Bordertown network links private and public mental health sectors
The birthplace of iconic former Prime Minister Bob Hawke, Bordertown in South Australia, hosted an MHPN workshop in February 2010 facilitated by the town’s visiting psychiatrist. It was well attended by 19 participants including four general practitioners, five nurses, a social worker, a psychologist and a mix of coordinators and case managers from the NGO sector.
An interdisciplinary mental health network has been established in conjunction with the local Division of General Practice, and is coordinated by the region’s visiting psychiatrist. The network’s first meeting was held in May 2010 where the members focused on the introduction in South Australia of the Mental Health Act 2009, and the management of agitated patients. The group has agreed to meet quarterly with a continued focus on education.
Overwhelming Response Leads to Second Workshop on Eating Disorders
After an initial scheduled MHPN workshop was overwhelmed with registrations, the RBW Hospital Eating Disorders Clinic in North Brisbane was encouraged to schedule another to cope with the overflow of interested parties. The two MHPN workshops were held in North Brisbane, co-facilitated by a social worker and a psychiatrist and sought to engage an eating disorders referral network with the RBW Hospital Eating Disorders Clinic where both of the facilitators work.
The workshops were attended by 18 and 19 participants respectively, including 16 GPs, 2 occupational therapists, 13 psychologists, 3 social workers, a mental health nurse and a psychiatrist. One of the aims of workshops was to assist in the development of effective referrals for patients with mental ill health.
The social worker who co-facilitated the workshops expressed how the workshops provided an arena where GPs could comfortably express their concerns about working with patients who are diagnosed with eating disorders. Meeting other health professionals who could support their treatment of these patients was an invaluable outcome of the workshops.
These two groups have merged to form one interdisciplinary MHPN network whose next meeting will be held in the clinic at RBW hospital. The RBW clinic feels more equipped from having access to new clinicians to refer to in their discharge planning.
headspace Supports Townsville Network
headspace continues to provide valuable support to a Townsville network after an MHPN workshop hosted at the headspace Townsville centre.
The workshop, facilitated by a local GP and attended by 23 clinicians including GPs, mental health nurses, a psychiatrist, several psychologists, social workers, as well as nurses and youth workers, helped cement the working relationship between practitioners who work out of the headspace centre and the public mental health providers.
The facilitator commented, “It was a great afternoon, and we achieved quite a lot about which type of client we could best serve, networked about appropriate referrals and the reasons why we are sometimes dissatisfied with each others' processes. This will hopefully lead to better management of our clients with the more appropriate service seeing clients in a timely manner with more inter-personal relationships/ networking assisting continuity of care.”
Issues discussed were family therapy, crisis intervention, early intervention, managing acute psychotic presentations, the GP Mental Health Care Plan, Care Plans in general, exercise programs and the limitation on the number of psychology visits available under Medicare, and Queensland Health processes. The group plans to meet twice between now and the end of the year. The next meeting will be held at the local Child and Youth Mental Health (QLD Health) and the final meeting for the year will be hosted at headspace.
Case Studies Keep Clinicians Interested
“Making Sense of Adolescent Depression in the Context of Family System - a Developmental Perspective” is just one example of the case studies being discussed at MHPN network meetings. This one, presented by Mental Health Nurse and practising Family Therapist David Hong, was presented recently in Parramatta. David has been actively involved in developing the Parramatta network since he facilitated his first MHPN workshop in February 2010.
The MHPN network in Parramatta now has an email distribution list of 53 clinicians including 10 GPs, 1 Psychiatrist, 29 Psychologists, 3 Social Workers, 3 Mental Health Nurses, 1 OT, 1 Case worker and 6 mental health workers.
After initial difficulty in finding a suitable low cost venue to hold network meetings, a network member, Tracey Stobo, Director of Clinical Services at the Northside West Clinic, offered a permanent meeting room at no cost with access to their in-house catering company. As a further community gesture of good will, the Northside West Clinic is providing a free meal for 23 practitioners at the next meeting.
Network members expressed value in the case study discussion and the sharing of ideas and information about clinical expertise and services with the network. Despite being in its infancy in terms of building relationships, there is a strong sense of collegiality and commitment from network members. David anticipates the energy of the group will drive this project forward and identify strategies that will generate the momentum required to ensure sustainability.
The next meeting will focus on formalising a small working party to explore how best to sustain this crucial development. There will also be a case study discussion and a brief overview of the clinical services of Northside West Clinic.
Big Network in the Blue Mountains
A Springwood network born from an MHPN workshop facilitated by Blue Mountains Social Worker Sandra Warn boasts a mailing list of more than 90 clinicians from six disciplines, making it one of the largest in the country.
After meeting in September 2009, the network has swelled. A continued willingness and enthusiasm to open this network group to practitioners from all over the Blue Mountains District has enabled the network membership to grow. Thirty seven practitioners actively participate in network meetings (5 GPs, 23 psychologists, 2 Social Workers, 1 OT and 6 public and community services workers) while a further 91 are members of the mailing list. These include practitioners who attended other MHPN workshops within the Blue Mountains district and clinicians who requested to join after hearing about the MHPN network.
The Blue Mountains GP Network has also been instrumental in expanding the MHPN network membership base and providing support as they circulate invitations to members on their database and actively promote MHPN network meetings.
Recognising that relationships are the key component of networking, members meet quarterly at the local Sports Club to have a meal together prior to moving to a private room for the more formal part of the meeting. Guest speakers at the network meetings have included psychiatrist, Dr Phil Lambert who spoke on medications, and staff from the non-government organisations Housing and Accommodation Support Initiative (HASI), Personal Helpers and Mentors Initiative (PHAMS) and the One in Five Creative Arts Association who presented the topic ‘Recovery and Mental Illness: Local NGO/Community Projects’.
Aboriginal Health in the North Coast of NSW
In NSW, Aboriginal people accounted for 2.2% of the population in 2006. The latest national report card on health, Australia’s Health 2010, highlights that Aboriginal people continue to fare worse than other population groups. Aboriginal people have much higher death rates and are twice as likely to have high or very high levels of psychological distress.
The key to the success of many ground breaking initiatives to improve Aboriginal health has been the development of close working relationships and collaborative programs between Aboriginal Medical Services (AMS) and mainstream health providers. In early 2010, MHPN engaged the various AMS which make up the Many Rivers Aboriginal Medical Service Health Alliance in the north coast of NSW. Five workshops were originally scheduled from Taree in the south to Tweed Heads in the north. Each workshop was well attended and proved so popular that a further four workshops were held in the region.
Together with MHPN, local facilitators invited individuals and organisations with an interest in Aboriginal social and emotional well-being. There was good representation at the workshops from Aboriginal mental health workers including case workers, counsellors, liaison officers and nurses and the executive from various AMS; legal practitioners; drug & alcohol counsellors; probation and parole officers; child protection case workers; carer support workers and a mental health consumer consultant.
Ongoing networks across the north coast will soon have access to a range of Aboriginal case studies relevant to the region. These are being developed by the Chief Executive Officer of Galambila Aboriginal Health Service in Coffs Harbour. In order that communities receive the best possible access to health care, network meetings focusing on working better with Aboriginal clients are also planned.
Rural Challenges, City Focus
Australian Capital Territory is being serviced by a Territory-wide interdisciplinary network after 200 clinicians from across all seven MHPN target groups attended initial MHPN workshops. Whilst two special interest networks have formed in the areas of youth mental health and Defence personnel, clinicians who participated in the remaining 16 location-based workshops are working together across the region to improve patient care.
Six interested network coordinators comprising of three psychologists, a former psychologist, a mental health nurse and a social worker have formed a committee to oversee the planning and facilitation of the ongoing meetings of this network. Two territory-wide events are being run before the end of 2010, with a likelihood of further special interest groups emerging. A de-identified case study will be discussed at the next meeting in September 2010.
Staff from the Mental Health Assessment Unit at Canberra Hospital Emergency Department are also presenting on the purpose and function of the unit and appropriate referral pathways. In November 2010 the network will meet again, this time to focus on the issue of Borderline Personality Disorder. That meeting will involve a multidisciplinary panel discussing a case study.
MHPN on the road for Autism
WA benefited from an MHPN ‘road show’ of sorts during March, April and June 2010. A psychologist, in conjunction with the Western Australian Autism Diagnostics’ Forum (WAADF) travelled to northern metro Perth, southern metro Perth, southern regional Western Australia (Bunbury), and northern regional Western Australia (Geraldton) to deliver four workshops with a focus on Autism.
WAADF is an organisation established to discuss standards, processes, and clinical issues in the assessment and diagnosis of autism spectrum disorders in Western Australia.
Attendance was strong at all workshops with 21, 30, 18 & 24 attendees respectively including attendance by 18 general practitioners at the two metro workshops and participation by speech pathologists and paediatricians at all four workshops. Ongoing networks have been established.
The workshop facilitator is coordinating the northern and southern metro groups, whilst the regional groups are to be supported by the workshop facilitator but led by local practitioners. The metro networks are meeting monthly and the regional groups have set their first meeting dates for August/September this year.
Sunbury Network Builds Local Service Register
Following a successful MHPN workshop in Sunbury, Victoria, a network has developed two mental health service registers for the region. The initial workshop was facilitated by a GP representative from the RACGP Victorian Faculty and the network has since met monthly at lunch time, alternating between the GP clinic where the original workshop was held and a psychologist’s meeting rooms.
The group has agreed to some core themes for their network meetings including community development, networking, sharing relevant information and addressing local service issues. For example, the group reviewed local mental health resources which led to the creation of two mental health service registers; one for the general public and one for other health professionals. A group member is liaising with the local Division of General Practice and Rotary club regarding the development and promotion of these service registers.
Each meeting also allows time for networking where members can discuss their areas of specialty and share information about upcoming events of interest.
The group is interested in indentifying and addressing local issues in mental health service delivery. In analyzing regional mental health needs, they have identified the most commonly encountered mental health issues presented to GP clinics are anxiety, depression and drug and alcohol issues.
Three Become One in Warrnambool
Three successful MHPN workshops held in Warrnambool, Victoria, have merged into one larger network which is actively engaging with local services such as Centrelink and a local Indigenous health service. The group is working to raise awareness of local services by holding network meetings at different service locations. This provides an opportunity for clinicians to familiarize themselves with the local services, to broaden referral options and to strengthen professional relationships.
The Warrnambool MHPN network has met three times since their initial workshops and meetings have been hosted by St John of God Hospital, Gunditjmara Health Service (including Cultural Respect Training) and Otway Division of General Practice (with a focus on drought and mental health). Other local services who have agreed to host the next three meetings are headspace, South West Health Care, Primary Mental Health Team and Centrelink.
Fighting Fragmentation
In Launceston, participants from four initial workshop groups are working together to establish one larger network with the aim of boadening professional associations. The local clinicians felt that there was an opportunity with the MHPN project to broaden professional associations.
A steering group of nine participants is actively working to attract GPs and other disciplines not currently represented in the network. The steering group has also assumed responsibility for ensuring that the network has a clear direction, input from different professional groups, and that the workload does not fall on just a few individuals. Members meet regularly to provide guidance to the network by determining the focus and agenda for meetings, and nominating a person to organize and facilitate each meeting.
This network showed earl initiative by planning their meetings for the remainder of the year. A recent meeting featured a lecture on borderline personality disorder and conversational model therapy, delivered by the psychiatrist from the steering group. A social worker who attended this network meeting commented that, “These get-togethers are brilliant as I work alone in my own practice.”
Private psychiatrist encourages mentoring
Since first meeting at an MHPN workshop in August 2009, a group of ten mental health professionals led by a Launceston psychiatrist continues to gather every month to mentor each other and aid professional development. The psychiatrist was quick to recognise the value in building relationships and he worked with MHPN to form a small multi-disciplinary peer review group. The initial workshop for this group had representation from each of the key professional groups working under the Better Access initiative.
The psychiatrist requested a group of no more than ten clinicians of mixed experience to create an environment for mentoring from some of the more experienced clinicians. Since the workshop, the network has met nine times over breakfast. The group discusses clinical cases and has invited representatives from support services to explore referral pathways and other related issues.
MHPN Sutherland Shire Network
The MHPN Sutherland Shire Network in NSW consists of general practitioners, occupational therapists and psychologists who meet every 3 months at the Sutherland Hospital Community Health Centre. Some food, tea and coffee are provided during the meeting. The meetings are facilitated by Dr Monica Moore, who has committed to coordinating the network for 12 months.
There is a cooperative partnership between the Division of General Practice and the Division of Mental Health at Sutherland Hospital where meetings of the joint mental health committee have been held regularly for over 12 years. This collaboration has assisted public mental health issues and GP issues to be shared and understood respectively. So there is already a friendly atmosphere between the 2 bodies.
The MHPN network meetings are run separately to the mental health committee. The meeting agenda for the MHPN Sutherland Shire network usually includes a case study discussion suggested by a participant. Topics have included:
- A case presentation by a private mental health provider outlining their approach to a 6 session Medicare referral, and one for an 18 session case. Part of the discussion focused on what constitutes a good referral letter from a GP and the same for a treating psychologist.
- Communication between a GP and mental health clinician where medicare is involved.
Subsequent meetings will have a different focus depending on the needs of the group.
Other benefits derived from network discussions include:
- Sharing information about services in the private and public sectors, and how to access them, eg. NGO support services
- Getting to know other practitioners for better referral matching to patient needs
- Learning about practical issues such as fees, after-hours work and special interests.
The future of the group is discussed at every meeting to ensure that all participants’ needs are met. The key drivers for the network to succeed are networking, problem-solving, finding good referral pathways, getting to know other practitioners, and ultimately better patient care and a more satisfying work environment.
Whilst allied health clinicians have been greater in attendance than medical professionals, GPs who can’t attend meetings are included on the email list and receive updates this way.
The Division of GP’s website has a mental health directory and network members are invited to submit their details for inclusion. GPs and other health professionals have access to the directory for referrals.
Sydney Northern Beaches
Situated on the northern coast of Sydney, the Northern Beaches MHPN group ticks all the boxes for becoming a model sustainable network. Having been formed as a result of 5 workshops merging, the Northern Beaches MHPN covers the Manly Warringah area of NSW. Its coordinators, Dr Mataji Kennedy and Mr Howard Wiggins, are active in their efforts organising and arranging network meetings every 2 months.
Discussions have been active as Dr Kennedy explains “We get together from 7-9pm and have coffee and bring some food to share. (At the last meeting) we didn't get through the agenda because some interesting professional development issues were raised and we decided to discuss those instead”.
Sustainable networks such as Northern Beaches are driven by the opportunity to meet those in similar roles, share information and learn from other people’s experiences. As Dr Kennedy further explains “I think people have continued to come as it’s great to network with people working in the same area. Private practice can be lonely if you are working on your own most days. Also I have had clients who I have needed to be referred on and this has been a good way of building a referral network”.
Below is an agenda example from the last Northern Beaches MHPN meeting.
Agenda
1. Group exercise - 5 min
2. Sharing resources (discuss interesting PD courses or experiences you have attended) - 15min
3. Case discussion (we can work through an MHPN case or a real case if participants bring cases for review) - 60min
4. Communication across professions (discussion on how we can better promote this) - 15min
5. Marketing ideas for Psychology week
Queensland Network
A Mental Health Working Group holds a monthly interdisciplinary mental health network meeting over morning tea. This group was already meeting under the auspice of the local Division but expanded their membership by holding an initial MHPN workshop facilitated by a local psychiatrist.
According to members this workshop enabled the group to “reinvigorate our membership and expand our group’s focus”. New network members include GPs, mental health nurses, psychiatrists and staff members from local non-government funded agencies. The group made a commitment at the initial workshop to continue meeting regularly.
The network meetings alternate between a facilitated case study discussions (using one of MHPN’s case studies) and planning for mental health community development activities. Meetings have been scheduled until the end of 2010. Different network members have volunteered to present each facilitated case study discussion.
The first was facilitated by a GP presenting on an adolescent with an eating disorder (Melissa- Case Study 2). Discussion at the meeting included formulating a GP mental health treatment plan and engagement with the teenager and parents in the plan.
The second case discussion was facilitated by the mental health program manager of the local private hospital. The review looked at treatment goals and management plans for a woman with a dual disability including obsessive compulsive disorder and mild intellectual disability (Robyn- Case study 11). During the community development meetings, the group has discussed various local mental health related issues including homelessness.
The local area has been identified as having the second highest rate of homelessness in the outer regions of Brisbane. As part of their community development focus they plan to hold a ‘Day for the Homeless’ to increase community awareness of the issue.