North Western Melbourne

Transcription

1 Primary Health Networks Primary Mental Health Care Funding Annual Mental Health Activity Work Plan Annual Primary Mental Health Care Funding Budget North Western Melbourne When submitting this. Mental Health Activity Work Plan (referred to as the Regional Operational Mental Health and Suicide Prevention Plan in the Schedule for Operational Mental Health and Suicide Prevention, and Drug and Alcohol Activities) to the Department of Health, the Primary Health Network (PHN) must ensure that all internal clearances have been obtained and has been endorsed by the CEO. Additional planning and reporting requirements including documentation, data collection and evaluation activities for those PHNs selected as lead sites will be managed separately. The Mental Health Activity Work Plan must be lodged to your Grant Officer via VicTasPHN on, or before 6 May

2 Introduction Overview In the financial year, PHNs are required (through the recent mental health Schedule which provided operational funding to PHNs this financial year) to prepare a Mental Health Activity Work Plan by May This Plan is to cover activities funded under two sources: the Primary Mental Health Care flexible funding pool (which will provide PHNs with approximately $1.030 billion (GST exclusive) over three years commencing in ); and Indigenous Australians Health Programme - an additional $28.25 million (GST exclusive) will be available annually under this programme and further quarantined to specifically support Objective 6 (detailed below): Enhance and better integrate Aboriginal and Torres Strait Islander mental health. This is to be distinguished from the Regional Mental Health and Suicide Prevention Plan to be developed in consultation with Local Hospital Networks (LHNs) and other regional stakeholders which is due in 2017 (see Mental Health PHN Circular 2/2016). Objectives The objectives of the PHN mental health funding are to: improve targeting of psychological interventions to most appropriately support people with or at risk of mild mental illness at the local level through the development and/or commissioning of low intensity mental health services; support region-specific, cross sectoral approaches to early intervention for children and young people with, or at risk of mental illness (including those with severe mental illness who are being managed in primary care) and implementation of an equitable and integrated approach to primary mental health services for this population group; address service gaps in the provision of psychological therapies for people in rural and remote areas and other under-serviced and/or hard to reach populations, making optimal use of the available service infrastructure and workforce; commission primary mental health care services for people with severe mental illness being managed in primary care, including clinical care coordination for people with severe and complex mental illness who are being managed in primary care including through the phased implementation of primary mental health care packages and the use of mental health nurses; encourage and promote a systems based regional approach to suicide prevention including community based activities and liaising with Local Hospital Networks (LHNs) and other providers to help ensure appropriate follow-up and support arrangements are 2

3 in place at a regional level for individuals after a suicide attempt and for other people at high risk of suicide, including Aboriginal and Torres Strait Islander people; and enhance access to and better integrate Aboriginal and Torres Strait Islander mental health services at a local level facilitating a joined up approach with other closely connected services including social and emotional wellbeing, suicide prevention and alcohol and other drug services. For this Objective, both the Primary Health Networks Grant Programme Guidelines Annexure A1 - Primary Mental Health Care and the Indigenous Australians Health Programme Programme Guidelines apply. Objectives 1-6 will be underpinned by: evidence based regional mental health and suicide prevention plans and service mapping to identify needs and gaps, reduce duplication, remove inefficiencies and encourage integration; and a continuum of primary mental health services within a person-centred stepped care approach so that a range of service types, making the best use of available workforce and technology, are available within local regions to better match with individual and local population need. Activities eligible for funding commission evidence-based clinical primary mental health care services in line with a best practice stepped care approach; develop and commission cost effective low intensity psychological interventions for people with mild mental illness, making optimal use of the available workforce and technology; the phased implementation of approaches to provide primary mental health care to people with severe and complex mental illness which offer clinical support and care coordination, including services provided by mental health nurses; establish joined up assessment processes and referral pathways to enable people with mental illness, particularly those people with severe and complex mental illness, to receive the clinical and other related services they need. This will include provision of support to GPs in undertaking assessment to ensure people are referred to the service which best targets their need; develop and commission region-specific services, utilising existing providers, as necessary, to provide early intervention to support children and young people with, or at risk of, mental illness. This should include support for young people with mild to moderate forms of common mental illness as well as early intervention support for young people with moderate to severe mental illness, including emerging psychosis and severe forms of other types of mental illness; 3

4 develop and commission strategies to target the needs of people living in rural and remote areas and other under-serviced populations; and develop evidence based regional suicide prevention plans and commission activity consistent with the plans to facilitate a planned and agile approach to suicide prevention. This should include liaison with LHNs and other organisations to ensure arrangements are in place to provide follow-up care to people after a suicide attempt. Each PHN must make informed choices about how best to use its resources to address the objectives of the PHN mental health funding. This document, the Mental Health Activity Work Plan template, captures the approach to those activities outlined above. The Mental Health Activity Work Plan will help guide activity to June 2016 and outline the planned mental health services to be commissioned for the period from 1 July 2016 to 30 June 2017, although activities can be proposed in the Plan beyond this period. The Department of Health will require an update in relation to these activities in the Annual Mental Health Activity Work Plan for The Mental Health Activity Work Plan template has two connected parts: 1) The Annual Mental Health Activity Work Plan for , which will be linked to and consistent with the broader PHN Activity Work Plan, and provide: a) The Strategic Vision on the approach to addressing the mental health and suicide prevention priorities of each PHN. b) A description of planned activities funded under the Primary Mental Health Care Schedule which incorporates: i) Primary Mental Health Care funding (PHN: Mental Health and Suicide Prevention Operational and Flexible Activity); and ii) Indigenous Australians Health Programme funding (quarantined to support Objective 6 see pages 2-3) (PHN: Indigenous Mental Health Flexible Activity). 2) The indicative funding budget for for: a) primary mental health care (PHN: Mental Health and Suicide Prevention Operational and Flexible Activity); and b) Indigenous Australians Health Programme (quarantined to support Objective 6 see pages 2-3) (PHN: Indigenous Mental Health Flexible Activity). Mental Health Activity Work Plan The template for the Plan requires PHNs to outline activities against each and every one of the six priorities for mental health and suicide prevention. The Plan should also lay the foundation for regional planning and implementation of a broader stepped care model in the PHN region. This Plan recognises that is a transition year and full flexibility in programme design and delivery will not occur until

5 The Plan should: a) Outline the planned mental health services to be commissioned from 1 July 2016, consistent with the grant funding guidelines. b) Outline the approach to be undertaken by the PHN in leading the development with regional stakeholders including LHNs of a longer term, more substantial Regional Mental Health and Suicide Prevention plan (which is aligned with the Australian Government Response to the Review of Mental Health Programmes and Services (available on the Department s website). This will include an outline of the approach to be undertaken by the PHN to seek agreement to the longer term regional mental health and suicide prevention plan from the relevant organisational signatories in the region, including LHNs. c) Outline the approach to be taken to integrating and linking programmes transitioning to PHNs (such as headspace, and the Mental Health Nurse Incentive Programme services) into broader primary care activities, and to supporting links between mental health and drug and alcohol service delivery. d) Have a particular focus on the approach to new or significantly reformed areas of activity particularly Aboriginal and Torres Strait Islander mental health, suicide prevention activity, and early activity in relation to supporting young people presenting with severe mental illness. In addition, PHNs will be expected to provide advice in their Mental Health Activity Work Plan on how they are going to approach the following specific areas of activity in to support these areas of activity: Develop and implement clinical governance and quality assurance arrangements to guide the primary mental health care activity undertaken by the PHN, in a way which is consistent with section 1.3 of the Primary Health Networks Grant Programme Guidelines available on the PHN website at Program_Guidelines, and which is consistent with the National Standards for Mental Health Services and National Practice Standards for the Mental Health Workforce. Ensure appropriate data collection and reporting systems are in place for all commissioned services to inform service planning and facilitate ongoing performance monitoring and evaluation at the regional and national level, utilising existing infrastructure where possible and appropriate. Develop and implement systems to support sharing of consumer clinical information between service providers and consumers, with appropriate consent and building on the foundation provided by myhealth Record. Establish and maintain appropriate consumer feedback procedures, including complaint handling procedures, in relation to services commissioned under the activity. Value for money in relation to the cost and outcomes of commissioned services needs to be considered within this planning process. 5

6 Activity Planning This initial Mental Health Activity Work Plan will be informed by a specific mental health needs assessment developed by PHNs (as a complement to the broader PHN needs assessment) which should explore mental health and suicide prevention priorities against those six areas of activity which the Government has articulated for PHNs, and in consultation with key stakeholders (refer to pages 2-6, for Objectives and Activities eligible for funding, and other requirements to be reflected in the Plan). Measuring Improvements Each mental health priority area has one or more mandatory performance indicators. In addition to the mandatory performance indicators, PHNs may select a local performance indicator. These will be reported on in accordance with the Primary Mental Health Care Schedule. Mental Health Activity Work Plan Reporting Period and Public Accessibility The Mental Health Activity Work Plan will help guide activity to June 2016 and outline the planned mental health services to be commissioned for the period from 1 July 2016 to 30 June A mental health focussed activity work plan is to be provided to the Department annually. This mental health activity plan will complement the broader PHN Activity Plan as part of the annual reporting mechanism and will build on the initial Mental Health Activity Work Plan delivered in Once approved, the Annual Mental Health Activity Work Plan component (Section 1(b) of this document) must be made available by the PHN on their website as soon as practicable. The Annual Mental Health Activity Work Plan component will also be made available on the Department of Health s website (under the PHN website). Sensitive content identified by the PHN will be excluded, subject to the agreement of the Department. It is important to note that while planning may continue following submission of the Mental Health Activity Work Plan, PHNs must not commit or spend any part of the funding related to this Activity Work Plan until it is approved by the Department. Further information The following may assist in the preparation of your Mental Health Activity Work Plan: The requirements detailed in the Primary Mental Health Care Schedule; PHN Needs Assessment Guide; Mental Health PHN Circulars; Primary Health Networks Grant Programme Guidelines Annexure A1 Primary Mental Health Care; and Indigenous Australians Health Programme Programme Guidelines. Please contact your Grants Officer if you are having any difficulties completing this document. 6

7 1. (a) Strategic Vision North Western Melbourne PHN s vision is to improve the health of everyone in our region. Our mission is to strengthen primary health care and connect services across the system. Equity, respect, collaboration and innovation are the guiding values that we apply to everything we do and every interaction we have. NWMPHN recognises the current barriers and constraints perceived by those with mental ill-health and those who support them within our region and beyond. NWMPHN is committed to ensuring that the health and well-being of our most vulnerable communities is improved in a coordinated and accountable manner. In the area of mental health activity and commissioning, we will do this by: identifying and understanding the priority needs in our region through interpretation of our initial needs assessment findings and through ongoing consultation with the sector and current recipients of services; supporting, developing, innovating, coordinating and measuring service responses to address priorities leading to increased service delivery within the mental health and the drug and alcohol treatment sector especially in targeted areas of need such as to our young people, Aboriginal community, CALD, refugee and asylum seekers, LGBTI community and beyond; strengthening and supporting general practice and the system as a whole to ensure targeted, coordinated and appropriate workforce development and networking occurs as a fundamental activity; demonstrating a commitment to quality, safety, efficiency, genuine value and innovation in everything we do leading to the commissioning of additional mental health services of excellence, based on evidence; working closely and collaboratively with government (Commonwealth, State and Local), general practice and other primary health care service providers, Local Hospital Networks, Non-Government Organisations, the private sector and patients, consumers and carers ensuring that services meet needs and support gaps in the existing system as a whole. modelling a continuum of primary mental health services within a person-centred stepped care approach so that a range of service types are available within local regions to better match with individual and local population need, making the best use of available workforce and technology; and developing evidence based regional mental health and suicide prevention plans and undertaking service mapping to identify needs and gaps, reduce duplication, remove inefficiencies and encourage integration. Each of these key principles informs NWMPHN s strategic vision for the 2016 to 2019 Mental Health Treatment Activity Work Plan. 7

8 1. (b) Planned activities funded under the Primary Mental Health Care Schedule PHNs must use the table below to outline the activities proposed to be undertaken in the financial year. These activities will be funded under the Primary Mental Health Care Schedule (PHN: Mental Health and Suicide Prevention Operational and Flexible Activity; and the PHN: Indigenous Mental Health Flexible Activity). Note 1: Indicate within the duration section of the table if the activity relates to a period beyond Note 2: PHNs must complete activities under every priority area in the tables below. Summary of activities Improve targeting of psychological interventions to most appropriately support people with or at risk of mild mental illness at the local level through the development and/or commissioning of low intensity mental health services Support region-specific, (including those with severe mental illness who are being managed in primary care) and implementation of an equitable and integrated approach to primary mental health services for this population group Address service gaps in the provision of psychological therapies for people in rural and remote areas and other under-serviced and/or hard to reach populations, making optimal use of the available service infrastructure and workforce Commission primary mental health care services for people with severe mental illness being managed in primary care, including clinical care coordination for people with severe and complex mental illness who are being managed in primary care including through the phased implementation of primary mental health care packages and the use of mental health nurses. 16 Encourage and promote a systems based regional approach to suicide prevention including community based activities and liaising with Local Hospital Networks (LHNs) and other providers to help ensure appropriate follow-up and support arrangements are in place at a regional level for individuals after a suicide attempt and for other people at high risk of suicide, including Aboriginal and Torres Strait Islander people Enhance access to and better integrate Aboriginal and Torres Strait Islander mental health services at a local level facilitating a joined up approach with other closely connected services including social and emotional wellbeing, suicide prevention and alcohol and other drug services

9 Develop a continuum of primary mental health services within a person-centred stepped care approach so that a range of service types, making the best use of available workforce and technology, are available within local regions to better match with individual and local population need Development of evidence based regional mental health and suicide prevention plans and service mapping to identify needs and gaps, reduce duplication, remove inefficiencies and encourage integration

10 Proposed Activities Priority Area 1: Low intensity mental health services Activity(ies) / Reference Description of Activity(ies) and rationale (needs assessment) Improve targeting of psychological interventions to most appropriately support people with or at risk of mild mental illness at the local level through the development and/or commissioning of low intensity mental health services. Activities to be commissioned in 2016/17 under this priority area include: 1.1 Scope and map available low intensity service options. 1.2 When available, promote broadly the Digital Mental Health Gateway. 1.3 Commissioning of low intensity mental health services. 1.4 Educate consumers and providers on available low intensity services. 1.5 Ongoing consultation regarding the proposed NWMPHN Regional Model of Care. During the 2016/17 period the following activities will be undertaken to support those with or at risk of mild mental illness: 1.1 Scope and map available services that will supplement the role of the digital gateway in providing an initial service step within a primary care stepped care framework. These may be web based, phone based, face to face and group based interventions. This may include promotion of beyondblue s NewAccess web based service. 1.2 When available, promote broadly the digital mental health gateway which will provide a central entry point for national low intensity telephone and web-based mental health services. 1.3 Commissioning of low intensity mental health services - (local or state based) to support people with or at risk of mild mental illness including phone and local face-to-face group services (i.e. for new mothers within regions of need / growth corridors who are at risk of PND; group programs for young people within schools; groups programs focussing on skills building for those no longer requiring intensive / hard to reach interventions). This could include the broader promotion of the web based icope assessment and treatment tool for new mothers and fathers. 1.4 Educate consumers and providers on low intensity services through regional communications campaigns directed toward targeted recipients, regarding referral pathways and service parameters to build supported Communities of Care across the region. 1.5 Ongoing consultation to align with the development and implementation of activity against the proposed NWMPHN Regional Model of Care, ongoing regional and sub regional consultation will be required to ensure that service providers are activated and invested in working within the model as it evolves. 10

11 Collaboration Duration Initial establishment activity 2016/2017 Coverage Commissioning approach This activity will be jointly developed (within the scope of the broader model of care development activity) with a number of other stakeholders, including headspace, schools, peak bodies, state and territory Governments, or other relevant support services, Area Mental Health Services, Local Health dependant on the piece and stage of activity. Coordination activity will be directly delivered by NWMPHN staff to support the commissioning of mental health treatment services and activity and to ensure that commissioned services are co-designed with community and local services, leading to equitable and best practice delivery across the region. Training / workforce development will be purchased and delivered to ensure that identified learning needs are met. Commissioned services will be monitored and evaluated according to organisation policies and procedures, which meet best-practice standards. 2015/16 evaluation findings will inform the commissioning of services in 2016/17. Ongoing activity /2018 This will be a regional approach aligning with NWMPHN boundaries. It should be noted that some services and key stakeholders operate across multi-phn or whole of Victorian region. The planned commissioning approach to this activity will include: 1. Targeted regional scoping of integration approaches, consultation and model development commissioned (through limited / restricted tender). 2. NWMPHN Mental Health Commissioning Manager and Officer focussed on overseeing all contracted deliverables, building and maintaining relationships with commissioned providers and related services and stakeholders, supporting workforce development through networking and regional education opportunities and approaches, ensuring timely data and reporting performance of commissioned organisations. 3. Commissioned activity through open tender (or restricted/limited depending on activity) in response to targeted projects, education providers and resource and tool development, as and where required. 11

12 Proposed Activities Priority Area 2: Youth mental health services Activity(ies) / Reference Support region-specific, (including those with severe mental illness who are being managed in primary care) and implementation of an equitable and integrated approach to primary mental health services for this population group. Activities to be commissioned in 2016/17 under this priority area include: 2.1 Ongoing commissioning of headspace centres. 2.2 Commissioning of services for children and young people with, or at risk of severe mental illness. 2.3 Commissioning of services for hard to reach children and young people. 2.4 Commissioning of new cross sectoral approaches to early intervention for children and young people with, or at risk of mental illness aimed at trialling new approaches to support regions and communities of disadvantage. 2.5 Workforce development and networking to build Communities of Care across the region. 2.6 Ongoing consultation regarding the delivery of this stream of funding and its delivery within the proposed NWMPHN Regional Model of Care. Description of Activity(ies) and rationale (needs assessment) Provide a short description of each activity relating to the priority area. This may include, but is not limited to: aim of activity; how the activity will address the priority; target population cohort. You must also demonstrate alignment with the PHN mental health funding objectives. 2.1 Ongoing commissioning of headspace centres ensuring the ongoing delivery of localised services to young people through the 5 established centres across the north western Melbourne region. This will be supported via a region wide NWMPHN Youth Expert Reference Group that will comprise of members from each of the current headspace lead organisations consortia. Engagement will also be undertaken with headspace National Office to ensure that nationally applicable activity is maintained and core functions are managed. 2.2 Commissioning of services for children and young people with, or at risk of severe mental illness following regional consultation and engagement with youth specialist services, NWMPHN will develop criteria to direct the commissioning of activity under this priority area. Services may include the localised implementation of youth specific Psychiatrists within headspace centres or other applicable sites who work in consultation with both local hospital and CAMHS services and who provide out-reach support to GPs and youth specific sites (including schools). NWMPHN will seek open expressions of interest from providers within the community to commission the piloted delivery of low intensity services that better meet the needs of our very at risk 12

13 Collaboration Duration Coverage Commissioning approach community. Target and delivery parameters will be clearly articulated to ensure that this activity meets both the regions INA findings and the PHN mental health funding objectives. 2.3 Commissioning of ATAPS-like services to children and young people see priority area Commissioning of new cross sectoral approaches to early intervention for children and young people with, or at risk of mental illness aimed at trialling new approaches to support regions and communities of disadvantage see priority area Workforce development and networking to build Communities of Care see priority area Ongoing consultation see priority area 7. Each of these activities will be supported with communications campaigns aimed at raising both primary care and community awareness. This activity will be jointly developed (within the scope of the broader model of care development activity) with a number of other stakeholders, including headspace lead organisations, headspace National Office; Area Mental Health Services, Local Health Networks, state and territory Governments, or other relevant support services, dependant on the piece and stage of activity. The coordination roles will be directly delivered by NWMPHN staff to support the commissioning of mental health treatment services and activity and to ensure that commissioned services are co-designed with community and local services, leading to equitable and best practice delivery across the region. Training / workforce development will be purchased and delivered to ensure that identified learning needs are met. Commissioned services will be monitored and evaluated according to organisation policies and procedures, which meet best-practice standards. 2015/16 evaluation findings will inform the commissioning of services in 2016/17. Initial establishment activity 2016/2017 Ongoing activity /2018 This will be a regional approach aligning with NWMPHN boundaries. It should be noted that some services and key stakeholders operate across multi-phn or whole of Victorian region. The planned commissioning approach to this activity will include: 1. NWMPHN Mental Health Commissioning Manager and Officer focussed on overseeing all contracted deliverables, building and maintaining relationships with commissioned providers and related services and stakeholders, 13

14 supporting workforce development through networking and regional education opportunities and approaches, ensuring timely data and reporting performance of commissioned organisations. 2. Targeted regional scoping of integration approaches, consultation and model development commissioned (through limited / restricted tender). 3. Commissioned activity through open tender (or restricted / limited depending on activity) in response to targeted projects, education providers and resource and tool development, as and where required. Proposed Activities Priority Area 3: Psychological therapies for rural and remote, under-serviced and /or hard to reach groups Activity(ies) / Reference Description of Activity(ies) and rationale (needs assessment) Address service gaps in the provision of psychological therapies for people in rural and remote areas and other underserviced and/or hard to reach populations, making optimal use of the available service infrastructure and workforce. Activities to be commissioned in 2016/17 under this priority area include: 3.1 Commissioning of mental health services (historically defined as ATAPS) to hard to reach groups/regions and communities of need. 3.2 Commissioning of new mental health services aimed at trialling new approaches to support hard to reach groups and communities of disadvantage. 3.3 Workforce development and networking to build Communities of Care across the region. 3.4 Ongoing consultation regarding the delivery of this stream of funding and its delivery within the proposed NWMPHN Regional Model of Care. During the 2016/17 period the following activities will be undertaken to support those with or at risk of mild mental illness: 3.1 Commissioning of mental health (ATAPS-like) services this activity aims to ensure continuity of service provision to clients, currently accessing, and entering this service for the first time in 2016/17. Regional consultation has shown that it has taken up to 8 months for GPs to feel confident that the ATAPS service was continuing (post PHN transition), therefore reinforcing the need to provide continuity through this activity in 2016/17. This program currently targets hard to reach clients, those unable to afford services elsewhere; those from vulnerable communities and from regions of need (i.e. children, youth, ATSI, CALD, refugee and asylum 14

15 Collaboration Duration Coverage seekers, homeless and LGBTIQ). These target groups will remain the focus of this commissioned service stream in 2016/17. NWMPHN will continue to utilise the current referdirect intake and assessment approach to ensure coordination of care, clinical governance/ compliance and data management is assured. NB: this activity includes the ongoing provision of tele and video CBT to clients in the Murrumbidgee PHN region. 3.2 Commissioning of new mental health services - historical analysis has indicated that some communities do not benefit from the existing service structure and inclusion criteria set within the ATAPS guidance. Based on this insight, NWMPHN will seek open expressions of interest from providers within the community to commission the piloted delivery of low intensity services that better meet the needs of our very at risk community. Target and delivery parameters will be clearly articulated to ensure that this activity meets both the regions INA findings and the PHN mental health funding objectives. NWMPHN will utilise the current referdirect intake and assessment approach to ensure coordination of care, clinical governance/ compliance and data management is assured. 3.3 Workforce development and networking to build Communities of Care see priority area Ongoing consultation see priority area 7. Each of these activities will be supported with communications campaigns aimed at raising both primary care and community awareness. This activity will be jointly developed (within the scope of the broader model of care development activity) with a number of other stakeholders, including Area Mental Health Services, Local Health Networks, state and territory Governments, or other relevant support services, dependant on the piece and stage of activity. The coordination roles will be directly delivered by NWMPHN staff to support the commissioning of mental health treatment services and activity and to ensure that commissioned services are co-designed with community and local services, leading to equitable and best practice delivery across the region. Training / workforce development will be purchased and delivered to ensure that identified learning needs are met. Commissioned services will be monitored and evaluated according to organisation policies and procedures, which meet best-practice standards. 2015/16 evaluation findings will inform the commissioning of services in 2016/17. Initial establishment activity 2016/2017 Ongoing activity /2018 This will be a regional approach aligning with NWMPHN boundaries. 15

16 It should be noted that some services and key stakeholders operate across multi-phn or whole of Victorian region. The planned commissioning approach to this activity will include: Commissioning approach 1. NWMPHN Mental Health Commissioning Manager and Officer focussed on overseeing all contracted deliverables, building and maintaining relationships with commissioned providers and related services and stakeholders, supporting workforce development through networking and regional education opportunities and approaches, ensuring timely data and reporting performance of commissioned organisations. 2. Targeted regional scoping of integration approaches, consultation and model development commissioned (through limited / restricted tender). 3. Commissioned activity through open tender (or restricted/limited depending on activity) in response to targeted projects, education providers and resource and tool development, as and where required. Proposed Activities Priority Area 4: Mental health services for people with severe and complex mental illness including care packages Commission primary mental health care services for people with severe mental illness being managed in primary care, including clinical care coordination for people with severe and complex mental illness who are being managed in primary care including through the phased implementation of primary mental health care packages and the use of mental health nurses. Activity(ies) / Reference Activities to be commissioned in 2016/17 under this priority area include: 4.1 Commissioning of Mental Health Nurse services across the region. 4.2 Commissioning of new models of innovative funding to support clinical care packages for people with severe and complex mental illness. 4.3 Single multiagency care plan for people with severe and complex mental illness. 4.4 Workforce development and networking to build Communities of Care across the region. 4.5 Ongoing consultation regarding the delivery of this stream of funding and its delivery within the proposed NWMPHN Regional Model of Care. This activity constitutes a core component of the national PHN pilot site activity and will therefore be undertaken to ensure accountability and transparency in accordance with the Commonwealths guidance. 16

17 Description of Activity(ies) and rationale (needs assessment) During the 2016/17 period the following activities will be undertaken to support those with severe and complex mental illness: 4.1 Commissioning of Mental Health Nurse services currently operating within the region this activity aims to ensure continuity of service provision to clients, currently accessing, and entering this service for the first time in 2016/17. At this time, consultation is occurring to ensure current providers transition smoothly by June Ongoing consultation and model development will ensure that a sustainable model of delivery is developed during 2016/2017. The delivery of services through currently identified mental health nurses and their applicable organisations will be reviewed at 6 and 12 month intervals. Lack of compliance/service delivery may result in discontinuation of contracts. NWMPHN will utilise the current referdirect intake and assessment approach to ensure coordination of care, clinical governance / compliance and data management is assured. This system is currently being adapted to manage all MH Nurse data based on the existing MDS variables. 4.2 Commissioning of new mental health services Once scoping of current providers and their capacity is finalised, NWMPHN will develop proposed approaches to meet the needs of consumers within areas where mental health nurses may not currently be available or alternate options for service interventions such as complex care coordination and models of innovative funding to support clinical care packages for individuals with severe and complex mental illness. Activity will focus on accessibility and the reorientation of services to better meet demand. It will also focus on the current maldistribution of activity by identified mental health Nurses across the region. Model development will be complimentary to current NDIS roll out and its implications on this level of service stream. NWMPHN will then seek open expressions of interest from providers within the community to commission the piloted delivery of these service approaches. Target and delivery parameters will be clearly articulated to ensure that this activity meets both the regions INA findings and the PHN mental health funding objectives. NWMPHN will utilise the current referdirect intake and assessment approach to ensure coordination of care, clinical governance / compliance and data management is assured. Activity will also promote better management of the physical health of individuals with severe mental illness within the region. 4.3 Promote the use of a single multiagency care plan for people with severe and complex mental illness over the past 18 months, NWMPHN has been developing a single multiagency care plan to help link providers across multiple services involved in an individual s care and to promote a medical home approach. This activity will continue with development occurring in line with regional model of care development. 4.4 Workforce development and networking to build Communities of Care see priority area Ongoing consultation promote the better integration of primary care services with community based psychiatry services and state mental health services for people with severe mental illness in the context of the development of regional Mental Health and Suicide Prevention Plans through ongoing consultation (see priority 17

18 Collaboration Duration Coverage Commissioning approach area 7 also). Each of these activities will be supported with communications campaigns aimed at raising both primary care and community awareness. This activity will be jointly developed (within the scope of the broader model of care development activity) with a number of other stakeholders, including Area Mental Health Services, Local Health Networks, state and territory Governments, or other relevant support services, dependant on the piece and stage of activity. The coordination roles will be directly delivered by NWMPHN staff to support the commissioning of mental health treatment services and activity and to ensure that commissioned services are co-designed with community and local services, leading to equitable and best practice delivery across the region. Training / workforce development will be purchased and delivered to ensure that identified learning needs are met. Commissioned services will be monitored and evaluated according to organisation policies and procedures, which meet best-practice standards. 2015/16 evaluation findings will inform the commissioning of services in 2016/17. Initial establishment activity 2016/2017 Ongoing activity /2018 This will be a regional approach aligning with NWMPHN boundaries. It should be noted that some services and key stakeholders operate across multi-phn or whole of Victorian region. The planned commissioning approach to this activity will include: 1. NWMPHN Mental Health Commissioning Manager and Officer focussed on overseeing all contracted deliverables, building and maintaining relationships with commissioned providers and related services and stakeholders, supporting workforce development through networking and regional education opportunities and approaches, ensuring timely data and reporting performance of commissioned organisations. 2. Targeted regional scoping of integration approaches, consultation and model development commissioned (through limited / restricted tender). 3. Commissioned activity initially tendered through restricted approach to current mental health nurses. 4. New commissioned activity through open tender (or restricted/limited depending on activity) in response to targeted projects, education providers and resource and tool development, as and where required. 18

19 Proposed Activities Priority Area 5: Community based suicide prevention activities Encourage and promote a systems based regional approach to suicide prevention including community based activities and liaising with Local Hospital Networks (LHNs) and other providers to help ensure appropriate follow-up and support arrangements are in place at a regional level for individuals after a suicide attempt and for other people at high risk of suicide, including Aboriginal and Torres Strait Islander people. Activity(ies) / Reference Description of Activity(ies) and rationale (needs assessment) Activities to be commissioned in 2016/17 under this priority area include: 5.1 Undertake planning of community-based suicide prevention activity. 5.2 Commence commissioning of community-based suicide prevention activities within the context of this plan. 5.3 Undertake targeted planning and commissioning of community-based suicide prevention activities for Aboriginal and Torres Strait Islander people. 5.4 Workforce development and networking to build Communities of Care. 5.5 Ongoing consultation. During the 2016/17 period the following activities will be undertaken to ensure appropriate follow-up and support for individuals after suicide attempt and support for those with at high risk of suicide: 5.1 Undertake planning of community-based suicide prevention activity - through a more integrated and systemsbased approach in partnership with LHNs and other local organisations, including arrangements for follow-up care to individuals after a suicide attempt. NWMPHN has 3 regional consultations scheduled May to June 2016, and will continue to undertake consultation to support planning and model development and implementation during 2016/17. The NWMPHN Regional Mental Health Expert Reference Group will provide guidance and support the targeted commissioning of services, as and where required; 5.2 Commence commissioning of community-based suicide prevention activities within the context of this plan - Whilst consultation is currently underway, the transition of current services on the 1st July 2016 (for the 16/17 period) may include: Incolink - The Victorian Building and Construction Industry Life Care; SANE Australia - Mental Illness, Bereavement and Suicide Prevention Project; and, Jesuit Social Services - Support After Suicide. This planned approach will result in expenditure of approximately one third of the funding allocation for the SPS general stream, leaving significant funding available to trial new commissioned approaches. Approaches will include support to families and carers exposed to suicide. Priority targets will be set for regions of need including youth in Macedon ranges, Melton and adults in Wyndham. 19

20 Collaboration Duration Coverage 5.3 Undertake planning and commissioning of community-based suicide prevention activities for Aboriginal and Torres Strait Islander people this activity will be undertaken in partnership with VACCHO and VAHS and will occur in collaboration with the planning, designing and commissioning of drug and alcohol services, mental health services, Integrated Team Care funding and social and emotional wellbeing services. 5.4 Workforce development and networking to build Communities of Care Activate the service system as a whole to work collaboratively, building the capacity of primary care to support and respond preventatively/ pre and post suicide attempt, for the individual and their families (see priority area 7). 5.5 Ongoing consultation promote the better integration of primary care services with community based psychiatry services and state mental health services for people with severe mental illness in the context of the development of regional Mental Health and Suicide Prevention Plans through ongoing consultation (see priority area 7). This activity will be jointly developed (within the scope of the broader model of care development activity) with a number of other stakeholders, including Area Mental Health Services, Local Health Networks, state and territory Governments, or other relevant support services, dependant on the piece and stage of activity. The coordination roles will be directly delivered by NWMPHN staff to support the commissioning of mental health treatment services and activity and to ensure that commissioned services are co-designed with community and local services, leading to equitable and best practice delivery across the region. Training / workforce development will be purchased and delivered to ensure that identified learning needs are met. Commissioned services will be monitored and evaluated according to organisation policies and procedures, which meet best-practice standards. 2015/16 evaluation findings will inform the commissioning of services in 2016/17. Initial establishment activity 2016/2017 Ongoing activity /2018 This will be a regional approach aligning with NWMPHN boundaries. It should be noted that some services and key stakeholders operate across multi-phn or whole of Victorian region. The planned commissioning approach to this activity will include: Commissioning approach 1. NWMPHN Mental Health Commissioning Manager and staff focussed on overseeing all contracted deliverables, building and maintaining relationships with commissioned providers and related services and stakeholders, supporting workforce development through networking and regional education opportunities and approaches, 20

21 ensuring timely data and reporting performance of commissioned organisations. 2. Targeted regional scoping of integration approaches, consultation and model development commissioned (through limited / restricted tender). 3. New commissioned activity through open tender (or restricted / limited depending on activity) in response to targeted projects, education providers and resource and tool development, as and where required. Proposed Activities Priority Area 6: Aboriginal and Torres Strait Islander mental health services Activity(ies) / Reference Description of Activity(ies) and rationale (needs assessment) Enhance access to and better integrate Aboriginal and Torres Strait Islander mental health services at a local level facilitating a joined up approach with other closely connected services including social and emotional wellbeing, suicide prevention and alcohol and other drug services. Activities to be commissioned in 2016/17 under this priority area include: 6.1 Undertake regional planning for mental health services for Aboriginal and Torres Strait Islander people in collaboration with VACCHO and VAHS completed by 30 September Commence commissioning of community-based mental health services for Aboriginal and Torres Strait Islander people, as and when able. 6.3 Undertake targeted commissioning of new approaches. 6.4 Workforce development and networking. 6.5 Ongoing consultation. During the 2016/17 period the following activities will be undertaken: 6.1 Undertake regional planning for mental health services for Aboriginal and Torres Strait Islander people in collaboration with VACCHO and VAHS. This activity will occur in collaboration with the planning, designing and commissioning of drug and alcohol services, mental health services, Integrated Team Care funding and social and emotional wellbeing services. Initial focus will be targeted toward services in the regions West and toward better integrating existing services. 6.2 Commence commissioning of community-based mental health services for Aboriginal and Torres Strait Islander people, as and when able. This may include continuation of mental health credentialed Aboriginal health care workers providing outreach to young people in Darebin and funding VAHS to provide mental health services in the West of the region. 6.3 Undertake targeted commissioning of new community-based services for Aboriginal and Torres Strait Islander 21