The Mid North Coast (NSW) Division of General Practice has consistently risen to the challenge of leading the delivery of primary mental health care on the Mid North Coast of NSW through a variety of innovative programs.

Since 1996, The Division has conducted the only specialized Post Natal Distress Support Service in rural and regional NSW although State and Area Health Services openly identify Post Natal Depression as one of the major causes of maternal morbidity impacting upon women (NSW Health PND Education Package).

The Program demonstrated a capacity to identify and respond to a growing demand from women living with PND and their families. A close working relationship was established with the Bowraville Senior Aboriginal Health Worker and Galambila Aboriginal Midwifery Program. The PND Project Officer regularly attended the Bowraville Aboriginal Health Clinic and was also involved in the development of the Aboriginal Maternal and Child Health Network. Regular Division presentations at training and community events included training for Volunteer Home Visiting Service Volunteers in Grafton, Bellingen and Macksville; Family Support Workers, Antenatal Educators.

The project managed to strengthen existing services by developing collaborative partnerships with other agencies and projects, including State and Commonwealth Family support initiatives such as Dona Maria Pre and Post Natal Support Network, Families First, Hope for the Children, Homestart, Child and Family Counselling and Early intervention programs. The project also facilitated ongoing professional education with GP’s in identifying and caring for this group of patients.

The Division soon added Attention Deficit Hyperactive Disorder (ADHD) to its stable of mental health support programs. This innovative program involved collaboration with 13 local schools, GPs, parents, psychologists, speech pathologists, teachers and counsellors in case conferencing for children with ADHD. The Division recorded the highest uptake of case conferencing in NSW under the Enhanced Primary Care initiative through this coordinated care approach. A private company, Partnership Potentials Pty Ltd., has developed and taken the program concept further to the National Level including expansion into other State Education Departments.

In 2001, an extensive More Allied Health Services needs study was carried out by the Division. The study found that the provision of Mental Health Services, including Psychologists and Counsellors, was the highest priority of need for the delivery of more Allied Health Services on the Mid North Coast. Direct Division employment was determined to be the most cost effective model for mental health service delivery and the Commonwealth Department of Health and Ageing funded MAHS program soon commenced with the employment of four Psychologists supported by the establishment of supporting offices and infrastructure in the townships of Grafton, Woolgoolga, Bellingen and Nambucca Heads.

MAHS funding to the Division was increased in 2003 and this enabled the employment of a Social Worker to complement and strengthen existing MAHS services, providing much needed outreach counselling services, care planning, patient, child and family support. The social worker continues to provide specific services to women suffering from Post Natal Distress (and their partners), coordination of and access to patient support services active involvement in building the capacity of other organisations and support groups to provide family intervention, development and support services. As an advocate for Aboriginal Health needs, the social worker attracted Indigenous Psychological Services to support the Bowraville Aboriginal Community, a community suffering grief and trauma associated with the homicide of several local children.

Initially envisaged as an enhancement to existing community mental health services, the MAHS psychology service had proven itself to be the primary public psychology service on the Mid North Coast.  The Division initiated the Mid North Coast Mental Health providers forum in late 2006, to promote the uptake of the recently introduced Commonwealth Government funded Better Access to Mental Health Service MBS item numbers for private psychologists, social workers and other allied health workers.  This initiative has resulted in a strong increase in private psychology and social worker services on the Mid North Coast, resulting in a reduction in the demand for public funded MAHS services.  The Division is currently reviewing the allocation of MAHS funded Psychology Services to complement MBS funded services, by targetting isolated and disadvantaged communities where private service delivery is not viable yet needed. 

In 2003, the Division initiated a pilot program under the Commonwealth Government Better Outcomes in Mental Health Initiative (BOHMI) with the employment of 1.2 FTE Psychologists to further improve community access to local psychology services. The BOHMI service established outreach clinics to Grafton, Dorrigo and Woolgoola. A further outreach clinic was established in partnership with Galambila Aboriginal Health Service and in May 2005 this service was extended to include a monthly clinic at Yarrawarra Aboriginal Health outpost, Corindi Beach. Until recently, therapy was provided on an individual basis. A Chronic Pain Group Therapy commenced in June 2005, and Anxiety Clinics and Parenting Programs have been developed.

Division Psychological Services are delivered according to a standard service model. Each clinic is conducted along similar lines to a private practice and tailored to meet the needs of the local community including clients of ethnic and Aboriginal Origin. Providers are supported with appropriate professional development and supervision opportunities, including monthly service meetings. GPs make discretionary decisions as to which patients are referred. Access to the service by the patients, whilst free, is also limited to a maximum of six sessions to ensure there is availability to all. The GP’s and Psychologists provide a complete bio-psychosocial model of care. The success of the model resulted in the development of the largest public service of Psychologists on the Mid North Coast of NSW.

As with the MAHS funded Psychologist Services, the Division has reviewed the structure of the BOiHMC Psychologist Services, resulted in a reduction of salaried positions, maintaining core services to meet existing public service need, while sucontracting services to private psyhology providers to service more isolated and disadvantaged communities.

In 2003, a Division proposal was approved under the Commonwealth funded More Specialists Outreach Assistance Program (MSOAP) to facilitate the establishment of visiting Psychiatry Clinics at Coffs Harbour and Grafton. Two Psychiatrists were recruited under this program. These services complement the existing Division Psychological services to support an integrated model of primary mental health care.  The Division MSOAP Psychiatrist Service has been expanded to include a female visiting Psychiatrist and a Child and Adolescent Psychiatrist, with outreach services provided to Nambucca Heads.

The Division supports the integration of General Practice, Allied Health and Specialist Mental Health Services with the provision of shared care primary mental health education and training programs. In 2001, the Division entered into a continuing collaborative ‘Upskilling in Primary Care Psychiatry’ project funded by the Mid North Coast Area Health Service. State Health funded ‘Teams of Two’ education activities have been conducted in collaboration with the Alliance of NSW Divisions of General Practice and Area Mental Health Services. BOHMI GP familiarization and educational support activities support GP registration under the program, along with the MSOAP upskilling activities and a mental health care peer support program.

The continued high growth in the rate of GP referrals to the Division MAHS, BOHMI and MSOAP services highlighted the paucity of Area Health Community Mental Health services in meeting a growing community demand for mental health care. This situation has resulted in the local community becoming heavily reliant upon the Division services for the provision of primary care mental health services.  With the introduction of the Commonwealth funded Better Access to Mental Health Services MBS items, the private psychologist workforce has increased significantly on the Mid North Coast of NSW resulting in increased community access to primary mental health care.  The Division continues to support the development and uptake of this vital workforce.

Over 70 organisations, including State Area Health, Not for profit support organisations, private health providers, Commonwealth and State funded support agencies have worked with the Division to deliver a highly integrated approach to the delivery of primary mental health care. In addition, Division Mental Health staff delivers education; mentoring and group work with other organisations to increase local service capacity. During the 2003-2004 financial year, Division Mental Health Services reported over 5,030 patient visits, a record that clearly demonstrates how a Division can make a difference in the

The Better Outcomes in Mental Health Program ( introduced in July 2001) is now complemented by a second primary health care initiative Better Access program. The Better Access to Psychiatrists, Psychologists and GPs through the Medicare Benefits Schedule program was introduced in November 2006 and includes the addition of a set of item numbers to the Medicare Benefits Schedule (MBS) that makes the services of registered psychologists (and selected social workers and occupational therapists) eligible for a rebate. Under these new item numbers, a GP can refer a consumer to a psychologist for 12 individual sessions per calender year, delivered in two groups of six with a review by the referring GP after the first six. Psychologists can directly bill the consumer who can then obtain a partial rebate from Medicare Australia.

To get the most current edition of the mental health practitioner directory click on attachment  June 2008 Community Health Directory below