Link-me: A randomised controlled trial of a systematic model of stepped mental health care in general practice

The intervention being tested in this trial is multifaceted and includes: 1. Estimating future symptom severity using a Decision Support Tool (DST) developed by our team using findings from our naturalistic longitudinal cohort study of depression in Australian primary care (the diamond study). Using an individual’s responses to the DST, he or she will be stratified into either the minimal/mild or severe/complex group, based on predicted severity of mental health problem in 3 months’ time. 2. Feedback to participants on their DST responses: "From what you have told us, things seem to be ok for you in these areas right now" and "Things seem to be difficult for you in these areas right now", presented on sequential screens 3. An opportunity to set priorities: If the participant has many areas that are identified as being difficult, he/she is encouraged to select one or two to focus on. 4. A treatment recommendation matched to severity group (minimal/mild or severe/complex), detailed below. Note that all patients enrolled in the trial will have their DST data recorded. Randomisation will occur at the point of DST completion, within severity groups as defined by DST results. Therefore both comparison and intervention groups will comprise a mix of symptom severities. Only participants randomly allocated to the intervention arm will receive the intervention as above. Participants identified as being likely to experience severe mental health symptoms in three months’ time and randomised to the intervention arm will receive assistance from a practice-based mental health care navigator to develop an individual care package. The care navigator is a registered health professional who will work with the patient, the GP and other providers to develop a care plan, support the patient through their care and ensure that elements of the care package are connected. Participants will be offered 8 appointments with the care navigator at their GP clinic over a 12 week period. Participants are free to take up the offer of care navigation or not. On completion of the DST, participants identified as being likely to have minimal/mild symptoms at 3 months and randomised to the intervention arm will receive a list of relevant low intensity services, matched to the areas prioritised by the participant. Services will include those delivered online, via telephone, via mobile app, and in the participant's local area, in order to assist participants find an option that is most acceptable and therefore most likely to be used. Participants are free to follow the recommendation or not, and are free to discuss it with their GP or not. It should be noted that the trial is designed to identify patients in the two groups above, however the DST will also identify a third group of patients – those whose mental health problems that are more severe than the minimal/mild group but less so than those in the severe/complex group. Patients in this ‘moderate’ group will not be randomised but instead will all enter into the usual care comparison arm (see below).