Successful provision of emergency mental health care to rural and remote New South Wales: an evaluation of the Mental Health Emergency Care–Rural Access Program

Abstract

Objective. To evaluate a rural emergency telepsychiatry program, the Mental Health Emergency Care-Rural Access Program (MHEC-RAP), which aims to improve access to emergency mental health care for communities throughout western New South Wales (NSW).Methods. A descriptive analysis of service activity data from the introduction of the MHEC-RAP in 2008 to 2011 using Chi-squared tests and linear regression modelling to assess change and trends over time.Result. There were 55 959 calls to the MHEC-RAP, 9678 (17%) of these calls initiated an MHEC-RAP service (~2500 each year). The use of video assessment increased over 18 months, then levelled off to an average of 65 each month. Health care provider use increased from 54% to 75% of all contacts, and 49% of MHEC-RAP patients were triaged 'urgent'. Most (71%) were referred from the MHEC-RAP for outpatient care with a local provider. The proportion of MHEC-RAP patients admitted to hospital initially increased by 12%, then declined over the next 2 years by 7% (by 28% for admissions to a mental health inpatient unit (MHIPU)).Conclusion. The MHEC-RAP is well established. It has achieved acceptable levels of service activity and continues to be as used as intended. Further research is required to confirm how the MHEC-RAP works in terms of process and capacity, how it has changed access to mental health care and to document its costs and benefits.

Why aren't physicians prescribing more buprenorphine?

“…A second approach is use of telemedicine or teleconsultation to link inexperienced providers with mentors to help navigate buprenorphine OMT procedures. These approaches are becoming more widely used in general medicine (Biery, Bond, Smith, LeClair, & Foster, 2015; Eaton et al, 2015; Gillis, 2015; Khan et al, 2015; Marcolino, Pereira Afonso Dos Santos, Santos Neves, & Alkmim, 2015), have been associated with reductions in medical errors or referrals to formal treatments (Campanella et al, 2015), and have particular value for remote or rural areas (Saurman, Lyle, Perkins, & Roberts, 2014) for which research has indicated there is a dearth of available opioid treatment options (Blum et al, 2016; Cunningham et al, 2007; Jones et al, 2015; Knudsen et al, 2005; Knudsen, 2015). The Physician Clinical Support System-Buprenorphine(PCSS-B) is a federally funded program that is already in place to pair newly waivered physicians with an experienced provider usually via telephone or email, but possibly with in-person meetings as well (Egan et al, 2010).…”

Assessing Program Efficiency: A Time and Motion Study of the Mental Health Emergency Care — Rural Access Program in NSW Australia

“…Program efficiency was estimated for the study period (to compare AM and PM shifts) and for a 12 month period using 2011 activity data which was previously collected for the evaluation [27,28]. These data were summarized graphically and used medians because data were skewed.…”

“…Evaluation findings have already been reported on service activity and program reach [27,28]. The decision to fund the program represents an opportunity cost that needs to be considered both in terms of improved access to specialist services and program efficiency.…”

Service providers’ experiences of using a telehealth network 12 months after digitisation of a large Australian rural mental health service

“…One Canadian demonstration project connecting older adults with a university-related psychogeriatric service improved the referring team's knowledge base and subsequent ability to construct better treatment plans for patients [8]. In Australia, one statewide health department has demonstrated that telehealth can successfully provide emergency mental health care for rural communities [9]. There has been significant progress in developing funding models to accommodate changes to clinical practice caused by telehealth by reimbursements for time and subsidies for infrastructure setup for providers [10,11].…”