| Project Objectives / Summary:
The aim of the project was to improve the delivery of mental health care in the Toowoomba district by establishing effective and sustainable partnerships between GPs and mental health service providers. This aim was achieved by the implementation of the following four interrelated strategies.
The principal strategy was to establish a GP Mental Health Liaison Unit in the Toowoomba District Community Mental Health Service, which was jointly supported by the Division and the Mental Health Service. On a two monthly cycle of four hours a week, three GPs acted as liaison officers between the interdisciplinary psychiatry staff at the Mental Health Service and a patient's GP.
The liaison officers attended the psychiatry staff team meetings and:
- Brought to the attention of the team a general practice perspective on the patient's care and any input received from the treating general practitioner; and
- Passed on to the treating GP relevant significant information identified at the team meeting.
The other strategies were:
- The formation of an intersectional mental health liaison committee;
- A GP Clinical Attachment Program that was made available to all Division GPs;
- A GP Upskilling Program conducted to improve general practitioner's skills in the detection and management of patients who present with mental health problems.
Project Outcomes:
The liaison officers identified the level of involvement of the GP in a patient's care, brought a general practice perspective to the Community Mental Health Team and liaised where appropriate with the patient's GP regarding the team's management. Knowledge and understanding of the local service was improved and personal links with staff were made. Discussion regarding problems of communication between clinicians and between different services resulted in more understanding if not resolution.
The two mental health upskilling courses covered areas such as psychiatric assessment, management of identified diagnostic groups, and a full day workshop on brief psychotherapies appropriate for use in General Practice. Both courses were over prescribed and feedback from participants showed a high level of satisfaction.
Clinical Attachments were available to participants for sitting in with individual clinicians in the psychiatric service. Despite being promoted, only two GPs participated. Both of the GPs reported that they found the experience highly worthwhile and helpful to them in their practice.
The mental health liaison committee was valuable as a steering committee but once the program was implemented, the need for meetings declined. Consumer contribution to the program was limited by the nature of the program. The consumers did, however, bring consumer issues to the group's attention.
Overall, the project was successful in fostering new health care delivery partnerships between GPs, mental health service providers and mental health consumers.
Recommendations:
Although the presence of a GP liaison officer was accepted and appreciated by the community psychiatry treatment teams, there was no proof of cost benefit. At the project's end, it was considered unlikely that Queensland Health would continue the employment of liaison officers, and there is no mechanism by which they can be funded by Medicare. However the possibility of using GPs, who have upgraded their skills in psychiatry, for primary care input and assistance in community clinics on a sessional basis had been discussed.
Another way of involving the treating GP in the psychiatry service is by means of the case conferencing Medicare items. This would involve the use of clinical pathways, developed in the Mental Health Unit, which could be extended across the boundaries of primary and secondary care. This would have the effect of prolonging the duration of effective, evidence based, psychiatric treatment plans, whilst improving the general health of patients suffering from serious psychiatric disorders. Initially these partnerships would be related to particular drug therapies such as mood stabilisers and people receiving long term anti psychotics.
The participating GPs all recognised the benefit of group discussion of the management of patients with chronic complicated mental health problems especially those with personality dysfunction and past history of childhood abuse. Further efforts will be made in the division to promote a peer group of General Practitioners, who treat these patients, to review their treatment and therapist-patient relationships.
Disseminating Project Information:
Publications:
- One of the GP Liaison Officers wrote an article about her experience in this role and included useful information that she had learnt as a result of her placement.
Conferences/Meetings:
- Dr Robert Craig provided project feedback at a function on 16 August 2000. About 20 people including Grace Groom from QDGP, staff from Community Mental Health, and GPs attended the function
- Dr Robert Craig, Program Manager, presented a paper on the project at The Mental Health Services Conference in Adelaide, 29-31 August 2000.
Lessons / Assessment:
The limitations of the program were structural and recognised from the outset. The program was only funded for twelve months and on-going funding was considered very unlikely.
Resources only allowed for basic pre and post assessment of the participants and the psychiatric team members. These brief studies did not have the power to determine change of knowledge or attitude of the subjects so any conclusions drawn are biased and anecdotal.
Consumer contribution to the program was limited. The presence of members of the Consumer Advisory Group at the rather infrequent liaison committee meetings could be said to make the program organisers aware of consumer issues but it did not allow for active participation.
Those patients interviewed as part of a course session were assessed pre-interview and post-interview and were comfortable with the arrangement. The course participants, however, were for the most part reluctant to expose their patients and themselves to this process.
The Telephone Support Line was not implemented as envisaged in the proposal. GPs did not contact the liaison officers to discuss patients attending the Community Mental Health Service (CMHS) despite the service being well advertised in the Division's newsletter. Rather GP Liaison Officers contacted patients' GPs when this was deemed an appropriate action at the Community Mental Health team meeting. |
