Kua hua te marama - Something has completed a full cycle

At the end of July 2019, our beloved Tāmaki Wellbeing Bach closed its doors, marking the end of chapter in a longer journey that still continues to bridge health and community through the activation of local wellbeing.

Here is a little reflection on the time and territory we covered through the tenure of 8 Clifton Court, Pamure, Tāmaki-Makaurau

Localities Mission Lift Off

From 2008, both Auckland and Waitemata District Health Boards (DHBs) reshaped experiences of mental health and wellbeing. The DHBs used a localities approach with the goal of working together with communities to create conditions where local people can take greater control over their own health and wellbeing.

This set in motion a move by the Auckland DHB Strategy, Participation and Improvement unit to focus on the Tāmaki locality (a cluster of East Auckland suburbs including Glen Innes, Pt England and Panmure) - with the goal of collaboratively improving meaningful health outcomes, determined and in partnership with the local community.

In 2013, a series of intensive community engagements led to the development of a shared vision where the experience of mental health and wellbeing focused on the wellness of the whole person in their family, whānau and community, over the whole of their life, supported by integrated services that are relevant to Tāmaki.

From this point onwards, a comprehensive programme of work was co-designed with a diverse group of stakeholders. A commercial lease was taken out on 8 Clifton Court, Panmure previously an old furniture shop which eventually became affectionately known as ‘the Bach’. This store front building was destined to become a whare headquarters which would go on to provide a space of care, creativity and community partnerships. The Bach would become a place where people would work and learn together, whilst producing wellbeing innovations that would bring the programmes vision to life.

A Portfolio of Health and Wellbeing Innovations

Wellbeing innovations you say.... here is a snapshot of a few projects that were launched from the Tāmaki Wellbeing Bach:

Also a Community Hub and Sanctuary

Even more impressive was the ability for the Bach to serve as a community hub and sanctuary for a range of initiatives, groups and individuals. This included a Jobs and Skills Pop Up Hub; Radio Tama’ohi, a Tongan community radio staion; Mental Health peer support groups; meeting space for the Tāmaki Youth Council and Pacific Island prayer groups; as well as an informal hangout space for local residents to come and have a cup of coffee on a Monday morning.

Ka pū te ruha, ka hao te rangatahi - The old net is cast aside, while the new net goes a-catching

Home is not merely roof and room but something we endear and a place where love and hope resides. We bid farewell to the Tāmaki Wellbeing Bach. Special thanks to Auckland DHB for sharing this home with us and for all those who worked alongside us over the years as well as those who came to celebrate our achievements at the closure of the Bach.

Although the Auckland DHB Tāmaki Wellbeing team are leaving this place, we‘re in the neighbourhood still and working out of the Tāmaki Response office (above the library). So whilst where we work from has changed, our māhi remains the same remains..

Awhi Ora – Walk Alongside Support is a flexible and person-centred wellbeing support service, helping people to identify and work on the challenges that are important to them. Several non-government organisations (NGOs) deliver the Awhi Ora – Walk Alongside Support in partnership with various Auckland and Waitemata general practitioner’s (GPs).

The relationship between the GP and the NGO worker is critical to establishing the right type of support for the person in need. Some NGOs are co-located in a GP practice and spend a couple of hours to a few days a week working there. Below, Lexi, an NGO support worker, shares her experience of being co-located in one of the practices she works with.

“I’m really enjoying it, and the practice is super on-board and appreciative of the service we provide. They enjoy having check in’s and love hearing the success stories of the people I am working with. Most of the doctors and nurses have gone out of their way to chat to me and talk about the people they’ve introduced to me, so the genuine care is so great to see!

I’m noticing a big difference in the clients when our service is delivered in this way, compared to elsewhere. In co-located practices I have found clients much more open and vulnerable, they also appear to have clearer expectations and come ready with question/support needs.

Overall it’s been an enjoyable experience. The relationship with the practice is good, and because of this we are working with the introduction process collaboratively to find what works best for us all.

Interestingly - today we had a client re-introduced into Awhi Ora who had previously pulled out of the service before our contact with him. In this re-introduction, the doctor included that he is “not comfortable meeting in his home/coffee shop because of his symptoms - but can meet in the surgery room at the GP practice”. I thought this just confirmed how important co-location is/can be for some clients, because we can see in this case how feelings around meeting location can pose a barrier to accessing support and how some clients naturally feel safer in their GP practice”.

Thanks to Lexi for contributing to the blog and updating on how Awhi Ora – Walk Alongside Support continues to provide a much needed service.

The Awhi Ora - Walk Alongside Support service is offered by over fifty GP practices in the Auckland and Waitemata District Health Board area's. For more information on accessing the service, please contact us here.

Two weeks ago Fiona from Kāhu Tū Kaha, Charlotte from Glen Innes Family Centre, Karl and I ran a workshop on the early years system mapping work we have been doing. The aim of this project is to try and understand and document the enablers and barriers to wellbeing for young children and their parent/s or caregivers and whānau.

The workshop was attended by a number of local early years’ service providers, research and education experts, a team member from our partner organisation Tāmaki Response and healthcare. Thank-you to those who attended and helped us with this work.

At the workshop we walked through the processes we have taken in this project presenting our findings to sanity check them. The project included desk-top research to identify service providers in the Tāmaki location, a literature scan of best practices and approaches for wellbeing in the early years, systems mapping and interviews.

We chose to use systems mapping as it provides a mechanism for visually documenting and understanding how complex networks and relationships interact. We were able to document multiple 'actors' such as individuals, organisations, service providers, local shops, green spaces and so on.

The mapping process involved talking to a number of local families and service providers to discuss their definitions and experiences of wellbeing. Families’ definitions of wellbeing included warm homes, reducing stress, an improved financial status and looking after themselves. Families spoken with also noted that helping others and contributing back to society was important to them.

We then explored the services and resources (such as green spaces or parks) that they used. Barriers to wellbeing were explored and documented. The strength of relationships including negative experiences were also captured. Individuals (including families) who took part in building these maps told us they liked the process as it was relationship focused and helped them to see all of the supports they had available to them. Systems mapping also allowed the individual/s to lead the mapping process and focus on what was important to them.

This was the first time for our team to use systems mapping. We found that participants engaged easily in the discussions. Participants were also able to identify what was lacking or any barriers to wellbeing for them and young children/families, This method also allowed the individuals to lead the mapping process and focus on what was important to them. Another positive outcome from this project is that some of the smaller non-government organisations (NGOs) involved stated the focus on and mapping of relationships was extremely meaningful to them and the way in which they approached their work..

At the workshop we held a discussion and added to the insights map developed from all of the maps, interviews and desktop research. Further refinement work of the insights map will now take place before we hold a final workshop with local parents and families. We are looking forward to checking our insights so far and then building the final model with Tāmaki whānau.

The Tāmaki Wellbeing initiative is turning new corners this year. We are building a closer working relationship with the Tāmaki Response and look forward to joint projects and work programmes.

Awhi Ora – Walk alongside support is an example of what Tāmaki Wellbeing has produced. Born in Tāmaki, the service involves a network of non-government organisations (NGOs) that are linked to doctors and social service providers to walk alongside people who need a bit of help to reach their goals and stop an accumulation of issues becoming overwhelming.

With some of the Tāmaki community, we designed what a walking alongside support should feel like, we then tried it with some local GPs and NGOs before checking it could work at a bigger scale with a number of GP practices across Auckland District Health Board. We are getting to the point where this support can be accessed through over 40 practices across Auckland and Waitemata District Health Board and, as a service Awhi Ora - Walk alongside support, no longer needs input from our project team.

We have had some proud moments along the way: the Auckland District Health Board Health Excellence Awards in 2017, being commissioned to create more primary mental health interventions by the Ministry of Health under the Fit for the Future project. A subsequent independent evaluation confirmed that the service is not only working but also improves access by groups that the health system is not very good at engaging with. The proudest moment though was to have the ‘Awhi Ora’ name formally gifted to us by a member of

the Tāmaki community – thank you!

So what will we be doing in the next few months? As a health system, we are continuing to build on what we have done with the Tāmaki communities to work on diabetes in Tāmaki and other parts of Auckland; and to create supports that will work for people who are homeless in central Auckland.

Over our tenure in Tāmaki, we have also learnt that health systems can’t provide all the support people need on their own: in order to make a difference to people’s lives, we need to look elsewhere. This is what we are gearing up to do in Tāmaki, to work with other agencies as part of the Tāmaki Response so we, alongside the community, can create ways to improve how we support children in their early years and through schools or families who are struggling on a daily basis.

More on that in the coming months…

What a year!

As 2018 nears its end, now is a good time for reflecting. There are three markers to be remembered for the Tāmaki Wellbeing initiative this year: the evaluation outcomes of Awhi Ora and Te Tumu Waiora, the Auckland DHB Health Excellence Awards and the Mental Health Inquiry report.

Awhi Ora and Te Tumu Waiora have been independently and proved to be effective together, and, as importantly to be accessed by Māori and Pacifica who the system typically fails to engage with.

The Fit for the Future project that gave birth to Te Tumu Waiora in Auckland received the Health Excellence Award in the Chief Executive category. A great occasion to share and celebrate with all our partners.

Finally the government made the Mental Health and Addictions Inquiry report available to the public. While it is great to see both Awhi Ora and Fit for the Future featured in the report, it reminds us that what matters to people around the country hasn’t changed from when we launched the Tāmaki Wellbeing Initiative.

I also wanted to take this opportunity to thank everybody who provides support out there, be it in general practice, with the Awhi Ora providers and so many of the whānau and people with lived experience who give back. Together you are making our communities stronger – thank you!

The holiday period is a time to get together and celebrate, and it is also a time when isolation can feel more present to some of us. Look out for those around you, and stay well everyone.

Ki Ora!

I'm Fiona, last month myself and Oliver, as part of the Tamaki Wellbeing Initiative spent a day talking with the local community about their wellbeing. First of all, thank you so much to everyone who shared and were involved. Participants in particular and also support from our venue staff at Panmure Library.

A bit of background….

We are part of a team who want to learn how people manage their health and wellbeing, to hear peoples’ experiences and to understand what matters to people in Tamaki. Through this we hope to better respond to peoples’ personal wellness and the wellness of the Tamaki Community.

Factors impacting wellbeing

We talked with people about the factors in their lives that impact their wellbeing. For some people it was their families, for others their physical health, and the lists were unique to each person.

Wellbeing Tree

Next, we asked people to think about things in their life that have a positive impact on their wellbeing, and the things that takeaway from their wellbeing. These were captured on our “Wellbeing Tree”. Green leaves were used for things that have a positive impact on wellbeing. The pink leaves represent things that take away from wellbeing.

Community Wellbeing

Lastly, we talked about Community Wellbeing, and (with maps) identified the places in Tamaki that have positive and negative impacts on wellbeing.

Next steps

We had a great response with people happy to share and participate. We will organize all the feedback we received and get back to you about what we found.

Travel well everyone - Fiona

Awhi Ora – Supporting Wellbeing is a flexible and person-centred wellbeing support service which supports people to identify and work on the challenges that are important to them. The Awhi Ora – Supporting Wellbeing service is free and provided by seven mental health non-government organisations (NGOs), which specialise in providing community and peer support.

This walk-alongside community-based support service takes a preventative, early intervention approach. The Awhi Ora – Supporting Wellbeing service broadens support to people experiencing challenges as well as those with a diagnosed mental health or addictions illness who are not under specialist care. Awhi Ora – Supporting Wellbeing is designed as a brief intervention service for three months or less.

Currently 38 GP practices are providing access to the Awhi Ora – Supporting Wellbeing service. In Auckland DHB it is also being piloted in three schools and can be accessed via other entry points such as the citizens advice bureau and libraries.

The supports available include navigation of social services, advocacy, peer support, coaching, support to develop plans, budgeting support and/or support with housing issues. Support can also be provided to improve community or whānau connection/s. Other supports offered include:

Emotional health and mental wellbeingSocial engagementEmploymentWINZLong term disabilityFamily/whānau issuesManaging drug use, drinking or gambling.

The Awhi Ora – Supporting Wellbeing Best Practice Guidelines were collaboratively developed with representation from Auckland and Waitemata District Health Boards, primary health care providers, and NGOs.

The Guidelines are based on the previous co-design work undertaken to create the Awhi Ora – Supporting Wellbeing service and provide standard practices for the service delivery in general practice. Guideline topics include;

Joining Awhi Ora - Supporting WellbeingIntroducing people to the serviceOnward introductions in the NGO support networkPrivacy and confidentialityEstablishing successful feedback loopsManagement and mitigation of concernsComplaints process and escalation pathwayReporting and data collection.

The Best Practice Guidelines will be launched in late October 2018, for more information please contact Shona Muir (Improvement Project Manager, Auckland District Health Board).

Additional information on the Awhi Ora - Supporting wellbeing service can be found here.

Bev Monahan is the Waitemata DHB lead for Awhi Ora – Supporting Wellbeing. She is also the Service Manager, Mental Health Team and a Counselling Psychologist for Comprehensive Care PHO.

When we first came to Tāmaki we asked the community “what matters to you?” The response from many was housing.

So when an opportunity arose earlier this year to work with Tāmaki Housing Association (THA) we jumped at it. The aim was to consider ways to strengthen support for social housing tenants, beyond housing.

We spoke to tenants, tenancy managers and other support organisations, looked at how other housing associations were operating and identified the following insights:

THA Tenancy Managers play a significant role in supporting the wellbeing of tenants.There is a lack of knowledge and understanding between organisations that work with tenants preventing effective working relationships, which often leads to crisis management (the point at which we all come together).Some social housing providers (e.g. in the UK) have used the sign up stage of the tenancy agreement to creatively incentivise positive changes for tenants.

We took these insights and brainstormed solutions with the THA tenancy managers and the following ideas emerged:

T workers

“T” workers have a breadth of knowledge coupled with an area of expertise. This concept applies to Tenancy Managers as they are required to have a breadth of knowledge of the support services across Tāmaki in order to connect tenants to other support services. In addition, several Managers are developing specialist skills in areas such as budget management. This solution builds a skill mix that offers the right support to tenant at the right time.

Breaking down barriers

The purpose of this work stream is for THA to work with key organisation to increase awareness of the roles that each organisation plays and to develop an early intervention model. This will develop a more joined up experience of support for tenants.

Continuous innovation

It is important for THA to continuously improve and innovate as a social housing provider with the view to offering improved services and outcomes for tenants. The intention of this work stream is to trial and develop unique initiatives that enable THA to remain innovative and person-centred.

These solutions are now being prototyped by THA.

In May of 2017 - we helped launch the very first design cycle of the Flipping East Lab, a social innovation platform embedded within the geo-local community of Tāmaki, aiming to foster strategic locally-driven responses in order to address complex social challenges that impact youth wellbeing. One of the lab founders, Hamish Lindop, wrote a blog at the end of our first waananga asking the simple question "Did we just start a youth movement? Time will tell".

Fast forward one year on and here we are with Flipping East in full swing - three paid youth interns delivering on a commissioned project from the Maungakiekie-Tāmaki Local Board to better understand youth aspiration, participation and voice within local democracy.

So far they have set up:

an agile project management systema project steering group made up of government agencies, local youth organisations and young peopleheld one-to-one dialogue interviews with over 30 young people and 15 community stakeholdersundertaken a crash course on co-design and put it to use by running two workshops including a youth world cafe and a peer to peer conversation with stakeholders who work with young people in the areaanalysed the initial findings to inform a theory of change and produce eight prototypes.

Some of the prototype work includes:

Whilst this is going on - prototypes from our first design cycle are still generating activity such as the young women empowerment holding a day of activities in June and the whānau dialogue videos looking to be used to collaborate with other whānau change efforts in the area to catalyse further deep conversations between Tāmaki youth and their parents.

Oh and No Six have bossed up and are now fully operational as a collective of young entrepreneurs of digital content creators - picking up contracts for media and communications services as well as running a space for other youth to come and learn the trade on Saturday mornings in Te Oro!

Breathe.

Almost forgot to mention that Flipping East is also working in collaboration with a group of community stakeholders on a collective impact Youth Wellbeing project to reduce youth suicide in Tāmaki - So Hamish my friend, “Did we just start a youth movement in Tāmaki?”

Microphone drop.

For this blog, we are happy to hand over the pen to Seyed who has supported people through Awhi Ora from the very early days – thank you Seyed!

“Awhi Ora – Supporting Wellbeing is a central point of contact for people to redress their personal or emotional issues. Through this initiative, I was able to support lots of people in the past three years in the Tāmaki region. I support people for the most part with: Housing New Zealand, Work & Income New Zealand, family issues, social outing, disability, migrant issues, wellness courses (gym, pool), empowerment classes, recreation and networking, ACC, employment, courts, addictions and youth support.

People are empowered because they are helped to develop their plan for their own journey. They take responsibility and make decision on their own with our support and guidance. I enjoy working and supporting people from different cultural backgrounds. I also make sure that every culture is valued and make them feel comfortable.

It takes time to gain the person’s trust so we use many strategies to win their heart before starting the service with them. Once they learned that we are genuinely interested in helping, they warm up to us and engage.

One way that illustrates a successful journey is people getting a job. I am pleased that some of my people are working as caregivers, heavy fork lift drivers, truck drivers, security guards and working at MacDonald’s. Some youths are motivated and supported through Awhi Ora to go back to tertiary education programmes, for example, to follow a computer course. I am so happy to see that after four months of customer service and computer training, one of the young people I supported is working as a part time customer service officer.

Awhi Ora brightens people’s life and brings smiles on their faces. We care about people, we motivate them and we support them to live a better life.

Go well Awhi Ora!”

Seyed – Awhi Ora support worker

An ever unfolding narrative and network of people committed to community wellbeing, vision, relationships, self awareness and collaboration.

Over the past seven months, our team has been supporting the Tāmaki Inclusive Engagement Strategy (TIES) taumata group in a co-design process to further develop the locally created framework and tools to enhance working and learning together in the Tāmaki community. The TIES taumata include local champions Chris Makoare, Georgie Thompson, Tess Liew and Tara Moala.

TIES Co-Design Workshop, Ruapotaka Marae, 2017

Our first gathering was held in October last year at Ruapotaka Marae in Glen Innes, where our group dialogue moved through questions such as what is TIES, why does it exist, where did it come from and what is next in its next chapter of local community development? We learnt about the many years of earnest service to the community of Tāmaki in which the TIES resource emerged, bringing the past into the room to provide a clear view of where we are in the arc of Tāmaki history.

The knowledge in the TIES book had been difficult to utilise due to the low number of prints in circulation. One of the innovations was enabling open source access to the TIES resource via an online platform called TamakiInclusive.com. This means everyone can now read and use the resource free of charge. To celebrate we held a website launch also at Ruapotaka Marae which saw the regathering of many of the faces who founded the original TIES resource. This was also an opportunity to welcome new people to the kaupapa of community engagement and development in Tāmaki.

Also to emerge from the co-design process was a TIES action-research prototype which seeks to learn how to achieve harmony and balance between three layers of community 'protagonists' that are said to participate in weaving the fabric of local society; the individual, the government agencies and institutions, and the various local communities which make up Tāmaki. It will strive to understand how might diverse community stakeholders engage, deliberate and organise towards greater horizontal and vertical collaboration to address difficult challenges in Tāmaki.

As the speed and complexity of change in Tāmaki increases, we sense the importance of this work and the work of many others who are striving to ensure equity of opportunity for local people to participate and shape their future rather than inherit or be excluded from it.

TIES Website Launch, Ruapotaka Marae, 2018

Happy new year everyone!

Awhi Ora - Supporting Wellbeing provides community based support to help people manage challenges that impact their wellbeing.

Watch these videosto find out more about how Awhi Ora has made a difference!

The service can be accessed through the providers listed here.

Our bach in Tāmaki makes such a difference to our work. It is a base for all the partners involved to work from in the heart of the community we serve. It has also become a true community asset where support groups are run (Wellness Recovery Action Plan, Peerzone, Vape2Save) and community led projects take shape (Breathing Spaces). The local Tongan language Radio Tama-Ohi broadcasts from here too!

It is great to see how our presence in the community has gone from strength to strength, resulting in unexpected consequences: the picture below shows a small sample of the plants and Christmas decoration that appeared here. Not the team’s doing! Thank you for making our bach more welcoming.

Go well over the holiday period, and happy Christmas everyone!

Through the "fit for the future" initiative we are seeking to understand the experiences of people with moderate mental health needs and the primary care and community services that provide support to this group. We spoke with 22 people of varied background and experiences, both in Tamaki and across Auckland, focussing on Māori, Pacific and youth populations.

We learnt that there are some key principles that can help to guide providers of support to develop positive experiences for people accessing their services. We are using these principles of practice to prototype new services and experiences of support across Auckland. In next week's blog we will talk more about how we are prototyping.

What matters to people with mental health and wellbeing needs when accessing support in general practice and the community?

This question was our starting point to understand the experiences' of people with mental health needs and the services that provide support to this group. We spoke with 22 people of varied background and experiences, both in Tamaki and across Auckland. We focused on Māori, Pacific and youth populations.

We are really grateful to the people who took the time to speak to us about their expereinces. The stories they shared helped us identify the commons experiences across the group and understand the challenges and opportunities to develop person-centred supports.

Through this process, we have developed a set of principles and ideas for change, which we are now prototyping in practice. In next weeks blog we will share the principles of practice which form the foundation for our prototypes.

It is well known that creative art is a magical gift that enriches people’s lives. We combined with Toi Ora and The Cut Collective to work alongside Tāmaki locals Fabian, Shequille and Huva to produce art that would breathe life to the once empty space and deepen the community connection to the project. With a camera in hand, Fabian took to the streets of Glen Innes to hold open, generative dialogue with people about what wellbeing means to them, all to seal the conversation and moment in time with a photograph. This dialogue also then informed a graffiti installation which Fabian undertook with friends Huva and Shequille, alongside Ross Liew from the Cut Collective. Dropping by when the art was in progress, it was clear to see the boys were stoked to be handling cans and putting it to work live in an open public space. Next time you are in Panmure, pop into our Clifton Court bach and check out the creativity – we are truly grateful for everyone involved.

Something that’s not commonly known about Tamaki, is that it’s a landscape exploding with bright spots and young leaders filled with possibility. I have worked with young people since I was young myself, and had struggled to improve youth outcomes as one person from one organisation with one lens for a solution. Social problems for (young) people are by their nature interconnected and interdependent and cut across many domains which involve diverse stakeholders, and yet the conventional response to them is single-lens, and single-problem focussed. There is also a tradition of focussing on problems and deficits, making everything feel like an uphill battle.

In my current role as Community Activator at the ADHB I saw young, talented, passionate young people creating change to enhance youth wellbeing, but often working in small pockets, with little resourcing. The initial idea which Tyrone Tangata-Makiri from CAYAD (community action youth and drugs) and I had was to bring these young change makers together, increase connection, and then advocate for them getting the support they needed in their efforts. This was about the time that I started talking to Hamish Lindop and Monique Nathu from Auckland Libraries, and together we saw that it was actually a challenge to tackle with the Social Labs method, bringing together a diverse range of community stakeholders with young change makers to dive in deep together, connect, understand, and act, as the basis for collaboration to enhance youth wellbeing in Tamaki.

We’ve met a lot of amazing people along the way, and many who would challenge assumptions and stereotypes about the rangatahi of Tamaki: The first female Pasifika Local Board member who has a casual and approachable style, a powerful, passionate and driven Pasifika entrepreneur who takes rangatahi to the local markets each weekend to teach them the ways of business and make dreams real, the first student at a Montessori High school just opened in Panmure, who is deeply inquiring into identity and exclusion through typography at the age of 15… the list goes on. Otto Scharmer talks about how five people in a committed team can practically change anything in the world; we feel like we’re going to have six of those teams working to enhance youth wellbeing in Tamaki.

It’s now three weeks until our foundation hui which will kick off three one month prototyping cycles, and steam is picking up. Zaid Hassan talks about the power of broadcasting one’s intention, and how the biggest problem will be figuring out what to do with all the help one gets, and we are certainly starting to understand what that’s like. But a big challenge has been our personal development, and development as a team which is readying us to afi the bigger whanau. This has felt like the Social Lab within and before the Social Lab, where we have learnt a lot in a short space about our strengths, weaknesses as individuals and as a team, and faced our assumptions and blind spots regarding social change, collaboration, and even human nature itself, and some of that learning has felt pretty raw at times. But we are excited to dive deeper, and finally meet, as a whole, the community and whanau we are slowly convening together. And so the journey continues.

Va Lelei – a good space…

Breathing Spaces is about community wellbeing and growing healthy relationships in Tāmaki. The initiative is community led and supported by a co-design team comprising two people from the community and two people from our ADHB Tāmaki Health and Wellbeing Programme team. Breathing Spaces provides an opportunity for women who raise families to come together in a safe and life giving ‘space’ where they can learn from each other as they nurture and grow healthy and prosperous whānau.

Breathing Spaces is values-led. The values AKO - ALOFA – ACCEPTANCE guide each Monday night meet up in Glen Innes and represent the cultural diversity of the women in the group.

“For me breathing spaces is time out, a place to vent, a place to share…”

“To find out how other mums, grandmothers and others are bringing up their children…”

“I think it has helped to build some confidence that is being tested out in new ways…”

“Time to eat, share, enjoy, laugh, plan, think, explore, help…”

“To meet new people and learn new things…”

What Breathing Spaces means … in our own words

A few weeks ago, over 40 Awhi Ora – Supporting Wellbeing practitioners came together. The social workers, peer support workers and occupational therapists from the 7 community NGOs got to support and hear from one another.

It was the second time they could hear feedback directly from local doctor Malcolm Lowe whose GP practice directly benefits from the pilot, share information about each organisation and work through several case studies.

In those case studies they discussed how we might best support the person in a way that is true to our core principles: at its heart the support should be person centred (based on what matters to the person), relational (based on trusting relationships) and collaborative (everybody supporting the person working together).

The programme of work has been developed and led from the front by the awesome 7 NGOs involved in the Awhi Ora Supporting Wellbeing pilot (Affinity, Mind and Body, Emerge Aotearoa, Framework Trust, Pathways, Mahitahi Trust and Vaka Tautua). The programme concept originated from desire from the NGOs to work more collaboratively, to be better connected as a shared collective service - How might we enable this they asked? What does this look like? This far, its looked like lots of laughter, getting to know each other as both people and practitioners and sharing successes and learning from people we've supported this far.

It is really inspiring seeing organisations working together in this way, sharing resource, experiences and insights as to how to work better together. You go NGOs! Looking forward to session #3!

We know that nearly half of all New Zealanders will experience mental illness and distress at some stage in their lives. They’ll either experience it themselves or come into contact with friends, family or colleagues experiencing mental illness. People want to help but they often don’t know how.

Increasing knowledge and understanding of mental illness is also important to counter the level of stigma that exists in our community. So we have teamed up with the HEART Network in Tāmaki to offer a free one-day workshop open to anyone who wants to learn how to recognise mental illness, relate to those experiencing distress and know how to respond appropriately. This will be held at Te Waipuna Puawai Mercy Oasis on the 16th of February.

The key elements the workshop will cover are:

Recognise good mental health and what you can do to maintain it. Recognise the signs of stress or deteriorating mental health.Relate to what people experiencing mental distress and mental illness may be going through. Understand how their reactions may impact on the thoughts, feelings and behaviours of others.

We have had a productive year and look forward to having more success and contact with our community next year.

The Holidays can be a time for family and celebrations, but also stressful so in light of that a few holiday tips for you to use share and build on based on the 5 ways to Wellbeing:

1 Connect, Whakawhanaunga:

Connect with family, friends, or maybe somebody you have lost touch with. Connect with nature and enjoy our lovely beaches for sun fun and forests for quiet shade. Try searching events in your local community, maybe spend some time getting a summer garden ready, your own or join your communities!

2 Give, Tukua

Give, not just financially but try your time, love, talents. Complement and talk to strangers, babysit or volunteer, make gifts, or give time to yourself for some self care and kindness.

3 Take Notice, Me aro tonu

Take notice of the gifts in your life, from family friends, to our environment. Enjoy minfullness practices of what is in and around your life. Actively make time to slow down to do this.

4 Learning, Me ako tonu

We are always learning, talk with people, tell and share stories with people, use your library, or join a new club!

5 Be Active, Me kori tonu

Summer is an excellent time for this. Free pools and the sea are resources, also while people are more free go for group walks, enjoy our parks, Take public transport to somewhere you have never been and explore….Or a great chance for a summer spring clean/garden do up!

Wishing you a safe and enjoyable holiday season!

Awhi Ora – Supporting Wellbeing is the name of our new walk alongside community support service. This service, designed in partnership with members of the Tāmaki community, offers a broad range of personalised support for people who are experiencing challenges that are impacting their health and wellbeing.

As part of growing the service it was important to have a name that best reflects what it’s all about – and ideally for that name to come from the locality and people who are co-creating and using the service. We were very fortunate to have Pt England resident Tashera Carter and Mind & Body peer support worker Christine Poto work together to come up with name ‘Awhi Ora – Supporting Wellbeing’ – a name that so richly and appropriately describes this new person-centred service

We gathered recently at Ruapotaka Marae in Glen Innes to bless and gift the name. Following a Powhiri, Taahina Tashera Carter guided a ceremony that revealed the whakapapa of the name, saw it blessed by the Reverend Roger Pym of the Canoe of Souls Unitarian Church, and then gifted to Dr Andrew Old, Chief of Strategy, Participation and Improvement at Auckland District Health Board, on behalf of the partner organisations who have been working together developing the service. It was a great celebration and brought together of all those involved with the new service in Tāmaki and furthered strengthened the many cross-sector and community relationships that have been forged on this journey.

A couple of weeks ago we launched our Primary NGO Support Hours pilot to the 12 practices taking part across Auckland.

As some of you may remember, we’ve successfully prototyped this service in a couple of Tāmaki practices, learnt A WHOLE HEAP, summarised in a kete of learning and this small pilot intends to teach us a whole lot more.

Half of the piloting practices are Tāmaki based with the other half from the wider ADHB area. The pilot will build from the experiences gained in the prototype, providing varied support for people experiencing current challenges and of course learn a whole lot more about the work and changes in practice involved for the health system to have the desired impact for the person.

It was a great night where time was spent firstly reviewing the learning this far and secondly for the GPs and nurses at the practices and the NGOs to get to know each other both personally and professionally - value each other’s strengths, understand how to work best work together and we know the great things that can happen from developing relationships in health care….

Want to know more? Just drop me a line at debbieO@procare.co.nz.

A few weeks ago, I was invited to talk about the Tamaki programme on "Take it from us", a show on Planet FM which explores the subject of mental health and discrimination. I was joined by Dan Crozier, who works for Pathways and has been instrumental in the development of peer/community support in GP practices in Tamaki.

It was great to talk with Sheldon Brown about the background of the programme and the work we are doing. If you want to find out a bit more about the programme, an edited version of the interview is available on the show website.

People sometimes ask us why our mental health and wellbeing work is focused on Tāmaki. The origin of working in a particular area came from central government’s 2009 ‘Better, Sooner More Convenient’ policy direction for health. This approach actively encouraged health professionals to work with one another in a more coordinated and co-operative way in the community.

In response to the desire of local communities to be more involved in health service planning and delivery, Auckland DHB, together with the Primary Health Organisations (PHOs) that support local GPs, developed the ‘Better, Sooner More Convenient’ national direction further by adopting a ‘Locality’ approach in 2011.

A driving force in the locality approach was the potential to improve equity (better health outcomes for everyone) and to develop local services to meet local needs. Tāmaki is a vibrant and ethnically diverse area. However, a quarter of its population of about 17,000 receive a government benefit. This lower socio-economic status means many people face health and social challenges and high levels of stress. Despite this, and the fact that the Tāmaki community has had programmes and interventions ‘done to it’ to the point of exhaustion over the last 25 years, there is energy, vitality and strong community leadership to involve Tāmaki communities in any changes that will affect their lives. This community drive can be seen writ large in the Tāmaki Inclusive Engagement Strategy (TIES) which was developed by a rōpū of local leaders. TIES is all about bringing people together and making things work better for the communities in the area. Given that the focus of our approach is to put the design of service and support into the hands of those who will use and provide it- Tāmaki a great first choice to do things differently together.

A case study of the Tamaki programme has been published on the social labs revolution website. The website is a platform to build the social labs community, which brings together a broad spectrum of labs practitioners from around the world.

The comprehensive case study is a great read, especially if you want to find out more about the development and current direction of the programme.

“People with serious mental illness and/or addiction issues experience significantly worse physical health than the general population and we can do something about this.” This is what the Equally well collective tells us and it is quite significant: life expectancy can be reduced by up to 25 years.

The evidence also tells us people with mental health issues are2 to 3 times more likely to smoke, and while they may have similar rates of colorectal cancer, they are 3 times more likely to die from it.

So what can we do about it? One of our design challenges is, “How might primary care (the general practice), secondary mental health and addictions (specialist mental health services) and community work together as one system to support the outcomes that matter to the population they serve in Tāmaki?”

By integrating general practice, specialist mental health services and community better, we are more likely to move away from providing healthcare for a mental health diagnosis only and create a coordinated response that addresses the physical health, mental health and social needs of the person.

To find out more about Equally Well, follow this link.

This community-led wellbeing strategy involves the development of community ‘breathing spaces’. Breathing spaces may be places to connect with other people; they may be places to go for ‘time-out’ from stressful situations. The purpose and essence of each breathing space will be defined by the groups we work with to create them. The idea of breathing spaces came from a community group run by HEART Parenting, which is part of the HEART Movement. HEART promotes healthy relationships through growing loving, safe and supportive relationships in the Tāmaki area.

The project is taking a human centred design approach and is in its early stages of development. The team has spoken with a number of people in Tāmaki to identify what breathing spaces currently exist why they are of value to the people using them. Some examples given are places, like the libraries and community gardens, others are groups, like ‘Just for Dads’. The work was enriched recently by Auckland DHB supporting team members to attend a two-day workshop “Activating Communities to create health”. Held at Ko Awatea, Counties Manukau District Health Board’s Innovation hub, the workshop introduces participants to the theory and practice of community organising and the leadership practices that support this. Anne Purcell and Anna Meredith of HEART Parenting found the training extremely valuable. Here’s what they had to say…

“I just want to say a massive thank you for the opportunity to work with you both at Ko Awatea over the past two days. It was awesome to be able to focus on Breathing Spaces together in such a supportive environment. I have taken away an enormous amount from the experience about activating communities to create health as well as creating wellbeing together in Tāmaki!” (Anne – HEART Parenting Coordinator, Glen Innes Family Centre)

“What an awesome two days! Thank you so much for the opportunity to be part of what I found to be such a valuable learning experience. I feel very privileged. I agree with Anne, the Activating Communities to promote health two day workshops provided a refreshing and doable way of connecting with our community which I’m itching to share and put into practice. Working with you both on our Breathing Space project throughout was a bonus the perfect icing on the cake!” (Anna – a community volunteer and member of the HEART parenting network)

It was great to see the conversations and to hear the range of views at our prototyping workshop on 11 May. We were exploring ways that we might connect health and community services in Tamaki to develop a holistic and person-centred approach to wellbeing and mental health support. The diversity of perspectives led to some stimulating ideation and creative solutions.

Over a hundred ideas were generated during the initial brainstorming session, which we have now themed and will provide a foundation for prototyping ways of improving connections.

The five themes are:

Ways that funding might change the way we workPathways and navigation to create one systemHolistic care and collaboration between services and communityIncreasing the capacity of primary health to support people with mental health and addiction needsPerson determined care and health promotion

A big thank you to all who attended the workshop and particular thanks to Mount Wellington Community Church for allowing us to use their community space to run the session.

In the Creating Wellbeing Together in Tāmaki initiative, we have systematically pursued working with the people of Tāmaki to co-design services that matter to them. To have an office space in Panmure has made a huge difference – we are now based in the community we are serving.

Our place there is looking better now that we have painted the inside. While painting was about making the space more welcoming, it is also a project involving members of community with the mural showed here.

Thank you to Ross and Toi Ora for facilitating this, and to Huva, Fabian and Shaquille for coming up with the beautiful story that goes beyond the words painted there with the tree in the background from its roots to its canopy.

It is great for us to work with them as we want our space to be available to organisations such as Toi Ora who run activities contributing to the wellbeing of the people of Tāmaki.

On another part of this project, Toi Ora is also working with members of the community on a photography project. Watch this space!

Over the last two months we have been talking to people who use and provide mental health and wellbeing services in Tamaki, to consider how these services might connect as one system to support the outcomes that matter to people. The views of people who use and provide services match on some levels, but equally they differ.

For example moving more supports into GP clinics and the community was a shared aspiration, as a way of providing more preventative and relational care.

Conversely, service providers want to develop care pathways and platforms to share information. These tools would be used to manage the quality and standardisation of care processes to improve clinical outcomes.

People who use services want providers to understand and prioritise their needs and communicate in their language.

The next step is to bring together the people who use and provide services to come together and design solutions to those challenges. We will be running the first of our prototyping workshop on 11 May to explore solutions.

Caring relationships are at the heart of attaining and maintaining effective wellbeing support. An important part of that for many people is connecting with the places and people in the community that matter most to them. Not always easy to do on your own.

The new service peer and community support workers are providing at local GP clinics is enabling them to develop caring relationships with the people who are accessing their support. These person-centred relationships are making a real difference.

In our ongoing evaluation of our work we are talking to support workers and the people they are supporting, and we’re learning heaps about what’s working and why, and what we might modify to improve things further.

We’ve learned how important it is to really listen…

“Just by me being present and listening to the concerns of the journey she’s been on, and reconnecting her back to the things she used to do… reconnecting her back to her Te Reo, her culture… she had put it on the side for a little bit there, and she hadn’t been back to church for a while. That’s re-established again now and has been very helpful for her”

(Peer Support Worker)

“I am very appreciative because when you live a life of disability it’s a very lonely life and so you tend to battle on… She greets me with kia ora, she has taught me a new waiata, because I can’t always go out to classes in the community, she has brought some new learning to me…[Having support] meant that I was able to set goals and get clarity… it was very beneficial having a support person to nut my issues out with… The professionalism and level of confidence of confidentiality I found I can maintain those with her, and she can maintain those with me. I can trust her and that’s a big plus.”

(Person receiving support)

This is another example of our person-centred practice in action.

In the Tāmaki work, we are aiming at improving the wellbeing of the people living in this area. We are designing and testing solutions for the GPs to be more connected to the network of support that is available for the community through Social workers, peer support workers etc.

We are doing this by bringing together people from different backgrounds, different experiences, from doctors to people who have experienced a journey of support. Together we are imagining solutions that bring the person in need of support to the centre of care.

This person-centred approach is a key principle for us. What people are telling us is that support should be designed around ‘what matters to me’ as opposed to ‘what is the matter with you’. Here is an example of this principle in action.

Sometimes what feels trivial is actually key: people in the community have told us texting is a great way to get in touch to begin support relationships. It’s easier first up to have a text conversation with a support worker. Texting to arrange to talk or meet a support worker gives a person more control as they can respond to the text when it suits them. If mobility is an issue it can be hard to get to a ringing phone and for many people the cost of picking up voice messages left on mobiles can be a real barrier. We have also found that the time it takes a support worker to respond to a person’s texts is an early measure of trust. Texting back quickly lets people know they matter, and goes a long way to getting a support relationship off to a good start.

What appeared to be a minor detail at first turned out to be a valuable learning.

Setting up a social lab is an exciting, if complicated challenge. Finding the right space is one thing (more news to come on this shortly)

but preparing for the challenges to be addressed through the lab is another task entirely. Fortunately, there are some great social labs in NZ that we can connect and learn with.

Recently the team crammed into a car and headed south to spend some time with the Auckland co-design lab in Otara. The lab is currently addressing the drivers license challenge. Peter Hanning (a member of the lab team) explained that the lack of a drivers licence can act as a barrier to getting a job, an issue that particularly impacts young people. The aim of the lab is to work with the community and across government departments to examine the components of the challenge and co-design solutions.

As we approached the lab, the sound of music drifted towards us and we could sense an energy in the air, but the buzz wasn't coming from the lab. Next door to the lab the Dziah Dance Academy, a big player the NZ hip hop street dance arena, was a hive of activity. The lab has benefited from being close and connected to this community hub. Community connectedness is also fundamental to the success of the Tamaki social lab and something that will continue to drive us into next year.

Inside the lab, the team was busy prototyping solutions to their challenge. The team is made up of people from central and local government, who work alongside technical experts and the wider community. It was great to see a diverse team collaborating in one space to address a common challenge. The effectiveness of this approach was made real to the Tamaki team and was one of our key learnings from the day.

Our social lab is an opportunity to explore whether offering a space for multi-agency teams to work with the community is an effective way to support innovation in and development of wellbeing in Tamaki. Our visit to Otara offered us an insight into how a social lab operates in a similar context. It was fantastic to see how connected the team had become over a short period of time and how effective fast paced experimentation and prototyping is in identifying innovative solutions.

Thank you Peter and the team!

In August and September we held a series of workshops to understand how people in Tamaki want to experience mental health, addiction and wellbeing support in their community. The workshops focussed on how support could be accessed through GP practices.

The workshops were a fantastic opportunity for us to learn from the diverse groups that attended. The meetings were full of energy and some amazing ideas and insights were generated. By the middle of September a clear theme emerged that called for a personalised service, which can be accessed in the right way, at the right place and with the right people. More specifically, people wanted support that was easily accessible, that supports them with goals that they identify and which includes a variety of support options.

The next step was to translate the themes into possible solutions. We have worked closely with Mind and Body, Affinity Services and Pathways, three community based support services, to put together a prototype support services. The service provides flexible, non-medical, mobile support that is driven by what matters to the person. Support workers will help the person to plan for their wellness and will provide practical support until they are able to get back on track to live the life that they want.

This service is being trialled through Panmure Medical Centre and East Tamaki Healthcare over the next six months. The trial is a great opportunity to learn and to adapt the service into one that is person-centred and reflective of what the user want.

More information will be available in upcoming posts, but if you have any questions about the service contact us.

How should primary care and GPs offer the people that they see support hours in partnership with local NGOs? What should people be experiencing at each stage of the process to ensure that their needs and expectations are met? What are the benefits for us as people using health services and support services?What are the benefits for primary care, GPs and NGO services?

"Our vision is an experience of health and wellbeing focused on the wellness of the whole person in their family, whanau & community, over the whole of their life, supported by integrated services that are relevant to Tamaki."

Follow us on the website to keep up to date with community events in Tamaki and how you can be a part of creating a flourishing community!

Tamaki co-design workshop, using images to stimulate thinking around mental well-being. Playing snakes & ladders to design primary care and new mental health support services together.