Government asks GPs to do more for mental health

The Government wants primary health clinics to take a greater role in diagnosing and treating people with mental illnesses.

The call comes in the Government's second mental health and addiction plan, made public yesterday by Health Minister Annette King.

One in three general practice patients has had a diagnosable mental illness in the preceding year, a study found. In the same survey, GPs said they had identified mental problems, from severe to mild, in half of the patients.

The new 10-year plan comes after a decade of advances in mental health care - following the closure of the big psychiatric hospitals - but also amidst continuing serious problems.

"Services for children and young people, while significantly improved from a decade ago, are still under-developed and under-resourced," the Mental Health Commission says in its latest annual report to MPs.

"The growing elderly population is also placing demands on a sector that appears fragmented and ill-prepared to meet the emerging needs."

The new plan says the creation of primary health organisations (PHOs), the conduit of new or increased state subsidies eventually for all enrolled patients, "provides an opportunity to improve responsiveness to mental health needs".

College of General Practitioners deputy president Dr Jonathan Fox, who had not seen the plan, said GPs were "very good at identifying people who need help. But we don't always have the things that we would like to be able to help them.

"We are often criticised for over-prescribing medications for treatment. We are all aware medication is often not the best treatment, but if you haven't got access to counselling or psychological support you have got very little else to offer to patients."

These therapies were not widely available because of lack of funding for them and the shortage of people trained in them, he said.

A 2003 document on the Health Ministry's website says PHOs are funded for their mental health care within their overall allocations from district health boards.

The ministry's deputy director-general, mental health, Dr Janice Wilson, said yesterday that how to finance PHOs to build their mental health capabilities was not yet known.

The ministry wanted patients to have greater access to counselling-type therapies through PHOs, but she said building the necessary workforce would take years. A variety of pilot mental health schemes were running at PHOs and would be evaluated once completed.

The plan also calls for the end of "incentives that can keep some service users tied to certain services". This partly refers to the abolition, now being carried out, of health board contracts with private providers of level 1 and 2 "supported accommodation". Levels 3 and 4, for more-severely affected patients, are being retained.
Dr Wilson said the intention was to create "packages of care" for many more patients in the community, providing the specific services they needed. "It's not about abandoning people; it's about trying to put in place supporting mechanisms that they need to be as independent as possible."

Mental health plan

The 2005-2015 plan aims to:

* Build on GPs' role in handling mental illness.

* Strengthen moves that provide for appropriate patient independence.

* Expand services, especially for the young and the elderly.

* Provide greater access to psychological therapies.