Professor Tony Dowell and Dr Sunny Collings (University of Otago, Wellington) are convinced that GPs and other primary health-care professionals can provide more effective care to the thousands of people suffering from mild to moderate mental health problems in New Zealand.
"Forty six per cent of the population will experience mental health problems or mental illness sometime in their lives, with most suffering from anxiety, depression or substance-use conditions," says Dowell, who is also a GP.
"This is a huge issue at the primary-care level and our research shows that the majority of these people – if their condition is not severe – can be treated effectively by GPs, nurses and other providers in primary health organisations, rather than being referred on for more specialised treatment." Dowell and psychiatrist Collings are encouraged by the results of their research aimed at a better deal for people with mental health problems. The study team used a variety of research methods to investigate how well 26 different primary mental health initiatives, funded by the Ministry of Health, treated people with mental health issues.
"The fact that 80 per cent of the 16,000 patients we followed showed improvement in their condition after visiting their GP is encouraging, since we'd expect at best 30 to 50 per cent of people to improve without specific interventions," says Dowell.
The other advantage is that the improvement was sustained in a six-month follow-up. Biostatistician Dr James Stanley highlighted the importance of being able to record the impact of the initiatives over time. Collings is now leading two further research projects to streamline the clinical intervention and determine how provision of mental health services in primary care can be best implemented.
"In that first project we found that people showed improvement, to some extent, regardless of the nature of the psychological intervention," she explains. This led her to explore what psychological treatment works in the primary-care setting, and then work with clinical psychologist Fiona Mathieson to develop a novel, brief treatment intervention for use by GPs and practice nurses, requiring only two hours' training.
"This should be a saving for the health system, as well as meaning much more direct access to help for patients."
Collings says the initial results are positive. "GPs liked the action points which focus around three clinical areas: relationships, problem behaviours and stress. We found that no patients deteriorated and most improved. Patient reaction was also really positive."
However, she says this new approach should now undergo a more rigorous clinical trial, with a bigger sample of doctors and patients, before it's rolled out across the country.
Collings and Dowell are also aware of the importance of adequate systemic frameworks to make these grassroots changes sustainable. To that end they are partnered with health systems consultants Synergia Ltd in a Health Research Council and DHB-funded study to develop a Toolkit for Primary Mental Health Care Development.
"This study is part of the big-picture support framework for improved mental health services at the primary level – the foundations as it were," says Collings.
"We're using the findings from the study of the primary mental health initiatives, along with the new data from this third project with four district health boards, to develop an implementation framework that service purchasers, planners and providers in DHBs, primary health organisations and NGOs can use to improve primary mental health care," she says.
"The tools will include written materials, computer simulation models and content for planning workshops.
"We have been lucky to work with talented colleagues on all three projects – about 10 others are involved in various aspects. Once we trial the brief intervention and then implement the framework, the treatment of thousands of people in primary health who suffer from mental health issues will be much improved."
- Ministry of Health
- Health Research Council of New Zealand