Primary Care Mental Health Services Research Articles

Barriers to integrated primary care and specialty mental health services: Perspectives from Latinx and non-Latinx White primary care patients.

Significant disparities in access to mental health care exist in the current mental health system; integrated primary care (IPC) offers an alternative model of service delivery with initial evidence for reducing disparities. Little is known about whether, and how, IPC reduces barriers to mental health services. Here we report on a set of three studies using mixed methodology to explore the perceptions of potential recipients of care regarding barriers to accessing mental health treatment by setting (IPC or specialty mental health [SMH]) and ethnicity (Latinx or non-Latinx White). In Study 1, a main effect of setting indicated IPC patients perceived fewer barriers to accessing IPC than SMH. A setting by ethnicity interaction revealed Latinx patients perceived greater barriers to SMH than non-Latinx White patients. In Study 2, data from qualitative interviews suggested IPC patients found behavioral health treatment in IPC to be accessible and satisfactory. In Study 3, a non-treatment-seeking sample did not endorse a difference in barriers by setting or ethnicity. Overall, it appears IPC patients perceive behavioral health treatment delivered in primary care to be satisfactory, beneficial, and successful in reaching individuals with mental health need who otherwise may not receive care. Non-treatment-seeking individuals with lower psychiatric distress did not identify a difference in barriers between IPC and SMH settings. Findings are consistent with the potential of the IPC setting for reducing barriers to care, although key elements of IPC may need to be addressed to increase acceptability across all population subgroups. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Widening access for minoritised ethnic communities in the Liverpool Step Forward psychological service

Step Forward, an NHS Primary Care Mental Health Service in Liverpool, endeavours to make their service more accessible to minoritised ethnic communities. This article outlines some important considerations in developing a more culturally responsive service and describes the initiatives Step Forward has implemented to achieve this aim.

Healthcare utilization after mass trauma: a register-based study of consultations with primary care and mental health services in survivors of terrorism

BackgroundKnowledge on healthcare utilization after mass trauma is needed to strengthen the public health preparedness to such incidents. Using register-based data, this study had a unique opportunity to investigate how young survivors’ use of primary care physicians (PCP) and mental health services (MHS) changed after a terrorist attack.MethodsWe examined register-based data on PCP and MHS consultations among 255 survivors (52% male) of the 2011 Utøya youth camp attack in Norway 3 years before and after the attack, and their reason for encounter with the PCP according to the International Classification for Primary Care (ICPC− 2).ResultsThe PCP and MHS consultation rates (CR) were higher in female than male survivors both acutely and at long-term. The mean yearly CRs increased from 2.25 to 4.41 for PCP and 1.77 to 13.59 for MHS the year before and after the attack in female survivors, and from 1.45 to 3.65 for PCP and 1.02 to 11.77 for MHS in male survivors. The third year post-attack CRs for PCP were 3.55 and 2.00; and CRs for MHS were 5.24 and 2.30 in female and male survivors, respectively. Among female survivors, 76% consulted PCP and 12% MHS the year preceding the attack; post-attack 93% consulted PCP and 73% MHS the first year; decreasing to 87 and 40% the third year. Among male survivors, 61% consulted PCP and 7% MHS the year preceding the attack; post-attack 86% consulted PCP and 61% MHS the first year, and 67 and 31% the third year. As for PCP consultations, there was a particular increase in psychological reasons for encounter following the attack.ConclusionsThis study indicates that it is important to anticipate an increased healthcare utilization several years following mass trauma, particularly of MHS. Both PCP and MHS practitioners played important roles in providing healthcare for psychological problems in young survivors of terrorism in a country with universal and largely publicly financed healthcare and a gatekeeping system. The healthcare utilization could be different in countries with other health systems or psychosocial care responses to mass trauma.

Telehealth in primary mental health care in rural and remote areas: A systematic review

Mental health problems are becoming more prevalent globally. Therefore, innovative patient care delivery approaches are being considered due to the rising need for primary mental health care services and an increase in the usage of digital communication tools online. For this reason, this systematic review was conducted to analyse relevant articles about telehealth in primary mental health care services in rural and remote areas. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was provided as guidance. The Joanna Briggs Institute (JBI) checklist was also used to evaluate the quality assessment. The databases are Scopus, Web of Sciences, and PubMed databases. Most telehealth in primary mental health care used in rural and remote areas takes the form of videoconferencing and application. Telehealth in primary mental health care services delivered to difficult-to-reach populations, like those in rural and remote areas, has significantly improved community mental health services in terms of results and satisfaction. Tele-mental health can be considered a safe and long-term solution but has several challenges that must be addressed.
 Keywords: Mental health; primary health care; rural area; remote Area; telehealth

A Veterans Affairs' perspective in response to Best Practice Model Subcommittee attribute statements for outpatient psychiatric pharmacists.

We applaud the work published by Lee et al1 and the best practice model subcommittee in their attribute statements for defining the optimal recommendations for outpatient psychiatric pharmacy practice. This serves as an excellent foundation in standardizing the expectations for clinical pharmacist practitioners (CPP) within outpatient mental health (MH) settings and our group believes these defined statements are being applied at the Department of Veterans Affairs (VA).2 Measurement-based care, suicide assessment, and comprehensive medication management (CMM) are all standards of care for VA outpatient MH CPP.3 The goal of our letter is to highlight the VA MH CPP model and the advancements in access, quality impact, and standardization.Integrating the MH CPP into the team-based care model significantly improves access to care, primarily when the CPP is utilized as a primary MH provider. Many strong CPP practices within the VA have been identified, including CPP integration into primary care MH services, outpatient MH clinics, specialty MH, and residential rehabilitation programs. Other strategies utilized by VA MH CPP to optimize access include utilizing analytics to target specific clinical interventions (population management), posthospital discharge appointments, and enhanced patient care in suicide risk stratification.In October 2017, the VA Pharmacy Benefits Management (PBM) partnered with the Office of Rural Health to increase access to care for veterans by utilizing MH CPPs as MH prescribers. Within 2½ years from its inception, 40 MH CPPs were hired, which increased direct patient care access and quality by providing CMM for 51 210 rural-residing patients.4 Due to the initiative's positive impact on patient care, an additional 46 MH CPP were hired in FY20/21, which demonstrates the importance of optimizing the MH CPP role in the team-based care model.MH CPP within the VA have established guidance for how to create a positive impact in the VA's internal performance metrics, including population management, continuity of care, experience of care, behavioral health screenings, and suicide risk management. They are also instrumental in serving as facility champions for psychotropic stewardship and safety. One of the attribute statements proposed by Lee et al1 recommends prescriptive authority and/or a collaborative practice agreement. In collaboration with VA PBM, a care coordination agreement (CCA) was created for MH CPP and establishes a partnership between MH and pharmacy services. This CCA covers many of the attribute statements, including attribute statements 14-24 and 27. The CCA is approved by service leadership and the chief of staff to ensure these attribute statements are being upheld. The PBM has also developed a business rules document to guide standardization of MH CPP practice within the VA. This includes in-depth descriptions defining clinical pharmacy practice, patient care delivery, optimizing access and integration, and documentation of workload.Overall, the VA has taken great strides to advance the practice of MH CPPs. Current practice by VA MH CPPs incorporates many of the attribute statements. We are hopeful that these well-developed attribute statements will help foster all psychiatric pharmacists to practice at the highest level of care, achieve reimbursement for clinical services, and bolster patient and provider satisfaction.

Five Failures and Five Challenges for Prevention and Early Intervention for Personality Disorder.

Despite global consensus regarding the early detection of personality disorder, current approaches to early intervention have failed to deliver for the majority of young people. This only serves to reinforce the enduring effects of personality disorder on functioning, mental and physical health, resulting in a reduction of quality of life and life expectancy. Here, we describe five significant challenges facing prevention and early intervention for personality disorder: identification, access to treatment, research translation, innovation and functional recovery. These challenges highlight the need for early intervention to shift from niche programmes in specialist services for a select few young people to become established in mainstream primary care and specialist youth mental health services. Reprinted from Curr Opin Psychol 2021; 37:134-138, with permission from Elsevier. Copyright © 2021.

Closing the nursing leadership gap: Leveraging partnerships with people with intellectual disabilities and developmental disabilities

Monumental changes in health care are needed and highly likely when nurses lead, specifically in the health outcomes for individuals with intellectual disabilities (ID) and developmental disabilities (DD), their families, and the community. Individuals with ID/DD represent approximately 17% of the US population, and experience higher morbidity and mortality rates at earlier ages compared to the general populous (Cooper et al., 2015). Unfortunately, access to primary medical and mental health care services is even lower compared to persons without disabilities (Doherty et al., 2020).

Exploring the impact on primary care mental health practitioners of the death of a patient by suicide: An IPA study.

There have been numerous qualitative studies into the impact of the death of a patient by suicide on clinicians, but the majority of studies have focussed on psychiatrists and psychologists, primarily in inpatient or secondary care settings. To date, little has been done to explore the impact of such deaths on other mental health practitioners working in primary care, such as those working in Improving Access to Psychological Therapies (IAPT) services. This qualitative study used purposive sampling and adopted an interpretative phenomenological analysis (IPA) methodology. All participants had experienced the death of a patient in their role as a practitioner in an IAPT service. Seven practitioners were recruited from services across the North of England. Semi-structured, one-hour telephone interviews were audio recorded and then transcribed verbatim. Analysis of the transcripts identified a number of themes, which were represented in the majority of cases. Specifically, the analyses yielded four superordinate themes: (1) feeling shocked and upset about the death of a patient; (2) attempting to understand the causes of the suicide; (3) learning from the tragic event; and (4) reflections on what helped in coping with the tragic event. The emotional responses of shock, upset, guilt and fear of blame by IAPT practitioners following the death of a patient through suicide is consistent with that found in studies of other mental health practitioners. It is hoped that the current study will help raise awareness amongst primary care mental health practitioners, services and training centres, of the impact of losing a patient to suicide and will encourage them to consider how best to prepare and support practitioners in this eventuality. Recommendations include raising awareness of the potential for patient suicide in primary care services, providing clarity on the individualised support available and on the requirements of investigations.

The Neighborhood Health Initiative: An Academic-Clinic-Community Partnership to Address the Social Determinants of Health.

A medical school, Federally Qualified Health Center, and community-based organizations wanted to improve social determinants of health and health outcomes in an urban area with economic and health inequities. To describe the development of the partnership called the Neighborhood Health Initiative (NHI). Community-engaged strategy with multidisciplinary partnerships used an established framework to develop trust, assess needs, and respond. Co-locating primary care services, traditional healers, mental health, and legal services in response to community partners' and residents' concerns helped to create a community-centered health home. As part of the needs assessment, community health workers conducted multiple visits to build trust and ascertain community members' strengths and challenges. Selected shared projects provide solutions to locally identified problems constituted community-driven initiatives. The NHI is working toward sustainable strategies to improve population health in an underserved area of Austin, Texas. Consistent and frequent contact contributed to developing relationships and trust; limiting partners and objectives focused activities on meeting initial goals of the NHI. Next steps include evaluation of the three aims of the NHI and process evaluation to guide future initiatives.

Understanding household health through data linkage.

ObjectivesHousehold factors can affect the level and type of health and social care a person with long-term conditions needs. Information on household composition and health needs within households is not easily available in routine health records but linked data from health providers and local government can address this gap. ApproachIndividual-level linked data from local government services, health providers and health commissioners in Barking and Dagenham was used. This provided sociodemographic, health and household information alongside activity data for five care settings (primary care, hospital, community, inpatient and outpatient mental health services, and social care). We identified 9222 residents aged 50+ living in two-person households between April 2016 and March 2018. Their long-term conditions were counted using primary care data. Annualised use and cost of care services were compared for households with one versus both residents having two or more long-term conditions (known as “multimorbidity”). ResultsOver 45% of multimorbid people in two-person households were co-resident with another multimorbid person. This percentage was higher in the most deprived areas. In households where both residents were multimorbid, each resident had higher use of some types of care. After adjustment for age, gender and area deprivation, those co-resident with another multimorbid person were 1.14 (95% CI 1.00, 1.30) times as likely to have any community care activity and 1.24 (95% CI 0.99,1.54) times as likely to have any mental health care activity compared to those co-resident with a healthy person. They had more primary care visits (8.5 (95% CI 8.2,8.8) vs 7.9 (95% CI 7.7,8.2)) and higher primary care costs. Outpatient care and elective admissions did not differ between these groups. ConclusionsCare use for people with multimorbidity depends on the health of others in their household. Use of household health data could inform local planning for health and other community services. Its use for delivering individual or household level care could be explored, if acceptable to patients. Future research could examine larger households.

Trends in mental health service utilisation by Australia's older population.

To examine the incidence, trends, and differences between age groups and sex in Medicare Benefits Schedule (MBS)-subsidised mental health service utilisation by older Australians over the past 10 years. A cross-sectional cohort study between 1 July 2009 and 30 June 2019 was conducted using publicly available MBS data for older individuals aged ≥65 years. Age- and sex-standardised yearly incidence rates of psychological therapy (MBS M06), GP mental health treatments (MBS A20), focussed psychological strategy (MBS M07), and psychiatric attendances (MBS A08) and incidence rate ratios (IRR) estimated using Poisson regression were calculated. Overall, the rate of utilisation of primary care mental health services by the older population increased over the study period, with psychological therapy claims increasing the greatest from 14.4/1000 older persons in 2009/10 to 38.5/1000 in 2018/19 (IRR 1.11, 95% CI 1.09-1.13), followed by GP mental health treatments increasing from 43.7/1000 (95% CI 43.4-43.9) in 2009/10 to 81.0/1000 (95% CI 80.7-81.3) in 2018/19 (IRR 1.07/year, 95% CI 1.06-1.09). Females aged 65-74 years had the highest use of GP mental health treatments at 123.8/1000 compared to 63.6/1000 in males in 2018/2019. While utilisation of mental health services by the older population in Australia has increased over the study period, it is important that policymakers and service providers continue to support access and use of these services, which may facilitate well-being and quality of life in the older population.

A state level analyses of suicide and the COVID-19 pandemic in Mexico

BackgroundWhile suicide rates in high- and middle-income countries appeared stable in the early stages of the pandemic, we know little about within-country variations. We sought to investigate the impact of COVID-19 on suicide in Mexico’s 32 states and to identify factors that may have contributed to observed variations between states.MethodsInterrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from Jan 1, 2010, to March 31, 2020), comparing the expected number of suicides derived from the model with the observed number for the remainder of the year (April 1 to December 31, 2020) for each of Mexico’s 32 states. Next, we modeled state-level trends using linear regression to study likely contributing factors at ecological level.ResultsSuicide increased slightly across Mexico during the first nine months of the pandemic (RR 1.03; 95%CI 1.01–1.05). Suicides remained stable in 19 states, increase in seven states (RR range: 1.12–2.04) and a decrease in six states (RR range: 0.46–0.88). Suicide RR at the state level was positively associated with population density in 2020 and state level suicide death rate in 2019.ConclusionsThe COVID-19 pandemic had a differential effect on suicide death within the 32 states of Mexico. Higher population density and higher suicide rates in 2019 were associated with increased suicide. As the country struggles to cope with the ongoing pandemic, efforts to improve access to primary care and mental health care services (including suicide crisis intervention services) in these settings should be given priority.

What factors influence engagement with primary mental health care services? A qualitative study of service user perspectives in rural communities of Mexico

BackgroundLow engagement with mental health treatment, including a lack of help-seeking and low subsequent attendance to treatment, are important challenges to the provision of mental healthcare. In settings with high levels of poverty, such as rural Mexican communities, low engagement may be aggravated by the limited availability of mental health services and existing barriers to access these services. This qualitative study was conducted to investigate factors that influenced engagement to a primary care mental health service programme in Chiapas, Mexico. MethodsWe conducted 30 semi-structured interviews with adult service users diagnosed with depression or anxiety who had received mental health services at 10 primary care clinics in rural communities in Mexico. Interviews were analysed through the framework analysis approach to understand service user perspectives on factors influencing: (a) help-seeking, and (b) subsequent treatment attendance. ResultsLack of attribution of symptoms to a mental illness, the perception that symptoms could be managed without treatment, and stigma hindered help-seeking. Perceived need for care, prompted by strong feelings of desperation and severe somatic symptoms, along with advice from trusted sources about the availability of relevant services at the primary health care clinics, were key incentives for service users to make their first contact with the clinics. An ongoing desire for symptom alleviation and satisfaction with services (e.g. due to the positive impact of treatment) improved subsequent attendance, while feeling that treatment was no longer necessary and structural barriers led to non-attendance. ConclusionsStrategies to enhance understandings between service users and health care providers are necessary to improve the extent to which the needs and preferences of service users are met by healthcare services. Further improvements in the mental health of communities are likely to require interventions outside the health setting that tackle social risk factors affecting mental health.

Organising Joint Primary & Secondary Care (CPA) Reviews for severe mental health disorders hosted at GP practice in Walsall UK, an exemplar of collaborative working

IntroductionProvision of holisitc, accessible and high quality mental health care to the patients requires sharing of responsibilities & resources, enhanced communication & collaboration at the interface (primary care systems and secondary care mental health services). An innovative model of single point of care for people with severe and enduring mental health problems hosted at a primary care (GP) setting has been developed and evaluated in Walsall, UK.ObjectivesTo develop and evaluate an integrated (multidisciplinary) approach of managing health & social care needs of people with severe mental health disorders.MethodsPeople with severe & enduring mental health problems were reviewed in primary care (N=65). A comprehensive physical, mental and psychosocial assessments were undertaken by the clinicians that included GP, Psychiatrist and Care-Coordinator.The reviews included: 1) A review of physical health indicators based on the Lester toolkit by practice pharmacist/nurse, including lifestyle, body weight, BMI and blood pressure. 2) Individualised interventions included physical / psychiatric prescribing, social prescribing and advise on lifestyle changes. Stable patients were recommended for stepping down from the secondary care. Outcomes included Patient Satisfaction Questionnaire (PSQ).ResultsSatisfaction on the PSQ was rated from very good to excellent. Results highlighted multiple benefits including trust generation, improved communication among professionals, physical health screening and prompt clinical decision making (e.g. referral / prescribing). Other benefits included patient access & satisfaction, time and cost efficiency by reducing the number of reviews.ConclusionsThe integtrated CPA reviews offers efficient, holisitc & cost effective model of care with high satisfaction levels for patients and is replicable.DisclosureNo significant relationships.

Implementing shared decision-making in Australia

Person-centred care (PCC) and shared decision-making (SDM) are part of national clinical standards for an increasing number of areas of health care delivery. In addition to existing standards for accrediting hospitals, day surgery facilities, public dental services and medical education in Australia, new standards governing primary health care and digital mental health services have been added. Implementation and measurement of PCC and SDM to comply with standards, and training of health professionals, remain challenges for the Australian health sector. Consumer involvement in health research, policy and clinical service governance continues to increase and the National Health and Medical Research Council has begun to encourage consumer and community involvement in health and medical research. This increased consumer engagement and moves towards more PCC provision is reflected in a focus on encouraging patients to ask questions during their clinical care and supports improvements in consumer health literacy. SDM support tools are now being culturally adapted whilst a need for more systemic approaches to their development and implementation persists. With increasing resources and tools for all aspects of PCC and SDM challenges to find sustainable solutions to ensure tools are kept up to date with the best available evidence remain.

A pragmatic preference trial of therapeutic yoga as an adjunct to group cognitive behaviour therapy versus group CBT alone for depression and anxiety

BackgroundYoga has several mechanisms that make it a promising treatment for depression and anxiety, including physical activity, behavioural activation, and mindfulness. Following positive outcomes from adapted CBT interventions incorporating mindfulness-based practices, this study explored the effects of a therapeutic yoga program as an adjunct to group-based CBT for depression or anxiety. MethodsThis was a pragmatic preference trial involving adults diagnosed with depression or anxiety in a regional primary mental healthcare service (n = 59), comparing transdiagnostic group CBT (n = 27) with transdiagnostic group CBT combined with an adjunct therapeutic yoga program (n = 32). A preference recruitment design allowed eligible participants (n = 35) to self-select into the adjunct program. The Depression Anxiety Stress Scale-21 (DASS) was assessed at baseline, post-intervention, and three-months follow up. ResultsCBT + Yoga was an acceptable alternative to CBT alone. Significant reductions were observed in total DASS scores and the 3 subscales of the DASS for both groups, however CBT + Yoga showed significantly lower depressive and anxiety symptoms post-intervention, compared to CBT alone. CBT + Yoga also showed sustained reductions in depressive symptoms over three-months, and more rapid reductions in depressive symptoms, compared to CBT alone. LimitationsThese findings should be considered preliminary due to the moderate sample size, with a rigorous randomised control trial necessary to definitively support the integration of yoga within mental health care to augment the benefits and uptake of transdiagnostic CBT for depression and anxiety. ConclusionsComplementing other mindfulness-based practices, therapeutic yoga shows promise as an adjunct to transdiagnostic CBT.

Trends in Primary Mental Health Care Service Use and Subsequent Self-Harm in Western Sydney Australia: Policy and Workforce Implications.

Background: This study investigated the trends in primary mental health care (PMHC) service use and hospital-treated self-harm in Western Sydney (Australia). Methods: A data linkage study and descriptive ecological study of PMHC referrals investigated the trends in referrals, treatment attendance, hospital-treated self-harm, and health care practitioners (HCPs) for the period of 2013−2018 (n = 19,437). Results: There was a substantial increase in referrals from 2016. The majority of referrals were females (60.9%), those aged <45 years (71.3%), and those presenting with anxiety or affective disorders (78.9%). Referrals of those at risk of suicide increased from 9.7% in 2013 to 17.8% in 2018. There were 264 (2.2%) cases of subsequent hospital-treated self-harm, with higher rates among those at risk of suicide and those who attended <6 sessions. The number of HCPs per referral also increased from 2013, as did waiting times for treatment initiation. Conclusion: Individuals presenting to PMHC services at risk of suicide, and who subsequently presented to a hospital setting following self-harm, were more likely to either not attend services following a referral or to attend fewer services. This trend occurred in the context of an increase in the number of clients per HCP, suggesting workforce capacity has not kept pace with demand.

Designing and scaling up integrated youth mental health care.

Mental ill-health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID-19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co-designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad-spectrum, integrated primary youth mental health care services. They represent a blueprint and beach-head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, "soft entry" youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill-health in young people globally demands that this focus be elevated to a top priority in global health.

Government-subsidised mental health services are underused in Australian residential aged care facilities

Objective To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access.

Enhancing primary care psychology services with assistant psychologists in Ireland: An evaluation of output, throughput and stakeholder satisfaction.

Primary care mental health services need to expand to assist the increased number of people reporting mild to moderate mental health difficulties. In Ireland, the primary care mental health service has been recently enhanced through the employment of Assistant Psychologists (AP) in primary care psychology. This paper provides an early and brief evaluation of the impact of the AP-enhanced model through a tripartite approach to evaluation which utilises measures of throughput, output and stakeholder satisfaction. We use data from two sources; Health service key performance indicators, and a routinely gathered minimal dataset of client measures. Results indicate that the numbers of clients seen in the period rose by 16%, that AP-delivered treatments are beneficial for clients with mild to moderate mental health difficulties, and more than 80% of clients reported being 'totally satisfied' with the care received. The data provide early evidence that the AP model is beneficial in meeting clients' needs across a range of presentations within the service admission criteria, and that the AP-enhanced model may offer a satisfactory solution to primary care needs. However, further data collection is required, and additional stakeholder input is necessary for a complete evaluation of the assistant psychologist model in primary care.