Why Did Divisions of General Practice Implement Some Access to Allied Psychological Services Mental Health Initiatives and Not Others?

By King, Kylie; Nicholas, Angela et al. | Australian Health Review, January 1, 2015 | Go to article overview

Why Did Divisions of General Practice Implement Some Access to Allied Psychological Services Mental Health Initiatives and Not Others?


King, Kylie, Nicholas, Angela, Fletcher, Justine, Bassilios, Bridget, Reifels, Lennart, Blashki, Grant, Pirkis, Jane, Australian Health Review


Introduction

InJuly2001, the Better Outcomes in Mental Health Care program was introduced by the Australian Government. The Access to Allied Psychological Services (ATAPS) program component of this program enables patients with common mental health disorders to receive free or low-cost evidence-based treatment from mental health professionals over 12 sessions (or 18 in exceptional circumstances). At the time of this study, ATAPS was managed by Divisions of General Practice (Divisions). In 2011-12, Divisions were replaced by Medicare Locals and, following changes recommended by the Australian Government in 2014, will once again change to larger primary healthcare organisations. The term 'Divisions' will be used throughout this article to describe these organisations, which is consistent with the terminology used at the time of the survey, except where the findings are particularly relevant to Medicare Locals.

Since 2008, various government policy changes have seen the introduction of funding for several new ATAPS initiatives (now known as Tier 2, while the original ATAPS is known as Tier 1) in order to enhance the capacity of Divisions to address the needs of specific groups: people at risk of suicide; children; women with perinatal depression; people who are experiencing, or are at high risk of, homelessness; Aboriginal and Torres Strait Islander people; and those in rural and remote areas.1 Funding has also been provided at different times to those Divisions impacted by extreme climatic events including bushfires, floods and cyclones. ATAPS Tier 1 funding is somewhat adaptable, with Divisions able to tailor programs to suit their local needs and context. Tier 2 initiatives offer even greater flexibility in the way they are delivered; for example, by allowing a greater number of sessions, service delivery in alternative locations or referrals from different health professionals.

At the time of this study in 2012, services for those at risk of suicide, and women with perinataldepression were mandatoryfor Divisions unless they demonstrated that the initiative duplicated existing services. Divisions could choose to adopt the other initiatives depending on the perceived needs of their community.

We have been undertaking an evaluation of ATAPS since 2003. This evaluation primarily involves the use of a web-based minimum dataset that collects referral, session, and consumer data for all consumers of the ATAPS program. To date, this dataset contains data related to over 1 000 000 ATAPS sessions. In addition, throughout the evaluation, qualitative data has been collected via surveys to address particular evaluation questions. Through our ongoingevaluation ofATAPS,we notedthat despite the provision of extra funding for Tier 2 services, many Divisions were either not yet delivering the services or had delivered a relatively low number of sessions via the services. We wanted to understand why services had not yet been implemented for people that were likely to be at increased need of psychological services.

The systematic review by Greenhalgh et al.2 relating to spreading and sustaining innovations in health service delivery, highlights an extensive number of factors both internal and external to an organisation that can affect the implementation of innovations. In summary, they show that innovations that have a clear, unambiguous advantage over existing services or products; are compatible with the intended adopters' values, norms and perceived needs; are perceived as simple to use; can be experimented with; have visible benefits; have required knowledge that can be transferred from one context to another; and that can be adapted and refined to suit their own needs, are likely to be adopted more easily. With these factors in mind, Divisions seem ideally situated to implement new mental health programs in the primary care context, as they possess both an existing framework within which to do so and compatible goals for the health of their local communities. …

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