This project is centered around embedding a Rural Generalist with advanced skills Mental Health within the existing medical workforce of the Cooktown cluster. It has enabled establishment of dedicated local and outreach primary mental health and addictions medicine clinics, improved capabilities and confidence of existing staff and resulted in closer collaboration with existing acute mental health teams, emergency and community-based services. It is improving patient outcomes and changing the way mental health and addictions services are delivered across the region for the better.
Rural Generalist – Mental Health: Working Better Together
Changing the way mental health and addictions services are delivered across the Cooktown cluster for the better though establishment of the rural generalist with advanced skills mental health position.
- High quality accessible, culturally appropriate primary mental health and addictions medicine care delivered where it is needed most.
- Improves capacity of all staff to manage mental health and addictions presentations through dedicated education/upskilling.
- Improved patient outcomes though better coordination, communication and collaboration between primary, hospital, community and emergency services in this sphere.
- Clinical oversight and management of complex mental health patients in the community who are unable to access required Psychiatry specialist services locally; noting this is not to replace Psychiatry services but rather to augment them.
- Large burden of disease in mental health and addictions presentations in our area but lack of available services/staffing.
- Particular gaps identified in addictions medicine and primary care mental health.
- No dedicated education for staff around mental health and addictions which was identified as an area of decreased confidence.
- Communication, collaboration and coordination between services in the general medical, emergency, community and mental health and addictions spheres was an area identified which could be optimised to improve patient outcomes.
- Monthly outreach Psychiatry services are not able to provide more intensive service needs to complex mental health clients and would benefit from local specialised care.
Establishment of the Rural Generalist – Mental Health position within the Cooktown Cluster as one of the Senior Medical Officers who is able to contribute to the general medical care of patients in the hospital, emergency and outpatient department, primary health care clinics, on call duties etc. but also provide on the run expertise around mental health and addictions presentations. In addition to this, establish regular GP-Mental Health clinics in the surrounding communities alongside existing GP clinics and weekly Alcohol and Other Drugs/Qld Opiate Treatment Program and GP-Mental Health clinic in Cooktown working in close collaboration with the Cooktown Cluster Mental Health and Alcohol and Other Drug Service. A key focus of the role has been to improve capacity of staff through education and support centred upon mental health and addictions presentations and also to develop relationships, collaboration and open lines of communication between various services involved to improve patient care.
The project is being evaluated via a number of qualitative and quantitative measures.
- Qualitative measures include number of clinics delivered to communities, number of patients seen for mental health specific item numbers, numbers of clients completing or continuing to engage in treatment, number of education sessions delivered, number of quality improvement/collaboration activities/initiatives implemented.
- Halfway point data collated to date indicates and exponential increase in all of these domains, either on target or above.
- Quantitative measures (pending) will include staff and patient surveys, case reports.
This service has grown to fill a gap in service between primary care and acute mental health and addictions services and provide the missing link between medical, emergency, community and mental health/addictions services in response to community need
- Having that one point of contact has allowed new initiatives to be implemented to improve patient outcomes across the board
- A close working relationship with the acute mental health and addictions service has been essential
- While clinics were initially conceptualised as a mixture of GP and GP-MH but as they became more focused on GP-MH, restructuring of clinic timetables and rostering was important to ensure adequate coverage of all areas of service need
- Defining boundaries of the service and delineating roles and clear lines of clinical governance in consultation with all parties has been an important part of establishing the role and making it sustainable long term
- A pro-active approach to seeking long term funding for the position has been important
References that the project was based on:
- World Health Organisation– Mental Health Action Plan 2013-2020
- National Strategic Framework for Rural + Remote Health
- Fifth National Mental Health and Suicide Prevention Plan
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