Care navigation for adults with depression or anxiety: A propensity matched comparison

The Care Navigation intervention is a 6-month program of support for adult patients with depression and/or anxiety referred by a GP for an assessment by a psychiatrist at the Black Dog Institute (BDI) Psychiatry Services. It aims to assist participants in navigating the mental health system and implementing the treatment plan written by their BDI psychiatrist and to subsequently improve mental health outcomes. It will be offered in addition to care as usual by participants’ referring GPs, and any other health professionals involved in their care (eg psychologist). The Care Navigation intervention includes three main components: 1) Participants will be provided with a copy (both digital and hardcopy) of the report and treatment plan written by their BDI psychiatrist, and will be offered a 30-minute feedback session with their BDI psychiatrist to ensure that they understand their diagnoses and treatment plan and have the opportunity to ask questions and express their preferences. As with care as usual, the report will also be sent to their referring GP. Also in line with care as usual, the treatment plan may include recommendations for medication, psychological therapy and/or self-management strategies, and may also include referral to other health professionals in the BDI Clinical Services, such as psychologists and exercise physiologists, and/or to online interventions or external services. 2) Scheduled follow-up calls from a BDI Patient Care Navigator to assist the participant with navigation of the mental health system, to identify any barriers to the implementation of their BDI treatment plan, and to offer assistance with accessing recommended health professionals or services. Each participant will be allocated one BDI Patient Care Navigator, who will be able to refer to that participant’s BDI psychiatrist report and treatment plan. The follow-up calls, of approximately 10 minutes duration, will be approximately fortnightly for the first three months and then monthly for the following three months. BDI Patient Care Navigators will make session notes for each of their follow-up calls in MediRecords in the BDI Clinical Services (ie, the clinic’s standard clinical management software), which will be able to be accessed by BDI clinical staff, including the participant’s BDI psychiatrist. 3) A final review by their BDI psychiatrist at six months, with a final report and discharge plan being provided to both the participant and referring GP. In addition, in line with care as usual provided by the BDI Psychiatry Services, participants may also have earlier review sessions by their BDI psychiatrist, according to their clinical need. It is anticipated that most participants would take part in two to three psychiatric review sessions over the six-month period. All participants will be offered the final review by their BDI psychiatrist at six months. Review sessions with a BDI psychiatrist will be of approximately 45 minutes duration. The Patient Care Navigators in the pilot trial will be five staff (non-clinicians) currently employed in the BDI Clinical Services to provide administrative and advocacy support for patients. They were consulted in the co-design process of the Care Navigation intervention, and will be supported by training prior to the trial, a manual outlining the procedures of the intervention and example scripts, weekly supervision by a clinical psychologist, and a BDI “Psychologist on Duty” each day. Patient Care Navigators will not be conducting mental health assessments, providing case management or psychological therapy or writing reports for referring GPs or other health professionals. The Care Navigation intervention will be manualized and primarily delivered via by telehealth. Psychiatrist consultations will be delivered as per care as usual for the BDI Clinical Services. That is, they will always be offered via teleconference, however, pending pandemic-related restrictions, they may also be available face-to-face. Patient Care Navigator follow-up calls will be by telephone.