The new model of primary mental health care has been trialled for the past five months and is already showing its success, supporters say.
Developed by ProCare over five years, the model includes a new clinical role – health improvement practitioner – that is based on the American role of behavioural health consultant.
The model aims to give patients access to focused support within their general practice – including from the new health improvement practitioners plus health coaches, community support workers, traditional referral-based talking therapies as well as shared care with district health board specialist teams.
ProCare general manager of patient services Johnny O’Connell said the goal was to develop a model that was “really easy” for those who needed help to access.
“When you have a mental health issue, it has a huge impact on your life. You need help now. Before you’d go on to a list and wait three months before you saw anyone and it was at a different service. This makes it as easy as possible at a convenient time in a place that you trust – your GP.”
Health improvement practitioners – who are all registered health professionals with a current practicing certificate and experience working within mental health – are given training in the new role by ProCare.
They then join general practices and work directly with patients and their families, alongside doctors, he said.
The model also includes health coaches, who support patients to find the resources, tools and supports to meet their goals.
While some health coaches are health professionals, people with training and experience in community health or people with lived experience of mental health issues, are also coaches.
Pilot could be rolled out nationwide
O’Connell said the common framework could be rolled out across the country and adapted to suit the community.
“There’s been a real poverty of options for people with mental health concerns. No one wants to be part of a stigmatising system. This model is available without the stigma and makes mental health care a regular part of everyday health care.”
American psychologist Patti Robinson, of Oregon-based Mountainview Consulting Group, has been helping with the development of the programme.
Robinson, who has been described as a pioneer in behavioral health integration and the use of Focused Acceptance and Commitment Therapy (FACT) in primary care – said the model had been working “very well” in all the clinics using it so far.
“People are being seen on the same day and they are getting the help they need when they need it.”
She said often patients would not get the care they needed if they were referred elsewhere.
“The model means there’s no stigma. People trust their doctors. Now the help is there when it is needed.”
Health improvement practitioner Marcia Sasano said the new model was much more patient-friendly.
“It’s an incredible way of connecting with the patient. It’s what we call a ‘warm handover’. The doctor is right there with the patient, and the patient knows the doctor is behind them. There’s confidence.”
She said patients were being seen on the same day they arrived at their general practice.
“Patients are so surprised to see someone almost straight away. They’re so grateful for that immediate help. This change in paradigm and the more integrated mental health becomes in primary care will mean it’s normalised and therefore more people will have access to the help they desperately need.”
Pilot requires ‘new way of thinking’
O’Connell said the pilot programme was being trialled by five practices across three district health boards.
“While it’s early days, the promise is huge. It’s a brand new way of working.”
He said the model has been used in other parts of the world for the past 20 years.
“It’s a proven model. It works. What we’re doing is adapting it to suit the New Zealand context and making sure it’s culturally appropriate.”
The challenge was changing practitioner’s ways of thinking.
“The health improvement practitioner is a different role so there’s been a bit of adapting to that. It does take a leap of faith into this new way of working.”
Robinson said the New Zealand health system was ready for a new way of working.
“The challenge has been making the doctors believe this could happen. It’s been so long that they’ve been working a particular way and that the same issues have been raised, they didn’t have faith.”
However, after trialling the new model, she said doctors were full of praise for it.
“It is much better care and it would be lovely to have it rolled out across the country. A lot of people need help. It give a little bit of help to a lot of people.”
Sasano agreed that the biggest challenge was the adjustment in thinking.
“It’s so different in how we were even taught. It took me awhile to really understand what my role was. It is so definitely worth it though.”
She said it would be a “step back” to return to the old ways.
“This model of care is really the way forward. Integrating mental health support in primary care with brief intervention, and working together as a multi-disciplinary team, is crucial to help us meet the great need in our communities.”
A full review of the pilot programme will be completed in the coming months.
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