Thursday 16 August 2012
Benefits of Primary Mental Health Intervention Service in the Lakes Area (PRIMHIS) Outlined in PRIMHIS Publication
Lakes District Health Board has joined forces with Te Ao Maramatanga, College of Mental Health Nurses, to profile the work of its PRIMHIS (Primary Mental Health Intervention Service). The booklet, Primary Mental Health Intervention Service in the Lakes DHB Area (PRIMHIS) Better, sooner, more convenient: integration and collaboration in action is available on the Lakes DHB and the College of Mental Health Nurses websites.
PRIMHIS commenced as a pilot project late in 2010, as a nurse-led model developed to support addressing the needs of the 17 percent (MOH, 2002) of the Lakes population experiencing some form of diagnosable mental health disorder that required intervention/treatment.
While it has been recognised internationally that the mental health needs of most people with mild to moderate mental health concerns are best met in the primary sector, in New Zealand the majority of the mental health professionals capability actually exists in the traditional secondary care services. And this resource sitting in secondary care services typically focuses on the three per cent of the population with the most serious mental health problems.
Michael O’Connell, Clinical Nurse Director for Mental Health and Addiction Services at Lakes DHB says the challenge was to find a model that would begin to span the sector ‘division’ and make better use of resources.
Prior to setting up PRIMHIS, an Integrated Sector Model of Care was developed for mental health and addiction services across the Lakes district, spanning community, primary and secondary level mental health services. Michael O’Connell says Lakes DHB was also aware that general practitioners across Rotorua and Taupo had limited access to established primary mental health service.
PRIMHIS allows services to be delivered flexibly to the consumer, based on the shared deliberations of the GP and mental health nurse therapist), supporting the delivery of holistic care, and utilising the broad scope of mental health nurses. In the background also, in a strong supportive/consulting relationship, is the specialist psychiatrist available to both the nurse and general practitioner via telephone and one to one consultation/clinical reviews.
One of the early objectives of PRIMHIS was to increase the accessibility of enrolled populations to better, sooner and more convenient primary health care. Building and strengthening the capability of the primary health care sector to respond to the needs of people with mental health and addiction needs was another desired outcome.
Uptake of the PRIMHIS service was helped by some general practices having had the services of a GP Liaison Nurse and being able to observe the benefit to the practice’s client group. By mid-2011 PRIMHIS was operating clinics in 10 of the 13 general practices in Rotorua.
Currently all PHO-aligned practices have PRIMHIS clinics operating. In Taupo the three general practices now also have direct access to a PRIMHIS clinic. The total staffing for the now established service is 2.7 full time equivalent staff.
Under the PRIMHIS model there is one treatment plan with clinical notation (assessment, interventions plan of care etc) provided in the existing primary care provider clinical notes. An electronic referral process to PRIMHIS staff ensures all referrals are immediately accessible by the team and then appointments scheduling is actioned by the general practice.
Mental Health Primary Liaison Nurse Jenny Collier is one of the PRIMHIS team profiled in the publication about the service. Jenny says the barriers between primary care and secondary Mental Health Services in part existed due to the different funding streams for mental health services, resulting in limited flexibility between and in connecting services. Jenny’s profile traces the development of PRIMHIS and the increasing ‘buy in’ to the service. Jenny says that GPs are no longer required ‘to make patients fit into mental illness category boxes so that they can be seen”. Along with the improved access to treatment options for patients, Jenny notes that PRIMHIS has been a great opportunity for advancing specialist practice options for her and mental health nurse colleagues.
Ngongotaha Medical Centre and Te Ngae Medical Centre are both profiled in the PRIMHIS publication. Dr Clem Le Lievre of Ngongotaha Medical Centre says timeliness is the biggest benefit of PRIMHIS.
“GPs can make an actual appointment when the patient first presents and know that it will be in time to help with the current crisis. The patient’s knowledge of when the care is starting is a very important component,” he says.
Drs Andrew McMenamin and Sally Hoskins of Te Ngae Medical Centre say the PRIMHIS nurse-led service “removes the stigma of being seen in a traditional mental health service waiting room and helps minimise the self-stigma that many patients experience”.