Academic journal article Australian Health Review

Models of Psychological Service Provision under Australia's Better Outcomes in Mental Health Care Program

Academic journal article Australian Health Review

Models of Psychological Service Provision under Australia's Better Outcomes in Mental Health Care Program

Article excerpt

Abstract

The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found:

* 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way;

* Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and

* The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%.

Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

Aust Health Rev 2006: 30(3): 277-285

THE BETTER OUTCOMES in Mental Health Care (BOMHC) program was introduced in Australia in July 2001,1 in recognition of the fact that although the majority of people with depression and anxiety see their general practitioner (and often no other mental health professional),2 GPs face structural, professional and financial barriers to providing optimal care.3,4 The Australian Government initially provided $120.4 million for 4 years from July 2001, and, in July 2005, committed further funds for the continuation ($102.2 million over 4 years) and expansion ($42.6 million over 5 years) of the program.

The BOMHC program comprises a number of interlocking components, described in detail elsewhere,1,5-7 and summarised in Box 1. One of these is the Access to Allied Psychological Services (ATAPS) component, which enables GPs who have satisfied specified training requirements to refer consumers to allied health professionals for six sessions of free or low-cost, evidence-based mental health care (with a following six sessions available upon GP review). This is occurring through 108 projects being conducted by Divisions of General Practice and funded in four funding rounds: 15 from June 2002 (Round 1 pilot projects); 14 from January 2003 (Round 1 supplementary projects); 41 from July 2003 (Round 2 projects); 32 from July 2004 (Round 3 projects); and six from July 2005 (Round 4 projects).

The vast majority (90%) of allied health professionals involved in the projects are psychologists,8 but the term "allied health professional" is used throughout the remainder of this paper in recognition of the fact that some social workers, occupational therapists and psychiatric nurses are also providing services. All providers are required to demonstrate certain competencies, including skills in cognitive behavioural therapy and related treatment approaches.

The overarching approach of the ATAPS projects is the same, in the sense that they all involve coherent, collaborative care between GPs and allied health professionals. They differ, however, in their specific models of service delivery. Specifically, they vary in terms of how they retain allied health professionals, the location of allied health professionals, and the referral mechanism used. Box 2 provides a detailed summary of the dimensions on which the models of service delivery differ.

The advantages and disadvantages of the models within each dimension have been explored in detail elsewhere, via various qualitative data collection exercises.7'9 Often the benefits of one model address barriers to another, and vice versa. For example, projects in which allied health professionals operate from their own rooms may have benefits for GPs in terms of access to a range of providers, but may present problems associated with reduced opportunities to collaborate. …

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