In late 2006, researchers at the University of Ballarat were contracted by Ballarat and District Division of General Practice (BDDGP) in regional Victoria to undertake the Pathways to Mental Health Care project. The project aimed to facilitate the implementation and delivery of the Better Access to Mental Health Care (BAMHC) program within the Ballarat region.

BAMHC was released by the Australian Commonwealth Department of Health and Ageing in 2006 and is a mental health initiative that seeks to enhance access and care to all Australians with mental health issues via GPs, psychiatrists and local allied mental health care professionals.

 GP Mental Health Care support tool - BDDGP

The project culminated in an internet-based Mental Health Support "toolbox" comprising an 8-stage decision support tool, and a service directory of local psychiatrists and allied mental health care professionals from across the region to support GPs and practice nurses in implementing and accessing localised-information relevant to BAMHC. Access to appropriate resources and assessment procedures in the early intervention and management of patients with a mental health disorder were also included in the toolbox.

Since its launch, feedback from site users – as well as site statistics – have been positive indicating that this resource has been well received and is being readily used within local practices.

This project outlines a process through which a newly initiated, national mental health program can be tailored to meet the needs and requirements of local health care professionals in primary health care settings. An internet toolbox provides a repository from which GPs and practice nurses can easily access current information about the program and complete necessary documentation during consultation with patients.

Commencing in January 2007 and completed in December 2007 this project was prompted by an increase in requests from local GPs to BDDGP staff for additional information about the BAMHC program, which occurred in the months following the program’s introduction. The BDDGP responded by collaborating with researchers at the University of Ballarat (UB) to develop a local, on-line toolbox for GPs about the BAMHC which is now hosted through the BDDGP website.

A UB research officer worked closely on this project with significant input from a senior researcher at UB and the BDDGP’s Mental Health and GP Wellbeing Coordinator. The project also received considerable support from key stakeholders, including local GPs, GP advisors from BDDGP, and BDDGP staff.  UB’s Centre for eCommerce and Communications (CeCC) undertook the construction of the on-line resource, including the support tool and service directory.

The first stage of this project comprised the identification of appropriate, relevant and reliable information about the BAMHC that could be included in the web tool. The research officer was guided in this process by the BDDGP’s Mental Health and GP Wellbeing Coordinator. Important program documents were sourced from the following Organisations:

• Commonwealth Department of Health and Ageing documents (on-line)
• Australian Division of General Practice
• Australian Psychological Society
• Other documents included on the website and were provided by the BDDGP (including sample referral letter; mental health measures etc).

Information for the local service directory was collected from other online service directories including the Australian Psychological Society, Psychologists Registration Board of Victoria, Australian Association of Occupational Therapists, Social Work Registration Board – as well as the Yellow Pages. Each service provider was then personally contacted confirming the details to be included in the service directory.

Information about the BAMHC which was collected during the first stage of this project was used to construct the decision support tool. This assists GPs to make appropriate decisions about treatment and referral options for patients with mental health needs who may benefit from the BAMHC program.

The support tool was developed by identifying distinctive steps relating to information about the program that GPs may need when referring their patient for psychological support through the BAMHC program. This information was then placed in a "best fit" sequence. Key stakeholders were then consulted to gauge their feedback about the decision support tool. Once feedback was received, the on-line web tool was then constructed by CeCC.

Prior to its official launch the web tool was trialled by six local GPs. The feedback obtained about the web tool and the information and features it contained was both very positive ("Excellent idea"; "Very good indeed") and valuable, with further, minor improvements made to the tool prior to its launch.

The official launch of the web tool in December 2007 was well attended by 16 GPs, 10 practices nurses and two practice managers from the region. In the time since its launch the website continues to be strongly used with over 2847 visits to the website and 11,500 pages accessed during this time with an average of four pages accessed per visit.

Interestingly, site statistics indicate that during each visit, most visitors access the home page, the referral template letter and a select number of different stages in the decision support tool. The number of repeat visitors to the website (40%) provides some further support for the value of this tool.  It is important to note that monitoring the number of hits on the site on a monthly or bi-monthly basis has provided a valuable means for assessing the extent of use by GPs and others.

Furthermore, there has been a large amount of positive feedback received about the website during, and in the time since, its launch. Recent written feedback received by two local GPs about the website indicated that the web tool is both useful in the practice setting and its content is appropriate for their needs.

Recent unsolicited, anecdotal reports to the Mental Health and GP Wellbeing Coordinator at BDDGP from four GPs at two separate practices indicate that they regularly use the web tool. A staff member at a neighbouring GP Division also indicated that the support tool "looks really great".  Such feedback adds credence at a practice level of the value of this resource to GPs and those working closing with the BAMHC program.

Integral to both the success of this resource and its sustainability is the close and continued monitoring and updating of the information contained on the website. Since its launch the website has undergone some changes including the updating of information in the service directory, updating resources which contain links to external agencies (particularly documents from the Department of Health and Ageing) and responding to feedback from GPs about the site - as well as from allied health service providers who wish to update their details or register for inclusion on the directory. This is occurring on a regular basis thus attesting to the value that service providers place on the service directory.

To highlight the effectiveness of the website as a means of updating information quickly and efficiently is the recent inclusion of an additional stage to the decision making support tool. This now allows local GPs to refer selected patients to a Mental Health Nurse. Furthermore, the website will soon allow GPs the option of accessing mental health information and services relevant to their patients presenting with perinatal issues as well as managing patients with alcohol and drug issues.

In summary, the development of an internet "tool box" - though perhaps not the preferred option for all GPs (especially those who do not have access to the internet at work) - is none-the-less an alternative method of parcelling-up information into a set of easily usable and accessible web tools that assist GPs and practice nurses to obtain information and understanding about the program at a locally-relevant level.

It is proposed that having resources at hand – or at the click of a few buttons – should assist GPs in their understanding of the BAMHC program and in stream lining their consultations with patients who are presenting with mental health problems.

Note. Further details about this project have been published in Rural and Remote Health:
 Project Report: Internet tool box for rural GPs to access mental health services information

Mental Health and GP Well Being Coordinator
Ballarat and District Division of General Practice
Phone: 03 5331 6303

Research Officer, School of Behavioural and Social Sciences and Humanities
University of Ballarat
Phone: 03 5327 9629