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13 Apr 2016

In 2014, the National Mental Health Commission delivered its key findings from its review of mental health programmes and services in Australia.  Key messages from the review included that there were multiple layers of investment in mental health that were contributing to inefficiencies, duplication and lack of coordinated implementation of programs on the ground.  The review found that some of the greatest inefficiencies were stemming from an imbalanced focus on acute crisis services and disability support, rather than on prevention and early intervention.  Services were being provided too late in a person’s life, or in the course of their illness.  Ineffectiveness of the system meant that people were not receiving the support they required, where they needed it and in a way that was matched to their presenting need.  In particular, support for people with severe and persistent mental illness lacked integration between clinical and social supports and was subject to duplication across sectors and government. There was strong agreement from the sector that there needed to be system change.

The Australian Government responded and established an Expert Reference Group (ERG) in mental health and also embarked on targeted stakeholder consultations. The advice coming from the ERG called for greater regional services, integration for planning and delivery of services, and for Primary Health Networks (PHNs) to play an important role in mental health planning and integration with appropriate support and accountability measures.

The ERG also argued for stepped care to underpin the service delivery approach, particularly in primary mental health care with services matched to need, with increasing digital mental health options becoming available to promote early intervention. Children and youth supports needed to be better integrated and have improved equity in service delivery particularly for young people with severe mental illness and that the approach to suicide prevention needed to be reviewed with an assistance–based regional implementation approach adopted. With the advice of the ERG in mind, the Commonwealth’s response came with nine interconnected areas of reform, which were announced on 26 November 2014 and detailed in the document titled Australian Government Response to Contributing Lives, Thriving Communities – Review of Mental Health Programmes and Services

Mental Health Reform Stakeholder Group

The Australian Government has given a commitment to continued consultation and engagement as the reforms are implemented by establishing a Mental Health Reform Stakeholder Group.  The purpose of the Stakeholder Group is to act as an informal mechanism for ensuring open dialogue and information flow between key mental health and suicide prevention stakeholders and the Australian Government Department of Health. Establishment of the Group facilitates regular communication on the progress of reform implementation and on practical reform matters. An initial priority is consultation on guidance material required for Primary Health Networks to successfully implement key aspects primary mental health care and suicide prevention reform.

The first meeting of the Mental Health Reform Stakeholder Group meeting held on 22 February 2016 in Canberra.

List of participants First Mental Health Reform Stakeholder Group Meeting 22 February 2016 

Adjunct Assoc. Prof. Kim RyanCEO, Australian College of Mental Health Nurses
Professor Malcolm HopwoodPresident, RANZCP
Professor Lyn LittlefieldExecutive Director, Australian Psychological Society
Professor Morton RawlinVice President, Royal Australian College of General Practitioners
Dr Bill PringPrivate Mental Health Alliance (PMHA), AMA Observer
Mr Frank QuinlanCEO, Mental Health Australia
Ms Georgie HarmanCEO, Beyondblue
Ms Sue MurrayCEO, Suicide Prevention Australia
Ms Marita CowieCEO, Australian College of Rural & Remote Medicine
Mr David MeldrumExecutive Director, Mental Illness Fellowship of Australia
Mr David ButtCEO, National Mental Health Commission
Ms Janet MeagherConsumer representative
National Mental Health Consumer and Carer Forum
Ms Eileen McDonaldCarer representative
National Mental Health Consumer and Carer Forum
Mr Stephen BrandSenior Manager, Policy & Advocacy
Australian Association of Social Workers
Professor Tom CalmaAdvisor
Australian Government Department of Health
Ms Natasha Cole (Chair)First Assistant Secretary, Health Services Division
Australian Government Department of Health
Ms Colleen KrestensenAssistant Secretary, Mental Health Reform Taskforce
Australian Government Department of Health
Dr Anthony MillgateAssistant Secretary, Mental Health Services Branch
Australian Government Department of Health
Ms Emma GleesonActing Assistant Secretary,
Mental Health Early Intervention Branch
Australian Government Department of Health

At the meeting, this diverse range of stakeholders raised a multitude of views and concerns, particularly the lack of mental health consumer and carer input for PHNs.

There is also widespread concern about both the capacity of PHNs to take on the role that has been detailed for them by the Government and the range of expectations being placed upon them in relation to mental health. There is concern that this together with the variability in the capacity between PHNs will result in most PHNs not being able to take on anything but a diluted coordinating role in mental health.

Other issues included the necessity for good clinical governance to be observed in PHN mental health processes, the risks associated with depriving people suffering mental illnesses from Medicare services, and the need for PHN’s to work closely with the private specialist mental health sector to ensure that there is not fragmentation of services. 

After the meeting, the Department issued a summary to reassure and assist Stakeholders with their broader communications with their sectors. In addition, the Department made available slides from the 22 February 2016 meeting, which are located on the PHN website at\PHN under the tools and resources tab, or by using this link

Departmental Summary

Since the Government’s Response to the Review of Mental Health Programmes and Services was announced on 26 November 2015, implementation arrangements have progressed across key elements of the Government’s reform package.

  • Importantly, funded organisations were provided with advice in December 2015 about funding arrangements to apply to their projects from 1 July 2016.  This includes Mental Health Nurse Incentive Programme, Partners in Recovery (refer below), Day to Day Living, Mental Health in Rural and Remote Areas, Access to Allied Psychological Services, Suicide Prevention, headspace and the Early Psychosis Programme
  • There will be a period of transition as existing funding arrangements between the Department and organisations are replaced by commissioning arrangements through PHNs. The Department is talking directly with affected organisations and PHNs to support effective transition arrangements.
  • Effort is focusing on the priorities for 2016-17 implementation, including the expanded role for PHNs, programme transition arrangements, development of new suicide prevention arrangements and child and youth arrangements.
  • The level of funding flexibility from 1 July 2016 will vary across programme areas and in general this move will occur gradually, with many arrangements for delivery of services remaining effectively unchanged in 2016-17. A phased implementation approach over the next three years is being used to implement the more complex aspects of the reform package, including clinical care coordination packages for severe and complex mental illness.
  • A package of detailed guidance material is being developed to assist PHNs in the successful delivery of system change reforms. The guidance material is intended to support the delivery of key mental health objectives while allowing for flexibility and innovation. It is anticipated the detailed guidance package will be provided to PHNs in late March 2016.
  • To further support implementation of the reform package, a Mental Health Reform Stakeholder Group has been established to support sector engagement, inform implementation issues and enable feedback to the Department and PHNs.  The Group has discussed the importance not only of providing detailed guidance to PHNs, but also of ensuring information flows over time to the broader non government sector about reforms, and to support mental health professionals as partners in implementation of the reform process.
  • PHN lead sites are also being established to trial more complex aspects of the stepped care approach and to inform broader roll out in later years. An Expression of Interest process has been undertaken to select the lead sites and applications are currently being assessed. Selection of sites will aim to provide coverage across multiple jurisdictions and across metropolitan and rural areas, and enable development of: severe packages of care (including for youth); low intensity service models; and innovative models of stepped care.

Extension of the Partners in Recovery programme

The PIR programme has been extended for up to three years to support the transition of programme funding to the National Disability Insurance Scheme (NDIS). National rollout of the NDIS commences from 1 July 2016, with full rollout to be achieved by 2019-20.

The extension will ensure service continuity for programme clients under NDIS rollout is completed in each jurisdiction. Funding arrangements will take into account the Timeframes for transition of eligible clients to the NDIS and implementation of continuity of support arrangements for clients found not eligible for the NDIS.

Further information on the funding extension process will be provided to PIR Organisations, together with programme guidelines for the transition period, in March 2016.

What Should Private Psychiatrists do?

There is an expectation that the PHNs will link in with the existing systems of public and private mental health care.  So beyond the MBS Review, there will be no major changes to Medicare, at this stage, in relation to the mental health reforms.

There may be some innovative approaches to packaging and coordinating available services and funding (including Medicare funding) for people with severe mental illness and complex needs. This will be led by PHN’s who will utilise demonstration models in the first instance.  Some of the demonstration sites will probably be in rural and remote locations. Part of that will be exploring an “in lieu” use of Medicare funding and other services such as mental health nurse services. This will be a staged approach commencing in 2016 with some initial trials and demonstration models. The AMA will monitor these initiatives closely, to ensure choice remains for consumers. Our scrutiny of Commonwealth policy indicates that “serious/severe” mental illness and suicide will be more definitively addressed in 2017. We have already called the attention of the Department to this, because we believe that serious cases and suicide should have a high priority in mental health policy from the beginning.

The AMAPG feels psychiatrists need to be mindful of the changes and how they might best negotiate with the PHNs at a local level.  Establishment of local clinical governance groups by PHN’s, and a mental health person in the PHNs to administer the mental health funding and liaise with the community, has been suggested to PHN’s.  It could be helpful for private psychiatrists in the different locations where you work, to attempt to engage with PHN’s at an early stage. This could be organised in conjunction with local private psychiatric hospitals, where appropriate. Public sector psychiatrists could ensure that their own area service is properly engaged in the PHN process, and has some psychiatrist representation as well. State and Territory departments are likely to have policies about the engagement of their area mental health services with PHN’s – but make sure something is actually happening!

Published: 13 Apr 2016