Increasing funding for mental health services has been a popular promise during the campaign months. And those at the coalface, like Counties Manukau’s Dr Pete Watson, know only too well how more resources could improve things.

Despite this, Watson – head of mental health and addiction services at the South Auckland District Health Board (DHB) – is marking eight months into a new community mental health model aimed at achieving better outcomes without relying on extra cash.

The integrated approach, first implemented on a wide scale in schools and GP practices in the semi-rural Auckland district of Franklin in February, involves teaming up specialist mental health clinicians with guidance and health staff at schools and family doctor clinics to improve overall mental health services.

Watson, whose DHB catchment area includes some of New Zealand’s most deprived communities, compared the new approach to “redesigning the plane while we’re flying it”.

“Mental health just can’t sit in a community clinic and wait for people to show up – that’s great for people who show up, but what about all the people who don’t show up,” Watson says.

“We need to get mental health to the school nurse, the practice nurse or to the GP, so we can do a better job of figuring out mental health issues and what they might do about it.”

According to the most recent Ministry of Health statistics, less than 40 percent of people who died by suicide or undetermined intent between the ages of 10 and 64 were mental health service users.

In Counties Manukau, Watson – based at Middlemore Hospital – says that statistic sits between 10 and 20 percent each year.

Accessing that “majority”, which are not known to mental health services when they die, is crucial to addressing suicide rates, as well as overall improvements in the mental health system, the clinician stresses.

“We’re not starting off and all of a sudden the system’s different – we’re growing it. “

– Dr Pete Watson

In a diverse community like Manukau, tapering systems to suit those most at risk is essential.

“There’s been quite a few young people who have died by suicide at the age of 18 in Counties [Manukau] and none of them have been in our service. It’s hard to know what you’ve done when they’re not here,” Watson says.

“The groups we know which have the highest rate, and the least access into service, are young people, and are Māori. Pācific people have low rates of access, but comparatively … are also smaller numbers in terms of suspected deaths by suicide.”

Running a team approach to mental health through schools and GP practices underpins the integrated care model, which has worked well in Franklin, he says. By the end of this month, Watson hopes to have more schools and practices in other parts of South Auckland involved.

As part of the model, Watson is working with staff at Papatoetoe’s Aorere College. Each week, key health and support staff at the school, including guidance counsellors, nurses and social workers, meet to discuss any students struggling with mental health. Watson, whose background is in youth mental health, alternates weekly attendance to those meetings with another specialist mental health clinician.

“They run through lists of people they are each dealing with where they’re concerned, and there might be a question where somebody says should we worry about this,” he says.

“I might provide advice about how to approach a family, or advise that what’s going on here might reflect this [situation or challenge] in their life.

“They also might have somebody who they know is in mental health services but they don’t know what’s going on, because we’re all working in silos, so I create that bridge. And if there was an emergency there – say they had somebody that was having a crisis – then I might help them then and there to do it, but that’s not my primary job. It’s not to see people,” Watson says.

An approach like what is happening at Aorere College is “adding to the capability” of those who interact frequently with people who might need help for mental health problems, but are least likely to access services.

It’s trying to support that “majority” which at the moment are not known getting into services when they need to, he says.

“I think it’s what everybody has been asking for … but changing a system, it’s really difficult – and of course, we’re doing it within the existing resources.

“We’re not starting off and all of a sudden the system’s different – we’re growing it. We’re rolling it out slowly and growing it as people want it,” Watson adds. 

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