Mid North Coast Mental Health Services Clinical Services Plan - ADDENDUM 2015 - September 2015

 
Mid North Coast Mental Health Services Clinical Services Plan - ADDENDUM 2015 - September 2015
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

Mid North Coast
Mental Health Services
Clinical Services Plan
ADDENDUM 2015

                                                             September 2015

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Mid North Coast Mental Health Services Clinical Services Plan - ADDENDUM 2015 - September 2015
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

Mid North Coast Mental Health Services Clinical Service Plan DRAFT ADDENDUM 2015
prepared for the Mid North Coast Local Health District by:
      richard gilbert consulting

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

     TABLE        OF     CONTENTS
      Table of Contents .................................................................................................................................... 3
1     EXECUTIVE SUMMARY & RECOMMENDATIONS ..................................................................... 5
    1.1      Introduction .................................................................................................................................... 5
    1.2      Projected Service Requirements ..................................................................................................... 5
    1.3      Current and Future Role ................................................................................................................. 8
    1.4      Recommendations .......................................................................................................................... 9
2     INTRODUCTION .................................................................................................................. 11
    2.1      The Mid North Coast Mental Health Service Clinical Service Plan 2013 ...................................... 11
    2.2      Developments Since 2013............................................................................................................. 12
    2.3      The MNC Mental Health Service Clinical Service Plan Addendum 2015 ...................................... 12
3     BACKGROUND .................................................................................................................... 14
4     POLICY & PLANNING FRAMEWORK ..................................................................................... 15
    4.1      NSW State Health plan and Rural Health Plan .............................................................................. 15
    4.2      National Mental Health Reforms .................................................................................................. 17
    4.3      NSW Mental Health Commission .................................................................................................. 19
    4.4      Mid North Coast Mental Health Literature Review ...................................................................... 20
5     SERVICE NEED ..................................................................................................................... 22
    5.1      Mid North Coast ............................................................................................................................ 22
    5.2      Current and Projected Population Profile..................................................................................... 22
    5.3      Service Demand ............................................................................................................................ 24
6     CURRENT ACTIVITY ............................................................................................................. 34
    6.1      Acute Inpatient Mental Health Services ....................................................................................... 34
    6.2      Non-Acute Inpatient Mental Health Services ............................................................................... 36
    6.3      Community Mental Health Services ............................................................................................. 36
7     PROJECTED DEMAND .......................................................................................................... 38
    7.1      Current Capacity measured against NSW Planning Benchmarks ................................................. 38
    7.2      Projected Capacity Requirements................................................................................................. 42
8     CURRENT SERVICES AND NEW SERVICE MODELS.................................................................. 45
    8.1      Mid North Coast Local Health District .......................................................................................... 45
    8.2      New Service Models...................................................................................................................... 47
    8.3      Acute Inpatient Units .................................................................................................................... 48

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

    8.4      Rehabilitation Unit ........................................................................................................................ 51
    8.5      Community Mental Health Services ............................................................................................. 52
    8.6      Older Persons ................................................................................................................................ 59
    8.7      Younger Persons ........................................................................................................................... 60
    8.8      General Practitioners and North Coast Primary Health Network ................................................. 61
    8.9      Non-Government Organisations ................................................................................................... 61
    8.10     Aboriginal Medical Services .......................................................................................................... 62
    8.11     Private Services ............................................................................................................................. 63
9     FUTURE ROLE OF PORT MACQUARIE MENTAL HEALTH INPATIENT UNIT AND FUNCTIONAL SPACE
      REQUIREMENTS .................................................................................................................. 64
    9.1        Hastings Macleay Clinical Network ............................................................................................. 64
    9.2        Port Macquarie Mental Health Inpatient Unit............................................................................ 65
10 References.......................................................................................................................... 73
11 Appendix ............................................................................................................................ 76
    11.1       Appendix 1 .................................................................................................................................. 77
    11.2       Appendix 2 ……………………………………………………………………………………………………………………..…….79
    11.3       Appendix 3 .................................................................................................................................. 83

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

1         EXECUTIVE SUMMARY &
          RECOMMENDATIONS
1.1       INTRODUCTION
A Clinical Services Plan utilises the latest available data to effectively plan service delivery by identifying
current service needs whilst also projecting future service needs. Notably, it remains a living document
and, accordingly, may be revised overtime in response to changing circumstances and emerging
challenges.
The development of the 2015 Mid North Coast Mental Health Service Clinical Services Plan ADDENDUM
builds on the earlier Mid North Coast Mental Health Services Clinical Services Plan 2013-2021. It provides
the opportunity to review population needs against current service capacity utilising updated population
projections, and plan for the range of Acute and Non-Acute Inpatient and ambulatory services required to
meet the needs of the Hastings Macleay Clinical Network (HMCN), and broader Mid North Coast
community, to 2021 and beyond. Additionally, it presents an opportunity to review and update the
models of care and review previous service enhancement priorities and determine which should have the
highest priority in the context of current and projected community demand and available resources.

The 2015 Mid North Coast Mental Health Service Clinical Services Plan ADDENDUM (ADDENDUM) has
been prepared with advice from key stakeholders to determine the service directions and capacity
requirements for the mental health service, with a focus on inpatient services at Port Macquarie Base
Hospital over the next five to ten years. The development of this ADDENDUM has drawn upon:
     consultations with local clinical staff and management, as well as consumers, carers and
        members of the local Aboriginal Community from April-June 2015 (see Appendix 1 for
        Consultation Profile and Appendix 2 for the Aboriginal Health Impact Statement and checklist);
     previous consultation with key stakeholders including service providers, Non-Government
        Organisations (NGOs), Commonwealth funded services, and consumers and carers at Planning
        Workshops in October 2012;
     review of National, State and MNCLHD policies, plans and Service Level Agreements with the
        Ministry of Health; and
     planning projections using modelling tools and benchmarks as endorsed by NSW Mental Health
        and Drug & Alcohol Office (MHDAO).

1.2       P R O J E C T E D S E R V I C E R E Q U I R E M E NT S
In projecting future service capacity requirements to 2020/2025, the ADDENDUM has been informed by
the use of the latest Mental Health – Clinical Care and Prevention (MH-CCP) (2010) methodology1, the
results of which have been summarised in Table 1.1 (shown over page) (see Appendix 3 for MNCLHD
Estimated Needs Met Using MH-CCP (2010), provided July 2015 by MHDAO).

1
    MHDAO (2012) MH-CCP 2010.
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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

Table 1.1          Mid North Coast Local Health District - Current and Projected Inpatient Bed
                   Requirements

                                            Current
                                              Bed                  MH-CCP (2010)#
               Age Group                    Numbers

                                              2015          2015         2020         2025

                                            Acute

Children & Adolescents (0-17)*
                                                0*            3            3            3
Mid North Coast
Adults (18-64)
                                             52 ** (42)      37           37            37
Mid North Coast
Older Persons (65+)
                                                 0           14           16            19
Mid North Coast

ACUTE TOTAL                                  52 ** (42)      54           56            58

                                         Non-Acute

Children & Adolescents (0-17)
                                                 0            2            2            2
Mid North Coast
Adults (18-64)
                                             20 ^ (8)         6            6            6
Mid North Coast
Older Persons (65+)
                                                 0            7            9            10
Mid North Coast

NON-ACUTE TOTAL                              20 ^ (8)        16           17            18

                                       Very Long Stay

Children & Adolescents (0-17)
                                                NA           NA           NA            NA
Mid North Coast
Adults (18-64)
                                                 0           16           16            16
Mid North Coast
Older Persons (65+)
                                                 0            6            7            8
Mid North Coast

VERY LONG STAY TOTAL                             0           22           23            24

GRAND TOTAL                                     72           91           96           101

# Small inconsistencies in figure summation are due to issues associated with rounding; * Acute Child and Adolescent Beds for
Mid North Coast currently provided within Lismore Base Hospital CAMHU; ** As the 10 Acute Beds at Kempsey District Hospital
are non-gazetted and are affected by issues of rurality, the MNC’s total of practicable Acute Adult Beds is 42; ^ The catchment for
North Coast Rehabilitation Unit Beds currently covers MNC and Northern NSW LHDs. The MNCLHD utilises 40 per cent (8) of
these Beds, whilst Northern NSW utilises the remaining Beds.
Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010
Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

When comparing the Mid North Coast’s current mental health inpatient bed capacity with the MH-CCP
(2010) estimates provided by MHDAO in July 2015, the following may be noted

      The MNCLHD has no Older Persons (65+ years) beds of any description (Acute, Non-Acute, or
       Very Long Stay (VLS)), whilst estimates indicate the need for 14 Acute beds, seven Non- Acute
       beds, and six VLS beds in 2015, increasing to 19 Acute, 10 Non-Acute and 8 VLS beds,
       respectively, by 2025.
      The MNCLHD has no Younger Persons (0-17 years) beds, whilst estimates indicate the need for
       three Acute beds and two Non-Acute beds in 2015 through to 2025.
      The MNCLHD has no VLS beds, although estimates indicate the need for 16 Adult VLS beds and
       six Older Person VLS beds in 2015, increasing to a total of 24 VLS beds by 2025. While the
       provision of 42 HASI Places within the MNCLHD offsets this need to some degree, such places are
       not commensurate with the 24 hour intensive support provided in VLS units. For instance, 26 of
       the MNCLHD HASI packages provide consumer assistance for a total of five hours/week, four
       packages provide assistance between two and three hours per day, and 12 packages provide
       assistance for five hours/day. Also impacting this service space is the new Metal Health Hospital
       to Community Initiative given that, wherever possible, individuals previously requiring an
       extended long stay in one of the residential mental health facilities in NSW will be gradually
       transitioned to the community. A small number of Mid North Coast residents form part of this
       cohort and it is expected they will be returned to the LHD for appropriate transitioning. In
       response to the existing service need as well as emerging needs, and the absence of very long
       stay beds in the Mid North Coast, the MNCLHD may need to secure capital funding to provide
       required services.
      According to the estimates, the MNCLHD has an adequate supply of Non-Acute beds through to
       2025. Presently, however, the catchment for the North Coast Rehabilitation beds covers MNC and
       Northern NSW LHDs, with Northern NSW utilising 60 per cent of the available 20 beds. This
       means the MNCLHD utilizes eight of the beds. Importantly, the premise whereby the MNCLHD
       has an adequate supply of Non-Acute beds is grounded in the expectation that by mid-2017
       Northern NSW will no longer require access the MNCLHD Non-Acute beds given the new Byron
       Bay Hospital currently under development includes a 20 bed Non-Acute Inpatient Unit.
      The MNCLHD has an adequate supply of Adult Acute beds given there are presently 52 Acute
       Adult beds in the MNCLHD and estimates indicate the need for 37 Acute Adult beds in 2015
       through to 2025. Three factors, however, mitigate the adequacy of this supply. The first is that
       there are no Acute Older Persons or Younger Persons beds within the MNCLHD; if the estimated
       need for these beds were included, the total number of Acute beds required by the MNCLHD
       becomes 54. Secondly, although the 10 beds located at Kempsey District Hospital are Acute beds,
       the consequences of rurality, including their distance from the Port Macquarie Inpatient Unit and
       associated specialist workforce, means that these non-gazetted beds are not utilised as Acute
       beds, per say. Therefore the total number of practicable MNCLHD Adult Acute beds is 42 rather
       than 52 beds. Finally, as noted in the CSP 2013, whilst the 2011 MH-CCP (2010) data estimated
       158.0 FTE were required to meet the MNC’s need for ambulatory (community) mental health
       services, the workforce comprised 76.8FTE. Additional pressure is placed on Acute Adult beds as a
       consequence because of the resulting limited capacity for post-discharge follow-up and assertive
       treatment within the community setting leading to increased readmission rates. The transition to

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

        new models of care will allow the MHS to make the best possible use of existing resources
        including FTE which may alleviate some of this additional pressure.

1.3     CURRENT        AND     FUTURE ROLE
The population of the Mid North Coast is projected to increase by 13 per cent between 2011 and 2026.
The population aged over 65 years is projected to increase by 53 per cent over the same period. These
demographic changes will place a substantial additional demand on mental health services within the Mid
North Coast.

Over the next ten years to 2026, Mid North Coast LHD Mental Health services are expected to be
managed and networked on a district-wide basis. Such networking provides the critical mass to provide
for the full range of services of secondary level mental health services, both hospital Inpatient and
ambulatory community based services, and tertiary services such as the Non-Acute Rehabilitation
Inpatient Unit at Coffs Harbour Campus.

As recommended in the Mid North Coast Mental Health Service Clinical Services Plan 2013-2021, the Mid
North Coast Mental Health Service has embarked on a process of reviewing service models of care. The
review has been premised on the need to implement contemporary service delivery models and also by
the recognition that, in an environment of limited resources, MNCLHD Mental Health Services must be
targeted to the achievement of a sustainable method of responding to the mental health needs of the
Mid North Coast population.

Within the LHD, the provision of Mental Health hospital and ambulatory services for the catchment
population will be managed within the Clinical Networks of Hastings Macleay and Coffs Harbour.

In terms of Inpatient bed capacity, the Coffs Harbour Clinical Network has a sufficient overall bed capacity
to meet population requirements for the next ten years. The ageing of the population will result in an
increased need for specialist mental health beds for older persons within this bed complement. It is
foreseen that 10 of the 30 existing Acute Adult beds at Coffs Harbour will, in due course, provide for this
service need.

The North Coast Rehabilitation Unit, located within the Coffs Harbour Clinical Network, currently provides
for the needs of a tertiary population catchment covering the Mid North Coast and Northern NSW LHDs.
Currently the Mid North Coast uses 40 per cent (8 of the 20) available beds. The projected service need
for the MNCLHD alone is for 16 beds across all ages in 2015, increasing to 18 beds in 2025.

The Hastings Macleay Clinical Network does not have sufficient Inpatient bed capacity for mental health
services. There are currently only 12 beds appropriate for providing Acute Inpatient Services:

       The Units at Port Macquarie Base Hospital (PMBH) and Kempsey District Hospital (KDH) do not
        meet Australasian Health Facility Guidelines in their current design and layout and as such
        represent a current and future clinical and corporate risk.
       Both Units at PMBH (12 beds) and KDH (10 beds) are of sub-optimal size. The optimal size for an
        Acute Adult Unit for efficiency of operation and safety and quality of care is around 18-35 beds.

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

1.4     RECOMMENDATIONS

In making the following recommendations it should be noted that this ADDENDUM has reviewed updated
population projections against current service capacity and identified where there are significant
shortfalls in available resources. Achievement of attracting these resources is dependent upon funding
submissions and enhancement funding provided via the Ministry of Health.

Recommended is the development of a 24-bed purpose designed Acute Mental Health Inpatient Unit at
Port Macquarie Base Hospital. Of the 24 beds, 12 will replace the existing 12-bed Adult Acute Unit,
resulting in a total of 12 new beds. At 12 beds the current Inpatient Unit is of sub-optimal size and does
not meet Australian Facility Guidelines.

Space for this development is available on the PMBH campus and would be designed as a gazetted unit to
provide care for involuntary patients. Voluntary patients could also be admitted.

The design of the proposed Inpatient Unit would allow beds to be used flexibly as ‘swing beds’ (beds that
can alternate between different types of care). As such, the proposed Inpatient Unit would contain 24
Acute Adult beds with the capacity to support the admission of eight older persons and four younger
persons.

The function of the Unit would be to provide, in a safe and therapeutic environment, appropriate facilities
for the reception, assessment, admission, diagnosis, observation, treatment and recovery of often acutely
unwell consumers, presenting with known or suspected psychiatric conditions and behavioural disorders.

The requirements of this Unit are outlined on the following page in Table 1.2.

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

Table 1.2 Recommended Requirements for the Proposed 24 Bed Port Macquarie Inpatient Unit

Future Requirements to 2025                   Current Beds/Facility              Comment

24 Acute Adult beds including:                12 beds                            Close observation beds - Complex behaviours can require observation of consumers
  - 4 close observation beds                    - which include 2 close          by staff and discreet security. This should, however, be achieved with a
  - 4 beds built to facilitate and support    observation beds                   therapeutic focus so that while necessary measures for safety and security are in
the admission of younger persons, as            - nil beds able to support the   place, they are non-intrusive and do not convey a custodial ambience.
required, as per Australian Health Facility   admission of younger persons
Guidelines B-0132 Child and Adolescent        or older persons                   Younger persons admission - Presently, tertiary inpatient services for Mid North
Mental Health Unit (2012)                                                        Coast children and adolescents are provided at the CAMHS Inpatient Unit at
  - 8 beds built to facilitate and support                                       Lismore Base Hospital. The nine-hour return journey and resulting family impact
the admission of older person, as                                                means some families reportedly opt not to seek treatment. Feedback throughout
required, as per Australian Health Facility                                      the ADDENDUM’S consultation process emphasised the significance of being able
Guidelines B-0135 Older Persons Acute                                            to respond effectively to the first episode of acute psychosis or suicidal intentions;
Mental Health Unit (2012)                                                        acute crisis and intensive family therapy is critical. The capacity to support the
                                                                                 admission of ounger persons within the proposed Unit would enable crisis
                                                                                 interventions to be commenced both locally and promptly.

                                                                                 Older persons admission - This community has one of largest concentrations of
                                                                                 older people in NSW, a population expected to increase by 53% between 2011 and
                                                                                 2026. The development of Specialist Mental Health Services for Older Persons
                                                                                 (SMHSOPs) was identified as a high priority throughout the consultation and
                                                                                 planning undertaken during the development of the ADDENDUM. The proposed
                                                                                 Unit provides the opportunity to establish purpose-designed inpatient beds for
                                                                                 older persons within the Mid North Coast. There would also be a close
                                                                                 collaboration with the Geriatric Evaluation and Management (GEM) Unit on site at
                                                                                 PMBH, to best utilise the linkages with clinical services including acute medical
                                                                                 and aged care services.
Seclusion Room                                1                                  Consumers may be agitated, aggressive and potentially a risk to themselves or
                                                                                 others, and may where necessary, require temporary containment.

A contemporary mental health                  Non-compliant                      This represents a current and future clinical and corporate risk.
facility compliant with Australian Health
Facility Guidelines.
ECT suite                                     Nil                                Currently, ECT is provided in Coffs Harbour for patients of both the Coffs Harbour
                                                                                 and Hastings Macleay Networks. The requirement to cover both areas reduces
                                                                                 access to this treatment for the patients of the Coffs Harbour Acute Mental Health
                                                                                 Unit. The timely provision of ECT for patients such as those with psychotic
                                                                                 depression improves patient outcomes and reduces length of stay. It is also a
                                                                                 recommendation of the SMHSOP's Acute IPU Model of Care Project Report (2012:
                                                                                 p. 56) that "all SMHSOP AIU should have local access to ECT."

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

2       INTRODUCTION

2.1     THE MID NORTH COAST MENTAL HEALTH SERVICE CLINICAL
        S E R V I C E P L A N 2013

In 2012-13 the Mid North Coast LHD developed a Clinical Service Plan for Mental Health Services. The Mid
North Coast Mental Health Services Clinical Services Plan 2013-2021 (CSP 2013) outlined current and
projected population needs for mental health services in the Mid North Coast and presented a series of
recommendations for further review and development of these services including the need for capital
development of enhanced mental health service capacity.

The CSP 2013 identified a shortfall in the provision of mental health services in the Hastings Macleay
Network to meet population needs. There is a need to enhance Inpatient capacity and replace out-dated
facilities with contemporary buildings that support contemporary models of care, including a greater
emphasis on primary, community and ambulatory care services.

In particular the CSP 2013 outlined a case for the establishment of a 25 bed consolidated Inpatient mental
health unit for the Hastings Macleay Clinical Network at Port Macquarie Base Hospital (PMBH) with 19
Adult Acute beds, including four Intensive Care Beds, and six Older Persons Acute beds.

Other key recommendations included:

           establishment of an Older Persons Inpatient Unit at Kempsey District Hospital;
           establishment of a Consortium of Service Providers for Mid North Coast mental health
            services, including MNCLHD Mental health Services, NGOs, Commonwealth funded services,
            Aboriginal Community Controlled Health Services and other key stakeholders, as an
            overarching body to oversee the development and implementation of mental health services
            in a collaborative partnership;
           undertake a thorough review of models of care operating in both Inpatient and ambulatory
            settings across the Mid North Coast, with the aim of updating these on the basis of latest
            evidence as to what works best for consumers including new models of care that have been
            implemented successfully in other locations, under the guidance of the Consortium of Service
            Providers; and
           redevelop Ellimatta Lodge at Port Macquarie as a location for day programs and outpatient
            clinics for Youth and Family Services.

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

2.2     D E V E L O P M E N T S S I N C E 2013

Since the CSP 2013 was completed and endorsed by the LHD in May 2013, the MNC LHD Mental Health
service has begun the process of implementing key recommendations. Implementation has been guided
by a recognition that, while demand will continue to grow driven by population growth, ageing and
increasing prevalence of people living with mental health issues in the community, and with limited
access to significant new recurrent funding, the LHD will need to develop a more sustainable approach
that enables the Mental Health Service to respond more effectively to consumer needs within available
resources.

The Mid North Coast Mental Health Service has begun the process of reviewing mental health models of
care in operation on the Mid North Coast in collaboration with key service partners. This work has
resulted in the establishment of the Mid North Coast Mental Health Integrated Care Collaborative.

Other key progress to date includes:

       development of a Feasibility Study for the potential expansion of adult Acute mental health beds
        and child and adolescent mental health unit on the Port Macquarie Base Hospital campus;
       development of a Models of Care for Mental Health Services on the Mid North Coast of NSW
        Discussion Paper which was circulated for discussion and feedback in November 2014 with
        implementation of the new Models of Care occurring from July to December 2015; and
       endorsement of proposal to develop Ellimatta Lodge as a centre for Mental Health youth and
        family ambulatory care services with capital works planning commenced and works to proceed
        from July to December 2015.

2.3     T H E MNC M E N T A L H E A L T H S E R V I CE C L I N I C A L S E R V I C E P L A N
        A D D E N D U M 2015

In order to inform the proposed development of a Business Case for the development of Mental Health
Service Inpatient capacity at PMBH, the ADDENDUM will incorporate the following:

       recent plans and policy directions including:
        - NSW Mental Health Commission Strategic Plan (2014)
        - Rural mental health service delivery models – literature review (2014);
       updating of population estimates and population projections for the Mid North Coast;
       updating of data on current utilisation of mental health services in MNCLHD;
       updating of population requirements for mental health services using the MH-CCP;
       identification of Inpatient bed requirements to meet the projected population demand; and
       review of relevant MNCLHD and related NGO and Commonwealth-funded services models of care
        impacting on the provision of Inpatient mental health services at PMBH.

The development of the ADDENDUM presents an opportunity to incorporate updated population
projections and latest activity data in the review of population needs and future service requirements for

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

the Mid North Coast to 2020 and 2025. It presents an opportunity to review and update the models of
care and review previous service enhancement priorities and determine which should have the highest
priority in the context of current and projected community demand and available resources.

In the development of the ADDENDUM, a range of NSW Health endorsed planning tools have been used
to project future service needs including MH-CCP (2010), FlowInfo Version 14.0, HIE data and information
provided by the Health Service. These have been used for trend analyses and NSW Statistical Local Area
(SLA) Population Projections 2014 have been used to define local and regional populations.

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

3        BACKGROUND
The Mid North Coast Local Health District provides a range of hospital Inpatient and community mental
health services. Mental health services are managed on a LHD basis and provided in each of the two
Service Networks, Hastings Macleay and Coffs. Mental health services provided in each Network include:

Hastings Macleay Network
    Port Macquarie Mental Health Inpatient Unit
    Port Macquarie Community Mental Health Service
    Kempsey Mental Health Inpatient Unit
    Kempsey Community Mental Health Service

Coffs Network
     Coffs Harbour Acute Mental Health Unit
     North Coast Mental Health Rehabilitation Unit
     Coffs Harbour Acute Care Service Community Mental Health
     Coffs Harbour Extended Care Service Community Mental Health

These services are the focus of this planning process. The ADDENDUM will focus in particular on service
provision within the Hastings Macleay Network. In addition to these public mental health services, there
is a range of non-government and private mental health services provided in the Mid North Coast.

In developing the ADDENDUM, the Mid North Coast Local Health District has been guided by the
following principles which were identified in the CSP 2013:

    I.   recovery focus of treatment and care;

  II.    consumer involvement – engagement of consumers and carers in care;

 III.    prevention and early intervention – emphasis on reducing the burden of illness caused by mental
         health conditions;

 IV.     quality and excellence – in the provision of mental health care;

 V.      effective partnerships – collaboration with key partners including NGOs and Commonwealth
         funded services;

 VI.     recognition of cultural diversity – delivery of appropriate services to culturally and linguistically
         diverse consumers; and

VII.     commitment to Closing the Gap in health outcomes for Aboriginal people and families on the Mid
         North Coast.

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

4       POLICY & PLANNING FRAMEWORK

4.1 NSW S T A T E H E A L T H             PLAN AND        RURAL HEALTH PLAN
NSW State Health Plan Towards 2021
The NSW State Health Plan: Towards 2021 builds upon the NSW State Health Plan Strategic Direction
bringing together existing State Health Plans, programs and policies to further develop the NSW
healthcare system to focus on the delivery of ‘the right care, in the right place, at the right time’ for
everyone. It is intended this will be delivered through the following three Strategic Directions:

       Keeping People Healthy – supporting people to live healthier, more active lives and reducing the
        burden of chronic disease. NSW Health will continue to invest in effective public health programs
        in the areas of smoking, obesity, risky alcohol use and early intervention.
       Providing World Class Clinical Care – providing timely access to safe, quality care in our hospitals,
        EDs and in the community. NSW Health will continue to focus on streamlining ED processes,
        reducing unwarranted variation in care, reducing re-admission rates and introduce models of care
        to address emerging health issues.
       Delivering Truly Integrated Care – creating a connected health system, so that patients and their
        carers can more easily navigate the healthcare system, get the care they need, where and when
        they need it. NSW Health will invest in integrated care and partnering with health service
        providers to avoid unplanned hospitalisations, improve transfer of care, patient and carers
        experiences and work towards better health outcomes.

These Strategic Directions will be delivered through implementation of the following key strategies:

       Supporting and Developing Our Workforce – developing a strong, skilled workforce to deliver
        first class, patient-centred care within our CORE values framework. NSW Health will further
        implement The Health Professionals Workforce Plan 2012-2022, establish the Health Education
        and Training Institute (HETI) to help drive skills and leadership development and improve
        workforce planning at the LHD level.
       Supporting and Harnessing Research and Innovation – pursuing cutting edge medical, health
        research and innovation. NSW Health will create a dedicated Office for Health and Medical
        Research to fast-track the development of innovative ideas, products, drug therapies and
        evidence based treatments to deliver improved healthcare.
       Enabling eHealth – improving digital connectivity for a smart, networked health system in our
        hospitals, in the community and in the future. Implement the Blueprint for eHealth in NSW to
        improve technology in clinical care, business services, infrastructure and community outreach.
       Designing and Building Future-Focused Infrastructure – improving facilities and equipment to
        support the delivery of care and meet growing and evolving healthcare needs of local
        communities and changing service delivery models.

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

NSW Rural Health Plan: Towards 2021
The NSW Rural Health Plan: Towards 2021 complements the NSW State Health Plan Strategic Direction
and the NSW State Health Plan to improve the delivery of health services for people living in regional and
rural communities.

Building truly integrated rural health services is a priority of the Rural Health Plan and sets the direction
for greater collaboration and the building of stronger partnerships between public and private health
service providers, Medicare Locals and General Practitioners (GPs), Aboriginal Medical Services (AMSs)
and other primary health organisations to provide more coordinated and seamless health service delivery
to rural and regional communities closer to home. The Rural Health Plan sets the direction over the next 7
years for further developing the rural health workforce, investment in infrastructure, new models of care,
research and eHealth technology.

The NSW Rural Health Plan: Towards 2021 further promotes the requirements of regional, rural and
remote NSW to keep the focus on placing sustainable contemporary services closer to where people live
through the following three Strategic Directions and three key Strategies:

       Healthy Rural Communities – Strengthen health promotion, disease prevention and community
        health services to ensure people in rural communities are healthy with a focus on priority areas
        including Aboriginal, maternal, child youth, mental, sexual and oral health services as well as
        investing in prevention and health promotion programs to reduce burden of disease associated
        with smoking, alcohol use and poor nutrition.
       Access to High Quality Care for Rural Populations – improve access to health services as close to
        home as possible and enable the provision of high quality care in local rural health services. The
        focus is to strengthen service networks, develop eHealth solutions and better support those who
        have to travel to access healthcare.
       Integrated Rural Health Services – ensure services and networks work together, are patient-
        centred and planned in partnership with local communities and heal service providers, and
        provide better continuity of care. Improve service integration with services planned and
        developed in partnership with rural communities and local health service providers.

These Strategic Directions will be delivered through implementation of the following key Strategies:

       Strategy 1: Enhancing the Rural Health Workforce – continue to build the health workforce in
        rural areas through enhanced recruitment, training, career development and support. Further
        implement Health professionals Workforce Plan 2012-2022 and continue to develop a more
        skilled workforce, increase the Aboriginal health workforce, implement innovative workforce
        models and strengthen the provision of training and development.
       Strategy 2: Strengthening Rural Health Infrastructure, Research and Innovation – invest in
        facilities, models of care and research and innovation to ensure the provision of high quality
        health services in rural communities. Support the growth of research and innovation in rural
        areas to develop and implement local solutions that meets the healthcare needs of local
        communities.
       Strategy 3: Improve Rural eHealth – implement eHealth solutions and strategies to transform
        connections between and access to health services in rural NSW. Implement the Rural eHealth
        Program that invests in eHealth infrastructure, improved governance arrangements to support
        integration and connectedness of health services.

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

There are specific goals in the Rural Health Plan to improve rural mental health including:
    Implement the NSW suicide prevention toolkit for small towns.

        Expand mental health outreach services via hub and spoke service delivery models and other
         locally appropriate models.

        Develop community based approaches to mental health to increase provision of services closer to
         consumer’s homes.

        Promote community mental health literacy, enhanced access and pathways to care for smaller
         communities.

        Develop initiatives that address the physical health needs of people with mental health issues.

        Continue to develop and implement initiatives targeting people with dual drug and alcohol and
         mental health diagnosis.

        Improve and enhance quality of, and access to, child and youth mental health services.

4.2 N A T I O N A L M E N T A L H E A L T H R E F O RM S

In December 2008, the Australian Health Ministers endorsed an overarching vision for the mental health
system in Australia through the National Mental Health Policy of

           … a mental health system that enables recovery, that prevents and detects mental
           illness early and ensures that all Australians with a mental illness can access effective
           and appropriate treatment and community support to enable them to participate fully
           in the community2.

The Fourth National Mental Health Plan (2009-2014) was released by the Commonwealth Government in
20093. The Fourth National Mental Health Plan adopts a population health framework which
acknowledges the importance of mental health issues across the lifespan from infancy to old age and
recognises that mental health and illness result from the complex interplay of biological, social,
psychological, environmental and economic forces at all levels.

2
 Commonwealth of Australia (2008) National Mental Health Policy.
3
 Commonwealth of Australia (2009) Fourth National Mental Health Plan – An agenda for collaborative action in mental health
2009-2014.
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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

The Fourth Plan operationalises the population health framework through a whole of government
approach to mental health reform that recognises the need for greater collaboration across
Commonwealth and State/Territory levels of responsibility. The Fourth Plan is underpinned by eight key
principles and focuses actions in five key priority areas:

        social inclusion and recovery;
        prevention and early intervention;
        service access, coordination and continuity of care;
        quality improvement and innovation; and
        accountability – measuring and reporting progress.

One of the key initiatives in the Fourth National Mental Health Plan is the development of a National
Mental Health Service Planning Framework (NMHSPF) which will provide a population based planning
model for mental health that will better identify service demand and care packages across the sector in
both Inpatient and community environments.

The Fourth National Mental Health Plan highlighted that, while there had been an increase in funding
over the past five years, the mental health system in Australia remains fragmented and as a
consequence presents problems to consumers and carers in continuity of care and gaining access to
services actually needed and promotes system inefficiency through inappropriate funding allocation —
resulting in service duplication and / or service gaps. In summary:
     “… despite increased funding to primary and specialist services, treatment rates for people
     with mental illness remain low compared with the prevalence of illness. For access to the right
     service to be improved, there needs to be an agreed range of service options, across both
     health and community support sectors. This should be informed by population based planning
     frameworks that specify the required mix and level of services required, along with resourcing
     targets to guide future planning and service development that are based on best practice
     evidence4.”

The Report of the National Review of Mental Health Programmes and Services was released by the
Commonwealth Government in 20155. This Review also highlighted the structural shortcomings of the
national mental health system with poorly planned and badly integrated systems of care.
This report proposed a reallocation of funding from downstream to upstream services including
prevention and early intervention. To achieve the required system reform, the National Mental Health
Commission has recommended changes to improve the longer term sustainability of the mental health
system based on three components:

    1. person-centred design principles;
    2. a new system architecture; and
    3. shifting funding to more efficient and effective “upstream” services and supports6.

4
  Op cit.
5
  Commonwealth of Australia (2014) Report of the National Review of Mental Health Programmes and Services, National Mental
  Health Commission.
6
  Op. cit.
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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

The components of a comprehensive mental health service have been described as part of the modelling
that resulted in the afore-mentioned National Mental Health Service Planning Framework. The range of
services that need to be delivered include:

            assessment (including physical exam and investigations, second opinions,
             tertiary service assessment (e.g. for early psychosis, forensic, eating disorders,
             neuropsychiatric, affective disorders, post-natal depression, personality
             disorders, dual diagnosis));
            review (including for acute and stable / maintenance stages);
            individual therapy (including medication, psychotherapies, living skills, social skills,
             rehabilitation);
            group therapy;
            tertiary service treatment;
            consultation / liaison;
            supported accommodation; and
            mental health prevention / promotion.

    The model is not prescriptive on the settings in which these services can be delivered and allows for
    the following locations:
          community based outpatient services;
          extended hours / crisis services;
          Acute Inpatient Services including general Acute beds, observation beds and Tertiary Service
           Acute beds;
          Non-Acute Inpatient Services (up to 90 days);
          very long stay Inpatient Services (365 days);
          forensic beds (long term); and
          supported community accommodation (“step down”).

Following the review of Medicare Locals in 2014, the Commonwealth Government established 31 Primary
Health Networks (PHNs) from 1 July 2015. The North Coast PHN will replace the current North Coast
Medicare Local and is expected to work closely with general practices and public and private health
providers. The National Review of Mental Health Programmes and Services indicated that the PHNs may
be renamed as Primary and Mental Health Networks, and will enable a better targeting of mental health
resources to meet population needs on a regional basis7.

4.3 NSW M E N T A L H E A L T H C O M M I S S I O N

NSW established the NSW Mental Health Commission of NSW in 2012. The Commission’s remit is to
consider the whole person, recognising that a person’s mental illness does not define them. The
Commission has recently developed a Strategic Plan for Mental Health in NSW. In developing the
Strategic Plan and the companion report Living Well: Putting People at the Centre of Mental Health

7
    Commonwealth of Australia (2014) Report of the National Review of Mental Health Programmes and Services, National Mental
    Health Commission.
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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

Reform in NSW8, the Commission is recognising the importance of putting people at the centre of any
future mental health reforms. A related goal is to keep the concept of recovery at the centre of the Plan.
Recovery means different things to different people, but it is principally concerned with supporting
people to find the help they need and want to make their lives better on whatever terms they choose.
Accordingly the Plan considers physical health, housing, employment, education, social participation and
a range of other issues central to people’s lives.

The Strategic Plan sets out directions for reform of the mental health system in NSW over the next ten
years9. Similar to the national reform documents, the NSW Strategic Plan for Mental Health indicates that
a shift is required in government mental health services, from crisis-driven responses towards prevention
and early intervention. In particular the Plan indicates that:

         “we must recognise that there is strenuous work ahead to reorient a system that has
         emphasised hospital beds for too long at the expense of other forms of support offered in
         or close to people’s homes. Our supports are still, in many places, inflexible, ineffective,
         outdated and under-resourced, and often do not join up well when people’s needs are
         complex and continuing. The situation is made all the more complex by the lack of clarity
         about state and Commonwealth responsibility for funding and service quality10.”

4.4 M I D N O R T H C O A ST M E N T A L H E A L T H L I T E R A T U R E R E V I E W

In 2014 the Mid North Coast LHD commissioned the Centre for Rural and Remote Mental Health to
undertake a literature review of mental health models of care11.

The Literature Review identified the importance of achieving a balanced approach to service delivery
with an optimal mix of mental health services including specialist mental health services (including
Inpatient facilities, specialist psychiatric services and community mental health teams) and mental
health services provided through primary health care services, and self-care.

In particular, the report identified the need to build the capacity of the primary (health) care sector as the
best known way to significantly and pragmatically increase service access for a greater proportion of
persons with a mental health problem in the Mid North Coast, as well as improving the delivery of mental
health promotion and the likelihood of earlier intervention.

The Review identified the need for specialist mental health services to work in closer collaboration with
primary health services, and identified the importance of developing strong governance structures to
underpin this collaborative form of working.

8
  Mental Health Commission of NSW (2014) Living Well: Putting people at the centre of mental health reform in NSW.
9
  Mental Health Commission of NSW (2014) A Strategic Plan for Mental health in NSW 2014-2024.
10
   Op cit.
11
   Centre for Rural and Remote Mental health (2014) Rural mental health service delivery models – a literature review.
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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

In developing this collaborative model of care, a c l e a r division of labour between service components
will be required. The role of the specialist mental health services, in the public and private sector and the
not for profit organisation sector, w i l l require more attention, as it is the specialist services that have
most influence over the direction but more importantly quality of delivery of the mental health services
system.

A more complete description of the role of specialist mental health services would include:
     almost exclusive responsibility for delivering Acute Services;
     prime responsibility for crisis intervention;
     providing a clinical response to, and managing all cases of, severe mental illness. Within the
         specialist services there is likely to be a more calibrated division of labour, with the non-
         government organisations through the Partners in Recovery (PIR) initiative taking most
         responsibility of an ‘assertive’ case management role through specifically employed ‘support
         facilitators’ and the public sector specialist services being the primary ‘go to’ resources for
         clinical intervention;
     providing an outreach clinical response through routinely organised and co-located clinics (in
         general practices, community health clinics, youth services, etc.) that would primarily target
         cases of severe and moderate mental illness but would also provide time for consultation
         and training with primary mental health care workers;
     providing consultant support (community liaison) to general practitioners and other primary
         mental health care providers for specific cases; and
     building the capacity of primary mental health care workers to manage more independently
         high prevalence disorders and contribute more to treatment of moderate cases of mental
         illness. Capacity building would occur in many ways including structured formal training
         processes, communities of practice, team learning opportunities and self-directed learning
         resources. In this regard it may be worthwhile adopting the Victorian PMHEI Team model,
         and assigning dedicated workers within the broader community mental health service to this
         role. The functions of this team would be to provide education, training and secondary
         consultation to primary health care workers and promote shared care arrangements
         between specialist mental health services and primary care providers.

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

5           SERVICE NEED

5.1 M I D N O R T H C O A ST

The Mid North Coast consists of the five local government areas of Kempsey, Port-Macquarie-Hastings,
Nambucca, Bellingen and Coffs Harbour.

Figure 5.1 Mid North Coast Local Health District

5.2 C U R R E N T             AND     P RO J E C T E D P O P U L A T I O N P RO F I L E

In 2011, the estimated resident population of Mid North Coast was 207,490 persons. The Mid North
Coast population increased by 4.1 per cent in the five years between 2006 and 2011. Table 5.1 (shown
over page) presents the population projections to 2026 using the approved Ministry of Health population
projections. The Mid North Coast population is projected to increase by 13 per cent to 235,419 in 202612.

12
     NSW State and Local Government Area Population Projections (2014 Final).
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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

       The Hastings Macleay Network and the Coffs Network are of comparable size, both having a population
       of around 103,000 to 104,000 in 2011. The projected population increase is higher for both Coffs Harbour
       (19 per cent) and Port Macquarie -Hastings (16 per cent) than in the smaller Mid North Coast LGAs.

       Table 5.1           Current and Projected Population, Mid North Coast, 2011-2026

                                                                                                                     % change
 LGA                         Age            2011 ERP           2016                2021             2026
                                                                                                                     2011-2026
                             0-14                      2,487            2,376               2,358            2,307            -7%
                             15-24                     1,335            1,198               1,038              952           -29%
 Bellingen                   25-44                     2,433            2,424               2,383            2,359            -3%
                             45-64                     4,158            4,128               3,894            3,567           -14%
                             65-84                     2,184            2,504               2,933            3,324            52%
                             85+                         326              360                 393              433            33%
 Total Bellingen                                     12,923            12,990              12,998           12,942               0%
                             0-14                    13,561            14,141              14,976           15,531           15%
                             15-24                    8,803             8,759               8,591            8,865            1%
 Coffs Harbour               25-44                   15,759            16,831              17,840           18,648           18%
                             45-64                   20,263            20,817              20,903           20,678            2%
                             65-84                   10,860            12,971              15,430           17,865           65%
                             85+                      1,726             2,054               2,292            2,666           54%
 Total Coffs Harbour                                 70,972            75,572              80,033           84,253           19%
                             0-14                      5,730            5,694               5,731            5,680            -1%
                             15-24                     3,260            2,993               2,767            2,692           -17%
 Kempsey                     25-44                     5,757            5,781               5,797            5,740             0%
                             45-64                     8,748            8,542               8,150            7,636           -13%
                             65-84                     4,908            5,797               6,742            7,569            54%
                             85+                         725              840                 893            1,056            46%
 Total Kempsey                                       19,128            29,648              30,079           30,373               4%
                             0-14                      3,444            3,443               3,407            3,318            -4%
                             15-24                     1,875            1,725               1,627            1,603           -15%
 Nambucca                    25-44                     3,330            3,320               3,246            3,240            -3%
                             45-64                     5,946            5,875               5,722            5,285           -11%
                             65-84                     4,004            4,649               5,358            6,103            52%
                             85+                         636              724                 782              899            41%
 Total Nambucca                                      19,235            19,735              20,143           20,448               6%
                             0-14                    13,281            13,728              14,222           14,556           10%
                             15-24                    7,749             7,627               7,532            7,643           -1%
 Port Macquarie-Hastings     25-44                   14,859            15,449              15,990           16,477           11%
                             45-64                   20,912            21,675              22,122           21,738            4%
                             65-84                   15,934            18,036              20,331           23,106           45%
                             85+                      2,497             3,030               3,420            3,883           56%

 Total Port Macquarie-Hastings                       75,232            79,545              83,618           87,403           16%

                             0-14                    38,503            39,383              39,383           41,392            8%
                             15-24                   23,022            22,301              21,556           21,756           -6%
 MNCLHD                      25-44                   42,138            43,804              45,257           46,464           10%
                             45-64                   60,027            61,037              60,791           58,904           -2%
                             65-84                   37,890            43,957              50,793           57,967           53%
                             85+                      5,910             7,007               7,780            8,936           51%
 Total MNCLHD                                       207,490           217,489             226,870          235,419               13%

Source: NSW State and Local Government Area Population Projections (2014 Final).

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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

A profile of the population served by the Mid North Coast LHD is provided below:

Significant Characteristics
         Population Growth: The Mid North Coast population is projected to increase by 13 per cent
          between 2011 and 2026.
         Aged population: A feature of the Mid North Coast is the substantial aged population. Over one-
          fifth (21.1 per cent) of the total Mid North Coast population in 2011 were aged 65 years and over.
          This compares with 13.5 per cent of the total NSW population aged 65 years and over in 2006.
          The aged population is projected to increase by 52.7 per cent to the year 2026, at which time this
          population group will comprise 28.4 per cent of the total population of the Mid North Coast. The
          population aged 85 years and over is projected to increase by 52 per cent between 2011 and
          2026.
         Aboriginal population: In 2011, 5.8 per cent of the Mid North Coast population were Aboriginal13.
          In NSW 2.9 per cent identify as Aboriginal and Torres Strait Islander14. Kempsey LGA has the
          largest number (3,715) and proportion of Aboriginal residents (12.8 per cent) of any LGA on the
          mid north coast14.
         Paediatric population: In 2011 18.6 per cent of the Mid North Coast population were aged 0-14
          years. This population is projected to increase by 7.7 per cent to 2021. In 2021, the 0-14 population
          will comprise 17.2 per cent of the total population of the Mid North Coast.
         Socio-economic status: Using the SEIFA scores (reference score for Australia is 1,000) all Mid
          North Coast LGAs have scores under 1,000, ranging from 880 (Kempsey) to 969 (Port Macquarie-
          Hastings)14. NSW has an IRSD score of 1,003 and an IEO score of 1,00515.
         Tourist population: The Mid North Coast is a popular tourist destination which places additional
          demand on emergency services during peak holiday periods.

A detailed epidemiological profile of the Mid North Coast population is provided in the CSP 2013.

5.3 S E R V I C E D E M A N D

There are several methods for identifying the population demand for mental health services. The Mental
Health Clinical Care and Prevention (MH-CCP) methodology provides an estimate of population need
using epidemiological and treatment data for population groups16. It also allows for the projection of
future service requirements in NSW. The MH-CCP model, originally developed in 2001, has recently been
reviewed and an updated methodology provided by the Mental Health and Drug & Alcohol Office in 2012.
This latest model, referred to as MH-CCP (2010), has been approved for use in the purpose of developing
estimates and projections of prevalence rates and resource requirements for the ADDENDUM.

13
   Australian Bureau of Statistics. (2011). 3238.0.55.001 - Estimates of Aboriginal and Torres Strait Islander Australians, June 2011.
http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3238.0.55.001June%202011?OpenDocument (accessed Nov 2013).
14
   ABS: 2033.0.55.001_ Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA). Australia, 2011.
15
   Population Health Division. The health of the people of New South Wales - Report of the Chief Health Officer 2008. Sydney: NSW
   Department of Health.
16
   Ministry of Health (2012) Mental Health Clinical Care and Prevention Model, 2010.
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