Professor Helen Keleher¹ and Dr Alexandra Gartrell²
¹ Department of Health Science, Monash University
² Department of Geography, Monash University
beyondblue Victorian Centre of Excellence
Project completion year
This study examined how people experience mental health care, specifically ‘shared care’.
Shared care refers to care given by more than one provider in ways other than the traditional referral model.
Aims of the study were to:
- enhance understanding of shared mental health care within the primary care sectors
- broaden current understanding of the term ‘mental health literacy’
- explore how social determinants of mental health affect pathways to care for individuals experiencing depression and related disorders.
Data was gathered via interview with 42 consumers of mental health care aged between 20 and 70, of whom 28 were female and 14 were male. Thirty four service providers from a range of relevant disciplines were also interviewed.
Demographic and social information was gathered via a short survey. Two validated scales, the K10 and DASS 21, measured distress, stress and anxiety. Every respondent reported depressive symptoms, with the majority reporting medium to high levels of distress.
Interviews were analysed qualitatively. The data enabled a comprehensive analysis of:
- care pathways
- collaborative mental health care
- help-seeking patterns
- recovery and depression management in relation to social disadvantage.
Engaging with the health system was more difficult for people without social networks of family and friends. Disadvantaged people had the fewest options and were the least likely to receive effective treatment.
The experience of depression for each respondent was shaped by complex interactions of social, psychological and physiological processes. As a consequence, respondents felt they needed a range of treatment types and options to address their unique needs.
Clinical care met only one aspect of consumers’ care needs, with a range of other non-medical providers contributing to pathways to effective treatment. These included:
- social and welfare organisations
- self-help groups
- community health services
- public mental health services
Whilst all consumers in this study had received services from more than one provider, few of these providers were connected to each other, and even fewer consumers described effective collaboration between them.
Consumers did see the value of services working collaboratively, or at least communicating about medication management and potential side effects.
While formal shared care models were useful for the GPs who engaged in them, shared care was primarily used as a model for referral with only weak levels of information sharing.
Implications for Policy and Practice
The chronic depression experienced by consumers and the complex pathways to care that they describe, suggests that early intervention and timely treatment has a role in preventing both chronicity and its associated distress.
Access to low cost mental health services in a timely manner is essential, given the relationship between depression and socio-economic disadvantage. However, consumers found low cost mental health services very difficult to access with long waiting lists.
The current message to consumers with depression to ‘see your doctor’ positions the GP as the most important primary care provider for people with depression. However, other providers were absolutely essential to consumers in this study, with the most important therapeutic relationships spanning a range of clinical providers including psychologists, social workers and social support providers. The complex and often chaotic pathways described by consumers indicate the need for clearer multi-disciplinary service support for people struggling with severe depression.
Each person has their own explanatory model for depression which implies that the care pathway needs to be individualised, at least to some extent. The capacity for providers to assist consumers to establish a recovery plan is critical and that plan needs to be reviewed periodically and augmented in responsive and timely ways.
The findings from this research illustrate the need to:
- broaden understanding of shared care to reflect the range of medical and non-medical providers
- develop stronger inter-professional models of working
- to assist consumers in developing pathways to recovery from depression.
This research raises questions about access to services that people with depression consider appropriate and useful for managing their illness.
About the Principal Researcher
Dr Helen Keleher is Professor and Head, Department of Health Science at Monash University. Her expertise is in health promotion, health policy and the determinants of health and of inequity. Her research is focused on mental health promotion, primary health care, and building capacity in the workforce, organisations, and in policy to support equity-focused health promotion. Helen is co-convenor of the Victorian Health Inequalities Network funded by VicHealth and holds an appointment to the Women and Gender Equity Knowledge Network of the WHO Commission on the Social Determinants of Health. Her co-edited book, Understanding Health : a Determinants Approach, is published by OUP, as is her most recent book, Understanding Health Promotion.