Updated Activity Work Plan 2016-2018: Primary Mental Health Care Funding Brisbane North PHN 1
1. (a) Strategic Vision The PHN s strategic vision is a community where good health is available for everyone. By working with others, we will: 1. Re-orient the health system toward care in our community 2. Achieve a health and community care system responsive to consumer need 3. Target resources to best meet health and community care needs for our region. Our vision for mental health and suicide prevention in this region aligns to our existing vision and strategic plan under these three goals. 1. Re-orient the health system toward care in our community A stepped care model requires people receive the level and intensity of care they require and no more; this leaves expensive hospital-based services reserved for those for whom no other form of intervention is appropriate. Our strategic commitment is to invest in and develop community-based treatment services capable of responding to the varying needs of people in our community. In planning terms, the achievement of this goal requires close collaboration with all parts of the mental health system. This goal in mental health is already well progressed in our region and further discussed below under governance. 2. Achieve a health and community care system responsive to consumer need A stepped-care service system can respond to varying levels of consumer need, but this system must also be person-centred and easy to navigate, with connections between various steps of care to ensure consumer safety, ease of access and delivery of the right level of care to meet consumers needs. Our commitment is to ensure consumer and family/carer participation in all aspects of commissioning, to ensure the system responds to consumer need. 3. Target resources to best meet health and community care needs for our region There are a number of service gaps in the stepped-care model in our region, most notably lowintensity services and support for people with severe mental illness. There is also a higher demand and need for services in the Moreton Bay North region. Our commitment is to invest in costeffective treatment services, across the spectrum of care, and to aim for equity of access geographically. In planning terms, this goal will be pursued by developing agreement across a wide stakeholder group on the priority areas. A system-wide approach ensures the PHN s investment is coordinated with the much larger investment occurring through MBS, PBS, private providers, the Queensland Government and Metro North HHS. Governance As a company limited by guarantee Brisbane North PHN has a board of directors responsible for overall governance of the organisation, assisted by our Community Advisory Committee and Clinical Council. The PHN has a Clinical Governance policy and an established clinical governance group for mental health services. This existing group has been reconstituted to cover all of the mental health, suicide prevention and alcohol and other drugs treatment clinical services (see Attachment 1 for Terms of Reference). A specific MHAOD clinical governance framework has been developed. 2
The PHN has already established a multi-stakeholder governance mechanism for regional planning in relation to adults with severe mental illness (Collaboration in Mind). In 2016/17 the PHN developed a similar arrangement for children and young people s mental health and suicide prevention. Over the longer term, the PHN hopes to combine these groups into one regional governance structure, also incorporating our Alcohol and Other Drug (AOD) Partnership Group. 3
1. (b) Planned activities funded under the Primary Mental Health Care Schedule Proposed Activities Priority Area Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) Existing, Modified, or New Activity Description of Activity Priority Area 1: Low intensity mental health services 1. Commission low intensity mental health services 1.1 New Access service 1.2 Group based supports 1. 3 App based support. This activity is an existing activity. The aim of this activity is to improve access to low intensity services for people aged 12 years and over. The PHN will commission structured, time-limited, evidence-based, psychological therapy; delivered by non-clinical staff, through various modalities; targeting hard-to-reach, vulnerable, socially disadvantaged groups, or others experiencing a significant life transition. The selected providers will provide the following activities with this funding: 1.1 New Access service Mental Illness Fellowship Qld Face to face assessment followed by up to six sessions (face-to-face/phone/skype). Consumers are followed up four weeks and six months after end of program. 1.2 Group based supports Neami National will deliver The Optimal Health Program (OHP) This consists of 12 sessions: 8 x 2-hour weekly face-to-face group sessions (with 8-10 participants) 4 x individual coaching sessions delivered via the telephone (in-between group sessions). A final peer-facilitated review/celebration session occurs 4 weeks after the completion of 12 main sessions. 4
The OHP will be delivered 24 times in the 18-month contract period. There will be at least one program tailored to meet the needs of the following three population groups: people who work full time (i.e. an after-hours program) people who are on probation or parole with the justice system people who identify as LGBTI. Change Futures will deliver Caring for Residents of Aged Care (CRAC) program There are two CRAC program options available based on client needs. Option A: 4 x individual sessions + pyscho education group + peer support group. Option B: 5 x individual sessions. Where possible residents will be directed to Option A but Option B is available for those unable to participate in group sessions. Initially (January-June 2017) the program will be delivered at St Vincent's Health and Aged Care Mitchelton and Bardon facilities. Change Futures Ltd will deliver the program to additional facilities from July 2017-June 2018. Multicultural Development Agency will deliver Problem Management Plus (PM+) There are two PM+ program options available based on client needs and preferences. Option A for clients needing individual sessions. Option B for those needing group sessions. Option A: 7 individual sessions: 2 face-to-face assessment and planning sessions 5 weekly face-to-face intervention sessions telephone support between sessions for clients who require extra level of support clients also offered additional support through existing group programs. 5
Target population cohort Option B: 7 sessions: 2 face-to-face individual assessment and planning sessions 5 group support sessions (8-10 participants) clients also offered additional support through existing group programs. The PM+ program will be delivered as an outreach model in various locations across Brisbane North. Individual support will also be provided in people s homes or safe place. 1.3 App based support Hello Sunday Morning Daybreak program is a 16-week online program for which includes between 32-48 intervention points per participant. Intervention points includes individual access to Daybreak program (2-3 times per week) in the form of: Screening, assessment and brief intervention self-guided cognitive behaviour Therapy (CBT) motivational interviewing supportive peer/group network 24-hour 7 days a week access to trained coaches. Coaches can escalate complex cases to clinical psychologists and refer clients to more complex treatment in local area as needed. If people require further access to the program to achieve and maintain goals, 36 weeks of aftercare is available. Overall, low intensity psychological services are provided for the following populations: People with mild mental illness and those in distress who may be at risk of developing a mental illness. Specific services will prioritise the following populations: 6
1.1 New Access service People who identify from the following groups: Aboriginal and Torres Strait Islander people people who are culturally and linguistically diverse (CALD) including Refugees homeless people people who identify as Lesbian, Gay, Bi-sexual, Transgender and/or intersex (LGBTI) new parents walking well people living in residential aged care people at risk of social isolation or in transition points. 1.2 Group based supports Neami National People who can use low intensity psychological services to build resilience which includes: people experiencing mental illness for the first time people with a moderate to severe mental health condition at risk of relapse people who are from groups that are hard to reach, vulnerable and socially disadvantaged including: o Aboriginal and Torres Strait Islander people o people who are culturally and linguistically diverse (CALD) including Refugees o homeless people o people who identify as Lesbian, Gay, Bi-sexual, Transgender and/or intersex (LGBTI) o people who are experiencing a significant life event or transition. Change Futures Residents of additional aged care facilities. Multicultural Development Agency Culturally and linguistically diverse populations, including Refugees. 1.3 App based support 7
People who: are at risk of onset of mental illness or experiencing mild/moderate mood/anxiety disorders that are driven or exacerbated by risky/harmful alcohol consumption want to reduce their harmful alcohol consumption and address mild/moderate symptoms of mood/anxiety disorders are moving through life transitions including: starting a new job expectant new mothers and fathers people using alcohol as self-medication for depression, anxiety and stress experienced through general life individuals who are socially isolated and unable to access face-to-face services or who wish to access anonymous services. Consultation Needs Assessment The needs assessment identified many not-for-profit organisations, telephone and counselling services operating in the PHN region such as Lifeline and beyondblue. Since producing this document many more providers have been identified operating in the low-intensity space, from mutual support groups such as GROW, through online support provided by the Black Dog Institute or Kids Helpline, to more traditional appointment-based counselling services delivered at low cost by professionals with lower qualifications than clinical psychologists. There is a need to better assess the full range of low intensity services operating in the region, and to better understand the extent to which these services operate from an evidence base. Co-design Brisbane North PHN s assessment has also highlighted the importance of not simply parachuting in new models of care which can further fragment service delivery, but to ensure any procurement increases coordination and connection across the system. Participants at co-design workshops consistently reported the silo nature of services, the fragmented nature of the service system and the need for service and system navigation. Achievement of an effective person-centred, stepped care model requires significant reform, and an understanding of how the various components within low-intensity services operate and coordinate with each other. This means the PHN s assessment process will identify agencies which are willing and keen to integrate, collaborate and coordinate with other providers. 8
Consultation to inform Procurement Strategy: Online Discussion paper & Survey Distributed to 750+ people, 400 + visitors to the online site, 60 downloads of discussion paper, 78 (10% response rate) survey responses Stakeholder meetings 8 meetings with key stakeholders including Beyond Blue, Sane Australia, Brook RED, Peach Tree and Institute for Urban Indigenous Health. Collaboration Duration Coverage Commissioning method (if relevant) From the engagement activities we identified three key strategy areas for low intensity mental health services needed in the Brisbane North region: 1. access to low intensity psychological services, in a variety of modalities 2. education and support for GP s and other primary health and community service providers 3. building the evidence base for low intensity services. This activity is to be solely implemented by North Brisbane PHN. Discussions are currently underway between Queensland PHNs and the Queensland Department of Health regarding possibilities for future co-ordinated commissioning or co-commissioning of mental health services. In addition the PHN and Metro North Hospital and Health Service have established a joint project to explore how we might more formally work jointly, including around commissioning. January 2017 to 30 June 2018 planning July to October 2016 procurement November to December 2016 commencement of service delivery January 2107. Whole Brisbane North PHN region. These activities will be wholly commissioned in line with Brisbane North PHN s Commissioning Framework (see Attachment 2). Needs are identified through an assessment process, involving the analysis of population health data and community consultation. Solutions to meet these needs are designed in partnership with stakeholders. 9
Approach to market Performance Indicator Local Performance Indicator target (where possible) Local Performance Indicator Data source Inclusive processes are used to decide how best to implement these solutions, either through direct intervention or the procurement of services. Services are procured through fair and transparent processes. These solutions are then evaluated and the evaluation outcomes used to inform further assessment and planning. Open Tender A specific Low Intensity Psychological Services procurement strategy was developed (see Attachment 3). The following providers have been contracted to deliver a service, as a result of the open tender approach: 1.1 New Access service Mental Illness Fellowship Qld 1.2 Group based supports Neami National, Change Futures, Multicultural Development Agency 1.3 App based support Hello Sunday Morning Priority Area 1 - Mandatory performance indicators: proportion of regional population receiving PHN-commissioned mental health services low intensity services average cost per PHN-commissioned mental health service low intensity services clinical outcomes for people receiving PHN-commissioned low intensity mental health services. No additional local indicators. N/A N/A 10
Proposed Activities Priority Area Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) Existing, Modified, or New Activity Description of Activity Target population cohort Consultation Priority Area 2: Child and youth mental health services 2.1 Continue funding to existing headspace sites at existing levels 2.2 Commission services for young people with, or at risk of, a severe mental illness This activity is an existing activity. The aim of this activity is to provide early intervention services for children and young people with, or at risk of developing, mental illness. 2.1 Continue funding to existing headspace sites at existing levels Lead agencies for the four Headspace centres in our region will be subcontracted to deliver Headspace services. The PHN will work closely with each lead agency to monitor performance and ensure appropriate access and service delivery. In addition, in 2016 the PHN established a quarterly network meeting for all lead agencies and key centre staff. This mechanism will continue in 2017/18 and will contribute to quality improvement and planning processes. 2.2 Commission services for young people with, or at risk of, a severe mental illness The PHN will commission a holistic, evidence-based, outreach services for hard-to-reach young people, their families, carers and support persons (where relevant)delivered by a multidisciplinary team. This service will target the hardest to engage young people living in the Moreton Bay North region, aged 12 to 18 years old with, or at risk of developing, severe mental illness. 2.1 Continue funding to existing headspace sites at existing levels Young people aged 12 to 25 years old with mild to moderate mental health issues. 2.2 Commission services for young people with, or at risk of, a severe mental illness Young people aged 12 to 18 years with, or at risk of developing, a severe mental illness who reside in the Moreton Bay North sub-region. Needs Assessment Our needs assessment specifically identified: 11
continue to support the delivery of early intervention services within existing headspace services in the region work with stakeholders to develop a local child and youth mental health service plan for commencement after the two-year transition period. The needs assessment has already identified the Moreton Bay North sub-region as the area of greatest need for young people with, or at risk of developing, a severe mental illness. Additionally, and subsequent to the submission of our needs assessment, the Department allocated funding to Brisbane North PHN to deliver services for young people with, or at risk of developing, severe mental illness, and so this activity is also addressed here. Consultation to inform Procurement Strategy: The following consultation was undertaken to inform the procurement strategy for services for young people with, or at risk of developing, severe mental illness. Headspace Centre meetings meeting with lead agencies and key staff from each headspace centre in the region to workshop ideas for future service provision and local needs stakeholder meetings 25 meetings with stakeholders including Act for Kids, Children s Health Queensland, Brisbane Youth Services, YourTown, Open Minds, Create Foundation and Mercy Services focus Groups workshops with Caboolture, Nundah and Redcliffe headspace youth reference groups Advisory Group meetings two meetings including workshopping activities with a cross sectoral stakeholder advisory group. Collaboration This extensive consultation process informed the procurement strategy for services for young people with, or at risk of developing, severe mental illness and the key service design components as outlines in the description above. This activity is to be solely implemented by North Brisbane PHN under the guidance of a Children and Young People Mental Health Advisory Group (including Hospital and Health Service, allied health, NGOs, Qld Government agencies, consumers and families). Discussions are currently underway between Queensland PHNs and the Queensland Department of Health regarding possibilities for future co-ordinated commissioning or co-commissioning of mental 12
Duration Coverage Commissioning method (if relevant) Approach to market health services. In addition the PHN and Metro North Hospital and Health Service have established a joint project to explore how we might more formally work together, including around commissioning. 2.1 Continue funding to existing headspace sites at existing levels July 2016 June 2018. 2.2 Commission services for young people with, or at risk of developing, a severe mental illness planning July to October 2016 procurement November to December 2016 commencement of service delivery January 2107. 2.1 Continue funding to existing headspace sites at existing levels Existing headspace centres are located in Taringa, Nundah, Redcliffe and Caboolture. 2.2 Commission services for young people with, or at risk of, severe mental illness Moreton Bay North Statistical Area level 4. These activities will be wholly commissioned in line with Brisbane North PHN s Commissioning Framework. Needs are identified through an assessment process, involving the analysis of population health data and community consultation. Solutions to meet these needs are designed in partnership with stakeholders. Inclusive processes are used to decide how best to implement these solutions, either through direct intervention or the procurement of services. Services are procured through fair and transparent processes. These solutions are then evaluated and the evaluation outcomes used to inform further assessment and planning. 3.1 Open Tender A specific procurement strategy was developed for services for young people with, or at risk of, severe mental illness. As a result of an open tender process, Redcliffe Area Youth Space has been 13
subcontracted to deliver this activity. Redcliffe Area Youth Space has two authorised subcontractors, Intercept Family Program and Deception Bay Community Youth Program. Performance Indicator Local Performance Indicator target (where possible) Local Performance Indicator Data source Priority Area 2 Mandatory performance indicator: support region-specific, cross sectoral approaches to early intervention for children and young people with, or at risk of mental illness (including those with severe mental illness who are being managed in primary care) and implementation of an equitable and integrated approach to primary mental health services for this population group. No additional local indicators. N/A N/A 14
Proposed Activities Priority Area Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) Existing, Modified, or New Activity Description of Activity Target population cohort Consultation Priority Area 3: Psychological therapies for rural and remote, under-serviced and / or hard to reach groups 3.1 Commission a range of providers to deliver evidence-based psychological therapies to underserviced and hard to reach groups. This activity is an existing activity. The aim of this activity is to address service gaps in the provision of psychological therapies for people in rural and remote areas and other under-serviced and hard to reach populations, making optimal use of the available service infrastructure and workforce. This will be achieved by commission a panel of providers to deliver structured, time-limited, evidencebased, psychological therapy; delivered through various modalities. Our Health Needs Assessment identified the following under-serviced and hard to reach groups as priority target cohorts for this activity: people at risk of homelessness Aboriginal and Torres Strait Islander peoples culturally and linguistically diverse people financially disadvantaged people people experiencing or who have experienced trauma or abuse children aged 0-11 years-old people who reside in the Moreton Bay North region Lesbian, gay, bisexual, transgender and intersex people people in contact with criminal justice system. Needs Assessment Our Health Needs Assessment identified the priority as: commission suitable providers to deliver mental health services for under serviced groups, specifically where health and service needs have been identified in the Health Needs Assessment. 15
Collaboration Duration Just 0.1% of the Brisbane North PHN population live in outer regional areas and no population lives in areas classified as remote or very remote within our boundary. Consultation to inform procurement approach: The following activities were undertaken to inform the procurement of a new service provider panel: consumer focus groups three focus groups sessions with service consumers to gain insight into current service issues and future needs provider workshop sessions current service providers were invited to a workshop session to provide feedback on current program delivery and opportunities for improving service delivery into the future PHN staff workshops and survey staff from the PHN undertook workshops and a survey to provide feedback on current service delivery and to identify opportunities to improve the service delivery primary health care survey a survey was distributed to primary health care providers, including GPs. Engagement with the sector identified the following current arrangements and needs: good GP knowledge and support is vital to a client s success in navigating the Brisbane MIND program success for clients is highly reliant on the ability to build rapport with the service provider the limit on the number of sessions available impacts on clients and service providers, causes stress and decreases the effectiveness of support in some cases providers and clients alike want to see a more holistic approach to supporting clients which may require services to be delivered by a broader range of providers in a variety of settings. This activity is to be solely implemented by Brisbane North PHN. Discussions are currently underway between Queensland PHNs and the Queensland Department of Health regarding possibilities for future co-ordinated commissioning or co-commissioning of mental health services. In addition the PHN and Metro North Hospital and Health Service have established a joint project to explore how we might more formally work jointly, including around commissioning. 3.1 Commission a range of providers to deliver evidence-based psychological therapies to underserviced and hard to reach groups. 16
Coverage Continuity of care Commissioning method (if relevant) Approach to market Performance Indicator planning February 2016 September 2016 procurement October 2016 January 2017 service delivery is ongoing and will continue July 2017 June 2018. Whole Brisbane North PHN region. Whilst the PHN has undertaken a procurement process to commission a new service provider panel, existing services have been in place for the entirety of the current financial year. Processes for continuity of care for services that have been decommissioned as a result of the recent procurement process are outlined below. These activities will be wholly commissioned in line with Brisbane North PHN s Commissioning Framework. Needs are identified through an assessment process, involving the analysis of population health data and community consultation. Solutions to meet these needs are designed in partnership with stakeholders. Inclusive processes are used to decide how best to implement these solutions, either through direct intervention or the procurement of services. Services are procured through fair and transparent processes. These solutions are then evaluated and the evaluation outcomes used to inform further assessment and planning. The PHN will continue to provide an administrative intake service for referrals in to this service. All service delivery to patients will be provided by contracted providers. An open tender process has now been completed and has resulted in 109 agencies being subcontracted to deliver services. Priority Area 3 - mandatory performance indicators: proportion of regional population receiving PHN-commissioned mental health services Psychological therapies delivered by mental health professionals average cost per PHN-commissioned mental health service Psychological therapies delivered by mental health professionals 17
Local Performance Indicator target (where possible) Local Performance Indicator Data source clinical outcomes for people receiving PHN-commissioned Psychological therapies delivered by mental health professionals. No additional local indicators. N/A N/A Proposed Activities Priority Area Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) Existing, Modified, or New Activity Description of Activity Priority Area 4: Mental health services for people with severe and complex mental illness including care packages 4.1 Deliver funding to existing employing agencies of Mental Health Nurses with allocated sessions under the current Mental Health Nurse Incentive Program (MHNIP) to ensure they deliver the same services at the same level in 2016/17. 4.2 Commission innovative clinical primary mental health care services to people with severe mental illness. This activity is an existing activity. The aim of this activity is to deliver primary mental health care services to people with severe mental illness who are being managed in primary care. This includes clinical care coordination for people with severe and complex mental illness who are being managed in primary care, including through the phased implementation of primary mental health care packages and the use of mental health nurses. 4.1 Existing MHNIP providers The PHN identified and made contact with all current MHNIP Providers operating in the region, and held dialogue with neighbouring PHNs as some existing MHNIP providers host agencies are located in other PHN regions but deliver services in Brisbane North PHN. A new approach to payment was offered to the host agencies of these MHNIP providers through a twelve-month contracting process. Existing MHNIP providers and host agencies were 18
Target population cohort advised this contract was transitional and only for 12 months to ensure continuity of care for existing clients, and that agencies must commit to seamless transition of clients to new arrangements on or before 30 June 2017. The PHN has issued contracts to all existing providers of MHNIP, extending their service provision until 30 June 2017. Payments are made to providers as per the contract. A data collection process, based on the ATAPS MDS, has been developed and is in use by providers. The PHN has met with providers one-to-one on several occasions and brought all providers together as group, to help transition them to the new arrangements and to inform future service models. 4.2 Commission innovative clinical primary mental health care services to people with severe mental illness The PHN has selected three providers - Morayfield Psychology Centre, Footprints and Toowong Private Hospital - to operate three MH Nurse service hubs offering clinical care coordination services across the region: Moreton Bay North Moreton Bay South & Brisbane North Brisbane Inner City and West These hubs will deliver best practice clinical care coordination and treatment services by (at least) three FTE mental health nurses to people with severe and complex mental illness in the PHN region. Referrals to the MH Nurse service hubs must be from GP s and community based Psychiatrists. GP s and psychiatrists will determine which patients are eligible for mental health nursing services and all of the following criteria must be met: a diagnosed mental disorder (according to criteria defined in the Diagnostic and Statistical Manual of Mental Health Disorders Fifth Edition or the World Health Organisation Diagnostic and Management Guidelines for Mental Health Disorders in Primary Care:ICD-10 Chapter V Primary Care Version) which is severe and either episodic or persistent in nature the mental disorder significantly impacts at least two areas of the persons social, personal and/or occupational functioning the person has, or is at risk of developing, a physical health problem 19
the mental disorder has resulted in hospital treatment in the previous 2 years or there is a risk of hospitalisation within the next 12 months if clinical care by a mental health nurse is not provided the patient is expected to need ongoing treatment and management of their mental disorder over the next two years a primary care based GP or psychiatrist is the main person responsible for the patients clinical mental health care they are not currently receiving clinical care coordination from another service they are over 18 years of age (services for young people with severe mental illness are being procured through a separate process) the patient provides consent to treatment from a mental health nurse. Needs Assessment Our Needs Assessment identified: collaborative partnership with Metro North Hospital and Health Service, community mental health services and consumers and family/carers to develop an integrated care package model which responds to local service gaps and identified needs in the community commissioning of mental health nursing in primary health care to support general practice to improve service coordinator and care for patients in the community. Consultation Co-design Collaboration in Mind has already done the work to assess priority outcomes for the regional service system for people with severe mental illness. Through engagement with more than 100 agencies and individuals, Brisbane North PHN has reviewed the needs of people with severe mental illness in the region. The System Development Plan for the region developed by Collaboration in Mind identifies (at page 8) fifteen priority outcome areas to improve the regional service system for people with severe mental illness. This activity will directly address at least two of those priorities, namely alternatives to hospital admission, and service availability. Brisbane North PHN s assessment has also highlighted the importance of not simply parachuting in new models of care or bolting on new services, as this can further fragment service delivery. To ensure any procurement increases coordination and connection across the system, strong linkages must occur across the activities listed above. Participants at co-design workshops consistently and strongly 20
emphasised that we do not take a silo approach to this funding by implementing six streams of activity completely disconnected. Participants highlighted the fragmented nature of the existing service system and the need for service and system navigation. Achievement of an effective person-centred, stepped care model requires significant reform, and an understanding of how the various components of service delivery operate and coordinate with each other. This means the PHN s procurement process will favour agencies that are willing and keen to integrate, collaborate and coordinate with other providers. Consultation to inform Procurement Strategy: Stakeholder meetings meetings with each of the currently funded MHNIP participants and nurses, as well as meetings with the Australian College of Mental Health Nurses. Collaboration Duration Engagement with the sector identified the following current arrangements and needs: inequitable distribution of services = significant service gaps, particularly in the north services are limited to patients of the employing agency inconsistencies in the functions performed by MHN s and implementation of referral criteria isolate casual/part-time workforce, lack of professional development and networking opportunities. This activity is to be solely implemented by North Brisbane PHN under the guidance of Collaboration in Mind an existing strategic partnership group focusing on the needs of adult with severe mental illness (membership includes the Hospital and Health Service, PHN, mental health NGOs, consumers and carers). Discussions are currently underway between Queensland PHNs and the Queensland Department of Health regarding possibilities for future co-ordinated commissioning or co-commissioning of mental health services. In addition the PHN and Metro North Hospital and Health Service have established a joint project to explore how we might more formally work jointly, including around commissioning. 4.1 Existing MHNIP providers 1 July 2016 to 30 June 2017. 4.2 Review and recommission mental health services for people with severe and complex mental illness January 2017 to 30 June 2018 21
planning July to October 2016 procurement November to December 2016 commencement of service delivery January 2107 (Moreton Bay North), July 2017 (Moreton Bay South & Brisbane North, Brisbane Inner City and West). Coverage 4.1 Existing MHNIP providers Access only available for patients of 6 organisations based in; Strathpine, Toowong, North Lakes, Margate and Kedron. 4.2 Review and recommission mental health services for people with severe and complex mental illness 3 hubs covering the following PHN sub-regions: Moreton Bay North (SA3: Redcliffe, Narangba-Burpengary, Caboolture Hinterland, Caboolture, Bribie-Beachmere) Moreton Bay South & Brisbane North (SA3: Strathpine, North Lakes, Hills District, Sandgate, Nundah, Chermside, Bald Hills-Everton Park) Brisbane Inner City & West (SA3: Brisbane Inner-West, Brisbane Inner-North, Brisbane Inner, The Gap-Enoggera, Sherwood-Indooroopilly, Kenmore-Brookfield-Moggill). Continuity of care Commissioning method (if relevant) Current providers have been involved in consultations throughout 2016 to inform the new model of delivery for mental health nursing. Current providers were formally notified in November 2016 that their contracts would not be renewed in 2017-18. Providers have be asked to make suitable alternative arrangements for the ongoing care of any remaining patients being supported by MHNIP post June 2017. These activities will be wholly commissioned in line with Brisbane North PHN s Commissioning Framework. Needs are identified through an assessment process, involving the analysis of population health data and community consultation. Solutions to meet these needs are designed in partnership with stakeholders. 22
Approach to market Performance Indicator Inclusive processes are used to decide how best to implement these solutions, either through direct intervention or the procurement of services. Services are procured through fair and transparent processes. These solutions are then evaluated and the evaluation outcomes used to inform further assessment and planning. 4.2 Open Tender A specific Mental Health Nurse Clinical Care Coordination and Treatment Service for People with Severe and Complex Mental Illness procurement strategy was developed. The following providers have been contracted to deliver a service, as a result of the open tender approach: Moreton Bay North Morayfield Psychology Centre Moreton Bay South & Brisbane North Footprints Brisbane Inner City & West Toowong Private Hospital. Priority Area 4 - mandatory performance indicators: proportion of regional population receiving PHN-commissioned mental health services Clinical care coordination for people with severe and complex mental illness (including clinical care coordination by mental health nurses) average cost per PHN-commissioned mental health service Clinical care coordination for people with severe and complex mental illness. No additional local indicator is identified. 23
Proposed Activities Priority Area Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) Priority Area 5: Community based suicide prevention activities 5.1 Ensure continuity of care for clients of existing suicide prevention services who may be at risk if the service is withdrawn. 5.2 GP and other service provider education. 5.3 Commission suicide prevention services. 5.4 Commission suicide prevention services specifically targeting Aboriginal and Torres Strait Islander people. Existing, Modified, or New Activity The following activities are existing activities 5.1, 5.3, 5.4 Description of Activity The following activity is a modified activity 5.2 (changed from develop a regional plan which is now part of Priority Area 8 below and our Lead Site activity). The aim of this activity is to encourage and promote a systems based regional approach to suicide prevention. This includes community based activities and liaison with the Hospital and Health Service and other providers to help ensure appropriate follow-up and support arrangements are in place at a regional level for individuals after a suicide attempt and for other people at high risk of suicide, including Aboriginal and Torres Strait Islander people. 5.1 Ensure continuity of care for clients of existing suicide prevention services who may be at risk if the service is withdrawn Brisbane North PHN has continued to fund the Nexus program, delivered by the Queensland Program of Assistance to Survivors of Torture and Trauma, through a joint arrangement with Brisbane South PHN. Brisbane North PHN contributes a proportion of funding to this project, based on the percentage of clients residing in our region. Continuation of this funding in 2017-18 will be confirmed prior to the end of 2016-17. 5.2 GP and other service provider education There are a wide number of suicide prevention services already available to people in the PHN region. Brisbane North PHN will map the existing services and produce educational resources for GPs and other service providers. 24
Target population cohort 5.3 Commission suicide prevention services The focus of this activity is a trial for a follow-up suicide prevention service. The primary purpose of this trial service is to integrate, complement and work collaboratively with the Redcliffe Hospital to improve the immediacy of follow-up response for individuals at a high risk of suicide, or who have recently attempted suicide and to provide wrap around support. The aim of the service is to provide a short-term transitional service, which provides follow-up support, short-term counselling, and case coordination to link individuals back into the community. 5.4 Commission suicide prevention services specifically targeting Aboriginal and Torres Strait Islander people The selected provider, Institute for Urban Indigenous Health (IUIH) will provide the following activities are part of an integrated social and emotion health and wellbeing approach (together with mental health and alcohol and other drug treatment services): Recruit and support 1 FTE Youth Worker/Outreach Workers to deliver services for the Northern Moreton Bay region. 5.1 Ensure continuity of care for clients of existing suicide prevention services who may be at risk if the service is withdrawn The clients of the program are young refugees but few are also survivors of torture and trauma and therefore not eligible for the other funded services delivered by Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT). Young refugees are a very hard to reach population who experience higher risk of suicide, and the PHN has not been able to identify alternative, culturally competent agencies in the region to whom these clients could be transferred. 5.2 GP and other service provider education GPs and other service providers in the Brisbane North PHN region. 5.3 Commission suicide prevention services 25
Individuals who are referred by services in the Redcliffe area (e.g. first responders, General Practitioners (GPs), Redcliffe Hospital) who have recently attempted suicide or who are at a high risk of suicide. 5.4 Commission suicide prevention services specifically targeting Aboriginal and Torres Strait Islander people Aboriginal and Torres Strait Islander young people. Needs Assessment Our Health Needs Assessment identified the following two priorities: develop a systems based integrated suicide prevention plan in partnership with service providers and consumers commission appropriate services to address local needs with specific focus on Aboriginal and Torres Strait Islander social and emotional wellbeing and agreement between Metro North HHS and community providers for follow up care. Consultation Collaboration Consultation to inform Procurement Strategy: Suicide Prevention Forums 102 people attended 2 Forums, including consumers, GP s, psychologists, HHS staff, community and private services providers, youth services, Aboriginal and Torres Strait Islander services and academic and research bodies stakeholder meetings 5 meetings with stakeholders including Redcliffe Hospital Collaborative and HHS Mental Health services and Queensland Police Service. The feedback from the Forums helped us to identify the need for a trial follow up service model in the Redcliffe region. Subsequent stakeholder meetings informed the key elements required for this trial model. Additional feedback throughout all of the engagement also identified the need for: improved networking amongst existing service providers to improve patient outcomes workforce capacity training. This activity is to be solely implemented by North Brisbane PHN under the guidance of our Suicide Prevention Strategic Partnership Group (including Hospital and Health Service, local government, NGOs, allied health, lived experience and family groups). Discussions are currently underway between Queensland PHNs and the Queensland Department of Health regarding possibilities for future co-ordinated commissioning or co-commissioning of mental 26
Duration Coverage health services. In addition the PHN and Metro North Hospital and Health Service have established a joint project to explore how we might more formally work jointly, including around commissioning. 5.1 Ensure continuity of care for clients of existing suicide prevention services who may be at risk if the service is withdrawn July 1 2016 to June 30 2017 (with possibility of 1-year extension). 5.2 GP and other service provider education January 2017 June 2017. 5.3 Commission suicide prevention services April 2017 to 30 June 2018 planning July to October 2016 procurement November to December 2016 service development January March 2017 commencement of service delivery April 2107. 5.4 Commission suicide prevention services specifically targeting Aboriginal and Torres Strait Islander people October 2016 to 30 June 2018 planning July 2016 procurement August to September 2016 commencement of service delivery October 2016. 5.1 Ensure continuity of care for clients of existing suicide prevention services who may be at risk if the service is withdrawn Whole of PHN region. 5.2 GP and other service provider education Whole of PHN region. 5.3 Commission suicide prevention services 27
Commissioning method (if relevant) Approach to market Referrals received from Redcliffe based services (Redcliffe Statistical Area level 3) 5.4 Commission suicide prevention services specifically targeting Aboriginal and Torres Strait Islander people Moreton Bay North Statistical Area level 4. These activities will be commissioned in line with Brisbane North PHN s Commissioning Framework (see Attachment 2). Needs are identified through an assessment process, involving the analysis of population health data and community consultation. Solutions to meet these needs are designed in partnership with stakeholders. Inclusive processes are used to decide how best to implement these solutions, either through direct intervention or the procurement of services. Services are procured through fair and transparent processes. These solutions are then evaluated and the evaluation outcomes used to inform further assessment and planning Activities 5.1, 5.3, 5.4 will be delivered through the procurement of services. Activities 5.2 will be delivered through direct intervention. 5.3 Open tender A specific Community Based Suicide Prevention Procurement Strategy was developed. The Mental Illness Fellowship Queensland (MIFQ) has been contracted to deliver the service, as a result of the open tender approach: 5.4 Direct engagement The Institute for Urban Indigenous Health and the Aboriginal and Torres Strait Islander Community Health Service are the only two community-controlled agencies delivering mental health services in the region. Given services need to be in place quickly, the PHN selected a direct engagement approach to procurement rather than open or select tender process. 28
The Institute for Urban Indigenous Health (IUIH) has been contracted to deliver the service, as a result of the direct engagement approach. Performance Indicator Local Performance Indicator target (where possible) Local Performance Indicator Data source Priority Area 5 - Mandatory performance indicator: Number of people who are followed up by PHN-commissioned services following a recent suicide attempt. No additional local indicators are suggested. N/A N/A 29
Proposed Activities Priority Area Activity(ies) / Reference (e.g. Activity 1.1, 1.2, etc) Existing, Modified, or New Activity Priority Area 6: Aboriginal and Torres Strait Islander mental health services 6.1 Commission mental health services for Aboriginal and Torres Strait Islander people. This activity is an existing activity. The aim of this activity is to enhance access to and better integrate Aboriginal and Torres Strait Islander mental health services at a local level, facilitating a joined up approach with other closely connected services including social and emotional wellbeing, suicide prevention and alcohol and other drug services. The selected provider, Institute for Urban Indigenous Health (IUIH) will provide the following activities as part of an integrated social and emotion health and wellbeing approach (together with suicide prevention and alcohol and other drug treatment services). Description of Activity recruit and support Senior Social Health Professional to carry out intake assessments in Northern Moreton Bay region recruit and support Child Psychologist to deliver services and respond to the demand for children-centred services in Deception Bay/Redcliffe region recruit and support Psychologist to extend and deliver services for the Northern Moreton Bay region recruit and support Social Health Care Coordinator to work closely with other Care Coordinator type roles (i.e. CCSS, Partners in Recovery Facilitators) to support clients with complex chronic and mental health conditions in Strathpine/Northgate region recruit and support Mental Health Nurse (Registered Nurse) to deliver services for the Northern Moreton Bay region in Northern Moreton Bay region. In partnership with Brisbane North PHN, IUIH will provide the following activities to establish and monitor services undertake a rapid needs assessment for Aboriginal and Torres Strait Islander mental health and alcohol and other drugs living in the region design, implement and evaluate the Community Engagement Hub program co-design the procurement strategy for PMHC services and Alcohol and Other Drug (AOD) 30
services. co-design PMHC and AOD service plan to improve Aboriginal and Torres Strait Islander social and emotional well-being participate in relevant PHN Mental Health Partnership groups (i.e. AOD Partnership Group) Undertake and/or participate in PMHC and AOD service evaluation and client feedback activities. Target population cohort Consultation Aboriginal and Torres Strait Islander people Needs Assessment The needs of Aboriginal and Torres Strait Islander people were documented as priorities in the Mental Health Needs Assessment and the Methamphetamine, Alcohol and Other Drugs Needs Assessment. The three opportunities and priorities were documented in the Aboriginal and Torres Strait Islander priority area of our broader Health Needs Assessment. One priority relates to smoking rates, and the other two are: Development of programs to promote and sustain social and emotional wellbeing in Aboriginal and Torres Strait Islander people, including appropriate mental health, suicide prevention and alcohol and other drug treatment services. Co-design The PHN worked with the Institute for Urban Indigenous Health to identify needs and service gaps in Aboriginal and Torres Strait Islander mental health services. Following this, the PHN has entered into a direct tender negotiation with the Institute for Urban Indigenous Health for the delivery of integrated mental health, suicide prevention and alcohol and drug treatment services. A plan of activity and a contract has been agreed. The Institute for Urban Indigenous Health (IUIH) will subcontract some of the service delivery to Brisbane Aboriginal and Torres Strait Islander Community Health Service. We will continue to engage the wider Aboriginal and Torres Strait Islander via IUIH as part of the development of our regional plan. 31