Better Access to Psychology Services in Primary Mental Health Care: An Evaluation

Article excerpt

Abstract

Introduction: The Access to Allied Psychological Services program was introduced as part of the Better Outcomes in Mental Health Care initiative in 2001-2002. Divisions of General Practice are funded to establish programs that allow GPs to refer patients for psychological treatments. The University of New South Wales evaluated programs run by the Southern Highlands and Illawarra Divisions of General Practice. This paper presents the findings of these evaluations.

Method: Both evaluations analysed process and patient outcomes. This was obtained from a combination of program data and qualitative satisfaction data.

Results: The two program models differed in the mechanism of retention of the psychologists and the method of referral of patients. Anxiety and depression were the main reasons for referral, and clinical data showed there was improvement in patient outcomes. Patients, GPs and psychologists expressed satisfaction with the programs.

Discussion: The Access to Allied Psychological Services programs in both Divisions have proven popular. Flexibility in the program structure allows Divisions to develop a model which suits their local circumstances. There is support for ongoing Commonwealth funding and the challenge is to find the most effective and financially sustainable model of delivery for psychological services in primary care.

Aust Health Rev 2006: 30(2): 195-202

MENTAL HEALTH CARE in Australia has tended to focus on specialist and hospital-based services for the more severely mentally ill, most often those with psychotic illness or severe depression. This has left those with the less severe but more common mood and anxiety disorders with poor access to specialist services, and they have thus relied on general practitioners.1

The capacity of GPs to provide effective services for these patients has to date been limited by a number of factors including the fee-for-service structure, which acts as a disincentive to long consultations, inadequate training in managing mental health problems and limited access to allied mental health providers.2 For patients in rural and regional Australia, access to psychiatrists is extremely limited due to a workforce misdistribution, with one psychiatrist per 6610 people in capital cities, one per 20593 in large rural centres and one per 41283 in other rural and remote centres,3 and it is GPs who manage the majority of mental health problems.1-4 Finally, cost acts as a barrier to patients accessing private services in both rural and urban areas.2

Against this background there has been considerable reform in mental health policy at a national level over the last decade. In broad terms it was acknowledged that a more integrated system of health care delivery was required in mental health and that primary care and general practice should play a key role.5 This shift in policy led to the introduction of the Better Outcomes in Mental Health Care initiative (BOMHC) in the 2001-02 budget.6 Its aim was to improve the quality of primary mental health care available in Australia. Initial data have shown good uptake of most components of the initiative.7

There are various models of integration between mental health services and general practice. These include consultation-liaison models, specialist clinics in general practice surgeries, community mental health teams and attached mental health professionals such as psychologists.8 The Access to Allied Psychological Services (ATAPS) program, one component of the BOMHC initiative, most closely resembles this last model of integration. It provides GPs with the opportunity to refer patients for timelimited focused psychological treatments with allied health professionals such as psychologists and counsellors. Divisions of General Practice act as the fundholders and "purchase" the services of the allied health providers. Fifteen pilot sites were funded initially and this has now been extended to 104 programs. …