1. Future directions for primary mental health care Rotorua July 2010

2. “ Single system, personalised care” “ Patient-centred integration”

3. Stepped care model STEP 5 Com-plex STEP 4 4.7% severe disorders STEP 3 9.4% moderate disorders STEP 2 6.6% mild disorders STEP 1 Adjustment problems; distress; subthreshold symptoms 79.3% of population no disorder Early identification of vulnerability Integrated family health centres Primary health care services Specialist mental health and AOD services PHQ=10-14 Brief Xmt Extended GP consultations; monitoring; green prescriptions; e-therapy; self-help books; education groups Pathway to secondary care First point of contact Supportive environment & health promotion eg, NDI, Like Minds, self-care, whānau ora, housing, employment, education, social network PHQ<10 Ultra-brief Xmt Advice, support, psycho-education PHQ=15-19 Low intensity Xmt Holistic assessment to determine patient needs; POC; guided self-help; SSRI PHQ ≥ 20 High intensity Xmt A range of talking & drug therapies Longer term Xmt ( for complex and/or chronic disorders)

5. 1. Provide personalised, patient-centred care

7. 2. Achieve seamless, integrated care

10. 6. Build workforce capacity and capability

13. 12. Improve performance & quality

16. Recommended screening/outcome measures for PC settings Individual, interpersonal, social & overall wellbeing Children & adults CDOI DSM-IV disorders Adults Mind Screen Depression Youth RADS Depression Youth & parents SMFQ Behavioural & emotional probs Children, youth & parents SDQ AOD misuse Youth SACS Alcohol Adults AUDIT & AUDIT-C Lifestyle issues Adults CHAT Anxiety Adults GAD-7 Depression & anxiety Adults K10 Depression & anxiety Adults PHQ-4 Depression Adults PHQ-9 Common physical & psychological probs Adults GHQ-12 Problems Population Measure