Melbourne, Australia | October 3, 20081 |

Mental Health and Physical

Health: The Role of Primary Care

Mental Health and Physical

Health: The Role of Primary Care‘World Mental Health Day 2010

Dr Gabriel Ivbijaro MBBS FRCGP FWACPsych MMedSci DFFP MA

Chair Wonca Working Party on Mental Health

Editor in Chief Mental Health in Family Medicine

http://www.globalfamilydoctor.com/

http://wwpomh.ning.com/

WMHD 2010

http://wwpomh.ning.com/

Thanks:Service usersSpeakersSponsorsWFMHWonca EuropeWonca WorldConference Organising

committee

All of you!

Wonca & WHO: A joint collaborationWonca & WHO: A joint collaboration

World Mental Health DayWorld Mental Health Day

Current trends (WHO 2008)Current trends (WHO 2008)

Too much emphasis on centralization can lead to:

– Increased fragmentation– Reduced access– Increased costs– Difficulty attaining holistic

care

This emphasizes the need for primary care reforms

World Health Assembly Report 2009World Health Assembly Report 2009

A European initiativeA European initiative

Evidence based summary – health & primary care

Evidence based summary – health & primary care

• Countries with strong primary care have:• Lower overall costs

• Generally healthier populations

• Within countries, areas with:• Higher primary care physician (but NOT specialist)

availability have healthier populations

• Higher primary care physician availability have reduced adverse effects resulting from social inequality

Gap in human resources:Number of psychiatrists per 100,000 population

Primary care for mental health must be supported by other levels of care including : community-based and

hospital services

informal services

and self-care

Meet the full spectrum of needsMeet the full spectrum of needs

An example of what can be done through collaboration

43.58% of all older people in Waltham Forest (aged 65+) have been sent questionnaires and more than a quarter of those have been referred for Single Assessment

Over 3000 older people received services following Single Assessment, over 70% of these

were provided in the voluntary sector

Statistical Summary 2002-2009 TotalTotal questionnaires sent out 10416Total questionnaires returned 4941Conditions identified 5164Older Adults indentified per Risk Factor (not known to services)Falls 01 (fallers) 248Falls 02 (at risk of falls) 885Functional decline 504Continence 467Memory 845Depression 122Social Interaction 1466Referred for single assessment 2543Older Adults (OA) over 65 years of age (2008) 23,900Percentage of OA sent questionnaires (of total population) 43.58Percentage of OA referred for single assessment (of total population) 10.64

% of patients diagnosed with dementia whose care has been reviewed in the previous 15M – WF (without exceptions)

% of patients diagnosed with dementia whose care has been reviewed in the previous 15M – WF (without exceptions)

Fig. : of patients diagnosed with dementia whose care has been reviewed in the previous 15M in WF by polysystem 2009-2010 provisional without exceptions (QOF target is 60% ).

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Handsw

orth Avenue

York Road M

edical Practice

Ridgew

ay Surgery

Old C

hurch Surgery

Churchill M

edical Centre

The Microfaculty

Larkshall Medical Practice

Kings Head M

edical Practice

Chingford M

edical Practice

Dr O

raelosi & Partners

Allum

Medical C

entre

SMA M

edical Centre

Craw

ley Road M

edical Centre

High R

oad Surgery

Leyton Green N

eighbourhood Health Service

Leyton Healthcare

Lyndhurst Surgery

Green M

an Medical C

entre

Agarw

al Practice (Langthorne HC)

Thatched House M

edical Centre

Lime Tree M

edical Centre

Harrow

Road Surgery

Francis Road M

edical Centre

Kiyani Medical practice

Sharma fam

ily practice

Ham

pton Medical C

entre

Vicarage R

oad Medical C

entre

Orient Practice

The Firs

Penrhyn Surgery

Dr Phillips &

Dr Patel

The Manor Practice

Forest Surgery

Queens R

oad Medical C

entre

Brunner R

oad Medical C

entre

St James H

ealth Centre

Grove Surgery

Wood Street H

ealth Centre

Addison R

oad Medical C

entre

Forest Road M

edical Centre

WF C

omm

unity & Fam

ily Health Services

Higham

Hill M

edical Centre

Hayat M

edical Centre

Dr J B

ailey

Dr A

Siddiqui

Clarem

ont Medical C

entre

Dr Shui

WA

LTHA

M FO

REST

All practices have achieved the national target of 60% without exceptions

Primary care for mental healthPrimary care for mental health

Primary care for mental health forms an essential part of both:

• comprehensive mental health care • general primary care.

General health care

Primary care

Mental health care

Primary care for mental health

Primary care for mental health must be supported by other levels of care including : community-based and

hospital services

informal services

and self-care

Meet the full spectrum of needsMeet the full spectrum of needs

UK Attitudes Survey 2008UK Attitudes Survey 2008

More worldwide health indicators More worldwide health indicators

More primary care access associated with better infant mortality and maternal mortality rates

mental health Gap Action Programme Scaling up care

for mental, neurological and substance use disorders

mhGAP

(WHO World Mental Health Consortium, JAMA, June 2nd 2004)

Gap in treatment:Serious cases receiving no treatment during the last 12 months

0

10

20

30

40

50

60

70

80

90

Developed countries Developing countries

Lower range Upper range Lower range Upper range

35%

50%

76%

85%

mhGAP 2009

Mobilizing a global response:Five barriers to implementation

Political will to address mental health is low:

Incorrect belief that mental health care is cost-ineffective

Inconsistent and unclear advocacy between different groups of mental health advocates (professionals, users, families) and within each group

People with disorders are not organized in a powerful lobby in many countries

mhGAP 2009

Wonca CollaborationWonca Collaboration

World Mental Health DayWorld Mental Health Day

World Mental Health Day – An Opportunity for Change

World Mental Health Day – An Opportunity for Change

gabriel.ivbijaro@gmail.comgabriel.ivbijaro@gmail.com

Thank you!