Literature Collection

BACKGROUND: In the state of Victoria, Australia, the 111-day lockdown due to the COVID-19 pandemic exacerbated the population's prevailing state of poor mental health. Of the 87% of Australians who visit their GP annually, 71% of health problems they discussed related to psychological issues. This review had two objectives: (1) To describe models of mental health integrated care within primary care settings that demonstrated improved mental health outcomes that were transferable to Australian settings, and (2) To outline the factors that contributed to the effective implementation of these models into routine practice. METHODS: A scoping review was undertaken to synthesise the evidence in order to inform practice, policymaking, and research. Data were obtained from PubMed, CINAHL and APA PsycINFO. RESULTS: Key elements of effective mental health integrated care models in primary care are: Co-location of mental health and substance abuse services in the primary care setting, presence of licensed mental health clinicians, a case management approach to patient care, ongoing depression monitoring for up to 24 months and other miscellaneous elements. Key factors that contributed to the effective implementation of mental health integrated care in routine practice are the willingness to accept and promote system change, integrated physical and mental clinical records, the presence of a care manager, adequate staff training, a healthy organisational culture, regular supervision and support, a standardised workflow plan and care pathways that included clear role boundaries and the use of outcome measures. The need to develop sustainable funding mechanisms has also been emphasized. CONCLUSION: Integrated mental health care models typically have a co-located mental health clinician who works closely with the GP and the rest of the primary care team. Implementing mental health integrated care models in Australia requires a 'whole of system' change. Lessons learned from the Mental Health Nurse Incentive Program could form the foundation on which this model is implemented in Australia.

Temporary mental health (MH) staffing gaps are common and may compound access challenges due to increasing demand for MH care combined with a shrinking MH workforce. In 2019, the Veterans Health Administration (VA) implemented a system of 18 regionally based Clinical Resource Hubs (CRHs) staffed with remote providers delivering virtual MH care. While the program demonstrated promise during early implementation for effectively addressing some access challenges, its sustainment may depend partly on leaders' perceptions of its ability to meet and adapt to access-related priorities. Our aim was to explore and describe how VA regional MH leadership identified and weighed values of the CRH during early implementation, and how it might have functioned beyond filling temporary staffing gaps. We conducted semi-structured interviews with CRH MH leaders (n = 36) across all 18 VA administrative regions. We analyzed data using a rapid qualitative approach that included templated summaries and matrix analysis. Three key perceived values of the CRH were identified: (1) its potential to offer a more integrated care experience than community (VA-purchased) care in some cases, (2) its ability to provide specialized MH services (e.g., suicide prevention) to rural areas and, (3) its capacity to improve MH provider recruitment and satisfaction. Virtual care delivered through the CRH can be a flexible option for maintaining access to MH services during staffing shortages. MH leaders' perspectives suggest the CRH program is not only a contingency staffing solution to access problems, but provides additional values that could be leveraged to improve MH care services more generally.