Innovations in primary mental healthcare
Lennart Reifels A C , Bridget Bassilios A , Kylie E. King A , Justine R. Fletcher A , Grant Blashki B and Jane E. Pirkis AA Centre for Health Policy, Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia. Emails: b.bassilios@unimelb.edu.au, k.king@unimelb.edu.au, justine.fletcher@unimelb.edu.au, j.pirkis@unimelb.edu.au
B Nossal Institute for Global Health, University of Melbourne, 161 Barry Street, Carlton, Vic. 3010, Australia. Email: gblashki@unimelb.edu.au
C Corresponding author. Email: l.reifels@unimelb.edu.au
Australian Health Review 37(3) 312-317 https://doi.org/10.1071/AH12203
Submitted: 26 July 2012 Accepted: 21 November 2012 Published: 22 April 2013
Abstract
Objective. We review the evidence on innovations in Tier 2 of the Access to Allied Psychological Services (ATAPS) program, which is designed to facilitate the provision of primary mental healthcare to hard-to-reach and at-risk population groups (including women with perinatal depression, people at risk of self-harm or suicide, people experiencing or at risk of homelessness, people affected by the 2009 Victorian bushfires, people in remote locations, Aboriginal and Torres Strait Islanders and children with mental disorders) and the trialling of new modalities of service delivery (e.g. telephone-based or web-based CBT). The primary focus is on the uptake, outcomes and issues associated with the provision of ATAPS Tier 2.
Methods. Drawing on data from an ongoing national ATAPS evaluation, including a national minimum dataset, key informant interviews and surveys, the impact of ATAPS innovations is analysed and illustrated through program examples.
Results. ATAPS Tier 2 facilitates access to, uptake of and positive clinical outcomes from primary mental healthcare for population groups with particular needs, although it requires periods of time to implement locally.
Conclusions. Relatively simple innovations in mental health program design can have important practical ramifications for service provision, extending program reach and improving mental health outcomes for target populations.
What is known about the topic? It is recognised that innovative approaches are required to tailor mental health programs for hard-to-reach and at-risk population groups. Divisions of General Practice have implemented innovations in the Access to Allied Psychological Services (ATAPS) program for several years.
What does this paper add? Drawing on data from an ongoing national ATAPS evaluation, this paper presents a systematic analysis of the uptake, outcomes and issues associated with provision of the innovative ATAPS program.
What are the implications for practitioners? The findings highlight the benefits of introducing innovations in primary mental healthcare in terms of increased access to care and positive consumer outcomes. They also identify challenges to and facilitators of the implementation process, which can inform innovation efforts in other primary care contexts.
Additional keywords: diffusion of innovation, mental health services, primary care.
References
[1] Hickie I, Groom G. Primary care-led mental health service reform: an outline of the Better Outcomes in Mental Health Care initiative. Australas Psychiatry 2002; 10 376–82.| Primary care-led mental health service reform: an outline of the Better Outcomes in Mental Health Care initiative.Crossref | GoogleScholarGoogle Scholar |
[2] Australian Government Department of Health and Ageing. 2010–2011 Operational guidelines for the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care program. Canberra: Australian Government Department of Health and Ageing; 2010.
[3] Australian Government Department of Health and Ageing. Outcomes and proposed next steps: review of the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care program. Canberra: Australian Government Department of Health and Ageing; 2010.
[4] West MA, Farr JL, editors. Innovation and creativity at work: psychological and organizational strategies. Chichester, UK: Wiley; 1990.
[5] Varkey P, Horne A, Bennet KE. Innovation in health care: a primer. Am J Med Qual 2008; 23 382–8.
| Innovation in health care: a primer.Crossref | GoogleScholarGoogle Scholar | 18820143PubMed |
[6] Kohn F, Pirkis J, Morley B, Naccarella L, Blashki G. Utilisation of findings from the evaluation of a major primary mental health care initiative in Australia. Evaluation Journal of Australasia 2007; 7 12–24.
[7] Flick U. Coding and categorizing. An introduction to qualitative research. London: Sage; 2006. pp. 295–318.
[8] Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales, 2nd ed. Sydney: Psychology Foundation; 1995.
[9] Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150 782–6.
| Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1c%2FgtFahtw%3D%3D&md5=4cc377978630ba943c094c097ff77218CAS | 3651732PubMed |
[10] Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SLT, et al Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002; 32 959–76.
| Short screening scales to monitor population prevalences and trends in non-specific psychological distress.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38vls1Wltg%3D%3D&md5=0bc768fa6232da3b6a8c5e1298713260CAS | 12214795PubMed |
[11] Miller IW, Norman WH, Dow MG, Bishop SB. The Modified Scale for Suicidal Ideation: reliability and validity. J Consult Clin Psychol 1986; 54 724–5.
| The Modified Scale for Suicidal Ideation: reliability and validity.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2s%2FjsVGhtQ%3D%3D&md5=c5861e157d92ca2dbb8f3c509c406fffCAS | 3771893PubMed |
[12] Australian Government Department of Health and Ageing. Medicare Locals: Discussion paper on governance and functions. Canberra: Australian Government Department of Health and Ageing, 2010.
[13] Pirkis J, Burgess P, Kohn F, Morley B, Blashki G, Naccarella L. Models of psychological service provision under Australia’s Better Outcomes in Mental Health Care program. Aust Health Rev 2006; 30 277–85.
| Models of psychological service provision under Australia’s Better Outcomes in Mental Health Care program.Crossref | GoogleScholarGoogle Scholar | 16879086PubMed |
[14] Bassilios B, King K, Fletcher J, Reifels L, Blashki G, Burgess P. et al. Evaluating the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care program. Eighteenth Interim Evaluation Report: an overview of the achievements of Tier 1 and Tier 2 ATAPS. Melbourne: Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, The University of Melbourne; 2011.
[15] Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004; 82 581–629.
| Diffusion of innovations in service organizations: systematic review and recommendations.Crossref | GoogleScholarGoogle Scholar | 15595944PubMed |
