Review of services for people living with HIV in New Zealand

The discussions in Wellington also raised two other familiar points of discussion: adequacy of mentalhealth and social work service coverage for PLHA, and the importance of streamlining referralprocesses.With respect to mental health coverage in Wellington, the following points were made by ProfessorEllis:“There would certainly be scope to extend psychological support and mental health services tomore people if resources were increased, so that consumers would have a greater choice ofclinicians and also of disciplines. Ideally, there would be a psychologist specifically attached tothe clinic as well as a psychiatrist, for instance. A regular commitment of 0.1 FTE psychiatristand 0.1 psychologist to the ID team would allow significant engagement with the ID team andother HIV services to better integrate care. An experienced MH nurse with counsellingexpertise (not just generic MH nursing skills) could supplement or even replace some of thattime, and further extend choice for clients. In addition, there would need to be the capacity torespond to crises and urgent referrals, including of inpatients, as needed. The service weprovide at present is unfortunately more a consultation than a true liaison one, albeitlongstanding collegial relationships assist considerably ... It would be of considerable benefitto include a specific recommendation on the quantum of provision of secondary mental healthservices to people with HIV, within the context of consultation liaison psychiatric services inparticular, and within mental health services more broadly as well. While mental healthconsumers have not been as vulnerable to infection with HIV as they have been in the USA,they are at greater risk and services need to address this.”In view of these remarks, which were entirely consistent with opinions up and down the country, itwould seem that the time is ripe for a broad discussion on appropriate benchmarks for mental healthservice coverage in the context of HIV services. The same could be said of benchmarks for socialwork needs in HIV care. In CCDHB, the current allocation of 0.2 FTE social workers for HIV patientswas described as being wholly insufficient to address the level of issues raised in relation to, forexample, housing and employment. In CCDHB, as in all other centres covered in this review, socialwork tasks are being undertaken by health professionals without the training or capability for suchwork. The consistently reported clinical fact is that the work is needed, as is the professional skill tocarry it out.CCDHB staff saw a fundamental need for service delivery integration at DHB (hospital) level –additional referral processes which take extra time, add uncertainty for patients and reduce clinicalseamlessness need to be eliminated. This observation may have been in reference to the contractingout of SH services in the Wellington region, which has inadvertently led to some unforeseencomplications in designing seamless service delivery (see below).Gaps in ID services were suggested as resulting from the fact that the service is not regional – atpresent it does not receive region‐specific funding. This could rectify, for example, the fact that thereare no clinics in Hutt or Masterton, which would benefit from having their own services. It was alsosuggested that outreach to specific communities – for example Māori and Pacific Islands populations– could best be effected by channelling it through DHB services. In other words, CCDHB staffsuggested that there be a re‐design of prevention initiatives, starting with a regional discussion onhow to ensure maximum impact through current service mechanisms, and how these systems needto evolve. An additional focus for future investment is adherence support for those receiving ARVsand HAART (psychological services play a significant role in this respect in some countries).REVIEW OF SERVICES FOR PLHA 17