Purpose built environments
The physical environment of any health service is critical to the care process and how it shapes an individuals’ experience of care and their engagement. Qualitative studies have found that the nature of waiting rooms and reception areas influences the experience of primary health care (Lester et al., 2005). Cramped, dark, and windowless waiting rooms may be particularly stressful for those with anxiety and schizophrenia. Additionally, paying attention to average waiting times and how staff, including receptionists, interact with patients is important (Lester et al., 2005). While evidence exists regarding the important part the physical environment plays in patient engagement and experience, it is not known how well existing primary care environments have been designed with this in mind. The physical environment of all treatment settings needs to be welcoming and carefully designed to accommodate people’s specific needs.
Fig. 2.1 Primary care strategies to improve recognition and treatment of mental disorders
Some innovative mental health services have made strident efforts to ensure that their internal physical environments are welcoming (e.g. Headspace in Australia, a prevention service provided to young people (18-24 y/o) (Rickwood et al., 2015). There have also been indications that co-located services are successful for supporting people with SMIs. Earlier models developed and implemented in the US included specific primary care clinics only for people with SMIs in order that the mental and physical health needs of these individuals could be appropriately addressed with continuity of care at the fore (Crews et al., 1998). In Australia a trial care model between GPs, non-government services, public mental health services, and a mobile primary care service using peer support workers was used successfully to improve the treatment of physical health problems for people living with SMIs (Lee et al., 2013). The contemporary manifestation of this type of model could be a ‘one stop shop’ service where the physical, mental and social needs of patients are met in a safe and supportive environment. This service might be housed in a building with a healthcare facility at the top and a shared cafe/social space at the bottom. Combined professional support options to address employment, housing, and other needs could also be available on the same premises. To achieve this would require substantial investment in purpose- built environments, and funding must be re-directed to primary health care.
Employment and housing are known to impact on personal health and well-being as well as recovery outcomes. Recognizing this as part of the challenge of health care and addressing these issues as a part of treatment can only result in improved health outcomes. Recognition and treatment could also be enhanced by extending the Prevention and Recovery Centres (PARC) models which are currently being implemented in Victoria, Australia. PARCs are community-managed services delivered with on-site clinical services, and are offered by community mental health teams with a view to being integrated with primary care. They offer a step up (focused support and treatment to avoid hospital admission) or step down (support for early discharge from hospital to promote recovery) model (Department of Health and Human Services, 2010). However, PARCs currently have small bed numbers and stay times are short, so it can be difficult to address any interrelated issues which may be initially responsible for causing psychopathological manifestations. These existing and previously trialled models all show promise and could successfully be implemented in current health care systems.