The context

Each year, one in five New Zealanders experience mental health or addiction challenges. The number of people who experience psychological distress is increasing, with recent statistics showing over 14% of adults in Aotearoa reporting high or very high distress. These numbers are even higher for young adults, and for Māori, Pacific and disabled adults. Year after year, there is a significant number of adults who want professional help for their mental health or substance abuse, but do not receive it.

In most instances, a general practice (GP) is where people would first raise or seek support for their mental distress. Historically, where patients were identified as having severe mental health support needs (roughly 3% of the population), GPs would refer them to external specialist services. Yet many more people experience more common and (generally) less severe mental wellbeing issues such as anxiety, depression, low mood and stress. This group (known as ‘the missing middle’) would have difficulty accessing support due to barriers such as affordability, long wait times, and restrictive referral processes or criteria. GP appointments are short, limiting the time, connection and ongoing support that is often required to address key social drivers of poor mental or physical health.

The 2018 Government Inquiry into Mental Health and Addiction called for better access and more choice, especially for people with mild to moderate needs. This led to pilots, expansion of existing services, and the introduction of a new model of care across the country. This model has different names throughout the country, recognising that one general model of care cannot work for everyone, such as Te Tumu Waiora, Tū Whakaruruhau, and Te Manawanui. Broadly, these sit under the umbrella of Integrated Primary Mental Health and Addiction Services (IPMHAS).

Key features of this model of care, which are still in practice today, include:

~ Recognising the importance of an enhanced general practice team, as well as ‘walk alongside’ community support.

~ Connecting patients with health professionals and support workers who can provide ongoing and cross-sector wellbeing and social support.

~ Integration of mental health and addition services into primary care.

~ Introduction of two new roles: Health Improvement Practitioners (HIPs) and Health Coaches.

~ Providing a holistic practice where patients receive a warm handover to the support practitioner from their GP, often on the same day, ensuring timely and ongoing support.