'LEARNING both ways' is an essential part of making health programs work in indigenous communities, the Top End Division of General Practice says. Its cooperation with health groups and Aboriginal elders has helped to improve mental health outcomes for indigenous people living in remote communities.The concept behind the project reflects the aim of the collaboration: learning from each other and understanding cultural differences.

As a result, the division was named as one of three finalists in the 'collaboration/integration' category of this year's Divisions Achievement Awards.

The division's Aboriginal Mental Health Worker Program places qualified and supported indigenous health workers in as many remote communities aspossible. Now in it second year, the project offers a 'ground up' approach to dealing with mental health problems. Community-based and controlled, it builds on local mental health teams and creates a close relationship between GPs and mental health workers.

"It's fantastic to be a finalist," program manager Sandy McConachy says."I'm very pleased that it has been recognised by the [Australian Divisions of General Practice] as a valuable and worthwhile program.

"It's extremely important working in remote indigenous health that there is an underlying collaboration and agreement, so that we're working towards the same end. Without the collaboration and dedication by each of the parties, it would make it far more difficult to provide services on the ground.

"The program is yielding results, with the indigenous workers providing earlyintervention and breaking down the stigma associated with mental health issues.

"GPs are no longer dealing in mental health crisis intervention ... [and] people are more likely to go to the GP whenthings start to get difficult at home," MsMcConachy says. "The incidence of airevacuations [to Darwin] for acute mental illness has been reduced markedly inmany of the communities.  The Top End division also employs two dedicated indigenous support staff to provide ongoing visits to GPs, clinic staff, community councils, Aboriginal elders and the mental health workers.

The Southern Tasmanian Division of General Practice has also been named as a finalist in this category for taking a collaborative approach to projects involving diabetes, mental health and asthma.

In the case of mental health, the division has created partnerships in order to boost its capacity to deliver health services.The division worked with the state health department mental health serviceteam to develop an agreed referral structure for doctors after extensive consultation with rural GPs and other health service providers, creating a model that was appropriate to general practice.

The rural General Practice Psychologist Service has been used by rural GPs for over a year, and a divisional survey shows that GPs and patients are happy with the result. The division has facilitated a local Mental Health Reference Group comprising GPs, consumers, government health service providers and specialists.It has established a GP Peer Circle that aims to improve collaboration between GPs and mental health specialists by facilitating small group learning sessions, at which GPs meet with psychiatrists, psychologists and other mental health specialists to explore patient management, best practice and referral pathways.

Collaboration is essential to ensuring good community health outcomes, and the division is very pleased to be recognised for its work, acting division manager and senior project officer Judy Broad says."If we are going to benefit the community,we really need to put our heads together and work collectively to ensure good service delivery, effective communication and quality outcomes," Ms Broad says. "Our Mental Health Reference Group is a great achievement, and is a real model of how we've collaborated with agencies and other service providerswith very direct benefits for GPs and the community.  The GP Peer Circle, which is where GPs are able to share ideas and strategies with their peers, has also been a valuable resource."

The NSW Central Coast Division of General Practice is the third named finalist for its commitment to collaboration through the development of a General Practice Collaboration Unit, a forum for integration between GPs and the local area health service.The unit was developed after the division and Central Coast Health (CCH) considered ways to ensure that area health services and divisions were working towards a more integrated approach to delivering services.In 1999, the division and CCH undertook a four-month project that identified the benefits of collaboration, areas for improvement and priorities for jointly supported activities.

Over the past two years, the unit has helped to provide GP input into health service planning, and has had a consultative and advisory role in enhancing and developing integration models between the division and the area health service.Since August 2000, over 30 collaborative activities have been undertaken by the unit, including:

• A meeting of stakeholders and a review of the GP Antenatal Share Care Program
• Asthma Watch, a program in which GPs, pharmacists, respiratory specialists,CCH and division representatives work together to raise community awareness about asthma management
• The development of a mental health shared-care model of client care, witha focus on improving partnerships between GPs and the CCH mental health service
• The Alcohol and Other Drugs Servicethat provides specialist advice, education and consultation for GPs when they are working with patients who have drug and alcohol problems.

The division is "ecstatic" to be named a finalist, and is happy that the hard work of the division and area health service had been recognised, division CEO Matt Hanrahan says."From our perspective, one core businessis to link general practice and GPs with other health care providers to try to improve services, create efficiencies, reduce duplication and provide a better health outcome for the patient but also the GP and area health service," Mr Hanrahan says."We try to work on a win-win situation where the health providers win, the patients win and the division is seen as doing its job with the area health service."

The winner will be announced at the divisions conference next month. MO

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