Outcomes and proposed next steps: review of the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care program
6 Initial refinements to the initiative resulting from the review process
The ATAPS review process commenced in July 2008 and has comprised a number of stages. As part of the review process, the Australian Government has already made some refinements to ATAPS to enable the initiative to better meet the emerging needs of communities in accessing mental health services. These recent enhancements of ATAPS have included:
- ATAPS innovative service trials
- Updated guidelines
- Mental health support to bushfire affected communities
- National Perinatal Depression Initiative
ATAPS innovative service trials
Telephone based cognitive behavioural therapyThe engagement of 22 rural and remote Divisions of General Practice to participate in a trial of telephone based therapy commenced in July 2008. This enhancement of ATAPS recognised the value of services being provided via non-face-to-face modalities particularly in rural and remote areas where it is often difficult for patients to travel vast distances to access health services. Additional funding was provided to participating Divisions to develop the infrastructure to enable ATAPS to be provided to patients via telephone. Training in providing services via the telephone was available for ATAPS providers. The trial is based upon a similar successful project undertaken in Doncaster, UK, which also utilised telephone based services and demonstrated very similar outcome results for patients receiving services via the telephone as compared to face-to-face.
Initially there was some difficulty in attracting GPs and patients to the trial. However, there is evidence that the uptake of the pilot has been underestimated because of data entry and a time lag for entry of data. Evidence from the trial suggests that the value of this mode of service delivery is recognised, despite an overall preference for face-to-face service. There may be merit in considering the permanent integration of the option for delivery of therapy sessions by telephone across the ATAPS projects rather than as a segregated initiative. The trial is being evaluated by the University of Melbourne, with final results expected in mid 2010.
Suicide preventionThis trial has engaged 19 Divisions of General Practice as demonstration sites to receive funding to better support GPs to manage patients who have presented following deliberate self harm or a suicide attempt commenced in July 2008. This trial was established in response to the substantial human and economic cost of suicide and self-harming behaviour. It also recognised the additional support that GPs may require in caring for these patients, including priority access to specialist allied mental health services. People who have attempted suicide are particularly at-risk of further attempts or completed suicide and thus require immediate and intensive management, as offered by this trial.
Divisions were selected to participate in the trial in consultation with State and Territory Governments primarily on the basis of higher suicide rates. Additional funding was provided to the selected Divisions to purchase additional ATAPS services so that GPs could have priority referrals for suicidal patients. Additional training was also provided to the ATAPS providers participating in the trial.
Despite some initial challenges in the establishment of this trial – particularly around clarifying the target population (patients presenting to GPs or emergency departments of hospitals following a suicide attempt or deliberate self harming incident) – this enhancement to ATAPS was met with great enthusiasm from participating Divisions. A number of non-participating Divisions have expressed their desire to also focus on this target population.
Information provided by the University of Melbourne states that between October 2008 and July 2009 there were 282 referrals (181 urban, 101 rural) made to services. The profile of consumers is somewhat different from the general ATAPS projects suggesting that these specialist services are reaching a different group of consumers and are complementing the general ATAPS projects. Consumers are receiving a free of cost service, with no co-payments reported in any sessions. Top of page
Updated guidelinesIn October 2008 the ATAPS Guidelines were updated to reflect and clarify modifications to the initiative since its commencement in 2001. This process was undertaken in consultation with Divisions of General Practice and other key stakeholders.
Mental health support to bushfire affected communitiesFollowing the February 2009 Victorian bushfires, additional ATAPS funding has been provided from March 2009 to nine Divisions of General Practice to increase mental health services in affected communities. Some additional funding has also been provided to another Division which experienced increased demand for ATAPS as a result of fires later in February 2009.
The funding has enabled Divisions to engage additional allied health professionals and purchase additional services for people experiencing persistent psychological symptoms. The nine Divisions of General Practice in the bushfire affected regions have directed funding to provide over 1,000 new referrals for services in bushfire affected communities.
In recognition of the impact of the bushfires on young people, funding was also provided for an allied health professional advisory service to support staff of local schools to assist children and staff in coping with trauma and loss. Specialised training in the management of trauma and grief was also made available to all mental health service providers.
ATAPS offered a flexible funding model to allow individual Divisions to direct funding in local areas to consumers most in need of services. Being able to use ATAPS as a funding mechanism facilitated swift action by the Australian Government to a devastating event where a practical response and corresponding resources were required immediately.
On a smaller scale, ATAPS has previously been responsive in providing additional funding for mental health services to Divisions affected by flood, earthquakes and other community tragedy.
National Perinatal Depression InitiativeIn addition to these enhancements, ATAPS was extended in February 2009 to provide services as part of the National Perinatal Depression Initiative. Funding was allocated to Divisions to build the capacity to treat women experiencing perinatal depression, based on population, rurality and relative access to Medicare funded mental health services.
This was the first time that the level of ATAPS funding to Divisions had taken into consideration the relative accessibility of services for consumers. This funding method was supported by Divisions and key national stakeholders and provides a useful model for consideration in the shaping of further ATAPS reforms.