Brisbane North PHN

Mental Health & Suicide Prevention

Health Needs Assessment

Submission to the Australian Department of Health
November 2016

Page 13 of 13

Partners 4 Health Ltd (ABN 55 150 102 257), trading as Brisbane North PHN

Brisbane North PHN gratefully acknowledges the financial and other support from the Australian Government Department of Health

Mental Health & Suicide Prevention Health Needs Assessment

Section 1 – Narrative

Needs Assessment process and issues
Brisbane North PHN developed a comprehensive Mental Health and Suicide Prevention Needs Assessment which builds on the preliminary needs identification undertaken in March 2016.
The PHN analysed mental health data from a range of sources in the development of the comprehensive Mental Health and Suicide Prevention Needs Assessment, including:
·  Australian Institute of Health and Welfare
·  Australian Bureau of Statistics
·  Social Health Atlas of Australia
·  Headspace
·  Queensland Health
·  Commonwealth Department of Health
·  Commonwealth Department of Health PHN Portal data, including
–  ABS mental health data
–  Access to Allied Psychological Services data
–  Mental Health Nurse Incentive Programme data
–  Private Mental Health Alliance data
·  Medicare Benefits Scheme
·  Internal PHN program data
·  NGOs including Lifeline and Beyond Blue.
The PHN synthesised data from the above sources to determine the breadth of mental health and service needs present in the PHN region. This information formed the basis of the comprehensive Mental Health and Suicide Prevention Needs Assessment.
The PHN consulted widely with the local community and a range of health service providers, including the Metro North Hospital and Health Service and the PHN Community Advisory Committee and Clinical Council.
The PHN’s consultation refined the Mental Health and Suicide Prevention Needs Assessment and assisted in the development of a range of strategies, through a collaborative co-design process that responds to the identified mental health and suicide prevention needs. Based on feedback from stakeholders the PHN has also established a Children & Young People Mental Health Advisory Group, as well as linking to the existing Collaboration in Mind Reference Group. The PHN also presented the draft needs assessment at two Suicide Prevention Forums held in September 2016. All of these stakeholder engagement activities have provided critical input to the needs assessment as well as shaping the activities developed in response to these needs.
Brisbane North PHN will continue this engagement and co - design to develop a regional Mental Health and Suicide Prevention Plan in partnership with stakeholders to allow for future service delivery to be evidenced based and reflective of the needs of the community, informed by the stepped care mental health policy framework.
Additional data needs and gaps
A key component of assessing future mental health and suicide prevention needs across government and non-government settings is to ensure that accurate and timely data is available. This will enable the PHN to make informed, evidence based decisions and allow for the appropriate commissioning of services in the region.
The lack of reliable age specific mental health prevalence data on the local level is an identified data gap, with existing prevalence data only available on a national or state level through the Australian Institute of Health and Welfare, or through age standardised modelled estimates available through the Social Health Atlas of Australia.
Quantitative data on hard to reach populations is difficult to obtain through existing frameworks, and accurately identifying the health needs of these population groups will remain a challenge.
Additional comments or feedback
It must be recognised that whilst Brisbane North PHN understands the need for consistency across the Primary Health Networks in developing these reports, the table format does not easily enable the presentation of trends and relationships between identified needs. Given the complex nature of mental health and suicide prevention as well as the service landscape, this limited reporting template makes it difficult to demonstrate a comprehensive picture of needs.

Page 13 of 13

Partners 4 Health Ltd (ABN 55 150 102 257), trading as Brisbane North PHN

Brisbane North PHN gratefully acknowledges the financial and other support from the Australian Government Department of Health

Section 2 – Outcomes of the health needs analysis

Identified Need / Key Issue / Description of Evidence /
Low intensity mental illness / High prevalence of psychological distress, depression and anxiety in the northern regions of the PHN where population growth is projected to occur. / From 2011 to 2013, there were an estimated 70,513 people in the PHN region aged 18 years and over with high or very high psychological distress which is a rate of 10.1 per 100 people[1]. This is lower than the Queensland rate of 10.6 but comparable to the Greater Brisbane area rate of 10.4 per 100 people[2]. Psychological distress is calculated using the Kessler 10 scale (K10) and a higher score indicates a higher prevalence of psychological distress.
The highest rates of people aged 18 years and over with high or very high psychological distress existed in the in the Morton Bay North sub region (11.9%), however service data also indicates this region has a lack of services and health workforce available[3].
Nationally, it is estimated that between 10 to 15 per cent of those aged 65 years and over experience depression and approximately 10 per cent experience anxiety. In 2011, an estimated 19 per cent of the population aged 65 years and over in the PHN region accessed PBS subsidised antidepressants, with 2.6 per cent of the same age cohort accessing MBS subsided GP mental health services[4].People residing in outside of the major metropolitan areas in the PHN region are more likely to access PBS subsided antidepressants compared to people residing in the metropolitan areas[5], indicating that a higher need exists in the Moreton Bay North area. The service utilisation data indicates that low intensity mental illness is of some concern among the older age cohorts in the PHN region, particularly in the more northern sections of the catchment.
In the PHN region, the number of patients commencing a GP mental health plan increased by three per cent each year between 2012-13 and 2014-15[6]. Within the region , the average annual increase in patients commencing a GP mental health plan was highest in the Moreton Bay North area, with 14.7 per cent increase in the Caboolture Hinterland area and 9.1 per cent increase in Bribie – Beachmere[7]. An estimated 6 per cent of the population commenced a GP mental health plan in the Brisbane Inner and Strathpine areas, indicating a high prevalence of mental illness. These trends are projected to increase.
Children and young people / Identifying health and wellbeing issues, such as mental health, when they occur in adolescences is socially and economically more effective than dealing with enduring problems in adulthood.
High levels of developmental vulnerability among children residing in socioeconomically deprived areas in the PHN region, potentially leading to higher rates of mental health issues among children and young people.
High proportion of young people experiencing psychological distress in the PHN region, particularly in areas of higher socioeconomic disadvantage. / Children and adolescents in low-income families, with parents and carers with lower levels of education and with higher levels of unemployment had higher rates of mental disorders in the previous 12 months. This is particularly evident in males who had higher rates across all five characteristics[8]. In the period between July 2013 and June 2015, there were over 10,000 emergency department presentations by people aged less than 25 years of age for mental and behavioural issues in the PHN region[9]. The most common reason for presentation was suicide ideation, general mental illness, anxiety and depression[10]. Almost one in ten mental health related emergency department presentations were by people residing in socioeconomically disadvantaged regions, including Caboolture, Deception Bay and Morayfield. This indicates that young people residing in socioeconomically disadvantaged areas in the PHN region have high mental health needs.
The Australian Early Development Census is an instrument which measures five domains of early childhood development that is predictors of a child’s health, education and social outcomes. In the region, almost one in four children (23.7 per cent) are developmentally vulnerable across one or more of the domains and a further 12 per cent are developmentally vulnerable across two or more domains[11]. A high proportion of children in the Moreton Bay North (28.9 per cent) and Redcliffe/North Lakes (28 per cent) planning areas are developmentally vulnerable in one or more domains, particularly when compared to the region average[12]. Children in the Moreton Bay North and Redcliffe/North Lakes planning areas are particularly experiencing higher rates of developmental vulnerability in the physical health, emotional, language and communication domains when compared to the rest of the region[13].
Data collated from the three headspace centres in the PHN region (Nundah, Redcliffe and Taringa sites) found that between 2015-16, there were 8559 occasions of services for 2032 young people. Trends also suggest that the number of young people accessing headspace is increasing and will continue to increase in the future. Whilst these services are designed as an early intervention tool to address mild and moderate mental health issues, of those currently presenting to the regional headspace centres, more than 60 per cent are identified as having high to very high psychological distress.
Hard to reach population groups and under-serviced areas / Lack of services in the northern part of the PHN region where need is greatest. / Within the PHN region, there is one area which is considered to be severely under-serviced and this is the Moreton Bay North sub region, which is also the sub region which has the highest prevalence of mental health conditions. This sub region is predicted to undergo high population growth[14]. Within this sub region, there is an estimated[15]:
·  6800 to 9000 children and young people with a mental health disorder
·  20,150 people with a mental health condition who visit a GP
·  4000 to 6000 people aged 65 years and over with depression and more than 4000 people aged 65 years and over have anxiety.
Existing workforce data suggests the distribution of mental health services does not adequately match the need present in the Moreton Bay North region[16]. The estimated number of allied mental health providers in the Bribie Beachmere (13 per 100,000), Caboolture (44 per 100,000) and Narangba – Burpengary (23 per 100,000) statistical areas were all below the PHN average of 75 allied mental health providers per 100,000 people, indicating that the Moreton Bay North area is underserviced,[17]. Full time equivalent rates for psychologists are in the Bribie – Beachmere and Narangba – Burpengary areas are 3.8 times and 3.2 times respectively lower than the Australian average[18]. This indicates that mental health services are currently not meeting population needs in the northern parts of the PHN region.
Those who identify as lesbian, gay, bisexual, transgender, intersex and questioning (LGBTIQ) people report higher rates of psychological distress than the general population and are at greater risk of suicide. / Australian LGBT people reported higher rates of psychological distress than the general population, a K10 average of 19.6 versus the national average of 14.5[19].
LGBTI people have the highest rates of suicidality of any population in Australia with 20 per cent of transgender Australians and 15.7 per cent of lesbian, gay and bisexual Australians reporting current suicidal ideation[20]. The average age of a first suicide attempt is 16 years of age and is often before ‘coming out’[21]. Almost half of transgender people have attempted suicide at least once in their lives and same-sex attracted Australians have up to 14 times higher rates of suicide attempts than their heterosexual peers[22]. Rates are six times higher for same-sex attracted young people[23]. Anecdotal evidence also suggests that the rate of suicidal tendencies in intersex people is significantly higher than the general population as well.
While estimating the prevalence of mental health issues is difficult on a local level, locally collected data for 2014-15 from headspace centres operating in the PHN region reported that one in five (19 per cent or 239 people) young people who accessed services identified as being either lesbian, gay, trans, intersex or questioning (LGBTIQ). Fifty-five per cent of all LGBTIQ young people in the PHN region who accessed headspace accessed the Nundah headspace centre. Consultation with local mental health service providers also indicates that people who identify as LGBTIQ are also at risk of poorer mental health than the general population in the PHN region.
Barriers to service for hard to reach and under-serviced populations, including culturally and linguistically diverse, homeless people and those in contact with the justice system. These populations are shown to be at higher risk of mental health illness than the general population. / Culturally and linguistically diverse populations - Within the Brisbane North PHN region almost one quarter of the population are born outside of Australia, representing a significant culturally and linguistically diverse population[24]. For these people stigma, lack of information about mental illness and mental health services in appropriate and accessible formats, and poor communication and cultural differences between clients and clinicians have been reported as major barriers to timely access to mental health services.
Lack of access negates the early intervention and ongoing partnerships with service providers that are essential for relapse prevention[25]. Furthermore, lack of early intervention contributes to the reality that people from some culturally and linguistically diverse communities are overrepresented among involuntary admissions and forensic populations.
Homelessness - As of 2011, it is estimated that over 2700 people in the PHN region were homeless or at risk of being homeless, with a further 1800 people residing in marginalised housing[26]. While the largest cohort of people who were homeless resided in the Inner City, over 500 people in the Moreton Bay North sub region were officially considered to be homeless[27]. Data from the PHN’s outreach services program indicates that a sizeable cohort of people in the Redcliffe peninsula area that are considered homeless also have high mental health needs[28].
National data indicates more than a quarter of homeless people identify as Aboriginal and Torres Strait Islander[29]. Of all who are homeless, young Australians aged 12 to 24 years make up 36 per cent[30]. Studies show that between 48 per cent to 82 per cent of homeless young people have diagnosable mental illness and the most common are mood disorders, anxiety disorders like post-traumatic stress disorder and substance misuse disorder[31].