Bringing services together
"Because the GPs are managing more of the client's medical issues, we aren't getting as many people coming in to see the psychiatrist to have their scripts reviewed. The waiting list for the psychiatrist has dropped."
Eamonn Corvan, nurse unit manager
The fruit and vegetables have been a roaring success, transforming the diets of the people who tend the Mudgee community garden. There is a bank of raspberries, a miniature apple orchard, abundant herbs and – by special request – an Irish strawberry tree.
The planting, pruning, watering and feeding are all undertaken by clients of the local community mental health service, some of whom have experienced severe long-term problems.
“We’re talking about really, really unwell clients who don’t get the chance to socialise, who have often been abused,” says Eamonn Corvan, nurse unit manager of the community mental health team. Most visitors to the garden – built with local business donations in a disused tennis court tucked behind a local church – have schizophrenia or bipolar disorder.
“Many of them are people who’ve never had a responsibilty in their lives,” Mr Corvan says, “but one woman took on the job and kept the gardens growing over Christmas.”
Clients take the produce home, and Housing and Support Initiative (HSAI) workers support people to learn to cook. There are also regular barbecues.
The garden project itself has grown out of an extraordinary depth of co-operation between the mental health service and a local general practice group, to ensure people’s physical and psychological health are supported in parallel.
It centres on a full-day clinic, with mental health worker and GP Dr Peter Bryant in attendance, which allows people with more complex mental health needs to be supported than either service could offer independently.
That is important in a small country town – Mudgee’s population is 9,000 but the mental health service draws on a population of about 18,000 – which does not have a resident psychiatrist.
Bookings are made through the mental health service but clients attend the low-key GP centre.
“We put all the people with anxiety and panic in the morning,” says community mental health nurse Teresa Lulund. “They wake up early, and they’re always on time. We put the people with chronic schizophrenia in the afternoon because they usually get up later.” 98% of appointments are kept, with some people using community transport or the support of a social worker to get there.
There is a dual intention: to monitor and treat physical health problems that may be more common in people with mental illness because of medication side effects and poor access to healthy food and exercise; and to extend GPs’ skills and confidence in supporting people with mental illness.
“It’s not about keeping them coming to the clinic forever,” says Ms Lulund. “It’s about normalising an experience of going to the GP. Most people - probably 90 per cent - graduate through the GP clinic and start seeing Dr Bryant or another GP by themselves.”
Before the clinic started, she said, clients’ physical health went relatively unattended. “They told us the GPs would concentrate on the mental health issue, even if they were there for a skin check, and they weren’t being offered other health interventions such as flu injections or pap smears.”
Being part of the clinic has taught her a lot about the importance of metabolic and heart rhythm monitoring in people who take medications for their mental health, Ms Lulund says.
Dr Bryant says he and his colleagues have learned from the mental health team. “It’s experience and it’s confidence and it’s being exposed to things. General practice can be quite isolating. You can sit in a room all day and see patients and not interact with other professionals.”
While it is difficult to measure, Dr Bryant believes the service “may possibly have reduced hospital admissions” as a result of monitoring people’s health more closely and acting to stabilise any problems soon after they emerge.
An additional benefit, Mr Corvan says, is better use of the visiting psychiatrist’s time. “Because the GPs are managing more of the clients’ medical issues, we aren’t getting as many people coming in to see the psychiatrist to have their scripts reviewed. The waiting list for the psychiatrist has dropped – and that’s a big thing because that resource which is very specialist and finite is actually being utilised much more effectively.”
Mr Corvan says establishing the joint clinic was not difficult. “It’s having people who want to really see it work, it’s just commitment. It doesn’t have to be big. It can actually start off being just a couple of hours, or a couple of clients and a mental health worker accompanying the clients to a GP appointment.”
At the community garden, summer berry season is coming to its end. The plan next is to plant flowers, for people to cut and take home. They may not have the direct nutritional benefits of fresh food, but they could give a welcome boost to people whose lives can be tough and monotonous. “A lot of these guys get given nothing,” Mr Corvan says.