Nurses in primary health have an important role to play in supporting people who are experiencing mental health and addiction problems. Many primary health organisations are looking at innovative ways to support nurses to develop their skills and knowledge in this area.

Since 2013 Manaia Health Primary Health Organisation (PHO) has supported their nurses to complete a training programme, based on the mental health and addiction credentialing framework offered by Te Ao Māramatanga NZ College of Mental Health Nurses.

Nurses who take part in the programme become credentialed nurses, which means they’ve been recognised as being able to apply mental health and addiction assessment, referral and treatments in a primary care setting.

By the end of this year, 40 of Northland PHOs’ primary health nurses will have completed the programme.

Ron and Lois Mortensen found the improved service they received from senior credentialed nurse Robynann Dyson at Bush Road Medical Centre has made a huge difference. Lois had experienced physical and mental health problems over many years, and this had put Ron under a lot of strain too.

“I was sinking into the mire and didn’t know who to approach and Robynann gave me service at a level I have not received elsewhere,” says Ron.

Robynann Dyson, senior credentialed nurse

Robynann Dyson, senior credentialed nurse.

Robynann provided Ron and Lois with information about where to get support and encouragement to ask for support. Ron feels Robynann’s helpful information and positive attitude helped them to access the support they needed.

Manaia Health PHO chose to use Te Ao Māramatanga’s credentialing framework because they saw it as a way to improve the level of mental health and addiction expertise of their nurses.

After three years of offering the training, the PHO now has a group of frontline primary health nurses with the skills and confidence to better support people experiencing mental health problems. This support includes providing people with brief treatments and ongoing support after more intensive approaches, and offering extended consultations. It also means people are able to access the right level of support rather than always seeing the GP, helping the centre to run more smoothly.

Northland District Health Board (DHB) practitioners deliver the training, enhancing the links between the DHB and primary health providers. Primary nurses are now working with the community mental health and addiction services, which is helping them connect people to other health services when needed.

Creating a successful model

Mary Carthew, Manaia Health PHO associate director of nursing in primary health, led the development of the training programme. A steering group of people from Manaia PHO, Te Tai Tokerau PHO and Northland DHB provided guidance to the project

“The Northland DHB team was immediately very supportive and that buy-in was critical,” says Mary.

Robynann Dyson, senior credentialed nurse

Mary Carthew, Manaia Health PHO associate director of nursing in primary health care.

Over the next six months the group developed training to meet the College’s credentialing requirements. The steering group supported the idea of the nurses developing portfolios, writing examples of how the training had changed or enhanced their everyday practice, to document the evidence of their learning.

The PHO provided relief funding to the general practices so the practice nurses could attend training one day per month over six months.

Robynann’s training journey

Robynann was part of the first group to complete the training. When Robynann started nursing, she avoided mental health nursing, but says the credentialing has totally changed her focus.

“I was apprehensive as I didn't understand what I could do to help people with mental health concerns. The knowledge I have now has removed this fear and I feel it is a privilege to work and walk alongside people with mental health and addiction issues.”

She initially felt nervous about writing portfolios, but soon found they offered a great way to learn.

“Portfolios made a big difference. We had to think about what we were doing and why we were doing it, so there was a huge amount of reflection and I now reflect regularly.”

Robynann now offers mental health screenings and extended consults. Other staff refer people to her including people who have recently been in the mental health unit at the hospital, or people experiencing anxiety or depression. She feels because practice nurses already have contact with people regarding their physical health, this makes it easier to establish trust around finding support for mental health needs.

Training now a part of workforce development plan

The training programme is now a part of the two Northland PHOs’ long term workforce development plan.

Nurses have been really positive about the training, and many GPs and practice managers are now encouraging nurses to enroll. Interest is also growing from Māori/iwi and other NGOs and ongoing training is being offered through Manaia PHO and Te Tai Tokerau PHOs to all Northland primary health nurses.

Maurein Betts, primary mental health and addictions programme leader for Northland PHOs, is now leading the programme. She says the next step is to look at ensuring appropriate supervision for the credentialed nurses that work with a higher number of people experiencing mental health and addiction problems and their whānau. She also wants to strengthen the understanding and relationships of nurses working with other service providers in the community, such as iwi and NGOs.

“We need to challenge the concept of ‘who is in your team?’. It’s not just the colleagues that work in your buildings but the many providers who work together to provide the best response to people in our community.”

Other PHOs are taking their lead from Manaia PHO’s success. Three Auckland-based DHBs and six PHOs have been working together to run and evaluate their own similar training programme, which kicked off in June.

Valerie Williams, Te Ao Māramatanga NZCMHN College credentialing manager, says there are now ten PHOs delivering credentialing training. The College has developed a re-credentialing process for nurses still working in primary health with a current practicing certificate.