Healthy Minds: Improving Access, Integration and Efficiency in Primary Mental Health Care

Abstract

In early 2013, the North Coast NSW Medicare Local (NCML) initiated a process for redesign of the delivery of its mental health services, including the Access To Allied Psychological Services (ATAPS) Program. The Australian Primary Mental Health Care system has two key components: ATAPS and Better Access. Both are Commonwealth funded and accessed via General Practice. Healthy Minds aims to provide mental health services to some of the most vulnerable members of the North Coast NSW community who have complex social needs and who are less likely to visit a GP, or are less likely to recognise the need for help. Healthy Minds breaks historical separations and disconnections. It combines Better Access and ATAPS funding and co‐locates private providers within Community Service Organisations (CSOs) and public services to deliver psychological support. Healthy Minds improves access by: 1) Providing services within organisations which are already being accessed by vulnerable groups, reducing the need for further transport, or orientation to new services; 2) Providing a ‘soft’ entry to mental health services by delivering them within less stigmatising organisations, such as employment agencies, family support services or neighbourhood centres; and 3) Partnering with organisations who are able to assist vulnerable groups to access a GP in order to receive their initial referral (e.g. by providing transport, making appointment, issuing reminders) and are able to provide the same support to enhance attendance rates with the Private Practitioner. Healthy Minds improves integration by: 1) Placing Private Practitioners within CSOs, community and public health services which are meeting the social needs of the person, allowing for greater connection of the services, communication, and integration; and 2) Using ATAPS to fund Private Practitioners to attend Case Conferencing within those organisations. Some of the types of CSOs in which Private Practitioners have been co-located include employment agencies, women’s shelters, Aboriginal Medical Services, family support services, homelessness services, youth services, neighbourhood centres and disability services Healthy Minds improves value by: 1) Identifying clinical space with organisations which can be used by Private Practitioners free of charge, reducing overhead expenses; 2) Reducing the ATAPS remuneration to match the Better Access item numbers so that there is no disincentive to bulk-bill – allowing Better Access funding to be used when ATAPS funding is exhausted; 3) Minimising the travel costs to the consumer by providing services within a setting they are already World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116613– http://www.ijic.org/ accessing; and 4) Potentially reducing ‘Did Not Attends’ as clients are familiar with, and familiar to the organisations. Initial estimates and observations indicate that this approach has more than doubled the number of access points for psychological services across the North Coast of NSW. The six months to December 2013 has seen a 42% increase in the number of ATAPS sessions delivered, compared to the previous year. This has been accompanied with a 61% reduction in the average cost per session for the North Coast NSW Medicare Local.