In part, the initiative focused on the addition of Mental Health Acute Care Support Specialty Education Nurses to Hutt Valley and Wellington Regional Hospital Emergency Departments.
A Registered Mental Health Nurse by background, Gavin Donnell was already working in Wellington ED as MHAIDS ED Liaison when he stepped into the additional MHAC Nurse Educator role, carrying out both roles until his departure from the service in October 2023.
His ED Liaison role was clinically focused, triaging people aged 18 and over with mental health difficulties, making onward referrals, and sometimes providing brief interventions, such as distress tolerance skills.
He was able to build on the existing connections he had formed with staff across MHAIDS and ED as he started the MHACS Nurse Educator role, to carry out education to support and upskill his ED colleagues in mental health and addiction.
Gavin employed a range of approaches to achieve this, from an increase in planned training for nurses, to ad-hoc on-the-spot training.
“ED staff are short on time and resources, so you have to jump in when you get the opportunity,” he says.
As well as nurses and doctors, he carried out training with reception-based admin staff - “they're front facing and have the initial interaction with tāngata whaiora,” he explains.
He also brought in stakeholders to deliver training, from elsewhere in MHAIDS and from NGOs and primary health. This helped make kaimahi more aware of services offered by other organisations, helping to promote greater collaboration.
One session that gained particularly good feedback saw representatives of Kites Trust speaking about their lived experience of seeking support from ED.
Gavin also introduced new quality initiatives to support his ED colleagues, such as a tool designed to help triage nurses assess people presenting with mental health challenges.
“It has quite direct – and for nurses, initially quite confronting - questions to ask tāngata whaiora. These help nurses to select the right triage code and the best place to refer tāngata whaiora,” he explains.
“It was designed to be structured and very brief. The nurses didn't know what questions to ask - this guides them.
“It's helped to improve safety and lower risk for the acutely unwell."
Another quality initiative focused on ED medics, with Gavin designing a brief assessment for those presenting with mild/moderate needs. Underpinned by Te Whare Tapa Wha and incorporating risk, the assessment helps doctors better determine the best next steps for the person.
“Often doctors would be referring tāngata whaiora on to the Crisis Resolution Service, when they didn't meet the criteria, and so would be discharged. And that wouldn't be the best experience for that person,” explains Gavin.
“Tāngata whaiora may be better served by being referred to a primary health provider, such as an NGO, or a Health Improvement Practitioner (HIP) through their GP, who will try and see people that same day.”
A sense of humour and a flexible attitude helped Gavin build relationships and create change, with consistent feedback from ED staff about the value he brought.
“You've made such a positive impact on the care of mental health (tāngata whaiora) in ED and have really helped the staff increase their skills and knowledge,” said one colleague. And the feeling is mutual.
“Out of my whole career as a mental health nurse, I've found this the most rewarding - seeing the progress made by ED staff members, and the knock-on effect it has on tāngata whaiora,” says Gavin.
Ongoing funding has been secured for two permanent part time (0.6FTE) MHACS Nurse Educator roles. MHAIDS is currently recruiting for these roles in Hutt Valley and Wellington. If you are interested, please contact Waka Saba WakaitiRaewyn.Saba@mhaids.health.nz for more information.
