Regional Mental Health, Alcohol and Other Drugs Plan
July 2019 - June 2021 Darling Downs and West Moreton PHN wishes to acknowledge Australia’s Aboriginal and Torres Strait Islander people as the Custodians of this land. We pay our respect and recognise their unique cultures and customs and honour their Elders past, present and emerging. Darling Downs and West Moreton PHN gratefully acknowledges the financial and other support from the Australian Government Department of Health. While the Australian Government Department of Health has contributed to the funding of this material, the information contained in it does not necessarily reflect the views of the Australian Government and is not advice that is provided, or information that is endorsed, by the Australian Government. The Australian Government is not responsible by negligence or otherwise for any injury, loss or damage however arising from the use of or reliance on the information provided herein.
2. Contents
1 Introduction______7
2 Development of the Plan______12
3 The Plan______14
4 Next Steps______23
Appendix 1______24
Appendix 2______26
Appendix 3______29
Darling Downs and West Moreton PHN, West Moreton Health and Darling Downs Health would like to acknowledge the Queensland Health, Mental Health and Alcohol and Other Drug Branch (MHAOD), Queensland Network of Alcohol and Other Drug Agencies (QNADA) and the Queensland Mental Health Alliance for their contribution to this Plan.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 3. Foreword
To ensure our region is best placed the mental health and alcohol and to adapt to the changing needs of other drug service system’, the Plan is our communities, Darling Downs and steered by the principles of: West Moreton PHN, West Moreton reducing stigma Health (WMH) and Darling Downs • Health (DDH) have committed • all services are culturally appropriate to joint planning for integrated • people are at the centre of the mental health, suicide prevention system and our services and alcohol and other drug (AOD) • strong and effective communication services. We recognise that we are • information sharing to improve stronger together and that by working care that respects privacy and collaboratively, we can effect change confidentiality for those that are the most vulnerable in our communities. We are committed to reducing stigma within our own organisations, in those The Regional Mental Health and we fund or commission and across the Alcohol and Other Drug Plan is the health system. first step in laying the foundation for ongoing collaboration and improved We would like to take this opportunity coordination to ensure that all people to thank those who have contributed living with a mental health condition to the preparation of this Plan, and AOD use in our region can access including those with lived experience, representatives from the Aboriginal effective and appropriate treatment. and Torres Strait Islander and Mental health, suicide prevention culturally and linguistically diverse and AOD use continue to be key communities, working groups and the priority areas for the PHN, DDH and steering committee who provided us WMH. Preparing a regional plan with their unique insights through presents our organisations with our consultation process. Over 100 the opportunity not only to lead the people, representing a wide range of health, mental health and social conversation and the work to ensure service organisations across the greater access for people, it also gives region, participated in consultations us the opportunity to collectively and workshops to identify key issues engage stakeholders across the and develop priorities. We would also Darling Downs and West Moreton PHN like to acknowledge the Queensland region to identify shared opportunities Health, Mental Health and Alcohol and goals for the future. This approach and Other Drug Branch (MHAOD), aligns with the Fifth National Mental Queensland Network of Alcohol and Health and Suicide Prevention Other Drug Agencies (QNADA), and the Plan, 2017 and the Shifting Minds Queensland Mental Health Alliance for Queensland Health, Mental Health, their contribution to the Plan through Alcohol and Other Drugs Strategic their involvement with the steering Plan 2018 - 2023 (Shifting Minds). committee.
Guided by a strong vision to provide We look forward to working with you something that is ‘action orientated, to improve accessibility and delivery of innovative and realistic – focused mental health, suicide prevention and on people and their journey through AOD treatment services in our region.
Merrilyn Strohfeldt Dr Kerrie Freeman Dr Peter Gillies CEO Chief Executive Chief Executive Darling Downs and West Moreton Health Darling Downs Health West Moreton PHN
4. Vision for the Plan
The Plan is action oriented, innovative and realistic - focused on people and their journeys through our mental health and AOD service system. The implementation of this Plan will lay the foundation for ongoing collaboration and improved coordination leading to the development of a comprehensive plan by 2022.
Principles
Information All services People are at the sharing to improve Strong and effective Reducing stigma are culturally centre of the system care that respects communication appropriate and our services privacy and confidentiality
Priorities
Integration and Partnerships Information Sharing Workforce
Improve quality and sustainability Improve access to current of care in the community for Increase mental health information about mental people with severe mental health workforce capacity health and AOD services conditions
Maximise capacity and Improve person-centred care Improve the quality and capability of the peer for people with mental health timeliness of referrals and workforce as key contributors conditions discharge across the system to the service system
Develop confidence in Improve understanding of needs of organisations and individuals to people with severe mental health share information conditions appropriately
Improve availability and equity of access to AOD services across the region
Implementation of the Plan Development of Comprehensive Plan
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 5. The joint Plan will provide a regional platform for developing a service system to better meet the needs of people and their families and carers with lived experience of mental illness, AOD use and suicide.
6. 1. Introduction
The Darling Downs and West Moreton PHN, West Moreton Health (WMH) and Darling Downs Health (DDH) have committed to joint regional planning for integrated mental health, AOD and suicide prevention services. This joint planning approach aligns with the Fifth National Mental Health and Suicide Prevention Plan, 2017 and the Shifting Minds Queensland Health, Mental Health, Alcohol and Other Drugs Strategic Plan 2018 - 2023 (Shifting Minds).
The joint Plan will provide a regional health condition and reducing and communities, ageing well and platform for developing a service early mortality; additional support for individuals system to better meet the needs of experiencing adverse life events and people and their families and carers 6. reducing stigma and discrimination; circumstances; and with lived experience of mental 7. making safety and quality central to • governments by enhancing system illness, AOD use and suicide. The mental health service delivery; and efficiency and effectiveness through overarching strategic framework to whole of government leadership guide coordinated government action 8. ensuring that the enablers of and accountability for integrated in mental health reform and service effective system performance and policy, planning, funding and delivery is the Fifth National Mental system improvement are in place. commissioning. Health and Suicide Prevention Plan1 (The Fifth Plan). Shifting Minds is built around three focus areas: The Fifth Plan outlines a vision for the SHIFTING MINDS: Australian mental health system that: QUEENSLAND MENTAL • better lives; • enables recovery; HEALTH, ALCOHOL AND • invest to save; and OTHER DRUGS STRATEGIC • whole of system improvement. • prevents and detects mental illness PLAN 2018 - 2023 early; and • ensures that all Australians with a Shifting Minds promotes a whole- mental health condition can access of-person, whole of community and CONNECTING CARE TO effective and appropriate treatment whole of government approach to RECOVERY 2016 - 2021 and community support to enable improving the mental health and 2 them to participate fully in the wellbeing of Queenslanders. It Connecting Care to Recovery is community. sets the direction for reform with the services plan for state-funded a focus beyond the treatment mental health and AOD services in The eight priority areas of the Fifth system proposing priorities for Queensland.3 The priorities of the Plan are: cross-sectoral action. plan include:
1. achieving integrated regional The plan focuses on outcomes that • Priority 1: Access to appropriate planning and service delivery; matter for: services as close to home as practicable and at the optimal time. 2. effective suicide prevention; • individuals, families and carers with a lived experience placing • Priority 2: Workforce development 3. coordinating treatment and community-based services at and optimisation of skills and scope. supports for people with severe the centre of integrated care and and complex mental illness; emphasising social economic • Priority 3: Better use of ICT inclusion and participation; to enhance clinical practice, 4. improving Aboriginal and Torres information sharing, data collection • communities by improving Strait Islander mental health and and performance reporting. suicide prevention; population mental health and wellbeing through the best start • Priority 4: Early identification 5. improving the physical health in life, prevention and early and intervention in response to of people living with a mental intervention in schools, workplaces suicide risk.
1 Commonwealth of Australia. The Fifth National Mental Health and Suicide Prevention Plan (2017) 2 Queensland Mental Health Commission, 2018. Shifting Minds: Queensland Mental Health, Alcohol and Other Drugs Strategic Plan 2018-2023 https://www.qmhc.qld.gov.au/sites/default/files/files/qmhc_2018_strategic_plan.pdf 3 Connecting Care to Recovery 2016 – 2017. Queensland Health 2016. www.health.qld.gov.au/__data/assets/pdf_file/0020/465131/connecting-care.pdf
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 7. • Priority 5: Strengthening patient’s rights Mental Health Act 2016. QUEENSLAND Our region:
The Connecting Care to Recovery geographical area of over Plan is supported by a resourcing 2 strategy of $430 million over five 95,500 km years for new operational growth = 5.5% of Queensland and infrastructure investment. Spans across 10 NATIONAL DRUG STRATEGY Local Government Areas (in full or in part) The National Drug Strategy 2017 - DARLING DOWNS AND WEST MORETON PHN 2026 aims to build safe, healthy and resilient Australian communities through preventing and minimising alcohol, tobacco and other drug- CHERBOURG related health, social, cultural and ABORIGINAL SHIRE
economic harms among individuals, SOUTH BURNETT families and communities. REGION Kingaroy The strategy has a balanced approach Miles Chinchilla
across the three pillars of harm WESTERN DOWNS SOMERSET REGION minimisation: Dalby Crows Nest REGION Esk Tara Oakey • Demand reduction - preventing the Gatton IPSWICH Toowoomba REGION LOCKYER Ipswich uptake and/or delaying the onset VALLEY TOOWOOMBA REGION Millmerran REGION SCENIC of use of alcohol, tobacco and RIM Boonah other drugs; reducing the misuse Warwick GOONDIWINDI of alcohol, tobacco and other drugs REGION SOUTHERN DOWNS REGION in the community; and supporting Goondiwindi people to recover from dependence Stanthorpe through evidence-informed treatment.
For more information about the Darling Downs and West Moreton PHN region, please see Appendix 1. • Supply reduction - preventing, stopping, disrupting or otherwise reducing the production and supply MENTAL HEALTH AND Effectively, a stepped care approach of illegal drugs; and controlling, ALCOHOL AND OTHER DRUG offers a broad spectrum of services managing and/or regulating the SERVICE SYSTEM through which people may move up availability of legal drugs. and down and within based on their 1.1 Stepped Care needs at the time. This allows for • Harm reduction - reducing the people to access services across the adverse health, social and economic Stepped care is central to the continuum of care simultaneously. The consequences of the use of drugs, Australian Government’s mental health Department of Health4 identifies four for the user, their families and the reform agenda and PHNs are using a core elements of stepped care: wider community. stepped care approach to guide the development and commissioning of 1. Stratification of the population mental health services. into different ‘needs groups’, ranging from whole of population Stepped care provides a continuum of needs for mental health promotion support aimed at meeting the needs of and prevention, through to those individuals from those with low levels with severe, persistent and of anxiety and depression to those complex conditions. with severe mental health conditions.
4 PHN Primary Mental Health Care Flexible Funding Pool Implementation Guidance – Stepped Care
8. 2. Setting interventions for each group – this is necessary because not all needs require formal intervention. 3. Designing a comprehensive menu of evidence-based services required to Severe mental Moderate illness At risk respond to the spectrum of need. Mild mental mental illness groups (early illness symptoms, 4. Matching service types to the Well previous treatment targets for each needs population illness) group and commissioning/ delivering services accordingly. Focus on Increase early Provide and Increase Improve promotion and intervention promote service access to AIMS 1.2 Spectrum of responses to prevention through access to access rates adequate level AOD issues by providing access to lower cost, maximising of primary access to lower cost, lower intensity the number mental Figure 2 provides an overview of the information, evidence- services of people health care spectrum of responses to AOD issues advice and based receiving intervention used in the Queensland AOD Service self-help alternatives evidence- to maximise Delivery Framework and public AOD resources to fact-to-face based recovery services model of service. psychological intervention and prevent therapy escalation. 1.3 Overview of current services Provide service system wrap-around coordinated Figure 3 provides an overview of the care for current responsibilities of different people with complex needs service providers in relation to the stepped care model. The hospital and Mainly Mainly self- Mix of Mainly Face to face health services (HHS) predominantly publicly help resources resources face-to-face clinical provide services to people with severe available including including primary care care using a mental illness, while primary care and SERVICES information digital mental digital mental services, combination non-government organisations (NGOs) and self-help health health backed up by of GP care, provide a range of services across the resources services and psychiatrist psychiatrists, stepped care spectrum. low intensity or links to mental health fact-to-face broader social nurses, 1.4 Planning Guidelines services supports psychologists Psychological Clinician and allied The Joint Regional Planning for services for assisted digital health Integrated Mental Health and Suicide those who mental health Coordinated, Prevention Services: A Guide for require them services and multi-agency Local Health Networks (LHNs) and other low services for Primary Health Networks (PHNs) intensive those with (the Guide) and a Compendium of services for a severe and minority complex Resources to assist LHNs and PHNs mental illness were endorsed by the Council of Australian Governments (COAG) Figure 1 Stepped Care Model5* Health Council in August 2017. The Fifth Plan represents commitment 5* Adapted from PHN Primary Mental Health Care Flexible Funding Pool Implementation Guidance – from all governments to work together Stepped Care to achieve integrated planning for the delivery of mental health and suicide prevention services.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 9. Figure 2 Spectrum of responses to AOD issues
The key objectives of the joint regional priorities including better • provide a systems approach to suicide planning outlined in the Guide are to: coordination of services for people prevention, improving Aboriginal and with severe and complex mental Torres Strait Islander mental health • embed integration of mental health, illness and linkages with social and suicide prevention; and suicide prevention and AOD services support, employment, education and pathways into a whole of system services and the National Disability • improve the physical health of approach; and Insurance Scheme (NDIS); people living with mental health conditions and AOD use. • drive and inform evidence-based service development to address identified gaps and deliver on regional priorities.
The intent of the joint approach to planning is to: Primary Care Moderate Severe • inform coordinated commissioning mental mental HHS Mild mental illness of mental health and AOD services illness illness across stepped care and across the lifespan; Well At risk population groups • support coordinated implementation of regional, state and national NGO
Figure 3 Overview of current regional service system
10. This Plan provides a platform for joint action in the short to medium term and will contribute to the development of a comprehensive plan.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 11. 2. Development of the Plan
This plan represents a new approach to planning for mental health, suicide prevention and AOD services in our region. It outlines agreed priorities for new and joint action by the PHN, DDH and WMH.
Each of the partner agencies, along workshops to identify key issues and have recently developed regional with other providers across the region develop priorities. suicide prevention plans. These plans continue to implement a wide range were developed separately for the of core services and programs to The process has been overseen Darling Downs and West Moreton meet the needs of the community. by a steering committee which regions prior to work commencing These have not been documented as includes representation from the on the joint Regional Mental Health, a part of this plan but are an integral three partner agencies as well as the Alcohol and Other Drugs Plan. Many component of the delivery of mental Queensland Health, Mental Health of the strategies included in this health and AOD services. and Other Drug Branch (MHAOD), Plan complement and support the Queensland Network of Alcohol strategies outlined in the two suicide The priorities and actions have and Other Drug Agencies (QNADA), prevention plans. Addressing the been agreed by the three partner Queensland Mental Health Alliance system issues identified in this Plan agencies following a process of data and people with lived experience and will support and underpin ongoing analysis, consultation and a series representatives from the Aboriginal work to implement the specific of workshops as shown in Figure 4. and Torres Strait Islander community. strategies identified in the suicide Key data sources included the PHN prevention plans. Mental health, This Plan provides a platform for Health Needs Assessment (HNA) and AOD and suicide prevention will be joint action in the short to medium the National Mental Health Services integrated in the comprehensive plan term and is a foundation for the Planning Framework (NMHSPF). Over to be developed by 2022. 100 people, representing a wide range development of a comprehensive plan. of organisations across the region, It should be noted that the PHN, in participated in consultations and consultation with the DDH and WMH,
Steering Priority Committee and Environmental System Vision Consultations Working Initial Plan Working Group Scan Workshop Groups established
• The PHN, • Review of • Consultations • Presentation • 3 workshops: • Plan agreed DDH, WMH PHN HNA with over 60 of key system › Information by Steering agree to • Review of organisations issues and Sharing Committee develop a Plan other previous and themes to › Integration by June 2019 planning and individuals to Steering and reports identify key Committee Partnerships strengths, › Workforce • Review of • Prioritisation issues and NMHSPF data of issues for • Priority opportunities inclusion in actions the Plan identified
September 2018 - October 2019 Figure 4 Development of the Plan
12. While changing community attitudes is beyond the control of our organisations, we are committed to reducing stigma within our own organisations, in those that we fund or commission and across the health system.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 13. 3. The Plan
The PHN, WMH and DDH are committed to implementing this plan in partnership with organisations and individuals who are part of the mental health, AOD and suicide prevention sectors across the region.
To support the implementation of the as a key priority in improving care for population from refugee backgrounds. plan the PHN, WMH and DDH commit people with mental health conditions These groups have unique and to strategies and principles that will and/or AOD related issues. We changing needs as they establish their underpin our collaborative approach. recognise the benefits of a well- lives in our community. We recognise Over time we will seek to embed connected service system and the the need to develop the capability these strategies in relevant strategic importance of enabling consumers of the mental health workforce to plans as well as in induction and and carers to make informed decisions respond effectively to the needs of professional development programs about their care. In this context, we people from a refugee background. for staff. These principles focus on: commit to the national standards in relation to privacy and confidentiality • reducing stigma associated as articulated in the National 3.1 PLAN PRIORITIES with mental health conditions Standards for Mental Health and AOD use; Services (2010). The Plan sets out three high level • creating a system built on strong and priorities identified through the effective communication; Good communication is essential to consultation and workshop process: consumer driven service delivery. In • recognising the need for information delivering services, we recognise that • integration and partnerships; sharing while upholding agreed effective communication has several principles of confidentiality and • information sharing; and key features including: privacy; and • workforce. • ensuring all services are culturally • clear and simple language; These priorities reflect the key appropriate and person-centred. • asking questions and encouraging underpinning enablers for a strong, others to ask questions; We recognise that there is effective and collaborative mental considerable stigma associated with • using consumers’ words wherever health, suicide prevention and AOD mental health conditions, suicide and possible; system. A summary of findings from AOD use. While changing community • understanding who you are the consultation process is included in attitudes is beyond the control of communicating with; Appendix 3. our organisations, we are committed • active listening; and The implementation of the Plan will be to reducing stigma within our own • being aware of the possible influence overseen by the cross agency steering organisations, in those we fund or of bias or personal judgement. committee supported by a working commission and across the health group with representation from the system. We commit to providing Cultural capability working with three partners, key health service training and education for staff to Aboriginal and Torres Strait Islander providers and consumers and carers. build respect and reduce stigma. people and recognition of diversity In addition, these governance groups Education activities will focus on is fundamental to the provision of will also be responsible for leading the identifying and addressing bias, equitable health care. We recognise development of the Comprehensive promoting reflective practice and the need for our mental health, suicide Regional Mental Health, AOD and providing support for supervisors prevention and AOD system to be built Suicide Prevention Plan. in addressing stigma and bias with on a foundation of trust, respect for their staff. Embedding peer workers diversity, fairness and social justice. across the mental health, suicide We commit to working within our own prevention and AOD workforce is a key organisations, as well as across the strategy to assist in reducing sigma system, to improve understanding and promoting client-centred service of the needs of diverse communities provision for organisations providing within our region and to respond to mental health services. their needs with dignity and respect.
Improving information sharing The Darling Downs and West Moreton between services has been identified region has a large and increasing
14. Priority Issue: Development of Comprehensive Regional Mental Health, AOD and Suicide Prevention Plan
Goal: To develop a Joint Comprehensive Mental Health, AOD and Suicide Prevention Plan for the Darling Downs and West Moreton region
STRATEGIES ACTION WHO TIMEFRAME
Continue the Darling Downs Update and formalise membership Led by: DDH, WMH, July 2019 - and West Moreton joint Mental and terms of reference for the steering PHN ongoing Health Steering Committee to committee. oversee implementation of the Establish mechanism to monitor Plan and development of the and review implementation of the Plan. Comprehensive Plan. Establish mechanism to monitor implementation of West Moreton (WM) and Darling Downs (DD) suicide prevention plans and to integrate action where appropriate. Develop a strategy for the development of the Comprehensive Plan. Establish a working group to Establish a Plan Working Group (WG) to Led by: PHN July 2019 support the implementation of the support the implementation of the Plan. WG representation Plan. Agree and document: from: • membership (to include health services, • DDH, WMH, PHN PHN, NGOs, consume/carers, and • GPs Aboriginal and Torres Strait Islander • allied and other representation as well as others as mental health and appropriate); and AOD professionals • Terms of Reference. • Aboriginal and Torres Strait Islander and culturally and linguistically diverse (CALD) mental health and AOD providers • peer workers • consumers/carers Develop a region-wide approach Review WM and DD suicide prevention Led by: WG Jan 2020 – to suicide prevention. plans to identify commonalities and Dec 2021 differences. Agree on a region-wide approach to identify the priorities from suicide prevention planning within the framework of the Comprehensive Plan. Develop data capability to Identify performance indicators that are Led by: Steering Jan 2020 – capture baseline mental health, measurable, informative and align with Committee Dec 2021 suicide and AOD data for the organisational aims Comprehensive Plan. Develop mechanisms for measuring indicators at regional level. Develop baseline measures for inclusion in comprehensive plan.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 15. Priority Issue: Integration and Partnerships
Goal: To improve quality and sustainability of care in the community for people with severe mental health conditions by developing new models of support to GPs
STRATEGIES ACTION WHO TIMEFRAME
Explore models of shared care WG to: Led by: WG Jan 2020 - between general practice, • review existing models of mental health June 2022 psychiatry and allied and other shared care locally and across Australia; mental health professionals. • identify model(s) applicable to PHN region; • trial and review selected model(s); and • develop strategies for region wide implementation for incorporation in the Comprehensive Plan. Define pathways for referral into hospital Led by: DDH July - Dec and health service (HHS) psychiatrist WMH 2019 sessions either for face to face or using GPLO telehealth. Review existing services (e.g. psychiatrist registrar consultant liaison) to identify options for improved and/or expanded delivery of community based psychiatry. Investigate additional options for on-call Led by: DDH, WMH Jan - Dec psychiatry consultant support for GPs: 2020 • describe current availability of psychiatry support for GPs; • review currently available services; and • consider options for fund pooling within and across regions (e.g. other PHNs and health services). Explore options to improve GP Investigate opportunities and capacity Led by: PHN Jan - June confidence in managing mental to implement Project ECHO® model, DDH 2020 health in the community. other clinical team learning models WMH and peer supervision to improve GP knowledge and skill.
16. Goal: To improve person centred care for people with mental health conditions, including people at risk of suicide
STRATEGIES ACTION WHO Timeframe
Raise awareness of the Encourage all service providers (acute Led by: WG Jan 2020 - importance of individual mental and community teams, GPs, NGOs, allied Dec 2022 wellbeing and safety plans and/ and other mental health professionals) or mental health treatment plans to identify if a person has an individual among service providers and mental wellbeing and safety plan and/or reduce duplication. mental health treatment plan: • share a variety of types of plans between organisations; • encourage service providers to collaborate in the development and implementation of mental well-being and safety plans; • HHSs to undertake awareness raising and training for all mental health and AOD staff including questions at intake about plans; • PHN to undertake awareness raising and training for GPs and commissioned services and encourage questions about plans; and • develop the capacity of service providers to support people with mental health conditions to have a person-centred individual plan for those that do not already have one and seek a mental health treatment plan from a GP where required. Include individual mental wellbeing and Led by: PHN July 2020 - safety plan templates in GP practice June 2021 software and link to GP Mental Health Treatment Plan.
Goal: To improve understanding of the needs of people with severe mental health conditions
STRATEGIES ACTION WHO TIMEFRAME
Undertake a research project to Audit of ED presentations to Toowoomba, Led by: PHN Jan - Dec understand the needs of people Ipswich and two rural hospitals to: 2020 with severe and complex mental • estimate the number of people with health conditions who: severe and complex mental illness who • do not meet criteria for acute have difficulty in accessing services that mental health services; and meet their needs; and • would benefit from alternatives • identify reasons for ED presentations to emergency department (ED) that are and are not referred to acute or presentation. inpatient services. Investigate alternative service options for meeting the differing needs of people with severe and complex mental illness to inform the Comprehensive Plan.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 17. Goal: To improve availability and equity of access to AOD support services
STRATEGIES ACTION WHO TIMEFRAME
Improve equity of access to AOD Explore opioid substitution therapy Led by: PHN Jan services across the region. opportunities in the region by increasing - Jun 2020 capability to prescribe and dispense (pharmacy and GP). Investigate the ‘Hospital in the Home’ Led by: DDH, WMH, Jan and other models for community-based PHN - Dec 2020 withdrawal such as models utilising GPs with nurse support particularly in rural locations.
Priority Issue: Information Sharing
Goal: To improve access to current information about mental health, suicide prevention and AOD services
STRATEGIES ACTION WHO TIMEFRAME
Develop a public online portal of Develop and enhance existing mental Led by: DDH and WMH July 2019 services and referral pathways health, suicide prevention and AOD HealthPathways Team - ongoing including clinical and non-clinical referrals through HealthPathways. GP Liaison Officers responses. Continue mapping of clinical health, PHN Health Service mental health and non-clinical, community Navigators social supports and services. System Integration Coordinators Explore options for using the community Led by: DDH and WMH Jan portal in HealthPathways. HealthPathways Team - June 2020 GPLO Build on HealthPathways to incorporate Led by: DDH and WMH Jan - Dec psychosocial support and other NGO HealthPathways Team 2020 services.
18. Goal: To improve the quality and timeliness of referrals and discharge across the mental health, suicide prevention and AOD systems
STRATEGIES ACTION WHO TIMEFRAME
Develop overarching best-practice WG to: Led by: WG Jan guidelines to inform content • review existing referral and discharge - Dec 2020 and processes for referral and practices across the system; discharge including clinical • identify key elements of good content and psychosocial/non-clinical and processes; services. • develop and disseminate guidelines; and • support workforce to adopt and embed guidelines into practice. Examine existing referral and WG to: Led by: WG Jan - Dec discharge tools to develop shared • identify common referral and discharge 2020 referral protocols informed by pathways and unique needs and features agreed guidelines. of these pathways; • develop draft tools and protocols to meet needs of different parts of the system; • trial and evaluate referral and discharge tools and protocols with health service providers and NGOs providing psychosocial support services; and • revise tools and protocol based on findings of the evaluation. Engage with the wider WG to: Led by: WG Jan 2020 - sector to clarify referral and • engage with agencies in other sectors Education Dec 2021 communication protocols. e.g. education, child safety, and Child Safety housing to identify referral patterns and requirements; Housing • adapt referral protocols to meet needs of other sectors where required; • trial and evaluate referral and discharge protocols; and • revise protocols based on findings of the evaluation.
Goal: To develop confidence in organisations and individuals to share information appropriately
STRATEGIES ACTION WHO TIMEFRAME
Raise awareness of frontline Identify professional development Led by: WG Ongoing workers of importance and activities and resources available and Other organisations value of appropriate information relevant to privacy principles and including NGOs sharing to ensure information information sharing. is shared in the best interests Examine and share professional of consumers. development opportunities between Ensure frontline workers have organisations to educate and publicise knowledge of information national privacy principles and application that can be shared to promote for appropriate sharing of information between services to foster collaborative care collaborative care aligned with e.g., through Mental Health Professional national privacy principles and networks, webinars and case examples. legislative requirements. PHN commissioning contracts require funded Led by: PHN July 2019 organisations to demonstrate mechanisms in – ongoing place to appropriately share information with other providers to facilitate collaborative care for clients whilst maintaining high quality and safety standards.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 19. Priority Issue: Workforce
Goal: To maximise capacity and capability of the peer workforce as key contributors to the service system.
STRATEGIES ACTION WHO TIMEFRAME
Develop the peer workforce across WG to: Led by: WG Jan 2020 – the DD and WM region. • support implementation of state level Dec 2021 Examine feasibility of developing peer workforce strategy in DD and WM and implementing a regional region; training program for peer workers. • examine current peer workforce Support peer workers to availability across the region and identify undertake recognised training workforce development requirements for leading to a qualification. mental health, suicide prevention and AOD supports and services across the spectrum of care; • co-fund training and development activities; • provide bursaries or cadetships as part of employment contracts; • provide resources for training of peer workers through commissioning contracts; • deliver recognised Cert IV and other training; and • encourage industry placements. Build the capability and Establish a peer network or expand current Led by: WG July 2019 - sustainability of the peer network reach using the mental health Dec 2021 workforce. professional network model. Increase the capacity of the Provide training on supervision of peer Led by: WG Jan 2020 – mental health, suicide prevention workers including operational and ongoing and AOD workforce to supervise professional support. peer workers. Investigate options for regional supervision (using face to face or remote modalities) to support smaller organisations to employ peer workers. Align regional activity with state peer workforce strategy. Increase recognition and value of Create materials to support education of Led by: PHN July 2019 - the role of low intensity mental GPs and other health professionals on the GPLO ongoing health services and peer workers benefits of low intensity services and peer in the mental health, suicide workers and how to utilise their skills and prevention and AOD systems. experience effectively: • recognising different perspectives of clinicians and others and communicating to reflect these differences; and • using consumer stories of positive experiences with low intensity services and peer workers. Use opportunities such as Grand Rounds, videos and social media to raise awareness and promote their roles. Incorporate information about low intensity services and peer workers into HealthPathways.
20. Goal: To increase mental health workforce capacity
STRATEGIES ACTION WHO TIMEFRAME
Increase utilisation of provisional Investigate opportunities to increase Led by: PHN Allied Jan 2020 - psychologists where appropriate. psychology supervision capacity in the Health Liaison ongoing region: USQ • encourage mental health professionals SQRH to offer supervision for provisional psychologists; and • explore shared supervision models. Expand use of provisional psychologists: • partner with USQ and SQRH to expand student learning clinics to rural areas with supported supervision. Build on existing workforce to Provide accredited training for practice Led by: PHN July 2019 – enhance system capacity. nurses in mental health and AOD (such ongoing as courses developed by the Australian College of Mental Health Nurses), potentially supported through accessing allied health bursaries and scholarships offered through Health Workforce Queensland (HWQ). Identify social workers and occupational therapists with an interest in mental health. Provide financial support for them to undertake training to become accredited mental health practitioners, for example; by accessing HWQ bursaries and scholarships. Increase use of telehealth as Identify rural locations with adequate Led by: WG July 2019 – a mechanism for increasing connectivity and infrastructure to establish ongoing access to psychiatry and telehealth hubs for psychological and psychology services. psychiatrist telehealth interventions. Identify psychiatrists/psychiatry practices interested in providing Medical & Benefits Schedule (MBS) funded telehealth psychiatric services to clients in rural and remote locations (building on learnings from current arrangements between urban- based psychiatry practice and GPs/ACCHOs in Miles, Dalby, Chinchilla and Tara). Facilitate the development of relationships between those services and referring GPs, providing education on when a psychiatric intervention is required. Investigate psychiatry and psychology Led by: WG July 2019 - options for telehealth interventions for ongoing refugees by linking with PHNs in areas where there are high refugee populations to identify mental health professionals with specific expertise and experience in delivering services to refugees. Facilitate the development of telehealth service delivery mechanisms for refugees. Support professional development Identify priority topics for discussion at Led by: All Ongoing for mental health professionals. the mental health professionals network, organisations based on local needs, emerging issues and culturally safe service delivery.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 21. This Plan will inform the development of the Comprehensive Plan which will be developed by 2022.
22. 4. Next Steps
The Joint Planning Guide stipulates that comprehensive regional plans should be developed by mid-2020 to coincide with the end of the Fifth National Mental Health and Suicide Prevention Plan. The Plan provides a sound basis for ongoing collaborative planning between the PHN, DDH and WMH.
THE PLAN WILL LAY THE FOUNDATIONS FOR THE COMPREHENSIVE PLAN WHICH NEEDS TO BE DEVELOPED BY 2022
2022 2018 2019 2020 2021 (and beyond)
Plan Development Comprehensive Plan Development
Short Term Priority Areas
Priority Medium Term Priority Areas Areas Long Term Priority Areas
Workforce Cross Cutting Information Sharing Issues Integration and Partnerships
Source: Adapted from Joint Regional Planning for Integrated Mental Health and Suicide Prevention Services A Guide for Local Health Networks (LHNs) and Primary Health Networks (PHNs), October 2018.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 23. Appendix 1
Overview of the Darling Downs and West Moreton region
GEOGRAPHY AND DEMOGRAPHY
The Darling Downs and West Moreton PHN region spans 95,639 square kilometres and is situated in the south
east corner of Queensland, adjacent CHERBOURG ABORIGINAL SHIRE to Brisbane. There are 558,803 people (2016 ERP) residing within the PHN SOUTH BURNETT region and of these people 24,549 REGION
(4.4%) people identify as Aboriginal Kingaroy 1 and Torres Strait Islander. Miles Chinchilla
The PHN region has a slightly higher WESTERN proportion of young people compared DOWNS Crows Nest REGION SOMERSET to Queensland (0- 4 years: 7.2%PHN Dalby REGION Esk vs 6.4% QLD; 5-19 years: 21.2%PHN vs Tara Oakey 19.5% QLD), a slightly lower proportion Gatton IPSWICH Toowoomba REGION of working age people (20-64: 56.3% LOCKYER Ipswich VALLEY PHN vs 59.0% QLD) and a similar TOOWOOMBA REGION Millmerran REGION SCENIC proportion of elderly people (65+ years: RIM 15.4% PHN vs 15.0% QLD).2 Boonah Warwick GOONDIWINDI REGION Around one third (32.2%) of the PHN SOUTHERN DOWNS REGION population live in a major city area; Goondiwindi 54.3% live in an inner regional area; Stanthorpe 12.5% live in an outer regional area; and the remainder (0.9%) live in a remote or very remote area.3
There are two hospital and health services (HHS), 12 private health facilities and six Aboriginal Medical Services situated in the Darling Downs and West Moreton region.
Darling Downs Health services approximately 280,200 people and SOCIAL DETERMINANTS (19.3%), Leichhardt - One Mile (15.7%) includes the local government areas and Goodna (13.1%).7 (LGAs) of Cherbourg, Goondiwindi, Unemployment South Burnett, Southern Downs, Crime The Darling Downs and West Moreton Toowoomba, Western Downs and a PHN region has a similar unemployment The number of reported offences in small portion of Banana. rate to that of Queensland (6.1% PHN Ipswich and Darling Downs Police West Morten Health services vs 6.2% QLD). The six areas with the Districts has steadily risen by around approximately 278,600 people and lowest unemployment rates include: one third since last year with 4160 includes the LGAs of Ipswich, Lockyer Highfields (1.9%) and Middle Ridge offences reported in December 2018. Valley, and portions of Somerset (81%), (1.5%) and areas with the highest The most common offence was theft, Scenic Rim (33%) and Brisbane (0.6%). unemployment rates include: Riverview followed by drug offences.4
1 Department of Health. Primary Health Networks. PHN Profile Reports [Internet]. 2019 Available from http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Profiles 2 PHIDU. Data by Primary Health Network [Internet]. 2018 Available from http://phidu.torrens.edu.au/social-health-atlases/data 3 Darling Downs and West Moreton Primary Health Network. 2018 Health Needs Assessment. DDWMPHN (QLD:AU). 4 Queensland Police Service. Online Crime Map [Internet]. 2019. Available from https://content-gis-psba-qld-gov-au.s3.amazonaws.com/apps/OCM/index.html
24. Socio-economic disadvantage Areas of particular concern in prescribing for antidepressants West Morton were: (women 2.5% higher than national Around a third (31.4%) of the Darling • Esk/Lake Manchester – England level of 9%) and anxiolytics in outer Downs and West Moreton population Creek/Lowood (29.2 ASR) regional areas of the PHN (3.1%) fall within the most disadvantaged compared with national rate (1.5%). quintile compared to 20% of • Lockyer Valley (25.4 ASR) Queensland. SA2 Areas with a high • Brassall/Leichardt – One Mile (25.1) Aboriginal and Torres Strait Islander proportion of the population in the • Ipswich East (19.9) Mental Health most disadvantaged quintile include: • New Chum/Redbank Plains (18.2 ASR) Riverview (100%); Nanango (91.0%); The PHN HNA 2019 has limited data relating to Aboriginal and Goodna (74.6%) and Leichardt - One Darling Downs Mile (74.0%).7 Torres Strait Islander Mental Health. • Kingaroy Region – North Nanango However, 9% of PHN commissioned Homelessness (26.9 ASR) services are provided • Chinchilla/Miles – Wandoan/Roma to Indigenous clients (where status The Darling Down and West (22.1) has been recorded). Moreton region has a lower rate of • Balonne/Goondiwindi/Inglewood – homelessness (36.8 per 100,000) Child and Youth Waggamba-Tara (18.0 ASR) compared to Queensland (44.5 per 100,000). However, SA2 areas with • Kingaroy/Kingaroy Region – South • headspace operates from three a high number of homeless persons (17.7 ASR) centres in the PHN region – include: Ipswich- Central (n=118); • Stanthorpe/Stanthorpe Region Ipswich, Toowoomba and Warwick. Darling Heights (n=115); and Kingaroy (16.1 ASR) Collectively these centres service region- North (n=111).7 400-600 young people per month In the Darling Downs region males (0.43% of persons aged 10-24 years). Disability die by suicide at a higher rate than Nearly two thirds of clients (63%) are females (7.2:1) with people aged aged between 12 and 17 years and At present, 6.4% of the PHN 35 years and under representing 12.7% of clients are Aboriginal and population (or 32,811 persons) live nearly 44% of suicides. The veteran Torres Strait Islander. with a profound or severe disability community has experienced an (5.4% QLD).6 The prevalence of increase in suicides. • There are some differences between psychosocial disability within the types of presentations to headspace DDWMPHN has been estimated to Emergency Department Presentations services at Toowoomba, Warwick affect 3593 persons under the age and Ipswich. of 65 (Darling Downs, n=1717; West Across the PHN 4.5% of Emergency • General assistance and care Moreton, n=1877) and 1128 persons Department (ED) presentations are coordination makes up one fifth of 65 years and over (Darling Downs, related to mental health, with two services at Warwick compared with n=673; West Moreton, n=456).5 thirds of these presentations occurring 2% in the other centres. between 10am and 8pm • Toowoomba sees more cases with Suicidal ideation, anxiety, depression PREVALENCE OF MENTAL higher severity i.e. 47% of clients and reaction to stress were the present as Stage 2 – threshold HEALTH AND AOD DISORDERS most common presentations in the diagnosis) compared to <30% in Darling Downs. In West Moreton, Darling Downs and West Moreton other centres and 20% nationally, suicidal ideation, unspecified mental PHN’s Health Needs Assessment and Stage 4 (ongoing severe disorders, intentional self-harm, 2019 provides the most recent data symptoms) 22.8% v 3.7% nationally. anxiety and depression were most the to inform the regional mental common presentations. Prevalence of problematic alcohol health plan. and other drugs use Anxiety and Depression Suicide and self-harm The National Drug Strategy Household There are high rates of self-reported In the PHN region, deaths from suicide Survey detailed findings report current anxiety and depression in the and self-inflicted injury occurred at an highlights PHN regions across Darling Downs and West Moreton average annual standardised rate of Australia with the five highest and 15.5 per 100,00 (2011-2015) compared region (the region as a whole has five lowest rates of smoking, lifetime with 14.1 for Queensland (10% higher) the highest percentage of clients risky drinking, single occasion risky and 11.5 for Australia (35% higher). self-reporting current anxiety and drinking and recent illicit drug use. The PHN region is ranked 5th highest 4th highest self-reporting current The PHN does not feature among 6 compared with all other PHNs. depression) and higher rates of either group.
5 Darling Downs and West Moreton Primary Health Network. 2019 Primary Mental Health Care. DDWMPHN (QLD:AU). 6 Australian Institute of Health and Welfare, National Drug Strategy Household Survey Detailed Findings 2016. Canberra: AIHW 2017
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 25. Appendix 2
Overview of current service system
PRIMARY CARE SERVICES Mild to moderate: Targeted there is considerable fluidity in this Psychological Therapies provide system due to the introduction of the MBS Services treatment to people who may not NDIS and changes to previous funding otherwise have access to services, arrangements. Psychosocial support Medicare rebates under the Better focussing on vulnerable and services are predominantly provided by Access to Psychiatrists, Psychologists marginalised groups. the NGO sector. and General Practitioners through the MBS (Better Access) initiative are Severe and complex: Mental Health available for patients with a mental Nurse Care is for people who are AOD SERVICES disorder to receive up to 10 individual diagnosed with a severe and complex NGOs provide a range of AOD support and up to 10 group allied mental mental illness who are currently being services including counselling, health services per calendar year. managed in the primary care setting casework, case management, family These services are generally provided via a GP and/or psychiatrist. Services services and residential rehabilitation in courses of treatment, with each are provided through a clinic setting (based in Toowoomba). course of treatment involving up to six or outreach model including clinical services provided by an allied mental coordination of services by a mental health professional. At the conclusion health nurse. HHS SERVICES of each course of treatment, the allied Health Service Navigators: Health Public mental health services are mental health professional must Service Navigators (HSNs) assist GPs, provided in each of the Hospital report back to the referring medical service providers, consumers and and Health Services. They deliver practitioner on the patient’s progress carers to navigate the services available specialised assessment, clinical and the referring practitioner assesses in the region. They can provide treatment and rehabilitation services the patient’s need for further services. information about and coordinate to reduce symptoms of mental illness linkages to supports and services for PHN Commissioned Services and facilitate recovery. These services consumers. They are responsible for are focused primarily on providing care Primary mental health care services mapping and identifying mental health to Queenslanders who experience the funded by the PHN are delivered service needs and gaps in communities most severe forms of mental illness and within a person-centred stepped care at the local level. behavioural disturbances, and those approach. Stepped care enables the who may fall under the provisions of Mild to Moderate Aboriginal and PHN to deliver a broader range of the Mental Health Act 2016. Torres Strait Islander Mental Health service types with the aim to match Services: These services provide free, Public mental health services work the intensity and mode of treatment culturally appropriate mental health in collaboration with primary health services to the intensity of a person's services to Aboriginal and Torres and private sector health providers individual needs. Strait Islander people with or at risk of who assist individuals with mental Primary mental health care services mental illness. health problems and facilitate access funded by the PHN are delivered by to specialist public and private mental health services when required. NGOs, private providers and Aboriginal PSYCHOSOCIAL SUPPORT Community Controlled Health DDH Services Organisations (ACCHOs) within the Psychosocial support includes following priority areas: supports and services which aim to The DDH public mental health services help people with severe mental illness have a range of service components Low Intensity: easily accessible who are not more appropriately funded providing access to crisis and services offering short term programs through the NDIS to increase their continuing care services across the for individuals with, or at risk of, low ability to do everyday activities through lifespan. These include: levels of anxiety and/or depression. a range of non-clinical community Programs are delivered face to face, based support. A range of programs • The 24-hour Acute Care Team (ACT) over the phone, via video conference are funded by the Commonwealth based in Toowoomba Hospital and through group sessions. and State governments. As of 2019 provides advice to the whole of
26. the DDHHS and has a broad role The Older Persons Service provides workers, psychologists, occupational to specifically liaise directly with assessment, clinic and home nursing therapists and peer workers people at risk of suicide arriving services as well as specialist support • Older Persons Mental Health Unit in the ED, home visit assessments, and outreach to people living in (OPMHU) based at Ipswich Hospital and outpatient acute care follow up. residential aged care services. providing expert mental health care The Acute Care Team also provides • Specialist Inpatient Acute Mental to adults over the age of 65 years a specialist Consultation Liaison Health Services are provided at who are experiencing mental illness, Psychiatry service to people in the Toowoomba Hospital with age dementia with behavioural or signs Toowoomba General Hospital, specific Adult, Older Persons and of longstanding mental illness • Community Mental Health Teams Adolescent inpatient units, complicated by age related illness. (including mental health nurses, The team provides both short and • A specialist Adolescent Day program longer term mental health care. psychologists and other allied health is provided in connection with the staff) work closely with people in Adolescent Inpatient Unit for young • Continuing Care Teams: The Goodna, crisis and collaborate closely with people experiencing difficulty Ipswich and Rural Continuing Care General Practitioners and other in mainstream schooling, with a Teams (CCT) provide community support agencies and services. specialist Education Queensland based mental health assessment, There are mental health teams in teacher in residence, and treatment and support for adults Warwick, Stanthorpe, Goondiwindi, (18-65 years) and their families • Specialist ambulatory Alcohol and Kingaroy, Dalby, Chinchilla and and/or carers living with mental Other Drugs Services with hubs in Cherbourg Hospitals. Each of the illness. They are multidisciplinary Toowoomba and Kingaroy/Cherbourg rural services provide outreach teams providing specialised and outreach workers in the Southern services to the smaller satellite mental health assessments and Downs and Western Downs. hospitals and centres in the DDHHS. interventions in a culturally diverse These teams work Monday to Friday, • DDH also provides community population to enhance community with after-hours support and advice residential mental health services integration and networking with being provided via the Acute Care at the Toowoomba Community Care available support agencies. Team, On-Call Psychiatric Registrars Unit and extended treatment and Gailes Community Care Unit: This and Psychiatrists, secure rehabilitation services at the • unit consists of 18 one-bedroom units Baillie Henderson Hospital. • The Darling Downs Child and Youth for adults in mental health recovery, Mental Health Service (Darling WMH Services who require additional support to Downs CYMHS) offers a free and build or regain independence in their confidential service specialising in The WHM Mental Health and life. This might include things like the assessment and treatment of Specialised Services (MHSS) aims help with life skills alongside long children and young people (up to 18 to provide the best care to the West term therapy. The team provides 24 years of age) who are experiencing, Moreton community and beyond hour, 7 days a week care and support. or at risk of developing, severe and with mental health issues, AOD The units are built to accommodate complex emotional, behavioural or problems, and to those requiring a adult in each unit and emulate mental health problems. There are health care in prisons. everyday living environment. 4 multidisciplinary CYMHS teams The WM MHSS has five main areas: Older Person’s Mental Health Service based in South Burnett, Southern • (OPMHS): This service provides Downs, Toowoomba, and Western • Acute Services: providing the comprehensive multidisciplinary Downs regions. CYMHS services first point of contact for anyone assessment and treatment for older also incorporate an Assertive Youth aged over 18. The team runs West adults over the age of 65 years. Mobile Outreach Service (AMYOS) Moreton Health’s 24/7 mental The service cares for those who and Evolve Therapeutic Services, health support line have a mental illness, dementia who close with Child Safety for • Adult Mental Health Unit (AMHU) with behavioural or psychological individuals with intensive support based at Ipswich Hospital and symptoms, or a longstanding mental needs. The CYMHS service works in provides expert care to adults illness complicated by age related liaison with Headspace Services in between 18 and 64 years who are illness. It provides inpatient care for both Toowoomba and Warwick, going through a mental health crisis. both acute and extended treatment • Older Persons Mental Health Services It is a safe, therapeutic place for with care provided by a multi- provides specialist psychogeriatric people who cannot be adequately disciplinary team. It also includes assessment and treatment to people supported in their own home. It care to older adults in the community over 65 years of age, or who have operates 24 hours a day, 7 days a experiencing severe mental health age related conditions impacting week. Services are provided by a problems including outpatient clinics, on their health in addition to their team of mental health professionals reviews for people in residential aged primary mental health condition. including psychiatrists, nurses, social care facilities and home visits.
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 27. • Child and Youth Mental Health Service is voluntary and people can access alleged to have committed a serious (CYMHS) is a specialised team of health the service without a referral. A range offence, involved with the criminal professionals that provides assessment, of free, professional and confidential justice system, and who present treatment and management of services are provided including: with complex mental health needs children and young people aged 0 requiring assessment, treatment • Screening to 17 years who have or are at risk of and rehabilitation. developing severe and complex mental • Treatment planning • Extended Forensic Treatment health issues. All programs provide • Assessment Rehabilitation Unit (EFTRU) – The targeted treatment and interventions Referrals for detoxification or • EFTRU provides a model of care taking into consideration the child's/ residential rehabilitation centred around the patient’s transition young person's age and physical, • Counselling back into the community. EFTRU is psychological and social needs. a statewide 20 bed unit, providing Interventions may include individual • Information ongoing specialised rehabilitation in a therapy, family therapy and group work. • Support and Case Management/ Care Coordination less restrictive environment. • Assertive Mobile Youth Outreach Service (AMYOS) is part of the West • Family support • Secure Mental Health Rehabilitation Moreton CYMHS. They provide free, • Psychotherapy Unit (SMHRU) – The SMHRU is 34 bed secure mental health rehabilitation confidential assessment, therapy • We provide individual and group unit. This unit provides inpatient and support to young people aged counselling including: 13 to 18 years and their families/ services to consumers from the West • Relapse Prevention (Back in Control Moreton, Metro South, and Gold carers who are experiencing complex - BIC) group education sessions or severe mental health problems Coast Hospital and Health Service. • Opioid Treatment Program and who maybe having difficulties • Prison Mental Health Service Anger Management Groups – for engaging with the regular child and • (PMHS) – The PMHS provides a both male and female clients youth mental health services. It is a multi-disciplinary in reach service mobile service and offers frequent • Court Program to people who are incarcerated in out-of-office support to young • Education and Promotion correctional centres across south people and their families in variety east Queensland. The primary goal of of locations, including in home or at • Forensic and Secure Services PMHS is to identify those individuals school. The team includes a variety of provides specialist secure who have a severe mental illness mental health professionals including rehabilitation and forensic mental or are at risk of developing mental psychologists, social workers, health services including: illness while incarcerated. mental health nurses, occupational • High Security Inpatient Service Prison Health Services (PHS) is therapists and speech pathologists. (70 bed) • They work closely with CYMHS and the first point of contact for people • Extended Forensic Treatment other service providers to ensure in custody requiring immediate Rehabilitation Unit (20 bed) that young people and their families/ health care. Our teams are based in carers receive the most appropriate • Secure Mental Health a health clinic setting within each intervention and treatment. Rehabilitation Unit (34 bed) prison and youth detention facility • Prison Mental Health Services in the West Moreton region. These Evolve Therapeutic Services: • (9 Correctional Centres) include the following: Evolve Therapeutic Services is a specialist service within Queensland • General Health Service • Brisbane Correctional Centre Health that supports children and • Specialist Mental Health • Brisbane Women’s young people in the care of the Intellectual Correctional Centre Department of Child Safety who have • Disability Service • Wolston Correctional Centre complex emotional and behavioural • Central Staffing Office • Borallon Training and problems. It provides mental health Correctional Centre support, behavioural support and • Forensic mental health services participation in education for provide assessment and treatment • Brisbane Youth Detention Centre children and young people in the of people with a mental disorder and • The Lived Experience Workforce is a care of Child Safety Services. a history of criminal offending, or dedicated team of lived experience those who are at risk of offending. • Alcohol and Other Drug Service staff. Members of the CCES (AODS team): provides support for • High Secure Inpatient Services participate in a range of activities people, their families and the local (HSIS) – The HSIS is the state’s only with consumers, carers and staff community who are experiencing forensic inpatient service. It provides to promote mental health wellness problems related to alcohol and other a highly supervised, supportive and and recovery including peer support substance use and misuse. The service secure environment for individuals and advocacy
28. Appendix 3
Systems Analysis
Following the consultation process, feedback was themed to identify key issues for consideration by the Steering Committee at the Systems Vision Workshop. The overview of system issues and consolidated issues are provided here as background to the Plan.
OVERVIEW OF SYSTEM ISSUES
OVERVIEW OF MENTAL HEALTH SYSTEM ISSUES
Mental Health Alcohol & Other Drugs
Prevention Mild - moderate Severe mental Maintenance & At risk groups & early Intervention mental illness illness after care intervention 1. Fragmented mix 2. Lack of capacity 5. Service gaps 9. Challenges 12. Lack of detox 17. Better of low intensity of provision of for people with engaging court services integrated PHN programs psychological severe mental directed people 13. Challenges for services across the services illness 10. Lack of people with needed to region 3. Limited access 6. Lack of step- integration of dual diagnosis promote recovery to GPs inhibits up-step-down AOD services 14. Limited access access to services with cross- to rehab mental health 7. Imminent loss govt agencies services services of psychosocial 11. Limited 15. Limited access 4. NGOs are not support community to opioid embedded capacity awareness substitution in the wider 8. Psychosocial of harm therapy mental health reduction, services & 16. Limited system safe injecting clinical services options operate in for people parallel suffering a drug induced psychosis
Workforce 18. Difficulties in attracting and recruiting 20. Mental health nurses and health navigator roles are appropriately skilled social support workers evolving and there are opportunities to deploy more and qualified mental health professionals effectively 19. People lack access to psychiatrists in the community 21. People need access to a consistent culturally competent workforce 22. Inconsistent and under-utilised peer workforce
Information Sharing 23. Poor communication across the system 24. Lack of timely and high quality information sharing between providers leads to poor client outcomes
Integration and Partnerships 25. Lack of cross system governance and performance management 26. Lack of clearly defined care pathways 27. People falling through cracks in the health system due to a lack of shared responsibility for specific patient groups 28. Funding mechanisms drives activity not outcomes and short term contracts inhibit sustainable service development
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 29. SUMMARY OF CONSULTATION FINDINGS
MENTAL HEALTH SYSTEM ISSUES (1/3) AT RISK GROUPS
Variety of programs and approaches means different programs offered in different locations
Skepticism about programs because they are not well understood - has led to poor referrals, particularly from GPs Fragmented mix of low intensity PHN programs across the region Low intensity programs poorly connected to psychologists and GPs
No programs specific to young people
MENTAL HEALTH SYSTEM ISSUES (2/3) MILD - MODERATE MENTAL ILLNESS
Long waiting lists for psychologists
High, unfunded costs for private practice psychologists to do reporting, case Lack of capacity reviews, accommodation of provision of psychological services Some psychologists holding high clinical risk because referrals are not accepted by HHS acute services
Poor information flow between community based psychologists and acute sector
Change to Targeted Psychological Therapies challenging for some GPs leading to poor referrals
Limited access to High turnover of GPs with particular reliance on locums and registrars General Practice services inhibits access to mental health services GPs have varying levels of interest and expertise in mental health
Cost and availability of GP appointments can limit access to referrals, GPMH plans and reviews
Some NGOs not recognised as providing mental health services but do provide similar services
NGOs are not embedded Variation in skills and qualifications required by different organisations, can lead in the wider mental to mistrust and lack of coordination between agencies health system
Poor information sharing between organisations and with clinical services inhibits care
30. MENTAL HEALTH SYSTEM ISSUES (3/3) SEVERE MENTAL ILLNESS
Primary care providers forced to hold clinical risk because there is no alternative Lack of options for people with severe mental illness HHS acute team receives referrals that they see as manageable in the community who do not meet the criteria for acute services GPs seeking greater psychiatric assistance for diagnosis & management of people in the community
Lack of step-up-step- People want to avoid hospital but have no other options down services between community and acute settings Limited options for transitional care between hospital and community
System disruption due to NDIS has led to greater competition & loss of some psychosocial services Imminent loss of Expected lower service support for new clients from July 2019 with psychosocial support Continuity of Service arrangements capacity Impact of poor access to psychosocial supports likely to impact on clinical services
Navigating available services is complicated for both people with mental illness and service providers Psychosocial services & Lack of coordinated and structured referral pathways between clinical and non clinical services operate clinical services in parallel
Connections often based on personal rather than systematic relationships
AOD SYSTEM ISSUES (1/3) PREVENTION AND EARLY INTERVENTION
Challenges engaging with AOD service outcomes challenged by working with people with low people who are court motivation to change directed
Lack of integration of AOD Limited availability of funding for emergency relief services with education, employment, housing, criminal justice and child Limited awareness of available family support services safety services
Limited community awareness of harm Proactive prevention programs required including those targeting youth reduction, safe injecting
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 31. AOD SYSTEM ISSUES (2/3) INTERVENTION
Absence of inpatient detox services in Darling Downs and West Moreton
Lack of detox services Reluctance to provide detox services in the community means people have to go across the region out of region
Timely admission to rehabilitation challenged
Clients with dual diagnosis struggle to find services Eligibility criteria impacts acceptance of clients into some services that treat both issues
Residential rehabilitation services limited to Toowoomba People have limited access to rehabilitation services Models of evidence-based non-residential rehabilitation programs required to meet people’s needs
Opioid replacement therapy limited to larger urban centres People have limited access to opioid replacement therapy Rural GPs are cautious to become opioid prescribers
Limited response options for people suffering a drug Absence of specialist mental health units in rural areas induced psychosis
AOD SYSTEM ISSUES (3/3) MAINTENANCE AND AFTER CARE
Limited examples of effective integration between services Better integrated mental health, AOD, primary heath care and community Limited housing options services needed to promote a person’s recovery Limited availability of aftercare / relapse prevention services
32. CROSS-CUTTING SYSTEM ISSUES (1/3) WORKFORCE
Agreed minimum qualifications, knowledge and skills for social support workers required with consideration of capacity development within funding contracts Difficulties in attracting and recruiting Innovative employment models required for social support workers in rural areas appropriately skilled social where small client numbers in any one sector (psychosocial, disability, aged care) support workers and qualified mental health professionals Multiple factors impact on workforce development, recruitment and retention of mental health professionals including access to clinical supervision, career pathways, isolated practice & pay disparities
Limited availability of community based private and public psychiatry People lack access to across the region psychiatrists in the community Referrals to public psychiatric services for diagnostic/ treatment advice in the absence of other options
Mental health nurses and Mental Health Nurse skills and experience aren’t available to people early in the health navigator roles assessment and development of treatment options are evolving and there are opportunities to deploy Role and function of Mental Health Service Navigators is unclear more effectively
There needs to be increased availability of indigenous workforce People need access to a consistent culturally competent workforce The entire workforce needs to be sensitive to the needs of a culturally diverse population including use of interpreters
Inconsistent and under- Attention to development of the peer workforce including education, integration utilised peer workforce with clinical teams and recognition in the system
Regional Mental Health, Alcohol and Other Drugs Plan | July 2019 - June 2021 33. CROSS-CUTTING SYSTEM ISSUES (2/3) INFORMATION SHARING
Service system is fragmented, with many organisations operating in silos
Competition between NGOs inhibits communication
Lack of agreed care pathways Poor communication across the system Many existing partnerships built on personal relationships that are not sustainable
Lack of common language across the system
Lack of commonality in assessment processes
System relies on clients holding and communicating information about their clinical and nonclinical care needs
Vulnerable people may miss treatment or appropriate care Lack of timely and high quality information Concerns around patient confidentiality prevent appropriate patient information sharing between providers being shared leads to poor client outcomes Quality of referrals is highly variable (e.g. not detailed enough, delays, lack of feedback to referring clinicians)
Quality and timeliness of discharge planning is problematic
CROSS-CUTTING SYSTEM ISSUES (3/3) GOVERNANCE, FUNDING AND PATHWAYS
No mechanism across the DDWM region for agencies to come together to plan, monitor and review services and programs
Lack of system-wide KPIs to monitor system performance against outcomes Lack of cross system governance and performance management Poor trust between services
Skepticism about joint planning process
Care pathways are largely dependent on where a person engages with the system rather than their need Lack of clearly defined care pathways Potential duplications and gaps because not looking at whole system in planning and allocating resources
Service and program eligibility criteria are barriers to accessing care People falling through cracks in the health system Appears to be lack of collective responsibility for people with severe mental due to a lack of shared health issues responsibility for specific patient groups High volume of forensic clients in West Moreton region
Services focus on KPIs not outcomes for people Funding mechanisms drives activity not outcomes and short Funding mechanisms focusing on activity don’t facilitate provider collaboration term contracts inhibit sustainable service development Short term funding contracts works against embedding NGO service providers into the service system 34.
Head Office West Moreton Level 1, 162 Hume Street (PO Box 81), Ipswich Corporate Centre, 6th Floor, Toowoomba QLD 4350 16 East Street, Ipswich QLD 4305 P (07) 4615 0900 F (07) 4615 0999 P (07) 3202 4433 F (07) 3202 4411
E [email protected] www.ddwmphn.com.au ABN 51 605 975 602 1711122 1910049