Why did Divisions of General Practice implement some Access to Allied Psychological Services mental health initiatives and not others?
Authors: King Kylie , Nicholas Angela , Fletcher Justine , Bassilios Bridget , Reifels Lennart , Blashki Grant , Pirkis Jane 
Published: November 2014

Objective
The Access to Allied Psychological Services (ATAPS) programs implemented through Divisions of General Practice (now Medicare Locals) enables general practitioners (GPs) to refer consumers with high-prevalence mental disorders for up to 12 individual and/or group sessions of evidence-based mental health care. The great strength of ATAPS is its ability to target vulnerable and hard-to-reach populations. Several initiatives have been introduced that focus on particular at-risk populations. This study aimed to determine the factors that had influenced Divisions’ decisions to implement the various Tier 2 initiatives.

Methods
An online survey was sent to all Divisions. The survey contained mostly multiple choice questions and sought to determine which factors had influenced their decision-making.

Results
The most common factors influencing the decision to implement an initiative were the perception of local need and whether there was an existing service model that made it easier to add in new programs. The most commonly cited factors for not implementing were related to resources and administrative capacity.

Conclusions
This research provides valuable insights into the issues that primary care organisations face when implementing new programs; the lessons learnt here could be useful when considering the implementation of other new primary care programs.

What is known about the topic?
Previous evaluations of ATAPS have shed light on some of the factors that act as barriers to the implementation of new mental health initiatives by Divisions operating in primary care, but there is nothing known about why Divisions choose to implement some programs over others. Previous research suggests that ‘barriers’ to change, as reported by organisations, may be constructions that are used to make sense of a situation and that the real impediment to change are intra-organisational factors such as the self-identity of organisations.

What does this paper add?
This paper reports on a survey that was undertaken with Divisions regarding the reasons they chose to implement particular mental health initiatives. The paper provides insight into the barriers that Divisions perceived when implementing new mental health programs. They were primarily cited as funding and resource barriers. The findings also provide further indirect evidence of the role of the self-identity of organisations in change.

What are the implications for practitioners?
The study has some implications for government policy development both locally and internationally. For instance, it is likely that primary care organisations such as Divisions, especially smaller ones, require support in terms of increased funding and resources if new mental health initiatives are to be successful. Mandating the delivering of initiatives also contributes to their successful uptake. It is likely that as primary care organisations become more experienced with implementing new mental health programs, the perceived barriers will reduce and implementation will occur with more ease.