Quality Standards for Diabetes Care Toolkit

Mental health or cognitive problems

The Ministry of Health (2009) suggest the following as key primary health service requirements for older people:

Give greater attention to detecting and treating mental health and substance use problems among older adults in primary care, particularly those with chronic health problems.

Be sensitive to the possibility that falls in older adults may be the result of AOD problems.

PHOs, Integrated Family Healthcare Centres (IFHCs) and other primary health care organisations have contracts for packages of care with non-governmental organisations (NGOs) specialised in mental health and addiction treatment for older people.

Potentially give lower doses of drug medications (according to best clinical practice) and monitor adverse side-effects more closely (BPAC 2008).

Assess and promote good mental health for carers of older adults.

Use a range of mental health screening measures with older primary care patients, including abbreviated versions of the following: Geriatric Depression Scale (GDS), Patient Health Questionnaire (PHQ), Beck Depression Inventory (BDI), General Health Questionnaire (GHQ), Center for Epidemiological Studies Depression Scale (CES-D) and Beck Anxiety Inventory – Primary Care (BAI-PC). The GDS, GHQ and CES-D have been validated with different ethnic groups and are available in multiple languages.
Based on the Ministry of Health’s (2009) guidance on primary mental health care document, Cosgriff (2009) makes a number of recommendations for improving outcomes for people who have developed metabolic syndrome or have increased cardiovascular risk as a result of being on antipsychotic medication. These include:

early cardiovascular risk assessment by either the mental health clinician or GP

routine monitoring programme for all patients prescribed antipsychotics according to established guidelines (eg, those set by the National Mental Health Metabolic Working Group in 2006). The National Institute for Health and Care Excellence (NICE) guidelines on schizophrenia recommend that primary care is best placed to monitor and manage the physical health needs of these patients (NICE 2002)

intervention programmes which are specially tailored to meet the needs of people with long term mental disorders and can be accessed from either primary care or secondary mental health services

clear roles and responsibilities of the primary care and mental health practitioners with respect to patients’ total health care

opportunities for further education and professional development about the clinical issues, implications, and available interventions.

Intellectual disability

Closer alignment of physical and mental health services is recommended as mental illness is commonly overlooked or misdiagnosed in people with intellectual disability. The Ministry of Health (2009, p 69) proposes the following as key primary mental health service requirements for people with disabilities. While focused on primary mental health services these requirements are also relevant to primary health care practitioners.

Primary health care practices are set up to enable people with disabilities easy access to the service, including:

physical access, eg, ramps

format of health information, eg, provision of information in Braille, easy-read, or highly visual format

access to sign language and interpreting services.

Primary mental health practitioners should have a broad understanding of disability issues.

Primary mental health practitioners are skilled in detecting depression and other mental health and/or substance use problems in people with disabilities; and in undertaking mental health screening for people with disabilities.

Primary mental health practitioners monitor people who have a disability and a mental health and/or substance use disorder closely.

There is more collaborative care and integration between primary health care, specialist mental health and disability services.

There is better coordination of care for patients who have co-morbid disabilities and mental health or substance use disorders.

Primary mental health practitioners are skilled in linking service users with disability support services.