Better Sooner More Convenient Primary Care - New Zealand Doctor

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Appendix Ten: Mental health This plan was written on the basis of funding being available to employ a Mental Health Co-ordinator in each (Integrated Family health Centre) IFHC. It became apparent on 23 February that this funding was not going to be available. While aspects of this plan may still be able to be implemented within existing resources and funding, this will require discussion with, and support from, clinicians from community mental health services, primary mental heath services and primary care. Given the time available a revision to this plan was therefore not attempted; this will done by June 30, 2010. 1. Aspirational statement: Every West Coaster will be able to access the care and support they need to enjoy positive mental health and well being. 2 Project overview This project aims to integrate mental health services and primary health care on the West Coast in a way that will result in better, sooner and more convenient services for patients, delivered from IFHCs. Changes in current service configurations include more seamless entry points for patients who require care and support for mental health issues, packages of care for those currently falling between primary and secondary services, shared care arrangements, improved discharge planning processes and delivery of secondary mental health and addiction service within IFHCs. A kaupapa Māori approach is incorporated into the plan. This will include enhanced information sharing and mental well being resources for both mental health professionals and service users. 3 Current Situation and problem definition The Primary Mental Health Program, targeted at enrolled patients with mild to moderate mental health issues, has been operational on the West Coast for the past four years, with very good results and good integration with general practices. A strength of the program is that it does not purport to be a separate service but is an integral part of the general practice teams – „in the practice, of the practice, for the practice‟. Patients Business case appendices V12 AC 25Feb2010 Page 88
emain under the care and management of their general practices, thus allowing a more holistic approach to well being with no stigma attached. Secondary mental health services on the West Coast currently provide services to more than 3% of the population. Services are mainly community based and include adult, psychiatric emergency, child and adolescent, alcohol and drug, and Māori mental health teams, with a small inpatient unit and family and consumer advisory services. There are close linkages with Canterbury regional specialty services (youth inpatient, mother and baby, eating disorders, detoxification services) and service users are able to access a range of NGO provided residential and support services. The Māori mental health team work alongside mental health service case managers to provide cultural support to clients of mental health service and support clinical processes to ensure they are delivered in a culturally appropriate manner. “Recognising the integral relationship between cultural identity as Māori and Māori wellbeing is a core element of a kaupapa Māori model of care. The term “Kaupapa Māori” refers to the culturally derived philosophy that underlies and is woven into all aspects of service delivery, with wellness for tangata whaiora Māori as the desired outcome 53 .” To date there has been limited integration of primary and secondary care mental health services on the West Coast because of the following reasons: - they have been established, funded and operated in very different ways in order to adhere to two distinct sets of criteria; - shortages of psychiatrists to help develop shared care systems, shortages of GPs with consequent lack of resource to take on a greater role; - primary mental health co-ordinator role has focused on assessments and not had capacity to take on a wider role; - the current patient pathway is only established as a one way track i.e. primary mental health team to secondary, no pathway back to primary mental health for brief intervention counselling; - current primary/secondary contracts add to the fragmentation of services due to their distinction between mild and moderate/severe. In terms of volumes, currently the adult community mental health services carry out 736 community adult assessments and admit to their service 636 new patients per year. This excludes TACT team (449 assessments), inpatient (63), Alcohol & Drug Services and Child & Adolescent Mental Health Services (382). The PHO Mental Health team assessed 414 patients (aged 14 and above: 37 Māori) in 08/09 of whom 180 received Brief Intervention Counselling (BIC) of up to six sessions per person. Issues of current concern that may be able to be addressed as part of an initiative to better integrate mental health services are: lack of seamless entry for patients into the most appropriate pathways via a stepped care approach 53 Te Haererenga mo te Whakaoranga 1996-2006. The Journey of Recovery for the New Zealand Mental Health Sector. Mental Health Commission. Pg 157 Business case appendices V12 AC 25Feb2010 Page 89
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Business Case Better, Sooner, More
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1 Caveats/status This business case
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Current situation By three years Wa
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staffed on a capacity model - in wh
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support from DHBs, specialist clini
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10.4 Key milestones................
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Annual government health funding pe
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Ambulatory Sensitive Hospitalisatio
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The base populations of the three d
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Māori/Pacific Not Māori/Pacific D
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4.7 West Coast region service deliv
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5 Future model of care 5.1 The desi
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support them. Help with understandi
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LEVERS VISION Better, sooner, more
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providing the majority of care). Th
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The Community Health System Deliver
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To better integrate the support pro
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5.5 Enablers A key aspect of this b
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Two rounds of meetings with front l
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While doctor-nurse substitution has
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Nick Goodwin, Kings Fund 14 , in hi
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Quality domains Each new initiative
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Preventative Acute LTC management R
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Preventative Acute LTC management R
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The core services are provided or p
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Total required FTEs for the Grey IF
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7 Governance, Ownership & Managemen
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Option D: PHO/DHB jointly owned Pri
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The IFHS will need the ability to b
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Of note, a large proportion of the
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The DHB delegates decision making o
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Limited integration of community se
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10.4 Key milestones The table below
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Expanded pharmacy roles Improving a
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Devolved community based services w
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Appendices Appendix One: Health Equ
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ongoing GP shortage creating an env
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10. What are the unintended consequ
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It is common for people with an acu
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Outcome measures Indicator Baseline
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determine ratio of nurses and GPs t
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C. Extended role for pharmacists:
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11 Engagement Working group who dev
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Appendix B: Acutely unwell adult pa
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4 Objectives to implement nur
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Review Buller after hours arrangeme
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Year three Community education camp
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13 Costs Budget considerations:
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established. This group now oversee
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Output measures Tobacco control / s
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Improving immunisation coverage - h
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Year three Continued joint plan
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extending health promotion activiti
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Page 109 and 110: The Community Health System Deliver
Page 111 and 112: Clinical care Practice self managem
Page 113 and 114: and increases in the numbers of pat
Page 115 and 116: Ambulatory Sensitive Hospitalisatio
Page 117 and 118: % CVD on lipid lowering drugs, beta
Page 119 and 120: Health navigators/ kaiawhina: chan
Page 121 and 122: Committee‟s objectives 41 of prov
Page 123 and 124: - lack of consistency of care betwe
Page 125 and 126: qualifications and skills. Where ca
Page 127 and 128: 6 Deliverables / activities Impleme
Page 129 and 130: “With an aging population and an
Page 131 and 132: Differences between revenue generat
Page 133 and 134: Appendix Seven: Integration - Healt
Page 135 and 136: It is expected that HealthPathways
Page 137 and 138: Year two implement the process to
Page 139 and 140: Low uptake by primary and secondary
Page 141 and 142: Appendix Eight: Improved access to
Page 143 and 144: to easily access by telephone). Oth
Page 145 and 146: Year One - July 2010 to June 2011 T
Page 147 and 148: LECG 50 evaluated whether “the im
Page 149 and 150: Appendix Nine: Referred services 1.
Page 151 and 152: them by technical errors or lack of
Page 153 and 154: Identify patients that would benefi
Page 155 and 156: • Provision of patient specific m
Page 157: 12 Organisational accountabilities
Page 161 and 162: Service user pathways in an optimal
Page 163 and 164: Model for shared care pathways deve
Page 165 and 166: Implementation plan: to June 30 Dev
Page 167 and 168: Year two Review progress, outcome m
Page 169 and 170: 10 Risk analysis Risk Probability I
Page 171 and 172: Appendix Eleven: Frail older people
Page 173 and 174: ehab and treatment programmes that
Page 175 and 176: Year one: Maintain and continue the
Page 177 and 178: Māori have a higher incidence of m
Page 179 and 180: 11 Organisational accountabilities
Page 181 and 182: There are often vacancies for allie
Page 183 and 184: 6 Deliverables / activities Program
Page 185 and 186: Professional development: Provide
Page 187 and 188: Mainstream arguments are concerned
Page 189 and 190: Appendix Thirteen: IFHCs - Faciliti
Page 191 and 192: A key possibility is that land at t
Page 193 and 194: This option is effectively a Greenf
Page 195 and 196: 7 Westland IFHC Facilities options
Page 197 and 198: Year two Substantive-IFHC in Greymo
Page 199 and 200: 12 Costs Capital costs Greymouth IF
Page 201 and 202: utilize MedTech, but via their own
Page 203 and 204: 4 Objectives: To implement c
Page 205 and 206: Security An individual‟s health i
Page 207 and 208: 8 Effect on inequalities The increa
Page 209:
Appendix Fifteen: Project advisory
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