Integrated primary mental health and addiction

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Enhancing the general practice team

Primary health organisations (PHOs) and general practice teams are often the first point of contact for many people experiencing mental health and/or addiction issues.

A new model of integrated primary mental health and addiction services (IPMHA) is being implemented across New Zealand by the Ministry of Health. This model of care is part of a suite of services being developed to expand access to, and choice of, Primary Mental Health and Addiction support.

The aim of these new services is to:

Increase access and equity of access
Increase choice in addressing people’s holistic concerns
Reduce wait times for mental health and addictions support
Improve population health and equity outcomes

This service is for anyone who is enrolled in the practice whose thoughts, feelings or actions are impacting on their health and wellbeing. There are no barriers to accessing this support, no referral criteria, no wait time, no cost to the patient and services are designed to ‘flex’ to meet the identified population health needs.

There are ‘key components’ of the service which will look similar across New Zealand. All services will be accessed via the general practice with priority given to Māori and Pacific peoples, youth and those people living in rural and remote locations. Some services may choose to use a locally relevant name for their service; however, in all cases new staff will join the practice team and become integrated within the practice. The key components of the service include:

Health Improvement Practitioner (HIP) - an experienced and registered health clinician who will provide assessment and brief intervention therapy as needed
Health Coach (HC) – a trained support, peer or cultural worker who will support the individual to manage their health through a range of personalised interventions
Support Worker (SW) who will provide access to cultural and social supports within the local community
A confident and competent general practice team
Effective links and coordination between primary and secondary services

The IPMHA model includes an evidenced based approach to providing behavioural health support within general practice. The IPMHA model has been adapted, piloted and provided in various regions in New Zealand since 2017. The HIP and HC work as a part of the practice team to provide brief intervention focused on strengthening self-management strategies. Their notes are written directly into the practice-based PMS and ‘warm handovers’ ensure that the practice team members can make an introduction when the need arises and are kept updated with patient information. Additionally, the HIP also supports the practice team through psycho-education, consultation and identifying patient pathways to increase access to behavioural support.

Watch the video below from the Ministry of Health, which goes through integrated primary mental health and addiction services in general practice in New Zealand.

Te Tumu Waiora is just one of the iterations of the programme that is being rolled out across New Zealand. Further information on Te Tumu Waiora is available here.

To support the further development of these services Te Pou has a role to provide the workforce development for the new roles. This includes:

Health improvement practitioner training
Health coach training
Identifying the knowledge and skills required to work in an integrated approach across a range of roles based in NGO, DHB and PHO providers
Supporting the nurse credentialing programme for primary care nurses delivered through Te Ao Maramatanga New Zealand College of Mental Health Nurses.

In addition to this, MH101 and Addiction 101 workshops may be helpful for front-of-house staff in general practice. These one-day courses are available from Blueprint for Learning.

By increasing knowledge of all staff working in general practice and having closer working relationships with specialist mental health and addiction services, those accessing primary care services will have greater choice as to who they see with a wider range of services available.