Table 3.

Service implementation barriers, facilitators and future improvement strategies

	Agency staffa	Referrersb	Professionalsc
Implementation barriers	ATAPS model limitations: • Need for GP referral • Accommodating client engagement and complex cases in session limit • Limited capacity to provide outreach or transport • One-on-one model • Challenging timelines in vast areas with transient populations Other barriers: • Establishing Indigenous community or service relationships • Shortage of Indigenous mental health and male professionals • Non AMS clients • No shows • Limited funding • Referrer /AMS turnover • Primary health reform • Non-identification of Indigeneity	• No barriers • Demand management restricting referral • Confidentiality of faxing client referrals	• No shows • Relationship building with Indigenous communities and health services • Limited funding to provide culturally appropriate (outreach) services • Central intake • Limited local/ cultural knowledge of ATAPS Suicide Support Line • Lacking clinical service support • Qualification requirements precluding Indigenous health workers from facilitating CBT-groups • Occasional waiting lists
Implementation facilitators	• Good Indigenous service relationships • Experienced professionals in communities • Indigenous workers from Closing the Gap and Indigenous primary healthcare teams • ATAPS funding • Indigenous ATAPS staff • Good referrer relations • Service demand • Alignment with existing Indigenous services • Willingness to learn how to work with Indigenous people	• Service availability • Streamlined referral • Referrer support • Clinician availability and engagement • Payment for no shows • Lack of a gap payment • Good governance	• Good relationships with Indigenous communities and services • Co-location with Indigenous health services • Good relationships with Medicare Locals • Funding • Project officer role • Skills and experience • Cultural awareness training • Provision of client transport • Flexible interventions • Provisional referral and priority appointments
Future improvement strategies	Cultural appropriateness: • Cultural awareness training and supervision • After-hours suicide line • Outcome measures • Indigenous mental health workers and outreach • Service guidelines Service engagement: • Service promotion and referrer awareness • AMS or NGO linkages • Target AMS non-engaged groups Enhanced service flexibility: • GP referral and treatment plan • Session limit • Session duration • Interventions • Client self-referral • Suicide timelines • Transport allowance Funding: • Non-session time (liaison work) • Rural/remote services • Pool ATAPS funding to flexibly meet demand • Maintain or increase funding Integration and responsiveness: • AMS co-location • Build community capacity to respond to suicidality • Involve Indigenous communities in delivery • Provide mental health first aid training for Indigenous primary care workers	• Increased availability • Client progress and wait list feedback • Referrer engagement • More sessions • Indigenous community engagement • No improvement required	Service flexibility: • Referral pathways (Indigenous health workers, self-referral) • Session limit / duration • Session time / location • Training and supervision funding • Indigenous health workers as providers • No shows • Service access for low income earners • Non-CBT interventions • Diagnosis requirement • Outreach Other strategies: • Cultural supervision / mentoring • Frequent remote visits • Funding increase • Paid consultation time • Direct AMS funding • Provide transport

Acronyms: AMS Aboriginal Medical Service, ATAPS Access to Allied Psychological Services, CBT Cognitive behaviour therapy, GP General practitioner, NGO Non-government organisation

^aincludes ATAPS administering agency staff of Medicare Locals and subcontracted provider agencies

^bincludes eligible ATAPS referrers

^cincludes eligible mental health professionals delivering ATAPS