• Looking after the family silver
• Managing the day to day
• Keeping the rules
• Guidance for the developing social finance trends

The family silver

Community organisations have traditionally benefitted from citizens’ generosity in many ways; voluntary input, money, property and bequests.  Over the years gifts of money and property have contributed to the asset base of some organisations, add to this prudent financial management on which many trusts and associations pride themselves and we have a healthy and fiscally sound non-profit organisation.

With expectations of both increased public disclosure of financial reporting and accessibility of this information via the internet, the financial situation of registered charities is wide open in the public domain. This financial accountability is absolutely right, yet in the current economic environment these hard won assets are sometimes at risk from zealous public health funders. In a cost cutting environment some believe that any savings or reserves should be applied to service delivery. There are also situations where organisations have been asked to justify the monies they have in reserve. Like many agencies, a number of the community organisations took a financial hit in the economic recession, as funds invested in a variety of places failed to perform.  This leaves us with questions; how can NGOs maximise and leverage the assets they have and as the financially qualified volunteers often flee in the face of increasing regulation, who is advising them.

Managing the day-to-day:

Recently, a CEO new to a mental health community organisation, but with a local government background, said how shocked he was by the complexity of the NGO financial environment. Multiple complex income streams and erratic Government contracting practices provide the backdrop to the day to day management for NGO financial officers.  They still have to deal with cash flow, costing and pricing, cost efficiencies, fraud, sub contracts and then there is managing growth, information, accountability and getting the best deals for the organisation’s cell phones, cars, rent etc.

The rules

New Zealand may be a small country but it has many rules and as NGOs cross the boundaries of public and private sector accountability, there are multiple financial directions to adhere to. The need to account to Government and philanthropic funders is accepted as part of the responsibility for accepting funding. Associated with that however, comes a growing amount of reporting requirements. Alongside the legal compliance required by IRD, ACC and GST etc. sits the un-charted area of moral accountability to clients, consumers, families and community. Providing metrics of activity increasingly falls into the role of “Finance”.

Understanding developing social finance models:

The New Zealand Treasury forecasts throw a gloomy light on future Government expenditure. Tightening spending growth in health has been signalled loudly; however demand for support from mental health and addiction services will probably increase. So as community agencies across New Zealand are beginning to ask themselves where the money will be coming from, there is growing interest in the ways social enterprise can be used to create income for non-profit organisations.  With social impact bonds being tried in the UK, USA and Australia, raising capital for social enterprise, the age of where money meets meaning is truly with us.

As community organisations tread into the unexplored world of finance beyond Government contracts, we need our financial   gurus more than ever.

All of these points are critical.

As a community NGO sector we have to find ways to pool our financial wisdom to improve the current financial relationships with the Crown AND build our financial literacy for our emerging world.

Jonathon Coleman, the local MP for Northcote and current Minister with responsibly for mental health (which makes him probably the best positioned person in the country to talk about the issues) withdrew a few days before the event. This left Maggie Barry the new National candidate for North Shore carrying the load for the current Governments performance and future plans in this contentious area.  Maggie had done the research, used her personal experience and transferred what she knows about other parts of the health system to make a coherent contribution to the debate.

Robyn Stent has a wealth of health related experience and at 9^th on the ACT list is the spokesperson for Health.  With statements about too much government bureaucracy, health inefficiency, the need for more competition and choice she didn’t really ever get into the issues the audience had come to hear about.

Labour put its faith in a new candidate Ben Clarke as Grant Roberson the health spokesperson was also engaged elsewhere. At least Ben was able to refer to his party’s  mental health policy which seems to bring back everything the current Govt has taken away; mental health targets, the Mental health Commission and the ring-fence.

Arriving about 25 minutes late and the laptop with the notes not working was perhaps a disadvantage for the Green candidate Saffron Toms. However once she was able to access the Green party’s policy the connection between societal inequity, poverty and mental wellbeing were made.

The candidates had been given about ten pre-set questions and from the responses it appeared that only the National and Labour party had done any preparation. Act and Greens where left to apply sweeping generalisations that were risky in this well informed audience. The questions covered included NGO sustainability, mental health and addictions in prisons, the Alcohol Action 5point plan, services for new migrants, the issues for the aging population and future investment in community services. The one deeply local issue was the current state of the inpatient unit as North Shore hospital. The responses were the worn-out expressions of inclusion, choice, early intervention and the relentless thrashing of the success of the anti-stigma campaign fronted by John Kirwin. With little new or inspirational contributions it was easy to assume there is little  political concern about the mental illness and addictions issues that are the fastest growing challenges for New Zealand’s health and welfare systems.

Things livened up with when a question from the floor challenged the way accountability gets passed between the Government and the District Health Boards and the example cited was the way the money the Government allocates money to DHBs for cost of living payments does not get passed  on to NGO’s. National explained to the audience of NGOs who have experienced no price increase for their service delivery  for a number of years as an “operational matter for DHBs” and they set the price for the service they provided. This was in contrast to $11 million that National took credit for putting into the rest home industry. Concern about New Zealand’s  appalling suicide rates was shared by the candidates and there was agreement that there needs to be more open conversations and help for people like teachers to be able to understand and talk to young people. The need for more education and understanding for young people about mental health issues was echoed from the floor.

It is difficult for political candidates to enter areas that are seen as specialist however as mental illness and addiction impact on the lives of children, young people and adults of all ages in New Zealand across justice, health, education and welfare some political champions would help.

In ‘An Epidemic of Mental Illness: Why?’  Angel reviews The Emperor’s New Drugs: Exploding the Antidepressant Myth by Irving Kirsch, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker and Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations About a Profession in Crisis by Daniel Carlat. Angel gives powerful voice to the growing numbers of children and adults in the US who have a mental illness diagnosis and the subsequent deluge of drugs that are being prescribed.

The shift from “talk therapy” to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs. That theory became broadly accepted, by the media and the public as well as by the medical profession…”

In the second review ‘ Illusions of Psychiatry’ she builds on the discussion and also has a resounding  crack at the psychiatric “Bible” the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) by American Psychiatric Association. Angel tracks the financial linkage between the pharmaceutical industry, psychiatrists and the diagnosis creation/ validation industry that appears to be rampant in the emerging DSM V.

…it appears that the already very large constellation of mental disorders will grow still larger.

In particular, diagnostic boundaries will be broadened to include precursors of disorders, such as “psychosis risk syndrome” and “mild cognitive impairment” (possible early Alzheimer’s disease). The term “spectrum” is used to widen categories, for example, “obsessive-compulsive disorder spectrum,” “schizophrenia spectrum disorder,” and “autism spectrum disorder.” And there are proposals for entirely new entries, such as “hypersexual disorder,” “restless legs syndrome,” and “binge eating.

With the increasing pressure on New Zealand to make changes to Pharmac as a trade off on a free trade deal  and New Zealand could become a new playground for the mental illness drug industry.

In the aftermath of Christchurch’s 22 February earthquake Wild Bamboo was truly able to prove its worth to customers with its client information system, Recordbase.

“The health service organisations using Wild Bamboo’s Recordbase were able to grab a laptop and a data card and be back up and running straightaway, without having to worry about their office’s computer system not working,” says Stu Prendergast, Wild Bamboo chief executive.

Even though their offices were uninhabitable, Wild Bamboo’s customers were able to provide services and support to people in a time of extreme need.

Wild Bamboo provides its smart information system, Recordbase, as a ‘cloud based’ service. Cloud computing allows organisations to access the information they would normally store on a local computer or server through a secure web portal over the Internet. This reduces the need to invest in equipment and technical expertise to store and maintain data. Cloud computing provides organisations with a sustainable, cost effective, flexible solution for their IT systems.Customers have access to their information anytime, anywhere with ongoing customer support and free product upgrades all covered by a low monthly fee.

Wild Bamboo’s cloud computing solution was recently profiled in Computerworld magazine.

The Wise Group is offering those directly affected by the Canterbury earthquakes free five-night stays at the Waikato wellness retreat, The Monastery.

The Monastery is the only wellness retreat of its kind in New Zealand able to offer this kind of support. For the past six years The Monastery has supported hundreds of women experiencing stress, depression and the effects of trauma. Since the September 2010 earthquake many Christchurch women have used The Monastery as a chance to rest and rejuvenate. Their feedback has been consistent. It was transformational for every one of them.

We’re offering tailored wellness retreats for men, women and groups of family or friends who need time away to rest and rejuvenate. For more information about this offer visit www.themonastery.co.nz or call us on 0800 MONASTERY (0800 66 62 78).

Our dream is to create fresh possibilities for the wellbeing of people, organisations and communities. Providing wellness retreats through The Monastery is one way we know we can support the people of Canterbury during this difficult time

A recently published column by Hooyman (2010) of a similar title, and the current Membership extension discussion document (2010) released by New Zealand’s Social Work Body, offered themselves as a catalyst for this article.  The profession of support work in New Zealand finds itself at a crossroad: the road of potential registration under social work or to continue down the non-registered path it is currently on. In discussions with social workers, support workers and employers I am aware that this is not an easy choice to make as both roads are not clear. The purpose of this paper is to briefly explore this opportunity and consider the potential benefits, not only for healthcare professionals but for the consumers of these services.

Support Worker’s Role

Over the past few years there has been much discussion regarding the role and position of support workers within the larger healthcare arena.  A British study undertaken in 1997 investigated the role of support worker within community mental health services (Murray, Shepherd, Onyett, & Muijen, 1997). Murray et al. reported support workers activities in three categories, practical tasks, social and emotional support, and mental and physical health. Caird (2001) conducted a review of the literature surrounding paradigms to support people with mental health in an attempt to get a sense of community support work in New Zealand, but it was not until Cowan’s 2008 work that the support worker role was clearly articulated. In 2009 Pace described the role as someone who “works with their clients, providing the human connection in support of them and to be a partner in recovery … encouraging their client to find their own answers” (Pace, 2009, p. 18).

How Support Workers can assist Professionals

During the 2007 New Zealand College of Mental Health Nursing conference a paper was presented entitled ‘How Paraprofessional can help you: The role and value of support workers in mental health services’ (Pace, 2007). The presentation articulated the findings of study conducted with over two focus groups comprising of 12 mental health support workers with a mean employment time of 4 years and 4 months.  The findings were delivered through the identification of three distinct themes: 1. Networking and contacts, 2. Sharing of resources and information, and 3. Sharing of experiences; each of which was discussed in turn.

1. Networking and Contacts

Networking with agencies and community groups, utilizing the whole of the community approach (Rapp & Goscha, 2006) was clearly identified as one area in which support workers are able to assist other professional groups.  More recently networking and maintaining a professional relationship within the community has again been highlighted as a key skill for support work practice (Skill Matters, 2009; Pace, 2010). Additionally under this theme of monitoring involvement was also discussed. Based on the “primary relationship” (Pace, 2007) the support worker hold with consumers they are able, and indeed should do, to provide current information on clinical involvement, vocational and social activities, and accommodation requirements to name a few.

2. Sharing of resources and information

Following on from networking the second potential benefit is the sharing of resources and information. The presentation (Pace, 2007) clearly identified that regular contact between support workers and health professionals, within the scope of the Health Information Privacy Code, would aid the flow of communication and thus improve the quality of service delivery.  Due to day to day contact and observation support workers have with consumers in a ‘primary’ relationships they are able to provide information that other health care professionals may not otherwise have access to. Likewise, support worker could be utilities to monitor particular patterns of behaviour, or other areas, medication compliance of example, in improve quality of service and continuity of care.

3. Sharing of experiences

Based on the research reported (Pace, 2007) a substantial number of support workers have, at some point, been a consumer of mental health services. Through sharing experiences as a consumer, support workers and other healthcare professionals are able to gain a different perspective of mental illness.

Working in Partnership

Just as best practice shows that working in a collaborative manner with consumers yields the best results, so too can be the case across disciplines. Providing a clear working relationship and in-depth understanding of the role and function of both social worker and support workers through the registration process will allow for a greatly improved professional collaboration. This in turn will see a better utilization of funding and resources, with a more fluidity between clinical and non-clinical/support services.

Continuity and Quality of Care

Through the registration process there would come a greater sense of security, for both social workers and support workers: Social workers based on the fact that support workers would have a governing body and code of practice and have been identified as competent to a predetermined standard; Likewise, support workers can be confident in knowing their practice is guided by a well established professional body, bringing credibility to their role and position within the caring sector. Ultimately the greater security of all will lay with the service users knowing that their continuity and quality of care is insured by a registered professional health and social care group.

Conclusion

The present opportunity for extending social worker registration is not one to be missed. The potential benefits of both social worker and support workers are numerous, as illustrated in this paper: Networking, sharing of resources, collaborative practice, and continuity of care are all areas identified in best practice models. Such inclusion of support and care workers would improve the quality and competency of social and healthcare staff to better serve service users and strengthen the care sector as a whole, bringing a heightened sense of professionalism two discipline which to do not receive the credit they should.

Reference:

Caird, B. (2001). Getting a sense of community support work: A review of literature on paradigms to support people who experience mental illness. Ministry of Health, Wellington: New Zealand.

Cowan, C. (2008). Supporting the journey of recovery in mental health: A guide for support workers, family/whanau and friends. Dunmore Publishing, Wellington: New Zealand.

Hooyman, N. (18 March 2010). Social Work–Direct Care Partnerships Would Improve Care. Retrieved 18.11.2010 from http://phinational.org/archives/social-work-direct-care-partnerships-would-improve-care/

Murray, A., Shepherd, G., Onyett, S., & Muijen, M. (1997). More than a friend: The role of support workers in community mental health services. The Sainsbury Centre for Mental Health, London: United Kingdom.

Pace, B. (2007). How Paraprofessional can help you: The role and value of support workers in mental health services. NZCMHN Conference, Hamilton: New Zealand.

Pace, B. (2009). A practical guide to mental health support work. First Edition Ltd, Wellington: New Zealand.

Pace, B. (2010). Exploring support work: Examining the role of mental health support workers in New Zealand. First Edition Ltd, Wellington: New Zealand.

Rapp, C. A., & Goscha, R. J. (2006).The Strengths Model: Case Management with People with Psychiatric Disabilities (2nd ed.). Oxford University Press, Oxford, United Kingdom.

Skills Matter. (2009). Mental health Support Worker role outlined. Available at: http://www.skillsmatter.co.nz/page/121-Roles-in-mental-health-and-addiction+Mental-health-support-worker+Mental-health-support-worker-role-outline.

Non government organisations need to work together in order to continue providing vital services in the face of significant funding challenges, says Platform chief executive Marion Blake.

Ms Blake, whose organisation is a national network of mental health and addiction NGOs, said that with years of austerity measures ahead, it is clear that New Zealand will not be able to invest in health in the way it has before.

“Clearly everybody in the health sector is going to have to learn to do more with less,” said Ms Blake. “We need to get more creative about how we use what we have and how we deliver services – and one of the keys to this will be collaboration. “Mental ill health is not going to go away. New Zealand has a high prevalence of anxiety, mood and substance disorders and it is estimated that 47 per cent of New Zealanders will experience a mental illness an addiction some time in their lives. “It will become essential for elements of our mental health and addiction services to collaborate, work differently with each other and even merge just as we are already starting to see happening in all aspects of organisational life in New Zealand.”

Ms Blake said that GPs should also be able to refer people directly to a community organisation contracted by a District Health Board to provide mental health and addiction services.

“Currently many NGOs can only provide help to people who have come via the hospitals,” she said. “We need to remove these barriers so that, where appropriate, GPs can refer people with a mental health or addiction issue directly to a community organisation for early and often brief intervention that could prevent them needing to be admitted to hospital.”

Ms Blake said that by working together all community services can help ensure early interventions and address issues that aggravate mental distress such as poor physical health, housing, poverty and loneliness.

“All community service providers are seeing people with mental distress. We need all organisations across the housing, social, community and health sectors to put a mental health lens on all social problems. “As a country we can continue reforming the health system steadily – but we need to work on transforming it quickly. We must get help to people faster.”

According to a US Study, Community-based research:

• is more effective,
• is a better use of money
• is more likely to be used
• is more likely to tell the truth
• builds and unites communities
• makes change

(Source: Aspen Institute)

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Non Government Organisations in health, disability support and social services are doing outstanding work in Christchurch.

Community support organisations had been working around the clock to help some of the most vulnerable people in the community.

For many organisations, their buildings were destroyed or damaged, as were the homes of their staff and their clients. Records were destroyed in the earthquake and a major task for community support organisations has been locating clients who required ongoing support but who had become ‘lost’ , had been moved to shelters, gone to family or just left town.

Many clients of mental health and addictions services are suffering from increased fear and anxiety or re-emergence of trauma.

Support staff have been working incredibly hard to find these people, which they have been successful in doing, to ensure they get the professional help they need and to find new accommodation for them.

This has highlighted the absolutely critical role that community support services play and this can only grow as demand for their help grows in the weeks and months to come.

The hospitals, institutions, asylums – call them what you like – were the physical manifestation of difference, between citizens in our communities. Always found out of town, although over time many towns grew to meet them, but enough distance to ensure that most people in the local community were not connected and indifferent to those who lived there.

New Zealand has the international reputation of being one of the first countries in the world to close our long standing psychiatric hospitals. Our mental health and addiction services now include a mix of services provided by staff employed by the District Health Boards, community organisations, General Practice and Primary care organisations and some private organisations and individuals are all part of the mix. We need the diversity of skills, experience and knowledge to work in this area because there are often many things happening to a person and their family all at the same time. The community organisations employ staff who help people stay well by connecting them to their community family and friends, this means finding places to live, things to do and employment. This is New Zealand’s mental health and addiction system, it has evolved over the last 15-20 years, it continues to develop, it is envied by many countries over the world and its success depends on each part doing what its bit well.

The recent decision of the Appeal Court, judged that staff must be paid a minimum hourly rate for sleep over shifts rather than the widespread practice of a nightly rate plus call out.  This will require a significant change in funding to community organisations. The Prime Minister and the Minister of Health have indicated that they “preferred to keep disabled people in the community, but it had to be affordable”. The public is being conditioned about the affordability of social justice, demonstrating how fragile progress really is.

There are truckloads of international evidence that proves institutions don’t work and are very expensive to run, a major contributing factor for closure in the first place. So going back to that archaic model of is not even on the agenda.

We are a small country and most of us know a family where someone’s life has been impacted by the distress of mental ill health or drug and alcohol addictions. We are working with the complexity and stress of 21th century living so we cannot treat mental illness, addiction or disability as a disease to be cured or managed. The answer to working with the complexity of life in the 21^st century is not as simple as opening a ‘hospital in the country’. Our investment needs to continue to be in the innovative solutions that are created when people who use the system are able to influence its direction and shape.