Update on Community Mental Health and Wellbeing Hubs: August 2023
The development of Community Mental Health and Wellbeing Hubs was the central focal point in the early stages of the Adult Community Mental Health & Addiction workstream. However, as the workstream progressed, our community partners gave us the clear message that hubs were best delivered through a community-led model, with a strong peer support component, rather than by specialist mental health and addiction services.
With this in mind the Community Mental Health and Wellbeing Hubs project became a stand-alone project that was running in parallel to the MHAIDS Local Adult Specialist Mental Health & Addiction project.
As early engagement work occurred, it became clear that not every local community wanted or needed a hub, but they did want to engage in discussions about better access to more integrated mental health and addiction services.
A readiness exercise was completed across the district, taking into consideration multiple factors. Kāpiti was subsequently identified as a locality with a high level of readiness due to the presence of an established community structure to support a hub. It was decided to initially pursue a Mental Health and Wellbeing Hub in one geographical area, with Kāpiti being the chosen location.
However, since the beginning of this year, the implementation of the national health reforms has meant the operating environment for the Hubs project has changed significantly. It has therefore been decided to pause progress on the development of Community Mental Health and Wellbeing Hubs until such time as the operating environment both locally and nationally has stabilised.
While this work is being paused for now, we remain committed to the principle of community-led service development and will continue to develop mental health and addiction services in accordance with the needs and preferences of each local community.
What is a Community Mental Health and Wellbeing Hub?
A hub is intended to provide a safe space and a key connection point for people who are in mental distress. It will have the infrastructure to support mental health and addiction service delivery, provide care coordination, and connect people to a wide variety of community supports that help to enhance wellbeing.
There are several evidence-based models that combine primary care and mental health in community hubs. In reviewing the literature, there are examples of integrated community mental health services that are administered through a variety of evidence-based models - including community hubs. Depending on the needs and preferences of the local community a hub may include one or more of the following functions:
a shared physical space for several mental health, health and social care organisations
support and service coordination
the ability to connect people with other community support organisations in the local ecosystem and;
more intensive wrap-around services for people who want and need it, especially those who are in mental distress.
The hub will welcome anyone who is in mental distress, whether or not that person is currently registered with a primary health or secondary mental health and addiction service provider.
What will the leadership and partnership arrangements look like?
The decisions about leadership and partnership arrangements for each geographical area will vary according to local iwi, different local geographies, population needs and existing organisational configurations. As the case studies from place-based initiatives in the England NHS show, there is no ‘one size fits all’ model for collaborative governance, but there are some key features that will need to be considered (Kings Fund, 2022)[1].
Whatever leadership and partnership management arrangements are selected, it is essential that the development of the hub is co-led by the local Māori/Iwi Partnership Board and the local Health District.
The hub’s core functions will be co-designed with tāngata whaiora, whānau and participating organisations with room for development, growth and improvement over time. This approach is more likely to result in a constellation of community supports and services that are responsive to people’s needs and continue to be a good fit with one another and with the local community.
Examples from Aotearoa and elsewhere
The community health hub model has been promoted nationally and internationally within various social and health contexts. Here are a few examples:
1.The South Seas Healthcare Community Hub in South Auckland has been operating for two and-a-half years and serves mainly a Pacific and Māori population. The Hub includes a free online pharmacy option called Zoom Pharmacy, which is one of South Seas’ 15 ‘village providers’ – comprised of healthcare, social service agencies and community groups that all take a wraparound approach.
2.Ngāi Tahu-owned health provider Te Kaika is planning to run a large community wellness hub that will be built on its Caversham health campus in Dunedin. The hub aims to provide a range of high-quality health and social services to support whānau, Pacific families and low-income families in Dunedin. The 2500sqm two-storey building will house outpatient services, primary care and social agencies on the ground floor, alongside clinical spaces and private facilities. It will offer access to Dunedin’s mental health and addiction services and will also offer outpatient clinics for a range of other health services including paediatrics, rheumatology, endocrinology, cardiology and diabetes.
3.Southcentral Foundation is a non-profit health care organisation that serves a population of around 60,000 Alaska Native and Native American people in Southcentral Alaska. It supports the community through what is known as the Nuka System of Care. This system incorporates key elements of the person-centred medical home model, with multidisciplinary teams providing integrated health and social care services in primary care centres and the community, co-ordinating with a range of other community services. This is combined with a broader approach to improving family and community wellbeing that extends well beyond the co-ordination of care services and includes things like tackling domestic violence, abuse and neglect across the population.
[1] Kings Fund (2022). Providers in Place-Based Partnerships: Case studies of local collaboration.
