The New England Framework, based on 50 years combined clinical practice, has been recently consolidated as an adaptation of the United Kingdom's 'Improving Access to Psychological Therapies' to include physical conditions. Founded on a collaborative approach in helping, health workers assist individuals to select and use self-administered cognitive and behaviourally based (CB) interventions specific to health problems. Heart disease and depression are the leading causes of disability worldwide. Obesity, diabetes, renal disease, respiratory conditions, chronic pain and addictions constitute another large percentage of suffering. Cognitive behavioural therapy (CBT) is the most effective non-pharmacological evidence-based treatment for most of all mental disorders and a wide range of physical health conditions. While CBT was originally developed as a self management tool to help reduce the negative impact that particular thinking and behaving patterns have on health, it evolved into a specific domain practice of professionals. Because of this, access to CBT has been impeded because of lack of available help, cost of treatment and time required - issues compounded for rural populations. With the rapid expansion of freely available online, virtual and print-based CBT, the value of self-directed minimal-assisted first-line treatments has been established.

Introduction: This paper reports on one major finding of an educational initiative aimed at improving the care of persons presenting to emergency departments (EDs) with mental health issues. This goal, to improve care, was based on the premise that enhanced knowledge and skills of ED staff in mental health, including drug and alcohol issues, would result in increased confidence and competence of staff. The outcome of this would be that they could provide more effective and efficient service and thus better facilitate triage of persons with these problems. Objective: To increase the confidence of staff in working with increasing numbers of mental health presentations in EDs. Methods: Pre and post Emergency Mental Health Alcohol and Other Drugs (EMHAD) course questionnaires assessed self-ratings of clinical confidence in working with people with mental health issues. Follow-up interviews assessed if new found confidence in mental health had been integrated into daily ED practice. Results: Self ratings of clinical confidence, including knowledge and skills, showed a significant improvement on all questions following the course. Responses to the follow-up interviews suggest that participants in the course had retained and integrated information into practice. This was especially evident in their ability to talk to people about mental health problems and to triage more appropriately. Conclusion: Since attending the course staff feel more confident and competent to deal with mental health, including alcohol and other drug presentations, in the emergency department.

In this paper we describe the development of the New England 4G Framework of Guided Self-health including rural health and workforce issues, models of care, and the United Kingdom's (UK) 'Improving Access to Psychological Therapies' (IAPT) initiative from which the Framework was derived. With a long history in the UK of CBT delivery by workforces such as mental health nurses, we have adapted the IAPT model to fit rural environments of Australia and included physical as well as mental health conditions as part of a low intensity approach to helping. Health workers in the New England Framework assist individuals to select and use self-administered cognitive and behaviorally-based (CB) interventions specific to health problems. The worker in the New England Framework goes beyond dispensing health information or brokering services and guides the person to identify a specific problem and make change. The framework includes information gathering information, generating a CB plan, giving self-health materials and guiding with follow-up.