Abstract
It is well established that the prevalence of mental health disorders in remote Australia is comparable to that of urban regions. However, accessing mental health services in remote areas is much more challenging. In an attempt to address this problem, a “patient-led” psychology clinic was established within the public adult mental health service of a remote Australian town in which patients scheduled their own appointments within the constraints and parameters of the service. Benchmarking methodology was used to compare the effectiveness and efficiency of this clinic with available published data from other clinics. Reliable and clinically significant change statistics were calculated and an efficiency ratio was derived. The service was evaluated after a 2-year period and results indicated that overall the service was both effective and efficient. Despite having unlimited access to the service, the average number of attended appointments was low, as was the number of missed and cancelled appointments. These results compare favorably to other practice-based studies across the literature in terms of efficiency of the service and the proportion of patients making reliable and clinically significant change. Providing an innovative system where people determine the timing and duration of psychological treatment is consistent with a recovery approach and raises important policy and practical implications for improving access to mental health services in remote regions of Australia. Furthermore, patient-led treatment methods possess immense benefit in contexts where there is increased demand and limited resources in mental health services.
Authors’ Contributions
SF played a major role in editing and finalizing the manuscript for submission. This included conducting appropriate literature searches and editing the final version of the manuscript. TAC collected the data and took a leading role in the analysis of the data as well as drafting a manuscript. SJT contributed to the design and data analysis of the study as well as the writing the manuscript. DL contributed major intellectual input to the composition of the manuscript.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Australian Government Department of Health. Principles of recovery orientated mental health practice. 2010. Retrieved from http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-toc~mental-pubs-i-nongov-pri
Australian Government Department of Health. Better access to mental health care: fact sheet for patients. 2017. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-ba-fact-pat
Australian Institute of Health and Welfare. Allied Health Workforce (2012). (Cat. No. HWL 51). 2012. Retrieved from https://www.aihw.gov.au/getmedia/ceeac63a-1670-4e75-85d2-61225ffb4ca9/15993.pdf.aspx?inline=true
Baldwin SA, Berkeljon A, Atkins DC, Olsen JA, Nielsen SL. Rates of change in naturalistic psychotherapy: contrasting dose-effect and good-enough level models of change. J Consult Clin Psychol. 2009;77:203–11.
Barkham M, Connell J, Stiles WB, Miles JNV, Margison F, Evans C, Mellor-Clark J. Dose-effect relations and responsive regulation of treatment duration: the good enough level. J Consult Clin Psychol. 2006;74:160–7.
Bower P, Gilbody S. Stepped care in psychological therapies: access, effectiveness and efficiency. Br J Psychiatry. 2005;186:11–7.
Brosnan L. Power and participation: an examination of the dynamics of mental health service-user involvement in Ireland. Stud Soc Justice. 2012;6:45–66.
Carey TA. Can patients specify treatment parameters? Clin Psychol Psychother. 2005;12:326–35.
Carey TA. The method of levels: how to do psychotherapy without getting in the way. Hayward: Living Control Systems Publishing; 2006.
Carey TA. Hold that thought! Two steps to effective counselling and psychotherapy with the method of levels. Chapel Hill: Newview Publications; 2008a.
Carey TA. Perceptual control theory and the method of levels: further contributions to a transdiagnostic perspective. Int J Cogn Ther. 2008b;1:237–55.
Carey TA. Will you follow while they lead? Introducing a patient-led approach to low intensity CBT interventions. In: Bennett-Levy J, et al., editors. Oxford guide to low intensity CBT interventions. Oxford: Oxford University Press; 2010.
Carey TA. As you like it: adopting a patient-led approach to the issue of treatment length. J Public Ment Health. 2011;10:6–16.
Carey TA, Kemp K. Self-selecting first appointments: a replication and consideration of the implications for patient-centred care. Clin Psychol Forum. 2007;178:33–6.
Carey TA, Mullan RJ. Patients taking the lead: a naturalistic investigation of a patient led approach to treatment in primary care. Couns Psychol Q. 2007;20:27–40.
Carey TA, Spratt MB. When is enough enough? Structuring the organisation of treatment to maximise patient choice and control. Cogn Behav Therapist. 2009;2:211–26.
Carey TA, Tai SJ, Stiles WB. Effective and efficient: using patient-led appointment scheduling in routine mental health practice in remote Australia. Prof Psychol Res Pract. 2013;44:405–14.
Carey TA, Mansell W, Tai SJ. Principles-based counselling and psychotherapy: a method of levels approach. London: Routledge; 2015.
Council of Australian Governments. The roadmap for national mental health reform 2012–2022. Canberra: Council of Australian Governments; 2012. Retrieved from http://www.coag.gov.au/sites/default/files/The%20Roadmap%20for%20National%20Mental%20Health%20Reform%202012-2022.pdf.pdf
Department of Health and Ageing. National practice standards for the mental health workforce. Canberra: Department of Health and Ageing; 2002. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/2ED5E3CD955D5FAACA25722F007B402C/%24File/workstds.pdf
Glover G, Webb M, Evison F. Improving access to psychological therapies: a review of the progress made by sites in the first roll-out year. Stockton-on-Tees: North East Public Health Observatory; 2010. Retrieved from http://www.iapt.nhs.uk/silo/files/iapt-a-review-of-the-progress-made-by-sites-in-the-first-roll8208-out-year.pdf
Hansen NB, Lambert MJ, Forman EM. The psychotherapy dose-response effect and its implications for treatment delivery services. Clin Psychol Sci Pract. 2002;9:329–43.
Howard KI, Kopta SM, Krause MS, Orlinsky DE. The dose-effect relationship in psychotherapy. Am Psychol. 1986;41:159–64.
Hunter E. Disadvantage and discontent: a review of issues relevant to the mental health of rural and remote Indigenous Australians. Aust J Rural Health. 2007;15:88–93.
Mansell W, Carey TA, Tai SJ. A transdiagnostic approach to CBT using method of levels therapy: distinctive features. London, UK: Routledge; 2012.
Miller SD, Duncan BL. The outcome and session rating scales: administration and scoring manual. Chicago: Institute for the Study of Therapeutic Change; 2004.
Mitchell JE, Agras S, Crow S, Halmi K, Fairburn CG, Bryson S, Kraemer H. Stepped care and cognitive-behavioural therapy for bulimia nervosa: randomised trial. Br J Psychiatry. 2011;198:391–7.
National Health Service England. Adult improving access to psychological therapies programme. 2017. Retrieved from https://www.england.nhs.uk/mental-health/adults/iapt/
NICE. Depression: the treatment and management of depression in adults. London, UK: National Institute for Health and Clinical Excellence; 2009.
Roufeil L, Lipzker A. Psychology services in rural and remote Australia. InPsych: Bull Aust Psychol Soc Ltd. 2007;29:9–11.
Slade M, Adams N, O’Hagan M. Recovery: past progress and future challenges. Int Rev Psychiatry. 2012;24:1–4.
Slade M, Amering M, Farkas M, Hamilton B, O’Hagan M, Panther G, … Whitley R. Uses and abuses of recovery: implementing recovery-orientated practices in mental health systems. World Psychiatry. 2014;13:12–20.
Stanhope V, Barrenger SL, Salzer MS, Marcus SC. Examining the relationship between choice, therapeutic alliance and outcomes in mental health services. J Pers Med. 2013;3:191–202.
Stiles WB, Barkham MB, Connell J, Mellor-Clark J. Responsive regulation of treatment duration in routine practice in United Kingdom primary care settings: replication in a large sample. J Consult Clin Psychol. 2008;76:298–305.
Talmon M. Single-session therapy: maximizing the effect of the first (and often only) therapeutic encounter. San Francisco: Jessey-Bass; 1990.
Weinstein N, Ryan RM. When helping helps: autonomous motivation for prosocial behavior and its influence on well-being for the helper and recipient. J Pers Soc Psychol. 2010;98:222–44.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Crown
About this entry
Cite this entry
Funnell, S., Carey, T.A., Tai, S.J., Lampshire, D. (2021). Improving Access to Psychological Services in Remote Australia with a Patient-Led Clinic. In: Carey, T.A., Gullifer, J. (eds) Handbook of Rural, Remote, and very Remote Mental Health. Springer, Singapore. https://doi.org/10.1007/978-981-15-6631-8_38
Download citation
DOI: https://doi.org/10.1007/978-981-15-6631-8_38
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-15-6630-1
Online ISBN: 978-981-15-6631-8
eBook Packages: MedicineReference Module Medicine