Mid North Coast Mental Health Services Clinical Services Plan - ADDENDUM 2015 - September 2015
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Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
Mid North Coast
Mental Health Services
Clinical Services Plan
ADDENDUM 2015
September 2015
1
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
2Mid 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
3Mid 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
4Mid 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.
5Mid 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).
6Mid 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
7Mid 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.
8Mid 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.
9Mid 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."
10Mid 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.
11Mid 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
12Mid 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.
13Mid 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.
14Mid 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.
15Mid 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.
16Mid 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.
17Mid 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.
18Mid 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.
19Mid 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.
20Mid 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.
21Mid 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).
22Mid 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).
23Mid 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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