Common Mental Disorders Depression - New Zealand Doctor

Quality improvement collaboratives
Aligning clinical practice with evidence-based practice has been achieved using
multidisciplinary collaboratives 561-563 Following publication of its guideline, ‘Assessment
and Management of People at Risk of Suicide’ (2003), 162 NZGG developed a
collaborative methodology for systems improvement in the management of self-harm.
It is based on the ‘Breakthrough’ approaches developed at the US-based Institute
of Healthcare Improvement (IHI) 564 , and the Australian National Institute for Clinical
Studies’ (NICS) ‘Community of Practice’ work. 563 The methodology has been applied
to improve uptake of the guideline’s recommendations in emergency departments
throughout New Zealand. 565 Across the 11 District Health Boards (DHBs) which
participated in the New Zealand collaborative in 2007, the median percentage of
self-harm or suicidality cases seen within 1 hour (as recommended in the guideline)
increased from 47% to 72% during the project. 566 Half of the DHBs showed increases
in the proportion of guideline-recommended mental health assessments completed
within 72 hours of presentation, ranging from substantial increase (0–73%) to more
modest improvements(13–36%). 566
Since mid-2005, a ‘Mental Health Initiatives’ programme has resulted in the creation
of a network of new ‘primary mental health coordinators’. 543 These positions have been
created to strengthen PHOs’ capacity and capability to deliver primary mental health
services. A recent evaluation of the programme found several challenges in the ‘process
of care’, including communication difficulties between general practitioners and nurses,
difficulties targeting the most at-risk populations, more acute cases using up resources,
and far fewer Mäori and Pacific people using the services than had been hoped. 543
Such issues are to be expected in these early stages of capacity development within
primary care; but the existence of this new mental health-dedicated infrastructure
represents an important opportunity to employ collaborative quality improvement
methods. Resources should be identified to involve primary mental health coordinators
and other stakeholders from primary, community and secondary mental health care
to change practices and pathways to better reflect recommendations in this guideline,
and improve the experiences of care for patients.
Workforce development
Chapter 9 discusses workforce as it relates to care models for Mäori and Pacific
populations. In addition to these particular challenges, there is a need to build further
workforce capacity to strengthen the capability of PHOs to better meet the mental
health needs of enrolled populations. Priorities here are:
• increasing capacity to deliver psychological therapies in the primary care setting
• increasing capacity to provide ongoing case management and monitoring
of patients with depression in the primary care setting
• increasing the use of protocol-driven assessment and management processes (see
Appendix D: Assessment Tools for Common Mental Disorders), as well as structured
interviewing to assess suicide risk (see Appendix C: Assessment of Suicide Risk).
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Identification of Common Mental Disorders and Management of Depression in Primary Care