The Primary, Secondary and Tertiary Health Sectors in New Zealand With Specific Reference to Mental...

7/30/2019 The Primary, Secondary and Tertiary Health Sectors in New Zealand With Specific Reference to Mental Health

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The Primary, Secondary and Tertiary Health sectors

with specific reference to the provision of

mental health services.

The delivery of modern health care depends on groups of trained professionals who come together

as interdisciplinary teams. All the professions work together for the good of the client, with the

professions supplementing each others input towards more effective and comprehensive service

delivery.

These professionals function at three levels or tiers of health care, or in three sectors i.e.

Primary, Secondary and Tertiary. The choice of the words levels, tiers and sectors is misleading as

it suggests that the primary, secondary and tertiary health services are discreet categories. In fact

the distinctions between the levels have become increasingly blurred. Increasing numbers of clinical

staff are working across the boundaries particularly between primary and secondary care.

The three levels, tiers or sectors are more accurately described as a continuum with primary at

the bottom, secondary in the middle and tertiary at the top. Consider the graph below, which

attempts to show that the three levels flow into each other, just as the colours do:

Even though the boundaries are uncertain, we can still describe and define the essence of each of

the three levels of service.

Primary care is the term for the health care services usually offered in the local community, i.e. not

in a hospital setting. It refers to the work of health care professionals who act as a first point of

consultation for all patients/clients within the health care system.

Primary care is usually provided by general practitioners and their attached and associated staff such

as nurses, along with other professionals such as physiotherapists and dieticians. It also includes

local pharmacists. It is important to note that the patients general practitioner remains the central

hub around which all treatment, assistance or therapy is implemented. If for example a patient seeks

advice or help from a dietician or psychotherapist as a first point of call, these professionals are

obligated to (a) inform the general practitioner that his/her patient has solicited their help and (b) to

keep the general practitioner informed of progress and outcome.

Primary care is also strongly oriented towards prevention, along with cure. This is where support

workers come into the picture. Part of their duty is to actively promote social well-being and a

fulfilling and productive life style for their clients, as this is the strongest defence against the onset of

mental illness and relapse.

Tertiary

Secondary

Primary
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By pursuing its focus, the Better, Sooner, More Convenient health policy seeks to:

Keep people healthier in the community for longer. Be prevention oriented, i.e. identify problems earlier, when they can most effectively be

addressed.

Reduce unplanned, urgent hospitalisations. Utilize the full range of skills of clinicians and support workers, following a team

approach.

Extend training, so that people with no formal health qualifications can perform workwhich helps protect the health of the community.

Two key organizational players in the primary health care sector are Public Health Organizations

(PHOs) and Non-Governmental Organizations (NGOs). While PHOs are allocated funding for health

promotion in line with their population base, most NGOs are dependent upon government contracts

to provide specific services.

Examples of NGOs and PHOs involved in Mental Health in Gisborne, New Zealand are:

Te Kupenga Net Trust

Supporting Families Challenge Trust

Ngati Porou Hauora

Examples of professions and roles typically found in one or more of the sectors:

Psychotherapist

Psychotherapists are trained to do psychotherapy. They help individuals, couples and groups to see,

think, feel or act differently and overcome general life problems they are experiencing with various

types of psychotherapy. Psychotherapists are typically found in the primary sector and often act as a

first point of call.

Clinical Psychologist

Like Psychotherapists, Clinical Psychologists do psychotherapy, but are additionally extensively

trained in mental illness and psychological tests, which given them an added diagnostic function.

They are trained to assess various psychological constructs such as personality, emotion and

intelligence. The information that the psychologist provides is usually used to generate a more

accurate and comprehensive picture of a clients current state, for use in treatment planning and

referral. They are equally at home in the primary and secondary sectors.


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Occupational Therapist

This is the professional group that uses activities and occupations to enable people to recover frommental illness. They work with people to regain lost abilities, or to develop new skills and interests.

Occupational therapists are found in both the primary and secondary sectors.

District Inspector

They are the watchdogs of patients rights, ensuring the Mental Health act is correctly applied and

the rights of individuals are respected and upheld. They are appointed by the Minister of Health

under the 1992 Act. They are always Barristers or Solicitors and this role is conducted in addition to

their usual legal practice. Their role does not include being the patients advocate or legal advisors

for mental health services. They visit every individual subject to the act and provide them withinformation on the process, explain their role, the patients rights and discuss options for review. As

their role is to oversee patient rights, more particularly where patients are treated or assessed

involuntarily, they are therefore chiefly active in the secondary and tertiary sectors.

Duly Authorised Officers

They are the front line operators of the Act. They are appointed by DAMHS (Directors of Area Mental

Health Services) and are trained mental health professionals. They should have identifying cards

provided by the Hospital or Health Service. They usually staff a 24/7 service and are there to assist

anyone who applies for an assessment of a person for whom there are mental health concerns. Theycan also help an individual make an application for assistance themselves. Their job often entails

responding to crisis situations. They consider clients diagnostically and then make their decisions as

to whether further diagnostic examination and/or treatment is necessary, and also whether such

examination or treatment should be compulsory. District Health Boards keep a list of their telephone

numbers so that you or your family or whanau can ring if you need help or advice. DAOs work in the

secondary sector.

Psychiatrist

This is a qualified medical doctor who has obtained additional qualifications to become a specialist in

the diagnosis, treatment and prevention of mental illness and emotional problems. Given the

psychiatrists level of specialization, they work in the secondary and tertiary sectors.

Responsible clinician

Every person undergoing compulsory examination or treatment, must have a responsible clinician.

This is usually a psychiatrist and is the person responsible for a persons treatment while they are

under the Mental Health Act. They are found in the secondary sector.


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Mental Health Nurse/Psychiatric Nurse

These people provide treatment, care and support for people with emotional, mental and

behavioural problems. They increasingly work in community settings, but the majority work inhospital outpatient or outpatient settings. They are skilled in the specialised use of communication,

counselling, psychopharmacology, applying speciality knowledge in the provision of clinical

assessment, monitoring, therapeutic interventions, treatment, and referral to other health

professionals. Some have special responsibilities under the Mental Health Act 1992 as duly

authorised officers. They are found in all three sectors.

Mental Health Support Workers

They are mainly employed in the non-government community support services sector. They provide

support and practical assistance and deliver rehabilitation services or programmes that facilitate therecovery process for people experiencing serious mental illness or emotional distress. They are

closely aligned with the primary sector.

Social Workers

These people look after social and practical needs such as family assistance, welfare benefits,

housing, jobs and so on. They are typically found in the primary and secondary sectors.

Clinical Specialists, previously known as Keyworkers

Clinical specialists are usually psychiatric nurses or social workers, and work for DHBs mental health

services. They form the link between the DHBs Mental Health Service and the client and are

responsible for implementing the clients management/treatment plan as developed by the various

mental health professionals involved with the client. They often work closely aligned with mental

support workers and will visit clients in their homes if its part of the management/treatment plan.

Of all the roles typically found in the DHBs mental health system,they are often closest to clients

and take responsibility to coordinate treatment options for them. At the moment they are more

likely to be found in the secondary sector, but given their role of active and ongoing contact with

clients/patients and their support workers, often find themselves defined as part of the primary

sector.

This document compiled and integrated from various sources on the www.

Intended use: National Certificate in Mental Health and Addictions Support

CMHA 401. Context and Safety

Tairawhiti Campus, 2012

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