The Initial Assessment and Referral (IAR) and Decision Support Tool (DST) is an initiative of the Australian Government Department of Health and Aged Care to help GPs and mental health clinicians to determine the most appropriate level of care for individuals seeking mental health support in a primary care setting.
Working within a stepped care model, IAR-DST is a standardised, evidence-based tool that forms part of the wider Head to Health service network improving access to, and coordination of, mental health services delivered digitally, via telephone and face to face.
Head to Health services are designed to make it easier to support patients with their mental health and direct them to the most appropriate service, based on their needs.
It does not replace the central role GPs play in looking after their patients’ mental wellbeing, but it does provide a streamlined entry point for those seeking mental health support and connects them with the right care as early as possible in their journey.
Support is offered at no cost, and can be accessed through the Head to Health Assessment and Referral Phone Service, Head to Health digital platform or through a Head to Health centre. WA Primary Health Alliance (WAPHA) has currently established centres in Armadale, Gosnells, Midland and Mirrabooka. More information on the suite of services is available in the Head to Health GP Brochure.
GPs can phone the Head to Health Assessment and Referral Phone Service during a patient consultation on 1800 595 212 to discuss confidential assessment and referral options. An intake clinician will then follow up with the patient within an agreed timeframe to complete the assessment over the phone.
Where appropriate, you can also advise patients to call the service directly on 1800 595 212 to speak to a qualified mental health clinician, Monday to Friday, 8:30am to 5pm.
Following an initial assessment, patients can then be referred to and connected with the service that best suits their needs. The Head to Health team will inform the patient’s GP of the service or support the patient is referred to.
All Head to Health mental health clinicians are trained in and use the IAR-DST to assist with determining the most appropriate level of care.
The IAR guidance identifies the following eight domains that should be considered when determining the next steps in the referral and treatment process for a person seeking mental health support.
There are four primary assessment domains and four contextual domains.:
- Symptom severity and distress
- Risk of harm
- Functioning
- Impact of coexisting conditions
- Treatment and recovery history
- Social and environmental stressors
- Family and other supports
- Engagement and motivation
See Fig 1.1 for specific criteria outlined in the guidance for assessing severity across each domain.
The information gathered through the initial assessment domains is used to recommend one of five levels of care within a stepped care model (based on service type and intensity) and inform a referral decision. This process is based on a clinically informed algorithm and is calculated automatically using the digital Decision Support Tool (DST). The levels of care are differentiated by the amount and scope of resources that are likely to be required (see Fig 1.2 for more information):
- Level 1: Self-management
- Level 2: Low intensity
- Level 3: Moderate intensity
- Level 4: High intensity
- Level 5: Acute and specialist
GPs are not required to use IAR-DST but may find it helpful. It can be used to confirm clinical judgement and can be useful in determining the type and intensity of care needed as it takes into account a wide range of factors relating to the patient’s presentation, and wider context.
Visit the ‘Mental Health Stepped Care and the IAR-DST’ HealthPathway to access the IAR-DST and for more information and guidance.
WA Primary Health Alliance is also providing interested GPs with paid* IAR-DST training covering two workshops in one online session.
View the GP Education and Events on p.10 to find out more and book a training session or visit the WA Primary Health Alliance website.
More information on how WAPHA is leading the establishment of a network of Head to Health services in WA as part of the Australian Government’s National Mental Health and Suicide Prevention Plan is available here
*With the exception of GPs who are already being paid for their time by a Commonwealth funded service (e.g. Adult Mental Health Centre or Aboriginal Medical Centre) or they attend Workshop Two out of hours. Only GPs who attend the full training session are eligible for the remuneration payment, no pro rata payments can be made.