Monarch Support Program Eligibility Criteria

Patient First Name *

Patient Last Name *

Patient Email Address

Patient Contact Number

First Name Of Referring Person *

Last Name Of Referring Person *

Email Of Referring Person

Contact Number Of Referring Person

The Monarch Support Program (MSP) is a ten-week case management and psychological support program, provided to new Monarch Mental Health Group (MMHG) patients receiving neurobiological treatments (i.e., TMS, TdCS and drug treatment (i.e., Esketamine). A primary focus of MSP is to scaffold the neurobiological and drug treatments patients receive with psychological support and assistance, as well as establish linkages to service providers for ongoing care, with the objective of increasing the likelihood of positive and sustained treatment outcomes for patients. MSP utilises a flexible, holistic, and collaborative approach working closely with patients to achieve these outcomes. The program is voluntary and patients can withdraw at any time.

The MSP has been briefly explained to the patient and they consent to this referral being made *

YesNo - Please discuss with patient to obtain consent before making the referral to MSP

Patient meets the following criteria

New patient (recently completed initial assessment for MMHG) *

DVA funded patient *

Does the patient meet any of the following criteria:

Chronic suicide risk.

Acute suicide risk.

Co-existing mental health conditions.

Limited formal and informal supports, with emphasis upon the absence of a G.P.

Financial Strain

Unstable accomodation.

Engaging in non-suicidal self-injurious behaviour.

Drug and alcohol use ranging from mild to excessive use requiring intervention.

Inconsistent engagement in treatment.

Emotional instability/vulnerability.

Planned and/or unplanned transitions.

Compromised executive functioning skills (e.g., planning and organisation).

Medication non-compliance/inconsistency.

Is The Patient Eligible For The MSP Program?

Based On The Criteria Is the Person Eligible For The MSP *

YesNo

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