General objectives of the collaborative model of care were to:

• facilitate/enable early clinical psychology intervention with mental health conditions (and some physical conditions with either a psychological cause or psychological sequellae) thereby preventing the development of more severe conditions and consequent greater frequency of use of medical services;

• locate services in the General Practice setting, thereby decreasing the stigma for patients in seeking help for psychological problems and increasing the frequency of access to specialist mental health services for those in need;

• develop and strengthen positive partnerships between medical general practitioners and clinical psychologists in primary mental health care;

• provide an effective way of supporting regional and rural GPs to more adequately meet their patients’ mental health needs, particularly in the context of lack of adequate, accessible and affordable specialist mental health services in rural areas.

In addition, it was aimed that the project would:

• support ongoing continuing medical education for GP’s ‘in situ’ by providing learning outcomes for general practitioners whilst working collaboratively with the profession of clinical psychology;

• offer optimal placement opportunities for postgraduate interns/registrars in clinical psychology at Charles Sturt, Ballarat, New England and several other Universities, and develop a generic training model for clinical psychology registrars in primary care (similar to general medical practice registrarships);

• provide opportunities to increase consumer awareness and improve the mental health of people living in regional/rural areas of Australia;

• develop appropriate and sustainable funding models for collaborative care between GPs and psychologists, enabling patients access to services where fee paying was not viable - ie. in most regional/rural areas. (When the project began, there was scarce funding for psychological services meaning that service delivery was essentially skewed towards those who could afford to pay);

• provide an innovative generic model of mental health service delivery which could be articulated nationally and funded under the public health system.

6.5.2 Hypotheses

Three key predictions underpinned the Clinical Psychology in General Practice Project.

1) Firstly, it was predicted that patients undertaking treatment for common mental disorders in primary care would do significantly better under a shared

care, collaborative model involving both GPs and clinical psychologists, than under GP treatment alone.

2) It was also predicted that GPs involved in collaborative care would find the model useful and of more value to their patients than straightforward medical care provided by themselves alone (ie. that significant “value added” was created through involvement of clinical psychologists in collaborative care).

3) Finally, it was predicted that students undertaking the primary care internships (ie. the clinical psychology registrars) would find their placement experiences of significant value in preparing for work in the general practice setting, and that more of them would opt for work in primary care as a consequence.

RESULTS

7.1 Overview

The results are divided into three sections: patients, general practitioners and clinical psychology registrars. Methodologies differ: the latter two sections outline survey responses from doctors and clinical psychology registrars, the first section describes both quantitative and qualitative findings from the treatment group of patients, and quantitative comparisons with the control group. Findings from screening analyses undertaken to confirm equivalence of the treatment and control groups on demographic variables (gender, age and socioeconomic status) were presented in the method chapter. Results presented here focus on the core questions surrounding pre- and post-intervention within-and-between-group differences on the mental health indices, and highlight findings in relation to efficacy of the collaborative care model.

As outlined in the method, the Depression, Anxiety and Stress Scale (DASS) is the main measure used in the study, with scores on the three key dimensions (depression, anxiety and stress) falling within one of five ranges: ‘normal’, ‘mild’, ‘moderate’,

‘severe’, and ‘extremely severe’. The General Health Questionnaire (GHQ) and General Wellbeing Index (GWBI) were also used, the former designed to measure changes in experiences (rather than actual experience as measured by the DASS) with four key sub-measures: somatic symptoms, anxiety, social functioning and depression; the latter to highlight hypothesised inverse growth in wellbeing with improvement. All statistical analyses for the present study were undertaken using SPSS Version 10.0 for Windows (Coakes & Steed, 2001).

7.2 Patients

7.2.1 Summary

As outlined in Chapter 6, the Clinical Psychology in General Practice Project was aimed at testing the efficacy of introducing clinical psychology services into the medical general practice setting in rural and regional areas of Australia, and

developing a model of early intervention by psychologists for primary care patients with common mental illnesses. By mid-2004, 309 patients had received treatment through the project in the three research centres of Bathurst, Armidale and Ballarat. It was estimated that the consent/participation rate of patients was high (about 95%). As outlined in Chapter 6, of the 66% of these patients (n=203) who completed initial and follow-up measures 71.9% were female and 28.1% were male. Treatment and control groups were found to be comparable in terms of demographic variables including sex ratio, age and socioeconomic status.

7.2.1.1 Varied numbers across measures

As mentioned in section 6.3.6.3, as data were collected and analysed, it became apparent that the total number of cases/patients varied by measure. There were missing data for some patients on either the pre-test or the post-test measures, but because participants still had complete data on other measures, they were not excluded from the study. When reading the following tables, this needs to be taken into account - and explains varying totals (“N’s”).