Dokotela's Partnership with Central & Eastern Sydney PHN - Transforming Mental Health Care

Australia’s Primary Health Networks (PHNs) play a crucial role in bridging gaps and enhancing mental healthcare in the region. One of our key relationships is with the Central Eastern Sydney Public Health Network (CESPHN), who we’ve forged a highly effective partnership with. This collaboration is reshaping mental health care delivery in the region, through support platforms for GPs, telehealth hubs for the most vulnerable and a commitment to continuously adapting and improving our service.

Addressing our community’s needs

The CESPHN region faced significant challenges in mental health care provision, particularly for those with severe and persistent mental illnesses. Many residents struggled to access psychiatric services, leaving a critical gap in care. Our partnership with the CESPHN has been transformative in addressing these needs.

"Our collaboration with Dokotela has dramatically improved access to psychiatry services in areas where none existed before," explains Renae Warden, the Mental Health Program Officer for Dokotela. "We're now able to provide care for patients who are often more severely unwell compared to other regions."

Empowering our GPs

One of the most significant outcomes of this partnership has been the empowerment of local GPs. Initially, some were hesitant about managing complex mental health cases and prescribing related medications, but through our proactive engagement, these GPs have grown in confidence and embraced the program.  Our collaborative care model is designed to increase access to mental health care by empowering GPs and providing them with the necessary support from both the specialists and the Dokotela team.  

Another key innovation to support our GPs was the creation of a direct messaging group, providing them with asynchronous access to Dokotela psychiatrists. This system offers:

1. An easy way for GPs to communicate with psychiatrists about patient care

2. Assistance with clinical questions, medication advice, and referral management

3. Real-time support and arrangement of further consultations when needed

"The open forum nature of these discussions allows GPs to learn from each other's questions and experiences. It's been a game-changer in building capacity among our primary care providers." says Renae Warden.  

Breaking down barriers  

While the advantages of telehealth are numerous, some were concerned initially about accessibility for vulnerable populations, particularly the homeless. Together with the CESPHN, we responded by setting up telehealth hubs in existing mental health locations for people within the PHN catchment area.  

Our clinical care coordinators visit the hubs to provide clients in the program with a physical location to access our psychiatry services. This arrangement allows us to offer a free telepsychiatry service to those who do not have access to the necessary resources.

"These hubs have significantly improved access for our most vulnerable community members," Mental Health Team Lead, Ellie, shares. "They provide a safe space where clients can access high-quality psychiatry services, even if they don’t have a phone, laptop or private space."

A commitment to continuous improvement  

Our partnership with CESPHN has been characterised by a commitment to continuous improvement. To ensure the program remains responsive to community needs, we hold quarterly meetings with the managers of the CESPHN program to discuss and address any issues, and surveys are sent to all referrers to gather feedback on the program’s effectiveness.

An example of this is how we’ve refined eligibility criteria to support those most in need.  "Working together, we have adjusted the criteria to ensure that those with severe and persistent mental illness, coupled with financial barriers, can always access timely psychiatric care." recalls Renae.

Enhancing communication and engagement

Valuable feedback from the GPs has led to another significant improvement in the service model. We learned that many GPs felt out of the loop after referring patients and were unsure whether their patient had attended their appointment or even proceeded with booking it.  

To address this concern, we implemented a system where GPs receive updates at key points in their patients' mental health journeys, from initial consultations to review appointments. This enhanced communication has dramatically increased GP engagement with our program, and fostered a more integrated approach to the mental health care we provide.

Looking to the future

As our partnership with the CESPHN continues to evolve and grow, we see a bright future for mental health care in the region.  This kind of collaboration illustrates how innovative thinking, adaptability, and a passion for improving lives can transform mental health care delivery. By addressing unique regional challenges, empowering local healthcare providers, and continuously adapting to community needs, this partnership is setting a new standard for mental health care in Australia.

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