A ‘radical’ shift in focus for mental health services toward primary and integrated care is proposed in the recently released Mental Health Workforce Service Review.
Recommendations include increasing role of Plunket nurses and practice nurses in screening for post-natal depression; increasing skills of school nurses in detecting mental health and addiction problems and moving experienced mental health nurses and nurse practitioners into primary care settings.
The review aims to preserve specialist services for people with severe and complex mental health and addiction needs (about 3% of the population) but to widen services to meet the often unmet needs of the 7-9 per cent of the population estimated to have high mental health and addiction problems.
The review for Health Workforce New Zealand was completed in mid-2011 but its public release was initially delayed because it’s increased focus on early intervention and involvement of the wider health and social services sector, was seen to raise “wider issues” about service delivery.
It was recently released by HWNZ which said it was working through the “implications” of the review’s recommendations” and that the review report sat alongside “a number of other initiatives” across the Ministry of Health and the mental health and addictions sector. One of these got underway last year with HWNZ and the College of Mental Health Nurses, starting an innovation project to upskill and credential primary health nurses with mental health skills.
Review group chair Professor Rob Kydd said the challenge set by HWNZ for all review groups was to look at meeting a doubling in demand by 2020 with only a 30-40 per cent increase in funding from 2010 levels.
To meet this vision the review says there would need to be a “lift in productivity” through more efficient and effective service delivery models and by integrated approaches with general and primary health providers plus increased collaboration from the education, social services, justice and correction sectors.
“While the sum total of what we are recommending may appear radical or ambitious, there is nothing radical in the component parts of the system being proposed,” the report says, but the focus and scale was different from the status quo.
It also says the suggested changes will require some in the current mental health workforce to assume “different roles” and “different skill sets”.
In particular “specialising up” primary care clinicians and “generalizing down” specialist mental health clinicians, particularly specialist mental health and addiction nurses.
Recommendations include prioritising more training of mental health nurses in assessment processes and effective interventions like cognitive behaviour therapy (CBT) dialectical behaviour therapy (DBT) and addiction therapies.
Also it recommends upskilling primary health clinicians, like nurses, in recognising and responding to mental health issues plus increasing the use of talking therapy interventions in primary care and says this could be achieved by ‘refocusing’ the role of specialist mental health nurses.
Another recommendation is to pilot practice nurses carrying out routine screening for postnatal depression at immunisation visits plus working with Plunket nurses and other well child providers to screen for postnatal depression.
Plus designing models of care that use specialists like experienced mental health nurses and nurse practitioners to “reach down” and support primary care clinicians working with consumers in the community.
The full review document can be found at www.heathworkforce.govt.nz under workforce service reviews.
