Improving mental health care outcomes: the agile psychological medicine clinic

Objective: We hypothesised that providing evidence-based care to people presenting in crisis to three Emergency Departments and the 24/7 phone Psychiatric Triage Service in Victoria, Australia, would improve their clinical outcomes over time and experience of the adult mental health system. We tested this through a service prototype, the agile Psychological Medicine clinic. Method: Descriptive statistics were used to understand the characteristics of people who presented in crisis. Patient journey maps were used to understand the impact of the system on the patient and assess whether they received the best clinical care over time. Insights from these analyses, and the evidence base, led to the development of the prototype. Using an open trial design, 194 patients received specialist treatment and effectiveness was measured through patient-reported outcome measures administered at initial and final appointments. Service utilisation was measured 12-months pre and post treatment. Results: The agile Psychological Medicine clinic delivered value; outcomes significantly improved across psychological symptomology and behaviours. Reductions in emergency department presentations, phone triage calls and service costs resulted. Conclusions: This innovative clinic demonstrated that access to front-end mental health treatment improves clinical outcomes, mitigates later complications and increases the prospects of keeping patients well over the longer term. What is already known about this topic: (1) Hospital emergency departments (EDs) can often be the initial point of care for people seeking immediate help for mental health crises. (2) Demand has increased, patient satisfaction has decreased and patients increasingly re-present in crisis. (3) Therapeutic alliance has been shown to be a robust predictor of treatment outcome. What this paper adds: (1) Mental health care could be improved for those presenting in situational crises by bringing evidence-based treatment with a consistent clinician with whom they could form a therapeutic alliance (2) The agile Psychological Medicine clinic demonstrated that bringing specialist treatment to the front end of the system of care, improves clinical outcomes, mitigates later complications and increases the prospects of keeping patients well over the longer term. (3) Patients who engaged in treatment had a 37% reduction in ED presentations 12 months after therapeutic intervention resulting in significant cost savings. Abbreviations: aPM: agile Psychological Medicine; CATT: Crisis Assessment and Treatment Team; CBT: Cognitive behaviour therapy; CCT: Continuing Care Team; ECATT: Emergency Crisis Assessment and Treatment Team; ED: Emergency Department; PTS: Psychiatric Triage Service; SECASA: South Eastern Centre Against Sexual Assault.