Improving access to services to address the physical health care needs of people engaged with a public mental health AOD services in Melbourne

A report back on Rebecca Brereton and Bradley Whitto's session Integrating hepatitis C care within community mental health and addiction services

An innovative model of care between a Nurse Practitioner and Hepatology Nurse. Rebecca Brereton and Bread Whitten are employed by The Alfred Hospital in Melbourne, Vic. Both nurse specialists who have set up a nurse-led Hep C clinic within the Psychiatry and AOD service. Their aim is to provide access to DAA’s whilst educating the broader Psychiatry/AOD teams and increasing their confidence in prescribing, with a hope to reduce the burden of disease amongst this vulnerable group of people.

We know that people with severe mental illness live between 15 and 30 years less than their peers without severe mental illness. We also know that those linked with public mental health services rarely have their physical healthcare needs met. Engaging nurses to address the physical health care needs of people in public mental health services is an increasing trend in Australia.

There are many reasons why people with disabling mental illness find it difficult to get their physical health care needs met, some identified in this presentation outlined that referring out to other services majority of the time does not work. People do not turn up to appointments and the opportunistic drop in approach would likely work better.  

At the time of the presentation 116 people had presented to this new service and 82% had received HCV testing. Showing some amazing results, the ‘pick up’ rate was quite astounding with 85% of people tested showing HCV PCR positive. 72% of these people had commenced treatment with the NP treating 51%. For those with complicated cirrhosis, of which there were 9% identified, they were easily referred on to Alfred Gastro for follow up and assisted to do this by their case worker supporting them to attend appointments.

The use of a CNC in Hepatology has proven to be an effective way to educate a nurse practitioner, who is not specialized in the area of Hepatology, to broaden her scope of practice to include the screening and treatment for Hep C. The use of a nurse practitioner to address the physical healthcare needs of people within public mental health services has been clearly demonstrated within this model to be efficient and effective.

I hope the consideration of utilizing nurse practitioners across public mental health/AOD services to address the physical healthcare needs of its serviced clients becomes more widely accepted in Australia. The physical health care needs of this population have been ignored for far too long and I am sure the Royal Commission into public MHS will echo this with strong recommendation. This service is seen to be leading the way. Well done guys.


Author bio: Sian is a nurse practitioner in Psychiatry and Addiction in her own nurse led clinic in Geelong. Sian is passionate about the physical health care needs of people living with mental illness and/or addiction.