Transcript Slide 1

Mental Health Planning in
Queensland.
Dr Aaron Groves
Director of Mental Health.
08/04/2011
Purpose & Scope of QPMH
The Qld Plan for Mental Health 2007-17 (QPMH):
– Provides a blueprint for reforming and improving the way we deliver
mental health services.
– Is a Whole-of-Government plan which includes collaborative actions
across a number of Government Departments & sectors.
– Provides evidence-based targets for service development.
– Is consistent with national mental health initiatives and policies.
The Process
1. Broad consultation with internal/external stakeholders.
2. Formation of ‘expert’ groups to provide recommendations
about the specific service development required over the next
10 years.
3. Developed evidence-based parameters for planning of mental
health services - Qld Centre for Mental Health Research
(QCMHR).
4. Established planning targets for five core mental health
service components using the recommendations provided by
the speciality groups and the benchmarks recommended by
QCMHR.
5. Developed the Qld Plan for Mental Health 2007-2017 &
obtained funding to support implementation of the first stage
of the Plan (2007-2011).
Guiding Principles
The QPMH articulates 6 principles to guide and support mental
health reform:
1. Consumer & carer participation
2. Resilience & recovery
3. Social inclusion
4. Collaboration & partnerships
5. Promotion, prevention & early intervention
6. Evidence-based
Community
Care &
Support
MAP OF MENTAL HEALTH SYSTEM IN QUEENSLAND
Referral
PRIVATE MENTAL HEALTH SERVICES
Self &
Carer
Referrals
General
Practitioners (GPs)
Police &
QLD
Ambulance
Service
Referral and Triage
Emergency
Depts
Psychologists
SPECIALIST MENTAL HEALTH SYSTEM
Community Mental Health Services
Bed-Based Treatment
NGO and
other
agencies
General
Practitioner
(GPs)
Psychiatrists
Acute Hospital
Beds & Clinics
C&Y
Adult
Older
Case Management


Triage and Acute Care





Mobile Intensive


All
Alcohol & Drug Problems

Consultation-Liaison

Eating Disorders

Transcultural/CALD

Forensic Liaison

Primary Care

Interagency Coordination

Special / Complex Needs

#

Aboriginal & Torres Straight Islanders
Mental Health Nurses
& Allied Health
Other Govt
Health
Service
GPs
Community Residential
Acute Beds
Community Care
Units
Extended Beds
(sub-acute)
Supported
Housing &
Accommodation
Specialised Statewide Mental Health Services
Eating Disorders
Forensic
Transcultural
Perinatal and Infant
Homelessness
Intellectual Disability
Acquired Brain Injury
Rural and Remote
Alcohol & Drug
Older Persons
Special / Complex Needs
#
NGO
Support
Services
Psychiatrists
and Other
Allied Health
Providers in
Private
Practice
Mental
Health
Nurses &
Allied Health
Other
Gov’t
Depts or
Agencies
Employment
Support
Aboriginal & Torres Straight Islanders
COMMUNITY SUPPORT SERVICES
Education
Alcohol & Other
Drug Services
Justice
Child Safety
Community Health
Employment
Support
Supported
Social Housing
Transitioning Prisoners
Psychiatric
Disability Support
#
Respite
Services
Includes Deaf & Hearing Impaired, Blind & Visually
Impaired and Mood, Anxiety & Personality Disorders
Planning Targets
CORE COMPONENT
SERVICE ELEMENT
PLANNING TARGET (Benchmark)
ACUTE BEDS
20 beds per 100k
NON ACUTE
10 beds per 100k
CLINICAL - 24 HOUR STAFFED
10 beds per 100k
NON CLINICAL,
STAFFED 8-24/24
15 beds per 100k
SUPERVISED HOSTELS
35 beds per 100k
SUPPORTED PUBLIC
HOUSING
35 beds per 100k
AMBULATORY CARE
CLINICAL SERVICES
CLINICAL STAFF
70 FTE per 100k
COMMUNITY SUPPORT
SERVICES
NGO SUPPORT SERVICES
INPATIENT SERVICES
ADULT RESIDENTIAL
REHABILITATION
SERVICES
SUPPORTED
ACCOMMODATION
15% service funding
The funding commitment
Qld Government investment since 2007
Queensland Health
Implementation of the QPMH
$443.45m
Implementation of the Review of MHA 2000
$40.14m
Mental Health Enterprise Integrated Information
System
$16.40m
Mental Health Stigma Reduction Strategy
$8.50m
NGO provided personal support and
accommodation
$35.64m
Housing with Support Program (personal support
packages)
$28.45m
Housing
Housing with Support Program (housing capital)
$40.0m
Justice and
Attorney-General
Implementation of the Review of MHA 2000
$13.35m
Disability Services
TOTAL
$634.4m
Priorities for Action
PRIORITY 1 – Promotion, prevention and early intervention
PRIORITY 2 – Improving and integrating the care system
PRIORITY 3 – Participation in the community
PRIORITY 4 – Coordinating care
PRIORITY 5 – Workforce, information quality and safety
Planning Targets of the
Queensland Plan for Mental Health 2007-17
Planning Target Assumptions
Targets are a guide only.
They need to be interpreted within the local service context. Districts still
need to evaluate the demographics of their own population when
considering how staffing targets apply at the district level.
Targets do not take into consideration local needs.
It is assumed that issues specific to the district need local management.
Targets provide a framework to allocated resources to achieve:
•a more equitable distribution of services across the state;
•improve access to the full spectrum of services; and
•improve levels of service provision comparable to national standards.
Targets do not consider prevalence rates in each district.
It is assumed that mental illness is relatively evenly distributed per 100,000
population.
Application of the planning targets
Developed service development plans for each district
mental health service:
• what services are currently available in each district
• what the target level of beds/staff should be by 2017
• what growth is needed to meet the target
Used these plans to guide new resource allocation:
• invest new resources to districts/programs that are
comparatively less well resourced
• implement a system to review new positions
(including vacancies of existing staff over time) to
ensure that resources are being directed into services
Application of the planning targets
Developed an ongoing relationship with district mental health
services to update, review and monitor service development to
ensure that staff:
•understand the planning targets
•understand how the planning targets apply to their service
•understand how their service compares to other services
•understand what their priorities for service development are
Application of the planning targets
1. Articulated the principles of mental health reform:
 Consumer & carer participation
 Resilience & recovery
 Social inclusion
 Collaboration & partnerships
 Promotion, prevention & early intervention
 Evidence-based
Application of the planning targets
2. Identified the priorities for investment:
 Promotion, prevention & early intervention
 Improving & integrating the care system
 Participation in the community
 Care coordination
 Workforce development, information, quality &safety
Application of the planning targets
3. Developed service development plans for each district
mental health service:
 what services are currently available in each district
 what the target level of beds/staff should be by 2017
 what growth is needed to meet the target
4. Used these plans to guide new resource allocation:
 invest new resources to districts/programs that are
comparatively less well resourced
 implement a system to review new positions
(including vacancies of existing staff over time) to
ensure that resources are being directed into services
Example
Redcliffe Caboulture
*Old population figures new 237726
2016
Acute Beds
2,006 2011 2016
Redcliffe/Caboulture
0-14
37,038
0-19
50,713
15-64
143,588
>64
46,124
Total
226,750
Child
Youth
Adult
Aged
3
2
22
21
Child
Youth
Adult
Aged
3
2
22
21
5
42
Extended Treatment programs 2016
ABI Aged ET&R Ddiag MedS High S
1.5 3.0 5.0 3.0
4.3
2.2 Acute
Child
Youth
Adult
Aged
3
7
11
7
8
4
7
15
15
45
Total Catchment
226750
0-14
15-19
15-64
>64
Total Child/Youth
Total Adult/Older Persons
Current Service Assignment Adult/Aged
Current Service AssignmentChild/Youth
24
RBH
Proposed Service Assignment Adult/Aged
Proposed Service AssignmentChild/Youth
RBH
44
44
3
7
11
7
8
15
4
Sunshine Coast
TPCH 8
13
7
TPCH
TPK
TPCH 14
13
7
23
TPK
(0-14)
(15-19)
(15-64)
(>64)
Example
Redcliffe-Caboolture
Projected 2016 population
Population 2006
Projected 2011 population
Community Mental Health
Programs (70 FTE/100,000)
Child & Youth
Older Persons
Consultation Liaison
Adult Case Mgt
Mobile Intensive Treat.
Acute Care
Indigenous
Primary Care
Transcultural
Dual Diagnosis
Intellectual disability
Eating Disorder
Sensory Impaired
Consumer Consultants
Leaders & Qual/Safety
Service Integration
Forensic liaison
Total
244618
192008
217333
Current
Target
FTE (at
FTE Rate June 07)
14.50
14.00
4.50
2.00
3.50
2.80
15.00
30.50
5.50
4.00
11.00
11.00
3.00
2.25
1.50
0.00
0.50
0.00
1.00
2.00
0.50
0.00
0.50
0.00
0.50
0.00
1.00
1.00
6.00
7.00
1.25
0.00
0.75
1.00
70.00
78.05
Target
FTE
2017
34.25
11.01
8.56
36.69
13.45
26.91
7.34
3.67
1.22
2.45
1.22
1.22
1.22
2.45
14.68
3.06
1.83
171.23
New
Progress to
FTE
target (at
needed June 2007)
19.75
42.34%
9.01
18.17%
5.76
32.70%
6.19
83.12%
9.45
29.73%
15.91
40.88%
5.09
30.66%
3.67
0.00%
1.22
0.00%
0.45
81.76%
1.22
0.00%
1.22
0.00%
1.22
0.00%
1.45
40.88%
7.68
47.69%
3.06
0.00%
0.83
54.51%
93.18
45.58%
Rate/100,000
total pop at
2006/07
7.55
1.04
1.46
15.88
2.08
5.73
1.17
0.00
0.00
1.04
0.00
0.00
0.00
0.52
3.65
0.00
0.52
40.65
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120%
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Community mental health
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80.00%
Increase in FTE since 2006-07 (%)
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Application of the planning targets
5. Developed an ongoing relationship with district mental health
services to update, review, monitor service development. Ensure
that staff:
understand the planning targets
understand how the planning targets apply to their service
understand how their service compares to other services
understand what their priorities for service development are
Application of the planning targets
Developed an evaluation framework to determine whether
investment in mental health is making a difference.
Measures of input
•
Progress in expenditure of
allocation to develop a
service model for rural and
remote mental health
services.
•
Public sector community
mental health FTE per
100,000 population.
•
Consumer and carer workers
per 100,000 population.
•
Aboriginal and Torres Strait
Islander mental health
workers per 100,000
population.
•
•
Transcultural mental health
workers per 100,000
population.
Inpatient beds per 100,000
population.
Measures of output




Proportion of Aboriginal and
Torres Strait Islander
consumers who have
Indigenous Health Workers
involved in care.
Proportion of community
mental health consumers
who have carers involved in
care.
Proportion of community
mental health consumers
who have a General
Practitioner involved in care.
Average bed occupancy for
acute mental health
inpatient units.
Measures of outcome
•
Proportion of the
Queensland population
receiving clinical mental
health care (public and
private).
•
Proportion of new clients
accessing Queensland public
mental health services.
•
Average treatment days per
three-month community
care period.
•
Seven-day post-discharge
community contact.
•
Rate of readmission to
mental health inpatient care.
•
Change in consumer’s
clinical mental health
outcomes.
•
Consumer mental health
outcomes participation.
Key Evaluation Questions
KEQ1. Was funding expended in the intended way?
KEQ2. To what extent has the infrastructure and capacity of the
mental health sector increased?
KEQ3. Has the quality of the mental health system improved?
KEQ4. Have the initiatives impacted on people living with mental
illness?
KEQ5. Has the mental health of the community improved?
Making Plans - to make plans and project
designs brings with it many good
sensations; and whoever had the
strength to be nothing but a forger of
plans his whole life long would be a
very happy man: but he would
occasionally have to take a rest from
his activity by carrying out a plan - and
then comes the vexation and sobering
up.
(Nietzsche, 1878/1986: 231)