Opening of NZ College of Mental Health Nurses

It is always nice to be a part of history, so I am delighted to be here today to formally launch Te Ao Maramatanga, the New Zealand College of Mental Health Nurses.

I don’t think I am exaggerating when I say this is a truly historic day for the mental health sector in New Zealand. I’m sure you’ve all been looking forward to it for some time, and you should feel deservedly proud and excited. The opening of this College marks a significant shift in the progression of mental health nursing, and it‘s a milestone that is certainly worth celebrating.

Yet we wouldn’t have anything to celebrate today if it wasn’t for the vision and perseverance of many people.

I won’t attempt to name them all individually, but I wanted to make special mention of Tony O’Brien, president of the College, the executive team and those pioneering nurses who kept this dream alive: Chris Walsh, Thelma Puckey, Kaye Carncross and Frances Hughes. I am also told that Iona Edmonds, Kate Prebble and Erina Morrison-Ngatai were instrumental in pushing for the idea of a separate New Zealand organisation.

Mental health nursing has consistently developed some of the best leaders we have in New Zealand today, and I want to thank you for your valuable contributions to the profession.

Of course, this new college has not simply sprung up overnight. As with all ‘births’, there is often a long gestation period before the big day arrives. If you’ll bear with me, I want to give you some of the background that foreshadows the launching of this new organisation.

In the late 1980s, mental health nurses in New Zealand started to become dissatisfied with what was occurring in their area, and also with the lack of advocacy and representation by main nursing bodies in relation to mental health. They felt marginalised and believed that their patients and consumers were not being valued.

A small group tried to establish a college of mental health nursing at that time, but did not succeed. However, the movement to establish a separate entity for mental health nursing grew. Under the leadership of Frances Hughes and other key nursing leaders who now form the executive of this new body, a New Zealand branch of the Australia New Zealand College of Mental Health Nursing was established.

This branch quickly increased in numbers and over the last 10 years, it became aware that the cultural differences between New Zealand and Australia were becoming an impediment to the profession in New Zealand. So New Zealand broke away from Australia, and now today we have the birth of Te Ao Maramatanga.

This story says much about dedicated people working to make a vision become reality; about becoming more aware of the need to acknowledge our bicultural heritage; and about the strength of professional direction that has gained momentum from many areas of the sector.

And since this is such an auspicious day, it is fitting to also release the new edition of the Standards of Practice. I will talk more about this later.

And while we are on a roll with launches and releases, why not add an award into the mix as well? This event also incorporates the presentation of the Henry Rongomau Bennett Memorial Scholarship to Menetta Te Aonui. Menetta, I understand that the scholarship governance body and Capital and Coast District Health Board have been very impressed by your ability to demonstrate strong leadership and commitment to Mäori Health. I wish you well in continuing your good work towards developing training around Mäori models.

The Government’s active role in fostering mental health services has included ongoing support for mental health nursing over several years through the Mental Health Directorate of the Ministry of Health and mental health workforce funding.

The Government's commitment to funding the Mental Health Blueprint has allowed DHBs to plan ahead with some degree of certainty so that additional services can be provided and priority areas within mental health receive a special focus.

Ongoing sustainable funding has allowed for support of new graduates in mental health and access to advanced programmes in mental health nursing. The number of mental health clinicians in the community increased by 23 per cent between 1999/2000 and 2003/2004. The number of alcohol and other drug workers in the community increased by 63 per cent between 1999/2000 and 2003/04.

The decision to fund two chairs in mental health nursing in New Zealand has increased the research capacity of mental health nursing, and I think also reflects the increasing value placed on the profession.

I was pleased to hear that many of you here today have been attending a seminar on the national framework for mental health nursing. I’m sure you’ll agree that there is much to be considered in terms of how to integrate various initiatives in mental health and how to develop roles in response to workforce issues.

I am pleased to tell you that this Government is the first to support the development of a framework for the specialty area of psychiatric/mental health nursing in New Zealand.

As those of you who attended the seminar today will know, an expert advisory group is developing this report and its recommendations will be given to Ministry of Health Deputy Director-General Janice Wilson. The views of the mental health sector were sought through a broad process of gap analysis and consultation outlined in the report.

The work was sponsored and chaired by Dr Frances Hughes, and she will be continuing this work until the expected completion date in February 2005.

In case some of you don’t already know, Frances recently resigned as Chief Advisor Nursing at the Ministry of Health and will be a big loss. I personally will miss her very much – she has been a mainstay to me as Health Minister. Frances has made an enormous contribution to mental health nursing over the years, but I know that will continue in her new role at the University of Auckland.

I consider the report on a national framework for mental health nursing is timely, and an important contribution to the strategic direction of building capacity and capability within the mental health nursing workforce in many existing as well as new areas -- for example, primary health settings, which I will speak more about later.

There are many challenges to be addressed: professional supervision and infrastructure, future post-entry clinical nurse training programmes, recruitment and retention and the competencies expected of mental health nurses. The framework will try to meet some of the needs identified by the sector consultations, as well as provide nurses with a transparent structure against which to perform.

The framework is highlighting the need to embed the Standards into services. The Government expects a transparent process where providers and nurses are supported by defined expectations. I also expect there to be consistent service delivery so people know what to expect from mental health services wherever they live or are based in New Zealand.

As I said, the Government has been committed from the start to fully implementing the Mental Health Blueprint, and we have been funding its implementation as fast as staffing resources allow. Mental health is, in fact, one of this Government’s seven health priorities, and mental health workforce development is part of the wider government priority for health workforce development.

Over all categories of service delivery, the Blueprint is 71 per cent implemented in 2003/2004 compared to 56 per cent in 1999/2000. On top of this past funding, the Government is putting in an extra $250 million during the next four years to continue implementation.

Most new funding during this time will be allocated to the northern half of the country to help bring this area closer to the level of Blueprint funding in other parts of New Zealand. The Government will increase baseline funding for mental health until full Blueprint levels are reached.

Mental health nurses form the largest component of the mental health clinical workforce. In 2003, there were more than 2800 registered nurses in the mental health workforce, working across a very broad range of areas. Post-entry clinical programmes funded by the Clinical Training Agency are to be increased, and this is one example of attempts to increase mental health nursing numbers.

Most importantly, there is a growing demand and recognition of the need for services that are culturally appropriate -- not only for Mäori and Pacific peoples, but also for the increasing proportion of refugees and Asian people in New Zealand.

These groups are particularly under-represented in the nursing workforce. However, at 13 per cent of the workforce, there are more Mäori in mental health nursing than in any other area of nursing.

There is a need for more mental health nurses in child and family, alcohol and drug, and Mäori and Pacific programmes. The Ministry of Health has responsibility for national mental health workforce development and the DHBs have responsibility for mental health workforce at a local level. To this end, the Ministry has entered into a partnership with DHBs to manage and govern national mental health workforce development.

Primary mental health care is definitely an emerging area that needs to be addressed. Mental health nurses will be crucial in helping to deliver primary health care to populations by providing advice and expertise to Primary Health Organisations, or being part of PHOs themselves. This is an area I feel really excited about.

The building of a sustainable workforce to deliver mental health care provides opportunities for nurses to work collaboratively with other professional groups.

In the near future, mental health services are likely to have a less exclusive focus on service provision, and to increasingly provide consultation and liaison to the primary health care sector. The preventative approach of primary health care is ideally suited to nurses, who can play a big part in monitoring mental health conditions. The draft Second National Mental Health and Addiction Plan gives a strong indication of the future role of PHOs in mental health care, and this increased emphasis on primary care is likely to impact significantly on the work of mental health nurses in the future.

I understand your college is exploring the potential development of mental health nurses as ‘Responsible Clinicians’ under the Mental Health Act 1992.

This has some parallels with the nurse practitioner development in terms of the broadening of nurse roles and the need for this in the current environment, and will obviously require some collaboration between disciplines. I’m sure you would find that collaboration useful.

I am very keen to see the development of the nurse practitioner role progressed, but unfortunately progress has not been as fast as I would like. The challenge now is for DHBs is to provide workforce planning and service development that enhances opportunities for nurse practitioners to work in the mental health area.

Finally today I want to mention briefly a report out this week from the Mental Health Foundation titled Respect Costs Nothing, the findings of the first national survey asking people who have experienced mental illness about the nature of any discrimination they may have encountered.

The report reveals that people who have experienced mental illness have often also experienced discrimination in all aspects of their lives, from employment and housing, to discrimination from friends and family and the community. Discrimination has left people feeling socially excluded from many aspects of daily living.

So clearly, despite the great advances made through the Like Minds, Like Mine campaigns, there is obviously much more work that needs to be done in this area, and there are certainly plenty of challenges ahead for mental health nurses. I am sure you are all ready to tackle them head on!

Thank you again for inviting me to share this historic occasion. I am delighted to declare the New Zealand College of Mental Health Nurses well and truly launched. I look forward to working with you in the future and have every confidence that your new organisation will represent your members, and the mental health sector, well.