10years Celebrating - Te Pou

10years Celebrating - Te Pou
Special 40th issue - September 2017

Mental health and addiction nursing newsletter

         Celebrating                                                    Reflections from
                                                                         Anna Schofield,

         10  years
                                                                       founding editor of
                                                                                          Page 2

                                                                     Mental Health
                                                               Nursing Framework –
                                                               Helen Hamer reflects
                                                                                         Page 16

                                                                             We introduce our
                                                                              editorial board
                                                                                          Page 5

                                                                            Meet the nurses at
                                                                                Te Oranganui
                                                                                         Page 25

                                                                      Complete 10-year index
                                                                        of Handover articles
                                                                                         Page 34

            Get Handover delivered to your inbox: Sign up at www.tepou.co.nz/subscribe
10years Celebrating - Te Pou
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Founding editor of
Handover looks back
                                         As the founding editor of
                                                                              "I was keen to get something out there about
                                         Handover, Anna Schofield finds
                                         it remarkable and extremely          the mental health nursing craft.”
                                         satisfying that the e-publication
                                         has survived 10 years and is still   Getting started
                                         going strong.
                                                                              Starting a publication from scratch is a big project, especially as Anna had
                                         Anna was new in the role as          never done anything like it before. “We decided it needed to be electronic
                                         workforce development nursing        so it had multifaceted use and could be printed off, put on noticeboards,
    Anna Schofield                       leadership manager at Te Pou         or read and stored electronically. We set up an archive on Te Pou’s website
                                         when she came up with the idea       to store each edition so it could be a resource for people to access and
of a publication for communicating the good work nurses were doing in         read about services or profiles at a later date.”
mental health and addiction, including primary care services.
                                                                              “Handover became a place to demonstrate the initiatives and innovative
“We wanted Handover to be a publication where we could share, profile         practice of individuals in finding solutions for what could be tricky situations
and celebrate the innovative approaches, solution focused nursing and         and gaps in services. This is still a strong theme in Handover today.”
nursing partnerships occurring around the country that have had a
                                                                              Anna says it was a busy project. As soon as one edition had gone to press
positive impact on service user outcomes. It also needed a national reach
                                                                              she had to start planning the next one, keep people to deadlines and
to develop national and regional networks,” says Anna.
                                                                              ensure enough appropriate and interesting material was coming through.
She says Handover aimed to give people accessing services, family and
                                                                              “It was all about making sure we captured and profiled the diversity
whānau a platform to share their experiences and tell their stories – a
                                                                              of the sector across the four editions each year, in a compelling and
very powerful process for nurses to hear about. “That kind of story telling
                                                                              interesting way.”
continues to grow.”
                                                                              “The longevity of Handover is due to ongoing commitment from the

"It was a great way to overcome a lack                                        nursing leader editors who have succeeded me,” says Anna. “They continue
                                                                              to be passionate about it and they keep it contemporary and relevant.
of information about mental health and                                        It is important too that the focus has now expanded to include other
addiction nursing within regular nursing                                      initiatives of interest for nurses.”

publications.”                                                                As a reader, not an editor, Anna still looks forward to receiving Handover as
                                                                              a vehicle for facilitating dialogue and unifying the sector. “You become so
Handover also set out to support recruitment by highlighting the work         focused on your own organisation, it is good to share approaches and have
nurses do in a real and authentic way, from chief nurse to community care,    a reminder of what others are doing, including the amazing consumer
to help overcome the stigma surrounding mental health and addiction.          lead work across the country.”

Anna says it was a great way to overcome a lack of information about mental
health and addiction nursing within regular nursing publications. “I was
                                                                              Moving on - 10 years later
keen to get something out there about the mental health nursing craft.”       After three years as workforce development nursing leadership manager,
                                                                              Anna took up the position of nurse director of mental health at Auckland

2      Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
10years Celebrating - Te Pou
“You become so focused on your
own organisation, it is good to share
approaches and have a reminder of what
others are doing, including the amazing
consumer lead work across the country.”

District Health Board (ADHB). More recently she became director of
mental health at ADHB.

As the only nurse currently in the position in New Zealand, Anna sees it as
a great privilege and responsibility to be accountable for overall delivery
                                                                               She sees huge opportunities for the workforce over the next 10 years,
of the Mental Health Directorate.
                                                                               including nursing, with where and how care will be delivered. “For example,
As nurse director, Anna was part of the directorate leadership senior          the nurse practitioner role and designated registered nurse prescribing,
team and accountable for all aspects of nursing practice and patient           what that means for advanced nursing practice and how and where service
safety, professional and workforce development. As the mental health           users can receive their care. It is pretty exciting for our nursing leaders to
director, her role is focused on strategy development and delivery, with a     be part of leading and influencing some of that change.”
directorate-wide focus on professional governance, quality care delivery
and ensuring the workforce are effectively equipped to do the best they can.   Mental health and addiction careers
“People are coming into mental health and addiction services with              “Career opportunities and pathways are endless in the mental health
increasing complexities and that creates another set of challenges for         and addiction sector,” says Anna. “It is exciting to see the enthusiasm and
the sector,” says Anna.                                                        passion of our New Entry to Specialist Practice Nursing (NESP) programme
                                                                               nurses coming into Auckland DHB. These include specialties across age
“A big part of my job is around making sure the workforce, including all
                                                                               groups, inpatient and community services, and pathways into leadership,
the leaders, are well supported to do their role but also able to talk about
                                                                               tertiary education and nurse practitioner roles.
their challenges openly and find a range of solutions.”
                                                                               “Where and how they will be delivering care in 20 years will be very different
She was attracted to the role because she wanted to participate in setting
                                                                               to now, and for a traditional role like nursing that’s really inspiring. I’ve
strategic direction about where and how care is delivered. “It is about
                                                                               been nursing for 21 years and have seen many colleagues and peers move
ensuring care across the sector is of high quality, supporting a range
                                                                               down very diverse pathways within the mental health and addiction sector.
of leaders to lead within their service group, as well as setting strategic
                                                                               That is a fabulous thing about mental health nursing.”
intent and developing services around that.”
                                                                               Anna’s own journey along the leadership pathway has been partly
Anna believes her mental health nursing background brings a unique
                                                                               serendipitous but also driven by a desire to be in a leadership role, taking
philosophy and perspective to the role.
                                                                               a system view of services and the sector. “I enjoy being able to influence
“The way we are trained to think and use our skills as mental health           systems to enhance the experiences and health outcomes of people
nurses enables us to influence, in a different way, the aims of what we        accessing services, and the experiences of the workforce.”
strive to do in the directorate.”

                                                                                10 th anniversary special issue
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                                                                                                                            S             S
Welcome to our 40th issue of Handover. We mark this occasion with a 10-year birthday celebration                   Founding editor of
                                                                                                                   Handover looks back .........................................2
issue that includes an index of all our articles since Autumn 2007. The index brings to light our
collection of stories about mental health, addiction and disability nurses along with stories from
                                                                                                                   Meet the Handover editorial board..................5
our regular column writers which have evolved over time.
                                                                                                                   Next issue...........................................................5
We lead out with a reflection from Anna Schofield, the creator of Handover, and hear about how                     Meet the team of nurses at
this national mental health and addiction nursing newsletter came to be and her career pathway                     Te Pou o te Whakaaro Nui.................................6
since leaving Te Pou in 2009.                                                                                      Patrick Au, A face of Handover, 2007................7
                                                                                                                   Mental Health
Patrick Au, one of the nurses who kindly agreed to have his picture on the masthead of several issues              – the time to act is now!.....................................8
of Handover, discusses his thoughts about a decade of working in an Asian mental health service.                   Taking a holistic approach to
                                                                                                                   mental health and addiction...........................10
Building the capacity and capability of the nursing profession to support global efforts to promote                The DOMHNs
good mental health throughout the life-course, is just one of the key messages in the ICN update                   reflect on the decade ........................................11
from Annette Kennedy (president).                                                                                  Addiction nursing
                                                                                                                   – reflecting on the past decade....................... 12
Jane Bodkin from the Office of the Chief Nursing Officer, Ministry of Health, notes the growing                    Matua Raki update........................................... 14
recognition of the bi-directional nature of mental health services and a need for a cross sector                   Introduction to
approach towards mental health. It is not a problem the health sector can address alone.                           the framework.................................................. 15
                                                                                                                   Helen Hamer - reflections on
In the regular directors of mental health nursing column reflections on Handover and the mental                    the mental health nursing framework........... 16
health nursing framework are shared. Daryle Deering reflects on the development of addiction                       Leadership........................................................ 18
nursing over the past decade and Klare Braye updates us on Matua Raki’s work. Mark Smith comments                  Professional supervision.................................. 19
on trends in information over the last decade.                                                                     Education .........................................................22
                                                                                                                   Making a difference
Our special feature is focused on Mental Health Nursing and its Future: A Discussion Framework                     in primary care.................................................25
(Ministry of Health, 2006). Helen Hamer reflects on the development of the framework and her                       Nurses supporting kaituhauora......................26
professional career. We focus on recommendations related to leadership, professional supervision
                                                                                                                   Developing workplace wellbeing practices....28
and education. Information about the newly updated suite of professional supervision guides for
                                                                                                                   Whitireia equipping nurses
nurses is shared. Future issues will include more articles about the mental health nursing framework.              to work with people who
                                                                                                                    experience co-existing problems...................29
Our nurse profiles feature four NGO nurses from Te Oranganui, an iwi health and social service for pēpe,           Reflections on the past decade.......................32
tamariki, paheke and kaumātua in the Whanganui region and a nurse practitioner Meg Robertson,                      Creating the nursing digest............................. 33
whose role focuses on supporting people who experience depression and/or anxiety.                                  Handover index of articles...............................34

Stacey Wilson from Massey University encourages us to consider developing workplace wellbeing

Catherine, Loma-Linda, Dianne, Wendy and Vicky from Whitireia New Zealand reveal how they are
                                                                                                                   issn: 2324-3821
equipping nurses to support people who experience co-existing problems.

Barry Kennedy and Shivika Singh share how they prepare the quarterly nursing digest, and our                              To subscribe to the Handover
index of Handover articles concludes this special celebratory issue.                                                      newsletter, go to the Te Pou website:

Nga mihi, Suzette and Caro                                                                                         Te Pou is now on Twitter and LinkedIn,
                                                                                                                   connect with us:
                    Suzette Poole                                   Caro Swanson
                    Editor                                          Editor
                   (RN-MH, MN)                                      SERVICE USER LEAD                                         linkedin.com/company/te-pou
                   – CLINICAL LEAD                                  caro.swanson@tepou.co.nz

4    Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
10years Celebrating - Te Pou
Meet the Handover editorial board
The editorship of Handover since its inception in 2007 has sat with the
nursing leader at Te Pou. Throughout the life of this publication service
user lead Caro Swanson has contributed to the editing of each edition. Her
attention to grammar and focus on using language that is less stigmatising
makes the style of Handover unique.

In July 2016, Issue 36, Caro joined Suzette Poole, mental health nurse and
clinical lead, to become the co-editor of Handover. Caro and Suzette work
                                                                              Suzette Poole                       Caro Swanson
with the Handover editorial board.

  • Angela Gruar, manager of the practice and leadership portfolio, Te
    Pou, has keen eyes for detail and is the one who signs off the final
    proof of each issue.

  • Mark Smith, principal advisor, Te Pou; is our regular ‘Information
    Alive’ column writer.

  • Rachel Kapeli, project co-ordinator, Te Pou; is the key person in
    keeping timeframes, making her an instrumental part of the team!
                                                                              Mark Smith                          Heather Casey
  • Heather Casey, director of mental health nursing representative,
    brings in sector leadership knowledge. Heather is the director
    of nursing of mental health, addiction and disability services for
    Southern District Health Board. She is a past president and fellow
    of Te Ao Māramatanga – New Zealand College of Mental Health

The Wise Group communication and design teams provide the talent
and skills to bring the content to life.
                                                                              Angela Gruar                        Rachel Kapeli
Sima Clarke, Te Pou team support co-ordinator, is the logistics queen who
ensures hard copies of each issue of Handover reach our valued readers.

It’s a real team effort and a project that we are all proud of!

Next issue                                                                    Sima Clarke

Our readers want to know about solutions and innovations                     Issue 41 will be our final issue for 2017 and we welcome stories about the
                                                                             highlights for mental health and addiction nurses and thoughts about
to improve services for people experiencing mental health
                                                                             what 2018 may hold.
and addiction problems. They also want to know how to
                                                                             Issue 41 will be released in early December and articles are due by Friday,
support the workforce to develop the values, attitudes,
                                                                             27 October 2017.
knowledge and skills that best support a person with their
                                                                             Articles can be 300-800 words and photos are welcome. Please send
recovery. So if you have a story like this, please get in touch.
                                                                             to either suzette.poole@tepou.co.nz or carolyn.swanson@tepou.co.nz.

                                                                              10 th anniversary special issue
10years Celebrating - Te Pou
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    Jo van Leeuwen                              Lois Boyd                                Mark Smith                                Suzette Poole

Meet the team of nurses at
Te Pou o te Whakaaro Nui
The first nurse to be employed by Te Pou was Anna Schofield in 2006.                     Dr Mark Smith, principal advisor, providing strategic clinical leadership
Eleven years on we now employ four nurses who take leadership roles in                   and advice about research and evaluation. Mark leads work on mental
delivering and contributing to many of our initiatives, drawing on their                 health outcomes measurement, mental health information use and
extensive nursing experience.                                                            the early intervention in psychosis project. He is a registered psychiatric
                                                                                         nurse and qualified as a registered nurse practitioner in 2002. He has
Introducing:                                                                             an interest in academic philosophy, particularly philosophy of mind and
                                                                                         ethics, in which he holds a PhD. Mark has worked in a range of clinical
Jo van Leeuwen, programme lead. Her projects include: Equally Well, talking
                                                                                         roles and as a lecturer at the University of Auckland. He is a Fellow of Te
therapies, working with families and whānau, primary mental health and Let’s
                                                                                         Ao Māramatanga, NZCMHNurses.
get real. Jo provides leadership for a range of workforce development initiatives
to assist district health board (DHB) and non-government organisation (NGO)              Suzette Poole, clinical lead. Suzette’s projects include supervision; trauma
services bring about service and workforce change, through planning and                  informed care; women in secure care; co-existing problems; and she is co-
enhancing practice. Jo is a registered nurse with a career that has spanned the          editor of Handover alongside Caro Swanson. Suzette qualified as a psychiatric
specialist adult and NGO Kaupapa Māori mental health sectors; workforce                  nurse in 1985 and has worked in a range of clinical and leadership roles,
education; and clinical and service management within DHB mental health                  including clinical nurse educator, clinical nurse director and nurse advisor –
and addiction services. Jo is a member of Te Ao Māramatanga, New Zealand                 health (Nursing Council of NZ). Suzette specialised in forensic mental health.
College of Mental Health Nurses (NZCMHNurses).                                           Her Masters of Nursing thesis was about workplace empowerment among
                                                                                         New Zealand mental health and addiction nurses. Suzette is an honorary
Lois Boyd, contracted co-leader of the least restrictive practice initiative alongside
                                                                                         lecturer at the University of Auckland, a Fellow of Te Ao Māramatanga,
Caro Swanson. Lois has worked in a wide variety of mental health settings
                                                                                         NZCMHNurses and a member of New Zealand Nurses Organisation.
including acute inpatient care; community mental health; early intervention;
supported housing; nursing research; and was the nurse consultant for Nelson/
Marlborough DHB. Lois is a member of Te Ao Māramatanga, NZCMHNurses.

6      Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
10years Celebrating - Te Pou
                                                                                                                           Ha ratul
                                                                                                                               ndo          a
                                            Te Pou                                                                      yea            ver tions
                                                    o te W                                                                   rs o         fo        to
                                           has sh           hakaa                                                                    f pu r rea
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                                                                                                                            he                atio ing 10
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                                                            of Me
                                                                 ntal H

Patrick Au, a face of Handover, 2007
                                         I feel somewhat emotional when I             been expanded. Over the years, other than
                                         look back on my professional journey         providing consultation and liaison work, I
                                         over the last 10 years. Looking at           have gradually become more involved in
                                         my photo on the front page of the            providing therapy to work with Asian
                                         first issue of Handover in 2007, my          families. On top of my Master’s degree
                                         first impression is that I have aged.        in counselling, which I obtained in
                                                                                      1999, I have attended various training
                                         I continue working in the same
                                                                                      workshops on family therapy both
                                         district health board and running
  Patrick Au                                                                          in New Zealand and China.
                                         the same Asian mental health
service. The change of my role from clinical co-ordinator to nurse specialist         On average, I present at mental
has been a highlight, as it has helped to reflect and recognise the nature            health conferences every few years and
of the work I am engaged in.                                                          provide guest lectures at universities. My recent
                                                                                      co-authored book Broken dreams? Chinese migrant families at risk: The New
Over the last 10 years, the Asian mental health service delivery model has
                                                                                      Zealand experience (Au & Ho, 2015) summarised my clinical experience in
not changed, and the number of staff working within the service has not
                                                                                      the last 10 years. In 2016, I was also involved in two Asian suicide studies
changed. But the number of Asian people residing, studying and working in
                                                                                      with the University of Auckland, one of which was funded by ADHB. We
the Auckland District Health Board (ADHB) area has increased considerably,
                                                                                      are about to publish the second suicide study in a journal.
as evidenced by the 2013 Census figures and recent government statistics.
Supporting and meeting the mental health needs of this third largest                  Overall, the past decade has been challenging but rewarding. I am ready
ethnic group in central Auckland has been keeping our team very busy.                 to meet any future challenges in the next 10 years, provided that I have
                                                                                      not retired earlier.
In terms of my career pathway, the scope of practice as a nurse specialist has

                                                                                       10 th anniversary special issue
10years Celebrating - Te Pou

Mental Health
– the time to act is now!
                                                                               Collaborators, 2016). According to the WHO (World Health Organization,
                          Annette Kennedy                                      2015), one in four people will experience an episode of mental illness in their
                          President                                            lifetime. Mental disorders are also the leading cause (25%) worldwide of
                          International Council of Nurses                      years lived with a disability. This is the single biggest cause and is more than
                                                                               cardiovascular disease and cancer combined (DALYs & Collaborators, 2016).

                                                                               In high income countries, men with mental health problems die 20 years
Earlier this year the International Council of Nurses (ICN) hosted our
                                                                               earlier and women 15 years earlier than people without mental health
2017 ICN Congress in Barcelona, Spain. This four-day event saw over
                                                                               problems. In Low-Middle Income Countries (LMIC) the gap is considered
8000 nurses from all over the world come together and share their
                                                                               much wider.
knowledge, experiences and discoveries under the theme Nurses at the
Forefront Transforming Care.                                                   There are strong links between mental health problems and chronic
                                                                               health problems. This is not only related to their causes and consequences,
At this Congress, we highlighted one of our priority areas, mental health,
                                                                               but also their prevention and management. Despite clear evidence that
including a main session address by Heather Casey, Past President and
                                                                               there can be no health without mental health, nowhere in the world does
Fellow of Te Ao Māramatanga, College of Mental Health Nurses New
                                                                               mental health enjoy parity with physical health in national policies and
Zealand and Dr Daryle Deering (Senior Lecturer, University of Otago). The
                                                                               budgets or in medical education and practice (United Nations, 2017).
fact remains that mental health continues to be a global health issue. In
many parts of the world, people with mental health problems experience         Globally, health systems have not been sufficiently resourced to meet the
discrimination and so-called treatments such as being chained, isolated        mental health burden of disease. There is a significant gap in the need for
and physically abused. There are gross human rights violations occurring       treatment and services offered. The WHO estimates that between 76-85%
and this should be considered a travesty of justice.                           of people with severe mental disorders receive no treatment in LMIC.
                                                                               Health systems are so under-resourced that they are unable to provide
This is why ICN is committed to the delivery of the United Nations
                                                                               even the most basic health care, including essential medicines to treat
Sustainable Development Goals (SPGs), adopted by world leaders in
                                                                               mental disorders (World Health Organization, 2013). Most investment is
September 2015 at an historic UN Summit.
                                                                               focused on long-term institutional care and psychiatric hospitals, resulting
This was the first time that mental health has been included in a global       in a near total policy failure to promote mental health holistically for all
health agenda - an historic step in recognising the cost of mental health      (United Nations, 2017).
problems. The SDGs define mental health as a priority area for action
                                                                               Now is the time to advocate for change. It is time for all governments and
over the next 15 years. Goal 3 seeks to ensure healthy lives and promote
                                                                               decision makers to invest in nursing with a particular focus on investment
wellbeing at all ages and target 3.4 includes the promotion of mental health
                                                                               into specialist mental health workforce. We know now that mental health
and wellbeing in reducing mortality from non-communicable diseases.
                                                                               is a priority for the UN and WHO. We know that there are gross inequalities
The UN placing such emphasis on the issue of mental health is a good start,    between the supply and demand of specialised and general health workers
but there is still much to be done. Mental health is a high cost problem. It   supporting people with mental health problems. However, we also know
is one that does not discriminate in gender, race or socio-economic status.    that nurses play many vital roles in supporting people with mental health
The issues pertaining to mental health disorders can happen to anyone          problems, including that of advocate, and are also often in the best position
at any time and for this reason it could be argued that the entire way in      to act as the liaison between the patient and family as well as other team
which the global community engages with mental health needs reform.            members and departments. Nurses are often the professionals ensuring
                                                                               that a patient’s human rights are maintained. Performing these roles
The facts are that mental health problems are responsible for a significant
                                                                               means that nurses must be knowledgeable and involved in all aspects
proportion (7.4%) of the total global burden of disease (DALYs &
                                                                               of the patient’s care as well as have a positive working relationship with

8     Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
10years Celebrating - Te Pou

                                                                      u nity           y.
                                                        o  p po   r t
                                                                            b i r thda
                                                     is                  th
                                       t a  ke th appy 10 ff of
                                 et  o              ry h                   ta
                    o u ld lik ver a ve                       g e  the s aro
                 Iw                 o                    le d               ka
                         H   and             c  k now te Wha                         nt
                  wis h
                                  s h to   a
                                                       o u  o              m  i tme
                          ow    i              Te P ing com e
                   I als ver and                      aver                   th
                       a  n d  o
                                           r u  n  w
                                                               i n g  and
                    H                 he i               urs
                         u  i for t          e a l th n
                      N                lh                   al.
                          o  m  enta n gener
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                             ro f essio
                                       ,                                s
                                  ards             dy,             urse
                              Reg         K  e nne       c i l of N
                                    ette             oun
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                                                al C
                                     r n a

other team members. Without nursing, we have no universal health
care (UHC), we have no primary health care (PHC). Specialist mental                          References
health nursing ensures not only mental health delivers what it should to
                                                                                             DALYs, G. B. D., & Collaborators, H. (2016). Global, regional, and national
consumers but, through their specialist knowledge and skills, provides                       disability-adjusted life-years (DALYs) for 315 diseases and injuries and
services to the whole health system. And nurses are the largest group of                     healthy life expectancy (HALE), 1990-2015: a systematic analysis for the
health care providers worldwide! Colleagues, the time is now!                                Global Burden of Disease Study 2015. Lancet, 388(10053), 1603-1658.
It is the vision of ICN to build the capacity and capability of the nursing
                                                                                             World Health Organization. (2013). Mental Health Action Plan 2013-2020.
profession to support global efforts to promote good mental health                           Retrieved from Geneva:
throughout the life-course, and support improved prevention, treatment
                                                                                             World Health Organization. (2015). Mental Health Atlas 2014. Retrieved
and management of services for populations with compromised mental
                                                                                             from Geneva:
wellbeing; to promote the role of patients and consumers’ in their recovery.
The right to mental health requires care and support facilities, goods and                   World Health Organization. (2017). Social Determinants of Mental
                                                                                             Health. Retrieved from http://www.who.int/mental_health/publications/
services that are available, accessible, acceptable and of good quality.
Rights-based care and support for mental health is an integral part of
health care for all (United Nations, 2017).                                                  United Nations. (2017). Report of the Special Rapporteur on the right
                                                                                             of everyone to the enjoyment of the highest attainable standard of
As a nurse, your ability to effect change is just as important as the technical              physical and mental health http://www.ohchr.org/EN/Issues/Health/
ability to deliver safe and effective care. Nurses’ sphere of influence as
health care professionals goes beyond the individuals, families, groups                      www.un.org/sustainabledevelopment
and communities with whom they work. It extends throughout the
health sector to nursing and midwifery colleagues, medical colleagues,
allied health colleagues, and those with policy, management and fiscal
responsibilities. Nurses are both needed and wanted around the policy
and decision-making tables.

I encourage you all to visit the ICN International Nurses’ Day website, (www.
icnvoicetolead.com), to read about some of the changes your colleagues
are making all over the world and share your own story.

                                                                                            10 th anniversary special issue
10years Celebrating - Te Pou

Taking a holistic approach to
mental health and addiction
                                                                                 Corporation; and others, are considering mental health issues in their
                          Jane Bodkin                                            work. Social sector agencies are working with the Ministry of Health to
                          Chief Advisor                                          develop work programmes that address mental health and addiction issues.
                          Office of the Chief Nursing Officer
                          Ministry of Health
                                                                                 Social investment
                                                                                 Social investment is a platform of this government. Social investment is
Mental health is an enormously important and complex area. Everyone
                                                                                 about understanding and sharing data, understanding what works and
who works in the health system, whether they work in mental health and
                                                                                 who to target. For example, there is growing evidence from sources, such
addiction services or not, are involved in work that includes and inevitably
                                                                                 as the Dunedin Longitudinal Study, that mental health issues typically
relates to mental health. Therefore, it is important that we don’t silo off
                                                                                 develop in an individual’s early years.
mental health as a separate part of the health system, in part because
the body and mind are so interconnected. We need a holistic approach.            Therefore, we need to focus on mental health early in people’s lives. Of
Mental health is everybody’s business. Nurses, midwives, allied health           course, the social investment approach needs to be balanced by connecting
and doctors – the whole workforce has a role to play in this.                    with people and understanding their needs and wants.

People with mental health and addiction problems are also more likely to         On 14 August, the government announced a package of 17 mental health
have poor physical health outcomes. A good example of work underway              initiatives aimed at helping New Zealanders experiencing mental health
in this area is Equally Well. https://www.tepou.co.nz/initiatives/equally-       problems as well as focusing on improving services and earlier intervention.
well-physical-health/37                                                          http://www.health.govt.nz/our-work/mental-health-and-addictions/
Good mental health and resilience
                                                                                 These include:
There is an increasing focus and realisation of the importance of building
resilience and keeping ourselves well. ‘Staying well’ features strongly in the   Distance and electronic therapies package

New Zealand Health Strategy. Building wellbeing and resilience occurs at           • Enhanced e-therapy options for pre-teens, adolescents and young
an individual, community and organisational level. At the same time, there           adults
are increasing demands on mental health and addiction services, which is a         • E-therapy for young prisoners
challenge. Our focus on existing mental health services needs to continue.
                                                                                   • Package of tailored telehealth pilots

                                                                                   • Ensuring support and follow-up for those who attempt suicide
Cross-agency approach
                                                                                   • Expanding and enhancing primary and community mental
There is a growing recognition of the bi-directional nature of mental                health and addiction care
health services. This means a person’s circumstances affect their mental
health and mental health affects their circumstances. For example,               Step-up/step-down support for people experiencing acute and emergency

housing, education and employment status affect mental health, and it            mental health needs package

is equally true that mental health affects your ability to work and other          • Support service for people in acute mental health crisis to sustain
aspects of your life. This is a key thing to understand and is why a cross-          tenancies
agency approach makes sense. Mental health is too complex to be solved             • Wraparound step-up/step-down care trial
by psychiatry, mental health services or even the health sector. It needs
                                                                                   • Multi agency co-response service for people who ring 111 for Police
a whole of government and whole of society approach. Many agencies,                  or Ambulance requiring a mental health response
such as the ministries of social development, justice and education; the
                                                                                   • Strengthening self-regulatory skills in early childhood
Corrections Department, New Zealand Police; Accident Compensation

10    Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
Schools package                                                                     experiences of family and/or sexual violence

  • Pilot frontline mental health input to schools                               • Enhancing mental health and neurodevelopmental capacity in
                                                                                   Gateway assessment teams and associated service pathways
  • Improve learning environments and build resilience
                                                                                 • Improving the evidence base about New Zealanders’ mental
  • Electronic HEEADSSS assessment and brief intervention for
                                                                                   health and interventions that work.
    young people

  • Supportive housing models for youth with a mental health condition              “There is a growing recognition of the
  • Strongest Families pilot
                                                                                    bi-directional nature of mental health
  • Culturally responsive trauma-focused CBT for children following

                                                                                                                  DIRECTORS OF MENTAL
                                                                                                                  HEALTH NURSES UPDATE

reflect on the decade
Ten years of Handover publications! Hard to believe it has been that long      “Handover shines a light on local mental
and also how the content and circulation has developed over these years.
Handover is a really important tool for sharing mental health nursing
                                                                               health nursing innovation, highlights topics
innovation and practice development, showcasing new roles and has              relevant within mental health, addictions
been a real enabler for the mental health nursing framework. Handover          and disability and provides an opportunity to
shines a light on local mental health nursing innovation, highlights topics
relevant within mental health, addictions and disability and provides an
                                                                               read about local topical issues.”
opportunity to read about local topical issues. It provides a close practice   The directors of mental health nurses (DOMHNs) network has been
to publication link, mirrors what is coming out of regulatory and statutory    operating for approximately 20 years and is an essential network for
bodies, and maintains relevance for the readers. Te Pou o te Whakaaro Nui      sharing information and innovation. Nursing leadership within services
has shown real leadership in maintaining this publication. We congratulate     is key to supporting and sustaining the nursing workforce and mental
them on this and hope to see this wonderful celebration of mental health       health nursing practice. The DOMHNs structure offers new nursing
and addiction nursing remain!                                                  leaders the support to develop their leadership capabilities and to work
                                                                               through many of the difficult challenges facing mental health services
It is also just over 10 years since the mental health nursing framework was
                                                                               by utilising the experience of the group.
released in 2006 and it has been an interesting process for district health
board (DHB) nursing leaders to reflect on the recommendations under            DOMHNs have key strategic relationships with all organisations and
the categories of leadership, nurse practitioners, standards, skill mix and    agencies who intersect with either mental health, addictions and
clinical career pathways. Progress in each of these areas can be dependent     intellectual disability sectors or nursing, such as the Nursing Council and
on the DHB governance structures, the financial state of DHBs and the          the Office of the Chief Nursing Officer. Key people from these agencies
personalities of people in leadership positions. The one area that has some    regularly attend our quarterly meetings to hear our views on what is
consistency in progress is clinical career pathways or as we know them         happening in the sector and share their own. Each year our work plan is
now, professional development and recognition programmes (PDRP).               refreshed. This plan reflects priorities in the sector and also proactive work
The national consistency comes from Nursing Council expectations of            to ensure nurses are well prepared for future practice or service delivery
PDRPs. Local variation may be more about uptake by nurses, but it isn’t        initiatives, such as registered nurse prescribing.
about content and processes as the expectations are clear and audited.
However, some more thinking about who sets expectations for nurses
practising in mental health settings is needed.

                                                                                10 th anniversary special issue
addiction nursing update

Addiction nursing – reflecting
on the past decade
                                                                                competencies for registered nurses and Te Ao Māramatanga - New
                          Dr Daryle Deering                                     Zealand College of Mental Health Nurses Standards of Practice (Te Ao
                          National Addiction Centre                             Māramatanga, 2012).
                          University of Otago
                                                                                The opportunity to be recognised as an advanced certified addiction nurse
                                                                                was then established. DANA members and non-members can apply for
                                                                                advanced certification to the DANA Credentialing Advisory Committee
In the past decade, government policy has emphasised greater integration
                                                                                via a process outlined on the DANA website http://www.danaonline.
of care for people affected by addiction and mental health issues (Ministry
of Health, 2010; Todd, 2010), greater integration of care between primary
and community services and secondary care services, accessible community        Symposia for addiction and related sector nurses were introduced and
services and early intervention (Ministry of Health, 2012).                     supported at least annually by Matua Raki. The symposia are hosted
                                                                                in different regions by addiction nurses and provide opportunities for
Nursing workforce implications have included a broadening of work
                                                                                nurses to hear about national nursing trends, develop networks and
settings from practicing mainly in specialist services, to opportunities to
                                                                                share innovations/developments in practice.
practice within primary care, non-governmental organisations, community
services and other sectors; while specialist nurses are to have an increasing   Addiction nurses have also supported the Te Ao Māramatanga credentialing
consultation liaison role in supporting/supervising other practitioners         project for enhancing primary care practice nurses’ mental health and
to provide assistance to people affected by mental health and addiction         addiction competencies.
problems within primary care and community services (Health Workforce
New Zealand, 2011).                                                             Addiction nurses now have roles that extend across an increasing range
                                                                                of settings including primary care, non-government organisation (NGO),
In addition, the urgent need to address the physical health of people           education and workforce development. Increasing numbers of addiction
with significant mental health and addiction issues has been highlighted        nurses are gaining postgraduate qualifications and undertaking master’s
(Te Pou o te Whakaaro Nui, 2014), thereby requiring mental health and           level research projects.
addiction nurses to enhance their physical health knowledge and skills.
Aligned with these trends, developments within the broader nursing              Two nurse practitioners, Louise Leonard and Sarah Barkley, have an

sector have included the embedding of nurse practitioner roles and the          addiction focus within their scope of practice and many other nurses are

introduction of registered nurse prescribing.                                   on a nurse practitioner pathway. Recent legislative changes have enabled
                                                                                a wider range of health practitioners to undertake certain functions
Within this context several developments have occurred within addiction         which were restricted to medical practitioners. Nurse practitioners and
nursing in New Zealand, supported particularly by Matua Raki (national          specialist registered nurse prescribers working in addiction services are
addiction workforce development centre).                                        now able to prescribe controlled drugs to treat addiction. Such changes
                                                                                should promote accessible and responsive care, for example, to people
A strategy discussion document on advanced practice nursing in the
                                                                                with opioid dependence, and greater capacity for care provision within
addiction specialty (Deering, 2008) was developed with regional input
                                                                                specialist and primary care, NGO and community services as well as in other
from addiction nurses. This national network of nurses provided a basis for
                                                                                sectors. Opportunities are also likely to present for nurse practitioners and
input to the development of the Drug and Alcohol Nurses of Australasia
                                                                                other addiction specialist nurses with the introduction of the Substance
(DANA), Addiction Specialty Nursing Competency Framework for Aotearoa
                                                                                Addiction (Compulsory Assessment and Treatment) Act in 2018.
New Zealand (Matua Raki, 2012). The framework describes the continuum
of nursing practice and the role of the specialist level addiction nurse.       With increasing opportunities for addiction nurses to be employed across a
It was designed to be congruent with Nursing Council of New Zealand             range of health and other sectors, practice networks and addiction nursing

12    Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
addiction nursing update

leadership become increasingly important. Recruitment of nurses with
addiction expertise will remain an important focus, as will supporting                      References
nurses to gain broad addiction nursing experience and postgraduate                          Deering, D. (2008). Development of the advanced practice nursing strategy
qualifications. It is essential that the needs of people with complex addiction             for the addiction treatment sector: A discussion document. Matua Raki
and mental health issues are responded to by nurses with the required                       Report: Wellington.

level of knowledge and skills. A specialist competency framework aligned                    Drug and Alcohol Nurses of Australasia. (2012). Addiction specialty nursing
with advanced certification is likely to become of increasing importance                    competency framework for Aotearoa New Zealand. Wellington: Matua Raki.

in this context, particularly given the potential for the establishment of                  Health Workforce New Zealand. (2011). Towards the Next Wave of Mental
nurse-led services.                                                                         Health & Addiction Services and Capability: Workforce Service Review
                                                                                            Report. Wellington: Health Workforce New Zealand.
Strong professional bodies that can attract addiction nurses have an
                                                                                            Ministry of Health. (2010). Service Delivery for People with Co-existing
important role to play in:
                                                                                            Mental Health and Addiction Problems: Integrated Solutions. Wellington:
  • promoting contemporary competencies and learning outcomes                               Ministry of Health.
    within nursing undergraduate education programmes
                                                                                            Ministry of Health. (2012). Rising to the Challenge. The Mental Health and
  • advocating for the implementation of a framework for specialist                         Addiction Service Development Plan 2012– 2017. Wellington: Ministry of Health.
    addiction nursing practice as the basis for practice
                                                                                            Te Ao Māramatanga New Zealand College of Mental Health Nurses Inc.
  • supporting increased nurse practitioner positions and registered                        (2012). Standards of Practice for Mental Health Nursing in Aotearoa New
    nurse prescribing                                                                       Zealand (3rd Ed.). Auckland: Te Ao Māramatanga New Zealand College
                                                                                            of Mental Health Nurses Inc.
  • advocating for accessible postgraduate education and skills
    development options                                                                     Te Pou o te Whakaaro Nui. (2014). The physical health of people with a serious
                                                                                            mental illness and/or addiction: An evidence review. Auckland: Te Pou.
  • supporting input from nursing, consumer and other stakeholders
    to national policy and service development.                                             Todd, F.C. (2010). Te Ariari o te Oranga: the Assessment and Management
                                                                                            of People with Co-existing Mental Health and Substance Use Problems.
                                                                                            Ministry of Health: Wellington.

                                                                                 a R  a k i tēnei tin
                                                                           atu                             na
                                                                   ana e M                      nei ki tō
                                                       E mihia             ver k   u a  e  k e
                                                                                                              i te
                                                          u e m  i a Hando               k a  u t ia nuitia a
                                                       ra                     Kaing    ā                       a
                                                           u t u a n gahuru.            g ā   t a p u hi hauor
                                                        ta                       er i n
                                                             t o k o a Handov               i w  aranga.
                                                         tau                   āt  a p u h
                                                                     ro me ng                        ui!
                                                          hinenga           , k ia m   anawan
                                                          kaha, kia
                                                                                  Matua R
                                                                    hānau o
                                                             Nā te w

                                                                                       10 th anniversary special issue
4                                                                          S
                                                                                                    0                                                      E
                                                                                                              *        I       S         S        U

Matua Raki update
                                                                                     Raki. Matua Raki has recently completed a series of workshops designed

                            Klare Braye                                              to support addiction, allied services and workforces to develop plans,

                            Project Lead                                             protocols, new roles and models of care in preparation to respond to
                            Matua Raki                                               requests on how to use the Act from that date. The SA(CAT) Act introduces
                                                                                     new addiction sector roles, processes and models of care for which nurses
                                                                                     can offer a significant contribution. An e-learning module providing a
As the year progresses it is encouraging to see the ongoing achievements             brief overview of SA(CAT) Act is available on the Matua Raki website
and activities of nurses working in the addiction sector. Moira Gilmour,             https://www.matuaraki.org.nz/initiatives/introduction-to-the-substance-
Capital and Coast District Health Board, is currently leading a small but            addiction-compulsory-assessment-and-treatment-act-2017/183.
very important project for us, prompting access and support for nurses
                                                                                     Knowing the enormous amount of work and preparation going into the
who may be using substances in a problematic way, and what they and/
                                                                                     upcoming 5th International Conference of Te Ao Māramatanga – New
or their colleagues can do to get support.
                                                                                     Zealand College of Mental Health Nurses, this is shaping up to be a
We have a small working group who are refreshing the Addiction Specialty             great event. This year the conference is titled Surfing the Waves – mental
Nursing Competency Framework for Aotearoa New Zealand https://www.                   health and addiction nurses responding in new and innovative ways.
matuaraki.org.nz/resources/addiction-specialty-nursing-competency-                   With sponsorship from Matua Raki; keynote speaker Dr Daryle Deering;
framework-for-aotearoa-new-zealand/377. The framework, published in                  workshops by Michelle Fowler and Ashley Koning about screening and
2012 and endorsed by the New Zealand National Nursing Consortium stands              brief interventions for substance use disorders across the age span and
alongside relevant nursing and other professional codes of ethics, legislative       theories of addiction and treatment; as well as several concurrent addiction
and policy frameworks, accepted best practice guidelines and compliments             focused sessions – it is exciting to see the strength of the addiction content.
the Standards of Practice for Mental Health Nursing (Te Ao Māramatanga –             Please make yourselves known to us at our stand.
New Zealand College of Mental Health Nurses). It provides guidance on the
                                                                                     Visit the Te Ao Māramatanga
clinical career pathway for nurses from foundation to advanced specialist;
                                                                                     – New Zealand College of
a description of the levels of practice of nurses; clarification of the specialist
                                                                                     Mental Health Nurses website
level of nursing practice for nurses, other professionals, peer support
                                                                                     for more information about
workers, consumers, consumer advisors, employers, funding and planning
                                                                                     the conference http://www.
personnel; and guidance for education providers in designing curricula.
Consideration for the Substance Addiction (Compulsory Assessment and                 Events/2017-Conference.
Treatment) Act 2017, SA(CAT) due to come into force in February 2018
is well underway with the Ministry of Health and supported by Matua

14    Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
                                                                                                    NURSING FRAMEWORK

Introduction to
the framework
Mental Health Nursing and its Future: A Discussion Framework – Report from the Expert Reference Group to the Deputy
Director-General, Mental Health Dr Janice Wilson, was published in 2006 by the Ministry of Health.

Dr Frances Hughes chaired the development of the report and Helen Hamer led the project. The final report was authored
by Helen Hamer, Mary Finlayson, Katey Thom, Frances Hughes and Sharon Tomkins.


The framework provided a strategic direction for the future of mental health nursing to strengthen both nursing leadership
and practice within the multidisciplinary clinical environment. The overall goal was to provide strategies to move the
profession of mental health nursing forward. Several recommendations were made about leadership, mental health nurse
practitioners, standards, skill mix, clinical career pathways, professional supervision, education, research, recruitment and
retention. We invited key stakeholders to revisit the framework and comment on progress and their thoughts on what
more is needed to support mental health and addiction nurses. We received a lot of feedback and over the next few issues
of Handover will share a summary of this with you on each of the recommendations.

In this issue Helen Hamer reflects on the framework and we focus on leadership, professional supervision and education.

Nga mihi, Suzette Poole

                   Suzette Poole
                   (RN-MH, MN)
                   – CLINICAL LEAD

                                                                   10 th anniversary special issue

Helen Hamer - reflections on the
mental health nursing framework
Dr Helen Hamer, project lead and report author of the 2006 framework,           documentation was written and
recalls great optimism in the sector about the framework development            placed in Te Pou’s resources;
as it got underway – and she was very excited to be involved.                   documentation that is still current
                                                                                and available to guide managers,
Creating a framework opened up the opportunity to do two things, she
                                                                                nurses and professional leads on
explains. “One was to develop the workforce of mental health nursing by
                                                                                providing a supervision structure.
giving managers and leaders recommendations to help them provide
a workforce environment that promoted the maximum leadership,                   “Momentum quickly grew,” says
governance, professional and clinical best practice from the mental             Helen. “The new graduate nursing         Helen Hamer
health nursing workforce. It was also to describe and clarify the role and      programme was strengthened and
function of the mental health nurse in the post-institutional environment.”     developed nationally through the Skills Matter programme.” Postgraduate
                                                                                funding was allocated for experienced mental health nurses to match
At the time Helen was working in a joint role as clinical nurse consultant
                                                                                their peers in physical health settings by developing academic and
for Auckland District Health Board and senior lecturer at the University
                                                                                research pathways that complimented their clinical expertise, such as
of Auckland, where she was leading the mental health component of the
                                                                                the nurse practitioner endorsement in mental health and intellectual
new Bachelor of Nursing programme.
                                                                                disability settings.
“Writing the framework was also a great opportunity to articulate my thoughts
                                                                                As well, Te Ao Māramatanga – New Zealand College of Mental Health
and those of other nurses, and to incorporate what research was telling me
                                                                                Nurses and New Zealand Nurses Organisation (NZNO) also reviewed
and say: this is what we do as nurses, and here are the recommendations
                                                                                the standards for mental health nurses.
that will support the profession to articulate the role as well as we can.”
                                                                                “Such initiatives sent a signal to the mental health sector that there were
Over a period of 18 months, she talked to many different sector groups,
                                                                                a variety of roles and career pathways available for mental health nurses,
including nurses, nurse leaders, educators and unions to ensure the
                                                                                including a leadership programme.”
framework truly represented what the sector was saying.
                                                                                “The framework was supported from inception to implementation by
“The reference group didn’t want the report to sit on a shelf and never see
                                                                                Frances Hughes who was the Ministry of Health’s chief nurse advisor,
the light of day. We wanted to make sure it was a living document that
                                                                                and embraced by the Directorate of Mental Health Nurses’ group, who
nurses would read, a snapshot of mental health nursing and of the things
                                                                                continue to support it,” says Helen.
we needed to have in place for the future of the profession.”

                                                                                Looking forward
How did it impact?
                                                                                Whilst these successes are making a huge difference to the mental
After publication, there was a desire to quickly implement tangible changes,
                                                                                health nursing sector, at times, Helen feels some momentum has been
says Helen. The Ministry of Health convened a meeting of key stakeholders
                                                                                lost; possibly due to funding and election cycles, making it important to
to advise and help determine the next steps, including prioritising
                                                                                revisit the framework.
recommendations. Part of that involved developing a specific nurse-led role
at Te Pou, to lead the implementation of the framework recommendations.         “When I began this framework project, my commitment was to consult
                                                                                widely and listen to the sector. I think it’s time to hear their views and
Professional supervision was the first recommendation to be implemented,
                                                                                voices again. The review needs to consider contemporary national and
as advised by Helen. A literature review and recommendations on
supervision practice were undertaken by the Centre for Mental Health
                                                                                international changes, and the direction for nursing as a whole.”

at the University of Auckland’s School of Nursing. Substantial supervision

16    Mental Health and Addiction Nursing Newsletter - Issue 40 - September 2017
                                                                                                                    NURSING FRAMEWORK

                                                                              "We wanted to make sure it was a living
     Other gains over the last 10 years include:
                                                                              document that nurses would read, a
        • salary incentives for mental health nurses to work in               snapshot of mental health nursing and of
          under-served geographical areas
                                                                              the things we needed to have in place for the
        • successes in the role of mental health nurses in the
          primary care arena, such as shared care approaches
                                                                              future of the profession.”
        • increased physical health screening by mental health                Her PhD thesis led to an honorary appointment at Yale University which
          nurses for people presenting to secondary services with             she took up in 2015. She is now completing further research at Yale
          mental health problems
                                                                              University, exploring the practices of social inclusion by mental health
        • continued growth in some DHBs for the role of clinical              staff in everyday clinical practice settings. These acts of citizenship by
          nurse specialists and educators
                                                                              mental health staff make a claim for justice, and support the rights of
        • extending the mental health nurses role into                        people in their care.
          new services such as home-based treatment
          approaches, non-government organisation settings                    “They are often small gestures, embedded in practice, that have enormous
          and as responsible clinicians within the legislative                positive impact on people’s recovery journeys and are sometimes described
          requirements of the Mental Health (Compulsory                       as ‘turning points’ on their journey, that foster their sense of social inclusion
          Assessment and Treatment) Act 1992.                                 as full citizens.”

                                                                              Primary care and mental health
Life after the framework                                                      Now an independent practitioner, Helen also contracts to DHBs, primary
                                                                              health organisations and other health and education providers. She is
After the framework was completed, Helen turned her sights to PhD
                                                                              currently contracted to Counties Manukau Health as nurse lead for a
study. She completed this in 2012 while still working in her clinical nurse
                                                                              project dear to her heart – primary care integration.
consultancy and university teaching roles. Her PhD topic ‘What does
citizenship mean for people who have serious mental illness?’, explored       Helen has a long-standing interest in promoting closer relationships
the structures in society that marginalise some citizens and privilege        between DHB mental health and addiction staff and primary care general
others, which leads to social exclusion particularly for people labeled       practice clinicians, to increase prevention and provide earlier intervention
with a mental illness.                                                        for people presenting with mental health and addiction problems.

“When you feel included in the dominant group you don’t question your         “These partnerships will help to reduce the health disparities and earlier
citizenship – it is often taken for granted because ‘you don’t know what      mortality for people accessing services and help to reduce stigma and
you’ve got ‘til it’s gone’. It isn’t as easy to express its deeper meaning    discrimination.”
unless you have experienced exclusion and marginalisation,” says Helen.
                                                                              Helen regards such initiatives as, “The third decade, and hopefully final
After completing her PhD, Helen worked on Stories of Successful Social        stage of the deinstitutionalisation of our mental health services, and
Inclusion, a Like Minds, Like Mine research project that was published in     the opportunity to future-proof mental health nursing as we extend
2014. The study found that many of the people accessing services whom         our practice to embrace a primary care approach to our specialist roles.”
were interviewed described mental health professionals as champions
who fostered their inclusion.

                                                                               10 th anniversary special issue
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