Fourth national mental health plan: an agenda for collaborative government action in mental health 2009-2014

Priority area 3: service access, coordination and continuity of care

Page last updated: 2009

Outcome
Summary of actions
Cross-portfolio implications
Indicators for monitoring change
Discussion

Outcome

There is improved access to appropriate care, continuity of care and reduced rates of relapse and re-presentation to mental health services. There is an adequate level and mix of services through population-based planning and service development across sectors. Governments and service providers work together to establish organisational arrangements that promote the most effective and efficient use of services, minimise duplication and streamline access. Top of page

Summary of actions

  • Develop a national service planning framework that establishes targets for the mix and level of the full range of mental health services, backed by innovative funding models.
  • Establish regional partnerships of funders, service providers, consumers and carers and other relevant stakeholders to develop local solutions to better meet the mental health needs of communities.
  • Improve communication and the flow of information between primary care and specialist providers, and between clinical and community support services, through the development of new systems and processes that promote continuity of care and the development of cooperative service models.
  • Work with emergency and community services to develop protocols to guide and support transitions between service sectors and jurisdictions.
  • Improve linkages and coordination between mental health, alcohol and other drug, and primary care services to facilitate earlier identification of and improved referral and treatment for mental and physical health problems.
  • Develop and implement systems to ensure information about the pathways into and through care is highly visible, readily accessible and culturally relevant.
  • Better target services and address service gaps through cooperative and innovative service models for the delivery of primary mental health care. Top of page

Cross-portfolio implications

To support a collaborative whole of government approach, these actions will require work across state, territory and Commonwealth governments, including work with acute health, community mental health, community support, income support, housing, Indigenous, primary care, alcohol and other drug services and justice programs.

Indicators for monitoring change

  • Percentage of population receiving mental health care
  • Readmission to hospital within 28 days of discharge
  • Rates of pre-admission community care
  • Rates of post-discharge community care
  • Proportion of specialist mental health sector consumers with nominated general practitioner *
  • Average waiting times for consumers with mental health problems presenting to emergency departments *
  • Prevalence of mental illness among homeless populations *
  • Prevalence of mental illness among people who are remanded or newly sentenced to adult and juvenile correctional facilities * Top of page

Discussion

The past few years have seen major changes in how mental health services are provided in primary care, especially through the development of initiatives such as the Better Outcomes in Mental Health Care program and the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative. These initiatives recognised that people commonly present to their general practitioner with mental health problems, and provided increased access to psychological treatments funded through the Medicare Benefits Schedule.

A number of state/ territory based initiatives also provide enhanced support to primary care. These developments recognised the high prevalence of mental health problems, and also the need to improve physical health care for those who experience mental illness. There has also been expansion of living support services provided by non-government organisations in the community which complement the treatment and care provided by clinical mental health services.

These initiatives have greatly increased the range of services provided, including models that cross sectors such as 'step up/step down' facilities located within community settings but with strong input by clinical staff. There have been improvements in design and amenity - for example, through the development of dedicated areas within emergency departments, or consideration of gender specific issues in bed based hospital and community units. The need for services which respond to particular groups or issues such as mother/baby units, secure forensic units or services for people with personality disorders also need consideration.

However, despite increased funding to primary and specialist services, treatment rates for people with mental illness remain low compared with the prevalence of illness. For access to the right service to be improved, there needs to be an agreed range of service options, across both health and community support sectors. This should be informed by population based planning frameworks that specify the required mix and level of services required, along with resourcing targets to guide future planning and service development that are based on best practice evidence.

A nationally agreed planning framework would also include delineation of roles and responsibilities across the community, primary and specialist sectors, including the private sector, and consideration of the workforce requirements to deliver the range of services. Some service planning work along these lines has been commenced at a state/ territory level - in New South Wales and Queensland in particular - and provides a foundation for building a comprehensive national service planning framework for mental health services.

In order to use the service system most effectively and appropriately, there is a critical need for links between and within sectors. Within the specialised mental health system, access pathways should be clear, and consumers, their families and carers engaged so that they can make an informed choice regarding the most appropriate service. This may be particularly important in those illnesses where recurrence or relapse is likely, so that consumers and their carers can access care as early as possible. Service providers need to inform consumers about how to re-access their service when doing discharge planning. There needs to be better coordination between the range of service sectors providing treatment and care, to promote continuity and lessen the risk of dropping out of services at periods of transition. These include both across the life span, and also in particular groups such as those in the justice system, children in protective services, and those with chronic physical illness or disability.

Top of pageThis connectivity and collaboration needs to be embedded across sectors including the public and private, primary and specialist, clinical and community living support sectors, and coordinated at a local or regional level, recognising that the service mix will vary, given the diversity of Australian communities across metropolitan, rural and remote areas.

Services will work in more collaborative ways if there is greater understanding and respect across and within sectors, and if funding supports flexible and responsive models rather than discrete and often rigid silos. There are particular areas of tension in this area, such as transport of people experiencing acute mental illness, access to inpatient units when demand is great, and management of people who may be acutely ill or intoxicated or both in an emergency department setting. How such tensions are resolved will depend on the development of local solutions backed by good collaboration between sectors and recognition of roles, responsibilities and limitations. Consumers and carers should routinely be involved in such deliberations.

* These indicators require further development