Primary Mental Health

Primary mental health care is usually the first port of call for mental health issues and forms a necessary part of comprehensive mental health care, as well as an essential part of general primary care. Populations seen within the primary mental health setting can range from at risk groups with early symptoms through to individuals with severe mental illness and complex needs.

Identified Need MH 1- Low intensity service delivery to reduce waiting lists and increase access to areas of high disadvantage Key Issue

Low intensity services delivered

In the 2017-18 period, low intensity services were delivered to 1,303 clients equating to 1.1% of our population compared to 133 clients in the previous year (total PHN population 484,609 at-risk groups 21.3% = 111,949). These numbers indicate a 5% growth in the number of people accessing low intensity episodes or where service capacity has been reached, a maintenance of the previous year’s rate. The clinical outcomes for people receiving low intensity Mental health services showed 100% decrease in psychological distress as reported by the K10.

Psychosocial health Currently the reporting mechanisms for psychosocial needs and trends within country South Australia is limited at best. Previously such data was collected in collaboration with mental health data and thus is difficult to isolate. The estimates reached were mainly drawn from Government pension numbers, carers support, Personal Helpers and Mentors Service (PHaMS) and Partners in Recovery (PIR) provider statistics.

∙ For the 2017 period ABS data country South Australia reported 18,011 persons on a disability support pension and 5,436 persons receiving a carer payment. Overall, 6.2% of country South Australians needed assistance with core daily activities and approximately 11,133 were unemployed ∙ Leading issue in priority matrix ∙ Key area of concern in stakeholder consultation and feedback ∙ SAMSS 2016/18 ∙ Characteristics of people using mental health services and prescription medication, 2015 ABS ∙ SA Health Hospital Separations data 2015-16 ∙ Estimated resident population 2016. ∙ ATAPS MDS data 2015-16

∙ ABS- Data by Region ∙ PHaMS (Personal Helpers and Mentors Service) ∙ PIR Country SA PHN Statistics ∙ Country SA PHN MHAOD consultations ∙ SAMSS, SA Health ∙ Leading issue in priority matrix ∙ Key area of concern in stakeholder consultation and feedback ∙ SAMSS survey of residents aggregated by SA3 ∙ AIHW: Healthy Communities: Hospitalisations for mental health conditions and intentional self-harm ∙ Headspace Centres Country SA PHN (FY2017-18) ∙ MBS data by Statistical Area 2016-17

Description of Evidence

Identified Need Low Intensity Service delivery to reduce waiting lists and increase access to areas of high disadvantage

- continued

Key Issue

∙ Psychological Distress Measurements revealed 13% of country South Australian’s experienced high or very high levels of distress, compared to the state average of 11.9%. Furthermore, this level increased for Aboriginal and Torres Strait Islander people with distress levels equating to 31.8% ∙ PHaMs data was similar to ABS statistics with 2,152 participants registered in the 2014/15 reporting period ∙ PIR client’s Needs Assessment files in 2016/18 highlighted 2041 clients with needs, 1095 of these needs remained unmet. Despite services being in place to assist clients, the demand exceeded capacity, thus for regions without PIR would equate to a higher percentage of unmet needs ∙ Of the PIR clients during this period 85% were unemployed or not in the labour force and their main source of income came from pensions or government benefits. For country South Australia, PIR is only functioning in the Country North region, leaving a significant gap in the Murray Mallee, Riverland and South East.

Through community consultations conducted in 2016 on MHAOD, significant issues were evident in rural and remote communities in regard to; access to services, cost of services and service waiting periods. These factors were believed to increase mental health problems and burden in the region. See above…

MH 2- Lack of mental health support for young people

Youth Mental Health Service aims to better engage young people and work with them to develop the skills and supports they need to manage mental health distress and enjoy the best health possible. Youth Mental Health Service provides a range of services to young people with mental see above…

Description of Evidence

Identified Need MH 2- Lack of mental health support for young

people - continued

MH 7- Community education and training opportunities for sector staff Key Issue

health issues ranging from low intensity to acute care, including: ∙ mental health assessment and care planning ∙ individual therapy, group work and family work ∙ Care coordination ∙ In-patient care including step-down care

Physical assessment ∙ Alcohol and other drugs assessment ∙ Co-care with GPs, partner agencies and other service providers ∙ Consultation and liaison services to support youth and community services ∙ Referrals to other services/agencies as appropriate

Child 0-11 years mental health

1 in 7 young people aged 4-17 years were assessed as having had a mental health disorder(s) in the previous 12 months. The main treatment services utilised for the younger child cohorts were psychological therapies.

MBS subsidised mental health - related services The proportion of population aged 12-24 years who accessed at least one MBS service from a clinical psychologist was highest in the Mid North (2.9%), followed by the Lower North (1.9%) and Gawler - Two Wells (1.8%). For the 0-11yrs cohort, the proportion of population accessing at least one MBS services was highest in the Mid North (0.6%), followed by the Yorke Peninsula (0.3%) and Eyre Peninsula and South West (0.3%).

Non-PHN commissioned services targeting this age cohort include Child and Adolescent Mental Health Service (CAMHS) whom currently have 11 country-based services in the region (for children 0-15 years). see above…

Description of Evidence

Identified Need MH 2- Lack of mental health support for young

people - continued

MH 7- Community education and training opportunities for sector staff Key Issue

Youth 12-24 years mental health – headspace For youth aged 12-24 years, Headspace is the predominant mental health service provider across the region. Headspace is the National Youth Mental Health Foundation providing early intervention mental health services to 12-25 year old’s, along with assistance in promoting young peoples’ wellbeing. Headspace undertakes a range of activities to increase the awareness of services and how to access them among young people, their families, friends and the broader community.

Headspace has six operational centres in the country SA region ∙ Port Augusta ∙ Berri ∙ Murray Bridge ∙ Mount Gambier ∙ Whyalla ∙ Mt Barker

Child and youth mental health services - delivered In the 2017-18 period, Headspace delivered 10,579 occasions of service to 2,148 young persons and 1,409 new clients. The average visit frequency was 4.9 for the total 2,276 clients compared to 4.7 for 1,654 clients in the previous year.

Occasions of service was highest for the Port Augusta Headspace Centre (3,092), followed by Mount Gambier (2,695) and Murray Bridge (2,635). Comparatively, the number of serviced young people was highest in Murray Bridge (638), followed by Mount Gambier (506). In terms of new clients visiting the centres, Murray Bridge and Port Augusta were the highest. see above…

Description of Evidence

Identified Need

MH 3- Address service gaps in the provision of psychological therapies and outreach to rural and remote areas Key Issue Mental health support specifically targeting youth and

younger people is limited across the country SA region. Key reasons include: ∙ Clients experience considerable waiting periods due to low service availability ∙ Limited number of practitioners, specifically skilled in youth mental health ∙ Difficulties retaining rural/regional workforce. Resilience in rural and remote communities and increased stigma around mental health Psychological therapies Psychological therapies are delivered to mild to moderate groups within the stepped care approach, services commissioned under this level of intervention within a stepped care approach must be evidence based for the population group being targeted. In the 2017-18 period, psychological therapies were delivered to 6,020 clients equating to 9% of our population compared to 3,190 clients in the previous year (total PHN population 484,609 mild to moderate groups 13.6% = 65,906). These numbers indicate a 5% growth in the number of people accessing psychological therapies. The clinical outcomes for people receiving psychological therapies showed 71% of clients had a decrease in levels of distress after receiving a service.

Better Access (MBS)

Access to mental health services billed to the MBS varied across the PHN, the lowest for each profession was consistently found in the Outback North and East (0.6%), Eyre Peninsula and South West (1.0%). The highest access for the CSAPHN region was in the Mid North. see above…

Description of Evidence

Identified Need Address service gaps in the provision of psychological therapies and outreach to

rural and remote areas continued

MH 4- Mental Health Hospital Separations Key Issue

∙ Access to MBS billed clinical psychology was lowest in the

Eyre Peninsula and South West where 0.4% of the population had at least one session billed to MBS, this was followed by Outback North and East with 0.6%.

Highest access was in the Adelaide Hills, Gawler – Two

Wells, and Barossa. ∙ Access to MBS billed mental health services by allied health professionals was lowest in both Eyre Peninsula and South West and Outback North and East, equally providing at least one session for 0.6% of the population.

Highest access for the CSAPHN region was in the

Limestone Coast, Gawler -Two Wells, and Fleurieu –

Kangaroo Island.

GP mental health care plans (2016-17)

The preparation of GP mental health care plans per 1,000 population was highest in ∙ Gawler – Two Wells ∙ Adelaide Hills ∙ Fleurieu – Kangaroo Island And lowest in ∙ Lower North ∙ Eyre Peninsula and South West ∙ Mid North

Mental health related hospital separations

Mental health hospitalisations are a method for measuring unmet health needs due to the acute nature of a hospitalisation being a proxy of the gap between known prevalence and available/suitable treatment options. If client needs escalate beyond service availability or appropriateness, they become visible as acute hospital see above…

Description of Evidence

Identified Need Key Issue

admissions (and potentially also drug and alcohol, and selfharm hospitalisations). The highest age-standardised rate of mental health related hospital admissions (2015/16) was in; ∙ Mid North SA3 ∙ Murray and Mallee SA3 ∙ Outback North and East SA3

Females were admitted to hospital for mental health issues slightly more often than males. The Murray and Mallee region had the highest proportion of admissions for both males and females in the region, followed by the OutbackNorth and East and the Mid North regions. Specific mental health conditions were varied in type of admissions across the CSAPHN region. These are summarized by SA3 below: ∙ Schizophrenia and other delusional disorders were highest in Outback North and East followed by Mid North and Eyre Peninsula and South West (2015-16). Of interest, the Mid North had the highest access to MBS psychiatry while the Outback North and East and Eyre

Peninsula had the lowest ∙ Depressive episodes were highest in the Murray and

Mallee, followed by Mid North, and Outback North and

East (2015-16) ∙ Anxiety and stress disorders were highest in Mid North,

Yorke Peninsula and Murray and Mallee (2015-16) ∙ Bipolar and mood disorders were highest in the Yorke

Peninsula followed by the Lower North, then the Mid

North (2015-16). see above…

Description of Evidence

Identified Need MH 5- Integrated and coordinated holistic mental health services

MH 7- Community education and training opportunities for sector staff Key Issue

Remote, rural and regional communities face a range of stressors unique to living outside of a metropolitan centre. Generally, demographics have lower socioeconomic status, reduced access to services, difficulties retaining health workforces, greater exposure to natural disasters, increased distance between communities, reduced access to transport and fewer employment opportunities, all of which influence mental health.

Mental health and psychological distress

Mental health conditions are self-reported in high proportions across the region, generally increasing in prevalence with increasing remoteness. The highest rates within the country SA region were for the following areas, all of which were above the state average ∙ Lower North (26.4%) ∙ Mid North (22.2%) ∙ Barossa (20.6%) ∙ Gawler and Two Wells (20.4%) Psychological distress can have a significant impact on an individual’s life and correlates with numerous mental health disorders. Furthermore, increased psychological distress is strongly associated with numerous factors unique to country region. For the 2016-18 period, psychological distress was highest in the Mid North (19.7%) followed by Gawler - Two Wells (17.4%), Barossa (17%), and Adelaide Hills (13.3%).

Diagnosed vs Undiagnosed mental illness

Low proportions of reported mental illness in the Outback North and East (SA3) contradict the high rates of hospitalisations for mental health related conditions. This suggests rates of undiagnosed mental illness rather than lower occurrence. see above…

Description of Evidence

Identified Need

MH 6- Step Up and Down interface with acute services Key Issue

Self-reported mental health service utilisation (2016/18)

The highest self-reported mental health service utilisation was in the Fleurieu – Kangaroo Island (8.0%) followed by Lower North (7.6%), Limestone Coast (6.5%), and Murray and Mallee (5.6%).

Step Up and Down offer clinically supported services providing short term care to manage the interface between inpatient and community settings. They provide an alternative to hospital admission (pre-acute) and provide bridging support following discharge from hospital (postacute). Step Up and Down services are usually delivered through staffed residential facilities but may be delivered in the person’s home

MBS psychiatry

The state average for MBS psychiatry services is 5.8 sessions per client. For the CSAPHN, only the Adelaide Hills (6.6 sessions per client) was above the state average, while all other SA3s were below the state average. The lowest average services for MBS psychiatry was the Eyre Peninsula and South West (average 2.9 sessions per client), followed by; ∙ Outback North and East (3.1 sessions per client) ∙ Murray and Mallee (3.2 sessions per client) See above…

Description of Evidence

Identified Need MH 6- Step Up and Down interface with acute

services - continued

Key Issue

MBS clinical psychology

The state average for MBS Clinical Psychology services was 4.3 sessions per client. For CSAPHN, access to MBS Clinical Psychology services ranged between an average of 3.5 sessions per client in Outback North and East to an average of 4.4 sessions per client in Adelaide Hills. SA3 regions with the lowest average services were; ∙ Limestone Coast ∙ Yorke Peninsula ∙ Murray and Mallee ∙ Outback North and East

Description of Evidence

Priority

Low Intensity Service delivery to reduce waiting lists and increased access of mental health to areas of

high disadvantage (MH 1)

Clinical Care Coordination services delivered

In the 2017-18 period, Clinical Care Coordination was delivered to 2,002 clients equating to 13.3% of our population compared to 500 clients in the previous year (total PHN population 484,609 severe mental illness groups 3.1% = 15,022). These numbers indicate a 5% growth in the number of people accessing Clinical Care Coordination. In the CSAPHN catchment Clinical Care Coordination is delivered in the following regions; Lower North, Eyre Peninsula and South West, Murray and Mallee, Adelaide Hills, Gawler- Two Wells and Limestone Coast.

Possible Options

1. Improved demand management strategies. 2. More focus on low intensity intervention through the implementation of a stepped care model through mental health and alcohol and other drugs reform. 3. Review feasibility and efficiency of centralised regional triage and intake. ∙ Decrease of wait times.

∙ Improved integration and patient journey through escalation and deescalation of severity within the stepped care model. ∙ CSAPHN leading these activities in consultation with SA Health and the six regional Local Health

Networks and metropolitan

LHNs with support provided from the APHN as the PHN with primary and first

Expected Outcome Potential Lead

Priority

Low Intensity Service delivery to reduce waiting lists and increased access of mental health to areas of

high disadvantage (MH 1) continued

Possible Options

4. Capacity building to address clinical governance deficiencies. 5. Implementation of a stepped care model through mental health and alcohol and other drugs reform. 6. Analysis of market for successful models and expansion through targeted commissioning to meet areas of need. 7. Support region-specific, cross sectoral approaches for children and young people with, or at risk of, mental illness. 8. Extensive service mapping of the sectors to ascertain service distribution and workforce gaps. 9. Identification of communities in need and their prevalence of service support need ongoing development.

10. Support region-specific, cross-sectoral approaches for people with, or at risk of, mental illness. ∙ More streamlining of access and decrease of inappropriate referrals. ∙ Improvement of quality, access and safety. ∙ Improved integration and patient journey through escalation and deescalation of severity within the stepped care model. ∙ Increased options of evidence-based models to targeted areas of high disadvantage. ∙ Consolidated up to date inventory of available services and workforce spread. ∙ Additional mapping of impact on access to services occasioned by cost of travel to obtain services arising through reduction or withdrawal of services from rural and remote areas.

Expected Outcome

∙ Improved integration and patient journey through escalation and deescalation of severity within the stepped care model.

Potential Lead

engagement with the Metro LHN’s.

Priority

Lack of mental health support for young people

(MH 2)

Address service gaps in the provision of psychological therapies and outreach to rural and remote areas

(MH 3)

Possible Options

1. Support organisations that provide family and community programs in the target regions. 2. Place youth workers with expertise in alcohol and other drugs and mental health in communities of need including engagement with the RFDS and headspace sites for improved outreach services. 3. Promote better mental health for youth through support to headspace and community programs and education and youth support and counselling activities. ∙ Improved health outcomes for developmentally vulnerable children.

∙ Appropriate services available to and easily accessible for youth in need.

∙ RFDS and headspace partnering in youth services in remote regions. ∙ Youth activities expanded from regional centres to all areas. ∙ CSAPHN/country SA headspaces and RFDS

1. Address service gaps in the provision of psychological therapies for people in rural and remote areas and other under-serviced and/or hard to reach populations.

2. Identification of communities in need and their prevalence of service support need ongoing development.

3. Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, assessment and diagnosis post admission, identification and integration of drug and alcohol needs.

4. Extensive service mapping of the sectors to ascertain service distribution and workforce gaps.

Expected Outcome

∙ Improvements achieved in awareness of principles and practical application of principles for quality use of medicines. ∙ Additional mapping of impact on access to services occasioned by cost of travel to obtain services arising through reduction or withdrawal of services from rural and remote areas.

∙ Consolidated, up to date inventory of available services and workforce spread. ∙ Engage widely across the sector nationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and coordinated care.

Potential Lead

∙ CSAPHN

∙ Headspace

Priority

Mental health hospital

separations (MH 4)

Possible Options

1. Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling continuity of care, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs. 2. Mental health upskilling across existing mental health programs and funded activity. 3. Improved data entry/coding and dissemination across region. ∙ Engage widely across the sector nationally and internationally to define best practice, simple and cost-effective options and practices that will improve the practicality of discharge planning and its connection to the flow of coordinated care. ∙ More accurate data of mental health admissions and separations. ∙ CSAPHN initiative in collaboration with APHN and all six regional LHN’s and SA health.

Integrated and coordinated

holistic services (MH 5) 1. Implementation of a stepped care model through mental health and alcohol and other drugs reform. 2. Engage with all providers to develop the capacity of the region to engage care coordinators in routine activities and to identify opportunities and create strategies to implement better discharge planning. 3. Promotion and facilitation of the Health Care Homes, review and redesign of integrated health systems. 4. Work with and drive inter-sectoral partners and use research to develop a primary health services, ‘Service

Delineation Model’ for rural SA. 5. Use existing resources, redirected, to engagement of care coordinators in various employment models. 6. CSAPHN will work with and support GPs, Adelaide

Primary Health Network (APHN), the six regional Local

Health Networks and metro LHNs in the implementation of integrated systems. 7. Utilise learnings from PIR and integrate support facilitation models. ∙ Improved integration and patient journey through escalation and deescalation of severity within the stepped care model. ∙ Patients will be able to access specialist and allied health consultations as close as possible to their place of residence as evidenced by increased uptake of care coordination packages. ∙ Mapping and education activity resulting occasions real restructuring of local activities to include care coordination models of service delivery. ∙ Effective linking of metropolitan based services for care provided in a local rural setting. Targeting of total

GDP cost of health occasioned through travel. ∙ CSAPHN initiative in collaboration with APHN and all six regional LHN’s and SA health.

Expected Outcome Potential Lead

Priority

Step Up and Down interface with acute

services (MH 6)

Community education and training opportunities for

sector staff (MH 7)

Improved service mapping for efficient commissioning and targeting of services

(MH 8)

Possible Options

1. Implementation of a stepped care model through mental health and alcohol and other drugs reform.

2. Explore telehealth options for increased access to psychiatry.

3. Investigate discharge planning processes across the acute sector and research best practice models to inform project design enabling improvements in the continuity of care including medication management, risk assessment and diagnosis post admission, identification and integration of drug and alcohol needs. ∙ Improved integration and patient journey through escalation and deescalation of severity within the stepped care model. ∙ Patients will be able to access specialist and allied health consultations as close as possible to their place of residence. ∙ Engage widely across the sector nationally and internationally to define best practice, simple and cost-effective options and practices. ∙ CSAPHN initiative in collaboration with all six regional LHN’s and SA

Health.

1. Specialised upskilling across existing mental health programs and funded activity. 2. Extensive service mapping of the sectors to ascertain service distribution and workforce gaps. 3. Community forums and awareness. ∙ Improvements achieved in awareness of principles and practical application of principles for quality use of medicines. ∙ Consolidated up to date inventory of available services and workforce spread. ∙ DATIS & CSAPHN partnership

4. Extensive service mapping of the sectors to ascertain service distribution and workforce gaps.

5. Transparency of mapping to increase awareness of service providers and commissioned services ∙ Consolidated up to date inventory of available services and workforce spread. ∙ CSAPHN

Expected Outcome Potential Lead