Regional Planning for Mental Health and Suicide Prevention – a Guide for Primary Health Networks (PHNs)
Department of Health
August2017
Version 1.01
1
Contents
Introduction
1.The Department’s expectations in relation to regional planning
1.1Overview
1.2What should be the scope of the Regional Plan?
1.3What timeframe should the Regional Plan encompass?
1.4What flexibilities will PHNs have in developing an innovative Regional Plan?
1.5How is the Regional Plan different from annual activity work plans
developed by PHNs, or by broader planning for commissioning?
1.6What should the Regional Plan look like? What should it try to achieve?
How does the Plan relate to the joint regional plans foreshadowed in the draft
Fifth National Mental Health Plan?
2Guidance on how PHNs might approach development of the Regional Plan
2.1The process of developing the Regional Plan
2.1.1Setting local parameters for the Regional Plan - refining and agreeing
local scope, assumptions, timeframe and focus
2.1.2Allocating resources to the planning process
2.1.3Establishing governance and consultation arrangements for the Regional
Plan
2.1.4Compiling the local evidence base
2.1.5Use of the National Mental Health Service Framework (NMHSPF) and
other tools and resources to identify service needs and targets
2.1.6Identifying priorities for change and service development
2.1.7Identifying duplication and inefficiencies, including ambiguity in roles and responsibility
2.1.8Considering opportunities for integrated service delivery and
supporting providers to work together
2.1.9Consideration of implementation issues
2.1.10Measuring progress in implementation of the Regional Plan
2.1.11Seeking agreement to the Regional Plan from LHNs and other
stakeholders
2.2The content of the Regional Plan
2.2.1The local context
2.2.2Embedding a stepped care framework within the Regional Plan
2.2.3Suicide prevention
2.2.4Aboriginal and Torres Strait Islander mental health and suicide
prevention.
2.2.5Other special population groups
2.2.6Workforce planning
2.2.7Drug and alcohol services
2.2.8Cross sectoral planning
3Resources available to support PHNs in development of the Regional Plan.
3.1PHN Mental Health Tools and Resources
3.2State/Territory mental health plans and frameworks.
3.3State/Territory Suicide prevention strategy
3.4Local, state and national data sources to support planning
3.5Resources to support planning for suicide prevention
3.6Resources to support planning for Aboriginal and Torres Strait Islander
Mental Health and Suicide Prevention
1.0 / 11 July 2016 / Version released to all PHNs
1.01 / 23 August 2017 / Minor editorial corrections to remove typos and formatting errors.Updated 1.1 Overview.
Introduction
This document provides guidance to Primary Health Networks (PHNs) on the requirements and opportunities associated with their requirement to develop a Regional Mental Health and Suicide Prevention Plan. It should be read in conjunction with other guidance documents, circulars and within the context of the funding Schedule for the PHN Program:Primary Mental Health Care Activity (the Funding Schedule).[1]
PHN development of the Regional Mental Health and Suicide Prevention Plan (Regional Plan) is a pivotal element of broader mental health reform.A comprehensive, evidence based Regional Plan, developed in partnership with Local Health Networks (LHNs) and other regional stakeholders, has the capacity to support future service delivery pathways which are integrated, targeted to need across the spectrum of stepped care, and which address local priorities. It can offer the opportunity to embed partnerships needed to make optimal use of resources and ultimately deliver improved outcomes and experiences of care for consumers and carers. The importance of a Regional Plan to support service integration and clarity of responsibilities at a regional level has been highlighted in the Government’s response to the Review of Mental Health Programs and Services[2]and as a priority area in the draft Fifth National Mental Health and Suicide Prevention Plan (the draft Fifth) Plan.[3]The need for regional planning and integration is also supported through several recent state and territory mental health plans and frameworks as well as bilateral agreements to support coordinated care currently being negotiated between the Commonwealth and states and territories. PHNs are ideally placed to undertake regional planningin partnership with LHNs and other stakeholders.
The parallel development over this period of the National Mental Health Service Planning Framework, and regionally targeted resources to support PHNs, provides opportunity to give some precision to planning processes to ensure that Regional Plans become a valued resource which genuinely inform planning and resource allocation by Commonwealth, state government and NGO service providers.
This guidance is broken into threeparts.
- Part1 provides advice on the Department’s requirements and expectations, and the parameters within which PHNs can work in developing a Regional Plan.
- Part 2 offers advice on how PHNs may wish to implement this area of activity, and considerations they may wish to take into account.
- Part 3 identifies resources which may be of further assistance to PHNs in development of the Regional Plan.
This guide does not override the requirements set out in the Funding Schedule.
1.The Department’s expectations in relation to regional planning
1.1Overview
The Department’s formal requirements for the development of a Regional Plan are set forth in the Funding Schedule and in related circulars. The Department’s expectations of, and parameters for, the contents of the Regional Plan are also linked to broader guidance and requirements of the Department for PHN mental health activity.
The Funding Schedule indicates that PHNs are required to
“develop, in partnership with LHNs and other stakeholders, a comprehensive Regional Mental Health and Suicide Prevention Plan, which is in addition to annual activity plans and is likely to span a number of years. It must be evidence based and be developed through comprehensive Needs Assessments and service mapping to identify gaps and opportunities for the efficient commissioning and targeting of services, including those related to the Key Objectives of this Activity. Once completed, this Plan should provide a vital resource to Australian Government, state government, non-government and services in the region to support the integrated delivery of mental health and suicide prevention services within the community. Agreement to the Plan must be sought from regional stakeholders including LHNs, who should also be encouraged to be co-signatories to the Plan”
(2.1 (iv) PHN Primary Mental Health Care Activity Funding Schedule)
Although the requirement for PHN’s to submit the completed Regional Plan to the Department has been removed as a contractual milestone, regional planning remains a very important component of PHN activity.
PHNs should seek agreement from LHNs and other regional stakeholders to the Regional Plan and to collaboratively develop the Regional Plan to the maximum extent possible. The Department recognises that the nature of this agreement may vary from endorsement of the Plan to acknowledgement to work together on specific priorities.
Local Hospital Networks (LHNs)
LHNs vary across states and territories. Local Hospital Networks (LHNs) entities established by state and territory governments to manage single or small groups of public hospital services, including managing budgets and being directly responsible for performance. Most, but not all, LHNs are responsible for managing public hospital services in a defined geographical area. At the discretion of states and territories, LHNs may also manage other health services such as community based health services. LHNs may have different names in some jurisdictions. For example, they are referred to as Local Health Districts in New South Wales, Health and Hospital Services in Queensland, Local Health Services in South Australia, and the Tasmanian Health Service in Tasmania.
The Department will not itself seek to assess, endorse or approve the Regional Plan, and there is no specific template or pro-forma with which PHNs need to comply. The Regional Plan will not in any way supersede or obviate other mental health obligations and objectives PHNs have in association with the Funding Schedule. For example, the existing commissioning priorities for mental health and suicide prevention funding under the Schedule will remain for the duration of the Schedule, regardless of whether other priorities at a regional level are identified for the longer term or for the broader government and non-government service sector.
Figure 1: Summary of Department of Health expectations set out in PHN Mental Health Circular No. 2 and related documents [4],[5]
The Department’s expectations of the Plan as set forth in Mental Health Circular2, March 2016 and in the Schedule and other documents and guidance materials can be summarised as follows.
- The Plan should be developed with, and desirably be agreed by, the Local Hospital Networks and other stakeholders as appropriate, including consumers and carers.
- It should be underpinned by evidence and data, including information obtained through needs assessments, and local population and service data.
- It should support an integrated, coordinated approach to service delivery and joined up pathways to care.
- The Plan’s development should take into consideration existing service arrangements provided in the region by ACCHS, LHNs and other organisations.
- It should aim to identify and address duplication, inefficiencies and gaps in the system and provide solutions to address them.
- It should seek to facilitate clear delineation of roles and responsibilities at a local level.
- It should identify key priorities for system and service development within the life of the plan.
- It should address a multi-year timeframe – potentially identifying longer term priorities for growth beyond the life of the plan.
- It must embed a stepped care approach to mental health service delivery to ensure that a broad range of service types are available.
- It must promote a joined-up approach to preventing suicide.
- It should consider cross sectoral links required particularly to promote mental health, support early intervention and prevent suicide.
1.2What should be the scope of the RegionalPlan?
In previous advice, the Department has suggested that the Regional Plan should encompass primary mental health care services and their interface with mental health services provided by state governments, private providers, the National Disability Insurance Scheme (NDIS), and non-government and Indigenous health sectors. It is not anticipated that the Regional Plan will cover admitted patient services delivered by hospitals, except to the extent that PHNs acknowledge referral pathways and the level and type of services available.
There is also an opportunity for the Regional Plan to engage with human services operating outside the health sector, particularly disability, education, employment and social services in providing support and services to people with mental illness, particularly in the context of suicide prevention activity.In summary, the Department expects the Regional Plan to position primary mental health care within a broader context, but acknowledges that PHNs will vary in the extent to which they are able to engage other sectors and services in the development of the Regional Plan. Further guidance later in this document elaborates on opportunities for extending the reach and scope of the Regional Plan.
1.3What timeframe should the Regional Plan encompass?
The Regional Plan should be a detailed multi-year document, however the exact timeframe for the Regional Plan should be subject to local agreement and consideration, and alignment with other local planning processes or with LHN planning timeframes. Others may wish to have a longer-termRegional Plan which potentially could be subject to review.
In general, The Department suggests that a period of three to five years is regarded by the Department as the timeframe that should be covered by regional plans. Should PHNs consider theRegional Plan should cover less than three years, it is requested that the rationale for this be provided when submitting the Plan to the Department.
1.4What flexibilities will PHNs have in developing an innovative Regional Plan?
The Department recognises that theRegional Plan is likely to vary significantly from one PHN to another, and that local priorities, aspirations and the extent of integration will vary.The Regional Plan provides opportunity for local innovation, and this may be reflected in a range of ways.
Significant flexibility, variation and innovationis anticipated in relation to:
- the format, structure and length of Regional Plan;
- the extent to which PHNs are able to agree a shared Regional Plan for service delivery into the future with LHNs and other stakeholders;
- priority issues and/or population groups;
- sub-regional issues requiring particular focus;
- aspirations for growth and change;
- innovative approaches to workforce, particularly in areas of workforce shortage;
- the depth and nature of partnerships with LHNs and other organisations in planning and commissioning of services; and
- the approach to engagement of other stakeholders.
While PHNs will have this flexibility, the Regional Plan does notamend contractual obligations associated with the current funding agreement with the Department for mental health activity.For example, the approach to planning youth mental health services would need to accommodate existing commitments regarding maintenance of headspace centres, and the six priorities of the funding agreement would remain in place.
1.5How is theRegional Plan different from annual activity work plans developed by PHNs, or by broader planning for commissioning?
Planning is a core activity which underpins most of the work PHNs undertake.The commissioning role undertaken by PHNs requires extensive structured planning arrangements, and has been subject to previous detailed advice and guidance from the Department.[6],[7] Similarly, PHNs have been required to provide specific workplans for their annual mental health activityfor which specific templates have been provided.
Many general principles associated with planning may apply to the development of a Regional Plan, and in this respect detailed guidance previously provided by the Department on undertaking needs assessments, and on planning in a commissioning environment may be helpful and relevant. These resources are summarised in Section 3 of this guidance document.
There are, however,some fundamental differences between these PHN specific planning activities and the planning associated with a Regional Plan.
- The Regional Plan maygo beyond a focus on the PHN’s activities to considerbroader mental health services and needs within the community, including services provided by LHNs and through non-health sectors.
- The Regional Plan is intended to span a multi-year period rather than an annual plan for action.
- The PHN’s role is todevelop the Regional Plan in collaboration with other regional stakeholders. Agreement to and, if possible, endorsement of the Regional Plan should be sought from local government, LHNs and local stakeholders.
1.6What should theRegional Plan look like? What should it try to achieve?
Various national, state and local mental health plans have been prepared previously which have served a broad range of purposes. Some simply articulate a vision, while others attempt to put together existing mental health commitments in a way which documents collaboration and ways of working together. Other more recent plans at a jurisdiction level have attempted to undertake evidence-based service planning to support a shared view of what services will be needed and by whom into the future.
The Regional Plan should provide a platform for regional service integration and planning by capturing a vision for improving services, documenting partnerships and existing commitments, and identifying strategies to improve service delivery. However, they need to do more than simply encapsulate principles, vision and existing arrangements.They should alsoendeavour to scope a plan for moving towards the vision, through an integrated service system, and articulate the changes in service delivery, service pathways and use of regional resources and workforce needed to address the identified priorities. Noting earlier guidance on engaging all relevant local stakeholders, it will important to clarify and agree on theroles and responsibilities in implementing these changes.
The Regional Plan will be limited by a range of factors, including the available resources, length of funding agreements and the capacity of LHNs and other stakeholders to engage and commit. Where possible PHNs should seek to mitigate identified risks to maximise the success of the Regional Plan.Having agreed aspirations and well developed service targets that perhaps go beyond the life of the Regional Plan ensures all parties are armed with evidence and agreed priorities in the eventshould additional resources become available.
Ultimately the value or success of the Regional Plan will be determined by whether it is embraced as a valued regional resource which articulates agreed service priorities and the partnerships, pathways, and local system changes which are needed to achieve them.
How does the Plan relate to the joint regional plans foreshadowed in the draft Fifth National Mental Health Plan?
Priority Area 1 of the draft Fifth Plan specifically focuses on regional planning and service delivery and commits governments to a range of actions to support the roles of PHNs and LHNs. Actions 1 and 2 of the draft Plan explicitly require the development of joint regional and suicide prevention plans by PHNs and LHNs. These actions also require governments to provide a range of support materials, including planning tools based on the NMHSPF, region-level data and guidance about the development of joint plans.
The Department anticipates that the regional plans developed by PHNs will provide a strong foundation for joint plans developed with LHNs in the future. Althoughthe requirement for PHN’s to submit the completed Regional Plan to the Department has been removed as a contractual milestone, regional planning remains a very important component of PHN activity.Regional Plans should be developed with stakeholder engagement and possible endorsement by LHNs wherever possible however, the extent to which this is achieved will vary across regions.
The first stage of implementation toward regional planning of mental health services may not cover the full range of services and may not extend into areas traditionally the responsibility of state and territory funded services. By contrast, joint regional and suicide prevention plans developed by PHNs and LHNs under the terms of the draft Fifth Plan will be expected to be comprehensive as well as be fully endorsed by the LHN(s) with service responsibilities within the PHN’s regional boundaries. It is also expected that state and territory central health departments will contribute to Regional Plans and may choose to set this as a requirement for any LHN endorsement. Implementation arrangements and guidance to support the development of joint plans, as committed in the draft Fifth Plan, will clarify this and other requirements.