The problems in Australia’s mental health system, which relies on a referral-based fee-for-service system are well known. Fragmented care, especially for 2.6 million Australians with a coexisting mental illness and chronic physical condition; and inequitable access, exist throughout the system. Furthermore, PHN commissioned mental health programs lack integration with the rest of primary care leading to siloed care. However, there is increasing attention worldwide to ways of integrating physical health, mental health and wellbeing within the general practice setting, which looks beyond the differences that can occur between medical specialty areas (physical health vs mental health) and between medical and non-medical professions. Using a team-based care approach, gathered around the patient/consumer, mental health professionals are core members of the general practice team, working seamlessly with GPs, practice nurses and others. Internationally, these models deliver holistic care, equitable access and quality early intervention; efficiently manage community distress reducing the burden on fee-for-service specialty mental health services; fewer hospitalisations and a safe landing for those stepping-down from State-based mental health services; whilst having a non-pathologising approach with reduced self-labelling that so often comes from accessing traditional specialty mental health services.

Paper 1:
International service models that integrate mental health and wellbeing with general practice. In addition to Better Access, there has been significant Commonwealth investment in community mental health services through PHN commissioning. These “Primary Mental Health” services (e.g. headspace, Head to Health) have been mapped to a stepped care model and delivered by Community Managed Organisations. However, none of these programs are integrated with the heart of primary care, general practice. This presentation will outline key scalable, evidence-based, co-located, models of care that integrate mental health and wellbeing with general practice. It will include a review of the literature, description of site visits to centres of excellence, and how governments have invested in these models in USA, UK and NZ. There are several models of care that could be adapted for the Australian context, including Primary Care Behavioural Health (PCBH), Collaborative Care Model (CoCM), Health Coaching and Social Prescribing. This presentation will highlight which models to prioritise, how they could work synergistically, and how they could be delivered at scale. A strong foundation for primary care reform has been laid with the 10 Year Plan which has a focus on population management (1), making this the right time for integrated models. If Australia is to have a robust health system, models of care that integrate all aspects of health and wellbeing delivered through team-based care in general practice should be prioritised by government.

Paper 2:
Implementation of the Primary Care Behavioural Health (PCBH) model in an Australian general practice. General practice transformation towards team-based care, integrating additional roles can be challenging (2). This presentation will describe a pilot model of care in Sydney, Australia, based on the Primary Care Behavioural Health (PCBH) model where a "Wellbeing Clinician" is embedded in the general practice clinical team and can provide on-the-day, unscheduled appointments to provide consultations for a broad range of presentations using Focused Acceptance and Commitment Therapy. This presentation will also outline the reasons for the selection of the Primary Care Behavioural Health (PCBH) model to pilot. A qualitative evaluation of the implementation in two GP clinics, including barriers and enablers, will be presented. We will hear from the Wellbeing Clinician and GPs from the Hornsby-Brooklyn GP Unit who have implemented the model.