The benefits of having an MHBIS presence in the PCP office as an initial point of contact were: easier access to treatment, acceptance by patients, smoother-running primary care visits, enhanced professional communication, and earlier detection and intervention of mental health disorders.
DISCUSSION
Systematic literature reviews have concluded that collaborative models of mental health delivery in primary care yield improved outcomes for patients.10,11 Our study results support those findings.
Our key findings are that ease of access is critical to providing effective mental health services in primary care. Furthermore, the MHBIS provides mental health care that is acceptable and valued by both PCPs and patients.
The model used by the MHBIS targets a patient population different from that served by SMHS, and is now used by most primary care providers in the South Island of New Zealand.
Generally, patients are seen in the PCP’s practice rooms, providing a familiar environment, continuity of care, and a referral path more readily accepted than referral to other community services. In this way, MHBIS is seen as an extension of the care provided by PCPs and is viewed as being an integral part of the practice.
This study supports the findings of the NZ Guidelines Group,12 an independent nonprofit organization that has provided the Ministry of Health with best-practice recommendations for treating mental illness in a primary care setting. (These recommendations include self-management strategies, patient education, and structured problem solving for patients with mild-to-moderate mental illness.)
Patients working with MHBIS are supported in making lifestyle changes that enable them to take control of their health by learning how to remain well and using self-help strategies.
While this model of mental health service provision has costs that prohibit its implementation for many primary care practices internationally, our study highlights the benefits of providing mental health services in terms of access, acceptability to patients, and communication with primary care providers.
Limitations of the study
Qualitative responses in many ways allow for deeper understanding, but they are nevertheless subjective.
The focus groups occurring as part of peer group meetings between physicians and PNs were time limited. Input from the MHBIS clinicians was also limited; at the time of the study, 2 staff members were new to the service, and this study’s researcher (ST) is an MHBIS clinician who did not otherwise participate. She is also known to some practices, which could have had either a positive or limiting impact on focus group feedback.
Nevertheless, our study highlights the effectiveness of MHBIS. The service is well accepted and provides good support for PCPs. As such, MHBIS fills a gap for patients who would not meet criteria for admission to SMHS and allows for early identification and treatment within primary care.
CORRESPONDENCE Sarah Taylor, MSW, South Link Health, PO Box 222, Timaru, South Canterbury, New Zealand; sarah_taylor@southlink.co.nz.