This service delivery project is evaluating the acceptability and feasibility of the Stepped Care Service to Primary Health Network staff, general practitioners, their patients, and practice staff in urban, regional and rural general practices.
Stepped-care approaches offer a solution to delivering accessible, effective and efficient services for individuals with mental health difficulties. In stepped-care approaches the least intensive intervention that is appropriate for a person is typically provided first, and more or less intensive treatments can be provided according to changing needs and in response to treatment.
The Black Dog Institute has developed an online stepped-care service called StepCare that is informed by international guidelines and fully integrated into the Australian primary health care system.
The service integration into the general practice environment is an ideal location for a stepped-care mental health service as GPs are typically the first clinical point of contact for people seeking help and act as gatekeepers to other service providers.
StepCare is currently being trialled across a number of PHNs in NSW. The trial is currently at capacity.
Each year, at least 1 in 5 Australians will experience a mental illness, with 45% of adults experiencing a mental illness at some point in their life. Mental illness, has a detrimental impact on a person’s quality of life, in fact research demonstrates that mental illnesses are the third leading cause of disability burden in Australia.
The problem is worsened by delayed treatment due to serious problems in detection, accurate diagnosis and accessing support. Prevention and early intervention for mental illness is often not a primary focus, despite being recognised as the best way to minimise the impact of mental illness. There is no existing system for regular screening for people with mental health difficulties like there is for physical illness.
Although effective treatments for mental health difficulties are available, a number of obstacles exist with respect to accessibility, effectiveness and efficiency of current mental health services.
Sadly, 65% of Australians with a diagnosed mental illness do not seek professional help for their mental health problems. That is, the proportion of people with mental illness accessing treatment is half that of people with physical disorders.
The Black Dog Institute has developed an online stepped-care service ‘StepCare’ that is informed by international guidelines and designed to fully integrate into the Australian primary health care system. It provides a structured screening program and an algorithm-based approach to directing patients with identified risk to a number of interventions tailored to case-by-case severity. StepCare takes a patient centred approach meeting the needs of the individual rather than a ‘one-size-fits-all’.
All patients attending their general practice for a GP appointment are invited to complete a very brief screening survey on a mobile tablet in the waiting room. The screening is designed to identify mild, moderate and severe levels of anxiety, depression and/or alcohol use.
Immediate feedback is provided to the patient on the mobile tablet and evidenced-based stepped care recommendations in line with symptom severity are sent to the GP’s software in real time via a secure messaging service.
Sample verbal scripts are also provided to GPs to assist with an assessment of the patient during the consultation and development of a Mental Health Treatment Plan (if appropriate). Patients complete fortnightly online monitoring, and immediate feedback is sent online to patients and alerting the GP to inform review and stepping up as required. GPs are able to monitor if patients are adhering to recommendations and whether their symptoms have improved or remitted.
All treatments recommended in the service are evidenced-based and have demonstrated efficacy in reducing symptoms of anxiety and/or depression. GPs remain the primary care manager for all their patients
The aim of Stepcare is to detect new cases through systematic screening for early intervention, and to provide evidence-based treatments in a structured way, thereby reducing the burden of disease and improving health service efficiency.
StepCare purposes to prevent under-servicing those with a higher level of clinical need and over-servicing individuals with lower levels of need. We know that 88% of Australians visit their GP on average 5.6 times per year, making general practice an idea location to assess the mental health of adult Australians.
Despite the ideal location and national and international recommendations, a stepped care mental health service is yet to be fully implemented and evaluated in Australian primary care.
Recently, the Australian Government has issued a policy direction requiring all Primary Health Networks to undertake a stepped-care approach through general practices, to facilitate access to the most appropriate mental health services, based on need.
Therefore, to ensure scalability and sustainability, a train-the-trainer service delivery model is used, whereby the Black Dog Institute Project Manager trains Primary Health Network (PHN) staff to implement the service in their local general practices.
Josephine Anderson, Judy Proudfoot, Jennifer Biggins, Jacinto Santamaria, Tobias Reid, Nyree Gale
HealthLink, Central and Eastern Sydney Primary Health Network, Western New South Wales Primary Health Network