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Royal Commission into Victoria’s Mental Health System

Case study:

Piri Pono: a case study

Piri Pono: a case study

‘Piri Pono’ is a Maori term meaning to be loyal, faithful and devoted.

Piri Pono offers a peer-led, community-based residential service in the outskirts of Auckland, New Zealand. It is run by Ember (a non-government organisation) and its services are delivered in collaboration with Waitemata District Health Board. It is set up as a home, providing a comfortable environment and an alternative to an acute mental health inpatient admission. The residents are called guests, not patients or clients.

Operating as a five-bed, 10-day-stay service since 2013, all the support staff have lived experience of mental illness. For six days of the week, the registered nurses at the service also have lived experience. General Manager of Operations at Ember, Mr Lee Reygate said:

Every shift we have two peer support workers on. Most of our staff were actually guests at Piri Pono. Our two main nurses both spent time here as guests and both said, ‘We want to work here’. Half of our staff have previously been guests and have come back and asked for a job.

All our support staff have lived experience. They use their stories to help others.

Guests have the chance to be part of a household that provides a safe and supportive environment, creating opportunities to learn from one another and from the peer support staff. Guests are active in their own recovery—they make plans, set goals, take part in structured daily programs and are involved in developing the documentation about their stay. They have a planned exit and receive follow-up from outreach peer support services and help with connecting to follow-up agencies.

Through close working relationships with Waitemata District Health Board, guests also have access to clinical mental health services. Waitemata District Health Board clinical teams coordinate the admissions process into Piri Pono, providing a single-entry point into the service and ensuring future guests are suited and well placed to focus on recovery as part of their stay at the service. Nurses are part of the care team, and regular visits are made by consultant psychiatrists. Clinical responsibility for consumers remains with the Waitemata District Health Board.

Mr Reygate said it was important to build trust and understanding in the early days because there was some resistance to a peer-led model, with some psychiatrists concerned the risk to clinical treatment was too high:

We don’t accept that argument. We have great systems and great communication. It’s important to get the balance right. We have a psychiatrist who has been with the service for a long time; she knows us well, there’s a strong trust there.

People often have a cautious approach to new ideas. Some clinicians are very sceptical, and from a research perspective this is understandable.

As we aren’t in a position to bring them over with research, the best method of bringing them on side is to do well and get the clinicians to win over their colleagues.

According to Mr Reygate, the power of Piri Pono lies in having those peer-to-peer conversations. Guests and staff echo this sentiment:

Having someone to talk to, cry with, laugh with, but always feeling safe and cared for. Most of all, never judged. (Piri Pono guest)

It feels like we are doing something new and that we’re stretching ourselves and the way that people view mental health and, yeah, it just feels right, it feels the right way forward for so many people. (Piri Pono staff member)

For the first time I wasn’t the only one with an illness in the room, for the first time I was understood, listened to and respected, for the first time I realised that I can possibly have a worthwhile life … (Piri Pono guest)

Mr Reygate said an early evaluation noted the success of the service but made a number of suggestions for organisations looking to establish acute alternatives: the need to be clear about the responsibilities of staff, crisis teams and police; having robust recruitment and staff-support processes; and ensuring that individuals making referrals understand the peer support model and expectations.

Source: Interim Report, November 2019