Lessons from evaluating a PHN-funded low intensity mental-health service
About the evaluation
In late 2018, Beacon Strategies undertook an evaluation of belong’s NewAccess program, which aims to improve the mental health and wellbeing of culturally and linguistically diverse (CALD) communities in Brisbane South. NewAccess is a program designed by beyondblue offering low intensity mental health coaching for people who are at early risk of developing common mental health conditions such as depression or anxiety disorders.
A model of how the program is intended to work (or a theory of change) is shown above.
Our evaluation explored how well the program had engaged people from CALD backgrounds, if it had led to improvements in mental health and wellbeing, and how the program ‘fits’ within the region’s stepped care model - meaning people are able to access the right level of support to meet their needs and step up or down in intensiveness as their needs change.
We analysed data to see how participants’ conditions changed over time and combined this with stories, experiences and perspectives we captured in interviews with past participants, sector stakeholders, the program’s funder (Brisbane South PHN) and non-participants (i.e. those from the target group who were eligible but opted not to participate).
You can find a snapshot of the key findings in the summary report below.
Lessons for PHNs and providers
While the program we evaluated focused on low intensity services specifically within a CALD setting, there were several things we discovered relating to low intensity services more broadly that we believe are important considerations for these types of programs into the future.
As many working in the sector would be very familiar with, recent national reforms talk of a ‘stepped care’ model for mental health services and highlight the need for more and better low intensity support as a means of early intervention.
In particular, Primary Health Networks (PHNs) across Australia are tasked with planning and commissioning mental health services. While some PHNs have opted for off-the-shelf program models like NewAccess, others are working with communities to develop more ground-up solutions.
Here are a few important things to consider for PHNs commissioning low intensity services:
Low intensity services are not just an effective intervention for people who experience lower levels of psychological distress. They can also contribute to a positive treatment effect for people with quite high levels of distress and experiencing more severe mental illness. They have distinct but complementary treatment goals than other clinical interventions with a strong focus on self-directed care.
Commissioning a provider who isn’t a specialist mental health provider can create new entry points to the mental health system for those people who are disconnected from traditional health care services (which is a significant number of people). For example, neighbourhood centres often hold a trusted position for community members and can leverage their existing relationships. Off-the-shelf programs from a reputable source like beyondblue’s NewAccess program enable these non-specialist providers to provide low intensity mental health services and provide a level of assurance around fidelity, quality and clinical governance to commissioners.
In other programs, inappropriate referrals may be a ‘negative’ finding, indicating that referrers have poor program awareness or a provider is accepting a referral more suited to another provider. We found that inappropriate referrals were a ‘positive’ finding, where low intensity services were an important gateway for individuals with quite high levels of distress to access support that they otherwise wouldn’t have
Developing and supporting a low intensity mental health workforce is an important priority if these types of services are going to offer a meaningful alternative. Providers currently find it challenging to locate and recruit suitable candidates with relevant experience (including lived experience), rapport-building skills but not necessarily formal qualifications. PHNs could lead the development of coordinated regional workforce development strategies for a low intensity workforce. Effective clinical supervision can support the low intensity workforce through reflective practice, clinical expertise and preventing burnout.
Low intensity services need a significant period of time for establishment before they mature. Initial estimates for client throughput are typically over-estimated, as it takes considerable time and effort to recruit and train suitable staff, build relationships with community leaders and create referral networks. PHNs should ensure they account for a gradual take-up of the service and remain committed to troubleshooting establishment hurdles as they inevitably arise. Allocating funding for a community engagement function within the model is vital for generating adequate referrals to ensure the viability of what is a high-volume and low-cost model.
We are looking forward to presenting the findings and implications of the evaluation to our project partners belong and the Brisbane South PHN in the coming month.
We feel it is vital that funders, service providers and evaluators commit to sharing the knowledge gained from program evaluations, and hope that sharing these considerations will guide others to make insightful decisions when commissioning or delivering mental health services.
If you would like more information about the evaluation or would like to access the full report, please get in touch with our evaluation team via email at info@beaconstrategies.net.