Rolling out more options for crisis care

Government recently announced that six new Crisis Recovery Cafés will be rolled out around the country over the next two years. The benefits of this type of care model are examined in our recently released insights paper on acute options for mental health care. Our Lived Experience team prepared the following overview of the paper.

There is huge potential for more peer-led, community-based and Kaupapa Māori, services to support people experiencing acute distress.  Te Hiringa Mahara has brought much needed attention to a wide range of options that haven’t always got the limelight they deserve in our Acute options for mental health care insights paper. While services are diverse, there are some key elements that contribute to their success.

It is well known that the type of care someone experiences while in distress has a big impact on their recovery. People respond in very different ways and what works for one person, will not necessarily work for another. The critical thing is people have choices and are in control of their own recovery.

In our insights paper we describe the range of options that could and, in some cases, do make up the acute care continuum in Aotearoa. Alongside traditional inpatient care, there is a wide variety of peer-led, community-based, and Kaupapa Māori approaches we can draw on.

Tāngata whaiora (people seeking wellness), have told us that an effective crisis response system has a number of important qualities. They want someone they can call to have immediate access to help, hope, and healing. It’s important to have a safe and welcoming place to go, and a compassionate and culturally appropriate response.

There are endless possibilities to co-create options to meet the diverse needs of tāngata whaiora. Day units, warm lines, crisis respite, and short-stay crisis units are all examples of what could be offered. We list and cite references for more than 20 options in our insights paper.

We spotlight the work of Tupu Ake, Te Waka Whaiora Trust, Taranaki Retreat, and Te Puna Wai as examples*. We acknowledge there are other examples that we could have included (e.g. Piripono, Kōtuku, Te Ao Marama, and many more). These examples illustrate creativity in action, demonstrating the success and benefits of alternative models to acute inpatient care. Each of the four example services are solutions created from the community, for the community, by the community to meet their needs. There are some key characteristics that are shared among the services as discussed in the insights paper. 

A key theme is the holistic nature of the services, which was highlighted as of critical importance by both staff and tāngata whaiora. Jamie Allen, the founder of Taranaki Retreat, explains this concept using the language of a “window of opportunity”: seeing crisis as a moment in time where there is an opportunity for tāngata whaiora and their supporters to address what is leading to the distress and to find alternative and sustainable ways to address these causes. As a staff member from Tupu Ake put it “Seven days is not long, the biggest goal is preparing people for when they go back home.”

Discussion with some of the services highlighted a theme that warrants further unpacking: how power was managed.  As a staff member from Taranaki Retreat put it “A supportive relationship is formed, in which the safety valve of a listener to both reflect and turn to, is available to them to make positive steps for change.” When power is shared with tāngata whaiora so is the accountability for their choices. Tāngata whaiora from the services spoke about being listened to and given options in response to their needs. As a guest from Te Puna Wai said, “[I] had a great chat with one of the staff members who helped de-escalate the situation and made me feel confident to stay safe when I got home.”

While our focus in the report is on ‘alternatives’, we acknowledge that inpatient units are an important part of the mental health ecosystem. These inpatient services can be under pressure so providing more acute options will benefit everyone. 

Our role is to bring to the fore the voices of lived and living experience, whānau and carers, and other priority populations to ensure services meet their needs and preferences. We will continue to advocate for choice at all levels of the system - through policy and government resourcing, commissioning, and service delivery. By promoting choice, we are better able to ensure tāngata whaiora are supported in ways that work for them and support their recovery.

Download: Acute options for mental health care insights paper