Fit for the Future Evaluation

The problem

People with mild to moderate mental health needs — often referred to as the “missing middle” — have historically been underserved by existing services. Many of these individuals bring strengths and lived experiences that could be better supported by a more responsive, holistic, and integrated approach to mental wellbeing.

They may not meet the thresholds for secondary mental health services, yet often seek support earlier in their wellbeing journey. Many navigate complex life circumstances with resilience, such as housing pressures, employment challenges, and cultural disconnection. However, systemic barriers have limited their access to timely, culturally affirming care.

The existing system had limited capacity to provide coordinated support or effectively integrate clinical and community-based services, particularly for Māori, Pacific peoples, young people, and low-income communities—groups whose strengths and aspirations have often been overlooked.

Our approach

Synergia was engaged to evaluate the implementation of Enhanced Integrated Practice Teams, a key initiative within the Fit for the Future (FftF) programme.

This model introduced three complementary roles into primary care settings:

Health Improvement Practitioners (HIPs) – registered mental health clinicians who deliver brief, timely interventions to support clients' mental wellbeing.
Health Coaches – non-clinical wellbeing partners who empower clients through motivational support, lifestyle guidance, and holistic navigation.
Awhi Ora – culturally grounded, community-based support that helps individuals and their whānau manage social determinants of health in ways that reflect their values and aspirations.

The evaluation used a mixed-methods approach designed to elevate client voices, capture practitioner and provider perspectives, and assess system impacts. It included:

Quantitative measures such as the K10 Distress Scale, Duke Health Profile, PHQ-9, and the Patient Activation Measure.
Client experience surveys and feedback from individual sessions.
Qualitative interviews with clients, kaimahi, and providers across sites.
Analysis of referral patterns, service delivery data, and demographic reach.

A co-designed framework of 12 principles, grounded in person-centred, holistic, and equitable care, guided the evaluation process.

Impacts

The evaluation and monitoring framework delivered several key benefits to PHARMAC:

Service Outcomes

Timely Access: 55% of HIP clients and 69% of Health Coach clients were seen on the same day, with over 88% seen within five working days.
Equity Advancements: Māori and Pacific clients engaged with services at rates exceeding their enrolment proportions in practices, particularly in high-priority communities.
Improved Wellbeing: 70% of Awhi Ora clients showed reductions in distress scores (K10). Over 90% of all clients rated their sessions as “very helpful.”

Client and Whānau Experience

Culturally Safe Engagement: Services were frequently delivered in te reo Māori and Pacific languages, affirming identity and building trust.
Whānau-Centred Support: The involvement of kaiāwhina and culturally grounded practitioners ensured that care addressed the needs of the individual and their whānau.

System-Level Benefits

Improved access to early intervention for people who had previously disengaged from formal health services.
Strengthened the ability of primary care to deliver appropriate support, reducing reliance on external referrals.