Mental Health Integration Imperative

 

Dr Gordon Shymko

Positive results from the north metropolitan youth early psychosis program is seeing the system spread, with some modification, to the south.

The past two years have seen some exciting advancements in the treatment of young people in the north metropolitan health area who have experienced early psychosis.

The clinical director of headspace Youth Early Psychosis Program (hYEPP), psychiatrist Dr Gordon Shymko, told Medical Forum that not least significant in the list of the program’s achievements was the demonstration that non-government organisations could deliver this kind of multidisciplinary service.

“Traditionally, in WA particularly, this model of care has been delivered in a public setting. With hYEPP we have been able to accomplish a full complement of care in the non-government sector, including medical – consultant psychiatrist and junior registrar –along with a full continuum of care in the community,” he said.

“Clients who are at risk of developing psychosis as well as those who have developed full-blown psychotic illnesses, including clients requiring more assertive treatments under the Mental Health Act, use of novel medication including depot injection medications and clozapine, are being provided services by hYEPP in the north metro, which I think is a fantastic achievement.”

Capacity for growth

Gordon said that the service, which has been operating since 2015, has about 200 clients on its books and the service is working well within its capacity of about 300.

“On top of that we are seeing some great outcomes. We think the service has made a huge difference to the lives of our clients. It has allowed them to be treated and served successfully in the community on a recovery trajectory that has allowed them to reintegrate into their activities and circumstances which illness denied them,” he said.

“We have clients who after literally months and months in hospital are able to maintain themselves, with our support, in the community.”

Gordon says there are two referral points to the service, which is administered by lead agency Black Swan Health. The first is through headspace, which has an open access referral system.

“Anyone wanting to be assessed can walk through the door. It is also a very good entry point for GPs. If they feel they have someone who has emerging psychosis or is psychotic they can refer directly at headspace,” Gordon said.

“But we also have referral pathway for public sector services, such as Emergency Departments. Unfortunately a number of our clients still reach a point of needing to present for the first time to an ED and some inpatient settings, so we do take referrals from hospitals and from some public mental health community settings.”

“The awareness of hYEPP is increasing. We spend time getting to know ED doctors so they know that they can refer on. It’s so often about relationships”

Service a boon to GPs

However, Gordon is hoping that GPs will make more use of the service.

“We think there could be more referrals coming from general practice and we would like to achieve more referrals before clients reach ED or inpatient settings. We encourage GPs to lower their referral threshold. If we have a suspicion that psychosis is emerging, we can follow up that person with the GP.”

“hYEPP is a bio-psycho-social model that includes medical and medicine management, which I don’t think GPs might be fully aware of as they see headspace more as a place for counselling. We, of course, provide that full range of counselling services but we can also provide the medical input, which is unusual for a non-government agency.”

Gordon said the service was in regular contact with a client’s GP.

“We routinely write a three-monthly letter, however, we also try to keep them in the loop more contemporaneously with phone contact and sometimes case conferencing, depending on availability and degree of involvement,” he said.

Move south mooted

The hEPP program has been so successful in the north metro region there are moves to establish a similar service in the south. However, while there is a standalone model in the north, the south will have a hybrid model that wraps around the public sector services.

Gordon explained that the hYEPP model has three components:

  • The Mobile Assessment Treatment Team (MATT) which is the entry point primarily for public sector services (ED, inpatients and community services). Following that assessment, clients are either maintained in that program or transitioned to another service. If they are referred to us, we will assess, maintain or transition.”
  • If they are transitioned to our service, the Continuing Care Team (CTT), which is the majority of services we provide, maintain clients from six months to five years, depending on their needs.
  • We also have a wraparound program, the Functional Recovery Program, (FRP), which we don’t see in the public services. It is comprised more of psycho social recovery measures to assist the person to recover and includes youth engagement, peer support, carer support, group support and psycho watch and, importantly, employment counselling and support. This program helps a person reintegrate into the things that were important to them prior to developing the illness.

WAPHA has called for expressions of interest to establish these FRP services in the south metro to wrap around the available public sector services for clients with first step psychosis.

Citywide safety net

Gordon, who along with being hYEPP clinical director is clinical director of the Peel and Rockingham Kwinana Mental Health Service (PaRK MHS), anticipates that with the development of the FRP in the south, a hybrid model can be established that approximates the north metro services.

“When this is established in the south, Perth will have effective cover for any young person who has developed a psychotic illness and if we maintain fidelity to the model, we will see some really good outcomes.”

“This world we live in now has to be collaborative among all sectors. There is nothing good whatsoever about this public/non-government divide.”

“Collaboration is one thing, but the level of integration and cohabitation as evidenced by hYEPP is another and it is really exciting to see services from the public and non-government sectors working like this. Apart from some collaborative partnerships such as between Ruah Inreach and PaRK MHS, historically we have generally seen the provision of public and non-government services occurring in parallel with duplication and poor communication often resulting. So this move to integration is really positive.”

“I have never before seen a non-government group provide a whole suite of services and we should be proud of that.”

ED: We contacted WAPHA regarding the letting of the south metro tender for the Functional Recovery Program and no decision had been made by the time we went to press.