Innovative preclinic triage system to guide Australians to the right mental health care first time
Tracey A. Davenport A * , Haley M. LaMonica
A D * , Shelley Rowe A B , Julie Sturgess C , Elizabeth M. Scott A , Grace Lee A , Vanessa Wan Sze Cheng A and Ian B. Hickie A
A Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia. Email: tracey.davenport@digitalhealth.gov.au; shelley.rowe@sydney.edu.au; e.scott@sydney.edu.au; grace.lee@sydney.edu.au; vanessa.cheng@sydney.edu.au; ian.hickie@sydney.edu.au
B GenHealth, 45–53 Little Street, Coffs Harbour, NSW 2450, Australia.
C Healthy North Coast, North Coast Primary Health Network, 106–108 Tamar Street, Ballina, NSW 2478, Australia. Email: jsturgess@ncphn.org.au
D Corresponding author. Email: haley.lamonica@sydney.edu.au
Australian Health Review 45(5) 578-583 https://doi.org/10.1071/AH20233
Submitted: 1 September 2020 Accepted: 30 January 2021 Published: 24 June 2021
Journal Compilation © AHHA 2021 Open Access CC BY-NC-ND
Abstract
This paper presents a case study of an innovative direct-to-consumer preclinic triage system designed to reduce predicted peak demand for Australian mental health services as a result of COVID-19 and its associated socioeconomic consequences by guiding Australians to the right mental health care first time. Our innovative, digital health solution comprises two components: (1) a highly personalised and measurement-based model of care (Brain and Mind Centre model of care) that considers both the heterogeneity of mental disorders and other underlying comorbidities, as well as clinical staging; and (2) a health information technology (i.e. the InnoWell Platform). This digital health solution has been embedded as part of standard service delivery into a community-based intake service, thus resulting in a redesigned service model. The service model is currently being implemented as part of a pilot feasibility study, the marker of acceptability at the health professional and service level, and is now under active evaluation to determine its effect on outcomes for consumers, health professionals and the service. For the purposes of this paper, this model served as a prototype for the preclinic triage system that was conceptualised for national scalability at the primary health network level. When implemented at a national level, our direct-to-consumer preclinic triage system is expected to be an effective population health demand management strategy to address the rapidly emerging mental health demand crisis in Australia, and is aligned with the recent recommendation from the Productivity Commission to develop a sustainable national digital platform to facilitate the assessment and referral process to ensure access to mental health care matched to an individual’s level of need.
What is known about the topic? Although there is increased recognition of the mental health demand crisis in Australia as a result of the COVID-19 pandemic, little has been done to ‘flatten’ the curve. The Australian Government committed additional funding to support the Better Access Pandemic Support measure; however, this approach to care fails to appreciate both the disparities in service availability across Australia and the gap fees that are prohibitive to some of those seeking help. Furthermore, the expansion of this program may only result in those in care remaining in care, thus further delaying access to those in need.
What does this paper add? This paper describes a digital health solution, comprised of a highly personalised and measurement-based model of care coupled with a health information technology, that has been embedded as part of standard service delivery. Consumers seeking mental health care complete a multidimensional self-report assessment via the technology, the results of which are available in real-time and used to facilitate triage to pathways of care as indicated by the severity of the consumer’s illness and level of need to more effectively and efficiently allocate consumers to care. The redesigned service model is now under active evaluation to determine its effects on outcomes at consumer, health professional and service levels.
What are the implications for practitioners? The redesigned local service model served as a prototype for our innovative direct-to-consumer preclinic triage system specifically designed to allocate consumers to self-management, ambulatory care or acute care based on clinical stage and level of need. It is our hypothesis that the preclinic triage system will be an effective population health demand management strategy. Importantly, the proposed preclinic triage system aligns with the recent recommendation from the Productivity Commission for the Australian Government to fund the development and sustained implementation of a digital platform to facilitate assessment and referral to evidence-based interventions matched to a consumer’s level of need.
Keywords: mental health, models of care, population health, health systems, ehealth, primary health care, digital health solutions, service model, service delivery.
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