Mental Health Workforce Study: Mental Health Workforce Planning Data Inventory

Transcription

1 Mental Health Workforce Study: Mental Health Workforce Planning Data Inventory September

2 Health Workforce Australia. This work is copyright. It may be reproduced in whole or part for study or training purposes. Subject to an acknowledgement of the source, reproduction for purposes other than those indicated above, or not in accordance with the provisions of the Copyright Act 1968, requires the written permission of Health Workforce Australia (HWA). Enquiries concerning this report and its reproduction should be directed to: Health Workforce Australia Post GPO Box 2098, Adelaide SA 5001 Telephone Internet Suggested citation: Health Workforce Australia 2013, Mental Health Workforce Planning Data Inventory, Health Workforce Australia: Adelaide 2

3 Contents Abbreviations 4 Introduction 6 Key findings 12 What data is available for the workforces in scope? 15 Primary workforces 15 Aboriginal and Torres Strait Islander health workers 16 Aboriginal mental health workers 20 General practice (GP) workforce 21 Mental health nurses 24 Mental health workers 28 Occupational therapists 30 Peer workers 33 Psychologists 35 Psychiatrists 38 Registered nurses and Enrolled nurses 41 Social workers 44 Other significant workforces 47 Dietitians 48 Pharmacists 50 Speech pathologists 53 What data is available to measure demand for workforces delivering services to mental health consumers? 56 What data is available on workforce entrants and exits? 59 Detailed data statements 61 References 81 3

4 Abbreviations AMHW ATAPS AMHSW APD ANZSCO AASW ACMHN ACRRM ABS The Census AHPRA AIHW BEACH COAG DEEWR DOHA DIAC DIICCSRTE DAA EN FTE GPET GP HWA HEP Aboriginal mental health worker Access to Allied Psychological Services Accredited Mental Health Social Worker Accredited Practising Dietitian Australian and New Zealand Standard Classification of Occupations Australian Association of Social Workers Australian College of Mental Health Nurses Australian College of Rural and Remote Medicine Australian Bureau of Statistics Australian Bureau of Statistics Census of Population and Housing Australian Health Practitioner Regulation Agency Australian Institute of Health and Welfare Bettering the Evaluation and Care of Health Council of Australian Governments Department of Education, Employment and Workplace Relations Department of Health and Ageing Department of Immigration and Citizenship Department of Industry, Innovation, Climate Change, Science, Research and Tertiary Education Dietitians Association of Australia Enrolled Nurse Full-time equivalent General Practice Education and Training General Practitioner Health Workforce Australia Higher Education Providers HESA Higher Education Support Act 2003 MTRP MBS MHE NMDS MH NGOE NMDS Medical Training Review Panel Medicare Benefits Schedule Mental Health Establishment National Minimum Dataset Mental Health Non-Government Organisation Establishments National Minimum Data Set 4

5 NCVER NHWDS NMHSPF NHMD NMDS NRAS NGO OT PHIAC PAG RN RANZCP RACGP SPA VET National Centre for Vocational Education Research Ltd National Health Workforce Data Set National Mental Health Service Planning Framework National Hospital Morbidity Database National Minimum Data Set National Registration and Accreditation Scheme Non-Government Organisation Occupational Therapist Private Health Insurance Administration Council Program Advisory Group Registered Nurse Royal Australian and New Zealand College of Psychiatrists Royal Australian College of General Practitioners Speech Pathology Australia Vocational Education and Training 5

6 Introduction The importance of mental health Mental illness describes a wide range of disorders. In general a mental illness is recognised as a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. Examples of the most common forms of mental illness include anxiety and depressive disorders 1. According to the 2007 National Survey of Mental Health and Wellbeing, almost half of all Australians experienced a mental illness or disorder during their lifetime, while one in five Australians (or 3.2 million people) aged between 16 and 85 experienced mental disorders in the 12 months prior to the survey. In addition, the Burden of Disease and Injury in Australia study found that mental disorders are one of the leading disability burdens in Australia in terms of the number of years lost due to disability. The effect of mental illness can be severe on individuals and families, and its influence is far-reaching for society as a whole. Social problems commonly associated with mental illness include poverty, unemployment or reduced productivity and homelessness. Those with mental illness often experience problems such as isolation, discrimination and stigma 2. As well as the social impact of mental illness, the economic cost of mental illness is also significant. In , almost $6.9 billion, or $309 per person, was spent on mental health related services in Australia 3, and the annual cost to employers of reduced productivity has been estimated at 30 million working days 4. For both the social and economic impacts of mental illness on the Australian community, a sustainable mental health workforce supporting the mental health system is essential. Policy context Recognising the impact of mental illness and mental disorder on the community, a collaborative approach to mental health has been taken by governments. In 1992, Australian Health Ministers endorsed a whole of government approach by endorsing the National Mental Health Strategy. This strategy consisted of the National Mental Health Policy, the National Mental Health Plan, and the Mental Health Statement of Rights and Responsibilities. The strategy has been reaffirmed on a number of occasions since Most recently the National Mental Health Policy was revised in 2008 and the Fourth National Mental Health Plan was released in Following the National Mental Health Strategy in 1992, in 1996 mental health was (and continues to be) identified as a national health priority area. This is in recognition of its significant contribution to the burden of illness and injury on the Australian community. As a national health priority area, this supports programs of collaborative action across governments, non-government organisations, service providers, clinicians, consumers and carers. Continuing the whole-of-government approach, in 2006 the Council of Australian Governments (COAG) endorsed the National Action Plan on Mental Health This targeted service improvements to mental health through measures including increased access and availability of services (the Better Access initiative), promotion and greater community awareness, and a focus on growing and building workforce capacity. In the budget, the Australian Government committed an additional $1.5 billion worth of additional funding for mental health initiatives, which when combined with previous budget commitments, equated to a record $2.2 billion worth of expenditure over a five-year period. Additionally, the Government also announced the establishment of the National Mental Health Commission, to monitor and evaluate the system as a whole by working closely with consumers, carers, stakeholders and all jurisdictions, and to seek and share knowledge and information on program and service evaluation 5. 6

7 Most recently, COAG endorsed the Roadmap for National Mental Health Reform in December The Roadmap outlines the reform directions governments will take over and reaffirms COAG s ongoing commitment and strategies to addressing mental health issues. The Roadmap also introduces new governance arrangements to ensure that governments are held to greater account for the commitments outlined in the Roadmap. Work HWA is conducting In line with the broader government commitment to mental health, and recognising the need for a national approach to develop and support a skilled and sustainable mental health workforce, HWA has established a mental health workforce program of work. The program is currently comprised of three projects: 1. Mental Health Peer Workforce project which aims to develop a better understanding of the peer workforce in Australia and barriers to their use; and to provide policy advice on training, regulatory and practice changes required to establish a career pathway for mental health peer workers into the mental health workforce. 2. Mental Health Capabilities Project which will develop mental health workforce capabilities, articulating functions across the continuum of mental health services and work roles. 3. Mental Health Workforce Study a foundation piece of work aiming to build the quantitative evidence on workforces delivering services to mental health consumers. The study is comprised of a data inventory, professionspecific supply and demand workforce projections, and potentially sector workforce planning (dependent on the release of the National Mental Health Service Planning Framework, a project funded by the Australian Government Department of Health and Ageing, and being led by the NSW Ministry of Health in partnership with Queensland Health and other jurisdictions). The Mental Health Workforce Planning Data Inventory The Mental Health Workforce Planning Data Inventory (the Inventory) is the first step in the Mental Health Workforce Study. Workforce is essential in delivering quality services to mental health consumers. The importance of, and focus on the mental health workforce is reflected in the creation of the National Mental Health Workforce Strategy and National Mental Health Workforce Plan, which were endorsed by Health Ministers in The Strategy aims to develop and support a well-led, high performing and sustainable mental health workforce that delivers quality, recovery focused mental health services, with the Plan identifying specific activities in support of the Strategy 6. In any workforce planning, the first key step is to understand the existing workforce. This encompasses both the supply and demand sides understanding the number and characteristics of the existing workforce as well as the service demand for the workforce. In mental health, services are delivered in a range of settings, and are funded through different levels of government and different government departments. This makes it difficult to develop a reliable and coherent understanding of the size and distribution of the mental health workforce 7. By identifying the current availability of quantitative data on the workforces delivering services to mental health consumers, and highlighting related data limitations and gaps, the Inventory begins to build the evidence base about the workforces involved in the care and support of people with mental illness. The Inventory is divided into the following six sections. 1. What workforces deliver services to mental health consumers? outlining the workforces in scope of the Inventory. 2. Key findings presenting the key findings from the Inventory. 3. What data is available for the workforces in scope of the Inventory? examining each workforce individually, and presenting summary information on: the role of the workforce generally, and more specifically within mental health service provision. 7

8 data available, including a snapshot of latest available data. data limitations. 4. What data is available to measure demand for workforces delivering services to mental health consumers? knowing the demand for workforces providing services to mental health consumers is important in determining how many people you need in the workforce. This section identifies information sources available to measure current service utilisation (expressed demand). 5. What data is available on workforce entrants and exits? knowing the number of people entering and exiting workforces delivering services to mental health consumers is an important component of workforce planning. This section identifies and describes information sources available on workforce inflows and outflows. 6. Detailed data statements presenting detailed data statements (where possible) for the identified data collections. These statements provide information including the scope and coverage of the collection, the frequency of collection and information on data availability. What workforces deliver services to mental health consumers? To develop the Inventory, the workforces involved in delivering services to mental health consumers needed to be identified. To do this, mental health services provided in Australia were identified, and from that, the workforces that commonly deliver those services were identified. Mental health services At its broadest, the mental health system can encompass services including: Population-based services such as mental health promotion and mental illness prevention Services targeted to individual need, such as the specialist public mental health system, private practitioners such as psychiatrists and other health professionals providing mental health services General and specialist health services that deal with co-morbidities such as drug and alcohol abuse Psychosocial rehabilitation and disability/recovery support services, such as employment and housing, used by people affected by mental illnesses Other services that deal with people with mental illnesses, for example, police. The National Mental Health Service Planning Framework (NMHSPF), one of the key initiatives in the Fourth National Mental Health Plan, is being developed to provide a population-based planning model for mental health that will better identify service demand and care packages across the sector in both inpatient and community environments 8. As part of this project, a nationally agreed taxonomy for mental health care is being developed, which will describe the full range of services in a mental health system (without specifying who delivers the services). Ideally, this taxonomy would have formed the basis for identifying mental health workforces in scope of the Inventory, however it was not publicly available during the Inventory s development. The Roadmap for National Mental Health Reform defines mental health services as: Services in which the primary function is to provide clinical treatment, rehabilitation or community support targeted towards people affected by mental illness or psychiatric disability, and/or their families and carers. For the purpose of the Inventory, HWA has adopted the definition used by the Roadmap for National Mental Health Reform , rather than take a broader approach encompassing mental health promotion, prevention, dealing with co-morbidities such as drug and alcohol abuse, and support services such as employment and housing. Focusing on mental health services targeted to individual need provides a realistic scope for this first step in the Mental Health Workforce Study. Future work may expand to encompass services across the whole mental health system. 8

9 Mental health service provision occurs via a complex set of interrelated services. Public, private and non-government service providers exist, delivering care through multiple service types and settings. Funding is provided by different levels of government and different government departments, and service delivery frameworks vary across states and territories. Figure 1 catalogues the primary methods of mental health service provision (relevant to the definition of mental health services being adopted by HWA for this Inventory). Figure 1: Mental health service types Service types Primary care and community care Private sector specialist mental health services Hospitals and other residential care General practitioner services Services provided by general practitioners to undertake early intervention, assessment and management of patients with mental illness, as well as providing referrals to other health professionals. Community based ambulatory care This includes outpatient clinics, mobile assessment and treatment teams, day programs and other services dedicated to the assessment, treatment, rehabilitation and care of people affected by mental illness or psychiatric disability who live in the community. Community based NGO services Services include accomodation outreach to support people living in their own homes, residential rehabilitation units, recreational programs, self-help and mutual support groups, carer respite services and system-wide advocacy. Private mental health services Consultation services provided by private practitioners, including psychiatrists, mental health nurses and allied mental health professionals in private practice. Services can be provided in a range of settings including hospitals, consulting rooms, home visits, over the phone and online. Emergency department Services to patients who present at an emergency department with an urgent need for medical care. Admitted patient mental health related care Services provided on admission to hospital, either public acute, public psychiatric or private hospital and can be with or without specialised psychiatric care. Ambulatory-equivalent admitted patient care Services comparable to those provided in community-based ambulatory care but provided on admission to hospital. Residential care Specialised mental health services including rehabilitation, sub-acute services, treatment or extended care, in a domesticlike environment on an overnight basis. Source: Derived from the Australian Institute of Health and Welfare, Mental Health Services in Australia, the Roadmap for national mental health reform and the National Mental Health Workforce Strategy. 9

10 Workforces delivering services to mental health consumers Workforces can work across the service types identified in Figure 1; and increasingly within the mental health sector, as well as more broadly across the health sector, services are being delivered in interprofessional multidisciplinary teams. The question was therefore raised on how far to extend the scope in including workforces in the Inventory. To this end, HWA was primarily guided by the National Mental Health Workforce Strategy and National Mental Health Workforce Plan that the mental health workforce encompasses those workforces whose primary role involves early intervention, referral, treatment, care or support to people with a mental illness, in a mental health service or other health service environment, including non-government community mental health services. The Strategy goes on to list those workforces as including: mental health nurses, psychiatrists, general registered nurses, enrolled nurses, general and other medical practitioners, occupational therapists, social workers, psychologists, Aboriginal mental health workers, Aboriginal health workers, mental health workers, consumer and carer workers. All of these workforces deliver services within the service types identified in Figure 1, and are in scope of this Inventory. HWA has also included pharmacists, dietitians and speech pathologists in the Inventory. While their primary role is not in the early intervention, referral, treatment, care or support to people with a mental illness, they can play a significant role, particularly as part of interprofessional multidisciplinary teams, in delivering services (in the described service types) to mental health consumers. Therefore they have been included in the Inventory. HWA recognise other workforces such as exercise physiologists, art therapists and music therapists can also deliver services to mental health consumers, however they have not been included at this stage of the Mental Health Workforce Study. Table 1 lists the workforces in scope of this Inventory, and the service types they generally operate within. Table 1: Workforces delivering mental health services Service type Workforce Primary care and community care Private mental health services Hospitals and other residential care Primary workforces Aboriginal mental health workers O Aboriginal and Torres Strait Islander health workers O Enrolled nurses O GPs O Mental health nurses O O O Mental health workers O O Occupational therapists O O O Peer workers O O Psychologists O O O Psychiatrists O O Registered nurses O O Social workers O O O Other significant workforces Dietitians O O O Pharmacists O O Speech pathologists O O O 10

11 Methodology The Inventory covers those workforces specified in Table 1. The Inventory is primarily limited to national, publically available data. Therefore this inventory should not be viewed as an exhaustive collation of mental health workforce data in existence, but a summary of known national data sources. To identify relevant data sources for the Inventory, desktop internet research was conducted, and extensive use was made of work previously conducted by the Mental Health Standing Committee. The draft Inventory was provided to the members of the HWA Mental Health Workforce Reform Program Advisory Group (PAG), and a representative from the Mental Health Information Strategy Sub-Committee for: Feedback on the structure and content of the Inventory. Assistance in identifying additional data sources for inclusion in the Inventory. Relevant Inventory entries were also supplied to professional bodies for review, where the professional body was not a member of the HWA Mental Health Workforce Reform PAG. 11

12 Key findings To be able to conduct workforce planning, three components need to be able to be enumerated: the existing workforce and their characteristics the demand for the workforce, and entrants to and exits from the workforce. Data sources available for each of these aspects for the workforces in scope of the Inventory were examined. Enumerating the existing workforces delivering services The data sources available to describe the workforces currently delivering services to mental health consumers were considered against five criteria to provide an indication of how suitable they are for workforce planning purposes. The five criteria were: Timeliness: has the data has been collected recently (within the last five years)? Frequency: is the data collected and published on a regular (annual, biannual) basis? Coverage: is the data representative of the national workforce? Completeness: does the data incorporate key variables required for workforce planning? Reliability: has the data been collected and sourced using appropriate methods and providers? As highlighted in the Inventory, the National Health Workforce Dataset (NHWDS) provides a strong basis for understanding the existing characteristics of the registered occupation workforces. A current limitation with the NHWDS is that it is relatively new, with limited time-series information and for one profession (occupational therapy), national information will not be available until However as the NHWDS is an annual collection, these limitations are short-term only. For non-registered occupations, the primary national source of information identified is the Australian Bureau of Statistics Census of Population and Housing. However, for workforce planning purposes, limitations associated with this include that information is self-reported, and responses provided depend on an individual s understanding and interpretation of the questions asked. For example, people who self-report as a particular occupation may not meet the occupational definition, or have appropriate qualifications. In addition, as the Census is conducted every five years, information is quickly out-of-date for workforce planning purposes. Perhaps the major limitation, regardless of data source, is identifying the amount of time a practitioner spends on mental health service provision (for those occupations where the role is not dedicated to mental health). So even having a well-enumerated workforce does not mean workforce planning can necessarily be conducted for mental health specifically, if it cannot be identified how much of a practitioner s time relates to mental health service provision. For the peer workforce, mental health workers, Aboriginal and Torres Strait Islander health workers and Aboriginal mental health workers, the lack of a nationally agreed definition means information is not currently available to reliably enumerate these workforces. Therefore for these workforces, there is no current base on which to start workforce planning. Table 2 summarises the suitability of current data sources available describing the existing workforces against the five criteria for workforce planning purposes. 12

13 Table 2: Evaluation of data sources identified in the Inventory Workforces Suitable for workforce modelling Timeliness Frequency Coverage Completeness Reliability Primary workforces Aboriginal mental health workers O Aboriginal and Torres Strait Islander health workers (a) O P P P P Enrolled nurses (b) O P P P P GPs (b) O P P P P Mental health nurses (c) P P P P P P Mental health workers O Occupational therapists (b) O P P P P Peer workers O Psychologists P P P P P P Psychiatrists P P P P P P Registered nurses (b) O P P P P Social workers O P Other significant workforces Dietitians O P Pharmacists (b) O P P P P Speech pathologists O P (a) The NHWDS is a suitable data source for Aboriginal and Torres Strait Islander Health Practitioners, however this workforce is only a subset of the Aboriginal and Torres Strait Islander health workforce. (b) Although the NHWDS provides a suitable data source for these workforces, it is not currently possible to quantify the contribution of this workforce to mental health service provision. (c) Using the AIHW and HWA definition that a mental health nurse is a registered nurse or enrolled nurse who reported their principal area of practice as mental health (regardless of any postgraduate qualification). 13

14 Measuring demand for workforces delivering services In terms of measuring demand for workforces delivering services to mental health consumers, an extensive number of datasets are available. However significant limitations exist in relation to measuring demand for workforce planning purposes. Firstly, there is incomplete coverage of services provided across the mental health sector specifically there is currently no national data collection for mental health service provision in the non-government organisation (NGO) sector. The NGO sector contribution to mental health service provision has increased substantially in recent years with the move to a recovery-focused service delivery approach, and the lack of information on this sector is a significant data gap. The Australian Institute of Health and Welfare (AIHW) is currently developing the Mental Health Non-Government Organisation Establishments National Minimum Data Set (MH NGOE NMDS), which once established, will allow routine, standardised collection of data relating to mental health NGOs. However the planned implementations for the MH NGOE NMDS is Incomplete coverage also refers to measuring the number of mental health services accessed. Most Medicare programs have a capped number of services per calendar year, which means not all visits to eligible mental health professionals will necessarily be captured. For example, under the Better Access initiative a consumer is eligible for a maximum of ten individual calendar sessions per year with an allied health professional. While consumers are not prevented from receiving further assistance, any further assistance given beyond the ten sessions is not captured by Medicare. Similarly, private health insurance funds have caps on the dollar amounts claimable through their policies, and once that amount is exceeded, further claims cannot be made, and any subsequent private consultations are not captured. Therefore it is likely a substantial amount of workforce activity is not captured. Finally, there is a lack of information on associating specific workforces with mental health service delivery. While some information is available from Medicare and the Private Health Insurance Administration Council (PHIAC) on which workforces are providing services, from many of the NMDS collections, it is not known what workforces deliver what services to the consumer. While the NMDS information can be used to measure an overall expressed demand for mental health services, applying this demand to individual workforces is problematic. For national workforce planning this is further complicated by the fact mental health service delivery frameworks differ across states and territories. Measuring entrants to, and exits from, workforces delivering services There are two primary streams of workforce entrants those that enter from education and those that enter through migration. Information sources exist for each of these streams. The primary limitation for workforce entrants relates to those workforces where there is not a defined or consistent education pathway through to the relevant occupation, such as Aboriginal and Torres Strait Islander health workers, Aboriginal mental health workers, peer workers and mental health workers. Workforce exits are a measure of the number of people who permanently or temporarily leave the workforce. The ability to calculate workforce exits varies between the registered and non-registered occupations because of data availability. For the registered occupations, workforce exists will be able to be derived from the Australian Health Practitioner Regulation Agency (AHPRA) registration data (upon at least two data points being available). For the non-registered occupations, measuring workforce exits is problematic because they do not have frequent, comparable data collections providing information on the number of practitioners. 14

15 What data is available for the workforces in scope? In workforce planning, the first step is to understand the existing workforce the number of workers and their characteristics, including age, gender, location and hours worked. In this section of the Inventory, each workforce listed in Table 1 is examined and summary information is presented on: The role of the workforce generally, and more specifically within mental health service provision. Data available, including a snapshot of latest available data. Data limitations. Information is presented firstly for those primary workforces identified as in scope of the Inventory, followed by the other significant workforces included in the Inventory. Primary workforces Primary workforces are those whose primary role involves early intervention, referral, treatment, care or support to people with a mental illness, in a mental health service or other health service environment, including non-government community mental health services. The following workforces were listed in the National Mental Health Strategy as primary workforces. All deliver services within the service types identified in Figure 1 in this report, and are therefore in scope of this Inventory: Aboriginal and Torres Strait Islander health workers. Aboriginal mental health workers. General practitioners. Mental health nurses. Mental health workers. Occupational therapists. Peer workers. Psychologists. Psychiatrists. Registered nurses and enrolled nurses. Social workers. 15

16 Aboriginal and Torres Strait Islander health workers The Aboriginal and Torres Strait Islander health worker workforce evolved from the need to provide health services to Aboriginal and Torres Strait Islander people whose health needs were not being met by mainstream services. With the evolvement of the role, Aboriginal and Torres Strait Islander health workers perform different tasks depending on what services are needed in their local context. This is now reflected in the wide degree of variation that exists in Aboriginal and Torres Strait Islander health worker roles, definitions, scopes of practice, education standards and career pathways 9. Commonly, Aboriginal and Torres Strait Islander health workers: perform a comprehensive primary health care role, for example, clinical assessment, monitoring and intervention activities, and health promotion provide culturally safe health care to Aboriginal and Torres Strait Islander people, such as advocating for Aboriginal and Torres Strait Islander clients to explain their cultural needs to other health professionals, and educating or advising other health professionals on the delivery of culturally safe health care adapt the roles they perform in response to local health needs and contexts 10. Eligible Aboriginal Health Workers can provide services under Medicare chronic disease management items. To be eligible, Aboriginal Health Workers need a Certificate Level III in Aboriginal and Torres Strait Islander Health from a registered training organisation (as a minimum). In the Northern Territory, Aboriginal Health Workers have been registered since This reflected the fact that Aboriginal Health Workers adapted their skills and learnt how to perform the clinical procedures that were in demand in their community. Registration was consequently introduced to protect people receiving these services 11. No other states or territory, until the introduction of the National Registration and Accreditation Scheme (NRAS) required Aboriginal Health Workers to be registered. In 2012, under the NRAS, Aboriginal and Torres Strait Islander health practitioners became a registered occupation. It should be noted that Aboriginal and Torres Strait Islander health practitioners are a subset of the Aboriginal and Torres Strait Islander health worker workforce. Under the NRAS, practitioners who are not required by their employer to use the titles Aboriginal and Torres Strait Islander health practitioner, Aboriginal health practitioner or Torres Strait Islander health practitioner, are not required to be registered, and are able to continue to work using the title Aboriginal Health Worker (unless they are practicing in the Northern Territory) 12. Upon the introduction of the NRAS, all people registered with the Northern Territory Aboriginal Health Workers Board were automatically registered as Aboriginal and Torres Strait Islander health practitioners. Recognising the complexity of the Aboriginal and Torres Strait Islander health worker workforce, and the barriers this creates for professional recognition, education and career pathways, one of the recommendations made in the HWA report Growing Our Future: the Aboriginal and Torres Strait Islander health worker Project Final Report was to: Endorse the national definition of an Aboriginal and Torres Strait Islander health worker as a person who: a. identifies as an Aboriginal and/or Torres Strait Islander and is recognised by their community as such, and b. is the holder of the minimum (or higher) qualification in Aboriginal and Torres Strait Islander primary health care, and c. has a culturally safe and holistic approach to health care. The above recommendation was noted by the Standing Council on Health, and the definition has been endorsed by the National Aboriginal Community Controlled Health Organisation, and the National Aboriginal and Torres Strait Islander Health Worker Association. 16

17 What is the role of an Aboriginal and Torres Strait Islander health worker in mental health service provision? Aboriginal and Torres Strait Islander health workers can work closely with consumers, carers and health care teams. They can undertake a range of roles in mental health service provision, including providing individual support, educating mental health workers on delivering culturally safe health care, acting as interpreters to ensure that the healthcare practitioner is clear about the patient s symptoms, medical and personal history and that the patient has a good understanding of the diagnosis, treatment and health care advice. Quantitative data available for Aboriginal and Torres Strait Islander health workers Australian Bureau of Statistics Census of Population and Housing (the Census) The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and characteristics of people who self-report as an Aboriginal and Torres Strait Islander health worker can be identified. In the Census, the Australian and New Zealand Standard Classification of Occupations (ANZSCO) is used to classify occupations, and in this classification, an Aboriginal and Torres Strait Islander health worker is defined as liaising with patients, clients, visitors to hospitals and other medical facilities and staff at health clinics, and works as a team member to arrange, coordinate and provide health care delivery in Aboriginal and Torres Strait Islander community health clinics. NHWDS: Aboriginal and Torres Strait Islander health practitioners Although only a subset of the Aboriginal and Torres Strait Islander health workforce, the NHWDS provides information on the number and characteristics of registered Aboriginal and Torres Strait Islander health practitioners. Characteristics of Aboriginal and Torres Strait Islander health workers Table 3 presents the latest available information from the Census on the number and characteristics of Aboriginal and Torres Strait Islander health workers (as defined by ANZSCO); and from the NHWDS on the number and characteristics of clinician Aboriginal and Torres Strait Islander health practitioners, that is, those who spent the majority of their time working on the diagnosis, care and treatment of patients. Please note, information from the Census is presented for those Aboriginal and Torres Strait Islander health workers who identified as being of Australian Aboriginal and/or Torres Strait Islander origin. 17

18 Table 3: Characteristics of the Aboriginal and Torres Strait Islander health worker workforce Characteristics Number Year Data source Headcount Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Full-time equivalent (FTE) (a) Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners FTE rate per 100,000 Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Average weekly hours Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Average age Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Per cent female Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners Per cent major cities: inner regional: outer regional: remote or very remote Aboriginal and Torres Strait Islander health workers Aboriginal and Torres Strait Islander health practitioners (b) 22: 19: 23: 36 3: 4: 31: Census NHWDS Census NHWDS Census NHWDS Census NHWDS Census NHWDS Census NHWDS Census NHWDS Per cent sector (public: private) Aboriginal and Torres Strait Islander health workers 64: Census Work setting Aboriginal and Torres Strait Islander health practitioners Aboriginal health service Community healthcare services Hospital Correctional services Other government department or agency Unknown/inadequately described/not stated Workforce inflows Higher education students (c) Student commencements Student completions Vocational education students (d) Commencing course enrolments Course completions Workforce outflows Workforce vacancies n.a. n.a NHWDS DIICCSRTE DIICCSRTE NCVER NCVER n.a. not available (a) FTE calculated based on a 38 hour standard working week. (b) Calculated for all employed Aboriginal and Torres Strait Islander health practitioners. At time of publication, information was unavailable by remoteness area for clinician Aboriginal and Torres Strait Islander health practitioners. (c) Students who identified as Indigenous, in higher education courses coded to the Indigenous health field of education. (d) Where course occupation is coded to ANZSCO code Aboriginal and Torres Strait Islander health worker and student identified as Indigenous. 18

19 Data limitations While Census information is available on the number and characteristics of Aboriginal and Torres Strait Islander health workers, the ANZSCO definition used may not be representative of all Aboriginal and Torres Strait Islander health workers given the variation in roles, definitions and scopes of practice. For workforce planning purposes, limitations also exist with Census data. Information is self-reported, and responses provided depend on an individual s understanding and interpretation of the questions asked. In addition, as the Census is conducted every five years (while providing information on long-term trends), information is quickly out-of-date for workforce planning purposes. Aboriginal and Torres Strait Islander health workers conduct a substantial amount of work outside of mental health service provision. Consequently, a major limitation for workforce planning is the difficulty in measuring specific Aboriginal and Torres Strait Islander health worker mental health related activity there is no data source available for this. The Aboriginal and Torres Strait Islander health practitioner NHWDS provides information on a subset of Aboriginal and Torres Strait Islander health workers only. As noted earlier, practitioners who are not required by their employer to use the titles Aboriginal and Torres Strait Islander health practitioner, Aboriginal health practitioner or Torres Strait Islander health practitioner, are not required to be registered. Therefore coverage of the population of interest is limited. The same as Aboriginal and Torres Strait Islander health workers, Aboriginal and Torres Strait Islander health practitioners also work outside of mental health service provision. However the NHWDS survey form asks people to record the work setting of their main job, and community mental health service and residential mental health care service are options. This information could be used to identify the number of Aboriginal and Torres Strait Islander health practitioners primarily providing mental health services. Relevant to the data limitations identified in this Inventory, is a recommendation from the HWA report Growing Our Future: the Aboriginal and Torres Strait Islander health worker Project Final Report, to: Develop a national approach to collecting data on the Aboriginal and Torres Strait Islander health worker workforce to establish a consistent national dataset across employment sector. 19

20 Aboriginal mental health workers There is currently no nationally agreed definition of an Aboriginal mental health worker (AMHW), and no common expectations as to their role, required experience and/or qualifications. For example, in Queensland, the primary role of an Aboriginal and Torres Strait Islander mental health worker is described as providing cultural support and guidance to clinical staff, establishing and maintaining networks with various community organisations and providing culturally appropriate mental health and social and emotional well-being promotion and prevention programs to the Aboriginal and Torres Strait Islander Community 13. In the Northern Territory, AMHWs are described as providing a link between community, culture and practices, and government and non-government health programs, as well as working with doctors and nurses and providing support care and advice for families, individuals and groups within the community 14. The Royal Australian and New Zealand College of Psychiatrists takes a broader approach, defining Aboriginal and Torres Strait Islander mental health workers as All Aboriginal and Torres Strait Islander people who work with mental health or emotional and spiritual well-being services for Aboriginal and Torres Strait Islander people within Australia. In New South Wales, AMHWs must meet minimum qualification requirements for employment. A dedicated program also exists (the New South Wales Aboriginal Mental Health Workforce Program) to increase the supply and standing of the AMHW workforce, and increase the education, retention and representation of Aboriginal people in specialist and primary mental health service delivery 15. The lack of a nationally agreed definition is reflected in the differing levels of information and policies surrounding the AMHW workforce across jurisdictions. Some states and territories include the AMHW role under the role of Aboriginal Health Workers 16, while others have structured programs and policies specifically about AMHWs, for example the Statewide Specialist Aboriginal Mental Health Service model in Western Australia and the New South Wales Aboriginal Mental Health Workforce Program. What is the role of an Aboriginal mental health worker in mental health service provision? Despite there being no nationally agreed definition of an AMHW, role descriptions commonly refer to AMHWs working in multidisciplinary teams, and providing links between community, culture and government, and cultural support to other health workers. Services provided by AMHWs can include crisis support to community members, mental health promotion, assisting GPs and other health workers in clinical consultations, assisting people to care and primary mental health liaison and linkage with specialist acute care 17. There can be overlap between the role of an Aboriginal and Torres Strait Islander health worker and an AMHW, and the role of an AMHW can be encompassed in the broader definition of an Aboriginal and Torres Strait Islander health worker in some jurisdictions. Where a distinction is made between the two roles, the main point of difference is that an AMHWs role is specific to a mental health context, whereas this is not necessarily the case for an Aboriginal and Torres Strait Islander health worker they can work in mental health areas, however their scope of practice is generally broader. Quantitative data available for the Aboriginal mental health workforce National, publicly available information on AMHWs was not identified in the preparation of this Inventory. Unpublished data may be available from sources such as Aboriginal Medical Services. 20

21 General practice (GP) workforce GPs are medical specialists who provide primary medical care meaning person-centred, continuing, comprehensive and coordinated whole person health care to individuals and families in their communities. GPs are usually the first medical specialist a person sees for health care in Australia. GPs scope of practice is broad, spanning prevention, health promotion, early intervention, and the management of acute, chronic and complex conditions within the practice population whether in the home, practice, health service, outreach clinic, hospital or community 18. What is the role of a GP in mental health service provision? GPs are often the first health professional a person sees when seeking assistance for mental illness. GPs can undertake early intervention, assessment and management of patients with mental illness, including prescribing medication, and referring patients to other specialists, health professionals and support groups. Quantitative data available for the GP workforce NHWDS: Medical Practitioners (2010 onwards) The NHWDS combines data from the NRAS with survey data collected on each of the registered health professions at the time of annual registration renewal. It provides information on counts of medical practitioners by type of specialist (including GPs), and includes demographic and employment information. AIHW Medical Labour Force Survey (pre-2010) This was the primary data collection on registered medical practitioners prior to the NHWDS, providing information on the demographics and employment status of registered doctors. Information was collected through questionnaires administered annually by the state and territory registration boards. Information was collected on primary care practitioners, which was mostly comprised of GPs. GP Workforce Statistics Department of Health and Ageing (DOHA) DOHA GP statistics provide the number of GPs by headcount, FTE and full-time workload equivalent annually. Counted are all GPs who provided at least one Medicare Service during the reference period and had at least one claim for Medicare service processed during the same reference period. The Census The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. It is conducted every five years, and its objective is to accurately measure the number and key characteristics of people who are in Australia on Census Night, and of the dwellings in which they live. From the Census, the number and detailed characteristics (including labour force status, age, gender, hours worked and country of birth) of people who self-report as a general medical practitioner can be identified. 21

22 Characteristics of the GP workforce Table 4 presents the latest available information from the NHWDS and other sources on the GP workforce. Information presented from the NHWDS relates to employed GPs only. Table 4: Characteristics of the GP workforce Characteristics Number Year Data source Headcount 25, NHWDS FTE (a) 24,492 Full-time workload equivalent (b) 21, NHWDS DOHA FTE per 100, NHWDS Average weekly hours NHWDS Average age NHWDS Per cent female NHWDS Per cent major cities: inner regional: outer regional: remote or very remote 70: 19: 8: NHWDS Work setting Private practice Aboriginal health service Community healthcare services Hospital Residential healthcare services Commercial/business services Education facility Correctional services Defence force Other government department or agency Other Workforce inflows Vocational training positions/trainees Advanced (RACGP/ACRRM) New fellows (RACGP/ACRRM) Immigration (c) Temporary visa grants Permanent visa grants Workforce outflows Workforce vacancies 22, / / n.a. n.a NHWDS MTRP MTRP DIAC DIAC n.a. not available (a) FTE calculated based on a 40 hour standard working week. (b) Full-time workload equivalent takes into account differing working patterns of doctors, and is calculated by dividing each doctor s Medicare billing by the average billing of full-time doctors for the year. (c) For ANZSCO code General Medical Practitioner. 22