Address by Mr. Tim O’Malley, T.D., Minister of State at the Department of Health and Children at the launch of the Primary Mental Health Care Initiative to the Mid-West Specialist Training Programme in General Practice on Monday 19th June in University of Limerick
At the outset, I would like to thank Dr. Griffin and Dr. Aherne for their very informative presentation. The Primary Mental Health Care Initiative is indeed a worthy programme which I understand is a collaborative initiative between General Practice and Psychology. I am aware that its objective is to contribute to the development and the provision of appropriate mental health care within the Primary Health Care Strategy.
The term ‘primary care’ is often used synonymously with ‘general practice’. While general practice is a key element of primary care, the term primary care encompasses a much broader range of health and social services, delivered by a variety of professionals, such as GPs, public health nurses, social workers, community welfare officers, welfare officers in places of employment, and many others.
Primary care is the first point of contact that the majority of people have with the health and personal social services. Primary care is the appropriate setting to meet 90–95% of all health and personal social services needs, including mental health needs. All but the most complex and acute health care needs of individuals, families and groups can be effectively met in the local primary care setting.
General Practitioners are the first, and, in many case the only health professionals to be involved in the management of a wide range of mental health problems. GPs are in a sense the ‘gatekeepers’ of mental health services, i.e. it is the role of GPs to detect and diagnose a mental health problem and either treat the individual themselves in the primary care setting, or refer the individual on to a mental health service. The typical mental health problems encountered by GPs are often centred on life events and social circumstances, such as bereavement or marital difficulties.
In line with government policy as outlined in the recently published “A Vision for Change” the philosophy of this initiative is to provide care in the community by offering the right level of intervention and support to enable people with psychiatric and psychological difficulties to achieve the maximum independence and control over their lives.
Currently, the treatment most usually offered to individuals with mental health difficulties in primary care is medication. However, there is good evidence that psychological interventions such as cognitive behaviour therapy and interpersonal therapies are often clinically effective as well as cost effective, and GPs and service users have expressed a desire for far greater availability of these treatments.
As a Pharmacist, an issue of particular concern to me is the widespread prevalence of polypharmacy; that is, the simultaneous prescribing of large numbers of drugs. Traditionally, polypharmacy has a negative connotation, implying an inappropriate or irrational use of multiple medications. While the use of multiple medications can sometimes be an effective clinical intervention, the degree of risk and benefit associated with polypharmacy varies depending on the medications used and of course the characteristics of the patient concerned.
Whilst alternatives to medication is a consistently strong theme when considering the future direction of mental health services, there must also be a very strong emphasis on the need for a far greater availability of mental health professionals within the community, particularly mental health nurses, psychologists, counsellors, occupational therapists and social workers. Whatever initiatives are established in the future, it is of the greatest importance that they are person-centred and take account of the resources and wisdom that already exist within the community.
This programme being launched today comes at a time when the primary care framework is being developed to enhance the provision of mental health services at primary care level across the country. Concerns about the failure to integrate mental healthcare into the primary care system and the poor links between community and hospital care were expressed in the consultation process undertaken on behalf of the Expert Group on Mental Health Policy.
One of the themes which permeated the consultation process which informed the development of every part of this policy was the need for greater access to psychological or ‘talk’ therapies. The demand for psychological and social therapies and the evidence for their effectiveness have been growing in recent years. The clear consensus among users and service providers was that they should be regarded as a fundamental component of basic mental health services, rather than as additional options that are not consistently available. In this regard, I welcome the information booklet and relaxation CD which is being produced for distribution to all GP’s. I am confident that both of these will be of benefit to service users.
I applaud your initiatives in providing low-cost, supervised counselling by qualified psychotherapists. A core objective of counselling is the empowerment of the individual. The personal resources of the person are drawn upon to help bring an undesirable personal situation to one where the person is in control of his/her own life and free from damaging influences. The fundamental principle of encouraging genuine personal communication and listening in our encounters with each other, and in particular with whose who are going through a “bad patch” needs to be emphasized. This helps to foster the confidence in the individual to face life events and to discover a way to cope with difficult situations.
There is a growing awareness among service providers that establishing a good quality of life for patients requires their involvement in the planning of the services that are important to them and which support their choices. The perspective of the patient and their families needs to be understood and appreciated. The vision that guides mental health policy requires that mental health services be characterised and led by a partnership between all stakeholders. A comprehensive mental health care system requires that services at all levels – from community support groups, to voluntary groups, to primary care, to specialist mental health services – work in an integrated, coordinated fashion for the benefit of all people with mental health difficulties. Your combined treatment card for use between psychologists /psychotherapists and GP’s which I understand is being piloted as part of this initiative will be of great benefit.
Looking to the future, the vision painted in the primary care strategy document “Primary Care: A New Direction”, is one where as many services as possible will be delivered at the level of the primary care team. The Specialist Vocational Training Programme in General Practice being launched today will endorse this vision. It is heartening to see that the HSE Mid-West is leading the way.