Search

People with mental health and substance use issues (tāngata whai ora katoa), regardless of ethnicity, are much more likely to be hospitalised or die from COVID-19 and were identified as a priority population (Priority Group 3) in Aotearoa New Zealand's vaccination roll-out plan. Data released by the Ministry of Health show that, despite tāngata whai ora katoa being a priority group, their vaccination rates are well below those of the general population. These inequities are pronounced for Māori with mental health and addiction issues (tāngata whai ora Māori). This is not acceptable. To support tāngata whai ora physical health and wellbeing, the onus is on all of us in the health system to actively reach out, have conversations, be supportive and provide accessible vaccination for people with mental health and addiction issues. Urgent action is needed. Now is the time to ensure tāngata whai ora katoa can be equally well.

Individuals with substance use disorder (SUD) often present with cognitive impairments, which may impede their ability to make decisions for themselves, including treatment-related decisions. It is therefore important to assess whether individuals with SUD have adequate decision-making capacity. Indeed, there have not been any capacity assessment tools tailored for use with SUD populations that demonstrate adequate psychometric properties or that have the strong ethical foundation that is required of capacity assessment tools. The Compulsory Assessment and Treatment–Capacity Assessment Tool (CAT–CAT) was designed to fill this gap in the literature. Therefore, the aim of this study was to establish the interrater and test–retest reliability, and discriminative validity of the CAT–CAT. The first of this two-part study recruited healthcare professionals in New Zealand and asked them to conduct a capacity assessment on two hypothetical clients. Generally, excellent interrater reliability (ρ = .998 overall) and test–retest reliability (ρ = .996 overall) was found. The CAT–CAT has exhibited reliability that was at least comparable to widely used capacity assessment tools for other pathologies. The second part of this study involved cognitively normal individuals undergoing capacity assessments to investigate the hypothesis that individuals that do not lack capacity will obtain scores significantly higher than 50% in each section of the CAT–CAT. This hypothesis was met with highly significant results. To conclude, preliminary data suggest that the CAT–CAT has excellent reliability and correctly classifies those with capacity.

Structural discrimination worsens physical health inequities and significantly reduces life expectancy for people with mental health and addiction issues. Aotearoa has recently made some notable changes in health policy by formally recognising the physical health needs of people with mental health and addiction issues. The COVID-19 vaccination sequencing framework provides an important opportunity to protect and promote the health of people with addiction and mental health issues. An expert advisory group, convened as part of the Aotearoa Equally Well collaborative, considered findings of a literature review on the vulnerability of people with mental health and addiction issues of contracting and dying from COVID-19. Evidence indicates an association between mental health and addiction issues and infection risk and worse outcomes. The group concluded mental health and addiction issues should be recognised as underlying health conditions that increase COVID-19 vulnerability, and that people with these issues should be prioritised for vaccination. For too long the health system has failed to address the life expectancy gap of people with addiction and mental health issues. Now is an opportunity to change the kōrero. People with mental health and addiction issues experience significant physical health inequities. Addressing these inequities must be integral in modern health policy-including our COVID-19 pandemic response.

Survey research is often interpreted as an exact science, but its role in assessing the social world—and its foundation in statistics—make it a methodological tool less about absolute certainty and more about estimation, choice, and trade-off. Much like any other research method, the survey process involves a number of important decisions for a researcher to make, and every decision affects not only the end result but also all of the subsequent choices along the way. Some of the most important issues that any researcher conducting a survey should consider include sampling, questionnaire design, and modality—and how these decisions, in turn, affect the thought processes and responses of survey takers. Each of these broader categories involves a multitude of choices that are dictated by research goals, as well as time and budget constraints. These aspects of the survey process have become more complex—and thus decisions have become more challenging—in the face of rapidly declining response rates and skyrocketing costs. There is no singular survey formula or path that all researchers follow; survey research is instead an accumulation of knowledge and best practices, trial and error of new techniques, and continual adaptation—all in an effort to say something with some level of statistical confidence about a particular population.

To quantify the relationship between any general practitioner (GP) visit and hazardous alcohol use, and whether this differs by sociodemographic factors.Hazardous alcohol use (scores 8+ Alcohol Use Disorders Identification Test) and any past year GP visits were examined using 2016/17 New Zealand Health Survey data from 13,598 adults. Sub-group analyses examined whether the association differed by age, sex or ethnicity (Māori/non-Māori), and socioeconomic status (NZDep2013) in post-hoc analyses.Results differed for Māori and non-Māori. Regardless of drinking behaviour, Māori males aged 15-24 years were least likely to visit a GP. Among Māori in each demographic group, GP visits were similar for people meeting hazardous drinking criteria and safer drinkers. Conversely, among non-Māori males aged under 45 and non-Māori females aged 15-24 and 45-64 years, GP visits were 10-13 percentage points higher among people meeting hazardous drinking criteria than safer drinkers. GP visits were lower for people meeting hazardous drinking criteria living in more deprived areas.Multiple strategies need to be prioritised to address service access particularly for young Māori, and support people drinking at hazardous levels. This includes increasing access to services in various settings, enhancing existing primary health services (eg, cultural responsiveness, alcohol screening, brief interventions), addressing access barriers, and health promotion.

The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug-taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self-injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de-escalation techniques, reduction tools, trauma-informed care, and consulting with consumers and whānau.

Meeting the needs of people with co-existing mental health and addiction problems is a challenge faced by many mental health and addiction services and providers. A compounding factor has been the separation of mental health and addiction services which has meant that many people with co-existing mental health and addiction problems have fallen through the cracks between services or had issues not recognized or responded to, leading to poor health outcomes. This chapter describes the approach taken by New Zealand's workforce development centers to support services to improve responsiveness and workforce capability to work with people with co-existing mental health and addiction problems. International research on implementation is briefly summarized before discussion about the impact of the national approach and the barriers to implementation that have emerged. Recommendations for next steps conclude this chapter.

I don’t give a damn about Election Day after what happened here. I am worried about the people of New Jersey. #Sandy.” In the hours after Hurricane Sandy made landfall in New Jersey, Governor Chris Christie—presumably clad in his now iconic navy blue fleece jacket—solidified his transition from Garden State bully to national bipartisan hero in a single tweet. It was a declaration he continued to repeat to the media in the days leading up to the 2012 presidential election, as he refused a visit from fellow partisan and Republican presidential nominee former Massachusetts governor Mitt Romney—a man for whom Christie had been campaigning extensively throughout the 2012 cycle while rumored at one point to become his running mate. Christie, stereotyped up to that point of his first term as brash and bossy due to his Mafioso-like style of governing, had suddenly morphed into a fearless leader of heroic proportions. Showing a more compassionate and courageous side of himself than ever before, Christie gained immense praise state and nationwide for putting politics aside, putting his people first, and—both literally and figuratively—embracing President Obama and the help of the federal government in the storm’s devastating aftermath.

This article describes public opinion polling as well as politics and governance in New York. The interaction between the polls, press, politicians, and public creates a constant, continual, and reciprocal interplay along six distinct paths (4P process). The 4P process is a core element of the manner in which modern representative democracy works. This process is developed over time as polling grew to maturity while politicians and the press experimented with its utility and implications and addressed the costs of using polling. Polling has become integral to governing. Furthermore, it examined four cases from the two survey models, comparing and contrasting the different parts of each survey in order to determine the effects of forced-choice questions versus intensity scales. Identifying ambivalence significantly lessened support and opposition for each major issue that New Yorkers faced.