A digital mental health screening tool for patients in general practices
In any one year, over one million Australian adults will experience depression and two million will be affected by anxiety. Early detection and intervention can prevent the development of anxiety and depression and/or reduce the severity, duration, and impact of symptoms. Effective treatments exist, but not everyone is aware of or has access to the most suitable one for them.
An estimated 88% of the Australian population visit their general practice in a year, thereby making it an ideal location for identifying and managing mental health symptoms experienced by patients.
The Stepped Care Model
A stepped care model of service delivery offers evidence-based interventions ranging from low intensity to high intensity that are matched to the individual’s needs. While there are multiple levels within a stepped care approach, they do not operate in silos or as one directional steps, but rather offer a spectrum of service interventions.
In a stepped care approach, a person presenting to the mental health system is matched to the intervention level that most suits their current need. An individual does not generally have to start at the lowest, least intensive level of intervention in order to progress to the next ‘step’. Rather, they enter the system and have their service level aligned to their needs.
The Australian Government has outlined the stepped care model as central to their mental health reform agenda which is now being used by Primary Health Networks (PHNs) to guide mental health activity. The aim is to increase prevention and early intervention and to promote access to low intensity services.
Further information can be found in the Dept. of Health's PHN Primary Mental Health Care Flexible Funding Pool Implementation Guidance
Black Dog Institute's StepCare Service
In response to this initiative the Black Dog Institute has developed the StepCare Service; a mental health digital solution designed specifically for the general practice setting. The StepCare Service integrates easily into the general practice workflow and supports GPs to provide timely, cost-efficient, early intervention and treatment for Australians with anxiety and depression.
The Black Dog Institute’s aim is to have mental health viewed and managed in the same way that physical health is; through regular universal screening, monitoring and review. The StepCare Service supports GPs to identify, assess, treat, refer and monitor adults with symptoms of depression and anxiety. The Service also supports shared decision-making between GPs and their patients.
The StepCare Service:
- identifies adults with anxiety, depression and/or at-risk behaviours;
- recommends evidence-based stepped prevention, early intervention and treatment;
- links patients to mental health care solutions tailored to the severity of their symptoms;
- monitors symptoms and treatment adherence providing feedback to both patient and GP.
How the StepCare Service works
adults with anxiety, depression and / or risky drinking - focus on early intervention
Adult patients are invited complete a brief questionnaire on a mobile tablet in the waiting room prior to their consultation with their GP. The questions screen for symptoms of anxiety, depression and risky drinking using evidence based screening tools.
evidence-based stepped care treatment - efficient and effective use of health professional resources
After completing the screening, an algorithm based stepped care treatment recommendation is sent to the GP's clinical software via secure messaging which is integrated with practice software. The recommendations are matched to the severity of the symptoms and include questionnaire scores, symptom range and prompts to support the GP to further assess the patient.
Treatment recommendations for symptom ranges are as outlined below:
- Normal | no intervention
- Mild | referral to an evidence based, digital self-guided mental health tool
- Moderate | referral to an evidence based, clinician guided digital mental health tool, or referral to a clinical psychologist and/or medication
- Severe | referral to a clinical psychologist or psychiatrist and/or medication. Digital self-guided mental health tools may also be beneficial for patients when used in conjunction with more intensive treatments.
GPs should use their clinical judgement to refer patients to the most appropriate treatments for depression, anxiety and risky drinking based on the patient’s symptoms, needs and circumstances. Online self-help programs are recommended for patients with mild symptoms and clinician-guided online programs are recommended for patients with moderate symptoms. Mental health practitioners recommended for patients with moderate to severe symptoms include clinical psychologists and psychiatrists as they hold specific skills in assessment, diagnosis and the psychological treatment of complex mental, behavioural and emotional disorders.
patient symptoms to provide feedback - focus on early intervention and notification of deterioration
After the initial appointment, each patient with symptoms in the mild to severe range (all patients not those in the normal range), will receive an automated email or SMS each fortnight for 18 weeks asking them to complete follow up surveys which track their progress.
On completion, patients will be provided immediate feedback and their results will be sent to the GP’s clinical software to inform ongoing review enabling the GP to step patient care up or down in response to their progress.