Centre for Mental Health

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Partnerships—General practitioners

Background

In 1999, NSW allocated $5.6 million to a program to strengthen partnerships between mental health services and general practitioners. Bringing the two service sectors closer together was one of the fundamental challenges for the program. The initial focus was on reorienting mental health services to acknowledge general practitioners as an integral part of the system of mental health care.

The program has now been in progress for over three years. The broad objectives have been a focus on service reform to achieve better access, communication and collaboration between general practitioners and mental health services.

A psychiatrist based at the Centre for Mental Health coordinates the Partnerships program. It has three broad, linked components: Local, State and National.

Local initiatives

Most Area Mental Health Services appointed a project officer to co-ordinate the development of local partnerships. In some Areas, a general practitioner was appointed to the project officer position; in some Areas the position was jointly funded by Divisions of General Practice and the Area Mental Health Service. In other Areas, the position was located in the Division of General Practice and funded by the Area.

Although the specific funding for the partnerships program will not continue beyond the Second National Mental Health Plan (1998-2003), it is expected that the partnership's agenda remains a priority with each Area Health Service. Some areas have already chosen to continue to fund a designated position from within existing resources.

Initiatives include:

• State of the Art
  Extensive collaborative work has taken place between Partnership project staff (Area Mental Health) and mental health staff of Divisions of General Practice. There are many examples of different approaches to partnerships in the work that has been done.

  A manual that provides examples of this joint project work called State of the Art has been produced as a joint venture between the Centre for Mental Health, the Alliance of NSW Divisions, and the State branch of the Commonwealth DHAC. The document provides a showcase of the collaborative work in NSW as well as a resource for staff entering this field of work.

• Area Mental Health Service Planning
  It is expected that each Area Mental Health Service will continue to consider GP partnerships as a priority. At a minimum, each Area should have:
  • general practitioner representation in Area Mental Health Planning
  • a strategy to improve general practitioners' access to acute mental health assessments for their patients
  • a process for continued monitoring and improvement in communication between mental health services and general practitioners.

NSW State initiatives

The State coordinator provides general direction for the overall program in consultation with representatives from general practice, Area Mental Health Directors, specialist mental health clinicians, and other groups where appropriate.

Providing a link between the Partnerships program and other programs within the Centre for Mental Health has been an important part of the role of the coordinator. This has included highlighting the role of the GP (where appropriate) in programs developed within the Centre for Mental Health, including prevention, promotion and early intervention; emergency mental health presentations; bereavement, and the mental health of women in the perinatal period; continuing care and rehabilitation; rural mental health service provision.

A pamphlet for general practitioners called Stress, Trauma and Traumatic Bereavement: Presentations in General Practice is currently be being developed.

At State level the Partnerships Program has undertaken collaborative programs with the Alliance of NSW Divisions of General Practice, the Mid Western Consortium for general practice training, the Royal Australian and New Zealand College of Psychiatrists (NSW Branch), and the NSW Institute of Psychiatry.

Initiatives include:

• Alliance of NSW Divisions of General Practice: general practice perspective
  The Centre for Mental Health funded the Alliance of NSW Divisions recurrently for three years, to provide a general practice perspective on the development of policy. This funding supported the appointment of two general practitioners to the Alliance. The initiative included a broad consultation with NSW Divisions of General Practice and representation of the views of general practitioners throughout NSW, both rural and metropolitan. Recommendations arising out of this consultation included: the need for better access to the expertise of psychiatrists; opportunities for shared care; the need for improved communication; and the specific difficulties of rural general practitioners accessing specialist mental health assessments.

  These recommendations are being considered in more depth by the Alliance of NSW Divisions. Opportunities within NSW to improve flow between private psychiatric services and general practice were the subject of a recent seminar hosted by the Alliance.

Teams of Two initiative

The Centre for Mental Health has supported a joint learning initiative with funds. The Alliance of NSW Divisions of General Practice has received funding to develop and support Teams of Two: a joint learning initiative. The project builds on work previously undertaken to enhance partnerships between general practice and mental health services and uses learning as a tool for collaboration. The Alliance of NSW Divisions is coordinating the project in conjunction with the Centre for Mental Health and NSW Institute of Psychiatry.

The primary aim of the modules is to facilitate greater collaboration between general practitioners and mental health professionals at the local level through interactive joint learning activities. Participants will engage in challenging and creative problem solving activities that will sharpen their clinical skills and examine the GP/mental health service interface in the provision of mental health care.

Initially, three modules are being developed for the Teams of Two initiative:

• physical health/mental health
• acute mental health presentations
• depression in older people.

Rural partnerships

There has been a special focus on rural general practitioners. General practitioners in rural areas face different challenges to their metropolitan counterparts. For example, there is less access to specialist backup. The Rural Psychiatry Project (RANZCP, NSW Branch) established in 2002 in collaboration with the Centre for Mental Health is concerned with psychiatrists' services in rural areas and has a specific focus on general practitioners and mental health.

An advanced training post for GPs in rural psychiatry has been available in Orange for the last three years. Building on the success of this post, NSW Health will be funding a further six mental health training posts in rural areas over the next three years. This will allow rural GPs an intensive experience of acute mental health. We are working to include experiences not only in adult mental health but also child and adolescent and older peoples mental health.

In partnerships with the Institute of Psychiatry and the RANZCP, a curriculum is being developed to support the general practitioners in these training posts. It is proposed that the training be developed with a combination of distance learning and intensive residential experiences.

National Initiatives

The NSW Partnerships program aims to work as closely as possible with national initiatives in mental health. These include:

• Primary mental health care initiative
  This is a Commonwealth program targeted directly at general practice through the Divisions network. The process for this initiative, like the partnerships program, is guided by a network of project officers.

  Combined meetings between the two sets of project officers have been co-convened by the Centre for Mental Health and the Alliance of NSW Divisions. The State of the Art manual provides examples of the joint work of the Partnerships program project officers and the Divisions mental health staff.

• Enhanced primary care initiative
  Incentives have been developed to encourage management of mental health in general practice. Items have been added to the Medicare schedule, namely, rebates for case conferencing, discharge planning, and extended consultations for yearly evaluation of complex conditions.

  In a number of Areas, the EPC items have been used as a tool for engagement between general practitioners and area mental health teams, particularly in the care of people with enduring mental illnesses.

• Better Outcomes in Mental Health initiative
  The Better Outcomes in Mental Health initiative has established Medicare rebates for assessment and management of mental health by general practitioners as well as the development of a fund-holding model for purchasing of psychological services by Divisions of General Practice.

  State-based initiatives in learning (including Teams of Two initiatives) and the proposed development of a Graduate Certificate in Mental Health for General Practitioners, have taken into account the requirements for accreditation under the Better Outcomes initiative.