21 minute read
Seven Domains of Future Focus for Collaboration
Summary of Domain Activity: Future Focus Areas ...................................................................... 14 Domain One: Engaging, Listening and Acting......................................................................................15 What we have achieved .................................................................................................................................... 15
Future Focus........................................................................................................................................................... 16
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Best Practice Spotlight: Regional forums and action plans................................................................ 16 Domain Two: Regional and Local Planning ........................................................................................... 17 What we have achieved .....................................................................................................................................17
Future Focus...........................................................................................................................................................18
Best Practice Spotlight: Stepped care mapping ......................................................................................18 Domain Three: Suicide Prevention.............................................................................................................19
What we have achieved .................................................................................................................................... 19
Future Focus.......................................................................................................................................................... 20
Best Practice Spotlight: Joint postvention referral mechanism after death by suicide ......... 20 Domain Four: Working With Aboriginal and Torres Strait Islander Services ..........................21 What we have achieved .................................................................................................................................... 21
Future Focus...........................................................................................................................................................22
Best Practice Spotlight: Australia first trial of culturally appropriate aftercare service..............22 Domain Five: Mental Health Commissioning........................................................................................23 What we have achieved ....................................................................................................................................23
Future Focus...........................................................................................................................................................24
Best Practice Spotlight: Joint CSAPHN/CHSALHN commissioning of services in areas of high need ..........................................................................................................................................24 Domain Six: Person Centred Care...............................................................................................................25
What we have achieved ....................................................................................................................................25
Future Focus...........................................................................................................................................................26
Best Practice Spotlight: Meeting community demand for accessible suicide prevention....26 Domain Seven: Safe and Quality Care......................................................................................................27 What we have achieved ....................................................................................................................................27
Future Focus...........................................................................................................................................................28
Best Practice Spotlight: Supporting accreditation of regional stepped care supplier .............28
Summary of Domain Activity: Future Focus Areas
The Foundation Plan focuses on setting out an intention to work with regional stakeholders to better use available resources to develop integrated approaches to meet regional mental health and suicide prevention needs. It aims to help to build momentum and continue shared interest in joint regional planning so as to set a framework for ongoing activity and improved integration over time.
The table below summarises areas of focus to address in conjunction with newly formed regional LHNs, service delivery partners and regional stakeholders.
See section two of the Foundation Plan Seven Domains of Future Focus for Collaboration for the full listing of Domain activities.
Domain
Domain One: Engaging, Listening and Acting
Domain Two: Regional and Local Planning
Domain Three: Suicide Prevention
Domain Four: Working with Aboriginal and Torres Strait Islander Services
Domain Five: Mental Health Commissioning
Domain Six: Person Centred Care
Future Focus areas
Consumer engagement Regional Action Plan implementation Clinician engagement plan Regional Voices
Transition planning Extend service mapping Explore shared data potential Gaps analysis
Continuity and integration SA Suicide Prevention Network collaboration Shared regional attempt data Knowledge sharing in aftercare
Culturally appropriate commissioning Share evaluation learnings Explore improved data mechanisms Increase community engagement
Sustainability and stability Increase consumer engagement Progress jointly funded Emergency and Follow Up Care Project Stepped care approach
Stepped care approach adopted GP engagement strategy Commitment to comorbidity approach
Domain Seven: Safe and Quality Care Workforce Clinical engagement Culturally appropriate commissioning Joint training and business improvement
Domain One: Engaging, Listening and Acting
Alongside the CHSALHN, CSAPHN undertook meaningful engagement with people with lived experience, stakeholders, clinicians and community - a business as usual priority through our processes, policies and project management.
This is not only best practice according to numerous participation models; it is a state-based objective and goal. The SA Health Strategic Plan states that one of its primary objectives is to increase the roles of consumers and communities in policy, design, planning, delivery and practice. In addition to this, the SA Suicide Prevention Plan has a goal to provide a socially inclusive community of resilient individuals and supportive environments.
While we have made significant progress in this area, we acknowledge that we will have some way to go to consistently engage, listen and act at all levels of our work in relation to mental health and suicide prevention.
What we have achieved
Lived Experience (LE) inclusion Local Health Clusters Partnering with existing groups for external participation Facilitation of National and State participation Clinical engagement LE reference group reviewed strategies, plans and proposed activity for the National
Suicide Prevention Trial (NSPT) Ten (10) CSAPHN Community Advisory Committees
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(Local Health Clusters) Co-design with sector and consumers for National Psychosocial Support Measure
Facilitated regional lived experience participation in a number of plans developed at
national, state and regional levels Clinical engagement in extension of evidence base through aftercare and remote access projects
Future Focus
Consumer engagement
Facilitate active and collaborative consumer reference groups Structure our current approach to effectively engage consumer and carers with participation in the commissioning cycle Mapping of networks and groups within existing state structures to look at joint areas of interest and purpose during this transition phase Explore joint consumer networks and foster collaborative meaningful partnerships with consumers and carers
Regional action plan
Clinician engagement plan
Driving actions determined through regional consultation and joint plans Work with regional LHNs on implementing solutions with local stakeholders • Work on an engagement plan with newly established regional
LHNs to understand local demand, service supplier capacity and more effectively network clinicians across projects and regions Regional Voices
Build inclusive engagement practices into the transition planning for both priority and vulnerable populations, such as, but not limited to, veterans, culturally and linguistically diverse, LGBTI and people with a lived experience of mental ill health and or suicide
In 2018, CSAPHN held ten (10) regional forums to ensure consumers, community and clinicians were heard. These were aimed at better understanding regional needs when it comes to mental health and suicide prevention. These forums will inform future decision making and have resulted in development of region-specific action plans focusing on needs and gaps in the regional hubs of South Australia.
CSAPHN completed joint mental health and suicide prevention service mapping across the stepped care model with CHSALHN. Further to this a series of joint regional forums in partnership with the Mental Health directorate of CHSALHN occurred in five (5) regions. The below needs across primary and tertiary mental health and suicide prevention services were identified for future focus. Key themes and areas of need highlighted in mental health:
Greater awareness and education surrounding appropriate referral and access to services
Lack of regional mental health workforce
Access and waiting times of psychological therapy services
Appropriate and timely access to psychiatry services
Impact of the NDIS roll-out and its effect on current psychosocial services.
Key themes and areas of need highlighted in suicide prevention:
Discharge planning and coordinated follow up care after a suicide attempt
Workforce collaboration to ensure coordinated care of clients
Suicide prevention training opportunities for the sector and whole of community
Stigma surrounding suicide a barrier to seeking help.
Domain Two: Regional and Local Planning
What we have achieved
Shared plans and KPIs Mapping and resourcing Agreements and referral mechanisms Amplified regional voices and context Five (5) regional mental health action plans developed for the purpose of informed future joint decisions between CSAPHN
and CHSALHN Stepped care service mapping across state and
federal jurisdictions Bilateral agreements for mental health, care coordination and suicide prevention services
Facilitated regional voices via lived experience reference groups, being heard in national committees One of the eight (8) targeted priority areas set out in the Fifth National Mental Health and Suicide Prevention Plan is the need for improved integration of services. Lack of integration was identified as a common need in the 2018 CSAPHN/CHSALHN hosted regional forums.
In addition to this, there is a South Australia Health Strategic Plan Objective to strengthen partnerships through a coordinated approach to relationship management as well as a South Australia Suicide Prevention goal to provide a sustainable, coordinated approach to service delivery and resources and information within communities to prevent suicide.
Data gaps and inconsistency in collection and reporting is a known issue when it comes to regional and local planning. CSAPHN has access to a range of national and regional data to inform service planning according to local needs. This presents a useful picture of regions but is by no means exhaustive and will require support from local jurisdictions to provide more substantial regional data on mental health and suicide prevention.
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Future Focus
Transition planning
Establish a joint CSAPHN/ CHSALHN transition taskforce to ensure continuity of service, implementation focus, and prioritisation of joint work required Review the regional transition plan at intervals against whole of state approach Best Practice Spotlight: Stepped care mapping From October 2017, CSAPHN undertook joint service mapping and collaboration with CHSALHN to look at what a stepped care continuum could look like across both our core service provision and commissioned services. The goal was to better identify the local service landscape and identify any regional gaps and barriers in the mental health system towards matching the appropriate intervention levels with local consumer needs. Extend service mapping
Extend and or realign CSAPHN/CHSALHN service mapping work to include redistributed CHSALHN workforce and activity Explore shared data potential
Explore and develop relationships for future shared data arrangements with regional LHNs to strengthen joint regional planning
Gaps analysis
Demographic and mental health specific population data Service utilisation data and evidence of service problems Needs assessment information and data
on special needs One such service barrier and congestion point across the stepped care continuum was identified within the Yorke and Northern region surrounding the step-up and step-down interface between specialist mental health care and the community setting. This instigated an innovative secondment of a CHSALHN mental health nurse into the primary general practice setting to provide clinical care coordination for those with severe and complex mental illness, leading to improvements in appropriateness of referral into state services and progress towards visible hospital avoidances.
Domain Three: Suicide Prevention
Suicide prevention is a complex area of policy with interconnected responsibilities. In the Australian Government Response to the National Mental Health Commission Review of mental health services, suicide prevention was recognised as a key pillar, with subsequent feedback resulting in the Fifth Mental Health Plan being renamed the Fifth National Mental Health and Suicide Prevention Plan. This ensured suicide prevention was a national priority and recognised public health issue at the highest level of government.
Government agencies, service providers and the communitymanaged sector all have a role in reducing suicide rates. An effective suicide prevention response may require concerted action by law enforcement agencies, planning and infrastructure developers, transport providers, social support agencies, housing providers and health agencies. While governments have a pivotal role to play in addressing suicide, effective community engagement and action is central to improving outcomes.
What we have achieved
Emergency and Follow Up Care
Community training
Focus on capacity building
Trial of Aboriginal aftercare Service Established and commissioned three (3) Emergency and Follow Up Care for Suicidal Crisis services (Aftercare) in seven (7) regions of need
Largest scale community capacity building strategy ever seen in regional SA - funded Question Persuade Refer (QPR) training across community, state and commonwealth workforce, Suicide Prevention Networks and Local Health Clusters
Investment in capacity building of SA Suicide Prevention Networks under the National Suicide Prevention Trial (NSPT)
Trial and evaluation of an Aboriginal aftercare service. Developed by Aboriginal people for Aboriginal people and delivered within an Aboriginal Community Controlled Health Organisation but integrated with an Emergency Department and Community Mental Health Team
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Future Focus
Work with CHSALHN teams to ensure sustainability, integration and referral pathways across jursidications for aftercare services Best Practice Spotlight: CSAPHN led twelve (12) months of negotiations for the state wide formal postvention referral mechanism across state and federal jurisdictions. For the first time, SA has a formalised referral mechanism between South Australia Police (SAPOL) and South Australia’s three (3) Commonwealth funded postvention providers. This agreement has changed the landscape significantly and ensures integration across the emergency service and suicide prevention sector and importantly timely access to specialised postvention support for those impacted by suicide. The postvention referral mechanism between SAPOL, StandBy Support After Suicide, National Indigenous Critical Response Service, Living Beyond Suicide, Adelaide PHN (APHN) and CSAPHN ensures timely referrals and access to services for those impacted by suicide. Key changes under the new formalised SA postvention referral mechanism include: process and postvention providers Continued support for and collaboration with South Australian Suicide Prevention Networks Shared regional attempt data Knowledge sharing in aftercare
Shared regional data arrangements for suicide attempts, creating an evidence base for informed joint decision making, regarding service access and design Shared findings and learnings from localised and national evaluations of the Aboriginal Aftercare service Explore and develop relationships for joint commissioning of
Families contacted within 24 hours and advised of the coronial aftercare services Permission from the families gained before their details are given to the provider Notification of referral via phone within 24-48 hours via SAPOL to the postvention provider Changes to one of SAPOL’s reporting forms thus embedding the referral process into protocol Mandatory collection for identification of Aboriginal or Torres Strait Islander to assist with provision of culturally appropriate support Joint training with the postvention providers for all South Australian police cadets One referral card in all police cars – replacing four service provider cards for different jurisdictions Dedicated SAPOL officer attached to the SAPOL’s Coronial Investigation Section, will coordinate notifications and information exchange between SAPOL and postvention providers.
What we have achieved
Inclusion from decision making to delivery
Working in partnership Culturally appropriate services National collaboration Building evaluation capacity Aboriginal and Torres Strait Islander people employed at all levels of CSAPHN, from decision making to delivery, including CSAPHN board representation and Chair of the NSPT steering committee
Working in partnership with Aboriginal Community Controlled Health Organisations (ACCHOs) to co-design programs with a particular emphasis on services
with comorbidity focus Prioritising the commissioning of culturally appropriate services to recognised Aboriginal Health
organisations Hosted national LifeSpan event to develop an integrated suicide prevention response for indigenous crisis and aftercare Evaluation of Aboriginal suicide prevention training, You Me-Which Way, which builds capacity and competencies in community One of the eight (8) targeted priority areas set out in the Fifth National Mental Health and Suicide Prevention Plan is to focus on the mental health and wellbeing of Aboriginal and Torres Strait Islander communities. Aboriginal and Torres Strait Islander adults are almost three times more likely to experience high or very high levels of psychological distress than other Australians, are hospitalised for mental and behavioural disorders at almost twice the rate of non-Indigenous people and have twice the rate of suicide than that of other Australians. Complementing this Fifth Plan priority, and the National Aboriginal and Torres Strait Islander Health Plan 2012-2023, is the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing, which sets out a comprehensive and culturally appropriate stepped care model that is equally applicable to both Indigenous specific and mainstream health services.
CSAPHN actively implements guidance set out in the above, and also contractually mandates its commissioned service providers to take guidance from the ATSISPEP (Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project) Report in the
“What brings us together is the strength of our community and our shared experience” - Wayne
establishment and delivery of suicide prevention services.
Future Focus
Culturally appropriate commissioning
Further support the ‘Gayaa Dhuwi (Proud Spirit) Declaration’ and incorporate its principles in mental health commissioning approaches Share evaulation learnings Explore improved data mechanisms Increase community engagement
Share findings and learnings from evaluation of Aboriginal Aftercare service with key stakeholders and community Work with regional LHNs and ACCHOs to look at mechanisms for increasing data capture and integrity Deepen and broaden engagement with Aboriginal and Torres Strait Islander communities
Community and stakeholder consultation undertaken by CSAPHN under the National Suicide Prevention Trial program revealed a need to improve emergency and follow-up care for Aboriginal people in suicidal crisis. In response, the CSAPHN established an Aboriginal working group to co-design an Aboriginal specific aftercare service model.
The service is designed to provide culturally and clinically appropriate coordinated care for Aboriginal people following a suicide attempt. The service is delivered by an Aboriginal Controlled Health Organisation (ACCHO) and includes access to high quality emergency and follow up care to maximise recovery and prevent escalation. This community led approach has led to the upskilling and capacity building of a rural ACCHO to lead the way in trialling culturally appropriate, evidence based best practice Aboriginal aftercare service.
Domain Five: Mental Health Commissioning
One of the eight (8) targeted priority areas set out in the Fifth Mental Health and Suicide Prevention Plan is specifically around commissioning and supply of services. CSAPHN mental health commissioning reflects best practice, with a focus on and commitment to co-design, partnership, integration, transparency, accountability and outcomes.
Co-commissioning with key stakeholders and service partners is essential to achieve the alignment of multiple funding streams and priorities. CSAPHN and CHSALHN have laid foundations to work towards more integrated opportunities and regional joint commissioning of service mapping.
What we have achieved
Clinical Care Coordination New model of care in country SA Emergency and Follow up Care HealthPathways Co-design and commissioning of Clinical Care Coordination program with CHSALHN in Yorke Peninsula with a focus on integration between acute and primary care sectors for people with severe and complex
mental illness Co-design and commissioning of the new model of care in country South Australia for the Statewide Mental Health
Shared Care (MHSC) program Shared data, service mapping and location identification between SA Health, Beyond Blue and CSAPHN for joint state and commonwealth funded Emergency and Follow up Care for Suicidal Crisis
Working in partnership with SA Health and APHN, HealthPathways, a portal for GPs and health professionals, was implemented across South Australia
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Future Focus
Sustainability and stability
Maintain and extend the commissioning processes with a focus on sustainability and stability Increase consumer engagement
Increase consumer engagement in the commissioning process Progress jointly funded Emergency and Follow up Care Project
Progress mapping, commissioning and co-design of jointly funded Emergency and Follow up Care for Suicidal Crisis in regional SA with regional LHNs, Beyond Blue and Stepped care approach
Further consolidate the stepped care approach in principle and jointly map available services against a stepped care spectrum
The Mental Health Shared Care (MHSC) program aims to assist individuals with complex mental health needs to increase their capacity to manage their physical and mental health, avoid relapse through early intervention or the onset of acute symptoms. In late 2018, CSAPHN and APHN were approached by SA Health to take over the commissioning of activity under this program across South Australia.
CSAPHN has worked with CHSALHN to co-design and develop the Country Mental Health Shared Care Model of Care to meet the aims of activity for people with severe mental illness being managed in primary care and to meet the service need in identified regional communities. CSAPHN It is intended that this partnership will improve mental health consumer flow through Community Mental Health teams to GPs which will enable mental health consumers in more acute settings to have better access to community mental health services.
The joint goal is to improve patient outcomes and reduce avoidable demand for public hospital services through a shared model of understanding and appreciation across primary and acute mental health care.
Domain Six: Person Centred Care
What we have achieved
Stepped care model adopted Regional approach to psychosocial support services Connecting with People Region wide low intensity platform Implemented risk matrices Adopted the stepped care model philosophy across state funded and federally commissioned activity resulting in joint mapping of CSAPHN/CHSALHN funded services and commitments to improving regional service
integration and communication Jointly worked to provide a collaborative regional approach to targeting psychosocial support services catering to individual needs Promoted and supported SA Health’s ‘Connecting with People’ training, providing commonality and consistency across the State Developed a region-wide 24/7 low intensity mental health service to meet the needs of people with, or at risk of, mild mental illness Introduced a consistent approach to organisational safety and risk reduction Putting the person at the centre of care is one of the eight (8) targeted priority areas set out in the Fifth National Mental Health and Suicide Prevention Plan. Lack of understanding of mental health vs mental illness and the equivalent services needed was also identified as an issue in regional forums.
CSAPHN saw the need to increase understanding and compassion at all levels, from community awareness and GP education to taking a stepped care approach so that service planning looks to accommodating present and future need for providing services to people at risk of mental illness and with mild to moderate mental illness as well as severe.
People and their families are at the centre of decisions concerning their health and we acknowledge them as experts, and are committed to working alongside them to make services more flexible to meet people’s needs in a manner that
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is best for them.
Future Focus
Stepped care approach adopted
Adoption of the stepped care approach as a foundation principle for joint working with continued trials of stepped care models GP engagement strategy
Develop a GP engagement strategy with regional LHNs to educate and create informed regional service hubs; shifting towards culture change and alternative referral pathways
Commitment to comorbity approach
Continued commitment to a comorbidity approach to holistic metal health care inclusive of physical and alcohol and other drugs related health issues
68% of country South Australians told us they wanted additional training and upskilling opportunities in suicide prevention during consultations under the National Suicide Prevention Trial (NSPT). In response, CSAPHN introduced the largest scale community capacity building strategy ever seen in regional South Australia.
In addition to supporting CHSALHN ‘Connecting with People’ Training, CSAPHN funded a multi-layered suite of evidencebased suicide prevention training programs to communities, workforce and priority populations. Training offered throughout the trial region included:
Question Persuade Refer
SafeTalk
Applied Suicide Intervention Skills (ASIST)
Accidental Counselling
You Me Which Way
Suicide Story
Youth Aware Mental Health.
Domain Seven: Safe and Quality Care
One of the eight (8) targeted priority areas set out in the Fifth National Mental Health and Suicide Prevention Plan is a focus on safety and quality in care.
A key South Australia Suicide Prevention Plan goal is to implement standards and continuous practice improvement in suicide prevention. This has been a priority area for CSAPHN with the review of care frameworks, looking at evidence and how to implement best practice processes and upskill health professionals and staff.
What we have achieved
Clinical governance frameworks Realigned quality Formed Clinical Council Invested in service provider workforce Implemented risk matrices Establishment of clinical councils and reference groups for priority populations to support the clinical governance and cultural competencies of commissioned
activity Provision of small grants to enable regional service providers to pursue accreditation against
relevant national standards Introduced support for the development of safety
requirements for suppliers Funded low intensity mental health workforce growth and
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Introduced a consistent approach to organisational safety and risk reduction
Future Focus
Workforce
• Jointly look at
CSAPHN/CHSALHN workforce capacity and development needs for regional, rural and remote South Australia
Formalise structures to routinely engage with Clinical Councils to support the CSAPHN in maintaining appropriate Clinical Governance of commissioned activities and provide key and timely advice on issues arising in local communities Best Practice Spotlight: As part of CSAPHN’s commitment to growing capacity within the sector and ensuring our commissioned mental health programmes and services align with best practice national standards and legislation, CSAPHN released a series of small grants to enable commissioned providers to register and fund their accreditation journey under the National Standards for Mental Health Services. To date, five (5) regional providers are now accredited under the National Standards focusing on areas such as service delivery, Further support the ‘Gayaa Dhuwi (Proud Spirit) Declaration’ and incorporate its principles in mental health commissioning approaches
Joint training and business improvement
Seek out joint training and business process improvement opportunities such as developing skills in primary care for safe referral and working with regional LHNs on discharge processes when it comes to safe step up and step-
down integration policies, standards, communication and consent, as well as consumer safety and privacy. Demonstration of the delivery of services against these standards ensures that consumers, carers and the community can be confident of what to expect from CSAPHN commissioned mental health services. It also allows our service providers to demonstrate that their services are transparent and are meeting their funding accountability requirements while promoting respect and trust between different parts of the service system and consumers they serve.
CSAPHN acknowledge Aboriginal and Torres Strait Islander people as the traditional owners of this country throughout Australia and their connection to land, waters and community. We would like to thank and acknowledge those with a lived experience of mental ill health and or suicide who featured or contributed to this document. These people generously shared their personal stories to support mental health and wellbeing in our regional communities. To read their full stories, view the Community Lived Experience Calendars for Eyre Peninsula and Yorke Peninsula.
This document has been prepared by CSAPHN with assistance from Borrowdale Communications, Michels Warren PR and China Shop Design.
Country SA PHN 30 Tanunda Road, Nuriootpa SA 5355 PO Box 868 Nuriootpa SA 5355 Ph: 08 8565 8900
