By Dr Lyn Littlefield OAM MAPS, APS Executive Director
THE Federal Government’s Better Outcomes in Mental Health Care (BOMHC) initiative aims to improve the quality of care provided through General Practice to Australians with mental health problems. It provides education and training, as well as incentive payments for assessment, mental health planning and review, and MBS items for GPs to deliver, focussed psychological strategies, improved access to psychiatric support through case conferencing and emergency telephone consultation, and access to allied health services.
Allied health services are provided via GP referrals in the context of the Three Step Mental Health process. Appropriately skilled, qualified and experienced allied health practitioners will provide up to six sessions of evidence-based, focussed psychological strategies approved for funding under this initiative, with a further six sessions being available following review by the referring GP.
These services will initially occur through Allied Health Pilot Projects administered by the Divisions of General Practice (DGPs). Earlier this year, DGPs were invited to submit projects in which allied health practitioners would provide assessment and psychological treatment services to patients who had mental health problems. In these projects, allied health professionals may be directly employed by the DGPs, or contracted as private providers (or a mix of both), and some current services may be expanded.
Recently, BOMHC released the list of funded Allied Health Pilot projects.As an indication of the level of support provided by the Department of Health and Ageing, 16 projects have been funded: far more than originally intended. The projects vary in location, target population, method of service delivery, and in particular how the allied health professionals will work with the GPs. Below are listed the DGPs selected, and a brief outline of the projects.
BOMHC Allied Health Services – Funded Pilot Projects
- Brisbane Inner South and Bayside (Qld): Mental Health Partnerships in Primary Care – Mental health professionals, offering a multi-disciplinary approach, will provide individual and group psychological interventions for patients with anxiety and depression, as well as assist GPs in the development of mental health plans. Services will be offered in metropolitan and outer metropolitan GP and allied health practices, community and hospital settings, and will include home visits.
- Logan Area (Qld): Mental Health Team Care Project – Catering for a extremely varied cultural and low socio-economic population of this urban fringe and rural area, the program will provide individual and group interventions through service contracts with individual psychologists, who will also assist GPs to develop mental health plans.
- Sunshine Coast (Qld): Allied Health Pilot – Targeting adults and youngpeople with a diagnosable mental health disorder, this program will offer interventions at two rural and two provincial locations. Focussed psychological strategies will be provided by an employed psychologist and a social worker, as well as by sessional psychologists, offering up to five individual sessions and one group session per patient.
- Toowoomba (Qld) General Practice and Allied Mental Health Care: Integrate for Recovery – Individual and group interventions for patients at risk of mental disorders will be provided by accredited health professionals (mainly psychologists). Individual treatment will occur in GP practices, and group treatment in community venues.
- Fremantle Region (WA): Increasing Consumer Access to Mental Health – Allied health service providers will be engaged on a sessional basis to provide short-term, individual psychological interventions, care planning and case conferencing with the GP and consumer. Services will be located in metropolitan GP practices.
- Perth and Hills Division (WA): Healthy Minds Pilot – Targeting the adult population, this program aims to involve psychologists, social workers and mental-health nurses in providing health services, including psychological interventions, to CALD and Aboriginal populations in the urban and rural fringe catchment area through GP practices or through community-based, multicultural, non-Government organisations.
- Adelaide Northern Division (SA): Northern Wellbeing – Patients over 16 years of age who present with a range of anxiety disorders or depression will receive up to five sessions of CBT with clinical psychologists, followed by outcome evaluation and the possibility of a further five treatment sessions.
- Top End-Darwin (NT): CBT – Group and Individual Sessions for Depression and Anxiety – Aiming to provide increased access to services for Darwin’s multicultural population, patients presenting with depression or anxiety will be offered CBT interventions in either group or individual sessions, by clinical psychologists at the Northern Territory Rehabilitation Service.
- Central Australian Division (NT): Fund Holding in the Bush – Allied health services will provide training and support to build the capacity of health teams and improve services in remote central Australian locations and Aboriginal community settings. Services will be flexible and tailored to the environment and life situations of clients and their communities and provide intergenerational and extended family therapies.
- Knox Division (Vic): Better Outcomes in Mental Health – In this outer urban region, patients experiencing mental-health problems for whom CBT may be beneficial will receive six intervention sessions from private psychologists, either in their own practices or in GP’s rooms.
- Bendigo and District (Vic): Practice Based Mental Health Workers for Rural GPs – Mental health workers will provide individual and group psychological interventions for patients who present with ICD-10 disorders, as well as training and support for GPs and other health providers. Services will be offered to the general population, including Aboriginal and transcultural communities in large regional centres and isolated rural areas.
- North West Melbourne (Vic): A Stepped Care Model – In GP clinics, allied health professionals (including an Aboriginal mental health worker), will provide counselling to patients experiencing mental disorders, and participate in case conferences, secondary consultation and professional supervision, to enhance mental health in a culturally diverse and socially disadvantaged population.
- Gippsland Divisions (Vic): Joint Better Outcomes in Mental Health Care – This joint project involving the three Gippsland DGPs, aims to provide focussed psychological strategies to patients in rural and remote areas of eastern Victoria with low socio-economic status. Appropriately qualified allied health practitioners will largely come from the public system and be supported by private practitioners.
- Dandenong and Greater South Eastern (Vic): Access to Allied Health Services – This program will target Health Care Card holders, other low-income earners and patients from ATSI and CALD backgrounds, who would normally have limited access to psychological treatment. A bank of existing local and specialist services will provide up to six sessions, which may include individual/group therapy and personal skills development delivered at their agencies, as well as some outreach services at GP practices.
- Central West (NSW): Allied Health Project – This project will trial a rural and remote model of allied mental-health care. Practitioners, including clinical psychologists and university clinical psychology trainees under supervision, will provide individual therapy, and a group program for Postnatal Depression from GP practices, community rooms or the universities.
- Outback (NSW) – Outreach and telephone services will be provided by psychologists from a Dubbo-based company to the very remote populations of Bourke and Cobar via GP’s surgeries.
Some of the questions to be answered by the Pilot Projects are:
- Does the model result in a more integrated primary care system?
- Are there improved health outcomes?
- What differences are needed for indigenous and transcultural populations?
- Which are the most effective models for referral?
- Which are the best locations for delivery of services?
- What are the most cost-effective models in different types of geographical locations?
Assessment of the various models of service proposed in these pilot projects will provide a basis for on-going and increased funding of this program throughout Australia. The possibilities that this initiative offers for demonstrating successful GP-Allied Health partnerships and effective psychological interventions for people with mental-health problems are enormous.
Congratulations to the successful project teams. It is encouraging to see the frequency of psychologists in these projects and we look forward not only to successful outcomes for clients but greater future involvement of our profession.
It is anticipated that there will be another call for submissions in late 2002 for projects for the next financial year. Watch out for it – and contact your local Division of General Practice with suggestions of partnership models for best psychological practice.