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PART EIGHT: APPENDICES

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8.4 Responses from State, Territory and Federal Governments

8.4 RESPONSES FROM STATE, TERRITORY AND FEDERAL GOVERNMENTS

8.4.1 RESPONSE FROM NEW SOUTH WALES GOVERNMENT

Download Letter from Morris Iemma, Minister for Health, Dated 4 May 2005 in PDF format
Download Letter from Morris Iemma, Minister for Health, Dated 4 May 2005 in Word format

NSW Health Response to Mental Health and Human Rights Report

NSW Health welcomes the opportunity to comment on the report of the Mental Health Council of Australia, The Brain and Mind Institute, in association with the Human Rights and Equal Opportunity Commission.

The principal objective of NSW mental health services is to improve the health, wellbeing and social functioning of people with disabling mental disorders and to reduce the incidence of suicide, mental health problems and mental disorders in the community.

To meet those objectives in 2004-05, the NSW Government allocated a $783 million to serve an estimated consumer population of about 100,000, focusing primarily on those people with severe and disabling mental health disorders. NSW mental health services comprised (in 2003-04) 5,573 full-time equivalent clinical staff, who provided 24,642 episodes of acute overnight inpatient care, 261,327 days of non-acute inpatient care and about 2 million community contacts.

In addition, NSW Health continued its telephone survey program to assess population levels of psychological distress in adults and parent-reported problems in children and young people, finding that the levels of both were about the same as in previous years and other countries. In 2003-04 hospitals in NSW admitted 9,500 people after suicide attempts, and the death rate by suicide dropped to 9.6 per 100,000 population, the lowest rate in Australia and the lowest level reached in more than 20 years.

Based on views expressed by those who attended consultations and made submissions, the MHCA report prepared with the assistance of Professor Hickie from the Brain and Mind Research Institute at Sydney University , in association with the Human Rights Commissioner Dr Ozdowski, is critical of mental health services provided by States and Territories.

In the section of the report covering NSW there are about 470 quotations judged to reflect “matters of concern”, including more than 100 citations regarding Standard 9 (service development). More than half of those 100 quotations come from just six submissions, all made by clinicians or clinical groups, each cited between 5 and 15 times. In NSW Health's view, the report's methodology places excessive emphasis on the opinions of service development expressed by a very small number of clinicians.

There is an important distinction to be made between what mental health services usually do, and what happens when, on occasion, services do not deliver what consumers and carers expect of them. While it is acknowledged that consumers and carers have reported unacceptable care and treatment, NSW Health does not accept that the report provides convincing evidence of NSW mental health services generally failing in their duty of care.

Mental health is a priority for the NSW Government. The Mental health budget is now at record levels, having increased 121 per cent since 1994-95. Demand for services continues to grow, and many existing services are under pressure. There is no doubt more needs to be done and NSW Health has plans to accelerate this growth in services over the next four years. Details are set out below:

Hospital and Emergency Services

Since June 2001, an additional 257 mental health beds have opened with a further, 40 beds to open by June 2005. These include additions or new units at:

Wyong, Tweed Valley , Coffs Harbour , Taree, Kempsey, Tamworth, Wagga Wagga, Albury, Wollongong and Bloomfield Hospital in Orange
child and adolescent beds at Westmead Hospital, Gna Ka Lun at Campbelltown, the Nexus Unit at John Hunter in Newcastle, Sydney Children's Hospital and Westmead Children's Hospital; and
refurbishments and additional beds at Prince of Wales, St George, Sutherland, Westmead, Cumberland and Nepean Hospitals .

Over the next three years the NSW Government will open 246 more mental health beds. They include:

Acute units at Lismore, Dubbo, Liverpool and Blue Mountains
100 longer stay beds in four 20 bed units at Campbelltown, St George, Shellharbour, Coffs Harbour and the Hunter
A new child and adolescent unit in Lismore
An older person's unit in Wollongong
Additional forensic mental health beds in a new stand alone Forensic Hospital ; and
A brand new 174 bed mental health facility to be built at Concord Hospital replacing the existing facilities at Rozelle. The first phase of this has begun, with the transfer of 40 psycho-geriatric beds from Rozelle Hospital to the new community health facility in Croydon.

Clinical Nurse Consultants have been employed in Emergency Departments to identify, triage and provide specialist care to patients with a mental illness in hospitals at:

Bankstown, Campbelltown, Gosford, Hornsby, Liverpool, Nepean, Prince of Wales, Royal North Shore, Royal Prince Alfred, St George, Sutherland, St Vincent's, Westmead, Albury-Wodonga, Blue Mountains, Coffs Harbour, Lismore, Maitland, Shellharbour, Tamworth and Taree.

Psychiatric Emergency Care Centres (PECCs) are dedicated services, situated adjacent to the Emergency Department, staffed 24 hours a day, 7 days a week by specialist mental health staff. PECCs have been successfully trialled at Liverpool and Nepean Hospitals and the program is being expanded with PECCs at St Vincent's, St George and Hornsby Hospitals and other centres to follow.

Based on its Mental Health – Clinical Care and Prevention planning model, NSW Health has been building up the less-resourced Areas while maintaining and improving those with higher resource levels. NSW Health has ensured that community as well as inpatient services are being enhanced, with the following developments:

Community Mental Health Services The NSW Government invests 45 per cent of the total mental health budget on community mental health services. In 2004/05, 2,570 mental health staff are working in the community – up from 1,398 in 1994-95.

Housing: A joint initiative between Health, Housing and non-government organisations - the Housing, Accommodation and Support Initiative (HASI) - is providing coordinated disability support, accommodation and health services to over 118 people requiring high-level support to live in the community. HASI Phase 2 is now being implemented with successful tenders awarded to NGOs to provide disability assistance to a further 460 people in public and community housing across NSW.

Court Liaison: In 2003/4 the NSW Government formally established the Statewide Court Liaison Service - a partnership between Health, Police, the Attorney General and Corrective Services. That year it screened 18,902 court attendees, referred 1,945 people for assessment and found 1,413 to have an identifiable mental illness. Of these, 204 were treated in hospital and 702 were provided with treatment by community mental health services. The Court Liaison Service now operates in 19 courts across metropolitan and regional NSW, starting from a two court pilot in 2000.

Human Rights and Legislative Issues

There seems to be a misapprehension in some submissions that NSW Health is over-emphasising the provision of acute inpatient services and adopting a custodial attitude. This is not so. The recent emphasis on adding acute inpatient beds and psychiatric emergency care is driven by the identified need to improve access to acute mental health services in NSW. As noted above, this has not occurred at the expense of community mental health.

NSW Health is not moving to a more custodial mode of service provision in mental health. The NSW Mental Health Act 1990 received favourable mention in the original Burdekin Report of 1993 for its efforts to place key definitions in law, and this requires constant review. The current review of the Mental Health Act sought views on these elements - there was strong endorsement of these definitions and there is no intention to amend them. The discussion papers are available at www.health.nsw.gov.au/pubs/2004/menthealthrev.html.

The formal submission phase of the review concluded in October 2004, but additional input will be sought when an exposure draft Bill is circulated. A further public consultation process on the review of the Mental Health Act has commenced, and NSW Health encourage all to consider the discussion papers and provide comment on to the exposure draft Bill.

Obtaining and responding to consumer and carer feedback

The NSW approach to this area is a direct result of consumer requests in 2001. We have now been working for several years with the NSW Consumer Advisory Group (NSWCAG) on the MH-CoPES (Consumer Perceptions and Experiences of Services) project. MH-CoPES was requested, planned, and managed by consumers. Results are documented at www.mentalhealth.asn.au/members/nswcag under “Projects”.

The aim of MH-COPES is to identify the best way for mental health services across NSW to hear and respond to consumers' views about those services.

The first phase of the project is almost complete, with consultations having been held across NSW in Bega, Yass, Broken Hill, Morisset, Port Macquarie, Tamworth and Griffith in September-December 2004, and Leichhardt, Newcastle and Penrith in February-March 2005. The instrument and process have been developed through a technical working group of twelve (eight of whom are consumers), and via open workshops in which about 130 consumers and service providers have collaborated.

The project team expects to move to Phase 2 of MH-CoPES via large-scale pilot implementation in 2005-06. The MH-CoPES questionnaire should soon be available for inspection, so that readers can verify for themselves what kind of feedback NSW consumers believe NSW Health services should receive and respond to.

The MHCA report notes that state or national authorities with “a genuine commitment to quality improvement” might adopt such mechanisms. NSW Health acknowledges and appreciates this endorsement of its consumer initiative.

Conclusion

If we are to achieve lasting results beyond the headlines, public support for mental health services is essential. The views of mental health consumers and carers are welcomed and their active participation in service provision and planning is essential.

All service improvement starts with open and frank discussion by consumers, carers and staff. To that end NSW Health accepts the report as an expression of legitimate opinion about problems faced in providing appropriate care and treatment of people who live with mental illness.

NSW Health makes many reports and Government responses on mental health issues available in the Publication Section of its website, and we invite readers to view those at http://www.health.nsw.gov.au/pubs/subs/sub_mental.html

8.4.2 RESPONSE FROM VICTORIA GOVERNMENT.

Victorian Context

There is widespread agreement that Victoria has laid the foundations of a comprehensive age based specialist mental health system, which is now well established and contains most of the elements needed to effectively treat and support people with mental illness. As a specialist system, the bulk of external funding is directed towards the clinical treatment of serious mental illness, supplemented by disability support for consumers to live independently in the community. Victoria , when compared nationally, has proportionally the largest community based system of clinical assessment and treatment and non-clinical support, and the greatest number of people treated in psychiatric wards co-located with general hospitals.

Clinical services treat approximately 56,000 continuing care clients per annum in inpatient and ambulatory settings with up to 12,000 clients also using disability support services with a clinical workforce of over 5000 staff. These services are resourced from a total mental health budget of $652 million in 2004-05.

Victorian Service Developments

In Victoria , the current operating environment is one of sustained demand pressure with an average growth of 7% per annum in clients over the last five years. In response to these pressures and the ongoing need to build on past reforms and improve services access, efficiency and effectiveness the Victorian Government has systematically invested more than $198 million in service improvement strategies since 1999-00. This funding has been directed to strengthening core services, implementing early intervention and relapse prevention initiatives, and creating an environment that enables clinical practice and service models to better align with the changing needs of consumers and their carers. Some major new and innovative initiatives include:

Primary Mental Health Teams that build the capacity of general practitioners and other primary health providers to support people with a mental illness through the provision of specialist consultation.
Early Psychosis programs which provide early intervention for young people with an emerging disorder.
Dual Diagnosis services which provide integrated responses to clients with co-existing mental illness and substance abuse.
Sub-acute services that provide transitional step down support from inpatient care to home.
Intensive housing support services for consumers with complex needs.

Mental Health continues to be high priority for the Victorian Government. It's social policy action plan A Fairer Victoria: Creating Opportunity and Addressing Disadvantage released on 28 April 2005 makes a substantial commitment of $180 million over the next four years for mental health service growth and improvement, including $55.5 million for planned capital developments. Mr Jeff Kennett, Chair of Beyondblue stated in the Melbourne Age on 29 April 2005 that this is “the largest contribution to mental health by any state government ever”.

Further improvements will focus on early intervention across the age groups by providing:

Intervention and prevention during the early stages of an emerging disorder (in order to prevent the illness progressing and/or avert escalation and the need for a long period of support).
A quicker service response (to prevent a crisis developing or worsening).
A more intensive service response (to ensure treatment is effective).
Better follow-up after discharge (to prevent relapse of the condition).

Victorian Response to the Report

A formal response for inclusion in the final report was requested in relation to sections of the Mental Health and Human Rights Draft Report forwarded to the Victorian Minister for Health on 24 March 2005. Consequently, the following comments are based on an incomplete draft version of the report.

Whilst information about specific consumer and carer experiences of the mental health system provide a critical contribution to the understanding of its performance, these experiences form part of the picture and do not on their own provide evidence of systemic problems in relation to human rights and national standards. However, Victoria accepts that the views expressed are legitimate and reflect the real experiences of particular individuals and wishes to express regret for the negative experiences described in the Victorian section of the report. Victoria also wishes to assure those people who are concerned with services in this state that any feedback received is taken very seriously and that Victoria will continue to improve its services for consumers and their carers.

Notwithstanding the above statements, Victoria has significant concerns with the report's methodology and findings. These concerns are summarised below:

The report lacks balance as it:
- Draws heavily on the opinions and perspectives of particular individuals and interest groups.
- Currently excludes publicly available information about service improvement, expansion and reform available at a state and national level.
- Shows little evidence of any efforts to elicit or report positive views during the consultation process.
- Gives no weight to the constraints the states and territories operate under including capped budgets and high levels of non-discretionary expenditure.
The report has questionable validity as it:
- Draws on the results of two surveys with very low response rates, and in Victoria, four meetings and 97 submissions (primarily from individuals), which is hardly representative of Victoria 's large consumer, carer and provider base.
- Generalises the experiences of a limited number of organisations and often aggrieved individuals to the whole system.
The report lacks objective data and evidence to support its findings and therefore makes an unconvincing and uninformed case regarding these findings. For example, it has disregarded the accreditation system for national standards, assessments made by the accreditation agency and level of compliance by services. In Victoria , 82% of area mental health services have completed the accreditation process.
The report draws simplistic conclusions about poor consumer and carer experiences which cannot always be attributed to specialist mental health system failures but may be:
- The result of relatively isolated and infrequent events.
- Linked to the diversity of views about involuntary treatment with it's inherent and complex balancing of rights and protections.
- Related to events which occurred many years previously.
The report employs an emotive and adversarial style that undermines its credibility and is likely to prove unproductive in an area of health where strong collaboration and partnership has underpinned progress to date.

Ultimately, the report is misleading and may undermine the confidence of the community, consumers and carers in the public mental health system. Available data in Victoria indicates that the system operates reasonably well most of the time despite sustained and increasing pressure. It should also be noted that the system contains high levels of accountability with checks and balances that are enshrined in legislation and practice. Service and clinical standards and guidelines are the subject of continued improvement and review. Recent amendments to the Mental Health Act have further embedded good practice into legislation.

The report also risks setting unrealistic expectations about what can be delivered by a publicly funded specialist system of care. A number of issues raised in the report sit well outside the mandate of the specialist mental health system and will require vigorous and sustained effort by the many different areas and levels of government, including the Commonwealth Government, to address.

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8.4.3 RESPONSE FROM QUEENSLAND GOVERNMENT

QUEENSLAND HEALTH RESPONSE TO THE HUMAN RIGHTS EQUAL OPPORTUNITIES COMMISSION AND MENTAL HEALTH COUNCIL OF AUSTRALIA REPORT

Executive Summary

In response to the report – ‘Not For Service' by the Mental Health Council of Australia and The Human Rights and Equal Opportunity Commission it is advised:

A submission was previously completed by Queensland Health in response to a request from the Human Rights and Equal Opportunity Commissioner.
The submission completed in January 2005 and forwarded to the Commission was not acknowledged in the ‘Not For Service' report, nor were issues raised incorporated into the final report.
‘Not For Service' indicates a number of processes occurred to assist in the preparation of the report. The document indicates that:
- A survey was undertaken to assist in the preparation of the report;
- Open community forums were conducted and written submissions were received.
While the report offers some individual insights, it is important that the information it contains is considered in the context of the small sample used.

Of the 714 surveys, 95 were for Queensland.
This represents a very small proportion of the service contacts for the State (779,527 for 2002/2003) and the projected number of individual community clients (75,300 - 76,240 for 2004/2005).

In addition, the report should be considered in the context of other data which are used to inform the system of key issues:
- Mental Health Services in Queensland have changed considerably over the last ten years.
- Queensland leads other States in terms of the implementation of the National Mental Health Strategy with this exemplified by the Outcomes data system.
- Queensland Health through their District Services has developed Consumer and Carer consultant roles that are providing significant input into services.
- District Services have an active complaint management system that is monitored through the mental health service management process in each district.
- However, services continue to confront rapid changes due to the rapid population growth and the impacts of drug and alcohol use.
- Recruitment and retention issues are linked to a variety of issues including the rate of graduation of mental health professionals from tertiary education units.
Notwithstanding the questions about the representative nature of material presented in the report and the limited acknowledgement of positive aspects and progress in Queensland Mental Health Services, Queensland Health will actively work to incorporate suggestions for improvement into its forward planning.
Queensland Health acknowledges that the continued maturation of services and agencies is required particularly with respect to the links with NGOs and Consumer and Carer groups.
The response to the report reflects the format adopted in ‘Not For Service' .

SUPPORTING DOCUMENTATION

NMH STANDARD 1: RIGHTS

Queensland Health has implemented training in relation to the Mental Health Act [2000] with this training provided to staff in all District Services. Training in the Mental Health Act [2000] emphasises the rights of those with mental illness and the need to provide treatment that takes into account the importance of the dignity and respect of the individual.

Each person within the mental health system is able to access Complaint's Managers should they perceive their rights have not been addressed. Services have introduced information brochures and signs that provide advice to carers and patients/consumers about rights and responsibilities. Mental Health Services have developed a number of mechanisms for increasing knowledge of rights and responsibilities with one service producing an introductory DVD that is provided to Patients/Consumers and Carers and is used during ward activities as a method of evoking group discussion.

With respect to the criminal justice system, it advised that police are receiving training in relation to mental health matters and that Queensland Health has developed a number of mechanisms that have improved dialogue between Police, Emergency Services and Mental Health Services. The improved communication has assisted in improving the care and treatment of those with mental illness, particularly during the initial phase of contact with Mental Health Services especially in the Emergency Departments.

The Mental Health Review Tribunal has adopted a model that addresses the need to respect the rights of the individual and aims to provide a maximum level of support to individuals. The Tribunal is comprised of a legal person, doctor (usually a psychiatrist) and a community member. Carers and Patients/Consumers attend the hearings and may be legally represented.

In relation to those within the prison service, Queensland Health and Corrective Services have developed a Prison Mental Health Service for those who are identified as having a mental illness. This service seeks to assist those within the Prison setting and, when necessary, facilitate their transfer to an Authorised Mental Health Service.

The Transcultural Mental Health Service has assisted in emphasising the importance of translators and services in Queensland regularly use translators although the cultural and linguistically diverse nature of Queensland impacts on the capacity of services to access some language groups. These rights are linked to those pertaining to all groups, especially to Aboriginal and Torres Strait Islanders.

All District Mental Services via the EQUIP Survey address the rights of individuals.

NMH STANDARD 2: SAFETY

Services in Queensland are confronted with a rapid growth in population and changes in demographics. This growth of between 80-85,000 per year over the last few years has placed stress on services in terms of availability of resources, increases in occasions of service and recruitment and retention of staff. Despite these pressures, services in Queensland have developed new initiatives such as recovery, alternative models of care programs and integrated models of service delivery.

Services now provide extended hours assessment programs. Outside of those hours an assessment can be received through the Emergency Department of a hospital. Queensland Health has developed mobile service teams and single point of entry processes. Services in Queensland are participating in studies that benchmark access issues with many adopting models that reflect priority systems that give specific time frames for patient reviews by Mental Health staff

Queensland Health has developed a policy on restraint to provide guidance for management of individuals who require restraint. Services are now involved in Aggression Management Training which will involve all staff within services.

The development of integrated Risk/Management processes and the Queensland Health Incident Management Policy has occurred on a state wide basis with services now using a standardised mechanism.

Queensland Health has developed a model for residential care that seeks to improve communication with residential care agencies and improve the safety and care of individuals within these services. New Queensland laws have been introduced to improve residential safety, and cross government committees have been developed to assist this process.

NMH STANDARD 3: CONSUMER AND CARER PARTICIPATION

Mental Health Services aim to provide care in the least restrictive manner and with the active involvement of the patient/consumer and carer. The approach for Queensland Health has been the active inclusion of consumers and carers in the delivery of mental health services. The Action Plan for Consumer and Carer Participation in Queensland Mental Health Services is currently being implemented. Consumer consultants are employed in 11 districts. Consumer and Carer Advisory Groups operate throughout the state. A new state wide advisory model for consumer and carer participation has been developed and a consultation process will commence in the near future.

Some services have developed consumer/patient and carer discharge surveys that are utilised to evaluate the service and contribute to service improvement with respect to activities such as information on medication, diagnosis and post discharge planning.

A curriculum for clinician education in consumer and carer participation has recently been developed and has been piloted in three District Services. This training is to be evaluated in 2005.

The involvement of consumer/carer groups in the early phase of treatment has commenced in one service with others beginning to explore this in relation to provision of care. Psycho-education programs for patients/consumers and carers have been developed in some services

NMH STANDARD 4: PROMOTING COMMUNITY ACCEPTANCE

Mental health services within Queensland provide education to the community both by way of direct contact, or involvement within community-based programmes such as those associated with Rotary, beyondblue, PPP programs and educational programs for health care professionals, NGOs and other government services. The total funds allocated to NGOs and some research institutions are $6.9 million.

Public Health as part of the promotion of prevention has undertaken activities within Queensland to highlight issues related to mental health including early recognition and de-stigmatisation.

Queensland Health is progressing mental health promotion, prevention and early intervention in this State under the National Mental Health Plan 2003-2008 . This process includes the mental health promotion, prevention and early intervention initiatives that seek to focus on the needs of priority groups identified in the Queensland Health implementation framework. The program aims at increasing the understanding and knowledge of mental health and the importance of maintaining mental health, and is linked to the recognition of these aspects in all environments and settings.

Mental Health week in Queensland has been actively used to highlight issues pertaining to Mental Health. Rural services are involved with media issues that emphasize the importance of early intervention, the multifactorial nature of mental illness, the importance of carers and the role of therapy in treatment and relapse and prevention.

NMH STANDARD 5: PRIVACY AND CONFIDENTIALITY

The problems raised within the report highlight the difficulties which confront clinicians, patients/consumers, carers and the broader community on a regular basis. Provision of information to family/carers is recognised as an important issue by Queensland Health. However, services are at times confronted with the competing desires of the patient/consumer versus the needs of the family/carers. This clearly, on occasions, causes concern for the community especially family members. However, despite being a difficult matter to overcome, in many cases with appropriate support and counselling communication with the family/carer can be achieved. The document indicates that for person's diagnosed with cancer and other significant illnesses the whole family is involved with this, contrasted with what occurs in mental illness. Unfortunately, this ideal is at times not achieved even when cancer, heart disease and diabetes is diagnosed with some patients refusing to have information divulged to family members.

Services have attempted to deal with this issue by adopting education programs and family focussed groups.

Privacy of patient/consumer and carers is recognised as important but at times is difficult to provide due to building design or the number of individuals presenting to services. The capital works program has resulted in the construction or modification of units with rooms that are single or 2-4 bed units. Units are provided with open space and services have implemented policies that seek to protect privacy and the individual's property.

NMH STANDARD 6 – PREVENTION AND MENTAL HEALTH PROMOTION

It is acknowledged that there are concerns in relation to the provision of rehabilitation programmes. Queensland Health has identified non-government organisations as integral to service delivery and is moving towards the development of programmes that integrate with external agencies and assist in the rehabilitation of people into the community. Mental Health Services are adopting a Recovery Focus that promotes maximising the persons and families/carers capacities.

The Mental Health Unit, in partnership with Health Promotion Queensland, is funding a multi-strategy health promotion project which promotes resiliency in children of primary school age in school, family and community settings. The project involves the measuring of elements that promote resiliency in individual children of primary school age.

Early Intervention and Prevention Officers have been appointed to services. At present this program is in its early phase and is still developing its full capacity. The problem of Alcohol and Drugs and its link to mental illness is well documented. Queensland is continuing to develop strategies to improve assessment and intervention for those with dual diagnosis.

Queensland Health has funded programs for the deaf and has granted further funding for a Centre based in a major teaching hospital. This Centre is widely recognised and from time to time its services are used by bodies from other jurisdictions.

NMH STANDARD 7: CULTURAL AWARENESS

All staff in Queensland Health are required to undergo training in relation to cultural awareness with respect to Aboriginal and Torres Strait Islanders. Queensland Health has developed an active state wide policy which promotes the involvement of the Indigenous mental health workers within services with these staff actively involved in improving the delivery of services to Aboriginal and Torres Strait Islanders within local regions.

Examples of the working relationships forged across the networks include the link established with the Aboriginal and Torres Strait Islander Health Unit and the consultation and input towards the following key activities:

Queensland Health Aboriginal and Torres Strait Islander Workforce Management Strategy;
Partnership Framework (Working party for ATODS/MH/Chronic Disease);
Cultural Respect Framework;
Outcome measures for Mental Health Services;
National Aboriginal and Torres Strait Islander Framework for Mental Health and Social and Emotional Wellbeing; and
Structures have been established on zonal and district levels and these structures/processes contribute to furthering the implementation of the Queensland Health Mental Health Policy – Aboriginal and Torres Strait Islander People 1996. These structures will also play a part in the implementation of the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples' Mental Health and Social and Emotional Well Being 2004-2009 for Queensland .

Queensland Health perceives Aboriginal and Torres Strait Islander people as a priority target group. The adoption of a holistic definition of health and mental health as defined by Aboriginal and Torres Strait Islander people is part of Mental Health Policy and aims to address Aboriginal and Torres Strait Islander social and emotional well being.

The establishment of Centre for Rural and Remote Mental Health is being explored with Aboriginal and Torres Strait Islander groups intimately involved in the working party. This Centre has attracted support from a variety of groups integral to the development of rural and remote mental health services including Royal Flying Doctor Service, Queensland Health, mining companies, Aboriginal and Torres Strait Islander groups and the Division of General Practice.

NMH STANDARD 8: INTEGRATION

Queensland has adopted an integrated model of care involving inpatient and community mental health services. The integration of services provides continuity of care with a single point of entry across the span of services. This continuity of care also reflects a model care for both the child and youth and older person's mental health services.

In relation to the issue of staff turnover and its impact on integration and care it is evident this reflects, not only the mobility of professional groups involved in mental health services, but problems related to staff resources which reflects decisions made in relation to training in the 1980s. These decisions have had a negative impact in the number of mental health professionals graduating from 1990 to beyond 2005. Governments at every level are attempting to address this issue but it is evident that the resolution of staff shortages will not occur in the short term and, as a consequence, there will continue to be difficulties in terms of the recruitment and retention of staff. Factors related to the care of individuals within the private sector are not within the direct province of Queensland Health . Strategies seeking to improve communication between the public and private sector have been developed at a service level. The difficulties in accessing appropriate resources within the private sector are also affected by rapid changes in population, the aging of trained professionals, changes in the culture of medical, nursing and allied health professional expectations and, as with the public sector, the impact of decisions made a number of years previously in relation to university numbers in the various disciplines. Despite the development of new medical schools within Queensland, the likelihood of any increase in the number of Australian trained psychiatrists will not occur for approximately 8-10 years due to the need for undergraduate and post-graduate training positions which is linked to the provision of funded, supervised training posts with in the public and private sector.

In recognition of the importance of increasing the numbers of trained mental health professionals, Queensland Health has funded scholarships for nurses and allied health staff and is funding the Director of Training (psychiatry). The Director of Training's position has a role in the provision of information to those doctors desirous of entering specialist training in psychiatry and assist in the development of training processes within the State. The state wide position has assisted in the recruitment of registrars within Queensland . Recruitment into training positions has demonstrated growth and is in contrast to other jurisdictions that are experiencing a decline in applicants.

The Commonwealth Government through the development of innovative general practice programmes has improved the training of General Practitioners. These programmes have improved the capacity to provide integration and increased resources to manage individuals within the community in shared-care arrangements. Services have developed Memorandums of Understanding with Divisions of General Practice that in some cases have permitted General Practitioners to refer patients to services for specific treatment groups while continuing as the ‘case manager'.

The management of individuals with complex needs is clearly, as indicated in the document, difficult, however, Queensland Health has developed a number of programs that have begun to address the issue of people with mental health disabilities which reflect a whole of Government approach. This process involves linkages with housing, Disability Services Queensland and non-Government Organisations (NGOs). The State Suicide Prevention Strategy is an example of this whole of Government approach and includes representatives from Housing, Police, Education, Premiers, Aboriginal and Torres Strait Islanders and the Commonwealth.

As part of the continued improvement in care, Queensland Health is developing a consultation liaison model of service delivery project that addresses the issues of the physical health of individuals with mental illness in relationship to general hospital inpatient care, outpatient services and primary care positions. This project is due for completion towards the end of 2005 and will have a focus on a broad range of issues related to physical illness and mental health across the state.

The Queensland Government has recently announced the provision of affordable accommodation for homes within Central Brisbane and a number of districts have begun to implement strategies that reflect a whole of Government approach.

As part of this broad strategy, there has been an increase in educational processes related to the care of people with mental illness with the services being provided to Police, Ambulance and other groups within the community.

In relation to the management of people with mental illness and their involvement with the judicial system, Queensland has adopted a model of care and a strategy for managing those with mental illness within the judicial system that is progressive. Those charged with an offence and who have a mental health defence are brought before the Mental Health Court rather than the judicial system. This model is judged by many as reflective of best practice and at the leading edge in terms of the care of those with mental illness who become involved with the legal system. The process allows early intervention for those identified with mental illness and management in a manner that respects their rights and in a less restrictive manner with integration across the prison and mental health systems.

Child and Youth services continue to face problems especially when confronted with the population growth, divorce/separation rates and the rate of child abuse. Following a major review, a new Department of Child Safety has been developed. Queensland Health and the Department of Child Safety, along with other agencies, are developing programmes for children most at risk.

NMH STANDARD 9: SERVICE DEVELOPMENT

The Queensland Mental Health Plan 1994 , represented the first strategic plan for mental health reform in this State. The plan focussed on integrated systems across regions. The document provided broad based principles that enabled the reform process to commence.

The Plan resulted in the mainstreaming of integrated services to promote continuity of care across service components, the local availability of care through more equitable distribution of mental health resources despite the geographical and demographic complexities of a rapidly growing and developing state, and consumers' and carers' involvement in the planning, operation and evaluation of services.

The Plan has resulted in the progressive reform of psychiatric hospitals, establishment and maintenance of links with Primary Health Care services and implementation of quality management systems including the Minimum Service Standards.

In 1996, this Plan was replaced by a more comprehensive planning document designed to set the framework for the full system of care, and providing the basis for a more equitable distribution of services throughout the State.

The Ten Year Mental Health Strategy for Queensland (TYMHSQ) advanced the directions already identified in the Queensland Mental Health Policy (1993) and Queensland Mental Health Plan (1994).

The TYMHSQ became the key strategic document for mental health reform in this State until 2003. The TYMHSQ assisted in planning and equitable resourcing of services throughout the State.

By 2002/2003, a review of progress of mental health reform found that with the exception of the full complement of community positions, the objectives of the TYMHSQ had generally been reached. The results of the review did not imply reform was complete but the State was able to progress with the National Mental Health Plan 2003-2008. It identified issues related to decentralisation and community positions.

The Queensland Strategic Plan for Mental Health (2003-2008) seeks to foster mental health in Queensland for the next five years and beyond. The Strategy aims to promote the mental health of the community, while continuing to build the capacity.

The Strategic Plan aims to address the mental health issues broadly across the community. Specific areas have been identified as a priority. Priority areas include:

Enhancement of core specialised mental health services.
Improving service quality and safety.
Improving service responsiveness.
Improving the capacity to meet the needs of specific groups within the population.
Strengthening partnerships across the spectrum of intervention.
Improving utilisation of data and information in service evaluation and planning.
Ensuring the availability of a strong and skilled workforce.

Care is seen as a service to be covered across a broad spectrum of providers including primary health care which participates in the continuum of care. Support of primary care providers will be enhanced by technology, the development of consultation/liaison and skills development programs.

Specialised mental health services are secondary and tertiary services are provided by specialist mental health personnel. These services, while focussing on the serious mental health problems, will also provide assessment and care for the high prevalence disorders. It is recognised that the high prevalence disorders negatively impact on quality of life and have the capacity for adverse social consequences.

Services across the state provide continuum of care for individuals. This is assisted by a variety of service activities including:

Acute Care and Assessment teams
A continuing care case management approach, which includes the following components:
- community treatment services
- outreach services
- acute inpatient services, with provision for short to medium term treatment, including secure treatment
- psychiatric crisis response and treatment
- specialist intensive treatment and support for identified ‘at risk' individuals (mobile intensive treatment teams)
- extended inpatient services for treatment and rehabilitation, with services organised around five clinical programmes
- a recovery focus that has been endorsed by the Queensland Human Services Chief Executive Officers' Committee.

The Strategy has developed a focus for improvement of Mental Health Services for Rural and Remote Communities and improvement in the Mental Health Services for People Involved in the Criminal Justice System.

The Queensland Forensic Mental Health Policy 2002 targets adults and young people with mental disorders or severe mental health problems who are also subject to criminal justice processes.

Access to secure inpatient treatment has been improved with the opening of a medium and high secure facility in Townsville allowing mentally ill offenders from North Queensland to receive treatment closer to their families and support networks.

Specialised community forensic services have developed active outreach processes to provide closer support to mental health services across the State, which assist in local patient management and ensure compliance with formal monitoring requirements. In North Queensland, outreach services extend as far as Papua New Guinea . This care of this group has been enhanced with the development of forensic liaison service positions.

A visiting service has been established to the Brisbane Youth Detention Centre integrating both mental health and drug and alcohol workers, and the Child and Youth Forensic Outreach Service facilitates transition from detention to the community.

The Prison Mental Health Service was established as a joint initiative between the Department of Corrective Services and Queensland Health to provide mental health services to people who have a mental illness and are resident in a correctional centre.

Mental health reform in Queensland has decentralised inpatient beds from the large psychiatric facilities based in Toowoomba, Charters Towers and West Moreton . Inpatient beds have been relocated to regional centres to ensure a more equitable distribution of resources across the State and to facilitate access. Decentralisation of inpatient beds was completed in 2002.

Inpatient programmes have been developed to encompass a range of services including acute inpatient, dual diagnosis, child and youth, psycho-geriatrics, acquired brain injury, medium and high secure services and community care units in suburban settings.

With changes in the inpatient services there has been a progressive expansion of community mental health services throughout the State during the life of the TYMHSQ. Planning targets were established at 30 per 100,000 total population for adult mental health services, 25 per 100,000 for the under 19 population, 10 per 100,000 of the 65+ population, whilst Indigenous workers are set at 5 and 6 per 10,000 for child and youth and adult services respectively.

Community Mental Health provides a range of services including extended hours, Acute Care Teams, Crisis Assessment Teams and Mobile Intensive Treatment Teams. In addition, dual diagnosis projects are being developed. The suicide prevention strategy and aged care strategy have been developed along with specific programs for trans-cultural mental health and those with hearing impairment. The P300 project has assisted in the transition of patients/consumers from hospital to the community.

Queensland Health, as part of the development of Mental Health Services, has fostered research in a variety of settings including the University of Queensland , The Park and in hospital appointments that have both clinical and academic roles.

NMH STANDARD 10: DOCUMENTATION

Documentation remains a difficult area for services despite records remaining fundamental to the mechanism of recording clinical information and a significant issue in the medico-legal arena. Poor documentation and lack of access to documents has been demonstrated to contribute to negative outcomes and has been noted by coroners to be a key issue in contributing to patient deaths.

Services in Queensland have been confronted with the difficulty of having separate charts for inpatients, community and other services such as alcohol and drugs. This separation has impacted on patient care. Over the last few years where separate charts existed, the services have moved towards integration of medical records. However, the lack of common record numbers across the State continues to cause some difficulties.

A number of services have introduced comprehensive audit processes that review the comprehensiveness of records, explores adequacy of notes, risk assessment, care plans and discharge planning. The audit mechanism reviews several charts each month in a random fashion with the audit reporting against specific criteria.

NMH STANDARD 11: DELIVERY OF CARE

The Queensland Mental Health Act 2000 is an Act about treating and protecting those with mental illness with this occurring in an environment that seeks to respect the rights of the individual and provide respect for the person's dignity. The Act aims to aid the provision of care in the least restrictive manner.

The broad approach to the management of individuals within Queensland Health Services involves the use of individual care plans, with these care plans developed in consultation with each patient/consumer.

Services are developing pathways of care that involve the recognition of the need for increased consumer involvement, explanation of the nature of the illness and advice on treatment modalities including the pharmacological methods.

Services adopt a broad treatment approach that addresses the psychological, social and pharmacological treatment of mental illness. A number of services provide not only individual but also group therapy and family therapy sessions.

Services are provided, irrespective of an individual's past. Assessment and care are related to the current needs of the person. On accessing a Mental Health Service a comprehensive assessment is undertaken with this reflecting those processes outlined in accreditation guidelines that are required of each district.

8.4.4 RESPONSE FROM SOUTH AUSTRALIAN GOVERNMENT

RESPONSE TO THE MENTAL HEALTH AND HUMAN RIGHTS DRAFT REPORT

EXECUTIVE SUMMARY

This response to the Mental Health and Human Rights Draft Report has been prepared by the Mental Health Unit, Department of Health, South Australia (SA).

Over 250,000 South Australians are predicted to have mental health problems/disorders. Of these 38,000 are estimated to have a severe condition. The prevalence of mental health problems/disorders differs across the age ranges.^[1]

SA acknowledges that mental illness is a whole of government and whole of population matter. Any adequate response to improving services for mentally ill consumers is built on cross-government planning, education, training and review and must involve a number of organisations including health, employment, housing, justice etc. Narrowing mental health focus to the health system will not suffice.

This whole of government commitment is articulated in South Australia 's Strategic Plan including a key objective to improve the Wellbeing of South Australians. The priorities are to focus on quality of life and the wellbeing of the community and individual citizens of which mental health is a key factor . Additionally, this state's Social Inclusion agenda specifically targets strategies for people who are the most vulnerable to the co-existence of homelessness, substance abuse, and social disadvantage, whereby mental illness is a major contributor. Also the government has established a cohesive advocacy sector including the Mental Health Coalition and the Health Consumer Alliance to ensure consumers have a voice in the planning and delivery of mental health services.

National Mental Health Strategy and Plans – achievements to date

SA accepts this framework for reform of mental health services in Australia in accordance with international trends. However, complexities of funding across Australian Government and State/Territory governments lead to patchy and uncertain planning and development of services. For example, enhancement monies from the Australian Government will promote development of specific aspects of a service, sometimes to the detriment of other aspects of the service.

Service models in SA have, to date, predominantly focused on acute care, with hospital services remaining highly significant. For example, SA is criticised as nearly 50% of direct dollars for mental health still goes towards the running of one hospital ( Glenside ). However, it must be recognised that much has been achieved in collaboration with other departments within the confines of the resources available.

Government commitment

The Labor government came to office with a clear commitment to improve mental health in SA. Immediately funds were injected for a range of services including services for children, young people and Aboriginal people; workforce development, and care packages.

Since coming to government there has been an additional recurrent commitment of $20 million to the reform and delivery of mental health services in this state. Also $80 million was allocated to build better facilities for consumers of mental health services and to enable incremental closure of Glenside Hospital , whilst reconfiguring the Mental Health System. In addition, the government funded $56 million to provide support to people residing in marginal accommodation, through the supported residential facility program. This program targets people with a mental illness who require additional services and supports to be able to maintain a level of independence.

As evidenced by the Mental Health and Human Rights Draft Report, SA has significant challenges ahead, in spite of this government's increased investment. However, there has been progress achieved through the commitment and work of many individuals and organisations. Further progress will be made through the government's ongoing pledge to improve not only the resources available, but also the legislation, structures and systems required to support reform.

A population based resource funding approach – the way forward

One of the key outcomes of SA's Generational Health Review was recognition that governance and funding arrangements were required to concentrate the health system ‘towards improving the health of the population, enhance capacity to promote population health and meet the equity objectives of the South Australian Government'. A population approach to mental health provides a framework which can respond to identified problems; unmet need (disorders which could be effectively prevented or treated but which are currently not); and accountability in population terms for improving health and lessening disease prevalence, morbidity, disability and mortality.^[2]

The initial focus of the South Australian Reform Agenda is to reorientate the whole health system to a population health planning approach, achieving gains in population health outcomes and improving health status by moving emphasis towards a primary health care focussed system.

Immediate responses

The new regional health structures within SA allow for immediate initiatives to focus on:

Reducing hospitalisation through extended hours of mobile emergency mental health teams working with ambulance; and a single point of access to mental health care in metropolitan Adelaide ;
Avoiding people entering the hospital system through alternatives to admission with intensive community treatment and support;
Assisting people to leave hospital earlier through post discharge intensive community follow-up;
Adequately skilled workforce by developing a single co-ordinated education and training strategy for all disciplines including non-clinical staff;
Building the capacity of the non-government community based sector to assist in supporting people in their home, out of hospital.

Strategies for sustainability

A number of new initiatives are proposed for SA within the current planning environment. The resources and services required to deliver best practice in mental health care for SA have been assessed and six (6) new strategies have been identified to bridge existing service gaps.

Strategy 1: The specific targeting of prevention and early intervention services where there is a risk of mental health problems and disorders.

Strategy 2: Accessible and responsive community based treatment and care to those for whom the failure to receive it is likely to result in relapse, or social disruption.

Strategy 3: Responsive partnership support to the broader human service sector where the interface has a significant impact.

Strategy 4: Recovery focused support services, which demonstrate outcomes in improved functioning, and reduced demand on high cost specialist services.

Strategy 5: A system of service allocation and monitoring, which facilitates appropriate streaming of consumers into packages of care.

Strategy 6: The development of an available and appropriately skilled workforce that supports the building of a sustainable system of mental health care.

Detailed supporting documentation in response to Part Six: South Australia

National Mental Health Standard 1: RIGHTS

ACHIEVEMENTS:

Comprehensive review of Mental Health Legislation in SA undertaken

Community Based Information System (CBIS) has been developed and implemented

Human rights legislation, particularly in the form of mental health acts, criminal law acts, ombudsman's acts, public guardianship acts and privacy acts are critical in preventing erosion of fundamental human rights of mental health consumers.

In recognition of this, the Review of Mental Health Legislation in SA was commissioned by the Department of Health last year and involved extensive consultation in metropolitan and country areas with carer and consumer groups, Aboriginal organisations, professional organisations and government agencies from August 2004 to March 2005. The Review Committee received and considered 60 submissions and its report is near completion however, it is yet to be formally received by the SA Government.

In relation to mental health and guardianship the broad themes that have emerged are:

The rights of carers and consumers should be articulated more clearly in the legislation, as other States have recently done;
Confidentiality should not be interpreted as a barrier to proper sharing of information in the best interests of consumers;
The particular needs of Aboriginal people need to be recognised as a matter of principle;
There must be an emphasis on community care, not just hospital services;
There should be more flexibility as to who can intervene to assist someone in need of care, or make initial orders for admission and detention;
Greater flexibility with orders to suit the individual is needed (for example, short-term detention orders to avoid inappropriate transfer of consumers from the country to the city);
The treatment plan should be a pivotal requirement of involuntary orders;
The Guardianship Board needs to be humanised from arrival at the door (eg through social work assistance or consumer representation);
A specialist appeal body should replace the court to ensure appeals and procedural fairness arguments are considered in a therapeutic context.

A Health and Community Services Complaints Commission has been recently established in SA. The government on coming to office has developed and passed legislation and appointed a commissioner. The legislation is the most comprehensive in Australia and includes both public and private health, and the full range of community services. It seeks to resolve complaints whilst developing, implementing and monitoring a Charter of Rights for Consumers. The Complaints Commission also has an educative role regarding rights of consumers and complaints management, coupled with monitoring the overall health system for improvement and quality performance.

The Rights Analysis Instrument recommends that consumers of a mental health service must have a representative whose task it is to advise and protect their rights as long as that person wishes. Consultation in SA also recommends that all consumers subject to involuntary treatment should have comprehensive treatment and discharge plans. Carers and consumers request such plans incorporate their views, goals for recovery and be regularly reviewed.

Advanced directives can be made by a consumer to empower others to make treatment decisions on his/her behalf during temporary and permanent incapacity. However, in SA consumers are not currently empowered by law to express, in writing, their own wishes or treatment preferences in advance for periods of temporary incapacity. Ulysses Agreements are one form of advanced directives that has been used in many countries in various ways. There is strong consumer support for legislative recognition of this concept in SA.

Concern: Information not provided

Mental Health Adverse Event investigations and coronial inquiries in SA have supported this concern by highlighting communication problems in the mental health area, a need for better electronic records and rapid exchange of information.

To achieve this a purpose built Community Based Information System (CBIS) has been developed to enable capture of consistent data to complement in-patient information. When fully operational, the system will provide demographic and contact data, Outcome measures (National Outcome & Casemix Collection – NOCC), risk assessment, triage, Management Plans as well as Crisis and Relapse Prevention Plans.

The intent of CBIS is to collect, analyse and use consistent relevant information to better inform decision-making at both the individual consumer level (eg care planning) and at a regional statewide level (eg resource allocation). Compliance with the National Standards for Mental Health Services and national reporting against minimum data sets are fundamental elements of the system. Access to this system will facilitate information transfer and shared care options and will be particularly helpful in emergency or crisis responses.

CBIS has a primary means of

Capturing consistent client information;
Providing functions to prepare management plans;
Giving security to client information;
Providing access to current and historical client information;
Being accessible from mental health locations across SA; and,
Interfaces to other mental health services' information (eg inpatient).

The National Mental Health Strategy seeks to ensure a jurisdiction's ability to identify "Who receives what services from whom, at what cost, and with what effect?" to support the reporting and management needs of clinical managers and service administrators. CBIS provides the capacity to record this information for Ambulatory and Community Residential services and will eventually link with inpatient systems to provide a comprehensive repository of information that can be retrieved and utilised at the local, regional and statewide levels.

National Mental Health Standard 2: SAFETY

ACHIEVEMENTS:

Establishment of quality systems to ensure increased safety and to facilitate the reporting of adverse events

Embedding safety and quality systems for mental health services within mainstream quality systems

Established a monitoring system for coronial inquiry recommendations to enable system-wide change

Incorporation of the National Standards for Mental Health Services into the Service Excellence Framework

Concern: Lack of services for children and youth with behaviour problems

ACHIEVEMENTS:

Establishment by Child and Adolescent Mental Health Services (CAMHS) partnerships with primary health care providers, the Department of Education, and Family and Youth Services in the provision of programs that focus on resilience and recovery for young people

Partnership between CAMHS and the Lyell McEwin Health Service for the development of models of care that assist adolescents in successful transition to adult mental health services. This model will be extrapolated to other services

Additional funds for the provision of mental health services to children and young people outside the metropolitan area

Provision of funds for a behavioural intervention service to children and young people in the northern metropolitan area

Increased investment in the provision of a mental health emergency triage service at the Women's and Children's Hospital

The longer term plan is to develop a systemic approach to training across the sector provided through a single point of co-ordination. With a clear agenda for training to accompany the mental health reform agenda of SA, this will include issues related to recovery, relapse prevention and rehabilitation. Critical to these will be the management of associated behaviours which may arise, including aggression management.

The Mental Health Act 1993 is not explicit that it applies to children. Since children rarely seek review of or appeal against involuntary orders, it has been recommended that legislation should provide for advocacy to ensure children's legal rights are exercised and protected and that any orders are reviewed on a regular basis. It is accepted best practice that, where possible, treatment for children should be provided in the community.

In calling for legislative clarity around the rights and treatment of children recommendation 27 of the Layton Child Protection Review Report called for the removal of barriers that prevent the appropriate exchange of information about children, young people and families involved with the child protection system and calls for a close working relationship between mental health and child protection services.^[3]

The Department of Health has commenced a statewide planning process to ensure that mental health services provided to children and young people are seamless, coordinated with consistent access and entry pathways.

Concern: Requirement for staff to be trained to respond appropriately to aggressive and difficult behaviour

The Mental Health Unit have contracted in the NSW Institute of Psychiatry to provide a range of short courses (to December 2005) in the areas of: Introduction to Mental Health; Rehabilitation in Mental Health; Relapse Prevention; Mental Illness and Substance Use; Consumer Advocacy and Carer Advocacy. Some of these courses will include elements of aggression management. The longer term plan is to develop a systemic approach to training across the sector provided through a single point of coordiation. With a clear agenda for training to accompany the mental health reform agenda of SA, this will include issues related to recovery, relapse prevention and rehabilitation. Critical to these will be the management of associated behaviours which may arise, including aggression management.

National Mental Health Standard 3: CONSUMER AND CARER PARTICIPATION

Concern: Tokenistic approach to consumer and carer involvement

ACHIEVEMENTS:

Establishment of a memorandum of understanding between the SAn branch of the Royal Australian and New Zealand College of Psychiatrists and the Mental Health Coalition declaring a commitment to the involvement of consumers and carers in all aspects of treatment and care

Establishment of Consumer and Carer Advisory Committees within metropolitan and country health units

Increased rural consumer and carer representation on government committees and advisory groups including rural areas

Employment of consumers and carers as peer support workers in a number of health services

Expanding a peer support programme is a priority in SA and would include training for participants. Appropriately trained and funded peer consumer therapists have a significant place in mental health services in other jurisdictions, but require appropriate funding and training. In keeping with overseas experience, consumers could ultimately provide up to 20% of the workforce and reduce, amongst other matters, the current workforce crisis.

Peer support workers in SA are a developing concept and the northern metropolitan area is leading the way in developing a programme. The vision is to have a paid, skilled and competent peer support workforce working alongside specialist staff at all points of the continuum.

Concern: Lack of funding for consumer and carer participation

ACHIEVEMENTS:

The Mental Health Unit has provided funding to the Health Consumers' Alliance to implement formal structures and processes to ensure consumers and carers contribute to the planning and delivery of local mental health services

The Mental Health Unit has also provided ‘one off' funds to the Carers Association to enable them to undertake a metropolitan/rural education and support forum for carers

The Mental Health Unit also provides funding to the Association of Relatives and Friends of the Mentally Ill SA to provide counselling, support services, educational programs and respite care for relatives of friends of people with a mental illness

Future directions in Mental Health in SA include strengthening participation by increasing consumer and carer participation reported through regional Health Service Agreements.

A significant development in SA involved the close working partnership between a Consumer and Carer Steering Committee and Mental Health Unit in developing a Framework for Developing Partnership Between Consumers and Carers and the Mental Health Sector. It is intended this document form the major mental health policy and directions in regard to carers and consumers. The Mental Health Unit has worked across the Department of Health to ensure the Framework informs the development of the broader participation mechanisms being developed and to ensure that a focus on mental health consumers and carers is maintained at all levels.

In view of Generational Health Review recommendations, the Department has sought to ensure that there is one consumer peak body supported by the Department and that resources are not dissipated through duplication of participation mechanisms or systems. The Health Consumer Alliance (HCA) has been endorsed as the peak consumer body in SA for the purposes of consumer/carer government interface.

The HCA is as an important mechanism to provide a strong independent and effective voice for consumers, carers and community groups in the SA health system and to ensure that mental health is integrated into broader health reforms at this state.

National Mental Health Standard 4: PROMOTING COMMUNITY ACCEPTANCE

Concern: High levels of stigma and discrimination

ACHIEVEMENTS:

Collaboration with the Commonwealth Government on programs such as Headroom, MindMatters and beyondblue and the National Suicide Prevention Strategy, with the goals of raising awareness and reducing stigma

SA recognises the following facts:

Community and population level studies have consistently shown the association between higher levels of self reported discrimination and poorer mental health (Krieger 2000)^[4]
Greater levels of community participation, social support and trust in others in the community have been associated with reduced experience of psychological distress (Berry & Rickwood)^[5]
People who are socially isolated have between two and five times the risk of dying prematurely from all causes compared to those who maintain strong ties with family, friends and community (Berkman & Glass 2000)^[6]
…socially isolated people feel fear, they feel alienated and they lose their sense of belonging, of value and opportunities to contribute in any meaningful way to their community^[7]
“One of the biggest barriers to recovery is discrimination. That is why stopping discrimination and championing respect, rights and equality for people with mental illness is just as important as providing the best treatments and therapies.”^[8]
The impact of mental illness, stigma and discrimination and the subsequent burden on the Australian population has been estimated to affect up to one in five people within a 12-month period.^[9]

Education involving consumers/carers and the community is very important. This will promote health literacy and help to minimise stigma. The work of beyondblue (National Depression Initiative) is a good example for this and uptake in SA has been high.

Jorm, Christensen and Griffiths^[10], in evaluating the impact of beyondblue found that awareness of beyondblue in states that funded the program was approximately twice as high as in those that did not. The high-exposure states had a greater change in beliefs about some treatments including counselling and medication and help-seeking.

The continued operation of an ageing and outdated Glenside Campus contributes to discriminatory perceptions of mental illness, and barriers to people accessing mental health care. The realisation of the government's mental health capital works program ($80 million) will result in modern integrated facilities over the next 5-7 years.

Concern: Discrimination directed towards children of parents with mental illness

The Children of Parents with Mental Illness (COPMI) organisation is proudly supported by SA and many initiatives have been driven from this state. For example, COPMI have produced a document titled “Principles and Actions for Services and People with Children of Parents with a Mental Illness” which has been published as a National Mental Health Strategy document and has set a framework for Australian agencies working with children of parents with mental illness.

Another publication is “ The Best for Me and My Baby ” which is a booklet for women with mental health problems and their partners who are thinking about having a baby. In addition, “Family Talk” is information for families where a parent has a mental health problem or disorder. In addition, these publications are underscored by the COPMI website www.copmi.net.au. COPMI has worked with various jurisdictions to determine how to implement the published guides. COPMI has worked with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to develop a position statement for Psychiatrists regarding the need to work with a whole family as more of a holistic systems view.

The Perinatal and Infant Mental Health in the Community project is a 2-year project, funded under the Department of Health Innovative Initiative Grants program. It is a partnership between Helen Mayo House, the South Australian Divisions of General Practice and Community Mental Health Services, Royal Adelaide Hospital . This project is ground breaking in terms of identifying and implementing training and workforce needs in relation to children of parents with a mental illness.

National Mental Health Standard 5: PRIVACY AND CONFIDENTIALITY

Concern: Negative consequences to relationships when carers are not involved

ACHIEVEMENTS:

The Review of Mental Health Legislation has recommended that:

Barriers to proper disclosure of information should be removed as a matter of urgency by legislative change

There should also be professional development of mental health staff on mental health law, and duties of care and confidentiality

There are approximately 250,000 carers in SA and it is estimated that the value of family carers in this State alone is in excess of $2 billion per annum.

Carers have a recognised need for educational assistance, not only in relation to aspects of assistance for their relative/friend with a disability, but also in techniques of personal resilience. The Department of Health has made available funding for 12 carer forums in 2005 across SA to assist family carers of mental health consumers to link with one another and to provide opportunities to meet and network. The forums aim to make local service providers more accessible and provide carers with opportunities to hear about new initiatives.

The National Privacy Principles^[11] have clarified issues of privacy and confidentiality. In response a – Code of Fair Information Practice was developed by Government and the Department runs training sessions including training for regional mental health services. Additionally, a document called “Achieving the Balance” targeted at mental health workers to explain ways in which privacy / confidentiality can be balanced with duty of care, will be incorporated into a training manual / module for mental health workers to be delivered as part of training for code of fair information practice.

Work will also be undertaken to convert this “Achieving the Balance” document into a format for consumers and carers including training through the Health Consumer Alliance to ensure consumers understand their rights.

National Mental Health Standard 6: PREVENTION AND MENTAL HEALTH PROMOTION

Concern: Prevention not a focus of mental health services

ACHIEVEMENTS:

Development of the next phase of activity with beyondblue is currently underway

Increased funding for suicide prevention activities

Support workforce development regarding mental health promotion, illness prevention and early intervention in partnership with national workforce development initiatives (additional funds provided to establish statewide over 1.5 years)

Development of a SA Mental Health First Aid training program that will aim to increase the mental health literacy

Advancing mental health promotion, illness prevention and early intervention is a key priority for government. This direction will lead to improving community awareness and knowledge about mental illness in order to reduce stigma and discrimination that is unfortunately associated with having mental health problems or illness.

The State Government, through the Department of Health, has established several partnerships that complement the directions contained within the National Mental Health Plan 2003-2008. These focus on the promotion of mental health and prevention of mental illness. For example, the State Government currently funds and supports the coordination of regular public education programs and activities that include Mental Health Week, the Dr Margaret Tobin Awards, Rotary Forums and Mental Health First Aid Training programs that contribute to increasing the mental health literacy of the community.

Concern: Lack of services to provide early intervention for youth is a critical problem

ACHIEVEMENTS:

SA participation in beyondblue-Schools Research Initiative projects across 16 high schools

Distribution of thousands of copies of the Mental Health First Aid booklet to government agencies and service providers

Continued development and support to SA media and communication outlets using national resource packages that include the national media initiative Mindframe that promotes respectful and responsible reporting

Supporting rural communities in the prevention of suicide and deliberate self harming practices through a range of community led projects and programs with a focus on young men and indigenous communities

The State Government, through the Departments of Health and Education, are working collaboratively in promoting the mental health and well-being of SA children and young people in areas of service provision (including service pathways) reducing depression (through the beyondblue School Research Initiative) and developing the skills and knowledge of the workforce (mental health and education and early childcare).

The State Government has developed a range of collaborative partnerships with key organisations and initiatives that include beyondblue (the national depression initiative), Auseinet (the Australian Network for Promotion, Prevention and Early Intervention for Mental Health) and MindMatters (national secondary schools mental health promotion initiative).

National Mental Health Standard 7: CULTURAL AWARENESS

Concern: Lack of culturally appropriate practices for Indigenous people

Aboriginal culture has a different, broader concept of mental illness. In essence, health is seen not just as the well-being of the individual, but also involves the extended family, and indeed, the social, emotional, spiritual, and cultural well-being of the whole community. Kinship ties, responsibilities and obligations place a strong emphasis on sharing and mutual support. Dispossession and racism have had a profound effect on families. Drug and alcohol abuse, depression and other forms of mental illness have followed.^[12]

In March 2005, a coronial inquest into the deaths of four Aboriginal men in the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands between May 2003 and March 2004 commented on future policy formulation including:

A need for high quality interpreting services and video-conferencing facilities;
A fast-tracked training program / supported employment of Aboriginal workers;
A longer-term and innovative program for the selection, support and training of Aboriginal Medical Officers and ultimately psychiatrists;
Further consideration of the role of Adelaide-based mental health services because of disincentives for patients to come to an Adelaide-based facility.

ACHIEVEMENTS:

Investment in the provision of specialist Aboriginal mental health services in the Pitjantjatjara Lands

Appointment of Aboriginal workers within the Aboriginal Youth Mental Health Partnership Project and Cavan and Magill Youth Training Centres to work with young people who are part of the juvenile justice system

Development of strategies in the western suburbs for mental health promotion and prevention, early intervention and illness recovery within the Aboriginal community

Additional funds for the development of a culturally appropriate mental health service for Aboriginal people in the metropolitan area to link to mainstream services

Funds for the provision of specialist Aboriginal mental health workers across the state including services to children and young people

Funding to assist with liaison between rural and remote inpatient services and country services for people from Aboriginal communities

Funding for a project for enhancement of primary health care for Aboriginal people in the western metropolitan area

Funding for Aboriginal Mental Health Liaison Services at the Noarlunga Health Services

The Commonwealth Government has made a commitment to invest in the construction of a Substance Misuse Facility on the APY Lands in the far northwest of SA. Additional facilities that are designed and operated to provide improved care for Aboriginal sufferers of mental illness and respite for their carers would be beneficial as would be the facilitation of Aboriginal self-management and community-controlled governance structures.

National Mental Health Standard 8: SERVICE INTEGRATION

Mental Health Services as they are currently configured in SA do not comprise an integrated system. The current mental health system is made up of a number of component services. The performance of each service component is contingent upon the effectiveness of other related service components.

However, the SA mental health reform is consistent with international and national directions, and has as a fundamental principle, that the hub of service delivery is the community mental health team. As far as practicable, people with mental health disorder should be treated within their community, and therefore within each region, specialist inpatient facilities and a range of community rehabilitation programs should be made available. Specialist statewide services, such as forensic mental health services, focus on specific target populations and should support and augment adult community mental health services.

Concern: Problems with continuity between adolescent and adult mental health services

A transitional program has commenced between Child and Adolescent Mental Health Services and Eastern Community Mental Health Services to cater for 16-18 year old young people who will require adult mental health care in the future.

The Department of Health has commenced statewide planning into mental health services for children and young people which will feature a specialised service for people with first episode of mental illness. The target age range will be 15-24 years.

Concern: Link between mental health services and general practitioners

ACHIEVEMENTS:

Establishment of the Metro GP Access program which, in partnership with GPs, provides a range of flexible psychiatric disability support services to people experiencing disability as a result of a mental illness

Implementation of standardised referrals between GPs through a partnership between the South Australian Divisions of General Practice and Mental Health Services and Programs

Establishment of partnerships between community mental health teams and local GPs, including mental health staff consultancy and advice via telephone or face-to-face

However in SA, primary health care is a central focus for health system reform and a Primary Health Care Policy has been released to inform the implementation of this focus.

However, despite significant development of GP services eg Better Outcomes in Mental Health (BOIMH), delivery of services through general practices is sub-optimal. A lack of first class electronic communication between general practice and the public sector leads to safety and quality concerns.

Parallel with this policy direction are ongoing changes to the health system in SA in moving to a regional model with mental health as a priority concern. Primary health care networks are being formed at a regional level with the main focus being on the management of chronic diseases. Mental health and in particular depression is a major co-morbidity for all leading chronic diseases and is a concern for health professionals and consumers. A range of models are also being considered in line with the National Chronic Disease Strategies.

Work with the Divisions of General Practice has commenced in SA developing shared care models including the role of mental health nurse practitioners within the general practice to provide improved mental health services to clients. These models seek to ensure the effective integration of care across service boundaries and to enhance the overall knowledge and capacity of general practice to identify and manage mental health complaints.

Concern: Problems with integration with NGO services

ACHIEVEMENTS:

Incorporation of the National Standards for Mental Health Services into the DHS Service Excellence Framework to assist in standardisation of service provision for non-government organisations

Provision of in-home support assisting people with a psychiatric disability to manage everyday living tasks through the Community Support Inc Scheme and the Metro Access Program

Establishment of partnerships between the government and non-government sectors in the delivery of programs for young people such as Primetime, a vocational rehabilitation program for young people with mental health problems

Integration between NGOs and specialist mental health services is a recognised priority of the Department of Health and strategies for capacity building and integration across human services has commenced.

The Mental Health Coalition is the newly established peak body for mental health non-government organisations. The Integration Project is funded as a one off grant to the Mental Health Coalition of SA (MHCSA). The aim of the project is to increase the viability of the smaller agencies by building their capacity via integrated management and administration.

Funding allocation has also been given to urgently address the lack of service integration across the mental health NGO sector and to modernise service delivery in accord with contemporary policy agendas.

Key Deliverables include:

Increased service viability and integration of services;
Established links between the NGO sector and key partners in service provision including primary care, education, disability, housing, welfare, aged care and other services;
A coherent service mix and model of service across the non government sector;
Services reshaped to better reflect contemporary models of care and support;
Sector capacity to function as a partner in delivering proposed rehabilitation packages;
Protocols and procedures to co-ordinate service delivery to consumers;\
Meet required national quality standards.

Concern: Lack of access to services to meet physical health needs

The Mental Health Emergency Demand Management Policy and Procedure series developed by the Mental Health Unit seeks to ensure appropriate medical assessment is undertaken when necessary. Additionally the recent National Institute of Clinical Studies (NICS) Mental Health Emergency Care Interface Project ensures that mental health services within the Emergency Department are mainstreamed and efficient.

The shared care models between mental health services and general practitioners provide greater access to mainstream medical care when required.

Concern: Housing

ACHIEVEMENTS:

Initiation of a national research project on the support of people with a mental illness who have been provided with emergency accommodation through the Supported Accommodation Assistance Program
Implementation of the SRF Reform Strategy which aims to provide better outcomes for people, many of whom have psychiatric disabilities, who are residents within Supported Residential Facilities or are affected by the closure of an SRF
Integrated care and support of homeless people with a mental illness into the Inner City Homelessness Strategy
Significant expansion of access to supported accommodation facilities
Homelessness initiatives:
- Transfer Liaison Officer positions,
- Boarding house outreach service,
- Best practice program for homeless persons with complex needs,
- Integrated services for homeless persons with dual mental health and drug and alcohol problems

There is currently a draft Memorandum of Understanding, developed by the SAHT, between the Minister for Housing (South Australian Housing Trust, Aboriginal Housing Authority and Australian Community Housing Authority) and the Minister for Health (South Australian Mental Health Services).

The MOU has been developed as a broad inclusive strategy to guide the coordinated delivery of mental health services and housing support services. The aim of the MOU is for the parties to the agreement to work collaboratively, to improve the well being and housing outcomes for people with mental health disorder.

Concern: Health and Community Care (HACC)

It is an objective of the Department of Health to increase the proportion of HACC funding allocated to psychiatric disability and to build HACC agencies' capacity around mental health. An increasing proportion of HACC funding is allocated for disability services.

Mental Health Services for Older People have been contracted to provide mental health training to HACC agencies and build sustainable local networks to give support and assistance to both workers, coordinators and managers of HACC programs as required.

Country
Ageing & Community Care have committed to the provision of funding for an additional suitably qualified person to join the Country team so that the Country team now has the capacity to expand their training program across all seven country regions and develop sustainable networks with local HACC agencies.
Metro
Ageing & Community Care have committed to the provision of funding for Metro Mental Health Services for Older People to expand their existing mental health training programs and support to all metro HACC agencies.

Concern: Police

ACHIEVEMENTS:

MOU developed between SA Police, Mental Health, SA Ambulance Service and the Royal Flying Doctors Service.

A Memorandum of Understanding (MOU) has been developed between SA Police, Mental Health, SA Ambulance and Royal Flying Doctor Services. This has been signed off by all parties and the final publication will be coordinated by SA Police.

The Memorandum seeks to clearly define the roles and responsibilities of each of the service providers and provides an endorsed strategy for implementation at an operational level.

The implementation strategy seeks to ensure that there is a consistent and coordinated state-wide response, provided by the parties to this agreement, to ensure that people with known and suspected mental disorder are provided with access to available mental health services.

Concern: Education

ACHIEVEMENTS:

Specific strategies for recruitment, retention and maintenance of a specialist mental health workforce ($1 million)

Support workforce development for mental health and related workforce regarding mental health promotion, illness prevention and early intervention (in partnership with national workforce development initiatives) establishment phase over 1.5 years

Funding provided for training and development for the non-government sector

30 scholarships to support staff undertaking post graduate studies in mental health nursing (20 metropolitan, 10 country

Two additional positions (one within each metropolitan region) to facilitate practice development within the mental health nursing

Additional funding to support the education of appropriate staff as supervisors, and to encourage the implementation of clinical supervision\

Provision of a wide range of training programs, for example:

- Training of direct care workers through TAFE

- Education and training for police officers

- Training for staff in emergency departments and Assessment and Crisis Intervention Services

- Clinical training in emergency mental health and drug and alcohol misuse for general clinical staff, including country health workers, the South Australian Ambulance Association and the Royal Flying Doctor Service

Development of mental health system workforce strategy has commenced. This integrates with regional health units and health system-wide workforce strategies and creates collaborative arrangements with relevant national committees, industrial bodies, academic institutions and peak bodies which support:

The development of new models of care;
Improved workforce utilisation (i.e., nurse practitioners);
Appropriate workforce mix and distribution;
A sustainable and competent workforce.

Establishment and funding for a training consortium has commenced in order to provide ongoing education and staff development programs for the workforce across the spectrum of service provision (including non-government service providers). Targeted recruitment and training for Aboriginal and Torres Strait Islander, and culturally and linguistically diverse mental health workers has taken place. Support for the existing workforce to transition to the provision of new models of care has commenced.

Concern: Centrelink

Centrelink and the lack of access to welfare and employment systems of centrelink for Mental Health consumers is a recognised issue in SA. The state recommends that the issue be addressed at the national level at the National Mental Health Policy interface with Welfare Policy.

Concern: Transport

SA Health Commission Guidelines for Patient Transport were developed in 1997 and are currently under review and the Mental Health Unit of the Department of Health is ensuring that they reflect best practice for mental health consumers.

Additionally, the Department of Health published a policy as part of the Mental Health Emergency Demand Management Strategy on ‘Emergency Transport of Mental Health Consumers from Country Locations ', which includes principles of care, legal and professional issues and specific procedures relating to transport. This policy promotes transport by the least restrictive means possible, in a manner that ensures the safety of the person and others with regard for the rights, dignity and privacy and with the with the involvement of consumers and carers in choices. A collaborative approach between health professionals, consumers, family members and emergency services, encourages good communication and agreed values, which will ensure timely access to metropolitan hospitals, including Emergency Departments and inpatient units.

Additionally, a Memorandum of Understanding (MOU) has been developed between SA Police, Mental Health, SA Ambulance and Royal Flying Doctor Services.

Concern: Wards of the State – Need for a whole-of-government approach

Research shows a number of underlying and interrelated factors contribute to environments where children are harmed which also includes mental illness and substance misuse. There has been an overall 35% increase in notifications in the last 3 years.

The South Australian Government's child protection reform program ‘Keeping Them Safe' commenced in May 2004. Child protection cannot be separated from policies that benefit children in many areas. The government is injecting significant resources to match our policy commitment to the wellbeing of children.

This child protection strategy seeks to provide the levels of safety, opportunity and choice that will enable children, families and communities to flourish.

The role of the Department of Health is to promote greater awareness and understanding amongst health services and health workers in relation to their responsibilities in the area of child protection and to aid in the integration of this work across health service policy and direction. In essence, to provide a well connected child centred approach, across the continuum of care, from promotion and prevention to acute assessment and therapeutic intervention.

‘Keeping Them Safe' identifies 5 key directions for reform, all directly related to Health:

Support to children and families
Effective, appropriate intervention
Reforming work practices and culture
Collaborative partnerships
Improved accountability

Health already has a significant role in the promotion of the health of families and children, including, target strategies for children of parents with a mental illness. The Department has provided Child and Adolescent Mental Health Services (CAMHS) with specific funds in order to prioritise referrals from this vulnerable group.

Concern: Health in rural and remote areas - Collaboration between state and federal governments to improve services in rural and remote areas.

ACHIEVEMENTS:

Investment for improved availability of inpatient country mental health services

Recurrent funding provided to Whyalla, Port Augusta, Port Lincoln and Wallaroo hospitals and Port Lincoln Aboriginal Health Services to improve mental health inpatient services

Approximately 28% of South Australians live in rural or remote areas. The dispersed nature of the population and service distribution, as well as fewer mental health clinicians per capita than metropolitan services, results in significantly reduced access to mental health care for country people. Of the young people waiting for service from Child and Adolescent Mental Health Service (CAMHS) nearly half are living in country regions. The Department of Health also recognises a need for psychogeriatric services to country regions.

Country SA is unique as there are no major rural bases and tertiary care is mostly provided by metropolitan Adelaide . Therefore, there is a requirement to build clinical networks that capitalise on the use of technology due to this reliance on Adelaide based services.

Significant funds from the Social Inclusion Board to develop suicide prevention programs in each rural region that are based upon collaborative care arrangements specifically designed to join up state and federal initiatives. Additionally, increase in access to both non-government organisations and primary health care services are key priorities for the Department of Health especially for Aboriginal people. This will be linked with the Commonwealth Aboriginal Primary Health Care Access Program (APHCAP).

Commitment has been made by the Department of Health in the form of Strategic Directions for Country Health 2005-2010. These state that the objectives for mental health will be met by cooperation and collaboration with other agencies on integrated mental health; ensuring consumer and community participation; provision of supportive environments for the safe and effective delivery of mental health care; ensure a highly skilled, well-supported, confident and sustainable health workforce.

Concern: Criminal Justice System - Collaboration with the Adelaide Magistrates Court to provide services to, and reduce offending by, people with mental illness.

ACHIEVEMENTS:

Establishment of the Mental Impairment Implementation Reference Committee (MIIRC) to address coordination of services across portfolios and to improve mental health outcomes for prisoners and offenders

Provision through the Magistrates Court Diversion Program of alternatives to incarceration for criminal offenders

Recent reviews^[13] have recommended the expansion of current capacity of Forensic Mental Health Services and Department of Correctional Services (DCS) professional staff to meet specialist inpatient, consultative and treatment needs of DCS clients and licensees who are in prison or in the community.

Diversion programme operations within the judicial system in the Magistrates / Children's Courts, are a cost-effective way of avoiding institutionalisation and the problems caused by institutionalisation.

It should be possible for a court to dismiss a charge and/or refer an offender for mental health services to prevent increasing use of the section 269 Mental Impairment Provisions (1995) of the Criminal Law Consolidation Act (1935) which results in clogging up of the courts and acute forensic mental health facilities. This issue is being addressed in the current review of the Mental Health Act and the con-current review of the Criminal Law Consolidation Act specifically section 269.

Planning for a new 40-bed forensic facility and a new secure 30-bed secure rehabilitation facility has commenced. Planning for the forensic facility will include a capacity to expand to a possible total of 50-beds. Consultants are to be engaged by mid-2005 and construction is due to commence in mid-2006 with completion expected by early 2008.

National Mental Health Standard 9: SERVICE DEVELOPMENT

Concern: Lack of resources and services and the impact of this on clinicians

Services models in SA have traditionally focused on acute care, with hospital services remaining highly significant. The initial focus of the SAn Reform Agenda is to reorientate the health system to a population health approach, achieving gains in population health outcomes and improving health status by moving emphasis towards a primary health care focussed system.

In acknowledging and proactively addressing criticisms, the South Australia Government has committed approximately eighty million dollars to a mental health capital program from 2002 to 2007.

Concern: Distribution of services – lack of services in rural and regional areas

ACHIEVEMENTS:

Investment for improved availability of inpatient country mental health services

Increased funding for country mental health services and linkages with the rural and remote mental health service

Expanded telepsychiatry, leading to better access for consumers in rural areas to specialist resources

An increase in the number of psychiatrists visiting rural areas to undertake shared care and provide support to GPs via a partnership between the Commonwealth Medical Specialist Outreach Assistance Program and the Rural Doctors Workforce Agency

Development of a Health and Community Services Complaints Commission in SA

In country regions, the focus is on increasing the availability of consultation and liaison services provided by community mental health services, distance consultation services and visiting specialist services to better support GPs and other local services. Then the priority will be to get the services to work as a single system of mental health care.

Concern: Model of mental health care needs to change – inappropriate focus on inpatient and crisis care

A Transition plan for consumers from Glenside has commenced entitled: – Returning Home Project.

Ongoing community support services will be provided by a non-government organisation to up to twenty people who will be assisted to transfer