Australian Primary Mental Health Research Articles

Prevalence and Correlates of Tobacco Use in Young People Presenting to Australian Primary Mental Health Services.

In Australian youth primary mental health settings it is unclear as to the rates and correlates of tobacco use at service entry. We aimed to delineate the prevalence and correlates of recent tobacco use (eg, cigarettes, chewing tobacco, cigars, etc) in the past 3 months in young people at their first presentation to primary mental health services as a function of age. Cross-sectional self-report measures were collected using a tablet device from young people presenting to one of five Australian primary mental health (headspace) services. Logistic regression assessed correlates of past 3-month tobacco use in adolescents (12-17 years) and young adults (18-25 years). Regular (at least monthly) tobacco use in the past 3 months was found in 23.4% (n = 247, N = 1055) of the sample. Increasing age (odds ratio [OR] =1.47 per year; 95% confidence interval [CI]: 1.15 to 1.89), male sex (OR = 1.98; 95% CI: 1.02 to 3.83), being in a relationship (OR = 1.96; 95% CI: 1.01 to 3.82), and poorer functioning (OR = 0.95 per unit Social and Occupational Functioning Assessment Scale increase; 95% CI: 0.91 to 0.99) predicted regular tobacco use in adolescents, but not in young adults. Living in a regional location (OR = 2.10; 95% CI: 1.40 to 3.13) and not studying (OR = 0.47; 95% CI: 0.31 to 0.73) predicted tobacco use in young adults. Having a diagnosed mental illness other than depression and/or anxiety predicted tobacco use in both groups (adolescents OR = 2.49; 95% CI: 1.26 to 4.94; young adults OR = 1.80; 95% CI: 1.13 to 2.89). Nearly a quarter of young people with mental illness are using tobacco, supporting the need for early intervention approaches. Adapting treatment targets by age could improve the impact of interventions in adolescents versus young adults. Poor functioning and lack of engagement in education were associated with tobacco use in both age groups, respectively; however, more research is needed to determine the direction of these relationships. Young people with mental illness have a high prevalence of recent tobacco use and this is evident when they first present to youth primary mental health services. Youth-oriented mental health settings may provide a unique window for tobacco use prevention and early intervention to reduce smoking in people with mental illness, a priority population. Age-specific targeted approaches might be needed in adolescents and young adults.

Therapeutic interventions in Australian primary care, youth mental health settings for young people with borderline personality disorder or borderline traits

BackgroundThis study aimed to investigate what therapeutic interventions were being applied by clinicians working with young people with a diagnosis of Borderline Personality Disorder or borderline traits in Australian primary mental health care settings. Given the current lack of evidence-based guidelines for treatment with this client population, investigating what is being implemented is needed. The study also aimed to determine whether the interventions clinicians are using are effective in reducing distress and increasing functioning for these clients.MethodsParticipant data came from the national minimum data set for headspace youth mental health centers across Australia. Young people’s data were included in the study if the young person was diagnosed with Borderline Personality Disorder or borderline traits during their first episode of care (N = 701). Clinician data that indicated the type of intervention used at each client session and outcome measures routinely captured were analyzed to determine interventions used and outcomes achieved.ResultsResults demonstrated that CBT was the most frequently used modality of intervention followed by supportive counselling and IPT, but that most clients received a variety of intervention types. There were no or only weak relationships between changes in outcomes and the amount of any type of intervention that was provided. No significant relationship was found with the amount of CBT a client received and changes in symptoms or functioning, despite being the most commonly employed modality.ConclusionsThe study highlights the need for evidence-based treatment guidelines for early intervention in young people with borderline personality disorder traits.

Caring hours and possible need for employment support among primary carers for adults with mental illness: Results from an Australian household survey.

Intensive unpaid caring is associated with greater likelihood of not being employed, but impacts for mental health carers specifically remain unknown. This study aimed to: (a) examine the association between caring intensity and not being employed for primary mental health carers, (b) ascertain whether this relationship differs from that for other disability carers, (c) enumerate Australian primary mental health carers with a possible need for employment support and (d) describe these carers' unmet support needs and barriers to employment. Co-resident, working age primary mental health (n=137) and other disability carers (n=821) were identified in the Survey of Disability, Ageing and Carers (collected July-December 2015). Multiple logistic regression analyses examined associations between levels of caring intensity (1-9, 10-19, 20-39, 40+hr/week) and not being employed. A 'possible need for employment support' indicator was derived from information about current employment status, caring hours, past impact of caring on employment and desire for more work or workplace accommodations. After controlling for demographic and caring role factors, mental health carers providing 40+hr of care weekly had greater odds of not being employed compared to carers providing <10hr (AOR 13.38, 95% CI: 2.17-82.39). For other disability carers, the odds of not being employed were also higher among those providing 20-39hr of care (AOR 3.21, 95% CI: 2.18-4.73). An estimated 54.1% (95% CI: 43.1-64.8) of carers had a possible need for employment support, with the proportion increasing as level of caring intensity increased. Of carers who were not employed, 42.2% (95% CI: 30.3-55.0) reported a desire to work, and the main reported barrier was no alternative care arrangements or disruption to the person supported. Findings suggest that improving employment participation for mental health carers requires a greater balance between unpaid care and access to formal services for people with mental illness.

Improving access to primary mental health care for Australian children.

This study examines the uptake by children aged predominantly 0-11 years of an Australian primary mental health service - the Access to Allied Psychological Services programme - which began in 2001. In particular, it considers access to, and use of, the child component of Access to Allied Psychological Services, the Child Mental Health Service, introduced in 2010. Using routinely collected programme data from a national minimum dataset and regional population data, we conducted descriptive and regression analysis to examine programme uptake, predictors of service reach and consumer- and treatment-based characteristics of service. Between 2003 and 2013, 18,631 referrals for children were made and 75,178 sessions were scheduled via Access to Allied Psychological Services, over 50% of which were via the Child Mental Health Service in its first 3 years of operation. The rate of referrals for children to the Child Mental Health Service was associated with the rate of Access to Allied Psychological Services referrals for consumers aged 12+ years. The Child Mental Health Service has increased services provided within the Access to Allied Psychological Services programme for children with emotional and behavioural issues and their families, and is potentially filling a service gap in the area of prevention and early intervention for children who have significant levels of need but are unable to access other mental health services. Our findings are policy-relevant for other developed countries with a similar primary mental health care system that are considering means of improving service access by children.

Nursing Revolution in Australian Primary Mental Health

In Australia, a revolution is in the offing in primary psychiatric service delivery. Mental health nurse specialists are moving out from crisis and community-care teams attached to the public hospitals and community psychiatric clinics. To-date, three levels of psychiatric nursing have evolved: traditional basic mental health nursing; novel advanced nursing; and, advanced nursing with prescribing rights (Keltner & Folks, 1999; Talley & Brooke, 1992). The advanced forms are partnering with primary care physicians in private practice (Fisher, 2005; Hurley et al., 2014). Psychiatrists are beginning to link up with these nurse specialists, at the GP clinics. They are their natural, professional partners, sharing roles and responsibilities (Elsom, Happell, Manias & Lambert, 2007) This article argues for the benefits of models of primary psychiatric care in which the psychiatric nurse is the lynchpin of service delivery.

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

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.

Assessing patient satisfaction in an Australian primary mental health care context

This paper presents the fi rst attempt to provide a national snapshot of patient satisfaction with the Access to Allied Psychological Services (ATAPS) programme in Australia. ATAPS is funded by the Department of Health and Ageing and provides focussed psychological strategies to patients with common mental health disorders. At the time this work was done, ATAPS was managed locally by Divisions of General Practice; it is now managed by Medicare Locals. We emailed the 105 Divisions operating ATAPS inviting them to provide any survey instruments they had used to gauge patient satisfaction data, as well as any available data. Nine Divisions provided surveys and data. The content of the surveys varied considerably. Eight of the nine surveys included a question regarding overall satisfaction with the service and/or the service provider. However, there were few other commonalities between the surveys. In total, 1,142 of the 1,211 respondents who answered the question about overall satisfaction (94.3%) rated it as positive or very positive. Since this study took place, measurement of patient satisfaction has become a national requirement for all Medicare Locals providing ATAPS services. Assessment of patient satisfaction is especially relevant as ATAPS continues to strive to reach vulnerable and hard-to-reach populations. Recommendations are made to assist Medicare Locals, and other systems of primary mental health care provision, in the further collection of patient satisfaction data.

Uptake of a national primary mental health program by young people in Australia

BackgroundThe purpose of this study was to examine the uptake of an Australian primary mental health care program (Access to Allied Psychological Services) by young people aged 12 to 25 years and the characteristics of consumers and the treatments received. Data were sourced from a national web-based minimum dataset.ResultsBetween 1 July 2003 and 30 June 2012, 51 716 young consumers received 245 704 sessions via the primary mental health program. Around two thirds were female and the average age was 19 years. The majority had depressive and/or anxiety disorders.Most services were delivered to individuals (including just the young person and/or the young person with one or both parents), in a face-to-face context and free of charge. Cognitive and behavioral strategies were the most common interventions delivered.ConclusionsThe primary mental health care program has been well utilized by people aged 12 to 25 years. Similar programs in other developed countries may improve access to primary mental health care for young people.

The complementarity of two major Australian primary mental health care initiatives.

Two pivotal Australian Government primary mental health reforms are the Access to Allied Psychological Services (ATAPS) projects, introduced in July 2001 and implemented by Divisions of General Practice, and the Better Access to Psychiatrists, Psychologists and GPs through the Medicare Benefits Schedule (Better Access) programme, introduced in November 2006. This research explores the reciprocal impact of the uptake of psychological treatment delivered by these two initiatives and the impact of location (rurality and socioeconomic profile) on the uptake of both programmes since the inception of the Better Access programme. ATAPS session delivery, before and after the introduction of the Better Access program, is also examined. General Practice Division-level data sources included a minimum dataset containing uptake data of ATAPS services, Medicare Benefits Schedule uptake data supplied by the Medicare Benefits Branch of the Department of Health and Ageing, a Rural, Remote and Metropolitan Area classification, and Indices for Relative Socio Economic Disadvantage (IRSD). Regression analyses were conducted to examine the reciprocal impact of the two programmes and the impact of rurality and socioeconomic status up to December 2008. A dramatic uptake of Better Access sessions, particularly in urban areas, coincided with a temporary reduction in sessions provided under ATAPS, with an overall small positive relationship detected between the two programmes. A greater proportion of ATAPS sessions (45%) have been delivered in rural areas compared with Better Access (18%). The combination of socioeconomic profile, rurality, and Better Access sessions accounted for a small but significant percentage of variance (7%) in the number of ATAPS sessions delivered, with a non-significant independent contribution of Better Access sessions to the prediction of ATAPS sessions. Weak but significant relationships between ATAPS sessions and each of socioeconomic profile (r = 0.22) and rurality (r = -0.24), respectively, were identified. In comparison, socioeconomic profile, rurality, and ATAPS sessions accounted for a much larger and significant percentage of variance (46%) in number of Better Access sessions delivered, with a non-significant independent contribution of ATAPS sessions to the prediction of Better Access sessions. Moderate significant relationships between Better Access sessions and each of socioeconomic profile (r = 0.46) and rurality (r = -0.66), respectively, were identified. The introduction of Better Access appears to have halted the steady increase in the number of ATAPS sessions previously observed. This finding should be interpreted alongside the fact that ATAPS funding is capped. The findings are policy relevant. ATAPS projects have been successfully providing equity of geographic and socioeconomic access for consumers most in need of subsidized psychological treatment. The uptake of psychological treatment under Better Access has been dramatic, suggesting that the programme is addressing an unmet need.

Australian primary mental health care: improving access and outcomes

The progressive achievements over time of the Access to Allied Psychological Services (ATAPS) component of the Better Outcomes in Mental Health Care program are examined using a web-based, purpose-designed minimum dataset that collects provider-, consumer- and session-level data on the projects. Findings indicate that the ATAPS projects have established themselves over time as a cornerstone of mental health service provision in Australia. Despite the more recent introduction of the complementary Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule program, the ATAPS projects have continued, since 2001, to attract substantial numbers of general practitioners and allied health professionals and deliver services to significant numbers of consumers. The profile of consumers being referred to the projects is now very consistent, with the majority being women with high prevalence disorders who may have had difficulty accessing mental health care in the past. The nature of sessions being delivered through the projects has also reached a point of consistency, with the majority being individual-level, cognitive behavioural therapy-based sessions of around 1 h in length. The only variation in session delivery is related to the charging of a co-payment. There is good evidence that the projects are achieving positive outcomes for consumers.