Clinical psychology in rural general practice: a national pilot of a new model of collaborative mental health service delivery

Abstract

ABSTRACT Approximately 23% of Australians suffer from a mental disorder in a twelve month. period. The vast majority of mental health service delivery is undertaken in primary care by General Practitioners (GPs). Current research evidence indicates that a combined pharmacological and psychological approach is required for maintained improvement in the treatment of depression, with appropriate evidence-based psychological interventions on their own proving effective in a large number of cases. Lack of public funding of psychological services has meant that many patients in need are unable to access appropriate psychological interventions. This thesis reports on research undertaken on behalf of the Commonwealth Government of Australia into the effectiveness of providing clinical psychology services in the primary care setting as an adjunct to previously available primary medical services. A collaborative model of treatment involving GPs and Clinical Psychologists was trialed in three geographic locations in Australia: Bathurst, Ballarat and Armidale entailing the placement of Clinical Psychology Registrars (later year interns) in the primary care setting. A controlled trial was undertaken in which patients’ levels of improvement on a number of mental health indices were monitored and compared with a control group of patients surveyed in the General Practice waiting room. In addition, added parameters of patient, GP and Clinical Psychology Registrar satisfaction with the model were included as part of the study. Findings indicated that whilst GP treatment of patients alone resulted on average across groups in significant gains on measured indices, those undertaking collaborative care involving both GPs and Clinical Psychologists improved significantly more than those receiving medical care alone. A matched-pair analysis of 47 patients confirmed this, highlighting significantly greater gains from the additional clinical psychological intervention and further validating the effectiveness of the collaborative care model. Follow-up patient, Clinical Psychology Registrar and GP satisfaction surveys indicated highly positive perceptions of the model of collaborative care as a treatment, training and adjunctive care framework. All results indicated clear “value added” for the collaborative model when compared to traditional medical care alone. Having obtained positive results from the research phase of the project, and in light of the current lack of a much-needed systemic perspective in which practitioners and their professional associations become involved in the political arena and policy formulation, a Submission to the Federal Minister of Health and Ageing was written prior to the 2004 Health Budget summarizing the positive results, the applied implications of the collaborative care framework and emphasising the need for inclusion of Clinical Psychology as a profession under primary care public health funding. Further Submissions were written to the Prime Minister in early 2006 prior to the Council of Australian Governments Meetings at which mental health service delivery reform was on the agenda. The current policy developments and service delivery changes occurring since the inception of the research project are discussed in the final chapter of the thesis.