The Ministry of Health is working to expand New Zealanders’ access to, and choice, of primary mental health and addiction services.
Watch a short video on how the Integrated Primary Mental Health and Addiction (IPMHA) model works, and how it is already making a difference to people’s lives.
>[An older woman is sitting on a chair with flowers behind her, and then shown standing on her balcony drinking a cup of tea. She wears a grey cardigan, black glasses, and has her hair pulled back from her face.]
[An older woman is sitting on a chair with flowers behind her, and then shown standing on her balcony drinking a cup of tea. She wears a grey cardigan, black glasses, and has her hair pulled back from her face.]
[Voiceover] Everything just looked so dark, like you're sitting beneath a dark cloud. As if you've lost a loved one and the grief is so deep and so embedded. I didn't realize how much I was taking on board myself without even turning to ask for help.
[A series of people onscreen: a young man is looking at the sea, with his back to the camera. He has a backpack over one shoulder. Rangitoto Island is visible in the distance. A woman is shown in silhouette, looking out a sliding door with net curtains. Two men in white shirts sit at a desk, facing a computer.]
[Over these images, white text reads: Each year, one in five New Zealanders experience mental health or addiction issues. Local general practices are the ideal place to provide free, skilled support for people’s mental wellbeing needs.]
[Title graphic: Integrated Primary Mental Health and Addiction Services in General Practice]
[Jo Chiplin, from the Ministry of Health, sits in an office.]
We're all very aware that we need to transform our approach to mental health and wellbeing in this country, and that's about recognising and responding to distress earlier, giving people greater access to support and greater choice of the supports that are available to them, and doing that in a way that's just part of their routine healthcare.
[Jo is shown talking to another woman]
This approach involves three new roles: health improvement practitioner, or HIP, who's the mental health professional embedded within the general practice team. Working alongside them is a health coach and a support worker. Sometimes they’re combined roles, sometimes they're separate.
[Graphics on screen: Health Improvement Practitioner, Health Coach, Health Support Worker]
The key focus of those roles is to help people learn how to manage their own mental health and well-being and to link people to community supports when they need them.
[Cindy Sharon, a Health Improvement Practitioner in Auckland, sits facing the camera.]
So a HIP is a generalist. We see people of any age for any issue that's impacting on their health and well-being, so one of the great benefits of a HIP in your practice is there is no referral criteria. If someone presents on the day and they need some assistance, we are there for any issue. So that means if someone comes in and they're in distress that day, they don't need to have a referral out, they don't need to wait several weeks - they can see us literally within 10 to 15 minutes.
[Dr Andrew Miller, a GP from Whangarei, stands with his arms crossed, smiling and looking at the camera. Then he is shown sitting at his desk in his office, with medical equipment behind him.]
The benefits to actually having a health coach and health improvement practitioner in the practice is that we can now ask people what really matters to them and deal with it on the spot right away. So it makes us so much more confident about asking people what really matters and then being able to do something immediately.
[Dr Tim Hou, a GP in Auckland, is shown at his desk.]
Oh, it's been a game changer for us. I think in the 20 years that I’ve been in general practice this is probably the model that stands out as the best innovation that I’ve had any experience with. There are no barriers to referral.
[Dr Hou talks to a patient, then walks down a corridor and introduces the patient to the Health Improvement Practitioner]
[Voiceover] In fact, we just walk them down the corridor when we have an issue and knock on the door and generally that's it. That’s the referral process.
[Tania Windleborn, a Health Improvement Practitioner in Kaitaia, sits in her office as she speaks to the camera.] You can help that person on that day go away with a plan that is going to help them.
[Tania and Herepete Herbert, a Health Coach, talk in a corridor, then Herepete is shown working with people in their homes.]
[Tania Windleborn Voiceover] I’m clinic based and the health coach is community and clinic based. I often describe him as the octopus going out and gathering up and visiting people.
[Herepete Herbert sits in his office, with a colourful chart on the wall behind him]
On top of the medical issues that they come in to see the doctor, we can support them with whatever social issues that they're dealing with.
[Michelle Ball, Implementation Lead, Northland, sits facing the camera]
So what really excites me about this model is that it's people-centred, it's bringing services to where people feel most comfortable to come to.
[Scenes of a Health Improvement Practitioner working with a client, demonstrating breathing exercises.]
[Voiceover] And it's providing resources when they need the most. They don't have to wait, they don't have to go and see somebody they don't know, it's right there at their general practice.
[Dr Andrew Miller shows a patient and Health Improvement Practitioner into his office, followed by scenes of the practice staff having a meeting together.]
[Voiceover] Now I can confidently ask people what matters to them. I am finding at least 80 percent of the time it's stuff that sits outside health, to do with parts of their life that are negatively impacting on their well-being. And I need to sort those things out if I want to really care for people properly, and now I can.
[Jo Chiplin talks to the camera again]
It's new, it's transformative, we need to understand what works well, we need to understand the challenges, and we need to be flexible enough to make sure that this works for each practice and the community that they serve.
[The woman from the start of the video is show walking into a room with Tania Windleborn, the Health Improvement Practitioner in Kaitaia. Both women are smiling. The woman is shown in her house again.]
I felt like with all this help that was put in place that we were just… they were all helping me to walk through it. You know when you're a child and you've got your friends and you're all walking together holding hands? That's what it felt like for me. That's what I felt.
[Screen fades to white, with black text: with this approach there are no barriers to people seeking help with their physical health, mental health or addiction issues. It connects people to the support they need within the practice or the wider community.]
[Video ends with a graphic of the Ministry of Health logo]
About Integrated Primary Mental Health and Addiction services
In response to He Ara Oranga, the Report of the Government Inquiry into Mental Health and Addiction, Budget 2019 invested $455 million over four years to expand primary mental health and addiction services, enabling people with mild to moderate needs to access free and immediate mental wellbeing advice and support, when and where they need it.
A key workstream in this “Access and Choice” work programme is the Integrated Primary Mental Health and Addiction (IPMHA) service. The IPMHA model provides easy access to mental wellbeing support available in GP sites across the country. Other workstreams include those focussed on the expansion and development of kauapapa Māori, Pacific and youth specific services.
The IPMHA programme reduces waiting times and barriers to access with 43% of people being seen on the same day they asked for support and the vast majority being seen within 3-5 days.
No longer do people in a participating general practice need to meet specific criteria to access support – services are available for anyone whose thoughts, feelings or actions are impacting their health and wellbeing. There is often no wait time and there is no additional costs for the person seeking support.
Under the IPMHA programme, a Health Improvement Practitioner and Health Coach/Support Worker work as a part of the team providing the person with immediate support and tools for wellbeing. Notes are written directly into the practice-based Patient Management System (PMS) and ‘warm handovers’ ensure that the practice team members can make an introduction when the need arises and are kept updated with patient information. Additionally, IPMHA services are able to adapt to meet the health needs of their local community.
The programme builds on the mental health and addiction expertise that already sits within general practice teams, and strengthens the collaboration and ties between general practices, non-government organisations, and DHB-led secondary mental health and addiction services.
Progress to date
In late 2019, we began rolling out IPMHA services progressively across 15 DHB areas. In May 2021, the next phase of the programme got underway with services now rolling out in all 20 DHB areas. At the end of the 2020/21 financial year, June 2021, there were 237 GP practices offering the services with more starting each month.
Over 12,000 people are being supported by these services each month, and from the data and feedback we have received, we know that these services are making a difference to people’s lives.
What people are saying about the service
Feedback from a person who used the IPMHA service in 2020
“I struggled with depression and anxiety for my whole adult life. The Health Improvement Practitioner and Health Coach helped understand why I was thinking the way I was. Explained simply and was easy to understand. I was given activities, mindfulness techniques and lots of other resources. I like going to see them, much prefer that over a phone call…”
Feedback from a Health Improvement Practitioner
“An elderly Kaumātua presented to our general practice requesting support for his anxiety. As a Health Improvement Practitioner I have worked with many Kuia and Kaumātua and his presentation was a familiar one. He was tough, resolute and someone the local community goes to for awhi, tautoko and manaaki. And yet here he was asking for awhi, tautoko and manaaki for an issue he had lived with most of his life. We worked together, and he was able to go away with practical skills he can use every day. This has supported him to maintain his mana amongst the community, as well as his own wellbeing.”