Government response to He Ara Oranga

He Ara Oranga endorses the Equally Well collaborative, citing it as an example of good practice to address physical health inequities (p.6). He Ara Oranga also calls for an increase in collective impact approaches, like Equally Well, as part of a transformed mental health and addiction system. This public acknowledgement is a reflection of all of your actions collectively, as Equally Well champions. So thank you.

Now that the government has formally responded to He Ara Oranga (with 38 of the 40 recommendations accepted, accepted in principle or agreed for further consideration), collectively we need to ensure a focus on physical health is front and centre of a transformed addiction and mental health system.

I have picked out a couple of recommendations that are very relevant to improving physical health and should be prioritised from an Equally Well perspective:

  • Recommendation - to increase choice by broadening the types of mental health and addiction services available. The Equally Well collaborative has continually expressed the need to increase choice and reduce the reliance on pharmacological responses, as an important contributor to improving physical health [include hyperlink to framework for collaborative action]. A transformed system would include prescribing practice balancing the physical health needs with mental health and addiction needs; medication discontinuation discussed routinely in consults, and active support given to people who would like to consider medication discontinuation. 
  • Recommendation - to increase choice by broadening service responses. Being in good work supports improvements to mental health and physical health.  A transformed system would include  access to individually tailored support to help people who wish to get and keep employment as a core part of addiction and mental health services.

The Te Pou 2017 Equally Well evidence update highlighted the positive impact that having a job has on improving both physical and mental health as well as the importance of prescribing for well-being and addressing polypharmacy (p.13).

In addition, since our launch in 2014, Equally Well has advocated for action to integrate services and strengthen shared care arrangements between mental health and addiction services and primary care. He Ara Oranga recommends increasing the capacity and capabilities of primary care to respond to people experiencing mental health and addiction issues. Taking forward this action will mean that many people will have support for physical health, mental health and addiction in one place. This is good news, however, what we know from our actions and the evidence, is that we must reduce the barriers to accessing primary care, particularly the financial costs. 
 
Culturally-led and culturally-informed initiatives are crucial if we are to also address the significant physical health inequities experienced by Māori and Pasifika living with mental health and addiction issues. As a collaborative we need to ensure that all Equally Well initiatives are led-by and designed by the people and communities directly affected.  

Culturally-led and culturally-informed initiatives are crucial if we are to also address the significant physical health inequities experienced by Māori and Pasifika living with mental health and addiction issues.

This is all great news, although we must not forget that Equally Well spans the health and health-related sectors. The Simpson review of the Health and Disability System is still underway and a consultation report is due out in August. The physical health of people experiencing mental health and addiction issues needs to be a priority for the whole of the health system. It should be a reportable health equity issue which all the health and disability system are accountable for addressing. This would include, for example, monitoring and improving the quality of cancer care for people who experience mental health and addiction issues, ensuring equity of access to cancer screening, and cardiovascular risk assessments. 

As Equally Well champions please influence this wider review of the health and disability system whenever you can. Please also continue informing and raising awareness and supporting a transformed addiction and mental health system which improves physical health as well as supporting mental health and addiction needs.