PHN PRIMARY MENTALHEALTH CAREFLEXIBLE FUNDING POOLIMPLEMENTATIONGUIDANCE
CHILD AND YOUTH MENTAL HEALTH SERVICES
PHNsarerequiredtocommissionprimarymentalhealthcareservicesforchildrenandyoungpeoplewith,or atriskof,mentalillnessbeingmanagedinprimarycare,includingdeliveryofheadspacecentresnationally.
In2016-17PHNsareexpectedto:
- maintainservicedeliverywithin headspacecentres,inlinewiththeexistingheadspaceservicedeliverymodel;
- improvetheintegrationofheadspacecentreswithbroaderprimarymentalhealthcareservices;physicalhealthservices;drugandalcoholservices;andsocialandvocationalsupportservices;
- commencethedevelopmentanddeliveryofevidence-basedearlyinterventionservicesforyoungpeoplewith,or atriskof,severementalillness;
- supportservicecontinuityforchildrenandyoungpeopleformerlyprovidedunderATAPSandothermentalhealthprograms;
- liaisewithrelevantlocalorganisations inthe context of futureregionalplanning,includingthosedeliveringFamilyMental HealthSupportServices(FMHSS),earlychildhoodservices,schools andtertiaryandvocationalproviders; and
- whererelevant,supporttransitionarrangementsassociatedwith servicesformerlyfundedundertheEarlyPsychosisYouthServicesprogram.
Longerterm,PHNswillbeexpectedto:
- supportthebroaderrolloutof evidence-basedearlyinterventionservicesforchildrenandyoungpeople with,oratriskof,severementalillness;
- promote resourcesfor clinical andnon-clinicalprofessionals availableunder thenewchildmentalhealthworkforceinitiative;
- promotelocalpartnershipsbetweenprimarymentalhealthcareservicesandtheeducationsector;and
- workwithLHNs,CAMHS,AMHS,FMHSSsandotherregionalorganisationstoensureappropriatepathwaysfor referralandsupportareavailableforchildrenandyoungpeople with or atriskof mental illnessinthecontextof implementationofregionalmentalhealthandsuicidepreventionplans.
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What are child and youth mental health services?
Approximately 560,000 children and adolescents are estimated to have mental illness and one in four young Australians aged 16-24 years will experience mental illness in any given year. Three quarters of all mental illness manifests itself in people under the age of 25.
Intervention early in life and at an early stage of illness can reduce the duration and impact of mental illness. Services that recognise the significance of family and social support and functional recovery are particularly important for children and young people.
The education sector also has a central role in supporting positive mental health outcomes for childrenandyoungpeople.Thisincludessupportingprotectivefactorsandeffectivereferralpathwaysaswellastheprovisionofservices,withapproximately40%ofchildrenandadolescentswithmentaldisordersaccessingservicesprovidedthroughschools.Thereisalsoevidencethatsupportingpositivementalhealthoutcomesforchildren andyoungpeople in theeducationsettinghasapositiveimpactoneducationaloutcomes.
Child andyouthmentalhealthservicesincludeboththoseservicescommissionedbyPHNsspecificallyforthose agedupto25 yearsaswellas broadermentalhealthservicesthat areaccessedbychildrenandyoungpeople.
Aspartof commissioningchildandyouthmentalhealthservices,PHNsarerequiredtomaintainfortwoyearstheexistingnationalnetworkofheadspacecentrestosupportyoungpeoplewith, oratriskof,mildtomoderate mentalillness.
PHNsarealsorequiredtocommission newservices tomeettheneedsoflocalyoungpeoplewith,oratriskof,severementalillness.
Inaddition,PHNshaveakeyroleinsupportingintegrationandpartnershipsbetweenhealthservices(includingstateandterritoryfundedservices,NGOsandprivatepractitioners),educationprovidersandother relevantsupport servicessuch asdrugandalcoholandsocialandvocationalsupportservices.
AdditionalguidanceontransitionarrangementswillbeprovideddirectlytothosePHNsthathaveexistingearlypsychosisyouthservices intheirregions.
WhatisexpectedofPHNs?
In 2016-17
Headspace centres
PHNsareresponsibleforthemanagementof the100existingandestablishingheadspacecentresfrom1July2016.headspacecentresaimtoimprovementalhealthoutcomesforyoungpeopleaged12-25yearswith,or at riskof, mildtomoderatementalillness.
Fortheperiod1July2016to30June2018,PHNs are requiredtoengagetheexistingheadspacecentreleadagenciestooperatetheheadspacecentresinthenominated100locationsnationallyinline withthe existingheadspacemodelofcare andconsistentwithcurrentfundinglevels.
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SpecificdetailsregardingtherequirementsofPHNs indeliveringheadspacecentres wereincludedinthescheduletothefundingagreement.
Services for young people with, or at risk of, severe mental illness
PHNsarerequiredtodevelopandcommission newearlyinterventionservicestomeettheneedsofyoungpeoplewith,or at riskof,severementalillnesswho canbe appropriatelymanagedintheprimarycaresetting.
Inadditiontotheinformationprovided in thesevere mentalillnessguidanceforPHNs, thereareparticular considerationsforyoungpeoplewith,oratriskof,severeillness. Theseincludedifferencesintheneedsof youngpeopleandtherelevantskillsandappropriateservicedeliverymodelstomeettheseneeds.Arangeofmodelsmaybeneededtoaddressthediverseclinicalneedsofyoungpeoplewithsevere mentalillness,asaone sizefitsallapproach isunlikelytobe appropriate.Inlinewith astepped care model,there islikelytobeaneedtomatchtheintensityandmixof servicestothe intensityofneedbythe youngperson.Forexamplesomeyoungpeoplemaysimplyrequireadditionalservices.Othersmayrequiremorecomplexpackagesofcare,oraccesstoabroaderrangeofprofessionalsupport.
Whatflexibilities doPHNshave?
Headspace
Inthefirsttwoyears,PHNswillberequiredtodeliverservicesin linewiththeexistingheadspacemodel.However, PHNswillbeabletoimproveintegrationbetweentheexistingmodelofcareandotherlocalservicesincludingthroughbroaderprimarymentalhealthcareservices,stateandterritoryservices,andalcoholandotherdrugservices.
Inthelongerterm, PHNswillhavegreaterflexibilityinmeetingthe needsoflocalyoungpeoplewith,oratriskof,mildtomoderate mentalillness.
Newservicesforyoungpeoplewith,or atriskof,severe mentalillness
Atransitionstrategyhasbeendeveloped fortheservicespreviouslyfundedundertheEarlyPsychosisYouthServicesprogram.AdvicewillbeprovidedregardingtherequirementsofPHNsinsupportingthosetransitionarrangements.
Beyondtherequirementtosupportthetransitionofexistingservices(whereapplicable),andthe importanceofstaying withintheparameterssetfor theflexiblefundingpoolbytheProgrammeGuidelinesandfundingschedule,PHNshaveconsiderableflexibilitytodeterminehownewservicesforyoungpeoplewith,oratriskof,severementalillnesswillbedelivered acrosstheirregion. Thereislikelytobetheneedto develop flexible andresponsivemodels in consultation with expertsand in line withevidencebasedbestpractice,which makeuseofabroaderrangeofworkforce,includingvocationalsupport,linkstoeducation,alliedhealthproviders,and casemanagers,aswellasofferingadditionalpsychologicaltherapy.Modelsshouldalsoconsider integrated approachesto provisionofservicestoyoungpeoplewithseveremental illnessandcomorbidsubstancemisuseproblems.
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Safetyandquality of care
PHNsareexpectedtoensureahighlevelofservice qualityforservicescommissionedwithinasteppedcareapproach.PHNsneedto establishmechanismstoensurecommissionedprovidersandconsumersareawareoflocalcrisisservicesandpathways.
ItisexpectedthattheworkforceinvolvedindeliveringPHNcommissionedservicesbeappropriatelyqualified,skilledandcompetenttoproviderelevantinterventions,inlinewithprofessionalscopeofpracticewhereapplicable.PHNsshouldensureappropriate clinicalsupervisionarrangementsareestablishedtomaintainthe safetyandqualityofcommissionedserviceprovision.PHNsalsoneedto establishpoliciesformanagingcomplaints.
Relevantnationalstandards(suchastheNationalStandardsforMentalHealthServices2010andtheNationalFrameworkforRecoveryOrientedMentalHealthServices 2013)regulationsandguidelinesshouldbeappliedwhere relevanttopromoteservicequalityandeffectiveness.
Delivery of headspace services should be supported by accreditation and guidance for the workforce and services provided by headspace national office.
PHNsshouldworkwithintheirregionalclinicalgovernancearrangementsandwiththeadviceand supportofexpertstoensureappropriatedutyofcareinrelationtocommissioningnewservicesforyoungpeoplewithseverementalillness.Giventhevulnerabilityofyoungpeoplewithsevere mentalillness itisimportanttoensureapproachestocareareconsistentwiththeevidencebase,involveclinicalsupervisionandareimplemented in linewithkeyprofessional standardsandguidance.Inaddition,giventheheightenedriskofcrisisandsuicideamongyoungpeoplewithseverementalillness,policiesto ensure ease of accessto crisissupportandtoensure staff are skilled inidentificationofindividualsatriskofsuicideandare ableto respondinemergencysituations.
Whyisthisa priorityactivityforPHNs?
Childandyouthmentalhealthservicesaimtoincreaseoverallcommunityaccesstoevidence-basedearlyinterventiontoreducetheprevalenceandimpactofmentalillness.Thereisevidencetodemonstratethatearlyinterventioninbothmanagementofthementalillnessandfunctionaldevelopment/recoveryforchildrenandyoungpeoplecanhaveasignificantimpactonawiderangeofoutcomes.
PHNshavearolein improvingaccesstoappropriateearlyinterventionservices,deliveredbysuitablyqualified mentalhealthprofessionalswith afocusonevidence-based earlyintervention.Forexampleaccesstoprimarymentalhealthcareservicescanbelimitedforchildrenand youngpeople by shortages in availablementalhealthprofessionalsofferingservicestothosewithparticularneeds(e.g.youngpeopleexhibitingself-harming behavioursorsuicidality).Thiscannegativelyimpactthelengthoftimebetweentheidentificationofaneedfor,andthedeliveryof,earlyinterventionservices. PHNsneedto
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identifytheparticularchallengesintheirregionsanddeveloplocallyappropriatestrategiestoaddressthesechallenges.
How should PHNsimplementthispriority?
In2016-17,implementation ofchildandyouthmentalhealth servicesshouldfocusonthefollowing:
- supportforthetransition ofheadspacecentres andmaintainservicedeliveryinlinewiththeexistingheadspaceservicedeliverymodel;
- identifyingpotentiallinkagesandinitialrelationshipbuildingbetweenheadspacecentresandbroaderhealth,mentalhealth,drugandalcoholand socialandvocationalsupportsectors;
- commencingthedevelopmentanddeliveryofearlyinterventionservicesforyoungpeoplewith,at oratriskof,severementalillness;
- supportforservicecontinuityforchildrenandyoungpeopleformerlyprovidedunderATAPSandothermentalhealthprograms;
- exploringthenon-clinicalservicesavailable in theregion,includingtheFMHSSandthetrialof youthmentalhealthDisabilityEmploymentServicestoreducetheriskofyoungpeopledisengagingfromeducationoremployment;
- commencingliaison withrelevant localorganisations in the context offutureregionalplanning,includingthosedeliveringFMHSS, earlychildhoodservices,schoolsandtertiaryandvocationalproviders;
- promotingresourcesforclinical andnon-clinicalprofessionalsavailableundertheNational Centre ofExcellenceforYouthMentalHealth;and
- whererelevant,supportingtransitionarrangementsassociatedwithservicesformerlyfundedundertheEarlyPsychosisYouthServicesprogram.
Longerterm,PHNswillbeexpectedto:
- supportthebroaderrolloutof evidence-basedearlyinterventionservicesforyoungpeoplewith,oratriskof,severementalillness;
- promote resourcesfor clinical andnon-clinicalprofessionalsavailableunder thenewchildmentalhealthworkforceinitiativein additiontothoseavailablefromtheNationalCentre ofExcellence in YouthMentalHealth;
- promotelocalpartnershipsbetweenprimarymentalhealthcareservicesandtheeducationsector;and
- workwithLHNs,CAMHS,AMHS,FMHSSsandotherregionalorganisationstoensureappropriatepathwaysfor referralandsupport are available forchildrenand youngpeoplewithoratriskofmentalillnessinthe contextofimplementation ofregionalmentalhealthandsuicidepreventionplans.
Whatnationalsupportwillbeavailableforlocalimplementation?
HeadspaceNationalOffice willcontinueto support PHNsinthedeliveryofheadspacecentresthroughadviceabouttheexistingservicedeliverymodelandsupporttheidentificationofsuitableleadagencieswherenecessary. TheheadspaceCentreofExcellencewillcontinuetoconductresearchrelevanttobothheadspace servicesandprimaryyouthmentalhealthcareand support PHNsintheplanning,designand
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commissioningof servicesforyoungpeople.Thiswillenableinformationon the latestresearch,resourcesandprofessionaldevelopmentregardingthedeliveryofserviceprovisionof youthmental health(includingsevere mentalillness)tobeavailabletoPHNsinmeetingidentifiedneed.PHNsarealsoencouragedtoprovidefeedbacktothe headspaceCentreofExcellenceregardinggapsthat maybeaddressedthroughfuturework.
Onceestablished,thenewChildMentalHealthWorkforceInitiativewillprovideresourcesfortheclinicalandnon-clinical workforcesthathave contactwith childrenandtheirfamilies. Inaddition,the nationallyfundednetworkofFamilyMental HealthSupportServiceswillalsoprovidelocallybasedinformationand resourcestosupportthebroaderneedsofchildrenwithmentalillness,andtheirparents.
How canthePHN ensure they arecommissioning value formoney services?
PHNsarenotrequiredtochargeconsumersaco-paymentforservices.However,incommissioningprimarymentalhealthservices,PHNsneedtodeterminetheirownconsumerco-paymentpoliciesandguidanceforserviceprovidersthattakeintoaccountthecharacteristicsofthepopulation,includingcapacitytopayforservices.
TheDepartmentisdevelopingfurtheradviceon servicequalityandvalueformoney.
Usefulresources
- Headspacewebsite –providesresourcesfor clinicalandnon-clinical staff
- NationalCentreofExcellenceinYouthMentalHealthResources:
- Improvingthe mentalhealthofchildrenandadolescents in Australia,positionpaperoftheAustralian Infant,Child,AdolescentandFamilyMentalHealth Association.Includestheprinciplesofeffectivecareforchildrenandyoungpeople
- EatingDisorders:TheWayForward,AnAustralianNationalFramework
- YoungMindsMatterSurvey
- KidsMatterwebsite -providesinformationaboutthisinitiativeforearlychildhoodeducationandcareservicesandprimaryschools,informationaboutchildmentalhealthaswell asresourcesforhealthand communitystakeholders
- MindMatterswebsite–providesinformationaboutthisinitiativeforsecondaryschools
- FamilyMentalHealthSupport Services(FMHSS)
- DisabilityEmploymentServices(DES)
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