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Table 3 Service implementation barriers, facilitators and future improvement strategies

From: Enhanced primary mental healthcare for Indigenous Australians: service implementation strategies and perspectives of providers

  Agency staffa Referrersb Professionalsc
Implementation barriers ATAPS model limitations:
• Need for GP referral
• Accommodating client engagement and complex cases in session limit
• Limited capacity to provide outreach or transport
• One-on-one model
• Challenging timelines in vast areas with transient populations
Other barriers:
• Establishing Indigenous community or service relationships
• Shortage of Indigenous mental health and male professionals
• Non AMS clients
• No shows
• Limited funding
• Referrer /AMS turnover
• Primary health reform
• Non-identification of Indigeneity
• No barriers
• Demand management restricting referral
• Confidentiality of faxing client referrals
• No shows
• Relationship building with Indigenous communities and health services
• Limited funding to provide culturally appropriate (outreach) services
• Central intake
• Limited local/ cultural knowledge of ATAPS Suicide Support Line
• Lacking clinical service support
• Qualification requirements precluding Indigenous health workers from facilitating CBT-groups
• Occasional waiting lists
Implementation facilitators • Good Indigenous service relationships
• Experienced professionals in communities
• Indigenous workers from Closing the Gap and Indigenous primary healthcare teams
• ATAPS funding
• Indigenous ATAPS staff
• Good referrer relations
• Service demand
• Alignment with existing Indigenous services
• Willingness to learn how to work with Indigenous people
• Service availability
• Streamlined referral
• Referrer support
• Clinician availability and engagement
• Payment for no shows
• Lack of a gap payment
• Good governance
• Good relationships with Indigenous communities and services
• Co-location with Indigenous health services
• Good relationships with Medicare Locals
• Funding
• Project officer role
• Skills and experience
• Cultural awareness training
• Provision of client transport
• Flexible interventions
• Provisional referral and priority appointments
Future improvement strategies Cultural appropriateness:
• Cultural awareness training and supervision
• After-hours suicide line
• Outcome measures
• Indigenous mental health workers and outreach
• Service guidelines
Service engagement:
• Service promotion and referrer awareness
• AMS or NGO linkages
• Target AMS non-engaged groups
Enhanced service flexibility:
• GP referral and treatment plan
• Session limit
• Session duration
• Interventions
• Client self-referral
• Suicide timelines
• Transport allowance
• Non-session time (liaison work)
• Rural/remote services
• Pool ATAPS funding to flexibly meet demand
• Maintain or increase funding
Integration and responsiveness:
• AMS co-location
• Build community capacity to respond to suicidality
• Involve Indigenous communities in delivery
• Provide mental health first aid training for Indigenous primary care workers
• Increased availability
• Client progress and wait list feedback
• Referrer engagement
• More sessions
• Indigenous community engagement
• No improvement required
Service flexibility:
• Referral pathways (Indigenous health workers, self-referral)
• Session limit / duration
• Session time / location
• Training and supervision funding
• Indigenous health workers as providers
• No shows
• Service access for low income earners
• Non-CBT interventions
• Diagnosis requirement
• Outreach
Other strategies:
• Cultural supervision / mentoring
• Frequent remote visits
• Funding increase
• Paid consultation time
• Direct AMS funding
• Provide transport
  1. Acronyms: AMS Aboriginal Medical Service, ATAPS Access to Allied Psychological Services, CBT Cognitive behaviour therapy, GP General practitioner, NGO Non-government organisation
  2. aincludes ATAPS administering agency staff of Medicare Locals and subcontracted provider agencies
  3. bincludes eligible ATAPS referrers
  4. cincludes eligible mental health professionals delivering ATAPS