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Improving recruitment to the mental health workforce in New Zealand

Dr. Simon Hatcher Associate Professor Suchi Mouly

Desiree Rasquinha

Dr. Wayne Miles Jim Burdett

Helen Hamer Dr. Gail Robinson

Improving recruitment to the mental health workforce in New Zealand

Dr. Simon Hatcher Associate Professor Suchi Mouly

Desiree Rasquinha

Dr. Wayne Miles Jim Burdett

Helen Hamer Dr. Gail Robinson

The Mental Health Workforce Development Programme is funded by the Ministry of Health and administered by Health Research Council of New Zealand.

Published in October 2005 by the Health Research Council of New Zealand

PO Box 5541, Wellesley Street, Auckland, New Zealand Telephone 09 379 8227, Fax 09 377 9988, Email [email protected]

This document is available

on the Health Research Council of New Zealand website http://www.hrc.govt.nz and the Mental Health Workforce Development Programme

website http://www.mhwd.govt.nz

ISBN 0-908700-39-3

The Mental Health Workforce Development Programme is funded by the Ministry of Health and administered by Health Research Council of New Zealand.

Published in February 2005 by the Health Research Council of New Zealand

PO Box 5541, Wellesley Street, Auckland, New Zealand Telephone 09 379 8227, Fax 09 377 9988, Email [email protected]

This document is available

on the Health Research Council of New Zealand website http://www.hrc.govt.nz and the Mental Health Workforce Development Programme

website http://www.mhwd.govt.nz

ISBN 0-908700-39-3

Author Details i

Author Details

Dr. Simon Hatcher is a Senior Lecturer in Psychiatry at the University of Auckland. He works half time at Waitemata Health as a Liaison Psychiatrist. In his role as Liasion Psychiatrist, he is extremely busy and experiences the effects of difficulties in recruiting mental health staff. He wanted to be involved in this project in order to do something about improving recruitment in the mental health workforce. He was the principal investigator and is responsible for writing most of this document V. Suchitra (Suchi) Mouly is an Associate Professor at the Department of Management and Employment Relations in the University of Auckland. She has a PhD in organisational behaviour from the Indian Institute of Science, Bangalore. She has published her doctoral and some of her post-doctoral work in a book, ‘Organizational Ethnography: An illustrative application in the study of Indian R&D settings’, which was brought out by Sage in 1995 (Jay Sankaran is the second author). Dr. Mouly has also published numerous articles in journals such as ‘Leadership Quarterly’, ‘Organization Studies’, ‘Journal of Management Studies’, and ‘Journal of Applied Behavioral Science’. Besides HRM, her research interests include qualitative methodology, organisational culture, and research and development management. Desiree Rasquinha is the Research Assistant for this project. She is currently enrolled at the University of Auckland, completing her Masters of Commerce in Human Resource Management at the Business School: Management and Employment Relations Department. Previous to this she has completed her Bachelor of Commerce with a double major in Management and Employment Relations, and International Business. Dr. Wayne Miles is currently Director of the Waitemata District Health Board Knowledge Centre, Clinical Reader in Psychiatry, University of Auckland, and Immediate Past-President RANZCP. He has had for many years a keen interest in the issues of developing better quality mental health services and along with that a more numerous and capable workforce. In his roles with the College of Psychiatrists, as a Director of Mental Health Services, and as a Member of the Mental Health Commission's Advisory Board he has seen many developments but also experienced many frustrations. He looks forward to this report being part of the information that helps the progress toward a sustainable high quality mental health care system in New Zealand. Jim Burdett has a Master of Arts in Philosophy and a Diploma in Professional Ethics. He is the Managing Director of Mind and Body Consultants Ltd., a company managed and staffed by people with personal experience of mental illness who provide a range of services to the mental health sector. Jim, in his role as Mind and Body’s senior consultant, is a member of the Mental Health Research and Development Strategy Steering Committee, and puts a significant amount of time into the MH-SMART Outcomes Initiative, a priority area of the Strategy. Jim was for six years senior consumer advisor to Auckland District Health Board Mental Health Services and a founding member of the National Association of Mental Health Services Consumer Advisors. Helen Hamer (RPN, RGN, Cert. Training and HR Dev., MN [Hons]) currently holds a joint position as Senior Lecturer and Nurse Consultant with the University of Auckland and the Auckland District Health Board (ADHB). Helen has many years of experience in mental health workforce development, teaching and supervision, and will be undertaking doctoral study analysing recruitment and retention issues for mental health nurses. Helen currently teaches and supervises undergraduate and post-graduate students within the university, and leads professional development for mental health nursing within ADHB. Helen is currently a co-researcher for the Post-Entry Clinical Training evaluation project for the Mental Health

Author Details i

Author Details

Dr. Simon Hatcher is a Senior Lecturer in Psychiatry at the University of Auckland. He works half time at Waitemata Health as a Liaison Psychiatrist. In his role as Liasion Psychiatrist, he is extremely busy and experiences the effects of difficulties in recruiting mental health staff. He wanted to be involved in this project in order to do something about improving recruitment in the mental health workforce. He was the principal investigator and is responsible for writing most of this document V. Suchitra (Suchi) Mouly is an Associate Professor at the Department of Management and Employment Relations in the University of Auckland. She has a PhD in organisational behaviour from the Indian Institute of Science, Bangalore. She has published her doctoral and some of her post-doctoral work in a book, ‘Organizational Ethnography: An illustrative application in the study of Indian R&D settings’, which was brought out by Sage in 1995 (Jay Sankaran is the second author). Dr. Mouly has also published numerous articles in journals such as ‘Leadership Quarterly’, ‘Organization Studies’, ‘Journal of Management Studies’, and ‘Journal of Applied Behavioral Science’. Besides HRM, her research interests include qualitative methodology, organisational culture, and research and development management. Desiree Rasquinha is the Research Assistant for this project. She is currently enrolled at the University of Auckland, completing her Masters of Commerce in Human Resource Management at the Business School: Management and Employment Relations Department. Previous to this she has completed her Bachelor of Commerce with a double major in Management and Employment Relations, and International Business. Dr. Wayne Miles is currently Director of the Waitemata District Health Board Knowledge Centre, Clinical Reader in Psychiatry, University of Auckland, and Immediate Past-President RANZCP. He has had for many years a keen interest in the issues of developing better quality mental health services and along with that a more numerous and capable workforce. In his roles with the College of Psychiatrists, as a Director of Mental Health Services, and as a Member of the Mental Health Commission's Advisory Board he has seen many developments but also experienced many frustrations. He looks forward to this report being part of the information that helps the progress toward a sustainable high quality mental health care system in New Zealand. Jim Burdett has a Master of Arts in Philosophy and a Diploma in Professional Ethics. He is the Managing Director of Mind and Body Consultants Ltd., a company managed and staffed by people with personal experience of mental illness who provide a range of services to the mental health sector. Jim, in his role as Mind and Body’s senior consultant, is a member of the Mental Health Research and Development Strategy Steering Committee, and puts a significant amount of time into the MH-SMART Outcomes Initiative, a priority area of the Strategy. Jim was for six years senior consumer advisor to Auckland District Health Board Mental Health Services and a founding member of the National Association of Mental Health Services Consumer Advisors. Helen Hamer (RPN, RGN, Cert. Training and HR Dev., MN [Hons]) currently holds a joint position as Senior Lecturer and Nurse Consultant with the University of Auckland and the Auckland District Health Board (ADHB). Helen has many years of experience in mental health workforce development, teaching and supervision, and will be undertaking doctoral study analysing recruitment and retention issues for mental health nurses. Helen currently teaches and supervises undergraduate and post-graduate students within the university, and leads professional development for mental health nursing within ADHB. Helen is currently a co-researcher for the Post-Entry Clinical Training evaluation project for the Mental Health

Author Details ii

Workforce Development Programme, and project manager for the National Framework for Mental Health Nursing contract from the Ministry of Health. Dr. Gail Robinson (MBBCh, FCPsych(SA), FRANZCP, GradDipBus(NVn), FAChAM) is a psychiatrist and Co-Director, Clinical Research and Resource Centre (CRRC), and Senior Clinical Advisor, Pacific Mental Health and Alcohol and Drug Services, Mental Health Services Group, Waitemata District Health Board (WDHB), Auckland. She is also Clinical Lecturer (Hon), in the Department of Social and Community Health, University of Auckland. Gail has undertaken a variety of projects in the mental health and addiction fields some of which have included assessment of the workforce roles and needs both within mainstream and Pacific services. Gail has held various positions of clinical leadership within mental health and the broader health sector. She is currently the Co-Chair of the WDHB Senior Medical Advisory Group, and sits on the National Executive of the Association of Salaried Medical Specialists due to her keen interest in workforce recruitment and development.

Author Details ii

Workforce Development Programme, and project manager for the National Framework for Mental Health Nursing contract from the Ministry of Health. Dr. Gail Robinson (MBBCh, FCPsych(SA), FRANZCP, GradDipBus(NVn), FAChAM) is a psychiatrist and Co-Director, Clinical Research and Resource Centre (CRRC), and Senior Clinical Advisor, Pacific Mental Health and Alcohol and Drug Services, Mental Health Services Group, Waitemata District Health Board (WDHB), Auckland. She is also Clinical Lecturer (Hon), in the Department of Social and Community Health, University of Auckland. Gail has undertaken a variety of projects in the mental health and addiction fields some of which have included assessment of the workforce roles and needs both within mainstream and Pacific services. Gail has held various positions of clinical leadership within mental health and the broader health sector. She is currently the Co-Chair of the WDHB Senior Medical Advisory Group, and sits on the National Executive of the Association of Salaried Medical Specialists due to her keen interest in workforce recruitment and development.

Acknowledgements iii

Acknowledgements

The project team would like to acknowledge the help of the following individuals who contributed to this report, Vaoita Turituri, Rees Tapsell, Kathy Brightwell, Hamsa Lilley, Wayne Hewlett, Jacqui Gough, Mark Coulston, Rebecca Kay, Rhys Jones, Siobhan Molloy, Jenny Boyle, Kath Harris, Kirsty Maxwell Crawford, Maureen Emery, Marion Blake, Marilyn Rimmer and Maryan Street. The views expressed in this document however are solely those of the authors.

Suggested citation

Hatcher, S., Mouly, V. S., Rasquihna, D., Miles, W., Burdett, J., Hamer, H. & Robinson, G. (2005). Improving recruitment to the mental health workforce in New Zealand. Auckland: Health Research Council of New Zealand.

Acknowledgements iii

Acknowledgements

The project team would like to acknowledge the help of the following individuals who contributed to this report, Vaoita Turituri, Rees Tapsell, Kathy Brightwell, Hamsa Lilley, Wayne Hewlett, Jacqui Gough, Mark Coulston, Rebecca Kay, Rhys Jones, Siobhan Molloy, Jenny Boyle, Kath Harris, Kirsty Maxwell Crawford, Maureen Emery, Marion Blake, Marilyn Rimmer and Maryan Street. The views expressed in this document however are solely those of the authors.

Suggested citation

Hatcher, S., Mouly, V. S., Rasquihna, D., Miles, W., Burdett, J., Hamer, H. & Robinson, G. (2005). Improving recruitment to the mental health workforce in New Zealand. Auckland: Health Research Council of New Zealand.

Table of Contents v

Table of Contents

Author Details.................................................................................................................... i Acknowledgements........................................................................................................... iii Table of Contents .............................................................................................................. v Executive Summary .......................................................................................................... 1 Introduction...................................................................................................................... 5

Background to project ......................................................................................................5 Chapter 1: The Strategic Environment ............................................................................. 7

Summary.......................................................................................................................10 Chapter 2: Key Stakeholders and Their Roles................................................................. 11

Government ...................................................................................................................11 Ministry of Health......................................................................................................11

The Ministry of Health’s Mental Health Directorate............................................................................11 The Ministry of Health’s Workforce Advisory Committee ................................................................12 The Ministry of Health’s Clinical Training Agency (CTA)................................................................12 The Mental Health Workforce Development Committee....................................................................12 The Ministry of Health-DHB Workforce Development Steering Committee .................................13

Ministry of Education.................................................................................................13 Tertiary education providers .....................................................................................................................13

Health service providers .............................................................................................13 District Health Boards and Non-Government Organisations..............................................................13

Intersectoral organisations ..........................................................................................14 Regional Mental Health Networks...........................................................................................................14 Unions...........................................................................................................................................................14 The Mental Health Commission ..............................................................................................................14 The Health Workforce Advisory Committee.........................................................................................15 Te Rau Matatini...........................................................................................................................................15 Mental Health Workforce Development Programme...........................................................................15 The Werry Centre .......................................................................................................................................15 A National Addictions Workforce Development Programme ............................................................16 Hauora.com..................................................................................................................................................16 The Mental Health Advisory Coalition...................................................................................................16 Regulation and standard setting bodies...................................................................................................16

Summary.......................................................................................................................17 Chapter 3: The Mental Health Workforce ...................................................................... 19

Who is in the workforce?................................................................................................19 Alcohol and drug workers...........................................................................................19

Alcohol and drug competencies for the generalist health workforce.................................................19 Counsellors................................................................................................................20 Clinical psychologists.................................................................................................20 Mental health consumer workers.................................................................................20 Family workers..........................................................................................................21 Mental health nurses...................................................................................................22 Mental health support workers ....................................................................................22 Occupational therapists...............................................................................................22 Psychiatrists...............................................................................................................22 Psychotherapists ........................................................................................................23 Social workers ...........................................................................................................23

Table of Contents v

Table of Contents

Author Details.................................................................................................................... i Acknowledgements........................................................................................................... iii Table of Contents .............................................................................................................. v Executive Summary .......................................................................................................... 1 Introduction...................................................................................................................... 5

Background to project ......................................................................................................5 Chapter 1: The Strategic Environment ............................................................................. 7

Summary.......................................................................................................................10 Chapter 2: Key Stakeholders and Their Roles................................................................. 11

Government ...................................................................................................................11 Ministry of Health......................................................................................................11

The Ministry of Health’s Mental Health Directorate............................................................................11 The Ministry of Health’s Workforce Advisory Committee ................................................................12 The Ministry of Health’s Clinical Training Agency (CTA)................................................................12 The Mental Health Workforce Development Committee....................................................................12 The Ministry of Health-DHB Workforce Development Steering Committee .................................13

Ministry of Education.................................................................................................13 Tertiary education providers .....................................................................................................................13

Health service providers .............................................................................................13 District Health Boards and Non-Government Organisations..............................................................13

Intersectoral organisations ..........................................................................................14 Regional Mental Health Networks...........................................................................................................14 Unions...........................................................................................................................................................14 The Mental Health Commission ..............................................................................................................14 The Health Workforce Advisory Committee.........................................................................................15 Te Rau Matatini...........................................................................................................................................15 Mental Health Workforce Development Programme...........................................................................15 The Werry Centre .......................................................................................................................................15 A National Addictions Workforce Development Programme ............................................................16 Hauora.com..................................................................................................................................................16 The Mental Health Advisory Coalition...................................................................................................16 Regulation and standard setting bodies...................................................................................................16

Summary.......................................................................................................................17 Chapter 3: The Mental Health Workforce ...................................................................... 19

Who is in the workforce?................................................................................................19 Alcohol and drug workers...........................................................................................19

Alcohol and drug competencies for the generalist health workforce.................................................19 Counsellors................................................................................................................20 Clinical psychologists.................................................................................................20 Mental health consumer workers.................................................................................20 Family workers..........................................................................................................21 Mental health nurses...................................................................................................22 Mental health support workers ....................................................................................22 Occupational therapists...............................................................................................22 Psychiatrists...............................................................................................................22 Psychotherapists ........................................................................................................23 Social workers ...........................................................................................................23

Table of Contents vi

The Maori workforce..................................................................................................23 The Pacific workforce ................................................................................................24 Primary Care .............................................................................................................24

What is the size of the workforce?...................................................................................24 How many vacancies are there? ......................................................................................26 How many more staff are needed?...................................................................................29

The problem of defining clinical .................................................................................29 Summary.......................................................................................................................29

Chapter 4: Current State Analysis of Recruitment Processes in New Zealand ................ 31 Aim...............................................................................................................................31 Method..........................................................................................................................31 Analysis ........................................................................................................................31 Results ..........................................................................................................................32 Communication .............................................................................................................33 Time .............................................................................................................................33 Quality ..........................................................................................................................34 Cost ..............................................................................................................................35 Media ............................................................................................................................36 Consumers.....................................................................................................................37 Multi-Employer Contract Agreements (MECA)...............................................................38 DHBs and NGOs working together .................................................................................38 Other comments.............................................................................................................39 Summary.......................................................................................................................39

Chapter 5: Literature Review and “Best Practice”.......................................................... 41 Literature review............................................................................................................41

Search strategy...........................................................................................................41 Findings ....................................................................................................................41

The definition of recruitment....................................................................................................................42 Recruitment, training and competencies.................................................................................................43 Recruitment and pay...................................................................................................................................46 Recruitment and organisational “attractiveness”...................................................................................46 Recruitment and stigma .............................................................................................................................48 Descriptions of recruitment initiatives in the academic literature ......................................................50 Recruitment to rural areas .........................................................................................................................57 “E-recruitment”...........................................................................................................................................58 Identifying ‘good’ staff..............................................................................................................................58 Maori and Pacific recruitment ..................................................................................................................59

“Best Practice”...............................................................................................................60 HR best practice.........................................................................................................61 Improving recruitment in the NHS..............................................................................62 Financial incentives....................................................................................................63 Bonuses.....................................................................................................................64 Alternative subsidies and assistance ............................................................................64 Payment of education costs and debt reduction.............................................................64 Summary...................................................................................................................64

Chapter 6: A Strategy to Improve Recruitment .............................................................. 65 “All of Government” approach........................................................................................65 Ministry of Health..........................................................................................................66 Ministry of Education.....................................................................................................66 DHBs............................................................................................................................67

Table of Contents vi

The Maori workforce..................................................................................................23 The Pacific workforce ................................................................................................24 Primary Care .............................................................................................................24

What is the size of the workforce?...................................................................................24 How many vacancies are there? ......................................................................................26 How many more staff are needed?...................................................................................29

The problem of defining clinical .................................................................................29 Summary.......................................................................................................................29

Chapter 4: Current State Analysis of Recruitment Processes in New Zealand ................ 31 Aim...............................................................................................................................31 Method..........................................................................................................................31 Analysis ........................................................................................................................31 Results ..........................................................................................................................32 Communication .............................................................................................................33 Time .............................................................................................................................33 Quality ..........................................................................................................................34 Cost ..............................................................................................................................35 Media ............................................................................................................................36 Consumers.....................................................................................................................37 Multi-Employer Contract Agreements (MECA)...............................................................38 DHBs and NGOs working together .................................................................................38 Other comments.............................................................................................................39 Summary.......................................................................................................................39

Chapter 5: Literature Review and “Best Practice”.......................................................... 41 Literature review............................................................................................................41

Search strategy...........................................................................................................41 Findings ....................................................................................................................41

The definition of recruitment....................................................................................................................42 Recruitment, training and competencies.................................................................................................43 Recruitment and pay...................................................................................................................................46 Recruitment and organisational “attractiveness”...................................................................................46 Recruitment and stigma .............................................................................................................................48 Descriptions of recruitment initiatives in the academic literature ......................................................50 Recruitment to rural areas .........................................................................................................................57 “E-recruitment”...........................................................................................................................................58 Identifying ‘good’ staff..............................................................................................................................58 Maori and Pacific recruitment ..................................................................................................................59

“Best Practice”...............................................................................................................60 HR best practice.........................................................................................................61 Improving recruitment in the NHS..............................................................................62 Financial incentives....................................................................................................63 Bonuses.....................................................................................................................64 Alternative subsidies and assistance ............................................................................64 Payment of education costs and debt reduction.............................................................64 Summary...................................................................................................................64

Chapter 6: A Strategy to Improve Recruitment .............................................................. 65 “All of Government” approach........................................................................................65 Ministry of Health..........................................................................................................66 Ministry of Education.....................................................................................................66 DHBs............................................................................................................................67

Table of Contents vii

NGOs............................................................................................................................68 Primary Health Organisations (PHO’s)............................................................................68 Professional bodies ........................................................................................................68 Maori specific ................................................................................................................69

The Way Forward........................................................................................................... 71 References....................................................................................................................... 73 Appendix 1: Mental Health Workforce Vacancies, March 2004...................................... 81 Appendix 2: Organisations Who Took Part in the Questionnaire and Interviews ........... 85 Appendix 3: Summary of Individual Responses to Questionnaire, Interview and Focus Group Questions ................................................................................................... 89 Appendix 4: National Mental Health Workforce Committee System.............................119

Table of Contents vii

NGOs............................................................................................................................68 Primary Health Organisations (PHO’s)............................................................................68 Professional bodies ........................................................................................................68 Maori specific ................................................................................................................69

The Way Forward........................................................................................................... 71 References....................................................................................................................... 73 Appendix 1: Mental Health Workforce Vacancies, March 2004...................................... 81 Appendix 2: Organisations Who Took Part in the Questionnaire and Interviews ........... 85 Appendix 3: Summary of Individual Responses to Questionnaire, Interview and Focus Group Questions ................................................................................................... 89 Appendix 4: National Mental Health Workforce Committee System.............................119

Table of Contents viii

Table of Contents viii

Executive Summary 1

Executive Summary

This report was commissioned by the Mental Health Workforce Development Programme to develop a national recruitment plan for the mental health workforce. It is not a manual describing best recruitment practice for District Health Boards. The first part of the report describes the strategic imperatives, which any recruitment plan would have to align with. The key stakeholders in mental health workforce development are described including their role in recruitment. There are numerous stakeholders with overlapping responsibilities and it is hard to see who is responsible for implementing a national recruitment plan. There is a lack of leadership in workforce development and key stakeholders are absent from decision-making. Clear communication between the different government departments will play a vital role in improving recruitment into the mental health sector. There is considerable overlap in responsibilities and there is no forum where key stakeholders can come together to discuss implementation and coordination. The project team feels that the place for this to happen is the Mental Health Workforce Development Committee. At present, the make up of this committee reflects mental health provision rather than stakeholders involved in workforce development, which is why this report recommends that this committee also contain representation from other key government stakeholders. Chapter 3 describes the mental health workforce in terms of the different roles workers have, the number of people in the workforce, the number of vacancies and the predicted need. The main conclusion from this is that there is very little reliable data to base plans on. Secondly, most vacancies in mental health are not advertised. Chapter 4 outlines a qualitative study of current recruitment processes in New Zealand. This tells us that human resource practices can be improved in most organisations. Chapter 5 describes the academic and grey literature on improving recruitment especially in mental health. There is little literature on mental health recruitment. The grey literature was more informative and the project team was impressed by the national recruitment strategy adopted by the United Kingdom National Health Service and the literature on improving teacher recruitment. It is clear from reviewing the literature that what needs to be done to improve recruitment in any organisation is well known – the literature rapidly gets repetitive on this point. The hard part is designing a system to make sure that best recruitment practice happens. The last chapter contains recommendations on improving mental health recruitment. The project team has presented the recommendations in two ways. First, the seven main priorities to improve recruitment into the mental health workforce in New Zealand are listed. Second, a longer comprehensive list of recommendations are presented in terms of who the project team believes has “ownership” of the different options. The key recommendations are:

• Establish a national electronic recruitment service as part of the Growth and Innovation Framework;

• Establish a national action research programme to drive improvements in Human Resources process;

• Develop return to practice schemes;

Executive Summary 1

Executive Summary

This report was commissioned by the Mental Health Workforce Development Programme to develop a national recruitment plan for the mental health workforce. It is not a manual describing best recruitment practice for District Health Boards. The first part of the report describes the strategic imperatives, which any recruitment plan would have to align with. The key stakeholders in mental health workforce development are described including their role in recruitment. There are numerous stakeholders with overlapping responsibilities and it is hard to see who is responsible for implementing a national recruitment plan. There is a lack of leadership in workforce development and key stakeholders are absent from decision-making. Clear communication between the different government departments will play a vital role in improving recruitment into the mental health sector. There is considerable overlap in responsibilities and there is no forum where key stakeholders can come together to discuss implementation and coordination. The project team feels that the place for this to happen is the Mental Health Workforce Development Committee. At present, the make up of this committee reflects mental health provision rather than stakeholders involved in workforce development, which is why this report recommends that this committee also contain representation from other key government stakeholders. Chapter 3 describes the mental health workforce in terms of the different roles workers have, the number of people in the workforce, the number of vacancies and the predicted need. The main conclusion from this is that there is very little reliable data to base plans on. Secondly, most vacancies in mental health are not advertised. Chapter 4 outlines a qualitative study of current recruitment processes in New Zealand. This tells us that human resource practices can be improved in most organisations. Chapter 5 describes the academic and grey literature on improving recruitment especially in mental health. There is little literature on mental health recruitment. The grey literature was more informative and the project team was impressed by the national recruitment strategy adopted by the United Kingdom National Health Service and the literature on improving teacher recruitment. It is clear from reviewing the literature that what needs to be done to improve recruitment in any organisation is well known – the literature rapidly gets repetitive on this point. The hard part is designing a system to make sure that best recruitment practice happens. The last chapter contains recommendations on improving mental health recruitment. The project team has presented the recommendations in two ways. First, the seven main priorities to improve recruitment into the mental health workforce in New Zealand are listed. Second, a longer comprehensive list of recommendations are presented in terms of who the project team believes has “ownership” of the different options. The key recommendations are:

• Establish a national electronic recruitment service as part of the Growth and Innovation Framework;

• Establish a national action research programme to drive improvements in Human Resources process;

• Develop return to practice schemes;

Executive Summary 2

• The Mental Health Workforce Development Committee should include representation from the Ministry of Education, Department of Labour, Ministry of Economic Development and primary care;

• Professional bodies should appoint Directors of Maori training;

• Establish financial incentives to improve recruitment; and

• Develop a mental health marketing and outreach programme to schools, universities and clinical programmes.

Comprehensive recommendations according to who has “ownership” of the tasks

“All of government” approach

1. Establish a national electronic recruitment service as part of the Growth and Innovation Framework;

2. Establish financial incentives to improve recruitment;

3. The Mental Health Workforce Development Committee should include representation from the Ministry of Education, Department of Labour, Ministry of Economic Development and primary care; and

4. A strategy for creating positive work environments in mental health should be developed.

Ministry of Health

1. Establish a national action research programme to drive improvements in Human Resources process;

2. Negotiate a “no poaching deal” with the National Health Service;

3. Improve nursing pay and pathways;

4. Improve Clinical Training Agency processes;

5. Encourage multi-employer contracts;

6. PGY 1 and 2 placements in liaison psychiatry;

7. Ring fence money for child and adolescent services within the District Health Board budgets; and

8. Produce a manual of best practice in recruitment for District Health Boards.

Ministry of Education

1. Allow non-traditional routes into the professions;

2. Fast track the establishment of mental health courses in tertiary institutions; and

3. Ensure competencies in clinical courses are appropriate for mental health work.

District Health Boards

1. Improve Human Resources practice;

2. Encourage local and regional recruitment websites;

Executive Summary 2

• The Mental Health Workforce Development Committee should include representation from the Ministry of Education, Department of Labour, Ministry of Economic Development and primary care;

• Professional bodies should appoint Directors of Maori training;

• Establish financial incentives to improve recruitment; and

• Develop a mental health marketing and outreach programme to schools, universities and clinical programmes.

Comprehensive recommendations according to who has “ownership” of the tasks

“All of government” approach

1. Establish a national electronic recruitment service as part of the Growth and Innovation Framework;

2. Establish financial incentives to improve recruitment;

3. The Mental Health Workforce Development Committee should include representation from the Ministry of Education, Department of Labour, Ministry of Economic Development and primary care; and

4. A strategy for creating positive work environments in mental health should be developed.

Ministry of Health

1. Establish a national action research programme to drive improvements in Human Resources process;

2. Negotiate a “no poaching deal” with the National Health Service;

3. Improve nursing pay and pathways;

4. Improve Clinical Training Agency processes;

5. Encourage multi-employer contracts;

6. PGY 1 and 2 placements in liaison psychiatry;

7. Ring fence money for child and adolescent services within the District Health Board budgets; and

8. Produce a manual of best practice in recruitment for District Health Boards.


1. Allow non-traditional routes into the professions;

2. Fast track the establishment of mental health courses in tertiary institutions; and

3. Ensure competencies in clinical courses are appropriate for mental health work.

District Health Boards

1. Improve Human Resources practice;


Executive Summary 3

3. Develop a strong marketing and outreach programme to local schools, clinical programmes and project a positive image;

4. Provide referral incentives;

5. Provide financial incentives;

6. Develop return to practice schemes; and

7. Encourage regional partnerships of Human Resources departments.

Non-Government Organisations



3. Provide financial incentives; and

4. Develop return to practice schemes.

Primary Health Organisations

1. There should be representation of primary care on the Mental Health Workforce Development Committee; and

2. A strategy for the primary mental health care workforce needs to be developed.

Professional bodies

1. Facilitate clinician mobility through licensing reciprocity;

2. Create a positive image; and

3. Professional bodies should appoint Directors of Maori training.

Maori specific

1. Encourage early outreach programmes;

2. Development of scholarship and grant programmes to encourage entry into tertiary training and for post-entry clinical training;

3. Provide supportive environments for mentoring, academic and personal support for Maori in clinical training; and

4. Facilitate support worker to clinician programmes.

Executive Summary 3

3. Develop a strong marketing and outreach programme to local schools, clinical programmes and project a positive image;


5. Provide financial incentives;

6. Develop return to practice schemes; and

7. Encourage regional partnerships of Human Resources departments.




3. Provide financial incentives; and


Primary Health Organisations

1. There should be representation of primary care on the Mental Health Workforce Development Committee; and

2. A strategy for the primary mental health care workforce needs to be developed.

Professional bodies

1. Facilitate clinician mobility through licensing reciprocity;

2. Create a positive image; and

3. Professional bodies should appoint Directors of Maori training.

Maori specific

1. Encourage early outreach programmes;

2. Development of scholarship and grant programmes to encourage entry into tertiary training and for post-entry clinical training;

3. Provide supportive environments for mentoring, academic and personal support for Maori in clinical training; and

4. Facilitate support worker to clinician programmes.

Executive Summary 4

Executive Summary 4

Introduction 5

Introduction

Background to project

This project was commissioned by the Mental Health Workforce Development Programme (MHWDP) to describe the current literature and best practice in recruitment, to produce a description of the current state of mental health workforce recruitment in New Zealand and to outline various options to improve recruitment into the mental health workforce. The goal stated in the terms of reference for this project was to: develop a national recruitment plan that meets the MHWDP goals and objectives; aligns with the MHWDP recruitment and retention goals and objectives; defines local, regional and national approaches; and is used as an input into the MHWDP “organisational development” programme. This report was produced over 8 months between December 2003 and July 2004. Whilst the focus of this report is on recruitment it is difficult to disentangle this from the wider problem of workforce development so the report will also address some aspects of this. This report concentrates on those workers who have direct contact with consumers of mental health services. The way the report is structured is: firstly, to describe various national strategies, initiatives and stakeholders which inform recruitment and set the context for recruitment into the mental health services; then describe the current mental health workforce and the current state of recruitment practices; outline the literature on recruitment and “best practice”; and finally propose options for improving recruitment.

Introduction 5

Introduction

Background to project

This project was commissioned by the Mental Health Workforce Development Programme (MHWDP) to describe the current literature and best practice in recruitment, to produce a description of the current state of mental health workforce recruitment in New Zealand and to outline various options to improve recruitment into the mental health workforce. The goal stated in the terms of reference for this project was to: develop a national recruitment plan that meets the MHWDP goals and objectives; aligns with the MHWDP recruitment and retention goals and objectives; defines local, regional and national approaches; and is used as an input into the MHWDP “organisational development” programme. This report was produced over 8 months between December 2003 and July 2004. Whilst the focus of this report is on recruitment it is difficult to disentangle this from the wider problem of workforce development so the report will also address some aspects of this. This report concentrates on those workers who have direct contact with consumers of mental health services. The way the report is structured is: firstly, to describe various national strategies, initiatives and stakeholders which inform recruitment and set the context for recruitment into the mental health services; then describe the current mental health workforce and the current state of recruitment practices; outline the literature on recruitment and “best practice”; and finally propose options for improving recruitment.

Chapter 1: The Strategic Environment 7

Chapter 1: The Strategic Environment

The provision of healthcare in New Zealand is based on the New Zealand Health Strategy and the New Zealand Disability Strategy. From this, several population-based strategies emerge including those for Maori (He Korowai Oranga) and older people. These are complemented by service specific strategies the most relevant for this document being the National Mental Health Strategy. Government funding applied to mental health services for the year ended 30 June 2003 totalled $738.9 million, (Table 1). Table 1. Mental Health Funding for 2002/03.

Total Vote Health: Mental Health Expenditure ($ millions, excluding GST) 738.9

Non-Government Organisations Share of Total Vote Health Mental Health Expenditure

28.0%

$ services per head of population (appropriately adjusted for valid comparisons)

– Northern Region 174

– Midland Region 173

– Central Region 186

– South Island 187

Source: Report to the Mental Health Commission Review of Mental Health Services Expenditure Report for the year ended 30 June 2003 by Andrew Gaudin, April 2004. There are three key strategic documents in Mental Health:

• ‘Looking Forward: Strategic directions for mental health services’ (Ministry of Health, 1994);

• ‘Moving Forward: The national mental health plan for more and better services’ (Ministry of Health, 1997); and

• ‘Blueprint for Mental Health Services in New Zealand: How things need to be’ (Mental Health Commission, 1998).

The seven strategic directions identified in ‘Looking Forward’ and ‘Moving Forward’ are:

1. More mental health services;

2. More and better services for Maori;

3. Better mental health services;

4. Balancing personal rights with protection of the public;

5. Developing and implementing the national drug policy;

6. Developing the mental health services infrastructure; and

7. Strengthening promotion and prevention. The ‘Blueprint’ is a National Mental Health Service Development Plan. It aims for a well functioning mental health system that provides adequate and appropriate treatment and support to those affected most severely by mental illness. The ‘Blueprint’ sets out a framework, key


Chapter 1: The Strategic Environment

The provision of healthcare in New Zealand is based on the New Zealand Health Strategy and the New Zealand Disability Strategy. From this, several population-based strategies emerge including those for Maori (He Korowai Oranga) and older people. These are complemented by service specific strategies the most relevant for this document being the National Mental Health Strategy. Government funding applied to mental health services for the year ended 30 June 2003 totalled $738.9 million, (Table 1). Table 1. Mental Health Funding for 2002/03.

Total Vote Health: Mental Health Expenditure ($ millions, excluding GST) 738.9

Non-Government Organisations Share of Total Vote Health Mental Health Expenditure

28.0%

$ services per head of population (appropriately adjusted for valid comparisons)

– Northern Region 174

– Midland Region 173

– Central Region 186

– South Island 187

Source: Report to the Mental Health Commission Review of Mental Health Services Expenditure Report for the year ended 30 June 2003 by Andrew Gaudin, April 2004. There are three key strategic documents in Mental Health:

• ‘Looking Forward: Strategic directions for mental health services’ (Ministry of Health, 1994);

• ‘Moving Forward: The national mental health plan for more and better services’ (Ministry of Health, 1997); and

• ‘Blueprint for Mental Health Services in New Zealand: How things need to be’ (Mental Health Commission, 1998).

The seven strategic directions identified in ‘Looking Forward’ and ‘Moving Forward’ are:

1. More mental health services;

2. More and better services for Maori;

3. Better mental health services;

4. Balancing personal rights with protection of the public;

5. Developing and implementing the national drug policy;

6. Developing the mental health services infrastructure; and

7. Strengthening promotion and prevention. The ‘Blueprint’ is a National Mental Health Service Development Plan. It aims for a well functioning mental health system that provides adequate and appropriate treatment and support to those affected most severely by mental illness. The ‘Blueprint’ sets out a framework, key


parameters, and principles for good service. From the point of view of workforce planning its advantage is that it specifies very clearly the numbers of full-time equivalent staff (FTE’s) needed to provide an adequate mental health service in New Zealand by 2010. This means that workforce planning does not have to rely on other indicators such as the number of unfilled positions, waiting times to be seen, excessive hours of work or other measures of workforce adequacy. However, this national direction imposes considerable pressure on the recruitment of the necessary workforce. The fact that New Zealand is attempting to rapidly grow its mental health services at a time when there is a global shortage of such a workforce requires a careful and concerted workforce strategy. The development of the mental health workforce is informed by three strategies.

• ‘Towards Better Mental Health Services: The report of the National Working Party on Mental Health Workforce Development’ (Ministry of Health, 1996) which identified seven strategies for improving the mental health workforce:

1. National and regional policies to support providers in retention and recruitment of staff. This document is partly a response to this priority;

2. Communication with the education sector regarding tertiary training;

3. Increased investment in training to increase skills and the pool of workers;

4. Research to provide information on outputs and outcomes;

5. National destigmatisation strategy. (This was developed and implemented by the Health Funding Authority and has been continued by the Mental Health Commission.);

6. Providers taking responsibility for workforce development; and

7. Management practice and organisational change to address the issues of recruitment and retention.

• ‘Developing the Mental Health Workforce: The report of the National Mental Health Workforce Development Coordinating Committee’ (Mental Health Commission, 1999) identified five strategies:

1. Competencies development – this has not happened because the strengths of the different professions outweighed any gains from having an homogenous competency framework;

2. Improving organisational effectiveness which includes the recruitment of staff;

3. Child and youth workforce initiatives;

4. Maori workforce development; and

5. Pacific peoples workforce development with recruitment of Pacific workers being mentioned as a specific consideration.

• Tuutahitia te Wero, Meeting the Challenges: Mental health workforce development plan 2000-2005 (Health Funding Authority, 2000) detailed eleven goals:

1. Strengthening and developing the Maori workforce;

2. Strengthen and develop the child/tamariki and youth/rangatahi workforce;

3. Strengthen and develop the Pacific workforce;

4. Develop generic skills training;

5. Address the training needs of consumers/tangata whaiora and families/whanau;

6. Develop the alcohol and drug, elderly mental health, community, primary mental health and forensic workforces;


parameters, and principles for good service. From the point of view of workforce planning its advantage is that it specifies very clearly the numbers of full-time equivalent staff (FTE’s) needed to provide an adequate mental health service in New Zealand by 2010. This means that workforce planning does not have to rely on other indicators such as the number of unfilled positions, waiting times to be seen, excessive hours of work or other measures of workforce adequacy. However, this national direction imposes considerable pressure on the recruitment of the necessary workforce. The fact that New Zealand is attempting to rapidly grow its mental health services at a time when there is a global shortage of such a workforce requires a careful and concerted workforce strategy. The development of the mental health workforce is informed by three strategies.

• ‘Towards Better Mental Health Services: The report of the National Working Party on Mental Health Workforce Development’ (Ministry of Health, 1996) which identified seven strategies for improving the mental health workforce:

1. National and regional policies to support providers in retention and recruitment of staff. This document is partly a response to this priority;

2. Communication with the education sector regarding tertiary training;

3. Increased investment in training to increase skills and the pool of workers;

4. Research to provide information on outputs and outcomes;

5. National destigmatisation strategy. (This was developed and implemented by the Health Funding Authority and has been continued by the Mental Health Commission.);

6. Providers taking responsibility for workforce development; and

7. Management practice and organisational change to address the issues of recruitment and retention.

• ‘Developing the Mental Health Workforce: The report of the National Mental Health Workforce Development Coordinating Committee’ (Mental Health Commission, 1999) identified five strategies:

1. Competencies development – this has not happened because the strengths of the different professions outweighed any gains from having an homogenous competency framework;

2. Improving organisational effectiveness which includes the recruitment of staff;

3. Child and youth workforce initiatives;

4. Maori workforce development; and

5. Pacific peoples workforce development with recruitment of Pacific workers being mentioned as a specific consideration.

• Tuutahitia te Wero, Meeting the Challenges: Mental health workforce development plan 2000-2005 (Health Funding Authority, 2000) detailed eleven goals:

1. Strengthening and developing the Maori workforce;

2. Strengthen and develop the child/tamariki and youth/rangatahi workforce;

3. Strengthen and develop the Pacific workforce;

4. Develop generic skills training;

5. Address the training needs of consumers/tangata whaiora and families/whanau;

6. Develop the alcohol and drug, elderly mental health, community, primary mental health and forensic workforces;


7. Enhance the ability of support workers to play an important role;

8. Encourage providers to take responsibility for those aspects of workforce development that they can address;

9. Provide clear direction for future post-entry clinical training in mental health;

10. Facilitate Ministry of Health and District Health Board (DHB) planning, contracting and monitoring related to mental health workforce development; and

11. Contribute to the coordinated development of the mental health workforce. The ‘Mental Health (Alcohol and Other Drugs) Workforce Development Framework’ (Ministry of Health, 2002) presented a snapshot of workforce development activity and key stakeholders 2 years into the implementation of Tuutahitia te Wero. It lists over 100 initiatives since 2000 that have contributed to the goals of Tuutahitia te Wero most of which relate to training. One of the future strategic imperatives identified here is to develop a national and regional response to issues of retention and recruitment. This objective seeks to assist DHBs and Non-Government Organisations (NGOs) to produce medium- to long-term solutions to national and regional recruitment problems across all services. Possible potential projects listed in this document include a review of recruitment and retention procedures, national and regional planning, and focused projects for attracting psychiatric registrars and mental health nurses. ‘The New Zealand Health Workforce Future Directions – Recommendations to the Minister of Health 2003’ (Health Workforce Advisory Committee, 2003) also informs wider recruitment issues in health. This mentions recruitment in three recommendations to the Minister:

• Recommendation 2.2.4 explicitly prioritise and invest in the development of healthy workplace environments, with a view to enhancing recruitment and retention;

• Recommendation 3.4.5 students and graduates are actively recruited to better represent the diversity of the New Zealand population using broad selection criteria; and

• Recommendation 4.4.3 development of outcome-based incentives for tertiary institutions providing health and disability education to increase Maori recruitment and course completion.

The Health Workforce Advisory Committee (HWAC) document ‘The New Zealand Health Workforce: A stocktake of issues and capacity 2001’ (HWAC, 2002) highlighted key issues around developing the mental health workforce. To summarise these are:

• The number of national agencies with a role in mental health workforce development leading to confusion over boundaries and responsibilities;

• Shortages both nationally and internationally of appropriately trained mental health workers;

• Training for Maori is inadequate as they are substantially underrepresented especially in the clinically trained workforce;

• Pacific mental health workers need to be trained and recruited to increase their representation at all levels of the mental health workforce;

• Data on the mental health workforce is lacking;

• Competency of the potential workforce is an issue especially with the change from an institutional approach to a community orientated focus;

• Involvement of service users as mandated by the Mental Health Standards;


7. Enhance the ability of support workers to play an important role;

8. Encourage providers to take responsibility for those aspects of workforce development that they can address;

9. Provide clear direction for future post-entry clinical training in mental health;

10. Facilitate Ministry of Health and District Health Board (DHB) planning, contracting and monitoring related to mental health workforce development; and

11. Contribute to the coordinated development of the mental health workforce. The ‘Mental Health (Alcohol and Other Drugs) Workforce Development Framework’ (Ministry of Health, 2002) presented a snapshot of workforce development activity and key stakeholders 2 years into the implementation of Tuutahitia te Wero. It lists over 100 initiatives since 2000 that have contributed to the goals of Tuutahitia te Wero most of which relate to training. One of the future strategic imperatives identified here is to develop a national and regional response to issues of retention and recruitment. This objective seeks to assist DHBs and Non-Government Organisations (NGOs) to produce medium- to long-term solutions to national and regional recruitment problems across all services. Possible potential projects listed in this document include a review of recruitment and retention procedures, national and regional planning, and focused projects for attracting psychiatric registrars and mental health nurses. ‘The New Zealand Health Workforce Future Directions – Recommendations to the Minister of Health 2003’ (Health Workforce Advisory Committee, 2003) also informs wider recruitment issues in health. This mentions recruitment in three recommendations to the Minister:

• Recommendation 2.2.4 explicitly prioritise and invest in the development of healthy workplace environments, with a view to enhancing recruitment and retention;

• Recommendation 3.4.5 students and graduates are actively recruited to better represent the diversity of the New Zealand population using broad selection criteria; and

• Recommendation 4.4.3 development of outcome-based incentives for tertiary institutions providing health and disability education to increase Maori recruitment and course completion.

The Health Workforce Advisory Committee (HWAC) document ‘The New Zealand Health Workforce: A stocktake of issues and capacity 2001’ (HWAC, 2002) highlighted key issues around developing the mental health workforce. To summarise these are:

• The number of national agencies with a role in mental health workforce development leading to confusion over boundaries and responsibilities;

• Shortages both nationally and internationally of appropriately trained mental health workers;

• Training for Maori is inadequate as they are substantially underrepresented especially in the clinically trained workforce;

• Pacific mental health workers need to be trained and recruited to increase their representation at all levels of the mental health workforce;

• Data on the mental health workforce is lacking;

• Competency of the potential workforce is an issue especially with the change from an institutional approach to a community orientated focus;

• Involvement of service users as mandated by the Mental Health Standards;


• The creation of generic mental health workers; and

• Alcohol and drug competencies for the generalist health workforce. Recruitment issues are not specific to health; similar problems are faced by teachers, the Police, the Defence Department and private firms trying to attract graduates to work with them. The Department of Education advertises teacher vacancies on the Ministry website and funds research to study how to improve teacher recruitment and retention. The Department of Labour (2004) report ‘Skills in the Labour Market – May 2004’ notes, “Skill shortages continue to trouble a lot of employers in early-2004. The main problem facing firms has shifted further from a lack of customers to a lack of labour, now the main factor limiting expansion for almost one in four firms, a thiry year high. This constraint and the large rise in job vacancies over the last year are explained by the sustained high difficulty of finding staff, despite a small fall in the March 2004 quarter”. The recently announced ‘Growth and Innovation Framework’ (Ministry of Economic Development, 2004) recognizes difficulties in recruitment in New Zealand and clearly outlines the role of government in addressing the problem. To support this $500 million of funding over the next 4 years was announced in the 2004 Budget. The government’s role is to enhance the development and utilisation of skills and talents through:

• Provision of education and training at all levels;

• Immigration policy;

• Employment policy;

• Provision of information and advice to assist better labour market matching; and

• Encouragement of information sharing by acting as a conduit for all interested parties. This is supported by funding of $12 to $17 million dollars per year for the next 4 years for “skills and talents initiatives”. These include: “An initiative to improve understanding and support action in the public and private sectors, as an initial step to improve New Zealand’s management capability”; “An initiative to assist New Zealand employers to find staff to fill their skills gaps through targeting marketing and promotion about work opportunities in New Zealand to suitable prospective migrants”; and “linking employers and prospective employees through a new ‘talent database’ on the Internet”.

Summary

There are governmental strategic plans in place for health and for improving recruitment into the wider New Zealand workforce but the two areas do not appear to overlap.


• The creation of generic mental health workers; and

• Alcohol and drug competencies for the generalist health workforce. Recruitment issues are not specific to health; similar problems are faced by teachers, the Police, the Defence Department and private firms trying to attract graduates to work with them. The Department of Education advertises teacher vacancies on the Ministry website and funds research to study how to improve teacher recruitment and retention. The Department of Labour (2004) report ‘Skills in the Labour Market – May 2004’ notes, “Skill shortages continue to trouble a lot of employers in early-2004. The main problem facing firms has shifted further from a lack of customers to a lack of labour, now the main factor limiting expansion for almost one in four firms, a thiry year high. This constraint and the large rise in job vacancies over the last year are explained by the sustained high difficulty of finding staff, despite a small fall in the March 2004 quarter”. The recently announced ‘Growth and Innovation Framework’ (Ministry of Economic Development, 2004) recognizes difficulties in recruitment in New Zealand and clearly outlines the role of government in addressing the problem. To support this $500 million of funding over the next 4 years was announced in the 2004 Budget. The government’s role is to enhance the development and utilisation of skills and talents through:

• Provision of education and training at all levels;

• Immigration policy;

• Employment policy;

• Provision of information and advice to assist better labour market matching; and

• Encouragement of information sharing by acting as a conduit for all interested parties. This is supported by funding of $12 to $17 million dollars per year for the next 4 years for “skills and talents initiatives”. These include: “An initiative to improve understanding and support action in the public and private sectors, as an initial step to improve New Zealand’s management capability”; “An initiative to assist New Zealand employers to find staff to fill their skills gaps through targeting marketing and promotion about work opportunities in New Zealand to suitable prospective migrants”; and “linking employers and prospective employees through a new ‘talent database’ on the Internet”.

Summary

There are governmental strategic plans in place for health and for improving recruitment into the wider New Zealand workforce but the two areas do not appear to overlap.

Chapter 2: Key Stakeholders and Their Roles 11

Chapter 2: Key Stakeholders and Their Roles

The purpose of this chapter is to describe the key stakeholders in mental health workforce development and their apparent roles. The Australian Medical Workforce Advisory Committee (American Medical Workforce Advisory Committee, 2003) report ‘Specialist medical workforce planning in Australia’ describes six broad groups of stakeholders involved in health workforce development: consumers; government; intersectoral organisations; service providers; professional groups; and educational representatives. In New Zealand, there is also the need to recognise the importance of Maori and the Treaty of Waitangi obligations in each stakeholder group and in overall workforce development. After identifying the stakeholders the next question is how are they actually involved in workforce development? This may take the form of committee membership, membership of specific working parties or project teams, consultation and liaison, and specifically responding to calls for submissions from various stakeholders. Furthermore, some bodies have a statutory obligation to provide advice whilst others have a contractual obligation to assist in workforce development. Action on workforce initiatives may take place, locally, regionally or nationally. National initiatives are needed, for example, where changes need to be made to the regulatory framework; regional, for example, when cost savings or efficiencies may occur where employers work together; and local when, for example, specific changes need to be made to organisational Human Resources (HR) practices. Recruitment is a particular aspect of workforce development, which has the following aims:

• To increase the pool of applicants with minimum costs;

• To meet an organisation’s legal and social obligations regarding demographic composition of the workforce;

• To increase the success rate of the selection process by reducing the percentage of applicants who are not qualified or have the wrong skills; and

• To improve stakeholder coordination. Among tasks that come under the heading of recruitment include: the need to market careers to potential applicants in schools; the provision of basic professional training in tertiary education institutes; the prediction of workforce needs; immigration controls and incentives; the provision of financial incentives; and the proper planning and management of HR in organisations. This is complex and time consuming. Described below are the major stakeholders in mental health workforce development, and where possible specifically describe their role in recruitment.

Government

Ministry of Health

The Ministry of Health’s Mental Health Directorate

• Maintains and articulates a strategic overview;

• Assists DHBs and NGOs to implement workforce development;

• Facilitates relationships of workforce development stakeholders within the mental health sector and across sectors;


Chapter 2: Key Stakeholders and Their Roles

The purpose of this chapter is to describe the key stakeholders in mental health workforce development and their apparent roles. The Australian Medical Workforce Advisory Committee (American Medical Workforce Advisory Committee, 2003) report ‘Specialist medical workforce planning in Australia’ describes six broad groups of stakeholders involved in health workforce development: consumers; government; intersectoral organisations; service providers; professional groups; and educational representatives. In New Zealand, there is also the need to recognise the importance of Maori and the Treaty of Waitangi obligations in each stakeholder group and in overall workforce development. After identifying the stakeholders the next question is how are they actually involved in workforce development? This may take the form of committee membership, membership of specific working parties or project teams, consultation and liaison, and specifically responding to calls for submissions from various stakeholders. Furthermore, some bodies have a statutory obligation to provide advice whilst others have a contractual obligation to assist in workforce development. Action on workforce initiatives may take place, locally, regionally or nationally. National initiatives are needed, for example, where changes need to be made to the regulatory framework; regional, for example, when cost savings or efficiencies may occur where employers work together; and local when, for example, specific changes need to be made to organisational Human Resources (HR) practices. Recruitment is a particular aspect of workforce development, which has the following aims:

• To increase the pool of applicants with minimum costs;

• To meet an organisation’s legal and social obligations regarding demographic composition of the workforce;

• To increase the success rate of the selection process by reducing the percentage of applicants who are not qualified or have the wrong skills; and

• To improve stakeholder coordination. Among tasks that come under the heading of recruitment include: the need to market careers to potential applicants in schools; the provision of basic professional training in tertiary education institutes; the prediction of workforce needs; immigration controls and incentives; the provision of financial incentives; and the proper planning and management of HR in organisations. This is complex and time consuming. Described below are the major stakeholders in mental health workforce development, and where possible specifically describe their role in recruitment.

Government

Ministry of Health

The Ministry of Health’s Mental Health Directorate

• Maintains and articulates a strategic overview;

• Assists DHBs and NGOs to implement workforce development;

• Facilitates relationships of workforce development stakeholders within the mental health sector and across sectors;


• Assists in the development and funding of workforce development initiatives via the national allocation;

• Advises the Minister of Health about mental health workforce development; and

• Funds Mental Health Workforce Development with a budget of $24 million for workforce development including $6.4 million for post-entry clinical training.

The Ministry of Health’s Workforce Advisory Committee

• Advises on the strategic overview of the contribution of the health and disability workforce to health and independence outcomes;

• Coordinates health and disability workforce issues and initiatives within the Ministry of Health and externally to ensure an integrated, consistent approach and efficient use of resources;

• Identifies key workforce problems and makes recommendations on priorities; and

• Recommends a set of principles to guide the development of the future health and disability workforce.

The Ministry of Health’s Clinical Training Agency (CTA)

• Purchases post-entry clinical training including Mental Health;

• Purchases specialist training programmes;

• Manages and monitors workforce development contracts on behalf of the Mental Health Directorate;

• Makes decisions which directly affect the number of trained clinicians available for recruitment; and

• Budget approximately $13.4 million part of which is for mental health workforce development mainly spent on post-entry clinical training for nurses and psychiatrists (Ministry of Health, 2002).

The Mental Health Workforce Development Committee

This Committee has the following responsibilities:

• Development of a strategic workforce development perspective;

• Manages the expenditure of an annual amount of funding from the National allocation for Workforce Development received from the Mental Health Directorate;

• Develops processes and systems to progress the implementation of mental health workforce development projects;

• Develops proposals, throughout the year, in consultation with the sector identifying national workforce development initiatives;

• Makes recommendations for approval by the MOH-DHB Mental Health Workforce Steering Committee;

• Presents reports to the MOH-DHB Mental Health Workforce Steering Committee identifying strategic implementation progress for monitoring and evaluation purposes;

• Oversees the work of a Project Manager, Analyst and Administrator responsible for project planning, contract tenders, contract management and contract evaluation;


• Assists in the development and funding of workforce development initiatives via the national allocation;

• Advises the Minister of Health about mental health workforce development; and

• Funds Mental Health Workforce Development with a budget of $24 million for workforce development including $6.4 million for post-entry clinical training.

The Ministry of Health’s Workforce Advisory Committee

• Advises on the strategic overview of the contribution of the health and disability workforce to health and independence outcomes;

• Coordinates health and disability workforce issues and initiatives within the Ministry of Health and externally to ensure an integrated, consistent approach and efficient use of resources;

• Identifies key workforce problems and makes recommendations on priorities; and

• Recommends a set of principles to guide the development of the future health and disability workforce.

The Ministry of Health’s Clinical Training Agency (CTA)

• Purchases post-entry clinical training including Mental Health;

• Purchases specialist training programmes;

• Manages and monitors workforce development contracts on behalf of the Mental Health Directorate;

• Makes decisions which directly affect the number of trained clinicians available for recruitment; and

• Budget approximately $13.4 million part of which is for mental health workforce development mainly spent on post-entry clinical training for nurses and psychiatrists (Ministry of Health, 2002).

The Mental Health Workforce Development Committee

This Committee has the following responsibilities:

• Development of a strategic workforce development perspective;

• Manages the expenditure of an annual amount of funding from the National allocation for Workforce Development received from the Mental Health Directorate;

• Develops processes and systems to progress the implementation of mental health workforce development projects;

• Develops proposals, throughout the year, in consultation with the sector identifying national workforce development initiatives;

• Makes recommendations for approval by the MOH-DHB Mental Health Workforce Steering Committee;

• Presents reports to the MOH-DHB Mental Health Workforce Steering Committee identifying strategic implementation progress for monitoring and evaluation purposes;

• Oversees the work of a Project Manager, Analyst and Administrator responsible for project planning, contract tenders, contract management and contract evaluation;


• Facilitates twice yearly sector wide mental health workforce development forum; and

• Has representatives from DHBs, NGOs, consumer, family, Maori, Pacific peoples, Mental Health Commission and clinicians (see Appendix 4).

The Ministry of Health-DHB Workforce Development Steering Committee

• Considers and reviews mental health workforce development strategic direction in light of the wider health context;

• Decides on the implementation of strategic imperatives via the Mental Health Workforce Committee;

• Ensures that due process and appropriate systems are developed and used by the Mental Health Workforce Committee; and

• Equal representation of three members each from the DHBs and the Mental Health Directorate, (see Appendix 4).


Tertiary education providers

These are universities, colleges and other tertiary providers who receive significant government funding via the Ministry of Education but are nominally independent of Government. They train the workforce required for the mental health sector. Unlike most other tertiary courses, (the exceptions being dentistry and veterinary science), the Ministry of Education places a cap on the number of funded positions for medical training. Increasing the cap is only justified if increased demand can not be met from other sources, primarily migration.

Health service providers

District Health Boards and Non-Government Organisations

DHB providers

• Identify workforce development requirements and include these within district annual plans;

• Attend to workforce development at district level;

• Contribute to regional and national initiatives;

• Major stakeholder for recruitment initiatives;

• Issues with getting specialist staff to fill positions; and

• Recruitment can be costly for these organisations.

District Health Boards New Zealand (DHBNZ)

• Exists to be an effective strategic advisory body for DHBs on national issues, ensuring that appropriate linkages and relationships are maintained across the health sector including with central Government and its agencies;

• Provides an organisational infrastructure for workforce development activity within and across DHBs;


• Facilitates twice yearly sector wide mental health workforce development forum; and

• Has representatives from DHBs, NGOs, consumer, family, Maori, Pacific peoples, Mental Health Commission and clinicians (see Appendix 4).

The Ministry of Health-DHB Workforce Development Steering Committee

• Considers and reviews mental health workforce development strategic direction in light of the wider health context;

• Decides on the implementation of strategic imperatives via the Mental Health Workforce Committee;

• Ensures that due process and appropriate systems are developed and used by the Mental Health Workforce Committee; and

• Equal representation of three members each from the DHBs and the Mental Health Directorate, (see Appendix 4).


Tertiary education providers

These are universities, colleges and other tertiary providers who receive significant government funding via the Ministry of Education but are nominally independent of Government. They train the workforce required for the mental health sector. Unlike most other tertiary courses, (the exceptions being dentistry and veterinary science), the Ministry of Education places a cap on the number of funded positions for medical training. Increasing the cap is only justified if increased demand can not be met from other sources, primarily migration.

Health service providers

District Health Boards and Non-Government Organisations

DHB providers

• Identify workforce development requirements and include these within district annual plans;

• Attend to workforce development at district level;

• Contribute to regional and national initiatives;

• Major stakeholder for recruitment initiatives;

• Issues with getting specialist staff to fill positions; and


District Health Boards New Zealand (DHBNZ)

• Exists to be an effective strategic advisory body for DHBs on national issues, ensuring that appropriate linkages and relationships are maintained across the health sector including with central Government and its agencies;

• Provides an organisational infrastructure for workforce development activity within and across DHBs;


• Develops a DHBNZ national strategic plan for workforce development; and

• Aggregates DHB demand for workforce development initiatives.

DHB Funding and Planning

• Ensures mental health resources are used within each of the 21 DHBs in a manner that reflects identified community needs;

• Drives district and regional mental health planning; and

• Funds service provision.


• NGOs are autonomous, diverse community organisations that include independent community, and iwi/Maori organisations operating on a not-for-profit basis;

• The Mental Health Commission estimates that there are 140 NGO mental health providers;

• NGOs can have a significant influence. They represent substantial economic value in the health sector and can mobilise powerful networks;

• Despite receiving over a quarter of mental health funding there is no equivalent of DHBNZ for NGOs, the closest is Platform which at present does not seem to have a strategic role;

• Major stakeholder for recruitment issues;

• Issues with being able to recruit a skilled workforce appropriate to the needs of consumers; and


Intersectoral organisations

Regional Mental Health Networks

• Represent regional mental health stakeholder groups, including DHB funders and planners, DHB providers, NGOs, tangata whaiora/consumers and whanau/families; and

• Inform regional mental health planning.

Unions

Unions are interested parties for recruitment issues for their members. They are involved in negotiating pay and conditions, which can affect recruitment:

• Public Services Association (PSA);

• Resident Doctors Association (RDA);

• Association of Salaried Medical Specialists (ASMS); and

• New Zealand Nurses Organisation (NZNO).

The Mental Health Commission

Established under the Mental Health Commission Act 1998 its statutory functions include:

• To promote employment in the mental health field as a desirable career choice;


• Develops a DHBNZ national strategic plan for workforce development; and

• Aggregates DHB demand for workforce development initiatives.

DHB Funding and Planning

• Ensures mental health resources are used within each of the 21 DHBs in a manner that reflects identified community needs;

• Drives district and regional mental health planning; and

• Funds service provision.


• NGOs are autonomous, diverse community organisations that include independent community, and iwi/Maori organisations operating on a not-for-profit basis;

• The Mental Health Commission estimates that there are 140 NGO mental health providers;

• NGOs can have a significant influence. They represent substantial economic value in the health sector and can mobilise powerful networks;

• Despite receiving over a quarter of mental health funding there is no equivalent of DHBNZ for NGOs, the closest is Platform which at present does not seem to have a strategic role;

• Major stakeholder for recruitment issues;

• Issues with being able to recruit a skilled workforce appropriate to the needs of consumers; and


Intersectoral organisations

Regional Mental Health Networks

• Represent regional mental health stakeholder groups, including DHB funders and planners, DHB providers, NGOs, tangata whaiora/consumers and whanau/families; and

• Inform regional mental health planning.

Unions

Unions are interested parties for recruitment issues for their members. They are involved in negotiating pay and conditions, which can affect recruitment:

• Public Services Association (PSA);

• Resident Doctors Association (RDA);

• Association of Salaried Medical Specialists (ASMS); and

• New Zealand Nurses Organisation (NZNO).

The Mental Health Commission

Established under the Mental Health Commission Act 1998 its statutory functions include:

• To promote employment in the mental health field as a desirable career choice;


• To work with all those involved in training for employment in the mental health field;

• To promote the provision of training opportunitie s of an appropriate range and quality;

• To promote the obtaining and maintaining, by people employed in the mental health field, of skills of an appropriate range and quality;

• Has a national role in monitoring workforce numbers and quality of services; and

• The budget is $2.3 million a year.

The Health Workforce Advisory Committee

The HWAC was established under Section 12 of the New Zealand Public Health and Disability Act 2000. The role of the Committee is to advise the Minister of Health on health workforce issues. It sits partly within the Ministry of Health but is also independent of the Ministry. The committee’s key tasks are to:

• Provide an independent assessment for the Minister of Health of current workforce capacity and foreseeable workforce needs to meet the objectives of the New Zealand Health and Disability Strategies;

• Advise the Minister on national goals for the health workforce and recommend strategies to develop an appropriate workforce capacity;

• Facilitate co-operation between organisations involved in health workforce education and training to ensure a strategic approach to health workforce supply, demand and development;

• Report progress on the effectiveness of recommended strategies and identify required changes;

• Plans to introduce a Medical Reference Group and a Maori Health and Disability Workforce Sub-committee in 2004; and


Te Rau Matatini

• Te Rau Matatini aims primarily to increase the capacity of the Maori mental health workforce. It was initially set up at Massey University in Palmerston North, but is now fully independent as a charitable trust contracted to the Ministry of Health. It is governed by a board of 16 members’ representative of the wider Maori mental health sector.

Mental Health Workforce Development Programme

• The MHWDP was launched in Wellington in May 2003. The Programme is a partnership between the DHB CEOs and the Ministry of Health to ensure a nationally coordinated approach to workforce development in the mental health sector. It is administered by the Health Research Council of New Zealand; and

• The budget is $4.6 million over 2 years.

The Werry Centre

• The Werry Centre is the National Child and Youth Mental Health Workforce Development Centre based at the University of Auckland. The Centre is contracted to the Ministry of


• To work with all those involved in training for employment in the mental health field;

• To promote the provision of training opportunitie s of an appropriate range and quality;

• To promote the obtaining and maintaining, by people employed in the mental health field, of skills of an appropriate range and quality;

• Has a national role in monitoring workforce numbers and quality of services; and


The Health Workforce Advisory Committee

The HWAC was established under Section 12 of the New Zealand Public Health and Disability Act 2000. The role of the Committee is to advise the Minister of Health on health workforce issues. It sits partly within the Ministry of Health but is also independent of the Ministry. The committee’s key tasks are to:

• Provide an independent assessment for the Minister of Health of current workforce capacity and foreseeable workforce needs to meet the objectives of the New Zealand Health and Disability Strategies;

• Advise the Minister on national goals for the health workforce and recommend strategies to develop an appropriate workforce capacity;

• Facilitate co-operation between organisations involved in health workforce education and training to ensure a strategic approach to health workforce supply, demand and development;

• Report progress on the effectiveness of recommended strategies and identify required changes;

• Plans to introduce a Medical Reference Group and a Maori Health and Disability Workforce Sub-committee in 2004; and


Te Rau Matatini

• Te Rau Matatini aims primarily to increase the capacity of the Maori mental health workforce. It was initially set up at Massey University in Palmerston North, but is now fully independent as a charitable trust contracted to the Ministry of Health. It is governed by a board of 16 members’ representative of the wider Maori mental health sector.

Mental Health Workforce Development Programme

• The MHWDP was launched in Wellington in May 2003. The Programme is a partnership between the DHB CEOs and the Ministry of Health to ensure a nationally coordinated approach to workforce development in the mental health sector. It is administered by the Health Research Council of New Zealand; and


The Werry Centre

• The Werry Centre is the National Child and Youth Mental Health Workforce Development Centre based at the University of Auckland. The Centre is contracted to the Ministry of


Health to increase the capacity of the child and adolescent mental health workforce by training, research and workforce development initiatives; and


A National Addictions Workforce Development Programme

• This programme based in Christchurch is similar to the Werry Centre and Te Rau Matatini in being contracted to the Ministry of Health. Two satellites of the NAC have been established in Wellington and Hamilton and these will work closely with the new Centre for Gambling Studies in Auckland. The programme is developing a five-year workforce development strategic plan and some key projects will include undertaking specific Maori addictions treatment workforce development in collaboration with Te Rau Matatini, and building on the existing leadership in the sector and to implement strategies that will build the capacity and capability of the addictions treatment workforce; and

• The programme has a Reference Group and is developing an addictions treatment training provider network that aims to identify key education and training providers, develop collegiality and cooperation to enhance efficiency, consistency and training opportunities, to identify gaps in the current range of education and training, and develop career pathways for addictions treatment workers.

Hauora.com

• Hauora.com is a Maori-led organisation supported by Maori health professional associations, Maori health providers and Maori health workers that is a national Maori workforce development organisation. The mission is to build and develop a unified, effective and Maori-led health workforce.

The Mental Health Advisory Coalition

• The MHAC is contracted by the Ministry of Health to provide a sector perspective and advise the Mental Health Directorate on policy review and development. The policy advice is provided at quarterly meetings and in follow up reports to the Minister of Health and the Ministry. It specifically provides advice on strategic issues, which presumably encompasses workforce development including factors affecting recruitment. It is administered by the Mental Health Foundation.

Regulation and standard setting bodies

These bodies set standards for training, assessment and registration of professionals. This affects the amount and type of training and the ease with which professionals are able to be registered to legally practice in New Zealand. These are factors which affect how long some recruitment initiatives take to have an effect and how easy it is to recruit individuals from overseas.

• New Zealand Medical Council;

• Nursing Council;

• New Zealand Psychologists Board;

• Other registration bodies;

• Professional organisations, for example the Royal Australian and New Zealand College of Psychiatrists;


Health to increase the capacity of the child and adolescent mental health workforce by training, research and workforce development initiatives; and


A National Addictions Workforce Development Programme

• This programme based in Christchurch is similar to the Werry Centre and Te Rau Matatini in being contracted to the Ministry of Health. Two satellites of the NAC have been established in Wellington and Hamilton and these will work closely with the new Centre for Gambling Studies in Auckland. The programme is developing a five-year workforce development strategic plan and some key projects will include undertaking specific Maori addictions treatment workforce development in collaboration with Te Rau Matatini, and building on the existing leadership in the sector and to implement strategies that will build the capacity and capability of the addictions treatment workforce; and

• The programme has a Reference Group and is developing an addictions treatment training provider network that aims to identify key education and training providers, develop collegiality and cooperation to enhance efficiency, consistency and training opportunities, to identify gaps in the current range of education and training, and develop career pathways for addictions treatment workers.

Hauora.com

• Hauora.com is a Maori-led organisation supported by Maori health professional associations, Maori health providers and Maori health workers that is a national Maori workforce development organisation. The mission is to build and develop a unified, effective and Maori-led health workforce.

The Mental Health Advisory Coalition

• The MHAC is contracted by the Ministry of Health to provide a sector perspective and advise the Mental Health Directorate on policy review and development. The policy advice is provided at quarterly meetings and in follow up reports to the Minister of Health and the Ministry. It specifically provides advice on strategic issues, which presumably encompasses workforce development including factors affecting recruitment. It is administered by the Mental Health Foundation.

Regulation and standard setting bodies

These bodies set standards for training, assessment and registration of professionals. This affects the amount and type of training and the ease with which professionals are able to be registered to legally practice in New Zealand. These are factors which affect how long some recruitment initiatives take to have an effect and how easy it is to recruit individuals from overseas.

• New Zealand Medical Council;

• Nursing Council;

• New Zealand Psychologists Board;

• Other registration bodies;

• Professional organisations, for example the Royal Australian and New Zealand College of Psychiatrists;


• Health and Disability Commission; and

• Standards New Zealand.

Summary

There are numerous stakeholders in mental health workforce development only some of whom are involved in the current planning process. The challenge in mental health workforce development is to get them all around the same table and to provide adequate leadership.


• Health and Disability Commission; and

• Standards New Zealand.

Summary

There are numerous stakeholders in mental health workforce development only some of whom are involved in the current planning process. The challenge in mental health workforce development is to get them all around the same table and to provide adequate leadership.

Chapter 3: The Mental Health Workforce 19

Chapter 3: The Mental Health Workforce

Before planning a recruitment strategy it was important to know who was in the workforce and what they did, the size of the mental health workforce, the number of current vacancies, and the number of staff needed to meet future ‘Blueprint’ requirements.

Who is in the workforce?

‘The New Zealand Health Workforce: A Stocktake of issues and capacity 2001’ (HWAC, 2002) described the composition of the mental health workforce and for each type of worker, the numbers in the workforce, education and training, regulation and key issues. The numbers in the mental health workforce have been updated and described in Table 2 (see p.25). The project team decided not to repeat the other sections except where they have changed significantly in the last 3 years, or where there is new information. For each type of worker, there is a brief description of their role. (The HWAC descriptions were used except where the sector has changed significantly.)

Alcohol and drug workers

Alcohol and drug workers identify, assess and plan appropriate interventions for drug and alcohol-related problems. Some mental health workers and drug and alcohol workers specialise in ‘dual diagnosis’ and deliver services to people who have both a mental illness and problems with drugs or alcohol.

Alcohol and drug competencies for the generalist health workforce

The National Alcohol Strategy (Alcohol Advisory Council of New Zealand [ALAC], 2001) states

“To maximise the potential that exists in the prevention and management of alcohol-related harm, education and training should ... be broadly based. Involvement in alcohol intervention can not be expected and will not be realised or effective unless a wide range of professionals acquire appropriate knowledge and skills”.

ALAC reports that significant barriers to training include the lack of adequate resourcing in this area, and limited recognition of its importance by the members of the different workforces, those responsible for their training, and those who fund training. The NAC will assist the sector in their process of scoping of courses for the Drug and Alcohol Practitioners Association Aotearoa-New Zealand (DAPAANZ) practitioner competencies, which should further support the effective recruitment of staff into the workforce. This programme is beginning to scope the recruitment issues which at this stage are seen to be affected by some of the following factors: increasing transience in career choice among new entrants; lack of career pathways; inadequate rewards and rewarded uptake of learning/training; need for district/regional recruitment strategy; current heavy emphasis on counselling over other skills; lack of pay parity between urban and rural areas/between DHB and NGO/between national pay scales and other anomalies (for example nurses compared to counsellors); poor service/treatment promotion (except for CADS Auckland); general stigmatisation of sector; and addiction. There are also concerns about the loss of up to 37 percent of the alcohol and drug workforce per annum (Rolling Telephone Survey, NAC, moving average 2001-2003).


Chapter 3: The Mental Health Workforce

Before planning a recruitment strategy it was important to know who was in the workforce and what they did, the size of the mental health workforce, the number of current vacancies, and the number of staff needed to meet future ‘Blueprint’ requirements.

Who is in the workforce?

‘The New Zealand Health Workforce: A Stocktake of issues and capacity 2001’ (HWAC, 2002) described the composition of the mental health workforce and for each type of worker, the numbers in the workforce, education and training, regulation and key issues. The numbers in the mental health workforce have been updated and described in Table 2 (see p.25). The project team decided not to repeat the other sections except where they have changed significantly in the last 3 years, or where there is new information. For each type of worker, there is a brief description of their role. (The HWAC descriptions were used except where the sector has changed significantly.)


Alcohol and drug workers identify, assess and plan appropriate interventions for drug and alcohol-related problems. Some mental health workers and drug and alcohol workers specialise in ‘dual diagnosis’ and deliver services to people who have both a mental illness and problems with drugs or alcohol.

Alcohol and drug competencies for the generalist health workforce

The National Alcohol Strategy (Alcohol Advisory Council of New Zealand [ALAC], 2001) states

“To maximise the potential that exists in the prevention and management of alcohol-related harm, education and training should ... be broadly based. Involvement in alcohol intervention can not be expected and will not be realised or effective unless a wide range of professionals acquire appropriate knowledge and skills”.

ALAC reports that significant barriers to training include the lack of adequate resourcing in this area, and limited recognition of its importance by the members of the different workforces, those responsible for their training, and those who fund training. The NAC will assist the sector in their process of scoping of courses for the Drug and Alcohol Practitioners Association Aotearoa-New Zealand (DAPAANZ) practitioner competencies, which should further support the effective recruitment of staff into the workforce. This programme is beginning to scope the recruitment issues which at this stage are seen to be affected by some of the following factors: increasing transience in career choice among new entrants; lack of career pathways; inadequate rewards and rewarded uptake of learning/training; need for district/regional recruitment strategy; current heavy emphasis on counselling over other skills; lack of pay parity between urban and rural areas/between DHB and NGO/between national pay scales and other anomalies (for example nurses compared to counsellors); poor service/treatment promotion (except for CADS Auckland); general stigmatisation of sector; and addiction. There are also concerns about the loss of up to 37 percent of the alcohol and drug workforce per annum (Rolling Telephone Survey, NAC, moving average 2001-2003).


The NAC is currently undertaking a national telephone survey of a random sample of 275 alcohol and drug workers on a database of about 850 clinical staff, which will yield some useful information about the current nature of the alcohol and drug field. Related activities include interviews with long standing staff and former staff, which will focus mainly on retention issues. There will be two follow-up interviews with nurses and Maori alcohol and drug workers identified through the national telephone survey, which will look at issues related to retention.

Counsellors

Counsellors help people deal with their feelings and responses, and assist their clients to decide on actions they can take to solve problems. Counsellors come from a wide range of training backgrounds and they provide services in many public sector organisations, including education, justice and health.

Clinical psychologists

Clinical psychologists have the skills to deliver the following services:

• Psychological assessment and formulation;

• Interventions with complex problems;

• Psychological testing;

• Diagnosis of mental disorder;

• Training, support and supervision;

• Design, implementation and evaluation of evidence-based interventions;

• Development and evaluation of new methods and approaches;

• Applied research; and

• Development of health policy. At an individual and client level clinical psychologists assess behavioural and mental health problems. Clinical psychologists give psychometric and neuropsychological tests to identify problems and to measure clients’ skills and abilities. They develop and implement individual treatment plans or group therapy treatment plans (for some problems) to address clients’ psychological difficulties.

Mental health consumer workers

This workforce group has developed in New Zealand over the last 10 years alongside similar international developments. The early role was that of consumer representative. The purpose of this role varied and included that of advocate for individual consumers with grievances, representation of the collective view and informal peer support. New Zealand has tended to be in the vanguard of consumer participation and continues to have a rather more sophisticated and extensive consumer workforce than countries such as the United States (U.S.), United Kingdom (U.K.), Canada and Australia. Growth of this group has occurred in all DHB mental health services, particularly in response to requirements in the New Zealand Mental Health Standards for consumer participation. There has been a similar growth in NGOs albeit generally in a less sophisticated form. Consumer workers are employed in a number of different capacities within DHB and non-government mental health service providers. Consumer providers also exist – The Lighthouse in Napier, Case Consulting in Wellington, and Mind and Body Consultants to


The NAC is currently undertaking a national telephone survey of a random sample of 275 alcohol and drug workers on a database of about 850 clinical staff, which will yield some useful information about the current nature of the alcohol and drug field. Related activities include interviews with long standing staff and former staff, which will focus mainly on retention issues. There will be two follow-up interviews with nurses and Maori alcohol and drug workers identified through the national telephone survey, which will look at issues related to retention.

Counsellors

Counsellors help people deal with their feelings and responses, and assist their clients to decide on actions they can take to solve problems. Counsellors come from a wide range of training backgrounds and they provide services in many public sector organisations, including education, justice and health.

Clinical psychologists

Clinical psychologists have the skills to deliver the following services:

• Psychological assessment and formulation;

• Interventions with complex problems;

• Psychological testing;

• Diagnosis of mental disorder;

• Training, support and supervision;

• Design, implementation and evaluation of evidence-based interventions;

• Development and evaluation of new methods and approaches;

• Applied research; and

• Development of health policy. At an individual and client level clinical psychologists assess behavioural and mental health problems. Clinical psychologists give psychometric and neuropsychological tests to identify problems and to measure clients’ skills and abilities. They develop and implement individual treatment plans or group therapy treatment plans (for some problems) to address clients’ psychological difficulties.

Mental health consumer workers

This workforce group has developed in New Zealand over the last 10 years alongside similar international developments. The early role was that of consumer representative. The purpose of this role varied and included that of advocate for individual consumers with grievances, representation of the collective view and informal peer support. New Zealand has tended to be in the vanguard of consumer participation and continues to have a rather more sophisticated and extensive consumer workforce than countries such as the United States (U.S.), United Kingdom (U.K.), Canada and Australia. Growth of this group has occurred in all DHB mental health services, particularly in response to requirements in the New Zealand Mental Health Standards for consumer participation. There has been a similar growth in NGOs albeit generally in a less sophisticated form. Consumer workers are employed in a number of different capacities within DHB and non-government mental health service providers. Consumer providers also exist – The Lighthouse in Napier, Case Consulting in Wellington, and Mind and Body Consultants to


name but a few. In many cases consumer workers, in the role of advisors, are part of the service management team and responsible for ensuring a service-user perspective is employed in service management processes. Consumer advisors employed in DHB mental health services have formed the National Association of Mental Health Services Advisors (NAMHSCA). People employed as consumer workers have a variety of different job titles in different provider services, including consumer adviser, consumer advocate, peer support worker and consumer consultant. There is an equally diverse range of job descriptions and working conditions, along with a lack of consistency between and within job descriptions. The titles are different in part because there are distinctly different roles although, in some cases, individuals may have a multifaceted role that combines a range of functions. The roles can be broken down into the following categories:

• Consumer advisor – primarily a DHB role, an evolution of the, often volunteer, role of consumer representation. Involves partic ipation in service provision and development at a management level representing the collective specific and abstract interests of consumers;

• Advocate – assists individuals to assert their rights and pursue grievances. Occasionally used by the Mental Health Commission to (confusingly) describe consumer advisors but, in this context usually qualified by describing the role as systemic advocacy. The distinction between these roles is generally well understood especially in DHBs;

• Peer support worker – a role that has been around for many years but generally only recently labelled as such. It is essentially different from the above roles in that it involves the provision of services directly to consumers. The role is similar to that of community support worker with the added dimension of the shared experience of mental illness. Funders are beginning to take this role seriously and offer contracts; and

• Other roles that consumers use their consumer experience in include, − Educators and trainers – mainly assisting mental health workers to understand recovery

concepts and competencies but also includes ethics courses, history of the consumer movement, training in the Strengths Model, and specific skills such as collaborative note writing and developing recovery plans,

− Audit and accreditation surveying, − Members of inquiry panels, for example the Health and Disability Commissioner’s

inquiry into the Burton case, − Trustees of NGOs, − Mental Health Commissioners, and − Members of reference and advisory groups; for example the Mental Health

Commission, Mental Health Research and Development Strategy, Mental Health Workforce Development Programme, Mental Health Advocacy Coalition (the group responsible for directly advising the Minister of Health).

Family workers

There is a small but increasing family member workforce. The two principal roles are those of family advisor and family support worker (sometimes called family field worker). A growing number of DHBs are employing family members of people with experience of mental illness to provide a range of services. These include:

• Advising management on service provision and development from a family perspective;

• Acting in a liaison role to aid communication between clinicians and family members;


name but a few. In many cases consumer workers, in the role of advisors, are part of the service management team and responsible for ensuring a service-user perspective is employed in service management processes. Consumer advisors employed in DHB mental health services have formed the National Association of Mental Health Services Advisors (NAMHSCA). People employed as consumer workers have a variety of different job titles in different provider services, including consumer adviser, consumer advocate, peer support worker and consumer consultant. There is an equally diverse range of job descriptions and working conditions, along with a lack of consistency between and within job descriptions. The titles are different in part because there are distinctly different roles although, in some cases, individuals may have a multifaceted role that combines a range of functions. The roles can be broken down into the following categories:

• Consumer advisor – primarily a DHB role, an evolution of the, often volunteer, role of consumer representation. Involves partic ipation in service provision and development at a management level representing the collective specific and abstract interests of consumers;

• Advocate – assists individuals to assert their rights and pursue grievances. Occasionally used by the Mental Health Commission to (confusingly) describe consumer advisors but, in this context usually qualified by describing the role as systemic advocacy. The distinction between these roles is generally well understood especially in DHBs;

• Peer support worker – a role that has been around for many years but generally only recently labelled as such. It is essentially different from the above roles in that it involves the provision of services directly to consumers. The role is similar to that of community support worker with the added dimension of the shared experience of mental illness. Funders are beginning to take this role seriously and offer contracts; and

• Other roles that consumers use their consumer experience in include, − Educators and trainers – mainly assisting mental health workers to understand recovery

concepts and competencies but also includes ethics courses, history of the consumer movement, training in the Strengths Model, and specific skills such as collaborative note writing and developing recovery plans,

− Audit and accreditation surveying, − Members of inquiry panels, for example the Health and Disability Commissioner’s

inquiry into the Burton case, − Trustees of NGOs, − Mental Health Commissioners, and − Members of reference and advisory groups; for example the Mental Health

Commission, Mental Health Research and Development Strategy, Mental Health Workforce Development Programme, Mental Health Advocacy Coalition (the group responsible for directly advising the Minister of Health).

Family workers

There is a small but increasing family member workforce. The two principal roles are those of family advisor and family support worker (sometimes called family field worker). A growing number of DHBs are employing family members of people with experience of mental illness to provide a range of services. These include:

• Advising management on service provision and development from a family perspective;

• Acting in a liaison role to aid communication between clinicians and family members;


• Advocating on behalf of family members; and

• Providing support, information, advice and education to family members. Family organisations such as Supporting Families/Schizophrenia Fellowship are contracted to provide field workers to provide a similar range of services to families.

Mental health nurses

A mental health nurse provides treatment, care and support for people with emotional, mental and behavioural problems. Mental health nurses are increasingly working in a community setting, but the majority work in hospital inpatient settings. They are skilled in the specialised use of communication, counselling, psychopharmacology, applying speciality knowledge in the provision of clinical assessment, monitoring, therapeutic interventions, treatment and referral to other health professionals. They work with individuals, groups and their families in a variety of settings, providing primary healthcare, health maintenance, acute care, and the care and recovery of people with long-term mental disorders. Some mental health nurses have special responsibilities under the Mental Health Act 1992 as duly authorised officers.

Mental health support workers

Mental health support workers are widely employed throughout the country in mainstream mental health, kaupapa Maori, general rehabilitation, home-based and mobile community support services. The mental health support workforce is mainly employed in the non-government support services sector. These workers provide support and deliver rehabilitation services or programmes that facilitate the recovery process for people experiencing serious mental or emotional distress. There is a growing need for this community-based workforce to work with people and family/whanau in their regular life activities (work, housing, learning, relationships and health).

Occupational therapists

The definition of occupational therapy is “Occupational therapy is a profession that enables people to lead meaningful and satisfying lives through participation in occupation” (New Zealand Association of Occupational Therapists, 2002). Occupational therapists help people identify and manage “occupations” that are difficult for them such as using computers, getting things done on time or developing supportive relationships. In 2003, there were 1609 active occupational therapists in New Zealand, although most of these were not working in mental health (New Zealand Occupational Therapy Board, 2003).

Psychiatrists

Psychiatry is a branch of medicine specialising in the prevention and treatment of mental disorder, and the promotion of mental health in the community. By virtue of their specialist training, psychiatrists bring a comprehensive and integrated bio-psychosocial approach to the diagnosis, assessment, treatment and prevention of psychiatric disorder for people with emotional, behavioural and cognitive mental health problems. Psychiatrists work with clients and their families, and primary healthcare practitioners, to work out the best options for managing recovery and minimising distress. They prescribe and administer medication, psychotherapy, and other treatment and rehabilitation programmes, and many psychiatrists have responsibilities under the Mental Health (Compulsory Assessment and Treatment) Act 1992.


• Advocating on behalf of family members; and

• Providing support, information, advice and education to family members. Family organisations such as Supporting Families/Schizophrenia Fellowship are contracted to provide field workers to provide a similar range of services to families.

Mental health nurses

A mental health nurse provides treatment, care and support for people with emotional, mental and behavioural problems. Mental health nurses are increasingly working in a community setting, but the majority work in hospital inpatient settings. They are skilled in the specialised use of communication, counselling, psychopharmacology, applying speciality knowledge in the provision of clinical assessment, monitoring, therapeutic interventions, treatment and referral to other health professiona ls. They work with individuals, groups and their families in a variety of settings, providing primary healthcare, health maintenance, acute care, and the care and recovery of people with long-term mental disorders. Some mental health nurses have special responsibilities under the Mental Health Act 1992 as duly authorised officers.


Mental health support workers are widely employed throughout the country in mainstream mental health, kaupapa Maori, general rehabilitation, home-based and mobile community support services. The mental health support workforce is mainly employed in the non-government support services sector. These workers provide support and deliver rehabilitation services or programmes that facilitate the recovery process for people experiencing serious mental or emotional distress. There is a growing need for this community-based workforce to work with people and family/whanau in their regular life activities (work, housing, learning, relationships and health).

Occupational therapists

The definition of occupational therapy is “Occupational therapy is a profession that enables people to lead meaningful and satisfying lives through participation in occupation” (New Zealand Association of Occupational Therapists, 2002). Occupational therapists help people identify and manage “occupations” that are difficult for them such as using computers, getting things done on time or developing supportive relationships. In 2003, there were 1609 active occupational therapists in New Zealand, although most of these were not working in mental health (New Zealand Occupational Therapy Board, 2003).

Psychiatrists

Psychiatry is a branch of medicine specialising in the prevention and treatment of mental disorder, and the promotion of mental health in the community. By virtue of their specialist training, psychiatrists bring a comprehensive and integrated bio-psychosocial approach to the diagnosis, assessment, treatment and prevention of psychiatric disorder for people with emotional, behavioural and cognitive mental health problems. Psychiatrists work with clients and their families, and primary healthcare practitioners, to work out the best options for managing recovery and minimising distress. They prescribe and administer medication, psychotherapy, and other treatment and rehabilitation programmes, and many psychiatrists have responsibilities under the Mental Health (Compulsory Assessment and Treatment) Act 1992.


Psychotherapists

Psychotherapists use particular therapeutic disciplines and attitudes of inquiry to help people in mental or emotional distress. While the immediate aim of psychotherapy maybe to relieve discomfort or distress, psychotherapy has the longer-range goal of changing the patterns of thinking, feeling and acting, as well as learning new, more effective and satisfying ways of living.

Social workers

The International Federation of Social Workers describes social work as, “a profession that promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance wellbeing. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work” (International Federation of Social Workers, 2000).

The Maori workforce

Recruiting more Maori into the mental health workforce is a priority (Health Funding Authority, 2000). It is also identified as a priority in the ‘New Zealand Health Workforce Future Directions – Recommendations to the Minister of Health 2003’ (HWAC, 2003). The recommendations here are:

• 4.1 the Minister of Health establishes a national Maori Health Workforce Development function in the form of a specialist advisory group to HWAC;

• 4.2 DHBs, − 4.2.1 include requirements for increasing the capacity of the Maori workforce in their

workforce development plans for 2004/2005, − 4.2.2 develop ‘Maori preferred-employer criteria’, − 4.2.3 provide ongoing education and development for existing Maori health

practitioners, and − 4.2.4 consider second-chance health education initiatives, including work experience

and internships for Maori;

• 4.3 the Ministry of Health collaborates with HWAC, the specialist advisory group, the TEC and health education providers to undertake a review of how current foundation, tertiary education and other clinical training programmes contribute to the development of the Maori health and disability workforce; and

• 4.4 the Ministry of Education, in collaboration with the Ministry of Health and DHBs, ensures, − 4.4.1 accessible, positive health career guidance is provided throughout all levels of

secondary schools for Maori students, − 4.4.2 development and resourcing of a marketing strategy to promote health and

science as career options for Maori, and − 4.4.3 development of outcome-based incentives for tertiary institutions providing

health and disability education to increase Maori recruitment and course completion. In 2002 Te Rau Matatini surveyed a section of the Maori mental health workforce to assess training needs, (Hirini & Durie, 2003). This survey found that of those surveyed about half worked in DHBs and a third in Maori health NGOs. The commonest roles were Maori health


Psychotherapists

Psychotherapists use particular therapeutic disciplines and attitudes of inquiry to help people in mental or emotional distress. While the immediate aim of psychotherapy maybe to relieve discomfort or distress, psychotherapy has the longer-range goal of changing the patterns of thinking, feeling and acting, as well as learning new, more effective and satisfying ways of living.

Social workers

The International Federation of Social Workers describes social work as, “a profession that promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance wellbeing. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work” (International Federation of Social Workers, 2000).

The Maori workforce

Recruiting more Maori into the mental health workforce is a priority (Health Funding Authority, 2000). It is also identified as a priority in the ‘New Zealand Health Workforce Future Directions – Recommendations to the Minister of Health 2003’ (HWAC, 2003). The recommendations here are:

• 4.1 the Minister of Health establishes a national Maori Health Workforce Development function in the form of a specialist advisory group to HWAC;

• 4.2 DHBs, − 4.2.1 include requirements for increasing the capacity of the Maori workforce in their

workforce development plans for 2004/2005, − 4.2.2 develop ‘Maori preferred-employer criteria’, − 4.2.3 provide ongoing education and development for existing Maori health

practitioners, and − 4.2.4 consider second-chance health education initiatives, including work experience

and internships for Maori;

• 4.3 the Ministry of Health collaborates with HWAC, the specialist advisory group, the TEC and health education providers to undertake a review of how current foundation, tertiary education and other clinical training programmes contribute to the development of the Maori health and disability workforce; and

• 4.4 the Ministry of Education, in collaboration with the Ministry of Health and DHBs, ensures, − 4.4.1 accessible, positive health career guidance is provided throughout all levels of

secondary schools for Maori students, − 4.4.2 development and resourcing of a marketing strategy to promote health and

science as career options for Maori, and − 4.4.3 development of outcome-based incentives for tertiary institutions providing

health and disability education to increase Maori recruitment and course completion. In 2002 Te Rau Matatini surveyed a section of the Maori mental health workforce to assess training needs, (Hirini & Durie, 2003). This survey found that of those surveyed about half worked in DHBs and a third in Maori health NGOs. The commonest roles were Maori health


workers, community support workers, registered nurses and counsellors. Maori tend to be over-represented in support worker roles and under-represented in the clinical professions.

The Pacific workforce

More Pacific people need to be recruited into the mental health workforce at all levels and in all occupations (Mental Health Commission, 2001). The Pacific Health and Disability Action Plan 2002 identified six priority areas of which Goals 4 and 5 relate to addressing workforce development issues. The ‘Pacific Mental Health Services and Workforce – Moving on the Blueprint’ (Mental Health Commission, 2001) also recommended additional work to be done in the area of Pacific workforce development. In the Auckland region, for example the Pacific mental health workforce makes up less than 9 percent of the total DHB workforce. Nurses and social workers make up the largest part of this workforce. The Northern Regional Pacific Mental Health and Addictions Plan (Northern District Health Board Support Agency, 2003) has identified the development of a competent and qualified Pacific mental health workforce as one of its six key goals. It recommends the introduction of recruitment and retention strategies for the major disciplines and managers including the development of a Pacific workforce plan (including a database). Significant effort is needed to increase the percentage of Pacific mental health workers with appropriate health qualifications and cultural knowledge. It is suggested that the role of ‘matua’ (‘Matua’ has a similar meaning to ‘elder’ in English) should be recognised as an integral part of mental health services for Pacific peoples. Cultural and clinical competency is an area of growing interest, as is issue of ethnic specific methods of delivering care.

Primary Care

Most of mental health care takes place in primary care. With the advent of primary health organisations, (PHOs), the opportunities for primary care workers to take a more coordinated and strategic role in mental health care have increased.

What is the size of the workforce?

Table 2 gives some indication of the size of the mental health workforce. The figures are of individuals rather than FTE’s. Some professional groups such as psychologists work mainly in private or in non-mental health work. The project team has only included groups for which information could be found, therefore there is no data on consumer and family workers. It does not include those medical practitioners (such as medical officers, registrars and house surgeons) who would also be working in hospital mental health services. The data is mainly based on Annual Practicing Certificate (APC) surveys for the psychiatrist, nursing and registered psychologists workforces.


workers, community support workers, registered nurses and counsellors. Maori tend to be over-represented in support worker roles and under-represented in the clinical professions.

The Pacific workforce

More Pacific people need to be recruited into the mental health workforce at all levels and in all occupations (Mental Health Commission, 2001). The Pacific Health and Disability Action Plan 2002 identified six priority areas of which Goals 4 and 5 relate to addressing workforce development issues. The ‘Pacific Mental Health Services and Workforce – Moving on the Blueprint’ (Mental Health Commission, 2001) also recommended additional work to be done in the area of Pacific workforce development. In the Auckland region, for example the Pacific mental health workforce makes up less than 9 percent of the total DHB workforce. Nurses and social workers make up the largest part of this workforce. The Northern Regional Pacific Mental Health and Addictions Plan (Northern District Health Board Support Agency, 2003) has identified the development of a competent and qualified Pacific mental health workforce as one of its six key goals. It recommends the introduction of recruitment and retention strategies for the major disciplines and managers including the development of a Pacific workforce plan (including a database). Significant effort is needed to increase the percentage of Pacific mental health workers with appropriate health qualifications and cultural knowledge. It is suggested that the role of ‘matua’ (‘Matua’ has a similar meaning to ‘elder’ in English) should be recognised as an integral part of mental health services for Pacific peoples. Cultural and clinical competency is an area of growing interest, as is issue of ethnic specific methods of delivering care.

Primary Care

Most of mental health care takes place in primary care. With the advent of primary health organisations, (PHOs), the opportunities for primary care workers to take a more coordinated and strategic role in mental health care have increased.

What is the size of the workforce?

Table 2 gives some indication of the size of the mental health workforce. The figures are of individuals rather than FTE’s. Some professional groups such as psychologists work mainly in private or in non-mental health work. The project team has only included groups for which information could be found, therefore there is no data on consumer and family workers. It does not include those medical practitioners (such as medical officers, registrars and house surgeons) who would also be working in hospital mental health services. The data is mainly based on Annual Practicing Certificate (APC) surveys for the psychiatrist, nursing and registered psychologists workforces.


Table 2. The size of the mental health workforce.

Clinician Number % Maori Source


+/- 850 National Addiction Centre

Mental health nurses1

2,871 registered nurses (1,722 in DHB inpatient units; 739 in community posts)

13% of registered mental health nurses

Nursing Council of New Zealand Annual Report 2003

253 enrolled nurses 19% of enrolled mental health nurses


974 27% NZQA graduates of the National Certificate in Mental Health Support Work2

Psychiatrists 415 1% Medical Council annual report 20033

269 NZHIS active specialists 20024

302 CTA strategic intentions 2004-20135

Psychologists 1,3056 (28% work in DHBs) 486 spend some time as clinical psychologists

4.7% NZHIS 2003 Annual workforce survey

Social workers 311 ANZASW7

1. 71 percent of registered nurses in mental health are female and that the median age is between 40 and 44. For enrolled mental health nurses 77 percent are female with a median age of 45 to 49. 2. Not all mental health support workers completed the National Certificate and not everyone who has done the certificate is working in mental health. NZQA is the New Zealand Qualifications Authority.

3. Based on doctors who are vocationally registered to practice Psychological Medicine or Psychiatry as of March 31, 2003, however, some of these are inactive and do not hold an APC. 4. Active here is defined as holding an APC and practicing for more than four hours a week. NZHIS is the New Zealand Health Information Service. 5. Quoted in the ‘Clinical Training Agency Strategic Intentions: 2004-2013’ (Ministry of Health, 2004) as the number of psychiatrists holding an APC in June 2003 based on the New Zealand medical register. 6. 1,305 is the number of psychologists sent an invoice for their APC in 2003. 889 psychologists responded to the workforce survey of which 486 stated that they spent some time as Clinical Psychologists. 121 of these worked in private practice and 211 in DHBs. 7. ANZASW is the Aotearoa New Zealand Association of Social Workers.


Table 2. The size of the mental health workforce.

Clinician Number % Maori Source


+/- 850 National Addiction Centre

Mental health nurses1

2,871 registered nurses (1,722 in DHB inpatient units; 739 in community posts)

13% of registered mental health nurses

Nursing Council of New Zealand Annual Report 2003

253 enrolled nurses 19% of enrolled mental health nurses


974 27% NZQA graduates of the National Certificate in Mental Health Support Work2

Psychiatrists 415 1% Medical Council annual report 20033

269 NZHIS active specialists 20024

302 CTA strategic intentions 2004-20135

Psychologists 1,3056 (28% work in DHBs) 486 spend some time as clinical psychologists

4.7% NZHIS 2003 Annual workforce survey

Social workers 311 ANZASW7

1. 71 percent of registered nurses in mental health are female and that the median age is between 40 and 44. For enrolled mental health nurses 77 percent are female with a median age of 45 to 49. 2. Not all mental health support workers completed the National Certificate and not everyone who has done the certificate is working in mental health. NZQA is the New Zealand Qualifications Authority.

3. Based on doctors who are vocationally registered to practice Psychological Medicine or Psychiatry as of March 31, 2003, however, some of these are inactive and do not hold an APC. 4. Active here is defined as holding an APC and practicing for more than four hours a week. NZHIS is the New Zealand Health Information Service. 5. Quoted in the ‘Clinical Training Agency Strategic Intentions: 2004-2013’ (Ministry of Health, 2004) as the number of psychiatrists holding an APC in June 2003 based on the New Zealand medical register. 6. 1,305 is the number of psychologists sent an invoice for their APC in 2003. 889 psychologists responded to the workforce survey of which 486 stated that they spent some time as Clinical Psychologists. 121 of these worked in private practice and 211 in DHBs. 7. ANZASW is the Aotearoa New Zealand Association of Social Workers.


The main message from Table 2 is that accurate figures on the size of the mental health workforce are hard to come by, and even when they are available, it is hard to know what they mean. For example, within 12 months there are three figures for the number of psychiatrists in New Zealand, which vary from 269 to 415. Some of the explanation lies in the definitions of active, registered and holding an APC but it is hard to see how this translates into filled FTE posts on the ground.

How many vacancies are there?

This is not a simple question to answer. There are several sources of data, which provide a measure of this. Firstly, there is the information provided by the DHBs every quarter to the Mental Health Commission, which subtracts the number of people employed in substantial posts from the number the DHBs estimate they are funded to provide. These are true vacancies as overtime and casual staff are excluded. The data are reported quarterly by each DHB for different areas of mental health provision. A summary of the figures for March 2004 is summarised in Table 3 (The complete figures are in Appendix 1). This shows that in March 2004 there were 489 FTE unfilled posts in the mental health workforce – this figure is roughly the same each quarter. Ten of the 21 DHBs had 10 percent or more of their funded community posts vacant on March 31, 2004. The highest proportions of vacancies were in child and adolescent services and North Island services. Currently the number of unfilled FTE posts is running at about 9 percent for the year 2003-2004; for the previous year the percentage of unfilled posts was about 6.5 percent for each quarter. This would suggest that although the number of funded posts has increased the DHBs have been unable to recruit enough people to fill them. Table 3. Summary of data reported to the Mental Health Commission by DHBs for vacancies in the mental health workforce, March 2004.

DHB Region Inpatient Community

Vacant FTE % Vacant FTE %

Northern 44.8 5 138.3 12

Midland 19 5 62.2 11

Central 79.8 15 36.3 6

Southern 40.2 6 36.8 5

NZ Total 183.8 7 273.5 9


The main message from Table 2 is that accurate figures on the size of the mental health workforce are hard to come by, and even when they are available, it is hard to know what they mean. For example, within 12 months there are three figures for the number of psychiatrists in New Zealand, which vary from 269 to 415. Some of the explanation lies in the definitions of active, registered and holding an APC but it is hard to see how this translates into filled FTE posts on the ground.

How many vacancies are there?

This is not a simple question to answer. There are several sources of data, which provide a measure of this. Firstly, there is the information provided by the DHBs every quarter to the Mental Health Commission, which subtracts the number of people employed in substantial posts from the number the DHBs estimate they are funded to provide. These are true vacancies as overtime and casual staff are excluded. The data are reported quarterly by each DHB for different areas of mental health provision. A summary of the figures for March 2004 is summarised in Table 3 (The complete figures are in Appendix 1). This shows that in March 2004 there were 489 FTE unfilled posts in the mental health workforce – this figure is roughly the same each quarter. Ten of the 21 DHBs had 10 percent or more of their funded community posts vacant on March 31, 2004. The highest proportions of vacancies were in child and adolescent services and North Island services. Currently the number of unfilled FTE posts is running at about 9 percent for the year 2003-2004; for the previous year the percentage of unfilled posts was about 6.5 percent for each quarter. This would suggest that although the number of funded posts has increased the DHBs have been unable to recruit enough people to fill them. Table 3. Summary of data reported to the Mental Health Commission by DHBs for vacancies in the mental health workforce, March 2004.

DHB Region Inpatient Community

Vacant FTE % Vacant FTE %

Northern 44.8 5 138.3 12

Midland 19 5 62.2 11

Central 79.8 15 36.3 6

Southern 40.2 6 36.8 5

NZ Total 183.8 7 273.5 9


DHB Region Maori Community Subset

Child and Youth Subset

Total

Vacant FTE

% Vacant FTE

% Vacant FTE

%

Northern 6 7 48.6 18 195.6 9

Midland 3.5 14 10.8 11 88.8 9

Central 11.1 11 16.7 10 120.5 10

Southern 2.5 10 9.3 5 84 6

NZ Total 23.2 10 85.3 12 488.7 8

Secondly, all mental health jobs advertised on the DHB websites on a certain day (July 4, 2004) were recorded. The table below shows that on this day the 21 DHBs advertised about 81 posts with a specific number of vacancies and 19 posts with an unspecified number of vacancies, (N? in the table). The latter were usually for nurses in inpatient psychiatric units. The majority of adverts were for nurses or psychiatrists which gives some indicator that these posts were the hardest to fill. According to the returns to the Mental Health Commission by the DHBs there are 489 FTE vacant positions currently in the New Zealand mental health workforce. Therefore, most vacant posts are not advertised. There is other evidence that vacancies are consistently underestimated (ASMS Mid Central Report). The Seek website (seek.co.nz), which describes itself as New Zealand’s leading job and career website, was also viewed. The vast majority of mental health posts advertised here (about 150 a week) are from overseas employers seeking New Zealanders to work abroad predominantly in the U.K. and Australia. Recruitment agencies also extensively use this site. The Department of Labour has a job vacancy monitoring programme (JVMP) which every month analyses newspaper advertisements in fourteen New Zealand newspapers for different jobs, and rings employers to find out how successful they have been in filling posts. One of the occupations it monitors is psychiatric nurses, however, the number of such posts advertised in newspapers is small, generally about three a month. It seems that most nursing positions are advertised electronically rather than in the print media. A third figure that is sometimes used to calculate vacancies is the number of positions that a DHB should have according to the ‘Blueprint’, which is not always the same as the number of contracted positions. The project team was unable to do a similar snapshot for the NGO workforce, as the information is not readily available.


DHB Region Maori Community Subset

Child and Youth Subset

Total

Vacant FTE

% Vacant FTE

% Vacant FTE

%

Northern 6 7 48.6 18 195.6 9

Midland 3.5 14 10.8 11 88.8 9

Central 11.1 11 16.7 10 120.5 10

Southern 2.5 10 9.3 5 84 6

NZ Total 23.2 10 85.3 12 488.7 8

Secondly, all mental health jobs advertised on the DHB websites on a certain day (July 4, 2004) were recorded. The table below shows that on this day the 21 DHBs advertised about 81 posts with a specific number of vacancies and 19 posts with an unspecified number of vacancies, (N? in the table). The latter were usually for nurses in inpatient psychiatric units. The majority of adverts were for nurses or psychiatrists which gives some indicator that these posts were the hardest to fill. According to the returns to the Mental Health Commission by the DHBs there are 489 FTE vacant positions currently in the New Zealand mental health workforce. Therefore, most vacant posts are not advertised. There is other evidence that vacancies are consistently underestimated (ASMS Mid Central Report). The Seek website (seek.co.nz), which describes itself as New Zealand’s leading job and career website, was also viewed. The vast majority of mental health posts advertised here (about 150 a week) are from overseas employers seeking New Zealanders to work abroad predominantly in the U.K. and Australia. Recruitment agencies also extensively use this site. The Department of Labour has a job vacancy monitoring programme (JVMP) which every month analyses newspaper advertisements in fourteen New Zealand newspapers for different jobs, and rings employers to find out how successful they have been in filling posts. One of the occupations it monitors is psychiatric nurses, however, the number of such posts advertised in newspapers is small, generally about three a month. It seems that most nursing positions are advertised electronically rather than in the print media. A third figure that is sometimes used to calculate vacancies is the number of positions that a DHB should have according to the ‘Blueprint’, which is not always the same as the number of contracted positions. The project team was unable to do a similar snapshot for the NGO workforce, as the information is not readily available.


Table 4. Mental health vacancies advertised on DHB websites on July 4, 2004. DHB Nurse Psychia-

trist Support worker

Mental health profes-sional

OT Psycho-logist

SW

West Coast N? 0.5 Maori

Wairarapa 1 1 child 1

Tairawhiti 1 (CD)+1 1 1 0.5+1 child

South Canterbury

1 0.5 Maori 1+1 child+1 AD

Wanganui 2 registrars

1 Maori AD

Lakes 1 Maori 3+ 1 Maori

Southland 1.8 1 0.8 1

Taranaki 2+1AD 1+1 child 1+1 AD+1 child

1 1

Nelson and Marlborough

website unavail-able

Hutt Valley 1 N?

Northland N? N?

Hawkes Bay N? N?

Mid Central 1+N?

Bay of Plenty

3+N?+1 Maori

3 +2 child

1

Otago N? 1 1AD 1 child

Capital Coast

N?+2+1AD

1FRID 1

Waikato 4 N? 1

Auckland N?+3+1PI

1 1 1 PI 2 1

Counties Manukau

N?+1 Maori

N? N?

Waitemata N?+5 2

Canterbury 2+1 child 1 1

TOTAL 29.8+N?

20+N? 4.5+N? 12.5+N? 5.8+N? 6.5 2

*Key to table: N = number of vacancies not specified; AD = alcohol and drug position; child = child and adolescent post; PI = Pacific Island post; Maori = Maori post; FRID = forensic post; and CD = clinical director.


Table 4. Mental health vacancies advertised on DHB websites on July 4, 2004. DHB Nurse Psychia-

trist Support worker

Mental health profes-sional

OT Psycho-logist

SW

West Coast N? 0.5 Maori

Wairarapa 1 1 child 1

Tairawhiti 1 (CD)+1 1 1 0.5+1 child

South Canterbury

1 0.5 Maori 1+1 child+1 AD

Wanganui 2 registrars

1 Maori AD

Lakes 1 Maori 3+ 1 Maori

Southland 1.8 1 0.8 1

Taranaki 2+1AD 1+1 child 1+1 AD+1 child

1 1

Nelson and Marlborough

website unavail-able

Hutt Valley 1 N?

Northland N? N?

Hawkes Bay N? N?

Mid Central 1+N?

Bay of Plenty

3+N?+1 Maori

3 +2 child

1

Otago N? 1 1AD 1 child

Capital Coast

N?+2+1AD

1FRID 1

Waikato 4 N? 1

Auckland N?+3+1PI

1 1 1 PI 2 1

Counties Manukau

N?+1 Maori

N? N?

Waitemata N?+5 2

Canterbury 2+1 child 1 1

TOTAL 29.8+N?

20+N? 4.5+N? 12.5+N? 5.8+N? 6.5 2

*Key to table: N = number of vacancies not specified; AD = alcohol and drug position; child = child and adolescent post; PI = Pacific Island post; Maori = Maori post; FRID = forensic post; and CD = clinical director.


How many more staff are needed?

From these figures, we can also get some forecast of future mental health workforce requirements using the ‘Blueprint’ targets and the current funded FTE’s. Table 5. Current FTE’s in post compared to the ‘Blueprint’ targets.

Current FTE’s in Post1

Implement ‘Blueprint’

Fully (FTE’s)2

FTE Needed Percentage Increase

Community clinical FTE’s

Inpatient clinical FTE’s

2721

2363

4723

2472

2002

109

74%

5%

Total clinical FTE’s

5084 7195 2111 42%

1. From DHB third quarter returns to the Mental Health Commission 2003-2004.

2. From Mental Health Commission ‘Report on Progress 2002-2003 towards implementing the Blueprint for mental health services in New Zealand’ (Mental Health Commission, 2004). In Table 5 it appears that only a small increase in inpatient clinical FTE’s is needed, whereas from the survey of advertised vacant posts these are the staff most in demand.

The problem of defining clinical

One of the difficulties the project team encountered when writing this report was in defining the term “clinical”. It also became apparent that different people in different organisations had varying ideas of what “clinical” meant. Generally, there were two main ways of defining “clinical”:

• Direct contact with consumers – but this could also include reception, cleaning and other staff; and

• Professionally qualified workers – but this excludes some consumers and mental health support workers.

The term “clinical” is also based on a particular way of working, which downplays lived experience of mental illness and promotes definable knowledge, skills and attitudes. In particular, it is unhelpful when describing innovative activities such as peer support of consumers.

Summary

It is clear from the information in this chapter that the size of the workforce and the numbers of vacancies are hard to accurately describe. This makes any nationally coordinated recruitment plan difficult to develop. The Mental Health Workforce Information Project is expected to produce more current and informed data about the size of the mental health workforce. The problem about the lack of data on which to base workforce development has been highlighted in a number of documents, most recently in the DHB/DHBNZ ‘Workforce Action Plan’, (District Health Boards New Zealand, 2003), where it is one of the three strategic priorities. (The other priorities being building effective stakeholder relationships and building strategic capacity.)


How many more staff are needed?

From these figures, we can also get some forecast of future mental health workforce requirements using the ‘Blueprint’ targets and the current funded FTE’s. Table 5. Current FTE’s in post compared to the ‘Blueprint’ targets.

Current FTE’s in Post1

Implement ‘Blueprint’

Fully (FTE’s)2

FTE Needed Percentage Increase

Community clinical FTE’s

Inpatient clinical FTE’s

2721

2363

4723

2472

2002

109

74%

5%

Total clinical FTE’s

5084 7195 2111 42%

1. From DHB third quarter returns to the Mental Health Commission 2003-2004.

2. From Mental Health Commission ‘Report on Progress 2002-2003 towards implementing the Blueprint for mental health services in New Zealand’ (Mental Health Commission, 2004). In Table 5 it appears that only a small increase in inpatient clinical FTE’s is needed, whereas from the survey of advertised vacant posts these are the staff most in demand.

The problem of defining clinical

One of the difficulties the project team encountered when writing this report was in defining the term “clinical”. It also became apparent that different people in different organisations had varying ideas of what “clinical” meant. Generally, there were two main ways of defining “clinical”:

• Direct contact with consumers – but this could also include reception, cleaning and other staff; and

• Professionally qualified workers – but this excludes some consumers and mental health support workers.

The term “clinical” is also based on a particular way of working, which downplays lived experience of mental illness and promotes definable knowledge, skills and attitudes. In particular, it is unhelpful when describing innovative activities such as peer support of consumers.

Summary

It is clear from the information in this chapter that the size of the workforce and the numbers of vacancies are hard to accurately describe. This makes any nationally coordinated recruitment plan difficult to develop. The Mental Health Workforce Information Project is expected to produce more current and informed data about the size of the mental health workforce. The problem about the lack of data on which to base workforce development has been highlighted in a number of documents, most recently in the DHB/DHBNZ ‘Workforce Action Plan’, (District Health Boards New Zealand, 2003), where it is one of the three strategic priorities. (The other priorities being building effective stakeholder relationships and building strategic capacity.)

Chapter 4: Current State Analysis of Recruitment Processes in New Zealand 31

Chapter 4: Current State Analysis of Recruitment Processes in New Zealand

This part of the report describes an interview and questionnaire survey of mainly HR and general managers to assess the current state of recruitment practices in mental health in New Zealand. The terms of reference for this project required us to do a “stocktake” of the capacity of the sector to undertake recruitment activities and to define areas, which needed to be addressed. As there has been little formal research on recruitment into mental health, it was decided to use a qualitative methodology to generate hypotheses about the current state of recruitment practices. It was expected that the results would be more informative about HR practices rather than wider strategic issues because the project team largely focused on employers (DHBs and NGOs).

Aim

The aim of this part of the project was to gain an understanding of the current state of recruitment practices across the mental health workforce in New Zealand.

Method

An online semi-structured questionnaire was developed to lead the individual and group data collection. The questionnaire was developed by the project team and was made available online with the help of Exotech. The initial invitation to complete the questionnaire was sent out to approximately 150 primary participants and increased to around 180 after suggestions from the primary participants. The invitations were sent to HR and General Managers of mental health services. When the initial response rate to the online questionnaire was slow, members of the Advisory Committee suggested that a postal mail out of the questionnaire should be done focusing on Maori organisations, as the project team had become aware that the online questionnaire was not reaching them. This was then undertaken focusing on 80 Maori NGOs, some of whom supplied mental health services. Following the questionnaire, a series of tape-recorded interviews and focus groups with key organisations and individuals was completed to expand on the information from the questionnaires. The focus group is effective to obtain group perceptions about a given problem or area of interest (McDaniel & Bach, 1994). The method is theoretically grounded, as there is a substantial body of knowledge and literature on group interaction, and the theory of group dynamics, that provides a firm foundation for research (Stewart & Shamdasani, 1990). The study was carried out in the first quarter of 2004.

Analysis

Interpretive analysis began by collating the transcribed data from the interviews and erasing identifying material (e.g., names, geographical locations). Transcripts were then discussed by the facilitators for accuracy of the spoken word. Data was analysed by blending the sound theoretical principles of qualitative analysis of authors Miles and Huberman (1994), with the specific focus group analysis of Morgan (1988). These approaches combine similar language and analytical techniques that are consistent with research conventions internationally.


Chapter 4: Current State Analysis of Recruitment Processes in New Zealand

This part of the report describes an interview and questionnaire survey of mainly HR and general managers to assess the current state of recruitment practices in mental health in New Zealand. The terms of reference for this project required us to do a “stocktake” of the capacity of the sector to undertake recruitment activities and to define areas, which needed to be addressed. As there has been little formal research on recruitment into mental health, it was decided to use a qualitative methodology to generate hypotheses about the current state of recruitment practices. It was expected that the results would be more informative about HR practices rather than wider strategic issues because the project team largely focused on employers (DHBs and NGOs).

Aim

The aim of this part of the project was to gain an understanding of the current state of recruitment practices across the mental health workforce in New Zealand.

Method

An online semi-structured questionnaire was developed to lead the individual and group data collection. The questionnaire was developed by the project team and was made available online with the help of Exotech. The initial invitation to complete the questionnaire was sent out to approximately 150 primary participants and increased to around 180 after suggestions from the primary participants. The invitations were sent to HR and General Managers of mental health services. When the initial response rate to the online questionnaire was slow, members of the Advisory Committee suggested that a postal mail out of the questionnaire should be done focusing on Maori organisations, as the project team had become aware that the online questionnaire was not reaching them. This was then undertaken focusing on 80 Maori NGOs, some of whom supplied mental health services. Following the questionnaire, a series of tape-recorded interviews and focus groups with key organisations and individuals was completed to expand on the information from the questionnaires. The focus group is effective to obtain group perceptions about a given problem or area of interest (McDaniel & Bach, 1994). The method is theoretically grounded, as there is a substantial body of knowledge and literature on group interaction, and the theory of group dynamics, that provides a firm foundation for research (Stewart & Shamdasani, 1990). The study was carried out in the first quarter of 2004.

Analysis

Interpretive analysis began by collating the transcribed data from the interviews and erasing identifying material (e.g., names, geographical locations). Transcripts were then discussed by the facilitators for accuracy of the spoken word. Data was analysed by blending the sound theoretical principles of qualitative analysis of authors Miles and Huberman (1994), with the specific focus group analysis of Morgan (1988). These approaches combine similar language and analytical techniques that are consistent with research conventions internationally.


During the interviews the facilitator/s summarised regularly to avoid interpretations, therefore such clarifications meant that the findings were confirmed. Dependability (or consistency) of the data in focus groups is gained when the researcher can provide sufficient information for others to follow the thinking and decisions made in the process of data analysis. This was ensured in this study by the use of co-facilitators and discussion of field notes after each interview, thereby minimising the possibility of bias by the researcher during the process of data analysis (Higginbottom, 1998). Once the data was grouped into questions, key words that commonly occurred in the transcripts were highlighted, and began the first level analysis, which generated headings that were recorded as a cognitive map. As concepts were identified in the data they were reduced to general categories or themes, and eventually organised into a general explanatory framework (Miles & Huberman, 1994; Strauss & Corbin, 1998). This was then supplemented from the responses to the online questionnaire, which covered similar ground to the interviews and focus groups. Data from both the individual interviews, focus groups and questionnaires demonstrated ‘saturation’ (Morgan, 1988). Due to this ‘saturation’ Sim (1998) argues that even if findings can not strictly be generalised, as in orthodox quantitative approaches to research, they can at least be transferred.

Results

The initial letter of information and the subsequent email with the online questionnaire link was sent to approximately 215 participants. This sometimes included five employees from a single organisation. The 215 included:

• The 21 DHB mental health managers;

• The 21 DHB HR managers;

• All members of the NAHHSCA (consumer advisors);

• List of 88 NGO’s that are members of PLATFORM;

• Six recruitment agencies;

• Four unions;

• Nine consumer networks;

• Six education providers (Unitec, The University of Auckland, Massey University, Victoria University, AUT);

• Nine supporting families organisations; and

• Ten Maori development organisations. (When this failed to achieve a good response rate, the questionnaire was sent by mail to around 75 Maori organisations from the Te Rau Matatini List. The 75 is not included in the email count of 215. The response rate to this particular initiative was 9 completed questionnaires.)

Fifty-three of the questionnaires were fully completed and returned. Twenty-six interviews and focus groups were performed, which included 3 trade unions, 3 recruitment agencies, 8 NGOs, and interviews of staff members from the following DHBs: Auckland; Christchurch; Lakes; Taranaki; Southland; Bay of Plenty; Counties Manukau; Waitemata; Wanganui; Hutt Valley; and MidCentral.


During the interviews the facilitator/s summarised regularly to avoid interpretations, therefore such clarifications meant that the findings were confirmed. Dependability (or consistency) of the data in focus groups is gained when the researcher can provide sufficient information for others to follow the thinking and decisions made in the process of data analysis. This was ensured in this study by the use of co-facilitators and discussion of field notes after each interview, thereby minimising the possibility of bias by the researcher during the process of data analysis (Higginbottom, 1998). Once the data was grouped into questions, key words that commonly occurred in the transcripts were highlighted, and began the first level analysis, which generated headings that were recorded as a cognitive map. As concepts were identified in the data they were reduced to general categories or themes, and eventually organised into a general explanatory framework (Miles & Huberman, 1994; Strauss & Corbin, 1998). This was then supplemented from the responses to the online questionnaire, which covered similar ground to the interviews and focus groups. Data from both the individual interviews, focus groups and questionnaires demonstrated ‘saturation’ (Morgan, 1988). Due to this ‘saturation’ Sim (1998) argues that even if findings can not strictly be generalised, as in orthodox quantitative approaches to research, they can at least be transferred.

Results

The initial letter of information and the subsequent email with the online questionnaire link was sent to approximately 215 participants. This sometimes included five employees from a single organisation. The 215 included:

• The 21 DHB mental health managers;

• The 21 DHB HR managers;

• All members of the NAHHSCA (consumer advisors);

• List of 88 NGO’s that are members of PLATFORM;

• Six recruitment agencies;

• Four unions;

• Nine consumer networks;

• Six education providers (Unitec, The University of Auckland, Massey University, Victoria University, AUT);

• Nine supporting families organisations; and

• Ten Maori development organisations. (When this failed to achieve a good response rate, the questionnaire was sent by mail to around 75 Maori organisations from the Te Rau Matatini List. The 75 is not included in the email count of 215. The response rate to this particular initiative was 9 completed questionnaires.)

Fifty-three of the questionnaires were fully completed and returned. Twenty-six interviews and focus groups were performed, which included 3 trade unions, 3 recruitment agencies, 8 NGOs, and interviews of staff members from the following DHBs: Auckland; Christchurch; Lakes; Taranaki; Southland; Bay of Plenty; Counties Manukau; Waitemata; Wanganui; Hutt Valley; and MidCentral.


The full list of organisations and individuals formally interviewed and who responded to the questionnaire is listed in Appendix 2. Several themes emerged in the findings.

Communication

Firstly, respondents told us that communication between HR and management (who ‘hold’ the vacancy position) is crucial in finding and confirming a suitable recruit. The HR Department predominantly controls recruitment activities. These HR resources or departments are either providing a core role to mental health managers, (i.e., they are within the geographical environment), or are clustered within a recruitment centre conducting a range of HR activities other than those specific to mental health. Liaison between both parties can be sporadic depending on the working relationship that has been developed.

“The actual department that has the vacancy … have help from the Recruitment Centre, but there is no actual liaison between them, its more like a step by step process and when one department is done the other takes over”.

NGO respondents reported input from a ‘clinical’ perspective less often than DHB interviewees but more commonly reported involvement of kaupapa Maori processes, cultural and service users. The NGO sectors reported that they have fewer staff and HR resources than the DHBs but have closer working relationships in the recruitment process. DHBs may have up to 30 HR staff, who were often involved in other activities for the rest of the organisation. Poor communication on recruitment processes put the larger organisations at risk of not securing candidates for vacancies.

“A concern is the haphazard way in which DHBs deal with potential employees. For example there was a job candidate that had applied directly to the DHB and hadn’t heard back from them. They eventually applied through a recruitment company and were offered the job. When the DHB realised that they had the candidate’s details within their database they refused to pay the recruitment agency”.

Time

Time can be a major factor that can help or hinder the successful filling of a vacancy. Most participants described this as too long, and was dependent on several factors including who sets the closing dates, the quality of the candidates and waiting for ‘request to recruit’ sign-off process to be completed in a timely way. This can lead to some timelines being anything from 1-12 months. When the recruitment process works well it takes 6-8 weeks to fill a vacated position, although for some posts, (e.g., psychiatrists), participants reported it could take 3-4 years to find a suitable applicant. Generally, respondents reported that it took less time to recruit in the NGO sector.

“ It takes too long to get approval for recruiting and the whole process is too long, there have been too many times that we have lost excellent applicants because of cumbersome procedures within the organisation”.

“As already mentioned the time delay is very off putting for outside applicants, in particular they get lost in the process and probably lose interest and consider that they are not valued. Efficiency and timeliness are what people from the outside see, so we have got to be better at it”.


The full list of organisations and individuals formally interviewed and who responded to the questionnaire is listed in Appendix 2. Several themes emerged in the findings.

Communication

Firstly, respondents told us that communication between HR and management (who ‘hold’ the vacancy position) is crucial in finding and confirming a suitable recruit. The HR Department predominantly controls recruitment activities. These HR resources or departments are either providing a core role to mental health managers, (i.e., they are within the geographical environment), or are clustered within a recruitment centre conducting a range of HR activities other than those specific to mental health. Liaison between both parties can be sporadic depending on the working relationship that has been developed.

“The actual department that has the vacancy … have help from the Recruitment Centre, but there is no actual liaison between them, its more like a step by step process and when one department is done the other takes over”.

NGO respondents reported input from a ‘clinical’ perspective less often than DHB interviewees but more commonly reported involvement of kaupapa Maori processes, cultural and service users. The NGO sectors reported that they have fewer staff and HR resources than the DHBs but have closer working relationships in the recruitment process. DHBs may have up to 30 HR staff, who were often involved in other activities for the rest of the organisation. Poor communication on recruitment processes put the larger organisations at risk of not securing candidates for vacancies.

“A concern is the haphazard way in which DHBs deal with potential employees. For example there was a job candidate that had applied directly to the DHB and hadn’t heard back from them. They eventually applied through a recruitment company and were offered the job. When the DHB realised that they had the candidate’s details within their database they refused to pay the recruitment agency”.

Time

Time can be a major factor that can help or hinder the successful filling of a vacancy. Most participants described this as too long, and was dependent on several factors including who sets the closing dates, the quality of the candidates and waiting for ‘request to recruit’ sign-off process to be completed in a timely way. This can lead to some timelines being anything from 1-12 months. When the recruitment process works well it takes 6-8 weeks to fill a vacated position, although for some posts, (e.g., psychiatrists), participants reported it could take 3-4 years to find a suitable applicant. Generally, respondents reported that it took less time to recruit in the NGO sector.

“ It takes too long to get approval for recruiting and the whole process is too long, there have been too many times that we have lost excellent applicants because of cumbersome procedures within the organisation”.

“As already mentioned the time delay is very off putting for outside applicants, in particular they get lost in the process and probably lose interest and consider that they are not valued. Efficiency and timeliness are what people from the outside see, so we have got to be better at it”.


The process of recruitment appears to be similar across DHB and NGO settings. Most respondents described a step-by-step process, stating that the ‘control’ for recruiting was with mental health, and the mechanical aspects being with HR. The referee and health checks, especially with overseas candidates can hold up the process. Adhering to ‘good process’ also means having well documented, timely reviews after each appointment by the interview panel.

“We have had a number of people who have come into the job without health clearance and there have been health issues immediately and we need to weigh that against the recruitment time and process. The onus is on the candidate to fill up their health questionnaire”.

In the NGO sector some respondents reported time as being too short, with participants saying they needed more time to gain an insight into the person before appointing. Whilst asking for experience, most reported that they get many non-qualified people applying and being interviewed, therefore this is time consuming. Lack of ‘efficiency’ in recruiting can lead to people taking the wrong job, or moving on to another vacancy elsewhere.

“There are many stages where the ball can be dropped and there are many risks that can come back to the process if certain things don’t get squared off. It is a balancing act getting a person into the business as quickly as they can and minimising risk to the organisation. And it gets a bit testy when the team is under pressure and they need someone fast and they live with the consequences of hasty recruitment for a long time”.

Quality

Respondents indicated that the quality of both the candidate and the organisation were strong themes. Organisations which were perceived as low quality had difficulty recruiting.

“We are not looking for people who only care; we want people with the relevant skill base too”.

Availability of good quality staff, who have resilience, drive, empathy, understanding, a determination to make things better for people and who are skilled in recovery-based practice, is paramount. Though the latter appear core requisites for the role, this is not commonly reflected in the reality of recruiting currently, and participants report a limited skilled pool of workers to draw from.

“Getting appropriately qualified people, we are taking on people that don’t fit what they want but that is because of shortages”.

Within the NGO sector some participants noted they were struggling as the people they employed are ‘para-professionals’ and there is no professional body to govern this employee group. Therefore, employers were often unsure of their attributes. NGO respondents also noted that they lack skilled HR personnel. The skills required by employers in the NGO sector not only relate to contact with consumers, but often required undertaking a variety of different roles depending on the task at hand. Quality of candidates also refers to lack of Maori available to apply for positions, and few candidates for consumer advisor vacancies, especially where a certain ethnic background would be an advantage. Matching the candidate’s qualities to a team is also important.


The process of recruitment appears to be similar across DHB and NGO settings. Most respondents described a step-by-step process, stating that the ‘control’ for recruiting was with mental health, and the mechanical aspects being with HR. The referee and health checks, especially with overseas candidates can hold up the process. Adhering to ‘good process’ also means having well documented, timely reviews after each appointment by the interview panel.

“We have had a number of people who have come into the job without health clearance and there have been health issues immediately and we need to weigh that against the recruitment time and process. The onus is on the candidate to fill up their health questionnaire”.

In the NGO sector some respondents reported time as being too short, with participants saying they needed more time to gain an insight into the person before appointing. Whilst asking for experience, most reported that they get many non-qualified people applying and being interviewed, therefore this is time consuming. Lack of ‘efficiency’ in recruiting can lead to people taking the wrong job, or moving on to another vacancy elsewhere.

“There are many stages where the ball can be dropped and there are many risks that can come back to the process if certain things don’t get squared off. It is a balancing act getting a person into the business as quickly as they can and minimising risk to the organisation. And it gets a bit testy when the team is under pressure and they need someone fast and they live with the consequences of hasty recruitment for a long time”.

Quality

Respondents indicated that the quality of both the candidate and the organisation were strong themes. Organisations which were perceived as low quality had difficulty recruiting.

“We are not looking for people who only care; we want people with the relevant skill base too”.

Availability of good quality staff, who have resilience, drive, empathy, understanding, a determination to make things better for people and who are skilled in recovery-based practice, is paramount. Though the latter appear core requisites for the role, this is not commonly reflected in the reality of recruiting currently, and participants report a limited skilled pool of workers to draw from.

“Getting appropriately qualified people, we are taking on people that don’t fit what they want but that is because of shortages”.

Within the NGO sector some participants noted they were struggling as the people they employed are ‘para-professionals’ and there is no professional body to govern this employee group. Therefore, employers were often unsure of their attributes. NGO respondents also noted that they lack skilled HR personnel. The skills required by employers in the NGO sector not only relate to contact with consumers, but often required undertaking a variety of different roles depending on the task at hand. Quality of candidates also refers to lack of Maori available to apply for positions, and few candidates for consumer advisor vacancies, especially where a certain ethnic background would be an advantage. Matching the candidate’s qualities to a team is also important.


“There are too few people with the right sort of heart for the job, the people we would like to employ (Maori people who have experienced mental illness) are difficult to find and often already under stress which makes dealing with a difficult job pretty risky”.

Recruiting for rural teams is also a major factor, due to the work undertaken and lifestyle that workers need to lead. The level of skill and the lack of quality infrastructure make it hard to cover and replace these staff.

“Recruiting for rural teams – due to the work undertaken and lifestyle that one needs to lead, the level of skill and the lack of infrastructure. As these people work in isolation and support is needed at every stage. It is hard to cover and replace these staff”.

Quality can also refer to the organisational values as an attraction for candidates. Participants noted that changing family needs would result in different job structures such as job share, working part-time and moving away from archaic rostoring rules so that workers have a balance of work and quality of life. Trying to create some variety for staff, staff rotations, and commitment to training and development was reported. These organisational values and flexibility around job structures were seen as important in making an organisation attractive to potential recruits. Improving managerial quality to develop stronger leadership was also important to participants. Respondents recommended a responsive positive attitude to enquiry and a willingness to put in extra effort to recruit and importantly the ability to match recruits with organisational values. Managers also need to have skills in leadership to ensure good supervision and succession planning is in place, which will allow workers to further their careers as well as allow new blood to join the organisation. Recruitment policy, protocols and handbooks are recommended to provide clarification and guidance for the recruitment and selection of staff, with training for all clinical leaders/managers involved in this process. Tertiary education providers need to work in closer coordination with employers, so that the courses provided met the needs of what is required in the workplace. Participant’s perceptions were that there is no consideration given currently to the prerequisite skills needed.

Cost

In the questionnaire respondents were asked what the annual budget allocation was for recruiting. About half the participants answered this with budgets ranging from none to nearly $200,000 for some large DHBs. Respondents were also asked if there were separate budgets for recruiting medical staff. Generally there were not, the exceptions were the larger DHBs. The budget for medical staff was usually, but not always, greater than for non-medical staff. Respondents stated that a recruitment process that is robust, well coordinated, structured and consistent in approach, with well-prepared and experienced interviewers representing all areas of mental health, where all applicants are treated the same is a cost-effective strategy. Participants talked about ‘costly’ mistakes that can be prevented from happening by having such a structure.

“With DHBs some of them don’t listen to HR, they need to realise that they function within a service industry and HR should be a key management strategy as with the sidelining of HR comes burgeoning costs”.

Considering a bonding system to attract new graduates is also highlighted in the data. Participants emphasized that staying in touch with candidates throughout the whole process,


“There are too few people with the right sort of heart for the job, the people we would like to employ (Maori people who have experienced mental illness) are difficult to find and often already under stress which makes dealing with a difficult job pretty risky”.

Recruiting for rural teams is also a major factor, due to the work undertaken and lifestyle that workers need to lead. The level of skill and the lack of quality infrastructure make it hard to cover and replace these staff.

“Recruiting for rural teams – due to the work undertaken and lifestyle that one needs to lead, the level of skill and the lack of infrastructure. As these people work in isolation and support is needed at every stage. It is hard to cover and replace these staff”.

Quality can also refer to the organisational values as an attraction for candidates. Participants noted that changing family needs would result in different job structures such as job share, working part-time and moving away from archaic rostoring rules so that workers have a balance of work and quality of life. Trying to create some variety for staff, staff rotations, and commitment to training and development was reported. These organisational values and flexibility around job structures were seen as important in making an organisation attractive to potential recruits. Improving managerial quality to develop stronger leadership was also important to participants. Respondents recommended a responsive positive attitude to enquiry and a willingness to put in extra effort to recruit and importantly the ability to match recruits with organisational values. Managers also need to have skills in leadership to ensure good supervision and succession planning is in place, which will allow workers to further their careers as well as allow new blood to join the organisation. Recruitment policy, protocols and handbooks are recommended to provide clarification and guidance for the recruitment and selection of staff, with training for all clinical leaders/managers involved in this process. Tertiary education providers need to work in closer coordination with employers, so that the courses provided met the needs of what is required in the workplace. Participant’s perceptions were that there is no consideration given currently to the prerequisite skills needed.

Cost

In the questionnaire respondents were asked what the annual budget allocation was for recruiting. About half the participants answered this with budgets ranging from none to nearly $200,000 for some large DHBs. Respondents were also asked if there were separate budgets for recruiting medical staff. Generally there were not, the exceptions were the larger DHBs. The budget for medical staff was usually, but not always, greater than for non-medical staff. Respondents stated that a recruitment process that is robust, well coordinated, structured and consistent in approach, with well-prepared and experienced interviewers representing all areas of mental health, where all applicants are treated the same is a cost-effective strategy. Participants talked about ‘costly’ mistakes that can be prevented from happening by having such a structure.

“With DHBs some of them don’t listen to HR, they need to realise that they function within a service industry and HR should be a key management strategy as with the sidelining of HR comes burgeoning costs”.

Considering a bonding system to attract new graduates is also highlighted in the data. Participants emphasized that staying in touch with candidates throughout the whole process,


having good orientation packages with a personal touch for overseas or out-of-area recruits, and having input from professional advisors is important.

“The principle of buddying with a person, who they can approach to talk too and this person introduces them to the processes and helps them feel more inculcated into the programme”.

“We need someone in the organisation to operate as a liaison person to help them link into the networks and give them a decent kiwi orientation particularly in the first weeks. To prevent culture shock they need to know what the costs they will face are. People don’t realize what their salaries compare with, what they can buy, and the comparison of living standards is not the same. And when it’s done well, people remember it”.

Data from the NGO sector indicated that an organisation may start with recruiting from the relatively local circle and only spend more money when they need to advertise widely, therefore limiting their cost. International recruitment brings its own cost issues. The cost of getting people here for interviews or telephone interviewing is sometimes prohibitive for organisations. Also the candidates bring with them their own financial constraints such as salary available or the cost and availability of housing. Here exit interviews were seen as a cost saving exercise, particularly as people from overseas leave for different reasons, such as to resume travel around the rest of the country, due to home sickness, or unexpected drop in salary. Being aware of these trends could be a cost saver if built into recruitment practices as arranging job exchanges in other parts of the country could reduce attrition. Other reasons identified by participants for exiting jobs are partner moving to another role, money they get for the job and unexpected working conditions. Low salaries were also a consideration. Some participants stated that the recruitment practices were not flexible enough, for example because of financial pressure to fill vacancies to keep FTE money, or adhering to a job contract for reporting to a funder. NGOs appeared to have more flexibility regarding the short listing and interviewing process. Recruitment policies and workforce needs are not analysed in enough detail and do not necessarily allow for innovation. For example, mental health recruitment is geared towards clinical or professional roles. Workforce strategies do not allow for broader thinking and philosophies outside the “medical model”. Hence cultural knowledge and competency are not recognised as valid in having an effect on outcome for consumers.

Media

The media emerged as a theme from the data, and plays a significant part in recruitment practices. Liaising with advertising advisors is an important step for strategies such as how and when to advertise, job description/contractual information, where to target the advert (professional journal, tertiary settings, community newspaper, radio, specific cultural settings, notified to recruitment agencies), and when to re-advertise when no suitable response. Most participants have a ‘preferred supplier agreement’, using a variety of creative strategies such as a website on the Internet via the recruitment centre. This more structured approach is recommended by some participants, as this could lead to ‘branding’ of DHBs as preferred employers. However, word of mouth was the commonest approach to advertising by most participants. Knowing your staff is an important part of recruitment success, for example, clinical leaders/managers know of people that could be interested or wanting to make a change. However, this raised issues of impartiality with both DHB and NGO participants.


having good orientation packages with a personal touch for overseas or out-of-area recruits, and having input from professional advisors is important.

“The principle of buddying with a person, who they can approach to talk too and this person introduces them to the processes and helps them feel more inculcated into the programme”.

“We need someone in the organisation to operate as a liaison person to help them link into the networks and give them a decent kiwi orientation particularly in the first weeks. To prevent culture shock they need to know what the costs they will face are. People don’t realize what their salaries compare with, what they can buy, and the comparison of living standards is not the same. And when it’s done well, people remember it”.

Data from the NGO sector indicated that an organisation may start with recruiting from the relatively local circle and only spend more money when they need to advertise widely, therefore limiting their cost. International recruitment brings its own cost issues. The cost of getting people here for interviews or telephone interviewing is sometimes prohibitive for organisations. Also the candidates bring with them their own financial constraints such as salary available or the cost and availability of housing. Here exit interviews were seen as a cost saving exercise, particularly as people from overseas leave for different reasons, such as to resume travel around the rest of the country, due to home sickness, or unexpected drop in salary. Being aware of these trends could be a cost saver if built into recruitment practices as arranging job exchanges in other parts of the country could reduce attrition. Other reasons identified by participants for exiting jobs are partner moving to another role, money they get for the job and unexpected working conditions. Low salaries were also a consideration. Some participants stated that the recruitment practices were not flexible enough, for example because of financial pressure to fill vacancies to keep FTE money, or adhering to a job contract for reporting to a funder. NGOs appeared to have more flexibility regarding the short listing and interviewing process. Recruitment policies and workforce needs are not analysed in enough detail and do not necessarily allow for innovation. For example, mental health recruitment is geared towards clinical or professional roles. Workforce strategies do not allow for broader thinking and philosophies outside the “medical model”. Hence cultural knowledge and competency are not recognised as valid in having an effect on outcome for consumers.

Media

The media emerged as a theme from the data, and plays a significant part in recruitment practices. Liaising with advertising advisors is an important step for strategies such as how and when to advertise, job description/contractual information, where to target the advert (professional journal, tertiary settings, community newspaper, radio, specific cultural settings, notified to recruitment agencies), and when to re-advertise when no suitable response. Most participants have a ‘preferred supplier agreement’, using a variety of creative strategies such as a website on the Internet via the recruitment centre. This more structured approach is recommended by some participants, as this could lead to ‘branding’ of DHBs as preferred employers. However, word of mouth was the commonest approach to advertising by most participants. Knowing your staff is an important part of recruitment success, for example, clinical leaders/managers know of people that could be interested or wanting to make a change. However, this raised issues of impartiality with both DHB and NGO participants.


Stigma with the mental health sector fuelled by the media was also found across all participants. Mental health can also be stigmatized by sentinel events publicised in the media, usually in a negative light. Media can also impact on the perception of the candidate in their choice of career or job. Participants strongly agreed that work needs to be done on increasing the positive profile of a career in mental health, as it is considered as a poor area to work in by the public (Wells, Ryan & McElwee, 2000). Creativity in advertising to bring in new applicants outside of the mental health sector is evident in the data. Promoting the training opportunities, support and supervision available to staff is also important. A direct approach to individuals is a positive way to recruit, as most people like the personal and directness of matching them to a position. This may also help to match philosophies that enhance team work and greater job satisfaction. Emphasizing the benefits of taking the job is also important, highlighting what are the points of difference. Phrases like “when you come here to work this is what you’ll get out of it; a lower nurse to patient ratio, time off for study, opportunity to work amongst the community” or “would you like to be part of improving the life of other people” have often been used. Using creative advertisements, including such items as relocation packages, the beauty of the country, wellness support programme for example, gyms and childcare facilities were also recommended by participants. Developing relationships with regional city councils to draw people to a central site have also been used.

Consumers

Respondents reported that consumer input into the selection process is commonly sought to provide a balanced process, which has an equal contribution with other people on the panel. The purpose of consumer input is to identify the ideal candidate with an understanding attitude to consumers, regardless of their personal experience, support the capacity of consumers to act in an informed way and have an awareness of the stigmatizing attitude that can exist not only within the community but also the mental health sector. In both the DHB and NGO sectors respondents were hesitant in support of consumer workers. The main issues were around quality of service issues, such as disclosure/privacy issues, negative stigma or consumer workers being ‘taken seriously’. From the DHB perspective participants indicated that the successful recruitment of more consumers in the labour force seemed to be dependent on several factors. Firstly, support was seen as being very important in order to increase more consumers in the sector; peer, managerial and administrative support were highlighted as key factors to make it possible, as often consumers were employed without this leading to high stress and to burn out. A career pathway for consumers is also recommended, rather than a ‘shelf-life’ approach. Successful inclusion and development of the consumer workforce is dependent on HR policies and procedures having sufficient flexibility to address issues of stigma, appropriate support, maintaining wellness and accommodating periods of unwellness. The development of a career pathway was seen as necessary to ensure retention. Some of the bigger centres do quite well, with a small pool of consumers who are well enough to work, but participants thought that the ongoing issues of their sickness, or which cycle of recovery they are in, produce mixed feelings amongst the sector in recruiting consumers as workers.

“It does happen, on an individual basis, but she is very careful about recruiting a service user, although they have some insight you have to be very clear where about on the cycle of recovery they are”.

“Often not, organisations don’t provide for consumer workers needs, no understanding they need a support package. Not in a shoe box. Having secretarial and admin support, having


Stigma with the mental health sector fuelled by the media was also found across all participants. Mental health can also be stigmatized by sentinel events publicised in the media, usually in a negative light. Media can also impact on the perception of the candidate in their choice of career or job. Participants strongly agreed that work needs to be done on increasing the positive profile of a career in mental health, as it is considered as a poor area to work in by the public (Wells, Ryan & McElwee, 2000). Creativity in advertising to bring in new applicants outside of the mental health sector is evident in the data. Promoting the training opportunities, support and supervision available to staff is also important. A direct approach to individuals is a positive way to recruit, as most people like the personal and directness of matching them to a position. This may also help to match philosophies that enhance team work and greater job satisfaction. Emphasizing the benefits of taking the job is also important, highlighting what are the points of difference. Phrases like “when you come here to work this is what you’ll get out of it; a lower nurse to patient ratio, time off for study, opportunity to work amongst the community” or “would you like to be part of improving the life of other people” have often been used. Using creative advertisements, including such items as relocation packages, the beauty of the country, wellness support programme for example, gyms and childcare facilities were also recommended by participants. Developing relationships with regional city councils to draw people to a central site have also been used.

Consumers

Respondents reported that consumer input into the selection process is commonly sought to provide a balanced process, which has an equal contribution with other people on the panel. The purpose of consumer input is to identify the ideal candidate with an understanding attitude to consumers, regardless of their personal experience, support the capacity of consumers to act in an informed way and have an awareness of the stigmatizing attitude that can exist not only within the community but also the mental health sector. In both the DHB and NGO sectors respondents were hesitant in support of consumer workers. The main issues were around quality of service issues, such as disclosure/privacy issues, negative stigma or consumer workers being ‘taken seriously’. From the DHB perspective participants indicated that the successful recruitment of more consumers in the labour force seemed to be dependent on several factors. Firstly, support was seen as being very important in order to increase more consumers in the sector; peer, managerial and administrative support were highlighted as key factors to make it possible, as often consumers were employed without this leading to high stress and to burn out. A career pathway for consumers is also recommended, rather than a ‘shelf-life’ approach. Successful inclusion and development of the consumer workforce is dependent on HR policies and procedures having sufficient flexibility to address issues of stigma, appropriate support, maintaining wellness and accommodating periods of unwellness. The development of a career pathway was seen as necessary to ensure retention. Some of the bigger centres do quite well, with a small pool of consumers who are well enough to work, but participants thought that the ongoing issues of their sickness, or which cycle of recovery they are in, produce mixed feelings amongst the sector in recruiting consumers as workers.

“It does happen, on an individual basis, but she is very careful about recruiting a service user, although they have some insight you have to be very clear where about on the cycle of recovery they are”.

“Often not, organisations don’t provide for consumer workers needs, no understanding they need a support package. Not in a shoe box. Having secretarial and admin support, having


access to mobile phones and computers and providing support along the lines of cars and transport. Often not there, sets people up to be stressed and to burn out”.

Multi-Employer Contract Agreements (MECA)

There were few and much briefer responses to the question on multi-employer contract agreements for pay and conditions (MECA). Generally, it was agreed that it was a good approach as it will get everyone at the same level and thus potentially increase the pool of recruits. Regionalisation of sector contracts for workers could lead to less competing by DHBs for employees. Some smaller centres were against MECA’s as they thought it would erode their competitive edge. Respondents reported that previously the culture in the DHBs was to meet and work through industrial issues, but with MECA’s this would not be possible.

“The MECA will allow for pay equity, and allow for staff and organisations to compete not on money but quality”.

DHBs and NGOs working together

Respondents thought that promoting collaboration between DHBs could lead to sharing potential resources and be more economic in the longer-term, potentially giving access to a larger pool of suitable candidates. However, there is still an attitude of competition between some DHBs.

“Sounds like a great idea, but in reality we are putting in a big chunk of money and the selfish attitude that we want what we got and we don’t want to share”.

“Very good idea ... lot more problematic that it sounds, still have to do it, New Zealand has a population of 4 million and there are a lot of economies to be made. Have to get away from the individual focus of the DHBs, big challenge. Big concern about equity, issues about employment to certain areas and that has to be managed. Very good on paper”.

Support for DHB/NGO collaboration elicited a more cautious response, with only tentative support from the two sectors. There has been a history of closer collaboration between these two sectors, such as access to HR and training opportunities in the early days when larger institutions were closing and community care increased, but this no longer occurs. Again, competition for scarce resources seems to be a factor and the needs of NGOs are sometimes different. Some participants said that DHBs do not understand the NGO sector, and that the NGO sector is seen as a poorer cousin. Participants suggested that this could be overcome by integration of the NGO and DHB services but this work is yet to be done.

“I don’t think DHBs understand the NGO sector, and the NGO sector is seen as a cheaper sort of cousin. There should be integrated service, but work needs to be done. NGOs lack HR and that is what they need, and he can see this one working better. Drawing up clear boundaries between the hospital aspect vs. the community aspect. NGOs have more flexibility but they don’t have the same level of clinical skill”.

“Bring it on. When the DHBs were first formed each DHB with a large HR department would extend to assist and include NGO recruitment, but that hasn’t happened anywhere in the country. 0.5 FTE, no way they can get expertise”.


access to mobile phones and computers and providing support along the lines of cars and transport. Often not there, sets people up to be stressed and to burn out”.

Multi-Employer Contract Agreements (MECA)

There were few and much briefer responses to the question on multi-employer contract agreements for pay and conditions (MECA). Generally, it was agreed that it was a good approach as it will get everyone at the same level and thus potentially increase the pool of recruits. Regionalisation of sector contracts for workers could lead to less competing by DHBs for employees. Some smaller centres were against MECA’s as they thought it would erode their competitive edge. Respondents reported that previously the culture in the DHBs was to meet and work through industrial issues, but with MECA’s this would not be possible.

“The MECA will allow for pay equity, and allow for staff and organisations to compete not on money but quality”.

DHBs and NGOs working together

Respondents thought that promoting collaboration between DHBs could lead to sharing potential resources and be more economic in the longer-term, potentially giving access to a larger pool of suitable candidates. However, there is still an attitude of competition between some DHBs.

“Sounds like a great idea, but in reality we are putting in a big chunk of money and the selfish attitude that we want what we got and we don’t want to share”.

“Very good idea ... lot more problematic that it sounds, still have to do it, New Zealand has a population of 4 million and there are a lot of economies to be made. Have to get away from the individual focus of the DHBs, big challenge. Big concern about equity, issues about employment to certain areas and that has to be managed. Very good on paper”.

Support for DHB/NGO collaboration elicited a more cautious response, with only tentative support from the two sectors. There has been a history of closer collaboration between these two sectors, such as access to HR and training opportunities in the early days when larger institutions were closing and community care increased, but this no longer occurs. Again, competition for scarce resources seems to be a factor and the needs of NGOs are sometimes different. Some participants said that DHBs do not understand the NGO sector, and that the NGO sector is seen as a poorer cousin. Participants suggested that this could be overcome by integration of the NGO and DHB services but this work is yet to be done.

“I don’t think DHBs understand the NGO sector, and the NGO sector is seen as a cheaper sort of cousin. There should be integrated service, but work needs to be done. NGOs lack HR and that is what they need, and he can see this one working better. Drawing up clear boundaries between the hospital aspect vs. the community aspect. NGOs have more flexibility but they don’t have the same level of clinical skill”.

“Bring it on. When the DHBs were first formed each DHB with a large HR department would extend to assist and include NGO recruitment, but that hasn’t happened anywhere in the country. 0.5 FTE, no way they can get expertise”.


Other comments

Apart from the formally analysed interviews described above, several people were spoken to informally. Their views usually matched the areas already described, however, there were some specific comments the project team wanted to record. These are summarised below:

• The project team were told of several courses in tertiary institutions, which had reverted

back to Ministry of Education funding as the CTA rules were too complex and compliance costs too high. Not everyone applying for psychiatry post-entry clinical training can be accepted onto training schemes. Psychiatry trainees needing to progress into advanced training cannot be funded by DHBs who complain that these posts receive little funding from the CTA.

• PGY 1 and PGY 2 intern years for doctors – some respondents felt that there was a missed opportunity here. There are psychiatric posts available for house officers but these are generally providing basic medical care rather than psychiatric care. At a time when young doctors are making career choices it was thought that placements which were more likely to encourage them to have some psychiatric experience would be more useful.

• Money not being ring-fenced. This was a problem for child and adolescent services where funding for development of these services within mental health service budgets is used for other things. Secondly, it is a problem for CTA funding for post-entry clinical training where money is given to organisations (e.g., universities or hospitals) and then is used for other things and can not be traced.

Summary

Because of the nature of this study what it tells us is mainly about the internal HR processes of organisations. As the project team has found, the first thing that people tell you about when you talk about recruitment is “HR disasters” where applications are lost, enquiries not returned or there are lengthy delays in the process. This anecdotal finding has been confirmed here where most of the themes arising from the qualitative analysis relate to issues of poor process. The main findings from this chapter are outlined below:

• Poor process – communication difficulties, delays in the process, the quality of the candidates and organisations – hinder recruitment;

• Financia l pressures can affect the recruitment process;

• Poor recruitment practices have their own costs;

• The poor media perception of mental health makes it hard to recruit workers into the sector;

• The consumer role appears to be valued in the selection process but there is more ambivalence in employing them as colleagues;

• Multi-employer agreements are generally favoured; and

• There was lukewarm support for DHB cooperation and DHB/NGO cooperation. Ways of addressing these issues are described in the chapter on options to improve recruitment.


Other comments

Apart from the formally analysed interviews described above, several people were spoken to informally. Their views usually matched the areas already described, however, there were some specific comments the project team wanted to record. These are summarised below:

• The project team were told of several courses in tertiary institutions, which had reverted

back to Ministry of Education funding as the CTA rules were too complex and compliance costs too high. Not everyone applying for psychiatry post-entry clinical training can be accepted onto training schemes. Psychiatry trainees needing to progress into advanced training cannot be funded by DHBs who complain that these posts receive little funding from the CTA.

• PGY 1 and PGY 2 intern years for doctors – some respondents felt that there was a missed opportunity here. There are psychiatric posts available for house officers but these are generally providing basic medical care rather than psychiatric care. At a time when young doctors are making career choices it was thought that placements which were more likely to encourage them to have some psychiatric experience would be more useful.

• Money not being ring-fenced. This was a problem for child and adolescent services where funding for development of these services within mental health service budgets is used for other things. Secondly, it is a problem for CTA funding for post-entry clinical training where money is given to organisations (e.g., universities or hospitals) and then is used for other things and can not be traced.

Summary

Because of the nature of this study what it tells us is mainly about the internal HR processes of organisations. As the project team has found, the first thing that people tell you about when you talk about recruitment is “HR disasters” where applications are lost, enquiries not returned or there are lengthy delays in the process. This anecdotal finding has been confirmed here where most of the themes arising from the qualitative analysis relate to issues of poor process. The main findings from this chapter are outlined below:

• Poor process – communication difficulties, delays in the process, the quality of the candidates and organisations – hinder recruitment;

• Financia l pressures can affect the recruitment process;

• Poor recruitment practices have their own costs;

• The poor media perception of mental health makes it hard to recruit workers into the sector;

• The consumer role appears to be valued in the selection process but there is more ambivalence in employing them as colleagues;

• Multi-employer agreements are generally favoured; and

• There was lukewarm support for DHB cooperation and DHB/NGO cooperation. Ways of addressing these issues are described in the chapter on options to improve recruitment.

Chapter 5: Literature Review and “Best Practice” 41

Chapter 5: Literature Review and “Best Practice”

This section summarises the relevant literature on recruitment with specific reference to the mental health sector. The chapter is divided into two parts. The first part describes a review of the academic literature on mental health recruitment. The second part outlines “grey literature” which while not being part of the academic literature is also useful. The section is under “best practice”.

Literature review

Search strategy

Initial searches of the literature were based on journals and keywords suggested by Associate Professor Suchi Mouly. The suggested journals were all in the area of HR, as a crucial part of the study was to show the importance and need for strategic HR input into mental health workforce recruitment. International journals searched were the ‘Human Resource Management Journal’ and ‘International Journal of Human Resource Management and Personnel Psychology’. Regional journals were the ‘Asia Pacific Journal of Human Resources’, ‘Asia Pacific Journal of Management’ and ‘New Zealand Journal of Human Resource Management’. Several keywords from the suggested list were tried with all searches, however, the keywords settled on were ‘mental health recruitment’ and ‘mental health’ with ‘staff recruitment’, in a combined search. Electronic databases searched were MEDLINE, Psycinfo, APAIS (HR and marketing), ABI/INFORM (HR and marketing), Ebsco (health business), ScienceDirect (various), ProQuest (various) and INNZ (New Zealand journals). As well as electronic searches, manual searches were made of recent issues of the journals from which other articles were selected. Another member of the research panel suggested a manual search of ‘Incite’ journal, a New Zealand journal with a consumer focus that produced some of the very few articles in the New Zealand context. Manual searches were also made of various books and articles from government agencies and of books on library shelves next to them. One reference to a website (Arnold et al., 2003) came from a Health Research Council of New Zealand contact and others from references in the articles selected (Johnson & Johnson, 2003 and 2004; Association of Salaried Medical Specialists, 2004; and American Association of Colleges of Nursing, 2002a & 2002b).

Findings

In total there were 1384 references for possible inclusion from which 85 were selected for reading. (867 articles were from two journals ‘The Behavioral Health Management Journal’ and the ‘Australian and New Zealand Journal of Mental Health Nursing’, of which 34 articles selected for further reading.) The final articles were considered to be relevant to this review because they referred to health in some way and they referred directly to recruitment and retention issues. It must be noted that no articles referred to mental health work in the broad perspective, some articles were media -type articles in professional journals, and many were descriptive rather than research-based. Many of the articles do not directly refer to mental health care, but it was felt that if they were in the health area they would at least be relevant for developing strategies in New Zealand because many of the problems faced were similar to those in the New Zealand mental health context. Most studies have focussed on general nursing, or have been clinician oriented, which is not always relevant in understanding the mental health settings.


Chapter 5: Literature Review and “Best Practice”

This section summarises the relevant literature on recruitment with specific reference to the mental health sector. The chapter is divided into two parts. The first part describes a review of the academic literature on mental health recruitment. The second part outlines “grey literature” which while not being part of the academic literature is also useful. The section is under “best practice”.

Literature review

Search strategy

Initial searches of the literature were based on journals and keywords suggested by Associate Professor Suchi Mouly. The suggested journals were all in the area of HR, as a crucial part of the study was to show the importance and need for strategic HR input into mental health workforce recruitment. International journals searched were the ‘Human Resource Management Journal’ and ‘International Journal of Human Resource Management and Personnel Psychology’. Regional journals were the ‘Asia Pacific Journal of Human Resources’, ‘Asia Pacific Journal of Management’ and ‘New Zealand Journal of Human Resource Management’. Several keywords from the suggested list were tried with all searches, however, the keywords settled on were ‘mental health recruitment’ and ‘mental health’ with ‘staff recruitment’, in a combined search. Electronic databases searched were MEDLINE, Psycinfo, APAIS (HR and marketing), ABI/INFORM (HR and marketing), Ebsco (health business), ScienceDirect (various), ProQuest (various) and INNZ (New Zealand journals). As well as electronic searches, manual searches were made of recent issues of the journals from which other articles were selected. Another member of the research panel suggested a manual search of ‘Incite’ journal, a New Zealand journal with a consumer focus that produced some of the very few articles in the New Zealand context. Manual searches were also made of various books and articles from government agencies and of books on library shelves next to them. One reference to a website (Arnold et al., 2003) came from a Health Research Council of New Zealand contact and others from references in the articles selected (Johnson & Johnson, 2003 and 2004; Association of Salaried Medical Specialists, 2004; and American Association of Colleges of Nursing, 2002a & 2002b).

Findings

In total there were 1384 references for possible inclusion from which 85 were selected for reading. (867 articles were from two journals ‘The Behavioral Health Management Journal’ and the ‘Australian and New Zealand Journal of Mental Health Nursing’, of which 34 articles selected for further reading.) The final articles were considered to be relevant to this review because they referred to health in some way and they referred directly to recruitment and retention issues. It must be noted that no articles referred to mental health work in the broad perspective, some articles were media -type articles in professional journals, and many were descriptive rather than research-based. Many of the articles do not directly refer to mental health care, but it was felt that if they were in the health area they would at least be relevant for developing strategies in New Zealand because many of the problems faced were similar to those in the New Zealand mental health context. Most studies have focussed on general nursing, or have been clinician oriented, which is not always relevant in understanding the mental health settings.


The definition of recruitment

Recruitment is about attracting and choosing people that are capable of performing well in the organisation and is essential for the achievement of organisational objectives (Rudman, 1999). Recruitment involves ‘searching for and obtaining qualified job candidates in such numbers that the organisation can select the most appropriate person to fill its needs’ (Jackson & Schuler, 2000, p. 257). “Recruitment strategies need to focus on the message – how an employer goes about recruiting is just as important as what the employer is offering in terms of employment opportunities. Additionally, employers need to identify not only who the potential applicants are for their jobs , but they must also identify what these potential applicants desire in terms of job opportunities, salaries, benefits and work environment. There is a direct link between what employment opportunities an employer offers, and the kind of applicants and employees that an employer will then have” (Langan, 2000, p. 463). “Recruitment has emerged as a critical human resource function for organisations, particularly in an environment of competitive labour markets and mobile employees” (Allen et al., 2004, p.-143). It is important to understand that recruitment does not function in isolation from other HR practices that constitute a part of the internal environment, as well as the broader external environment, which consists of the economic, social, political, technological and industry variables; labour market conditions; competition and legislation governing recruitment within the country where the organisation operates. The internal environment describes the characteristics of the organisation, including such factors as the number of staff, the number of locations the business operates in, and whether the business engages in strategic or business planning (Du Plessis, 2003). Anthony, Kacmar and Perrewe (2002) have listed the following choices that the organisations have to make when developing their HR policies:

• Organisations can choose to ‘make’ or ‘buy’ their employees;

• Organisations make strategic decisions regarding the budget allocated for recruiting employees;

• Organisations make strategic decisions regarding the technological sophistication of their recruiting devices and the extent to which internal versus external recruiting methods are used;

• An organisation can make a choice to explore the untapped labour sources; and

• An organisation must decide whether to develop a plan to retain qualified workers. Baird and Meshoulam (1988, as cited in Boxall & Purcell, 2003) argue for both external and interna l fit of the HR strategies implemented within the organisation. External fit is when the structure and systems of the HR activities fit in with the organisation’s stage of development. Internal fit occurs when the individual HR policies are designed to support and fit each other. “There are certain broadly applicable principles and processes of good labour management but the methods firms adopt to reach their performance goals are inevitably affected by societal, sectoral and organisational factors. “The practice of human resource management in New Zealand, while sharing commonalities with practices found elsewhere in the developed world, will of necessity have adapted to local issues and will continue to change in response to them” (Macky & Johnson, 2000, p. 3). “The sort of practices that are more desirable to employees – such as high levels of pay, training and security - are not cost effective across all sectors or, indeed across all types of labour in a single firm” (Boxall & Purcell, 2000, p. 193). Little is known about the number of New Zealand firms that currently have a formal policy guiding the recruitment decisions and actions of their recruiters. However, the 1997 Cranfield


The definition of recruitment

Recruitment is about attracting and choosing people that are capable of performing well in the organisation and is essential for the achievement of organisational objectives (Rudman, 1999). Recruitment involves ‘searching for and obtaining qualified job candidates in such numbers that the organisation can select the most appropriate person to fill its needs’ (Jackson & Schuler, 2000, p. 257). “Recruitment strategies need to focus on the message – how an employer goes about recruiting is just as important as what the employer is offering in terms of employment opportunities. Additionally, employers need to identify not only who the potential applicants are for their jobs , but they must also identify what these potential applicants desire in terms of job opportunities, salaries, benefits and work environment. There is a direct link between what employment opportunities an employer offers, and the kind of applicants and employees that an employer will then have” (Langan, 2000, p. 463). “Recruitment has emerged as a critical human resource function for organisations, particularly in an environment of competitive labour markets and mobile employees” (Allen et al., 2004, p.-143). It is important to understand that recruitment does not function in isolation from other HR practices that constitute a part of the internal environment, as well as the broader external environment, which consists of the economic, social, political, technological and industry variables; labour market conditions; competition and legislation governing recruitment within the country where the organisation operates. The internal environment describes the characteristics of the organisation, including such factors as the number of staff, the number of locations the business operates in, and whether the business engages in strategic or business planning (Du Plessis, 2003). Anthony, Kacmar and Perrewe (2002) have listed the following choices that the organisations have to make when developing their HR policies:

• Organisations can choose to ‘make’ or ‘buy’ their employees;

• Organisations make strategic decisions regarding the budget allocated for recruiting employees;

• Organisations make strategic decisions regarding the technological sophistication of their recruiting devices and the extent to which internal versus external recruiting methods are used;

• An organisation can make a choice to explore the untapped labour sources; and

• An organisation must decide whether to develop a plan to retain qualified workers. Baird and Meshoulam (1988, as cited in Boxall & Purcell, 2003) argue for both external and interna l fit of the HR strategies implemented within the organisation. External fit is when the structure and systems of the HR activities fit in with the organisation’s stage of development. Internal fit occurs when the individual HR policies are designed to support and fit each other. “There are certain broadly applicable principles and processes of good labour management but the methods firms adopt to reach their performance goals are inevitably affected by societal, sectoral and organisational factors. “The practice of human resource management in New Zealand, while sharing commonalities with practices found elsewhere in the developed world, will of necessity have adapted to local issues and will continue to change in response to them” (Macky & Johnson, 2000, p. 3). “The sort of practices that are more desirable to employees – such as high levels of pay, training and security - are not cost effective across all sectors or, indeed across all types of labour in a single firm” (Boxall & Purcell, 2000, p. 193). Little is known about the number of New Zealand firms that currently have a formal policy guiding the recruitment decisions and actions of their recruiters. However, the 1997 Cranfield


Survey found that 65 percent of the 570 New Zealand companies that responded had a written policy on recruitment and selection, while 11 percent had no policy” (Macky and Johnson, 2003, p. 212). Focussing on a mental health workforce analyses carried out in other parts of the world suggests that there is a dearth internationally of literature in this area (Wells, Ryan & McElwee, 2000). It appears that strategic human resource practice input is of benefit in recruiting mental health staff (Hall & Hall, 2002). Therefore, in this review material with a mental health focus is linked with the HR management literature, to allow a cross-disciplinary vantage point. It appears that recruitment to the mental health workforce in New Zealand has not been well coordinated and is often likened to having a ‘shotgun’ approach to recruitment issues. ‘Moving Forward’ (Ministry of Health, 1997) recognised that mental health workforce development in New Zealand had been neglected which has led to major deficiencies in skills. A clear picture of the mental health workforce in New Zealand is currently not available, although the project team has tried to describe it in this document from a number of sources. Recruitment strategies are often based on local needs and regularly take no account of the impact on the region or country as a whole. Recruitment has often relied on attracting suitably skilled talent from overseas. Due to an international shortage of mental health workers, (11 percent of consultant psychiatrists post in the U.K. are unfilled, Royal College of Psychiatrists, 2004), this talent pool has been greatly reduced and has resulted in many countries placing embargoes on offshore recruiting (for example Canada). New Zealand, therefore, needs to respond to these challenges by creating and using coordinated strategies that lead to recruitment, development and retention of suitably skilled people to work within the New Zealand context.

Recruitment, training and competencies

There seems to be general acknowledgement that it is difficult to ‘sell’ mental health nursing as a career. Hazelton (2000) notes that “we need to identify teaching and learning approaches and course designs, which will capture the imaginations of students and directly influence decisions to enter mental health nursing at the point of graduation” (p. 99). A new campaign is underway in Australia and New Zealand that attempts to change perceptions of nursing and highlight and enhance the opportunities within nursing (Johnson & Johnson, 2003). This campaign could act as a blueprint for similar campaigns in New Zealand as part of a national recruitment strategy in mental health. Prebble (2001) proposes that mental health nursing is a distinct code of practice that requires speciality undergraduate preparation with at least three to 4 years of specialised training. Prebble recognises that the modern comprehensive nursing programme has improved the nursing workforce but that is has minimalised and marginalised mental health nursing in the process. There seems to be an expectation that those students who are interested in mental health will do their undergraduate training and then move to post-graduate mental health training. Yet in Australia, where the system is similar, this has not been found to be the case (Happell, 1999). At a forum of mental health nurses convened by the Ministry of Health (New Zealand) in 2000 it was concluded that the mental health component of general undergraduate nursing programmes was not adequate to equip nurses to work in this area. It would seem important therefore that increasing the amount and quality of mental health nurse training is critical. Research overseas has shown that ‘perceived level of competence’ (discussed later) is a good predictor of which students will chose to work in mental health (Durkin, 2002). Boladeras (2001), at Waikato Institute of Technology, teaches a final semester integrated practice course for student nurses choosing a mental health speciality. Boladeras notes that as the students interact with consumer educators and consumers, they come to recognise that within themselves


Survey found that 65 percent of the 570 New Zealand companies that responded had a written policy on recruitment and selection, while 11 percent had no policy” (Macky and Johnson, 2003, p. 212). Focussing on a mental health workforce analyses carried out in other parts of the world suggests that there is a dearth internationally of literature in this area (Wells, Ryan & McElwee, 2000). It appears that strategic human resource practice input is of benefit in recruiting mental health staff (Hall & Hall, 2002). Therefore, in this review material with a mental health focus is linked with the HR management literature, to allow a cross-disciplinary vantage point. It appears that recruitment to the mental health workforce in New Zealand has not been well coordinated and is often likened to having a ‘shotgun’ approach to recruitment issues. ‘Moving Forward’ (Ministry of Health, 1997) recognised that mental health workforce development in New Zealand had been neglected which has led to major deficiencies in skills. A clear picture of the mental health workforce in New Zealand is currently not available, although the project team has tried to describe it in this document from a number of sources. Recruitment strategies are often based on local needs and regularly take no account of the impact on the region or country as a whole. Recruitment has often relied on attracting suitably skilled talent from overseas. Due to an international shortage of mental health workers, (11 percent of consultant psychiatrists post in the U.K. are unfilled, Royal College of Psychiatrists, 2004), this talent pool has been greatly reduced and has resulted in many countries placing embargoes on offshore recruiting (for example Canada). New Zealand, therefore, needs to respond to these challenges by creating and using coordinated strategies that lead to recruitment, development and retention of suitably skilled people to work within the New Zealand context.

Recruitment, training and competencies

There seems to be general acknowledgement that it is difficult to ‘sell’ mental health nursing as a career. Hazelton (2000) notes that “we need to identify teaching and learning approaches and course designs, which will capture the imaginations of students and directly influence decisions to enter mental health nursing at the point of graduation” (p. 99). A new campaign is underway in Australia and New Zealand that attempts to change perceptions of nursing and highlight and enhance the opportunities within nursing (Johnson & Johnson, 2003). This campaign could act as a blueprint for similar campaigns in New Zealand as part of a national recruitment strategy in mental health. Prebble (2001) proposes that mental health nursing is a distinct code of practice that requires speciality undergraduate preparation with at least three to 4 years of specialised training. Prebble recognises that the modern comprehensive nursing programme has improved the nursing workforce but that is has minimalised and marginalised mental health nursing in the process. There seems to be an expectation that those students who are interested in mental health will do their undergraduate training and then move to post-graduate mental health training. Yet in Australia, where the system is similar, this has not been found to be the case (Happell, 1999). At a forum of mental health nurses convened by the Ministry of Health (New Zealand) in 2000 it was concluded that the mental health component of general undergraduate nursing programmes was not adequate to equip nurses to work in this area. It would seem important therefore that increasing the amount and quality of mental health nurse training is critical. Research overseas has shown that ‘perceived level of competence’ (discussed later) is a good predictor of which students will chose to work in mental health (Durkin, 2002). Boladeras (2001), at Waikato Institute of Technology, teaches a final semester integrated practice course for student nurses choosing a mental health speciality. Boladeras notes that as the students interact with consumer educators and consumers, they come to recognise that within themselves


they have the resources to work with consumers, and feel hopeful and empowered about making change. Training that increases this sense of knowledge and competence therefore, has the potential to increase the level of recruitment into mental health nursing. Along with this, Prebble notes that the quality and visibility of the mental health component in nurse training appears to be dependent upon the personal qualities of one, or two, teachers. It appears that reassessing mental health nursing education could have a beneficial impact on recruiting mental health staff. As well as creating innovative programmes, educators can act as positive role models and advocates for work in mental health settings (Durkin, 2002). Particular teaching methods used are also of importance, with some evidence showing that problem-based learning can positively influence student attitudes towards psychiatric nursing (Durkin, 2002). The selection of sites for attaining clinical experience and the roles of staff in those settings are critical in creating a positive attitude in students to working in mental health. Durkin (2002) notes some positive experiences that lead to greater likelihood of recruitment:

• Attendance at team conferences led by a psychiatrist;

• Having an opportunity to interact one-on-one with clients;

• Having an opportunity to interact with clients dealing with a range of issues;

• Experiencing the milieu; and

• Attending activities with clients. The author also identified negative experiences that tended to reduce students interest in mental health as a career:

• Negative interactions amongst staff;

• Negative interactions between staff and clients, and limited interactions between staff and clients;

• Negative attitudes towards students by staff; and

• Lack of welcome from staff and uncertainty about staff expectations of students. In the U.K. a study reviewing student nurse perceptions of courses and their likelihood of working in the National Health Service (NHS), found that age and level of preparation were the main predictors of nurses choosing to work in the NHS as mental health nurses (Murrells & Robinson, 1999). Older students were more likely to stay and students needed to perceive that they had the personal capabilities to work effectively in the mental health sector. Arnold et al. (2003) carried out a study to determine the attractiveness of the NHS as a potential employer for nurses and found very similar results. A series of recommendations they suggest for nurse recruitment are very similar to others outlined in detail later in this section. Only one article was found that was specifically related to the recruitment of clinical psychologists (Ashcroft & Turpin, 1994) despite evidence of a shortage of clinical psychologists in many countries. Many aspects of the shortage of clinical psychologists in the U.K. (Ashcroft & Turpin, 1994) appear to be similar to the situation in New Zealand. In the U.K. one limitation to the number of clinical psychologists is the lack of training resources. There are few faculty staff available to supervise trainees and there is a shortage of internship and placement positions. From anecdotal evidence here in New Zealand a similar situation seems to exist. At several universities only 10-12 trainees are accepted into courses each year from up to 80 applicants per course, with 20 or so at a time who, on paper, would be appropriate for the job. Again anecdotally there appears to be a heavy leaning toward choosing trainees who have particular interest in research rather than practice as such. This maybe a reflection both of the


they have the resources to work with consumers, and feel hopeful and empowered about making change. Training that increases this sense of knowledge and competence therefore, has the potential to increase the level of recruitment into mental health nursing. Along with this, Prebble notes that the quality and visibility of the mental health component in nurse training appears to be dependent upon the personal qualities of one, or two, teachers. It appears that reassessing mental health nursing education could have a beneficial impact on recruiting mental health staff. As well as creating innovative programmes, educators can act as positive role models and advocates for work in mental health settings (Durkin, 2002). Particular teaching methods used are also of importance, with some evidence showing that problem-based learning can positively influence student attitudes towards psychiatric nursing (Durkin, 2002). The selection of sites for attaining clinical experience and the roles of staff in those settings are critical in creating a positive attitude in students to working in mental health. Durkin (2002) notes some positive experiences that lead to greater likelihood of recruitment:

• Attendance at team conferences led by a psychiatrist;

• Having an opportunity to interact one-on-one with clients;

• Having an opportunity to interact with clients dealing with a range of issues;

• Experiencing the milieu; and

• Attending activities with clients. The author also identified negative experiences that tended to reduce students interest in mental health as a career:

• Negative interactions amongst staff;

• Negative interactions between staff and clients, and limited interactions between staff and clients;

• Negative attitudes towards students by staff; and

• Lack of welcome from staff and uncertainty about staff expectations of students. In the U.K. a study reviewing student nurse perceptions of courses and their likelihood of working in the National Health Service (NHS), found that age and level of preparation were the main predictors of nurses choosing to work in the NHS as mental health nurses (Murrells & Robinson, 1999). Older students were more likely to stay and students needed to perceive that they had the personal capabilities to work effectively in the mental health sector. Arnold et al. (2003) carried out a study to determine the attractiveness of the NHS as a potential employer for nurses and found very similar results. A series of recommendations they suggest for nurse recruitment are very similar to others outlined in detail later in this section. Only one article was found that was specifically related to the recruitment of clinical psychologists (Ashcroft & Turpin, 1994) despite evidence of a shortage of clinical psychologists in many countries. Many aspects of the shortage of clinical psychologists in the U.K. (Ashcroft & Turpin, 1994) appear to be similar to the situation in New Zealand. In the U.K. one limitation to the number of clinical psychologists is the lack of training resources. There are few faculty staff available to supervise trainees and there is a shortage of internship and placement positions. From anecdotal evidence here in New Zealand a similar situation seems to exist. At several universities only 10-12 trainees are accepted into courses each year from up to 80 applicants per course, with 20 or so at a time who, on paper, would be appropriate for the job. Again anecdotally there appears to be a heavy leaning toward choosing trainees who have particular interest in research rather than practice as such. This maybe a reflection both of the


politics of education in New Zealand but also of the international recognition of an increasing need for recruiting and retaining physician scientists (Kupfer et al., 2002). Ashcroft and Turpin (1994) also found that recruitment of staff to training institutions was difficult with many positions being filled by very young psychologists with little clinical experience. They saw a need to increase pay and benefits to attract senior faculty who were experienced and enthusiastic about working in the public mental health system. A literature review of career decision making by doctors (American Medical Workforce Advisory Committee, 2002) found that the most important factors in determining choice of career were mentors/significant others, hours and conditions of work and stress. For female doctors job flexibility and part-time work were also important. These findings highlight the importance of mentoring and the possibility of more formal programmes being introduced in medical schools to attract students to psychiatry. The time when young doctors are most likely to make a decision about future careers is in their house officer/PGY 1 and two years. At present in New Zealand these doctors are able to work in psychiatry but paradoxically their role is to provide basic physical care usually on inpatient wards. A study by Hargrove, Fox and Goldman (1991) looked at the perceptions of public sector work amongst students at tertiary institutions studying for careers in the mental health area. They found that public service is not perceived by students as an attractive place to work and are more likely to go into private practice. Those who do choose public sector jobs after graduating often do so merely to gain experience and a personal profile. The authors suggest that a situation arises where “temporary mental health workers coexist with work-worn veterans” (Hargrove, Fox & Goldman, 1991, p. 200). The other issue they perceive is the lower rates of pay in public service that often leads to good clinicians moving into administrative roles as their only means of earning better incomes. It is also often assumed that good clinicians will make good administrators, which may not be the case. The authors discuss possible solutions under four headings summarised below.

• Availability of opportunity – clinical experience during training must match the areas needing staff (for example experience in a community setting may not lead to someone choosing to work in intensive inpatient units): − A wide range of possible opportunities needs to be made available for students to

experience different aspects of mental health work. The authors note financial incentives that maybe offered for academic programmes that specifically train people for public sector work; and

− The experience during placements must be positive and aimed at breaking down stigma around mental health clientele and the mentally ill generally. Students need to be able to see themselves as capable of working with the seriously mentally ill. In many training programmes this training comes late (e.g., clinical psychology in New Zealand) and could become a feature earlier in undergraduate study.

• Role models: − Academic role models who are enthusiastic, interested and have experience of public

mental health work such that they can enthuse students; and − Faculty have current experience with and knowledge of public mental health facilities.

• Financial support: − People entering the mental health workforce often have several years of pre-

professional training at undergraduate and post-graduate levels. Students may feel pressure to earn and may not see public service as the place to maximise this;

− Funding of training by public mental health system can obligate students to work for the system for a period of time;


politics of education in New Zealand but also of the international recognition of an increasing need for recruiting and retaining physician scientists (Kupfer et al., 2002). Ashcroft and Turpin (1994) also found that recruitment of staff to training institutions was difficult with many positions being filled by very young psychologists with little clinical experience. They saw a need to increase pay and benefits to attract senior faculty who were experienced and enthusiastic about working in the public mental health system. A literature review of career decision making by doctors (American Medical Workforce Advisory Committee, 2002) found that the most important factors in determining choice of career were mentors/significant others, hours and conditions of work and stress. For female doctors job flexibility and part-time work were also important. These findings highlight the importance of mentoring and the possibility of more formal programmes being introduced in medical schools to attract students to psychiatry. The time when young doctors are most likely to make a decision about future careers is in their house officer/PGY 1 and two years. At present in New Zealand these doctors are able to work in psychiatry but paradoxically their role is to provide basic physical care usually on inpatient wards. A study by Hargrove, Fox and Goldman (1991) looked at the perceptions of public sector work amongst students at tertiary institutions studying for careers in the mental health area. They found that public service is not perceived by students as an attractive place to work and are more likely to go into private practice. Those who do choose public sector jobs after graduating often do so merely to gain experience and a personal profile. The authors suggest that a situation arises where “temporary mental health workers coexist with work-worn veterans” (Hargrove, Fox & Goldman, 1991, p. 200). The other issue they perceive is the lower rates of pay in public service that often leads to good clinicians moving into administrative roles as their only means of earning better incomes. It is also often assumed that good clinicians will make good administrators, which may not be the case. The authors discuss possible solutions under four headings summarised below.

• Availability of opportunity – clinical experience during training must match the areas needing staff (for example experience in a community setting may not lead to someone choosing to work in intensive inpatient units): − A wide range of possible opportunities needs to be made available for students to

experience different aspects of mental health work. The authors note financial incentives that maybe offered for academic programmes that specifically train people for public sector work; and

− The experience during placements must be positive and aimed at breaking down stigma around mental health clientele and the mentally ill generally. Students need to be able to see themselves as capable of working with the seriously mentally ill. In many training programmes this training comes late (e.g., clinical psychology in New Zealand) and could become a feature earlier in undergraduate study.

• Role models: − Academic role models who are enthusiastic, interested and have experience of public

mental health work such that they can enthuse students; and − Faculty have current experience with and knowledge of public mental health facilities.

• Financial support: − People entering the mental health workforce often have several years of pre-

professional training at undergraduate and post-graduate levels. Students may feel pressure to earn and may not see public service as the place to maximise this;

− Funding of training by public mental health system can obligate students to work for the system for a period of time;


− Without funding only students who can afford training are likely to complete professional training – these people are less likely to stay in public service;

− By financing training, the public mental health system can materialise it’s value system; and

− By financing research the public mental health system can further materialise it’s values and guide faculty development in directions suitable to the public sector.

• Peer support: − The fostering of peer groups working in similar areas is more likely to promote mutual

involvement and experience that will be harder for trainees to break away from.

Recruitment and pay

The World Health Organisation document ‘Imbalances in the health workforce. Briefing paper’ (Zurn, Dal Poz, Stilwell & Adams, 2002), provides a review of the effect of increasing wages on nursing participation in the health workforce. The studies reviewed showed a positive correlation, albeit not strong, between nurse’s wages and participation in the labour market.

Recruitment and organisational “attractiveness”

Several authors point to the importance of creating effective and attractive organisations in promoting recruitment rates (Covey, 2003; Sloane, 2003; Jardine & Amig, 2001; Lambert, 2003; Barney, 2002). A series of solutions to the problem of recruitment is offered in the Healthcare Review (2004):

• Brand the hospital as a great place to work. Advertising should emphasise workplace benefits, the quality and types of care given, and the quality of the caregivers already in place;

• Employers drive future image of nurses. Employers, educational institutions and national policy bodies should have a coordinated strategy that creates a positive image of nursing for teens and their families. However, employers should begin to adopt a ‘grow their own’ policy, attracting young people through promotion and such means as scholarships and internships;

• Retain, retain, retain. “….retention is your best recruitment strategy” (p. 10) (see also Reilly, 2003); and

• Do not sacrifice a good fit for a quick fix. The importance of creating an organisation that recognises staff achievements, provides training and career guidance, and promotes personal development of staff is a recurring theme in many of the studies reviewed. Many also note, in some form that, “to achieve worthwhile results, (the issue of) recruiting and retaining good employees should be treated the same way” (Gering & Conner, 2002). The Sainsbury Centre for Mental Health summarises the link between recruiting and retention in Figure 1 (Sainsbury Centre for Mental Health, 2000).


− Without funding only students who can afford training are likely to complete professional training – these people are less likely to stay in public service;

− By financing training, the public mental health system can materialise it’s value system; and

− By financing research the public mental health system can further materialise it’s values and guide faculty development in directions suitable to the public sector.

• Peer support: − The fostering of peer groups working in similar areas is more likely to promote mutual

involvement and experience that will be harder for trainees to break away from.

Recruitment and pay

The World Health Organisation document ‘Imbalances in the health workforce. Briefing paper’ (Zurn, Dal Poz, Stilwell & Adams, 2002), provides a review of the effect of increasing wages on nursing participation in the health workforce. The studies reviewed showed a positive correlation, albeit not strong, between nurse’s wages and participation in the labour market.

Recruitment and organisational “attractiveness”

Several authors point to the importance of creating effective and attractive organisations in promoting recruitment rates (Covey, 2003; Sloane, 2003; Jardine & Amig, 2001; Lambert, 2003; Barney, 2002). A series of solutions to the problem of recruitment is offered in the Healthcare Review (2004):

• Brand the hospital as a great place to work. Advertising should emphasise workplace benefits, the quality and types of care given, and the quality of the caregivers already in place;

• Employers drive future image of nurses. Employers, educational institutions and national policy bodies should have a coordinated strategy that creates a positive image of nursing for teens and their families. However, employers should begin to adopt a ‘grow their own’ policy, attracting young people through promotion and such means as scholarships and internships;

• Retain, retain, retain. “….retention is your best recruitment strategy” (p. 10) (see also Reilly, 2003); and

• Do not sacrifice a good fit for a quick fix. The importance of creating an organisation that recognises staff achievements, provides training and career guidance, and promotes personal development of staff is a recurring theme in many of the studies reviewed. Many also note, in some form that, “to achieve worthwhile results, (the issue of) recruiting and retaining good employees should be treated the same way” (Gering & Conner, 2002). The Sainsbury Centre for Mental Health summarises the link between recruiting and retention in Figure 1 (Sainsbury Centre for Mental Health, 2000).


Figure 1. The cycle of staffing frustration.

The Sainsbury model links the various issues researchers identified when investigating severe difficulties faced by U.K. mental health services in recruiting and retaining staff. They saw potential for targeting recruitment and training initiatives to older people, women returning to the workforce after a career break, young people making training choices, and people who are considering retraining in mid-career. Incentives they considered for targeting these groups are:

• Making flexible working options available;

• Making pension schemes more flexible (i.e., not based on last 3 years income); and

• Targeting mental health work information early at people making training choices. An important aspect of the Sainsbury Centre report (2000) was the conducting of focus groups with staff in a range of mental health services to discover the incentives and disincentives to working in this sector. Staff expressed concerns about the general perception that their work was low status and poorly paid, that roles were often not clear, and professional autonomy was being undermined in some areas. They felt that one of the best aspects of their jobs was the opportunity to work with high calibre colleagues in a multi-disciplinary setting. Recommendations from the report are very similar to those outlined from other studies. The report particularly emphasised the need to include HR strategy at the heart of all organisational strategies, with HR acting as the interface between staff and their employers. They note that “HR departments still occupy a peripheral place in some mental health services. HR strategy must be built into the wider organisational strategy as a component part rather than as an added extra” (p. 5). Werrbach and DePoy (1993) summarise literature on aspects of social work and social workers and suggest that social workers “…experience a high degree of job stress and a low degree of external reward for their job tasks …yet most social workers derive satisfaction from the significance of their job tasks and the potential for professional growth” (p. 308). The authors piloted an instrument designed to ascertain student perceptions about aspects of working with the mentally ill in community-based settings, and the importance of organisational attributes that are characteristic of such settings to future job satisfaction. Results indicated that graduate students appeared to be more flexible and comfortable with unusual work settings and found difficult aspects of working with mentally ill to be challenging rather than deterrents. The


Figure 1. The cycle of staffing frustration.

The Sainsbury model links the various issues researchers identified when investigating severe difficulties faced by U.K. mental health services in recruiting and retaining staff. They saw potential for targeting recruitment and training initiatives to older people, women returning to the workforce after a career break, young people making training choices, and people who are considering retraining in mid-career. Incentives they considered for targeting these groups are:

• Making flexible working options available;

• Making pension schemes more flexible (i.e., not based on last 3 years income); and

• Targeting mental health work information early at people making training choices. An important aspect of the Sainsbury Centre report (2000) was the conducting of focus groups with staff in a range of mental health services to discover the incentives and disincentives to working in this sector. Staff expressed concerns about the general perception that their work was low status and poorly paid, that roles were often not clear, and professional autonomy was being undermined in some areas. They felt that one of the best aspects of their jobs was the opportunity to work with high calibre colleagues in a multi-disciplinary setting. Recommendations from the report are very similar to those outlined from other studies. The report particularly emphasised the need to include HR strategy at the heart of all organisational strategies, with HR acting as the interface between staff and their employers. They note that “HR departments still occupy a peripheral place in some mental health services. HR strategy must be built into the wider organisational strategy as a component part rather than as an added extra” (p. 5). Werrbach and DePoy (1993) summarise literature on aspects of social work and social workers and suggest that social workers “…experience a high degree of job stress and a low degree of external reward for their job tasks …yet most social workers derive satisfaction from the significance of their job tasks and the potential for professional growth” (p. 308). The authors piloted an instrument designed to ascertain student perceptions about aspects of working with the mentally ill in community-based settings, and the importance of organisational attributes that are characteristic of such settings to future job satisfaction. Results indicated that graduate students appeared to be more flexible and comfortable with unusual work settings and found difficult aspects of working with mentally ill to be challenging rather than deterrents. The


authors suggest the need to understand and develop the aspects of graduate training that promote flexibility so that it can be enhanced at undergraduate and graduate levels. The authors also found that students with previous experience of working with mentally ill people were much more tolerant of ambiguous feedback from them. They were still able to feel they were making a difference regardless of that feedback. Experienced students rated salary, varied job responsibility, fringe benefits and regular supervision more highly than those without experience. Wanting to work with the seriously mentally ill was also highly correlated with the placing of greater importance on continuing education and on the opportunity to work alone or alone with client groups (Werrbach & DePoy, 1993). When recruiting from these groups of students, therefore, salary and fringe benefits are not of primary concern. What needs to be highlighted is the availability of education, in-service programmes, training, supervision and the opportunity to have input into the structure of their work. Other authors have found similar needs when investigating ways to recruit and retain nurses (McGuire et al., 2003; Tuttas, 2002).

Recruitment and stigma

One of the barriers to recruitment of mental health workers is the stigma attached to working in mental health by portrayals of the mentally ill in the media and from the politicisation of mental health (Mental Health Workforce Development Coordinating Committee, 1999). People, it seems, have been put off entering the mental health field because of these negative portrayals. In fact, in the U.K. a new recruitment drive for mental health nurses has developed in response to the “the failure of care in the community” and in response to “concern over crimes committed by people with serious psychiatric illness” (Doult & Stephen, 1998). In looking at the barriers to recruitment, Happell (1999) carried out a study in Victoria, Australia, looking at the relative desirability of various options for nursing students. Using a questionnaire, commencing undergraduate nursing students were asked to rank nine areas of nursing speciality. Psychiatric nursing emerged as the second least popular choice, only just ranking above geriatric nursing. The author suggests that there maybe many factors that keep people from making the mental health field their career choice. The following are reasons undergraduate nurses cited for not making psychiatric nursing their first choice:

• Lack of knowledge, lack of belief in personal attributes or experience as being applicable;

• Negative attitudes towards the mentally ill (e.g., “their situation is hopeless”);

• Negative attitudes about working environments in mental health;

• Fear and discomfort with the mentally ill; and

• Working with the mentally ill is sad, depressing and/or stressful. What was of interest in the Happell (1999) study was that there seemed to be a greater preference for males to psychiatric nursing than females. It would appear that targeting males might be a useful recruitment strategy. This is one strategy being adopted in the U.S. where the benefits of nursing are being promoted to men by hospital recruiters. Better pay, ample jobs, career mobility and the ‘rigorous’ nature of the job have been suggested as incentives. Overseas the number of males in nursing has doubled to 5 percent since 1980, and men are 8 percent of the total number of students in nursing programmes at present. Mariolis and Picard (2002) report on an innovative programme on a state college campus in Massachusetts, U.S. The Quality of Life and Wellness Programme (QLWP) was designed to allow junior nursing students to work with mental health clients in a mutually beneficial relationship. During a two-hour contact on campus, the first hour was informal, allowing clients to engage in social activity with students while the second hour was designated for a structured group session run by students in consultation with supervisors. Clients experienced a number of


authors suggest the need to understand and develop the aspects of graduate training that promote flexibility so that it can be enhanced at undergraduate and graduate levels. The authors also found that students with previous experience of working with mentally ill people were much more tolerant of ambiguous feedback from them. They were still able to feel they were making a difference regardless of that feedback. Experienced students rated salary, varied job responsibility, fringe benefits and regular supervision more highly than those without experience. Wanting to work with the seriously mentally ill was also highly correlated with the placing of greater importance on continuing education and on the opportunity to work alone or alone with client groups (Werrbach & DePoy, 1993). When recruiting from these groups of students, therefore, salary and fringe benefits are not of primary concern. What needs to be highlighted is the availability of education, in-service programmes, training, supervision and the opportunity to have input into the structure of their work. Other authors have found similar needs when investigating ways to recruit and retain nurses (McGuire et al., 2003; Tuttas, 2002).

Recruitment and stigma

One of the barriers to recruitment of mental health workers is the stigma attached to working in mental health by portrayals of the mentally ill in the media and from the politicisation of mental health (Mental Health Workforce Development Coordinating Committee, 1999). People, it seems, have been put off entering the mental health field because of these negative portrayals. In fact, in the U.K. a new recruitment drive for mental health nurses has developed in response to the “the failure of care in the community” and in response to “concern over crimes committed by people with serious psychiatric illness” (Doult & Stephen, 1998). In looking at the barriers to recruitment, Happell (1999) carried out a study in Victoria, Australia, looking at the relative desirability of various options for nursing students. Using a questionnaire, commencing undergraduate nursing students were asked to rank nine areas of nursing speciality. Psychiatric nursing emerged as the second least popular choice, only just ranking above geriatric nursing. The author suggests that there maybe many factors that keep people from making the mental health field their career choice. The following are reasons undergraduate nurses cited for not making psychiatric nursing their first choice:

• Lack of knowledge, lack of belief in personal attributes or experience as being applicable;

• Negative attitudes towards the mentally ill (e.g., “their situation is hopeless”);

• Negative attitudes about working environments in mental health;

• Fear and discomfort with the mentally ill; and

• Working with the mentally ill is sad, depressing and/or stressful. What was of interest in the Happell (1999) study was that there seemed to be a greater preference for males to psychiatric nursing than females. It would appear that targeting males might be a useful recruitment strategy. This is one strategy being adopted in the U.S. where the benefits of nursing are being promoted to men by hospital recruiters. Better pay, ample jobs, career mobility and the ‘rigorous’ nature of the job have been suggested as incentives. Overseas the number of males in nursing has doubled to 5 percent since 1980, and men are 8 percent of the total number of students in nursing programmes at present. Mariolis and Picard (2002) report on an innovative programme on a state college campus in Massachusetts, U.S. The Quality of Life and Wellness Programme (QLWP) was designed to allow junior nursing students to work with mental health clients in a mutually beneficial relationship. During a two-hour contact on campus, the first hour was informal, allowing clients to engage in social activity with students while the second hour was designated for a structured group session run by students in consultation with supervisors. Clients experienced a number of


benefits, but more importantly for this review, students noted that they felt significantly less fearful in working with clients in the programme than with inpatients they were assigned on a separate clinical day. They also reported more willingness to take risks and be more proactive in their nursing care (Mariolis & Picard, 2002). The authors note the importance of, but also the difficulty in, finding placements for students in psychiatric settings. Students were often forced to observe staff-client interactions without the feeling of playing a significant part. Martin and Happell (2001), and Rushworth and Happell (2000), note the importance of education and positive placements in increasing the positive perceptions of working in mental health for nurse trainees.

In a study of psychiatric nursing in Ireland a decline was noted in recruitment to nursing programmes at the same time as social work diploma and degree programmes are being over subscribed (Wells, Ryan & McElwee, 2000). These differences existed despite the fact that social workers often do similar psychosocial work with similar client groups, yet were often paid less. The researchers carried out a pilot study with focus groups to ascertain reasons for course and career choices among school leavers, psychiatric nursing students and social care students. Results indicated that students were relying on stereotypical views of mental health as part of their choice-making process. The most significant factors in the students decision-making were the degree of perceived preparation necessary to work with mentally ill patients, obtaining a good job after study and the opportunities offered by the course to broaden their education. Interestingly, the fact that a chosen career had a high rate of unemployment often did not affect the choice they made. It appears that the student's worldview of occupations and the opportunity structure available to them in terms of family background and exposure to different careers were the most significant determinants of career choice. In other words, what they saw on television and the movies, what their parents said about careers and where they worked, what school teachers and guidance counsellors said, and what their friends said about and chose as careers, were all part of the choice making process. Wells, Ryan and McElwee (2000) cite other research that showed that students who completed psychiatric nursing electives had more positive attitudes than those who did not. They suggest that college work experience schemes may therefore operate as an effective means of increasing recruitment to psychiatric nursing. This supports the findings from the QLWP study discussed earlier. The researchers note that it is important to sample students at the actual time of decision-making. In this way inaccurate recall is remedied and those who make a negative choice are sampled as well as those who make a positive choice. A study of the attitudes of New Zealand school students towards working in mental health occupations and how this maybe influenced by the attitudes of parents, peers, media and professionals such as teachers and school career guidance counsellors, could be useful to the issue of recruitment and retention. According to Wells, Ryan and McElwee (2000), recruitment campaigns for nursing tend to fall back on traditional stereotypes and fail to highlight new and exciting career opportunities available due to extensive changes in the profession. This could well be the case in New Zealand; our constantly changing health services may portray a negative picture rather than one of increased opportunity. Several themes arose regarding perceptions of working in mental health from participants involved in the focus group part of the Wells, Ryan and McElwee (2000) study:

• Students felt their family were disappointed if they indicated a preference for working in mental health;

• Students in psychiatric nursing felt a negative attitude from their general nursing peers and from outsiders who thought psychiatric nursing was not real nursing;


benefits, but more importantly for this review, students noted that they felt significantly less fearful in working with clients in the programme than with inpatients they were assigned on a separate clinical day. They also reported more willingness to take risks and be more proactive in their nursing care (Mariolis & Picard, 2002). The authors note the importance of, but also the difficulty in, finding placements for students in psychiatric settings. Students were often forced to observe staff-client interactions without the feeling of playing a significant part. Martin and Happell (2001), and Rushworth and Happell (2000), note the importance of education and positive placements in increasing the positive perceptions of working in mental health for nurse trainees.

In a study of psychiatric nursing in Ireland a decline was noted in recruitment to nursing programmes at the same time as social work diploma and degree programmes are being over subscribed (Wells, Ryan & McElwee, 2000). These differences existed despite the fact that social workers often do similar psychosocial work with similar client groups, yet were often paid less. The researchers carried out a pilot study with focus groups to ascertain reasons for course and career choices among school leavers, psychiatric nursing students and social care students. Results indicated that students were relying on stereotypical views of mental health as part of their choice-making process. The most significant factors in the students decision-making were the degree of perceived preparation necessary to work with mentally ill patients, obtaining a good job after study and the opportunities offered by the course to broaden their education. Interestingly, the fact that a chosen career had a high rate of unemployment often did not affect the choice they made. It appears that the student's worldview of occupations and the opportunity structure available to them in terms of family background and exposure to different careers were the most significant determinants of career choice. In other words, what they saw on television and the movies, what their parents said about careers and where they worked, what school teachers and guidance counsellors said, and what their friends said about and chose as careers, were all part of the choice making process. Wells, Ryan and McElwee (2000) cite other research that showed that students who completed psychiatric nursing electives had more positive attitudes than those who did not. They suggest that college work experience schemes may therefore operate as an effective means of increasing recruitment to psychiatric nursing. This supports the findings from the QLWP study discussed earlier. The researchers note that it is important to sample students at the actual time of decision-making. In this way inaccurate recall is remedied and those who make a negative choice are sampled as well as those who make a positive choice. A study of the attitudes of New Zealand school students towards working in mental health occupations and how this maybe influenced by the attitudes of parents, peers, media and professionals such as teachers and school career guidance counsellors, could be useful to the issue of recruitment and retention. According to Wells, Ryan and McElwee (2000), recruitment campaigns for nursing tend to fall back on traditional stereotypes and fail to highlight new and exciting career opportunities available due to extensive changes in the profession. This could well be the case in New Zealand; our constantly changing health services may portray a negative picture rather than one of increased opportunity. Several themes arose regarding perceptions of working in mental health from participants involved in the focus group part of the Wells, Ryan and McElwee (2000) study:

• Students felt their family were disappointed if they indicated a preference for working in mental health;

• Students in psychiatric nursing felt a negative attitude from their general nursing peers and from outsiders who thought psychiatric nursing was not real nursing;


• Social care workers also felt a lack of appreciation of their work from other professionals;

• Psychiatric nursing was often seen as largely menial (for example “they wipe backsides”);

• Students often expressed negative stereotypical views of the mentally ill (for example “I couldn’t cope going into a place with people ranting and raving”); and

• Even when attempting to be positive a negative qualification is included (for example “People in psychiatric hospitals are not all bad”).

Career guidance in schools tended to:

• Not give psychiatric nursing a profile, but focussed on general nursing;

• Not give support to students who indicated a preference for social work or psychiatric nursing; and

• Not give a satisfactory range of job opportunities (e.g., “We only ever get told about ‘happy jobs’-like hair dressing”) (Wells, Ryan & McElwee, 2000).

Choice and motivation themes included:

• Students felt that media coverage of mental health issues portrayed a very negative image that would put students off;

• Students who did choose to work in mental health often had family or friends involved or had some form of work experience;

• Many students did not see scholarship money as being a big influence on their choice of career, rather it was more important that their course of study was ranked with other degree programmes. They saw themselves as being important, “more than just a number”;

• Social care students did not rate psychiatric services very highly; such an attitude did not aid recruitment into the area or further sound interactions between different staff within organisations. Such factionalism would be a huge hindrance to recruitment;

• Being content and making a proactive contribution was seen as significant motivation; and

• Some students did not feel they had the right personal characteristics (Wells, Ryan & McElwee, 2000).

Many of these themes suggest areas for further research in the New Zealand context. Many also point to possible means of increasing recruitment through the reduction in perceived barriers both personal and social.

Descriptions of recruitment initiatives in the academic literature

Mental health recruitment literature indicates that there is an uncoordinated approach to mental health recruitment. Rather individual organisations and individual workforce groups have developed strategies of their own for recruitment and retention. This section of the literature review presents relevant material from various studies that could be useful in developing a coordinated recruitment strategy in New Zealand. The Law and Mental Health (LAMH) programme at the Centre for Addiction and Mental Health in Toronto, Canada, is extending programmes into the forensic sector so that offenders suffering mental illness have access to mental health systems for assessment, treatment and rehabilitation. In the process they have developed what they see as a successful model for recruitment and retention (Pullan & Lorbergs, 2001). This model was based on recruitment of psychiatric nurses in an environment of intense competition for nurses, when forensic nursing was perceived to be of low status and lacking glamour.


• Social care workers also felt a lack of appreciation of their work from other professionals;

• Psychiatric nursing was often seen as largely menial (for example “they wipe backsides”);

• Students often expressed negative stereotypical views of the mentally ill (for example “I couldn’t cope going into a place with people ranting and raving”); and

• Even when attempting to be positive a negative qualification is included (for example “People in psychiatric hospitals are not all bad”).

Career guidance in schools tended to:

• Not give psychiatric nursing a profile, but focussed on general nursing;

• Not give support to students who indicated a preference for social work or psychiatric nursing; and

• Not give a satisfactory range of job opportunities (e.g., “We only ever get told about ‘happy jobs’-like hair dressing”) (Wells, Ryan & McElwee, 2000).

Choice and motivation themes included:

• Students felt that media coverage of mental health issues portrayed a very negative image that would put students off;

• Students who did choose to work in mental health often had family or friends involved or had some form of work experience;

• Many students did not see scholarship money as being a big influence on their choice of career, rather it was more important that their course of study was ranked with other degree programmes. They saw themselves as being important, “more than just a number”;

• Social care students did not rate psychiatric services very highly; such an attitude did not aid recruitment into the area or further sound interactions between different staff within organisations. Such factionalism would be a huge hindrance to recruitment;

• Being content and making a proactive contribution was seen as significant motivation; and

• Some students did not feel they had the right personal characteristics (Wells, Ryan & McElwee, 2000).

Many of these themes suggest areas for further research in the New Zealand context. Many also point to possible means of increasing recruitment through the reduction in perceived barriers both personal and social.

Descriptions of recruitment initiatives in the academic literature

Mental health recruitment literature indicates that there is an uncoordinated approach to mental health recruitment. Rather individual organisations and individual workforce groups have developed strategies of their own for recruitment and retention. This section of the literature review presents relevant material from various studies that could be useful in developing a coordinated recruitment strategy in New Zealand. The Law and Mental Health (LAMH) programme at the Centre for Addiction and Mental Health in Toronto, Canada, is extending programmes into the forensic sector so that offenders suffering mental illness have access to mental health systems for assessment, treatment and rehabilitation. In the process they have developed what they see as a successful model for recruitment and retention (Pullan & Lorbergs, 2001). This model was based on recruitment of psychiatric nurses in an environment of intense competition for nurses, when forensic nursing was perceived to be of low status and lacking glamour.


The authors identified the importance of an environment that offers education and clinical opportunities and sensitivity to the “generalised stigma and fears associated with working with this specialised population” (p. 20). They perceived that good career opportunities existed in the field for clinical practice, education and research. They thought that recruitment and retention could be successful if strategies were implemented that integrated the goals and objectives of the organisation with the needs of individual nurses. The LAMH programme implemented a range of recruitment opportunities for external recruiting such as (Pullan & Lorbergs, 2001):

• Attending nursing job fairs in several areas;

• Guest lecturing at colleges and universities;

• Advertising in national and local newspapers;

• Offering student placements within all inpatient units of the LAMH programme;

• Developing a course for a local nursing school that emphasised forensic nursing; and

• Presented papers and posters at international nursing conferences promoting the field of mental health nursing and highlighting career opportunities.

The recruitment strategies used were ongoing and long-term, with the LAMH programme offering extensive orientation and training programmes. The programme developers saw this as an incentive for recruitment and retention. This model was designed for the mass staff recruitment of a complete unit. However, the authors suggest that with modification it could be an effective model for ongoing recruitment and retention in healthcare generally. The model included a well-formulated staff selection process and a comprehensive training and orientation programme covering all clinical staff. The model was phased, with the first phase involving a complete review of the goals, objectives, culture and philosophy of the organisation. The mandate of the overall forensic programme, as well as the mandate of particular units, was articulated and characteristics of forensic nurses clearly identified. When selected, all staff were evaluated for their strengths and areas needing development. The orientation and training programme incorporated lectures, group work, role -playing, case studies, presentations and hands on exercises. Presenters of and participants in the programme consisted of people from all areas involved in LAMH including forensic programme staff, management, forensic mental health experts and mental health experts, frontline forensic staff, external stakeholders and other hospital staff. In a review evaluating long-term outcomes and benefits, the investment of time and money in the recruitment and training phase was found to be critical to the programmes success (Pullan and Lorbergs, 2001). The evaluation findings indicate that the model promoted staff empowerment because staff were able to partic ipate in programme planning, development of policies and procedures, and in the development and facilitation of clinical programmes. An atmosphere of supportive learning was created that began at training and orientation, and was incorporated into daily operations. Staff empowerment and recognition were intrinsic to the model and the model has promoted staff satisfaction, identified areas for continuous staff development and supported participation in decision-making. These factors made for a work environment that fostered recruitment and promoted retention efforts. Five years after a mass recruitment into the new programme, 50 percent of registered nurses and 80 percent of registered practical nurses remained. Many of those who had moved on have done so within the LAMH organisation (Pullan & Lorbergs, 2001). In the U.S., Johnson and Johnson (2004) funded a recruitment campaign aimed at reducing the shortage of general nurses. According to a new progress report entitled ‘Healing the Crisis in


The authors identified the importance of an environment that offers education and clinical opportunities and sensitivity to the “generalised stigma and fears associated with working with this specialised population” (p. 20). They perceived that good career opportunities existed in the field for clinical practice, education and research. They thought that recruitment and retention could be successful if strategies were implemented that integrated the goals and objectives of the organisation with the needs of individual nurses. The LAMH programme implemented a range of recruitment opportunities for external recruiting such as (Pullan & Lorbergs, 2001):

• Attending nursing job fairs in several areas;

• Guest lecturing at colleges and universities;

• Advertising in national and local newspapers;

• Offering student placements within all inpatient units of the LAMH programme;

• Developing a course for a local nursing school that emphasised forensic nursing; and

• Presented papers and posters at international nursing conferences promoting the field of mental health nursing and highlighting career opportunities.

The recruitment strategies used were ongoing and long-term, with the LAMH programme offering extensive orientation and training programmes. The programme developers saw this as an incentive for recruitment and retention. This model was designed for the mass staff recruitment of a complete unit. However, the authors suggest that with modification it could be an effective model for ongoing recruitment and retention in healthcare generally. The model included a well-formulated staff selection process and a comprehensive training and orientation programme covering all clinical staff. The model was phased, with the first phase involving a complete review of the goals, objectives, culture and philosophy of the organisation. The mandate of the overall forensic programme, as well as the mandate of particular units, was articulated and characteristics of forensic nurses clearly identified. When selected, all staff were evaluated for their strengths and areas needing development. The orientation and training programme incorporated lectures, group work, role -playing, case studies, presentations and hands on exercises. Presenters of and participants in the programme consisted of people from all areas involved in LAMH including forensic programme staff, management, forensic mental health experts and mental health experts, frontline forensic staff, external stakeholders and other hospital staff. In a review evaluating long-term outcomes and benefits, the investment of time and money in the recruitment and training phase was found to be critical to the programmes success (Pullan and Lorbergs, 2001). The evaluation findings indicate that the model promoted staff empowerment because staff were able to partic ipate in programme planning, development of policies and procedures, and in the development and facilitation of clinical programmes. An atmosphere of supportive learning was created that began at training and orientation, and was incorporated into daily operations. Staff empowerment and recognition were intrinsic to the model and the model has promoted staff satisfaction, identified areas for continuous staff development and supported participation in decision-making. These factors made for a work environment that fostered recruitment and promoted retention efforts. Five years after a mass recruitment into the new programme, 50 percent of registered nurses and 80 percent of registered practical nurses remained. Many of those who had moved on have done so within the LAMH organisation (Pullan & Lorbergs, 2001). In the U.S., Johnson and Johnson (2004) funded a recruitment campaign aimed at reducing the shortage of general nurses. According to a new progress report entitled ‘Healing the Crisis in


Nursing’, issued by the company, 84 percent of nursing schools have experienced an increase in applications and enrolments. Issued in conjunction with the first anniversary of ‘The Campaign for Nursing’s Future’, Johnson and Johnson's multi-year campaign to attract more people to the nursing profession in hospitals and extended care facilities. This new report found a major shift in public attitudes toward the nursing profession. Survey findings showing that 55 percent of teens aged 16-18 years have personally considered a career in nursing or know someone who has. While another 67 percent would view very positively the news that a family member or friend was considering a career in nursing and amongst adults 75 percent shared this view (Johnson & Johnson, 2004). These findings come one year after implementation of the programme when the profile of nursing was “off the radar screen”. Gorgos (2004) also notes that a website dedicated to nursing information (www.discovering nursing.com) received more than 9 million page visits. As part of the campaign (“Celebration of Nursing”) more than $3 million was raised towards undergraduate student scholarships, nurse educator fellowships and faculty development grants (Gorgos, 2004). In a recent student survey, out of 68 potential options, nursing scored number four within the top five career choices, just behind a career in medicine, law or music. Johnson and Johnson launched ‘The Campaign for Nursing’s Future’ in February 2002 with the company investing more than $25 million in this initiative, which included:

• Providing free recruitment brochures, posters and videos to hospitals, high schools, nursing schools and nursing organisations;

• A retention effort providing continuing education for nurses in the areas of leadership, management skills and mentorship programmes for nurses;

• Raising funds for student scholarships, faculty fellowships and nursing school grants;

• Regional “celebration of nursing” events to raise money for the local nursing community;

• A website highlighting the benefits of a nursing career, featuring searchable links to hundreds of nursing scholarships and more than 1,000 accredited nursing educational programmes; and

• A national advertising campaign that celebrates nursing professionals and their contributions to healthcare.

The American Association of Colleges of Nursing (AACN) provides a website (www.aacn.nche.edu/) with a number of publications dealing with strategies to reduce nursing shortfalls (AACN, 2002a, 2002b; Frase-Blunt, 2002). Their policy statement suggests that any recruitment and retention solution must address education, health delivery systems, work environment, reimbursement, legislation, regulation and technological advances as part of a concerted strategy (AACN, 2002a). They particularly make recommendations in the areas of education and the workplace.

• Education: − Develop initiatives to accelerate students through studies and into the workforce, and

identify a range of options above entry-level for career development opportunities such as researcher, teaching faculty and administrator;

− In education and practice, institute a remuneration system that reflects the educational requirements of different healthcare roles;

− Support healthcare employers in instituting and maintaining staff development programmes and lifelong learning for continual competence; and


Nursing’, issued by the company, 84 percent of nursing schools have experienced an increase in applications and enrolments. Issued in conjunction with the first anniversary of ‘The Campaign for Nursing’s Future’, Johnson and Johnson's multi-year campaign to attract more people to the nursing profession in hospitals and extended care facilities. This new report found a major shift in public attitudes toward the nursing profession. Survey findings showing that 55 percent of teens aged 16-18 years have personally considered a career in nursing or know someone who has. While another 67 percent would view very positively the news that a family member or friend was considering a career in nursing and amongst adults 75 percent shared this view (Johnson & Johnson, 2004). These findings come one year after implementation of the programme when the profile of nursing was “off the radar screen”. Gorgos (2004) also notes that a website dedicated to nursing information (www.discovering nursing.com) received more than 9 million page visits. As part of the campaign (“Celebration of Nursing”) more than $3 million was raised towards undergraduate student scholarships, nurse educator fellowships and faculty development grants (Gorgos, 2004). In a recent student survey, out of 68 potential options, nursing scored number four within the top five career choices, just behind a career in medicine, law or music. Johnson and Johnson launched ‘The Campaign for Nursing’s Future’ in February 2002 with the company investing more than $25 million in this initiative, which included:

• Providing free recruitment brochures, posters and videos to hospitals, high schools, nursing schools and nursing organisations;

• A retention effort providing continuing education for nurses in the areas of leadership, management skills and mentorship programmes for nurses;

• Raising funds for student scholarships, faculty fellowships and nursing school grants;

• Regional “celebration of nursing” events to raise money for the local nursing community;

• A website highlighting the benefits of a nursing career, featuring searchable links to hundreds of nursing scholarships and more than 1,000 accredited nursing educational programmes; and

• A national advertising campaign that celebrates nursing professionals and their contributions to healthcare.

The American Association of Colleges of Nursing (AACN) provides a website (www.aacn.nche.edu/) with a number of publications dealing with strategies to reduce nursing shortfalls (AACN, 2002a, 2002b; Frase-Blunt, 2002). Their policy statement suggests that any recruitment and retention solution must address education, health delivery systems, work environment, reimbursement, legislation, regulation and technological advances as part of a concerted strategy (AACN, 2002a). They particularly make recommendations in the areas of education and the workplace.

• Education: − Develop initiatives to accelerate students through studies and into the workforce, and

identify a range of options above entry-level for career development opportunities such as researcher, teaching faculty and administrator;

− In education and practice, institute a remuneration system that reflects the educational requirements of different healthcare roles;

− Support healthcare employers in instituting and maintaining staff development programmes and lifelong learning for continual competence; and


− Reach out to youth (ages 12-18) through guidance counsellors, youth organisations, schools and other outlets to promote recruitment of a younger more diverse nursing population.

• Work environment: − Introduce greater flexibility in work environment structures and work schedules; − Reward experienced nurses for serving as mentors and preceptors for new nurses; − Establish appropriate management structures that allow for a partnership environment; − Provide staff with sufficient autonomy over their practice; and − Provide roles that enable an ageing workforce to remain active and to promote new

recruitment. A link on the AACN site is to a website (www.nursesource.org/) that forms part of a national campaign promoting nursing using these and other strategies throughout the U.S. Fong (2004) notes the following organisational strategies being used to increase nurse recruitment:

• The recruitment and training of nurse speakers to talk to high school students in Maryland;

• Also in Maryland a pilot programme to survey and track nurses to find ways of retaining nurses;

• Radio and television advertising aimed at increasing interest in healthcare careers in Georgia;

• In Minnesota another nursing website and partnership with nursing organisations to find ways to improve the profile and work experience of nurses; and

• Also in Minnesota, college nursing programmes have attempted to increase enrolments by persuading hospitals to allow nurse time off to teach and talk to students.

From a recent report in the Australian Nursing Journal (News, 2002) it appears that the Victorian State government is carrying out a similar campaign with newspaper advertising and the production of 200 videos. The videos feature six psychiatric nurses during a week’s daily activity, and are designed for distribution to schools and tertiary educators. Consideration was also being given to increasing the psychiatric content of undergraduate nursing courses and the creation of scholarships for post-graduate psychiatric nursing study. Frase-Blunt (2002), in an article on the AACN website, looks at various strategies employed by nursing colleges to boost enrolments. Some of the approaches noted are:

• Recruiting from within by attracting other students already doing other undergraduate programmes on campuses using displays and holding stands at job fairs on campus;

• Advertising and promotion – one nursing school in Kansas increased enrolments by 20 percent by using a combination of radio and newspaper advertisements, a year long run of still ads before movies and a static display in a local mall. The advertisements were designed to raise the profile of the course and to promote what the students had said attracted them to nursing, i.e., nurses are caring people who want to help others;

• Priming the early pipeline – younger students are being targeted as part of a longer-term strategy. Courses at high school are being offered as credits towards nursing courses and one college is trailing nursing camps for school children as an option. Others have gone to senior staff who are enthusiastic about the profession to conduct ‘shadow days’ for high school students. Students get to spend a day ‘shadowing’ a nurse in the hospital setting for a day. They report that many come away “so excited”. Others have used colouring books, talks at assemblies, scouting programmes, classroom sessions with prizes and stickers, to raise the interest in nursing at primary school level;


− Reach out to youth (ages 12-18) through guidance counsellors, youth organisations, schools and other outlets to promote recruitment of a younger more diverse nursing population.

• Work environment: − Introduce greater flexibility in work environment structures and work schedules; − Reward experienced nurses for serving as mentors and preceptors for new nurses; − Establish appropriate management structures that allow for a partnership environment; − Provide staff with sufficient autonomy over their practice; and − Provide roles that enable an ageing workforce to remain active and to promote new

recruitment. A link on the AACN site is to a website (www.nursesource.org/) that forms part of a national campaign promoting nursing using these and other strategies throughout the U.S. Fong (2004) notes the following organisational strategies being used to increase nurse recruitment:

• The recruitment and training of nurse speakers to talk to high school students in Maryland;

• Also in Maryland a pilot programme to survey and track nurses to find ways of retaining nurses;

• Radio and television advertising aimed at increasing interest in healthcare careers in Georgia;

• In Minnesota another nursing website and partnership with nursing organisations to find ways to improve the profile and work experience of nurses; and

• Also in Minnesota, college nursing programmes have attempted to increase enrolments by persuading hospitals to allow nurse time off to teach and talk to students.

From a recent report in the Australian Nursing Journal (News, 2002) it appears that the Victorian State government is carrying out a similar campaign with newspaper advertising and the production of 200 videos. The videos feature six psychiatric nurses during a week’s daily activity, and are designed for distribution to schools and tertiary educators. Consideration was also being given to increasing the psychiatric content of undergraduate nursing courses and the creation of scholarships for post-graduate psychiatric nursing study. Frase-Blunt (2002), in an article on the AACN website, looks at various strategies employed by nursing colleges to boost enrolments. Some of the approaches noted are:

• Recruiting from within by attracting other students already doing other undergraduate programmes on campuses using displays and holding stands at job fairs on campus;

• Advertising and promotion – one nursing school in Kansas increased enrolments by 20 percent by using a combination of radio and newspaper advertisements, a year long run of still ads before movies and a static display in a local mall. The advertisements were designed to raise the profile of the course and to promote what the students had said attracted them to nursing, i.e., nurses are caring people who want to help others;

• Priming the early pipeline – younger students are being targeted as part of a longer-term strategy. Courses at high school are being offered as credits towards nursing courses and one college is trailing nursing camps for school children as an option. Others have gone to senior staff who are enthusiastic about the profession to conduct ‘shadow days’ for high school students. Students get to spend a day ‘shadowing’ a nurse in the hospital setting for a day. They report that many come away “so excited”. Others have used colouring books, talks at assemblies, scouting programmes, classroom sessions with prizes and stickers, to raise the interest in nursing at primary school level;


• Hiring dedicated recruiters – several colleges report tremendous success from the employment of dedicated recruiters. Although initially expensive some have raised enrolment levels by up to five times; and

• Polishing the image of nursing – nursing is often seen as a risky, low-status and under-rewarded profession, especially by school guidance counsellors. Some schools have attempted to change this image by attending school guidance counselling conferences and sending out packages of promotional material to counsellors. Some have sponsored breakfasts at schools where they sit down and talk about nursing.

AACN (2002b) and Andrews (2003) have discussed ways of increasing diversity as a means of boosting recruitment to nursing. They note that men and minority groups are under-represented in nursing. Although the percentage of males in nursing is higher in New Zealand than the U.S., there is still much that could be done to entice males into the workforce here. The above authors cite several reasons for the lack of diversity that include the presence of role stereotypes, economic barriers, few mentors, gender biases, lack of direction from early authority figures, misunderstanding about the practice of nursing and increasing opportunities in other areas. Because these differences are historical, faculty and staff in teaching institutions also lack diversity and this tends to perpetuate the problem. Traditional advertising messages have not been cued to target diverse audiences. As a result, some educators have retooled promotional messages and brochures with images that include subjects from underrepresented groups (AACN, 2002b). AACN cite results from a forum of male nurses conducted by the University of Texas Health Science Centre to find out why male nurses had taken up the career of nursing (AACN, 2002b). The male nurses suggested they play up the macho aspects of nursing, advertise in sports pages of student media, and to take feminine and flowery language out of brochures. These changes contributed to an increase in male enrolments to 29 percent of the total enrolments compared to just over 5 percent nationally. Indiana University entered into collaboration with a local school faculty, whereby graduate nurses and current nursing students were linked with school students interested in nursing (AACN, 2002b). Students from diverse backgrounds were particular targets of the mentoring programme. Other mentoring programmes are in place that tracks minority students right through their education, helping them to prepare for exams, manage time and money, as well as other skills needed to succeed at University. Adding an interview component to the admission process, rather than just relying on grades, was found by another university to reduce the dropout level and raise the numbers of minority students applying to and being accepted into programmes (AACN, 2002b). A good example of a coordinated campaign to reach out to minorities and men is that of the University of Nebraska Medical Centre (College of Nursing) (AACN, 2002b). The College increased minority admissions by 43 percent in 20 months using a part-time recruiter. Among other strategies used, the school also:

• Hired a recruiter with full nursing experience at various levels;

• Updated all marketing materials, using diverse images of men and minorities and colours that were deemed ‘male friendly’;

• Developed outreach letters in other languages that were sent out to parents and explained the shortage of minority groups in nursing;

• Used high school fairs (especially at all male schools), community job fairs, and a variety of nurse conventions up to national level to distribute marketing material;

• Encouraged guidance counsellor to steer good students towards nursing;


• Hiring dedicated recruiters – several colleges report tremendous success from the employment of dedicated recruiters. Although initially expensive some have raised enrolment levels by up to five times; and

• Polishing the image of nursing – nursing is often seen as a risky, low-status and under-rewarded profession, especially by school guidance counsellors. Some schools have attempted to change this image by attending school guidance counselling conferences and sending out packages of promotional material to counsellors. Some have sponsored breakfasts at schools where they sit down and talk about nursing.

AACN (2002b) and Andrews (2003) have discussed ways of increasing diversity as a means of boosting recruitment to nursing. They note that men and minority groups are under-represented in nursing. Although the percentage of males in nursing is higher in New Zealand than the U.S., there is still much that could be done to entice males into the workforce here. The above authors cite several reasons for the lack of diversity that include the presence of role stereotypes, economic barriers, few mentors, gender biases, lack of direction from early authority figures, misunderstanding about the practice of nursing and increasing opportunities in other areas. Because these differences are historical, faculty and staff in teaching institutions also lack diversity and this tends to perpetuate the problem. Traditional advertising messages have not been cued to target diverse audiences. As a result, some educators have retooled promotional messages and brochures with images that include subjects from underrepresented groups (AACN, 2002b). AACN cite results from a forum of male nurses conducted by the University of Texas Health Science Centre to find out why male nurses had taken up the career of nursing (AACN, 2002b). The male nurses suggested they play up the macho aspects of nursing, advertise in sports pages of student media, and to take feminine and flowery language out of brochures. These changes contributed to an increase in male enrolments to 29 percent of the total enrolments compared to just over 5 percent nationally. Indiana University entered into collaboration with a local school faculty, whereby graduate nurses and current nursing students were linked with school students interested in nursing (AACN, 2002b). Students from diverse backgrounds were particular targets of the mentoring programme. Other mentoring programmes are in place that tracks minority students right through their education, helping them to prepare for exams, manage time and money, as well as other skills needed to succeed at University. Adding an interview component to the admission process, rather than just relying on grades, was found by another university to reduce the dropout level and raise the numbers of minority students applying to and being accepted into programmes (AACN, 2002b). A good example of a coordinated campaign to reach out to minorities and men is that of the University of Nebraska Medical Centre (College of Nursing) (AACN, 2002b). The College increased minority admissions by 43 percent in 20 months using a part-time recruiter. Among other strategies used, the school also:

• Hired a recruiter with full nursing experience at various levels;

• Updated all marketing materials, using diverse images of men and minorities and colours that were deemed ‘male friendly’;

• Developed outreach letters in other languages that were sent out to parents and explained the shortage of minority groups in nursing;

• Used high school fairs (especially at all male schools), community job fairs, and a variety of nurse conventions up to national level to distribute marketing material;

• Encouraged guidance counsellor to steer good students towards nursing;


• Approached local media to write stories about the needs of greater diversity in the nursing workforce;

• Encouraged current nursing students to spend time at recruitment events talking to interested people;

• Attended community events of various minority groups;

• Reached out to younger children by developing flash cards, colouring sheets that showed diversity in gender and ethnicity, and creating a multi-cultural children’s website;

• Placed ads in minority newspapers and encouraged families to attend an open house with an “exploratorium for kids” that was staffed by current nursing students;

• Developed a system to track progress of prospective students with personal follow-up of minority candidates; and

• Encouraged job shadowing for all students. In the U.K., Wolverhampton Health Care Trust targeted the local population, which was highly diverse and had high unemployment rates (Pyrah, 2003). They found that few of the local people considered working in the NHS. “The Trust’s organisational philosophy was that every member of staff has a route up in the organisation. If the person chose not to progress that was accepted, people would be ‘developed’ so they were excellent in what they did. If they have career routes people will enjoy their work more” (p. 2) With this in mind the Trust set out to attain staff from the community by hiring at entry level positions, then developing these staff and promoting them upwards in the organisation. They offered work experience for school leavers, volunteer schemes and training for long-term unemployed people and provided a mentoring service (Pyrah, 2003). The scheme was financed from external funding sources set up to lower unemployment rates nationally. The results were not immediate, but did have long-term and profound impacts on the local community. They created an atmosphere where longer-term recruitment of staff improving as more people saw the benefits. In the U.K. a nurse rotation scheme has been trialled that is aimed at recruiting nurses from other health sectors into mental health (Coyne & Beadsmore, 2001). Nurses are offered a developmental programme that rotates them through three 8-month staff nurse placements in a variety of service delivery areas. Specialist clinical supervision is offered within each area for each nurse. In an evaluation of the first trial, 25 nurses were recruited, with 11 stating that they would not have been attracted there without the scheme. Eighteen service delivery areas within the west London mental health trusts involved have filled positions with full-time staff. This scheme may offer a means of redeploying staff to build up the mental health workforce and leave places available for new nurses. In scoping the nursing workforce in Australia, Clinton and Hazelton (2000) note that 12,500-17,700 nurses were employed in areas other than nursing. This is a large pool of workers that could possibly be tapped if sufficient motivation were present. What these authors see as missing in attracting nurses to the mental health workforce is the lack of career opportunities, lack of professional development, inflexible working practices and undervaluing of skills due to rigid divisions of labour among the mental health professions. If a similar situation exists in New Zealand then a pool of possible recruits and a means of re-motivating those people exist. In 2000 the finance division of a Virginia (U.S.) based healthcare group, Inova, faced severe recruitment and retention challenges (MacDonald, 2002). Being a non-profit organisation they had to compete against local businesses that were able to offer significant financial incentives to attract staff. As a result, the organisation had 30-40 percent staff vacancies and the average term of employment was only one year. The first step in solving the staffing dilemma was the


• Approached local media to write stories about the needs of greater diversity in the nursing workforce;

• Encouraged current nursing students to spend time at recruitment events talking to interested people;

• Attended community events of various minority groups;

• Reached out to younger children by developing flash cards, colouring sheets that showed diversity in gender and ethnicity, and creating a multi-cultural children’s website;

• Placed ads in minority newspapers and encouraged families to attend an open house with an “exploratorium for kids” that was staffed by current nursing students;

• Developed a system to track progress of prospective students with personal follow-up of minority candidates; and

• Encouraged job shadowing for all students. In the U.K., Wolverhampton Health Care Trust targeted the local population, which was highly diverse and had high unemployment rates (Pyrah, 2003). They found that few of the local people considered working in the NHS. “The Trust’s organisational philosophy was that every member of staff has a route up in the organisation. If the person chose not to progress that was accepted, people would be ‘developed’ so they were excellent in what they did. If they have career routes people will enjoy their work more” (p. 2) With this in mind the Trust set out to attain staff from the community by hiring at entry level positions, then developing these staff and promoting them upwards in the organisation. They offered work experience for school leavers, volunteer schemes and training for long-term unemployed people and provided a mentoring service (Pyrah, 2003). The scheme was financed from external funding sources set up to lower unemployment rates nationally. The results were not immediate, but did have long-term and profound impacts on the local community. They created an atmosphere where longer-term recruitment of staff improving as more people saw the benefits. In the U.K. a nurse rotation scheme has been trialled that is aimed at recruiting nurses from other health sectors into mental health (Coyne & Beadsmore, 2001). Nurses are offered a developmental programme that rotates them through three 8-month staff nurse placements in a variety of service delivery areas. Specialist clinical supervision is offered within each area for each nurse. In an evaluation of the first trial, 25 nurses were recruited, with 11 stating that they would not have been attracted there without the scheme. Eighteen service delivery areas within the west London mental health trusts involved have filled positions with full-time staff. This scheme may offer a means of redeploying staff to build up the mental health workforce and leave places available for new nurses. In scoping the nursing workforce in Australia, Clinton and Hazelton (2000) note that 12,500-17,700 nurses were employed in areas other than nursing. This is a large pool of workers that could possibly be tapped if sufficient motivation were present. What these authors see as missing in attracting nurses to the mental health workforce is the lack of career opportunities, lack of professional development, inflexible working practices and undervaluing of skills due to rigid divisions of labour among the mental health professions. If a similar situation exists in New Zealand then a pool of possible recruits and a means of re-motivating those people exist. In 2000 the finance division of a Virginia (U.S.) based healthcare group, Inova, faced severe recruitment and retention challenges (MacDonald, 2002). Being a non-profit organisation they had to compete against local businesses that were able to offer significant financial incentives to attract staff. As a result, the organisation had 30-40 percent staff vacancies and the average term of employment was only one year. The first step in solving the staffing dilemma was the


employment of a recruitment and retention officer. Existing employees were targeted as a valuable source of information and a management team conducted weekly informal meetings with groups of staff (10-15 at a time) to discuss work life experiences. Employees were asked to provide ideas about changes they would like to see and about ways to increase staff satisfaction. Mandatory exit interviews were instituted to capture their parting comments and suggestions. Additionally, staffs were asked about aspects of the organisation the found positive so that these strengths could be built upon and highlighted when attempting to attract new staff. The organisation had a great social atmosphere and staff had common bonds that created a family atmosphere in and out of work. However, what they lacked were competitive remuneration packages, defined career pathways and an adequate training programme. Part of the problem was that the ongoing costs of recruiting new staff and then losing them were financially constraining the organisation and affected its ability to pay well (MacDonald, 2002). Inova then instituted a number of strategies to build on the identified strengths, such as increasing social activities and the recognition of staff achievements. Financial incentives were given for achievements in training, salaries were also increased to market rates, and management were placed on a pay-for-performance system that included bonuses for staff retention. All staff were placed on a mentoring programme with a senior staff member with monthly meetings to review progress. Early results showed positive comments from staff, and staff were proactively asking for a greater say in the running of the organisation. Following efforts to increase retention (and create a more attractive work environment for potential staff) Inova tackled the issue of recruitment in several ways (MacDonald, 2002):

• Referral incentives were paid to any staff member who referred someone who was subsequently hired;

• A marketing campaign was conducted in the local community to expose the community to the need for recruitment. Staff were given key chains with a slogan on to hand out at conferences and local meetings;

• A recruitment video was produced (cost less than $5,000) highlighting Inova’s current workforce and work environment. The organisation found that it was important to impress candidates at initial contact and throughout the recruitment process, and the video formed a useful tool for this; and

• The interviewing process was refined and developed to select the best candidates. As a result of these strategies, Inova in 2002 had staff vacancies of less than 5 percent and had achieved recognition locally and nationally as an employer of choice (MacDonald, 2002). Similar strategies for recruitment are included in a discussion on current trends in employment by a recruitment specialist in the U.S. (Meyers, 2001). The Inova example has several aspects relevant to mental health recruitment in New Zealand and also highlights the importance of developing retention, particularly through organisational structuring and culture, as part of recruitment. Larson, Hewitt and Anderson (1999) investigated agencies that supply services to people with disabilities. They found similar issues as those at Inova regarding recruitment and retention. Agencies were spending more money on overtime than they were on advertising for recruiting. In attempts to recruit, most agencies used monetary incentives along with flexible hours and paid time off. Few used strategies such as enhanced job responsibility, educational support, worker bonuses for recruiting or peer mentoring. Other strategies suggested by these authors were similar to those adopted by Inova.


employment of a recruitment and retention officer. Existing employees were targeted as a valuable source of information and a management team conducted weekly informal meetings with groups of staff (10-15 at a time) to discuss work life experiences. Employees were asked to provide ideas about changes they would like to see and about ways to increase staff satisfaction. Mandatory exit interviews were instituted to capture their parting comments and suggestions. Additionally, staffs were asked about aspects of the organisation the found positive so that these strengths could be built upon and highlighted when attempting to attract new staff. The organisation had a great social atmosphere and staff had common bonds that created a family atmosphere in and out of work. However, what they lacked were competitive remuneration packages, defined career pathways and an adequate training programme. Part of the problem was that the ongoing costs of recruiting new staff and then losing them were financially constraining the organisation and affected its ability to pay well (MacDonald, 2002). Inova then instituted a number of strategies to build on the identified strengths, such as increasing social activities and the recognition of staff achievements. Financial incentives were given for achievements in training, salaries were also increased to market rates, and management were placed on a pay-for-performance system that included bonuses for staff retention. All staff were placed on a mentoring programme with a senior staff member with monthly meetings to review progress. Early results showed positive comments from staff, and staff were proactively asking for a greater say in the running of the organisation. Following efforts to increase retention (and create a more attractive work environment for potential staff) Inova tackled the issue of recruitment in several ways (MacDonald, 2002):

• Referral incentives were paid to any staff member who referred someone who was subsequently hired;

• A marketing campaign was conducted in the local community to expose the community to the need for recruitment. Staff were given key chains with a slogan on to hand out at conferences and local meetings;

• A recruitment video was produced (cost less than $5,000) highlighting Inova’s current workforce and work environment. The organisation found that it was important to impress candidates at initial contact and throughout the recruitment process, and the video formed a useful tool for this; and

• The interviewing process was refined and developed to select the best candidates. As a result of these strategies, Inova in 2002 had staff vacancies of less than 5 percent and had achieved recognition locally and nationally as an employer of choice (MacDonald, 2002). Similar strategies for recruitment are included in a discussion on current trends in employment by a recruitment specialist in the U.S. (Meyers, 2001). The Inova example has several aspects relevant to mental health recruitment in New Zealand and also highlights the importance of developing retention, particularly through organisational structuring and culture, as part of recruitment. Larson, Hewitt and Anderson (1999) investigated agencies that supply services to people with disabilities. They found similar issues as those at Inova regarding recruitment and retention. Agencies were spending more money on overtime than they were on advertising for recruiting. In attempts to recruit, most agencies used monetary incentives along with flexible hours and paid time off. Few used strategies such as enhanced job responsibility, educational support, worker bonuses for recruiting or peer mentoring. Other strategies suggested by these authors were similar to those adopted by Inova.


Another attempt to both retain, and facilitate recruitment is that of an internship programme for psychiatric nurses in New Jersey (Caroselli-Karinja, McGowan, and Penn, 1998). Similarly to other authors (for example Prebble, 2001) they cite the lack of clinical experience in a psychiatric setting that is frequently found in modern undergraduate generic nursing programmes. The internship programme effectively trains nurses to be confident and competent in the psychiatric speciality. All members of staff are involved in training and interns attend multi-disciplinary meetings where their input is valued. The authors note the interest the programme generated both inside and outside the programme. Senior staff were interested and stimulated to present lectures which were open to all hospital staff and other students. Various staff and students were also permitted to attend course components. In this way the course acted to facilitate entry to psychiatric nursing for potential nurses and extended the level of interest to other potential candidates in other health sectors. A nurse mentoring programme is being trialled in California that it is hoped will produce similar results (Reilly, 2003). In this programme new nurses are paired with senior nurses to provide training and support.

Recruitment to rural areas

Another area within mental health that has had little study is that of provision of mental health services in rural areas. One such study highlights the common and specific aspects of recruiting people to work in mental health in rural areas (Merwin, Goldsmith, & Manderscheid, 1995). The authors identified that one of the problems with rural communities was that they are heterogeneous. Generally having fewer specialised services, fewer providers, higher levels of poverty and unemployment, and greater transportation problems. Services to the mentally ill are more likely to come from the general medical sector than from the speciality mental health sector. The authors note that most training of medical and mental health specialists is geared implicitly for urban situations. That major role changes are necessary to change an urban trained and experienced professional into a competent and happy rural one. They further state that those practitioners desiring specialisation, close supervision, continuing education, and who have a low tolerance of different values will find the transition particularly hard (Merwin, Goldsmith, & Manderscheid, 1995). Distance, isolation and deficiencies in support services are obstacles that can produce a feeling “akin to that of culture shock” (p. 532). Moreover, this contributes to high rates of turnover of staff in the first year of service. Rural mental health workers may often have to adopt more of a generalist role and also may need to adopt new roles such as community liaison. Computers are being trialled by some workers as a means to maintain regular contact with colleagues. The authors suggest three strategies to allow for greater recruitment of mental health professionals to rural areas:

• Retraining members of the current workforce for rural work;

• Integrate the roles of speciality and non-specialist health professionals for rural mental health services; and

• Incorporate the provision of mental health services within expanding alternative delivery models.

Another strategy being trialled is that of a “new breed” of worker, one consisting of a hybrid of nurse, doctor and therapist (Waters, 2003). These therapists and nurses undergo 6 months of training for the new roles. The strategy is to be trialled at Kingston Hospital NHS Trust in Surrey. Titled “healthcare practitioners”, they will be responsible for patients during their first 48 hours as inpatients in a medical assessment unit. Healthcare practitioners will see only patients with certain types of physical and mental problems. Course participants report that the roles are beneficial in breaking down barriers in the health service, something they have seen as being particularly frustrating while working as nurses or therapists. They will be responsible for


Another attempt to both retain, and facilitate recruitment is that of an internship programme for psychiatric nurses in New Jersey (Caroselli-Karinja, McGowan, and Penn, 1998). Similarly to other authors (for example Prebble, 2001) they cite the lack of clinical experience in a psychiatric setting that is frequently found in modern undergraduate generic nursing programmes. The internship programme effectively trains nurses to be confident and competent in the psychiatric speciality. All members of staff are involved in training and interns attend multi-disciplinary meetings where their input is valued. The authors note the interest the programme generated both inside and outside the programme. Senior staff were interested and stimulated to present lectures which were open to all hospital staff and other students. Various staff and students were also permitted to attend course components. In this way the course acted to facilitate entry to psychiatric nursing for potential nurses and extended the level of interest to other potential candidates in other health sectors. A nurse mentoring programme is being trialled in California that it is hoped will produce similar results (Reilly, 2003). In this programme new nurses are paired with senior nurses to provide training and support.

Recruitment to rural areas

Another area within mental health that has had little study is that of provision of mental health services in rural areas. One such study highlights the common and specific aspects of recruiting people to work in mental health in rural areas (Merwin, Goldsmith, & Manderscheid, 1995). The authors identified that one of the problems with rural communities was that they are heterogeneous. Generally having fewer specialised services, fewer providers, higher levels of poverty and unemployment, and greater transportation problems. Services to the mentally ill are more likely to come from the general medical sector than from the speciality mental health sector. The authors note that most training of medical and mental health specialists is geared implicitly for urban situations. That major role changes are necessary to change an urban trained and experienced professional into a competent and happy rural one. They further state that those practitioners desiring specialisation, close supervision, continuing education, and who have a low tolerance of different values will find the transition particularly hard (Merwin, Goldsmith, & Manderscheid, 1995). Distance, isolation and deficiencies in support services are obstacles that can produce a feeling “akin to that of culture shock” (p. 532). Moreover, this contributes to high rates of turnover of staff in the first year of service. Rural mental health workers may often have to adopt more of a generalist role and also may need to adopt new roles such as community liaison. Computers are being trialled by some workers as a means to maintain regular contact with colleagues. The authors suggest three strategies to allow for greater recruitment of mental health professionals to rural areas:

• Retraining members of the current workforce for rural work;

• Integrate the roles of speciality and non-specialist health professionals for rural mental health services; and

• Incorporate the provision of mental health services within expanding alternative delivery models.

Another strategy being trialled is that of a “new breed” of worker, one consisting of a hybrid of nurse, doctor and therapist (Waters, 2003). These therapists and nurses undergo 6 months of training for the new roles. The strategy is to be trialled at Kingston Hospital NHS Trust in Surrey. Titled “healthcare practitioners”, they will be responsible for patients during their first 48 hours as inpatients in a medical assessment unit. Healthcare practitioners will see only patients with certain types of physical and mental problems. Course participants report that the roles are beneficial in breaking down barriers in the health service, something they have seen as being particularly frustrating while working as nurses or therapists. They will be responsible for


delivering care packages drawn up by a multi-disciplinary team with the 18 month pilot results being compared to a traditional healthcare unit in a neighbouring ward. Other benefits that the new workers perceive is that they will be able to offer holistic management, being main care provider for a group of patients, offering continuity of care, which is something they see as being very important for clients (Waters, 2003). The course is based on problem-based learning and clinical practice. The new role offers the opportunity of attracting mental health staff from other areas of healthcare and in increasing retention. “A lot of them were saying it was exactly the kind of thing they were looking for, an opportunity to improve their skills and responsibility without having to go into management” (Waters, 2003, p. 2).

“E-recruitment”

Modern technology in recruiting is another issue raised in the literature. Marzulli (2002) promotes the use of the Internet to facilitate identification, interviewing and hiring of candidates for healthcare positions. By streamlining the process, Marzulli suggests that potential candidates may not be lost as is possible in a slower standard process, and employees will see the organisations as modern and progressive. As well, e-recruitment can automate and track all the tasks involved between considering a candidate to terminating their employment, which allows recruiters to focus on more strategic goals. Such a system would also allow healthcare organisations to share candidate applications and information, creating a pool of potential staff for a whole organisation rather than just its parts. Interviews can be created that are standardised for all candidates and which allow employers to at least create short lists of candidates who fit their organisational work cultures (Marzulli, 2002).

Identifying ‘good’ staff

Hall and Hall (2002) examined 50 years of work that had attempted to find the means of detecting ‘good’ mental health staff. They concluded, “there are no well-researched tools for hiring applicants who will be good direct-care staff members” (p. 201). Problems have occurred in defining what is a ‘good worker’. Some organisations may define ‘good’ as equalling someone who stays, while for some it maybe someone who is punctual, neat and compliant. While some of these competencies may have been relevant in an older institutional mental health care system, a modern community-based system geared toward a recovery model may have different definitions of a ‘good worker’. One of the above authors has been instrumental in developing a set of situational questions that indicate a person’s inherent value system and how that would fit with enhancing the well-being of persons with developmental disabilities. Such a questionnaire maybe adaptable for use in recruiting mental health workers. A more recent article from Ohio (U.S.), maybe the first representative of a new interest in developing psychological assessment tools for recruiting mental health workers. Clasen et al. (2003), developed and piloted an instrument to establish core competencies for workers in inpatient mental health settings. The authors identified 26 competencies that formed two subscales. The first subscale is the importance of the competency and the second refers to how much behavioural healthcare workers could benefit from training on that competency. Clasen et al. (2003) noted that there are, in fact, several studies investigating the core competencies of mental health workers, they just have not been amalgamated as a measuring instrument. The instrument they developed is designed to answer the questions: What are the competencies that are most important for mental health care workers to have?; and What are the competencies that would most benefit from training? In testing the instrument it was found to be internally reliable (Cronbach’s Alphas were 0.93 and 0.95) and correlations between knowledge items and benefit items were all significant. The five competencies that were ranked as highest in importance for a direct care mental health worker to have were:


delivering care packages drawn up by a multi-disciplinary team with the 18 month pilot results being compared to a traditional healthcare unit in a neighbouring ward. Other benefits that the new workers perceive is that they will be able to offer holistic management, being main care provider for a group of patients, offering continuity of care, which is something they see as being very important for clients (Waters, 2003). The course is based on problem-based learning and clinical practice. The new role offers the opportunity of attracting mental health staff from other areas of healthcare and in increasing retention. “A lot of them were saying it was exactly the kind of thing they were looking for, an opportunity to improve their skills and responsibility without having to go into management” (Waters, 2003, p. 2).

“E-recruitment”

Modern technology in recruiting is another issue raised in the literature. Marzulli (2002) promotes the use of the Internet to facilitate identification, interviewing and hiring of candidates for healthcare positions. By streamlining the process, Marzulli suggests that potential candidates may not be lost as is possible in a slower standard process, and employees will see the organisations as modern and progressive. As well, e-recruitment can automate and track all the tasks involved between considering a candidate to terminating their employment, which allows recruiters to focus on more strategic goals. Such a system would also allow healthcare organisations to share candidate applications and information, creating a pool of potential staff for a whole organisation rather than just its parts. Interviews can be created that are standardised for all candidates and which allow employers to at least create short lists of candidates who fit their organisational work cultures (Marzulli, 2002).

Identifying ‘good’ staff

Hall and Hall (2002) examined 50 years of work that had attempted to find the means of detecting ‘good’ mental health staff. They concluded, “there are no well-researched tools for hiring applicants who will be good direct-care staff members” (p. 201). Problems have occurred in defining what is a ‘good worker’. Some organisations may define ‘good’ as equalling someone who stays, while for some it maybe someone who is punctual, neat and compliant. While some of these competencies may have been relevant in an older institutional mental health care system, a modern community-based system geared toward a recovery model may have different definitions of a ‘good worker’. One of the above authors has been instrumental in developing a set of situational questions that indicate a person’s inherent value system and how that would fit with enhancing the well-being of persons with developmental disabilities. Such a questionnaire maybe adaptable for use in recruiting mental health workers. A more recent article from Ohio (U.S.), maybe the first representative of a new interest in developing psychological assessment tools for recruiting mental health workers. Clasen et al. (2003), developed and piloted an instrument to establish core competencies for workers in inpatient mental health settings. The authors identified 26 competencies that formed two subscales. The first subscale is the importance of the competency and the second refers to how much behavioural healthcare workers could benefit from training on that competency. Clasen et al. (2003) noted that there are, in fact, several studies investigating the core competencies of mental health workers, they just have not been amalgamated as a measuring instrument. The instrument they developed is designed to answer the questions: What are the competencies that are most important for mental health care workers to have?; and What are the competencies that would most benefit from training? In testing the instrument it was found to be internally reliable (Cronbach’s Alphas were 0.93 and 0.95) and correlations between knowledge items and benefit items were all significant. The five competencies that were ranked as highest in importance for a direct care mental health worker to have were:


• Treating clients with respect, dignity, and as equal partners in their treatments;

• Knowing the symptoms/characteristics of mental illness;

• Knowing and using crisis interventions;

• Working in a professional way; and

• Including family members and other support people/groups in the client’s treatment.

The five competencies most highly rated as being ones that workers could benefit from additional training in were:

• Using different ways to reduce worker stress;



• Using computer technology; and

• Keeping accurate work-related records. The testing and further development of such an instrument in the New Zealand mental health context could have benefits in terms of streamlining recruitment, ensuring the recruitment of people with the ‘right stuff’, and enable a training programme that is personalised for individuals that will increase relevant skills. Norris and Platz (2003) comment that mental health workers, when working in a recovery paradigm, need an underpinning philosophy and worldview that is consistent with that paradigm. This philosophy and worldview must be able to accommodate the individual beliefs and motivations of service users such that they are intrinsically motivated and self-directed. Craig (1999) further suggests that while it is important for mental health workers to understand client’s health/illness beliefs, patterns and goals, it is equally important that they understand their own. By understanding their own internalised set of values, they are more able to not impose these on clients. Any instrument that is developed must be able to recognise and measure these characteristics in some way.

Maori and Pacific recruitment

New Zealand is a bi-cultural society, which means that the ‘tangata whenua’ and their ‘tino ranga tira tanga’ that is their customs and beliefs, are inculcated into all organisational policies and practice. Research by Lapsley, Nikora, and Black (2003) found that even though most Maori recovery stories have the same kind of events and processes used for the non-Maori people, there were also aspects of recovery, which seemed unique to being Maori. Most Maori implied that encountering a Maori health service provider generally had a positive impact on them, as this increased their comfort levels and allowed for greater cultural understanding when discussing and dealing with their issues. New Zealand has a limited number of Maori and Pacific Island employees within the mental health sector. By recognising the special qualities of Maori workers, more are likely to be enticed into mental health work. A macro-analysis of the Maori mental health workforce (Ponga, Maxwell-Crawford, Ihimaera & Emery, 2004) described the wider socio-economic context for Maori including the age structure of the Maori population, a description of Maori in tertiary education and the impact of student loans. According to the New Zealand University Student Association (NZUSA) Maori take longer to pay off student loans than Pakeha but not as long as Pacific Island students (the average time taken to pay off a student loan for a woman taking a two year diploma is 26 years for Maori, 28 years for a Pacific Islander and 22 years for Pakeha [NZUSA, 2003]). Maori have lower incomes and low savings which together with low educational attainments, poor health, poor vocational skill and poor housing, form a cycle of


• Treating clients with respect, dignity, and as equal partners in their treatments;



• Working in a professional way; and

• Including family members and other support people/groups in the client’s treatment.

The five competencies most highly rated as being ones that workers could benefit from additional training in were:

• Using different ways to reduce worker stress;



• Using computer technology; and

• Keeping accurate work-related records. The testing and further development of such an instrument in the New Zealand mental health context could have benefits in terms of streamlining recruitment, ensuring the recruitment of people with the ‘right stuff’, and enable a training programme that is personalised for individuals that will increase relevant skills. Norris and Platz (2003) comment that mental health workers, when working in a recovery paradigm, need an underpinning philosophy and worldview that is consistent with that paradigm. This philosophy and worldview must be able to accommodate the individual beliefs and motivations of service users such that they are intrinsically motivated and self-directed. Craig (1999) further suggests that while it is important for mental health workers to understand client’s health/illness beliefs, patterns and goals, it is equally important that they understand their own. By understanding their own internalised set of values, they are more able to not impose these on clients. Any instrument that is developed must be able to recognise and measure these characteristics in some way.

Maori and Pacific recruitment

New Zealand is a bi-cultural society, which means that the ‘tangata whenua’ and their ‘tino ranga tira tanga’ that is their customs and beliefs, are inculcated into all organisational policies and practice. Research by Lapsley, Nikora, and Black (2003) found that even though most Maori recovery stories have the same kind of events and processes used for the non-Maori people, there were also aspects of recovery, which seemed unique to being Maori. Most Maori implied that encountering a Maori health service provider generally had a positive impact on them, as this increased their comfort levels and allowed for greater cultural understanding when discussing and dealing with their issues. New Zealand has a limited number of Maori and Pacific Island employees within the mental health sector. By recognising the special qualities of Maori workers, more are likely to be enticed into mental health work. A macro-analysis of the Maori mental health workforce (Ponga, Maxwell-Crawford, Ihimaera & Emery, 2004) described the wider socio-economic context for Maori including the age structure of the Maori population, a description of Maori in tertiary education and the impact of student loans. According to the New Zealand University Student Association (NZUSA) Maori take longer to pay off student loans than Pakeha but not as long as Pacific Island students (the average time taken to pay off a student loan for a woman taking a two year diploma is 26 years for Maori, 28 years for a Pacific Islander and 22 years for Pakeha [NZUSA, 2003]). Maori have lower incomes and low savings which together with low educational attainments, poor health, poor vocational skill and poor housing, form a cycle of


cumulative causation with each factor reinforcing the others, and leave few pathways out of a lifetime of relative poverty (Douglas, 2001). Mental health education is expensive and within the New Zealand environment a student loan is a hardship that many students do not want to undertake especially with students from lower income families. An NZUSA and NZNO study on the effects of student debt on nursing found that nurses owed nearly $20,000 on graduation, two thirds of the survey said that the loan had influenced their decision to do further study and more than one in five had considered leaving nursing because of difficulties paying off their student loan on a nurses salary (Brown & Matthews, 2003). A review of the barriers and incentives of Maori participation in the psychology workforce (Levy, 2002) found that the relying on a “western” model of psychology, an overemphasis on academic achievement at the expense of cultural competence, financial hardship, conflicting responsibilities, an absence of support and a lack of a critical mass of Maori psychologists were barriers to participation. Incentives included the formation of informal and formal networks for Maori psychologists and students, researching Maori psychology and having an increased focus specifically on Maori psychology. A medical speciality that has been particularly successful in attracting Maor i has been the Faculty of Public Health Medicine. The two key initiatives here which seem to have made a difference are the appointment of a Director of Maori Training within New Zealand and the CTA giving money for post-entry clinical training indirectly to the faculty (Rhys Jones personal communication). This has been facilitated by the Faculty of Public Health Medicine forming a charitable trust, which was able to receive CTA funding. The Director of Maori Training receives some direct funding from the CTA. Our experience in mental health is that CTA money for the academic component of post-entry clinical training is given to educational institutions where it is not ring fenced and is subsequently “lost”. Te Rau Puawai, an initiative located within Massey University, provides financial support, targeted academic support and a peer mentoring system for Maori to gain a relevant qualification that allows them to work within mental health in a range of occupations from alcohol and other drug work, social work, through to psychology. Bursars under the Te Rau Puawai scheme have achieved an 80 percent pass rate, which considerably exceeds the pass rate for Maori enrolled in other courses at Massey University (65 percent). Evaluation of this programme by Linda Nikora (2002) has shown that the reason for the success of this programme were the mentoring and other supports offered by the programme.

“Best Practice”

The project team decided to use this heading as apart from the academic literature. There is considerable grey literature on recruitment available as government or professional reports, or documents on “best practice” available from the Internet or as books. As previously mentioned, recruitment difficulties are not unique to health and there is an informative grey literature in other settings; the literature on recruiting teachers is especially pertinent to this report. An Internet Google search using “health recruitment strategies” resulted in approximately 1,150,000 hits. The search did yield some additional examples of best practice, however, due to the number of hits the project team was unable to check all of the references. The grey literature can be divided up into two types and examples from both of these areas are described. First, there was a considerable literature on “best practice” in the process of recruitment as seen from the view of an HR department. Second, there was a smaller literature on more innovative ways of improving recruitment. In particular, in the U.K. the NHS has a comprehensive plan to increase recruitment and component parts of this are described.


cumulative causation with each factor reinforcing the others, and leave few pathways out of a lifetime of relative poverty (Douglas, 2001). Mental health education is expensive and within the New Zealand environment a student loan is a hardship that many students do not want to undertake especially with students from lower income families. An NZUSA and NZNO study on the effects of student debt on nursing found that nurses owed nearly $20,000 on graduation, two thirds of the survey said that the loan had influenced their decision to do further study and more than one in five had considered leaving nursing because of difficulties paying off their student loan on a nurses salary (Brown & Matthews, 2003). A review of the barriers and incentives of Maori participation in the psychology workforce (Levy, 2002) found that the relying on a “western” model of psychology, an overemphasis on academic achievement at the expense of cultural competence, financial hardship, conflicting responsibilities, an absence of support and a lack of a critical mass of Maori psychologists were barriers to participation. Incentives included the formation of informal and formal networks for Maori psychologists and students, researching Maori psychology and having an increased focus specifically on Maori psychology. A medical speciality that has been particularly successful in attracting Maor i has been the Faculty of Public Health Medicine. The two key initiatives here which seem to have made a difference are the appointment of a Director of Maori Training within New Zealand and the CTA giving money for post-entry clinical training indirectly to the faculty (Rhys Jones personal communication). This has been facilitated by the Faculty of Public Health Medicine forming a charitable trust, which was able to receive CTA funding. The Director of Maori Training receives some direct funding from the CTA. Our experience in mental health is that CTA money for the academic component of post-entry clinical training is given to educational institutions where it is not ring fenced and is subsequently “lost”. Te Rau Puawai, an initiative located within Massey University, provides financial support, targeted academic support and a peer mentoring system for Maori to gain a relevant qualification that allows them to work within mental health in a range of occupations from alcohol and other drug work, social work, through to psychology. Bursars under the Te Rau Puawai scheme have achieved an 80 percent pass rate, which considerably exceeds the pass rate for Maori enrolled in other courses at Massey University (65 percent). Evaluation of this programme by Linda Nikora (2002) has shown that the reason for the success of this programme were the mentoring and other supports offered by the programme.

“Best Practice”

The project team decided to use this heading as apart from the academic literature. There is considerable grey literature on recruitment available as government or professional reports, or documents on “best practice” available from the Internet or as books. As previously mentioned, recruitment difficulties are not unique to health and there is an informative grey literature in other settings; the literature on recruiting teachers is especially pertinent to this report. An Internet Google search using “health recruitment strategies” resulted in approximately 1,150,000 hits. The search did yield some additional examples of best practice, however, due to the number of hits the project team was unable to check all of the references. The grey literature can be divided up into two types and examples from both of these areas are described. First, there was a considerable literature on “best practice” in the process of recruitment as seen from the view of an HR department. Second, there was a smaller literature on more innovative ways of improving recruitment. In particular, in the U.K. the NHS has a comprehensive plan to increase recruitment and component parts of this are described.


HR best practice

‘Recruitment and selection – a best practice guide January 2003. The Leeds Teaching Hospital NHS Trust’ – A fairly straightforward guide to recruitment and selection best practice as carried out in this NHS Trust. Available from the NHS Trust’s website http://www.leedsth.nhs.uk/recruitment/details.php?systemID=11&fileID=79 ‘Guidance for Best Practice on the Recruitment of Overseas Nurses and Midwives’ – published by Nursing Policy Division, Department of Health and Children, Hawkins House, Hawkins Street, Dublin 2, Ireland, December 2001. Available from www.doh.ie ). This is from the Irish Department of Health and Children and sets out guidelines on recruiting from overseas. Similarly the Department of Health in the U.K. has produced the ‘Code of Practice for NHS employers involved in the international recruitment of healthcare professionals’ (Department of Health, 2001). The American Hospital Association (AHA) is particularly concerned about recruitment and retention issues in the USA. This is also reflected in the different health professional groups especially amongst nurses. The AHA have surveyed U.S. hospitals and found that the strategies in Figure 2 have been used to address recruitment and retention issues. The other major strategy used in the U.S. is the provision of generous scholarships to encourage individuals to start studying a health professional course especially nursing. The AHA has numerous examples of recruitment and retention initiatives on its website and is also one of many organisations which have produced books outlining ways of improving recruitment and retention. Figure 2. Percentage of U.S. hospitals offering recruitment and retention incentives.

0 20 40 60 80 100

Transportation

Child care

Shared governance

Clinical ladders

Bonuses

Flexible hours

Tuition reimbursement

Source : American Hospital Association, 2001.


HR best practice

‘Recruitment and selection – a best practice guide January 2003. The Leeds Teaching Hospital NHS Trust’ – A fairly straightforward guide to recruitment and selection best practice as carried out in this NHS Trust. Available from the NHS Trust’s website http://www.leedsth.nhs.uk/recruitment/details.php?systemID=11&fileID=79 ‘Guidance for Best Practice on the Recruitment of Overseas Nurses and Midwives’ – published by Nursing Policy Division, Department of Health and Children, Hawkins House, Hawkins Street, Dublin 2, Ireland, December 2001. Available from www.doh.ie ). This is from the Irish Department of Health and Children and sets out guidelines on recruiting from overseas. Similarly the Department of Health in the U.K. has produced the ‘Code of Practice for NHS employers involved in the international recruitment of healthcare professionals’ (Department of Health, 2001). The American Hospital Association (AHA) is particularly concerned about recruitment and retention issues in the USA. This is also reflected in the different health professional groups especially amongst nurses. The AHA have surveyed U.S. hospitals and found that the strategies in Figure 2 have been used to address recruitment and retention issues. The other major strategy used in the U.S. is the provision of generous scholarships to encourage individuals to start studying a health professional course especially nursing. The AHA has numerous examples of recruitment and retention initiatives on its website and is also one of many organisations which have produced books outlining ways of improving recruitment and retention. Figure 2. Percentage of U.S. hospitals offering recruitment and retention incentives.

0 20 40 60 80 100

Transportation

Child care

Shared governance

Clinical ladders

Bonuses

Flexible hours

Tuition reimbursement

Source : American Hospital Association, 2001.


Improving recruitment in the NHS

All the NHS initiatives described below can be accessed from the U.K. Department of Health website at http://www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/fs/en.

1. The NHS International Fellowship Programme – this offers doctors, including psychiatrists, from outside the U.K. two year fellowships working as consultants in the NHS. Relocation costs up to $36,000 and the cost of rental accommodation of up to $75,000 over the 2 years are available as part of the package which also includes an attractive salary. This is aggressively marketed by the NHS in New Zealand and Australia where it is a feature of most major psychiatric conferences. This is one response to a workforce shortage – throwing money at the problem and poaching other countries workforce. The scheme has provoked some controversy in the U.K. because of its questionable ethics and the effects on developing countries. Some countries such as Canada have a reciprocal “no poaching” agreement with the U.K.

2. The NHS Recruitment and Retention Collaboration. The Recruitment and Retention Initiative started in 2001 and consists of four key programme activities: Local Retention and Recruitment Collaboratives; Train-the-Trainer; Programme for Enabling Retention and Recruitment Improvement (PERRI); and Building HR Improvement Capacity. It is run by the NHS Modernisation Agency and uses an action research methodology at a local level to improve recruitment and retention processes. Local teams supported and trained by the central Research and Recruitment Collaborative use a continuous method of improvement in which ideas for change are tested starting on a small scale using the Plan-Do-Study-Act cycle. It appears to be a practical way of implementing HR best practice. The ‘Retention and Recruitment Collaborative 2003-2004 Outcome and Impact Report’ (NHS, 2004) describes a mean reduction in the length of the recruitment process of 68 percent and a 67 percent reduction in advertising spend in organisations who took part in the initiative. The central budget for the Retention and Recruitment Collaborative was £56,000.

3. Publicity Campaigns – “The Looking Good?” research project was conducted by a team from Loughborough University Business School and was funded by the U.K. Department of Health (Arnold et al., 2003). It was a 2 year project that commenced in September 2000 which interviewed 231 people from a range of different groups and asked questions about their perceptions of the NHS as an employer. The purpose of this was to inform recruitment strategies and how jobs in healthcare are portrayed. The recommendations are outlined below: − To attract potential nursing and allied health staff to the NHS a combination of

increased pay coupled with a less pressurised working environment is required; − Greater financial support for the process of training and qualification would also help

and there maybe a case for considering flexible forms of training delivery that allow people to undertake their training whilst still working in another job;

− Career progression, employment security, a pension scheme and the opportunity to find work in most parts of the country could be highlighted more in recruitment publicity;

− More promotion opportunities to high levels that retain patient contact in a professional capacity would help recruitment and retention in all three professions;

− Flexibility and limited length of working hours to fit with other commitments is another very important factor for people who might consider working in the NHS, especially as a nurse. The NHS’s existing initiatives to accommodate flexible working (including childcare support) could be publicised more and perhaps further innovations encouraged at local level;

− Further attempts are needed to publicise nursing and (especially) the allied health professions in schools. Publicity that portrays male role models might be particularly helpful; and


Improving recruitment in the NHS

All the NHS initiatives described below can be accessed from the U.K. Department of Health website at http://www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/fs/en.

1. The NHS International Fellowship Programme – this offers doctors, including psychiatrists, from outside the U.K. two year fellowships working as consultants in the NHS. Relocation costs up to $36,000 and the cost of rental accommodation of up to $75,000 over the 2 years are available as part of the package which also includes an attractive salary. This is aggressively marketed by the NHS in New Zealand and Australia where it is a feature of most major psychiatric conferences. This is one response to a workforce shortage – throwing money at the problem and poaching other countries workforce. The scheme has provoked some controversy in the U.K. because of its questionable ethics and the effects on developing countries. Some countries such as Canada have a reciprocal “no poaching” agreement with the U.K.

2. The NHS Recruitment and Retention Collaboration. The Recruitment and Retention Initiative started in 2001 and consists of four key programme activities: Local Retention and Recruitment Collaboratives; Train-the-Trainer; Programme for Enabling Retention and Recruitment Improvement (PERRI); and Building HR Improvement Capacity. It is run by the NHS Modernisation Agency and uses an action research methodology at a local level to improve recruitment and retention processes. Local teams supported and trained by the central Research and Recruitment Collaborative use a continuous method of improvement in which ideas for change are tested starting on a small scale using the Plan-Do-Study-Act cycle. It appears to be a practical way of implementing HR best practice. The ‘Retention and Recruitment Collaborative 2003-2004 Outcome and Impact Report’ (NHS, 2004) describes a mean reduction in the length of the recruitment process of 68 percent and a 67 percent reduction in advertising spend in organisations who took part in the initiative. The central budget for the Retention and Recruitment Collaborative was £56,000.

3. Publicity Campaigns – “The Looking Good?” research project was conducted by a team from Loughborough University Business School and was funded by the U.K. Department of Health (Arnold et al., 2003). It was a 2 year project that commenced in September 2000 which interviewed 231 people from a range of different groups and asked questions about their perceptions of the NHS as an employer. The purpose of this was to inform recruitment strategies and how jobs in healthcare are portrayed. The recommendations are outlined below: − To attract potential nursing and allied health staff to the NHS a combination of

increased pay coupled with a less pressurised working environment is required; − Greater financial support for the process of training and qualification would also help

and there maybe a case for considering flexible forms of training delivery that allow people to undertake their training whilst still working in another job;

− Career progression, employment security, a pension scheme and the opportunity to find work in most parts of the country could be highlighted more in recruitment publicity;

− More promotion opportunities to high levels that retain patient contact in a professional capacity would help recruitment and retention in all three professions;

− Flexibility and limited length of working hours to fit with other commitments is another very important factor for people who might consider working in the NHS, especially as a nurse. The NHS’s existing initiatives to accommodate flexible working (including childcare support) could be publicised more and perhaps further innovations encouraged at local level;

− Further attempts are needed to publicise nursing and (especially) the allied health professions in schools. Publicity that portrays male role models might be particularly helpful; and


− Structured (and perhaps individualised) refresher training programmes should be provided and publicised to qualified staff considering returning to the NHS from other health employers.

This report seems to have informed the NHS 2003 National Recruitment campaign, which involved a coordinated high profile promotion of careers in the NHS through television, press and radio advertising, both at a national and local level. This included digital television, which allowed viewers to request further information directly through their television upon seeing the adverts.

4. An Electronic Recruitment Service. This involves the use of a centrally funded national Electronic Recruitment Service. It involves a web-based recruitment service, advertising posts, providing information about jobs and NHS employers, and an electronic application process. It also allows local websites which candidates can access via the national site for more detailed local information. The provision of this service is sub-contracted to a private firm which estimates that involvement in this project saves local NHS Trusts £60,000 a year in HR costs.

5. Return to practice scheme. Another U.K. initiative is the Return to Practice Scheme, where nurses, midwives, health visitors, allied health professionals and healthcare scientists deciding to return to the NHS receive: − Free refresher training; − A minimum of £1,000 financial support whilst retrain ing (£1,500 for midwives); − Assistance with childcare support of up to £135 per week for one child and £200 for

two or more children; and − Assistance with travel and books.

Financial incentives

There maybe lessons to be learned from within the education sector that uses financial incentives as a strategy for attracting and keeping teachers in classrooms. The National Education Association (NEA) in the U.S. produces a useful publication ‘Meeting the challenges of recruitment and retention. A guidebook on promising strategies to recruit and retain qualified and diverse teachers’, (National Education Association, 2003), which outlines many of these financial incentives with examples from teaching. The financial incentives can be in the form of direct cash payments such as bonuses or salary increases, or through subsidies such as housing assistance, tuition assistance or by tax credits. These strategies appear to be successful in attracting new teachers to the districts offering these incentives, but it remains unclear as to how effective these incentives will be in actually retaining teachers. The NEA accepts the concept of financial incentives with the following provisions:

• NEA opposes any attempt to establish tiered compensation systems that place entry-level employees on a salary and/or benefits schedule that differs from that of career employees;

• NEA opposes financial incentives for teachers in hard-to-staff subject areas;

• NEA supports financial incentives for teachers in priority schools provided that all teachers in those schools receive bonuses; and

• NEA believes that no compensation structure should bypass the bargaining process or negotiated agreements.


− Structured (and perhaps individualised) refresher training programmes should be provided and publicised to qualified staff considering returning to the NHS from other health employers.

This report seems to have informed the NHS 2003 National Recruitment campaign, which involved a coordinated high profile promotion of careers in the NHS through television, press and radio advertising, both at a national and local level. This included digital television, which allowed viewers to request further information directly through their television upon seeing the adverts.

4. An Electronic Recruitment Service. This involves the use of a centrally funded national Electronic Recruitment Service. It involves a web-based recruitment service, advertising posts, providing information about jobs and NHS employers, and an electronic application process. It also allows local websites which candidates can access via the national site for more detailed local information. The provision of this service is sub-contracted to a private firm which estimates that involvement in this project saves local NHS Trusts £60,000 a year in HR costs.

5. Return to practice scheme. Another U.K. initiative is the Return to Practice Scheme, where nurses, midwives, health visitors, allied health professionals and healthcare scientists deciding to return to the NHS receive: − Free refresher training; − A minimum of £1,000 financial support whilst retrain ing (£1,500 for midwives); − Assistance with childcare support of up to £135 per week for one child and £200 for

two or more children; and − Assistance with travel and books.

Financial incentives

There maybe lessons to be learned from within the education sector that uses financial incentives as a strategy for attracting and keeping teachers in classrooms. The National Education Association (NEA) in the U.S. produces a useful publication ‘Meeting the challenges of recruitment and retention. A guidebook on promising strategies to recruit and retain qualified and diverse teachers’, (National Education Association, 2003), which outlines many of these financial incentives with examples from teaching. The financial incentives can be in the form of direct cash payments such as bonuses or salary increases, or through subsidies such as housing assistance, tuition assistance or by tax credits. These strategies appear to be successful in attracting new teachers to the districts offering these incentives, but it remains unclear as to how effective these incentives will be in actually retaining teachers. The NEA accepts the concept of financial incentives with the following provisions:

• NEA opposes any attempt to establish tiered compensation systems that place entry-level employees on a salary and/or benefits schedule that differs from that of career employees;

• NEA opposes financial incentives for teachers in hard-to-staff subject areas;

• NEA supports financial incentives for teachers in priority schools provided that all teachers in those schools receive bonuses; and

• NEA believes that no compensation structure should bypass the bargaining process or negotiated agreements.


Bonuses

One-time bonuses are being offered to attract teachers into some schools, either offering signing bonuses to all new teachers or providing target bonuses to teachers in critical demand subject areas, or agreeing to teach in a hard-to-staff school, or for extended period of time or to bilingual teachers. This is also used in the U.K. to attract General Practitioners, “the Golden Hello”, and in Alberta Canada to attract physicians to rural areas (Alberta Rural Physician Action Plan, http://www.rpap.ab.ca/).

Alternative subsidies and assistance

These include a variety of incentives:

• Housing subsidies, loans and grants/reduced mortgage rates – for example Raritan Bay Medical Center in Perth Amboy and Old Bridge, New Jersey, USA have an employer-assisted housing (EAH) benefit in partnership with a local bank. The programme offers employees a US$5,000 loan for use in purchasing a home and forgives the loan after 2 years of service;

• Relocation assistance;

• Reduced/free rent and utilities;

• Hospital housing;

• Reduced-price homes;

• Assistance with down payments and closing costs;

• Tax credits or exemptions;

• Tuition assistance;

• Loans and forgivable loans linked to teachers working for a number of years; and

• Referral incentives – One school district in North Carolina, for example, offers employees a US$100 finder’s fee for every certified teacher they recommend who is eventually hired.

Payment of education costs and debt reduction

Of particular importance to the New Zealand health sector is the impact of high student debts on completion of training. The education sector have progressed this overseas by paying education costs or relieving education debt as a powerful incentive for attracting new teachers. Other incentives include awarding scholarships to people working in a geographical shortage area, a high-poverty or hard-to-staff school, or in a critical demand subject area. Other states offer scholarships to mid-career professionals who hold a bachelor’s degree, enroll full time in an approved teacher preparation programme, and commit to teach in one of the state’s low-performing schools.

Summary

There is extensive experience in increasing recruitment to the health workforce. How to increase recruitment appears to be well known and is repetitively described in the HR and management literature. The difficulty is in designing a system that will ensure that best practice happens.


Bonuses

One-time bonuses are being offered to attract teachers into some schools, either offering signing bonuses to all new teachers or providing target bonuses to teachers in critical demand subject areas, or agreeing to teach in a hard-to-staff school, or for extended period of time or to bilingual teachers. This is also used in the U.K. to attract General Practitioners, “the Golden Hello”, and in Alberta Canada to attract physicians to rural areas (Alberta Rural Physician Action Plan, http://www.rpap.ab.ca/).

Alternative subsidies and assistance

These include a variety of incentives:

• Housing subsidies, loans and grants/reduced mortgage rates – for example Raritan Bay Medical Center in Perth Amboy and Old Bridge, New Jersey, USA have an employer-assisted housing (EAH) benefit in partnership with a local bank. The programme offers employees a US$5,000 loan for use in purchasing a home and forgives the loan after 2 years of service;

• Relocation assistance;

• Reduced/free rent and utilities;

• Hospital housing;

• Reduced-price homes;

• Assistance with down payments and closing costs;

• Tax credits or exemptions;

• Tuition assistance;

• Loans and forgivable loans linked to teachers working for a number of years; and

• Referral incentives – One school district in North Carolina, for example, offers employees a US$100 finder’s fee for every certified teacher they recommend who is eventually hired.

Payment of education costs and debt reduction

Of particular importance to the New Zealand health sector is the impact of high student debts on completion of training. The education sector have progressed this overseas by paying education costs or relieving education debt as a powerful incentive for attracting new teachers. Other incentives include awarding scholarships to people working in a geographical shortage area, a high-poverty or hard-to-staff school, or in a critical demand subject area. Other states offer scholarships to mid-career professionals who hold a bachelor’s degree, enroll full time in an approved teacher preparation programme, and commit to teach in one of the state’s low-performing schools.

Summary

There is extensive experience in increasing recruitment to the health workforce. How to increase recruitment appears to be well known and is repetitively described in the HR and management literature. The difficulty is in designing a system that will ensure that best practice happens.

Chapter 6: A Strategy to Improve Recruitment 65

Chapter 6: A Strategy to Improve Recruitment

The literature on improving recruitment whether it is of health professionals, teachers or other groups is fairly consistent in describing what needs to be done. The same strategies arise repeatedly in different documents describing recruitment practices. The challenge is deciding not so much “what” needs to be done but “how” to do it – how to design a system to ensure that best practice happens. There is a need for a nationally consistent approach that draws on the strengths and opportunities of close regional cooperation. There also needs to be absolute clarity about the level of intervention; currently there is a tendency for the central agencies to take the operational rather than to provide the strategic. Achieving the benefits of local application with national consistency will not occur unless there is a clear strategic framework, good monitoring and feedback, and opportunity for local solutions within the wider strategic framework. The options to improve recruitment are listed below under the organisations the project team believed should have primary responsibility for making them happen.

“All of Government” approach

This is necessary to coordinate all the parts of government, which affect the factors that influence recruitment at a national level. The Growth and Innovation Framework to us seems an opportunity to develop an “all of government” approach to improving recruitment. There are two aspects to this.

1. Firstly, as part of the Growth and Innovation Framework, it is proposed to set up a national website to advertise jobs. The project team believe that this is an opportunity to develop a New Zealand version of the NHS Electronic Recruitment Service. This would not be a replacement for regional websites but would act as a portal for the whole of New Zealand and allow online applications for jobs. It would also provide an opportunity to “brand” the New Zealand health service.

2. Secondly, matching policy to recruitment needs. This is necessary for several of the financial incentives, which have been found to be effective in increasing recruitment. The project team recommend that the following strategies be considered in trying to recruit the mental health workforce. There will need to be coordination and agreement between Treasury, the Inland Revenue and other Government Departments: − Housing loans and grants; − Housing subsidies; − Reduced/free rent and utilities; − Housing for mental health workers; − Housing loans and grants; − Reduced-price homes; − Low-interest mortgages; − Assistance with down payments and closing costs; − Tax credits for individuals working in mental health; − Forgivable student loans for people working in mental health – at present New Zealand

has designed a scheme which is a model of how not to increase recruitment of young professionals into the health service. The financial incentives positively encourage them to emigrate overseas to pay off or escape their student loans. This is an example of how an “all of government” approach is necessary as this is a problem that the mental health sector alone can not solve; and


Chapter 6: A Strategy to Improve Recruitment

The literature on improving recruitment whether it is of health professionals, teachers or other groups is fairly consistent in describing what needs to be done. The same strategies arise repeatedly in different documents describing recruitment practices. The challenge is deciding not so much “what” needs to be done but “how” to do it – how to design a system to ensure that best practice happens. There is a need for a nationally consistent approach that draws on the strengths and opportunities of close regional cooperation. There also needs to be absolute clarity about the level of intervention; currently there is a tendency for the central agencies to take the operational rather than to provide the strategic. Achieving the benefits of local application with national consistency will not occur unless there is a clear strategic framework, good monitoring and feedback, and opportunity for local solutions within the wider strategic framework. The options to improve recruitment are listed below under the organisations the project team believed should have primary responsibility for making them happen.

“All of Government” approach

This is necessary to coordinate all the parts of government, which affect the factors that influence recruitment at a national level. The Growth and Innovation Framework to us seems an opportunity to develop an “all of government” approach to improving recruitment. There are two aspects to this.

1. Firstly, as part of the Growth and Innovation Framework, it is proposed to set up a national website to advertise jobs. The project team believe that this is an opportunity to develop a New Zealand version of the NHS Electronic Recruitment Service. This would not be a replacement for regional websites but would act as a portal for the whole of New Zealand and allow online applications for jobs. It would also provide an opportunity to “brand” the New Zealand health service.

2. Secondly, matching policy to recruitment needs. This is necessary for several of the financial incentives, which have been found to be effective in increasing recruitment. The project team recommend that the following strategies be considered in trying to recruit the mental health workforce. There will need to be coordination and agreement between Treasury, the Inland Revenue and other Government Departments: − Housing loans and grants; − Housing subsidies; − Reduced/free rent and utilities; − Housing for mental health workers; − Housing loans and grants; − Reduced-price homes; − Low-interest mortgages; − Assistance with down payments and closing costs; − Tax credits for individuals working in mental health; − Forgivable student loans for people working in mental health – at present New Zealand

has designed a scheme which is a model of how not to increase recruitment of young professionals into the health service. The financial incentives positively encourage them to emigrate overseas to pay off or escape their student loans. This is an example of how an “all of government” approach is necessary as this is a problem that the mental health sector alone can not solve; and


− Auckland weighting because of the higher cost of living.

3. Thirdly, the Mental Health Workforce Development Committee should include representation from the Ministry of Education, Department of Labour, the Ministry of Economic Development and primary care. At present, the committee contains stakeholders that represent mental health provision rather than stakeholders involved in workforce development. There appears to be no links from this committee to professional organisations involved in mental health.

4. That a strategy be developed for creating positive work environments, which will attract recruits.

Ministry of Health

1. The project team suggest that the Ministry of Health fund an action research programme similar to the NHS Recruitment and Retention Collaboration to drive improvements in HR process and encourage best practice in the recruitment of Maori, especially into psychiatry.

2. Stop poaching – one of the strategies to improve recruitment into the U.K. NHS is to provide attractive packages for staff wanting to work in the U.K. This is supported by an aggressive marketing drive where NHS champions come to meetings in New Zealand and actively try to recruit professionals. Although initially directed at psychiatrists according to our respondents, the NHS has also started to actively recruit community support workers in New Zealand. There is no reciprocal New Zealand government funded “poaching strategy” in the U.K. It is recommended that the New Zealand government enter into a no poaching agreement with the U.K. (similar to Canada).

3. Improve nursing pay and career pathways.

4. Improve CTA processes – for example, training money for the academic component of psychiatric training should go directly to the individual training programmes rather than through institutions that do not ring fence money and where it is hard to track. The RANZCP should enter into discussions with the CTA to form one or more charitable trusts to directly receive CTA funding with the purpose of administering and providing the Psychiatry Training Programmes.

5. Multi-employer collective contracts – through MECAs, unions aggregate members into bigger bargaining units to deliver better levels of settlement and greater consistency in terms and conditions of employment across DHBs. The consistency of approach allows for a bigger pool of recruits.

6. PGY 1 and 2 placements in liaison psychiatry. (With the New Zealand Medical Council). Currently placements of PGY 1 and 2 doctors in psychiatry is in inpatient units where the emphasis is on providing basic physical care rather than psychiatry. The project team believe this is a wasted opportunity: PGY 1 and 2 doctors should also be allocated to liaison psychiatry services where they can be exposed to psychiatry in a familiar setting; to mental health care that would be relevant to them whether they practice psychiatry or not; and where they would practice some psychiatry rather than do physical care.

7. Ring fence money for child and adolescent services within the mental health budget received by DHBs.

8. Fund the Mental Health Workforce Information System.


1. Encourage non-tradit ional routes into the professions – for example, by giving clinical experience or cultural competence the same weight as a first degree.


− Auckland weighting because of the higher cost of living.

3. Thirdly, the Mental Health Workforce Development Committee should include representation from the Ministry of Education, Department of Labour, the Ministry of Economic Development and primary care. At present, the committee contains stakeholders that represent mental health provision rather than stakeholders involved in workforce development. There appears to be no links from this committee to professional organisations involved in mental health.

4. That a strategy be developed for creating positive work environments, which will attract recruits.

Ministry of Health

1. The project team suggest that the Ministry of Health fund an action research programme similar to the NHS Recruitment and Retention Collaboration to drive improvements in HR process and encourage best practice in the recruitment of Maori, especially into psychiatry.

2. Stop poaching – one of the strategies to improve recruitment into the U.K. NHS is to provide attractive packages for staff wanting to work in the U.K. This is supported by an aggressive marketing drive where NHS champions come to meetings in New Zealand and actively try to recruit professionals. Although initially directed at psychiatrists according to our respondents, the NHS has also started to actively recruit community support workers in New Zealand. There is no reciprocal New Zealand government funded “poaching strategy” in the U.K. It is recommended that the New Zealand government enter into a no poaching agreement with the U.K. (similar to Canada).

3. Improve nursing pay and career pathways.

4. Improve CTA processes – for example, training money for the academic component of psychiatric training should go directly to the individual training programmes rather than through institutions that do not ring fence money and where it is hard to track. The RANZCP should enter into discussions with the CTA to form one or more charitable trusts to directly receive CTA funding with the purpose of administering and providing the Psychiatry Training Programmes.

5. Multi-employer collective contracts – through MECAs, unions aggregate members into bigger bargaining units to deliver better levels of settlement and greater consistency in terms and conditions of employment across DHBs. The consistency of approach allows for a bigger pool of recruits.

6. PGY 1 and 2 placements in liaison psychiatry. (With the New Zealand Medical Council). Currently placements of PGY 1 and 2 doctors in psychiatry is in inpatient units where the emphasis is on providing basic physical care rather than psychiatry. The project team believe this is a wasted opportunity: PGY 1 and 2 doctors should also be allocated to liaison psychiatry services where they can be exposed to psychiatry in a familiar setting; to mental health care that would be relevant to them whether they practice psychiatry or not; and where they would practice some psychiatry rather than do physical care.

7. Ring fence money for child and adolescent services within the mental health budget received by DHBs.

8. Fund the Mental Health Workforce Information System.


1. Encourage non-tradit ional routes into the professions – for example, by giving clinical experience or cultural competence the same weight as a first degree.


2. Fast track mental health courses in tertiary institutions – currently changes to post-graduate courses can take 3 years to effect.

3. Ensure competencies are appropriate for mental health work. This is particularly an issue for comprehensively trained nurses who despite the title of their training often lack competency and confidence in mental health work. A similar issue arises with child and adolescent training in medical and nursing programmes where exposure to the subject is minimal.

DHBs

1. Improve HR practice (also see point 1 under Ministry of Health). One of the issues that was raised repeatedly in interviews and questionnaire responses was that of poor HR practice. HR should be used as a strategic tool by employers to improve recruitment. There are several issues here. First, recruitment should not be seen as separate to selection and retention. All these aspects should be integrated. Second, employing organisations should have a comprehensive recruitment plan. A number of best practice initiatives, for example the Leeds project are essentially guidelines on how to run a good HR department. Core components involve: − Gathering a recruitment team – this team is to collect data, evaluate needs, identify

resources, and recommend a list of changes in policies and practices. This can be informed by action research (see later recommendation). The team should include diverse stakeholders including Maori and consumers;

− Assessing needs – this is informed by the ‘Blueprint’ as well as the goals and mission of the organisation;

− Culture change – this involves an assessment of the culture of the organisation to see if there is anything about it that prevents people applying for posts in the organisation;

− Identifying the target audience – for most health organisations this will be a mixture of local training organisations and overseas job markets;

− Involvement in the community – that sells the health provider and working in mental health. It could also involve getting local businesses to buy into recruitment initiatives. An example from teaching in North Carolina U.S.A., is that incentives include discounts from local merchants and banking fee waivers for the first few months of teachers employment. The North Central Regional Educational Laboratory (NCREL) suggests that local businesses can be recruited to do such things as provide tuition support to a community’s education students, refinance the college loan debt loads of new teachers returning to the community, provide childcare for community members who are pursuing teacher training at local institutions, and provide discounts on merchandise and transportation to teachers;

− Collect data – recruitment and HR practice appears to be a “data free zone”. HR departments should be collecting accurate data to see which recruitment strategies are attracting applicants and which are not; and

− Having one person as the key contact for different professional groups.

2. Maximise opportunities from technological approaches – using innovative Internet-based strategies to improve recruitment. Good quality websites allow the candidates to apply on line and track the progress of their application; it has links to information about the local area; immigration and registration information; information about local schools; and probably most importantly links to other regional job sites so that spouses who move are also supported in their job search. Access to local sites can be from the national electronic recruitment site.


2. Fast track mental health courses in tertiary institutions – currently changes to post-graduate courses can take 3 years to effect.

3. Ensure competencies are appropriate for mental health work. This is particularly an issue for comprehensively trained nurses who despite the title of their training often lack competency and confidence in mental health work. A similar issue arises with child and adolescent training in medical and nursing programmes where exposure to the subject is minimal.

DHBs

1. Improve HR practice (also see point 1 under Ministry of Health). One of the issues that was raised repeatedly in interviews and questionnaire responses was that of poor HR practice. HR should be used as a strategic tool by employers to improve recruitment. There are several issues here. First, recruitment should not be seen as separate to selection and retention. All these aspects should be integrated. Second, employing organisations should have a comprehensive recruitment plan. A number of best practice initiatives, for example the Leeds project are essentially guidelines on how to run a good HR department. Core components involve: − Gathering a recruitment team – this team is to collect data, evaluate needs, identify

resources, and recommend a list of changes in policies and practices. This can be informed by action research (see later recommendation). The team should include diverse stakeholders including Maori and consumers;

− Assessing needs – this is informed by the ‘Blueprint’ as well as the goals and mission of the organisation;

− Culture change – this involves an assessment of the culture of the organisation to see if there is anything about it that prevents people applying for posts in the organisation;

− Identifying the target audience – for most health organisations this will be a mixture of local training organisations and overseas job markets;

− Involvement in the community – that sells the health provider and working in mental health. It could also involve getting local businesses to buy into recruitment initiatives. An example from teaching in North Carolina U.S.A., is that incentives include discounts from local merchants and banking fee waivers for the first few months of teachers employment. The North Central Regional Educational Laboratory (NCREL) suggests that local businesses can be recruited to do such things as provide tuition support to a community’s education students, refinance the college loan debt loads of new teachers returning to the community, provide childcare for community members who are pursuing teacher training at local institutions, and provide discounts on merchandise and transportation to teachers;

− Collect data – recruitment and HR practice appears to be a “data free zone”. HR departments should be collecting accurate data to see which recruitment strategies are attracting applicants and which are not; and

− Having one person as the key contact for different professional groups.

2. Maximise opportunities from technological approaches – using innovative Internet-based strategies to improve recruitment. Good quality websites allow the candidates to apply on line and track the progress of their application; it has links to information about the local area; immigration and registration information; information about local schools; and probably most importantly links to other regional job sites so that spouses who move are also supported in their job search. Access to local sites can be from the national electronic recruitment site.


3. Strong marketing and outreach programme (with the Ministry of Health): − Liaison with local schools; − Relationships with local clinical programmes; and − Positive image – this could be done either nationally or regionally through newspapers,

radio and TV to promote working in mental health.

4. Provide referral incentives – this encourages the word of mouth referral, which again respondents identify as one of the most effective recruitment strategies. Offering incentives to encourage referrals is a simple, cost effective means of obtaining candidates. This can also be an easy way to boost staff members’ morale, giving them ownership in the recruitment process and rewarding them for their efforts.

5. Financial incentives: − Bonuses – the “Golden Hello” a one time bonus to attract workers in hard to staff areas

such as inpatient units, unpopular regions or shortage specialties such as child and adolescent mental health;

− Signing bonuses for new mental health professionals; − Targeted salary increases; and

− Tuition assistance – paying education costs or relieving education debt can be an extremely powerful incentive for attracting new workers.

6. A return to practice scheme – similar to the NHS this could involve payment of retraining courses, free childcare and costs of books and travel.

7. The project team suggest that DHBs investigate forming regional partnerships of their HR departments in the same way as Waitemata DHB and Counties Manukau DHB have combined to form Health Alliance.

NGOs

1. Encourage local and regional recruitment websites.

2. Provide referral incentives (see DHB section).

3. Provide financial incentives (see DHB section).


Primary Health Organisations (PHO’s)

1. There should be representation of primary care on the Mental Health Workforce Development Committee.

2. A strategy for primary mental health care, including workforce development, needs to be developed.

Professional bodies

1. Facilitate clinician mobility through licensing reciprocity.

2. Create a positive image to attract prospective entrants into the workforce.

3. Professional bodies such as the New Zealand Branch of the Royal Australian and New Zealand College of Psychiatrists appoint national Directors of Maori Training.


3. Strong marketing and outreach programme (with the Ministry of Health): − Liaison with local schools; − Relationships with local clinical programmes; and − Positive image – this could be done either nationally or regionally through newspapers,

radio and TV to promote working in mental health.

4. Provide referral incentives – this encourages the word of mouth referral, which again respondents identify as one of the most effective recruitment strategies. Offering incentives to encourage referrals is a simple, cost effective means of obtaining candidates. This can also be an easy way to boost staff members’ morale, giving them ownership in the recruitment process and rewarding them for their efforts.

5. Financial incentives: − Bonuses – the “Golden Hello” a one time bonus to attract workers in hard to staff areas

such as inpatient units, unpopular regions or shortage specialties such as child and adolescent mental health;

− Signing bonuses for new mental health professionals; − Targeted salary increases; and

− Tuition assistance – paying education costs or relieving education debt can be an extremely powerful incentive for attracting new workers.

6. A return to practice scheme – similar to the NHS this could involve payment of retraining courses, free childcare and costs of books and travel.

7. The project team suggest that DHBs investigate forming regional partnerships of their HR departments in the same way as Waitemata DHB and Counties Manukau DHB have combined to form Health Alliance.

NGOs

1. Encourage local and regional recruitment websites.

2. Provide referral incentives (see DHB section).

3. Provide financial incentives (see DHB section).


Primary Health Organisations (PHO’s)

1. There should be representation of primary care on the Mental Health Workforce Development Committee.

2. A strategy for primary mental health care, including workforce development, needs to be developed.

Professional bodies

1. Facilitate clinician mobility through licensing reciprocity.

2. Create a positive image to attract prospective entrants into the workforce.

3. Professional bodies such as the New Zealand Branch of the Royal Australian and New Zealand College of Psychiatrists appoint national Directors of Maori Training.


Maori specific

1. Early outreach programmes – going into schools, iwi and marae to positively, identify, mentor and encourage young Maori who want to work in mental health.

2. Scholarship/grant programmes – directed at those Maori at the time of entry to tertiary institutions for training and at the time when they choose to start post-entry clinical training.

3. Providing supportive environments for mentoring, academic and personal support for Maori in clinical training.

4. Support worker to clinician programmes – facilitate a culture of expectation that support workers will train to become clinicians, (the Mason Clinic provides an example). Provide specific funding and job description of someone to own this role.


Maori specific

1. Early outreach programmes – going into schools, iwi and marae to positively, identify, mentor and encourage young Maori who want to work in mental health.

2. Scholarship/grant programmes – directed at those Maori at the time of entry to tertiary institutions for training and at the time when they choose to start post-entry clinical training.

3. Providing supportive environments for mentoring, academic and personal support for Maori in clinical training.

4. Support worker to clinician programmes – facilitate a culture of expectation that support workers will train to become clinicians, (the Mason Clinic provides an example). Provide specific funding and job description of someone to own this role.

The Way Forward 71

The Way Forward

The New Zealand mental health workforce is characterised by shortages in several workforce types, particularly psychiatry, clinical psychology and nursing. Most of the shortfall and increase in workforce numbers must come from within New Zealand given the widespread shortage of health workers in many countries internationally. Strategies for recruitment must also be supported by a national retention strategy, given the likelihood of other countries attempting to recruit from New Zealand and the close links between recruitment and retention. The approach to improving recruitment needs to be a combination of attracting the existing workforce and also growing new. These efforts need to be complimentary not competitive. Expenditure of human and financial resource in increasing the size and capacity of the mental health sector workforce must be seen as an investment designed to reduce the considerable burden of disease that has been shown internationally to be an under-rated part of mental illness. Therefore, there needs to be both short- and long-term strategy with an “all of government approach”. It must be recognised that like all long-term investments some of the expenditure will not get a return for a considerable time, (for instance it takes a minimum 13 years of tertiary level training for a young person to qualify as a psychiatrist). The review also highlights the fact that the development of the mental health workforce is a complex problem. There are multiple stakeholders, who often have strong feelings about personal and professional identity and there are large sums of money involved. Like all complex problems it has a number of simple solutions and they are all wrong. The hope that there is a simple solution that we have not yet found or that we are not yet applying is a serious impediment to progress. The way forward is well summarised by a plan, do, study, act philosophy. Any system is perfectly designed to get the results it gets. That means that unless there is a concerted and total system attention to the range of issues that emerge from this report that we will not see dramatic change. For a considerable time there have been a number of very good ideas, very sound approaches and indeed success stories. The problem is that these have been in isolation. The conclusion of the review has to be that if we are to breach the gaps between the current and projected future workforce we have to invoke a collection of strategies that are well informed by available information, have a clear strategy and are regularly monitored. Having no data is no excuse for not wanting information; not having information is not an excuse for not planning. The project team believe that this document should be used to inform a recruitment strategy led by the Mental Health Workforce Development Committee. Primary Health Organisations are clearly important in providing for the future mental health of New Zealanders and should be involved in developing such a recruitment strategy. The project brief was to cover recruitment rather than other aspects of workforce development, however, the project team believe that a similar strategy addressing retention is also required. This needs to include strategies for making the work environment a good place to work. In keeping with the content of this document, it should be presented to an “all of government” forum rather than just be restricted to the Mental Health Directorate of the Ministry of Health.

The Way Forward 71

The Way Forward

The New Zealand mental health workforce is characterised by shortages in several workforce types, particularly psychiatry, clinical psychology and nursing. Most of the shortfall and increase in workforce numbers must come from within New Zealand given the widespread shortage of health workers in many countries internationally. Strategies for recruitment must also be supported by a national retention strategy, given the likelihood of other countries attempting to recruit from New Zealand and the close links between recruitment and retention. The approach to improving recruitment needs to be a combination of attracting the existing workforce and also growing new. These efforts need to be complimentary not competitive. Expenditure of human and financial resource in increasing the size and capacity of the mental health sector workforce must be seen as an investment designed to reduce the considerable burden of disease that has been shown internationally to be an under-rated part of mental illness. Therefore, there needs to be both short- and long-term strategy with an “all of government approach”. It must be recognised that like all long-term investments some of the expenditure will not get a return for a considerable time, (for instance it takes a minimum 13 years of tertiary level training for a young person to qualify as a psychiatrist). The review also highlights the fact that the development of the mental health workforce is a complex problem. There are multiple stakeholders, who often have strong feelings about personal and professional identity and there are large sums of money involved. Like all complex problems it has a number of simple solutions and they are all wrong. The hope that there is a simple solution that we have not yet found or that we are not yet applying is a serious impediment to progress. The way forward is well summarised by a plan, do, study, act philosophy. Any system is perfectly designed to get the results it gets. That means that unless there is a concerted and total system attention to the range of issues that emerge from this report that we will not see dramatic change. For a considerable time there have been a number of very good ideas, very sound approaches and indeed success stories. The problem is that these have been in isolation. The conclusion of the review has to be that if we are to breach the gaps between the current and projected future workforce we have to invoke a collection of strategies that are well informed by available information, have a clear strategy and are regularly monitored. Having no data is no excuse for not wanting information; not having information is not an excuse for not planning. The project team believe that this document should be used to inform a recruitment strategy led by the Mental Health Workforce Development Committee. Primary Health Organisations are clearly important in providing for the future mental health of New Zealanders and should be involved in developing such a recruitment strategy. The project brief was to cover recruitment rather than other aspects of workforce development, however, the project team believe that a similar strategy addressing retention is also required. This needs to include strategies for making the work environment a good place to work. In keeping with the content of this document, it should be presented to an “all of government” forum rather than just be restricted to the Mental Health Directorate of the Ministry of Health.

References 73

References

Alcohol Advisory Council of New Zealand. (2001). The National Alcohol Strategy. Wellington: Alcohol Advisory Council of New Zealand and Ministry of Health.

Allen, D. G., Van Scotter, J. R., & Otondo, R. F. (2004). Recruitment Communication Media: Impact on Pre-hire Outcomes, Personnel Psychology, Vol 57, Spring, ABI/INFORM Global.

American Association of Colleges of Nursing, (2002a). Strategies to Reverse the New Nursing Shortage: A Policy Statement From Tri-Council Members. Retrieved January 2004 from American Association of Colleges of Nursing website: http://www.aacn.nche.edu/

American Association of Colleges of Nursing, (2002b). Effective Strategies for Increasing Diversity in Nursing Programs. Retrieved January 2004 from American Association of Colleges of Nursing website: http://www.aacn.nche.edu/

American Hospital Association. (2001). The hospital workforce shortage: Immediate and Future. Trend Watch, 3(2), 1-8.

Andrews, D. R. (2003). Lessons from the past: Confronting past discriminatory practices to alleviate the nursing shortage through increased professional diversity. Journal of Professional Nursing, 19(5), 289-294.

Anthony, W. P., Kacmar, K. M., & Perrewe, P. L. (2002). Human Resource Management: A Strategic Approach. 4th Edition, Australia: South-Western Thomson Learning.

Arnold, J., Loan-Clarke, J., Coombs, C., Park, J., Wilkinson, A. & Preston, D. (2003). Looking Good? The Attractiveness of the NHS as an Employer to Potential Nursing and Allied Health Professional Staff. Retrieved on January 29th, 2004 from the Loughborough University Business School website http://www.lboro.ac.uk/departments/bs/lookinggood/LookingGood.html

Ashcroft, J. J. & Turpin, G. (1994). Clinical psychology postgraduate training: Meeting the shortfall. Health Manpower Management, 20(2), 35-36.

Association of Salaried Medical Specialists. (2004). Psychiatrist Case Highlights Specialist Recruitment Problems. Retrieved 29/01/04 from Association of Salaried Medical Specialists website, http://www.asms.org.nz/

Australian Medical Workforce Advisory Committee. (2002). Career Decision Making By Doctors in Their Postgraduate Years – A Literature Review. Sydney: Australian Medical Workforce Advisory Committee.

Australian Medical Workforce Advisory Committee. (2003). Specialist Medical Workforce Planning in Australia. Sydney: Australian Medical Workforce Advisory Committee.

Barney, S. M. (2002). Retaining our workforce, regaining our potential. Journal of Healthcare Management, 47(5), 291-294.

Boxall, P. & Purcell, J. (2000). Strategic human resource management: where have we come from and where should we be going?, International Journal of Management Review, Vol 2, Issue 2, p 183-204.

Boxall, P. & Purcell, J. (2003). Management, Work and Organisations: Strategy and Human Resource Management. New York: Palgrave Macmillan.

References 73

References

Alcohol Advisory Council of New Zealand. (2001). The National Alcohol Strategy. Wellington: Alcohol Advisory Council of New Zealand and Ministry of Health.

Allen, D. G., Van Scotter, J. R., & Otondo, R. F. (2004). Recruitment Communication Media: Impact on Pre-hire Outcomes, Personnel Psychology, Vol 57, Spring, ABI/INFORM Global.

American Association of Colleges of Nursing, (2002a). Strategies to Reverse the New Nursing Shortage: A Policy Statement From Tri-Council Members. Retrieved January 2004 from American Association of Colleges of Nursing website: http://www.aacn.nche.edu/

American Association of Colleges of Nursing, (2002b). Effective Strategies for Increasing Diversity in Nursing Programs. Retrieved January 2004 from American Association of Colleges of Nursing website: http://www.aacn.nche.edu/

American Hospital Association. (2001). The hospital workforce shortage: Immediate and Future. Trend Watch, 3(2), 1-8.

Andrews, D. R. (2003). Lessons from the past: Confronting past discriminatory practices to alleviate the nursing shortage through increased professional diversity. Journal of Professional Nursing, 19(5), 289-294.

Anthony, W. P., Kacmar, K. M., & Perrewe, P. L. (2002). Human Resource Management: A Strategic Approach. 4th Edition, Australia: South-Western Thomson Learning.

Arnold, J., Loan-Clarke, J., Coombs, C., Park, J., Wilkinson, A. & Preston, D. (2003). Looking Good? The Attractiveness of the NHS as an Employer to Potential Nursing and Allied Health Professional Staff. Retrieved on January 29th, 2004 from the Loughborough University Business School website http://www.lboro.ac.uk/departments/bs/lookinggood/LookingGood.html

Ashcroft, J. J. & Turpin, G. (1994). Clinical psychology postgraduate training: Meeting the shortfall. Health Manpower Management, 20(2), 35-36.

Association of Salaried Medical Specialists. (2004). Psychiatrist Case Highlights Specialist Recruitment Problems. Retrieved 29/01/04 from Association of Salaried Medical Specialists website, http://www.asms.org.nz/

Australian Medical Workforce Advisory Committee. (2002). Career Decision Making By Doctors in Their Postgraduate Years – A Literature Review. Sydney: Australian Medical Workforce Advisory Committee.

Australian Medical Workforce Advisory Committee. (2003). Specialist Medical Workforce Planning in Australia. Sydney: Australian Medical Workforce Advisory Committee.

Barney, S. M. (2002). Retaining our workforce, regaining our potential. Journal of Healthcare Management, 47(5), 291-294.

Boxall, P. & Purcell, J. (2000). Strategic human resource management: where have we come from and where should we be going?, International Journal of Management Review, Vol 2, Issue 2, p 183-204.

Boxall, P. & Purcell, J. (2003). Management, Work and Organisations: Strategy and Human Resource Management. New York: Palgrave Macmillan.

References 74

Brown, E. & Matthews, R. (2003). The impact of student debt on nurses: an investigation. Wellington: New Zealand University Student Association and New Zealand Nurses Organisation.

Caroselli-Karinja, M. F., McGowan, J. & Penn, S. M. (1988). Journal of Psychosocial Nursing, 26(8), 28-31.

Clasen, C., Meyer, C. B., Mase, W. & Cauley, K. (2003). Development of the competency assessment tool-mental health, an instrument to assess core competencies for mental health care workers. Psychiatric Rehabilitation Journal, 27(1), 10-17.

Clinton, M. & Hazelton, M. (2000). Scoping the Australian mental health nursing workforce. Australian and New Zealand Journal of Mental Health Nursing, 9, 56-64.

Covey, S. (2003). Investing in people: Stephen R. Covey, best-selling author and management mentor, explains how behavioural training can help to achieve a more productive workforce in the healthcare sector. Nursing Management, 9(10), 32-34.

Coyne, P. & Beardsmoore, A. (2001). A turn for the better: A nurse rotation programme has already boosted recruitment in the hard-to-staff mental health sector. Health Service Journal, April, 29.

Craig, A. B. (1999). Mental health nursing and cultural diversity. Australian and New Zealand Journal of Mental Health Nursing, 8, 93-99.

Department of Health. (2001). Code of Practice for NHS employers involved in the international recruitment of healthcare professionals. London: Department of Health

Department of Labour. (2004). Skills in the labour market – May 2004. Retrieved July 2004 from the Department of Labour website: http://www.dol.govt.nz/lmr-Skills.asp

District Health Board New Zealand. (2003). Workforce Action Plan. Wellington: District Health Boards New Zealand Incorporated.

Douglas, E. M. K. (2001). Te Iwi Maori, Asia Pacific Viewpoint, Vol 42, No 1, April, Wellington: Victoria University, p 17-25.

Doult, B. & Stephen, H. (1998). Recruitment drive for mental health nurses. Nursing Standard, 13(12), 5.

Du Plessis, D. (2003). Chapter 14: Contemporary issues in recruitment and selection in Wiesner, R. & Millett, B. (Eds), Human Resource Management: challenges and future directions, Sydney: John Wiley & Sons Australia Ltd, 169-186

Durkin, A. (2002). Psychiatric nursing recruitment: Roles for educators and nursing staff. Journal of Psychosocial Nursing, 40(8), 32-35.

Fong, T. (2003). It takes a nation; Coalition trying to spur worker interest. (Workforce Report 2003) (the health care industry continues to try and figure out how to keep nurses from leaving the profession). Modern Healthcare, 33(24), 25.

Frase-Blunt, M. (2002). Amid Nursing Shortages, Schools Employ Strategies to Boost Enrollment. Retrieved January 2004 from American Association of Colleges of Nursing website: http://www.aacn.nche.edu/

Genkeer, L., Gough, P. & Finlayson, B. (2003). London’s Mental Health Workforce: A review of recent developments. London: Kings Fund.

Gering, J. & Conner, J. (2002). A strategic approach to employee retention. Healthcare Financial Management, 56(11), 40-45.

References 74

Brown, E. & Matthews, R. (2003). The impact of student debt on nurses: an investigation. Wellington: New Zealand University Student Association and New Zealand Nurses Organisation.

Caroselli-Karinja, M. F., McGowan, J. & Penn, S. M. (1988). Journal of Psychosocial Nursing, 26(8), 28-31.

Clasen, C., Meyer, C. B., Mase, W. & Cauley, K. (2003). Development of the competency assessment tool-mental health, an instrument to assess core competencies for mental health care workers. Psychiatric Rehabilitation Journal, 27(1), 10-17.

Clinton, M. & Hazelton, M. (2000). Scoping the Australian mental health nursing workforce. Australian and New Zealand Journal of Mental Health Nursing, 9, 56-64.

Covey, S. (2003). Investing in people: Stephen R. Covey, best-selling author and management mentor, explains how behavioural training can help to achieve a more productive workforce in the healthcare sector. Nursing Management, 9(10), 32-34.

Coyne, P. & Beardsmoore, A. (2001). A turn for the better: A nurse rotation programme has already boosted recruitment in the hard-to-staff mental health sector. Health Service Journal, April, 29.

Craig, A. B. (1999). Mental health nursing and cultural diversity. Australian and New Zealand Journal of Mental Health Nursing, 8, 93-99.

Department of Health. (2001). Code of Practice for NHS employers involved in the international recruitment of healthcare professionals. London: Department of Health

Department of Labour. (2004). Skills in the labour market – May 2004. Retrieved July 2004 from the Department of Labour website: http://www.dol.govt.nz/lmr-Skills.asp

District Health Board New Zealand. (2003). Workforce Action Plan. Wellington: District Health Boards New Zealand Incorporated.

Douglas, E. M. K. (2001). Te Iwi Maori, Asia Pacific Viewpoint, Vol 42, No 1, April, Wellington: Victoria University, p 17-25.

Doult, B. & Stephen, H. (1998). Recruitment drive for mental health nurses. Nursing Standard, 13(12), 5.

Du Plessis, D. (2003). Chapter 14: Contemporary issues in recruitment and selection in Wiesner, R. & Millett, B. (Eds), Human Resource Management: challenges and future directions, Sydney: John Wiley & Sons Australia Ltd, 169-186

Durkin, A. (2002). Psychiatric nursing recruitment: Roles for educators and nursing staff. Journal of Psychosocial Nursing, 40(8), 32-35.

Fong, T. (2003). It takes a nation; Coalition trying to spur worker interest. (Workforce Report 2003) (the health care industry continues to try and figure out how to keep nurses from leaving the profession). Modern Healthcare, 33(24), 25.

Frase-Blunt, M. (2002). Amid Nursing Shortages, Schools Employ Strategies to Boost Enrollment. Retrieved January 2004 from American Association of Colleges of Nursing website: http://www.aacn.nche.edu/

Genkeer, L., Gough, P. & Finlayson, B. (2003). London’s Mental Health Workforce: A review of recent developments. London: Kings Fund.

Gering, J. & Conner, J. (2002). A strategic approach to employee retention. Healthcare Financial Management, 56(11), 40-45.

References 75

Gorgos, D. (2004). Johnson & Johnson campaign helping to reduce nursing shortage. Dermatology Nursing, 15(4), 366.

Hall, P. S. & Hall, N. D. (2002). Hiring and retaining direct-care staff: After fifty years of research, what do we know? Mental Retardation, 40(3), 210-211.

Happell, B. (1999). Who wants to be a psychiatric nurse? Novice student nurse's interest in psychiatric nursing. Journal of Psychiatric and Mental Health Nursing, 6, 479-484. Journal of Psychiatric and Mental Health Nursing, 7, 79-87.

Hargrove, D. S., Fox, J. C. & Goldman, C. R. (1991). Recruitment, motivation, and reinforcement of preprofessionals for public sector mental health careers. Community Mental Health Journal, 27(3), 199-207.

Hazelton, M. (2000). Special Theme: Education and training for mental health nursing. Australian and New Zealand Journal of Mental Health Nursing, 9, 99.

Health Funding Authority. (2000). Tuutahitia te Wero, Meeting the challenges: Mental Health Workforce Development Plan 2000-2005. Wellington: Health Funding Authority.

Health Workforce Advisory Committee. (2002). The New Zealand Workforce: A stocktake of issues and capacity 2001. Wellington: Health workforce Advisory Committee.

Health Workforce Advisory Committee. (2003). The New Zealand Health Workforce Future Directions – Recommendations to the Minister of Health 2003. Wellington: Health Workforce Advisory Committee.

Higginbottom, G. (1998). Focus groups: Their use in health promotion research. Community Practitioner, 71(11), 360-363.

Hirini, P. R. & Durie, M. H. (2003). Te Rau Matatini Workforce Profile. Palmerston North: Te Rau Matatini.

International Federation of Social Workers. (2000). Definition of social work. Retrieved July 2004 from the International Federation of Social Workers website: http://www.ifsw.org/Publications/4.6e.pub.html

Jackson, S. E. & Schuler, R. S. (2000). Managing Human Resources: A partnership perspective, 7th Edition, Australia: Southwestern Thomson Learning.

Jardine, E. & Amig, S. (2001). Managing human capital: Improving employee recruitment retention in a changing economy. Behavioral Health Management, 21(2), 22-25.

Johnson & Johnson. (2003). Campaign for the Future of Nursing: Changing Perceptions. Retrieved January, 2004 from Johnson & Johnson’s New Zealand website, http://www.valueofnursing.co.nz/nursing-midwifery/nursing/info_changing.jsp

Johnson & Johnson. (2004). Healing the Crisis in Nursing News Report. Retrieved January 2004 from the Johnson & Johnson website at http://www.jnj.cm/news/jnj_news

Kupfer, D. J. Hyman, S. E. Schatzberg, A. F. Pincus, H. A. & Reynolds, C. F. (2002). Recruiting and retaining future generations of physician scientists in mental health. Archives of General Psychiatry, 59, July, 657-660.

Lambert, M. J. III. (2003). Recruiting and retaining employees: Critical issues for organizational leaders. Physician Executive, 29(4), 18-20.

Langan, S. (2000). Finding the Needle in the Haystack: The Challenge of Recruiting and Retaining Sharp Employees, Public Personnel Management, Vol 29, No 4, Winter, p 461-463.

References 75

Gorgos, D. (2004). Johnson & Johnson campaign helping to reduce nursing shortage. Dermatology Nursing, 15(4), 366.

Hall, P. S. & Hall, N. D. (2002). Hiring and retaining direct-care staff: After fifty years of research, what do we know? Mental Retardation, 40(3), 210-211.

Happell, B. (1999). Who wants to be a psychiatric nurse? Novice student nurse's interest in psychiatric nursing. Journal of Psychiatric and Mental Health Nursing, 6, 479-484. Journal of Psychiatric and Mental Health Nursing, 7, 79-87.

Hargrove, D. S., Fox, J. C. & Goldman, C. R. (1991). Recruitment, motivation, and reinforcement of preprofessionals for public sector mental health careers. Community Mental Health Journal, 27(3), 199-207.

Hazelton, M. (2000). Special Theme: Education and training for mental health nursing. Australian and New Zealand Journal of Mental Health Nursing, 9, 99.

Health Funding Authority. (2000). Tuutahitia te Wero, Meeting the challenges: Mental Health Workforce Development Plan 2000-2005. Wellington: Health Funding Authority.

Health Workforce Advisory Committee. (2002). The New Zealand Workforce: A stocktake of issues and capacity 2001. Wellington: Health workforce Advisory Committee.

Health Workforce Advisory Committee. (2003). The New Zealand Health Workforce Future Directions – Recommendations to the Minister of Health 2003. Wellington: Health Workforce Advisory Committee.

Higginbottom, G. (1998). Focus groups: Their use in health promotion research. Community Practitioner, 71(11), 360-363.

Hirini, P. R. & Durie, M. H. (2003). Te Rau Matatini Workforce Profile. Palmerston North: Te Rau Matatini.

International Federation of Social Workers. (2000). Definition of social work. Retrieved July 2004 from the International Federation of Social Workers website: http://www.ifsw.org/Publications/4.6e.pub.html

Jackson, S. E. & Schuler, R. S. (2000). Managing Human Resources: A partnership perspective, 7th Edition, Australia: Southwestern Thomson Learning.

Jardine, E. & Amig, S. (2001). Managing human capital: Improving employee recruitment retention in a changing economy. Behavioral Health Management, 21(2), 22-25.

Johnson & Johnson. (2003). Campaign for the Future of Nursing: Changing Perceptions. Retrieved January, 2004 from Johnson & Johnson’s New Zealand website, http://www.valueofnursing.co.nz/nursing-midwifery/nursing/info_changing.jsp

Johnson & Johnson. (2004). Healing the Crisis in Nursing News Report. Retrieved January 2004 from the Johnson & Johnson website at http://www.jnj.cm/news/jnj_news

Kupfer, D. J. Hyman, S. E. Schatzberg, A. F. Pincus, H. A. & Reynolds, C. F. (2002). Recruiting and retaining future generations of physician scientists in mental health. Archives of General Psychiatry, 59, July, 657-660.

Lambert, M. J. III. (2003). Recruiting and retaining employees: Critical issues for organizational leaders. Physician Executive, 29(4), 18-20.

Langan, S. (2000). Finding the Needle in the Haystack: The Challenge of Recruiting and Retaining Sharp Employees, Public Personnel Management, Vol 29, No 4, Winter, p 461-463.

References 76

Lapsley, H., Nikora, L. W. & Black, R. (2003). Cultural contributors to Maori recovery: an extract from “Kia Mauri Tau! Narratives of Recovery From Disabling Mental Health Problems”. Incite, 2(1), 42-52.

Larson, S. A., Hewitt, A. & Anderson, L. (1999). Staff recruiting challenges and interventions in agencies supporting people with developmental disabilities. Mental Retardation, 37(1), 36-46.

Levy, M. (2002). Barriers and Incentives to Maori Participation in the Profession of Psychology. A report for the New Zealand Psychologists’ Board: Maori and Psychology Research Unit, University of Waikato.

Macdonald, L. (2002). Raising the bar on recruitment and retention. Healthcare Financial Management, 56(6), 58-61.

Macky, K. & Johnson, G. (2000). The Strategic Management of Human Resources in New Zealand, Auckland: Irwin/McGraw-Hill.

Macky, K. & Johnson, G. (2003). Managing Human Resources in New Zealand, 2nd Edition, Auckland: McGraw-Hill.

Mariolis, T. & Picard, C. (2002). The quality of life and wellness program: Alternative to traditional psychiatric nursing clinical placements. Educational Innovations, 41(11), 510-503.

Martin, T. & Happell, B. (2001). Undergraduate nursing student's views of mental health nursing in the forensic environment. Australian and New Zealand Journal of Mental Health Nursing, 10, 116-125.

Marzuli, T. (2002). Using internet technology to streamline healthcare recruiting. Healthcare Financial Management, 56(6), 62-65.

McDaniel, R. W. & Bach, C. A. (1994). Focus groups: A data -gathering strategy for nursing research. Nursing Science Quarterly, 7(1), 4-5.

McGuire, M., Houser, J., Jarrar, T., Moy, W. & Wall, M. (2003). Retention: It’s all about respect. The Health Care Manager, 22(1), 38-45.

Mental Health Commission. (1998). Blueprint for Mental Health Services in New Zealand: How Things Need to Be. Wellington: Mental Health Commission.

Mental Health Commission. (1999). Developing the Mental Health Workforce: Report of the National Mental Health Workforce Development Co-ordinating Committee. Wellington: Mental Health Commission.

Mental Health Commission. (2001). Pacific Mental Health Services and Workforce. Moving on the Blueprint. Wellington: Mental Health Commission.

Mental Health Commission. (2004). Report on progress 2002-2003 towards implementing the Blueprint for mental health services in New Zealand. Wellington: Mental Health Commission.

Mental Health Workforce Development Co-ordinating Committee. (1999). Developing the Mental Health Workforce: Report of the National Mental Health Workforce Development Co-ordinating Committee. Wellington: National Mental Health Workforce Development Committee.

Merwin, E. I., Goldsmith, H. F. & Manderscheid, R. W. (1995). Human resource issues in rural mental health services. Community Mental Health Journal, 31(6), 525-536.

References 76

Lapsley, H., Nikora, L. W. & Black, R. (2003). Cultural contributors to Maori recovery: an extract from “Kia Mauri Tau! Narratives of Recovery From Disabling Mental Health Problems”. Incite, 2(1), 42-52.

Larson, S. A., Hewitt, A. & Anderson, L. (1999). Staff recruiting challenges and interventions in agencies supporting people with developmental disabilities. Mental Retardation, 37(1), 36-46.

Levy, M. (2002). Barriers and Incentives to Maori Participation in the Profession of Psychology. A report for the New Zealand Psychologists’ Board: Maori and Psychology Research Unit, University of Waikato.

Macdonald, L. (2002). Raising the bar on recruitment and retention. Healthcare Financial Management, 56(6), 58-61.

Macky, K. & Johnson, G. (2000). The Strategic Management of Human Resources in New Zealand, Auckland: Irwin/McGraw-Hill.

Macky, K. & Johnson, G. (2003). Managing Human Resources in New Zealand, 2nd Edition, Auckland: McGraw-Hill.

Mariolis, T. & Picard, C. (2002). The quality of life and wellness program: Alternative to traditional psychiatric nursing clinical placements. Educational Innovations, 41(11), 510-503.

Martin, T. & Happell, B. (2001). Undergraduate nursing student's views of mental health nursing in the forensic environment. Australian and New Zealand Journal of Mental Health Nursing, 10, 116-125.

Marzuli, T. (2002). Using internet technology to streamline healthcare recruiting. Healthcare Financial Management, 56(6), 62-65.

McDaniel, R. W. & Bach, C. A. (1994). Focus groups: A data -gathering strategy for nursing research. Nursing Science Quarterly, 7(1), 4-5.

McGuire, M., Houser, J., Jarrar, T., Moy, W. & Wall, M. (2003). Retention: It’s all about respect. The Health Care Manager, 22(1), 38-45.

Mental Health Commission. (1998). Blueprint for Mental Health Services in New Zealand: How Things Need to Be. Wellington: Mental Health Commission.

Mental Health Commission. (1999). Developing the Mental Health Workforce: Report of the National Mental Health Workforce Development Co-ordinating Committee. Wellington: Mental Health Commission.

Mental Health Commission. (2001). Pacific Mental Health Services and Workforce. Moving on the Blueprint. Wellington: Mental Health Commission.

Mental Health Commission. (2004). Report on progress 2002-2003 towards implementing the Blueprint for mental health services in New Zealand. Wellington: Mental Health Commission.

Mental Health Workforce Development Co-ordinating Committee. (1999). Developing the Mental Health Workforce: Report of the National Mental Health Workforce Development Co-ordinating Committee. Wellington: National Mental Health Workforce Development Committee.

Merwin, E. I., Goldsmith, H. F. & Manderscheid, R. W. (1995). Human resource issues in rural mental health services. Community Mental Health Journal, 31(6), 525-536.

References 77

Meyers, S. (2001). Trends and troubles: A leading recruiter reflects on current developments in the employment marketplace. Behavioral Health Management, 21(2), 14-16.

Miles, M. B. & Huberman, A. M. (1994). An expanded source book: Qualitative data analysis. Thousand Oaks, CA: Sage.

Ministry of Economic Development. (2004). Growth and Innovation Framework. Retrieved June 2004 from the Ministry of Economic Development website: http://gif.med.govt.nz/aboutus/index.asp

Ministry of Health. (1994). Looking forward: Strategic directions for mental health services. Wellington: Ministry of Health.

Ministry of Health. (1996). Towards Better Mental Health Services: The report of the National Working Party on Mental Health Workforce Development. Wellington: Ministry of Health.

Ministry of Health. (1997). Moving Forward – The National Mental Health Plan for more and Better Services. Wellington: Ministry of Health.

Ministry of Health. (2002). Mental Health (Alcohol and Other Drugs) Workforce Development Framework. Wellington: Ministry of Health.

Ministry of Health. (2004). Clinical Training Agency Strategic Intentions: 2004-2013. Wellington: Ministry of Health.

Morgan, D. L. (1988). Focus groups as qualitative research. Thousand Oaks, CA: Sage.

Murrells, T. & Robinson, S. (1999). Phase 1 of a longitudinal study of mental health nurses' careers: Exploring the relationships between profiles, course perceptions and plans to work in the NHS. Journal of Mental Health, 8(1), 55-69.

National Education Association. (2003). Meeting the challenges of recruitment and retention. A guidebook on promising strategies to recruit and retain qualified and diverse teachers. National Education Association.

News. (2002). Recruitment to tackle mental health crisis. Australian Nursing Journal, 10(5).

New Zealand Association of Occupational Therapists. (2002). Occupational Therapy. Retrieved July 2004 from the New Zealand Association of Occupational Therapists website: http://www.nzaot.com/aboutus/documents/FinalOTHowCanItHelp.pdf

New Zealand Occupational Therapy Board. (2003). New Zealand Occupational Therapy Board Annual Report 2003. Retrieved July 2004 from the New Zealand Occupational Therapy Board website: http://www.regboards.co.nz/occtherapists/pdfs/OT_AR2003.pdf

New Zealand University Student Association. (2003). Student Loan Repayment Times for Borrowers with Certificates and Diploma. Retrieved July 2004 from the New Zealand University Students Association website: http://www.students.org.nz/content/documents/2003-z-repaymenttimescertdipba.PDF.

NHS. (2004). Retention and recruitment collaborative 2003-04 outcome and impact report. London: NHS Modernisation Agency.

Nikora, L., Levy, M., Henry, J. & Whangapirita, L. (2002). Te Rau Puawai Evaluation Overview. Technical Report No 1, Vol 1: Commissioned Research Reports.

Norris, H. & Platz, G. (2003). A house with four rooms: An integral vision and an integrated practice. Incite , 2(2), 12-22.

References 77

Meyers, S. (2001). Trends and troubles: A leading recruiter reflects on current developments in the employment marketplace. Behavioral Health Management, 21(2), 14-16.

Miles, M. B. & Huberman, A. M. (1994). An expanded source book: Qualitative data analysis. Thousand Oaks, CA: Sage.

Ministry of Economic Development. (2004). Growth and Innovation Framework. Retrieved June 2004 from the Ministry of Economic Development website: http://gif.med.govt.nz/aboutus/index.asp

Ministry of Health. (1994). Looking forward: Strategic directions for mental health services. Wellington: Ministry of Health.

Ministry of Health. (1996). Towards Better Mental Health Services: The report of the National Working Party on Mental Health Workforce Development. Wellington: Ministry of Health.

Ministry of Health. (1997). Moving Forward – The National Mental Health Plan for more and Better Services. Wellington: Ministry of Health.

Ministry of Health. (2002). Mental Health (Alcohol and Other Drugs) Workforce Development Framework. Wellington: Ministry of Health.

Ministry of Health. (2004). Clinical Training Agency Strategic Intentions: 2004-2013. Wellington: Ministry of Health.

Morgan, D. L. (1988). Focus groups as qualitative research. Thousand Oaks, CA: Sage.

Murrells, T. & Robinson, S. (1999). Phase 1 of a longitudinal study of mental health nurses' careers: Exploring the relationships between profiles, course perceptions and plans to work in the NHS. Journal of Mental Health, 8(1), 55-69.

National Education Association. (2003). Meeting the challenges of recruitment and retention. A guidebook on promising strategies to recruit and retain qualified and diverse teachers. National Education Association.

News. (2002). Recruitment to tackle mental health crisis. Australian Nursing Journal, 10(5).

New Zealand Association of Occupational Therapists. (2002). Occupational Therapy. Retrieved July 2004 from the New Zealand Association of Occupational Therapists website: http://www.nzaot.com/aboutus/documents/FinalOTHowCanItHelp.pdf

New Zealand Occupational Therapy Board. (2003). New Zealand Occupational Therapy Board Annual Report 2003. Retrieved July 2004 from the New Zealand Occupational Therapy Board website: http://www.regboards.co.nz/occtherapists/pdfs/OT_AR2003.pdf

New Zealand University Student Association. (2003). Student Loan Repayment Times for Borrowers with Certificates and Diploma. Retrieved July 2004 from the New Zealand University Students Association website: http://www.students.org.nz/content/documents/2003-z-repaymenttimescertdipba.PDF.

NHS. (2004). Retention and recruitment collaborative 2003-04 outcome and impact report. London: NHS Modernisation Agency.

Nikora, L., Levy, M., Henry, J. & Whangapirita, L. (2002). Te Rau Puawai Evaluation Overview. Technical Report No 1, Vol 1: Commissioned Research Reports.

Norris, H. & Platz, G. (2003). A house with four rooms: An integral vision and an integrated practice. Incite , 2(2), 12-22.

References 78

Northern District Health Board Support Agency. (2003). The Northern Regional Pacific Mental Health and Addictions Plan 2003-05 Tevita Hingano. Northern District Health Board Support Agency.

Nursing in Focus. (2004). Successful nurse recruiting more than just recruiting. Healthcare Review, 15(17), 9.

Ponga, L.N., Maxwell-Crawford, K.M., Ihimaera, L.V. & Emery, M.A. (2004). Macroanalysis of the Maori Mental Health Workforce. Palmerston North: Te Rau Matatini.

Prahalad, C.K. & Hamel, G. (1994). Strategy as a field of study: Why search for a new paradigm?, Strategic Management Journal, Vol 15, Summer, London: John Wiley & Sons Ltd., p 5-16.

Prebble, K. (2001). On the brink of change? Implications of the review of undergraduate education in New Zealand for mental health nursing. Australian and New Zealand Journal of Mental Health Nursing, 10, 136-144.

Pullan, S.E. & Lorbergs, K.A. (2001). Recruitment and retention: A successful model in forensic psychiatric nursing. Journal of Psychosocial Nursing, 39(9), 18-25.

Pyrah, M. (2003). Career routes are key to recruitment and retention: radical approach boosts trust’s staff numbers and reduces unemployment rates. Nursing Standard, 17(28), 9.

Reilly, P. (2003). Trying to keep their own; Mentoring program aims to improve nurse retention. Modern Healthcare, 33(17), 17.

Royal College of Psychiatrists. (2004). Recommendations to increase the recruitment of and the overall numbers of consultant psychiatrists and to improve their retention A report to the Mental Health Caregroup Workforce Team and the Recruitment and Retention Sub-group of the RCPsych. London: Royal College of Psychiatrists.

Rudman, R. (1999). Human Resources Management in New Zealand, 3rd Edition, Auckland: Longman New Zealand.

Rushworth, L. & Happell, B. (2000). ‘Psychiatric nursing was great, but I want to be a “real” nurse’: Is psychiatric nursing a realistic choice for nursing students? Australian and New Zealand Journal of Mental Health Nursing, 9, 128-137.

Sainsbury Centre for Mental Health. (2000). Finding and Keeping: Review of Recruitment and Retention in the Mental Health Workforce. Retrieved on 25th January 2004 from website http://ww.sainsburycentre.org.uk

Sim, J. (1998). Collecting and analyzing qualitative data: Issues raised by the focus group. Journal of Advanced Nursing, 28(2), 345-352.

Sloane, T. (2003). The vanishing workforce: Our report shows why the industry needs to keep current employees happy. Modern Healthcare, 33(24), 20.

Stewart, D.W. & Shamdasani, P.N. (1990). Focus groups: Theory and practice. Newbury Park, CA: Sage.

Strauss, A. & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd Ed.). Thousand Oaks, CA: Sage.

Tuttas, C. (2002). Robbing Peter to pay Paul: Breaking the RN “recruitment cycle”. Journal of Nursing Care Quality, 16(4), 39-46.

Waters, A. (2003). First of a new breed: A hybrid healthcare worker role combining nurse, doctor and therapist is about to be piloted. Nursing Standard, 17(33), 16-17.

References 78

Northern District Health Board Support Agency. (2003). The Northern Regional Pacific Mental Health and Addictions Plan 2003-05 Tevita Hingano. Northern District Health Board Support Agency.

Nursing in Focus. (2004). Successful nurse recruiting more than just recruiting. Healthcare Review, 15(17), 9.

Ponga, L.N., Maxwell-Crawford, K.M., Ihimaera, L.V. & Emery, M.A. (2004). Macroanalysis of the Maori Mental Health Workforce. Palmerston North: Te Rau Matatini.

Prahalad, C.K. & Hamel, G. (1994). Strategy as a field of study: Why search for a new paradigm?, Strategic Management Journal, Vol 15, Summer, London: John Wiley & Sons Ltd., p 5-16.

Prebble, K. (2001). On the brink of change? Implications of the review of undergraduate education in New Zealand for mental health nursing. Australian and New Zealand Journal of Mental Health Nursing, 10, 136-144.

Pullan, S.E. & Lorbergs, K.A. (2001). Recruitment and retention: A successful model in forensic psychiatric nursing. Journal of Psychosocial Nursing, 39(9), 18-25.

Pyrah, M. (2003). Career routes are key to recruitment and retention: radical approach boosts trust’s staff numbers and reduces unemployment rates. Nursing Standard, 17(28), 9.

Reilly, P. (2003). Trying to keep their own; Mentoring program aims to improve nurse retention. Modern Healthcare, 33(17), 17.

Royal College of Psychiatrists. (2004). Recommendations to increase the recruitment of and the overall numbers of consultant psychiatrists and to improve their retention A report to the Mental Health Caregroup Workforce Team and the Recruitment and Retention Sub-group of the RCPsych. London: Royal College of Psychiatrists.

Rudman, R. (1999). Human Resources Management in New Zealand, 3rd Edition, Auckland: Longman New Zealand.

Rushworth, L. & Happell, B. (2000). ‘Psychiatric nursing was great, but I want to be a “real” nurse’: Is psychiatric nursing a realistic choice for nursing students? Australian and New Zealand Journal of Mental Health Nursing, 9, 128-137.

Sainsbury Centre for Mental Health. (2000). Finding and Keeping: Review of Recruitment and Retention in the Mental Health Workforce. Retrieved on 25th January 2004 from website http://ww.sainsburycentre.org.uk

Sim, J. (1998). Collecting and analyzing qualitative data: Issues raised by the focus group. Journal of Advanced Nursing, 28(2), 345-352.

Sloane, T. (2003). The vanishing workforce: Our report shows why the industry needs to keep current employees happy. Modern Healthcare, 33(24), 20.

Stewart, D.W. & Shamdasani, P.N. (1990). Focus groups: Theory and practice. Newbury Park, CA: Sage.

Strauss, A. & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd Ed.). Thousand Oaks, CA: Sage.

Tuttas, C. (2002). Robbing Peter to pay Paul: Breaking the RN “recruitment cycle”. Journal of Nursing Care Quality, 16(4), 39-46.

Waters, A. (2003). First of a new breed: A hybrid healthcare worker role combining nurse, doctor and therapist is about to be piloted. Nursing Standard, 17(33), 16-17.

References 79

Wells, J.S.G., Ryan, D. & McElwee, C.N. (2000). “I don’t want to be a psychiatric nurse”: an exploration of factors inhibiting recruitment to psychiatric nursing in Ireland. Journal of Psychiatric and Mental Health Nursing, 7, 79-87.

Werrbach, G.B. & DePoy, E. (1993). Working with persons with serious mental illness: Implication for social work recruitment and retention. Community Mental Health Journal, 29(4), 305-319.

Zurn, P., Dal Poz, M., Stilwell, B. & Adams, O. (2002). Imbalances in the health workforce. Briefing paper. Geneva: The World Health Organisation.

References 79

Wells, J.S.G., Ryan, D. & McElwee, C.N. (2000). “I don’t want to be a psychiatric nurse”: an exploration of factors inhibiting recruitment to psychiatric nursing in Ireland. Journal of Psychiatric and Mental Health Nursing, 7, 79-87.

Werrbach, G.B. & DePoy, E. (1993). Working with persons with serious mental illness: Implication for social work recruitment and retention. Community Mental Health Journal, 29(4), 305-319.

Zurn, P., Dal Poz, M., Stilwell, B. & Adams, O. (2002). Imbalances in the health workforce. Briefing paper. Geneva: The World Health Organisation.

References 80

References 80

Appendix 1: Mental Health Workforces Vacancies, March 2004 81

Appendix 1: Mental Health Workforce Vacancies, March 2004

Figures compiled by the Mental Health Commission based on DHB returns for the mental health workforce vacancies March 31, 2004. These figures are “true” vacancies, which exclude temporary or casual staff.

Appendix 1: Mental Health Workforces Vacancies, March 2004 81

Appendix 1: Mental Health Workforce Vacancies, March 2004

Figures compiled by the Mental Health Commission based on DHB returns for the mental health workforce vacancies March 31, 2004. These figures are “true” vacancies, which exclude temporary or casual staff.

DH

B

Inpa

tient

C

om

mu

nity

Clin

ical

M

aori

Su

bse

t

E

st

Act

ual

Vac

ant

%

Con

trac

t A

ctua

l V

acan

t %

C

ontr

act

Act

ual

Vac

ant

%

Nor

thla

nd

50.8

49

.8

1.0

2%

11

6.5

10

3.9

3.

4

3%

17.5

14

.3

0.0

0%

Wai

tem

ata

39

0.9

38

3.3

7.

6

2%

475.

1

425.

3

49.7

10

%

43.9

40

.4

3.5

8%

Auc

klan

d

268.

5

232.

3

36.2

13

%

277.

6

238.

8

38.8

14

%

10.0

7.

5

2.5

25

%

Cou

ntie

s M

anuk

au

178.

5

178.

5

0.0

0%

28

2.1

23

5.7

46

.4

16%

15

.3

21.7

0.

0

0%

No

rth

ern

To

tal

888.

7

843.

9

44.8

5%

1,

151.

2

1,00

3.7

13

8.3

12

%

86.8

83

.9

6.0

7%

Wai

kato

23

4.7

22

1.0

13

.7

6%

218.

8

194.

6

24.2

11

%

0.0

0.

0

0.0

0%

Bay

of P

lent

y 77

.3

77.3

0.

0

0%

156.

4

146.

4

10.0

6%

5.

0

3.9

1.

1

21%

Lake

s

30.7

26

.0

4.7

15

%

62.3

44

.1

18.2

29

%

14.1

11

.6

2.4

17

%

Tar

anak

i 41

.3

41.3

0.

0

0%

79.8

75

.0

4.8

6%

5.

0

5.0

0.

0

0%

Tai

raw

hiti

14

.2

13.6

0.

6

4%

34.4

29

.4

5.0

14

%

0.0

0.

0

0.0

0%

Mid

land

To

tal

398.

1

379.

1

19.0

5%

55

1.6

48

9.5

62

.2

11%

24

.1

20.6

3.

5

14%

Haw

ke's

Bay

44

.9

40.1

4.

8

11%

93

.5

87.2

6.

4

7%

27.5

26

.0

1.5

5%

Wha

ngan

ui

98.7

94

.3

4.4

4%

50

.4

45.1

6.

2

12%

12

.0

10.8

2.

2

18%

Mid

Cen

tral

56

.2

56.2

0.

0

0%

100.

5

97.2

3.

3

3%

12.0

12

.0

0.0

0%

Wai

rara

pa

9.0

4.

8

4.2

47

%

18.8

15

.5

3.3

18

%

4.0

3.

1

0.9

24

%

Hut

t Val

ley

46.7

46

.7

0.0

0%

76

.2

72.6

6.

2

8%

15.0

12

.0

3.0

20

%

Cap

ital &

Coa

st

274.

6

208.

2

66.4

24

%

248.

4

237.

4

11.0

4%

28

.1

26.4

3.

5

12%

Cen

tral

To

tal

530.

2

450.

3

79.8

15

%

587.

8

554.

8

36.3

6%

98

.6

90.3

11

.1

11%

Nel

son

Mar

lbor

ough

57

.8

54.8

3.

0

5%

87.7

78

.7

8.1

9%

3.

0

3.0

0.

0

0%

Can

terb

ury

400.

8

384.

8

16.0

4%

31

7.6

30

7.9

12

.7

4%

1.0

1.

0

0.0

0%

Wes

t Coa

st

16.0

16

.0

0.0

0%

35

.6

34.1

1.

6

4%

3.0

2.

0

0.0

0%

S

outh

Can

terb

ury

16.5

16

.5

0.0

0%

31

.7

27.9

3.

9

12%

2.

0

1.5

0.

5

25%

Ota

go

199.

2

181.

1

18.2

9%

15

4.5

15

6.3

0.

0

0%

11.5

9.

5

2.0

18

%

Sou

thla

nd

39.1

36

.1

3.0

8%

79

.9

68.3

10

.6

13%

5.

8

5.8

0.

0

0%

So

uth

ern

To

tal

729.

4

689.

3

40.2

6%

70

7.0

67

3.2

36

.8

5%

26.3

22

.8

2.5

10

%

NE

W Z

EA

LA

ND

TO

TAL

2,54

6.4

2,

362.

6

183.

8

7%

2,99

7.6

2,

721.

2

273.

5

9%

235.

7

217.

5

23.2

10

%

DH

B

Inpa

tient

C

om

mu

nity

Clin

ical

M

aori

Su

bse

t

E

st

Act

ual

Vac

ant

%

Con

trac

t A

ctua

l V

acan

t %

C

ontr

act

Act

ual

Vac

ant

%

Nor

thla

nd

50.8

49

.8

1.0

2%

11

6.5

10

3.9

3.

4

3%

17.5

14

.3

0.0

0%

Wai

tem

ata

39

0.9

38

3.3

7.

6

2%

475.

1

425.

3

49.7

10

%

43.9

40

.4

3.5

8%

Auc

klan

d

268.

5

232.

3

36.2

13

%

277.

6

238.

8

38.8

14

%

10.0

7.

5

2.5

25

%

Cou

ntie

s M

anuk

au

178.

5

178.

5

0.0

0%

28

2.1

23

5.7

46

.4

16%

15

.3

21.7

0.

0

0%

No

rth

ern

To

tal

888.

7

843.

9

44.8

5%

1,

151.

2

1,00

3.7

13

8.3

12

%

86.8

83

.9

6.0

7%

Wai

kato

23

4.7

22

1.0

13

.7

6%

218.

8

194.

6

24.2

11

%

0.0

0.

0

0.0

0%

Bay

of P

lent

y 77

.3

77.3

0.

0

0%

156.

4

146.

4

10.0

6%

5.

0

3.9

1.

1

21%

Lake

s

30.7

26

.0

4.7

15

%

62.3

44

.1

18.2

29

%

14.1

11

.6

2.4

17

%

Tar

anak

i 41

.3

41.3

0.

0

0%

79.8

75

.0

4.8

6%

5.

0

5.0

0.

0

0%

Tai

raw

hiti

14

.2

13.6

0.

6

4%

34.4

29

.4

5.0

14

%

0.0

0.

0

0.0

0%

Mid

land

To

tal

398.

1

379.

1

19.0

5%

55

1.6

48

9.5

62

.2

11%

24

.1

20.6

3.

5

14%

Haw

ke's

Bay

44

.9

40.1

4.

8

11%

93

.5

87.2

6.

4

7%

27.5

26

.0

1.5

5%

Wha

ngan

ui

98.7

94

.3

4.4

4%

50

.4

45.1

6.

2

12%

12

.0

10.8

2.

2

18%

Mid

Cen

tral

56

.2

56.2

0.

0

0%

100.

5

97.2

3.

3

3%

12.0

12

.0

0.0

0%

Wai

rara

pa

9.0

4.

8

4.2

47

%

18.8

15

.5

3.3

18

%

4.0

3.

1

0.9

24

%

Hut

t Val

ley

46.7

46

.7

0.0

0%

76

.2

72.6

6.

2

8%

15.0

12

.0

3.0

20

%

Cap

ital &

Coa

st

274.

6

208.

2

66.4

24

%

248.

4

237.

4

11.0

4%

28

.1

26.4

3.

5

12%

Cen

tral

To

tal

530.

2

450.

3

79.8

15

%

587.

8

554.

8

36.3

6%

98

.6

90.3

11

.1

11%

Nel

son

Mar

lbor

ough

57

.8

54.8

3.

0

5%

87.7

78

.7

8.1

9%

3.

0

3.0

0.

0

0%

Can

terb

ury

400.

8

384.

8

16.0

4%

31

7.6

30

7.9

12

.7

4%

1.0

1.

0

0.0

0%

Wes

t Coa

st

16.0

16

.0

0.0

0%

35

.6

34.1

1.

6

4%

3.0

2.

0

0.0

0%

S

outh

Can

terb

ury

16.5

16

.5

0.0

0%

31

.7

27.9

3.

9

12%

2.

0

1.5

0.

5

25%

Ota

go

199.

2

181.

1

18.2

9%

15

4.5

15

6.3

0.

0

0%

11.5

9.

5

2.0

18

%

Sou

thla

nd

39.1

36

.1

3.0

8%

79

.9

68.3

10

.6

13%

5.

8

5.8

0.

0

0%

So

uth

ern

To

tal

729.

4

689.

3

40.2

6%

70

7.0

67

3.2

36

.8

5%

26.3

22

.8

2.5

10

%

NE

W Z

EA

LA

ND

TO

TAL

2,54

6.4

2,

362.

6

183.

8

7%

2,99

7.6

2,

721.

2

273.

5

9%

235.

7

217.

5

23.2

10

%

DH

B

Pac

ific

Su

bse

t C

hild

and

You

th C

omm

unity

To

tal C

hild

and

You

th

Tota

l C

on

trac

t To

tal

Act

ual

T

ota

l Vac

ant

C

ontr

act

Act

ual

Vac

ant

%

Con

trac

t A

ctua

l V

acan

t %

T

otal

C

ontr

act

Tot

al

Vaca

nt

%

Nor

thla

nd

0.0

0.

0

0.0

0%

19

.0

17.2

0.

0

0%

19.0

0.

0

0%

171.

8

157.

5

5.4

3%

Wai

tem

ata

22

.2

22.0

2.

2

10%

75

.0

70.0

5.

0

7%

75.0

5.

0

7%

898.

4

835.

7

62.8

7%

Auc

klan

d

10.6

8.

0

2.6

25

%

57.3

50

.2

7.1

12

%

117.

8

23.9

20

%

574.

8

495.

6

79.2

14

%

Cou

ntie

s M

anuk

au

0.0

11

.7

0.0

0%

55

.9

36.3

19

.6

35%

55

.9

19.6

35

%

463.

6

415.

4

48.2

10

%

No

rth

ern

To

tal

32.8

41

.7

4.8

15

%

207.

2

173.

8

31.7

15

%

267.

7

48.6

18

%

2108

.6

1,90

4.1

19

5.6

9%

Wai

kato

0.

0

0.0

0.

0

0%

30.6

32

.5

0.0

0%

30

.6

0.0

0%

46

0.2

42

0.9

39

.3

9%

Bay

of P

lent

y 0.

0

0.0

0.

0

0%

29.5

28

.8

2.7

9%

29

.5

2.7

9%

23

6.7

22

6.5

10

.2

4%

Lake

s

0.0

0.

0

0.0

0%

14

.5

9.4

5.

1

35%

14

.5

5.1

35

%

113.

6

84.7

28

.9

25%

Tar

anak

i 0.

0

0.0

0.

0

0%

13.9

12

.9

1.0

7%

13

.9

1.0

7%

12

3.1

11

8.3

4.

8

4%

Tai

raw

hiti

0.

0

0.0

0.

0

0%

8.0

6.

0

2.0

0%

8.

0

2.0

25

%

51.3

45

.8

5.6

11

%

Mid

lan

d T

ota

l 0.

0

0.0

0.

0

0%

96.5

89

.7

10.8

11

%

96.5

10

.8

11%

98

4.8

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8%

Appendix 2: Organisations Who Took Part in the Questionnaire and Interviews 85

Appendix 2: Organisations Who Took Part in the Questionnaire and Interviews

Organisations that completed the questionnaire

DHBs

• Good Health Wanganui

• Capital and Coast DHB: 2 people from this organisation completed the questionnaire

• Waitemata DHB

• Health Waikato

• Auckland DHB: 2 people from this organisation completed the questionnaire

• Canterbury DHB

• Southland DHB

• Bay of Plenty DHB – 2 people from this organisation completed the questionnaire, including BOPDHB-CADS

• South Canterbury DHB

• Nelson and Marlborough DHB

• Midcentral DHB

• Hutt Valley DHB

• Taranaki DHB

• Lakes DHB

• Counties Manukau DHB

NGOs

• Framework Trust

• Challenge Trust

• Richmond Fellowship

• Mind and Body Consultants

• SF Nelson

• Eating Disorder Services

• Pacific Health

• Oamaru Mental Health Support Centre

• Partnership in Practice

• Te Toka O Maru O Taranaki Trust

• Arataki Ministries

• Arahura Charitable Trust

• Council of Mental Well Being


Appendix 2: Organisations Who Took Part in the Questionnaire and Interviews

Organisations that completed the questionnaire

DHBs

• Good Health Wanganui

• Capital and Coast DHB: 2 people from this organisation completed the questionnaire

• Waitemata DHB

• Health Waikato

• Auckland DHB: 2 people from this organisation completed the questionnaire

• Canterbury DHB

• Southland DHB

• Bay of Plenty DHB – 2 people from this organisation completed the questionnaire, including BOPDHB-CADS

• South Canterbury DHB

• Nelson and Marlborough DHB

• Midcentral DHB

• Hutt Valley DHB

• Taranaki DHB

• Lakes DHB

• Counties Manukau DHB

NGOs

• Framework Trust

• Challenge Trust

• Richmond Fellowship

• Mind and Body Consultants

• SF Nelson

• Eating Disorder Services

• Pacific Health

• Oamaru Mental Health Support Centre

• Partnership in Practice

• Te Toka O Maru O Taranaki Trust

• Arataki Ministries

• Arahura Charitable Trust

• Council of Mental Well Being


• Step Ahead Trust

• Glenbrook Lodge

• Hillcrest Lodge 2000 Ltd.

• Tyneside House

• Take 5 and Te Whare Marama

• Kites Trust

• The Phobic Trust of New Zealand Inc 1983

• Te Tai Tokerau MAPO

• Workwise

• Gracelands Group of Service

• Mental Health Foundation

• Te Hauora Runanga o Wairarapa Inc

• Te Awa O Te Ora Trust

• Whaioranga Trust

• Healthcare of New Zealand Ltd.

• Rata Counselling Centre

Others

• Medical Council of New Zealand

• Massey University

• Pacific Health – CMHS Eastern Region

• Regional Consumer Network

• Auckland University of Technology – School of Occupational Therapy

• Health Link New Zealand (Recruitment Agency)

• Geneva Health International Ltd. (Recruitment Agency)

• John Tovey, Consumer Consultant for Central Potential, Consumer network

Organisations Interviewed

DHBs

• Dale Rook, Auckland DHB (Clinician and professional leader for OT’s)

• Carol Seymour, ADHB (Nurse Leader)

• Sandy Adams, CDHB (Unit Manager, Acute Inpatient Unit, Hillmorton Hospital)

• Vivienne Martini, CDHB

• Deborah Selwood, CDHB (Unit Manager)

• Murray Cameron, CDHB (Consumer Advisor)

• Blair Nugent, Waitemata DHB (HR Manager)


• Step Ahead Trust

• Glenbrook Lodge

• Hillcrest Lodge 2000 Ltd.

• Tyneside House

• Take 5 and Te Whare Marama

• Kites Trust

• The Phobic Trust of New Zealand Inc 1983

• Te Tai Tokerau MAPO

• Workwise

• Gracelands Group of Service

• Mental Health Foundation

• Te Hauora Runanga o Wairarapa Inc

• Te Awa O Te Ora Trust

• Whaioranga Trust

• Healthcare of New Zealand Ltd.

• Rata Counselling Centre

Others

• Medical Council of New Zealand

• Massey University

• Pacific Health – CMHS Eastern Region

• Regional Consumer Network

• Auckland University of Technology – School of Occupational Therapy

• Health Link New Zealand (Recruitment Agency)

• Geneva Health International Ltd. (Recruitment Agency)

• John Tovey, Consumer Consultant for Central Potential, Consumer network

Organisations Interviewed

DHBs

• Dale Rook, Auckland DHB (Clinician and professional leader for OT’s)

• Carol Seymour, ADHB (Nurse Leader)

• Sandy Adams, CDHB (Unit Manager, Acute Inpatient Unit, Hillmorton Hospital)

• Vivienne Martini, CDHB

• Deborah Selwood, CDHB (Unit Manager)

• Murray Cameron, CDHB (Consumer Advisor)

• Blair Nugent, Waitemata DHB (HR Manager)


• Charles Hunt, TDHB (HR Manager)

• Tayler Whitehead, Wanganui DHB (Consumer Advisor)

• Steve Osborne, Lakes DHB (Consultant Clinical Psychologists, Youth Services, Professional Advisor)

Focus Groups

• Counties Manukau DHB:

− G. P. Singh (HR Manager) and Heather Campbell, Recruitment Centre.

• Southland DHB:

− Wendy Creurer, Associate Director of Mental Health; − Fay Mcleod and Louis traves, Nursing Community Mental Health Team, Specialist

Team; and − Mike Fitzgerald, Mental Health Manager.

• Midcentral DHB:

− Nicholas Glubb, Group Manager; − Killian O’Gorman, Administrator; − Keith Roffe, Project Leader Clinical Nurse Educator Role; − Kara Coombes, Team Leader Child Adolescent and Family Services; − Sharessa Langley, HR Administrator; − Roechelle Stewart-Withers, Clinical Nurse Specialist Mental Health Services; − Teresa Keedwell, Consumer Advisor; and − Faith Brown, Team Leader, Maori Mental Health.

• Bay of Plenty DHB:

− Ray Fergusson, HR Advisor; − Helaine Stolz, Acute Inpatient Unit; − Saleem, Acute Inpatient Unit; − Kate Stewart, Nursing; − Gordon Mackay, HR Manager; and − Tony Abbey and Peter Jones from Whakatane.

• Attended and presented at a regional NGO and DHB sector meeting Moana Pasifika Fono.

Unions

• Angela Belich, ASMS

• Deborah Powell, RDA

• Glenn Barclay, PSA

Recruitment Agencies

• Eden Recruitment: Nicci Slack


• Charles Hunt, TDHB (HR Manager)

• Tayler Whitehead, Wanganui DHB (Consumer Advisor)

• Steve Osborne, Lakes DHB (Consultant Clinical Psychologists, Youth Services, Professional Advisor)

Focus Groups

• Counties Manukau DHB:

− G. P. Singh (HR Manager) and Heather Campbell, Recruitment Centre.

• Southland DHB:

− Wendy Creurer, Associate Director of Mental Health; − Fay Mcleod and Louis traves, Nursing Community Mental Health Team, Specialist

Team; and − Mike Fitzgerald, Mental Health Manager.

• Midcentral DHB:

− Nicholas Glubb, Group Manager; − Killian O’Gorman, Administrator; − Keith Roffe, Project Leader Clinical Nurse Educator Role; − Kara Coombes, Team Leader Child Adolescent and Family Services; − Sharessa Langley, HR Administrator; − Roechelle Stewart-Withers, Clinical Nurse Specialist Mental Health Services; − Teresa Keedwell, Consumer Advisor; and − Faith Brown, Team Leader, Maori Mental Health.

• Bay of Plenty DHB:

− Ray Fergusson, HR Advisor; − Helaine Stolz, Acute Inpatient Unit; − Saleem, Acute Inpatient Unit; − Kate Stewart, Nursing; − Gordon Mackay, HR Manager; and − Tony Abbey and Peter Jones from Whakatane.

• Attended and presented at a regional NGO and DHB sector meeting Moana Pasifika Fono.

Unions

• Angela Belich, ASMS

• Deborah Powell, RDA

• Glenn Barclay, PSA

Recruitment Agencies

• Eden Recruitment: Nicci Slack


• Geneva Health: Maryanne Lagaluga and Ruth Murray

• Medical Staffing: Kirsten Thomforde

NGOs

• Richmond Fellowship: Peta Knibb (Christchurch) and Mike Payne (Gisborne)

• Te Ara Hou (Equip from 1st July, 2004): Robyn Gedye

• Relationship Services: Fran Hoover

• Whaioranga Trust: Rawinia Haua

• Te Awa O Te Ora Trust: Jillian Greig

• Workwise: Warren Elwin

• Challenge Trust: Lorna Murray, Jude (Organisational Development Officer), and Leela (Administration)

• Comcare Trust: Ruth Teasdale

DHBNZ

• Maryan Street (Employment Relations Portfolio)

• Marilyn Rimmer (Workforce Development Portfolio)


• Geneva Health: Maryanne Lagaluga and Ruth Murray

• Medical Staffing: Kirsten Thomforde

NGOs

• Richmond Fellowship: Peta Knibb (Christchurch) and Mike Payne (Gisborne)

• Te Ara Hou (Equip from 1st July, 2004): Robyn Gedye

• Relationship Services: Fran Hoover

• Whaioranga Trust: Rawinia Haua

• Te Awa O Te Ora Trust: Jillian Greig

• Workwise: Warren Elwin

• Challenge Trust: Lorna Murray, Jude (Organisational Development Officer), and Leela (Administration)

• Comcare Trust: Ruth Teasdale

DHBNZ

• Maryan Street (Employment Relations Portfolio)

• Marilyn Rimmer (Workforce Development Portfolio)

Appendix 3: Summary of Individual Responses to Questionnaire, Interview and Focus Group Questions

89


DHB responses

Q. 1. Which department is in control of the recruitment predominantly?

• Health Alliance.

• Recruitment centre – the actual department that has the vacancy and they have help from the recruitment centre, but there is no actual liaison between them, it’s more like a step-by-step process and when one department is done the other takes over.

• HR department.

• HR division.

• The individual units, things go through HR department and the units identify what their needs are, whether the job position needs to be created, or whether it needs to be changed due to clinical activity.

• HR, input from the different departments, when there in a vacancy the units come up with the requisition. So the units have a big say in how they do it. Feedback is given, the first meeting they decide on what sources, and meet if it isn’t suitable. Statistics are kept, he introduced the structured way of collecting the data as accurately as he can and gone from there. To find out which sources are most productive.

• The control is with mental health, the mechanical aspects are with HR.

• Mental health does their own recruitment by themselves and the recruitment centre picks it up at the stage of the request to recruit, the ad and the job description and they liaise with the advertising advisors and then decide on how and when to advertise. They run through the acknowledgement of the candidates, contractual issues.


• HR coordinates recruitment process and advisors/supports managers. The respective clinical service managers are responsible for the recruitment and selection of staff for their units.

Q.2. How long does the recruitment process normally take?

• Depends on who sets date of final applications.

• 1-3 months.

• 2-3 weeks depends on the quality of candidates.

• Start to finish 3 months, if it is an internal process it’s quite easy. Quite a process to identify the vacancy and then the follow up.

• Anything from 1-12 months depending on the position.

• Too long, 2 months to replace someone.

• Varies greatly. They would like to think they are pretty good on most roles 6-8 weeks though there are certain positions that are hard to fill and that could be around 3-4 years if not longer which means you have to start re-advertising. Agencies they use: they have a preferred supplier agreement. Sometimes they have to think outside the box if they are


89


DHB responses



• Recruitment centre – the actual department that has the vacancy and they have help from the recruitment centre, but there is no actual liaison between them, it’s more like a step-by-step process and when one department is done the other takes over.

• HR department.

• HR division.

• The individual units, things go through HR department and the units identify what their needs are, whether the job position needs to be created, or whether it needs to be changed due to clinical activity.

• HR, input from the different departments, when there in a vacancy the units come up with the requisition. So the units have a big say in how they do it. Feedback is given, the first meeting they decide on what sources, and meet if it isn’t suitable. Statistics are kept, he introduced the structured way of collecting the data as accurately as he can and gone from there. To find out which sources are most productive.

• The control is with mental health, the mechanical aspects are with HR.

• Mental health does their own recruitment by themselves and the recruitment centre picks it up at the stage of the request to recruit, the ad and the job description and they liaise with the advertising advisors and then decide on how and when to advertise. They run through the acknowledgement of the candidates, contractual issues.


• HR coordinates recruitment process and advisors/supports managers. The respective clinical service managers are responsible for the recruitment and selection of staff for their units.


• Depends on who sets date of final applications.

• 1-3 months.

• 2-3 weeks depends on the quality of candidates.

• Start to finish 3 months, if it is an internal process it’s quite easy. Quite a process to identify the vacancy and then the follow up.

• Anything from 1-12 months depending on the position.

• Too long, 2 months to replace someone.

• Varies greatly. They would like to think they are pretty good on most roles 6-8 weeks though there are certain positions that are hard to fill and that could be around 3-4 years if not longer which means you have to start re-advertising. Agencies they use: they have a preferred supplier agreement. Sometimes they have to think outside the box if they are

Appendix 3: Summary of Individual Responses to Questionnaire, Interview and Focus Group Questions 90

trying to recruit a senior doctor. It’s a matter of turning our minds to where we should target the advert. That’s not normal procedure it’s only in case of a specialist.

• 3-4 weeks.

Q.3. What is the procedure followed?

• Through newspaper ads and Internet – using the organisation recruitment centre. Other processes include word of mouth and networking. Have also looked at advertising in Pacific newspapers and radio in specific Pacific languages. Using networks through learning institutions and professional advisors. Staff in the service will sometimes know of people that could be interested or wanting to make a change.

• Someone gives their notice and depends on the day it is based and after the resignation is received, Chief Exec has to sign off. All jobs advertised internally, on their website and then decide what publication. Fortnight till the closing date. If you get someone 6 weeks is a quick turnaround. Authority to recruit – sign off – position description automatically reviewed each time.

• There are guidelines where is the best place to advertise and part of that is cost, and we are doing some prelim analysis and what’s coming through is web and word of mouth. Strategy is to try and get people coming through a system called hire.com. Similar to Seek.

• Advertising – 10 days; close-off; short-listing – 2 days; set up interviews – we allow 3-4 days to allow candidates to get time off work and prepare for the interview; interviews – 1-2 days depending on candidate availability; notify successful/unsuccessful following selection decision 1-2 days.

• Require: CV; application form; certificate of good standing; Police check; 3 verbal refs (2 for RMOs); 3 written refs (2 for RMOs); supervision arrangements (if applicable); credential checklist (SMOs only); appointment instructions. Once received/completed these are sent to recruitment who processes accordingly and sends out offer of employment.

Q.4. How are candidates recruited? Which method is most effective?

• Everyone completes the same application form whether in the organisation or not.

• Networks and word of mouth – this has been the most successful especially in positions where Pacific workforce is limited such as nursing. Usually nurses will know of other Pacific colleagues and do a lot of work in talking to them about moving to Pacific service.

• Internal – word of mouth, job bulletin, positions are created and offered to certain people.

• Advertise through website, some specific adverts in overseas discipline journals, contact through agencies, direct recruitment from me the Professional Leader to known or recommended staff.

• Internet.

• Word of mouth.

• Internal job bulletin.

• Industry specific journals.

• Positions are advertised on the website word of mouth and email interest groups. Positions are often advertised in monthly New Zealand professional body (psychology) newsletter. Occasional use of the national newspaper.

• Overseas journals.


trying to recruit a senior doctor. It’s a matter of turning our minds to where we should target the advert. That’s not normal procedure it’s only in case of a specialist.

• 3-4 weeks.


• Through newspaper ads and Internet – using the organisation recruitment centre. Other processes include word of mouth and networking. Have also looked at advertising in Pacific newspapers and radio in specific Pacific languages. Using networks through learning institutions and professional advisors. Staff in the service will sometimes know of people that could be interested or wanting to make a change.

• Someone gives their notice and depends on the day it is based and after the resignation is received, Chief Exec has to sign off. All jobs advertised internally, on their website and then decide what publication. Fortnight till the closing date. If you get someone 6 weeks is a quick turnaround. Authority to recruit – sign off – position description automatically reviewed each time.

• There are guidelines where is the best place to advertise and part of that is cost, and we are doing some prelim analysis and what’s coming through is web and word of mouth. Strategy is to try and get people coming through a system called hire.com. Similar to Seek.

• Advertising – 10 days; close-off; short-listing – 2 days; set up interviews – we allow 3-4 days to allow candidates to get time off work and prepare for the interview; interviews – 1-2 days depending on candidate availability; notify successful/unsuccessful following selection decision 1-2 days.

• Require: CV; application form; certificate of good standing; Police check; 3 verbal refs (2 for RMOs); 3 written refs (2 for RMOs); supervision arrangements (if applicable); credential checklist (SMOs only); appointment instructions. Once received/completed these are sent to recruitment who processes accordingly and sends out offer of employment.


• Everyone completes the same application form whether in the organisation or not.

• Networks and word of mouth – this has been the most successful especially in positions where Pacific workforce is limited such as nursing. Usually nurses will know of other Pacific colleagues and do a lot of work in talking to them about moving to Pacific service.

• Internal – word of mouth, job bulletin, positions are created and offered to certain people.

• Advertise through website, some specific adverts in overseas discipline journals, contact through agencies, direct recruitment from me the Professional Leader to known or recommended staff.

• Internet.

• Word of mouth.

• Internal job bulletin.

• Industry specific journals.

• Positions are advertised on the website word of mouth and email interest groups. Positions are often advertised in monthly New Zealand professional body (psychology) newsletter. Occasional use of the national newspaper.

• Overseas journals.


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• Seek.

• www.jobpulse.co.nz website, (the Waitemata and Counties Manukau DHB recruitment website).

• Word of mouth.

• Well developed email networks.

• Internal advertising, CDHB, press and the Intranet (the website). On occasions (probably less so) use the recruitment agency for more senior staff, larger pool of people to attract so have to go overseas.

• Advertised on Intranet, promoted through the Department, applications are screened for pre-requisite qualifications, candidates interviewed.

• Advertising in local, national and international publications, notified to recruitment agencies.

• From a nursing perspective, internal website for X amount of time and depending on response, they then go to media , and then the time is decided upon. Significant number of people who ring for vacancies and they know the vacancies and get the other units to call. Community psych nurse – small community and word of mouth, and then they make a decision about the publications, make a call on a situation-by-situation basis.

• Both, not a good handle on the source of those candidates, in the application form they have to fill out where they first saw or heard of the project. The experience of the nurses also makes a difference so the pool is limited and the level of skill.

• Word of mouth does in the sense that within a range of services in mental health you tend to keep in touch, and if there is interest from outside and they have no vacancy then they refer them to other services.

• Internal jobs-newsletter.

• Local newspapers.

• Internet.

• Specialist journals and magazines.

• Internal advertisement circulated to all wards/departments. External advertisement(s) placed on DHB website, other employment websites, and where appropriate professional journals, employment publications, newspapers, and occasionally recruitment agencies. Sometimes clinical leaders may approach individuals (Internal or external) and encourage them to apply. Candidates obtain application form and position description from HR. Candidates submit application form and CV to HR. Candidates short-listed by clinical leader once closing date has passed. Non short-listed candidates advised by HR that application was unsuccessful. Short-listed candidates interviewed by clinical leader, HR adviser, and relevant health professional. Referee checks, Police clearance and health screening undertaken by HR and clinical leader on top ranking candidate. Subject to referee/Police check outcome and service manager approval, a job offer is made to top candidate by HR. Unsuccessful interviewees notified by HR. Orientation booking made for new appointee.

Q.5. What do you think are the strengths of your current recruitment practices?

• All applicants are treated the same.

• Structured and rigid in its approach thus avoids a lot of mistakes in recruitment.


91

• Seek.

• www.jobpulse.co.nz website, (the Waitemata and Counties Manukau DHB recruitment website).

• Word of mouth.

• Well developed email networks.

• Internal advertising, CDHB, press and the Intranet (the website). On occasions (probably less so) use the recruitment agency for more senior staff, larger pool of people to attract so have to go overseas.

• Advertised on Intranet, promoted through the Department, applications are screened for pre-requisite qualifications, candidates interviewed.

• Advertising in local, national and international publications, notified to recruitment agencies.

• From a nursing perspective, internal website for X amount of time and depending on response, they then go to media , and then the time is decided upon. Significant number of people who ring for vacancies and they know the vacancies and get the other units to call. Community psych nurse – small community and word of mouth, and then they make a decision about the publications, make a call on a situation-by-situation basis.

• Both, not a good handle on the source of those candidates, in the application form they have to fill out where they first saw or heard of the project. The experience of the nurses also makes a difference so the pool is limited and the level of skill.

• Word of mouth does in the sense that within a range of services in mental health you tend to keep in touch, and if there is interest from outside and they have no vacancy then they refer them to other services.

• Internal jobs-newsletter.


• Internet.

• Specialist journals and magazines.

• Internal advertisement circulated to all wards/departments. External advertisement(s) placed on DHB website, other employment websites, and where appropriate professional journals, employment publications, newspapers, and occasionally recruitment agencies. Sometimes clinical leaders may approach individuals (Internal or external) and encourage them to apply. Candidates obtain application form and position description from HR. Candidates submit application form and CV to HR. Candidates short-listed by clinical leader once closing date has passed. Non short-listed candidates advised by HR that application was unsuccessful. Short-listed candidates interviewed by clinical leader, HR adviser, and relevant health professional. Referee checks, Police clearance and health screening undertaken by HR and clinical leader on top ranking candidate. Subject to referee/Police check outcome and service manager approval, a job offer is made to top candidate by HR. Unsuccessful interviewees notified by HR. Orientation booking made for new appointee.


• All applicants are treated the same.

• Structured and rigid in its approach thus avoids a lot of mistakes in recruitment.


• Strictly aligned to contract thus good for reporting purposes but means it is less flexible and responsive to change and innovation.

• Having a professional leader that new staff can connect with to discuss the discipline specific roles and issues that are relevant.

• The process being robust, rigid structure sometimes prevents mistakes from happening.

• Promote the training opportunities the networking, support and supervision available to staff. Direct approach to individuals is a positive way to recruit, almost like warming potential applicants up work for the organisation. Most people like the personal and directness of matching them to a position, I think the service then also benefits as you employ people with similar philosophies that enhance team work and more job satisfaction etc.

• Making orientation important wherein new candidates get a feel for the place and the job before they actually start off within the work environment.

• Being timely.

• Maintaining contact all through out the recruitment process even with those candidates that have been unsuccessful.

• Knowledgeable staff and processes that are proven to work well. More than one department involved, i.e., mental health and recruitment so keep each other in check.

• Vacancy arises, job description formalised may require modification to suit development of the intended role, vacancy advertised internationally, short-listing of applicants, interviews, reference checks, and appointment made. If non-appointment the process maybe deferred or be repeated depending on the urgency to have position filled. If unable to recruit to the position the alternative may include secondment into the role for a fixed contract period until the appropriate applicant can relocate to New Zealand.

• Mental health is well coordinated as a service, there is a mentality of working together.

• Supported by an able recruitment centre.

• Lot being done to make mental health a good place to work.

• Agencies take care of a lot of the hassle of overseas recruiting.

• Consumer perspective into the selection process, and he always says that his job is not to provide advice on technical perspective. A balanced process: having an equal contribution along with other people on the panel. The ideal candidate will have: understanding attitude to consumers, regarding their experience; the capacity of consumers to act in an informed way and have some idea or awareness of the stigmatizing attitude that can exist not only within the community but also the mental health sector.

• A robust system, within the unit, tends to get staff that wish to stay. Whilst it takes forever you don’t have difficulty to retain, putting energy in the beginning keeps them for a longer. Recruitment isn’t an issue, retention is. Robust – a very full interview panel, robust short-listing process, 6-7 interview panel even if they are doing telephone interviews, taken terribly seriously, clear about what they need when interviewing referees, expect a full CV, and all part of the short-listing. If someone doesn’t look good in the beginning they don’t waste time.

• Maintain statistics and information that show where we recruit more effectively from, provide a personal touch once the candidate has been selected particularly from overseas as this encourages word of mouth referrals, makes units review their service.

• Information – it tells you about the best practices, and then whether something is working or not. Hard to recruit into mental health.


• Strictly aligned to contract thus good for reporting purposes but means it is less flexible and responsive to change and innovation.

• Having a professional leader that new staff can connect with to discuss the discipline specific roles and issues that are relevant.

• The process being robust, rigid structure sometimes prevents mistakes from happening.

• Promote the training opportunities the networking, support and supervision available to staff. Direct approach to individuals is a positive way to recruit, almost like warming potential applicants up work for the organisation. Most people like the personal and directness of matching them to a position, I think the service then also benefits as you employ people with similar philosophies that enhance team work and more job satisfaction etc.

• Making orientation important wherein new candidates get a feel for the place and the job before they actually start off within the work environment.

• Being timely.

• Maintaining contact all through out the recruitment process even with those candidates that have been unsuccessful.

• Knowledgeable staff and processes that are proven to work well. More than one department involved, i.e., mental health and recruitment so keep each other in check.

• Vacancy arises, job description formalised may require modification to suit development of the intended role, vacancy advertised internationally, short-listing of applicants, interviews, reference checks, and appointment made. If non-appointment the process maybe deferred or be repeated depending on the urgency to have position filled. If unable to recruit to the position the alternative may include secondment into the role for a fixed contract period until the appropriate applicant can relocate to New Zealand.

• Mental health is well coordinated as a service, there is a mentality of working together.

• Supported by an able recruitment centre.

• Lot being done to make mental health a good place to work.

• Agencies take care of a lot of the hassle of overseas recruiting.

• Consumer perspective into the selection process, and he always says that his job is not to provide advice on technical perspective. A balanced process: having an equal contribution along with other people on the panel. The ideal candidate will have: understanding attitude to consumers, regarding their experience; the capacity of consumers to act in an informed way and have some idea or awareness of the stigmatizing attitude that can exist not only within the community but also the mental health sector.

• A robust system, within the unit, tends to get staff that wish to stay. Whilst it takes forever you don’t have difficulty to retain, putting energy in the beginning keeps them for a longer. Recruitment isn’t an issue, retention is. Robust – a very full interview panel, robust short-listing process, 6-7 interview panel even if they are doing telephone interviews, taken terribly seriously, clear about what they need when interviewing referees, expect a full CV, and all part of the short-listing. If someone doesn’t look good in the beginning they don’t waste time.

• Maintain statistics and information that show where we recruit more effectively from, provide a personal touch once the candidate has been selected particularly from overseas as this encourages word of mouth referrals, makes units review their service.

• Information – it tells you about the best practices, and then whether something is working or not. Hard to recruit into mental health.


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• Word of mouth by psychiatrist, looking for a service manager for the mental health. In the steering committee, the U.K. people know about organisations and made a referral.

• Offer relocation packages, and differs as to how critical the vacancy is, organise the travel internally and accommodation.

• Assistance with registration, people from the U.K. have already done that. The allowance is not good enough to cover it but it’s something, and some DHBs don’t give it at all.

• Good process is followed, well documented, timely reviews after each appointment on the panel and see how has that worked and if something has not worked well then they try to review it. Invercargill as a place to live: HR person knows explicitly what is happening in the mental health services. They go to lengths to make it easy for people to come there: Hospital housing is quite hard to get but they rent a place in advance particularly if it is a family and then put them into contact with school and then personal engagement.

• Succession planning, recently held a forum with the U.K. nurses and they felt they had settled well into the services and the mentoring system was key and great appreciation for accommodation provided when they moved there and they had a one way air fare paid. One consideration is to get people that are more settled in the area.

• Advertising and creating a brand name and selecting local people.

• Relatively clear process, which has to be a strength. Sarcasm used to diffuse the situation (Observers comment).

• Sometimes questions to be asked when something new is introduced.

• There is clarity – flowchart of what is needed and also easy access to support information.

• Recruitment interestingly enough there are many stages where the ball can be dropped and there are many risks that can come back to the process if certain things don’t get squared off, and it is a balancing act on getting a person into the business and as quickly as they can, and minimizing risk to the organisation. And it gets a bit testy when the team is under pressure and they need someone fast and they live with the consequences of hasty recruitment for a long time.

• Interview panels and very large and good family whanau focus, consumer focus. A bit mind boggling for an interviewee to see 6 people, time consuming in the time constraints of the interview panel.

• Recruitment is a time to decide whether this person is appointable. Have the courage to re-advertise and sometimes you decide to provide support and supervision to someone junior but with enough training they will get into the field. The market for people even internationally, there is a growing scarcity of people, places greater demands on how are we going to find candidates to meet those demands, can we enable the support resources to enable this person to grow.

• It’s getting people, the recruitment costs have come down, sharing resources and hiring at hire.com and once the system captures you it leaves you passive. Area of contention, to get the person to apply for the job, not worked out the protocols, don’t know if the people want to be badgered, you are passively contacted but not proactive.

• Ability to advertise to such a large organisation internally first for example secretarial staff without having to spend money on outside resources. Internet use is high and cost saving, time saving and resource saving. Good contacts all over the country and world regarding specific disciplines (e.g., consultant psychiatrists). High profile organisation, potential candidates often on record already. Good staff benefits, etc. Strong HR policies and procedures in recruiting practices.


93

• Word of mouth by psychiatrist, looking for a service manager for the mental health. In the steering committee, the U.K. people know about organisations and made a referral.

• Offer relocation packages, and differs as to how critical the vacancy is, organise the travel internally and accommodation.

• Assistance with registration, people from the U.K. have already done that. The allowance is not good enough to cover it but it’s something, and some DHBs don’t give it at all.

• Good process is followed, well documented, timely reviews after each appointment on the panel and see how has that worked and if something has not worked well then they try to review it. Invercargill as a place to live: HR person knows explicitly what is happening in the mental health services. They go to lengths to make it easy for people to come there: Hospital housing is quite hard to get but they rent a place in advance particularly if it is a family and then put them into contact with school and then personal engagement.

• Succession planning, recently held a forum with the U.K. nurses and they felt they had settled well into the services and the mentoring system was key and great appreciation for accommodation provided when they moved there and they had a one way air fare paid. One consideration is to get people that are more settled in the area.

• Advertising and creating a brand name and selecting local people.

• Relatively clear process, which has to be a strength. Sarcasm used to diffuse the situation (Observers comment).

• Sometimes questions to be asked when something new is introduced.

• There is clarity – flowchart of what is needed and also easy access to support information.

• Recruitment interestingly enough there are many stages where the ball can be dropped and there are many risks that can come back to the process if certain things don’t get squared off, and it is a balancing act on getting a person into the business and as quickly as they can, and minimizing risk to the organisation. And it gets a bit testy when the team is under pressure and they need someone fast and they live with the consequences of hasty recruitment for a long time.

• Interview panels and very large and good family whanau focus, consumer focus. A bit mind boggling for an interviewee to see 6 people, time consuming in the time constraints of the interview panel.

• Recruitment is a time to decide whether this person is appointable. Have the courage to re-advertise and sometimes you decide to provide support and supervision to someone junior but with enough training they will get into the field. The market for people even internationally, there is a growing scarcity of people, places greater demands on how are we going to find candidates to meet those demands, can we enable the support resources to enable this person to grow.

• It’s getting people, the recruitment costs have come down, sharing resources and hiring at hire.com and once the system captures you it leaves you passive. Area of contention, to get the person to apply for the job, not worked out the protocols, don’t know if the people want to be badgered, you are passively contacted but not proactive.

• Ability to advertise to such a large organisation internally first for example secretarial staff without having to spend money on outside resources. Internet use is high and cost saving, time saving and resource saving. Good contacts all over the country and world regarding specific disciplines (e.g., consultant psychiatrists). High profile organisation, potential candidates often on record already. Good staff benefits, etc. Strong HR policies and procedures in recruiting practices.


• We have just completed a total review and rewrite of all our recruitment practices. recruitment policy, protocols and handbooks having been developed (in the process of being implemented) to provide clarification and guidance for managers involved in the recruitment and selection of staff. Training is to be provided for all managers involved in this process.

• Consistent process.

• We advertise all vacancies on our own jobsite, as well as external jobsites – NZjobs and Seek. Depending on the position, we usually also place advertisements within print media (e.g., NZ Herald and suburban papers), and specialist publications (e.g., Nursing Times, medical journals etc). Generally, each position is assigned a position number and a closing date, and after this date all applications are forwarded to the manager responsible for hiring in this department/team. They then short-list candidates for interview (on an interview panel usually comprising between 2 and 5 people – both clinical, management and cultural advisors). From this point the preferred candidate(s) would be referenced checked, had any necessary screenings (e.g., Police and occ health checks) and then a verbal offer will be followed by a letter of employment.

Q.6. What are the issues that have presented themselves when recruitment is undertaken?

• Process for recruitment might be a bit too structured.

• Communication between management and recruitment staff.

• Within the organisation recruitment processes are generic and don’t really address particular service need. Processes are one dimensional and not too flexible in addressing Pacific needs. Recruitment is not really connected to job analysis and thus is not very specific which generally reflects the lack of emphasis that the organisation places on particular workforce development and human resource strategies for its Pacific workforce. As our particular service is funded on an FTE basis, there is often pressure to fill vacancies as resource is linked to FTE. Such pressure can sometimes result in the service not employing the best person for the job, which in effect can be more costly than waiting for the right person.

• Recruitment policies and workforce needs are not analysed in enough detail and don’t necessarily allow for innovation. For example, mental health recruitment is basically geared towards clinical or professional roles. Workforce strategies don’t allow for broader thinking and philosophies outside the medical model.

• Manager’s inconsistency in following processes.

• Philosophical differences and different perspectives on the value of workers as an asset to the organisation with ability to effect and provide competitive advantage.

• Inability to recognise knowledge skills and attributes of Pacific workers other than those knowledge, skills and abilities (KSA’s) linked to professional or clinical roles. Hence cultural knowledge, competency, etc. is not recognised as valid in having an effect on outcome hence is not recognised in monetary or other forms.

• Growing need for younger staff but no ability to influence strategies to attract younger workforce to mental health.

• Takes too long to get approval for recruiting and the whole process is too long, there have been too many times that we have lost excellent applicants because of cumbersome procedures within the organisation.

• Candidate shortages – always creates issues, competing on a worldwide basis Appendix 3: Summary of Individual Responses to Questionnaire, Interview

and Focus Group Questions 94

• We have just completed a total review and rewrite of all our recruitment practices. recruitment policy, protocols and handbooks having been developed (in the process of being implemented) to provide clarification and guidance for managers involved in the recruitment and selection of staff. Training is to be provided for all managers involved in this process.

• Consistent process.

• We advertise all vacancies on our own jobsite, as well as external jobsites – NZjobs and Seek. Depending on the position, we usually also place advertisements within print media (e.g., NZ Herald and suburban papers), and specialist publications (e.g., Nursing Times, medical journals etc). Generally, each position is assigned a position number and a closing date, and after this date all applications are forwarded to the manager responsible for hiring in this department/team. They then short-list candidates for interview (on an interview panel usually comprising between 2 and 5 people – both clinical, management and cultural advisors). From this point the preferred candidate(s) would be referenced checked, had any necessary screenings (e.g., Police and occ health checks) and then a verbal offer will be followed by a letter of employment.


• Process for recruitment might be a bit too structured.

• Communication between management and recruitment staff.

• Within the organisation recruitment processes are generic and don’t really address particular service need. Processes are one dimensional and not too flexible in addressing Pacific needs. Recruitment is not really connected to job analysis and thus is not very specific which generally reflects the lack of emphasis that the organisation places on particular workforce development and human resource strategies for its Pacific workforce. As our particular service is funded on an FTE basis, there is often pressure to fill vacancies as resource is linked to FTE. Such pressure can sometimes result in the service not employing the best person for the job, which in effect can be more costly than waiting for the right person.

• Recruitment policies and workforce needs are not analysed in enough detail and don’t necessarily allow for innovation. For example, mental health recruitment is basically geared towards clinical or professional roles. Workforce strategies don’t allow for broader thinking and philosophies outside the medical model.

• Manager’s inconsistency in following processes.

• Philosophical differences and different perspectives on the value of workers as an asset to the organisation with ability to effect and provide competitive advantage.

• Inability to recognise knowledge skills and attributes of Pacific workers other than those knowledge, skills and abilities (KSA’s) linked to professional or clinical roles. Hence cultural knowledge, competency, etc. is not recognised as valid in having an effect on outcome hence is not recognised in monetary or other forms.

• Growing need for younger staff but no ability to influence strategies to attract younger workforce to mental health.

• Takes too long to get approval for recruiting and the whole process is too long, there have been too many times that we have lost excellent applicants because of cumbersome procedures within the organisation.

• Candidate shortages – always creates issues, competing on a worldwide basis


95

• Stigma with the sector.

• Changing perception in schools and institutions, as all you hear are the things that went wrong.

• Perception of the unit – hard work, lot of stress.

• Nursing not perceived as a good occupation.

• Salary a consideration.

• Getting qualified workers from overseas.

• Agencies have sent through people that haven’t panned out.

• There is sometimes an interview panel where there is only candidate, wink and the nod for the position without a real interview. Have experience of the candidate working well: pro and a con can automatically put an outside candidate to a disadvantage, can make it difficult for the entire panel to be impartial.

• Lack of suitable candidates.

• Consumer issues – how they are involved in terms of the interview panel, the last minute strategy, ensure consumer participation is valued, consulted around the time and place of the interview. Not just last minute.

• Within the service there are no concerns, we tend to spend a lot of money as an organisation trying to attract people from overseas, personally would like to see new graduates have a bonding system, allowing them some work experience.

• Harder to get male nurses, harder to get people that want to work within the mental health sector.

• When submitting a requisition to authorise filling a vacant position all the required documents are not attached i.e., a reviewed position description, advertisement, job task analysis (risk management) and the proper authority has not been named. This in effect slows down the HR process, however, most clinicians do not see this as an integral part of the process. This in effect can slow down the recruitment process by 2 weeks though clinicians blame it on bureaucracy, though if they spent 10 more minutes satisfying the procedural demands then they could enhance the recruitment process by up to 2 weeks.

• One of the main issues – location, not attractive to the lot of people, budget constraints but money only goes so far.

• Housing shortage in our area, going through an economic boom and not suitable to find housing to even purchase, not straightforward as moving to a big city.

• Media interest – both a positive and negative. Some of the nurses in the U.K. got back with some concerns about high profile reports of “disasters”. Media attention does have an impact.

• Size has an impact, no work for a full-time forensic psychologist and then they have to combine jobs and somebody that is suitable for the entire position. It took 3 years to fill that position.

• Matching person to the team is very important, and within the mental health working within the team is important.

• International recruitment – cost of getting people here. Schedule of money, of getting people here, inevitably to get people from a distance they incur considerable costs, bond people for 2 years and that guarantees a minimum length of stay. Big amounts of money spent.


95

• Stigma with the sector.

• Changing perception in schools and institutions, as all you hear are the things that went wrong.

• Perception of the unit – hard work, lot of stress.

• Nursing not perceived as a good occupation.

• Salary a consideration.

• Getting qualified workers from overseas.

• Agencies have sent through people that haven’t panned out.

• There is sometimes an interview panel where there is only candidate, wink and the nod for the position without a real interview. Have experience of the candidate working well: pro and a con can automatically put an outside candidate to a disadvantage, can make it difficult for the entire panel to be impartial.

• Lack of suitable candidates.

• Consumer issues – how they are involved in terms of the interview panel, the last minute strategy, ensure consumer participation is valued, consulted around the time and place of the interview. Not just last minute.

• Within the service there are no concerns, we tend to spend a lot of money as an organisation trying to attract people from overseas, personally would like to see new graduates have a bonding system, allowing them some work experience.

• Harder to get male nurses, harder to get people that want to work within the mental health sector.

• When submitting a requisition to authorise filling a vacant position all the required documents are not attached i.e., a reviewed position description, advertisement, job task analysis (risk management) and the proper authority has not been named. This in effect slows down the HR process, however, most clinicians do not see this as an integral part of the process. This in effect can slow down the recruitment process by 2 weeks though clinicians blame it on bureaucracy, though if they spent 10 more minutes satisfying the procedural demands then they could enhance the recruitment process by up to 2 weeks.

• One of the main issues – location, not attractive to the lot of people, budget constraints but money only goes so far.

• Housing shortage in our area, going through an economic boom and not suitable to find housing to even purchase, not straightforward as moving to a big city.

• Media interest – both a positive and negative. Some of the nurses in the U.K. got back with some concerns about high profile reports of “disasters”. Media attention does have an impact.

• Size has an impact, no work for a full-time forensic psychologist and then they have to combine jobs and somebody that is suitable for the entire position. It took 3 years to fill that position.

• Matching person to the team is very important, and within the mental health working within the team is important.

• International recruitment – cost of getting people here. Schedule of money, of getting people here, inevitably to get people from a distance they incur considerable costs, bond people for 2 years and that guarantees a minimum length of stay. Big amounts of money spent.


• The referee checks: especially with overseas candidates. Can hold up a lot of time.

• Health questionnaire can be a stumbling block – health checks.

• Financial constraints on interviewee or job candidate.

• Losing people to organisations with a faster recruitment process, making offers on the basis of positive health clearance.

• Have had a number of situation who have come into the job without health clearance and there have been health issues immediately and weighing that against the recruitment time and process. Onus on candidate to fill up their health questionnaire. The local ones can be quite fast.

• Getting appropriately qualified people, we are taking on people that don’t fit what they want but that is because of shortages.

• Global shortages.

• Recruiting for rural teams – due to the work undertaken and lifestyle that one needs to lead, the level of skill and the lack of infrastructure. As these people work in isolation and support is needed at every stage. Hard to cover and replace these staff.

Q.7. How could your organisations recruitment policies and practices be improved?

• This organisation has the best system for hiring people, not sure if we are receiving the best applicants available in the mental health sector.

• Certainly room for improvement. As already mentioned the time delay is very off putting for outside applicants in particular they get lost in the process and time, probably lose interest and consider that they are not valued. Efficiency and timeliness are what people from the outside see, so we have got to be better at it. Better training for staff to be interviewers.

• Incentive – employee referral scheme.

• Use the electronic registration system.

• More about long-term relationships.

• Engaging in regular contact.

• There is always room for constant improvement.

• There are many areas where more can be added to the hiring process but there is always a trade off between the selection steps and the time to have somebody positively contribute. Examples of possible additions are: website development to include more background on organisation/New Zealand lifestyle; testing of applicants; vetting of applicants; guides regarding gathering verbal reference reports; key staff available to liaise with applicants regarding info on the service.

• Attractive salary, transparent process of recruiting, fees of recruitment agencies are horrendous, more publicity overseas.

• Exit interviews – leave to go and work somewhere else, people going for different experiences, they like the community, resume their travel. Two people have returned home because they are home sick or can’t manage the financial situation.

• Value worth and its all to easy for organisation to say I have no money we can’t do this, think more creatively about where their resources are allocated. Decide where the importance lies.


• The referee checks: especially with overseas candidates. Can hold up a lot of time.

• Health questionnaire can be a stumbling block – health checks.

• Financial constraints on interviewee or job candidate.

• Losing people to organisations with a faster recruitment process, making offers on the basis of positive health clearance.

• Have had a number of situation who have come into the job without health clearance and there have been health issues immediately and weighing that against the recruitment time and process. Onus on candidate to fill up their health questionnaire. The local ones can be quite fast.

• Getting appropriately qualified people, we are taking on people that don’t fit what they want but that is because of shortages.

• Global shortages.

• Recruiting for rural teams – due to the work undertaken and lifestyle that one needs to lead, the level of skill and the lack of infrastructure. As these people work in isolation and support is needed at every stage. Hard to cover and replace these staff.


• This organisation has the best system for hiring people, not sure if we are receiving the best applicants available in the mental health sector.

• Certainly room for improvement. As already mentioned the time delay is very off putting for outside applicants in particular they get lost in the process and time, probably lose interest and consider that they are not valued. Efficiency and timeliness are what people from the outside see, so we have got to be better at it. Better training for staff to be interviewers.

• Incentive – employee referral scheme.

• Use the electronic registration system.

• More about long-term relationships.

• Engaging in regular contact.

• There is always room for constant improvement.

• There are many areas where more can be added to the hiring process but there is always a trade off between the selection steps and the time to have somebody positively contribute. Examples of possible additions are: website development to include more background on organisation/New Zealand lifestyle; testing of applicants; vetting of applicants; guides regarding gathering verbal reference reports; key staff available to liaise with applicants regarding info on the service.

• Attractive salary, transparent process of recruiting, fees of recruitment agencies are horrendous, more publicity overseas.

• Exit interviews – leave to go and work somewhere else, people going for different experiences, they like the community, resume their travel. Two people have returned home because they are home sick or can’t manage the financial situation.

• Value worth and its all to easy for organisation to say I have no money we can’t do this, think more creatively about where their resources are allocated. Decide where the importance lies.


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• Positions are widely known, making the job attractive and having clear guidelines for travelling through positions.

• If someone would like to come and see the service, come in and work for the day and see what it’s all about, and pay them for that. Difficulty for external applicants ….very successful, they don’t have surprises. If someone has applied for a job, and not suitable, then she follows it up. They might be suitable for another position.

• Yes, I think we have, due to feedback we receive from new employees. I have often got comments about our very personal approach, our thorough induction/orientation processes. I do think we need more flexibility in the recruitment policies, however, this document was developed to ensure all people were treated fairly and had the opportunity to apply for positions. By this I mean there should be times when we shouldn’t have to advertise though the minimum we are required to do is internal advertising, sometimes I think we do it to satisfy a process.

• We need to be more consistent with our own objectives across the medical and non-medical spectrum i.e., bringing the latter into line with the former – more evenly devoting energy, time and priority in the process.

• More money, more flexibility more proactively looking at the vacancies and the explanation as to why they need to have the person in the situation. If they had the process in a large DHB, it would be too cumbersome, size allows them to have the process, CEO need not sign off but that is the way it has always been done.

• We have identified in terms of providing a good orientation programme to new entrants and then there are service specific orientation programmes. This helps increase retention.

• The principle of buddying and a person they can approach, who to talk too, and this person introduces them to the processes and helps them feel more inculcated into the programme.

• A role in the organisation to operate as a liaison person to help them link into the networks and give them a decent kiwi orientation particularly in the first weeks, and to prevent culture shock they need to know what the costs they will face are and that people didn’t realize what their salaries compare with, what they can buy, comparison of living standards are not the same. And when it’s done well, people remember it.

• From a process point of view, it’s about how we present in the likes of our website or what information do we provide on it. They have a nurse recruiter role, specifically dealing with general nursing and that lady by chance is going to be in the U.K. and there is a job expo and she will be part of the process. It is part of the regional initiative.

• They have exit interviews, an online exit interview tool and as people’s resignations come through and there is an automatic response to let them know to complete the tool. Overall trends – key things as to why people leave relate to partner moving to another role, the money they get for the job and working conditions, and what goes into the bucket that creates the conditions.

Q.8. Do you take specific steps to make your job vacancies/descriptions more attractive to applicants?

• A lot of time is spent creating an advertisement that will bring in new applicants outside of the mental health sector. Phrases like ‘would you like to be part of improving the life of other people’ have often been used.

• Promote the training opportunities, the networking, support and supervision available to staff. Direct approach to individuals is a positive way to recruit, almost like warming potential applicants up work for the organisation. Most people like the personal and


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• Positions are widely known, making the job attractive and having clear guidelines for travelling through positions.

• If someone would like to come and see the service, come in and work for the day and see what it’s all about, and pay them for that. Difficulty for external applicants ….very successful, they don’t have surprises. If someone has applied for a job, and not suitable, then she follows it up. They might be suitable for another position.

• Yes, I think we have, due to feedback we receive from new employees. I have often got comments about our very personal approach, our thorough induction/orientation processes. I do think we need more flexibility in the recruitment policies, however, this document was developed to ensure all people were treated fairly and had the opportunity to apply for positions. By this I mean there should be times when we shouldn’t have to advertise though the minimum we are required to do is internal advertising, sometimes I think we do it to satisfy a process.

• We need to be more consistent with our own objectives across the medical and non-medical spectrum i.e., bringing the latter into line with the former – more evenly devoting energy, time and priority in the process.

• More money, more flexibility more proactively looking at the vacancies and the explanation as to why they need to have the person in the situation. If they had the process in a large DHB, it would be too cumbersome, size allows them to have the process, CEO need not sign off but that is the way it has always been done.

• We have identified in terms of providing a good orientation programme to new entrants and then there are service specific orientation programmes. This helps increase retention.

• The principle of buddying and a person they can approach, who to talk too, and this person introduces them to the processes and helps them feel more inculcated into the programme.

• A role in the organisation to operate as a liaison person to help them link into the networks and give them a decent kiwi orientation particularly in the first weeks, and to prevent culture shock they need to know what the costs they will face are and that people didn’t realize what their salaries compare with, what they can buy, comparison of living standards are not the same. And when it’s done well, people remember it.

• From a process point of view, it’s about how we present in the likes of our website or what information do we provide on it. They have a nurse recruiter role, specifically dealing with general nursing and that lady by chance is going to be in the U.K. and there is a job expo and she will be part of the process. It is part of the regional initiative.

• They have exit interviews, an online exit interview tool and as people’s resignations come through and there is an automatic response to let them know to complete the tool. Overall trends – key things as to why people leave relate to partner moving to another role, the money they get for the job and working conditions, and what goes into the bucket that creates the conditions.


• A lot of time is spent creating an advertisement that will bring in new applicants outside of the mental health sector. Phrases like ‘would you like to be part of improving the life of other people’ have often been used.

• Promote the training opportunities, the networking, support and supervision available to staff. Direct approach to individuals is a positive way to recruit, almost like warming potential applicants up work for the organisation. Most people like the personal and


directness of matching them to a position, I think the service then also benefits as you employ people with similar philosophies that enhance team work and more job satisfaction etc.

• They try to make it fast, and get into the candidates mind-set, tell them what they need and point out the benefits.

• More is given to doctors, there is perception of it and causes resentment.

• Advertise the country.

• We offer a relocation package, both for applicants outside Auckland and from overseas. Have recently changed the way we work – moved into Integrated Teams based on locality giving more team support and variety in work.

• Looking at working out a package.

• Buddy system.

• Ask Managers to spend more thought on what are the benefits for a person taking up their job, what are the points of difference we have to offer. I see no sense in writing a lot of information about what say an OT does, as they will know this info. I think it is more important to say, “when you come here to work this is what you'll get out of it; a lower nurse to patient ratio, time off for study, opportunity to work amongst the community, etc.”

• Discussion around it, decided against it – pretty pictures and more interesting language used and decided that it is better to just be plain and keep it simple. Just job characteristics. We refer people to the regional council website and their role to promote the local area. Certainly want to give information about the position.

• We try to, pretty boring ads overall, the overall desire in the regional sense is to have a website that people can draw all their information from and to have smaller ads but drive people to the website from where they can draw the information. They are trying to fine tune the adverts, but in doing that they need something eye catching, be creative but there is always room for improvement and also having a contact person who can tell you about the service is advantageous.

• Equity is a bit of a problem and no equity between nurses and doctors. Need to be more fair and maybe come up with a standard rule and there is a disparity. And this can cause some real dissatisfaction.

• There are more general and specific orientation programmes – manual with a tick box to say they have done everything in their orientation programme. Organisation wide and government investment in certain areas and one of those is a provision of a general orientation day, and treaty of Waitangi training offered to staff as well, other organisation wide programmes and cultural awareness.

• We have a legal obligation not to misrepresent the position to potential candidates. Our job descriptions/advertisements are written to reflect what is required to undertake the position being advertised. It is always our aim to ensure that the job description does not include any essential skills, experience or qualifications that are irrelevant to the position and that the advert identifies any unique aspects of the role and communicates to the candidate the essential skills/qualifications.


directness of matching them to a position, I think the service then also benefits as you employ people with similar philosophies that enhance team work and more job satisfaction etc.

• They try to make it fast, and get into the candidates mind-set, tell them what they need and point out the benefits.

• More is given to doctors, there is perception of it and causes resentment.

• Advertise the country.

• We offer a relocation package, both for applicants outside Auckland and from overseas. Have recently changed the way we work – moved into Integrated Teams based on locality giving more team support and variety in work.

• Looking at working out a package.

• Buddy system.

• Ask Managers to spend more thought on what are the benefits for a person taking up their job, what are the points of difference we have to offer. I see no sense in writing a lot of information about what say an OT does, as they will know this info. I think it is more important to say, “when you come here to work this is what you'll get out of it; a lower nurse to patient ratio, time off for study, opportunity to work amongst the community, etc.”

• Discussion around it, decided against it – pretty pictures and more interesting language used and decided that it is better to just be plain and keep it simple. Just job characteristics. We refer people to the regional council website and their role to promote the local area. Certainly want to give information about the position.

• We try to, pretty boring ads overall, the overall desire in the regional sense is to have a website that people can draw all their information from and to have smaller ads but drive people to the website from where they can draw the information. They are trying to fine tune the adverts, but in doing that they need something eye catching, be creative but there is always room for improvement and also having a contact person who can tell you about the service is advantageous.

• Equity is a bit of a problem and no equity between nurses and doctors. Need to be more fair and maybe come up with a standard rule and there is a disparity. And this can cause some real dissatisfaction.

• There are more general and specific orientation programmes – manual with a tick box to say they have done everything in their orientation programme. Organisation wide and government investment in certain areas and one of those is a provision of a general orientation day, and treaty of Waitangi training offered to staff as well, other organisation wide programmes and cultural awareness.

• We have a legal obligation not to misrepresent the position to potential candidates. Our job descriptions/advertisements are written to reflect what is required to undertake the position being advertised. It is always our aim to ensure that the job description does not include any essential skills, experience or qualifications that are irrelevant to the position and that the advert identifies any unique aspects of the role and communicates to the candidate the essential skills/qualifications.


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Q.9. In your view what are the most important factors that affect recruitment in the mental health sector?

• The ability to advertise and bring in new people to the mental health sector. Some pay offs do happen working in mental health sector no one has explored that side of mental health for a recruiting drive.

• Maintaining interest in the sector.

• The low availability of suitably qualified staff wanting to work in New Zealand.

• Identifying people who will make a difference in their practice with consumers.

• Public perception.

• Media impact.

• Worldwide and national competition, attractiveness of employment packages, selling New Zealand lifestyle, rapidity and consistency of response, mutual support and collaboration between providers, adequate resourcing of the process, mental health service focus, utilisation of multi-modal communication methods, long-term view.

• Honesty, approachability, support of candidate through process, candidate/job match, work environment, money/conditions.

• Candidate perception.

• Offering positions with scope for professional development, recognising experience and clinical expertise, flexibility in job sizing, and scope to match applicants strengths and preferences.

• Support for new graduates making the transition from student to novice occupational therapist. Clearer understanding of the role of occupational therapy in mental health by other health professionals and mental health service managers.

• Area that needs to spend more money to get their profile out there – at the moment it is considered as a poor area to work in.

• Experience in mental health.

• Making the position interesting, ensuring that the organisation is committed to ongoing training and education. Being honest with candidates about what is right and what is wrong with the organisation. No surprises. I think the personal touch is what helps, putting a face to the organisation. Acknowledging that it is a difficult area to work but that it can also have strengths, such as collegiality and making the job fun and stimulating. Involving staff in organisational wide activities so that mental health is not their total focus. Good working relationship with HR manager.

• Trying to establish where the available pool of candidates is; nationally, internationally; using the word of mouth mechanism to the fullest extent; encourage succession planning across disciplines; don’t always look to recruit the ideal candidate, look for potential to build on as the available pool is very small and we are in a global market; conduct a workforce plan and implement the actions, don’t make it like what many other documents are which sit on shelves.

• Training/post-grad study, supervision, career pathways, clear progression opportunities for staff. Staff employed to practise in the way that best utilises their skills. Quite a few OT staff leave as they don’t consistently feel like they are valued and supported to practise in a recovery focussed way. This is slowly changing but a way to go yet.

• Ensuring appropriate qualifications and experience of incumbent(s). Paper trail.


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• The ability to advertise and bring in new people to the mental health sector. Some pay offs do happen working in mental health sector no one has explored that side of mental health for a recruiting drive.

• Maintaining interest in the sector.

• The low availability of suitably qualified staff wanting to work in New Zealand.

• Identifying people who will make a difference in their practice with consumers.

• Public perception.

• Media impact.

• Worldwide and national competition, attractiveness of employment packages, selling New Zealand lifestyle, rapidity and consistency of response, mutual support and collaboration between providers, adequate resourcing of the process, mental health service focus, utilisation of multi-modal communication methods, long-term view.

• Honesty, approachability, support of candidate through process, candidate/job match, work environment, money/conditions.

• Candidate perception.

• Offering positions with scope for professional development, recognising experience and clinical expertise, flexibility in job sizing, and scope to match applicants strengths and preferences.

• Support for new graduates making the transition from student to novice occupational therapist. Clearer understanding of the role of occupational therapy in mental health by other health professionals and mental health service managers.

• Area that needs to spend more money to get their profile out there – at the moment it is considered as a poor area to work in.

• Experience in mental health.

• Making the position interesting, ensuring that the organisation is committed to ongoing training and education. Being honest with candidates about what is right and what is wrong with the organisation. No surprises. I think the personal touch is what helps, putting a face to the organisation. Acknowledging that it is a difficult area to work but that it can also have strengths, such as collegiality and making the job fun and stimulating. Involving staff in organisational wide activities so that mental health is not their total focus. Good working relationship with HR manager.

• Trying to establish where the available pool of candidates is; nationally, internationally; using the word of mouth mechanism to the fullest extent; encourage succession planning across disciplines; don’t always look to recruit the ideal candidate, look for potential to build on as the available pool is very small and we are in a global market; conduct a workforce plan and implement the actions, don’t make it like what many other documents are which sit on shelves.

• Training/post-grad study, supervision, career pathways, clear progression opportunities for staff. Staff employed to practise in the way that best utilises their skills. Quite a few OT staff leave as they don’t consistently feel like they are valued and supported to practise in a recovery focussed way. This is slowly changing but a way to go yet.

• Ensuring appropriate qualifications and experience of incumbent(s). Paper trail.


• In the DHB, locally our hospital has the highest sick leave taken and highest staff turnover in the country – this speaks for itself! Poor management, over work, no sense of being valued are the main problems. As the support work workforce is growing and becoming more skilled, I think it is imperative that the needs of this group are addressed within a national framework that reflects the importance of their role in providing recovery focused support. This is the workforce that I think needs strengthening and if we are to do this, then pay and a career structure that rewards skills and qualifications needs to happen urgently.

• Focus on the entire organisational experience.

• Information – in terms of information given to prospective candidates, have a positive spin on it, the positive possibilities, the support packages need to be clearly stated, and that includes such things as wellness support programme: gyms, supporting people through mental and physical unwellness, childcare.

• Systems set up to grow and nurture people to grow in the area of mental health.

• Important that organisation realize the changing family needs. Job-share, working part-time, moving away from archaic rostering rules.

• Enthusiasm – come across as a place that’s progressive.

• Personal engagement, advertise, people express interest.

• Availability of candidate pool.

• Recruitment into mental health is made more difficult by negative press such as the Burton case. Salaries need to improve, more money available to target graduating students, and have supportive new graduate programmes.

• Trying to create some variety for staff, not healthy to leave a person too long in an area, bit more commitment to training and development. Shortages cause all sorts of stress and that doesn’t make it attractive. Upskilling up the managers, so don’t have personality issues and we need to develop more strongly their leadership. Haven’t totally sussed out, the stress factor, more risk there now. He doesn’t think the industrialised responses to the workforce works. The media spotlight doesn’t help.

• An active strategy.

• Clear and concise recruitment information for candidates.

• The mental health sector is all about people, so finding not only the suitably qualified and experienced applicant, but making sure that person will fit within the environment and team they will be working in.

• Responsive positive attitude to enquiry.

• The mental health sector needs to cooperate and not vigorously compete internally. An ethos that prohibits “poaching” is necessary. Most people who work in mental health do so with a sense of mission. They are committed but in short supply. Career paths that enable people to move through DHBs and NGOs broaden peoples’ experience. Our recruitment strategies must recognise this.

• Willingness to put in extra effort to recruit, especially with overseas applicants.

• Staff fit – organisation values that match the values of the applicants.

• Empathy.

• Recruiting high quality and skilled staff ideally with experience to the area being recruited to. Willingness of staff to embrace values and standards of the organisation. Desire to continue to develop professionally. Recruitment process occurs in an expedient manner. Attraction of a large pool of possible and qualified candidates (particularly New Zealand


• In the DHB, locally our hospital has the highest sick leave taken and highest staff turnover in the country – this speaks for itself! Poor management, over work, no sense of being valued are the main problems. As the support work workforce is growing and becoming more skilled, I think it is imperative that the needs of this group are addressed within a national framework that reflects the importance of their role in providing recovery focused support. This is the workforce that I think needs strengthening and if we are to do this, then pay and a career structure that rewards skills and qualifications needs to happen urgently.

• Focus on the entire organisational experience.

• Information – in terms of information given to prospective candidates, have a positive spin on it, the positive possibilities, the support packages need to be clearly stated, and that includes such things as wellness support programme: gyms, supporting people through mental and physical unwellness, childcare.

• Systems set up to grow and nurture people to grow in the area of mental health.

• Important that organisation realize the changing family needs. Job-share, working part-time, moving away from archaic rostering rules.

• Enthusiasm – come across as a place that’s progressive.

• Personal engagement, advertise, people express interest.

• Availability of candidate pool.

• Recruitment into mental health is made more difficult by negative press such as the Burton case. Salaries need to improve, more money available to target graduating students, and have supportive new graduate programmes.

• Trying to create some variety for staff, not healthy to leave a person too long in an area, bit more commitment to training and development. Shortages cause all sorts of stress and that doesn’t make it attractive. Upskilling up the managers, so don’t have personality issues and we need to develop more strongly their leadership. Haven’t totally sussed out, the stress factor, more risk there now. He doesn’t think the industrialised responses to the workforce works. The media spotlight doesn’t help.

• An active strategy.

• Clear and concise recruitment information for candidates.

• The mental health sector is all about people, so finding not only the suitably qualified and experienced applicant, but making sure that person will fit within the environment and team they will be working in.

• Responsive positive attitude to enquiry.

• The mental health sector needs to cooperate and not vigorously compete internally. An ethos that prohibits “poaching” is necessary. Most people who work in mental health do so with a sense of mission. They are committed but in short supply. Career paths that enable people to move through DHBs and NGOs broaden peoples’ experience. Our recruitment strategies must recognise this.

• Willingness to put in extra effort to recruit, especially with overseas applicants.

• Staff fit – organisation values that match the values of the applicants.

• Empathy.

• Recruiting high quality and skilled staff ideally with experience to the area being recruited to. Willingness of staff to embrace values and standards of the organisation. Desire to continue to develop professionally. Recruitment process occurs in an expedient manner. Attraction of a large pool of possible and qualified candidates (particularly New Zealand


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trained mental health candidates – doctors/nurses). Clarity around job description/role definition. Developing an employer brand

• Having the right attitude for the job along with the required KSA’s.

• Training organisations and tertiary education providers need to work in closer coordination with employers, so that the courses provided meet the needs of what is required. Most polytechs just want to fill the seats, there is no consideration given to the prerequisite skills needed.

• Barriers like shift work and childcare affect people within the workforce.

• Supervision a must.

• Succession planning has to be done, will allow people to move to further their careers, as well as allow new blood to join the organisation.

• Multi-disciplinary teams work better.

• That consumers of mental health services are recruited to provide the perspective that only a consumer can provide with integrity. In some organisations there maybe resistance to hiring a consumer even though many consumers would be very capable of performing the work. This is partly as Maori are employed in areas where Maori perspectives are sought. Currently there seems insufficient education, particularly in the smaller cities, that would help fill the abilities of those who seek to work in mental health.

Q.10. What do you think of DHBs working together and pooling their resources together? What are the pros and cons that come to mind when you think of this scenario?

• Promotes New Zealand as a place to come and work in.

• Sing from the same handbook, we can help each other.

• Regional considerations need to be taken into account.

• Very good idea been involved in workforce development, lot more problematic that it sounds, still have to do it, New Zealand has the population of 4 million and there are a lot of economies to be made. Have to get away from the individual focus of the DHBs, big challenge. Big concern about equity, issues about employment to certain areas and that has to be managed. Very good on paper.

• Sounds like a great idea, but in reality we are putting in a big chunk of money and the selfish attitude that we want what we got and we don’t want to share.

Q.11. DHBs and NGOs working together?

• Bring it on. When the DHBs were first formed that each DHB with a large HR department would extend to assist and include NGO recruitment, but that hasn’t happened anywhere in the country. 0.5 FTE, no way they can get expertise.

• Stunned silence (observers comment), competition will be uncomfortable and the needs of NGOs are sometimes different. In terms of managing variations in demand of causal staff, there is not enough work to go around so they work two jobs.

• I don’t think DHBs understand the NGO sector, and the NGO sector is seen as a cheaper sort of cousin. There should be integrated service, but work needs to be done. NGOs lack HR and that is what they need, and he can see this one working better. Drawing up clear boundaries between the hospital aspect vs. the community aspect. NGO have more flexibility but they don’t have the same level of clinical skill.


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trained mental health candidates – doctors/nurses). Clarity around job description/role definition. Developing an employer brand

• Having the right attitude for the job along with the required KSA’s.

• Training organisations and tertiary education providers need to work in closer coordination with employers, so that the courses provided meet the needs of what is required. Most polytechs just want to fill the seats, there is no consideration given to the prerequisite skills needed.

• Barriers like shift work and childcare affect people within the workforce.

• Supervision a must.

• Succession planning has to be done, will allow people to move to further their careers, as well as allow new blood to join the organisation.

• Multi-disciplinary teams work better.

• That consumers of mental health services are recruited to provide the perspective that only a consumer can provide with integrity. In some organisations there maybe resistance to hiring a consumer even though many consumers would be very capable of performing the work. This is partly as Maori are employed in areas where Maori perspectives are sought. Currently there seems insufficient education, particularly in the smaller cities, that would help fill the abilities of those who seek to work in mental health.


• Promotes New Zealand as a place to come and work in.

• Sing from the same handbook, we can help each other.

• Regional considerations need to be taken into account.

• Very good idea been involved in workforce development, lot more problematic that it sounds, still have to do it, New Zealand has the population of 4 million and there are a lot of economies to be made. Have to get away from the individual focus of the DHBs, big challenge. Big concern about equity, issues about employment to certain areas and that has to be managed. Very good on paper.

• Sounds like a great idea, but in reality we are putting in a big chunk of money and the selfish attitude that we want what we got and we don’t want to share.


• Bring it on. When the DHBs were first formed that each DHB with a large HR department would extend to assist and include NGO recruitment, but that hasn’t happened anywhere in the country. 0.5 FTE, no way they can get expertise.

• Stunned silence (observers comment), competition will be uncomfortable and the needs of NGOs are sometimes different. In terms of managing variations in demand of causal staff, there is not enough work to go around so they work two jobs.

• I don’t think DHBs understand the NGO sector, and the NGO sector is seen as a cheaper sort of cousin. There should be integrated service, but work needs to be done. NGOs lack HR and that is what they need, and he can see this one working better. Drawing up clear boundaries between the hospital aspect vs. the community aspect. NGO have more flexibility but they don’t have the same level of clinical skill.


Q.12. Consumers as an untapped labour force?

• As long as there are appropriate support mechanisms.

• As the position is set up – shelf life not a career pathway, they move on or become ineffective.

• Often not, organisations don’t provide for their needs, no understanding, they need a support package. Not in a shoe box. Having secretarial and admin support, having access to mobile phones and computers, and providing support along the lines of cars and transport. Often not there, sets people up to be stressed and to burn out.

• Problem – certain standards have to be maintained, so they can’t compromise the standard. Even if the person has a qualification and then there are some privacy issues that make it difficult.

• Definitely good intention, different approaches to what he can employ as an HR manager, it is an HR nightmare and that is because the systems aren’t flexible enough, but from the point of trying to develop a quality service, you need to know what you can do and can’t do. If there is an easy way through that try to employ consumers.

• A consumer advisor, made a mention that their job is still not taken seriously, for example a service manager when asked by the consumer advisor to help with the service, told her that the waiting room needed to be a painted a better colour.

Q.13. Unions and multi-employer contracts?

• It is good because it will get everyone at the same level, but won’t solve the problem for Auckland. With regards to the bidding war which has happened in the past, there is some need for regionalization.

• Not competing as DHBs. Previously the culture met and worked through issues, people not going to have much ability to influence that anymore.

• Sense that you are not involved in decisions that will affect you. Logically the MECA makes a lot of sense. He is talking about the personal irrational stuff. Don’t feel they have a personal effect on the outcome.

NGO responses to interviews and focus groups


• General manager.

• We are an NGO Kaupapa Maori organisation run by governance board and manager.

• Administration – selection by team and consumers.

• Kamiti and manager.

• Manager.

• Management.

• Local branches of organisation in each area – service manager.

• Management.

• Team leader – causal pool for youth, involved within the recruitment within that area.

• Northern District Support agency – they fund the process.



• As long as there are appropriate support mechanisms.

• As the position is set up – shelf life not a career pathway, they move on or become ineffective.

• Often not, organisations don’t provide for their needs, no understanding, they need a support package. Not in a shoe box. Having secretarial and admin support, having access to mobile phones and computers, and providing support along the lines of cars and transport. Often not there, sets people up to be stressed and to burn out.

• Problem – certain standards have to be maintained, so they can’t compromise the standard. Even if the person has a qualification and then there are some privacy issues that make it difficult.

• Definitely good intention, different approaches to what he can employ as an HR manager, it is an HR nightmare and that is because the systems aren’t flexible enough, but from the point of trying to develop a quality service, you need to know what you can do and can’t do. If there is an easy way through that try to employ consumers.

• A consumer advisor, made a mention that their job is still not taken seriously, for example a service manager when asked by the consumer advisor to help with the service, told her that the waiting room needed to be a painted a better colour.

Q.13. Unions and multi-employer contracts?

• It is good because it will get everyone at the same level, but won’t solve the problem for Auckland. With regards to the bidding war which has happened in the past, there is some need for regionalization.

• Not competing as DHBs. Previously the culture met and worked through issues, people not going to have much ability to influence that anymore.

• Sense that you are not involved in decisions that will affect you. Logically the MECA makes a lot of sense. He is talking about the personal irrational stuff. Don’t feel they have a personal effect on the outcome.

NGO responses to interviews and focus groups


• General manager.

• We are an NGO Kaupapa Maori organisation run by governance board and manager.

• Administration – selection by team and consumers.

• Kamiti and manager.

• Manager.

• Management.

• Local branches of organisation in each area – service manager.

• Management.

• Team leader – causal pool for youth, involved within the recruitment within that area.

• Northern District Support agency – they fund the process.


103

• Service leader.

• Each area team manages its own recruitment.

• General manager, organisational development officer and admin person, all part of the recruitment process in different stages.

• Administration.

• HR department.


• 4-6 weeks.

• Dependant on replies to advertising.

• 1-2 months.

• Support workers 4-6 weeks.

• 6 weeks.

• 6 weeks.

• 3 weeks approximately

• 2-3 weeks.

• 2 months.

• 6 weeks.

• A month to 6 weeks.

• 6 weeks approximately.

• 4-6 weeks.

• 6-12 weeks.


• Advertising, short-listing, interviews.

• Initially answer queries from different sources, send out package of information, wait to get a reply, when she gets enough replies, she rings them up and makes appointments, commandeer another colleague and conduct and interview, and then she sets up the file and contract.

• Does vary, people respond back in different time frames, once received the response takes a fortnight, Police checks take a little time to return and that can delay things.

• Notification of vacancy asking for expressions of interest. Depending on the vacancy and the number and quality of applicants, we will use either a behavioural interview or assessment of performance in the current role or a combination of both. For some positions, particularly those with a Maori or Pacific Island focus, we will ask the whanau/fono to recommend a candidate.

• External advertising (e.g., local paper, Health Gazette, health web pages, local DHB recruiting paper); send out position description and job description to all applicants; completed applications received; short-listed against criteria; panel interview includes manager, clinical input, HR, and consumer advocate; written exercise; for senior positions –


103

• Service leader.

• Each area team manages its own recruitment.

• General manager, organisational development officer and admin person, all part of the recruitment process in different stages.

• Administration.

• HR department.


• 4-6 weeks.

• Dependant on replies to advertising.

• 1-2 months.

• Support workers 4-6 weeks.

• 6 weeks.

• 6 weeks.

• 3 weeks approximately

• 2-3 weeks.

• 2 months.

• 6 weeks.

• A month to 6 weeks.

• 6 weeks approximately.

• 4-6 weeks.

• 6-12 weeks.


• Advertising, short-listing, interviews.

• Initially answer queries from different sources, send out package of information, wait to get a reply, when she gets enough replies, she rings them up and makes appointments, commandeer another colleague and conduct and interview, and then she sets up the file and contract.

• Does vary, people respond back in different time frames, once received the response takes a fortnight, Police checks take a little time to return and that can delay things.

• Notification of vacancy asking for expressions of interest. Depending on the vacancy and the number and quality of applicants, we will use either a behavioural interview or assessment of performance in the current role or a combination of both. For some positions, particularly those with a Maori or Pacific Island focus, we will ask the whanau/fono to recommend a candidate.

• External advertising (e.g., local paper, Health Gazette, health web pages, local DHB recruiting paper); send out position description and job description to all applicants; completed applications received; short-listed against criteria; panel interview includes manager, clinical input, HR, and consumer advocate; written exercise; for senior positions –


health screening and psychological testing; reference checking – minimum of two; appointment.

• When the position is vacant then they have to fill in a request to recruit, and then it goes through to HR.

• Review of relevant documents. Coordinator and staff sub-committee review the current job description. Job is advertised in local paper and through networks. Selection has three people – staff sub-committee member, participant representative and the coordinator. (Both genders to be represented on panel.) Selection panel reads all applications and meets to prepare a short-list. Two main selection procedures for candidates: a formal interview; and a visit of at least 2 hours to the organisation during a working day. The informal visit gives an opportunity to see how candidates interact in the organisation setting. Contact short-listed candidates to set up interviews and visits. Tell them of their right to bring in whanau/support group. Selection panel decides on questions to be asked. Questions should cover: skills and experiences; cultural sensitivity/Treaty of Waitangi responsibilities; training and education; the use of creative expression; dependability; ability to work under stress; understanding of issues faced by mental health consumers; and personal goals. After the interviews discuss top candidates and decide on the ideal person. Contact referees and report referee comments back to panel for final decision. Coordinator offers the position to successful applicant and reaches agreement on terms, conditions and start date.

• Position is advertised with requirements and closing date. Applicants are short-listed. A values group interview is held for successful applicants. Individual interviews for successful applicants are held. Referees for the successful applicant are contacted and a Police check undertaken. The position is offered to the successful applicant. Negotiation of terms and conditions of contract are undertaken. A starting date is negotia ted. A powhiri is held for the new applicant.


• Advertisements.

• Newspaper advertising.

• Networks.

• Newspaper.

• Colleagues.

• Professional associations.

• Word of mouth.

• Advertise in the Herald and suburban newspapers and often post a notice at training institutes, also task force green.

• Newspaper ads, emailed ads to relevant lists.

• The position will be advertised in the local newspaper. If no suitable candidates are found via the initial internal and external ‘advertising’, the position will be re-advertised over a broader geographical area.

• Some small part-time positions are filled internally from our members.

• Local newspapers including community papers.

• Email all on mailing list, newspaper adverts, web job sites, professional journals/newsletters, our own website, flyers, (e.g., word of mouth). Lots of people approach us through our website.


health screening and psychological testing; reference checking – minimum of two; appointment.

• When the position is vacant then they have to fill in a request to recruit, and then it goes through to HR.

• Review of relevant documents. Coordinator and staff sub-committee review the current job description. Job is advertised in local paper and through networks. Selection has three people – staff sub-committee member, participant representative and the coordinator. (Both genders to be represented on panel.) Selection panel reads all applications and meets to prepare a short-list. Two main selection procedures for candidates: a formal interview; and a visit of at least 2 hours to the organisation during a working day. The informal visit gives an opportunity to see how candidates interact in the organisation setting. Contact short-listed candidates to set up interviews and visits. Tell them of their right to bring in whanau/support group. Selection panel decides on questions to be asked. Questions should cover: skills and experiences; cultural sensitivity/Treaty of Waitangi responsibilities; training and education; the use of creative expression; dependability; ability to work under stress; understanding of issues faced by mental health consumers; and personal goals. After the interviews discuss top candidates and decide on the ideal person. Contact referees and report referee comments back to panel for final decision. Coordinator offers the position to successful applicant and reaches agreement on terms, conditions and start date.

• Position is advertised with requirements and closing date. Applicants are short-listed. A values group interview is held for successful applicants. Individual interviews for successful applicants are held. Referees for the successful applicant are contacted and a Police check undertaken. The position is offered to the successful applicant. Negotiation of terms and conditions of contract are undertaken. A starting date is negotia ted. A powhiri is held for the new applicant.


• Advertisements.


• Networks.

• Newspaper.

• Colleagues.

• Professional associations.

• Word of mouth.

• Advertise in the Herald and suburban newspapers and often post a notice at training institutes, also task force green.

• Newspaper ads, emailed ads to relevant lists.

• The position will be advertised in the local newspaper. If no suitable candidates are found via the initial internal and external ‘advertising’, the position will be re-advertised over a broader geographical area.

• Some small part-time positions are filled internally from our members.

• Local newspapers including community papers.

• Email all on mailing list, newspaper adverts, web job sites, professional journals/newsletters, our own website, flyers, (e.g., word of mouth). Lots of people approach us through our website.


105

• Networks – especially consumer networks and the local mental health sector and community sector. We have also utilised secondment opportunities – from other NGO organisations and government departments.

• Using word of mouth, email and notices. Short-list and structured interview for ongoing positions interview for project workers. Advertise in local press, word of mouth, email and notices. Short-list and structured interview for ongoing positions interview for project workers.

• Internal – Nga Hauora, hospital, hapu, iwi. External – media.


• Word of mouth.

• List advert with WINZ.

• Advertise internally.

• Advertise in related organisations.

• Advertise in the press.

• Not that proactive, just posters around the polytechs.

• Position is advertised in staff meetings, internal mail.

• Newspaper advertising – locally and generally.


• Approach polytechs.

• Casual pool if the job is upcoming.

• Word of mouth – though it can become a bit incestuous, because of it being a small community.

• Word of mouth – works really well, particularly with counsellors, they shoulder tap somebody they respect. Often the people through newspapers won’t be short-listed, as they have no qualification where as word of mouth are qualified.

• Interview – everybody goes through a two pronged approach, formal interview panel and a work sample and for counsellors will be a role play. And for non-counselling sends them in with a group that pretend to be their staff. Panel – are senior or external stakeholders and role play are all lower subordinates, gets a different data set from both sets people.

• We advertise in the local newspapers, for a senior position or if they are struggling then the national paper. Job sites – Seek, NZjobs recent use. If it is a counselling position, use the professional newspapers and communication methods like email.

• Websites, newspapers, internally they express interest, but very rarely done.

• Medical staff – means something to you but not to me! I recruit staff that are to work in mental health area, and often I am not looking for people with medical qualifications – rather an in built ability to work with people, to empathise and to have respect for their journeys, all with a recovery focus. The question of their qualifications (nurse, O/T, S/W, Level 4 National Certificate in mental health support work, etc.) is less important. So, be careful that you let the respondents to this questionnaire know what you mean by “medical staff”! Anyway, to answer your question above, internal recruitment is generally by letting staff know of the vacancy, and or asking particular individuals if they are interested.


105

• Networks – especially consumer networks and the local mental health sector and community sector. We have also utilised secondment opportunities – from other NGO organisations and government departments.

• Using word of mouth, email and notices. Short-list and structured interview for ongoing positions interview for project workers. Advertise in local press, word of mouth, email and notices. Short-list and structured interview for ongoing positions interview for project workers.

• Internal – Nga Hauora, hospital, hapu, iwi. External – media.


• Word of mouth.

• List advert with WINZ.

• Advertise internally.

• Advertise in related organisations.

• Advertise in the press.

• Not that proactive, just posters around the polytechs.

• Position is advertised in staff meetings, internal mail.

• Newspaper advertising – locally and generally.


• Approach polytechs.

• Casual pool if the job is upcoming.

• Word of mouth – though it can become a bit incestuous, because of it being a small community.

• Word of mouth – works really well, particularly with counsellors, they shoulder tap somebody they respect. Often the people through newspapers won’t be short-listed, as they have no qualification where as word of mouth are qualified.

• Interview – everybody goes through a two pronged approach, formal interview panel and a work sample and for counsellors will be a role play. And for non-counselling sends them in with a group that pretend to be their staff. Panel – are senior or external stakeholders and role play are all lower subordinates, gets a different data set from both sets people.

• We advertise in the local newspapers, for a senior position or if they are struggling then the national paper. Job sites – Seek, NZjobs recent use. If it is a counselling position, use the professional newspapers and communication methods like email.

• Websites, newspapers, internally they express interest, but very rarely done.

• Medical staff – means something to you but not to me! I recruit staff that are to work in mental health area, and often I am not looking for people with medical qualifications – rather an in built ability to work with people, to empathise and to have respect for their journeys, all with a recovery focus. The question of their qualifications (nurse, O/T, S/W, Level 4 National Certificate in mental health support work, etc.) is less important. So, be careful that you let the respondents to this questionnaire know what you mean by “medical staff”! Anyway, to answer your question above, internal recruitment is generally by letting staff know of the vacancy, and or asking particular individuals if they are interested.


• Advertising in local papers. Advertising on web-based job-search site. Flyers placed in mental health services with their approval. Emails via networks (e.g., Auckland Regional Consumer Network), and they then send out to their networks.

• Media advertising, utilising Networks, internal advertising, utilising recruitment agencies, sometimes personal approach.


• Safe process.

• Skilled panellists.

• Kaupapa Maori processes.

• Panel interviews.

• Being a speciality service.

• Clear guidelines; strong networks; focus on organisational fit; values and competencies; flexibility in remuneration negotiations; cultural and service users input.

• Well organised, prompt response times and good teamwork between individuals and departments. Willing to advertise widely and willing to be flexible in employment arrangements and will assist in relocation costs.

• Organisation is seen as professional to work for. Has a good reputation and Kaupapa environment. Community not hospital-based.

• They are straight forward, not complex and suit the size of our organisation.

• Long-term employees, the systems in place seem to hold staff for many years. Attrition rates have been negative for several years due to service expansion, longest employee 17 years, then 7 years and then several around 5-6 years.

• None in recruitment, strengths in selection process. Comprehensive orientation and consumer input.

• There is nothing particularly strong about it. We do what we have to do. Being an incorporated society of people (mostly Maori) who have experience mental illness, means it’s not your common or garden person who is most suitable to join our team. We have advertised 3 times in 10 years and have always had a good number of applicants.

• Very clear recruitment policy and procedures, interesting work, always include a consumer external to the organisation in recruitment process.

• Provide interested persons with information on the organisation, the work, salary etc., so we usually only get applications from people who feel suited to the work and our organisation.

• The process: Karanga (invitations/panui); Whakawhanagodanga; Mihimihi, (introductions, checks, interview process, settling time and orientation) Whakawatea; and Hei Mahi.

• Being clear about the position, i.e., non-clinical and having a clear job description.

• Clear, concise and user friendly.

• A good recruitment procedure, open communication and supportive work environment, good induction programme.

• Reputation, word of mouth.

• We involve a consumer rep, the invite and outside NGO work and supporting families. 3-4 people on the panel. Sometimes he doesn’t see any strengths at all and he does the best he can.


• Advertising in local papers. Advertising on web-based job-search site. Flyers placed in mental health services with their approval. Emails via networks (e.g., Auckland Regional Consumer Network), and they then send out to their networks.

• Media advertising, utilising Networks, internal advertising, utilising recruitment agencies, sometimes personal approach.


• Safe process.

• Skilled panellists.

• Kaupapa Maori processes.

• Panel interviews.

• Being a speciality service.

• Clear guidelines; strong networks; focus on organisational fit; values and competencies; flexibility in remuneration negotiations; cultural and service users input.

• Well organised, prompt response times and good teamwork between individuals and departments. Willing to advertise widely and willing to be flexible in employment arrangements and will assist in relocation costs.

• Organisation is seen as professional to work for. Has a good reputation and Kaupapa environment. Community not hospital-based.

• They are straight forward, not complex and suit the size of our organisation.

• Long-term employees, the systems in place seem to hold staff for many years. Attrition rates have been negative for several years due to service expansion, longest employee 17 years, then 7 years and then several around 5-6 years.

• None in recruitment, strengths in selection process. Comprehensive orientation and consumer input.

• There is nothing particularly strong about it. We do what we have to do. Being an incorporated society of people (mostly Maori) who have experience mental illness, means it’s not your common or garden person who is most suitable to join our team. We have advertised 3 times in 10 years and have always had a good number of applicants.

• Very clear recruitment policy and procedures, interesting work, always include a consumer external to the organisation in recruitment process.

• Provide interested persons with information on the organisation, the work, salary etc., so we usually only get applications from people who feel suited to the work and our organisation.

• The process: Karanga (invitations/panui); Whakawhanagodanga; Mihimihi, (introductions, checks, interview process, settling time and orientation) Whakawatea; and Hei Mahi.

• Being clear about the position, i.e., non-clinical and having a clear job description.

• Clear, concise and user friendly.

• A good recruitment procedure, open communication and supportive work environment, good induction programme.

• Reputation, word of mouth.

• We involve a consumer rep, the invite and outside NGO work and supporting families. 3-4 people on the panel. Sometimes he doesn’t see any strengths at all and he does the best he can.


107

• We get the message out well, good pool of people to select from, manage to keep the cost down.

• Start with the relatively local circle and only spend more money when they need too. Limits cost.

• Because they are not public service, and if they know somebody they can just appoint, no public sector requirements.

• Approachability.

• Pre-selection process is strong for – job fit.

• Fair open transparent process.

• Quality of interviewers strong.

• We are flexible regarding the short-listing and interviewing process. We are inclined to use unconventional methods that gives us insight into how well a candidate is likely to fit into our organisation (as our organisation operates quite differently from conventional businesses).

• Personal contact – when people express interest, keep them informed.

• Forging links with the universities and polytechs.


• Nil.

• Lack of accredited Maori available to apply for positions.

• None really.

• We find that we get very few candidates for consumer advisor vacancies, especially where a certain ethnic background would be an advantage (especially Maori and Pacific).

• Keeping up with legislation.

• Availability of good quality staff.

• In the past with a smaller team we have been able to have a lot of fun as a group. Now we are much bigger and can no longer get all the staff together. Orientation is becoming a huge part of HR.

• Whilst asking for experience, actually get many non-qualified people applying – time consuming.

• No issues, it is a method that has proved to be effective for us.

• Cost of advertising and staff resource in process.

• We have weak staff management skills currently in our clinical management team. This means that a non-clinical person is trying to promote the clinical positions without in-depth knowledgeable support.

• Just not enough putea.

• Timing to respond to service demand.

• By describing who we are – this will attract some, and repel others (e.g., NGO, size of organisation, family friendly, flexible, opportunity for part-time work, training etc).

• Skills versus reliable.


107

• We get the message out well, good pool of people to select from, manage to keep the cost down.

• Start with the relatively local circle and only spend more money when they need too. Limits cost.

• Because they are not public service, and if they know somebody they can just appoint, no public sector requirements.

• Approachability.

• Pre-selection process is strong for – job fit.

• Fair open transparent process.

• Quality of interviewers strong.

• We are flexible regarding the short-listing and interviewing process. We are inclined to use unconventional methods that gives us insight into how well a candidate is likely to fit into our organisation (as our organisation operates quite differently from conventional businesses).

• Personal contact – when people express interest, keep them informed.

• Forging links with the universities and polytechs.


• Nil.

• Lack of accredited Maori available to apply for positions.

• None really.

• We find that we get very few candidates for consumer advisor vacancies, especially where a certain ethnic background would be an advantage (especially Maori and Pacific).

• Keeping up with legislation.

• Availability of good quality staff.

• In the past with a smaller team we have been able to have a lot of fun as a group. Now we are much bigger and can no longer get all the staff together. Orientation is becoming a huge part of HR.

• Whilst asking for experience, actually get many non-qualified people applying – time consuming.

• No issues, it is a method that has proved to be effective for us.

• Cost of advertising and staff resource in process.

• We have weak staff management skills currently in our clinical management team. This means that a non-clinical person is trying to promote the clinical positions without in-depth knowledgeable support.

• Just not enough putea.

• Timing to respond to service demand.

• By describing who we are – this will attract some, and repel others (e.g., NGO, size of organisation, family friendly, flexible, opportunity for part-time work, training etc).

• Skills versus reliable.


• Often delays when paperwork is completed, which can appear as a lack of interest to potential candidates.

• We are a very small organisation and we do not have a high staff turnover. It is difficult to make any comments in this regard as there was no need to appoint staff since my own appointment.

• Financial constraints, we struggle to offer a competitive remuneration sala ry package.

• Range of barriers – lack of access to resource, that resource maybe transport, money for clothes, there is some process or skill development, CV writing, interview training. Challenges around how to go about the job search part of it.

• Disclosure issues are enormous.

• Fear around benefits – shift happening.

• Time constraints – a balancing act between all the other allocated jobs.

• Limited pool to draw from.

• Short and inadequate recruiting and selection process, need more time to gain an insight into the person.

• We are struggling as the people we employ are para-professionals and there is no professional body to govern this employee group.

• Unsure of attributes and no work has been done on it.

• We are not looking for people who only care; we want people with the relevant skill base too.

• Interviews are a waste of time as it can be hard to judge the appropriateness of a candidate.

• The difficulties are, the sometimes interviews don’t work, a better way of doing things, getting around the orientation thing, can be a bit of a hassle to orientate people, maybe a dedicated staff.

• Being a small organisation, people undertake different roles depending on the task at hand, to orientate people to the different roles in such a manner that they don’t forget where they are coming from can be tough.

• It takes quite a high degree of time and energy from the staff that are involved, can be quite slow thus left with a significant gap and hasn’t found anything that will work faster.

• Doesn’t work where they have a particula r location, and they can’t find anybody. Struggle to find another mechanism to find applicants. For example problem with small town because of location, generic problem for all departments. Community wide problem.

• Quality of staff.

• The organisation has a reputation for employee development, thus they lose or have their staff poached.

• Inability to advertise widely or use recruitment agencies more frequently due to financial constraints, insufficient training for service users in interview techniques, capacity of HR department, inability to compete with clinical services on the basis of remuneration.


• Policies and practices are reviewed annually.

• Every organisations policies and practices can be improved. Appendix 3: Summary of Individual Responses to Questionnaire, Interview

and Focus Group Questions 108

• Often delays when paperwork is completed, which can appear as a lack of interest to potential candidates.

• We are a very small organisation and we do not have a high staff turnover. It is difficult to make any comments in this regard as there was no need to appoint staff since my own appointment.

• Financial constraints, we struggle to offer a competitive remuneration sala ry package.

• Range of barriers – lack of access to resource, that resource maybe transport, money for clothes, there is some process or skill development, CV writing, interview training. Challenges around how to go about the job search part of it.

• Disclosure issues are enormous.

• Fear around benefits – shift happening.

• Time constraints – a balancing act between all the other allocated jobs.

• Limited pool to draw from.

• Short and inadequate recruiting and selection process, need more time to gain an insight into the person.

• We are struggling as the people we employ are para-professionals and there is no professional body to govern this employee group.

• Unsure of attributes and no work has been done on it.

• We are not looking for people who only care; we want people with the relevant skill base too.

• Interviews are a waste of time as it can be hard to judge the appropriateness of a candidate.

• The difficulties are, the sometimes interviews don’t work, a better way of doing things, getting around the orientation thing, can be a bit of a hassle to orientate people, maybe a dedicated staff.

• Being a small organisation, people undertake different roles depending on the task at hand, to orientate people to the different roles in such a manner that they don’t forget where they are coming from can be tough.

• It takes quite a high degree of time and energy from the staff that are involved, can be quite slow thus left with a significant gap and hasn’t found anything that will work faster.

• Doesn’t work where they have a particula r location, and they can’t find anybody. Struggle to find another mechanism to find applicants. For example problem with small town because of location, generic problem for all departments. Community wide problem.

• Quality of staff.

• The organisation has a reputation for employee development, thus they lose or have their staff poached.

• Inability to advertise widely or use recruitment agencies more frequently due to financial constraints, insufficient training for service users in interview techniques, capacity of HR department, inability to compete with clinical services on the basis of remuneration.


• Policies and practices are reviewed annually.

• Every organisations policies and practices can be improved.


109

• Unsure.

• Not sure, an employment agency for the sector would be good. That also matched student placements on call staff, and those eligible for WINZ subsidized programmes. With a WINZ worker we can take on more staff and provide a better service.

• Our organisation has used a variety of hiring practices including secondments from other organisations. Each time hiring is undertaken we review how it went and make changes. Personally, the process was a positive experience for me.

• Use of an electronic point of advertising within the NGO/Community sector – I think platform is considering this.

• The organisation has the best hiring practices but due to time or lack of time, process can be a bit long.

• Specific targeted financing.

• We need to interview a full range of applicants even if the intent is to fill the position internally.

• The scope of advertising i.e., we employ Maori staff we need to ensure the position is read by Maori.

• Interview process to be revamped, it’s a much bigger issue, the whole value of this kind of work is underestimated and therefore it is not seen as a status occupation. Low status occupation.

• Financial constraints – avoid taking on relief workers and spending wages and time when they will not be used in the long run.

• One of the things that they have been trying is international recruitment, very useful to access more information about what people overseas qualifications meant.

• Just as an NGO with limited resources, very interested in interviewing a person from New Mexico and found it difficult to set up a video link. Organisations that have the resource can lease it out and thus share expertise.

• Central pool with available resources they can tap into.

• Collaboration between the NGO sector.

• Ad size and wording.

• Workforce development and recruitment and retention need to work together.

• There is always room for improvement, but we are not rigid in our approach and will vary from time to time if we think there will be better ways of attracting candidates and/or getting the best person for the job.

• Collaborate with other clinical/non clinical services (e.g., sharing of advertising space, sharing of possible candidates across the sector, sharing of HR resources to improve efficiency and reduce fragmentation of recruitment practices/costs, sharing of recruitment practice workshops).


• Put logos and banners around the advert.

• Clear overview of specs.

• Clear closing date of applications.


109

• Unsure.

• Not sure, an employment agency for the sector would be good. That also matched student placements on call staff, and those eligible for WINZ subsidized programmes. With a WINZ worker we can take on more staff and provide a better service.

• Our organisation has used a variety of hiring practices including secondments from other organisations. Each time hiring is undertaken we review how it went and make changes. Personally, the process was a positive experience for me.

• Use of an electronic point of advertising within the NGO/Community sector – I think platform is considering this.

• The organisation has the best hiring practices but due to time or lack of time, process can be a bit long.

• Specific targeted financing.

• We need to interview a full range of applicants even if the intent is to fill the position internally.

• The scope of advertising i.e., we employ Maori staff we need to ensure the position is read by Maori.

• Interview process to be revamped, it’s a much bigger issue, the whole value of this kind of work is underestimated and therefore it is not seen as a status occupation. Low status occupation.

• Financial constraints – avoid taking on relief workers and spending wages and time when they will not be used in the long run.

• One of the things that they have been trying is international recruitment, very useful to access more information about what people overseas qualifications meant.

• Just as an NGO with limited resources, very interested in interviewing a person from New Mexico and found it difficult to set up a video link. Organisations that have the resource can lease it out and thus share expertise.

• Central pool with available resources they can tap into.

• Collaboration between the NGO sector.

• Ad size and wording.

• Workforce development and recruitment and retention need to work together.

• There is always room for improvement, but we are not rigid in our approach and will vary from time to time if we think there will be better ways of attracting candidates and/or getting the best person for the job.

• Collaborate with other clinical/non clinical services (e.g., sharing of advertising space, sharing of possible candidates across the sector, sharing of HR resources to improve efficiency and reduce fragmentation of recruitment practices/costs, sharing of recruitment practice workshops).


• Put logos and banners around the advert.

• Clear overview of specs.

• Clear closing date of applications.


• Emphasize great team to work with.

• Not really, we just describe the job; we want people who understand how difficult it is.

• All of our advertisements contain ‘we strongly encourage people who have used mental health services to apply’ Ko ta matou ki te hunga kua waia ki ngo ratonga hauora a-hinengaro, kia kaha te tono mai. This wording has seen an increase in applications from Maori and consumers.

• Rewriting adverts to appeal to intrinsic rewards.

• Once successful, staff are sent for training courses for the Treaty of Waitangi and Blueprint courses.

• Very important that they get the right people with the right ethos, so statement starts with the ethical philosophy and the expectations of the organisation.

• We make them factual so people know what they are applying for.

• Include opportunities for education support, career development, employee wellness and social programmes.


• Skilled practioners.

• Practitioners who display empathy, professionalism, good assessment skills. Good knowledge of presenting mental health illness.

• Making sure there is a good fit of skills, values and knowledge better the applicant and the organisation. In the NGO sector, the addition of applicants with a fervour for the area, or personal experience is an additional advantage, but it needs to be assessed at selection alongside other qualities.

• Provision of good placement opportunities and teaching material in order to attract students (social work) to mental health.

• Selecting employees with empathy for the clients. Skills and qualifications next. If employees can not relate to clients with whom they will be working with they will not be employed at the centre.

• Being real about the nature of the role/s and challenges that are presented but also highlighting that with challenges come rewards.

• Getting experienced staff.

• Salary and working conditions, clinical staff are supported properly to enable them to do their job to the best of their ability in that clear direction is given through the management structure and through team meetings and forums. Ongoing training is provided to keep skills up-to-date and to enable staff to seek promotion within the organisation. Other critical factors are a lack of mental health specific training available, such as alcohol and drug counselling and a lack of this emphasis in the national nursing curriculum, difficulty getting younger people attracted to the mental health area.

• Money, experience and alleviation of stress in mental health workers.

• Attention to the values. Appreciating that the employment relationship commences at the moment that an advert is drafted. Robust systems to check background, references, experience and competency.


• Emphasize great team to work with.

• Not really, we just describe the job; we want people who understand how difficult it is.

• All of our advertisements contain ‘we strongly encourage people who have used mental health services to apply’ Ko ta matou ki te hunga kua waia ki ngo ratonga hauora a-hinengaro, kia kaha te tono mai. This wording has seen an increase in applications from Maori and consumers.

• Rewriting adverts to appeal to intrinsic rewards.

• Once successful, staff are sent for training courses for the Treaty of Waitangi and Blueprint courses.

• Very important that they get the right people with the right ethos, so statement starts with the ethical philosophy and the expectations of the organisation.

• We make them factual so people know what they are applying for.

• Include opportunities for education support, career development, employee wellness and social programmes.


• Skilled practioners.

• Practitioners who display empathy, professionalism, good assessment skills. Good knowledge of presenting mental health illness.

• Making sure there is a good fit of skills, values and knowledge better the applicant and the organisation. In the NGO sector, the addition of applicants with a fervour for the area, or personal experience is an additional advantage, but it needs to be assessed at selection alongside other qualities.

• Provision of good placement opportunities and teaching material in order to attract students (social work) to mental health.

• Selecting employees with empathy for the clients. Skills and qualifications next. If employees can not relate to clients with whom they will be working with they will not be employed at the centre.

• Being real about the nature of the role/s and challenges that are presented but also highlighting that with challenges come rewards.

• Getting experienced staff.

• Salary and working conditions, clinical staff are supported properly to enable them to do their job to the best of their ability in that clear direction is given through the management structure and through team meetings and forums. Ongoing training is provided to keep skills up-to-date and to enable staff to seek promotion within the organisation. Other critical factors are a lack of mental health specific training available, such as alcohol and drug counselling and a lack of this emphasis in the national nursing curriculum, difficulty getting younger people attracted to the mental health area.

• Money, experience and alleviation of stress in mental health workers.

• Attention to the values. Appreciating that the employment relationship commences at the moment that an advert is drafted. Robust systems to check background, references, experience and competency.


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• The right ability to make relationships, stand alongside rather than “do to”; a recovery focus; ability to think outside the square; absolute ability to make the client feel they have been heard; enthusiasm; stable home life; good personal boundaries. The academic staff is secondary.

• Good self-management and time management.

• Availability of qualified staff, career progression, training and supervision opportunities. NGO sector now more attractive than in the past as a step in a career.

• Choosing the right staff – hiring for purposeful staff, aligned with organisation culture.

• Personal experience and empathy. Ability to be a voice, either a quiet one supporting others, or a robust and loud one.

• Good resourcing, up to date technology, supportive environment, salary, adequate holiday breaks (e.g., above average for this field).

• Lack of sufficient training in clinical areas in New Zealand and need to recruit from pool of overseas candidates who are transient and not always committed to New Zealand context. This also contributes to lack of continuation of service to clients who have to change workers over and over again. There appears to be a stigma attached to working in mental health here which goes against the trend of many other countries where this is seen as an area of prestige. The money is not great. There does not appear to be any coherent integrated plan for workforce development.

• Careful documentation skills and report writing skills.

• Have a willingness to learn and train.

• Qualifications for positions.

• Knowledge of Kaupapa Maori.

• It is important that mental health work places are great places to work – where staff feel genuinely valued with more than just their pay packet. Opportunities to attend (paid) training/study to continue to develop skills. People need a realistic picture of what to expect in the workplace. Things like poor team morale become obvious very quickly and applicants need to be aware beforehand.

• Being alcohol, drug and smoke free.

• Negative factors – lack of funding and positive public awareness in mental health. No nationwide promotion of training/career opportunities in this growing field. Limited pool of experienced staff currently. As a Charitable Trust we do not have the money for more extensive external advertising but we do have good local networking.

• Qualifications.

• Experience.

• Prove a track record in working in the mental health area.

• Employee-related law.

• In the NGO sector, poor pay and a lack of a clear career structure for support work are constantly cited. Generally, there seems to be high job satisfaction in the NGO’s and a reasonable sense of being valued with staff training being readily available.

• Limited budget that often means we can not really pay people what they are really worth.

• Astute instincts of management at initial stage, interview before selection. Pick up on more subtle characteristics of the person.


111

• The right ability to make relationships, stand alongside rather than “do to”; a recovery focus; ability to think outside the square; absolute ability to make the client feel they have been heard; enthusiasm; stable home life; good personal boundaries. The academic staff is secondary.

• Good self-management and time management.

• Availability of qualified staff, career progression, training and supervision opportunities. NGO sector now more attractive than in the past as a step in a career.

• Choosing the right staff – hiring for purposeful staff, aligned with organisation culture.

• Personal experience and empathy. Ability to be a voice, either a quiet one supporting others, or a robust and loud one.

• Good resourcing, up to date technology, supportive environment, salary, adequate holiday breaks (e.g., above average for this field).

• Lack of sufficient training in clinical areas in New Zealand and need to recruit from pool of overseas candidates who are transient and not always committed to New Zealand context. This also contributes to lack of continuation of service to clients who have to change workers over and over again. There appears to be a stigma attached to working in mental health here which goes against the trend of many other countries where this is seen as an area of prestige. The money is not great. There does not appear to be any coherent integrated plan for workforce development.

• Careful documentation skills and report writing skills.

• Have a willingness to learn and train.

• Qualifications for positions.

• Knowledge of Kaupapa Maori.

• It is important that mental health work places are great places to work – where staff feel genuinely valued with more than just their pay packet. Opportunities to attend (paid) training/study to continue to develop skills. People need a realistic picture of what to expect in the workplace. Things like poor team morale become obvious very quickly and applicants need to be aware beforehand.

• Being alcohol, drug and smoke free.

• Negative factors – lack of funding and positive public awareness in mental health. No nationwide promotion of training/career opportunities in this growing field. Limited pool of experienced staff currently. As a Charitable Trust we do not have the money for more extensive external advertising but we do have good local networking.

• Qualifications.

• Experience.

• Prove a track record in working in the mental health area.

• Employee-related law.

• In the NGO sector, poor pay and a lack of a clear career structure for support work are constantly cited. Generally, there seems to be high job satisfaction in the NGO’s and a reasonable sense of being valued with staff training being readily available.

• Limited budget that often means we can not really pay people what they are really worth.

• Astute instincts of management at initial stage, interview before selection. Pick up on more subtle characteristics of the person.


• There are too few people with the right sort of heart for the job, the people we would like to employ (Maori people who have experienced mental illness) are difficult to find and often already under stress which makes dealing with a difficult job pretty risky.

• Students need positive experiences in the mental health sector during training so they then want to work in the sector.

• Non-registered health workers (e.g., support workers need to be valued – both financially and by the rest of the sectors).

• Cost and resource – expensive process, especially for a small NGO as us, who often are looking for people who may not already be working in mental health.

• Innovation – we run a recruitment and temping agency called ‘Temporary Solutions’ to the sector. This agency provides competent workers with experience of mental health issues for casual and short-term paid work in the mental health and community sector.

• Knowledge (mental health), affinity toward tangata whaiora, empathy, admin and reporting skills and a sense of humour.

• Diverse skills and experiences.

• Financia l and other rewards and recognition.

• Effective training programmes.

• Getting the advert seen by all Maori.

• Negate the blame culture.

• There needs to a skill-based training programme not just theory.

• New blood into the organisation and the sector.

• People that have passed the certificate are not necessarily any good for the job, so something needs to be done to gauge people’s effectiveness in the job.

• Looking for people that don’t have a prejudgment on the causes of mental illness.

• Very important to find people that can put their beliefs to one side, whilst dealing with the needs of the people in front of them.

• Help people find their own answers and not assume that my answers are their answers.

• Money is what gives you pulling power over the competitors.

• Candidates join for reputation.

• Resilience and drive.

• Empathy and understanding.

• A determination to make things better for people.

• Insight.

• Finding staff that are skilled in recovery-based practice.

• Clear guidelines and policies.

• Ability to collaborate with the sector on recruitment.

• Ability to offer remuneration packages which are truly reflective of the nature of the positions and not of the organisational financial limitations.

• People being very well informed about the job. Informing people about the type of support they will receive when working. Having appropriate qualifications.


• There are too few people with the right sort of heart for the job, the people we would like to employ (Maori people who have experienced mental illness) are difficult to find and often already under stress which makes dealing with a difficult job pretty risky.

• Students need positive experiences in the mental health sector during training so they then want to work in the sector.

• Non-registered health workers (e.g., support workers need to be valued – both financially and by the rest of the sectors).

• Cost and resource – expensive process, especially for a small NGO as us, who often are looking for people who may not already be working in mental health.

• Innovation – we run a recruitment and temping agency called ‘Temporary Solutions’ to the sector. This agency provides competent workers with experience of mental health issues for casual and short-term paid work in the mental health and community sector.

• Knowledge (mental health), affinity toward tangata whaiora, empathy, admin and reporting skills and a sense of humour.

• Diverse skills and experiences.

• Financia l and other rewards and recognition.

• Effective training programmes.

• Getting the advert seen by all Maori.

• Negate the blame culture.

• There needs to a skill-based training programme not just theory.

• New blood into the organisation and the sector.

• People that have passed the certificate are not necessarily any good for the job, so something needs to be done to gauge people’s effectiveness in the job.

• Looking for people that don’t have a prejudgment on the causes of mental illness.

• Very important to find people that can put their beliefs to one side, whilst dealing with the needs of the people in front of them.

• Help people find their own answers and not assume that my answers are their answers.

• Money is what gives you pulling power over the competitors.

• Candidates join for reputation.

• Resilience and drive.

• Empathy and understanding.

• A determination to make things better for people.

• Insight.

• Finding staff that are skilled in recovery-based practice.

• Clear guidelines and policies.

• Ability to collaborate with the sector on recruitment.

• Ability to offer remuneration packages which are truly reflective of the nature of the positions and not of the organisational financial limitations.

• People being very well informed about the job. Informing people about the type of support they will receive when working. Having appropriate qualifications.


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• The process of recruitment is a fundamental position within all disciplines within the health sector. The position for mental health however, is that it has to continuously encourage new workforce given the demand of health professionals both clinically and non-clinical within mental health. This recruitment process must also be taken into consideration at a strategic level when planning the sector through the current 3-5 year strategic planning process, which is currently being engaged by the Northern Region. What I mean by this is, when planning the sector’s design or redesign, then the HR implications around workforce both existing and new, needs to be clearly examined, also when determining new or improving current service delivery within the mental health sector.


• Political effect, not sure where the benefits are.

• Needs to move to a more community-based thinking, giving equal importance to family and support work. But the danger of deskilling DHB work.


• Needs to happen so that there is no cut-throat competition.


• It does happen, on an individual basis, but she is very careful about recruiting a service user, although they have some insight you have to be very clear where about on the cycle of recovery they are.

• Some of the bigger centres do quite well, small pool of consumers who are well enough to do work. Sometimes you end up with ongoing issues of their sickness, consumer group in town falls over, because all the workers become unwell and they tend to burn themselves out. They don’t get the support. Mixed feelings.

• Peer support issues.

• Quality of service issues.

• Disclosure issues.

• Stigma issues.

Interviews with recruitment agencies

Main methods used by recruitment agencies

• Internet – via their website.

• Road shows.

• Publications – suburban newspapers.

• Word of mouth.


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• The process of recruitment is a fundamental position within all disciplines within the health sector. The position for mental health however, is that it has to continuously encourage new workforce given the demand of health professionals both clinically and non-clinical within mental health. This recruitment process must also be taken into consideration at a strategic level when planning the sector through the current 3-5 year strategic planning process, which is currently being engaged by the Northern Region. What I mean by this is, when planning the sector’s design or redesign, then the HR implications around workforce both existing and new, needs to be clearly examined, also when determining new or improving current service delivery within the mental health sector.


• Political effect, not sure where the benefits are.

• Needs to move to a more community-based thinking, giving equal importance to family and support work. But the danger of deskilling DHB work.


• Needs to happen so that there is no cut-throat competition.


• It does happen, on an individual basis, but she is very careful about recruiting a service user, although they have some insight you have to be very clear where about on the cycle of recovery they are.

• Some of the bigger centres do quite well, small pool of consumers who are well enough to do work. Sometimes you end up with ongoing issues of their sickness, consumer group in town falls over, because all the workers become unwell and they tend to burn themselves out. They don’t get the support. Mixed feelings.

• Peer support issues.

• Quality of service issues.

• Disclosure issues.

• Stigma issues.

Interviews with recruitment agencies

Main methods used by recruitment agencies

• Internet – via their website.

• Road shows.

• Publications – suburban newspapers.

• Word of mouth.


Strengths

• There are specialist recruitment agencies for certain professions/occupations.

• Branding with the recruitment agency name, as they have found that when the brand isn’t mentioned they get a lower response rate.

• There is a to and fro process between agencies and DHBs wherein dialogue between the two is constant even if no vacancies have arisen but there is a suitable candidate.

• They work differently to DHBs, their main speciality business. They market the candidate depending on where the candidate wants to live in New Zealand. The candidates’ wants come first and thus they are processed quicker.

• Vacancies are ongoing in mental health sector. Don’t worry about the vacancies as there are just too many, send the candidate’s CV to all hospitals and see what comes with. Thus there is a constant effort being made by recruiters to try and get suitable placements. An ongoing untiring effort that needs to be made.

• Certain recruiters provide a support structure to the candidate.

• Preferred supplier agreements with DHBs so that when vacancies do arise within the DHB and they decide to use a recruitment agency, it is the agency that holds the preferred supplier agreement that gets first dibs on filling the vacant position.

Concerns

• Recruitment is not a core business of DHBs and they don’t know how to do it, so why don’t they just outsource recruitment to professionals.

• Working with the HR departments of the DHBs can be time consuming and a waste of time as many a time there are CV’s that just don’t go through the gate keepers within the HR department. Though in saying that there are some DHBs that have a brilliant HR department.

• Identified allocated funding for external recruitment fees. Improved response processes within mental health/HR facilities. For psychiatrists increased salary and benefits to match international ones. New Zealand has lagged significantly behind in this speciality and this is a significant detractor to experienced psychiatrists taking positions up in New Zealand.

• HR under-paid and over-stressed. They receive no training in interview processes; they are getting better at it though.

• Professional opportunities and professional development as well as international exposure at conferences and a transparent, honest process coupled with salary package that is equal with that offered in the international arena.

• The haphazard way in which DHBs deal with potential employees. For example, there was a job candidate that had applied directly to the DHB and hadn’t heard back from them. He/she eventually applied through a recruitment company and was offered the job, when the DHB realised that they had the candidate’s details within their database they refused to pay the recruitment agency. In this case does it help build productive relationships or increase negativity? The main moral of the story being short-term gains are considered more important than long-term productivity.

• DHBs harvest names but not an investment. Recruitment is seen as a cost and not an investment, which is what it should be.

• Agencies are an intermediary, it is up to the hospital or rather the organisation to attract the candidate and keep them there.


Strengths

• There are specialist recruitment agencies for certain professions/occupations.

• Branding with the recruitment agency name, as they have found that when the brand isn’t mentioned they get a lower response rate.

• There is a to and fro process between agencies and DHBs wherein dialogue between the two is constant even if no vacancies have arisen but there is a suitable candidate.

• They work differently to DHBs, their main speciality business. They market the candidate depending on where the candidate wants to live in New Zealand. The candidates’ wants come first and thus they are processed quicker.

• Vacancies are ongoing in mental health sector. Don’t worry about the vacancies as there are just too many, send the candidate’s CV to all hospitals and see what comes with. Thus there is a constant effort being made by recruiters to try and get suitable placements. An ongoing untiring effort that needs to be made.

• Certain recruiters provide a support structure to the candidate.

• Preferred supplier agreements with DHBs so that when vacancies do arise within the DHB and they decide to use a recruitment agency, it is the agency that holds the preferred supplier agreement that gets first dibs on filling the vacant position.

Concerns

• Recruitment is not a core business of DHBs and they don’t know how to do it, so why don’t they just outsource recruitment to professionals.

• Working with the HR departments of the DHBs can be time consuming and a waste of time as many a time there are CV’s that just don’t go through the gate keepers within the HR department. Though in saying that there are some DHBs that have a brilliant HR department.

• Identified allocated funding for external recruitment fees. Improved response processes within mental health/HR facilities. For psychiatrists increased salary and benefits to match international ones. New Zealand has lagged significantly behind in this speciality and this is a significant detractor to experienced psychiatrists taking positions up in New Zealand.

• HR under-paid and over-stressed. They receive no training in interview processes; they are getting better at it though.

• Professional opportunities and professional development as well as international exposure at conferences and a transparent, honest process coupled with salary package that is equal with that offered in the international arena.

• The haphazard way in which DHBs deal with potential employees. For example, there was a job candidate that had applied directly to the DHB and hadn’t heard back from them. He/she eventually applied through a recruitment company and was offered the job, when the DHB realised that they had the candidate’s details within their database they refused to pay the recruitment agency. In this case does it help build productive relationships or increase negativity? The main moral of the story being short-term gains are considered more important than long-term productivity.

• DHBs harvest names but not an investment. Recruitment is seen as a cost and not an investment, which is what it should be.

• Agencies are an intermediary, it is up to the hospital or rather the organisation to attract the candidate and keep them there.


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• Lack of experienced staff.

• Lack of information – give the candidate all client information before you let them get into the field. So for example if the client has a history of attempted suicide, let the job respondent know before hand so that they do not find out for themselves.

• Training is limited – go back to hospital -based training.

• Our main concern regarding recruitment of mental health professionals is the slow response from mental health units when new candidates are presented due to the pressure of running clinical units and the demands on managers. There is also a lack of allocated funding for recruitment fees which slows the whole process down and often results in the mental health unit losing potential candidates as they request to be referred to other organisations in other countries. Funding and identified systems for improved response times are the key issues that if addressed would have a significant impact on the success of sourcing and placing mental health professionals.

The most important factors in recruitment

• To keep New Zealanders here is to pay them more, good environment, making it safe for them. Training – career development.

• Bi-Culturalism and yet within these agencies there is no special recruitment undertaken for Maori mental health workers.

• The personal and occupational stress and how candidates would handle it.

• Registration with the respective organisations. General Medical Council for example.

• The value that DHBs place on their staff and how valued the staff feel as a trickle down effect.

• Safety.

• Mental health is culturally-based, and it is necessary to transfer professional proficiencies into our own cultural context and needs to be kept in mind when recruiting offshore.

Interviews with unions

Three unions were interviewed for the purpose of this project. They were the RDA, the ASMS and the PSA. The findings are described below.

Q.1. Who are the different staff within the mental health sector that are represented by these unions?

• The PSA has the largest mental health union membership, consisting of mental health nurses, allied health and clerical workers.

• Senior doctors – two types of consultants in psychiatry and Moss’s in provincial areas that need greater support.

• Psychiatric registrars.

Q.2. What are some of the issues and concerns that unions face when dealing with mental health employees?

• The issues that face unions are those that affect the mental health sector globally and also the staffing levels within New Zealand and specifically within the Auckland area.


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• Lack of experienced staff.

• Lack of information – give the candidate all client information before you let them get into the field. So for example if the client has a history of attempted suicide, let the job respondent know before hand so that they do not find out for themselves.

• Training is limited – go back to hospital-based training.

• Our main concern regarding recruitment of mental health professionals is the slow response from mental health units when new candidates are presented due to the pressure of running clinical units and the demands on managers. There is also a lack of allocated funding for recruitment fees which slows the whole process down and often results in the mental health unit losing potential candidates as they request to be referred to other organisations in other countries. Funding and identified systems for improved response times are the key issues that if addressed would have a significant impact on the success of sourcing and placing mental health professionals.

The most important factors in recruitment

• To keep New Zealanders here is to pay them more, good environment, making it safe for them. Training – career development.

• Bi-Culturalism and yet within these agencies there is no special recruitment undertaken for Maori mental health workers.

• The personal and occupational stress and how candidates would handle it.

• Registration with the respective organisations. General Medical Council for example.

• The value that DHBs place on their staff and how valued the staff feel as a trickle down effect.

• Safety.

• Mental health is culturally-based, and it is necessary to transfer professional proficiencies into our own cultural context and needs to be kept in mind when recruiting offshore.

Interviews with unions

Three unions were interviewed for the purpose of this project. They were the RDA, the ASMS and the PSA. The findings are described below.

Q.1. Who are the different staff within the mental health sector that are represented by these unions?

• The PSA has the largest mental health union membership, consisting of mental health nurses, allied health and clerical workers.

• Senior doctors – two types of consultants in psychiatry and Moss’s in provincial areas that need greater support.

• Psychiatric registrars.

Q.2. What are some of the issues and concerns that unions face when dealing with mental health employees?

• The issues that face unions are those that affect the mental health sector globally and also the staffing levels within New Zealand and specifically within the Auckland area.


• Too much emphasis on ‘community’, first the patient has to be treated and the staff need to have that ability to deal with crisis.

• Pay structures within the NGOs is a worry, so relationships need to be developed to aid in bargaining and contracting arrangements within this sector.

• Salaries not competitive enough and in the light of the work that is done, most members face being stressed or they burn out. For example a psych consultant does 72 hours a week, as well as supervising other Moss’s.

• The student loan hit, that will affect members within the unions soon enough.

• Overseas members find it hard to get acculturated with New Zealand, as the nature of work is different, cultural perspective different and the way of handling things differs too.

• Oversight to non-vocational staff is a problem where the psychiatrists feel that they will be held responsible.

• Psychiatrists would be lucky to treat a patient; at the moment they are just trying to keep the thing afloat so that no one kills themselves on their shift.

• With a larger woman membership and the work load, most people try to cut down their roster shifts and they refuse to take up a role of clinical leadership as there is no authority given by management.

Q.3. What is being done to resolve these issues?

• Union helps set basic conditions and the multi-employer contracts will help reduce pay disparity.

• Working with DHBs to try and improve work conditions.

• Part-time training initiative.

• Talking to the employers is like talking to a brick wall.

Q.4. What are the major achievements within the union when it comes to mental health staff?

• Concentrating on the individual, rather than treating every member as the same.

• Making sure that senior doctors get decent conditions and pay.

• Unions offer support in different ways, by allowing overseas candidates a form of dialogue, explaining to them the realistic expectation that needs to be present when entering the mental health sector within New Zealand.

• If unions didn’t exist then there would have been a lot more variation and it would have been a relic of the way things were funded.

Q.5. Do you think collective agreements aid in recruitment? Examples.

• The MECA will allow for pay equity, and allow for staff and organisations to compete not on money but quality.

• The MECA allows for collective strength in bargaining; from the union’s perspective.

• Helps with retention, as potential overseas job candidates know the kind of price brackets they will be entering into.


• Too much emphasis on ‘community’, first the patient has to be treated and the staff need to have that ability to deal with crisis.

• Pay structures within the NGOs is a worry, so relationships need to be developed to aid in bargaining and contracting arrangements within this sector.

• Salaries not competitive enough and in the light of the work that is done, most members face being stressed or they burn out. For example a psych consultant does 72 hours a week, as well as supervising other Moss’s.

• The student loan hit, that will affect members within the unions soon enough.

• Overseas members find it hard to get acculturated with New Zealand, as the nature of work is different, cultural perspective different and the way of handling things differs too.

• Oversight to non-vocational staff is a problem where the psychiatrists feel that they will be held responsible.

• Psychiatrists would be lucky to treat a patient; at the moment they are just trying to keep the thing afloat so that no one kills themselves on their shift.

• With a larger woman membership and the work load, most people try to cut down their roster shifts and they refuse to take up a role of clinical leadership as there is no authority given by management.

Q.3. What is being done to resolve these issues?

• Union helps set basic conditions and the multi-employer contracts will help reduce pay disparity.

• Working with DHBs to try and improve work conditions.

• Part-time training initiative.

• Talking to the employers is like talking to a brick wall.

Q.4. What are the major achievements within the union when it comes to mental health staff?

• Concentrating on the individual, rather than treating every member as the same.

• Making sure that senior doctors get decent conditions and pay.

• Unions offer support in different ways, by allowing overseas candidates a form of dialogue, explaining to them the realistic expectation that needs to be present when entering the mental health sector within New Zealand.

• If unions didn’t exist then there would have been a lot more variation and it would have been a relic of the way things were funded.

Q.5. Do you think collective agreements aid in recruitment? Examples.

• The MECA will allow for pay equity, and allow for staff and organisations to compete not on money but quality.

• The MECA allows for collective strength in bargaining; from the union’s perspective.

• Helps with retention, as potential overseas job candidates know the kind of price brackets they will be entering into.


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Q.6. Could a union assist in promoting mental health as a career choice?

• If great links are maintained with people in training then yes a union could affect career choice.

• They could affect it, if they were convinced that it was a safe and happy career choice.

• Mental health has been sort of population funded.

Q.7. What are your opinions about national strategies?

• Unions can cooperate and do it under the umbrella of the CTU, so national cooperation strategies should also work for them.

• National bodies tend to do nothing. They are more a political organisation that takes responsibility away from the employers.

Q.8. What are some other issues that you would like to mention within this interview?

• Negotiations with employers are difficult, with the gripe of employers being that they never have any money. DHBs are focused on their budget not on the issues. They don’t have a bright idea amongst them. They just want to get from day to day.

• HR departments don’t know what they are doing, there are a handful of competent employment relations people and most other staff seem to be great on the theory but no practical experience.

• With DHBs some of them don’t listen to HR, they need to realise that they function within a service industry and HR should be a key management strategy as with the sidelining of HR comes burgeoning costs.


117

Q.6. Could a union assist in promoting mental health as a career choice?

• If great links are maintained with people in training then yes a union could affect career choice.

• They could affect it, if they were convinced that it was a safe and happy career choice.

• Mental health has been sort of population funded.

Q.7. What are your opinions about national strategies?

• Unions can cooperate and do it under the umbrella of the CTU, so national cooperation strategies should also work for them.

• National bodies tend to do nothing. They are more a political organisation that takes responsibility away from the employers.

Q.8. What are some other issues that you would like to mention within this interview?

• Negotiations with employers are difficult, with the gripe of employers being that they never have any money. DHBs are focused on their budget not on the issues. They don’t have a bright idea amongst them. They just want to get from day to day.

• HR departments don’t know what they are doing, there are a handful of competent employment relations people and most other staff seem to be great on the theory but no practical experience.

• With DHBs some of them don’t listen to HR, they need to realise that they function within a service industry and HR should be a key management strategy as with the sidelining of HR comes burgeoning costs.

Appendix 4: National Mental Health Workforce Committee System 2004 119

Appendix 4: National Mental Health Workforce Committee System

FUNCTION:

District Health Boards Jan White (CEO Waikato)

Glenys Baldick (CEO Nelson/Marlborough) Memo Musa (CEO Wanganui)

Mental Health Directorate Dr. Janice Wilson (Chair)

Phillipa Gaines Arawhetu Peretini

MOH-DHB Steering Committee

• Strategic Planning • Decisions

• Final Sign Off

Mental Health Workforce

DevelopmentCommittee

Secretariat 3.5 FTEs

Robyn Shearer (Programme Manager)

Jacob Read (Analyst)

Alana Ruakere-Mack (Contract Relationship Manager)

Olympia D’souza (Support Co-ordinator)

Stakeholders Included DHBs, NGOs, Consumers, Families, Maori, Pacific Island, Child and Youth,

Alcohol and Other Drugs, Primary Health, Older People

FUNCTION:

• Implementation • Coordination

Appendix 4: National Mental Health Workforce Committee System 119

Appendix 4: National Mental Health Workforce Committee System

FUNCTION:

District Health Boards Jan White (CEO Waikato)

Glenys Baldick (CEO Nelson/Marlborough) Memo Musa (CEO Wanganui)

Mental Health Directorate Dr. Janice Wilson (Chair)

Phillipa Gaines Arawhetu Peretini

MOH-DHB Steering Committee

• Strategic Planning • Decisions

• Final Sign Off

Mental Health Workforce

DevelopmentCommittee

Secretariat 3.5 FTEs

Robyn Shearer (Programme Manager)

Jacob Read (Analyst)

Alana Ruakere-Mack (Contract Relationship Manager)

Olympia D’souza (Support Co-ordinator)

Stakeholders Included DHBs, NGOs, Consumers, Families, Maori, Pacific Island, Child and Youth,

Alcohol and Other Drugs, Primary Health, Older People

FUNCTION:

• Implementation • Coordination

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