It can be challenging for GPs and other clinicians to determine the most appropriate level of care for patients with mental health concerns.
The Initial Assessment and Referral (IAR) Decision Support Tool (DST) provides primary healthcare with a nationally-consistent, evidence-based and objective approach to initial assessment and referral of patients seeking mental health support.
SWSPHN is providing training, ongoing support to assist GPs in using the IAR DST in their daily practice, updates and resources.
What is the IAR?
SWSPHN’s mental health planning and commissioning of services is founded upon a stepped care approach. This means, a person needing support is matched with the least intensive and least intrusive evidence-based intervention which will lead to the most significant gain for that individual.
Without a consistent national approach, GPs and other clinicians will inevitably assess and assign levels of care inconsistently, resulting in discrepancies in the type of care provided for similar clinical presentations.
The IAR is a tool to assist GPs to recommend the most appropriate level of care for a person seeking mental health support. The IAR DST is an initiative of the Department of Health and brings together information from a range of sources, including Australian and international evidence and advice from a range of leading experts.
What is the IAR DST not?
- Not prognostic
- Not diagnostic
- Not predictive
- Not a treatment planning tool
- Not a replacement for clinical judgement and decision-making
Why has the IAR DST been developed?
One in five Australian adults (aged 16 to 85 years) will experience a mental illness each year and almost half will experience a mental disorder in their lifetime. In total, 10 million people, or about 38 per cent of the Australian community, have some level of mental health need.
SWSPHN commissions a range of services across the stepped care spectrum to meet the mental health needs of our community.
These include: low intensity services; psychological therapies; coordinated care for people with severe and complex mental health conditions; services for children and young people, including headspace; psychosocial services for people with severe mental illness; Aboriginal and Torres Strait Islander mental health services; and suicide prevention services.
The IAR DST is designed to assist the various parties involved in the assessment and referral process to ensure:
- Patients are guided to the option which best meets their needs, and has the least burden on them and the health system
- Best use is made of the full range of options available to assist people in need in a way which targets resources to where they are needed most
Why are GPs an important part of mental healthcare?
GPs are often the first contact point when a mental health issue emerges and patients talk to their GP about mental health more than any other issue.
About 75 per cent of referrals for commissioned mental health services are made by GPs.
A general practice may be the only point of care for patients requiring mental health services, in certain circumstances, or individuals who might not otherwise have contact with the healthcare system for various reasons might have contact with a general practice.
General practice also bridges the gap between the community and services such as hospitals, mental health outpatient services, drug and alcohol rehabilitation facilities, and prisons.
GPs oversee patients’ mental health across various ages and stages. Their ongoing relationships with patients can facilitate early intervention for emerging symptoms, assessment of suicide risk, and effective monitoring of chronic mental illness.
For these reasons, it is important GPs have access to the best guidance to make informed treatment decisions.
What are the benefits of using IAR DST?
Widespread use of the IAR DST improves the awareness of and transparency about how decisions relating to referral appropriateness are made – reducing frustration which occurs when service providers do not accept referrals.
Using a standardised tool like IAR helps referrers record and communicate initial assessment and referral information and articulate treatment needs using language commonly understood across the sector.
Appropriate use of the IAR DST will likely minimise the risks and liabilities associated with under-estimating a person’s treatment needs and equips users with a framework for decision-making. The IAR DST does not replace the GP’s capacity to make individualised clinical decisions based on the consumer/patient’s particular circumstances.
How does the IAR work?
An initial assessment is used to gather information from the referrer and patient. The assessment is undertaken across eight domains which aim to describe clinical severity and service needs, and guide decisions on the most appropriate next steps (for example, intervention, further assessment).
To find more information, download:
- PHN Initial Assessment and Referral (IAR) Snapshot Resource
- Initial Assessment and Referral Decision Support Tool
- National PHN guidance – initial assessment and referral for mental healthcare
How do GPs access training/support to implement the tool?
Two hours of training is available to assist GPs in implementing the IAR tool into their daily practice. Workshop 1 is a 30-minute webinar and is a pre-requisite for workshop 2, 90 minutes of on-site training at time convenient to the GP. Workshop 1 must be completed within six-months prior to Workshop 2.
The training will include an introduction to IAR; orientation to the domains, levels of care, and the decision support tool; information on clinical judgement and supported decision-making; and a practical activity using case studies to the IAR in referral, assessment and intake settings.
A $300 once-off incentive payment is available per GP and CPD points apply.