Caroline Johnson
Dr Johnson is a Senior Lecturer at the University of Melbourne in the discipline of General Practice and is in active clinical practice as a General Practitioner. Dr Johnson’s research has a strong focus on primary mental health care. She has published on recovery from depression, mental health treatment plans and the role of general practice in providing care for common mental disorders. In 2018 she was a member of both the Mental Health Reference Group and the Psychiatry Clinical Committee of the Medicare Benefits Review Taskforce, where she provided advice to government about modernising the MBS to better align it with evidence-based practice. In 2019 she was called as a witness to the Royal Commission into the Victorian Mental Health System. Dr Johnson represents the Royal Australian College of General Practitioners on the Equally Well Alliance.
Presentation
Abstract
Title: Aligning clinical prevention strategies with consumer goals in concurrent physical and mental health issues; experiences from a pilot evaluation
Author(s): Lucy Bashfield and Dr Caroline Johnson
People who use public mental health services in north-western Melbourne have a life expectancy of 52 years, which is more than 30 years lower than the Australian population. Studies identify the main contributors to early death for this cohort as cardiovascular disease, respiratory conditions and cancers, together responsible for 82% of natural cause early death. In response, North Western Melbourne Primary Health Network funded two organisations to trial a care coordination service for people living with concurrent physical and mental health issues. In 2020-21, a research team comprised of lived-experience evaluators, a doctor, a nurse, and evaluators from Equally Well, Charles Sturt University, and RMIT University, completed the first stage of an evaluation on both services. Through discussions with consumers and their care teams, we noted that case coordinators, who were in both organisations, registered nurses, were deeply attuned to their consumers’ priorities. However, support for consumers’ priorities led to a disconnect with clinical priorities and primary prevention strategies. Similarly, within the evaluation team, an ongoing conversation about prioritising clinical needs against both personal needs and preventative strategies occurred between the health and lived-experience evaluators. Interviews with consumers showed that when emotional support needs were met, best practice clinical screening was not prioritised. While rapport building within a re-engagement model is vital, particularly within a cohort who may have disengaged from health services due to negative past experiences, primary and secondary prevention of significant health issues should not be compromised. Though consumers felt heard, often re-engaged in allied health care, and some were able to set, achieve, and self-manage goals after using the case coordination program, the disconnect between clinical and personal priorities remained present throughout consumers’ experiences. In continuing case coordination, how can services stay consumer centred, while meeting clinical needs? What does a best practice collaborative approach look like when personal and clinical goals differ for people with chronic and concurrent physical and mental health issues?
