updated activity work plan 2016-2018: primary mental ......updated activity work plan 2016-2018:...

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Updated Activity Work Plan 2016-2018: Primary Mental Health Care Funding

Brisbane North PHN

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1. (a) Strategic Vision

The PHN’s strategic vision is a community where good health is available for everyone. By working with others, we will:

1. Re-orient the health system toward care in our community 2. Achieve a health and community care system responsive to consumer need 3. Target resources to best meet health and community care needs for our region.

Our vision for mental health and suicide prevention in this region aligns to our existing vision and strategic plan under these three goals.

1. Re-orient the health system toward care in our community

A stepped care model requires people receive the level and intensity of care they require and no more; this leaves expensive hospital-based services reserved for those for whom no other form of intervention is appropriate. Our strategic commitment is to invest in and develop community-based treatment services capable of responding to the varying needs of people in our community.

In planning terms, the achievement of this goal requires close collaboration with all parts of the mental health system. This goal in mental health is already well progressed in our region and further discussed below under governance.

2. Achieve a health and community care system responsive to consumer need

A stepped-care service system can respond to varying levels of consumer need, but this system must also be person-centred and easy to navigate, with connections between various “steps” of care to ensure consumer safety, ease of access and delivery of the right level of care to meet consumers’ needs.

Our commitment is to ensure consumer and family/carer participation in all aspects of commissioning, to ensure the system responds to consumer need.

3. Target resources to best meet health and community care needs for our region

There are a number of service gaps in the stepped-care model in our region, most notably low-intensity services and support for people with severe mental illness. There is also a higher demand and need for services in the Moreton Bay North region. Our commitment is to invest in cost-effective treatment services, across the spectrum of care, and to aim for equity of access geographically.

In planning terms, this goal will be pursued by developing agreement across a wide stakeholder group on the priority areas. A system-wide approach ensures the PHN’s investment is coordinated with the much larger investment occurring through MBS, PBS, private providers, the Queensland Government and Metro North HHS.

Governance

As a company limited by guarantee Brisbane North PHN has a board of directors responsible for overall governance of the organisation, assisted by our Community Advisory Committee and Clinical Council.

The PHN has a Clinical Governance policy and an established clinical governance group for mental health services. This existing group has been reconstituted to cover all of the mental health, suicide prevention and alcohol and other drugs treatment clinical services (see Attachment 1 for Terms of Reference). A specific MHAOD clinical governance framework has been developed.

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The PHN has already established a multi-stakeholder governance mechanism for regional planning in relation to adults with severe mental illness (Collaboration in Mind). In 2016/17 the PHN developed a similar arrangement for children and young people’s mental health and suicide prevention. Over the longer term, the PHN hopes to combine these groups into one regional governance structure, also incorporating our Alcohol and Other Drug (AOD) Partnership Group.

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1. (b) Planned activities funded under the Primary Mental Health Care Schedule

Proposed Activities

Priority Area Priority Area 1: Low intensity mental health services

Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc)

1. Commission low intensity mental health services

1.1 ‘New Access’ service

1.2 Group based supports

1. 3 App based support.

Existing, Modified, or New Activity This activity is an existing activity.

Description of Activity

The aim of this activity is to improve access to low intensity services for people aged 12 years and over.

The PHN will commission structured, time-limited, evidence-based, psychological therapy; delivered by non-clinical staff, through various modalities; targeting hard-to-reach, vulnerable, socially disadvantaged groups, or others experiencing a significant life transition.

The selected providers will provide the following activities with this funding:

1.1 ‘New Access’ service – Mental Illness Fellowship Qld

Face to face assessment followed by up to six sessions (face-to-face/phone/Skype). Consumers are followed up four weeks and six months after end of program.

1.2 Group based supports

Neami National will deliver The Optimal Health Program (OHP)

This consists of 12 sessions:

• 8 x 2-hour weekly face-to-face group sessions (with 8-10 participants)

• 4 x individual coaching sessions delivered via the telephone (in-between group sessions).

A final peer-facilitated review/celebration session occurs 4 weeks after the completion of 12 main sessions.

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The OHP will be delivered 24 times in the 18-month contract period.

There will be at least one program tailored to meet the needs of the following three population groups:

• people who work full time (i.e. an after-hours program)

• people who are on probation or parole with the justice system

• people who identify as LGBTI.

Change Futures will deliver Caring for Residents of Aged Care (CRAC) program

There are two CRAC program options available based on client needs.

Option A: 4 x individual sessions + pyscho education group + peer support group.

Option B: 5 x individual sessions.

Where possible residents will be directed to Option A but Option B is available for those unable to participate in group sessions.

Initially (January-June 2017) the program will be delivered at St Vincent's Health and Aged Care Mitchelton and Bardon facilities. Change Futures Ltd will deliver the program to additional facilities from July 2017-June 2018.

Multicultural Development Agency will deliver Problem Management Plus (PM+)

There are two PM+ program options available based on client needs and preferences. Option A for clients needing individual sessions. Option B for those needing group sessions.

Option A:

7 individual sessions:

• 2 face-to-face assessment and planning sessions

• 5 weekly face-to-face intervention sessions

• telephone support between sessions for clients who require extra level of support

• clients also offered additional support through existing group programs.

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Option B:

7 sessions:

• 2 face-to-face individual assessment and planning sessions

• 5 group support sessions (8-10 participants)

• clients also offered additional support through existing group programs.

The PM+ program will be delivered as an outreach model in various locations across Brisbane North .

Individual support will also be provided in people’s homes or safe place.

1.3 App based support – Hello Sunday Morning

Daybreak program is a 16-week online program for which includes between 32-48 intervention points per participant. Intervention points includes individual access to Daybreak program (2-3 times per week) in the form of:

• Screening, assessment and brief intervention

• self-guided cognitive behaviour Therapy (CBT)

• motivational interviewing

• supportive peer/group network

• 24-hour 7 days a week access to trained coaches. Coaches can escalate complex cases to clinical psychologists and refer clients to more complex treatment in local area as needed.

If people require further access to the program to achieve and maintain goals, 36 weeks of aftercare is available.

Target population cohort

Overall, low intensity psychological services are provided for the following populations:

People with mild mental illness and those in distress who may be at risk of developing a mental illness.

Specific services will prioritise the following populations:

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1.1 ‘New Access’ service People who identify from the following groups:

• Aboriginal and Torres Strait Islander people • people who are culturally and linguistically diverse (CALD) including Refugees • homeless people • people who identify as Lesbian, Gay, Bi-sexual, Transgender and/or intersex (LGBTI) • new parents • walking well • people living in residential aged care • people at risk of social isolation or in transition points.

1.2 Group based supports Neami National People who can use low intensity psychological services to build resilience which includes: • people experiencing mental illness for the first time • people with a moderate to severe mental health condition at risk of relapse • people who are from groups that are hard to reach, vulnerable and socially disadvantaged

including: o Aboriginal and Torres Strait Islander people o people who are culturally and linguistically diverse (CALD) including Refugees o homeless people o people who identify as Lesbian, Gay, Bi-sexual, Transgender and/or intersex (LGBTI) o people who are experiencing a significant life event or transition.

Change Futures • Residents of additional aged care facilities. Multicultural Development Agency • Culturally and linguistically diverse populations, including Refugees .

1.3 App based support

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People who: • are at risk of onset of mental illness or experiencing mild/moderate mood/anxiety disorders

that are driven or exacerbated by risky/harmful alcohol consumption • want to reduce their harmful alcohol consumption and address mild/moderate symptoms of

mood/anxiety disorders • are moving through life transitions including: • starting a new job • expectant new mothers and fathers • people using alcohol as self-medication for depression, anxiety and stress experienced

through general life • individuals who are socially isolated and unable to access face-to-face services or who wish to

access anonymous services.

Consultation

Needs Assessment The needs assessment identified many not-for-profit organisations, telephone and counselling services operating in the PHN region such as Lifeline and beyondblue. Since producing this document many more providers have been identified operating in the low-intensity space, from mutual support groups such as GROW, through online support provided by the Black Dog Institute or Kids Helpline, to more traditional appointment-based counselling services delivered at low cost by professionals with lower qualifications than clinical psychologists. There is a need to better assess the full range of low intensity services operating in the region, and to better understand the extent to which these services operate from an evidence base. Co-design Brisbane North PHN’s assessment has also highlighted the importance of not simply parachuting in new models of care which can further fragment service delivery, but to ensure any procurement increases coordination and connection across the system. Participants at co-design workshops consistently reported the silo nature of services, the fragmented nature of the service system and the need for service and system navigation. Achievement of an effective person-centred, stepped care model requires significant reform, and an understanding of how the various components within low-intensity services operate and coordinate with each other. This means the PHN’s assessment process will identify agencies which are willing and keen to integrate, collaborate and coordinate with other providers.

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Consultation to inform Procurement Strategy: • Online Discussion paper & Survey – Distributed to 750+ people, 400 + visitors to the online site, 60

downloads of discussion paper, 78 (10% response rate) survey responses • Stakeholder meetings – 8 meetings with key stakeholders including Beyond Blue, Sane Australia,

Brook RED, Peach Tree and Institute for Urban Indigenous Health. From the engagement activities we identified three key strategy areas for low intensity mental health services needed in the Brisbane North region:

1. access to low intensity psychological services, in a variety of modalities 2. education and support for GP’s and other primary health and community service providers 3. building the evidence base for low intensity services.

Collaboration

This activity is to be solely implemented by North Brisbane PHN.

Discussions are currently underway between Queensland PHNs and the Queensland Department of Health regarding possibilities for future co-ordinated commissioning or co-commissioning of mental health services. In addition the PHN and Metro North Hospital and Health Service have established a joint project to explore how we might more formally work jointly, including around commissioning.

Duration

January 2017 to 30 June 2018

• planning – July to October 2016 • procurement – November to December 2016 • commencement of service delivery – January 2107.

Coverage Whole Brisbane North PHN region.

Commissioning method (if relevant)

These activities will be wholly commissioned in line with Brisbane North PHN’s Commissioning Framework (see Attachment 2).

Needs are identified through an assessment process, involving the analysis of population health data and community consultation. Solutions to meet these needs are designed in partnership with stakeholders.

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Inclusive processes are used to decide how best to implement these solutions, either through direct intervention or the procurement of services. Services are procured through fair and transparent processes.

These solutions are then evaluated and the evaluation outcomes used to inform further assessment and planning.

Approach to market

Open Tender

A specific Low Intensity Psychological Services procurement strategy was developed (see Attachment 3).

The following providers have been contracted to deliver a service, as a result of the open tender approach:

1.1 ‘New Access’ service – Mental Illness Fellowship Qld

1.2 Group based supports – Neami National, Change Futures, Multicultural Development Agency

1.3 App based support – Hello Sunday Morning

Performance Indicator

Priority Area 1 - Mandatory performance indicators:

• proportion of regional population receiving PHN-commissioned mental health services – low intensity services

• average cost per PHN-commissioned mental health service – low intensity services • clinical outcomes for people receiving PHN-commissioned low intensity mental health services.

No additional local indicators.

Local Performance Indicator target (where possible)

N/A

Local Performance Indicator Data source N/A

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Proposed Activities

Priority Area Priority Area 2: Child and youth mental health services

Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) 2.1 Continue funding to existing headspace sites at existing levels

2.2 Commission services for young people with, or at risk of, a severe mental illness



The aim of this activity is to provide early intervention services for children and young people with, or at risk of developing, mental illness.

2.1 Continue funding to existing headspace sites at existing levels

Lead agencies for the four Headspace centres in our region will be subcontracted to deliver Headspace services. The PHN will work closely with each lead agency to monitor performance and ensure appropriate access and service delivery. In addition, in 2016 the PHN established a quarterly network meeting for all lead agencies and key centre staff. This mechanism will continue in 2017/18 and will contribute to quality improvement and planning processes.


The PHN will commission a holistic, evidence-based, outreach services for hard-to-reach young people, their families, carers and support persons (where relevant)delivered by a multidisciplinary team.

This service will target the hardest to engage young people living in the Moreton Bay North region, aged 12 to 18 years old with, or at risk of developing, severe mental illness.



Young people aged 12 to 25 years old with mild to moderate mental health issues.


Young people aged 12 to 18 years with, or at risk of developing, a severe mental illness who reside in the Moreton Bay North sub-region.

Consultation Needs Assessment

Our needs assessment specifically identified:

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• continue to support the delivery of early intervention services within existing headspace services in the region

• work with stakeholders to develop a local child and youth mental health service plan for commencement after the two-year transition period.

The needs assessment has already identified the Moreton Bay North sub-region as the area of greatest need for young people with, or at risk of developing, a severe mental illness.

Additionally, and subsequent to the submission of our needs assessment, the Department allocated funding to Brisbane North PHN to deliver services for young people with, or at risk of developing, severe mental illness, and so this activity is also addressed here.

Consultation to inform Procurement Strategy:

The following consultation was undertaken to inform the procurement strategy for services for young people with, or at risk of developing, severe mental illness.

• Headspace Centre meetings – meeting with lead agencies and key staff from each headspace centre in the region to workshop ideas for future service provision and local needs

• stakeholder meetings – 25 meetings with stakeholders including Act for Kids, Children’s Health Queensland, Brisbane Youth Services, YourTown, Open Minds, Create Foundation and Mercy Services

• focus Groups – workshops with Caboolture, Nundah and Redcliffe headspace youth reference groups

• Advisory Group meetings – two meetings including workshopping activities with a cross sectoral stakeholder advisory group.

This extensive consultation process informed the procurement strategy for services for young people with, or at risk of developing, severe mental illness and the key service design components as outlines in the description above.

Collaboration

This activity is to be solely implemented by North Brisbane PHN under the guidance of a Children and Young People Mental Health Advisory Group (including Hospital and Health Service, allied health, NGOs, Qld Government agencies, consumers and families).

Discussions are currently underway between Queensland PHNs and the Queensland Department of Health regarding possibilities for future co-ordinated commissioning or co-commissioning of mental

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health services. In addition the PHN and Metro North Hospital and Health Service have established a joint project to explore how we might more formally work together, including around commissioning.

Duration


• July 2016 – June 2018.

2.2 Commission services for young people with, or at risk of developing, a severe mental illness

• planning – July to October 2016 • procurement – November to December 2016 • commencement of service delivery – January 2107.

Coverage


Existing headspace centres are located in Taringa, Nundah, Redcliffe and Caboolture.

2.2 Commission services for young people with, or at risk of, severe mental illness

Moreton Bay North Statistical Area level 4.


These activities will be wholly commissioned in line with Brisbane North PHN’s Commissioning Framework.




Approach to market 3.1 Open Tender

A specific procurement strategy was developed for services for young people with, or at risk of, severe mental illness. As a result of an open tender process, Redcliffe Area Youth Space has been

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subcontracted to deliver this activity. Redcliffe Area Youth Space has two authorised subcontractors, Intercept Family Program and Deception Bay Community Youth Program.


Priority Area 2 – Mandatory performance indicator:

• 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.

No additional local indicators. Local Performance Indicator target (where possible)

N/A


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Proposed Activities

Priority Area Priority Area 3: Psychological therapies for rural and remote, under-serviced and / or hard to reach groups

Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) 3.1 Commission a range of providers to deliver evidence-based psychological therapies to under-serviced and hard to reach groups.



The aim of this activity is to address service gaps in the provision of psychological therapies for people in rural and remote areas and other under-serviced and hard to reach populations, making optimal use of the available service infrastructure and workforce.

This will be achieved by commission a panel of providers to deliver structured, time-limited, evidence-based, psychological therapy; delivered through various modalities.


Our Health Needs Assessment identified the following under-serviced and hard to reach groups as priority target cohorts for this activity:

• people at risk of homelessness • Aboriginal and Torres Strait Islander peoples • culturally and linguistically diverse people • financially disadvantaged people • people experiencing or who have experienced trauma or abuse • children aged 0-11 years-old • people who reside in the Moreton Bay North region • Lesbian, gay, bisexual, transgender and intersex people • people in contact with criminal justice system.

Consultation

Needs Assessment

Our Health Needs Assessment identified the priority as:

• commission suitable providers to deliver mental health services for under serviced groups, specifically where health and service needs have been identified in the Health Needs Assessment.

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Just 0.1% of the Brisbane North PHN population live in ‘outer regional areas’ and no population lives in areas classified as ‘remote’ or ‘very remote’ within our boundary.

Consultation to inform procurement approach:

The following activities were undertaken to inform the procurement of a new service provider panel:

• consumer focus groups – three focus groups sessions with service consumers to gain insight into current service issues and future needs

• provider workshop sessions – current service providers were invited to a workshop session to provide feedback on current program delivery and opportunities for improving service delivery into the future

• PHN staff workshops and survey – staff from the PHN undertook workshops and a survey to provide feedback on current service delivery and to identify opportunities to improve the service delivery

• primary health care survey – a survey was distributed to primary health care providers, including GPs.

Engagement with the sector identified the following current arrangements and needs:

• good GP knowledge and support is vital to a client’s success in navigating the Brisbane MIND program

• success for clients is highly reliant on the ability to build rapport with the service provider • the limit on the number of sessions available impacts on clients and service providers, causes

stress and decreases the effectiveness of support in some cases • providers and clients alike want to see a more holistic approach to supporting clients which

may require services to be delivered by a broader range of providers in a variety of settings.

Collaboration

This activity is to be solely implemented by Brisbane North PHN.


Duration 3.1 Commission a range of providers to deliver evidence-based psychological therapies to under-serviced and hard to reach groups.

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• planning February 2016 – September 2016 • procurement October 2016 – January 2017 • service delivery is ongoing and will continue July 2017 – June 2018.


Continuity of care

Whilst the PHN has undertaken a procurement process to commission a new service provider panel, existing services have been in place for the entirety of the current financial year. Processes for continuity of care for services that have been decommissioned as a result of the recent procurement process are outlined below.






The PHN will continue to provide an administrative intake service for referrals in to this service. All service delivery to patients will be provided by contracted providers.

Approach to market An open tender process has now been completed and has resulted in 109 agencies being subcontracted to deliver services.


Priority Area 3 - mandatory performance indicators:

• proportion of regional population receiving PHN-commissioned mental health services – Psychological therapies delivered by mental health professionals

• average cost per PHN-commissioned mental health service – Psychological therapies delivered by mental health professionals

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• clinical outcomes for people receiving PHN-commissioned Psychological therapies delivered by mental health professionals.

No additional local indicators.


N/A


Proposed Activities

Priority Area Priority Area 4: Mental health services for people with severe and complex mental illness including care packages


4.1 Deliver funding to existing employing agencies of Mental Health Nurses with allocated sessions under the current Mental Health Nurse Incentive Program (MHNIP) to ensure they deliver the same services at the same level in 2016/17.

4.2 Commission innovative clinical primary mental health care services to people with severe mental illness.



The aim of this activity is to deliver primary mental health care services to people with severe mental illness who are being managed in primary care. This includes clinical care coordination for people with severe and complex mental illness who are being managed in primary care, including through the phased implementation of primary mental health care packages and the use of mental health nurses.

4.1 Existing MHNIP providers

The PHN identified and made contact with all current MHNIP Providers operating in the region, and held dialogue with neighbouring PHNs as some existing MHNIP providers’ host agencies are located in other PHN regions but deliver services in Brisbane North PHN.

A new approach to payment was offered to the host agencies of these MHNIP providers through a twelve-month contracting process. Existing MHNIP providers and host agencies were

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advised this contract was transitional and only for 12 months to ensure continuity of care for existing clients, and that agencies must commit to seamless transition of clients to new arrangements on or before 30 June 2017.

The PHN has issued contracts to all existing providers of MHNIP, extending their service provision until 30 June 2017. Payments are made to providers as per the contract. A data collection process, based on the ATAPS MDS, has been developed and is in use by providers. The PHN has met with providers one-to-one on several occasions and brought all providers together as group, to help transition them to the new arrangements and to inform future service models.

4.2 Commission innovative clinical primary mental health care services to people with severe mental illness

The PHN has selected three providers - Morayfield Psychology Centre, Footprints and Toowong Private Hospital - to operate three MH Nurse service hubs offering clinical care coordination services across the region:

• Moreton Bay North • Moreton Bay South & Brisbane North • Brisbane Inner City and West

These hubs will deliver best practice clinical care coordination and treatment services by (at least) three FTE mental health nurses to people with severe and complex mental illness in the PHN region. Referrals to the MH Nurse service hubs must be from GP’s and community based Psychiatrists.


GP’s and psychiatrists will determine which patients are eligible for mental health nursing services and all of the following criteria must be met:

• a diagnosed mental disorder (according to criteria defined in the Diagnostic and Statistical Manual of Mental Health Disorders – Fifth Edition or the World Health Organisation Diagnostic and Management Guidelines for Mental Health Disorders in Primary Care:ICD-10 Chapter V Primary Care Version) which is severe and either episodic or persistent in nature

• the mental disorder significantly impacts at least two areas of the persons social, personal and/or occupational functioning

• the person has, or is at risk of developing, a physical health problem

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• the mental disorder has resulted in hospital treatment in the previous 2 years or there is a risk of hospitalisation within the next 12 months if clinical care by a mental health nurse is not provided

• the patient is expected to need ongoing treatment and management of their mental disorder over the next two years

• a primary care based GP or psychiatrist is the main person responsible for the patients clinical mental health care

• they are not currently receiving clinical care coordination from another service • they are over 18 years of age (services for young people with severe mental illness are being

procured through a separate process) • the patient provides consent to treatment from a mental health nurse.

Consultation

Needs Assessment Our Needs Assessment identified:

• collaborative partnership with Metro North Hospital and Health Service, community mental health services and consumers and family/carers to develop an integrated care package model which responds to local service gaps and identified needs in the community

• commissioning of mental health nursing in primary health care to support general practice to improve service coordinator and care for patients in the community.

Co-design Collaboration in Mind has already done the work to assess priority outcomes for the regional service system for people with severe mental illness. Through engagement with more than 100 agencies and individuals, Brisbane North PHN has reviewed the needs of people with severe mental illness in the region. The System Development Plan for the region developed by Collaboration in Mind identifies (at page 8) fifteen priority outcome areas to improve the regional service system for people with severe mental illness. This activity will directly address at least two of those priorities, namely alternatives to hospital admission, and service availability.

Brisbane North PHN’s assessment has also highlighted the importance of not simply parachuting in new models of care or bolting on new services, as this can further fragment service delivery. To ensure any procurement increases coordination and connection across the system, strong linkages must occur across the activities listed above. Participants at co-design workshops consistently and strongly

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emphasised that we do not take a silo approach to this funding by implementing six streams of activity completely disconnected. Participants highlighted the fragmented nature of the existing service system and the need for service and system navigation. Achievement of an effective person-centred, stepped care model requires significant reform, and an understanding of how the various components of service delivery operate and coordinate with each other. This means the PHN’s procurement process will favour agencies that are willing and keen to integrate, collaborate and coordinate with other providers.

Consultation to inform Procurement Strategy: • Stakeholder meetings – meetings with each of the currently funded MHNIP participants and

nurses, as well as meetings with the Australian College of Mental Health Nurses. Engagement with the sector identified the following current arrangements and needs:

• inequitable distribution of services = significant service gaps, particularly in the north • services are limited to patients of the employing agency • inconsistencies in the functions performed by MHN’s and implementation of referral criteria • isolate casual/part-time workforce, lack of professional development and networking

opportunities.

Collaboration

This activity is to be solely implemented by North Brisbane PHN under the guidance of ‘Collaboration in Mind’ an existing strategic partnership group focusing on the needs of adult with severe mental illness (membership includes the Hospital and Health Service, PHN, mental health NGOs, consumers and carers).


Duration


1 July 2016 to 30 June 2017.

4.2 Review and recommission mental health services for people with severe and complex mental illness

January 2017 to 30 June 2018

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• planning – July to October 2016 • procurement – November to December 2016 • commencement of service delivery – January 2107 (Moreton Bay North), July 2017

(Moreton Bay South & Brisbane North, Brisbane Inner City and West).

Coverage


Access only available for patients of 6 organisations based in; Strathpine, Toowong, North Lakes, Margate and Kedron.

4.2 Review and recommission mental health services for people with severe and complex mental illness

3 hubs covering the following PHN sub-regions:

• Moreton Bay North (SA3: Redcliffe, Narangba-Burpengary, Caboolture Hinterland, Caboolture, Bribie-Beachmere)

• Moreton Bay South & Brisbane North (SA3: Strathpine, North Lakes, Hills District, Sandgate, Nundah, Chermside, Bald Hills-Everton Park)

• Brisbane Inner City & West (SA3: Brisbane Inner-West, Brisbane Inner-North, Brisbane Inner, The Gap-Enoggera, Sherwood-Indooroopilly, Kenmore-Brookfield-Moggill).

Continuity of care

Current providers have been involved in consultations throughout 2016 to inform the new model of delivery for mental health nursing. Current providers were formally notified in November 2016 that their contracts would not be renewed in 2017-18. Providers have be asked to make suitable alternative arrangements for the ongoing care of any remaining patients being supported by MHNIP post June 2017.




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Approach to market

4.2 Open Tender

A specific Mental Health Nurse Clinical Care Coordination and Treatment Service for People with Severe and Complex Mental Illness procurement strategy was developed.

The following providers have been contracted to deliver a service, as a result of the open tender approach:

• Moreton Bay North – Morayfield Psychology Centre • Moreton Bay South & Brisbane North – Footprints • Brisbane Inner City & West – Toowong Private Hospital.


Priority Area 4 - mandatory performance indicators:

• proportion of regional population receiving PHN-commissioned mental health services – Clinical care coordination for people with severe and complex mental illness (including clinical care coordination by mental health nurses)

• average cost per PHN-commissioned mental health service – Clinical care coordination for people with severe and complex mental illness.

No additional local indicator is identified.

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Proposed Activities

Priority Area Priority Area 5: Community based suicide prevention activities


5.1 Ensure continuity of care for clients of existing suicide prevention services who may be at risk if the service is withdrawn.

5.2 GP and other service provider education.

5.3 Commission suicide prevention services.

5.4 Commission suicide prevention services specifically targeting Aboriginal and Torres Strait Islander people.

Existing, Modified, or New Activity The following activities are existing activities – 5.1, 5.3, 5.4

The following activity is a modified activity – 5.2 (changed from ‘develop a regional plan’ which is now part of Priority Area 8 below and our Lead Site activity).


The aim of this activity is to encourage and promote a systems based regional approach to suicide prevention. This includes community based activities and liaison with the Hospital and Health Service 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, including Aboriginal and Torres Strait Islander people.

5.1 Ensure continuity of care for clients of existing suicide prevention services who may be at risk if the service is withdrawn

Brisbane North PHN has continued to fund the Nexus program, delivered by the Queensland Program of Assistance to Survivors of Torture and Trauma, through a joint arrangement with Brisbane South PHN. Brisbane North PHN contributes a proportion of funding to this project, based on the percentage of clients residing in our region.

Continuation of this funding in 2017-18 will be confirmed prior to the end of 2016-17.

5.2 GP and other service provider education

There are a wide number of suicide prevention services already available to people in the PHN region. Brisbane North PHN will map the existing services and produce educational resources for GPs and other service providers.

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5.3 Commission suicide prevention services

The focus of this activity is a trial for a follow-up suicide prevention service. The primary purpose of this trial service is to integrate, complement and work collaboratively with the Redcliffe Hospital to improve the immediacy of follow-up response for individuals at a high risk of suicide, or who have recently attempted suicide and to provide wrap around support. The aim of the service is to provide a short-term transitional service, which provides follow-up support, short-term counselling, and case coordination to link individuals back into the community.

5.4 Commission suicide prevention services specifically targeting Aboriginal and Torres Strait Islander people

The selected provider, Institute for Urban Indigenous Health (IUIH) will provide the following activities are part of an integrated social and emotion health and wellbeing approach (together with mental health and alcohol and other drug treatment services):

• Recruit and support 1 FTE Youth Worker/Outreach Workers to deliver services for the Northern Moreton Bay region.



The clients of the program are young refugees but few are also survivors of torture and trauma and therefore not eligible for the other funded services delivered by Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT). Young refugees are a very hard to reach population who experience higher risk of suicide, and the PHN has not been able to identify alternative, culturally competent agencies in the region to whom these clients could be transferred.


GPs and other service providers in the Brisbane North PHN region.


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Individuals who are referred by services in the Redcliffe area (e.g. first responders, General Practitioners (GPs), Redcliffe Hospital) who have recently attempted suicide or who are at a high risk of suicide.


Aboriginal and Torres Strait Islander young people.

Consultation

Needs Assessment Our Health Needs Assessment identified the following two priorities:

• develop a systems based integrated suicide prevention plan in partnership with service providers and consumers

• commission appropriate services to address local needs with specific focus on Aboriginal and Torres Strait Islander social and emotional wellbeing and agreement between Metro North HHS and community providers for follow up care.

Consultation to inform Procurement Strategy: • Suicide Prevention Forums – 102 people attended 2 Forums, including consumers, GP’s,

psychologists, HHS staff, community and private services providers, youth services, Aboriginal and Torres Strait Islander services and academic and research bodies

• stakeholder meetings – 5 meetings with stakeholders including Redcliffe Hospital Collaborative and HHS Mental Health services and Queensland Police Service.

The feedback from the Forums helped us to identify the need for a trial follow up service model in the Redcliffe region. Subsequent stakeholder meetings informed the key elements required for this trial model. Additional feedback throughout all of the engagement also identified the need for:

• improved networking amongst existing service providers to improve patient outcomes • workforce capacity training.

Collaboration

This activity is to be solely implemented by North Brisbane PHN under the guidance of our Suicide Prevention Strategic Partnership Group (including Hospital and Health Service, local government, NGOs, allied health, lived experience and family groups).

Discussions are currently underway between Queensland PHNs and the Queensland Department of Health regarding possibilities for future co-ordinated commissioning or co-commissioning of mental

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health services. In addition the PHN and Metro North Hospital and Health Service have established a joint project to explore how we might more formally work jointly, including around commissioning.

Duration


July 1 2016 to June 30 2017 (with possibility of 1-year extension).


January 2017 – June 2017.


April 2017 to 30 June 2018

• planning – July to October 2016 • procurement – November to December 2016 • service development – January – March 2017 • commencement of service delivery – April 2107.


October 2016 to 30 June 2018

• planning – July 2016 • procurement – August to September 2016 • commencement of service delivery – October 2016.

Coverage


Whole of PHN region.


Whole of PHN region.


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Referrals received from Redcliffe based services (Redcliffe Statistical Area level 3)


Moreton Bay North Statistical Area level 4.


These activities will be commissioned in line with Brisbane North PHN’s Commissioning Framework (see Attachment 2).



These solutions are then evaluated and the evaluation outcomes used to inform further assessment and planning

Activities 5.1, 5.3, 5.4 – will be delivered through the procurement of services.

Activities 5.2 will be delivered through direct intervention.

Approach to market

5.3 Open tender

A specific Community Based Suicide Prevention Procurement Strategy was developed.

The Mental Illness Fellowship Queensland (MIFQ) has been contracted to deliver the service, as a result of the open tender approach:

5.4 Direct engagement

The Institute for Urban Indigenous Health and the Aboriginal and Torres Strait Islander Community Health Service are the only two community-controlled agencies delivering mental health services in the region. Given services need to be in place quickly, the PHN selected a direct engagement approach to procurement rather than open or select tender process.

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The Institute for Urban Indigenous Health (IUIH) has been contracted to deliver the service, as a result of the direct engagement approach.


Priority Area 5 - Mandatory performance indicator:

• Number of people who are followed up by PHN-commissioned services following a recent suicide attempt.

No additional local indicators are suggested.


N/A


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Proposed Activities

Priority Area Priority Area 6: Aboriginal and Torres Strait Islander mental health services

Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) 6.1 Commission mental health services for Aboriginal and Torres Strait Islander people.



The aim of this activity is to enhance access to 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.

The selected provider, Institute for Urban Indigenous Health (IUIH) will provide the following activities as part of an integrated social and emotion health and wellbeing approach (together with suicide prevention and alcohol and other drug treatment services).

• recruit and support Senior Social Health Professional to carry out intake assessments in Northern Moreton Bay region

• recruit and support Child Psychologist to deliver services and respond to the demand for children-centred services in Deception Bay/Redcliffe region

• recruit and support Psychologist to extend and deliver services for the Northern Moreton Bay region

• recruit and support Social Health Care Coordinator to work closely with other Care Coordinator type roles (i.e. CCSS, Partners in Recovery Facilitators) to support clients with complex chronic and mental health conditions in Strathpine/Northgate region

• recruit and support Mental Health Nurse (Registered Nurse) to deliver services for the Northern Moreton Bay region in Northern Moreton Bay region.

In partnership with Brisbane North PHN, IUIH will provide the following activities to establish and monitor services

• undertake a rapid needs assessment for Aboriginal and Torres Strait Islander mental health and alcohol and other drugs living in the region

• design, implement and evaluate the Community Engagement Hub program • co-design the procurement strategy for PMHC services and Alcohol and Other Drug (AOD)

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services. • co-design PMHC and AOD service plan to improve Aboriginal and Torres Strait Islander social

and emotional well-being • participate in relevant PHN Mental Health Partnership groups (i.e. AOD Partnership Group) • Undertake and/or participate in PMHC and AOD service evaluation and client feedback

activities.

Target population cohort Aboriginal and Torres Strait Islander people

Consultation

Needs Assessment

The needs of Aboriginal and Torres Strait Islander people were documented as priorities in the Mental Health Needs Assessment and the Methamphetamine, Alcohol and Other Drugs Needs Assessment. The three opportunities and priorities were documented in the Aboriginal and Torres Strait Islander priority area of our broader Health Needs Assessment. One priority relates to smoking rates, and the other two are:

• Development of programs to promote and sustain social and emotional wellbeing in Aboriginal and Torres Strait Islander people, including appropriate mental health, suicide prevention and alcohol and other drug treatment services.

Co-design

The PHN worked with the Institute for Urban Indigenous Health to identify needs and service gaps in Aboriginal and Torres Strait Islander mental health services.

Following this, the PHN has entered into a direct tender negotiation with the Institute for Urban Indigenous Health for the delivery of integrated mental health, suicide prevention and alcohol and drug treatment services. A plan of activity and a contract has been agreed. The Institute for Urban Indigenous Health (IUIH) will subcontract some of the service delivery to Brisbane Aboriginal and Torres Strait Islander Community Health Service.

We will continue to engage the wider Aboriginal and Torres Strait Islander via IUIH as part of the development of our regional plan.

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Collaboration



Duration

October 2016 to 30 June 2018

• Planning – July 2016 • Procurement – August to September 2016 • Commencement of service delivery – October 2016

Coverage

PHN sub-regions: Moreton Bay North (SA3: Redcliffe, Narangba-Burpengary, Caboolture Hinterland, Caboolture, Bribie-Beachmere) and Moreton Bay South – partial (SA3: Strathpine)

This initiative may deliver services to people who live anywhere in the PHN region but the bulk of funding will be directed towards sub-regions listed above.


These activities will be commissioned wholly in line with Brisbane North PHN’s Commissioning Framework.



These solutions are then evaluated and the evaluation outcomes used to inform further assessment and planning

Approach to market

Direct engagement

The Institute for Urban Indigenous Health and the Aboriginal and Torres Strait Islander Community Health Service are the only two community-controlled agencies delivering mental health services in the PHN region. Given services need to be in place quickly, the PHN will select a direct negotiation approach to procurement rather than open or select tender process.

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The Institute for Urban Indigenous Health has been contracted to deliver the service, as a result of the direct engagement approach.



• Proportion of Indigenous population receiving PHN-commissioned mental health services where the services were culturally appropriate.

No additional local indicator.


N/A


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Proposed Activities

Priority Area Priority Area 7: Stepped care approach

Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) 7.1 Promote a stepped care approach to mental health service provision.

Existing, Modified, or New Activity This activity is a new activity.


The aim of this activity is to develop 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. Brisbane North PHN will commission primary mental health care services across the continuum of needs, from low intensity psychological services, to psychological services for hard-to-reach groups, to services for people with severe mental illness, to follow-up services for people after a suicide attempt. Contracts with service providers will require them to work within a stepped care approach and to refer on consumers whose needs change. Educational resources will be developed to promote an understanding and use of a stepped care approach to mental health services. Communications from the PHN and funded provider will reference the stepped care approach. Stepped care will be an overall theme in the Regional Plan. Working with other PHNs, Brisbane North PHN will develop an IT solution, which will include the collection of the Primary Mental Health Care Minimum Dataset (PMHC-MDS) from providers. It will also incorporate screening/triage, referral, assessment and billing. Should a national approach emerge, this local approach will cease. MDS data will be returned to the PHN on a bi-monthly basis (as per providers contracts) and will be reviewed. Data visualisation software will be used to help “make sense” of the data.

The Queensland Department of Health and the Metro North Hospital and Health Service are working on a number of projects to develop and implement systems to support sharing of consumer clinical information between service providers and consumers. This includes GP access to ‘The Viewer’ (read only access to hospital records) and a trial of shared-care clinical records. Brisbane North PHN is an

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active partner in these developments. We will also review ‘My Health Record’ developments and incorporate into local systems as appropriate.

The PHN will work with providers to explore approaches to consumer feedback, including complaints). At present, feedback and complaints about services are made to the service provider in the first instance and can be escalated to the PHN as funded if necessary. Patient Opinion, an online consumer feedback forum is also utilised within one of our existing program areas. We are also exploring the use of the YES (Your Experience of Service) survey among all PHN commissioned service users.

Target population cohort Residents of the Brisbane North PHN region, specifically people with a mental illness, at risk of developing a mental illness and people at risk of suicide and their carers.

Consultation The approach to and implementation of stepped care for mental health will be a topic of consultation in the development of the Regional Plan (see Activity Area 8 below).

Collaboration



Duration This activity is an ongoing activity.


Commissioning method (if relevant) N/A

Approach to market N/A



• Proportion of PHN flexible mental health funding allocated to low intensity services, psychological therapies and for clinical care coordination for those with severe and complex mental illness.

No additional local indicator. Local Performance Indicator target (where possible)

N/A

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Proposed Activities

Priority Area Priority Area 8: Regional mental health and suicide prevention plan

Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) 8.1 Develop a mental health and suicide prevention regional plan.

Existing, Modified, or New Activity This activity is a new activity.


The aim of this activity is to develop an evidence based regional mental health and suicide prevention plan, which has been developed and agreed with the Hospital and Health Service, and other stakeholders. Once completed it should provide a vital resource to State Government, non-government and Commonwealth services in the region to support integrated delivery of mental health and suicide prevention services within the community. The plan will identify needs and gaps, reduce duplication, remove inefficiencies and encourage innovation. It will be evidence based and informed by comprehensive needs assessments and service mapping. Content areas are likely to include:

• staying healthy/early intervention • children & young people • psychological services (inc. low intensity services, Brisbane Mind, Better Access) • people with severe mental illness (inc. mental health nursing, PiR/NDIS, acute care) • suicide prevention • alcohol and other drugs • crisis services (including safe space).

Recurring sections within each chapter: • Aboriginal & Torres Strait Islander people • consumer participation • carers/family • data & evaluation.

Target population cohort Residents and service providers in Brisbane North PHN region.

Consultation “Blue Sky” planning

In 2018/19 the PHN will have a fully flexible primary mental health care budget, which we can use to meet the primary mental health care needs of the local population. We also hope to work much more

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closely with the Queensland Depertment of Health on co-ordinated or co-commissioning of mental health and AOD services. PHNs may also have responsibility for additional AOD treatment funding. Given this fully flexible and joined-up commissioning future, we want to talk to stakeholders about what this may mean. Possible “blue sky” engagement questions could include:

• how should the sector arrange services to be more integrated? What does a fully integrated MHAOD system look like?

• how should a stepped care model operate across the region? • how can consumers enter the ‘system’ and get the right services, in the right place at the right

time? • how should the PHN identify/prioritise areas of spending within the PMHC/AOD budgets? • how can the mental health sector/PHN efficiently and effectively engage the wider health and

human services sectors? • how will we all know if the system is working (i.e. meeting the needs of consumers)?

The PHN will facilitate whole-of-sector symposia at the beginning of the consultation period and at the end to identify cross-cutting and underlying themes and pull it all together. “Stream” specific engagement

Each “stream” or chapter in the plan (see Description above) will develop an engagement plan. This will begin by identifying what we already know about the needs, services and issues in each “stream”, and who we need to consult with. A range of engagement activities will then be facilitated including:

• Partnership Group meetings (see below) • online via ‘My Voice’, the PHNs online engagement portal • consumer focus groups • stakeholder workshops.

Brisbane North PHN has partnered with the Institute for Urban Indigenous Health to develop and implement and ongoing, Indigenous specific engagement process, which will feed in to the development of the regional plan.

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Collaboration

The development of the mental health, suicide prevention and alcohol and drug regional plan is a joint initiative between Brisbane North PHN and the Metro North Hospital and Health Service.

The PHN has established ongoing Partnership Groups in the following areas:

• child & youth mental health • people with severe mental illness (Collaboration in Mind) • suicide prevention • alcohol and other drugs.

These Partnership Groups with guide the development and content of the regional plan in their areas of interest.

Duration

Five year plan 2017 to 2022.

Consultation and development – January to September 2017.

Procurement of services based on Regional Plan to commence by June 2018.


Commissioning method (if relevant) The regional plan will be informed by and be a part of Brisbane North PHN’s commissioning strategy.

Approach to market N/A


Priority Area 8 - Mandatory performance indicators:

• Evidence of formalised partnerships with other regional service providers to support integrated regional planning and service delivery.

No additional local indicator.


N/A


Attachment 10

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updated activity work plan 2016-2018: primary mental ......updated activity work plan 2016-2018:...

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