frequently occur after settlement (Ministry of Health 2001). PHOs need to be aware of these factors if they have enrolled migrant communities. Rural communities Providing primary mental health care in rural areas may offer particular difficulties because of the remote location of many members of the enrolled population and distance from other health care providers and services. PHOs will need to identify and develop links with other providers, not only within local communities but in distant cities to ensure effective service delivery. Specific areas to consider include: • developing and maintaining a rural workforce skilled in mental health service provision • improving access to support and advice for practitioners from distant providers • improving access to specialist mental health services • using innovative delivery models such as telepsychiatry clinics • using mobile outreach services.
Primary Health Organisations: 13Service development toolkit for mental health services in primary health care Physical health needs of service users People who have long-term needs for mental health services and support often have poor physical health compared with the general population. An Australian study of 240,000 people over 20 years who had contact with mental health services compared their mortality and hospital admissions with the general population. This report concluded: • people with enduring mental illness had poor global health outcomes and early mortality from both under-diagnosed and under-treated physical illnesses • behavioural factors, particularly smoking, alcohol and other drug use, lack of exercise and poor nutrition, were important contributors to their increased mortality • their physical health also suffered because of side-effects and complications associated with medications prescribed for their mental health. It is now generally recognised that: • mental health operates as an independent risk factor for the development of physical disease • there is a higher incidence of mental health disorders in people with chronic physical health problems • there is a higher rate of physical health problems in people with mental health disorders. Therefore, it is essential that there is greater collaboration between primary health care practitioners and specialist services, so the physical health outcomes of all mental health service users are improved. Further information Abbott M. 1997. Refugees and immigrants. In: PM Ellis and SCD Collings (eds) Mental Health in New Zealand from a Public Health Perspective(pp 250–64). Public Health Report Number 3. Wellington: Public Health Group, Ministry of Health. Druss BG, Rohrbaugh RM, Levinson CM, et al. 2002. Integrated medical care in a mental health clinic improved quality of care and outcomes in serious mental disorders. Evidence-based Mental Health5: 46.
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