Mental Health Reform ImplementationOn 26 November 2015 the Australian Government released its Response to the Review of Mental Health Programmes and Services. PHNs will play a key role in the reform process particularly through the planning and commissioning of primary mental health services at a regional level, supported by a flexible funding pool for mental health and suicide prevention services.
Circular 1/2016 - Questions and Answers for Primary Health Networks (PHNs)
The Department will work closely with PHNs in the transition to the new arrangements. Regular circulars, providing advice on key developments or on issues of concern to PHNs, will be an important element of communication through the transition period. These circulars will supplement communication taking place through the regular CEOs teleconferences organised by PHN Establishment Branch, and the less formal PHN Mental Health Consultative forum which will meet by teleconference to discuss implementation details during the transition period.
This first circular seeks to respond to a number of initial queries from PHNs on programme transition arrangements and the next steps in implementation.
The Department is currently developing programme guidelines to provide parameters for PHNs on the use of new flexible funding arrangements. The Department also remains committed to developing more detailed guidance and programme support for PHNs to support new areas of responsibility by the end of March.
FUNDING AND PROGRAMME TRANSITION ARRANGEMENTS
What arrangements have been put in place to advise organisations currently directly funded by the Department that their funding is transitioning to PHNs?There will be a period of transition as existing funding arrangements between the Department and organisations are replaced by commissioning arrangements through the flexible fund managed by PHNs.
As a first step, the Department has now provided all funded organisations with advice on funding arrangements to apply to their project from 1 July 2016. This has included information on whether the relevant funding stream which supports funding to organisations is continuing, transitioning to PHNs or whether other transitional arrangements are to be developed. PHNs have been informally advised of arrangements for many of these projects, and provided with detailed information on those projects transitioning to them.
In summary the arrangements which are most relevant to PHNs are as follows:
Mental Health Nurse Incentive Programme (MHNIP) – MHNIP funding will form an integral part of the care packages for people with severe and complex mental illness. Funding for the Programme will transition to the PHN flexible funding pool in 2016-17, however, to support continuity of service a transition period of 12 months has been put in place to support current service providers and patients. This means that PHNs will be required to contract existing providers to continue delivering mental health nursing services in 2016-17. Over the next three years, the intention is to address the maldistribution of mental health nursing services provided through the MHNIP programme. To commence this process, some modest additional funding is being made available in the 2016-17 year to support PHNs most disadvantaged by the maldistribution. More information on this will be provided.
Partners in Recovery and Support for Day to Day Living Programmes – The Partners in Recovery Initiative and Day to Day Living programme are in scope to transition to the National Disability Insurance Scheme (NDIS). The NDIS will begin expanding from existing trial sites from 1 July 2016, with national coverage to be achieved by 30 June 2019. Bilateral negotiations are currently underway to agree transition arrangements. These programmes do not form part of the PHN flexible funding pool.
A decision has been made by the Minister to extend the PIR and D2DL programmes for three years to support transition to the NDIS. Further information on programme arrangements from 1 July 2016 will be provided shortly.
Mental Health Services in Rural and Remote Areas (MHSRRA) – a small number of MHSSRA projects are currently funded through organisations other than PHNs. In these cases, organisations have been advised the funding will form part of the flexible funding pool through PHNs from 1 July 2016. Funding arrangements for the Cape York Wellbeing Centres are yet to be determined.
Suicide prevention – projects which have been recipients of grants for community based funding activity have been advised that from 1 July 2016 their funding agreements will cease and the funding stream for community suicide prevention will be provided to PHNs as part of the flexible mental health pool to support suicide prevention priorities. PHNs will have flexibility in decision making about regional suicide prevention activity and are not necessarily required to continue current project activity unless it is a priority for the region. It is anticipated that future commissioning of suicide prevention activity will be informed by regional planning processes. PHNs may wish to indicate this to any organisations approaching them for funding. National, population level suicide prevention project activity is the subject of other funding arrangements and processes to be managed by the Department, including some limited tender activities.
PHNs will receive more detailed guidance to support their role in suicide prevention. In general, PHNs will be encouraged to support suicide prevention on two levels. Firstly, PHNs will use their partnerships with LHNs and other organisations to help to inform appropriate planning of mental health and suicide prevention services and pathways.
Secondly, PHNs will use the flexible funding pool to commission suicide prevention activity at the regional level to address key priorities and gaps emerging from the planning process. It is expected that both roles would include a focus on ensuring there is adequate followup arrangements in place for individuals upon discharge from hospital after a suicide attempt or who otherwise are known to be at very high risk of suicide.
Headspace and Early Psychosis funding – headspace has been advised that funding for local headspace sites is transitioning to PHNs from 1 July 2016, and that PHNs will be asked to continue current sites and services for a two year period. headspace has also been advised that funding for Early Psychosis services is being transitioned to PHNs. Arrangements for the transitioning of the existing six early psychosis services to support continuity of care for young people receiving services are still being resolved in consultation with headspace and other relevant stakeholders. Further information on headspace is provided later in this circular.
What elements of the mental health pool will be flexible? And to what extent will funding be tied to existing activity in the first year?As foreshadowed through the above advice and in the response, there will be some areas where transition arrangements will result in limited flexibility for a period of time. In general in 2016-17 there will be less flexibility than in future years. Activity including headspace sites, early psychosis services, and MHNIP will require some funds to continue to target particular activities and providers. There will be increased flexibility in the approach to targeting hard to reach groups currently targeted by ATAPS and MHSRRA, particularly with a view to developing more efficient and affordable models of low intensity support to these groups. However, PHNs may also wish to implement transitional arrangements for these programmes which support continuity of care. The Department does not require any ATAPS services to be discontinued from 1 July 2016, given these services are consistent with the intent of the focus on hard to reach groups. It will be important for PHNs to utilise their regional mental health plans in future commissioning of services.
The impact of the mental health reform package on the PHN workforce is significant. What is the planned approach to support increased staffing and infrastructure?The Department remains committed to providing some operational funding commencing this financial year to PHNs to support change management and planning for the new commissioning role to commence in relation to mental health from July 2016. The intention would be that this funding would assist developing an initial mental health and suicide prevention plan in consultation with local LHNs, community representatives and other providers to support activity in 2016-17. It is anticipated that the funding will support every PHN to have the capacity to recruit the equivalent of one or more dedicated operational staff. We are currently liaising with Grant Services Division on the best approach to operationalise this funding. It is envisaged that this funding will be added to the current PHN operational funding.
Will flexible funding provided to PHNs be quarantined to mental health?The flexible funding pool has been established for the commissioning of primary mental health services only. The pool will be quarantined from other PHN funding specifically for this purpose, but within the pool, funding can be used flexibly dependent upon identified community need. Additional funding to support integration of Indigenous mental health and other services will be further quarantined. Programme guidelines are currently under development for the utilisation of funds within the pool and it is anticipated will form an annexure to the PHN Grant Programme Guidelines.
When will guidance material be provided to support PHNs in their role?Detailed guidance material is being scoped to support PHNs in their expanded mental health role in relation to the six priority areas of activity. This may include suggestions for approaches and/or best practice models to assist PHNs in addressing their key mental health objectives. Guidance will be provided in such a way that does not stifle flexibility or innovation and does not unnecessarily increase regulatory burden. It is anticipated the more detailed guidance will be provided to PHNs by the end of March 2016.
LEAD SITES FOR ROLLOUT OF STEPPED MENTAL HEALTH CARE APPROACH
When will lead sites for the rollout of stepped care be identified?An Expression of Interest (EOI) was circulated to PHNs immediately prior to Christmas, with the aim of selecting up to eight lead sites. The Department aims to have the EOI settled within the coming weeks.
In addition to the mental health integration and commissioning role that all PHNs will play, PHN lead sites will be established to trial more complex aspects of the stepped care approach and to inform the national roll out in later years.
Key functions of lead sites will be:
- Establishing models for the development of regional community mental health and suicide prevention plans in collaboration with Local Hospital Networks, non-government organisations, National Disability Insurance Scheme providers, and other related services and organisations.
- Demonstrating models of stepped care, including coordinated clinical care for people with severe mental illness who are managed in primary care; and models of early intervention low intensity mental health care, such as ‘coaching’ services.
PROGRAMME TRANSITION ARRANGEMENTS
What are the transition arrangements for headspace?From 1 July 2016, the headspace and early psychosis youth services programmes will be rolled into the PHN flexible funding pool. This will enable PHNs to lead a more integrated and equitable approach to youth mental health services within their regions.
It is expected that PHNs will continue to operate headspace centres at current sites for two years. This will include maintaining the headspace branding.
headspace National Office and relevant PHNs will work together to jointly identify lead agencies for those centres currently led by PHNs, new locations to be established in 2016 and in any other circumstances where a new lead agency needs to be appointed.
Further details on transition arrangements will be negotiated and confirmed in future correspondence.
What will be the role of headspace National Office?Negotiations are underway with headspace regarding the role National Office will play beyond June 2016.
Further advice will be provided on the transition arrangements for early psychosis services and the role of headspace in relation to these services.
NATIONAL LEADERSHIP IN MENTAL HEALTH REFORM
How will the Commonwealth policy reforms interact with state and territory mental health plans, and the forthcoming National Mental Health Plan (and when is the latter expected to be available)?The Fifth Plan is currently being drafted in collaboration between governments. It will aim to articulate nationally agreed priority areas and actions for the next five years to achieve an integrated mental health system.
The Commonwealth will seek the support of states and territories in delivering enduring reform in key areas which align with the response.
What work is being done by the Commonwealth to develop mental health data, particularly in relation to treatment rates? Can an update be provided on the work of the Mental Health Information Strategy Committee on the development of the National Minimum Data Sets for Mental Health Care work programme, and to what extent will PHNs be able to participate in that development work, noting this data will be required to inform one of the 4 national KPIs for PHNs.The arrangements for mental health data capture and management in relation to treatment rates are unchanged at present in accordance with the Australian Mental Health Outcomes and Classification Network (AMHOCN) and National Outcomes and Casemix Collection (NOCC) arrangements under the overall guidance of the Mental Health Information Strategy Standing Committee (MHISSC). The Department understands that a framework for reporting on the progress of mental health reform is scheduled on the MHISSC agenda for discussion.
Arrangements for further developing data collection to support the role of PHNs in mental health and assist reporting requirements are currently being considered and will be the subject of future advice.
FURTHER INFORMATIONPlease contact firstname.lastname@example.org.
Queries on the overall implementation of the mental health reforms or the Mental Health PHN Consultative Forum can also be directed to Colleen Krestensen (02 6289 3698), Monique Machutta (02 6289 2554) or through the existing PHN Establishment Branch contacts.
Specific queries relating to the transition of youth mental health services and suicide prevention services can be directed to Emma Gleeson, on 02 6289 5327.
Queries relating to ATAPS, MHSRRA, PIR, D2DL or the MHNIP programme can be directed to Anthony Millgate on 02 6289 7343.