Mental Health

 

MENTAL HEALTH

 

 

Quality Mental Health Care in the Hawkesbury-Hills Region

There are a number of ways a patient can access quality mental health care within the Hawkesbury-Hills region. They are:
 
FREE Group Counselling:
 
HHDGP’s Healthy Mind = Healthy Life Group Counselling project is an ideal way for people who may be struggling with mental health issues, to participate in counselling in a supportive group environment. It provides FREE access to quality mental health care delivered by Allied Mental Health Professionals, such as Clinical Psychologists and Registered Psychologists.
 
There are many different counselling groups scheduled for 2008 to be run at various times throughout the year catering for ADULTS (men, women and mixed), TEENS and CHILDREN.
 
Many people, although initially a little nervous, find Group to be a really positive experience. Patients are in a group with others who fully understand what it is that you are going through and how they feel because they’ve also been there and experienced the same things. Nearly all group members comment that working toward their own goals within a group is great with the added support of others as well as the guidance of the psychologist.
 
The groups (up to 12 sessions) target: Depression and Anxiety; Chronic Pain Management; Binge-eating and Bulimia Nervosa; Sleep Disorders; Alcohol Dependence; as well as Children with Anxiety (for 8 to 12 year olds); and Surviving the Blues for adolescents.
 
Each group runs for up to 12 weeks with group members meeting once a week for 2 hours, mostly in the evenings but there are some day groups being offered, as well as Saturday mornings.
  
Individual Counselling:
 
The Better Access initiative (through the Medicare Benefits Scheme) aims to increase community access to mental health professionals and team-based mental health care, with general practitioners encouraged to work more closely and collaboratively with psychiatrists, clinical psychologists and other allied mental health professionals.
 
Patients referred under Better Access receive up to 12 individual counselling sessions delivered by either: Registered Clinical Psychologists, Psychologists, Mental Health Workers, Occupational Therapists, or Social Workers. 
 
Consultation rates vary - the Australian Psychological Society’s (APS) recommended rate for Psychologists is currently $193 per hour, however most psychologists charge under this rate.
 
The Division has produced an Allied Mental Health Directory which outlines psychologist’s locations, fees, bulk-billing status (if applicable) and other relevant information. For a copy of this, please contact the Division or email info@hhdgp.com.au
 
Patient Medicare rebates (at November 2007): 
 
Clinical Psychologist:           $112.45
Psychologist:                         $76.65
Occupational Therapist:       $67.85
Social Worker:                      $67.85
 
The above rebates are based on sessions >50 minutes.
  
BOTH:
 
Patients can access both group counselling and individual counselling. They can be used concurrently, separately or as an alternative to the other.
 

Tools to refer a patient to counselling (group or individual)

To access either group or individual therapy a patient must have a GP Mental Health Care Plan (item 2710)
 
A GPMHCP should be in consultation with the patient and/or carer and have the agreement of the patient (it does not require input from other professionals). A written copy of the GP Mental Health Care Plan must be offered to the patient and/or carer (where appropriate) and a copy kept in the patient’s medical records.
 
 
To register a patient for group counselling, please complete the one page registration form.
 
 

Outcome Tools

What is an outcome measurement tool and why should I use it?
 
An outcome measurement tool, measures: symptoms; quality of life; level of functioning; and a patient’s condition and change over time, all of which are essential in an evidence-based approach to mental health care. Outcome measurement tools are used to maintain high standards of patient mental health care and are important to both the patient and the clinician. For consumers, they are able to monitor progress; for clinicians, they can monitor the patient’s progress and their own performance as a clinician.
 
An outcome measurement tool should be utilised during the assessment and the review of the GP Mental Health Care Plan and Review, except where it is considered clinically inappropriate.
 
What outcome measurement tools can I use?
 
The choice of outcome measurement tools to be used is at the clinical discretion of the GP.
 
GPs using outcome tools should be familiar with their appropriate clinical use, and if they are not, they should seek the appropriate education and training. It should be noted that outcome tools are not diagnostic tools.
 
Outcome Tool Edinburgh PND Scale
 
 

More about group therapy - What is it? What's different about it?

 
What is Group Therapy?
 
Group therapy is a highly effective form of mental health counselling that can be used together with individual counselling or as an alternative. Each group consists of about 6 to 12 people who have all been referred by their GP for similar reasons. The group is facilitated by a psychologist who has expertise in the area.
 
What’s different about Group Therapy?
 
Studies have shown that group therapy is as effective as individual and in fact has something unique to offer. In the group environment there is an opportunity for the patient to:
  • Learn about their symptoms, experience & treatment of the disorder
  • Share experiences
  • Develop more effective coping skills
  • Develop themselves & support others in achieving personal goals
Become part of a supportive and accepting peer group
 

Case studies from group counselling

Children with Anxiety Group
 
Toby is an 11 year old boy in Year 6 at the local primary school. He had been assessed by the school counselor who reported that there was strong evidence that he would meet diagnostic criteria for affective disorder, anxiety disorder and somatic problems. Results from the Child Behaviour Checklist, which was completed by his mother, indicated that Toby’s Total Problems and Internalising scores were in the clinical range. His scores on the Anxious/Depressed, Somatic Complaints and Thought Problems syndrome were in the clinical range above the 97th percentile for boys aged 6 to 11. Symptoms of particular note were listed as fearful, nervous, worried, nightmares, bites nails, headaches, nausea, vomiting, twitching, sleep walking, ruminations, some minor difficulties with concentration and some talk of suicide. Toby’s Competence scores were in the normal range and his mother described him as above average student in maths and science, participates in sport, is compliant and carries out his chores at home.
 
The school counselor suggested to Toby’s mother that they should visit their GP to discuss therapy and support options for Toby. Toby was subsequently referred to a Children with Anxiety Group which was an 8 session programme targeted at children aged between 8 and 12 years of age with symptoms of anxiety, excessive worry, physiological symptoms such as increased heart rate and nausea and avoidance of fear provoking situations such as school. The group was facilitated by 2 clinical psychologists and also included parents of the children in order to increase their understanding of anxiety, how it manifests in children and importantly how to assist their children to manage anxiety and enhance ‘brave’ behaviour. Group sessions focussed on cognitive and behavioural strategies with some narrative therapy included.
 
Toby participated well in group and exhibited a good level of insight and recognition of his thoughts and feelings however he had difficulty with persistent worry and ruminations. Toby learnt thought stopping techniques and thought challenging skills which enabled him to change red thoughts (ie unhelpful thoughts) into green thoughts that were more helpful to him and his ability to cope. Toby also reported great benefit from learning and practicing progressive muscle relaxation which he said helped calm him and he slept better. This is a particularly good relaxation strategy for children as they learn to identify the difference in sensations between tense/stressed muscles and relaxed muscles. The final challenge for Toby and the other group participants was to ‘face their fears’ during exposure to anxiety-inducing situations.
 
At the conclusion of the program the CBCL was re-administered and Toby’s anxiety levels had reduced to normal levels. His mother also reported improvements in confidence and coping strategies. Toby commented that he felt more in control of his feelings and was confident that he could cope in fearful situations in the future.
 
Chronic Pain Management Group
 
Sally was referred by her GP to the Chronic Pain Management Group. Her presenting problems were outlined in her GP Mental Health Care Plan as depression and anger related to her chronic pain and home situation. Sally is a 39 year old patient with right hip pain caused by sacro-illiac joint dislocation as a result of a fall 18 months ago. She is the mother of 2 primary school aged boys and is a house-wife and part-time university student.
 
Since her accident, Sally has continued to visit her GP for on-going pain management and support, an orthopaedic specialist and attended physiotherapy. Sally reported that the physio was somewhat helpful but that visits to osteopath and chiropractic services were not helpful in her case. Sally has been attending individual therapy with a psychologist for the last 10 months which she feels has been very helpful. The therapist reported that she was clinically depressed and anxious and was struggling with acceptance of her on-going situation, holding onto the hope of the possibility of successful medical intervention.
 
The Group commenced with a thorough individual assessment of each patients presenting issues, medical history, social and family situation and mental state. Sally’s key presenting issues were identified as being irritability; exhaustion; feelings of uselessness; being mostly house-bound & confined to her bedroom; limited interaction with her children; limited household chores; constant use & reliance on her walking stick; and high dependence on pain medication and rest as responses to increased pain. Sally’s initial DASS score placed her in the extremely severe range for depression and mild to moderate range for anxiety and stress.
 
During the first 6 sessions of the 12 week program the focus was mainly on psycho-education, understanding what increases and decreases pain, pacing, goal setting, relaxation, sleep hygiene and gentle exercise and stretches. The group was facilitated by two psychologists and a physiotherapist.
 
At the mid-group review Sally felt that she had made significant gains. She reported increased activity, enhanced mood, decreased irritability, increased interaction with her children. She has enjoyed increased activity including hydrotherapy twice per week and taking her dog for a walk at the park. She is also gradually commencing to walk for short periods without her walking stick. She has reported a reduced reliance on medication to manage her pain and her children have also noticed improvement in her moods. Sally’s self-reported depression levels on re-administration of the DASS were reduced to the upper moderate range.
 
The process of group counselling has provided an environment of mutual support and encouragement for Sally. The participants provide each other with understanding, positive reinforcement and the opportunity to share problem solving strategies in a therapeutic space that is safe and unconditionally accepting. It is hoped that Sally’s self-rated levels of depression and stress will continue to improve in the second half of the group program as coping skills are developed and supportive relationships are strengthened.
 
 

Mental Health Training

As of 1 November there will be no mandatory training requirements for GPs to refer patients through the new Better Access initiative.  This includes GPs referring patients under Better Access for services through the Access to Allied Psychological Services (ATAPS) projects. However, it is strongly recommended that GPs providing mental health care using the new GP Mental Health Care items have completed appropriate mental health training, such as training recognised through the General Practice Mental Health Standards Collaboration. GPs claiming Service Incentive Payments for 3 Step Mental Health process services, or providing Focussed Psychological Strategies (FPS), continue to require Level 1 or Level 2 training respectively and registration with Medicare Australia.
 

Other Mental Health Resources within the Hawkesbury-Hills Region

Click Here to obtain the list outlining Other Mental Health Resources within the Hawkesbury-Hills Region
 

Useful websites

 
AGPN – Primary Mental Health Care
Department of Health and Ageing
Medicare Australia
RACGP – Mental Health
Australian Psychological Society (APS)
Australian Association of Social Workers
Australian Association of Occupational Therapists
Beyond Blue
Blackdog Institute
Mental Health Association NSW Inc
Mental Health Coordinating Council