StepCare in General Practice program
StepCare is an innovative digital mental health assessment and intervention program delivered in general practice waiting rooms. StepCare started in selected general practices in our region from 1 July 2017.
The stepped care model is based on a person-centred approach, aiming to increase early intervention and prevention of mental health issues, thus providing the right care, in the right place, at the right time.
This project is being completed in partnership with the Black Dog Institute and local general practices who are key to the success of this trial.
Reasons for implementing the program
Depression and anxiety affects the lives of many Australians: one sixth will experience depression and one quarter will experience an anxiety disorder in their lifetime. These illnesses lower quality of life, increase the risk of suicide, and worsen outcomes of other physical and mental health problems. Unfortunately, the majority of Australians with anxiety and depression do not seek treatment.
Murray PHN is one of 31 Primary Health Networks established by the Australian Government to increase the efficiency and effectiveness of medical services, particularly for those individuals who are at risk of poor health outcomes, and to improve coordination of care. National objectives and key priority areas set by the Government include mental health, suicide prevention and potentially preventable hospital admissions.
Given that depression and anxiety are among the most common illnesses in primary care, general practitioners are ideally placed to facilitate better mental health outcomes. Stepped care approaches offer a solution to providing accessible, efficient and effective mental health services, however such a service is yet to be integrated into Australian primary care.
What stepped care means
Stepped care is defined as an evidence based, staged system comprising a hierarchy of interventions, from the least to the most intensive, matched to the individual's needs. While there are multiple levels within a stepped care approach, they do not operate in silos or as one directional steps, but rather offer a spectrum of service interventions. Within a stepped care approach, an individual will be supported to transition up to higher intensity services or transition down to lower intensity services as their needs change. Stepped care is a different concept from 'step up/step down% services.
How the program will work for patients and practices
General practitioners will be central to this project as they are typically the first clinical point of contact for people seeking help and treat patients in a 'whole-of-person% approach. This early intervention is particularly important to provide the best quality preventative and evidence-based treatment plan.
The project involves a web-based program developed by the Black Dog Institute, a world leader in the diagnosis, treatment and prevention of mood disorders such as depression. This program uses digital health technology and the stepped care approach to deliver better screening and treatment to patients experiencing mental health.
Upon entering a participating general practice, patients who are over the age of 18 years and who have an email address will be asked to complete a mental health assessment on a tablet in the waiting room. The results will be immediately sent to the patient and GP. The GP will also receive a combined symptom range, a stepped care treatment recommendation (depending on the symptom severity) and prompts to assist further assessment.
The patients involved in this project will be monitored each fortnight for 12 weeks. Regular online feedback is sent to patients and GPs to inform treatment reviews. Notifications are also sent to GPs if their patient does not follow through with the treatment recommendations.
Practice support and implementation
The StepCare in General Practice program will have an initial 10 implementation sites based in general practice clinics. Clinics will be provided with the required technology, including with tablets. The devices will be offered to patients while they await their appointment to complete the online screening assessment that has been developed by Black Dog Institute. The responses are relayed to the GP in real time and can then be discussed with consent by the patient and their doctor, to consider any needs, as well as appropriate options for services and support.
The implementation of the StepCare in General Practice program will be supported by a Murray PHN funded Project Coordinator and the Black Dog Institute. The specific implementation of the screening will vary depending on the needs of the general practice.
Financial, resource and operational support for the project period will be available, including:
- $10,000 as a one-off payment
- Supply of the tablet (more than one for larger practices)
- Ongoing IT support as required for this project
- Installation of Healthlink by Black Dog Institute
- Access to a regionally based Murray PHN staff as required for this project
An expression of interest (EOI) process directed specifically for general practices is now available through the TenderSearch web portal. You must be registered with TenderSearch to view and respond to tender opportunities. The tender closes 4pm Wednesday 24 May.
Murray PHN encourages general practices from across the Murray PHN to consider being involved.
Click here to register for TenderSearch, or to view and apply for the EOI.
For further information on Black Dog's StepCare program: blackdoginstitute.org.au/e-mental-health#stepcare and for recommended online therapy programs: blackdoginstitute.org.au/getting-help Additionally, watch the below videos.
Why GPs need to know about mental health
Visit the eMHPrac website for more information, including training.
How the StepCare project will work
Case study example of StepCare being implemented into a practice
To view this video, login to your Google (gmail) account.