Sharing enhances caring for people with mental illness 

A new improved web-based shared care plan aims to increase access and continuity of care for people with lived experience of mental illness, boosting their health, wellbeing and quality of life.  

When people with mental illness feel seen and heard and are able to access streamlined person-centred care, there are many long term positive knock-on effects for their mental and physical health. To provide this inclusive, co-ordinated approach, it’s critically important to ensure ongoing engagement with health providers and continuity of care between services.  

Passionately supporting this model of wraparound care is Dr Andrew McDonald, Clinical Director of Mental Health for Sydney Local Health District. McDonald has been instrumental in the development and study of a web-based shared care program. Called SHAReD, the initiative, has received funding from the NSW Health Translational Research Grants Scheme, to improve care of mental health consumers using Mental Health Services and Primary Care across the Sydney Local Health District. 

Building bridges between services  

“Our main objective is to improve the frequency and quality of primary and preventive healthcare offered between Mental Health Services and General Practice, to reduce health risks for consumers experiencing mental illness,” McDonald explains. “We hope that this approach allows for more effective communication and transfer of information between GPs, clinicians and the people with lived experience they are supporting.” The program builds on an existing shared care model that involved a partnership between Central and Eastern Sydney Primary Health Network. “Though the initial year of rollout of the model in 2019, proved highly successful, the onset of Covid caused the program to hit a bit of a ceiling,” McDonald explains. “It needed updating to enable and encourage better engagement of mental health consumers and their families and also improve information sharing between GPs and Mental Health Services. The current proposal, developed in collaboration with the University of New South Wales, was the next logical step.” 
 
Under this new shared care model, the GP initiates the share care plan and tailors it to the patient, while community Mental Health workers and the consumer have online access to the plan and receive reminders when key actions such as a GP review, are due. The mental health consumer can also provide access to their families and carers to view their health data and care plan. If computer access is an issue, they can be provided with a printed copy of the plan or view it on the mental health clinician’s mobile device.  

A wholistic approach to mental health care 

The 12-month SHAReD study commenced in 2022, and following a number of Covid related delays, is due to finish in June 2024. “We’ve been conscious for a long time that consumer health information sits within medical records behind firewalls – either in our services or in primary care, meaning the mental health consumer, their family and their carers don’t have access to this important information,” McDonald says. “We are very hopeful that the online shared care plan, combined with telehealth sessions, will improve access to frequency and quality of primary and preventive care for people with a lived experience of severe mental illness.” 

Better continuity through care co-ordination

The shared care plan was modelled on the diabetes cycle of care, which directs monitoring, tests and reviews by clinicians. “The web-based platform alerts Mental Health Services that a patient is due for a particular shared-care task, such as an annual check-up or the ordering of blood tests, and prompts the co-ordination of an appointment booking for the patient,” McDonald explains. “These results are then linked to the web-based platform, meaning they are visible to all stakeholders – such as GPs, clinicians, consumers and carers.”

The study has been measuring if the program improves consumer ratings or how well their GP and Mental Health Service have been working together to plan their care in the last nine months. It is tracking whether the shared care program leads to a reduction in health risk behaviours such as smoking and a drop in cardiovascular risk factors such as blood pressure and cholesterol, through improved monitoring and swift treatment. Impacts on consumer hospitalisations are also being mapped and the study is confirming whether the SHAReD approach helps mental health consumers feel more understood and supported by their healthcare providers.  

“Historically, it’s been difficult to get consumers to engage with ongoing health support and follow-ups,” McDonald observes. For example, a consumer may have taken a while to find a GP and then arrives for an appointment and may face long waiting times sitting in a busy reception area. If the GP then orders a blood test and says, ‘come back again in four weeks and we’ll review them’, the consumer’s care may then be interrupted. “We want to make sure that when the mental health consumer gets there the GP has as much information as possible to make definitive management decisions, so that the patient doesn’t have to come in for repeat visits after they’ve done further tests,” McDonald says. “Results so far are promising, indicating improved engagement with services and better patient outcomes.”