kaumātua, kuia or other cultural advisors, as appropriate (18 percent).

Other low-scoring questions related to access to peer-support staff (24 percent) and staff communicating well with one another (37 percent).

The survey included an exploratory question about the experience of harm while using MHA services. Each person answering this question defined for themselves the meaning of ‘harm’. Some participants experienced aspects of their care/support as harmful. The most common type of harm experienced was emotional or psychological harm (59 people; 22 percent). People who reported harm also reported a less positive experience across most other questions.

The Commission has a programme focusing on learning from adverse events and consumer, family and whānau experience of review processes in mental health and addiction services. It will be working with the sector to consider the implications of these findings and investigate further.

People who had used community-based services were more positive about their experience across many questions, compared with people who had used inpatient services; and older people reported a more positive experience across most experience questions compared with younger consumers.

Mr Keelan says the next step is for the mental health and addiction sector to translate the survey results into real service improvements for consumers, families and whānau.

'The MHA programme team is here to support the sector in this work. For example, at the request of several DHBs, implicit bias training tools tailored to the needs of the MHA workforce in Aotearoa New Zealand are being developed. These tools help staff recognise and address their own implicit biases and the impact of these biases on care provided to tāngata whaiora Māori and others.'

He says tools and training to improve involvement and knowledge of co-design and other aspects of providing a quality MHA service are also being developed.

These tools help staff recognise and address their own implicit biases and the impact of these biases on care provided to tāngata whaiora Māori and others.'

He says tools and training to improve involvement and knowledge of co-design and other aspects of providing a quality MHA service are also being developed.

Reports from Ngā Poutama: consumer, family & whānau experience are available to download from our website.

Note

A total of 267 people took part in the Ngā Poutama survey. The estimated consumer response rate was 3.3 percent, which was lower than expected. There has been feedback about shortcomings in the survey planning and methodology. After the survey period ended, staff from the Commission held debrief sessions with leaders from DHB MHA services to understand their specific challenges and hear their ideas to improve future versions of the survey.

We acknowledge the survey process could have been improved and have learned from this experience. Despite these challenges, the survey results have considerable value in informing quality improvement work, and the 267 voices of those who took part contain important messages for everyone in the MHA sector.