Primary Health Network. Needs Assessment Reporting Template

Primary Health Network Needs Assessment Reporting Template This template must be used to submit the Primary Health Network s (PHN s) Needs Assessment report to the Department of Health (the Department) by 30 March 2016 as required under Item E.5 of the Standard Funding Agreement with the Commonwealth. Name of Primary Health Network Western Victoria PHN (Mental Health) Page 1

Section 1 Narrative This section provides PHNs with the opportunity to provide brief narratives on the process and key issues relating to the Needs Assessment. Needs Assessment process and issues (500-600 words) in this section the PHN can provide a summary of the process undertaken; expand on any issues that may not be fully captured in the reporting tables; and identify areas where further developmental work may be required (expand this field as necessary) Mental Health was an area of focus in the Western Victoria PHN needs assessment and the data in the general needs assessment underpins the data in this Mental Health specific needs assessment. Mental Health mapping was undertaken and relevant information was collected from mental health services delivered within the Western Victoria Primary Health Network (PHN). This began with collecting publicly available data from websites and online lists of services and then these services were contacted individually to provide additional information in order to obtain a comprehensive understanding of the services they delivered. The data analysis was based on a range of inputs including consultations with health professionals, in-depth interviews with a range of health providers delivering allied health services in rural areas, mental health mapping, review of the health and wellbeing plans of the 21 Local Government Areas in the PHN, general practice surveys, focus groups with internal staff currently delivering mental health services (mostly consisting of ATAPS clinicians) and interviews with all the ACCHOs within the region. Mental health data was obtained from a range of publicly available data sources such as the Victorian Population Health Survey, Australian Health Survey and National Health Performance Authority, National Mental Health and Wellbeing Survey, National Survey of people living with a Psychotic Illness, Child and Adolescent Survey of Mental Health and Wellbeing, The Second National Survey of the Health and Wellbeing of GLBT Australians, and the National Australian Aboriginal and Torres Strait Islander Health Survey. Material consulted in this process included, but was not limited to: Aspex Consulting (2015) Independent Review of New Arrangements for the delivery of Mental Health Community Support Services and Drug Treatment Services. The Department of Health and Human Services. This document will be referred to herein as: Aspex Consulting (2015). Independent Review of MHCSS and Drug Treatment Services. Commissioned by DHHS. Leonard, L., Pitts, M. et al. (2012). Private Lives 2: The second national survey of the health and wellbeing of gay, lesbian, bisexual and transgender Australians. Melbourne: The Australian Research Centre in Sex, Health & Society, La Trobe University. This document will be referred to herein as: Private Lives 2 (2012). Couch, M., Pitts, M. et al. (2007). Tranznation: A report on the health and wellbeing of transgender people in Australia and New Zealand. Melbourne. The Australian Research Centre in Sex, Health & Society: La Trobe University. This document will be referred to herein as: Tranznation Report (2007). Page 2

To determine the health and service need priorities the identified issues were rated based on the following criteria: The strength of the evidence for each particular issue (i.e. the quality of the quantitative evidence and whether it was verified by the qualitative evidence). The impact of the issue - whether it was consistent across the region. The impact of the issue for particular populations/areas within the PHN. The impact of the issue for those at risk of poor health outcomes. Whether addressing the issue will contribute to improved population health within the region. The levers the PHN has to impact the health need or service issue positively. Additional Data Needs and Gaps (max 400 words) in this section the PHN can outline any issues experienced in obtaining and using data for the needs assessment. In particular, the PHN can outline any gaps in the data available on the PHN website, and identify any additional data required. The PHN may also provide comment on data accessibility on the PHN website, including the secure access areas. (Expand field as necessary). A particular challenge we have encountered in analysing publicly available health and socioeconomic/demographic statistics is that data has not consistently been aggregated to the same geographic areas. For example, the Needs Assessment Guide asked PHNs to analyse demographic data at the Statistical Area 2 (SA2) level. However, much publicly available data we have used to inform the Needs Assessment is aggregated to larger geographic units than an SA2 (e.g. local government areas or PHNs). Furthermore, the units various departments and agencies aggregate data to vary. This is an issue because it has limited our capacity to develop a comprehensive understanding of conditions in small geographies by linking all the relevant available data together. The capacity to do this is particularly important in the Western Victoria PHN because the region is home to diverse local communities. There is no prevalence data on mental health conditions for children under the age of 12 within our region. For the Aboriginal and Torres Strait Islander population there is limited local-level mental health data available. Due to small numbers there are often issues with data quality or data is suppressed in accordance with data quality frameworks. We have reported national and state level data where this is available. National data on the prevalence of mental health conditions in the Aboriginal and Torres Strait Islander population is not available, as a prompt card containing certain mental health conditions was incorrectly excluded from the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS). There is no Victorian data available on leading causes of mortality or suicide rates of the Aboriginal and Torres Strait Islander population due to the small number of Aboriginal and Torres Strait Islander deaths reported. There is a lack of data on the mental health of culturally and linguistically diverse populations including refugees and asylum seekers at both a local and national level. Page 3

Service mapping is a labour intensive undertaking and is for a given point in time. As the National Health Service Directory develops, it is anticipated that this will provide a resource that will allow for ease in mapping of services and provide clarity around service gaps and changes over time Additional comments or feedback (max 500 words) in this section the PHN can provide any other comments or feedback on the needs assessment process, including any suggestions that may improve the needs assessment process, outputs, or outcomes in future (expand field as necessary). The challenge in assessing mental health needs and service issues is the lack of reliable and robust data at the local level. Due to the short time frames for the completion of the Mental Health Needs Assessment we were unable to conduct specific mental health consumer consultations. The service provider consultations conducted as a part of the baseline needs assessment provided information on mental health needs and services however this component of the consultations would have been addressed differently in light of the need to complete a mental health specific needs assessment. Page 4

Section 2 Outcomes of the health needs analysis This section summarises the findings of the health needs analysis in the table below. For more information refer to Table 1 in 5. Summarising the Findings in the Needs Assessment Guide on www.health.gov.au/phn. Additional rows may be added as required. Outcomes of the health needs analysis Priority Area Key Issue Description of Evidence Prevalence of mental health conditions in a number of local areas. 1. Low intensity mental health services High levels of psychological distress including high prevalence of depression and anxiety. There are a number of localities within the Western Victoria PHN which fare poorly on a range of indicators related to the social determinants of health. These determinants influence the health experiences of individuals (including mental health), population health Data on the prevalence of depression, anxiety and high psychological stress was sourced from the Victorian Population Health Survey (VPHS) 2011-12 and data compiled by the Public Health Information Development Unit (PHIDU) based on modelled estimates from the 2011 13 Australian Health Survey (AHS), ABS (unpublished) and the average of the ABS Estimated Resident Population, 30 June 2011 and 30 June 2012, based on the Australian standard. The prevalence of mental health conditions was also a common issue raised in the service provider consultations. Nationally the most common mental disorders are anxiety disorders, affective disorders (such as depression) and substance use disorders (ABS, National Survey of Mental Health and Wellbeing: Summary of Results. 4236.0, 2007). As with physical health, mental health and many common mental disorders, are shaped by various social, economic and physical environments (World Health Organization and Calouste Gulbenkian Foundation. Social determinants of mental health. Geneva, World Health Organization, 2014). A range of indicators were assessed Page 5

Outcomes of the health needs analysis 2. Youth mental health services outcomes, and important equity issues such as access to health care. Nationally, children and adolescents living outside capital cities have significantly higher rates of mental disorders. based on the ten categories of social determinants outlined in The Solid Facts (2nd edn.) report of 2003 from the World Health Organization (R. Wilkinson and M. Marmot [eds.]) as outlined in the baseline needs assessment At a national level an estimated 13.9% of 4-17 year olds in Australia were assessed as having mental disorders in the previous 12 months; 12.6% in Greater capital cities and 16.2% in rest of state (Lawrence D, Johnson S, Hafekost J, Boterhoven De Haan K, Sawyer M, Ainley J, Zubrick SR (2015) The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Department of Health, Canberra). 3. Risk of poor mental health outcomes for rural and remote, underserviced and/or hard to reach groups 4. Mental health services for people with severe and complex illness including care packages Further exploration into the key conditions and support services needed for those at risk of poor mental health outcomes is required. In terms of the total Australian population, 4.1% had severe mental disorders in the previous 12 months; and of the one in five (20.0%) Australians aged 16-85 years who experienced mental disorders in the previous 12 months, one-fifth (20.5%) were classified as severe. There is limited data available on the rates of mental illness in populations known to be at risk of poor mental health outcomes. Research suggests the mental health of LGBTIQA+ people is worse than that of the general population and that there are also variations within the LGBTIQA+ population Private Lives 2 (2012) and Tranznation Report (2007). Slade et al, 2009. The Mental Health of Australians 2. Report on the 2007 National Survey of Mental Health and Wellbeing. Department of Health and Ageing, Canberra. Amongst the low prevalence psychotic disorders schizophrenia is most common. An estimated 0.5% of the Australian population aged 18-64 have a Page 6

Outcomes of the health needs analysis 5. Community based suicide prevention activities 6. Prevalence of mental health conditions within the Aboriginal and Torres Strait Islander population Higher rates of suicide within the Western Victoria PHN compared to the Victorian rate. Further exploration into the key conditions and support services needed for the local Aboriginal and Torres Strait Islander populations at risk of poor mental health outcomes. psychotic illness and are in contact with public specialised mental health services each year, 47% of this population are diagnosed with schizophrenia (Morgan et al, People Living with a psychotic illness 2010. Report on the second Australian National Survey. Department of Health and Ageing, Canberra). Overall, half of the LGAs within Western Victoria PHN had higher rates of deaths from suicide and self-inflicted injuries compared to the Victorian rate (Data compiled by PHIDU from deaths data based on the 2009 to 2012 Cause of Death Unit Record Files supplied by the Australian Coordinating Registry and the Victorian Department of Justice, on behalf of the Registries of Births, Deaths and Marriages and the National Coronial Information System. The population at the small area level (Statistical Area Level 2) is the ABS Estimated Resident Population (ERP), 30 June 2009 to 30 June 2012; the population standard is the ABS ERP for Australia at 30 June 2011). At a national and state level, Aboriginal and Torres Strait Islander persons experience poorer mental health compared to the population as a whole. For example, this is evident in the higher rates of psychological distress (national and state level) and suicide (national). Data sourced from the 2012-13 ABS Australian Aboriginal and Torres Strait Islander Health Survey; AIHW National Mortality Database (at 3 October 2014) and Aboriginal and Torres Strait Islander Health Performance Framework 2014 report: Victoria. Cat. No. IHW 160. Canberra: AIHW. 8. Regional mental health A range of consultations with service providers Over half of the local governments in the Western Victoria PHN Page 7

Outcomes of the health needs analysis and suicide prevention plan Comorbidity with alcohol and other drugs identified mental health as an issue within communities throughout the Western Victoria PHN. Alcohol can mask, trigger or increase the risk of mental health conditions. included mental health as a priority area in their Health and Wellbeing Plans 2013-17. This included targeting youth, women, and men; and the identification of workforce gaps. The SA3s where multiple general practices identified Mental Health as an issue were Ballarat, Geelong, Surf Coast-Bellarine Peninsula, and Warrnambool- Otway Ranges. Stakeholder consultations identified the need to target the following areas and groups: trauma, perinatal care, Alzheimer s, chronic disability, rural, youth, aged, adults/adolescents, sole parents, and those on low incomes. NHMRC (2009) Australian Guidelines to reduce health risks from drinking alcohol and service provider consultations. Mental illness among individuals in AOD treatment programs range from 51-84% (Comorbidity Guidelines developed by Turning Point 2014). Page 8

Section 3 Outcomes of the service needs analysis This section summarises the findings of the service needs analysis in the table below. For more information refer to Table 2 in 5. Summarising the Findings in the Needs Assessment Guide on www.health.gov.au/phn. Additional rows may be added as required. Outcomes of the service needs analysis Priority Area Key Issue Description of Evidence 1. Low intensity mental health services 2. Youth mental health services 3. Psychological therapies for rural and remote, under-serviced and/or hard to reach groups 3. Psychological therapies for rural and remote, under-serviced and/or hard to reach groups There are significant waitlists for low priority mental health clients across the Western Victoria PHN. Limited access to child specific counsellors, family therapy and support services across the Western Victoria PHN. There is limited access to certain mental health services in some localities. Limited number of psychologists and psychiatrists in some areas. Service providers reported that low priority clients are not being seen which is leading to a gap in the provision of early intervention; and consequently those with non-clinical mental health issues are not able to access services. There are substantially higher waitlists for child counselling services delivered by the Western Victoria PHN across the region; and lack of child specific services in some localities. Information sourced from service provider consultations. Gaps in service provision were identified through service provider consultations and mental health service mapping. Specific examples include dementia services and outreach mental health services in the Barwon region. Four Local Government Areas (LGAs) within Western Victoria PHN have limited or no mental health services located within their area. Psychologists The number of full time equivalent psychologists per 100,000 population in 2014 was lowest in the following SA3s: Barwon-West, Grampians, Maryborough-Pyrenees and Surf Coast-Bellarine Peninsula (AIHW National Health Workforce Data Set (NHWDS), 2014). The limited number of Page 9

Outcomes of the service needs analysis 3. Psychological therapies for rural and remote, under-serviced and/or hard to reach groups 4. Mental health services for people with severe and complex illness including care packages 5. Community based suicide prevention activities Challenges in delivering mental health services for vulnerable groups. Over half of the LGAs in the Western Victorian PHN had higher hospital admissions for mental health related conditions compared with the Victorian rate. Higher rates of suicide within the Western Victoria PHN compared to the Victorian rate. psychologists within the Grampians region was confirmed through consultations with service providers. Psychiatrists There are a small number of psychiatrists delivering services outside of Geelong and Ballarat, especially within the Great South Coast region, according to service provider consultations and Medicare Australia Statistics, Consultant Psychiatrist Attendances, July 2014 to June 2015, Australian Government Department of Human Services. Service provider consultations identified a lack of outreach models for hard to reach vulnerable populations (e.g. Aboriginal and Torres Strait Islander population, GLBTQIA+ and children and families with complex and chronic needs). Cost of transport and limited transport options can be a barrier to accessing mental health services. Delivering services to CALD clients is challenging when using interpreters. Face to face services are a preferable method of delivery for vulnerable groups (Aspex Consulting (2015) Independent Review of MHCSS and Drug Treatment Services. Commissioned by DHHS). Hospital admissions with the principal diagnoses being mental health related conditions, aged standardised rate (ASR) per 100,000 people, by local government area, 2011/12. Compiled by PHIDU using data from the Australian Institute of Health and Welfare, supplied on behalf of State and Territory health departments for 2011/12; and the average of the ABS Estimated Resident Population, 30 June 2011 and 2012. Overall, half of the LGAs within Western Victoria PHN had higher rates of deaths from suicide and self-inflicted injuries compared to the Victorian rate (Data compiled by PHIDU from deaths data based on the 2009 to 2012 Cause Page 10

Outcomes of the service needs analysis 6. Aboriginal and Torres Strait Islander mental health services Lack of access to child and youth public mental health services. Most of the ACCHOs in the PHN offer mental health and wellbeing services but it is unclear if this is meeting the needs of local Aboriginal and Torres Strait Islander populations. of Death Unit Record Files supplied by the Australian Coordinating Registry and the Victorian Department of Justice, on behalf of the Registries of Births, Deaths and Marriages and the National Coronial Information System. The population at the small area level (Statistical Area Level 2) is the ABS Estimated Resident Population (ERP), 30 June 2009 to 30 June 2012; the population standard is the ABS ERP for Australia at 30 June 2011). In consultations with the eight ACCHOs in the Western Victoria PHN, one identified that there has been an increase in children and youth with mental health issues, which was thought to be due to a gap in early intervention services. A lack of bulkbilling child psychiatrists and psychologists and difficulty recruiting psychologists were also identified as issues. While mental health professionals may be difficult to recruit when they are present ACCHOs are able to meet the needs of the local population and may use contractor staff intermittently Mental Health consultations reported that only a limited number of sessions are being delivered to Aboriginal and Torres Strait Islander clients despite trying different strategies to engage the local Aboriginal and Torres Strait Islander population. 7. Stepped care approach Lack of flexibility in the service models to meet client needs. Service provider consultations and the mental health mapping process identified that service models for mild to moderate mental illness do not always meet the needs of clients. The mental health reform in Victoria has resulted in changes in the way community mental health services are delivered. For example a Page 11

Outcomes of the service needs analysis 8. Regional mental health and suicide prevention plan Comorbidity (including alcohol and other drugs AOD) Current communication practices do not always support optimal mental health service coordination. Challenges in service delivery when there is a dual intake. discontinuation of drop-in services and group services. Additionally a lack of focus on early intervention was identified in relation to Mental Health Community Support Services (Aspex Consulting, 2015. Independent Review of MHCSS and Drug Treatment Services. Commissioned by DHHS). Evidence of issues with service coordination and communication practices between service providers was obtained through service provider consultations. The issues identified included providers and communities having limited knowledge of the full complement of mental health services available and limited connections between mental health service providers. There are different treatments and approaches to mental health and AOD. It is perceived that the mental health services component isn t meeting the needs of AOD clients when delivering services to people with AOD as a comorbidity. Insufficient focus on clients with multiple service needs, including dual diagnosis clients and homeless clients and lack of a funding structure for dual diagnosis clients. This leads to silos between drug treatment and MHCSS. (Aspex Consulting, 2015. Independent Review of MHCSS and Drug Treatment Services, Commissioned by DHHS, service provider and consumer group consultations). Page 12