Shaking Up the Delivery of Traditional Mental Health Services

Several primary health care organizations (PHCOs) that I have spoken with in the states and in Australia during my 10-month fellowship have established a central referral point or “one stop shop” to help primary care practices connect their patients to community-based mental health and/or substance abuse services. These referral centers can take the load off practices helping to sort out the myriad of community programs, assess patient eligibility criteria, and assist with scheduling appointments. The North Coast New South Wales Medicare Local established “Healthy Minds” as the referral point for mental health services for vulnerable people in their catchment area, but then the Medicare Local took an additional step. It turned the service delivery upside down, shaking the mental health providers out of their private offices and placing them in community organizations.

North Coast NSW Medicare Local began by contacting all of the community based, non-government organizations (NGOs) providing homelessness services, employment support, women’s health, aboriginal medical services, etc. in their catchment area and asked, “Would your clients/patients benefit from a psychologist co-located with you?” NGOs were invited to submit an “Expression of Interest.” Through emails, websites, media releases, and a targeted outreach to ensure there was a good regional spread of organizations, the Medicare Local received about 29 applications and narrowed the list down to 24 appropriate candidates. The next step was to contact private mental health providers to ask, “Would you like to work with a NGO in your region?” The Medicare Local heard from about 60 applicants interested in working with an NGO. From there, the North Coast NSW Medicare Local facilitated matching the NGO with the mental health provider.

The matchmaking process began with the mental health provider indicating their area of expertise (for instance pediatrics, trauma) and geographic area he or she would like to co-locate and then providing a list of appropriate NGOs for the provider to indicate their preferences. The Medicare Local sent the mental health provider’s CV off to the NGOs and then facilitated an interview process whereby the NGO and the mental health provider could determine if each other were a good fit, and if positive, they then worked out a schedule. For instance, a mental health provider may work at a primary care practice for 1 or 2 days a week and a women’s clinic a half-day, depending on the volume of patients.

Healthy Minds accomplishes two major purposes:

  • It takes mental health services into community organizations (NGOs) where health services have not traditionally resided, thus bringing social support and clinical care together.
  • It also places mental health professionals in primary care practices, ensuring that mental health services are together with other clinical services e.g. in Aboriginal Medical Services.

Both of these actions help lessen the stigma that is often associated with receiving mental health care in traditional mental health office settings. It also greatly distributes mental health services across the entire sector opening up multiple entry points for care.

australia-footballAustralia Habits, Part II: Obsession with footy

Make no mistake; the U.S. loves its professional sports, especially football. But the Australian love of sports involving the word “foot” spans four sports. Footy in Australia refers to Soccer (we all know that one), Rugby Union (this is the original game played throughout the world), Rugby League (rules are slightly different than Rugby Union, but only played in Australia, New Zealand and South Africa) and Australian Football (where players kick a rugby size ball through one of six goal posts on an oval field). Having attended the various footy matches, I cannot tell you anything learned about the games but I can provide a brief commentary on eating traditional stadium food: mini meat pies. Got napkins?