Future directions for primary mental health care Rotorua July 2010
“ Single system, personalised care” “ Patient-centred integration”
Stepped care model STEP 5 Com-plex STEP 4 4.7% severe disorders  STEP 3 9.4% moderate disorders STEP 2 6.6% mild disorders...
Four key objectives <ul><li>Provide personalised, patient-centred care </li></ul><ul><li>Achieve seamless, integrated care...
1. Provide personalised, patient-centred care
Core functions for providing personalised care <ul><li>Prioritisation on the basis of need for mental health and AOD servi...
2. Achieve seamless, integrated care
Guidance for achieving integrated care <ul><li>Why integrate?  - To improve the patient experience, wellbeing and health a...
10 strategies to achieve patient-centred integration <ul><li>Designated liaison role  </li></ul><ul><li>Consultation-liais...
6. Build workforce capacity and capability
Immediate workforce development priorities <ul><li>More GPs, nurses and other PC practitioners  </li></ul><ul><li>More Māo...
Immediate workforce development priorities <ul><li>Increase PHC’s responsiveness to children and youth </li></ul><ul><li>I...
12. Improve performance & quality
Mechanisms for improving performance & quality <ul><li>An equitable funding mechanism that is based on need and supports s...
Recommended key performance indicators (MOH & RNZCGP) <ul><li>% of patients identified with common mental health disorders...
Recommended screening/outcome measures for PC settings Individual, interpersonal, social & overall wellbeing Children & ad...
Contact Details <ul><li>Dr Sarah Dwyer  </li></ul><ul><li>Mental Health, Alcohol and Drug Policy Group  </li></ul><ul><li>...
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Future directions for primary mental health care, Sarah Dwyer

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  • The best practitioners simply work harder at improving performance = deliberate practice ≠ hours spent on the job Know your baseline performance Ask for feedback Client Directed, Outcome Informed (CDOI)
  • Two key elements: Good initial assessment Good monitoring –tell story about the secret to success The stepped care approach encompasses both levels of intervention – population level and personal level.
  • Match interventions to service users needs
  • Future directions for primary mental health care, Sarah Dwyer

    1. 1. Future directions for primary mental health care Rotorua July 2010
    2. 2. “ Single system, personalised care” “ Patient-centred integration”
    3. 3. Stepped care model STEP 5 Com-plex STEP 4 4.7% severe disorders STEP 3 9.4% moderate disorders STEP 2 6.6% mild disorders STEP 1 Adjustment problems; distress; subthreshold symptoms 79.3% of population no disorder Early identification of vulnerability Integrated family health centres Primary health care services Specialist mental health and AOD services PHQ=10-14 Brief Xmt Extended GP consultations; monitoring; green prescriptions; e-therapy; self-help books; education groups Pathway to secondary care First point of contact Supportive environment & health promotion eg, NDI, Like Minds, self-care, whānau ora, housing, employment, education, social network PHQ<10 Ultra-brief Xmt Advice, support, psycho-education PHQ=15-19 Low intensity Xmt Holistic assessment to determine patient needs; POC; guided self-help; SSRI PHQ ≥ 20 High intensity Xmt A range of talking & drug therapies Longer term Xmt ( for complex and/or chronic disorders)
    4. 4. Four key objectives <ul><li>Provide personalised, patient-centred care </li></ul><ul><li>Achieve seamless, integrated care </li></ul><ul><li>Build workforce capacity and capability </li></ul><ul><li>Improve performance and quality of services </li></ul>
    5. 5. 1. Provide personalised, patient-centred care
    6. 6. Core functions for providing personalised care <ul><li>Prioritisation on the basis of need for mental health and AOD services more intensive than what primary care offers </li></ul><ul><li>A targeted approach to meeting the needs of vulnerable population groups </li></ul><ul><li>Active support for self-care or guided self-help </li></ul><ul><li>Connecting patients with appropriate services </li></ul><ul><li>Interventions which address patients’ needs </li></ul><ul><li>Care coordination </li></ul><ul><li>Active monitoring of service users </li></ul><ul><li>Review mechanism to determine patients’ progress </li></ul><ul><li>Feedback from service users </li></ul>
    7. 7. 2. Achieve seamless, integrated care
    8. 8. Guidance for achieving integrated care <ul><li>Why integrate? - To improve the patient experience, wellbeing and health and social outcomes. </li></ul><ul><li>What activities should be integrated? - Direct delivery of care </li></ul><ul><li>How much co-location, collaboration, integration? </li></ul><ul><li>Who should be involved? – General practice should serve as patients’ medical home. Both horizontal and vertical integration important. </li></ul>
    9. 9. 10 strategies to achieve patient-centred integration <ul><li>Designated liaison role </li></ul><ul><li>Consultation-liaison </li></ul><ul><li>Shared care </li></ul><ul><li>Co-location of services </li></ul><ul><li>A new mental health and/or AOD clinician in the primary care team </li></ul><ul><li>Clinical networks </li></ul><ul><li>Contracting for collaborative care </li></ul><ul><li>Pooled budgets </li></ul><ul><li>Clear service user pathways </li></ul><ul><li>An effective IT platform which enables sharing of electronic records & access to electronic decision support </li></ul>
    10. 10. 6. Build workforce capacity and capability
    11. 11. Immediate workforce development priorities <ul><li>More GPs, nurses and other PC practitioners </li></ul><ul><li>More Māori, Pacific and Asian practitioners </li></ul><ul><li>More community support workers </li></ul><ul><li>Funders and providers of training to develop and implement training programmes to increase essential knowledge, skills and attitudes required to work with people with mental health and AOD problems at primary care end of continuum. </li></ul><ul><li>Develop and implement training on: </li></ul><ul><ul><li>Psychoeducation </li></ul></ul><ul><ul><li>Increasing physical activity </li></ul></ul><ul><ul><li>Behavioural activation </li></ul></ul><ul><ul><li>Problem solving and/or solution focused counselling </li></ul></ul><ul><ul><li>Simple anxiety management </li></ul></ul><ul><ul><li>Simple motivational strategies </li></ul></ul><ul><ul><li>Parent management training </li></ul></ul><ul><ul><li>Skills training in anger management, social skills, communication and stress management </li></ul></ul>
    12. 12. Immediate workforce development priorities <ul><li>Increase PHC’s responsiveness to children and youth </li></ul><ul><li>Increase PHC’s responsiveness to AOD problems </li></ul><ul><li>Ensure access to regular cultural and clinical supervision </li></ul><ul><li>Further develop practice teams which include a mental health/AOD clinician as part of the team </li></ul><ul><li>Further develop the role of peer support workers and consumer advisors for services at the primary care end of the continuum </li></ul><ul><li>Increase the level of consultation-liaison support between primary and specialist care </li></ul>
    13. 13. 12. Improve performance & quality
    14. 14. Mechanisms for improving performance & quality <ul><li>An equitable funding mechanism that is based on need and supports single system, personalised care </li></ul><ul><li>Clinical governance and leadership </li></ul><ul><li>Accountability and monitoring mechanisms </li></ul><ul><li>Ongoing collection of outcome data </li></ul><ul><li>Easy access to best practice guidelines and other high quality, up-to-date information and resource materials relevant to primary mental health care </li></ul>
    15. 15. Recommended key performance indicators (MOH & RNZCGP) <ul><li>% of patients identified with common mental health disorders (CMHDs) </li></ul><ul><li>% of patients identified with CMHDs who are followed up within 2 weeks of identification </li></ul><ul><li>% of patients identified with CMHDs who are screened for alcohol problems (eg, using the AUDIT-C, 3 items). </li></ul><ul><li>(Note: If too difficult to track CMHDs, substitute with depression) </li></ul><ul><li>Prescription of SSRIs for the management of depression </li></ul><ul><li>Referral to other primary care providers for the management of CMHDs. </li></ul>
    16. 16. Recommended screening/outcome measures for PC settings Individual, interpersonal, social & overall wellbeing Children & adults CDOI DSM-IV disorders Adults Mind Screen Depression Youth RADS Depression Youth & parents SMFQ Behavioural & emotional probs Children, youth & parents SDQ AOD misuse Youth SACS Alcohol Adults AUDIT & AUDIT-C Lifestyle issues Adults CHAT Anxiety Adults GAD-7 Depression & anxiety Adults K10 Depression & anxiety Adults PHQ-4 Depression Adults PHQ-9 Common physical & psychological probs Adults GHQ-12 Problems Population Measure
    17. 17. Contact Details <ul><li>Dr Sarah Dwyer </li></ul><ul><li>Mental Health, Alcohol and Drug Policy Group </li></ul><ul><li>Population Health Directorate </li></ul><ul><li>Ministry of Health </li></ul><ul><li>Ph: 04 496 2326 </li></ul><ul><li>E-mail: sarah_dwyer@moh.govt.nz </li></ul>

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