The Quiet Revolution

How Information is Transforming Mental Health Services in New Zealand

An article by Dr Mark Smith, Clinical Lead Specialist, Information, Te Pou

18 March 2008


A quiet revolution is happening in mental health services - one which has received almost no mention in the media. This quiet revolution, as I term it, concerns the type of information collected and used within the mental health and addiction sector.

There is a strong public appetite for articles on the latest treatment or medication available for mental health problems. Additionally, there are newspaper articles and profiles on professionals and others working, or receiving services, in the mental health and addiction sector. This focus is understandable, but unfortunate given there are other important matters to publicise in this area, including our "quiet revolution".

The notion represents a radical change to the sector's information systems; this change will have a dramatic impact on the treatments available and, therefore the recovery of service users.

To understand what is quietly going on and why, we must first take a look at what information is currently collected.

Information from the 21 DHBs is collected and sent to the New Zealand Health Information service (NZHIS), which is part of the Ministry of Health. This information covers the various activities occurring within DHB mental health services: the number of clients, the number of contacts with services, the kinds of interventions. This data is known as MHINC, and it is, in reality, the where, what and who of service provision. It is vital but, unfortunately, it isn't comprehensive, for two main reasons:

Firstly, most of the several hundred NGOs in New Zealand simply don't supply this information to the Ministry of Health. Secondly, this information tells us nothing about outcomes for service users, ie, it doesn't tell us how well services are doing and whether or not service users are recovering.

The quiet revolution will, in time, deliver on the comprehensiveness test.

Over the next few years, the NGO sector will start to supply information to the Ministry. This will be a great achievement in itself but, when we can add this to the rest of the information we gather, this will be the beginning of the new outcomes-focused world of mental health care in this country.

How will outcomes feature in the information collected?

As of 1 July 2008, a new information collection approach called the Programme for the Integration of Mental Health Data (PRIMHD) will come into effect. This new integrated data will combine the what, where and who information data (MHINC) with outcomes data.

Outcomes information is currently based on an assessment tool called the Health of the Nation Outcome Scale (HoNOS). This tool has been trialled and used over the past few years in the New Zealand environment. It has also been used extensively overseas in the UK and Australia.

HoNOS asks the clinician to rate how well the service user is doing in a range of areas, such as mood, thought processes, behaviour, etc, at admission and then three-monthly until discharge.

Given how much money we spend on mental health services, it is fair and reasonable to expect that services will endeavour to show in what way they are making a difference with helping people move on with their recovery. Once this outcome information is combined for the first time with the MHINC data to form the new PRIMHD data, this will be possible.

The implications of having this information for the Ministry, DHBs, clinicians and service users are enormous. The collection will come to be seen as a revolution in the way we view services across the whole sector.

Te Pou, along with NZHIS, is charged with overseeing the outcome component of this development.

I suspect the revolution will not be an easy one to introduce.

Page last updated: 22 May 2009