With the signing of the Midland Service Level Agreement for MHAS's (SLAT), between the Midland DHB and the Midland Health Network, came an agreement to a 'stepped model of care' which essentially established a 'whole of sector approach' to the provision of services to those experiencing psychological distress and/or psychiatric disorder.
Following an initial pilot of a DHB liaison team, in partnership with Pathways Support Workers, to enable 160 people to transition their mental health care to primary care, it was recognised that although this was successful, it was unsustainable as a solution.
The ultimate end goal is that dedicated mental health liaison is primary care business as usual, but this a bridge too far for both primary and secondary services at the present time.
As an interim step, an Integrated Care Coordination team has been established. This team is responsible for building capability across the secondary/primary pathway, through education, liaison and support. As confidence increases, it is anticipated that as the community mental health teams identify primary care transition much earlier in a person’s journey, and relationships improve, consideration can be given to the most appropriate deployment of these resources. One option will be to move the resources to primary care to support the ongoing management of the population previously captured within secondary services.
“What we learnt from the pilot was that shared care is about building relationships and excellent communication," said Vicki Aitken, Director Mental Health and Addictions Servcies at Waikato DHB.
“To support this process we have also developed a transition shared care plan, which can be used in conjunction with the service user, to agree and coordinate shared care arrangements between secondary mental health and addiction services and primary care”.
For service users transitioning their mental health care to primary care as well as those who continue to have their mental health needs met in secondary mental health and addiction services, packages of care, funded by the DHB for extended appointments with GPs and practice nurses are being offered. It is anticipated that, should this be successful, it will managed directly via the Primary Health Organisations, which removes the financial barriers to accessing primary care for a number of population groups who have high healthcare needs.
This change is all about integrated care, whether the person requires primary care services with little input from specialist services or the specialist service is the predominant provider. It also involves integrated care with NGO services as well.
This approach provides options to strengthen support for people with enduring need as a result of mental illness and or addictions and is delivered through two streams:
- Support for additional primary care services (physical health and mental health) whilst a person with stable mental health needs is transitioning back to full care within the primary care setting
- Improving access to primary care to ensure physical health care needs are met for long term mental health clients (2 years or more) remaining under specialist mental health services who are not currently engaged in primary care.