Apex Clinics

Mindgardens Tertiary Referral Service for Psychosis

Prince of Wales Hospital (SESLHD)

Who is it for?

The Mindgardens Tertiary Referral Service for Psychosis (TRSP) will offer intensive and individualised therapeutic approaches for people who live with complex psychotic disorders. Typically, such people have already tried multiple services and treatment approaches, often over many years, without finding support that is truly helpful to them.

What is it about?

The TRSP aims to integrate multiple therapeutic approaches, including medication, psychological support and physical health care, while carefully monitoring in real time how people respond to the components of their care.

This will create a feedback loop in which the treatment elements that are most valuable for an individual can be maintained or increased, while those that are not working or carry unacceptable side-effects can be tapered-off or discontinued.

Every patient’s treatment regime and responses to it will be comprehensively recorded, creating a unique trove of highly detailed data that researchers can mine to find new patterns, and more confidently make treatment recommendations for future patients.

The establishment of the TRSP has been possible by leveraging a $1.4 million grant from NSW Health on the merger of the Schizophrenia Research Institute with NeuRA and developed in partnership with SESLHD. The TRSP has been initially designed to be an 18-month pilot service starting in October 2019 at the Euroa Centre at Prince of Wales Hospital. It will be the first demonstration of the Mindgardens “clinic” model, in which clinicians and researchers collaborate deeply on the most challenging questions. The pilot will indicate whether the TRSP model can optimise people’s outcomes as assessed by their ability to work or study, live independently, have positive relationships, or other measures meaningful to them. It will also show whether the approach offers good value for money and should be continued and extended into other regions of NSW.

Another goal is to provide training workshops for clinicians across NSW, to coach them in applying real time monitoring of their clinical interventions to achieve more personalised targeted treatment strategies for individual patients. By supporting the medical community’s learning in this way, the Mindgardens TRSP model has the potential to improve treatment of complex disorders across all levels of mental health services.

Which organisations are involved?

  • South Eastern Sydney LHD
  • NeuRA
  • NSW Health has funded the TRSP pilot as part of the Schizophrenia Research Institute’s merger with NeuRA (this is combined with additional funding from Mindgardens)
  • Collaborations are being established with:
    • NSW Health’s Pathways to Community Living Initiative (PCLI), which supports people to move from long-term hospital care to appropriately supported homes in the community
    • UNSW Neuropsychiatric Institute; Department of Developmental Disability Neuropsychiatry; and National Drug and Alcohol Research Centre
    • Health Education and Training Institute
    • Agency for Clinical Innovation

Mindgardens Clinic for Depression

Black Dog Institute

Who is it for?

Every year, more than a million adults receive treatment from a GP for depression. It is becoming increasingly clear that some depression is too complicated for a GP to manage alone, but not so complex that the person needs in-patient care or support from a community mental health team. The Depression Clinic is for this “missing middle”.

What is it about?

The Mindgardens Clinic for Depression will offer an integrated spectrum of therapies for people whose depression is more complex, including medications, psychotherapy, exercise physiology and “social prescribing” – in which doctors make referrals for activities such as community groups that can improve people’s wellbeing. It will provide a mix of bulk-billed Medicare and fee-paying services.

The approach is modelled on integrated holistic clinics in other medical specialties, such as diabetes, where a multidisciplinary approach has been shown to improve patients’ health. It also includes aspects of the UK’s successful Improving Access to Psychological Therapies model, in which cognitive behaviour therapy (CBT) courses have been made more widely available to support people with depression. In addition, the Depression Clinic will interface with the Black Dog Institute’s popular Online Clinic, with its mental health screening software serving as a pathway for patients who need more intensive face-to-face care. Eventually, clients could be referred via online services to other Mindgardens apex clinics.

Working in close collaboration with its clients’ GPs, the Depression Clinic will evaluate whether this comprehensive, combined treatment model leads to quicker and more sustained recovery for depression patients and allows them to successfully resume their usual lives, and – if so – whether the approach represents value for money within the context of the Australian health care system.

Which organisations are involved?

  • Black Dog Institute
  • South Eastern Sydney LHD
  • Central and Eastern Sydney Primary Health Network