Initial intake and referral procedure for primary mental health services

The Commonwealth has issued guidance to Primary Health Networks (PHNs) that requires the establishment of processes to ensure patients referred to commissioned services have a standardised initial assessment to support treatment choices. See the National Guidance Initial Assessment and Referral for Mental Healthcare for more information

Rather than devolve this responsibility to referrers, many already fully occupied managing existing workloads, WA Primary Health Alliance will collaborate with the sector to commission a new “measurement-based care” service. This will enable GPs to request a mental health assessment, formulation and recommendations, undertaken by an experienced clinician operating from a virtual clinic, and standardised according to the national guidance recommendations.

The new service will establish integrated workflows with commissioned providers, so will also be able to act on referral options with GP authorisation, ensuring that not only is the initial assessment provided in a timely manner, but referrals are similarly managed.

The national guidance identifies eight domains that should be covered when conducting an initial assessment to determine next steps in the referral and treatment process. The eight domains fall into two categories:

  1. Primary Assessment Domains (1 to 4): These cover Risk of Harm, Symptoms and Distress, Functioning and Impact of Co-existing Conditions. Primary Assessment Domains represent the basic areas for initial assessment that have direct implications for decisions about assignment to a level of care.
  2. Contextual Domains (5 to 8): These cover Treatment and Recovery History, Social and Environmental Stressors, Family and Other Supports, and Engagement/Motivation. Assessment on these domains provides essential context to moderate decisions indicated by the primary domains.

Core processes, documentation and associated information management will be designed with GPs to meet general practice requirements, including compatibility with practice software, MHCP and My Health Record. Processes will also be enabled to ensure those GPs who prefer to undertake the assessment themselves and directly refer to services can do so without the need to use the “central gateway”.

More details can be found in the WAPHA Mental Health Activity Work Plans 2019-2020: See Priority Area 7: Stepped care MH1.10a-1.03b

WA Primary Health Alliance has prepared a detailed project plan to guide the development of the IAR model for Western Australia over the next 2 years, including project governance and resourcing, work program, timelines and milestones. Effective engagement with GPs and other stakeholders is core to the plan, as critically important to the success of this initiative. To discuss this project further please email Dr Daniel Rock