'What recent evidence tells us about meeting the physical health needs of people with diagnoses of serious mental health conditions and addiction issues, who are being managed in primary care' was recently featured in NZ Doctor, written by Candace Bagnall with input from Dr David Codyre and Helen Lockett. Wendy Donaldson reviews this excellent and informative article. 

Turning evidence into practice in primary care

Improved access to better primary care and support from primary care to manage physical health issues, is particularly important as increasingly more mental health and addiction consumers are being referred back to and managed in general practice. PHOs report increasing numbers of consumers in general practice with more severe mental health problems, often compounded by a range of social and economic problems.  

A recent article based on the 2017 evidence update was written following a request from NZ Doctor to be part of the series of clinical articles and e-learning tools, 'How to Treat' (Bagnall, 2018). This is another way of getting the important research findings to primary care practitioners. 

What recent evidence tells us about meeting the physical health needs of people with diagnoses of mental health conditions and addiction issues, who are being managed in primary care was published on 6 June 2018. 

The article starts by asking the readers a few quiz questions, which I found really engaging, as they got you thinking from the outset what you did actually know about the subject. Then throughout the article, and after each section, some pertinent discussion points are raised for the reader to reflect on. 

NZ Doctor has developed a longer e-learning quiz for GPs and practice nurses to complete after reading the article, which is worth CME points. 

The article itself is an interesting mix of important clinical information based on the evidence review, some discussion points around what needs to change and some stories of change. The key learning and discussion points are divided into sections identifying: 

  • the ‘why’ of comorbidity in mental health and addiction issues in primary health care 
  • the significance of continuing progress in building on primary mental health developments 
  • the systems changes needed for successful primary care models to improve outcomes 
  • provider awareness and skill development to improve consumer health 
  • physical health impacts of psychiatric medications 
  • the problem of psychotropic prescribing trends for primary care. 

It is concerning reading the mounting evidence of the relatively poor physical health of people with mental health conditions and addiction issues, which has worsened in recent decades and apparently continues to worsen (Hayes, Marston, Walters, King, & Osborn, 2017; Saha, Chant, & McGrath, 2007). The better part about reading the article is the amount of evidence provided to address this trend, including how to relate to mental health and addiction consumers, developing the skills of practitioners and the important role peer support can have in primary care setting as well.  

The evidence is compelling for new delivery and funding models for primary care to improve access and address the increasing health inequity. Having an integrated practice team approach appears to be the most effective model in meeting the needs for people with mental health conditions and addiction issues in primary care. Certainly, the article provides good evidence on the common factors identified for successful integration.  

Some primary health care providers in New Zealand are piloting a combination of many of these factors, and I hope the stories of new ways of doing things are motivating for both people accessing services as well as for providers of services, I certainly found them to be. The recent RNZCGPs policy brief on this topic is one example included in the article of practical ‘how to treat’ recommendations and information for general practice.  

Priority actions identified for improving the health of people who experience mental health and addiction issues are identified in the article (Te Pou, 2018). Particularly interesting is the conclusion that we may have greater expectations of general health services these days, however, for people accessing mental health and addiction services this change is occurring much more slowly and many people have had to go to extraordinary lengths to have their concerns taken seriously. (Ewart, Bocking, Happell, Platania-Phung, & Stanton, 2016).  

A number of discussion points are suggested throughout the article for consideration. These include several barriers readers will readily identify with and are not new to mental health and addiction services. The discussion points and the considerable strength of evidence around the potential problems with psychotropic prescribing in primary care are informative and thought provoking.  

In conclusion, the article seeks to highlight key learning and discussion points relevant to clinicians working in primary care, who can play an essential role in improving physical health outcomes for people with mental health conditions and addiction issues. 

Do let people in your primary care networks know about this article, and encourage them to read it, and participate in the e-learning module, if they, their practice, or their PHO subscribe to NZ Doctor. 

References 

Bagnall, C., Codyre, D., & Lockett, H. (2018). How to Treat: Comorbidity in mental health, addiction. How to Treat. New Zealand Doctor.   

Ewart, S. B., Bocking, J., Happell, B., Platania-Phung, C., & Stanton, R. (2016). Mental Health Consumer Experiences and Strategies When Seeking Physical Health Care: A Focus Group Study. Global Qualitative Nursing Research, 3.  

Hayes, J. F., Marston, L., Walters, K., King, M. B., & Osborn, D. P. (2017). Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014. The British Journal of Psychiatry, bjp-bp.  

Saha, S., Chant, D., & McGrath, J. (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry, 64(10), 1123-1131.