Using ‘Low Intensity Coaches’ Yields 60% Recovery Rates for People with Mild-Moderate Mental Health Illnesses

Walkabout Medical Homes with Mary Takach: A 10-month Study of Australia
November 2014 
According to the World Health Organization, the cost of mental health problems in developed countries is estimated to be between 3% and 4% of GNP. In addition, the cost to national economies in terms of economic burden (productivity) can add up to several billion dollars more [Investing in Mental Health, 2003]. Treating mental illness at early stages before the symptoms manifest and disable is the aim of two-year pilot being tested by three primary health care organizations (PHCOs) in Australia.
As background, since 1992, Australia has had a long history of evolving PHCOs as a core underpinning of the Commonwealth’s primary health strategy. Australia’s PHCOs, currently known as Medicare Locals¹, share similar core characteristics to PHCOs found in many states such as North Carolina, Colorado, and Oregon, to name a few. In all these instances, PHCOs serve as the intermediary, ‘ears to the ground’ structure between the community (providers and patients) and the government (payer, purchaser) and often serve as launching pads for innovative initiatives for their catchment area. According to Leanne Wells, CEO of the ACT Medicare Local in Canberra, becoming the first organization in Australia to pilot a new mental health workforce model called NewAccess, is one of its proudest achievements.
NewAccess is based on the “Improving Access to Psychological Therapies” (IAPT) a Low Intensity Cognitive Behavioral Treatment model aimed at those individuals with mild to moderate depression and anxiety that was successfully trialed and subsequently scaled in the United Kingdom. Two Australian foundations (Movember and beyondblue) — each with a strong interest in expanding access to early intervention mental health services particularly for hard to reach populations (such as men) – partnered to “Australianize” the IAPT program with an eye to deploying a new mental health workforce model. The ACT Medicare Local was approached by beyondblue in 2003 to submit a proposal to be the first pilot site. A short time after, beyondblue competitively selected two other Medicare Locals to further test the pilot.
NewAccess offers:

• Free services—up to six (6) one-on-one sessions. The first session is typically done face to face, but it also can be done over the phone. The last session serves as a review to assess client progress and refer the client to more intensive mental health services, beyond NewAccess, if needed.
• Simple referral pathways including self-referral: individuals can call a “coach” directly or make an appointment right from ACT Medicare Locals website. Ninety percent of referrals are self-referrals.
• During the first session, a person-centered assessment is done. During this session, the client and coach develop a ‘problem statement’ that includes mutually agreed on goals and approaches. The client leaves with a guided self-help plan. Subsequent sessions are done over the phone, email, or face to face.
• Coaches provide community referrals, for instance, to employment, housing, and financial services if they are linked to addressing the client’s condition. At any stage, the coach can “step up” the client to more intensive mental health services if needed.

Expanding access to mental health services resulted in the development of a new cadre of mental health workers—“coaches” that function like personal trainers. Lauren Anthes, ACT Medicare Local Mental Health Program Manager, explained that they look to people with experience in working with vulnerable populations, not necessarily those with experience or qualifications in mental health or a college degree. “NewAccess is very procedurally driven and interventions are very specific. There is concern that people with previous clinical training in mental health might impact the services delivered by the pilot,” stated Anthes. “Ideal candidates should also have the ability to learn, adapt quickly, and stick to procedures well.” A number of candidates also self-identified as having personal experience with mental health issues either through dealing with family members or personally, which can be an asset.
Flinders University in Adelaide adapted the IAPT workforce training curriculum and developed a year-long curriculum that begins with a six-week program of intensive training followed by bimonthly day-long workshops for the year’s remain. Currently, Flinders University uses a mix of modalities with the six-week program being done on campus and the ability to administer the remainder of the program on-line or remotely. In addition, a clinical supervisor from Flinders University travels to the Medicare Local to shadow the ‘coach in training’ as he or she work with clients. Beyondblue is looking at options to make the curriculum more accessible across the country.
Are six sessions enough? The answer according to Anthes is, “Yes!” A robust evaluation is underway and early findings point to a recovery rate of 60 percent at the ACT Medicare Local, with aggregate recovery rates across the three pilot sites at 58 percent. These numbers align well with the 50 percent recovery rate findings experienced in the United Kingdom. These numbers point to the success of NewAccess helping people to get back on track and take charge of their lives through the development of life skills to manage mild to moderate anxiety and depression.

More on dangerous creatures in Australia, Part II

In my last blog, I reported on the perils of being attacked by menacing magpies. Another creature that I also was not warned about that lurks in cities across Australia is the MAMIL. Yes, encounters with MAMILs are a daily occurrence for any commuter whether on foot, bike, or car. MAMIL, as it turns out in Australia, stands for Middle Aged Men in Lycra. In Australian cities, cyclists rule the roads and sidewalks, and lowly pedestrians are relegated to clinging to sidewalk edges trying to stay out of their way, which is no easy feat during rush hours. MAMILs are the subject of frequent media rants about protecting the general public from dodgy collisions and testy encounters—yesterday, on my walk home from work, I witnessed a MAMIL cutting in quite close to a stopped car and yelling at the motorist, “Okay, killer! Easy killer!” I offer the Commonwealth of Australia my policy suggestion of the month: rather than crack down on all cyclists, just ban the Lycra.
¹Note: In Australia, under the new administration, the PHCO landscape is under reform. There will be in a new competition in 2015, and the PHCO borders will be redrawn (reducing the 61 to 30), the name will change (from Medicare Locals to Primary Health Networks), and responsibilities will be modified as well –more on this in a future blog.