Needs Assessment Snapshot. Latrobe Local Government Area

Transcription

1 Needs Assessment Snapshot Latrobe Local Government Area June

2 Introduction This snapshot includes Latrobe specific information included in the Gippsland PHN Needs Assessment for the Gippsland region, which was developed between November 2015 and March The regional needs assessment forms the foundation for the Gippsland PHN priorities for Please refer to the Gippsland PHN website for the regional context and information about the Needs Assessment and priorities The Needs Assessment incorporated three main components; A Brief Population Health Profile which identifies health issues in Gippsland based on quantitative sources of information and allows a comparison of Gippsland and its six Local Government Areas (LGA) with other PHNs and/or Victoria and Australia. Measures of demography, social status, health behaviours and risk factors, health conditions and status and service use / access are included. This document is available from the Gippsland PHN web site Qualitative data from an analysis of existing reports documenting views of consumers and other stakeholders in Gippsland related to health. Qualitative data derived from 69 interviews with key stakeholders (professionals). The methodology is described in more detail in Appendix 1 (overview) and more information about the qualitative methods can be found in the Needs Assessment Qualitative Report (June 2016). This document is available from the Gippsland PHN web site Please note, information about Latrobe is also available from the following sources: Gippsland Health Online; Latrobe City web site; Central West Gippsland Primary Care Partnership; The DHHS Health and Wellbeing planning guides 2

3 What the Brief Population Health Profile tells us about Latrobe The following information about Latrobe notes key information or differences compared to other Gippsland Local Government Areas, Gippsland as a whole, or Victoria / Australia. Population Latrobe has a population of 73,903 (2016) which is predicted to increase to 76,319 in 2021, and 82,455 in 2031; an annual growth rate of 0.6% ( ), the second lowest growth rate compared to other LGAs in Gippsland % of Latrobe s population are aged 60 years or older, 44.2% are years and 31.8% are 24 years and under. The percentage of 60+ year olds in Latrobe is the lowest in Gippsland and the percentage of year olds is the highest in Gippsland. 1 There are 4,543 people in Latrobe with a profound or severe disability. 3 Latrobe has the highest population density in Gippsland; 51.8 people per square km compared to Gippsland (24.8) % of the population identify as Aboriginal and/or Torres Strait Islander, consistent with the Gippsland rate of 1.8% and higher than the Victorian rate of 0.8%. 2 Latrobe has a fertility rate of 2.1; equal lowest of Gippsland LGAs but higher than Victoria s rate of Latrobe has a teenage fertility rate (live births by mothers <19 years) of 26; equal highest in Gippsland and markedly higher than the Victorian rate of Socio-economic information Disadvantage The SEIFA measure of socio economic disadvantage for Latrobe is 940, the lowest in Gippsland and lower than Victoria (1010). 2 (Note: a low score means more disadvantage). Income, employment and housing Latrobe has 777 age pension recipients per 1,000 eligible population, the highest rate in Gippsland and higher than the Victorian rate of Latrobe has the highest unemployment rate in Gippsland; 6.4% which is also higher than Victoria 5.8% % of Latrobe residents receive an unemployment benefit; the highest in Gippsland and higher than Victoria (4.9%). 2 22% of children under 15 live in jobless families in Latrobe, the highest in Gippsland and higher than Victoria (13%). 2 The equivalised median income of $942 in Latrobe is the second highest in Gippsland, but lower than the Victorian median of $1, % of families in Latrobe are low income/welfare dependent; the highest proportion in Gippsland and higher than Victoria (9%). 2 10% of the Latrobe population (16-64 years) receive the Disability Support pension; the highest rate in Gippsland and double the Victorian rate of 5.3%. 2 29% of the Latrobe population have rental stress; consistent with Gippsland (28%), but higher than Victoria (25%). 2 20% of Latrobe households are in dwellings receiving rent assistance; the second highest rate in Gippsland and a higher rate than Victoria (16%). 3 3

4 Other socio-economic information Latrobe has the highest percentage of people born in a non-english speaking country in Gippsland at 8.5%, but this is low compared to Victoria (21%). 2 Latrobe has low community acceptance of diverse cultures; 41% (the second lowest in Gippsland), compared to 51% for Victoria. 2 Latrobe has the highest gaming machine losses per head of adult population in Gippsland at $732; much higher than Gippsland ($563) and Victoria ($550). 2 A low proportion of school leavers participate in higher education; 16% in Latrobe compared to Gippsland (19%) and Victoria (36%). 2 20% of people in Latrobe are volunteers, the lowest proportion in Gippsland and consistent with Victoria (19%) % of people in Latrobe experience food insecurity, high compared to Gippsland (6.8%) and Victoria (4.6%). 2 Crime Children Latrobe s crime rate is 13,850 (total offences per 100,000 people); the highest in Gippsland and much higher than the Victorian rate of 7, Latrobe has 2,768 family incidents per 100,000 people; the highest in Gippsland and much higher than the Victorian rate of 1, Latrobe has 990 family incidents where children are present per 100,000 people; the highest in Gippsland and much higher than the Victorian rate of The rate of substantiated child abuse is 21 per 1,000 population in Latrobe, higher than Gippsland (14) and Victoria (7). 2 The alcohol related family violence rate is 74 incidents per 10,000; the highest in Gippsland and more than double the Victorian rate (27). 6 Three of the top seven regional Significant Urban Areas with the greatest increase in drug use and possession incidents between 2011 and 2015 were in Latrobe; Moe, Newborough, and Morwell % of children in Latrobe are developmentally vulnerable on two or more domains, the highest percentage in Gippsland, and higher than Victoria (9.5%). 2 Latrobe has the highest rate of children in out of home care in Gippsland; 13.4 per 1,000 population compared to Gippsland (9.9) and Victoria (4.6). 2 Latrobe has the second highest rate in Gippsland of adolescents being bullied; 23% compared to Gippsland (22%) and Victoria (18%) % of babies in Latrobe were low birth weight; the second highest rate in Gippsland and higher than the Victorian rate of 6.6%. 2 39% of babies in Latrobe are fully breastfed at 3 months; lower than Gippsland (47%) and Victoria (51%). 2 Latrobe has the highest rate of fully immunised 1 year old children in Gippsland; 94% compared to Gippsland (92%) and Australia (91%). 2 Causes of death/disability The top five causes of death in Latrobe are (in order); malignant cancers, cardiovascular disease, unintentional injuries, chronic respiratory disease and intentional Injuries. 4 The top five causes of disability (Disability Adjusted Life Years) in order are mental disorders neurological and sense disorders, malignant cancers, chronic respiratory disease and cardiovascular disease. 4 4

5 Latrobe has a significantly higher rate than Australia and the highest rate in Gippsland of premature deaths (0-74 year olds) for both males and females; 378 for males and 214 for females (age-standardised rate per 100,000 people). The rate for specific conditions was also significantly higher than Australia for: 3 o all cancers; 120 compared to Australia (102) o lung cancer; 28 compared to Australia (21) o circulatory system diseases; 64 (48) o diabetes; 11 (6) o ischaemic heart disease; 36 (26) o external causes; 42 (30) o road traffic injuries; 10 (6) o suicide and self-inflicted injuries; 17 (12). Latrobe has a higher rate of alcohol related deaths than Victoria; 2.4 deaths per 10,000 compared to Victoria (1.5). 6 Health status Male life expectancy in Latrobe is 76.9 years and female is 82.2 years, which is the lowest in Gippsland and lower than Victoria (80.3 and 84.4 years respectively) % of people in Latrobe report Type 2 diabetes; higher than Gippsland (5.4%) and Victoria (5.0%). 2 32% of people in Latrobe report high blood pressure; higher than Gippsland (28%) and higher than Victoria (24%) % of people in Latrobe report osteoporosis; higher than Gippsland (5.3%) and higher than Victoria (5.3%). 2 14% of people in Latrobe report high or very high psychological distress; high compared to Gippsland (12%) and Victoria (11%). 2 Latrobe has 1.8 pertussis notifications per 1,000 people, higher than Victoria at Latrobe has the highest rate of chlamydia notifications per 1,000 people in Gippsland; 4.3 compared Gippsland (3.3) and Victoria (3.5). 2 Latrobe has a rate of 522 malignant cancers diagnosed per 100,000 people; the same as the Victorian rate and lower than other Gippsland LGAs. 2 Latrobe has 94 unintentional injuries treated in hospital per 1,000 people; consistent with Gippsland and higher than Victoria (59). 2 Latrobe has 4.7 intentional injuries treated in hospital per 1,000 people; higher than Gippsland (4.2) and Victoria (3.1). 2 Latrobe has 378 asthma and related respiratory admissions to hospital for 3-19 year olds (agestandardised rate per 100,000); the second highest rate in Gippsland and higher than Victoria (310). 7 Latrobe has 130 asthma admissions to hospital for year olds; the second highest in Gippsland and higher than Victoria (87). 7 Heart failure admissions for people aged 40 years or older are more common in Latrobe at 547 per 100,000 (age-standardised rate); higher than Victoria (440) % of the Latrobe population (or 1,391 people) are predicted to have dementia in 2020; the lowest rate in Gippsland, but higher than the Victorian rate of 1.6%. 5 Health behaviours 18% of Latrobe adult males are smokers; consistent with Victoria (18%), and lower than Gippsland (21%). 2 22% of Latrobe adult females are smokers; higher than Gippsland (16%) and Victoria (13%). 2 5

6 24% of Latrobe residents are obese; higher than Gippsland (20%) and Victoria 17%. 2 22% of Latrobe residents consume soft drink daily; higher than Gippsland (20%) and Victoria (16%). 2 60% of Latrobe females aged years participate in breast cancer screening; higher than Victoria (55%). 2 Service use / access Latrobe has the highest number of GP attendances per person in Gippsland; 6.4 compared to Gippsland (5.6) and Victoria (5.5). 7 Like the rest of Gippsland, there are low rates of after-hours GP attendances per person in Latrobe; 0.18 per person compared to Gippsland (0.15) and Australia (0.31). 7 Latrobe has three GP practices open for hours in the after-hours period (in Moe, Morwell and Traralgon). Latrobe has the highest rate of bulk billed GP attendances in Gippsland; 90% compared to Victoria (84%). 7 Latrobe has a rate of 465 hospital inpatient separations per 1,000 population; the second highest rate in Gippsland and higher than Victoria (420). 2 Latrobe has 398 emergency department presentations per 1,000 people; high compared to Victoria (259) and similar to other Gippsland LGAs with an emergency department. 2 Latrobe has 196 primary care type presentations to emergency department per 1,000 people; high compared to Victoria (108) and similar to other Gippsland LGAs with an emergency department. 2 Latrobe has the highest rate of people who received alcohol and drug treatment in Gippsland; 12.2 per 1,000 people, compared to Victoria (5.8). 2 Latrobe has the highest rate of registered mental health clients in Gippsland; 16.3 per 1,000 people and higher than Victoria (11.1). 2 Latrobe has 21 ambulance call outs per 1,000 people for low acuity (Code 3), the second highest rate in Gippsland (18) and 2½ times the Victorian rate (8). 8 Latrobe has an alcohol related ambulance attendances rate of 44 per 10,000; comparable to high rates in East Gippsland and Bass Coast, but higher than the Victorian rate of Latrobe has the highest rate in Gippsland for CT imaging of the lumbar spine; 1,509 per 100,000 (age standardised) and higher than Australia (1,225). 4 Latrobe has the highest rate in Gippsland of potentially preventable hospitalisations; 2,644 per 100,000 people (age standardised) compared to Australia (2,436). Specific conditions that also have a higher rate compared to Victoria: 7 o chronic disease; 1,298 (Victoria 1,122) o acute and vaccine preventable diseases; 1,352 (1,325) o cellulitis; 263 (237) o heart failure; 276 (195) o diabetes complications; 205 (166). Workforce There are lower numbers of registered professionals per 1,000 population of; o Dentists 0.39 (Victoria 0.59) 9 o Medical specialists 0.99 (Victoria 1.31); but higher than other Gippsland LGA s 9 o Occupational therapists 0.55 (Victoria 0.66) 9 o Physiotherapists 0.70 (Victoria 1.11) 9 o Optometrists 0.17 (Victoria 0.25) 9 o Pharmacists 0.84 (Victoria 1.09) 9 6

7 o Podiatrists 0.13 (Victoria 0.36) 9 o Psychologists 0.61 (Victoria 1.02) 9 There are higher numbers of registered professionals per 1,000 population of; o Medical radiation practitioners 0.70 (Victoria 0.52) 9 o Registered nurses 11.8 (Victoria 10.2) 9 o Enrolled nurses 3.4 (Victoria 3.1) 9 There are similar numbers of registered professionals per 1,000 population of; o GPs 1.28 (Victoria 1.22) 9 Medical practices Rates presented here are prescriptions dispensed / investigations / procedures per 100,000 population (age standardised rate). Mental health treatment plans by GPs were more common in Latrobe; age-standardised rate of 5,113 per 100,000 population compared to Victoria (4,769). 7 Hysterectomy and endometrial ablations are more common in Latrobe; age-standardised rate of 687 per 100,000 population compared to Victoria (276). 7 Fibre optic colonoscopies were less common in Latrobe; 1,612 age-standardised rate per 100,000 population, compared to Victoria (2,469). 7 Prescribing rates were low for: 7 o anticholinesterase medications (5,933 age-standardised rate per 100,000 population compared to Victoria 14,027). Prescribing rates for were high for: 7 o opioid prescriptions (101,728 age-standardised rate per 100,000 population, compared to Victoria 55,414 and the highest rate in Gippsland) o antidepressant prescriptions year olds (148,1712 compared to Victoria 99,774 and the highest rate in Gippsland) o antidepressant prescriptions 65 years or older (214,050 compared to Victoria 194,225 and the highest rate in Gippsland) o ADHD prescriptions for 17 year olds or younger (20,558 compared to Victoria 7,367 and the highest in Gippsland) o antipsychotic prescriptions for 17 year olds and younger (2,131 compared to Victoria 1,774) o antipsychotic prescriptions aged (28,265 compared to 19,663) o anxiolytic prescriptions (30,187 compared to 20,689) o asthma prescriptions for 3-19 and year olds (37,331 and 33,845 compared to Victoria 23,810 and 19,496 respectively; and both the highest rates in Gippsland) o asthma and COPD prescriptions, aged 45 years or older (91,151 compared to Victoria 75,164) o antimicrobial dispensing, amoxicillin clavulanate (19,244 compared to Victoria 17,267). 7

8 What the Qualitative Data tells us about Latrobe Information about the qualitative methodology is in Appendix 1 (overview) and more detailed information is in the Needs Assessment Qualitative Report (June 2016). This document is available from the Gippsland PHN web site Existing Reports Consumer Input Themes from a consumer s perspective for Latrobe were identified based on four reports, incorporating input from approximately 1,500 consumers. All four reports were published by Latrobe City and the themes will be influenced by this. In contrast to other Gippsland LGAs, there were no stand -out themes in Latrobe with no theme scoring more than a count of two (Table 1). Table 1. Consumer themes identified in reports for Latrobe, including a count of number of times mentioned. Theme Community Connectedness (refers to social participation, social isolation, being part of a community) Service Model (comments about service models that either promote or limit client engagement and service delivery, e.g. need youth specific health services) Social and economic determinants of health (income and education stated as impacting on health) Physical Activity (refers to any comments relating to physical activity and health status) Healthy Eating (refers to any comments relating to food access, food quality, food safety) Built Infrastructure (refers to buildings, venues, recreation facilities, walking trails, bike paths, crossings,seating, water fountains, etc) Alcohol (refers to comments about the link between alcohol and health) Transport (refers to comments about public /private transport, flexible transport options and links with health status and service access) Service Access (where access to services is identified as an issue with no specifics) Tobacco (refers to comments about the link between tobacco and health Safety (refers to road and pedestrian safety, falls, poisoning) Reproductive And Sexual Health (includes references to sexual and/or reproductive health issues e.g. incidence of STIs) Family Violence (refers to violence within the family including violence against women, children, general references and elder abuse) Drugs (refers to comments about the links between drug use and health status) Immunisation (refers to immunisation rates and uptake issues) Service gaps - parenting Count 2 1 8

9 Existing Reports Other Stakeholder Input The key themes emerging from other stakeholders perspectives in existing reports for Latrobe City (n=5), and the number of times they were identified are found in Table 2. The top theme identified by other stakeholders was service gaps, relating to dementia and aged care, specialists, and children s services. The second most frequently mentioned theme was social and economic determinants of health, consistent with the numerous indicators of socioeconomic disadvantage identified in quantitative data (including housing, employment, towns, income). Table 2. Other Stakeholder themes identified in reports for Latrobe, including a count of number of times mentioned. Theme Service gaps (Dementia, Dementia trained allied health, Aged CALD specific, CAPS and EACH packages, Aged services, COPD specialists, Stroke specialists, Endocrinology, Oral health, Paediatric Allied Health, Childcare, Parenting, Playgroup, Independent living support) Count 14 Social and Economic Determinants of Health (includes; housing (4), employment (3), town viability (2), income (1) 10 Family violence (refers to violence within the family including violence against women, children and elder abuse) 3 Health Service Infrastructure (refers to comments about the need for additional or updated health service infrastructure ) 3 Healthy Eating (refers to any comments relating to food access, food quality, food safety) 3 Care Pathways Drugs Health Workforce Shortages Immunisation Service coordination Transport 2 9

10 Service Coordination ehealth Health Service Planning Information on Health Mental Health Other Service Infrastructure Population Changes Service Model Service Quality 1 10

11 Results of Stakeholder Interviews Seven interviews were conducted with Latrobe professionals. The top theme identified was mental health, both as a top health issue and in relation to service gaps, especially psychiatry (Table 3). Additional themes included chronic disease (including diabetes, asthma and heart disease) and addressing the social and economic determinants of health. Table 3. Themes identified in interview data for Latrobe, including a count of number of times mentioned. What are the top three health issues? Mental health Mental health but at an early stage need people to feel like they are learning and contributing and connected, leads to employment. Chronic disease including diabetes, asthma and heart disease 3 Social and Economic Determinants of Health 3 Tobacco use 2 5 Skin conditions Wound Management Immunisations Outcomes of mine fire Obesity Drugs/Obesity Build connectedness Family violence What are the top three health service gaps? 1 Mental health; psychiatry, bulk billing 3 Specialist wound management Asthma clinic Diabetic educator Lack of specialists in local area; ENT Access to free legal services Supported accommodation; suitable rental accommodation with long term tenure and with outreach support. Aboriginal health and the gap, no ACCHO in Latrobe Services to connect with schools and support families preventing health issues. Many children don t have a family to support them. Need more optimism re: future of the Valley and globally. Jobs after coal and better environment. Involve people in improving environment & infrastructure. 1 11

12 What is working well for health? Good clinical skills 3 Reputation, adaptability of general practices 2 After Hours services 2 Come a long way with schools, healthy eating & physical activity. Also mental health & wellbeing, realising they have a big influence Outreach support model in Traralgon for chronic mental illness Service providers work well together and have good intentions- better cooperation and communication than previous years Access to specialists Connectedness to community What is not working well for health? 1 Current dependence of patients wanting to the same GP rather than trying new ones in clinic "Weight loss to address key areas of health like diabetes Access to district nursing - not currently enough DN to cover needs Diabetes Nurse/Education expansion of current program needed. People want to learn about healthy eating and cooking but hard to get them to attend. Community engagement - not happening Need longer term funding. Can t change anything within on political cycle. Need resources and continuity Physical environment also needs improvement, e.g. paths & safe environment. Wish list for health That they all lose weight for health Wipe off 10' weight loss education/drive Team of carers to visit the elderly for triage, reassurance and to check on welfare. This would keep calls to ambulance and presentations to ED at the acute level. Obesity biggest issue as it affects everything. For people to take responsibility for their health and not rely on others to fix things for them. Around mental health - provide learning opportunities to empower people to understand and allow employment down the track. Need more prevention and wellbeing thinking. Funding needed in right areas. Other comments Be preventatively pro-active Have tried lots of things and will keep trying. When there is a crisis, services are provided, not early. A tiny amount of resources are in prevention. No capacity with alcohol issues when identified- can t access locally. Also behaviour change programs. Financial literacy - how to manage on a small budget. 12

13 References 1. Victoria In Future 2015; /victoria-in-future Local Government Area Profiles Datasheet 2013, Department of Health and Human Services, Victoria, includes data from various sources, 3. Social Health Atlas of Australia; Data by Primary Health Network, published by Public Health Information Development Unit, November 2014; 4. Gippsland Health and Demographic Snapshot, Gippsland Health Online, 5. Access Economics: Projections of dementia prevalence and incidence in Victoria : Department of Health Regions and Statistical Local Areas. 6. Turning Point; 7. National Health Performance Authority, 8. Ambulance Victoria data, using POLAR Explorer for the analysis (January 2016) 9. AIHW National Health Workforce Dataset, ct%2fexpenditure%20and%20economics%2freports&reportname=health%20workforce&appswitcher Disabled=tr and population estimates for SA3 in Gippsland based on Victoria in Future Crime Statistics Agency, Sutherland P and Millsteed M, Briefing Copy - Recorded drug use and possession crime in metropolitan, regional and rural Victoria, Victoria Police LEAP, ; 13

14 Appendix 1 Methodology for Gippsland PHN Needs Assessment 2016 Gippsland PHN formed an internal Steering Committee for the Needs Assessment and invited comments from local representatives of the Monash School of Rural Health and the Department of Health and Human Services. The following components formed part of the needs assessment: A Brief Population Health Profile was produced to identify health issues in Gippsland based on reliable sources of information which allowed a comparison of Gippsland and its six Local Government Areas (LGA) with other PHNs and/or Victoria and Australia. Measures of demography, social status, health behaviours and risk factors, health conditions and status and service use / access were included. This document can be accessed via the Gippsland PHN web site. The service needs analysis included an overview of workforce and service provision by LGA, based on information available on web sites. It was identified that additional work is required to accurately describe available service options and coordination. A desktop analysis of existing reports including consumer and/or other stakeholder input on health issues from local organisations in Gippsland was undertaken. A letter was also sent to stakeholders requesting their assistance in identifying relevant reports. In total, 35 reports including consumer input and 46 reports including other stakeholder input were included in the analysis, representing LGAs, health services, non-government organisations and consumers across the PHN catchment. Reports were read and relevant consumer and stakeholder material was cut and pasted into separate documents. A qualitative analysis was undertaken by two independent reviewers using slightly different methodology (one using a combination of the techniques of pawing, word repetitions, and compare/contrast, while the other used a combination of cutting-and-sorting, word repletion and repetition-in-context). Key themes were developed and compared, arriving at a common set with agreed definitions and a count against each. Limitations to some of this data are acknowledged, such as an over-representation by local government reports, bias introduced by the authors since the analysis was not based on raw data and incomplete coverage of geographical areas and population groups. However, an important benefit of this analysis was the recognition of existing work and considerable efforts to include consumer input and engagement of key stakeholders. Semi-structured interviews were held with 69 key stakeholders representing general practice, health services, bush nursing centres, Aboriginal community-controlled organisations, local and state government organisations and non-government organisations. Stakeholders were invited to be interviewed based on their role, employer and geographical location to achieve broad representation. Direct experience with key population groups (including aged, children, young people and Indigenous people) or priority areas such as mental health was also considered. A set of seven open-ended questions was used as the basis for the interviews and responses were recorded by each of the five interviewers. A qualitative analysis of themes was undertaken using similar methods to those described under desktop analysis above. Assessment and triangulation of information from each component was undertaken in order to identify priorities. Initially, a modification of the method described in the guidelines provided by the Department was applied. The identified potential priorities were provided to the Gippsland PHN Clinical Council and interviewed key stakeholders who ranked them. Subsequently, additional triangulation incorporating the ranking results and measures of the size, severity and changeability of the issue and a measure of the PHNs role in addressing the potential priority was conducted. Resulting draft priorities were then distributed to the Steering Committee, the Gippsland PHN 14

15 Clinical Councils and interested stakeholders who provided information about suggested options to address them. Throughout the process of the needs assessment, it has been a priority to engage stakeholders as much as possible and to build relationships for future partnerships. This focus has affected the time available for in depth data analysis. However, the rich data gathered during interviews and through the Clinical Councils has been very valuable and possible partnership options have been identified, ensuring a strong position for Gippsland PHN for the future. Decisions about how to best capture consumer views in a short time frame warrant some additional comment. Initial plans included adding direct input from specific population groups after identifying gaps. However, after undertaking a desk top analysis of existing reports, it was found that a considerable body of information derived from consultations with thousands of consumers in Gippsland existed. In addition, it was identified that there was a risk that the quality of consumer input would be compromised if we chose, within short time lines, to undertake consumer surveys, or consultations without input from the Community Advisory Committee which was not yet operational. Therefore, it was decided that broad consumer input would be undertaken during , ideally in collaboration with municipal planners to ensure a coordinated approach. For the 2016 Needs Assessment, consumer views were obtained directly and indirectly from key groups including; - the Indigenous sector, including specific Alcohol and Other Drug input and via representation on the Gippsland Aboriginal Health Advisory Committee, - the mental health sector, including PIR consumer representatives and PIR Advisory Group input and input from the Gippsland Mental Health Alliance, and - the Gippsland Catchment Planning for AOD and Mental Health Community Support Services consumer and carer focus groups and the Gippsland Alcohol and Drug Service Providers Advisory group. 15