Rural Generalist – Mental Health: Working Better Together

Aim

Changing the way mental health and addictions services are delivered across the Cooktown cluster for the better though establishment of the rural generalist with advanced skills mental health position.

Benefits

• High quality accessible, culturally appropriate primary mental health and addictions medicine care delivered where it is needed most.
• Improves capacity of all staff to manage mental health and addictions presentations through dedicated education/upskilling.
• Improved patient outcomes though better coordination, communication and collaboration between primary, hospital, community and emergency services in this sphere.
• Clinical oversight and management of complex mental health patients in the community who are unable to access required Psychiatry specialist services locally; noting this is not to replace Psychiatry services but rather to augment them.

Background

• Large burden of disease in mental health and addictions presentations in our area but lack of available services/staffing.
• Particular gaps identified in addictions medicine and primary care mental health.
• No dedicated education for staff around mental health and addictions which was identified as an area of decreased confidence.
• Communication, collaboration and coordination between services in the general medical, emergency, community and mental health and addictions spheres was an area identified which could be optimised to improve patient outcomes.
• Monthly outreach Psychiatry services are not able to provide more intensive service needs to complex mental health clients and would benefit from local specialised care.

Evaluation and results

The project is being evaluated via a number of qualitative and quantitative measures.

• Qualitative measures include number of clinics delivered to communities, number of patients seen for mental health specific item numbers, numbers of clients completing or continuing to engage in treatment, number of education sessions delivered, number of quality improvement/collaboration activities/initiatives implemented.
• Halfway point data collated to date indicates and exponential increase in all of these domains, either on target or above.
• Quantitative measures that include staff and patient surveys and case reports.

The Rural Generalist Mental Health (RG-MH) Service Delivery Model Framework has increased availability of mental health and addiction services in Cooktown, Laura, Hope Vale and Wujal by establishing new clinics, providing improved access to GP based mental health services, offering the program locally and cutting down on the number of patient travel requests.

The RG-MH Service Delivery Model Framework has been effective in improving the overall health status of patients of the Cooktown Cluster.

The RG-MH Service Delivery Framework has been effective in increasing the confidence of Torres and Cape HHS staff to deliver mental health and addiction related treatment to patients.

Lessons learnt

This service has grown to fill a gap in service between primary care and acute mental health and addictions services and provide the missing link between medical, emergency, community and mental health/addictions services in response to community need

• Having that one point of contact has allowed new initiatives to be implemented to improve patient outcomes across the board
• A close working relationship with the acute mental health and addictions service has been essential
• While clinics were initially conceptualised as a mixture of GP and GP-MH but as they became more focused on GP-MH, restructuring of clinic timetables and rostering was important to ensure adequate coverage of all areas of service need
• Defining boundaries of the service and delineating roles and clear lines of clinical governance in consultation with all parties has been an important part of establishing the role and making it sustainable long term
• A pro-active approach to seeking long term funding for the position has been important

References

References that the project was based on:

1. World Health Organisation– Mental Health Action Plan 2013-2020
2. National Strategic Framework for Rural + Remote Health
3. Fifth National Mental Health and Suicide Prevention Plan
4. Sen Gupta T, Manahan D, Lennox D, Taylor N. “The Queensland Health Rural Generalist Pathway: providing a medical workforce for the bush.” Rural and Remote Health. 13: 2319. (Online) 2013.
5. Ernst and Young. Evaluation and Investigative Study of the Queensland Rural Generalist Program. Queensland Health, February 2013
6. Lynch J, Askew D, Mitchell G, Hegarty K. Beyond symptoms: Defining primary care mental health clinical assessment priorities, content and process. Social Science & Medicine 2012; 74: 143-149.
7. Reeve J. Interpretive Medicine: Supporting generalismin a changing primary care world. The Royal College of General Practitioners. January 2010 (88).
8. UstenTB & Sartorius N (Eds). Mental illness in general health care: An international study (1995). Wiley: Chichester
9. Lawrence D, Holman CDJ, Jablensky AV (2001) Preventable Physical Illness in People with Mental Illness. Perth: The University of Western Australia.
10. Kelly BJ, Stain HJ, Coleman C et al. Mental health and well-being within rural communities: The Australian rural mental health study. Aust J Rural Health 2010; 18(1): 16-24.
11. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981 Feb;19(2):127-40.
12. Levesque JF, Harris M, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in Health 2013; 12:18.

Further Reading

Presentation at Rural Medicine Australia Conference 2017 re: the concept role and model of service

Concept model of service for Mental Health Advanced Skill