PRIMARY HEALTH NETWORKS NEEDS ASSESSMENT REPORT 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 15 November 2017 as required under Item E.5 of the PHN Funding Schedules under the Standard Funding Agreement with the Commonwealth. This template should include the needs assessment of primary health care after hours services. To streamline reporting requirements, the Drug and Alcohol Treatment Needs Assessment Report and Mental Health and Suicide Prevention Needs Assessment Report may be included in this template as long as they are discretely identified with clear headings. Name of Primary Health Network Brisbane North PHN When submitting this Needs Assessment Report to the Department of Health, the PHN must ensure that all internal clearances have been obtained and the Report has been endorsed by the CEO.
Instructions for using this template Overview This template is provided to assist PHNs to fulfil their reporting requirements for a Needs Assessment as required under Item E.5 of the Standard Funding Agreement (Funding Agreement) with the Department. Further information for PHNs on the development of needs assessments is provided in the Needs Assessment Guide, available on the Department s website (www.health.gov.au/phn). The key output of needs assessment will be to inform the Activity Work Plan. In addition, the information provided by PHNs in this report may be used by the Department to inform programme and policy development. Reporting The Needs Assessment report template consists of the following: Section 1 Narrative Section 2 Outcomes of the health needs analysis Section 3 Outcomes of the service needs analysis Section 4 Opportunities, priorities and options Section 5 Checklist PHN reports must be in a Word document and provide the information as specified in Sections 1-5. Limited supplementary information may be provided in separate attachments if necessary. Attachments should not be used as a substitute for completing the necessary information as required in Sections 1-5. While the PHN may include a range of material on their website, for the purposes of public reporting the PHN is required to make the tables in Section 2 and Section 3 publicly available on their website. Submission Process The Needs Assessment report must be lodged via email to Qld_PHN@health.gov.au on or before 15 November 2017. Reporting Period This Needs Assessment report will cover the period of 1 July 2016 to 30 June 2018 and will be reviewed and updated as needed by 15 November 2017. Page 2
TABLE OF CONTENTS PRIMARY HEALTH NETWORKS... 1 NEEDS ASSESSMENT REPORT... 1 BRISBANE NORTH PHN HEALTH NEEDS ASSESSMENT... 4 Section 1 Narrative... 4 Section 2 Outcomes of the health needs analysis... 6 Section 3 Outcomes of the service needs analysis... 13 MENTAL HEALTH AND SUICIDE PREVENTION NEEDS ASSESSMENT... 17 Section 1 Narrative... 17 Section 2 Outcomes of the health needs analysis... 19 Section 3 Outcomes of the service needs analysis... 33 ALCOHOL AND OTHER DRUGS NEEDS ASSESSMENT... 40 Section 1 Narrative... 40 Section 2 Outcomes of the health needs analysis... 42 Section 3 Outcomes of the service needs analysis... 47 Page 3
BRISBANE NORTH PHN HEALTH NEEDS ASSESSMENT Section 1 Narrative Needs Assessment process and issues Brisbane North PHN (PHN) developed a comprehensive Health Needs Assessment (HNA) in collaboration with key stakeholders, consumers and clinicians in March 2016. The development of this HNA included a comprehensive process of data collation, analysis and consultation with over 400 stakeholders. The PHN has developed a joint HNA with the Metro North Hospital and Health Service (Metro North HHS) in February 2017. This approach draws on the knowledge of both organisations to enable a more holistic understanding of the health service needs of the region, allowing for more effective planning. The joint HNA builds on previous work by the PHN and HHS in undertaking health service planning and health needs assessments in the region. A combination of different sources of information were used to inform the HNA including discussions with key stakeholders and analysis of data from a range of sources including the: o o o o o o Department of Health Australian Bureau of Statistics Queensland Government Statistician's Office Public Health Information Development Unit Australian Institute of Health and Welfare Queensland Department of Health The PHN engaged with a range of external stakeholders in the ongoing review of the HNA. The engagement process included: online survey tool stakeholder workshops and meetings two community workshops Throughout the engagement process, the PHN heard from over 400 stakeholders 1 and collated over 300 pieces of specific feedback regarding the health needs. This feedback was analysed and themed to enable it to be considered alongside the data in the HNA. The PHN will continue to engage with relevant stakeholders in each of these sectors as we continue regional service delivery to meet the identified needs of the Brisbane North region. Additional data needs and gaps When attempting to gain specific localised data to provide insight into the areas of comparative need across the region, we found that there was limited information available at a suitable granular level. We would see value in developing data sources which are available in sub-regional structures. In some instances, Aboriginal and Torres Strait Islander data was not available at a PHN level. Recent data releases and collaborations between PHNs and Commonwealth agencies have improved the flow of information at a sub PHN level, however a number of data gaps still remain. Chronic disease estimates are derived from modelled estimates, which may be problematic when attempting to accurately determine the chronic disease profile of the PHN region. Cancer incidence and 1 See appendix for a list of stakeholders engaged Page 4
screening data are reported on the PHN level, which does not allow for more accurate identification of health needs and areas of potentially low screening rates. While privacy restrictions prevent this information being reported on too small a level, more local data should be made available to properly identify trends. Additional comments or feedback Given that many of the data sources used to develop the HNA are only updated at frequencies of two, three, five and in some cases ten years, there is limited value in PHNs producing annual needs assessments. Page 5
Section 2 Outcomes of the health needs analysis Outcomes of health needs analysis Coordinated care for older people The PHN has identified care coordination for our older population as a key issue. Older people with multiple health issues require coordinated care to maintain a quality of life and remain safely in their communities and homes. The Australian population is an ageing population, with almost 15 per cent of the population in 2014 aged 65 years and over 2. In the PHN region, 13.5 per cent of the population is aged 65 years and over, a total of over 129,000 people. This number has increased from 107,000 people in 2010 and the trend will continue, with the number of people aged 65 years and over in the PHN region expected to increase to 185,000 people by 2026 3. People are also living longer, with an average life expectancy in the PHN region of 83 years for females and 80 years for males. In 2014-15, one in three Australians aged 65 years and over reported having three or more chronic conditions, compared with just 2.4 per cent of people under the age of 45 years 4. By 2026, the population aged 65 years and over is expected to increase by 46.9 per cent, a rate significantly higher than the general adult population, which is expected to increase by 12.9 per cent 5. In the PHN region, one in five admitted hospital separations were attributed to people aged 65 years and over 6.Between 2014-15 and 2016-17, the number of hospital admissions attributed to people aged 65 years and over increased by 22 per cent 7. Between 2012 and 2015, over 280,000 GP services were delivered in residential aged care settings in the PHN region 8. On average, this equates to 96,145 services delivered to 14,561 patients annually, almost seven services per patient. Within the PHN region, the trend for GP attendances to Residential Aged Care facilities in the Hills District and Caboolture is increasing. 2 Australian Bureau of Statistics, 2015 3 Queensland Government Statistician s Office, 2016 4 Australian Bureau of Statistics, 2016 5 Queensland Government Statistician s Office, 2016 6 Metro North Hospital and Health Service, 2017 7 Metro North Hospital and Health Service, 2017 8 Medicare Benefits Schedule, 2016 Page 6
Outcomes of health needs analysis Coordinated care for older Trends in GP chronic disease management are also increasing. Between 2012-13 and 2014-15, there was a 7.7 per cent increase in the number of patients commencing a GP chronic disease management plan people. There was a large variation within the PHN region, with the highest increases occurring in the Caboolture Hinterland, Bribie Beachmere and Bald Hills Everton Park SA3 areas. These areas are home to older populations. The data indicates that people aged 65 years and over are increasingly using all components of the health system. This represents a significant challenge in ensuring the services people receive are integrated and connected. This requires effective coordination across the whole health sector. The PHN conducted extensive engagement between July and October 2017. This engagement revealed a number of broad issues which support the data including: improving the health literacy of health professionals and the older population to ensure that people are accessing the appropriate services better supporting families and carers of the PHN region s older population improving the integration and coordination between the different components of the health system to improve patient care 9 Department of Health, 2016 Page 7
Outcomes of health needs analysis Culturally responsive services for Aboriginal and Torres Strait Islander people The Health Needs Assessment identifies that significant health inequalities persist across a number of indicators, contributing to shorter life expectancy for Aboriginal and Torres Strait Islander people. The need for culturally responsive services for Aboriginal and Torres Strait Islander people has been identified to reduce health and service inequities in the Brisbane North region. As of the 2016 Census 10, more than 20,000 people in the PHN region identify as Aboriginal, Torres Strait Islander or both 11. The population identifying as Aboriginal, Torres Strait Islander or both increased by over 40 per cent between 2011 and 2016. More than 40 per cent of this population lives in the Moreton Bay North subregion 12. Life expectancy for Indigenous Australians in Queensland is 10.9 years less for males and 9.7 years less for females than non-indigenous population. Aboriginal and Torres Strait Islander people also experience higher rates of a number of health risk factors compared to the non-indigenous population including obesity rates at 27.6 per cent compared to 22.1 for non-indigenous peoples in the region. Indigenous smoking rates are 2.7 times the rate of non-indigenous people 13. Two in every five (41.5 per cent) pregnant Aboriginal and Torres Strait Islander women report smoking at some stage during their pregnancy, 4.5 times the rate for non-indigenous women (9.2 per cent). In the region, Aboriginal and Torres Strait Islander people have a higher disease burden across all ages when compared to the non-indigenous population (Metro North Hospital and Health Service, 2016). The largest burden of disease among the Aboriginal and Torres Strait Islander population in the region was attributable to mental health at 28.6 per cent of the disease burden among Aboriginal and Torres Strait Islander people 14. This is much higher than the non-indigenous population in the region, where 16 per cent was attributable to mental disorders. The mental health burden disproportionately affects the population aged 25 years and under. Over half (51.2 per cent) of the Aboriginal and Torres Strait Islander population reported having two or more long term health conditions. A further 25 per cent reported having one long term 10 Australian Bureau of Statistics, 2017 11 Australian Bureau of Statistics, 2011 12 See appendix for a map of the PHN subregions. 13 Australian Bureau of Statistics, 2015 14 Metro North Hospital and Health Service, 2016 Page 8
Outcomes of health needs analysis Culturally responsive services for Aboriginal and Torres Strait Islander people health condition. Giving a total of 76.2 per cent with at least one long term health condition. This rate is 1.7 times the rate for the non-indigenous population of the region (44.8 per cent) 15. The PHN conducted extensive engagement between July and October 2017. This engagement revealed a number of broad issues affecting the Aboriginal and Torres Strait Islander population that support the data. These issues include: Poor health literacy among health professionals and consumers relating to Aboriginal and Torres Strait Islander health Lack of self-agency among Aboriginal and Torres Strait Islander people to take charge of their health Structural barriers preventing Aboriginal and Torres Strait Islander people from accessing appropriate care. These issues contribute to the health gap that exists between the Indigenous and non-indigenous communities in the PHN region. While progress has been made to reduce the health gap, significant inequities still persist. 15 Australian Bureau of Statistics, 2015, National Health Performance Authority, 2015 Page 9
Outcomes of health needs analysis Improved The health outcomes for people in the The Morton Bay North subregion experiences high rates of a number of risk factors including: access to Moreton Bay North subregion measured through both social determinants of health, almost one in three adults are overweight 16 health & health status and health risk factors show community one in five adults are current smokers, compared to one in six adults in the PHN region significant disparity when compared to care in other regions of the PHN, highlighting one in five women smoke during pregnancy, compared to one in ten women in the PHN significant health needs in this region. Moreton Bay region 18 North (right care, right high rates of high risk alcohol consumption compared to the rest of the PHN region 19 time, right Combined, health risk factors and poor social determinants of health in the Moreton Bay North subregion are contributing to poorer health outcomes among the population, including: place) the highest estimated rates of mental and behavioural disorders 20 the highest rates of chronic conditions across seven of the eight reported conditions higher than average rates of potentially avoidable deaths the highest rate of suicide per 100,000 people, in the region at 17 per 100,000 people 21 The area also has a higher prevalence of arthritis/musculoskeletal conditions, asthma, cardiovascular disease, circulatory system diseases, chronic obstructive pulmonary disease (COPD) and diabetes. One in five adults in the Moreton Bay North region self-assess their health as fair or poor compared to one in seven people across the PHN region. 16 Public Health Information Development Unit, 2016 17 Public Health Information Development Unit, 2016 18 Queensland Department of Health, 2016 19 Public Health Information Development Unit, 2016 20 Queensland Government Statistician s Office, 2015 21 Public Health Information Development Unit, 2015 Page 10
Outcomes of health needs analysis Improved access to health & community care in Moreton Bay North (right care, right time, right place) One third of people living in the Moreton Bay North subregion are considered to be most disadvantaged. The median household income per annum in Moreton Bay North is just $66,908, which is $23,000 less than the figure for the overall region 22. A high proportion of children in the Moreton Bay North subregion (28.9 per cent) are developmentally vulnerable in one or more domains compared to 23.7 per cent in the overall PHN region. Less than half (45.9 per cent) of the population have completed Year 11 or 12 at school, significantly lower than the PHN region (63.4 per cent) 23. Unemployment rates among individuals (8.6 per cent) and families with no parent employed (18.3 per cent) are higher in Moreton Bay North 24 than the rest of the PHN region. Income inequality, health outcomes inequities and poorer access to health services are of considerable concern in the Moreton Bay North region. Children are particularly vulnerable and are at risk of inequitable physical and mental health outcomes. The PHN conducted extensive engagement between July and October 2017. This engagement revealed a number of broad issues present in the region that support the data. These issues include: social isolation for people living alone or separated from their communities and its impact on their health poor health literacy and lack of service awareness contributes to poorer health outcomes for people. structural barriers to service access, including affordability and transport These issues prevent many residents of the Moreton Bay North region from accessing the right care in the right place at the right time. 22 Queensland Government Statistician s Office, 2015 23 Queensland Government Statistician s Office, 2016 24 Queensland Government Statistician s Office, 2016 Page 11
Outcomes of health needs analysis After - Hours Health Care Data from the HNA shows high level of demand for after-hours service across general practice deputising services, hospital emergency departments and 13 HEALTH services, indicating there is a continuing health need for after-hours services in the region. For all public hospitals in the PHN region, the peak hours of activity during after-hours are 6pm to 9pm. During this period, a total of 29,765 non-admitted categories four and five presentations occurred, accounting for 45.7 per cent of all presentations across the whole after-hours period 25. The majority of after-hours non-admitted category four and five presenters to emergency departments in the PHN region were aged under 30 years of age (57.6 per cent) 26. In addition, a large number of these presentations live in the northern sections of the PHN region, with a large cohort residing in the suburbs of Caboolture, Morayfield and Deception Bay. A higher proportion of Aboriginal and Torres Strait Islander people utilise the 13HEALTH phone service, with 2.8 per cent of callers who disclosed their Indigenous status identifying as Aboriginal 27. A total of 3.6 per cent of 13HEALTH callers during the after-hours period in the PHN region identified as either Aboriginal, Torres Strait Islander or both Aboriginal and Torres Strait Islander, compared to 1.6 per cent of the general population in the PHN region who identify as Aboriginal and Torres Strait Islander 28. The PHN conducted extensive engagement between July and October 2017. This engagement revealed a number of broad issues present regarding the after-hours healthcare that support the data. These issues include: improving the coverage of after-hours GP services in more regional parts of the PHN region improving coverage of after-hours GP services to residential aged care facilities to prevent avoidable hospitalisations particularly in after-hours periods. Currently, a lack of adequate after-hours GP services servicing residential aged care facilities is leading to a high level of emergency department presentations during the after-hours period. 25 Queensland Health, 2016 26 Queensland Health, 2016 27 Queensland Health, 2016 28 Queensland Health, 2016 Page 12
Section 3 Outcomes of the service needs analysis Outcomes of service needs analysis Better support There is a need to better support people with complex and chronic conditions so for people with that they can achieve better health chronic and outcomes, while reducing the burden of complex unnecessary hospitalisations. conditions across the care continuum. Overall potentially preventable hospitalisations (PPH) age standardised, in 2013 14 were 2540 per 100,000 people in Brisbane North PHN compared to 2436 per 100,000 people in Australia 29. Brisbane North PHN has higher rates of potentially preventable hospitalisations, (2013 14) than the nation for COPD, Cellulitis, heart failure and kidney and urinary tract infections 30. Preventable hospitalisations represent 7.1 per cent of all hospitalisations for the Brisbane North PHN region in 2013-14. Across all types of preventable admissions (Acute/Vaccine and Chronic) Moreton Bay North had the highest rates of admission (3433 per 100,000 people) 31. Between 2012-13 and 2014-15, there were a total of 16,935 admitted patient episodes for coronary heart disease (CHD). People aged 65 years and over experience the highest rates of admission for CHD, with 62 per cent of all admitted patient CHD episodes being for people aged 65 years and over. In the PHN region, an average of 6359 people per 100,000 population commenced a GP chronic disease management plan between 2012-13 and 2014-15 32. This was an estimated six per cent of the PHN region s population. Between the period 2012-13 and 2014-15, there was a 7.7 increase in the number of patients commencing a GP chronic disease management plan in the PHN region 33. This increase was not uniform across the region, Trends in GP chronic disease management follow a similar pattern to the average number of GP attendances per person, indicating that a large proportion of people residing in areas of higher socioeconomic disadvantage are more likely to require coordinated care to manage their chronic conditions. 29 AIHW, 2016 30 AIHW, 2016 31 AIHW, 2016 32 Sourced from Medicare Benefits Schedule data, Department of Health 2016. 33 Department of Health, 2016 Page 13
Outcomes of service needs analysis Better support for people with chronic and complex conditions across the care continuum. While there has been a recent update on potentially preventable hospitalisations data, changes to reporting methodologies mean the data is unable to be trended. However, information from other components of the health system indicate that unnecessary hospitalisations remain a concern. This is expressed through high use of emergency departments for conditions that could be treated by a GP, fluctuating rates of chronic disease management and high rates of potentially preventable hospitalisations. The PHN conducted extensive engagement between July and October 2017. This engagement revealed a number of broad issues present in the region that support the data. These issues include: provision of multi-sectoral support for patients can improve care outcomes for patients improving the integration and coordination between different parts of the health system to improve patient care improving the health literacy of both health professionals and consumers to better manage and coordinate chronic disease management Qualitative feedback from stakeholders also highlighted that improved health literacy and better service navigation remain key contributing factors to preventable hospitalisations for disadvantaged people and those with complex and chronic conditions. Equally, the provision of appropriate primary and community health services can help to prevent admissions to hospital. Page 14
Outcomes of service needs analysis Improved Moreton Bay North has been identified for access to its service needs due to the significantly higher levels of service demand and health & unequal workforce distribution across the community region. care in Moreton Bay North (right care, right time, right place) The demographics of the Moreton Bay North subregion highlight that this region has significant levels of disadvantage and poorer health status than other subregions. This leads to higher levels of health service needs including the highest level of general practice service usage across the region at an average of 6.2 visits per person per year which is 71 per cent higher than any other subregion 34. The region also has the highest number of potentially preventable hospitalisations and the lowest number of healthcare practitioners. There are 26,261 health professionals in the PHN region, of which, 3597 work in the Moreton Bay North subregion (14 per cent) 35. There are 230 full time equivalent (FTE) doctors in the Moreton Bay North subregion which equates to 98.5 doctors per hundred thousand people compared to 116.8 per hundred thousand for the PHN region as a whole 36. Updated workforce data indicates that the health workforce in Moreton Bay North is smaller than the rest of the region. Medical professionals working in Moreton Bay North, particularly GPs, report working longer hours compared to medical professionals working in other areas 37. This may be due to a smaller workforce working longer hours to meet greater demand for services. The PHN conducted extensive engagement between July and October 2017. This engagement revealed a number of broad issues present in the region that support the data. These issues include: Primary and community health workforce shortages limit available care options Difficulties in obtaining same day appointments in the Moreton Bay North region Limited number of home care places in the Moreton Bay North region compared to relative need. These issues contribute to poorer access to appropriate healthcare services, leading to a higher rate of unnecessary hospitalisations. 34 AIHW, 2016 35 Australian Institute of Health and Welfare, 2016 36 Australian Institute of Health and Welfare, 2016 37 Australians Institute of Health and Welfare, 2016 Page 15
Outcomes of service needs analysis After-Hours Service Delivery A possible after-hours service gap exists in the northern areas of the PHN region. With high rates of after-hours emergency department presentations and higher than average after-hours GP attendances. A number of medical deputising services operate in the Brisbane North PHN region. Although all medical deputising services are reported to cover the whole PHN region, service gaps are known to exist in the Samford, Dayboro and Kilcoy, Caboolture, Morayfield and Bribie Island local areas, within the Moreton Bay North region. The average number of after-hours GP attendances per person during 2013/14 in the PHN region was 0.35, with the highest average attendances occurring in the Caboolture and North Lakes areas 38. This area also has the highest proportion of calls to 13HEALTH, including calls from Caboolture, Kallangur, Morayfield and Deception Bay 39. In 2014-15 and 2015-16, usage rates of GP after-hours services continued to increase across the PHN region, particularly in the Caboolture, Narangba Burpengary, Redcliffe and North Lakes areas 40. This increase is also in line with population growth rates within these areas, indicating a greater demand for after-hours GP services. In addition, a large number of category four and five non-admitted emergency department presenters during the after-hours period live in the northern sections of the PHN region, with a large cohort residing in the suburbs of Caboolture, Morayfield and Deception Bay 41. The PHN conducted extensive engagement between July and October 2017. This engagement revealed a number of broad issues present regarding the after-hours healthcare that support the data. These issues include: improving the coverage of after-hours GP services in more regional parts of the PHN region improving coverage of after-hours GP services to residential aged care facilities to prevent avoidable hospitalisations help develop out of hours or urgent GP services in priority areas 38 Department of Human Services, 2015b 39 Queensland Health, 2016 40 Australian Institute of Health and Welfare, 2017 41 Queensland Health, 2016 Page 16
MENTAL HEALTH AND SUICIDE PREVENTION NEEDS ASSESSMENT Section 1 Narrative Needs Assessment process and issues Brisbane North PHN has continued to develop a comprehensive Mental Health and Suicide Prevention Needs Assessment which builds on the preliminary needs identification undertaken and submitted to the Department of Health in March 2016 and subsequent revision submitted in November 2016. This needs assessment also informs the ongoing development of the Mental Health and Suicide Prevention regional plan, informing a range of action plans to further develop the mental health sector in the Brisbane North PHN region. The PHN analysed mental health data from a range of sources in the development of the Mental Health and Suicide Prevention Needs Assessment, including: Australian Institute of Health and Welfare Australian Bureau of Statistics Social Health Atlas of Australia Headspace Queensland Health Commonwealth Department of Health Commonwealth Department of Health PHN Portal data, including o ABS mental health data o Access to Allied Psychological Services data o Mental Health Nurse Incentive Programme data o Private Mental Health Alliance data Medicare Benefits Scheme Internal PHN program data NGOs including Lifeline and Beyond Blue. The PHN synthesised data from the above sources to determine the breadth of mental health and service needs present in the PHN region. This information formed the basis of the comprehensive Mental Health and Suicide Prevention Needs Assessment. The PHN has also continued to engage with stakeholders throughout the needs assessment and in the development of the regional Mental Health and Suicide Prevention Plan. Throughout early 2017, the PHN held a series of community workshops to discuss key issues in the mental health, suicide prevention and alcohol and other drug treatment services system. The PHN will continue to engage extensively with the sector in the continued development and implementation of the regional plan. This will ensure that future service delivery is evidenced based and reflective of the needs of the community and informed by the stepped care mental health policy framework. Additional data needs and gaps A key component of assessing future mental health and suicide prevention needs across government and non-government settings is to ensure that accurate and timely data is available. This will enable the PHN to make informed, evidence based decisions and allow for the appropriate commissioning of services in the region. Page 17
The lack of reliable age specific mental health prevalence data on the local level is an identified data gap, with existing prevalence data only available on a national or state level through the Australian Institute of Health and Welfare, or through age standardised modelled estimates available through the Social Health Atlas of Australia. Quantitative data on hard to reach populations is difficult to obtain through existing frameworks, and accurately identifying the health needs of these population groups will remain a challenge. Additional comments or feedback It must be recognised that whilst Brisbane North PHN understands the need for consistency in developing these reports, the table format does not easily enable the presentation of trends and relationships between identified needs. Given the complex nature of mental health and suicide prevention as well as the service landscape, this limited reporting template makes it difficult to demonstrate a comprehensive picture of needs. Page 18
Section 2 Outcomes of the health needs analysis Outcomes of health needs analysis Low intensity mental illness High prevalence of mild mental health conditions, including depression and anxiety in the northern regions of the PHN where population growth is projected to occur. In the PHN region, the number of patients commencing a GP mental health plan increased by three per cent each year between 2012-13 and 2014-15 42. Within the region, the average annual increase in patients commencing a GP mental health plan was highest in the Moreton Bay North area, with 14.7 per cent increase in the Caboolture Hinterland area and 9.1 per cent increase in Bribie Beachmere 43. An estimated 6 per cent of the population commenced a GP mental health plan in the Brisbane Inner and Strathpine areas, indicating a high prevalence of mild to moderate mental illness. These trends are projected to increase and it is estimated that in 2017, 90,343 people in the PHN region will have a mild mental illness, with an estimated 45,172 of this population requiring treatment 44. Nationally, it is also estimated that between 10 to 15 per cent of people aged 65 years and over experience depression and approximately 10 per cent experience anxiety. In 2011, an estimated 19 per cent of the population aged 65 years and over in the PHN region accessed PBS subsidised antidepressants, with 2.6 per cent of the same age cohort accessing MBS subsided GP mental health services 45. People residing outside of the major metropolitan areas in the PHN region are more likely to access PBS subsided antidepressants compared to people residing in the metropolitan areas 46, indicating that a higher need exists in the Moreton Bay North area. The service utilisation data indicates that low intensity mental illness is of some concern among the older age cohorts in the PHN region, particularly in the more northern sections of the catchment. In early 2017, the PHN held a series of community workshops to discuss key issues in the mental health, suicide prevention and AOD treatment services system. The results of the workshop, and subsequent stakeholder engagement, indicated that there was significant demand for low 42 Medicare Benefits Schedule, 2016 43 Medicare Benefits Schedule, 2016 44 National Mental Health Service Planning Framework, 2017 45 Australian Bureau of Statistics, 2016a 46 Australian Bureau of Statistics, 2016a Page 19
Outcomes of health needs analysis Low intensity intensity psychological services. The consultation indicated that there is a need for increased mental illness awareness of low intensity services and a need for services to be more accessible to the community. Page 20
Outcomes of health needs analysis Children and Early intervention, family and perinatal young people support for vulnerable children aged zero to four years. High levels of developmental vulnerability among children residing in socioeconomically deprived areas in the PHN region, potentially leading to higher rates of mental health issues among children aged six to eight years. High proportion of young people experiencing psychological distress in the PHN region, particularly in areas of higher socioeconomic disadvantage; complex and vulnerable young people and sexually and gender diverse young people. Healthy early childhood development is fundamentally linked to long-term health outcomes 47. An increasing body of evidence indicates that the first 1,000 days from the start of a woman s pregnancy to her child s second birthday are critical in the social, emotional and physical development of a child 48. The Australian Early Development Census is an instrument which measures five domains of early childhood development that are predictors of a child s health, education and social outcomes. In the PHN region, almost one in four children (23.7 per cent) are developmentally vulnerable in one domain and a further 12 per cent are developmentally vulnerable across two or more domains 49. A high proportion of children in the Moreton Bay North (28.9 per cent) and Redcliffe - North Lakes (28 per cent) planning areas are developmentally vulnerable in one or more domains, particularly when compared to the region average 50. Children in the Moreton Bay North and Redcliffe - North Lakes subregions experience higher rates of developmental vulnerability in the physical health, emotional, language and communication domains when compared to the rest of the region 51. The estimated prevalence of mental health issues among children aged 4-11 years varies from 13 per cent in the Brisbane Inner City subregion to 20 per cent in Moreton Bay North 52. Similar patterns are observed for young people aged 12-17 years, with estimated prevalence rates varying from 9 per cent in Brisbane Inner City to 16 per cent of young people in Redcliffe North Lakes and 18 per cent of young people residing in Moreton Bay North experiencing a mental health issue 53. These patterns reflect trends of socioeconomic disadvantage in the PHN region, with higher mental health prevalence rates and developmental vulnerability in areas of higher socioeconomic disadvantage. 47 Franks et al, 2015 48 1,000 days initiative 49 Queensland Government Statistician s Office, 2016 50 Queensland Government Statistician s Office, 2015 51 Queensland Government Statistician s Office, 2016 52 Estimates derived from Young Minds Matter, 2014 53 Estimates derived from Young Minds Matter, 2014 Page 21
Outcomes of health needs analysis Children and Children and adolescents in low-income families, with parents and carers with lower levels of young people education and with higher levels of unemployment had higher rates of mental disorders in the previous 12 months. This is particularly evident in males who had higher rates across all five characteristics 54. In the period between July 2013 and June 2015, there were over 10,000 emergency department presentations by people aged less than 25 years of age for mental and behavioural issues in the PHN region 55. The most common reason for presentation was suicide ideation, general mental illness, anxiety and depression 56. Almost one in ten mental health related emergency department presentations were by people residing in socioeconomically disadvantaged regions, including Caboolture, Deception Bay and Morayfield. This indicates that young people residing in socioeconomically disadvantaged areas in the PHN region have high mental health needs. In the PHN region as of 2017, an estimated 19,482 children and young people aged 0-17 years had a mild mental health condition. An estimated 9806 children and young people aged 0-17 had a moderate mental health condition and an estimated 5022 children and young people had a severe mental health condition 57. Combined, this represents 26 per cent of all children and young people aged 0-17 years in the PHN region. Data collated from three of the four headspace centres in the PHN region (Nundah, Redcliffe and Taringa sites) found that between 2015-16, there were 8559 occasions of services for 2032 young people. Trends also suggest that the number of young people accessing headspace is increasing and will continue to increase in the future. Whilst these services are designed as an early intervention tool to address mild and moderate mental health issues, of those currently presenting to the three headspace centres, more than 60 per cent are identified as having high to very high psychological distress. 54 Lawrence, et al., 2015 55 Queensland Health, 2015 56 Queensland Health, 2015 57 The University of Queensland, 2017 Page 22
Outcomes of health needs analysis Children and In early 2017, the PHN held a series of community workshops to discuss key issues in the mental young people health, suicide prevention and AOD treatment services system. The results of the workshop, and subsequent stakeholder engagement indicated six main priority population cohorts: - early intervention through family and perinatal support; - vulnerable children aged zero to four; - children aged six to eight with behavioural issues; - vulnerable and complex young people; - suicide and self-harm and sexually and - gender diverse children and young people. Consultations also revealed that children living in out of home care experience poorer health outcomes. Page 23
Outcomes of health needs analysis Hard to reach Lack of services in the northern part of the Within the PHN region, areas of higher disadvantage and poorer health determinants experience PHN region where need is greatest. population higher rates of psychological distress. Rates of psychological distress are particularly high in the Moreton Bay North and Redcliffe - North Lakes subregions, where rates vary from 16.7 per cent in groups and Caboolture to 13.6 per cent in North Lakes 58. These areas area also have a fewer number of under-serviced services available, contributing to existing inequities and service gaps for mental health treatment. areas Both the Moreton Bay North and Redcliffe - North Lakes subregions are predicted to undergo high population growth 59. Within these subregions, there are an estimated 60 : 6800 to 9000 children and young people with a mental health disorder 43,146 people receiving MBS mental health services 61 4000 to 6000 people aged 65 years and over with depression and more than 4000 people aged 65 years and over have anxiety. Existing workforce data suggests the distribution of mental health services does not adequately match the need present in the Moreton Bay North region 62. The estimated number of allied mental health providers in the Bribie Beachmere (13 per 100,000), Caboolture (44 per 100,000) and Narangba Burpengary (23 per 100,000) statistical areas were all below the PHN average of 75 allied mental health providers per 100,000 people, indicating that the Moreton Bay North area is underserviced 63. Full time equivalent rates for psychologists are in the Bribie Beachmere and Narangba Burpengary areas are 3.8 and 3.2 times lower respectively than the Australian average 64. This indicates that mental health services are currently not meeting population needs in the northern parts of the PHN region. 58 Public Health Information Development Unit, 2017 59 Queensland Government Statistician s Office, 2016 60 Department of Health, 2016 61 Department of Health, 2016 62 Australian Institute of Health and Welfare, 2016; Brisbane North PHN, 2016 63 Medicare Benefits Schedule, 2016 64 Australian Institute of Health and Welfare, 2016 Page 24
Outcomes of health needs analysis Hard to reach population groups and under-serviced areas In the five years between 2011-12 and 2015-16, 59,199 ATAPS services were delivered to 11,669 patients 65. This was an average 11,840 services delivered to 2,399 patients per annum, equating to an average of 5 services per patient 66. Within the region, the Moreton Bay North subregion had the highest number of services, with 27,707 services, representing 37 per cent of all services delivered in the PHN region. The number of services delivered in Moreton Bay North increased considerably in 2014-15 67. The growth in MBS mental health patients per 100,000 population in Redcliffe North Lakes and Moreton Bay North indicates that the growth in patients is not tied to population growth alone. This indicates that the rate of patients accessing services in these areas is increasing and may indicate increasing demand for services. Growth rates in patients accessing ATAPS services during 2012-13 and 2014-15 also indicate significant demand for mental health services in the Moreton Bay North and Redcliffe North Lakes subregions. While the increase in the number of services delivered in these regions may indicate that needs are being met, there is still evidence of service gaps, particularly within the Moreton Bay North subregion. Those who identify as lesbian, gay, bisexual, transgender, intersex and questioning (LGBTIQ) people report higher rates of psychological distress than the general population and are at greater risk of suicide. In Australia LGBTIQ people reported higher rates of psychological distress than the general population, a K10 average of 19.6 versus the national average of 14.5 68. LGBTI people have the highest rates of suicidality of any population in Australia with 20 per cent of transgender Australians and 15.7 per cent of lesbian, gay and bisexual Australians reporting current suicidal ideation 69. The average age of a first suicide attempt is 16 years of age and is often before coming out 70. Almost half of transgender people have attempted suicide at least once in 65 Department of Health, 2016b 66 Department of Health, 2016b 67 Department of Health, 2016b 68 Leonard, 2015 69 Rosenstreich, 2013 70 Rosenstreich, 2013 Page 25
Outcomes of health needs analysis Hard to reach population groups and under-serviced areas their lives and same-sex attracted Australians have up to 14 times higher rates of suicide attempts than their heterosexual peers 71. Rates are six times higher for same-sex attracted young people 72. Anecdotal evidence also suggests that the rate of suicidal tendencies in intersex people is significantly higher than the general population. While estimating the prevalence of mental health issues is difficult on a local level, locally collected data for 2014-15 from headspace centres operating in the PHN region reported that one in five (19 per cent or 239 people) young people who accessed services identified as being either lesbian, gay, trans, intersex or questioning (LGBTIQ). Consultation with local mental health service providers also indicates that people who identify as LGBTIQ are also at risk of poorer mental health than the general population in the PHN region. Barriers to service for hard to reach and under-serviced populations, including culturally and linguistically diverse people, homeless people and those in contact with the justice system. These populations are shown to be at higher risk of mental health illness than the general population. Culturally and linguistically diverse populations Within the Brisbane North PHN region almost one quarter of the population are born outside of Australia, representing a significant culturally and linguistically diverse population 73. For these people stigma, lack of information about mental illness and mental health services in appropriate and accessible formats, poor communication and cultural differences between clients and clinicians have been reported as major barriers to timely access to mental health services. Lack of access negates the early intervention and ongoing partnerships with service providers that are essential for relapse prevention 74. Furthermore, lack of early intervention contributes to the reality that people from some culturally and linguistically diverse communities are overrepresented among involuntary admissions and forensic populations. Homelessness As of 2011, it is estimated that over 2700 people in the PHN region were homeless or at risk of being homeless, with a further 1800 people residing in marginalised housing 75. While the largest cohort of people who were homeless resided in the Inner City, over 500 people in the Moreton Bay North 71 Rosenstreich, 2013 72 Rosenstreich, 2013 73 Queensland Government Statistician s Office 2015 74 Rickwood, 2006 75 Australian Bureau of Statistics, 2011 Page 26
Outcomes of health needs analysis Hard to reach population groups and under-serviced areas subregion were officially considered to be homeless 76. Data from the PHN s outreach services program indicates that a sizeable cohort of people in the Redcliffe peninsula area that are considered homeless also have high mental health needs 77. National data indicates more than a quarter of homeless people identify as Aboriginal and Torres Strait Islander 78. Of all who are homeless, young Australians aged 12 to 24 years make up 36 per cent 79. Studies show that between 48 per cent to 82 per cent of homeless young people have diagnosable mental illness and the most common are mood disorders, anxiety disorders like posttraumatic stress disorder and substance misuse disorder 80. Contact with the justice system Prisoners continue to have high rates of mental health related issues and in 2012, 46 per cent of people discharged from prison nationally 81 reported having ever been told they have a mental health issue (including alcohol and drug use issues) 82. It is also known that those who identify as Aboriginal and Torres Strait Islander and have been in contact with the justice system are more likely to have mental health issues and are less likely to access resources. 76 Australian Bureau of Statistics, 2011 77 Brisbane North PHN outreach services program, 2016 78 Commonwealth of Australia 2008 79 Mission Australia 2016 80 Flatau et al. 2015 81 Included are data from 794 prison entrants, just over 4,000 prisoners who visited the clinic and about 9,000 prisoners who took medication. New in 2012 are indicative data from 387 prison dischargees (prisoners expecting to be released in the 4 weeks following the collection). Data was provided from all states and territories except Western Australia. 82 Australian Institute of Health and Welfare 2013 Page 27
Outcomes of health needs analysis Aboriginal and Torres Strait Islanders The significant disparities in the health of Indigenous and other Australians have been well documented but the overall picture is one that consistently shows gaps in health outcomes across the life course. Social and emotional wellbeing is often used to describe issues of mental health but it has broader scope as the Indigenous culture takes a holistic view of health. It recognises the importance of connection to land, culture, spirituality, ancestry, family and community and how these connections have been shaped across generations and the processes by which they affect individual wellbeing. Studies report though that approximately 10 per cent of the health gap between Indigenous and the general population in Australia is linked with a mental health condition (including: depression, anxiety and substance misuse). The Australian Aboriginal and Torres Strait Islander Health Survey reported that 12 per cent of Indigenous Australians had reported feeling depressed or having depression as a long-term condition which was significantly higher than the corresponding proportion for all Australians (9.6 per cent). Nearly one third of Indigenous adults report high or very high levels of psychological distress in their lives, which is nearly three times the rate reported by other Australians 83. There were significant differences in the proportions of men and women who had experienced high/very high levels of psychological distress (24 per cent compared with 36 per cent). Rates of high/very high psychological distress were significantly higher for women than men in every age group, apart from those aged 45 to 54 years 84. In the PHN region, it is estimated that 3140 Aboriginal and Torres Strait Islander people aged 15 years and over have high or very high psychological distress and almost two in five live in the Moreton Bay North subregion (1210 people) 85. This is supported by locally collected data from general practice which highlights 1283 Aboriginal and Torres Strait Islander people have a mental health condition (1.8 per cent of the practice population). Aboriginal and Torres Strait Islander people are over-represented in emergency department presentations for mental health related conditions in the PHN region. A total of 5.2 per cent of emergency department presentations for mental health related conditions in 2013-15 identified as Aboriginal and Torres Strait Islander 86, most commonly for suicidal ideation/self-harm and general mental illness. According to the Metro North HHS (2016), almost one third of the disease burden among Aboriginal and Torres Strait Islander people in the PHN region is attributable to mental health. This burden is higher among younger people 87. The higher mental health burden among Aboriginal and Torres Strait Islander people in the PHN region is linked to the poorer social determinants present among this population group 8889. 83 Australian Bureau of Statistics, 2013 84 Australian Bureau of Statistics, 2013 85 Public Health Information Development Unit, 2015 86 Queensland Health, 2015. 87 Metro North Hospital and Health Service, 2016 88 Public Health Information Development Unit, 2016 89 Australian Bureau of Statistics, 2015 Page 28