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Can a new breed of “coaches” help transform mental health care?

Jennifer Doggett reports on an innovation in mental health care profiled at the Health Workforce Australia Conference 2013 in Adelaide 

When your health workforce is already working at capacity, how do you address the un-met need for care among those with early-stage disease without depleting the services available to people with serious illnesses?

Creating a completely new health workforce might seem an impossible task but that is exactly what Kate Carnell and her team at beyondblue are doing in the mental health sector via an innovative pilot program called New Access.

Presented at the Health Workforce Australia Conference 2013, New Access is a $13.4 million early intervention pilot program, based on a successful UK-based program developed by the National Health Service (NHS).

It is intended to provide easily accessible, free and quality services for people with mild to moderate depression and anxiety who are currently not accessing mental health services.  Men are one of the major target groups as they typically do not seek support from conventional mental health services.

beyondblue has spent four years researching and adapting New Access for the Australian context, and it is now being implemented as a demonstration project by three Medicare Locals. The program is jointly funded by beyondblue and Movember and receives no financial support from government.  The pilot will be subject to full independent external evaluation, which will report in 2016.

The core of the program is the provision of free, confidential, Low Intensity Cognitive Behavioural Therapy provided by trained and clinically supervised mental health “coaches”. These coaches operate like personal trainers, providing individual tailor made support programs incorporating relevant areas such as problem solving, goal setting, dealing with worry or exposure therapy.

They are typically people who have themselves experienced depression or anxiety and who therefore have some understanding of their clients’ situation.  As well as providing direct support to clients, coaches can link them into local community networks and engage them with other service providers, such as employment, financial or housing assistance.

New Access is innovative, not just because it creates an entirely new workforce of mental health workers to address a major area of unmet need. It also transforms the provision of mental health care by re-orienting services around consumers and changing the language and imagery associated with mental illness.

“We found that the language used in conventional mental health services – such as being ‘ill’ and ‘seeking help’ – presented a barrier to accessing mental health care for many people.  By changing the language we used, we could re-frame the service provided by the coach as less like a therapist and more like a personal trainer.  It may sound like a minor shift but it’s actually a very profound change which reflects the consumer – rather than provider – focus of the program,” Ms Carnell said.

The program was thoroughly researched from both a client and a clinical perspective and a strong focus of its development has been on ensuring the safety of people receiving the service.  Rigorous training for coaches is provided by Flinders University and they also receive supervision and support on a regular basis from a central clinical service.

Ms Carnell says that gaining support for the pilot program from all stakeholders was a challenge but that a shared goal to increase access to mental health care helped overcome some initial concerns. Ensuring all aspects of the program were well researched and based in evidence also assisted in promoting the pilot to stakeholder groups.

While she has presented the program to the Federal Government, Ms Carnell says she is not seeking government funding and that one advantage of self-funding is that beyondblue is not constrained by a restrictive government contract and can be more responsive to the outcomes as the program is implemented across all three sites.

If successful, Ms Carnell sees the program as having potential beyond the mental health sector. “So many behavioural risk factors for chronic diseases are related to motivation and the ability to self-regulate and comply with recommended treatments.  This approach has the potential to be used for other conditions, such as obesity and drug and alcohol addiction, where people know what they need to do to improve their health but require some additional support to do so,” she said.

“By re-orienting our health services around the needs of consumers, rather than trying to fit consumers into services designed around providers, we have a much better chance of reducing the future burden of lifestyle-related diseases on our community”.

And some tweet-reports:



And in other news in health workforce innovation…




And, finally, a conference quote worth noting:


• You can track Croakey’s coverage of the conference here

 

 

 

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