Government funding commitment for mental health

TE TUMU WAIORA COLLABORATIVE COMMITMENT TO MENTAL HEALTH SUPPORT IN PRIMARY CARE

Government funding commitment for mental health and wellbeing programme within general practice

Barriers to mental health and wellbeing services will be dramatically reduced for all Kiwis as a result of the government’s announcement it will support primary mental health and wellbeing programme Te Tumu Waiora[1], say members of the Te Tumu Waiora Collaborative.

Te Tumu Waiora is a model of care that provides free and immediate access to dedicated support for anyone presenting to their GP clinic with stress, social issues, or long term physical health struggles. The programme supports GPs to put mental and physical health and wellbeing back in the heart of general practice, with the introduction of two new focused roles into the traditional GP/practice nurse team; a Health Improvement Practitioner (HIP) who focuses on mental health, and a peer/cultural Health Coach who works to improve self-management skills for people struggling to manage long term medical conditions such as diabetes.

Dr David Codyre, clinical lead for mental health at Total Healthcare PHO/Tamaki Health and member of the Te Tumu Waiora Collaborative, says the Te Tumu Waiora model incorporates a range of innovative evidence-based approaches which will help to meet the huge demand for mental health and wellbeing services.

“While the traditional primary care team of GPs and practice nurses capably manage acute medical needs, the increase in mental health, addiction, and lifestyle-related long term medical conditions over the last 50 years has put pressure on primary care. With limited resource some are struggling to meet this need.

“We know that 35% of patients presenting to their GP have an underlying mental health or addiction issue. It is therefore critical that we find ways to support our general practices teams so they have the ability to offer patients a broader range of support options.

“This model ensures earlier intervention, so people access help before things escalate to the point where they may be suicidal, or need more intensive specialist mental health intervention. Te Tumu Waiora also removes the stigma around seeking support for mental health, it just makes it part of normal everyday healthcare”, he says.

Dr Codyre says existing traditional roles within the practice setting are enhanced as part of the Te Tumu Waiora programme and will be complemented by health coaching, Health Improvement Practitioners, plus where DHB contracts support this, access to NGO peer and community support workers to address wider psychosocial need, which are all aligned around an integrated and holistic primary and community approach to wellbeing.

The enhanced practice team is further extended through links to new NGO community support roles and dedicated specialist support from secondary care.

Johnny O’Connell, ProCare’s General Manager Patient Services and member of the Te Tumu Waiora Collaborative says the wellbeing of New Zealand communities will be greatly improved thanks to the government investment announced in Budget 2019.

“We are delighted with the government response to He Ara Oranga and commitment of $455M in Budget 2019 to support the national roll out of Te Tumu Waiora.

“Most Kiwis have long term trusted relationships and frequent interactions with their GP clinic, which makes it a logical place to expand capability and access to support for mental health and addiction issues”, he says.

Mr O’Connell says Te Tumu Waiora, the result of a collaboration between DHBs, PHOs and NGOs, has been piloted in eight practices in the Auckland region since June 2017.

“Over the past two years Te Tumu Waiora has been successfully piloted in eight general practices across Auckland, giving people immediate access to needed support. Based on the success of the model in these eight practices, a number of other PHO’s and DHB’s across Auckland and New Zealand have also started their own pilot programmes within general practices in their regions.

External evaluation[2] of the pilot shows the approach is working exceptionally well, with services reaching more than three times as many people as existing referral-based therapy services. 66% of people are seen on the same day for talking therapy (compared to 5% for conventional talking therapy services) and over 80% of people report an improvement in their wellbeing. People accessing health coaching achieve improvement in both their physical health state, and their subjective wellbeing. Most importantly the new approach significantly increased access for three key groups not served well by traditional service approaches – young people, Māori and Pacific.

For more information visit www.tetumuwaiora.co.nz

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Te Tumu Waiora – Overview
Te Tumu Waiora has been collaboratively developed with DHB, NGO, PHO and client involvement using a co-design process and drawing on best available evidence. The programme has been working successfully in eight Auckland general practices since November 2017 and has recently expanded to include another eight general practices via programmes set up by Northland NHB, Lakes District DHB/Pinnacle Midlands Health Network, Tu Ora Compass PHO, and Pegasus PHO.

Te Tumu Waiora has been designed as a holistic model, supporting and addressing the physical, emotional and social needs of patients. The programme delivers targeted, brief intervention to a large number of people as opposed to a large amount of therapy, to a small group of people. The programme gives patients access to focused support from two new roles integrated into GP teams – i) mental health clinicians, known as health improvement practitioners (HIPs) in the general practice setting - HIPs can be psychologists, psychotherapists, or other health professionals with a mental health qualification; and ii) Health Coaches – a non-registered occupational group whose role is improving self-management skills for people struggling to manage long term medical conditions. Health Coaches typically bring experience of living with a long term condition and/or cultural expertise to their role. Induction to both roles entails an intensive 1 week training programme, followed by a number of days in-house observed practice over the ensuing months of practice.

Access to both roles is as simple as the doctor or nurse walking with a patient down the corridor of their practice to be introduced to the HIP or Health Coach depending on their presenting need. Where the underlying issue related to social needs or stress, any member of the team can link people to NGO peer or community support services to address this need.

About the Te Tumu Waiora Collaborative
The Te Tumu Waiora Collaborative is a group of health organisations committed to supporting the establishment and ongoing development of Te Tumu Waiora across New Zealand and ensuring participating practices and community settings adhere to core model fidelity and provide high quality and a consistent standard of care.

To achieve its principal object, the Collaborative will implement, promote, maintain and oversee the Te Tumu Waiora Model of Care with a view to improving patient health care, health outcomes and the management of related services.

The collaborative includes primary health organisations Total Healthcare/Tamaki Health, ProCare, Tū Ora Compass Health, Pegasus Health, Pinnacle Midlands Health Network and Northland District Health Board.

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[1] Te Tumu Waiora Collaborative comprises representatives from Northland NHB, Lakes District DHB/Pinnacle Midlands Health Network, Tu Ora Compass PHO, Pegasus PHO, Total Healthcare PHO, and ProCare PHO

[2] Synergia report: Fit for the Future - Evaluating Enhanced Integrated Practice Teams, a report for the Ministry of Health, 1 October 2018.

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