What is primary mental health

What is primary mental health?

Primary mental health care refers to the assessment, treatment and, when needed, the ongoing management of people with mental health and/or addiction issues in the primary care setting. It encompasses promotion, prevention, early intervention and ongoing treatment for mental health and addiction issues.

Why is primary mental health care important?

Mental health and addiction is recognised as a major public health issue. A World Health Organization (WHO) study of the global burden of disease found that mental health disorders make up five of the ten leading causes of disability with some 40 per cent of all disability (physical and mental) due to mental illness and rates of mental illness continuing to increase internationally. Consistent with these international findings, Te Rau Hinengaro, The New Zealand Mental Health Survey found that 46.6 per cent of the population is predicted to meet the criteria for a mental health disorder sometime in their lives with 20.7 per cent having a disorder in the past 12 months. Lifetime and 12 month prevalence rates are even higher for Maori (50.7 per cent and 29.5 per cent respectively) and Pacific (46.5 per cent and 25 per cent respectively).

Primary care is usually the first point of contact for people with mental health and/or addiction issues. A number of New Zealand studies have shown that only 3-8 per cent of those accessing general practice sight mental health problems as the main reason for their consultation. However, just over a third (36 per cent) of all attendees had one or more of the three most commonly presenting mental health disorders - anxiety, depression or substance use disorder. In addition, approximately half have some level of psychological distress. With the majority (50-70 per cent) of these individuals managed solely by general practice, it is evident that the recent prioritising of, and investment in, primary mental health service delivery and development is timely and necessary.

What is the role of primary care in the broader mental health sector?

The literature clearly supports the view that primary care services have a key role in the provision of mental health services for those with mild to moderate mental health and/or addiction issues. Primary mental health care also has a role to play in supporting people with severe mental health and/or addiction issues. Examples of this include the facilitation of clear referral pathways to secondary and tertiary services or managing the physical and psychological care of people with stable conditions.

Responsive primary mental health care is central to a vision for society where:

• people and their families/whanau have appropriate, non-stigmatising access to mental health and addiction care when they need it
• primary health care has the capacity and skills to promote mental health and wellbeing and to respond appropriately and effectively to the needs of people with mental health and/or addiction issues.

Primary health care has at least three key roles to play in mental health and addiction care.

1. To promote mental health and advocate for mental health promotion in the work of other sectors.
2. To provide affordable, accessible and appropriate treatments and systems of referral and care for people with mental health and/or addiction issues.
3. To integrate mental health, addiction and psychosocial interventions into the management of physical health problems (and vice versa). This is consistent with findings showing that:

• mental health operates as an independent risk factor for the development of physical disease
• there is a higher incidence of mental health disorders in people with chronic physical health problems
• there is a higher rate of physical health problems in people with mental health disorders.

Related to these roles are a number of principles that also underpin the policy recommendations for improving primary mental health and addiction services in New Zealand. These are as follows:

• Be clinically effective and cost effective by matching service users' needs with the least intensive yet effective intervention.
• Expand the range of treatment options for people with mental health and/or addiction issues by using evidence-based talking therapies and other psychosocial interventions.
• Support people with mental health and/or addiction issues through active monitoring, provision of lifestyle advice, and connecting people with self-help resources such as books and e-therapies.
• Promote and support self care.
• Have the flexibility to tailor service configuration to the characteristics of the population in different regions.
• Have some flexibility to provide complementary and alternative treatments and traditional healing options for people from different cultural and ethnic backgrounds when the efficacy of such interventions can be demonstrated.
• Have clear referral pathways and good integration with specialist mental health and/or addiction services and other relevant community organisations.
• Listen to service users and identify and build upon each person's assets, strengths, and areas of health and competence.
• Be responsive to the needs of service users across the whole age spectrum and the needs of different population groups, e.g. Maori, migrant and refugee peoples, those with addiction issues and those with comorbid physical and/or psychological health problems.

 References

1. Murray and Lopez 1997 as cited in: Ministry of Health. 2009. Towards optimal primary mental health care in New Zealand: A discussion paper. Wellington: Ministry of Health.
2. Murray 2007 as cited in: Dowell AC, Garrett S, Collings S, McBain L, McKinlay E, Stanley J. 2009. Evaluation of the Primary Mental Health Initiatives: Summary report 2008. Wellington: University of Otago and Ministry of Health.
3. Oakley Browne, M.A., Wells, J.E., Scott, K.M (eds). 2006. Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington: Ministry of Health.
4. Findings from the Mental Health in General Practice, MaGPIe, study as cited in: Dowell AC, Garrett S, Collings S, McBain L, McKinlay E, Stanley J. 2009. Evaluation of the Primary Mental Health Initiatives: Summary report 2008. Wellington: University of Otago and Ministry of Health.
5. Sourced from: Ministry of Health. 2004. Toolkit for mental health services in primary health care. Ministry of Health.