The Initial Assessment and Referral (IAR) Decision Support Tool (DST) : a national approach to mental health referral
What is stepped care?
CESPHN’s regional mental health planning and commissioning of services is founded upon a stepped care approach.
Stepped care aims to match a person presenting to the health system with the least intensive level of care that most suits their current treatment need, with the ability to monitor treatment experiences and outcomes to enable a step up or down in treatment intensity as necessary.
Without a consistent national approach, GPs and other clinicians will and are taking a variety of approaches to assess and assign levels of care, resulting in discrepancies in the type of care provided for similar clinical presentations.
With a congested and overworked mental health sector, providing a consistent, standardized and transparent process for referral is timely and necessary.
How can the IAR-DST help GPs?
The Initial Assessment and Referral (IAR) Decision Support Tool (DST) provides primary healthcare with a nationally-consistent, evidence-based and objective approach to initial assessment and referral of patients seeking mental health support.
GPs are often the front door for people presenting for mental health care. They oversee patients’ mental health across various ages and stages and are in a unique position to notice emerging symptoms, implement early interventions for those at risk, and effectively monitor chronic mental illness
The data bellow has been reported in 2022 by the Australian Bureau of Statistics and the General Practice Mental Health Standards Collaboration (GPMHSC):
- Over two in five Australians aged 16-85 years (43.7 percent or 8.6 million people) have experienced a mental disorder at some time in their life and in 2020-21 alone, one in five people (21.4 percent) experienced a mental disorder.
- Attending to mental health concerns forms a significant proportion of a GPs caseload with current estimates indicating that 38 percent of consults across a typical week include a mental health element.
- Relying on MBS data to determine this caseload underestimates the actual volume of mental healthcare performed by GPs with estimates indicating that for every 1 consult billed as a mental health consult, another 1.8 are not.
The IAR DST has been developed to assist GPs (and other referrers) to find the most suitable level of care for their patients.
The IAR-DST is an initiative of the Australian Department of Health and brings together information from a variety of sources including Australian and international evidence and advice from a range of leading experts.
The tool is designed to be used alongside a usual mental health assessment and the information gathered is then used to determine severity across eight domains:
- There are four primary domains and four contextual domains, the ratings for which contribute to the final level of care calculated based on a clinically informed algorithm within the tool.
- There are five Levels of Care differentiated by the intensity of resources that are likely to be required and not indicative of the format that treatment may take or who it may be delivered by.
Further detail on the eight domains and five levels of care can be found in the IAR Snapshot (244 KB) .
Completion of the IAR-DST is intended to guide the conversation between referrer and patient to support shared, informed decision making about next steps. Studies have shown that when patients are involved in the decision process, they are empowered and more likely to adhere to care.
The IAR-DST is NOT:
- an assessment tool
- a replacement for clinical judgement
Challenges in determining the most appropriate level of mental health care and services required for patients are experienced by GPs and allied health professionals daily.
Complexities with interrelated factors and availability of local services can also make it difficult to determine the right pathway for an individual.
The development of the IAR-DST provides primary healthcare with a nationally-consistent, evidence-informed and objective approach to initial assessment and referral of patients seeking mental health support.
The IAR-DST simplifies how clinicians determine the care needs of a patient with mental health concerns, aiming to prevent patients being overburdened with services they may not need or can cope with, or under-serviced with recommendations that may not meet their needs.
The IAR-DST aims to create consistency and a common language amongst professionals, enabling them to articulate treatment needs that will be understood across the sector. Widespread use of the Tool will improve transparency on decisions made relating to referrals.
CESPHN has been tasked with training GPs in our region to use the IAR-DST effectively and implement the tool into practice. A comprehensive training package is available to all GPs in the CESPHN region and will be delivered by our IAR Training and Support Officer. GPs will be paid $300 upon completion of the training and RACGP CPD hours are available.
Completion of the training includes the following:
- Viewing of a 30 minute pre-recorded webinar (Workshop 1*) via Open Learning and completion of a post webinar survey. A link to this Workshop will be sent to you with your Workshop 2 registration confirmation.
- Attendance at a 90 minute live webinar (Workshop 2) and completion of a post workshop survey
- Completion of a follow up survey that will be emailed to you 3 months following Workshop 2
*please note that completion of Workshop 1 is COMPULSORY prior to attending workshop 2. Workshop 1 can be completed at any time within 6 months prior to attending Workshop 2
Upcoming workshop dates are below, click the date of your choice to be taken to the registration page.
Monday – Thursday Workshop 2 sessions are delivered in the evening from 7:00 – 8:30pm and Friday sessions are 1:00 – 2:30pm via Zoom.
You will be asked to read through a number of vignettes that may be used for the practical example in the workshop. These vignettes can be found here.
Join our Initial Assessment and Referral Decision Support Tool (IAR-DST) working group
Sign up to join our IAR working group.