Article:

Primary Mental Health and Early Intervention Services

In response to the Victorian Government’s priority areas in mental health service reform the Mental Health Branch, Department of Human Services, has proposed the formation of Primary Mental Health Teams (PMHT) and Early Intervention (EI) initiatives to commence implementation in 2001.

At present there are substantial problems of communication and co-ordination between GPs and other primary care workers in mental health and specialist mental health services. Those who feel the effects of these gaps most keenly are people who suffer disorders such as anxiety and depression, for which they may require a mixture of on-going primary care and brief specialist assistance.

The idea of the PMHT and EI initiatives is that that they should make mental health care more accessible and effective. To do this they will:

• help community health centres and GPs to recognise and treat mental health problems and disorders more effectively within shared-care arrangements;
• Enhance the capacity of Specialist Mental Health and Community Health Services, and general practitioners to prevent/minimize crisis.
• provide early intervention services to young people who are at risk of or are experiencing significant psychological disturbance, particularly first-episode psychosis, and where multiple risk factors may apply.

Those participating in the formation of the teams are clinical mental health services (including aged, child and adolescent, and adult mental health services), psychiatric disability support services, divisions of general practice and community health centres. The implementation process is in two stages:

• a Memorandum of Understanding that identifies the partnership structure for the development of the initiative, signed by all four stakeholders in February 2001;
• a Planning and Service Proposal which outlines the strategy to develop a local community mental health plan and implement the PMHTs and EI workers to be developed by April 2001.

The DHS expects that 10-15 planning and service proposals will be approved in the 2000/2001 financial year. The new teams will each employ the equivalent of three to five full-time staff. There will be one early intervention worker attached to each team in rural Victoria and the equivalent of nine full-time EI staff across the metropolitan area.

The teams will engage in consultation and liaison with primary care providers; short-term treatment; crisis prevention; and education and training to primary health care providers Direct service delivery will be critical to their success and the department expects that they will take on a significant role in short-term casework in the context of shared care and of the continued involvement of primary care providers. Additionally, the teams will also support CHC staff, GPs and other primary care providers through patient psychiatric assessment and management advice.

It is intended that the clinical, consultative and educative work will be conducted in primary care settings, often on an outreach basis, for example, at general practices. Adult mental health services are likely to be the fund-holders and to have responsibility for the day-to-day management, professional development and clinical support for the new teams.