Primary Mental Health Care Research Centre

Directors

Professor Helen Winefield and Professor Deborah Turnbull
Schools of Psychology, General Practice, and Public Health
Faculty of Health Sciences, the University of Adelaide

The relevant background facts are as follows:

• One in five Australian adults suffers sufficient psychological distress and dysfunction to interfere with their capacity to perform their usual roles (e.g. employee, parent, family care-giver).

• Most receive no professional treatment, and the majority of those who do, seek it via their General Practitioner.

• GPs want to be able to help but feel they need both more knowledge and more referral options.

• The public mental health system is over-burdened and can offer few services for the high prevalence conditions such as anxiety, depression and family or relationship problems.

• Clinical and health psychologists have expertise in the development, delivery and evaluation of treatments to prevent and manage these high prevalence psychological disorders.

• There is a nation-wide impetus to explore the contribution of clinical psychology to primary health care, by adding Psychologists to general practice settings and by encouraging diverse collaborative links between Psychologists and GPs.

Research in Primary Mental Health Care

School of Psychology staff and postgraduate students are engaged in a number of related projects to gain understanding of the above issues. In this work we collaborate with colleagues from the Disciplines of General Practice and Public Health, as well as with many other researchers both within and beyond South Australia. We have a pool of skilled and enthusiastic students working on projects at Honours, Masters and PhD level; some are mentioned below but the ever-changing composition of the teams, as students complete their work and move on, means that mostly only the staff members have been named in what follows.

A sample of the projects includes:

Primary Mental Health Care Delivery

In 2001 the School of Psychology appointed Senior Clinical Psychologist Brian Williams, who provides mental health services at the Highbury Family Practice Unit on three days per week. He also manages the School’s Psychology Clinic there for Masters students undergoing professional training in Clinical Psychology, and sits on the Mental Health Committee of the Adelaide North East Division of General Practice. In 2003, Dr. Lisa Kettler joined the clinical psychology team at Highbury, where she provides one day per week of direct service delivery to children and adolescents with mental health problems.

The impact of adding psychological services to a large suburban general practice was carefully monitored from the points of view of both the health service users and the GPs at the practice. This initiative prepared us for the next stage.

In 2002 we were invited by the Adelaide Northern Division of General Practice to become a partner in their application for Allied Health Services funding under the Commonwealth’s Better Outcomes in Mental Health Care Initiative. The application was successful and the Northern Well Being Project is now well under way. It is providing psychological interventions to patients of GPs in Adelaide’s northern suburbs, and the effectiveness of these services is being evaluated.

Those involved in this project include Helen Winefield, Deborah Turnbull, Brian Williams, John Taplin, Chris Seiboth, Justin Beilby, Ian Wilson, and Cate Howell. A similar trial is now in progress with the Adelaide North East Division of General Practice.

Psychological Interventions in Primary Health Care

Under this broad heading are several projects aimed to increase knowledge relevant to providing integrated mental health care via general practices:

Clinical Health Psychology for Older People

How can and do family members and GPs cope best with older people who, due to physical or cognitive decline, may need to leave their homes for a higher level of residential care? How do decisions get made and whose priorities should count most heavily? (Linley Denson, Lynn Ward, Jan Harry). What lifestyle or professional service factors promote successful ageing (Trish McCann-Mortimer)? What is the role for example of household pets to provide company, a sense of purpose, and exercise (Helen Winefield and Anna Chur-Hansen)?

Developing an Evidence Base for Family Therapy

Family-oriented interventions are widely applied to mental health problems of children and more generally within family units – but there is little agreement about what therapeutic techniques constitute “family therapy” and therefore about how efficacious and effective this approach is. The time has come to apply quantitative methods to evaluate the outcomes of specifically defined treatment approaches within this general orientation (Lisa Kettler, Helen Winefield, Catherine Sanders).

Developmental States Psychotherapy

The highest-level skill of the therapist treating anxiety, depression, and the common presentations of distress in primary health care lies in matching the treatment modality to the needs of the help-seeker. This project aims to develop and evaluate an innovative package of therapeutic techniques for which we are collecting evidence of effectiveness (Brian Williams, Jane Blake-Mortimer, Helen Winefield).

Research Methodologies for Clinical Psychology

There is a common misconception that the choice of research designs in applied psychology is either a randomised clinical trial or a complete rejection of quantification. In fact there are many variations of quantitative, qualitative and mixed designs, which are highly appropriate for increasing our understanding of what therapy works for whom. Particularly through the original research studies conducted by Masters students as part of their clinical training, we are developing expertise in small-sample designs and the bridges between quantitative and qualitative methodologies (Deborah Turnbull, Paul Delfabbro, Nick Burns, Helen Winefield, Jane Blake-Mortimer).

Preventive Mental Health Programs

• Successful bonding between parents and infants is a cornerstone for later psychological resilience in the children, as well as a source of satisfaction and self-esteem for the parents. Several projects are investigating the attachment process, particularly the effects on it of stressful circumstances affecting the mother (Jane Blake-Mortimer, Lisa Kettler, Clara Bookless).

• Parent education can be carried out in groups and improves parents’ confidence and ability to provide a loving and supportive family environment. Foster parents can face particular challenges as they care for children who have suffered many disrupted placements (Paul Delfabbro, Helen Winefield, Lisa Kettler, Annette Brock).

• Much psychological disturbance in childhood and adolescence goes undetected and untreated. Other diagnoses such as Attention Deficit & Hyperactivity Disorder or intellectual disability require long-term management. Early intervention improves the prospects for a successful response to help (Lisa Kettler, John Taplin, Michael Sawyer).

Management of Long-lasting Health Conditions

• People who have a chronic illness are often asked by their doctors to carry out a complicated self-care regime on a permanent basis, and it is recognised that they often do not keep up with all the treatments as recommended. How can adherence to treatment plans be improved (Lisa Kettler, Helen Winefield)?

• Some people suffer multiple symptoms which don’t fit neatly into a known diagnostic category, and or which don’t respond to medical treatments. These patients cause anxiety to their doctors and can also feel dissatisfied with the medical care they receive; examples include chronic pain or fatigue and multiple chemical sensitivities. We need to understand more about the connections between physical and emotional distress, and about how to offer effective help. There is some evidence for the helpfulness of psychological treatments (Helen Winefield, Ann Thornton, Liana Taylor).

• When a family member is suffering from chronic or severe illness or injury, they and others in the family also need information and emotional support in addition to medical care. Cancer patients, adults with chronic mental illness and those who have suffered brain injury through motor vehicle accidents are some groups of people whose needs, and whose carers’ needs, we are currently studying (Helen Winefield, Jane Mathias, Rebecca Gooden). The role of the Internet as a source of information from both experts and fellow-sufferers, and of emotional support, is an expanding area of relevant research.

• The Australian government is vitally interested in ways to improve the care for people with chronic conditions within primary care settings. Deborah Turnbull and colleagues at the University’s Discipline of General Practice are integrally involved in a range of industry and government sponsored projects to develop and evaluate such interventions.

Screening for Chronic Illnesses

Large-scale projects are being carried out with external grant funding by Deborah Turnbull and colleague Carlene Wilson (CSIRO / Flinders University of South Australia). A number of higher degree research and honours students are attached to these projects, which examine ways of enhancing uptake of established and emerging health technologies.

Immunological Markers of Health

Psychoneuroimmunology of stress is being studied by Jane Blake-Mortimer with colleagues Ainsley Chalmers (FMC) and Professor Ian Olver, Director of the RAH Cancer Centre.

Higher Degree Research student Neha Mahajan has recently joined the research center from Punjab, India to examine stress and relationship variables on the outcome of in-vitro fertilization and embryo transfer.

Health Providers’ Occupational Health

Several projects address the psychological well being of the health care providers themselves. Seeing sick and unhappy people every day and trying to alleviate their distress can be stressful in itself, and there is a corresponding need to explore the causes and consequences of this occupational stressor for the health and productivity of the professionals concerned. The role of training and professional development appears to be crucial:

• Work stress effects and management in general practitioners and nurses (Helen Winefield, Bronwyn Veale, Linley Denson, Liz Farmer, Sandra Pisaniello).

• Recruitment and training and supports for rural and indigenous health care providers (Jonathan Newbury, Helen Winefield, Deborah Turnbull, Justin Beilby).

• Enhancing the capacity of the health care workforce through multidisciplinary training (Helen Winefield, Anna Chur-Hansen, Brian Williams, Chris Seiboth).

• Skills-based pre-registration training in clinical and public health psychology (Helen Winefield, Deborah Turnbull, Jane Blake-Mortimer, Lisa Kettler, Brian Williams).

Publications 2000-2004

Sarris, A., Winefield, H.R. & Cooper, C. (2000). Behaviour problems in adolescence: A comparison of juvenile offenders and adolescents referred to a mental health service. Australian Journal of Psychology, 52, 17-22.

Winefield, H.R. & Chur-Hansen, A. (2000). Evaluating the outcome of communication skill teaching for entry-level medical students: Does knowledge of empathy increase? Medical Education, 34, 90-94.

Winefield, H. R. (2000). Stress reduction for family caregivers in chronic mental illness: Implications of a work stress management perspective. International Journal of Stress Management, 7, 193-207.

Dollard, M., Winefield, H. R., Winefield, A.H. & De Yonge, J. (2000). Psychosocial job strain and productivity in human service workers: A test of the demand control support model. Journal of Occupational and Organizational Psychology, 73, 501-510.

Winefield, H., Dollard, M. & Winefield, A. (2000). The role of supervisors in managing occupational stress for service professionals. Journal of Occupational Health & Safety - Australia & New Zealand, 16, 343-349.

Dollard, M., Winefield, H.R. & Winefield, A.H. (2001). Occupational strain and efficacy in human service workers: When the rescuer becomes the victim. Dordrecht, Kluwer Academic.

Winefield HR & Veale BW (2002). Work stress and quality of work performance in Australian General Practitioners. Australian Journal of Primary Health, 8, 59-65.

Kettler, L.J., Sawyer, S.M., Winefield, H.R. and Greville, H.W. (2002). Determinants of adult adherence to treatment in cystic fibrosis. Thorax, 57, 459-464.

Simmons, T.A. and Winefield, H.R. (2002) Predictors of patient enablement: the role of doctors’ helpgiving style, patient and visit characteristics. Australian Journal of Primary Health, 8, 39-46.

Dollard, M., Winefield, A.H. & Winefield, H.R.. (2003). Occupational Stress in the Service Professions. London, Taylor & Francis.

Winefield H.R., Coventry B.J., Pradhan M., Harvey, E. and Lambert, V. (2003). A Comparison of Women with Breast Cancer who do and do not Seek Support from the Internet. Australian Journal of Psychology, 55,30-34.

Winefield, H.R. and Chur-Hansen, A. (2003) Working with a Multidisciplinary Staff. In L. M. Cohen, D. McChargue, & F. Collins (Eds) The Health Psychology Handbook: Practical Issues for the Behavioral Medicine Specialist. Thousand Oaks, Sage (pp. 28-41).

Winefield, H. (2003) Work stress and its effects in general practitioners. In Dollard, M., Winefield, A.H. and Winefield, H.R. (Eds) Occupational stress in the service professions. London: Taylor & Francis (pp. 187-207) .

Winefield, H.R., Coventry, B.J., Lewis, M.A. & Harvey, E.J. (2003) Attitudes of breast cancer patients to support groups. Journal of Psychosocial Oncology , 21, 39-54.

Dollard, M. F., Dormann, C., Boyd, C., Winefield, H.R. , & Winefield, A.H. (2003). Unique aspects of stress in human service work. Australian Psychologist, 38, 84-91.

Winefield, H., Marley, J., Taplin, J., Beilby, J., Turnbull, D., Wilson, I. & Williams, B. (2003). Primary health care responses to onsite psychologist support Australian eJournal for the Advancement of Mental Health, vol 2iss1.

Winefield, HR, Coventry, B.J. and Lambert, V. (2004). Setting up a health education website: Practical advice for health professionals. Patient Education and Counseling, 53, 175-182.

Winefield, H.R.(2004) Developing and evaluating training and teaching. In S. Michie and C. Abraham (Eds.) Health Psychology in Practice. London: Blackwell. Pp. 317-336.

Winefield, H.R. & Chur-Hansen, A. (2004) Integrating psychologists into primary mental health care in Australia. Families, Systems, and Health, 22, 294-305.

Winefield, H.R., Turnbull, D.A. & Taplin, J.T. (In press) Frequency and course of psychological distress in patients attending an integrated primary care service. Clinical Psychologist (accepted 6 th June 2004).

Winefield, H.R. (In press) Support provision and emotional work in an internet support group for cancer patients. Patient Education and Counselling (accepted 4 th May 2005).

Recent Publications

Turnbull DA, Wilkinson C. (2000) Women’s role and satisfaction in the decision to have a caesarean section. (Letter to the Editor). Medical Journal of Australia, 172(1), 46.

Walker R, Golois E, Turnbull D, Wilkinson C. (2001) Why choose caesarean section. (Letter to the Editor). The Lancet, 357(9256), 635-636.

McIntyre E, Hiller JE, Turnbull D. (2001) Attitudes towards infant feeding among adults in a low socioeconomic community: what social support is there for breastfeeding? Breastfeeding Review, 9(1), 13-24.

Eckert K, Turnbull D, MacLennan A. (2001) Immersion in water in the first stage of labour – a randomised controlled trial. Birth, 28(2), 84-93.

Khong TY, Turnbull D, Staples A. (2001) Provider attitudes about consent gaining for perinatal autopsy. Obstetrics and Gynaecology, 97(6), 994-998.

Turnbull D, Wilkinson C, Walker R. (2001) Women’s request for caesarean section. (Letter to the Editor). Birth, 28(2), 146-147.

Marley JE, Searle P, Chamberlain NL, Turnbull DA, Leahy CM. (2001) Carols in the wind. Medical Journal of Australia, 175, 656-658.

McIntyre E, Hiller JE, Turnbull D. (2001) Community attitudes to infant feeding. Breastfeeding Review, 9(3), 27-33.

Walker RB, Turnbull DA, & Wilkinson, C. (2002) Strategies to address global caesarean section rates: a review of the evidence. Birth, 29(1), 28-39.

Turnbull D,Mensforth H, Beilby J, Marley JE, Qureshi F, Tonkin A. (2002) An empirical model for the development of Disease Management Programs in General Practice: a case study using hypertension. Disease Management and Health Outcomes, 10(11), 723-729.

Durkin SR, Bascomb A, Turnbull D, Marley J. (2003) Rural origin students…how do they cope with the medical school environment? Australian Journal of Rural Health, 11, 89-95.

Winefield H, Marley J, Taplin J, Beilby J, Turnbull D, Wilson I, Williams B. (2003) Primary health care responses to onsite psychologist support. Australian e-Journal for the Advancement of Mental Health , 2(1), 1-7.

Turnbull D, Buckley P, Robinson JS, Mather G, Leahy C, Marley J. (2003) Increasing the evidence base for selection for undergraduate medicine: Four case studies investigating process and interim outcomes. Medical Education, 37, 1115-1120.

Turnbull DA, Wilkinson C, Gerard K, Shanahan M, Ryan P, Griffith EC, Kruzins G, Stamp GE. (2004) Clinical, psychosocial and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women. The Lancet, 363, 1104-1109.

Robinson JS, Turnbull DA. (2004) Changing healthcare organisations to change clinical performance. (Invited commentary). Medical Journal of Australia, 180 (6 Suppl), S61-2.

Walker R, Turnbull D, Wilkinson C. (2004) Increasing caesarean section rates: exploring the role of culture in an Australian community. Birth, 31, 117-124.

Winefield HR, Turnbull DA, Taplin JE. Frequency and course of psychological distress in primary health care patients. (Accepted 18.02.04, Clinical Psychologist).

Turnbull DA, Beilby JJ, Ziaian T, Qureshi F, Nelson M, Tonkin AL, Marley JE. Disease management for hypertension: a pilot cluster randomised trial of 67 Australian general practices. (Accepted, Disease Management and Health Outcomes, 27.09.04)

Recent Peer Reviewed Grants

Winefield HR, Turnbull D, Marley J, Taplin J. (2001) The University of Adelaide, Faculty of Health Sciences, Medical Research Category B3 Funding. Integrated primary mental health care: Development and evaluation of a new service delivery model: $14 980.

Young G, Turnbull D, Cole S. (2002) National Health and Medical Research Council. Screening for colorectal cancer: Attitudes affecting participation and implementation of strategies for improvement: $468 750.

Young GP, Cole SR, Esterman A, Turnbull D, Wilson C. (2005) National Health and Medical Research Council, A population-based communication strategy to optimise colorectal cancer screening behaviour in Australia: $523 800.

Recent Sponsored Research

Beilby J, Turnbull D, Marley J. AstraZeneca Pharmaceuticals, Aventis Pharma, Bayer Australia Ltd, Pfizer Pty Ltd. (2000) Disease management approach to hypertension – completion of an intervention package (Stage 2): $85 750.

Beilby J, Turnbull D, Marley J, Tonkin A, Qureshi F, Nelson M. (2000-2001) AstraZeneca Pharmaceuticals, Aventis Pharma, Bayer Australia Ltd, Pfizer Pty Ltd. Pilot study to compare the change in cardiovascular risk in patients with mild-moderate hypertension treated according to an evidence-based disease management program with that of current practice: $1 010015.

Powis, D, Marley J, Rolfe I, Murphy B, Turnbull D, Beilby J, Ozolins I. (2000) Royal Australian College of General Practitioners. Proposal for the evaluation of the RACGP Training Program National Selection Process and Outcomes: $96 008.

Beilby J, Turnbull D, Pekarsky B, Marley J, Walker D, Holton C, Pratt N, Duszynski K. (2001) Department of Health and Aged Care. Evaluation Design of Phase 2 of the Integrated Care Program: $45 000.

Turnbull D. (2002) Evaluation of the social and physical environment of the Faculty of Health of the University of Newcastle: $8 000.

Turnbull D, Winefield HR. (2002) Evaluation of the Better Outcomes in Mental Health Care, Northern Well being Project. Adelaide Northern Division of General Practice: $10 000.

Beilby J, Turnbull D, Duszynski A. (2003) Modifying clinical heart activities. Computerised Disease Management System. Alphapharm Pty Ltd: $72, 622.

Beilby J, Turnbull D. (2003). The evaluation of the trial of ICP Phase2. Department of Health and Ageing: $142, 132.