Future role of NGOs within the community sector

Dr Janice Wilson

I recently had the privilege of attending the 20th anniversary celebration of Wellink Trust in Wellington.  The gave cause for some reflection about NGOs and the very significant role they have played and still do play within the mental health and addiction sector. There is no doubt in my mind that the changes we have seen in the past 20 years in mental health (and addiction) services would not have occurred without the active advocacy and the extensive growth in service delivery seen amongst the non government agencies. 

Why is this? Traditionally NGOs (or not for profit organisations) grow out of communities of specific interest– they are the voice of that community and have the values and aspirations of that community embedded in their vision and working culture. In mental health and addiction, such voices have been those who have had experience of mental ill-health and of traditional service use, or those families affected by this and involved in caring and larger communities who understand the importance of human rights, fairness and justice within the social contexts of society.

NGOs have provided a framework or structure that has supported and encouraged the empowerment of those who have been unwell and used services to take charge of their own lives and become visible and included into ordinary neighbourhoods and communities.  Those that have done this well also understand the importance of strong partnerships with traditional health services – those provided by DHBs and also primary health care.

This paradigm shift could not have occurred without strong active NGOs. 

Around the world the economic recession is a catalyst for governments to focus on the role of the state, and how state services can be more connected with communities and the private sector to achieve improved outcomes, and of course better value for their investments. 

This thinking will underpin changes ahead, I believe, within the social sector, including health.  Where do NGOs fit in?  I believe that there are, can be and will be opportunities for NGOs to develop even stronger partnerships with traditional government services to deliver services in different and perhaps more innovative ways, which also align with communities’ expectations. 

This may not be evident as you read this, but all the signs are there, not just in NZ, of governments wanting communities to be more active and take more control of services that affect them.

This could be a time of great opportunity, but governments are interested in organisations that are aligned and working well together, not isolated, dispirited or fragmented. There is a challenge for you all to demonstrate alignment and connectedness.  There are approximately 350 NGOs in the mental health and addiction sector.  This may just be too many for NZ!

Dr Janice Wilson - August 2009

Dr Peter McGeorge

The services provided by NGOs in the community are a critical part of the continuum of care provided for mental health and addictions service users and have a vital role to play now and in the future.

 Because they are community based they are able to facilitate the integration of people into ordinary life and thus support their recovery in ways that clinical services are less able to do. For these reasons I believe that there will always be a place for the NGO community sector.

However, the community sector does face challenges and one of these is the fact that we have not yet properly solved the problems around acute intervention.

In general, acute services are provided by specialist public mental health services. I would see a time when the NGO sector is much more involved in acute care. However at present when things go wrong the default position is to focus on the provision of more acute beds and crisis services.

Having worked in emergency psychiatry in inner city Sydney for the last five years I know that good acute clinical services are essential and I certainly wouldn’t want to under-estimate the challenges that people in acute need can present. However we still need to be thinking about the system as a whole and finding ways of anticipating and intervening early in situations where people are relapsing and/or being overcome by life stresses.

As the Commission goes around the country looking at the services provided by various DHBs it is clear that some areas are working better than others in terms of the acute options available to people.

Peer run services for example hold a lot of promise, as do collaborative ventures between NGOs and specialist public services. However until we can establish more confidence in this area there will  be a tendency to focus back on hospital acute beds and crisis intervention services – in much the same way that hospital services tend to focus on acute surgery and medication. That is where funding goes first whenever there is a problem and this is where our thinking has to change. We have to continue to develop community oriented services and it is in that part of the mental heath sector that the NGO sector is absolutely critical.

In this regard it is important that we develop funders who are knowledgeable about the variety of consumer need and are sympathetic to the concept of recovery in terms of both the internal and external condition needed to support it. Funders have significant challenges to confront, especially today, and the difficulty in terms of developing their expertise when you have a high turnover of personnel, as is still the case, is that not enough people acquire the institutional knowledge that is necessary to enable them to take a comprehensive view of mental health and mental health care.

 In a small country you really need the best people to be making the most critical decisions and this can only be achieved when circumstances are such that a body of knowledge with experienced people is built up. This can be a problem when there are so many DHBs.

There is a need therefore to not only focus politicians’ minds on alternatives to hospital based care (which as I have indicated is vital in its own right) but also to focus the funders’ minds on safe alternatives to acute care. In essence we need good wise planning that appreciates the intricate nature of mental health and addictions and the need for a truly comprehensive system of care in which the NGO sector remain key players. 

This will undoubtedly require us to think more regionally in terms of how we use our resources and also about how we can better integrate services across the hospital and community interfaces. In this regard, despite all of the progress we have made in NZ, robust mechanisms still need to be established to ensure that sectors and services work together hand in glove in a way that is focused on what is best for the consumers. If that does not happen then our systems will continue to operate separately from one another on the basis of territory and ownership rather than on a system of truly integrated care. There is a good evidence base for the value of integrated care and it is also worthy of remembering that most incidents occur when care is changed from one set of circumstances to another.

It is important therefore to have ways of ensuring that people understand and appreciate the contributions that different parts of the system make to the recovery of persons with mental illness and, in particular, why the NGO contribution is critical in this endeavour. If this is the case then you are more likely to get a system that meets the overall  needs of service users rather than focusing on one aspect or another of their being rather than whole persons. To do otherwise would be to impede their recovery.

Dr Peter McGeorge, Chair of the Mental Health Commission, August 2009