It’s been a very long time coming but today the Federal Government finally released its response to the National Mental Health Commission’s Review of Mental Health Programmes and Services, Contributing lives, thriving communities.
Here’s the Government’s full response and the media release from Health Minister Sussan Ley, and this additional statement on the new single national mental health phone line (without a number yet, it will be rolled out over the next year).
In this Fact Sheet, the Government says the Commission’s review “highlighted the existing complexity, inefficiency and fragmentation of the mental health system.”
“There is a critical need for long-term reform,” it said, adding that the mental health consumer “is at the centre of the reforms”.
The focus of the reforms is primary mental health care services and areas of ongoing Commonwealth responsibility, while the response also encourages partnerships and better integration with other service providers.
It says work will immediately commence on nine key action areas. See them listed here below, and – further below in this post – early responses from the mental health sector, which has generally welcomed the the reforms though noted there is much to be viewed yet in the detail and implementation.
In a statement, the National Mental Health Commission said the government’s response was “a major step forward in enabling people to lead more contributing lives and for Australia to grow thriving communities” and represented “a ringing endorsement” of the strategic directions outlined in the Commission’s review. It said:
“The focus now must be on effective and efficient implementation, as well as on change management, to ensure the community reaps the full benefits of the reform package. It is critical that implementation actively engages key stakeholder groups across the mental health sector, and places individuals, families, carers and other support people at the centre.”
Follow the discussion on Twitter via the hashtag #mentalhealth.
1. Locally planned and commissioned mental health services and a new flexible primary health care funding pool
Primary Health Networks (PHNs) will lead mental health planning and integration at a regional level, in partnership with Local Hospital Networks, non-government organisations, Aboriginal and Torres Strait Islander organisations, National Disability Insurance Scheme (NDIS) providers, and drug and alcohol services.
From 2016, Commonwealth mental health programme funding will be transitioned to Primary Health Networks (PHNs) to form a newly created mental health flexible funding pool.
PHNs will have the flexibility to use this funding to commission regionally delivered primary mental health services suited to local needs with in a stepped care model.
Mental health priorities for PHNs will include:
- regional mental health plans to identify needs and gaps, reduce duplication and remove inefficiencies
- improved links and innovative approaches to support clinical care coordination for people with severe mental illness and complex needs, including new joined up assessment arrangements integrating Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing services and other services at a local level
- cross-sectoral approaches to early intervention for children and young people and commissioning of services to support to a broader group of young people with or at risk of mental illness
- a regional approach to suicide prevention, including community based activities and integrated post discharge care for people at high risk of suicide
- strategies to target services to people in rural and remote areas and other hard to reach and at risk populations.
2. A new easy to access digital mental health gateway
Online mental health interventions, including self-help and exchanges with clinicians, have proven benefits. For some people suffering from depression and anxiety, digital services can be as effective as face-to-face sessions.
A new digital mental health gateway will be the first point of service for people looking for information, advice or an online psychological service. It will encourage consumers to use digital interventions, where appropriate.
The gateway will bring together existing evidence based information, advice and digital mental health services. People will be connected to services through a centralised telephone and web portal. Ease of access to crisis support services will be promoted through the gateway.
3. A ‘stepped care’ model for primary mental health care
Over a three year period, existing Commonwealth-funded primary mental health care programmes will be redesigned to reflect the different levels of care needed by consumers, moving from a ‘one size fits all’ approach to a system that optimally meet individual needs – people will get the right care at the right time.
Refocusing efforts to achieve better targeting of service within a stepped care model will involve:
- promoting the new digital mental health gateway as the first point of contact and service for many consumers;
- cost effective, low intensity services for people with mild mental illness, recognising digital services will not be appropriate for some people;
- better targeting of Medicare subsidised psychological services to the needs of people with moderate to severe mental illness;
- in parallel with broader primary health care reforms, developing new funding models to support coordination of care for people with ongoing, severe mental illness and complex needs, including young people with severe illness; and
- stronger support to GPs to enable them to assess and refer people to the best services, especially in relation to people with severe and complex mental illness.
4. Joined up support for child mental health
Commonwealth programmes in the health and education portfolios will be joined up to create more effective interventions for child mental health from early years to adolescence.
This will be achieved by:
- a single, integrated school based mental health programme to develop awareness of mental health issues, prevent problems and build resilience. This will build on the success of KidsMatter and MindMatters, and be promoted through the Safe Schools Hub;
- improved access for children and young people to telephone and web-based information and advice through the new digital mental health gateway;
- stepped care arrangements for children through PHNs;
- a national workforce support initiative to assist clinical and non-clinical professionals and services who work with children to identify, support and refer children at risk and to promote resilience building. This will include children who have experienced trauma; and
- partnerships at a regional level between clinical and non-clinical support services, including Family Mental Health Support Service providers, supported by the national workforce support initiative.
5. An integrated and equitable approach to youth mental health
Youth mental health services including headspace will be better integrated with primary care services in each region, through the local PHN. There will also be better integration of mental health and drug and alcohol services for young people.
Early intervention will be provided to a broader group of young people presenting to primary care services who have or are at risk of severe mental illness.
A trial will be held of a new model to better integrate employment and educational support for young people up to 25 years old who have a mental illness.
Through the Department of Social Services, employment specialists will be integrated into youth mental health services to help individuals find work or achieve their education goals.
6. Integration of Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing services
Access to culturally sensitive mental health services for Aboriginal and Torres Strait Islander people will be increased through better planning, integration and commissioning of services by PHNs.
Social and emotional wellbeing support, mental health, suicide prevention and alcohol and other drug services for Indigenous people will be better joined up on the ground, in recognition of the links between these various needs.
Mental health will also be a high priority within the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023.
7. A renewed approach to suicide prevention
A new national suicide prevention strategy will be implemented immediately, with four critical components:
- national leadership and infrastructure, including whole of population activity and crisis support services;
- a systematic and planned regional approach to community based suicide prevention. PHNs will commission regionally appropriate activities, in partnership with LHNs and other local organisations;
- efforts to prevent Aboriginal and Torres Strait Islander suicide will be refocused; and
- working with states and territories, including in the context of the Fifth National Mental Health Plan, to ensure people who have self-harmed or attempted suicide are given effective follow-up after discharge.
8. Improved services and coordination of care for people with severe and complex mental illness
Better, more coordinated support to people with severe mental illness and complex needs who are being managed with primary care, will be a priority.
Innovative funding models will allow funding to follow the consumer’s needs, including young people with complex needs. These models will be implemented over time, in conjunction with primary health care reforms.
The role of mental health nurses will be promoted in coordinating the care for people with severe mental illness and supporting the role of GP as care manager.
Regionally based clinical assessment arrangements for people with severe and complex mental illness will be improved and linked to Local Hospital Network and NDIS assessment and referral processes based on the consumer need.
Mental health providers and consumers will be encouraged to use a single digital health record to improve communication and understanding.
The Government will also continue to work with state and territory governments to ensure the effective transition to the NDIS for people with severe and persistent mental illness and psychosocial disability.
It will periodically review progress of the transition to NDIS to ensure that the scheme provides choice and good support for people with a disability arising from mental illness, while people with severe mental illness who are not eligible for NDIS also receive continued support.
9. National leadership in mental health reform
In addition to leading reform and system change in the areas outlined above, the Commonwealth will continue to play a leading role in prevention and early intervention initiatives.
It will renew efforts to reduce the stigma associated with mental illness and promote access to services, including support available through the new digital gateway.
It will ensure the mental health needs of particular population groups are serviced, including Aboriginal and Torres Strait Islander people, humanitarian entrants who have experienced trauma, defence personnel and veterans.
It will enhance the evidence base to support national policy and planning for mental health services, including data collection and evaluation, as a key to continuous improvement.
It will support consumer participation, through a new consumer and carer participation framework.
The Australian Government is committed to working with the sector and stakeholders in moving these critical reforms forward and improving the mental health system for all Australians.
Early responses from the mental health sector
National Mental Health Commission: http://www.mentalhealthcommission.gov.au/media-centre/news/giant-steps-towards-building-the-mental-wealth-of-the-nation.aspx
Prof Helen Christensen, Director of Black Dog Institute and Chair of NHMRC Centre for Research Excellence in Suicide Prevention: http://www.blackdoginstitute.org.au/newsmedia/newsdesk/index.cfm
Mental Health Australia: https://mhaustralia.org/media-releases/mental-health-reform-starts-today
St Vincent’s Health Australia: https://svha.org.au/home/newsroom/announcements/mental-health-package-welcomed-but-acute-services-must-not-be-weakened
Australian Healthcare and Hospitals Association (AHHA) http://ahha.asn.au/news/mental-health-announcements-good-foundation-better-care
Australian Medical Association: https://ama.com.au/media/mental-health-framework-well-intentioned-lacks-detail-new-funding-and-service-delivery