CHAPTER FOUR: ANALYSIS, RESULTS AND DISCUSSION
4.5 Theme Four: How Professionals Perceive Young Peoples Experience in the Mental Health System
4.7.1 The Umbrella Approach and Youth One Stop Shops
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their creation prior to the interview, was unprovoked, and not something I had suggested as a researcher. I have named these new approaches the “Umbrella approach” and the “Micro teams approach”, entitled as such after the descriptive terms used by each participant. Both approaches draw heavily on collaboration between individual professionals and amongst services.
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layers of management, as seen in the current system, would be eliminated and instead Participant #11 suggested that managers of each mental health specialism meet regularly and form a board of directors. This suggestion addresses some of the comments made by participants within theme one who stated that often the funding is incorrectly allocated when decision makers are not informed about or considerate of the needs identified by those working on the front line. The reduction of middle management and bureaucracy also addresses concerns expressed by participants within theme one who identified that funding often is allocated to paying the wages of these managers and therefore doesn’t increase FTE or care packages for young people.
Participant #11 then discussed how this newly designed model of care would address current issues with interagency or interprofessional collaboration stating that within this umbrella system “those relationships would be tighter, and you guys are under the same umbrella, you have the same values [...] when you make those referrals, you're like, oh, hey, how's it going over there, and not having to build on those external relationships at the same time as referring my client”. Participant #11 stated that this system would be extremely large, incorporating all mental health services under one umbrella, or even one roof, and that has its impracticalities. They also acknowledged that interprofessional care would still have its challenges due to the size of the
organisation. However, they believed that these issues would be mitigated through the implementation of collaborative care training, companywide core values and aligned goals, rather than separate organisations operating upon varying agendas and policies.
Participant #11’s design is not fully formed, and it is not without space for critique.
However, it reflects the concerns and subsequent suggestions of many participants.
Participant #11’s design identifies key challenges associated with the lack of collaborative care, specifically in relation to young people being referred between services and the communication between professionals. In response, Participant #11
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designs an organisational structure that removes elements of bureaucracy, elevates the voices of professionals who work on the front line, and is intrinsically holistic and collaborative. I am not presenting this model as the solution to the challenges identified earlier in this chapter. I am presenting this model as an example of
participant initiative and advocacy, designing a new system, based on the identified needs of young people, which when unpacked, makes claims that are supported by other participants and external literature.
Participant #11’s claims about the importance of collaborative care have been addressed in theme five. However, their reference to Youth One Stop Shops, presents collaborative care within a more applicable rather than a uniquely
theoretical light. A Youth One Stop Shop, often referred to as YOSS (also known as ICYSHs, Integrated Community Based Youth Service Hubs), “is a youth focussed community-based centre providing a range of primary healthcare and
social/development services at little or no direct cost for 10- to 25-year-olds”
(Ministry of Health, 2009, as cited in Garrett et al., 2019). A Youth One Stop Shop adopts a holistic, multidisciplinary, collaborative approach, providing a variety of supports that young people may need such as education, mental health, physical health, addiction concerns, sexual health and family planning, employment services, social services and culturally specific services targeted at Māori, Pacific, migrant or refugee youth (Garrett et al., 2019; Hetrick et al., 2017; Settipani et al., 2019). Each of these services occur at a youth friendly, accessible location, with professionals coordinating regularly to lift professional standards, providing truly wrap around care, enabling the positive health development of young people (Garrett et al., 2019).
Evidence suggests that youth benefit from this collaborative, multidisciplinary care that caters to all elements of their wellbeing (Garrett et al., 2019; Hickie et al., 2019;
Hetrick et al., 2017; Lake & Turner, 2017; Settipani et al., 2019), and that they prefer to have all their needs met in one physical location (Hetrick et al., 2017).
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Within New Zealand, there are a variety of Youth One Stop Shops, all acting
independently from one another, usually community grown and operated (Settipani et al., 2019). Youth One Stop Shops are few in quantity and are sparsely located across the country, with many major cities lacking the implementation of the model (Healthify He Puna Waiora, 2022; Ministry of Health, 2009). The sparsity of Youth One Stop Shops, despite their clear therapeutic benefits, in alignment with holism and collaborative care, is arguably due to funding restraints and government
support (Garrett et al., 2019; Lee & Murphy, 2013). A government document of note is the ‘Under one Umbrella. Integrated Mental Health, Alcohol and Other Drug Use Care for Young People in New Zealand’ commissioned by the Aotearoa New
Zealand government to address some of the challenges in the mental health system (Cross-Party Mental Health and Addiction Wellbeing Group, 2023). This document was published after interviews with participants were completed, however it supports many of the claims made in this research, bereft the sociological perspective. This document is briefly outlined in the literature review.
Participant #11’s “umbrella approach”, reflects a lot of the principles that a Youth One Stop Shop embodies. Specifically, the incorporation of a variety of services, under one system, or even one roof (in the case of many One Stop Shops), all working together, implementing the same values through a holistic,
multidisciplinary approach for the benefit of the young person. Other participants also stated that extensive implementation of Youth One Stop Shops, through their hypothetical incorporation into the reimagined public system, was something they would like to see. Participant #35 stated that they would like to see “everybody working collaboratively together, getting other services so that you kind of get a hub of services all working together to support whanau and the youth”. Upon discussing Youth One Stop Shops and their hypothetical expansion Participant #76 stated that “I think that would be amazing. Because one thing I've noticed in this line of work that holds you back from working collaboratively with other services, is privacy…. confidentiality, you
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cannot information share. So if there was a way that we could all come together, where you can freely share information to get them the services….And it would also help the young people because they wouldn’t feel like they’re getting bounced around from service to service, it would be under one umbrella and encompassed with everything. Yeah, just a collaborative way to support them”. One important note to make here is the privacy and
confidentiality laws that are in place, specifically the Health Information Privacy Code 2020, and the parameters around sharing information (Privacy Commissioner, 2020).
Participant #23 elaborated on the concept of Youth One Stop Shops, and arguably Participant #11’s ‘umbrella approach’ design, stating that the decentralisation of funding, directly contributes to what Participant #19 referred to in as ‘fragmented silos’ (within theme two), where funding is allocated to a variety of non-government organizations, and this results in competition for funding and contracts. Participant
#11’s design, incorporates all non-government and government organisations into one system, combating the notion of competitive fragmented services. Participant
#23 supports this claim stating that “I think how you do that is by having a more centralised funding, rather than funding like a gazillion NGOs, to just have the DHBs (public system) do everything…. have them be aspects of one thing, rather than sending money in all these directions and hoping that stuff gets done”.
Drawing on the concept of Youth One Stop Shops, or the “umbrella approach”, we can see the benefit of centralised funding and services and how one larger
organisation, incorporating multidisciplinary teams, would facilitate collaboration and mitigate some of the fragmentation that occurs within the current system.
Therefore, a reimagined system, may benefit from incorporating all service into one system, or implementing more Youth One Stop Shops that act as “umbrella services”
on a slightly smaller scale, within each town.
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