Support for specialist mental health services improved through a successful pilot

A 12-month pilot was developed to provide effective, nurse-led care to people engaging with community specialist mental health services (tangata whaiora) and has been enormously beneficial.

Under the Mental Health (Compulsory Assessment and Treatment) Act 1992, Registered Nurses and other health professionals can be appointed responsible clinicians (RCs) in New Zealand. However, only small numbers have been appointed to that role since 1992.

Skye Sadlier is a Clinical Nurse Specialist and Responsible Clinician within the General Adult Mental Health Service in Te Tai Tokerau, based in Whangārei.

“Much of my role involves care and coordination of tangata whaiora under the Mental Health Act,” said Skye.

“This requires me to not only keep up to date with any changes in the Act but also ensure I am completing the required reviews, attending Mental Health & Addiction court, and, most importantly, working alongside tangata whaiora and their whānau to plan and set goals for the future. This helps to establish how we may be able to support them to become an informal patient, where appropriate.”

Experienced senior nurses working to the top of their scope enables doctors to have more capacity and enhances the traditional models of care, where the team consider it appropriate for nurse-led care.

“This nurse-led care involves working alongside other disciplines, including psychiatrists, to ensure the delivery of timely specialist mental healthcare and continuity of care to one of the most vulnerable populations within the community,” said Jane Simperingham, Nurse Director of Mental Health and Addiction Services in Te Tai Tokerau.

Upon completion of the pilot, a formal evaluation deemed the pilot successful, with favourable clinical impacts and very positive feedback from staff, senior leaders, and tangata whaiora.

This pilot was a pioneering initiative in New Zealand aimed at introducing the roles at scale, which gained national interest and has since been used to inform the implementation of the roles in other districts.

The Health NZ Directors of Mental Health Nursing national group has written a guidance document on developing non-medical roles as responsible clinicians. The Mental Health Directors of the Allied Health group have also committed and documented their support for allied health clinicians to take up these roles, where their expertise is suitable for treatment.

As a result of the wide support for expanding these roles, a national training programme is being developed to support their development in our mental health services.