Good evening.  Thank you for the opportunity to speak to you tonight about the Government's priorities for primary mental health care.

I'd like to acknowledge the work of AUT University, Waitemata District Health Board and the Mental Health Foundation in bringing us together today to raise fresh ideas and further the progress that has been made towards improving the mental health and wellbeing of New Zealanders.

It is timely that the WHO has chosen primary care as the theme for this year's Mental Health Awareness Week, since here in New Zealand we have reached a promising stage in the development of our primary mental health services.

I have worked as a GP and know well the importance of effective primary and secondary services in delivering mental health care.  Early, appropriate intervention is vital to achieving good outcomes.

It's likely that investment in primary mental health is also very cost effective, and I say that based on international evidence as well as the intuitive logic that argues for intervening early to reduce demand on specialist mental health.  It's essential that our health services demonstrate value for money as well as good health outcomes.

As I'm sure many of you have heard already, the Government would like to see a more personalised primary health care system generally. The Ministry of Health has issued an Expression of Interest to attract proposals for more tailored primary care from eligible primary health providers.  Submissions are due to close on 14 October 2009. 

The Government also fully supports efforts being made in primary care to address mental health problems.  In the May 2009 Budget, the Government invested an additional $5.3 million for further development of primary mental health care services, bringing the total to $24.4 million for direct service delivery in the sector.

Te Rau Hinengaro: The New Zealand Mental Health Survey shows that about 20 percent (20.7%) of the population meet the criteria for a mental health and/or substance use disorder over a 12 month period, and almost 47 percent (46.6%) of the population are expected to have a mental disorder at some time in their lives.  During this time of economic downturn, the burden of mental health and substance use disorders is expected to further increase.

Primary mental health funding has enabled all 80 PHOs to establish primary mental health initiatives, targeted at people with mild to moderate mental health and/or substance use disorders.  Key components of these initiatives include:

• a. extended consultations with a general practitioner (or practice nurse)


• b. primary mental health coordinators,


• c. training and education for primary mental health practitioners, and


• d. packages of care for patients (like assessment and brief talking therapy interventions).

Professor Tony Dowell and his team from the University of Otago have recently published an evaluation of the development of primary mental health initiatives in New Zealand and the outcomes achieved to date.

The evaluation shows that, given appropriate resources and support, primary care can provide high quality, effective treatment and support to patients with mild to moderate mental health problems.

The evaluation included over 16,000 primary mental health service users and 80 per cent showed positive improvement.  These benefits were maintained at follow up after six months.

What is more, the rate of improvement for service users did not differ significantly between ethnic groups.  From what we know, it would be reasonable to expect about 35 per cent of patients to improve under ‘care as usual' conditions and fewer still to get better without any intervention at all.

I understand a more detailed presentation of the results was given by Professor Dowell this afternoon but this is an important evaluation, and is meaningful for future service development. 

The success of the initiatives has given us confidence that these approaches deserve ongoing support.  I'm optimistic that this investment will reap many benefits for New Zealanders.

There is work to be done to improve the experience of service users across our health services, especially where they are moving between primary and secondary care. One of the Government's priorities is to improve the integration between primary and specialist mental health services, so that more patients can be managed in primary care.  The challenge for all of us is to take the opportunity to make this happen, without compromising patient safety.

Central to further success is the notion of ‘stepped care.'  This recognises that mental health problems occur in different ways for each individual.  Care needs to reflect the level of severity of the problem, and the person's situation.  The idea is to match the patient's needs to the right level of intensity of the intervention.

Part of stepped care involves recognising the importance of self care, and ensuring information and support is provided to enable self care where possible.  We are fortunate to have John Kirwan helping New Zealanders in this respect.  The highly successful campaign on depression that he has fronted over the last three years will be extended into its next phase and will include a new online self-management programme that anyone can sign up to.  The online programme should be available by mid 2010.

This year it was a privilege to attend and launch the new Decision Support Tool in Wellington to support the recently published depression guidelines.  The tool will make it easier to assess the severity of depression, to access other resources, to encourage self management if appropriate and to make referrals.  The Decision Support Tool will also make it easier for GPs to encourage patients with mild to moderate depression to try the JK programme.  It will become part of a ‘toolbox' of options, like Green Prescriptions, that will support patient-controlled self-management.  GPs and mental health professionals will also be able to refer their patients to this programme, and support them in completing it and benefiting from the information it provides.

The programme is an early intervention approach.  It aims to prevent mental health issues getting worse.  It will also be an asset for those in recovery from more severe mental health problems, and help maintain their wellness.

I met John Kirwan when he was in NZ filming the next phase of the NDI, and saw some of the unedited footage.  It is inspirational, and certainly a departure from other online ‘e-therapy' interventions currently available.  It will be fascinating to see how many New Zealanders are prepared to translate their enthusiasm for the campaign into a six-week programme where JK coaches them into better health - both mental and physical.

I'm looking forward to seeing the final result once it has been trialled in the New Year.  It will be launched, alongside a series of new television ads, in early June next year.  The pre-testing results from the ads are extremely positive, building on the success of the previous series.

The internet provides primary care with fresh opportunities to address some of the unmet need for mental health services in a cost-effective way that allows service users more flexibility and often, easier access.

The Lowdown youth website and support services for young people is an excellent example of how the internet can be used to reach young people.  It arms them with information, encourages them to seek help for themselves and their friends, helps them to feel they belong to a relevant social network, and makes it easy to get help.  In their first 18 months of service, Lowdown Team counsellors have helped thousands of young people, many of whom would never dream of seeking help from a GP.  In the same time period, the Lowdown Team has intervened in 55 emergency situations where suicide was a risk.

Where appropriate, the Lowdown counsellor supports the young person to get to an appropriate local primary or mental health service.  They then follow up later to check that the young person is happy with the outcome.

I'm pleased to hear that most of them do report high levels of satisfaction with the primary care services they access.  But the point is; there might have been a very different outcome for these young people if they could not easily reach this support.

Another example of computer-based innovation is SPARX, a new e-therapy programme for young people developed by Dr Sally Merry and her team from the University of Auckland.  This programme is based on cognitive behaviour therapy but comes in the form of a computer game complete with different fantasy worlds, avatars and the latest interactive technology.  It is being trialled at the moment and will be available for use in primary care and school settings towards the end of 2010.

The Ministry will be funding more e-therapy services in the future as part of the primary mental health programme and an opportunity will exist for e-therapy interventions to be implemented in primary care.  All of these approaches will give primary care leaders the support they need to improve patient outcomes. 

Thank you for the opportunity to speak here tonight.  New Zealand has made good progress in mental health service provision.  We need to ensure the health sector is able to work collaboratively to achieve a more seamless approach to assisting people with mental health concerns.  The conversations we have tonight will go some way to meeting this challenge.  We are at a significant turning point in primary care development in New Zealand.  The challenge and opportunity is held with primary care practitioners to show leadership and support for improving patient mental health and wellbeing. 1600 words