Common Mental Disorders Depression - New Zealand Doctor

9
Models of care
9.1 Introduction
Various models of service delivery have been proposed for the delivery of mental
health services in primary care and for the configuration of primary care and
secondary care mental health services. A narrative review was conducted of the
relevant evidence, with a focus on New Zealand literature and special issues for
Mäori and Pacific peoples.
This review does not constitute guidance, but aims to provide an informative summary
of issues and points to consider.
9.2 Generic models: evidence review
A recent high-quality New Zealand Health Technology Assessment systematic review 339
reviewed nine systematic reviews and 35 randomised controlled trials (RCTs) on the
structure and workforce configuration of effective models of mental health service
provision and quality improvement in primary care, focusing on services for those
with mild to moderate mental disorders.
The following models were identified:
• staff training: education of primary care staff (eg, on prescribing habits, skills in
psychological therapies, dissemination of guidelines and information, intensive
practice-based education seminars)
• consultation-liaison: mental health specialist involvement in an ongoing
educational relationship with primary care clinicians to enable them to care for
individual patients. Referral to specialist care required in a small proportion of cases
• collaborative care: includes new quasi-specialist staff (sometimes called case or
care managers) who work with patients and liaise with both primary care clinicians
and secondary care specialists in order to improve quality of care. This model may
also involve screening, education of patients, changes in practice routines and
developments in information technology
• replacement/referral: primary responsibility for the management of the patient’s
presenting problem is passed to a mental health specialist for the duration of
treatment (eg, often associated with psychological therapy).
Identification of Common Mental Disorders and Management of Depression in Primary Care 119