Showcasing: Gold Card Clinics - Emotional Health Clinic and Research Unit

Region
Western Sydney

Lead agency
Western Sydney Local Health District (WSLHD) Department of Psychology 

Living Well domain
Right type of care

Program overview

People living with a personality disorder often present to emergency departments (EDs) with a presenting issue of mental distress and crisis, self-harm or feeling suicidal. EDs are often unable to provide the evidence-based crisis care options best suited for people with lived experience of a personality disorder.

Research has demonstrated that trauma informed psychological therapy approaches have been the most effective support option for people experiencing mental distress in the context of a personality disorder1,2. The Gold Card Clinics are an innovative program providing practical, evidence-based, therapeutic techniques through crisis oriented psychological intervention. It also ensures the right type of care is provided more quickly, reducing the need to access emergency services.1,2 

Challenge

A review of the WSLHD Mental Health service was conducted by The Project Air Strategy, University of Wollongong in 2016 to determine how effectively the organisation provides care for people with lived experience in crisis, particularly those presenting to hospital with a diagnosis of personality disorder. Shorter term crisis-oriented options for people presenting to EDs and admission units were often limited. In addition, a separate clinical redesign program found that people with a personality disorder occupied about 32% of inpatient beds (Grenyer., Lewis., Fanaian & Kotze, 2018) and were the most likely diagnostic cohort to be re-admitted to an inpatient mental health facility within a month of their previous discharge. 

Solution

The Gold Card Clinics and the Emotional Health Clinic and Research Unit (EHCRU) were initially developed to address these gaps. 

The Gold Card Clinics are clinical services offered through the Department of Psychology in WSLHD. The clinics provide a brief psychological intervention program for adults aged 18-65 years old in the Western Sydney area who have recently experienced a mental health crisis. The intervention focuses on providing timely, accessible and evidence-based psychological intervention for people who frequently present to EDs, Acute or Inpatient Services in the context of psychosocial crisis with emotion dysregulation, suicidal ideation or self-harming behaviour. 

The program provides an initial three sessions that focus on identifying and addressing psychological and behavioural factors that contributed to the crisis. An additional session for carers, partners and family members is included in the intervention where needed. When nearing the end of the intervention, referrals to appropriate services or ongoing psychological therapy are discussed between the clinical psychologists and people with a lived experience.

 

The Gold Card Clinic forms part of the Project Air Strategy for personality disorders implementation into WSLHD Mental Health services and works in a recovery oriented and trauma informed way. There are three Gold Card Clinic services operating across WSLHD as part of the Project Air implementation including: Cumberland Gold Card Clinic, Parramatta Gold Card Clinic, and the Blacktown Gold Card Clinic. The Emotional Health Clinic and Research Unit includes the Cumberland Gold Card Clinic, offering a brief evidence-based crisis oriented psychological intervention of up to four sessions following a crisis. Additionally, for those in need, a further six sessions are offered through the EHCRU component of the service.

The Gold Card Clinics take referrals from the Parramatta or Blacktown Acute Mental Health teams and aim to offer an appointment to suitable clients within 1-3 working days of referral.

The clinics recognises that all people have individual needs and it is important to deliver person-centred care rather than use a one-size-fits-all approach. Therefore, the clinic operates on a stepped-care model. The model starts with the least intensive treatment, for some people, this will be enough to improve their quality of life and meet their needs, whereas others may benefit from further treatment and be moved up to the next step.

Outcomes

The Gold Class Clinics have provided services to approximately 400 people with lived experience and their families. Clinical outcomes indicate that a brief psychological intervention has a significant positive impact on reducing self-harming behaviours, suicidality, emotion dysregulation, paranoid perceptions of others, and negative perceptions of self2.

Next steps

Research is underway to evaluate the outcomes of the EHCRU and Gold Card Clinics against key local state-driven key performance indicators such as ED presentations, hospital re-admissions and post-discharge engagement with services. Evidence to date has demonstrated that the Gold Card Clinics have assisted in providing the right type of care for people with personality disorders further assisting them to self-manage and live well in the community. The clinics have also benefited WSLHD by contributing to a reduction in ED presentations and re-admissions for this cohort. 

References

  • Grenyer, B.F., Lewis, K.L., Fanaian, M. and Kotze, B., 2018. Treatment of personality disorder using a whole of service stepped care approach: A cluster randomized controlled trial. PloS one, 13(11), p.e0206472.
  • Sheppard, K. and Duncan, C., 2018. Borderline personality disorder: Implications and best practice recommendations. The Nurse Practitioner, 43(6), pp.14-17.
  • National Health and Medical Research Council. Clinical Practice Guideline for the Management of Borderline Personality Disorder. Melbourne: National Health and Medical Research Council; 2012.