Professor Malcolm Battersby 1, Associate Professor James Bennett-Levy2, Dr Judy Singer, Ms Michele Moreau, Mrs Fidelma Breen
1 Flinders Human Behaviour and Health Research Unit, Flinders University
2 University Department of Rural Health (Northern Rivers), University of Sydney, Southern Cross University
Project completion year
Only 35 to 40 per cent of Australians with the high prevalence disorders depression and anxiety appear to adequately access appropriate services. The UK Improving Access to Psychological Therapies (IAPT) program uses a government-sponsored 'whole systems' approach to mental health service delivery using low intensity (LI) cognitive behaviour therapy (CBT) interventions developed specifically to address access issues (including reaching people who are hard to reach). IAPT enabled 43,000 people in 11 health regions to access services in the first six months of the national roll-out and achieved recovery rates of approximately 50 per cent in an average of five sessions.
This study looked at whether there is a need for an easily accessible, population-based, LI service for anxiety/depression in Australia; whether the UK IAPT program provides a useful model; what current Australian research initiatives could contribute to an Australian-adapted IAPT (AusIAPT) model; and what adaptations might be needed for an Australian healthcare context.
The project included a literature review, site visits in the UK, key informant interviews in Australia and the UK, focus groups of consumers and health professionals in outer metropolitan Adelaide, rural South Australia, Victoria and Northern New South Wales, online surveys of health professionals and consumer and a National Consensus Workshop.
There was overwhelming support for AusIAPT, especially in rural, remote and outer metropolitan areas where issues such as distance, transport, stigma and cost mean that existing programs are not available or gap payments make them inaccessible. A small number of health professionals sought more qualified support, for instance, wanting LI practitioners to have health qualifications.
There are five key ways in which consumer access and service safety and quality can be ensured:
- LI services should have multiple points of entry (self-referral, GPs, other services) and easy access (phone or face-to-face assessment, after-hours services, free phone calls).
- LI services should have a menu of service delivery options (internet-based and book-based alternatives, a range of communication options, link-guided self-help to a broader service delivery system, choice of locally-based and centrally-based LI services) which meet consumer needs and preferences.
- There must be effective promotion of LI services.
- The quality of LI practitioners must be ensured through national training programs, competencies and accreditation procedures. However, practitioners can be drawn from a range of backgrounds.
- There should be careful selection of fit-for-purpose organisations to run LI services. Key criteria include:
- having effective governance structures, administrative procedures and accountability systems
- being able to use a patient data management system
- being able to provide supervision and support for the LI workforce.
The LI service should be embedded within a stepped-care model and have extensive linkages and referral pathways to other services.
Implications for policy, practice and further research
The researchers recommend that AusIAPT models should be trialled using a carefully selected mix of metropolitan/rural/remote services, states/territories, service providers and stepped-care models.
Evaluation measurements will include clinical, social and employment outcomes; numbers referred and assessed and sessions attended; and an economic analysis of cost savings from return to employment. Key performance indicators should include:
- providing multiple points of entry, a menu of service delivery options and competent LI practitioners
- promoting services effectively
- good organisational governance.
The trials should run alongside Better Access, incorporate the e-Mental Health Portal, and evaluate the impact of trained LI practitioners with lived experience of mental health problems. Funding should be allocated for specific interventions for Indigenous Australians and other hard-to-reach communities.
In 2012, funding has been secured from Beyond Blue and the Movember Foundation for three year demonstration trials of the AusIAPT model – given the working title Beyond Blue Community Access Program (BBCAP). These trials are planned to begin in the second half of 2013, and will have a particular focus on improving access for men. Trial sites will be selected through an expression of interest process, as will the independent evaluators of the trials.
For more information visit Beyond Blue Community Access Program (bbCAP).