| Project Objectives / Summary:
The project's aim was to improve quality of care through development of integration between GPs and Regional Mental Health Services by a combination of educational and service measures, along with GP upskilling.
The project was a model of shared care that used a number of strategies to attain a level of communication between GPs, Mental Health professionals, community service providers, mental health consumers and their carers and families. It included educational strategies, system changes and service measures, GP upskilling and tools such as care plans and case conferencing to address the issues around roles and responsibilities of General Practitioners and Mental Health Professionals. The model utilised the EPC MBS items to assist the GP with remuneration for conducting a care plan and case conference.
Utilising, action research theory and practice and incorporating key community stakeholders, "A Model of Sharing Mental Health Care in Far North Queensland" was developed to best meet the specific needs of the community. A number of issues have arisen over time namely overcoming cultural and attitudinal barriers, professional rivalry and time constraints. Despite these issues, coordinated-shared care continues to build momentum in the Far North Queensland region.
Project Outcomes:
- GPs wanted the opportunity to discuss specific questions relating to their own practice and patients.
- The need to provide education aimed at GPs with different levels of knowledge and targeting GPs who felt they did not need upskilling in mental health.
- Consumer advice on providing GPs with enhanced communication skills. It was evident from a consumer and carer perspective that GPs did not need to know every mental health disorder and its treatment. Rather, the ability to communicate in a non-judgmental and open manner "How can I help" (Consumer, Project Team 2001).
Guided by international, federal and state policies on mental health, and the needs of local GPs the Project Team explored a number of options and conducted a survey. The following strategies were developed and implemented:
Education consultation/liaison model:
A sustainable consultation liaison model designed to give GPs an opportunity to learn through observation. Twice a year over a four-day period, a Psychiatrist agreed to assist GPs with assessment and management of mental health consumers who do not fit the criteria of mental health services. This model included pre and post briefing to assist the GP with further management. It is an educational model not to replace lack of mental health services/professionals in the region. To date this model has not been implemented due to the lack of availability of the Psychiatrist. The Division is exploring videoconferencing as an option to face-to-face meetings.
GP Case Discussion Forum:
The bi-monthly forums aimed at enhancing GPs mental health knowledge and skills by providing a multidisciplinary forum where two case studies are presented GPs and facilitated by a Psychiatrist. It was based on peer based learning and building rapport and relationships across disciplines. A total of four GP mentors were recruited to drive the project. They were provided with a package including step-by-step instructions on organising and facilitating each forum. The forums are approximately one - hour in length, include two Continuing Medical Education points per hour and may be conducted any time of day suitable to the GPs in that region. GPs, Mental Health Professionals and local mental health services are invited to attend. The project is sustainable through sponsorship of two pharmaceutical companies who will both provide funding and assist the GP Mentors organise the bi-monthly meetings.
On- Line CME -Availability of direct links to web sites that provide On-line CME Activities
Keeping mental health education on the main CME calendar has posed a challenge. GPs did not request mental health upskilling in the 2001 annual needs assessment and the absence of formal mental health CME on the 2001 calendar illustrates the lack of knowledge in CME program development using the typology of need concept and formal acknowledgment of the role CME can play in changing culture and attitude for improved coordinated care.
Recommendations:
- To provide two formal Continuing Medical Education mental health activities on the main Far North Queensland Rural Division of General Practice Continuing Medical Education Calendar;
- Invite Allied Health Professionals (both private and public) to appropriate Far North Queensland Rural Division of General Practice Continuing Medical Education Activities to promote integration at the local level;
- Continue to support General Practitioners in the uptake of the Enhanced Primary Care MBS Items;
- To provide, resource and support bi-monthly Mental Health Integration & Quality Project, Mental Health Project Team meetings;
- To provide regular updates in the Divisional Newsletter, Top Doc on all local Mental Health Services;
- Regular six monthly reviews of systems;
- Mental Health Consumer and Care input at all levels of decision making;
- More coordination with the Cairns Division of General Practice and Cairns Integrated Mental Health Program; and
- To continue the coordinated care strategies established in September 1999 to facilitate integration and the change process over time.
Disseminating the Project:
Article "Division sets up psych line" in Professional News
Lessons / Assessment:
In the early stages of implementation, a number of problems emerged based on cultural and attitudinal barriers to coordinated care in both GP and MHS. Action research theory and practice were utilised to assist project team identify the problems and address the barriers effectively. Action research techniques facilitated the change process through providing a tool for advocating and facilitating at the local level.
However, time continued to be a barrier facilitating coordinated care at the local level. Time to change culture and attitude and formal processes has hampered the project team in proceeding with implementation of shared care. It is the process over time that gives all Project Team Members the opportunity to build rapport in a multidisciplinary Team that builds on relationships, trust and mutual respect. Underpinning the decision-making model was concepts of social justice including rights, access, participation, equity and equality. The recipe of time, process, and consensus decision-making and social justice resulted in ownership of the project by the team. Consumers and carers on the Project Team stated "The Division has given Tablelands Consumer Advisory Committee recognition in the community" (Consumer, Tablelands Consumer Advisory Group, 2000). Despite the time restrictions, persistence with the recommendations will overcome many of the cultural, attitudinal and systematic barriers experienced by the project team. |
