Common Mental Disorders Depression - New Zealand Doctor

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New Zealand evidence supports these findings. 57 A WHO framework for development of youth-friendly health services has been drawn up 166 and various models of youthfriendly service provision have been initiated, but as yet there is little evidence on health outcomes. 164,165 Accessible health services for young people is a national goal in New Zealand, 550 and a network of services is being set up, though provision remains patchy. 551,552 The provision of innovative and well-assessed youth-friendly services should be a priority for the future. 165 Issues for evidence-based practice There is evidence that multifaceted collaborative care has benefits for the treatment of depression in the primary care setting. Potential elements of a cost-effective model include a stepped care approach, use of telephone care management and the employment of care managers (eg, practice nurses) to work with patients and liaise across levels of care. 9.4 Service delivery: special issues for Mäori Kaupapa Mäori services For Mäori, cultural identity is an essential component of good health and effective services must reflect all dimensions of wellness. 553 It is a cornerstone of government health policy that Mäori should be actively involved in defining and prioritising their health needs and directly aided to deliver services to their own communities. 553 Services that are delivered by Mäori for Mäori have been termed ‘Kaupapa Mäori’. 200 Materoa Mar 554 suggests that Kaupapa Mäori services include the following: • kuia and koroua influencing, guiding and advising in all aspects of the service, both delivery and development • development of identity for both staff and clients encompassing te reo (Mäori language), tikanga (values and beliefs) and Mäori models of practice • recruitment and retention of skilled Mäori staff • workforce development opportunities for Mäori • provision of training/education/information about kaupapa Mäori approaches • ability for kaimahi (community health workers), tangata whaiora and whänau to participate at all levels • research that supports further development for Mäori • clear accountability both internally and externally • advocacy 122 Identification of Common Mental Disorders and Management of Depression in Primary Care
Chapter 9 Models of care • networking by all kaimahi internally and intersectorally • a physical environment conducive to Mäori beliefs • autonomy and control in development of Mäori mental health services • striving to work with whänau, thus contributing to overall Mäori development • access to information that assists informed development • building and maintaining relationships at all levels with consumers, whänau groups and individuals on a national, local and international level • acknowledgement of Mäori processes, both at a managerial level and within service provision. Workforce issues Current efforts to increase Mäori health workforce recruitment and retention are having a positive effect. A recent report 555 has described key success factors as follows: • Mäori led, focussed and targeted interventions • consistent investment over a prolonged period • emphasis on the development of dual cultural and clinical competencies • integration of student support programmes within a university environment • provision of comprehensive support to tertiary students, including financial assistance, access to Mäori mentors and peer support, and inclusion in communities of learning • congruence with industry needs • supported transitions into and between study and work • attention to the broader determinants of Mäori health workforce participation • action across workforce development areas (including secondary schools). Primary-care based mental health services Mäori working in mental health have consistently described the interdependence of Mäori as the individual’s responsibility to a collective that is linked by whänau, whänaungatanga and whakapapa. 200 Whakapakari Ake Te Tipu, the Mäori Child and Adolescent Mental Health and Addiction Workforce Strategy 200 advocates a cross-sector, all age approach to reflect a holistic view of health. The primary care sector has been identified as the logical place for the delivery of mental health care to Mäori, as it offers better prospects of early intervention and the management of comorbidities, and is more closely linked to community agencies such as schools, maraes and recreational centres. 200 This will require developing the workforce and upskilling primary care workers so that interventions can be delivered in primary care settings. 200 Whakapakari Ake Te Tipu provides examples of primary-based mental health services that deliver early intervention programmes for young Mäori and reduce the divide Identification of Common Mental Disorders and Management of Depression in Primary Care 123
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Identification of Common Mental Dis
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Statement of intent Evidence-based
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Endorsements Te Ao Maramatanga New
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3.6 Clinical features of common men
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List of figures 3.1 When to refer a
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About the guideline Foreword The Ne
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About the guideline Guideline devel
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About the guideline Paediatric subg
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About the guideline Royal New Zeala
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Algorithm 1 Management of depressio
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Algorithm 2a Management of severe d
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Algorithm 2c Management of mild dep
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• limited access to psychiatrists
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Asian peoples About 7% of the New Z
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12-month period amongst adults atte
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Table 1.2 Prevalence of common ment
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1.4 Etiology of common mental disor
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The ‘hopelessness theory’ 94 co
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Sexuality Data from the Christchurc
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Since those who are affected by sui
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2.3 Managing depression: the steppe
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to informed consent. 152 There is a
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3 Recognition and assessment of com
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Chapter 3 Recognition and assessmen
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Good practice points Management of
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Box 4.1 Whänau Ora The concept of
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If the young person/rangatahi/tamar
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Exercise There was insufficient evi
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at any timepoint. Treatment as usua
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5 Recognition and assessment of com
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6 Management of depression in adult
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Chapter 6 Management of depression
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Page 118 and 119: Recommendations continued... Women
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Page 122 and 123: Secondary care evidence Based on ev
Page 124 and 125: Advice for women It may be helpful
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Page 130 and 131: This evidence comprised two recent
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Page 145 and 146: 9 Models of care 9.1 Introduction V
Page 147: Chapter 9 Models of care were reduc
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Page 154 and 155: Quality improvement collaboratives
Page 156 and 157: NZGG has been funded to develop sum
Page 158 and 159: Appendix A: Guideline development p
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Page 162 and 163: Appendix C: Assessment of suicide r
Page 164 and 165: Appendix D: Assessment tools for co
Page 166 and 167: Anxiety Anxiety is often comorbid w
Page 168 and 169: Appendix F: Self-management resourc
Page 170 and 171: Information about mental disorders
Page 172 and 173: Dysthymia Dysthymia is a chronic lo
Page 175 and 176: Glossary, abbreviations and acronym
Page 181 and 182: References 1. The MaGPIe Research G
Page 183 and 184: References 38. Tse S, Tong K, Hong
Page 185 and 186: References 72. Kendler K, Kuhn J, P
Page 187 and 188: References 107. Halligan SL, Murray
Page 189 and 190: References 143. Dejesus RS, Vickers
Page 191 and 192: References 179. Shaffer D, Scott M,
Page 193 and 194: References 215. Garralda ME, Bowman
Page 195 and 196: References 249. Zwaanswijk M, Verha
Page 197 and 198: References 283. Linde K, Berner M,
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References 318. Henkel V, Mergl R,
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References 353. Rush AJ. STAR*D: wh
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References 386. Ward E, King M, Llo
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References 417. Kirsch I, Deacon BJ
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References 451. Zigmond AS, Snaith
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References 486. Appleby L, Warner R
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References 520. Irwin M, Artin KH,
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References 557. Agnew F, Pulotu-End
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Common Mental Disorders Depression - New Zealand Doctor

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