One-stop-shop: service treats mental illness, neurological, and addiction as 'brain disorders'

An Australia-first initiative that demolishes the "artificial" silos separating mental illness and neurological conditions aims to do for people with “brain diseases” what comprehensive cancer centres have done for its patients.

The Mindgardens Neuroscience Network brings together one-stop specialist clinics that tap into the latest research and a range of new community services, including an after-hours drop-in centre for people at risk of suicide.

The collaboration between UNSW, the Neuroscience Research Australia (NeuRA), the Black Dog Institute and South East Sydney Local Health District will be launched on Tuesday with $7 million in federal government funding.

It will focus on personalised treatment enmeshed with emerging research - including enrolling patients in clinical trials - to target mental illnesses, neurological and substance use disorders.

“We’re trying to look at the whole brain,” Professor Helen Christensen, director at the Black Dog Institute said, rejecting the artificial splintering-off of “brain disorders”.

“They have never been considered together and the result is overwhelmingly strong ... we are simply not doing enough both to understand the causes of these disorders, but also to come up with the models of care that are actually going to work.”

The model mimicked gold-standard cancer centres, but it would be wrong to consider Mindgardens used a reductive medical model for mental illness that negates social factors, Professor Christensen said.

“Often there are interactions between these conditions,” Professor Christensen said, for instance a patient with complex depression may also have a drug or alcohol disorder and need parallel intervention, or someone with the beginnings of dementia and chronic back pain.

This integration was "life-changing" for Nancy Goymerac, whose debilitating chronic back pain triggered deep depression.

For days, the "hellish" pain would leave her bedridden. At her lowest ebb, she was dependent on her mother to cook and help her to the bathroom.

“There were some really dark days ... I thought, 'I am going to be lying on my lounge for the rest of my life in pain? I felt useless, really depressed worrying about my future," Ms Goymerac said.

Her GP enrolled her in a sensory-motor retraining trial study - a forerunner of a Mindgardens trial.

“They taught me about how pain worked- that is was not coming from the damaged part of my body, but signals from my brain,” Ms Goymerac said. Her pain and depression have since dissipated.

Associate Professor James McAuley, a psychologist and the trial's lead investigator said "people find it really difficult being told ‘we can’t find anything wrong with your back, it’s all in your head’.”

“In one sense that’s right, but it’s not that they’re making it up. It’s that their brain is processing sensory information in a way that makes it easier to produce the feeling of pain,” he said.

The trial will combine promising new medications with sensory-motor retraining to improve pain and depression.

Chairman of Mindgardens John Grill said patients would be monitored to guide treatment choices for others, creating a “feedback loop between real-world medicine and scientific studies”.

Multidisciplinary specialist teams would support patients from diagnostic testing and treatment options, through to ongoing management.

The initiative would also establish a drop-in centre in south-east Sydney for people experiencing mental health or suicidal crises as an alternative to overcrowded emergency departments.

Its planned community hubs will offer services for people whose depression is too complex for GPs to manage alone but not so severe that they need to be hospitalised.

UNSW dean of medicine Professor Vlado Perkovic said there was increasing community concern about the delivery and quality of services for people with mental illness, neurological problems and alcohol and drug disorders.

“UNSW is proud to be part of the Mindgardens network to pioneer and test new approaches that can then be applied more broadly,” he said.