Table 12 - uploaded by Richard Moulding
Content may be subject to copyright.
Summary of Evidence for the Cost-Effectiveness of Collaborative Models of Mental Health Care Involving Psychological Treatments
Source publication
POLICY CONTEXT
The Better Outcomes in Mental Health Care and Better Access policy initiatives have
expanded consumer access to psychological treatments. These programs fund treatments provided by health professionals including general practitioners (GPs), psychologists, social workers, occupational therapists and Indigenous health workers.
We re...
Similar publications
Objectives: To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function.
Design: A pragmatic multicentre randomised controlled trial, stratified by centre.
Setting: Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spa...
Background
Late-life depression is most often treated in primary care, and it usually coincides with chronic somatic diseases. Given that antidepressants contribute to polypharmacy in these patients, and potentially to interactions with other drugs, non-pharmacological treatments are essential. In this systematic review and meta-analysis, we aimed...
Citations
... As a result of the mental healthcare reforms, consumer access to evidence-based psychological treatments greatly increased, with this access being primarily through the gateway of primary care (General Practitioners, GPs). The background to these changes is outlined in detail in Hickie and Groom (2002) and Moulding et al. (2007) but briefly summarised below. ...
... Perhaps most importantly, the program had far greater uptake-and hence far greater costs-than initially forecast (Jorm, 2011;Moulding et al., 2007). In its first decade, over 5 million people have received over 33 million Medicaresubsidised mental health-specific services (Littlefield, 2017c). ...
In this article, we focus on the various recent healthcare reforms in Australia and their implication for cognitive behavioural therapy (CBT). Specifically, we focus on three areas relevant to CBT in Australia. After discussing the background of mental healthcare in Australia, we highlight the impact that recent health reforms have had on the foregrounding of evidence‐based treatment, with CBT as a focus. Second, we consider the limitations to therapy in this country, in particular the 10‐session limit within the Medicare system acting as a limitation on therapy. Finally, we discuss the impact of the acceptance of psychological treatment, and mental illness more generally in Australia.
... disorders among adults in the primary care setting [2][3][4]. Since 2001 the Australian Government has been funding primary mental health care in a targeted manner through its Access to Allied Psychological Services (ATAPS) program. Since 2006, ATAPS has been complemented by population-based primary mental health care subsidised via the Medicare Benefits Schedule, Australia's publicly funded universal health care scheme [5]. ...
Background
Introduced in July 2001, Australian Access to Allied Psychological Services (ATAPS) was the inaugural national policy initiative to provide community access to government-funded psychological services in primary care. Our aim was to examine the achievements of ATAPS in relation to its stated objectives using a set of indicators that largely drew on data from a minimum data set that we designed for the evaluation of ATAPS.
Methods
We used de-identified professional-, consumer- and session-level data from the minimum dataset, and secondary analyses of our quantitative and qualitative data collected for a series of specific evaluation studies. Available data covered the period from 1 July 2003 to 31 December 2012.
Results
Approximately 350,000 referrals were made to the ATAPS program over the 9.5 year analysis period, 79 % of which resulted in services. Over 1.4 million sessions were offered. Overall, 29 % of consumers were male, 4 % children, and 3 % Aboriginal people; 54 % of consumers had depression and 41 % an anxiety disorder; at least 60 % were on low incomes; and around 50 % resided outside of major cities. The most common interventions delivered were cognitive and behavioural therapies. Selected outcome measures indicated improvement in mental health symptoms.
Conclusions
Access to Allied Psychological Services achieved its objectives within a decade of operation. The program delivered evidence-based services to a substantial number of consumers who were disadvantaged and historically would not have accessed services. Importantly, where data were available, there were indications that ATAPS achieved positive clinical outcomes for consumers. This suggests that ATAPS carved an important niche by successfully addressing unmet need of hard-to-reach consumers and through means that were not available via other programs. It will be interesting to see the effects from July 2016 of the reform of ATAPS, which will see ATAPS subsumed under psychological services commissioned by regional primary care organisations.
... The integration of psychologists into primary health care systems is, therefore, one important step towards scaling up mental health services (Hass & deGruy, 2004). As an example, Moulding et al. (2007) reported good evidence for the effectiveness of psychotherapies delivered in primary health care. Indeed, psychotherapies delivered by psychologists had similar effects on the course of depression as that of antidepressant medication usually delivered by doctors (Hass, 2004). ...
Enhancing primary health care to incorporate mental health services is a key strategy for closing the treatment gap for people with mental disorders. The integration of psychological care into primary health care is a critical step in addressing poor access to mental health specialists. As the psychology profession is increasingly called upon to prepare psychologists for primary health care settings, an international experts' consensus is valuable in guiding the development of a high-quality curriculum for psychologists working in the primary health care context. A Delphi method was used to gain a consensus on the most appropriate roles and training for psychologists. Initial constructs and themes were derived from a detailed literature review and sent to 114 international experts in primary mental health care from five continents. Overall, 52 experts who participated agreed that psychologists should have wide-ranging roles and skills including clinical, health promotion and advocacy skills. This study has identified the specific roles and training needed by psychologists to enable them to work more effectively in primary health care settings. The consensus will inform the development of a curriculum for psychologists working in primary health care in Indonesia, and is part of a broader suite of studies.
... The second model of integration of psychologists into primary health care is often termed shared care and involves psychologist continuing to work in a separate location, usually private, but nevertheless working closely with primary health-care providers through close referral networks and inter-professional communication. This model is common in Australia and the Netherlands (Derksen, 2009;Moulding et al., 2007). ...
Mental health is a critical issue in Indonesia, since its population ranks among the top five in the world and the prevalence of common mental disorders is 11.6% of the adult population. However, the need to build an effective mental health-care system that is accessible to the whole population has only been recently addressed. The Aceh tsunami in 2004 brought to the forefront an unexpected window of opportunity to build a mental health-care system. Integration of mental health care into primary health care is a key strategy to close the treatment gap for people with mental disorders. Existing integration of psychologists into primary health care is a big step to meet the shortage of mental health-care specialists. As primary mental health care is an emerging field, the perspectives of Indonesian experts on Indonesian mental health care are needed to develop a curriculum for training psychologists to work in primary health care. In this study, data have been collected through semi-structured interviews with 24 Indonesian mental health experts, and three focus group discussions with 26 psychologists. Overall, experts agreed that to be able to work in primary health-care psychologists should have roles and training ranging from clinical to advocacy skills. Participants also agreed that psychologists should work in the community and contribute to primary health care as service providers and that strong collaborations between psychologists and other primary health-care providers are the key; these can be developed partly through referral and by respecting each other's unique strengths.
... So far, evidence from randomised controlled trials indicates that brief CBT of up to 12 sessions delivered by suitably trained psychologists may be cost-effective, and enable patients with depressive symptoms to recover faster when compared to usual care in general practice [23,24]. However, a systematic review of the literature found that given the lack of relevant studies, it is difficult to determine the efficacy of social worker delivered CBT for depression and anxiety [25]. In response to this gap, we developed a new training programme in focused psychological strategies for social workers (SW-fps). ...
... The study was undertaken in the context of major mental health reforms within Australia[18,38] and the UK[16] which have provided funding for health workers, including social workers in Australia, to deliver brief evidence-based psychological therapies. However, a systematic review of the literature had found that given the lack of relevant studies, it is difficult to determine the efficacy of social worker delivered CBT for depression and anxiety [25]. This study provided evidence that a brief educational intervention can prepare social workers to competently deliver targeted cognitive behavioural strategies. ...
Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy).
A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs.
40 Melbourne-based (Australia) social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97%) completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group). The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02) on the 66 point Cognitive Therapy Scale) and in subjective confidence (mean improvement of 1.28 (0.84-1.72) on a 5 point Likert scale). On average, the intervention group improved from below to above the base competency threshold on the Cognitive Therapy Scale whilst the control group remained below.
Social workers can attain significant improvements in competency in delivering cognitive behavioural strategies from undertaking brief face to face training. This is relevant in the context of health reforms that involve social worker delivery of evidence based psychological care. Further research is required to assess how these improvements in competence translate into performance in practice and clinical outcomes for patients.
... As Blashki (2008) notes, this represents a particular challenge because communities that are most vulnerable to climate change are generally underserviced rural and regional areas to begin with. Evidence is accruing that psychological interventions for depression (the most prevalent of common mental disorders) are at least as effective as antidepressants and superior to usual treatment (Moulding, Blashki, Gunn, Mihalopoulos, Pirkis, Naccarella, & Joubert, 2007). These interventions can be effectively delivered in primary health care settings; under the Better Access to Psychiatrists, Psychologists and General Practitioners, these services are delivered at little or no cost to clients (Morley, Pirkis, Naccarella, Kohn, Blashki, & Burgess, 2007). ...
In view of the growing disease burden of mental disorders, we consider the pressing need to update medical school psychiatry education to better equip doctors to recognise and treat these conditions. Key challenges to the delivery of medical school mental health curricula, and possible directions for reform, are reviewed with the aims of stimulating collaboration and enhancing the efficiency across schools.
In Australia, medical school expansion provides opportunities to prepare many training doctors to meet growing mental health care needs. Despite this, published reviews of practice and curriculum models are notably lacking. Australia, unlike other countries, has yet to agree on a core curriculum in medical school psychiatry, with practices varying widely between schools. Curricula should equip doctors to better recognise and treat common mental disorders during early stages, as well as preparing some for specialist psychiatry training. High-quality, multidisciplinary teaching in varied clinical settings may boost teaching resources. Additionally, medical education provides opportunities to better equip doctors to take care of their own mental health. Key challenges are to achieve a consensus on core curricula across Australian medical schools, and an appropriate proportion of medical school curriculum time for mental disorders, relative to their complexity and large disease burden.
General practitioners (GPs) have historically been at the centre of primary health-care delivery in Australia, including delivery of mental health-care services. Recent changes, however, by the Australian Federal government have led to the creation of a number of mental health-care items provided by psychologists that are now available on the Medicare Benefits Schedule. The aim of the present study was to examine GPs' perceptions of psychologists and the ways in which GPs have responded to these policy changes in making referrals for mental health patients. Nine GPs were interviewed regarding the provision of mental health-care services. Analysis of the interviews indicated a number of themes including the benefits of the new Medicare policy in increasing accessibility of psychologists, GPs' frustrations with the bureaucracy surrounding the use of this policy, GPs' knowledge about the specific skills and training of psychologists, and the importance of GPs' matching patients and clinicians. Recommendations are made to facilitate the professional and clinical relationship between GPs and psychologists.
