Mental Health Reform Implementation
Needs assessment and planningThis is the second circular for PHNs to support communication in the move towards the establishment of a flexible funding pool and expanded new service delivery arrangements for mental health and suicide prevention services. The first circular focused on transition arrangements for programmes and initiatives to form part of the flexible pool. This second circular seeks to respond to a number of initial queries from PHNs on the development of mental health and suicide prevention needs assessment, on preparing the mental health activity work plans, and on the longer term development of regional mental health and suicide prevention plans. It also provides a summary update on work in progress to support PHNs in relation to their mental health responsibilities.
Approach to mental health needs assessment and planning.A key role for PHNs is to be leading mental health and suicide prevention planning and integration at a regional level in partnership with LHNs and other key regional stakeholders, consistent with the Government Response to the Review of Mental Health Programmes and Services. In this context the development over time, commencing in 2016-17, of regional mental health and suicide prevention plans through a robust consultation process and informed by regional needs assessments will be encouraged. Regional mental health and suicide prevention plans will offer the potential to guide and support a broader regional model of stepped care, support the process of integration with state services, facilitate the development of new pathways, make optimal use of available workforce and resources as well as helping to target investment by PHNs in mental health and suicide prevention activity.
In the 2015-16 financial year, PHNs are required (through the recent mental health schedule which provided operational funding to PHNs this financial year) to prepare a regional operational mental health and suicide prevention plan by May 2016. The Commonwealth recognises that the capacity to develop a detailed plan within this time frame may be limited, particularly given development will require the establishment of new partnerships, relationships and significant community consultation. This initial plan therefore is expected to focus more on how the PHN itself will operationalise its new role in mental health, transition arrangements to taking on new funding roles, and priorities against new funding streams, particularly in areas such as suicide prevention. The plan should also support a stepped care approach to mental health, with a range of service types identified in the region to address individual and local population need. The plan should highlight opportunities for working closely with government agencies, non-government and private organisations, consumers and carers in order to achieve a more integrated, coordinated and comprehensive system of mental health services across the PHN region.
It is anticipated the regional operational mental health and suicide prevention plan will be linked to and consistent with the broader PHN Activity Work Plan which is also due for submission to the Department on 6 May 2016.
The initial regional operational mental health and suicide prevention plan will be informed by the needs assessment due 30 March 2016 which is currently being undertaken by PHNs. It is expected that a specific mental health needs assessment will be developed by PHNs which will explore mental health and suicide prevention priorities against those areas of activity which the Government has articulated for PHNs, and in consultation with key stakeholders.
This circular clarifies expectations for the needs assessment, consultation and broad content of the 2015-16 regional operational and suicide prevention plan to help guide activity to June 2016 and outline the planned mental health services to be commissioned from 1 July 2016. As with all mental health and suicide prevention activity, expectations for both the needs assessment and the regional operational and suicide prevention plan are closely linked to the six key objectives of PHN mental health and suicide prevention activity. These six areas are summarised in the objectives in Attachment A to this circular.
Key needs assessment and planning deliverables for 2015-16 and anticipated related deliverables for 2016-17 are detailed in the table below. Templates for PHN annual assessment and planning more broadly are under development and can be utilised for mental health related deliverables as appropriate.
|Mental Health and Suicide Prevention – key deliverables|
2015-16 RequirementsKey documents that PHNs will be required to deliver in 2015-16 include:
1) Mental Health Needs Assessment (due 30 March 2016)An initial mental health needs assessment report is to be provided to the Department as a complement to the broader needs assessment.
The PHN Needs Assessment Guide (December 2015) available at http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Needs_Assessment_Guide provides an overarching structure for this work, noting that mental health is already included as one of the six key priority areas for PHN action. The following key expectations will apply to the needs assessment.
- PHNs will need to ensure that the mental health component of the needs assessment reflects an increased focus on mental health in line with the Government’s mental health reforms.
- It is important to the Department that the assessment should incorporate a needs analysis relating to Aboriginal and Torres Strait Islander mental health and suicide prevention. The needs assessment should also consider the interface between mental health activity and drug and alcohol services (noting separate assessment arrangements will be in place for new drug and alcohol investment).
- In assessing mental health and suicide prevention needs, the Department’s core expectation will be that needs are assessed within the context of a stepped care approach and against the six key areas of activity articulated in the objectives at Attachment A.
2) Regional operational Mental Health and Suicide Prevention Plan (due 6 May 2016)This should lay the foundation for implementation of a stepped care model in the PHN region. This plan recognises that 2016-17 is a transition year and full flexibility in programme design and delivery will not occur until 2018-19.
The plan should:
- Outline the planned mental health services to be commissioned from 1 July 2016, consistent with the grant funding guidelines (which are currently being finalised; proposed core objectives and eligible use of the funding is summarised at Attachment A, pending finalisation).
- Outline the approach to be undertaken by the PHN in leading the development with regional stakeholders of a longer term, more substantial regional mental health and suicide prevention plan (which is aligned with the Australian Government Response to the Review of Mental Health Programmes and Services (available on the Department’s website). This will include an outline of the approach to be undertaken by the PHN to gain formal agreement to the longer term regional mental health and suicide prevention plan from the relevant organisational signatories in the region.
- Outline the approach to be taken to integrating and linking programmes transitioning to PHNs (such as headspace, and the Mental Health Nurse Incentive Programme services) into broader primary care activities, and to supporting links between mental health and drug and alcohol service delivery.
- Have a particular focus on the approach to new or significantly reformed areas of activity – particularly Aboriginal and Torres Strait Islander health, suicide prevention activity, and early activity in relation to supporting young people presenting with severe mental illness.
In addition, PHNs will be expected to provide advice in their regional operational mental health and suicide prevention plan on how they are going to approach the following specific areas of activity in the following year, and could helpfully outline any activity which will be initiated in 2015-16 to support these areas of activity:
- Develop and implement clinical governance and quality assurance arrangements to guide the primary mental health care activity undertaken by the PHN, in a way which is consistent with section 1.3 of the Primary Health Networks Grant Programme Guidelines available on the PHN website at http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Program_Guidelines.
Additional guidance on quality assurance issues, including relevant mental health service standards, practice standards, legislation and models of engaging appropriate mental health expertise in governance activity will be provided as part of the guidance material foreshadowed for March.
- Ensure appropriate data collection and reporting systems are in place for all commissioned services to inform service planning and facilitate ongoing performance monitoring and evaluation at the regional and national level, utilising existing infrastructure where possible and appropriate (noting a future circular will advise on data and reporting systems and resources for PHNs).
- Develop and implement systems to support sharing of consumer history and information between service providers and consumers, building on the foundation provided by myHealth Record.
- Establish and maintain appropriate consumer feedback procedures, including complaint handling procedures, in relation to services commissioned under the activity.
Value for money in relation to the cost and outcomes of commissioned services needs to be considered within this planning process.
2016-17 RequirementsKey documents that PHNs will be required to deliver in 2016-17, include:
1) Mental Health Needs Assessment (due March 2017)This is intended to build on the initial mental health needs assessment provided to the Department in March 2016. It is expected that the 2017 mental health needs assessment will require substantial revision/updating as additional tools, resources and information becomes available through the year (refer below) and consultations with the mental health sector in the PHN region progress.
The overarching PHN Needs Assessment Guide (December 2015) continues to also apply.
In assessing mental health and suicide prevention needs, the Department’s core expectation will be that needs are assessed against the continuum of stepped care, within the context of broader services available within the region, and against the six key areas of activity articulated in the objectives at Attachment A.
2) Mental Health Activity Work Plan (due May 2017)A mental health focussed activity work plan is to be provided to the Department annually. This activity plan will complement the broader PHN Activity Plan as part of the annual reporting mechanism and will build on the regional operational mental health and suicide prevention plan delivered in 2016.
3) Regional Mental Health and Suicide Prevention Plan – developed with LHNs and other stakeholders (due date - 2017)In addition to the above annual reports, PHNs will be expected to develop a detailed regional mental health and suicide prevention plan.
This Plan should, when completed and agreed, provide a vital resource to state government, non-government and Commonwealth services in the region to support the integrated delivery of mental health and suicide prevention services within the community, and is likely to span a number of years. Whilst the operational workplan is an annual document, we envisage that regional mental health and suicide prevention plans could have a duration of two or more years, with the potential to be updated as required.
These evidence-based mental health and suicide prevention plans should be developed based on comprehensive needs assessment and service mapping to identify gaps and opportunities for the efficient commissioning and targeting of services. Whilst a key component of the Plan will be primary mental health care services, the Plan should also articulate the interface between these services and mental health services provided by State Governments, the NDIS and the non-government and Indigenous health sectors. In consultation with local Aboriginal community controlled health services, it should enable better targeting, integration and access within the region, specifically where Aboriginal and Torres Strait Islander people access mental health care. It should also consider priorities and pathways for suicide prevention in the region, and may include consideration of the needs of other priority groups such as children, youth, people in rural and remote areas or hard to reach groups. It is not anticipated the Plan would encompass in-hospital services or needs, although outpatient services provided by private or public hospitals should be considered.
The plan should address the full range of clinical needs across the region’s population from low intensity care to high levels of care, including those with severe mental illness requiring coordinated care. The Plan should also reflect action that will ensure services are integrated ‘on the ground’ at a regional level, including the development of partnerships with LHNs and other key stakeholders such as non-government organisations, Indigenous organisations, alcohol and other drug services and consumer organisations. The Plan could also articulate innovative approaches to making the best use of available workforce particularly in rural and remote areas.
Further guidance on requirements and format of the regional mental health and suicide prevention plan will be provided by the Department over coming months.
Update on other developments in mental health
- PHNs will have received the initial Schedule to provide supplementary operational funding for PHNs to support preparation for the expanded role in mental health and suicide prevention to commence in 2016-17. This Schedule provided additional funding to cover the 6 month period to June 2016. Further operational funds will be negotiated with PHNs to support their ongoing role in mental health and suicide prevention beyond July 2016.
- The first meeting this year of the PHN Consultative Forum on mental health, took place through which PHNs had the opportunity to teleconference with the Department to ask questions about implementation detail and programme transition arrangements. A further meeting is being organised for early March.
- Development of mental health guidance material for PHNs is underway. Guidance advice is being provided in relation to:
- Stepped care
- Regional mental health and suicide prevention planning
- Providing low intensity mental health services in the context of the digital gateway
- Providing psychological therapies to hard to reach groups
- Child and youth mental health issues – including opportunities for integrating headspace services with other services within a primary care setting, new arrangements for supporting young people with severe illness and opportunities to support professionals working with children with or at risk of mental illness
- Providing services to people presenting with severe forms of mental illness – including information on the role of mental health nurses, and the phased implementation of arrangements for providing packages of care to people with severe and complex illness. This paper will also provide background information on broader arrangements and programmes outside the flexible pool associated with the National Disability Insurance Scheme
- Community based suicide prevention
- Providing mental health services to Aboriginal and Torres Strait Islander people
- Patient data collection in relation to mental health service delivery.
- The Department hopes to have all or most of the above materials available in draft form for the PHN workshop to provide an opportunity for PHNs to comment. Further guidance will be developed in a second tranche of activity, including potential topics such as managing comorbid substance misuse and mental illness, and engaging with consumers and carers in the provision of services, including optimal use of peer workers.
- The Department has also established a stakeholder group to support agile communication with the sector on progress on implementation of mental health reform. It is planned to share documents emerging from this group with PHNs through the portal, including PowerPoint slides. Opportunities for linking this group with the PHN consultative forum or a subset thereof will be considered.
- Lead site applications are currently being processed. A decision on these sites is expected to have been made by the March workshop.
Mental Health dataA range of mental health data (including Australian Bureau of Statistics mental health data and service utilisation data for some Commonwealth-funded programmes) is available on the PHN website at http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Home
Over the coming months, data available on this website will be expanded and will further assist PHNs to plan the appropriate level, mix and type of services for their region.
National Mental Health Service Planning FrameworkThe development of a National Mental Health Service Planning Framework is being progressed to provide a key tool to support planning for mental health services and resource allocation (including at the regional level) in a nationally consistent manner.
Learnings from lead PHN sitesLearnings from lead PHN demonstration sites exploring more complex aspects of the stepped care approach may also inform national roll out in later years. This should be reflected in future regional mental health and suicide prevention plans, as appropriate.
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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 Access to Allied Psychological Services (ATAPS), Mental Health Services in Rural and Remote Areas (MHSRRA), Partners in Recovery (PIR), Day to Day Living (D2DL) or the Mental Health Nurse Incentive Programme (MHNIP) can be directed to Anthony Millgate on 02 6289 7343.
Summary advice on PHN mental health funding objectives
The objectives of the PHN mental health funding are to:
- improve targeting of psychological interventions to most appropriately support people with or at risk of mild mental illness at the local level through the development and/or commissioning of low intensity mental health services;
- support region-specific, cross sectoral approaches to early intervention for children and young people with, or at risk of mental illness (including those with severe mental illness who are being managed in primary care) and implementation of an equitable and integrated approach to primary mental health services for this population group;
- address service gaps in the provision of psychological therapies for people in rural and remote areas and other under-serviced and/or hard to reach populations, making optimal use of the available service infrastructure and workforce;
- commission primary mental health care services for people with severe mental illness being managed in primary care, including clinical care coordination for people with severe and complex mental illness through the phased implementation of primary mental health care packages and the use of mental health nurses.
- encourage and promote a regional approach to suicide prevention including community based activities and liaising with Local Hospital Networks (LHNs) and other providers to help ensure appropriate follow-up and support arrangements are in place at a regional level for individuals after a suicide attempt and for other people at high risk of suicide;
- enhance and better integrate Aboriginal and Torres Strait Islander mental health services at a local level facilitating a joined up approach with other closely connected services including social and emotional wellbeing, suicide prevention and alcohol and other drug services.
Objectives 1-6 will be underpinned by:
- evidence based regional mental health and suicide prevention plans and service mapping to identify needs and gaps, reduce duplication, remove inefficiencies and encourage integration; and
- a continuum of primary mental health services within a person-centred stepped care approach so that a range of service types, making the best use of available workforce and technology, are available within local regions to better match with individual and local population need.
Activities eligible for funding
- commission evidence-based clinical primary mental health care services in line with a best practice stepped care approach;
- develop and commission cost effective low intensity psychological interventions for people with mild mental illness, making optimal use of the available workforce and technology;
- the phased implementation of approaches to provide primary mental health care to people with severe and complex mental illness which offer clinical support and care coordination, including services provided by mental health nurses;
- establish joined up assessment processes and referral pathways to enable people with mental illness, particularly those people with severe and complex mental illness, to receive the clinical and other related services they need. This will include provision of support to GPs in undertaking assessment to ensure people are referred to the service which best targets their need;
- develop and commission region-specific services, utilising existing providers, as necessary, to provide early intervention to support children and young people with, or at risk of, mental illness. This should include support for young people with mild to moderate forms of common mental illness and also early intervention support for young people with moderate to severe mental illness, including emerging psychosis and severe forms of other types of mental illness;
- develop and commission strategies to target the needs of people living in rural and remote areas and other under-serviced populations; and
- develop evidence based regional suicide prevention plans and commission activity consistent with the plans to facilitate a planned and agile approach to suicide prevention. This should include liaison with LHNs and other organisations to ensure arrangements are in place to provide follow-up care to people after a suicide attempt.