Q. What is Integrated Primary Mental Health Care?
Integrated Primary Mental Health Care is a new approach for the way primary mental health care is delivered in WA. It is designed to connect vulnerable people more easily to mental health support at the right level and at the right time, wherever they are in WA.
There are two key elements of the new approach:
- A single point of contact for GPs and other regional and rural practitioners seeking primary mental health support for patients (the Mental Health Portal)
- A stepped care model for mental health treatment, ensuring patients can access better, more targeted mental health support services.
Integrated Primary Mental Health Care represents a fundamental change in the way primary clinicians such as GPs refer and treat patients who have mild to moderate mental health needs. It will improve access for the most vulnerable in society and enable people to get support at a level appropriate to their needs.
Q. Why is the primary care approach to mental health changing?
In 2014, the National Mental Health Commission reviewed every aspect of Australia’s mental health care delivery, and found the existing system was poorly planned and badly integrated.
The Commission found primary mental health care was frequently delivered with a ‘one-size-fits-all’ approach, which did not adequately cater to the diverse needs of individuals with mental illness. Access to mental health support was also limited in many cases, with fewer than half of those with common mental health illness receiving treatment. Rural and regional areas particularly lacked access to qualified mental health practitioners.
With 3.6 million Australians likely to experience mental ill health on an annual basis, the Federal Government recognises the growing need for more effective mental health care in Australia.
In 2016, the Commonwealth decided to reallocate funding for several legacy programs, including Access to Allied Psychological Services (ATAPS) and Mental Health Services in Rural and Remote Areas (MHSRRA). Funding in WA for both these programs ceases as of 30 June 2017.
The mental health funding from these legacy programs has now been reallocated to Primary Health Networks, who are responsible for developing an approach that will deliver more integrated and accessible mental health services to more people.
The funding has been used to commission a wider range of services designed to deliver appropriate support for vulnerable people across WA who have mild to moderate mental health needs.
Q. What are the main changes?
There are two key elements of the new approach for Integrated Primary Mental Health Care:
- A single point of contact has been established for GPs and other regional and rural practitioners seeking primary mental health support for patients, known as the Mental Health Portal. Once an eligible person has been referred to the Mental Health Portal, a qualified mental health professional will assess their condition and needs and direct the person to appropriate levels of treatment.
- A stepped care model for mental health treatment offering better, more targeted mental health support services. Stepped care refers to a system of care in which there is a range of staged treatment options available. People are matched with the right care for their level of need.
Whereas previous programs required GPs to contact service providers directly to refer a patient, the new Mental Health Portal will act as the single point of contact coordinating access to a range of services designed the meet the mental health needs of the most vulnerable in our community.
WA GPs will be able to refer vulnerable people with mental illness within the community to the Mental Health Portal and they will be assessed and matched to appropriate levels of care.
In Metro Perth, the Mental Health Portal will coordinate care for eligible patients with mild to moderate mental health needs.
In Country WA, each regional Mental Health Portal will coordinate care for patients with mild to moderate mental health needs and can also support GPs in their treatment of patients with severe and complex mental health needs. They can do this by directing eligible patients to care management services — a coordinated approach to managing a patient’s care.
This service is designed to help people experiencing severe mental illness and complex issues get the support they need, while finding a more permanent place-based service to support their long-term management and recovery.
Q. What is the Mental Health Portal?
The Mental Health Portal is a single point of contact for GPs and other regional and rural practitioners to connect vulnerable people with mental illness to mental health care services matched to their needs.
Once a GP connects a patient to the Mental Health Portal, the patient will receive a phone call from a mental health professional who will coordinate a comprehensive assessment to determine the right care services for the patient.
While previous programs required GPs to contact service providers directly to refer a patient, the new Mental Health Portal will provide a single, central point of contact coordinating a patient’s access to a range of services designed the meet the mental health needs of the most vulnerable in our community.
It is important to note the Mental Health Portal is not a physical location or clinic, but rather a single contact and coordination point to support GPs to connect their patients to the right mental health care services for their needs.
Q. What is stepped care?
Stepped care refers to a system of care in which there is a range of staged treatment options available. People are matched with the right care for their level of need. In the same way that physical ailments are treated differently depending on their severity, mental illnesses can require different treatments and people need varying levels of support depending on their circumstances.
Stepped care also allows for easier access to early intervention, so that someone can get early support to address issues and manage symptoms before their health becomes worse.
Q. What do the changes mean for people with mild to moderate mental health needs?
Under the system, once an eligible patient presents to a GP with a common mild or moderate mental illness, such as depression, anxiety or problematic alcohol and substance use, they can be referred to the Mental Health Portal.
Once a person is referred to the Portal, they will be contacted to book a time at which a registered mental health professional will conduct comprehensive assessment, informed by the GP’s referral. The person will then be connected to a structured psychological therapeutic service appropriate to their needs. Under the stepped care model, services can be delivered in different ways, allowing greater flexibility and equity of access.
Q. What treatment options are available?
The range of treatments will grow over time as the stepped care model is implemented.
In Country WA, services available from July 1 will include brief therapy by phone or in person, online options, group support and connection to community services. The mode of care will be aligned with the needs of the patient. As new care options are added, clinicians will be contacted by their local Mental Health Portal service provider with more information and details.
In Metro Perth, services will start with need-based access to face-to-face therapy sessions. WAPHA is progressively rolling out additional services in the city, GP by GP. The mode of care will be aligned with the needs of the patient and additional options will include phone-based therapy, access to short courses online or in workbooks that promote recovery, and other forms of face-to-face support.
Depending on their needs, people can also be connected to local community support services who can reinforce their care, reconnecting and engaging people as required.
As a person’s needs change, they can move up or down the stepped care continuum, accessing the right intervention as appropriate for their care.
Q. Who will provide face-to-face therapy?
From July 1, face-to-face therapy sessions will be available based on need to people for whom this is the best recommended treatment. In Metro Perth, GPs will refer patients to the Mental Health Portal and, if face-to-face therapy is appropriate, this will be provided by ORS Psychology, which provides high quality, locally relevant and effective brief interventions.
Services are designed to meet the mental health needs of vulnerable and disadvantaged people. They are also suitable for patients who have specialised needs, including Aboriginal and Torres Strait Islanders, children, and those with perinatal needs. The service can also be tailored depending on a person’s cultural background and a translation service is available.
Services are tailored to the needs of each person but can include:
- psychological assessments
- psychological counselling to address specific symptomatology associated with depression/anxiety and other lower level psychological disorders
- crisis counselling including suicide prevention counselling
- drug and alcohol counselling
- relapse prevention counselling and plan development
- anger management counselling.
These services provide support, understanding, facilitate skill and technique development for managing mental health symptoms and are highly practical in focus.
A treatment care plan is provided to GPs after the first session and a summary report after the last session. GPs are kept informed of their patient’s progress into and out of the service, including if they are referred or linked to an alternative service which better meets a patient’s needs.
In Country WA, the provider of face-to-face therapy will vary by region. The Regional Mental Health Portal is available to discuss with GPs the range of services available in each area and appropriate modes of access for regional and country residents.
Q. What happens to people currently receiving mental health support through Access to Allied Psychological Services (ATAPS)?
Current ATAPS providers are contracted through to 30 June 2017 to ensure existing patients can complete their current cycle of care. People currently receiving ATAPS will need to make an appointment with their GP to be referred to the new system, and they will be transitioned across to the new services.
For patients with mild to moderate mental health needs, immediate treatment options include need-based access to face-to-face support, with more options becoming available over time. The face-to-face services offered during the transition will be of equivalent or higher intensity than those formerly available under ATAPS.
Q. Will the new service be suitable for people with chronic mental ill health?
A look at the historic take-up of ATAPS psychological services indicates that the majority of people received five or fewer treatment sessions. Approximately a quarter of ATAPS patients have had mental health needs that required additional sessions, however, and a small percentage have needed repeated rounds of treatment.
ATAPS was never designed to provide ongoing treatment for chronic mental health problems, and a lack of reporting to GPs means it is unclear whether continued rounds of services improved patient outcomes.
The new model of stepped care includes regular, structured reports for the GP to ensure a person’s progress can be tracked over time. For people with moderate to severe mental ill health, the new service will offer a range of care options. These include face-to-face sessions but also better access to other support services. The new model will also include better advice for GPs about instances where state-based community mental health services are more suitable for ongoing patient care.
Q. What services are available for severe and complex mental health patients?
State-based care services are designed to be the main point of contact for patients with severe and/or complex mental health needs. Over time, however, some GPs have used the ATAPS program to help these patients access intervention.
The new stepped care model recognises that some people with severe mental illness and complex needs require special coordination of care. This group includes those with bipolar disorder or schizophrenia coupled with other complex problems.
Integrated Primary Mental Health Care now includes a new option for people with severe and complex mental health needs in the form of care management — a coordinated approach to managing a patient’s care. This service is designed to help people get the support they need, while finding a more permanent place-based service to support their long-term management and recovery.
Q. Why is the funding changing?
The National Review of Mental Health Programmes and Services in 2014 identified that the greatest costs associated with mental illness in Australia occurred due to a lack of intervention in keeping people well and participating in the community.
Instead, many people were only offered medical care and support for their mental illness once they were in crisis or at risk of harm.
By intervening early, and providing the right interventions at the right time, it was possible to save enormous costs throughout a person’s lifetime — just as the health system has been able to do with physical problems such as heart disease and cancer.
The review concluded that it was important for mental health funds to be spent earlier and more effectively in supporting people before they reached a level of acute need.
Supporting a person in a single hospital stay would, on average, cost the same as providing support through community mental health services to that person for an entire year.
The stepped care model for mental health enables vulnerable people to access low-level treatment options more easily, to provide early effective treatment for mild to moderate mental health needs.