9 Sep 2019

Staffing a challenge in meeting mental health demands - doctor

10:27 am on 9 September 2019

Finding and training staff to deliver mental health services at general practices and kaupapa Māori will be a significant challenge, a doctor working in the field says.

Male nurse taking pulse of senior patient at hospital.

A pilot programme is successfully offering a range of same-day mental health services to those in need at some general practices in Auckland. Photo: 123rf.com

Yesterday the government announced a $6 million funding for mental health services at 22 general practices and a kaupapa Māori provider across seven District Health Boards.

The practices are all using a non-referral based model, which means patients get same-day access to mental health support.

Prime Minister Jacinda Ardern has said she wants every New Zealander to be able to access mental health specialists at the same medical centre as their GP.

Dr David Codyre, the clinical lead for mental health for The Tamaki Health - which is among those using the model - told Morning Report the initial pilot sites were established in Auckland as a collaboration between DHBs, two NGOs (non-governmental organisations) and two primary health organisations.

Previously, doctors and nurses were finding there was too much complexity and not enough time as demand for mental health services increased.

Dr Codyre said there were three aspects that were being used successfully at the pilot sites: a mental health clinician seeing people on the day; in clinics with many cultures having a peer cultural health coach role, which was helping with engagement and self-management support; and the third key element was ready access to NGO organisations to help with psycho-social issues, such as housing, poverty and income.

The combination of those roles had been evaluated and found to have a huge impact on meeting people's broader needs, Dr Codyre said.

He would like to see the programme rolled out immediately but workforce was going to be one of the big challenges on expanding this model nationwide.

A training programme is now in place and it was likely many of the roles would be filled by nurses, social workers, counsellors and psychologists.

"So there is a significant training onboarding process for these roles so we'll be gearing up later this year to begin recruiting, training, and inducting for spread which will then be rolling on in coming years."

Health Minister David Clark said there was "quite a lot of money" set aside for training so that current staff would be equipped to work in frontline mental services.

He believed three-quarters of the staff needed would come from those already working in the health sector who would just need to get an extra qualification.

He said within five years the government believed 325,000 people would be using these services delivered under the new model.

More funds for DHBs on Mental Health Foundation's wishlist

The Mental Health Foundation said the government needed to look at more funding for district health boards as part of their mental health plan.

Yesterday the foundation welcomed the government's announcement to boost funds for mental health services but it said DHBs have been understaffed and overstretched, affecting services on the ground.

Foundation spokesperson Sophia Graham told First Up it's encouraged by the investment which would go a long way towards tackling the issue.

As the first port of call for those affected by mental health problems it was pleasing that they would get extra funding, she said.

Sophia Graham, Mental Health Foundation

Sophia Graham Photo: supplied

"The best place for them [patients] to go is to their GP and to get the right kind of support there and we've been really pleased with the results of some of the pilot programmes and thrilled to see the government is now investing in those services too."

In the past funding had not kept pace with population growth which made it hard to access services. It was also important services were "culturally appropriate".

Ms Graham said evidence showed the more emphasis that was placed on culture, the more effective the services would be because they were more in tune with the person being treated.

The high Māori suicide rate was indicative of a high level of distress among Māori. They had to be empowered to deliver the solutions themselves.

"One way they can do that is through administering kaupapa Māori services, mental health services. Those have high success and they are warmly embraced by their communities and we want to see more of those around Aotearoa."

Staff working in the mental health sector were understaffed and overstretched, resulting in the current industrial action which was putting more pressure on services.

While the DHBs and unions were in negotiations, the funding announced yesterday would not be used for salaries and was another area the government should be looking at, Ms Graham said.

Labour not delivering on promises, National says

The National Party said the government has had two years to deliver on mental health services and still hadn't achieved anything.

National's mental health spokesperson Matt Doocey said Labour talked a big game in Opposition but hadn't delivering on its promises.

"We've got the government desperate to look as though they're actually doing something. They announce $6m and all it's really doing is covering the cost of existing mental health provision and GPs and PHOs so there's really nothing new here."

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