A pioneering program at Monash Health is bridging the long-standing gap between genetic and mental health care, and families say it’s transforming how they understand themselves.
When a young woman arrived at Monash Health’s mental health service carrying a childhood genetic test result she had never fully understood, she didn’t expect the appointment to change her life. But after a session with the program’s genetic counsellor, guided entirely by her own questions, she left with something she hadn’t anticipated: peace of mind.
‘She expressed how much peace of mind she gained from understanding the underlying genetic factors contributing to her challenges,’ recalls Clinical Genetic Counsellor Joanne Isbister-Smith, who worked with her.
‘It gave her a sense of validation that her struggles weren’t just “in her head”, and it gave her hope for the future.’
That appointment is one of many that have quietly unfolded since Monash Health, a leading academic health service, launched what is believed to be Australia’s first dedicated psychiatric genetic service embedded within a mental health program.
Mental health conditions such as depression, bipolar disorder, anxiety, and schizophrenia can be heritable for some people. In addition, a number of genetic disorders include mental health symptoms and conditions. Yet genetics has been a missing piece in mental health care.
The Mental Health Genetics team at Monash Health has published a paper in the Journal of Genetic Counseling detailing the structure, implementation, and collaborative function of the novel service, illustrating how genetic counsellors can work effectively within interdisciplinary mental health teams.
Reshaping care
Mental Health Program Director Professor Megan Galbally brought a distinctive professional vantage point to the role when she arrived in 2022, having previously overseen both a mental health service and a statewide genetics program in Western Australia.
‘In my previous role, I oversaw both mental health services and a statewide genetics service and saw the value in bringing the 2 together, including seeing the collaboration benefit patient outcomes,’ said Professor Galbally.
‘For too long, genetics has been the missing piece in psychiatric care. By putting that piece back where it belongs, this program is changing the trajectory of care for patients and families.’
Building awareness of the new service within mental health was one of the early hurdles, as teams were unaccustomed to working with genetics colleagues.
To help shape the service, the team at Monash Health sought guidance internationally, including from the All Wales Psychiatric Genetics Service in the United Kingdom, and The Adapt Clinic in Canada Evidence-Based Genetic Counseling for Psychiatric Disorders: A Road Map – PMC which provided advice and support as the program was established.
Pioneering role
At the centre of the day-to-day work is Ms Isbister-Smith, currently the only genetic counsellor in Australia employed within a mental health program.
‘Being the first in this program has given me the opportunity to help shape the structure and scope of the service in a way that best addresses the needs of our patients,’ she said.
‘We are hopeful that, as the field grows, we will see more genetic counsellors working within mental health programs, both here in Victoria and across Australia, as well as internationally.’
The service began with a focus on women of reproductive age with psychiatric histories, a population where the intersection of mental health conditions and questions about inheritance is especially pressing. It proved particularly valuable in high-risk perinatal cases, where psychiatric conditions intersected with fetal anomalies.
From there, it expanded into inpatient adult psychiatry, dual disability, and child and adolescent mental health, facilitating timely interventions and supporting complex case management across a broad range of presentations.
The jar analogy
One of the most powerful tools in the clinic is not a test. It is a story.
Ms Isbister-Smith frequently draws on the ‘mental illness jar’ analogy, developed by Professor Jehannine Austin, a leading researcher in psychiatric genetic counselling.
She explains that in this analogy, the jar represents an individual’s overall risk of developing a mental health condition. Genetic factors inherited from biological parents are already present at birth.
As a person encounters life stressors and adversity, environmental factors fill the jar over time. When the combined load overflows, a mental health challenge may emerge.
Critically, this model emphasises that no single factor, genetics or environment, determines outcomes alone.
‘Understanding this interplay between environment and genetic factors can significantly reduce feelings of uncertainty, confusion, blame, shame or guilt,’ she explained.
‘This information can also empower individuals to take proactive steps in managing their mental health with more informed decisions, whether through lifestyle changes, therapy, medication, or other preventive measures.’
Ethics and care
The program has not shied away from the complex ethical terrain that genetic information can open.
One of the central principles is what Ms Isbister-Smith describes as offering ‘the right test at the right time.’
‘Genetic information can reveal predispositions to conditions that might not manifest for years, which may raise concerns about the potential for discrimination, stigmatisation, and/or psychological harm,’ she noted.
‘In some instances, we may meet with patients more than once to discuss the option of genetic testing, and we ensure patients have given informed consent before proceeding.’
When a genetic condition is identified, the response extends well beyond the clinic room.
The team connects patients and families with psychiatrists, psychologists, and relevant medical specialists, including endocrinologists, cardiologists, and gynaecologists, depending on what the findings reveal about broader health risks.
‘When I sit with a family and can explain why their child is experiencing what they’re experiencing, and what it might mean for them and for siblings, that’s when you see the relief on their faces. It changes the conversation entirely,’ Ms Isbister-Smith said.
Growing global reach
The program’s reach has extended beyond Victoria. It has supported student clinical placements and hosted clinical observers from the United States, Italy, and Cyprus, a signal that the model is attracting international attention as a potential blueprint.
Ms Isbister-Smith also serves as co-chair of the Genetic Counselling Special Interest Group for the International Society of Psychiatric Genetics, a role that positions Monash Health’s model at the heart of an emerging global conversation.
The service recently added Clinical Geneticist Dr Tegan French to the team. While a genetic counsellor interprets tests, offers psychological support and educates families, a clinical geneticist is a medical doctor who diagnoses and treats diseases.
Both Professor Galbally and Ms Isbister-Smith say they hope to expand further, growing both the counselling and medical genetics capacity in the years ahead.
‘This innovative model of care shows how genetic services might effectively operate within the Australian healthcare landscape,’ said Professor Galbally.
For Ms Isbister-Smith, the work is personal in its impact, even as it remains clinically rigorous.
‘It’s incredibly rewarding to be able to offer that clarity and support to individuals and their family members in this space,’ she said. ‘With no two days being the same.’
