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Mental Health and Suicide Prevention Regional Plan A joint foundation plan between Country SA PHN and Country Health SA Local Health Network 2019 - 2021


Regional Action Planning in Context Introduction ................................................................................................................................................. 2 A personal perspective ........................................................................................................................................ 2 A few words from the Country SA PHN CEO ............................................................................................ 2 The Government’s vision for mental health reform ................................................................................ 2 Consultation and Regional Commitment ......................................................................................... 3 Consultation with Delivery Partners ............................................................................................................... 3 Commitment to collaboration ......................................................................................................................... 3 Plan endorsement ................................................................................................................................................. 3 Document Purpose ................................................................................................................................... 4 Overview ........................................................................................................................................................5 About Country SA PHN ....................................................................................................................................... 5 Our Partnership with our LHN .......................................................................................................................... 6 Our Region ............................................................................................................................................................... 6 Mental Health and Suicide Prevention Milestone Snapshot .................................................................7 National and State Implementation Progress Indicators ....................................................................... 8 Key Statistics and Mental Health Demographics ............................................................................ 9 Prevalence of mental illness and community need ................................................................................ 9 Our Service Principles: Stepped Care ..........................................................................................................10 Key statistics in a South Australian context .................................................................................................11 Seven Domains of Future Focus for Collaboration ...................................................................... 13

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Introduction A few words from the Country SA PHN CEO A personal perspective “In order to better the social and emotional wellbeing of the people they seek to serve, it is essential for all services to work better to understand the world as it is seen through the eyes of those with personal experience of mental illness, mental ill health or emotional distress. “Our differences in backgrounds, cultures, lands and personal struggles may seem vast at times but what draws us together is the strength of our community and our shared experiences. We are all in this together and must design solutions to any problems we face with empathy, solidarity and purpose.”

“It is only through working together that we will be able to address fragmentation of services and support mental health and suicide prevention reform priorities at a regional level to achieve more effective, patient-centred care for South Australians. “Country SA PHN is here to support regional Local Health Networks (LHNs), Government, regional Suicide Prevention Networks and community advocates to do just that; build and share our strengths and together confront our challenges head on.” Kim Hosking, Country SA PHN CEO

Wayne Oldfield, Aboriginal Lived Experience Representative to the National Mental Health Consumer and Carer Forum and Past Director of the Aboriginal Health Council of SA. Wayne is a descendant from the Peerapper Language Group/Clan, and identifies as Palawa, meaning Aboriginal Tasmanians as a collective group, and has lived in country South Australia for 45 years.

The Government’s vision for mental health reform “PHNs over the next five years will serve as commissioners of primary care mental health services and as a system integrator. “They cannot achieve mental health reform and system transformation on their own, and all stakeholders within the complex mental health and social care system have a role to play.” Reform and System Transformation – A Five-Year Horizon for PHNs (September 2018)

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Consultation and Regional Commitment Consultation with Delivery Partners This Foundation Plan was developed by Country SA PHN in consultation with:

Plan endorsement This Plan and the commitment to its continuous development and enhancement throughout regional implementation has been endorsed by the signatories below.

• Country Health SA Local Health Network • Country SA PHN Lived Experience Reference Group • South Australian Mental Health Commission • The Premier’s Council on Suicide Prevention.

Mr Umit Agis Director Mental Health Strategy and Operations Country Health SA Local Health Network

Commitment to collaboration While this Plan is regionally focused, Country SA PHN and Country SA LHNs are committed to seeking out collaboration opportunities with state peak bodies, Adelaide PHN/LHNs and other key stakeholders to look at mental health and suicide prevention with a whole of state lens to increase efficiency, reduce duplication and foster integration where appropriate.

Mr Reg Harris Director Mental Health & Alcohol and other Drugs Country SA PHN

Endorsed are the ‘Seven Domain’ future areas of focus for collaboration: 1 Engaging, Listening and Acting 2 Regional and Local Planning 3 Suicide Prevention 4 Working with Aboriginal and Torres Strait Islander Services 5 Mental Health Commissioning 6 Person Centred Care 7 Safe and Quality Care.

Yorke Peninsula

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Document Purpose Country SA PHN (CSAPHN) is committed to the publication and implementation of a joint Mental Health and Suicide Prevention Regional Plan (Foundation Plan). While there is a requirement to report against national performance indicators and publish a comprehensive regional plan, CSAPHN’s primary purpose in developing a Foundation Plan is to assist in a smooth transition towards our new State Local Health Network (LHN) re-structure in mid-2019. The Foundation Plan is intended to support newly inaugurated regional LHNs to hit the ground running and build on the current work achieved to date with our current LHN partner Country Health SA. This Plan will form the axis on which transition and future collaboration can be based with a commitment to develop a joint Comprehensive Service Development Plan by mid-2022.

This ‘Regional Action Planning in Context’ document should be reviewed in conjunction with the Mental Health and Suicide Prevention Seven Domains of Future Focus for Collaboration, which together form the complete Mental Health and Suicide Prevention Foundation Plan. Within this document you will find: • A summary of consultation and stated commitment to the Foundation Plan; • Introductory information about CSAPHN and State based activity to date; • Key statistics and demographic information in relation to mental health and suicide prevention, both nationally and at a State level;

The Foundation Plan aims to:

• Regional snapshots highlighting key issues, projects and services;

1 Continue to jointly address identified gaps and deliver on regional priorities and drive evidence-based service to address those needs for regional South Australia;

• An introduction to the Stepped Care model for implementation; and

2 Further integrate mental health and suicide prevention services and pathways for people with or at risk of mental illness or suicide through a whole of systems approach; and

• Summary of Domain activity. That is, areas for future focus for CSAPHN to action in with regional stakeholders and delivery partners, particularly regional LHNs colleagues.

3 Set out collaboration and integration opportunities so as to meet short and long-term mental health and suicide prevention objectives identified across the State and, in some cases, suggest mechanisms by which these objectives can be jointly identified and owned moving forward.

Eyre Peninsula

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Overview About Country SA PHN

Our Vision

CSAPHN is the health network set up to service the country regions of South Australia, increasing the efficiency and effectiveness of service delivery while improving the coordination of patient care.

Better health and well-being for all country South Australians.

Established by the Federal Government, CSAPHN exists to bridge the gap of health inequity and access in rural South Australia by building a collaborative and responsive health care system. A key objective is to increase the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and to improve the coordination of care to ensure patients receive the right care in the right place at the right time.

Values

Valuing the individual Respect Equity

To bridge the gap in health inequity and access for all country South Australians by working with communities to provide quality primary health care.

Strategic Planning

Strategic Objectives

Strategic Priorities

Assessing and understanding our community’s health needs through Population Health Planning

Improving the health and wellbeing of our communities, particularly those individuals at risk of poor outcomes

Building local capacity, resilience and sustainability of services

Bridging the gap in health access and inequity

Knowledge Collaboration

Our Purpose

Increasing health services efficiency and effectiveness Enhancing patient centrered, integrated health care Ensuring patients receive the right care, in the right place at the right time

Improving patient primary health care experience Developing solutions that meet individual community needs Commissioning services that are equitable, efficient and effective

Outcomes

Impoved health access and equity Improved patient journey and experience Improved patient outcome Locally connected, responsive primary health care

Ensuring effective corporate and clinical governance

Strengthening the building blocks of country SA primary health Workforce | Health Information & Technologies | Stakeholder Engagement | Health Financing & Management | Governance & Leadership

Healthier, happier communities

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Our Partnership with our LHN Development and implementation of sustainable solutions to challenges our regions face in relation to mental health and suicide prevention requires ongoing joint work with CHSALHN to meaningfully engage consumers, community and clinicians.

Our partnership approach is intended to enhance the impact of health service provision and to serve as a resource for improvement and innovation through: 1

Joint planning

The CSAPHN and CHSALHN partnership was built on the shared goal of improved health outcomes for rural and remote communities in South Australia.

2

Integrated information and communications technology systems

3

Change management

4

Shared clinical priorities

The partnership and journey shared with CHSALHN recognised strategic linkages between the two organisations and formed the basis by which we worked towards the common objective of achieving the best possible health outcomes for our communities.

5

Aligned incentives

Joint Objectives • Share information, knowledge and resources; • Facilitate, in a timely manner, the provision of good quality and appropriately designed health services through a coordinated approach; • Develop and embed health planning policies in planning for the region; and

6

Population focus

7

Measurement and evaluation

8

Continued professional development

9

Community engagement

10 Innovation It is the intent that these same goals, objectives and commitment to partnership transfer to our new relationships with our future regional LHNs colleagues and the foundation laid can continue to evolve and prosper through joint activity, planning and commissioning.

• To support the delivery of the CHSALHN’s and the PHN’s strategic objectives.

Our Region Both CSAPHN and CHSALHN boundaries currently align, covering all South Australia, apart from the Adelaide metropolitan area. This shared service area means CSAPHN and CHSALHN covers 99.8% of the State geographically and approximately 30% of SA’s total population. It must be noted that CHSALHN will devolve on 30 June 2019 to become six (6) regional LHNs governed by new boards with realigned boundaries.

CSAPHN and CHSALHN cover 99.8% of the State geographically and approximately 30% of SA’s total population

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Mental Health and Suicide Prevention Milestone Snapshot The below shows key mental health and suicide prevention milestones from the introduction of regional delivery through PHNs to today’s Foundation Plan and establishment of six regional LHNs for South Australia.

April 2015

November 2015

National Mental Health Commission’s Review of Mental Health Programmes and Services ‘Contributing Lives, Thriving Communities’ handed to Government

June 2018

Signing of Bilateral National Psychosocial Support Measure

Australian Government Response to National Mental Health Commission’s Review of Mental Health Programmes and Services ‘Contributing Lives, Thriving Communities’

July 2018

SA Premier’s Council on Suicide Prevention announced

31 PHNs (Primary Health Networks) established nationally

October 2018

National Mental Health Commission’s first report on the progress of the implementation of the 5th National Mental Health and Suicide Prevention Plan released

October 2016

Release of the Draft 5th National Mental Health Plan for public consultation

October 2018

SA Government Issues Group on Suicide Prevention inaugural meeting

August 2017

5th National Mental Health and Suicide Prevention Plan endorsed by COAG and Implementation Plan published

September 2018

July 2016

Reform and System Transformation: A Five-Year Horizon for PHNs

September 2017

SA Suicide Prevention plan 2017-2021

June 2019

Submission of this Foundation Plan to the Commonwealth Department of Health

December 2017

SA Mental Health Strategic Plan 2017-2021

July 2019

Establishment of six (6) regional LHNs

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National and State Implementation Progress Indicators When it comes to mental health and suicide prevention, there are a number of implementation commitments that have been made at regional, state and federal levels. No one agency or organisation can deliver the expected benefits. It is only through partnership and collaboration that these complex challenges and often-ambitious objectives can be met. The image below is a snapshot of several milestones and progress indicators that have been articulated since the introduction of PHNs and the regional implementation model.

2019

2020

South Australian mental health policy and plans South Australian Mental Health Strategic Plan 2017-2022 South Australian Suicide Prevention Plan 2017-2021 SA Health Partnering with Carers Strategic Action Plan 2017-2020 SA Health Strategic Plan 2017-2020 Action Plan for People Living with Borderline Personality Disorder 2017–2020

2021

2022

2025

Five year Progress indicators for PHNs and the Regional Mental Health and Suicide Prevention Plan 2019

2022

Foundation Plan published (mid 2019)

Collaborative commissioning Regional workforce strategy Data sharing arrangements with regional stakeholders Agreement and implementation of above plan commences

2020 Consumer, Community and Clinician engagement Work with regional LHNs on transition planning (2019/2020)

2025

2021

Transparent learning culture

Regional Mental Health and Suicide Prevention Plan implemented in partnership Commence comprehensive service development planning

2017-2022

5th National Mental Health and Suicide Prevention Plan (2017-2022)

2017-2023

MENTAL HEALTH AND SUICIDE PREVENTION REGIONAL PLAN | REGIONAL ACTION PLANNING IN CONTEXT

National Strategic Framework for Aboriginal and Torres Strait Islander Mental Health and Social Emotional Wellbeing 2017-2023

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Key Statistics and Mental Health Demographics Prevalence of mental illness and community need An understanding of the prevalence of mental illness across the spectrum of severity sets the context for understanding the different service responsibilities across the sector. In total, 9.1 million people, or around 38 percent of the Australian community, have some level of mental health need. Not all require health care or professional treatment, nor will they seek formal assistance; however, when they do, it is imperative that that they receive the right care in the right place at the right time appropriate to their needs. South Australia must work towards a ‘no wrong door’ approach and integration across services, no matter where that individual sits on the spectrum of mental health need. Nationally, one in five Australian adults (aged 16 to 85 years) will experience a mental illness each year and almost half will experience a mental disorder in their lifetime.1 Anxiety disorders and affective (mood) disorders are the most common, affecting approximately 14% and 6%, respectively, of the adult population each year, with these conditions often co-occurring. In addition, almost one in seven (14%) young people (aged 4 to 17 years) are estimated to have experienced a mental illness in the previous year.2 The experience of mental health conditions ranges across a wide spectrum. The most common experience is of approximately 5.4

million people ‘at risk’ who do not meet criteria for a diagnosis but who have some mental health need. This includes people who have had a previous illness and are at risk of relapse without ongoing care, as well as those who have early symptoms and are at risk of developing a diagnosable illness. For these people, prevention and early intervention through primary health care (mainly general practitioners), digital mental health and self-help services are most relevant. These services are predominantly the responsibility of the Commonwealth. People with mild mental illnesses, estimated at 2.1 million people, as well as those with moderately severe mental illness, around 1.1 million people, represent the next largest groups. People with mild to moderately severe illnesses are also predominantly managed in the primary mental health care system, with the bulk of services currently being provided through general practice and the Medicare Better Access initiative. Again, this layer of service responsibility rests with the Commonwealth. At the highest end of the spectrum of need, there are approximately 715,000 people with severe mental illness. For this group, the responsibility for clinical services is shared between the Commonwealth and states, as well as private hospitals. The National Disability Insurance Scheme will provide support to eligible individuals experiencing the most significant disability associated with severe mental illness.3

Diagram showing population across spectrum Estimated prevalence of mental health conditions and stepped care levels of need based on severity

At Risk Groups

Well Population Population

Mild Mental Illness

Moderate Mental Illness

Severe Mental Illness

23.1%

9%

4.6%

3.1%

People in SA (approx)

115,274

44,912

22,955

15,470

Focus on promotion and prevention by providing access to information, advice and self-help resources

Increase early intervention through access to lower cost, evidence-based alternatives to face-to face psychological therapy services

Provide and promote access to lower cost, lower intensity services

Increase service access rates maximising the number of people receiving evidencebased intervention

Improve access to adequate level of primary mental health care intervention to maximise recovery and prevent escalation. Provide wrap-around coordinated care for people with complex needs

Source: Adapted from Figure 8, COAG Health Council (2017), The Fifth National Mental Health and Suicide Prevention Plan, Commonwealth on Australia.

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Our Service Principles: Stepped Care By introducing principles of stepped care across the State, we will be able to focus on service delivery that matches the needs of individuals and has a particular emphasis on early intervention and self-care. That is, the person presenting to the mental health system is matched to the intervention level that most suits their current need. They do not have to start at the lowest level of intervention in order to progress to the next step, rather they have their service level aligned to their requirements. CSAPHN and CHSALHN mental health directorates have conducted systematic analysis and service mapping across the continuum of care, to further address: 1 Priority areas for service enhancement; and 2 Shared understanding of stepped model of care in line with the 5th National Mental Health Plan. 2017-18 Joint CSAPHN/CHSALHN stepped care service mapping across regions in country SA of mental health and suicide prevention services can be viewed here: Barossa, Hills & Fleurieu stepped care service mapping Eyre, Flinders & Far North stepped care service mapping

Limestone Coast stepped care service mapping Riverland, Mallee & Coorong stepped care service mapping Yorke & Northern stepped care service mapping Stepped care is defined as an evidence-based, staged system comprising a hierarchy of interventions, from the least to the most intensive, matched to the individual’s needs. While there are multiple levels within a stepped care approach, they do not operate in silos or as one directional steps, but rather offer a spectrum of service interventions. In a stepped care approach, a person presenting to the mental health system is matched to the intervention level that most suits their current need. An individual does not generally have to start at the lowest, least intensive level of intervention in order to progress to the next step. Rather, they enter the system and have their service level aligned to their requirements. Since the introduction of PHNs nationally and the implementation of the Stepped Care Model, there has been significant growth in the choice and access for individuals in Country SA as seen below.

CSAPHN client access across stepped levels of care 2016-17

2017-18

At Risk Groups

Mild Mental Illness

Moderate Mental Illness

Severe Mental Illness

7000 6000 5000 4000 3000 2000 1000

1. ABS (2008), National Survey of Mental Health and Wellbeing 2007: Summary of Results, ABS cat. no. 4326.0, Canberra, ABS. 2. Lawrence D, Johnson S, Hafekost J, Boterhoven De Haan K, Sawyer M, Ainley J, Zubrick SR (2015), The Mental Health of Children and Adolescents: Report on the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra, Department of Health. 3. National Guidance Initial Assessment and Referral for Mental Healthcare- Version 1.0 March 2019.

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Key statistics in a South Australian context Prevalence of mental illness in South Australia received Medicare-subsidised mental health specific services in 2017-2018 using mental health-specific MBS item numbers.

Timely and accessible health care is crucial for those living in country SA who are experiencing mental disorders. This includes the provision and delivery of appropriate prevention and early intervention services, primary healthcare services and specialist mental health services that are joined up and integrated.

Of the above, 2.1 million people consulted their GP, 1.2 million people saw a psychologist or other allied health provider. A total of 400,000 people consulted a psychiatrist. (Many individuals consulted more than one of these professionals.)

While research suggests that there is no difference in the prevalence of mental illness between those living in rural and remote communities to those living in the city, a Royal Flying Doctor Service research report (March 2017) 4, reveals dramatic differences in how sick people become. It states poor service access, distance, cost, and continued reluctance to seek help all contribute to higher mental illness acuity experienced by those living in rural and remote communities.

In 2017-18 140.9 per 100,000 persons in South Australia presented at a public hospital emergency department (ED) for mental health related illness, comprising 4.8% of all ED presentations - higher than the national average of 115.9 per 100,000 persons and 3.6% of all ED presentations within Australia. 15.9% of these presentations in South Australia were an emergency, and 51.3% were considered to be urgent.

Medicare Subsidised Mental Health Related Services 2017-18 , shows that 2.5 million Australians (10.5% of the population) 5

250,077

71 4

Male

Total public hospitals

2017 Total CSAPHN population Total private hospitals

249

6

16,703 Aboriginal and Torres Strait Islander

499,020

248,943

Mental health services

2017-18 ED mental health related presentations in South Australia were for

Female

33.1% neurotic, stressrelated and somatoform disorders

11.7%

24.7% mental disorders due to psychoactive substance abuse

for schizophrenia or schizotypal disorders

8.7% for mood disorders (ABS)

4. Bishop, L., Ransom, A., Laverty, M., & Gale, L. (2017). Mental health in remote and rural communities. Canberra: Royal Flying Doctor Service of Australia. 5. ABS. Medicare Subsidised Mental Health Related Services 2017-18, by PHN. Canberra. 6. PHIDU. Social Health Atlas of Australia: South Australia. Data by Local Government Area. The University of Adelaide: Adelaide.

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Key statistics in a South Australian context Intentional self-harm and suicide

Service access and use

• 2017 age-standardised suicide rate nationally, 12.6 per 100,000 • 2017 age-standardised suicide rate for greater Adelaide, 11.5 per 100,000

Collectively, CSAPHN mental health services and CHSALHN country community mental health services provided a mental health service to 20,722 clients in 2017-18.

• 2017 age-standardised suicide rate for rest of SA, 18.3 per 100,000

• 2017-18 total clients seen by CSAPHN mental health services, 12,808

• 2013-2017 age-standardised suicide rate for SA Aboriginal and Torres Strait Islander people was 25.0 per 100,0007

• 2017-18 total sessions delivered by CSAPHN mental health services, 39,634

While suicide is an infrequent occurrence in Australia, the effects and aftermath can be both traumatic and long-lasting for families and communities alike. Across Australia, people residing in rural and remote communities have a higher risk of suicide than those living in metropolitan areas. Particular rural communities across the state experience significantly higher rates of attempts and deaths, compared to the national and state averages.

• 2017-18 FY total clients seen by CHSALHN country mental health community services, 7,914 • 2017-18 FY total service contacts CHSALHN country mental health community, 112,292 • 2017-18 FY total hospital admissions run by CHSALHN country mental healt, 1,041

In 2017, country SA had a higher suicide rate when compared to greater Adelaide. A similar trend that was observed across most states and territories. Five year trends (2013-2017) in the age-standardised suicide rate for the joint CSAPHN/CHSALHN service area noted a slight decrease for 2016 before increasing once again in 2017. However, overall the region saw a steady incline for the five year period (2013-2017).8 Trending with national averages, males accounted for the majority of deaths by suicide (75-85%), and this trend continued across the five-year period. Males remain a priority population especially those aged 25-44 years in regional SA.8 For Aboriginal and Torres Strait Islander people in this state, suicide remained as ranked fifth in the leading cause of death for 20132017.8 While much has been done recently to respond to local needs and identify new learnings in relation to suicide prevention strategies, the statistics show we still have much to do.

Yorke Peninsula

7. ABS Causes of Death data, 2018 8. ABS 2018, Customised report

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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 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

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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

Future Focus areas

Domain One: Engaging, Listening and Acting

Consumer engagement Regional Action Plan implementation Clinician engagement plan Regional Voices

Domain Two: Regional and Local Planning

Transition planning Extend service mapping Explore shared data potential Gaps analysis

Domain Three: Suicide Prevention

Continuity and integration SA Suicide Prevention Network collaboration Shared regional attempt data Knowledge sharing in aftercare

Domain Four: Working with Aboriginal and Torres Strait Islander Services

Culturally appropriate commissioning Share evaluation learnings Explore improved data mechanisms Increase community engagement

Domain Five: Mental Health Commissioning

Sustainability and stability Increase consumer engagement Progress jointly funded Emergency and Follow Up Care Project Stepped care approach

Domain Six: Person Centred Care

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

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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

LE reference group reviewed strategies, plans and proposed activity for the National Suicide Prevention Trial (NSPT)

Local Health Clusters

Ten (10) CSAPHN Community Advisory Committees (Local Health Clusters)

Partnering with existing groups for external participation

Co-design with sector and consumers for National Psychosocial Support Measure

Facilitation of National and State participation

Ben is passionate about the difference taking care of your own body has for mental fitness

Clinical engagement

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

Click here to read more about Ben’s story

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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

Regional action plan • Driving actions determined through regional consultation and joint plans • Work with regional LHNs on implementing solutions with local stakeholders

Clinician engagement plan • 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

• Explore joint consumer networks and foster collaborative meaningful partnerships with consumers and carers

Best Practice Spotlight: Regional forums and action plans 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.

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Domain Two: Regional and Local Planning What we have achieved Shared plans and KPIs

Five (5) regional mental health action plans developed for the purpose of informed future joint decisions between CSAPHN and CHSALHN

Mapping and resourcing

Stepped care service mapping across state and federal jurisdictions

Agreements and referral mechanisms

Bilateral agreements for mental health, care coordination and suicide prevention services 

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.

“You have got to have your support network around you” Amplified regional voices and context

Facilitated regional voices via lived experience reference groups, being heard in national committees   

MENTAL HEALTH AND SUICIDE PREVENTION REGIONAL PLAN | DOMAIN TWO

Click here to read more about Emma’s story

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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

Extend service mapping • Extend and or realign CSAPHN/CHSALHN service mapping work to include redistributed CHSALHN workforce and activity

• Review the regional transition plan at intervals against whole of state approach

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

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.

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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.

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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

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

Focus on capacity building

Investment in capacity building of SA Suicide Prevention Networks under the National Suicide Prevention Trial (NSPT)

Trial of Aboriginal aftercare Service

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

“What you are going through is real. And it’s not that uncommon” Click here to read more about Angus’ story

MENTAL HEALTH AND SUICIDE PREVENTION REGIONAL PLAN | DOMAIN THREE

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Future Focus Continuity and integration • Work with CHSALHN teams to ensure sustainability, integration and referral pathways across jursidications for aftercare services

SA Suicide Prevention Network collaboration • Continued support for and collaboration with South Australian  Suicide Prevention Networks 

Shared regional attempt data • Shared regional data arrangements  for suicide attempts, creating an evidence base for informed joint decision making,  regarding service access and design

Knowledge sharing in aftercare • Shared findings and learnings from localised and national evaluations of the Aboriginal Aftercare service  • Explore and develop relationships for joint commissioning of aftercare services 

Best Practice Spotlight: Joint postvention referral mechanism after death by suicide 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.

• Permission from the families gained before their details are given to the provider

Key changes under the new formalised SA postvention referral mechanism include:

• Dedicated SAPOL officer attached to the SAPOL’s Coronial Investigation Section, will coordinate notifications and information exchange between SAPOL and postvention providers.

• Families contacted within 24 hours and advised of the coronial process and postvention providers

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• 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

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Domain Four: Working With Aboriginal and Torres Strait Islander Services What we have achieved Inclusion from decision making to delivery

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

Working in partnership with Aboriginal Community Controlled Health Organisations (ACCHOs)  to co-design programs with a particular emphasis on services with comorbidity focus

Culturally appropriate services

Prioritising the commissioning of culturally appropriate services  to recognised Aboriginal Health organisations

National collaboration

Building evaluation capacity

Hosted national LifeSpan event to develop an integrated suicide prevention response for indigenous crisis and aftercare

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 establishment and delivery of suicide prevention services.

“What brings us together is the strength of our community and our shared experience” - Wayne

Evaluation of Aboriginal suicide prevention training, You Me-Which Way, which builds capacity  and competencies in community

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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 • Share findings and learnings from evaluation of Aboriginal Aftercare service with key stakeholders and community

Explore improved data mechanisms • Work with regional LHNs and ACCHOs to look at mechanisms for increasing data capture and integrity

Increase community engagement • Deepen and broaden engagement with Aboriginal and Torres Strait Islander communities

Best Practice Spotlight: Australia first trial of culturally appropriate aftercare service 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.

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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.

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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

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

Emergency and Follow up Care

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 

HealthPathways

Working in partnership with SA Health and APHN, HealthPathways, a portal for GPs and health professionals, was implemented across South Australia

“If one person has trouble then the people close to them are also affected” Click here to read more about Annabelle’s story

MENTAL HEALTH AND SUICIDE PREVENTION REGIONAL PLAN | DOMAIN FIVE

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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

Progress jointly funded Emergency and Follow up Care Project

• Increase consumer engagement in the commissioning process

• 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 CSAPHN

Stepped care approach • Further consolidate the stepped care approach in principle and jointly map available services against a stepped care spectrum

Best Practice Spotlight: Joint CSAPHN/CHSALHN commissioning of services in areas of high need 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.

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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.

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Domain Six: Person Centred Care What we have achieved Stepped care model adopted

Regional approach to psychosocial support services

Connecting with People

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

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 is best for them.

Promoted and supported SA Health’s ‘Connecting with People’ training, providing commonality and consistency across the State

“Once you start talking about it, it does start to feel better fairly quickly” Region wide low intensity platform

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

Implemented risk matrices

Introduced a consistent approach to organisational safety and risk reduction

MENTAL HEALTH AND SUICIDE PREVENTION REGIONAL PLAN | DOMAIN SIX

Click here to read more about Todd’s story

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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

Commitment to comorbity approach

• Develop a GP engagement strategy with regional LHNs to educate and create informed regional service hubs; shifting towards culture change and alternative referral pathways

• Continued commitment to a  comorbidity approach to holistic metal health care inclusive of physical and alcohol and other drugs related health issues

Best Practice Spotlight: Meeting community demand for accessible suicide prevention 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.

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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.

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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

Establishment of clinical councils and reference groups for priority populations to support the clinical governance and cultural competencies of commissioned activity

Realigned quality

Provision of small grants to enable regional service providers to pursue accreditation against relevant national standards Â

Formed Clinical Council

Invested in service provider workforce

For Jane being outside on the property is a source of wellbeing

Implemented risk matrices

Introduced support for the development of safety requirements for suppliers

Funded low intensity mental health workforce growth and upskilling

Introduced a consistent approach to organisational safety and risk reduction

Click here to read more about Jane’s story

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Future Focus Workforce

• Jointly look at CSAPHN/CHSALHN workforce capacity and development needs for regional, rural and remote South Australia

Clinical engagement

Culturally appropriate commissioning

• 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

• 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 stepdown integration

Best Practice Spotlight: Supporting accreditation of regional stepped care suppliers 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,

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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.

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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 www.countrysaphn.com.au

Profile for CSAPHN

Regional Mental Health & Suicide Prevention Plan 2019-2021