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A new approach to mental health care

11 February 2020 - Dr Janette Randall

I’m a GP with a special interest in mental health.  For the past three years I have been working with Medibank Health Solutions to support the implementation of a range of programs for people with chronic and complex health conditions.  It has been a great opportunity to ensure that these programs are inclusive of people with mental health issues, and to encourage an integrated and community-based approach. 

Day to day within my role I have been providing clinical support to an exciting new mental health program being funded by SA Health and trialled in two large hospitals in Adelaide.  This pilot program, called the Rapid Hospital Avoidance Program, aims to provide an alternative to hospitalisation for people presenting with acute mental health issues that might otherwise require a period of time as an admitted patient.

  

Here’s how it works....

A person with acute mental health issues presents or is brought to ED for assessment by the mental health team.  If they are deemed safe to be discharged with an increased level of support a referral is made to our RHAP team.  After consultation with the mental health clinicians, the RHAP team send the referral to myself or one of our consultant psychiatrists for review.   For the most part we accept the referral, but we decline an occasional one if they are high risk, active drug users, or outside the scope of our skill set.  Once accepted, our clinicians help them transition back into the community.  This could involve transporting them home from hospital, arranging emergency accommodation if required,  reconnecting them with their family/friends/support people, and ensuring they are safe and have food and other basic requirements.  

Our clinicians then work with the client for up to 90 days, but usually for 2-4 weeks, to provide:

  • a safety plan and brief interventions,
  • support compliance with existing treatment plans or arrange for review if required,
  • ensure an effective care team is in place for ongoing support,
  • and work with the client on relapse prevention

Our psychiatrists can provide skype consults if required eg for patients with diagnostic uncertainty and lack of access to a local psychiatrist, and our multidisciplinary allied health team can provide additional support as required.  Our occupational therapist for example has provided much needed support for clients trying to access the NDIS by undertaking functional assessments.

What have we learned

The program is undergoing formal evaluation and I look forward to sharing the results with you in a future blog.  While we expected to see clients with relapse of their chronic mental health conditions, what has surprised us is the number of clients presenting with a first episode mental health issue or crisis event who usually have good support and manage quite well.  This represents about 40% of clients – they are often working, have good interpersonal relationships, and have just experienced a difficult life event or loss which has tipped the balance.  They present in crisis, often with self harm or suicidality. Avoiding hospitalisation for this group of patients is a game changer.  We can quickly get them back to their usual environment, enable their coping strategies, integrate their experience in a way that makes sense for them, and save them the often traumatising experience of an inpatient stay.  Hopefully over time we will see more investment in community based treatment programs for patients with mental health conditions.

Dr Janette Randall
Dr Janette Randall

Janette is a General Practitioner and GP education facilitator at Black Dog Institute. She is a current Director of the NPS subsidiary company Venturewise, undertakes work in the corporate health sector and provides medical advisory services to Medibank’s Care Complete chronic disease program. 

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