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Guidelines on catchment areas in relation to the implementation of the Primary Mental Health and Early Intervention Initiative - August 2002

• Introduction
• Background
• Purpose
• Rationale
• Key Principles
• Determining Catchment Area for Primary Mental Health and Early Intervention Teams

Introduction

The Primary Mental Health and Early Intervention (PMHEI) Teams are consistent with the commitment to develop a more responsive and inclusive mental health service and to strengthen the partnership between specialist services and primary care providers.

Key objectives of the PMHEI Teams are to:

• Improve access to, and the quality of, mental health services provided by specialist and primary health care providers to people across the life span.
• Support and enhance the capacity of a range of primary care providers, in the first instance community health services and general practitioners, to recognise and treat mental health problems and disorders more effectively, via the provision of education, training and secondary consultation.
• Promote shared-care arrangements between specialist mental health services and primary care providers.
• Provide an improved service delivery approach to people with high prevalence disorders, in particular but not limited to, depression and anxiety disorders.
• Provide early intervention services to young people who are experiencing the early signs and symptoms of first episode psychosis, particularly those young people with multiple risk factors and at risk of or experiencing significant psychological disturbance.

Background

Catchment areas are complex. This is due in part to the variation in catchment area boundaries across Child and Adolescent, Adult, and Aged Mental Health Services.

Current catchment areas and target populations for specialist mental health services are varied depending on the program. Adult Area Mental Health Services have a target population age group ranging from 16 – 64 years with a focus on serious mental illness. Child and Adolescent Mental Health Service target the population age group from 0 – 18 years with a focus on children and adolescents with serious psychiatric disturbance, or who are known to be at risk of such disturbance. Aged Psychiatric Mental Health Services target the population age group of 65 years and over focusing on people with both functional and organic mental disorders.

Currently these programs predominantly operate on providing a service to their target population who reside within the boundaries of their catchment area.

The rationale for catchment areas includes:

• Increasing the capacity for service development and planning on a statewide basis,
• Identifying specific population needs and facilitating services being tailored to meet those needs,
• Providing funding based on population,
• Enhancing and facilitating access and continuity of care by clearly identifying service providers.

The 21 Area Mental Health Services are the fund holders for each of the 21 Primary Mental Health and Early Intervention Teams. Their target group is primary care providers (General Practitioners and Community Health Services). Specifically the role of the PMHEI is to assist primary care providers in the early recognition and management of people across the age span presenting with high prevalence disorders particularly depression and anxiety disorders. They also focus on providing consultation and training to specialist mental health services and primary care providers regarding early recognition and effective treatment interventions for young people aged 16 –25 years with or at risk of experiencing psychotic symptoms.

Purpose

To provide clear guidelines for Primary Mental Health and Early Intervention Teams concerning catchment areas. These guidelines are intended to:

• Provide direction in relation to catchment areas that meets the intent of the PMHEI Initiative, the requirements of the target groups and the AMHS service requirements;
• To promote effective working relationships to enable the provision of quality services for persons who suffer high prevalence disorders or young people at risk of, or experiencing psychotic symptoms.

Rationale

PMHEI Teams are intended to assist primary care providers to recognise and treat high prevalence disorders within shared care arrangements. This is a different emphasis to predominantly the direct care and case management focused programs currently provided by specialist mental health services. This has implications for catchment areas.

The Department of Health (DHS) recognises that a consistent approach to catchment areas across the state will reduce confusion, and assist PMHEI services to be delivered as effectively and efficiently as possible, in a manner that meets the needs of the identified target groups.

Effective working relationships between PMHEI Teams and primary care providers are vital for the success and effectiveness of the PMHEI Initiative. Providing a service only to consumers who reside within a particular Area Mental Health Service catchment cannot be strictly applied to PMHEI Teams.

Collaboration and consistency between PMHEI teams and primary care providers is important to ensure that there is increased accessibility to specialist mental health services for people with high prevalence disorders, predominantly depression and anxiety disorders. Another important goal is enhancing primary care providers’
capacity to recognize and effectively manage high prevalence disorders and to provide early intervention for young people experiencing psychotic phenomena.

Key Principles

• The primary care provider is the identified client of the PMHEI Team.
• Input from the PMHEI Team is provided on a shared care basis.
• Establishment of consistent and clear communication between primary care providers and PMHEI teams is vital.
• Approximately 50% of services provided by PMHEI teams for primary care providers will be training and secondary consultation type services, and 50% will be direct services through shared care.

Determining Catchment Area for Primary Mental Health and Early Intervention Teams

Catchment areas for each of the 21 PMHEI teams should be based on the address of the primary care provider’s practice or service address being within each of the 21 AMHS catchment areas.

This guideline is based on the primary care provider being the client of the PMHEI team. Therefore services including direct care would be provided irrespective of where the primary care provider’s client/patient resides.

Direct care provided by PMHEI teams is generally of a time-limited nature and is provided within a shared care framework. Within this context the majority of direct contacts should occur primarily at the work premises of the primary care provider within the AMHS catchment area.

Situations where a more intensive continuing care or crisis response is identified to be necessary by specialist mental health services (whether Aged, CAMHS or Adult) the PMHEI team should facilitate a referral to the relevant mental health service. The specialist mental health service providing the response would be the service that covers the area in which the client resides. Refer to current protocols / program management circulars issued by the Office of the Chief Psychiatrist in relation to Accessing Services Across Regions & Areas and Out of Area Patients.