Primary Care-Led Mental Health Service Reform: An Outline of the Better Outcomes in Mental Health Care Initiative

Abstract

Objective : To describe the key features of the ‘Better Outcomes in Mental Health Care’ initiative (2001–2005) and to detail some of the conceptual, community, professional and epidemiological forces that shaped its content. Conclusions : The ‘Better Outcomes in Mental Health Care’ initiative represents a major development in mental health care in Australia. It recognises the central role of primary care, promotes integrated medical and psychological care, rewards treatments that occur over an episode of illness, promotes active purchasing of non‐pharmacological interventions earlier in the course of illness, and attempts to better link general practitioners, non‐medical mental health specialists and psychiatrists to meet population‐based mental health needs. Central to its development has been a commitment by general practitioners to develop progressively better mental health skills and measure both individual consumer and system‐related outcomes.

Can we Reduce the Burden of Depression? The Australian experience with Beyondblue: The National Depression Initiative

“…Such coordinated care has not been a feature of the Australian mental health system previously. 16,17,34 At the primary care level, this means focusing on improved quality of prescribing, increased access to non-pharmacological forms of treatment, increased access to authoritative and independent health-care information and increased adherence to treatments. At the system level, it means tracking access to specialised treatment and support services, quality of services provided and continuity of care.…”

Primary Mental Healthcare and Integrated Services

“…This state of affairs is due in part to the modest progress made in implementing current reforms (for example, very little development of shared care, understaffed psychosocial teams at community care centers, and inadequate operation of single access points). Findings of poor mental healthcare quality unfortunately are not specific to Quebec; numerous studies (Pawlenko, 2005;Nolan & Badger, 2002) have found similar results in other countries; however, recent efforts in some countries, for example, the United Kingdom and Australia to bring about improvements in this regard have been noted (Hickie & Groom, 2002;Lester et al, 2004). Repeated mention of insufficient collaboration among providers, particularly psychiatrists and general practitioners, can be found in the literature (Bambling et al, 2007;Cunningham, 2009).…”

Better access to psychology services in primary mental health care: an evaluation

“…In broad terms it was acknowledged that a more integrated system of health care delivery was required in mental health and that primary care and general practice should play a key role. 5 This shift in policy led to the introduction of the Better Outcomes in Mental Health Care initiative (BOMHC) in the 2001-02 budget. 6 Its aim was to improve the quality of primary mental health care available in Australia.…”

“…One of the aims of the BOMHC initiative was better integration and provision of mental health services in primary care. 5,6 GPs and psychologists involved with the ATAPS program did feel it enhanced their relationship and provided opportunities for greater communication. In the Illawarra, psychologists conducted some consultations at the GPs' surgeries and this factor probably contributed to enhanced communication.…”