South Western Sydney PHN provides ongoing training and support to assist GPs and other clinicians in using the Initial Assessment and Referral (IAR) and Decision Support Tool (DST) - a useful support to complement clinical judgement and assessment for recommending the most appropriate level of care for a person seeking mental health support.
What is the IAR-DST?
SWSPHN’s regional mental health planning and commissioning of services is founded upon a stepped-care approach.
Stepped care aims to match a person presenting to the health system with the least intensive level of care that most suits their current treatment need, with the ability to monitor treatment experiences and outcomes to enable a step up or down in treatment intensity as necessary.
Without a consistent national approach, GPs and other clinicians will and are taking a variety of approaches to assess and assign levels of care, resulting in discrepancies in the type of care provided for similar clinical presentations.
With a congested and overworked mental health sector, providing a consistent, standardised and transparent process for referral is timely and necessary.
A national approach
The IAR-DST is an initiative of the Department of Health and Aged care. This initiative brings together information from a range of sources, including Australian and international evidence and advice from a range of leading experts.
The National IAR Guidance and IAR Decision Support Tool (IAR-DST) were developed to provide primary healthcare with a nationally-consistent, evidence-based and objective approach to initial assessment and referral of patients seeking mental health support. The IAR-DST simplifies how clinicians determine the care needs of a patient with mental health concerns.
The tool has been used by the Head to Health intake team and other clinicians in the mental health sector since 2019. The Department of Health and Aged Care is now expanding its availability into primary care.
1. Consistent and transparent referrals
The IAR-DST provides a standardised framework for referrers to communicate assessment and referral information consistently, and articulate treatment needs using a language commonly understood across the sector. Widespread use of the IAR-DST improves awareness and transparency of how decisions about the appropriateness of referrals are made.
2. Improved patient outcomes
Effective communication of a consumer’s circumstances will ensure that they are matched to the most appropriate service for their needs, minimise the risks and liabilities associated with under-estimating a person’s treatment needs. Moreover, this can reduce frustration and save time in managing rejected referrals, meaning more patients receive the right care at the right time.
3. Supported decision making
Referrers can use the tool to guide the discussion about treatment options with consumers, with the flexibility to adjust treatment needs in response to changes in their circumstances Studies have shown that when consumers are involved in the decision process, they are empowered and more likely to adhere to care.
4. Streamlined referral process
Integration of the IAR-DST within existing primary systems and mapping of available services to each level of care will streamline decision-making processes and reduce overall administrative load.
How IAR works
The IAR-DST is used to alongside a usual mental health assessment to gather information from the consumer. The assessment is undertaken across holistic 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).
Why GPs are important in mental health
For most Australians, a general practice is the first port of call when they access Australian’s healthcare system, and their general practitioner (GP) is usually the first person they consult about their mental health care. In 2020-21, almost 13% of Australians aged 16-85 saw a GP for their mental health.
In 2019-20, approximately 30% of Medicare-subsidised services specific to mental health were provided by GPs. In a recent report, GPs reported – for the sixth consecutive year- that psychological conditions (including sleep disturbance and depression) were the most commonly reported reasons for patient presentations.
This is why GPs would benefit from skills and knowledge to identify and address patient’s mental health needs.
Practice IAR Resources
For more information on IAR and DST read this Under The Microscope introduction.
IAR-DST workshop flier
Initial Assessment and Referral Decision Support Tool (IAR-DST) workshop flier advising GPs of paid CPD training incentives and learning outcomes.
Initial Assessment and Referral (IAR) snapshot
A snapshot of IAR and DST from the Department of Health.
National PHN guidance – initial assessment and referral for mental healthcare
This Guidance is focussed on the initial response to requests for mental health assistance in primary care settings and is designed to assist the various parties involved in the initial assessment and referral process.