WESTERN SYDNEY INTEGRATED REGIONAL MENTAL HEALTH AND SUICIDE PREVENTION PLAN - 2020-2022 PUBLIC DOCUMENT
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WESTERN SYDNEY INTEGRATED
REGIONAL MENTAL HEALTH AND
SUICIDE PREVENTION PLAN
2020-2022
PUBLIC DOCUMENT
ABOUT THIS
REGIONAL
PLAN Western Sydney Integrated
Regional Mental Health and Suicide
Prevention Plan
The Western Sydney Integrated 3. Developing, integrating
Regional Mental Health and Suicide and utilising eHealth systems
Prevention Plan (the Regional Plan) to improve self-directed care,
is an agreement about what has connectivity and collaboration
to change, by when, how, and who between service providers.
will be responsible for leading the
change. The Regional Plan has a 4. Improving the access to and the
three-year focus (2020-2022) to align quality of perinatal, infant, and child
with the planning cycles of state mental health services.
health organisations and that of
5. Ensuring adolescents and young
WentWest, Western Sydney Primary
people are supported through
Health Network (WSPHN).
the school years and during the
The Regional Plan will guide transition to adulthood.
collaborative governance, planning,
6. Implementing suicide and
commissioning and monitoring
self-harm prevention and crisis
by the Western Sydney LHD and
interventions tailored to the needs
WentWest (WSPHN) as the lead
of the community.
agencies.
7. Attracting and retaining a
The seven priority areas for
committed and culturally competent
action are:
and accredited workforce.
1. Strengthening collaborative
These priorities are consistent with
governance and information sharing
the Fifth National Mental Health
for planning, commissioning and
and Suicide Prevention Plan, the
evaluating services.
reforms outlined in the NSW State
2. Forging partnerships within and Health Plan, with a focus on a value
beyond the health and social care based healthcare, the Living Well
sectors that deliver better mental Mental Health Plan, the Western
health outcomes for the Western Sydney LHD Services Plan, and the
Sydney community across the life span. WentWest (WSPHN) Strategic Plan.
P2ABOUT
THE
WESTERN
SYDNEY
REGION
The Western Sydney region (WSPHN residents or nearly 32,000 per year.
and WSLHD) encompasses four Local
Government Areas (LGAs) - Blacktown, Over 17,000 people identify as
The Hills Shire, Parramatta and Indigenous with the largest numbers
Cumberland - and is located in the residing in the Blacktown LGA (3.4% of
outer western suburbs of Sydney. the total population).
Covering an area of 790 km2, the The region is one of the most culturally
boundaries of the catchment extend diverse in Australia with nearly 40
from Auburn in the East to Blacktown percent of the population born overseas
in the West, and to the Hills in the in a predominately non-English
North, encompassing an urban, outer speaking country. Nearly 7 percent of the
urban and semi-rural population that population report speaking languages
is now over 1,000,000 people. other than English, and many speak
either little or no English. The highest
The population is predicted to grow proportion of residents (13 percent) with
by 67 percent in the 20 years 2016- low proficiency or use of English reside in
2036 - or an additional 635,000 the LGA of Cumberland.
DEMOGRAPHICS AGE
(ERP 2016) (ERP 2016)
50.47% MALE 0-4
49.53% FEMALE 5-18
478,750 MALE 19-64
469,843 FEMALE 65+
* ERP refers to the 2016 ABS Census data.
P3DEVELOPMENT
OF THE
REGIONAL
PLAN
This Regional Plan builds on the and undertaken by the Centre for national and data policy context, of
foundations provided by the Western Mental Health Research at ANU the existing and current planning
Sydney Health Partnership between and the revised WSPHN Needs documents, and actions identified by
WSPHN, WSLHD and Sydney Assessment 2019-2022. governments relevant to the Western
Children’s Hospitals Network (SCHN), Sydney region.
The Steering Committee has
operating under the auspices of the
examined a range of population and This Regional Plan is the first time
Partnership Advisory Council with
service data to identify existing and that a formalised plan has been
a Memorandum of Understanding
emerging needs and gaps in the developed by this State-funded
and longstanding shared priorities,
current spectrum of care. Through Local Health District and the
including mental health. It has been
consultations with consumers, Commonwealth-funded Primary
developed more intensively over a 12
carers, primary care providers,
month period commencing in early Health Network. This is an important
the community managed mental
2019 and involved stakeholders in precedent in that it demonstrates
health sector social care providers,
a range of consultative processes. a commitment by both State and
and state wide services and
The Plan has taken into account Federal governments to empower
academic partners, we have a better
the consultations undertaken by regional governance and service
understanding of what is working
NSW Mental Health Commission in development. This Plan therefore does
well, what needs improving, and what
the mid-term review of the Living not displace existing plans approved
needs to commence.
Well Plan in 2019, the re-analysis by these two lead authorities but
of psychosocial care services The Steering Committee has also seeks to define the critical areas of
commissioned by WentWest (WSPHN) undertaken extensive reviews of the collaboration over the medium term.
Figure 1: Inputs to the Western Sydney
Integrated Regional Plan for Mental
Health and Suicide Prevention
National and State Population Needs and
Policy Guidance Services Data
Western Sydney
REGIONAL PLAN
Stakeholder Consultations Best Practice and
(interviews, forums, surveys) Innovation
P5KEY
POLICY
GUIDANCE
The development of this Regional Plan • NSW Strategic Framework and
has been informed and guided by: Workforce Plan in Mental Health
(2018-2022)
• The Fifth National Mental Health
& Suicide Prevention Plan and • Gaya Dhuwi (Proud Spirit)
Implementation Plan Declaration Implementation Guide
• The NSW Value Based • WentWest (WSPHN) Strategic Plan
Healthcare Framework (2016-2019)
• Living Well – A Strategic Plan for • Western Sydney Local Health
Mental Health in NSW (2014-2024) District Health Services Plan to 2026.
and the July 2019 Mid-term Review
• Strategic Framework for Suicide
Prevention in NSW (2018-2023)
Ten Common Strategic Mental
Health Policy Issues:
1. Regional – collaborative 7. Engage and address the needs of
governance – co commissioning special populations
2. Integrated, person centred, 8. Whole of community resilience
stepped care – quality building
3. Recovery focused, trauma 9. Data – applied to decision
informed making, shared and outcomes focus
4. Consumer, carer/family
10. Suicide prevention – alternatives
involvement
to ED and aftercare
5. Community care capacity
…. All underpinned by a culturally
6. Improving physical health competent and networked workforce.
P6KEY
TERMS &
ACRONYMS
Abbreviation DEFINITION Abbreviation DEFINITION
AIHW Australian Institute of Health and Welfare NGO Non Government Organisation
ABS Australian Bureau of Statistics NMHC National Mental Health Commission
AOD Alcohol and Other Drugs NSMHWB National Survey of Mental Health and Wellbeing (ABS)
ASR Age Standardised Rate np Data not available for publication
CALD Culturally and Linguistically Diverse PAGES Providers of Australian Government Employment Services
CMO Community Managed Organisations PBS Pharmaceutical Benefits Scheme
COAG Council of Australian Governments PCLI Pathways to Community Living Initiative
DCJ Department of Communities and Justice (NSW) PCMH Patient Centre Medical Homes
GP General Practitioner PHIDU Public Health Information Development Unit
GOT IT Getting on Track In Time PMHC Primary Mental Health Care Services
HCH Health Care Homes PHN Primary Health Network
IAMHWS Integrated Atlas of Mental Health for Western Sydney SDH or SDOH Social Determinants of Health
IRSD Index of Relative Socio-Economic Disadvantage SDR Service Delivery Reform
LGA Local Government Areas SLA Statistical Local Area
LHD Local Health District SA3 Statistical Area Level 3
MASH Making a Safe Home WFT Whole Family Team
MBS Medicare Benefits Schedule WSLHD Western Sydney Local Health District
MECSH Maternal Early Childhood Sustained Home-visiting WSPHN Western Sydney Primary Health Network (WentWest)
MNAT Mental Health Ambulance Team VBHC Value Based Health Care
MHC NSW Mental Health Commission of NSW
P7KEY
DEFINITIONS
Carer Person-centred Trauma Informed
A person with lived experience of Care Care
caring for someone with a mental
health problem. This can be a family Person-centred care places the person Trauma Informed Care (TIC) is a
member or friend – paid or unpaid. in context, over and above bodily treatment framework supported by an
systems or diseases, and places this organisational structure that involves
Community concept at the centre of healthcare.
Person-centred care respects
understanding, recognising, and
responding to the effects of all types of
Managed individual diversity and enables
personal control of healthcare.
damaging life events and experiences.
TIC is an approach to service delivery
Organisations based on an understanding of the
Community managed organisations
Special ways trauma affects people’s lives,
their service needs and service
(CMOs) are private, not-for-profit
organisations that may be managed
Populations usage. It incorporates principles of
safety, choice, collaboration, trust and
by a board of representatives and/or Populations which are either empowerment.
elected community members. underrepresented in accessing
Consumer
care or have higher risk or poorer
health outcomes than the general
Value Based
Referring to a person with a lived
population. It includes some
Culturally and Linguistically Diverse
Healthcare
experience of mental illness and/or communities, Aboriginal and Torres (VBHC)
recovery who has used or uses Strait Islander people, children and
treatment, rehabilitation and/or young people, people with chronic VBHC means continually striving to
support services. health conditions and veterans. deliver care that improves:
1. health outcomes that matter to
Integrated Care Social patients,
Integrated care is a way of working Determinants of 2. experiences of receiving care,
that enables care to be provided in
a way that reflects the whole of a Health 3. experiences of providing care, and
person’s health needs; from prevention 4. effectiveness and efficiency of care.
Social, environmental and economic
through to end of life, across both
factors that play a significant role in
physical and mental health, and in
shaping the health and wellbeing of
partnership with the individual, their
individuals and populations.
carers and family. The individual
experiences care as though provided
by a single unified health system. The
aim is to have care centred around the
person, rather than organisations, to
help people with complex needs get
the care they need. To transform to a
more person-centred model of care,
changes are required at organisation,
service and care delivery levels.
P8MEASURING
PROGRESS
What gets measured, how and by whom
A critical factor in achieving the The KPIs listed here are, in the majority
intentions set out in this Regional of cases, required for reporting
Plan, will be our commitment to what against national data sets and are
gets measured, how we measure, expected to be available at a regional
and who has a lead responsibility level during the timeframe of this
for each measure. In addition to Plan. Some additional indicators have
reporting to Commonwealth and been added to ensure measurement
State governments, the WSLHD, against regional priorities is routinely
WSPHN and SCHN Boards, we undertaken. Details on the methods
will routinely report to the Western and tools used for measuring progress
Sydney community to ensure we are will be available from the WentWest
transparent and accountable to them, (WSPHN) website following a co-
and we help to build a community design process with community and
of support for better mental health stakeholders to determine the priority
outcomes across the region. measures / KPIs.
DOMAIN & INDICATOR LEAD REPORTED
KPI DOMAIN 1. CONSUMER AND CARER REPORTED OUTCOMES OF SERVICE USE – QUALITY, IMPROVEMENT, TIMELINESS, SUITABILITY
Proportion of consumers & carers with positive experiences of service WSPHN Bi-annual
(all commissioned services)
Proportion of consumers & carers with positive experiences of service WSLHD (all public MHS) Bi-annual
Rate of involuntary hospital treatment WSLHD Annually
Rate of seclusion & restraint in acute units WSLHD Annually
KPI CLUSTER 2. HEALTH STATUS
Life expectancy & mortality gap for people with mental illness WSPHN Annual
Proportion of children developmentally vulnerable in the Australian Early
Development Census (AEDC) WSLHD Three-yearly
Proportion demonstrating a positive change over time
Percentage of population with very high psychological distress WSPHN Annual
KPI CLUSTER 3. SERVICE ACCESSIBILITY
Population access to mental health care WSPHN Annually
Mental health related ED presentations WSLHD Annually
Referral Wait Time for Primary Mental Health Care services WSPHN Bi-annually
KPI CLUSTER 4. SERVICE INTEGRATION
Readmission rate to hospital WSLHD Annually
Percentage of new clients to Primary Mental Health Care services WSPHN Bi-annually
Post hospital discharge community care WSLHD Annually
Measurement of Integrated care across Western Sydney ^ WSPHN Annually
KPI CLUSTER 5. WORKFORCE AVAILABILITY, SKILLS AND SATISFACTION
Planned vs actual FTE/vacancy rate WSPHN Annually
Competency in team-based care & collaboration* WSPHN Annually
Workforce satisfaction WSPHN Annually
Notes:
^ This is based on the Rainbow Model of Integrated Care Measurement Tool (Valentijn, 2016). See Appendix 1.
* This would be based on a standard set of agreed competencies for team-based care and collaboration.
Appendix 2 contains the National Indicators as set out in the Fifth National Mental Health and Suicide Prevention Plan. P9COLLABORATIVE
GOVERNANCE
Underway and core to our way of working
WentWest (WSPHN), Western Sydney professionals work together. The health • Scaling collaborative efforts to
Local Health District (WSLHD) and system needs to pursue right care, right realise system wide impacts - We plan
Sydney Children’s Hospitals Network time, right place with the consumer as to reform the Western Sydney health
(SCHN) have jointly commissioned an active member of the care team. system, by thinking as ‘one system’
services into areas of need for more and working accordingly. We will work
than eight years. We are proposing that over the coming within a shared regional framework
years, to combine our efforts and seek of objectives, principles and strategies
Currently there are several joint State and Commonwealth support to applied flexibly in and with local
collaboratives including: further scale this work. Rather than communities, creating diverse place
focus on one model of care, the Boards based and sustainable developments.
• Partnership Advisory Council (PAC) and Executives of WentWest (WSPHN)
- supports collaboration and integration, and WSLHD will focus on whole system • Strategically focus on the levers
and focuses on shared strategic priority reforms to the health system. of change - Our approach considers
areas for the SCHN, WSPHN and macro, meso and micro reforms
WSLHD, effectively demonstrating the THE AIMS OF COLLABORATIVE required to realise short, medium and
virtual ‘pooling’ of resources to deliver COMMISSIONING long term impacts, but also represents
specific models of integration. the next step toward our mutual long
1. Collectively deliver ‘one Western
• Service Delivery Reform (SDR) cross Sydney health system’ which is value- term aims with a specific focus on
sector initiative which aims to improve based and patient-centred. change management and ‘changing
service delivery to vulnerable families/ hearts and minds’, orienting the system
populations. 2. Deliver right care, at the right time, toward our new operating paradigm.
and in the right place – in community This will necessarily involve trialling
• Integrated Chronic Care and Health and primary care wherever possible. and evaluation of changes to financing
Care Homes - supports communication – notably general practice financing, to
and integration between the hospital, 3. Improve equity in health, reducing
build capability and enhance recognition
GPs and patients. health risks, promote healthy lifestyles
of value-based care provision.
and respond to social determinants.
• After Hours Programs, Aboriginal • Being realistic about what can be
Health Promotion, Students as KEY FEATURES OF OUR PROPOSED
achieved but being scalable to other
Lifestyle Activists (SALSA), and the APPROACH:
cohorts - Our initial plans cover two
implementation of Thrive@5 (first 2,000 • Moving from input and activity specific cohorts – patients requiring
days) within the suburb of Doonside. to outcome-based commissioning value-based urgent care and patients
- Reforming Western Sydney’s ‘joint at risk showing symptoms of chronic
Although joint commissioning is
commissioning’ of service models heart conditions. This will include
well embedded into the way of doing
and funding of inputs/activities to mental health consumers and we
things in Western Sydney, WentWest
collaborative commissioning of activity have begun scoping additional cohorts
(WSPHN) and WSLHD recognise a more
and incentivising outcomes and value which could benefit from a collaborative
cohesive and systematically coordinated
across providers. This would include joint commissioning approach including
approach is necessary to enable
accountability for outcomes and agreed Aboriginal health, diabetes, mental
collaboration and deliver care that is
mechanisms for sharing benefits. health, frailty and vulnerable families.
consistently value-based, person-
centred, and can be delivered at scale • Consolidating and enhancing • Engagement of consumers and
across the region. governance - Our Person Centred clinicians - A co-design approach was
Co-commissioning Group (PCCG) applied with consumer and clinical
WSLHD, the SCHN and WentWest
governance includes a consolidated councils over many years to develop
(WSPHN) want to remove organisational
and enhanced governance model for these models, however, much of the
and professional barriers, alleviate the
broader Western Sydney collaboration. thinking needs further development
siloed, fragmented nature of care and
While these efforts will initially focus to be updated and customised to the
pursue our mutually shared vision of
on collaborative commissioning current Western Sydney context. We
‘one Western Sydney health system’ in
within the health system, we will be plan to test more extensively during
order to provide true value-based and
looking to build on Western Sydney’s a joint development phase, including
person-centred care. This requires us
Service Delivery Reform program, working with local community providers
to reimagine how primary, community,
which already includes the Stronger – linking Community Health, General
acute and social care is delivered.
Communities Cluster (Justice and Practice and NGO services to build
Health system pressures have never ‘Their Futures Matter’), Treasury, Police Patient Centred Medical Home (PCMH)
been greater, and we need to think and Education Clusters, to address the clusters in connected Health Care
differently about how providers and social determinants of health. Neighbourhoods (HCNs).
P10WESTERN
SYDNEY
COLLABORATIVE
GOVERNANCE Delivering this Regional Plan will
be a joint effort, with commitment
from partners across our region.
Our commitment to a One Western
Sydney Health System has already
commenced. The Patient Centred Co-
Commissioning Group (PCCG) Executive
is established and the first two sub-
committees (Value-Based Urgent
Care and Cardiology in Community)
are evolving. A sub-committee for
progression of our Mental Health &
Suicide Prevention Regional Plan
will be developed as part of our
implementation and delivery plan.
ONE WESTERN SYDNEY HEALTH SYSTEM
WESTERN SYDNEY
SYDNEY CHILDREN’S WENTWEST
LOCAL HEALTH HOSPITALS (WSPHN)
DISTRICT NETWORK BOARD
BOARD BOARD
PARTNERSHIP ADVISORY COUNCIL
PATIENT CENTRED CO-COMMISSIONING GROUP (PCCG) EXECUTIVE
The Patient Centred Co-commissioning
Group (PCCG) will report into the
Partnership Advisory Council, which in
turn, reports into the three local health
system Boards. P11PATIENT CENTRED CO-COMMISSIONING GROUP (PCCG) EXECUTIVE
HEAD AGREEMENT
MOH – WSPHN / WSLHD
WSLHD Director WSLHD WSPHN Director
WSLHD
WSLHD CE WSPHN CEO Medical Services Consumer/ WSPHN WSPHN Executive Primary Care
Director Allied
(Co-Chair) (Co-Chair) or Emergency Patient GP Leader GP Leader Director of Transformation
Health
Physician Operations & Integration
Workstreams / Enablers
Value Based Urgent Care (sub-committee) Cardiology in Community (sub-committee)
Project Management Commissioning Data, Analytics & eHealth
PCCG Change Lead
Provider Agreements (examples)
Single Point
General WSLHD WSPHN Evaluation
Access
Practices Provider
Provider
Key features of the PCCG Executive patient representation to ensure a
includes: co-design approach and continual
validation that the services are
• Co-Chairs: CE, WSLHD and CEO,
delivering on consumer/patient
WSPHN.
expectations. Sub-committees are
• Members: WSLHD clinicians (2), responsible for driving the design and
WSPHN GP Leaders (2), consumer, implementation of their respective
WSLHD Executive and WSPHN model utilising PCCG enablers.
Executive.
The following diagram demonstrates
Sub-committee will be co-chaired expected membership of each
by a WSLHD clinician and a sub-committee, including key
WSPHN GP Leader. Each sub- partners which will be integral to the
committee will have consumer/ realisation of benefits.
P12PATIENT CENTRED CO-COMMISSIONING GROUP (PCCG) SUB COMMITTEE STRUCTURE
VALUE BASED URGENT CARE
WSPHN / WSLHD
WSLHD WSLHD
WSPHN WSLHD
General Manager Western Sydney Network Director WSPHN
GP Leader Divisional Medical
Westmead & of Emergency GP Leader
Consumer Director - Acute
Auburn Hospitals (Co-Chair) Medical Training Medicine
(Co-Chair)
WSPHN WSLHD WSPHN Key PCCG
Director Primary Director Integration Medical Director Implementation
Care & Enablers, Immediate Care staff
Transformation & Integrated & (Partner (as required)
Integration Community Health Organisation)
PATIENT CENTRED CO-COMMISSIONING GROUP (PCCG) SUB COMMITTEE STRUCTURE
CARDIOLOGY IN COMMUNITY
WSPHN / WSLHD
WSLHD Digital Health CRC WSLHD WSLHD
Professor of Medicine WSPHN Director of Executive Director Director HITH,
& Academic Director GP Leader WSPHN Integration &
Research and Nursing and
Westmead Applied (Co-Chair) GP Leader Enablers,
Director of Digital Midwifery & Clinical
Research Centred Governance Integrated &
Capacity | Consumer
(Co-Chair) Community Health
WSPHN WSLHD Key PCCG
Director Primary Director Integration WSPHN
Implementation
Care & Enablers, General Practice
staff
Transformation & Integrated & Pharmacist
(as required)
Integration Community Health
WSLHD and WentWest (WSPHN) have There will also be ongoing regular
agreed on the Lead of each enabler consultations with key stakeholders
including: Program Management including WentWest Clinical Advisory
led by WSLHD; Commissioning led Council, WSLHD Clinical Governance
by WSPHN; and Data, Analytics and Committee, and WentWest and
eHealth led by WSPHN. WSLHD Consumer Advisory Councils.
Communication plans (internal, public
We expect that each enabler will include and through media channels), with key
at least one seconded person from the messages and consideration of “when
non-lead organisation to enable the people need to know what” and “for
free flow of information between the what purpose” will be vital to success.
organisations.
The project will also build in key points
The PCCG Change Lead will drive where feedback can be received from
program and change management stakeholders, whether that be through
and, in consultation with the Co-Chairs, follow up surveys (post accessing the
assign clear accountabilities for tasks. model of care) or public surveys to
Current or new working groups and gauge public awareness of the Value
focus groups will be created as required Based Urgent Care service and the
to drive actions and outcomes. Cardiology in Community service.
Clinical leadership will be a core WHAT THIS MEANS FOR MENTAL
element of each sub-committee, HEALTH IN WESTERN SYDNEY
with primary care and acute care
In simple terms moving to a Person
representation.
Centred Co-commissioning Group
COMMUNITY AND CONSUMER in mental health will see shared
ENGAGEMENT investments to build a more
integrated service system that is
Each sub-committee will include easier for consumers and carers to
consumers with direct links to navigate and get the suite of services
community. they need to live well.
P13KEY
PARTNERS
Bonding the health sector
In pursuing the vision of a mentally provider of mental health, community
healthy and inclusive Western Sydney support and disability support
community, it is essential that a broad services to people with a lived
coalition of health and non-health experience. Services include supported
organisations are brought together. In accommodation, daily living support,
the health sector WentWest (WSPHN) recovery programs, community
and Western Sydney LHD will work to connection and suicide prevention or
build robust bonds across the partners postvention (aftercare). Families and
in health care to ensure pathways to and carers of people with a lived experience
from health care for those with mental are supported through the family and
health needs are clear, well known and carer programs run by community
effective. Tackling the root causes of managed organisations.
mental distress and many mood and
substance disorders requires that we • Private providers including
build bridges to partners beyond health psychiatrists, psychologists and
care to tackle the social determinants of allied health professionals, such
ill-health and that we sustain coalitions as dieticians, physiotherapists or
to ensure those families and individuals counsellors, may also be part of the
with complex needs get the hand up care team.
they need.
• Private hospitals, some
In the health care sector we need specialising in mental health treatment,
strong bonds between Consumers, supplement services for people who
their carers and families, those with a need hospital admission.
lived experience of mental illness and/
or suicidal behaviour - key partners in • Health promotion, prevention
the design, implementation, operation, and early intervention programs
and monitoring of services, and: may be offered in different sectors,
by local governments and public and
• State Hospital, Mental Health and national, state and/or local community
Community Health services providing organisations (e.g. beyondblue, R U OK?
a wide spectrum of mental health care and NSW Cancer Council).
services from early prevention through
to acute hospital based care. • Alcohol and other Drug services
may be offered by Health as well as
• General Practitioners funded by CMOs. These include some residential
the Australian government through rehabilitation services, some of which
Medicare and consumer co-payments, offer targeted support to Aboriginal and
provide comprehensive primary health Torres Strait Islander people.
care, a high proportion of total mental
health care, and will be involved in • Peak bodies play a role in
shared care of people with a lived community managed sector
experience of mental ill-health. development, capacity building in
community managed organisations,
• Community Managed and in advocacy for consumers
Organisations (CMOs) are a key and carers.
P14KEY
PARTNERS
Building bridges beyond health
• Early childhood, children and • Police have a role in protecting
young people’s services, child the community and preventing and
protection and out of home care responding to crime. In the mental
services led by the Department of health context, police may be first
Communities and Justice (DCJ) responders during a mental health
address the needs of children and crisis being experienced by a person
families. They may identify concerns in the community.
that require mental health support
and partner in providing a holistic • Legal, statutory and/or advocacy
response to the child and/or family. services – government agencies,
courts and tribunals may be involved
• Education NSW and non-public in supporting and advocating for the
education providers. School years rights of people with a lived experience
are key periods when developmental, on an individual or systemic level. This
conduct and mental health disorders includes Mental Health Commission
first appear. Ensuring schools are NSW, the Mental Health Review
equipped to support the social and Tribunal, Legal Aid Commission, NSW
emotional learning of every child and Civil and Administrative Tribunal,
are able to support those that are at Juvenile Justice, and Public Guardian.
risk and have need for care
is important. • Volunteer community
organisations help to undertake
• Post-secondary education and local community capacity building
employment services may assist activities. Groups such as Rotary,
people with a lived experience to Lions and LandCare groups can play
access education, vocational training a prominent role in supporting better
and work. This includes TAFE, Western mental health for the community.
Sydney University, private vocational
training providers, Providers of • Local government plays a
Australian Government Employment critical role in urban space design,
Services (PAGES) and others. environmental protection and
community services, and facilities like
• Aged Care services, funded by the libraries, parks and playgrounds, and
Australian government and user fees, supporting community events that
are able to provide support to people celebrate living in Western Sydney.
aged 65 and over or Indigenous people
aged 50 and over in their own homes • Business sector of Western
or in aged care facilities. Sydney wants a mentally healthy
workforce for now and the future.
• Ambulance services, as first Business is increasingly aware
responders, play a vital role in field that mental illness is a real threat
assessment, screening and treatment to business continuity and offers
for those experiencing a mental partnership opportunities for both
health crisis. WSLHD and WentWest (WSPHN).
P15THE LIVING WELL
MID TERM REVIEW
WESTERN SYDNEY In mid 2019 the NSW Mental Health priorities’ are summarised here.
Commission, in collaboration with
WSLHD and WentWest (WSPHN), A series of ‘graphic scribes’ were
undertook community consultations produced to capture the interactions
to review the progress made in and feedback gathering through a
the region on the implementation workshop held at Homebush in July
of the Living Well Strategic Plan. 2019. These are available at https://
The key messages in relation to nswmentalhealthcommission.com.
‘what’s working well’, ‘what are au/living-well-agenda/living-well-
the challenges’ and ‘what are the mid-term-review/western-sydney.
KEY MESSAGES FROM THE NSW MENTAL HEALTH COMMISSION’S 2019 MID-TERM REVIEW
WHAT’S WORKING WELL IN WESTERN SYDNEY WHAT ARE THE CHALLENGES?
Awareness: Awareness of mental health, and diverse communities; Visibility of services: Variation between services, same service but
People are more aware of services different maze, lack of linkage; Mental health sector is a maze
Co-design and peer workforce: Greater number of consumer led Access: Young people who need high levels of care and can’t get it;
programs and the peer workforce NDIS long waiting times
Diversity: Culturally linguistically diverse programs Workforce: Workforce to meet demands; Student development;
Quality of employees; Workforce gaps
Outreach: More assertive outreach in the community and less Funding: Length of funding, limited contracts
admissions
Community engagement: More authentic engagement of carers and
families in service design and planning
WHAT THEN, ARE THE PRIORITIES?
Early intervention: Invest in good community care that has demonstrated success in early intervention; Early invention in the education system
Funding: Funded service to point people towards help; Simplified tendering process – system standardised questions; 10-year funding priority
Accessibility: Navigation of services
Community based services: Accessible community based services to avoid hospital, respite and rehab; Stable housing
Workforce: Training and remuneration for workers; Training for non-mental health services; Training for mental health police
Co-design: Access across each government area
P16THEMES FROM
THE CONSULTATIONS
WITH OUR
STAKEHOLDERS
FOR THE
REGIONAL PLAN
WentWest (WSPHN) and WSLHD • Collaborative Commissioning –
undertook further consultations with an emerging process.
consumers and carers, and a range
of commissioned service providers • Improved interagency
and stakeholders, in late 2019 and cooperation; improved relationships
early 2020 to provide input into the now embedding.
finalisation of the Regional Plan. The
• Early adoption of innovation – e.g.
workshops and online survey used an
youth navigator model.
appreciative enquiry method to capture
views of the strengths and what has • Collaboration between General
changed and improved in recent Practice and Allied Health.
years through the reform efforts. The
emerging opportunities, the policy and • Sharing of information.
systems issues placing constraints and
challenges on the community and then • Improved psychosocial services in
finally the data and information gaps the community.
were identified. From this, a set of eight
issues were seen as the priorities for OPPORTUNITIES
reform under the Regional Plan. Using
• Address the unmet needs of
their words, we have summarised the
special populations.
feedback here.
STRENGTHS OF WESTERN SYDNEY • LHD reform agenda and progress
REGION – communication and collaboration
to be strengthened.
• WentWest (WSPHN) and WSLHD
working together as agents for change. • Teacher and school community
collaboration.
• Service Delivery Reform (SDR) –
involves all human services. Regular • Expand the GP-psychiatry liaison
meetings of the Mental Health service.
Working Group.
• Greater cohesion and cooperation
• The Integrated Care Management
between housing and health – need
Group convened by DCJ, with a
to work together to keep consumers
designated lead agency for every client.
in public housing.
• The MASH Program – 28 families
with savings of $2.3m. • Suicide prevention programs.
P17Themes from the consultations with
our stakeholders for the Regional Plan
(continued)
POLICY AND SYSTEM ISSUES • High density living – need to see
more ‘5 Star Green Community’
• The link between service planning developments (see Fairwater).
and delivery, using data to inform. Data
not yet fully driving service planning at • Clear referral pathways – schools to
local level. community and to health services. Youth
navigation program a positive step.
• There is a fundamental disconnect
in the rhetoric of ‘integration’ and • Safe & Well for all schools.
‘regional’ and the way many programs
are funded. Shared care still dependent • Clear signposts for the community
on individual provider/HCP; payment – who to reach out to/go to if you need
systems divide not connect. support.
• Needs to have greater emphasis on • Cultural support and knowledge
technology – the need to have systems – updated, accessible, relevant; CALD
to allow sharing of client data/care groups using specific Facebook sites.
plans (with consent); shared metrics on
outcomes; My Health Record not proving • Auburn – Healthy Communities
to be fully useful at this point. initiative.
• Early childhood is not seen as • Workforce component – emphasis
a priority. Need to have whole of life on Multi-Disciplinary Teams; more
approach. Day care services are capacity to partner.
overwhelmed with demand.
• Data must move to focus on
• Funding – this is THE elephant in outcomes, in all settings.
the room. Funding based on the needs
• NDIS: lack of sustainable funding
of Western Sydney for community
for mental health providers; huge risks
managed funds.
for clients transitioning and those now
• Social determinants are absent needing to access NDIS packages.
– housing, education, employment,
environment. • High rates of non-engagement
of young people not in education,
• Inadequate focus on prevention employment training – one in seven
– universal social and emotional young people 16-21 years.
wellbeing missing.
• Absence of employment services
• Whole of community resilience – no with health care; some linkage with
one is addressing this. headspace but it’s small.
P18Themes from the consultations with
our stakeholders for the Regional Plan
(continued)
DATA AND SERVICE GAPS • Continuing issues around stigma
among service providers – cultural
Data Gaps and toward AOD and Mental Health
• Health issues – HIV+ and Hepatitis consumers.
C infection numbers and growth. • Stable public housing - provision
• Socio-economic issues – data not & access.
linked to health data (enough) nor at • Inadequate knowledge of what
‘granular level’ (i.e. SA 2). services are available for the community
• Data on domestic violence; child from GPs and medical staff.
protection; children in out of home care PRIORITY NEEDS - WHAT MATTERS
(including the levels of trauma and MOST
poor health outcomes).
• Developing alternative sources of
• Struggling and vulnerable families funding – the need to look for strategic
– need for data on non-attendances at partners beyond government and
school, numbers of families using crisis reduce ‘silos of funding’.
food banks and housing, number of
families under extreme financial stress, • Children – prior to schooling;
where and who can offer support. the early schooling with Social
and Emotional Learning K-12 plus
• Multicultural community data specialist programs for children with
- including separating refugee data higher needs like GOT It!
– actual migration – planned vs
non-planned and numbers impacted • The need to tackle social
by trauma; plus, the number of determinants and risk factors – 5 Star
temporary visitors. Green Communities: Healthy Eating,
Healthy Action.
• On self-harm – when GPs do the
treating, there won’t be data captured • The need to ensure young people
by the ED presentation data. have access to employment, education
and/or training.
• Drug-related hospital presentations.
• Youth in out of home care – lack
Service Gaps of flexibility with CAMHS; greater
• Gap in comorbid services – AOD- access (timely) to MH services needed;
MH (complex) treatment. ‘Intensive Community Care for Youth’
(DCJ coordination).
• Prevention, early intervention
targeted services. • Under 18 yo homeless - not funded
to support these clients; complexity not
• CALD / refugee service provision. addressed in funding at present.
• Impact of high density living – poor • Workforce development and
health outcomes, lack of community training – must mirror the community
space, alienation of community. it serves.
• Tailored programs to address high • Research and evaluation – better
rates of smoking among some groups data to inform service planning and
including mental health consumers. monitoring of outcomes.
P19IMPROVEMENTS
IN RECENT
YEARS
(2015-2019)
STRUCTURAL AND SYSTEMS WSHIU portal to monitor the health
status of the community, identify health
Collaborative Governance needs, develop programs to reduce
risk, foster policies which promote
WentWest (WSPHN), Western Sydney
health, plan and evaluate the provision
Local Health District (WSLHD) and
of healthcare and manage and
Sydney Children’s Hospitals Network
implement change.
(SCHN) have jointly commissioned
services into areas of need for more Integrated Mental Health Atlases of
than eight years. Currently there are Western Sydney, 2014 and 2019
several joint collaboratives including
the Service Delivery Reform (SDR), WentWest (WSPHN) was the first
Partnership Advisory Council (PAC) regional health authority in Australia to
and Integrated Chronic Care and apply an internationally validated tool to
Health Care Homes. the geo-mapping population of mental
health needs and available services.
Collaborative Commissioning also
This Atlas uses a standard classification
underpins a number of specific
system, the “Description and Evaluation
programs including Western Sydney
of Services and Directories in Europe
After Hours Programs, Aboriginal
for long-term care” model (DESDE-
Health Promotion, Students as
LTC), to map the services. The use
Lifestyle Activists (SALSA), and
of a common language has allowed
the implementation of Thrive@5
us to compare the pattern of mental
in Doonside.
health care provided in Western Sydney,
Western Sydney Health Intelligence other regions across Australia and
Unit (WSHIU) with regions in Europe and elsewhere.
We continue to develop and use the
The WSHIU supports and contributes ‘Mental Health Atlas’ to enhance our
to the new shared services in the understanding of the functional mix of
region providing an agreed and capacity (or spectrum and capacity of
expanding range of services, including services) in the region and compare this
information production, knowledge to international benchmarks using a
management, web-based reporting standard taxonomy.
and capacity building.
The 2019 Integrated Atlas of
The WSHIU works to support health Psychosocial Mental Health services
professionals and system partners showed significant changes to the
to make informed decisions towards capacity and location of these services
better health and social care outcomes from 2014 and showed a closer
by using the evidence base of health. alignment between needs and
A wide variety of stakeholders use the service provision.
P20Improvements in Recent Years
(continued)
Suicide Prevention Research Low-intensity services provide public
Collaboration and Systems Mode information, self-help strategies,
digital and phone-based mental health
The suicide prevention research services as well as group, peer and
collaboration led by the University GP support. The services include The
of Western Sydney, Sax Institute, Shed in Mount Druitt, Western Sydney
and the Brain and Mind Centre at Recovery College, and the Connections
the University of Sydney developed Helpline. Medium intensity services
a systems modelling approach are face-to-face services and include
to community-based suicide psychological services and clinician-
prevention and suicidality attempts. assisted, digital mental health services,
The collaboration has developed and GP support. High intensity services
a Dynamic Modelling approach to are multi-agency care including
suicide prevention that incorporates coordinated multi-agency support,
the Lifespan Model from the Black psychiatric support, mental health
Dog Institute. WentWest (WSPHN) nurse services, acute care and hospital-
will act as a local implementation based services.
partner for the research collaborative
enabling the systems modelling The Principles and Characteristics of
approach to be tested in real the Stepped Care approach are shown
life scenarios and enable our in Appendix 3.
commissioning framework to draw Primary Care – Psychiatry Liaison
on the evidence of effectiveness and Services Model of Care (PC-PLS)
impact for suicide prevention. This
will address the current fragmented This service aims to improve both
nature of suicide prevention physical and mental health outcomes
activities and provide a rigorous in people with mental health issues,
approach to commissioning of through better integration of care
suicide prevention services. and increased access to psychiatric
expertise and psychosocial support
IMPROVED ACCESS TO AND within primary care settings. WentWest
QUALITY OF SERVICES (WSPHN) has engaged a Lead Agency
to employ two full-time psychiatrists
Stepped Care to support up to 20 general practices
across the region to target a range
WentWest (WSPHN) commissions a
of priority population groups. The
number of mental health services
psychiatrists provide consultant liaison
within Western Sydney informed
support to GPs and brief intervention to
through a comprehensive Needs
people accessing PC-PLS, increasing
Assessment. These services are
access to professional mental health
structured within a ‘Stepped Care’
services in the primary care setting.
approach to help a range of people
A unique feature of this PC-PLS
with low to high mental health needs,
model is the layering of support, to
with many of these services being
ensure people with a diverse range
free and easy to access without the
of support needs can be supported
need of a referral from a health
comprehensively. The PC-PLS also
professional. The Stepped Care
place emphasis on providing a
approach connects primary mental
person-centred and recovery-oriented
health care with Western Sydney
approach.
community members and helps
health professionals, including GPs, The preliminary evaluation of the PC-
deliver the right care by determining PLS has shown significant improved
the service level required. health outcomes and a good quality
P21Improvements in Recent Years
(continued)
Gold Card Clinics aims to strengthen integrated
mental health care for pregnant
The Gold Card Clinics (GCCs), are women, mothers, their infants and
clinical services offered through families throughout NSW. SwOPS
WSLHD’s Department of Psychology. provide telephone, telehealth and
They provide a brief psychotherapeutic online support. Consultations aim to
intervention for people aged 18-65 provide rapid response to support and
years old in the WSLHD catchment facilitate access to specialist Perinatal
area who have recently experienced a Mental Health Assessment. SwOPS-
mental health crisis. The intervention mh is based in Redbank House,
focuses on providing timely, accessible Westmead Hospital.
and evidence-based psychological
intervention for people who frequently Specialist Perinatal and Infant Mental
present to EDs or Inpatient Services Health Services (PIMHS) aare for
in the context of psychosocial crisis pregnant women and mothers with
with emotion dysregulation, suicidal severe and complex mental illness
ideation or self-harming behaviour. with infants up to two years of age.
PIMHS provides coordinated care for
The intervention provides an initial the mother’s mental health needs,
three sessions that focus on identifying parenting capacity, and parent-infant
and addressing psychological and relationship. It also provides hospital
behavioural factors that contributed in-reach as well as in-home support
to the crisis. An additional session for to women and their families, reducing
carers, partners and family members separation of mothers from their
is included in the intervention where families wherever possible. NSW Health
needed. When nearing the end of the are planning two new Mother Baby
intervention, referrals to appropriate inpatient units with one to be based at
services or ongoing psychological the Westmead Hospital campus.
therapy are discussed between the
GCC team and consumers. Child, Adolescent and Youth Services
The GCCs forms part of the Project ED Navigator
Air for Personality Disorders
implementation in WSLHD Mental The Child &Youth (C&Y) Mental
Health Services and works in a Health Emergency Department
recovery oriented, trauma informed (ED) Navigator program is a
way. There are four Gold Card Commonwealth funded pilot initiative
Clinics operating across WSLHD at between WSLHD and WentWest
Cumberland, Parramatta, Merrylands (WSPHN). It commenced in April 2018
and Blacktown. The GCCs take at Westmead Hospital and has utilised
referrals from the Parramatta or a Child and Youth trauma informed
Blacktown Acute Mental Health teams approach to acute intervention in the
and aim to offer an appointment to ED for children and young people
suitable clients within 1-3 working experiencing acute mental health
days of referral. crises with complex needs. This
innovative project is aimed at providing
While a relatively new service, the right care at the right time at the
the clinical outcomes from the right place and thereby linking young
GCC service indicate that a brief people to appropriate supports in
psychological intervention has a the community and preventing non-
significant positive impact on reducing urgent re-presentations to the ED
self-harming behaviours, suicidality, whilst attempting to promote suicide
emotion dysregulation, paranoid prevention and minimise risk of self-
perceptions of others, and negative harm. The impact of the program
perceptions of self. has exceeded expectations and there
has been a significant reduction in
Improved Perinatal and Infant Mental
re-presentation rates. The service has
Health
been extremely well received by young
The Statewide Outreach Perinatal people, their families/carers and the
Service for mental health (SwOPS-mh) general community.
P22Improvements in Recent Years
(continued)
U12s Community Mental Health mental disorders. PEIRS is a multi-
Service disciplinary service that encompasses
prevention, mental health promotion,
Emotional and/or behavioural early identification and intervention,
symptoms can cause significant relapse prevention, recovery and
disruptions in family life and school. research initiatives. The PEIRS Team
The U12s Community MHS aims to covers The Hills, Cumberland and
address these needs. All referrals are Parramatta LGAs.
triaged, with an individual assessment
of the child and the family context ENABLE provides assertive intervention
in which that child resides with for young people aged 12 -24 years
appropriate treatment. The also who are at risk of hospital admission
provide specialist transition to school or ED presentation by offering intensive
programs include the ‘Getting Ready outreach, assertive crisis intervention,
for School’ and The Early Intervention risk management and short-term
‘Now Ready for School’. The U12s support (up to 8 weeks).
service is based at Auburn, Redbank
(Westmead) and the Rupertswood SPECIALIST SERVICES FOR
Hub (Mount Druitt). VULNERABLE FAMILIES
Got It! The Whole Family Team (WFT)
Got It! is a school-based specialist The WFT is a specialist child-focused,
mental health early intervention family-centred service for children,
program for young children in young people, families and carers,
Kindergarten to Year Two with where parental or carer mental health
disruptive behaviour disorders and/or drug and alcohol issues co-exist
and their families. Got It! teams with significant child risk of significant
work closely with local school harm concerns. The WFT primarily
staff, children, parents and other works with families referred by Family
local service providers to deliver a and Community Services (FaCS) to
multilevel school-based intervention address the impact and associated
conducted across two school trauma of parental mental health and/
terms. An initial parent and teacher or drug and alcohol concerns and aims
screening for emerging conduct to enhance family functioning, increase
problems, leads to voluntary the safety of children and all family
participation in a 10-week targeted members, and improve health and
clinical program for children with developmental outcomes for children
identified problems and their and young people.
parents/carers. It is supported
The Alternate Care Clinic (ACC)
by whole-of-school intervention,
specialist assessment and referral ACC based at Redbank (Westmead)
for individual needs. offers a psychiatric clinic for children
and young people in out-of-home-care
BEAT, PEIRS and ENABLE
(aged 0-17 years) in the region. The
The Blacktown Early Access Team clinic seeks to improve connections to
(BEAT) provides specialist clinical services for these children and youth
mental health services to youth aged through more direct access for FaCS
12-24 years with severe mental illness. referrals and to improve the continuity
The team covers the Blacktown Local of care through individually tailored
Government Area. treatment and support plans. The ACC
offers a range of therapeutic options
The Prevention Early Intervention including individual and group work
Recovery Service (PEIRS) team is with children and young people, family
a child and adolescent community work and group training with foster
service offering a range of clinical carers, and systemic intervention and
interventions to young people aged 12- training for residential care workers and
25 years affected by the recent onset of members of FaCS.
P23Improvements in Recent Years
(continued)
PATIENT CENTRED HEALTH CARE
HOMES
The Patient Centred Medical Home
(PCMH) model plays a pivotal role
in achieving improved health of
populations, enhanced patient
experiences, health care cost
reductions, and better support for
health professionals – also known
as the Quadruple Aim. The PCMH
model continues to evolve as the
potential future of primary health
care internationally. The principles
that underpin PCMH are universally
relevant and fundamental to strong
primary care.
WentWest launched the first stage in
the PCMH journey in 2014, partnering
with 25 trailblazing local general
practices, to support PCMH principles
applied within the Australian context.
Over the years, local practices continue
to join this journey.
National and local experience
demonstrates that practices with a
quality improvement focus, who adopt
and work through the 10 Building
Blocks of High Performing Primary
Care, develop a greater capacity in both
their business and clinical models, to
sustain transformation, in turn shaping
the practices of the future.
P24PRIORITY
OBJECTIVES AND
ACTIONS
OBJECTIVE 1. STRENGTHENING 1.4 Share data across primary, • Through forums like the Service
COLLABORATIVE GOVERNANCE community and acute sectors to drive Delivery Reform (SDR), ensure a
AND INFORMATION SHARING FOR and inform evidence-based service coordinated cross sector response
PLANNING, COMMISSIONING AND development, monitoring and evaluation. supports the most vulnerable
EVALUATING SERVICES individuals and families and support
• Establish systems that drive forward initiatives to improve equity of access to
1.1 1.1 Develop a whole-of-system data sharing and move towards shared services for these groups.
(regional) approach to incentivise analysis and interpretation, creating an
local autonomy and accountability informed community of providers and • Strengthen the collaboration with
for delivering patient-centred and consumers designing a modern system Housing, the community housing sector
outcome-focused mental health care in built on good evidence and knowledge and the rental market operators to build
the community. of outcomes. more accommodation capacity and
more stable accommodation for mental
• Continue with the Living OBJECTIVE 2. FORGING PARTNERSHIPS health consumers and their families.
Well reforms and leverage the WITHIN AND BEYOND THE HEALTH
commissioning of Commonwealth AND SOCIAL CARE SECTORS THAT • Trial a ‘root cause coalition’ focused
funded mental health services in DELIVER BETTER MENTAL HEALTH on refugee populations to put in place the
Western Sydney, enabled through OUTCOMES ACROSS THE LIFESPAN pathways to participation and successful
national mental health reform. transition to living in Western Sydney.
2.1 Continue to build a One Western
• Collaborate in service networking Sydney health and social support and 2.3 Progressively transition care from
and care arrangements to improve care service system. acute settings to primary/community
service integration between WSLHD based settings, wherever appropriate
mental health inpatient and • Rebalance investments for an to do so, through collaborative
community teams, GPs, primary care integrated community and inpatient commissioning arrangements, building
providers and CMOs. mental health service that facilitates a mentally healthier and more resilient
timely access and recovery. Western Sydney community.
1.2 Across all services, shift the focus
of non-clinical and clinical support • Work with the CMOs to ensure • Support the Auburn Healthy
services and projects from outputs in-reach into acute inpatient units is Communities initiative, exploring
to outcomes. integrated into models of care and successful themes with potential to
connected to the Multi-Disciplinary expand across our region.
• Ensure in all commissioning, service Team for seamless transitions for
providers have clearly defined outcome consumers back to the community. • Implement mental health
measures to routinely report against. promotion and mental health literacy
• Support the ongoing transformation initiatives that engage and empower
• Continue to build on our capacity in of general practice to Patient Centre the community in self-care, reducing
evaluation and research, measuring the Medical Homes (PCMHs) and ensure that discrimination in all its forms and taking
impact of everything we do and publish/ the physical health needs of mental health action to help others experiencing
share our contribution publicly. consumers are addressed effectively. mental distress and mental ill-health.
1.3 Provide regular, clear communication • Invest in a stepped-care primary care • Engage with local government
on the implementation of this Plan and model supported by a GP-psychiatry and urban developers to ‘design in’
other mental health reforms to the liaison service and tele-psychiatry. mental health and wellbeing to new
Western Sydney community. developments or redevelopments.
• Develop shared care protocols,
• Establish a time limited co-design common functional assessment 2.4 Strengthen the Patient Centred
Working Party to develop the priority tools and processes, defined referral Medical Home model (PCMH) through
indicators relevant to the community. pathways and consumer centred care an enhanced team-based care model to
plans across primary, community and prevent, intervene early, support care
• Ensure through digital and tertiary health care services. co-ordination and continuity of care.
traditional reporting methods, the
Western Sydney community is kept 2.2 Develop coalitions with partners • As the PCMH model expands
informed on the progress of mental to address root causes of mental across general practice, ensure team-
health reform and the performance of distress, mental illness and suicidal based care always includes principles of
the local mental health services. behaviour. good mental health support.
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