North Coast Primary Health Network www.ncphn.org.au Northern NSW Severe & Complex Pilot Joining up Psychiatry , General Practice, Psychotherapy and Social Services North Coast Primary Health Network www.ncphn.org.au

Context Mental Health Symposium held in mid June to address a Whole Person Mental Health Care Model - Joining Up Psychiatry, General Practice, Psychotherapy and Social Services In collaboration with Murrumbidgee and Western NSW PHNs. In a first for NSW, internationally renowned experts, mental health professionals, GPs, people with lived experience of mental health conditions, representatives from community service organisations and staff from community health came together to be “one team”. The symposium was separated over two days and included presentations from scholars on various models of mental health care. Stories of lived experience reinforced the message that current model/s need to be improved.

The role of asynchronous Telepsychiatry Asynchronous technology is used extensively for such specialties as dermatology, pathology and radiology, where photos of skin conditions, slides or X-rays are sent electronically for expert evaluation. UC Davis researchers have spearheaded its use for psychiatry evaluations over several years. The approach is generally used to assess patients with mood disorders, substance abuse disorders, or anxiety disorders and is not intended to replace traditional psychotherapy. The approach has proved feasible and very efficient in early research, and patients report that it is highly convenient for them as they are able to have their full evaluation done in their primary-care office.

Models identified - UC-Davis Train New Trainers Primary Care Psychiatry (TNT-PCP) The UC-Davis Train New Trainers Primary Care Psychiatry (TNT-PCP) Fellowship is a year-long cross-disciplinary, interprofessional fellowship certificate program designed to train primary care physicians (PCPs) in managing the most frequently encountered mental health–related disorders and their treatments. It is taught by UC-Davis faculty in psychiatry, emergency psychiatry, community psychiatry, geriatric psychiatry, psychology and neuropsychology, and somatic medicine. Trainees learn how to complete an evidence-based and efficient psychiatric interview in the primary care setting. They are also trained to effectively diagnose and treat commonly encountered psychiatric conditions. Most importantly, trainees learn how to teach these principles to their primary care colleagues.

National Mental Health Integration Program and learning from local towns Findings show that the facilitation of sustainable linkages between general practice and community mental health requires the skilful exercise of power, knowledge, and resources by partners in order to address the social and structural factors that influence local health situations.  The Mudgee Community Mental Health Team (CMHT) cares for around 200 clients. After realising that many of their patients experienced considerable difficulties in accessing primary care and following a proposal by the then local GP, a monthly clinic was set up to allow CMHT patients to see a GP at no cost to have their physical health needs attended to. The clinic has been running for five years and has developed its scope of practice to include patients with alcohol and other drug issues and clozapine prescribing.

Aims & Outcomes for the pilot Develop a model that provides people with severe and complex mental illness holistic, timely and recovery oriented primary care mental health support Outcomes Coordinated Care To empower GPs as primary care givers of comprehensive mental and physical healthcare with sufficient support To empower patients and clients for self-care

Requirements to establish a pilot site GP engagement Robust community Mental Health services (LHD) Availability of community mental health nurses Adequate supply of allied mental health professionals Available social services Psychiatry – (through various channels) Lismore identified as the most appropriate area based on the criteria

Pilot model The pilot will be built on the foundations of the ‘winter strategy’ Using this model of care can translate to severe and complex clients within General Practice settings.