Initial Assessment and Referral Decision Support Tool for Mental Health
The Initial Assessment and Referral and Decision Support Tool (IAR-DST) is an instrument for use in primary health care settings. It is based on a holistic framework to provide recommended stepped levels of care for an individual seeking mental health support, to achieve the greatest benefit with the least intrusive evidence based interventions. The background to its development- important in recognising its utility, relevance and value- can be considered as having three major inputs. These relate to current mental health epidemiology in Australia, challenges in mental health diagnosis, and resource availability and accessibility for treatment of mental health disorders.
Each of the Primary Health Networks (PHN) nationally have established an IAR team to support dissemination of IAR-DST information and provide training for GPs to use and embed the tool into clinical practice as appropriate.
Please contact IAR-DST@adelaidephn.com.au for further information about the tool and upcoming training sessions.
To download a copy of our CRU service map, click here.
Adelaide PHN regurarly holds two-hour group training sessions to help GPs understand how to use the IAR-DST and embed it into their clinical practice. Training will attract 2 certified hours for CPD purposes. GPs will also receive $300 for their time upon completion of the training. Places will be limited.
If you are a GP practicing in metro Adelaide who is interested to learn more, please get in touch with our team by emailing IAR-DST@adelaidephn.com.au.
Upon completion of the training, GPs will -
- Receive $300 payment (excl. GST) for their time
- Attract 2 certified hours for CPD purposes
- Have dedicated and ongoing support from our IAR-DST team in the use and implementation
- Have facilitation of cross service referral
- Minimise risk by using a standardised instrument
- Have provision of service map availability
- Receive a certificate of completion
The tool also supports clinicians by providing a standardised framework to deliberate their decisions when connecting people with the right intensity of mental health care, at the right time.
- Provides a framework to articulate treatment needs and improve transparency around how referral decisions are made, aiming to reduce frustration when referrals are not accepted
- Widespread uptake of the IAR-DST will promote a nationwide common language across the mental health sector about what level of service intensity a person requires
- Brings together existing initial assessment findings into eight holistic domains that are important for referral decision making, rather than replace (or require additional) existing clinical assessment
- Aims to minimise risks that can occur through under-servicing (poor outcomes) and over-servicing (unnecessary burden of care for the individual).
It is in this context the IAR-DST has been developed. An Expert Advisory Group comprising GPs, medical specialists, allied mental health clinicians, individuals with lived experience collaborated with The Department of Health and consulted with a wide range of stakeholders to develop the IAR-DST. It represents a mélange of the views of clinical practitioners from multiple disciplines, those with lived experience, and stakeholders from wide ranging backgrounds and is informed by the current best evidence based research.
The IAR-DST is based on a recognition of the increase in mental health problems, the wide treatment gap, the diagnostic challenges of mental health conditions and the pressure on resources. In using the most recent evidence based approaches it employs a stepped care model in both assessment and management. Importantly it recognizes the value general practitioners bring to the health system and aims to support their clinical work. It does this with an instrument which being constructed in 8 Domains is conceptually holistic. The medical and psychosocial aspects of a person’s life are included simply by using the IAR. This streamlines thinking, ensuring significant factors are not overlooked, and helps GPs with time constraints. It also improves communication with other health professionals through usage in common, ensures compliance, and is linked to an automatically generated management plan which again helps GPs with time management.
The model of stepped care provides patients with the best level of care that is clinically indicated at that particular time. It allows care to be varied as the dynamic clinical situation demands. Provision of and accessibility to resources is optimized, and because the IAR-DST is a standardized and an accepted instrument it offers GPs a protective framework in any underservicing (associated with poor patient outcomes), or overservicing (unnecessary burden on patients) dispute that may arise in the often lengthy and challenging history in treating patients with complex needs.
Training in using the IAR-DST is best viewed as an opportunity to acquire additional skills which facilitate best practice assessment and associated management planning. It is an adjunct to clinical practice and judgement. It is not a replacement for these. Nor is training in its use a commitment to incorporating it into daily GP practice.
The past few decades has seen a dramatic increase in mental health disorders in Australia where currently 45% experience a mental illness in a lifetime, and 20% have experienced a mental illness in the previous 12 months. Mental health disorders are now the fourth largest contributor to the Total Disease Burden and the second largest contributor to the Non-fatal Disease Burden in Australia. However the treatment gap, which is variously reported in differing population groups, with ranges between (20-80)% is overall approximately 50%. Despite this treatment gap 4.5 million individual Australians received mental health related services in 2020-2021. The impact then of mental health on individuals and the wider community is enormous, substantially unmet and increasing.
Mental health, and psychiatry in particular, has a long history of difficulty in establishing reliable, consistent and valid taxonomies which are durable over time. The changes which have taken place in the various editions of The Diagnostic and Statistical Manual of Mental Disorders (DSM) since the first edition in 1952 to the fifth edition published in 2013 reflect this level of diagnostic uncertainty and the challenges which underpin it. Indeed the most recent DSM (V) met with considerable criticism, and opinions were, and remain divided about its value. In the last few years there has been an increasing literature based on addressing the problems in diagnosis in mental health by recognising the value and accuracy of a taxonomy that is hierarchical, recognizes symptoms as a spectrum rather than a category, and which is ‘stepped’ in approach.
The increasing incidence of mental health disorders and confusion around diagnosis is further compounded by the substantial reduction in GP training numbers. The Royal Australian College of General Practitioners reports only 14% of new medical graduates in Australia plan a career in general practice. This is a dramatic fall in numbers over the past decades. The prevalence of mental health disorders are increasing at the same time as the critical resources are diminishing. Further, the greatest stressors in general practice, reported as overwork, reduced autonomy, and increasing administrative tasks are also increasing.
Want to learn more?
If you are a GP practicing in metropolitan Adelaide and haven’t yet undertaken the IAR training, please watch the below short explainer video to learn more about the tool and see what benefits it can bring to your practice.