Outcome 11 - Mental Health

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Improved mental health and suicide prevention, including through targeted prevention, identification, early intervention and health care services

Major Achievements

Implementation of the 2011-12 Budget Delivering National Mental Health Reform package, including:

• announcing 15 new headspace locations and two outposts as well as almost doubling the average funding each existing headspace site receives;
• significantly increasing the funding to Medicare Locals and Divisions of General Practice to provide access to psychological services for hard to reach groups;
• surpassing the 2011-12 expansion target of 600 participating schools for the KidsMatter Primary initiative;
• working with states and territories to finalise projects to be funded under the new National Partnership Agreement, with all agreements finalised by 30 June 2011;
• rolling out measures aimed at tackling suicide including providing free calls from mobiles to Lifeline; and
• finalising the National e-Mental Health Strategy and launching the new single online e-mental health portal, called mindhealthconnect.

Challenges

• Managing complex stakeholder views and needs in developing a Ten Year Roadmap for National Mental Health Reform.

Outcome Strategy

Outcome 11 aims to improve services and support for people with mental illness, their families and carers. The Department worked to achieve this Outcome by managing initiatives under the program outlined below.

Program 11.1: Mental Health

Program 11.1 aims to improve the capacity of the mental health system to provide better coordinated and integrated care across the spectrum of severity of mental illness. The Program also aims to strengthen primary mental health care; strengthen mental health services for children and young people; improve the transparency and accountability of mental health services nationally and develop strategies to reduce the impact of suicide.

The Government is delivering on its commitment to make mental health a priority, with recent investment totalling $2.2 billion over five years from 2011-12, including $1.5 billion in new measures. The reforms are focused on improving the lives of thousands of Australians experiencing mental illness – better detection, better targeting and better coordination.

The Delivering National Mental Health Reform package is a cross-sector reform package that recognises the diverse impact of mental illness throughout a person’s lifetime and will build resilient children, support teenagers and families dealing with the challenge of mental illness, improve access to primary care and target more community-based services to people living with severe mental illness and their families.

The Department is finalising a Ten Year Roadmap for National Mental Health Reform (the Roadmap). The Department is working with states and territories and other Australian Government departments, including the Department of the Prime Minister and Cabinet. At its meeting of 13 April 2012, COAG noted that work on the draft Roadmap is continuing and that all governments would consider the Roadmap later in 2012.

Investment in More and Better Coordinated Services for People with Severe Mental Illness

In 2011-12, the Department progressed elements of the 2011-12 Budget Delivering National Mental Health Reform package, which target people with severe and persistent mental illness and provide for the broad range of their clinical and other needs.

During 2011-12, the Department consulted widely and worked with key stakeholders to develop a model for the Partners in Recovery initiative that will support effective collaboration across multiple service sectors. This initiative will bring together the various services and supports required to meet the complex needs of people living with severe and persistent mental illness in a more coordinated and integrated way. An Expert Reference Group has been providing cross-sectoral leadership and guiding the development and implementation of the initiative. Commissioning work for tools and resources to support the initiative, including assessment frameworks and partnership building and governance tools, is underway.

Additional funding was rolled out in January 2012 to expand the capacity of existing services to improve the quality of life for individuals with severe and persistent mental illness by providing places in structured and socially based activities. An extra $19.3 million over five years was provided to expand the Day to Day Living in the Community Program.

The additional funding was allocated to the existing ‘Support for Day to Day Living in the Community: A Structured Activity Program’ sites to meet an increase in service demand. The funding is available through new funding agreements spanning 1 January 2012 to 30 June 2015. All services have received an approximate increase of 30% on their previous funding levels to reflect increased costs and service expansion.

With additional funding provided from January 2012, service providers have been able to offer additional services to people living with a severe and persistent mental illness.

Additional funding provided from January 2012 has resulted in more services being provided and more people able to access the Support for Day to Day Living in the Community Program.

Expansion of the Early Psychosis Prevention and Intervention Centre Model (EPPIC)

The Department worked with all state and territory governments to plan for the establishment of up to 16 youth early psychosis services based on the EPPIC model. The EPPIC model provides intensive clinical and non-clinical support for young people experiencing first episode psychosis, promoting early detection and management and provides holistic support including help with management of housing, educational and employment goals. It is anticipated that youth early psychosis services will commence in 2012-13.

National Partnership Agreement (NPA) Supporting National Mental Health Reform

The NPA was agreed by the Council of Australian Governments in April 2012, and will particularly benefit people with severe and persistent mental illness who are frequent users of emergency departments and need stable accommodation to keep well and break the cycle of hospitalisation and homelessness. Priority areas of activity under the NPA include stable accommodation and support for those with mental illness; and presentation, admission and discharge planning in emergency departments and major hospitals, and related support services.

Strengthening Primary Mental Health Care

In 2011-12, the Department completed the transition of the fund holding arrangements for the Access to Allied Psychological Services (ATAPS) Program from Divisions of General Practice to Medicare Locals with all funding agreements in place to 30 June 2014. Medicare Locals have also been provided with new resources and training to support the expanded delivery of services under the ATAPS Program. The Department will continue to work with Medicare Locals to support appropriate targeting and integrated service delivery within the local primary care system. This includes the development of partnerships and linkages with state primary care services, particularly for services targeting children and their families and Aboriginal and Torres Strait Islander peoples.

The 2011-12 Budget reforms to Medicare subsidised mental health services under the Better Access to Psychiatrists, Psychologists, and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative were implemented. Time-tiered rebates for GP Mental Health treatment plans were introduced from 1 November 2011. Changes to the number of allied health services available were also introduced, with transition arrangements in place between 1 March and 31 December 2012 to allow time for providers and consumers to adapt to these changes and for new mental health services to be established and build capacity to meet the needs of people with more complex needs.

The Better Access initiative provided over 5.9 million Medicare subsidised mental health services during 2011-12. This included over 786,000 rebates for GP Mental Health Treatment Plans, almost 1.4 million Medicare subsidised psychological therapy services provided by clinical psychologists, almost 2.3 million Medicare subsidised Focused Psychological Strategies services provided by registered psychologists, occupational therapists and social workers, and almost 133,000 Medicare rebateable psychiatry services.

To complement primary mental health care, the Department established an expert e-mental health committee which provided advice on the design of an e-mental health portal. The Department contracted the National Health Call Centre Network to build and operate this portal. The portal, operational in June 2012, will improve access to authoritative mental health information, online therapy and psychosocial support services for people with mental health concerns and conditions. Australians will be able to access effective online therapy and information any time of the day, without the need to travel and can do so anonymously. The portal will provide people the option of a guided search to assist them to the most appropriate services for their needs.

In 2011-12 incentive payments under the Mental Health Nurse Incentive Program continued to be made available to general practices, private psychiatrist services, Divisions of General Practice and Aboriginal and Torres Strait Islander Medical Services to engage credentialed mental health nurses to coordinate clinical care for people with severe and persistent mental illness. A total of $36.5 million was spent on the program in 2011-12. Support provided under this initiative targets patients with severe and persistent mental illnesses living in the community during periods of significant disability.

In 2011-12 funding agreements were executed with all 61 Medicare Locals for ongoing and additional psychological strategies services under the ATAPS Program to 30 June 2014. This included additional funding for services for children and their families, and culturally appropriate services for Aboriginal and Torres Strait Islander peoples.

The e-mental health portal went live on 29 June 2012, providing Australians with access to authoritative mental health information and a range of automated online cognitive behavioural therapy services for high prevalence mental health disorders.

During 2011-12, there were 35,950 people referred to ATAPS, resulting in over 152,450 sessions of care provided.

100% of operational Divisions of General Practice/Medicare Locals have the capacity to provide services to this target group.

Boosting Services for Children and Young People

Inadequate prevention and early intervention investment can contribute to a lifetime of disadvantage caused by chronic mental illness. The Government is strengthening its focus on prevention and early intervention, especially for children and young people, through creating partnerships between family support and health services and expanding on a significant scale proven models of mental health care such as headspace.

In 2011-12 all Medicare Locals received funding to establish and expand services for children and their families. Operational guidelines have been developed in consultation with stakeholders, and distributed to Medicare Locals to inform service planning.

In 2011-12 Divisions of General Practice and operational Medicare Locals received funding to provide services to children. There were 1,371 child referrals for ATAPS which resulted in the provision of 5,660 sessions of care.

The principal consideration in transitioning the ATAPS Program from Divisions of General Practice to Medicare Locals was to maintain service continuity to new and existing clients during the transition period. The transition process involved consultative transition planning to address local situations and needs while focusing on minimising disruption to service delivery. All Medicare Locals were advised of their funding allocations for child mental health services to 30 June 2014 early in 2012, and the ATAPS Program was successfully transitioned by 30 June 2012.

In 2011-12, more than 70% of Divisions of General Practice provided services to children under the ATAPS Program.

All locations identified for the first 40 headspace sites are fully operational. In October 2011, locations for a further 15 headspace sites were announced, and these are expected to be operational by early 2013.

Ten new headspace sites were opened during 2011-12, allowing better access to services for more young people.

Existing Child and Youth Mental Health Programs

When the signs of mental illness are identified early in very young children and they and their families are supported with appropriate services, children are more likely to develop resilience and learn life skills that support them to participate fully in society as they grow up.

In 2011-12, the Department continued to improve the mental health and emotional wellbeing of Australian children through the expansion of the KidsMatter Primary initiative.

KidsMatter is proven to make a positive difference to children’s mental health and learning. It supports mental health promotion, prevention and early intervention for all children through universal evidence-based primary school and early childhood programs.

The KidsMatter Primary initiative grew from 427 to 793 participating schools, which includes the 101 schools that participated in the pilot during 2007 and 2008. By June 2014, KidsMatter Primary will be expanded to 2,000 primary schools across Australia. In addition to KidsMatter Primary, KidsMatter Early Childhood was piloted in over 100 preschools and long day care centres nationally in 2010 and 2011.

The MindMatters initiative continued to be implemented in many secondary schools throughout Australia. Through targeted programs, the Department also continued to support children and youth at high risk of mental health difficulties such as children of parents with a mental illness, Aboriginal and Torres Strait Islander children, and children who have experienced trauma, loss or grief.

Suicide Prevention

In September 2011, the Australian Health Ministers Conference formally endorsed the LIFE Framework as the overarching national framework for suicide prevention in Australia.

In 2011-12, the Department implemented 74 suicide prevention specific projects with funding provided through the 2010 Mental Health: Taking Action to Tackle Suicide package and the National Suicide Prevention Program. These projects aim to reduce the incidence of suicide and self-harm, through targeted and select interventions for those at high risk, and promote mental health and resilience.

The Department continued to focus on groups identified as being at highest risk of suicide under the National Suicide Prevention Action Framework. High risk target groups include those bereaved by suicide, Aboriginal and Torres Strait Islander peoples, people living with mental illness, men, young people, rural and remote populations and gay, lesbian, bisexual, transgender and intersex people. Since 2008, around 4,500 people at risk of suicide or self-harm, including those who have previously attempted suicide, have received more than 26,000 services through the Access to Allied Psychological Services (ATAPS) Program delivered by Divisions of General Practice and Medicare Locals.

The Department has commenced developing Australia’s first Aboriginal and Torres Strait Islander Suicide Prevention Strategy. It is expected the strategy will be completed in 2012.

The Mental Health: Taking Action to Tackle Suicide package set aside $6 million over 2011-12 to 2014-15 to specifically address Indigenous suicide. As part of this investment, the Department has funded five culturally appropriate suicide prevention projects in 2011-12, and will call for applications from across Australia for remaining funds in 2012-13.

In 2011-12 the Department commenced a comprehensive evaluation of suicide prevention projects under the National Suicide Prevention Program and the Mental Health: Taking Action to Tackle Suicide package. During 2012-13, priorities for the Department will include the completion of the Aboriginal and Torres Strait Islander Suicide Prevention Strategy and the evaluation of suicide prevention activities, in consultation with stakeholders, state and territory governments and the Australian Suicide Prevention Advisory Council.

In 2011-12, implementation of the Mental Health: Taking Action to Tackle Suicide package has been a priority of the Department. A number of existing projects have been expanded such as StandBy Response Service project. A range of new suicide prevention initiatives have also been implemented, including the headspace school support measure.

The Department also continued to co-chair the National Suicide Prevention Working Group; a joint planning mechanism under the Fourth National Mental Health Plan for the Australian Government and state and territory governments.

In 2011-12, the Department established 17 nationally significant suicide prevention projects with funding provided through the 2010 Taking Action to Tackle Suicide package and continued to support 54 projects under the National Suicide Prevention Program. These projects aim to reduce the incidence of suicide and self-harm, and to promote mental health and resilience across the Australian population.

Additionally, Indigenous communities are supported with five culturally appropriate suicide prevention projects which commenced in 2011-12. This represents an initial investment from funds quarantined specifically for Indigenous suicide prevention activity under the Taking Action to Tackle Suicide package.

Whole of Program Performance Information

A summary report on the results of the Second National Survey of People Living with Psychotic Illness was released in November 2011. This provides data on the prevalence of psychosis, and information on the health and wellbeing, housing and employment of those being treated for psychosis, as well as information on the various services people receive. This complements the data of the 2007 National Survey of Mental Health and Wellbeing, conducted by the Australian Bureau of Statistics, which provided data on the prevalence of common mental health disorders and services used in the general population aged 16-85 years.

Work on the second child and adolescent component of the survey started in June 2012 with field work to be completed by the end of 2013. The information obtained from the survey will enable the Commonwealth, state and territory governments and mental health service providers to plan appropriate services for children and adolescents with mental health problems and disorders, to determine the need for additional services and what these might be, and to benchmark progress in achieving national and jurisdictional goals in promoting the social and emotional wellbeing of children and adolescents.

In 2011-12, there was strong stakeholder participation in the development of implementation planning for each measure under the Budget package. For instance, the Partners in Recovery initiative included stakeholder workshops, discussions with states and territories, and the establishment of an expert reference group to provide cross-sectoral leadership and advice to inform the development of the initiative. Stakeholders were also consulted of the revision to the Mental Health Statement of Rights and Responsibilities and the development of a National Recovery Framework. A sixth National Seclusion and Restraint Forum was held in October 2011 and a National Recovery Forum on 21-22 June 2012.

The underspend is mainly due to the Virtual Clinic and other Teleweb projects not commencing in 2011-12, due to the requirement to design the e-mental health portal first. The portal, mindhealthconnect was launched on 29 June 2012. The remaining underspend relates mainly to delays in implementation of some mental health programs including scoping of requirements and associated procurement activities for training in child mental health services and infrastructure projects at suicide hotspots.

Outcome 11 – Financial Resources Summary

1. Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.
2. ’Expenses not requiring appropriation in the current year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information.

129. Data entry delays have occurred as a result of Division of General Practice transitioning to Medicare Locals which may have resulted in a significant under representation of the number of clients and services provided under ATAPS. Revised figures will be reflected in the next annual report.
130. Data entry delays have occurred as a result of Division of General Practice transitioning to Medicare Locals which may have resulted in a significant under representation of the number of clients and services provided under ATAPS. Revised figures will be reflected in the next annual report.

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