Abstract
Objective In 2005, a district health board in New Zealand established the Mental Health Brief Intervention Service (MHBIS)—a government-funded initiative that allows primary care practitioners (PCPs) to refer patients with mild-to-moderate mental health problems to a mental health clinician for up to 4 sessions per year at no additional cost. Our goal was to evaluate the impact that MHBIS had on primary care practice referrals to secondary mental health services and patient outcomes in South Canterbury, New Zealand.
Methods We used a survey questionnaire and focus groups for primary care physicians, practice nurses, and MHBIS clinicians (nurses, social workers, and an occupational therapist). A total of 49 surveys were returned from a sample of 96 physicians, practice nurses, and MHBIS clinicians. We conducted focus groups with 21 members of the sample. The MHBIS database provided information from 474 referrals.
We coded quantitative responses to the questionnaires and entered them directly into the Statistical Package for the Social Sciences program (SPSS) for analysis. We thematically coded data collected in the focus groups and the responses made in the comment section of the questionnaire. The data were transformed into quantitative variables and entered into SPSS for further analysis.
Results MHBIS improved outcomes by facilitating treatment for patients with depression. Physicians prescribed fewer psychotropic drugs and said they did so “more effectively.” In addition, patient use of MHBIS reduced the need for primary care referrals to secondary mental health services, reserved for patients with severe mental health disorders.
Conclusion The study supports the use of a collaborative model of care. This approach allows for the effective treatment of mild-to-moderate mental disorders by supporting practitioners with a brief intervention in addition to usual care.
Te Rau Hinengaro, a New Zealand Mental Health Survey,1 provided the first comprehensive review of data on the extent of mental health issues in New Zealand. This survey revealed that many people who self-reported mental health symptoms that would have met criteria for illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM-1V, 1994) did not seek treatment.2 The survey also found that a number of years may elapse between the onset of symptoms and a request for help.
Primary care practitioners (PCPs)—that is, physicians and practice nurses—are in a position to identify patients with mental health disorders and assist them in accessing appropriate treatment.3 However, such patients often have substantial impairment requiring a level of assistance not easily offered within a time-limited PCP consultation.4
In our survey of PCPs, we sought to evaluate the Mental Health Brief Intervention Service (MHBIS)—a government-funded initiative that allows PCPs to refer patients with mild-to-moderate mental health problems to a mental health clinician for up to 4 sessions per year at no additional cost to patients. We wanted to determine whether the program helped patients cope with their mental health disorders and whether it resulted in more effective treatment prescribing.5
Background
In New Zealand, the Ministry of Health launched an initiative to provide mental health services within primary care practices, assess patients for mild-to-moderate mental health disorders, and conduct psychoeducation and counseling, as needed.6 (Secondary mental health services [SMHS] provide care for those in the general population identified with severe mental health disorders [3%].)4
MHBIS was established in 2005 as a South Canterbury District Health Board (SCDHB) initiative to assist practices in providing mental health care for the estimated 17% of the population5 with mild-to-moderate mental health disorders. Although many of these patients have symptoms that do not meet full DSM-IV criteria, they are nevertheless at risk of developing a major depressive disorder.2 The MHBIS works with 28 primary care practices, including those in rural areas serving a population of approximately 55,000 patients. MHBIS receives government health funding administered through South Link Health and provides services to which PCPs can refer patients at no additional cost. Nurses, social workers, and an occupational therapist are employed as MHBIS clinicians (5 altogether), each of whom is assigned to work with specific PCPs.
PCPs may refer patients with mild-to-moderate mental health problems for up to 4 sessions per year with a mental health clinician. Usual reasons for referral are depression, anxiety, stress, grief, and distress from life events. Referrals are received electronically or by fax, and patients are contacted within 24 hours and offered an appointment. The referring PCP receives initial assessment notes electronically after the first MHBIS appointment and all notes upon completion of patient visits. MHBIS clinicians generally see patients in PCP offices, allowing for continuity of service for patients and opportunities for immediate discussions with the PCP, if needed.