AGPN acknowledges the financial support of the Australian Government Department of Health and Ageing
Queensland Divisions of General Practice Mental Health Network MeetingNovember 2009 Joy ThomasPrincipal Network AdviserAGPN November 2009
Health Reform Agenda • The Australian Government’s acknowledgement of and commitment to Primary Health Care • Undertaking key reforms in this area • Release of discussion paper on Primary Health Care • Challenges and opportunities presenting in moving towards reform • Govt acknowledgement of the work and potential roles of Divisions network in the future primary health care system. • Acknowledgement from both sides of politics at last week’s Forum – the key role of the Divisions network.
Reform Agenda • Reports to the federal government: - the National Health and Hospitals Reform Commission report - Australia’s First National Primary Health Care Strategy - National Preventative Health Taskforce
Reform Agenda • Last week’s AGPN Forum provided an opportunity for all participants to take the discussion further • Invitation by the Minister for Health and Ageing, the Hon Nicola Roxon for the Divisions network to take a lead in the debate • The Health and Hospitals Reform commission has made it clear that the proposed Primary Health Care Organisations (PHCOs) – could evolve from or replace the existing Divisions of General Practice. • The Minister has acknowledged that Divisions are well positioned to undertake the job. • The Minister open to suggestions from AGPN as to the shape of PHCOs.
Reform Agenda • Minister acknowledged the need for governance arrangements of future primary care organisations to reflect the diversity of clinicians and services forming comprehensive primary health care. • Also that not one size fits all – and understanding the sometimes different nature and make up of Divisions. • The Forum showcased the vision of some Divisions for PHCOs • And some already moving into this space – eg northern NSW – NW Slopes Division, Barwon, New England, Hunter Rural – working collaboratively and sharing some resources.
Mental Health ATAPS Review: • Early 2009 – discussion paper released • 100 responses received by the Department of Health and Ageing • Divisions have demonstrated their innovation in meeting the needs of different population groups. • And suggestions for improving ATAPS – to ensure sustainability, efficiency and better targeting.
ATAPS Review: The federal government agrees that a future ATAPS should be shaped to ensure: • Better focus on activity that will address service gaps • Increased efficiency • Innovation • Improved quality
ATAPS Review • Department of Health and Ageing developing an implementation plan against these 4 directions • The plan will be developed against the broader national health reforms • In October the Minister announced a 6 months extension to existing ATAPS contracts – until June 2010. • This included: Perinatal Depression Initiative, Suicide and T-CBT pilots. • AGPN now has some space to work with the Department – to develop an implementation plan.
ATAPS Additional programs • Telephone CBT: 20 Divisions – mainly rural (4 in Qld)) • Suicide Prevention: 19 Divisions, mainly urban (3 in Qld) - increased referral pathways: E & T for GPs, AHP, A & G. • General ATAPS – increasing demand and no increase in funding. Approx 50% Divisions are limiting services • Additional funding post Victorian bushfires with relaxed guidelines (to 9 Vic Divisions for ATAPS & capacity building & linkages to state initiatives) • Perinatal Depression: offered to all Divisions
ATAPS: Suicide pilot evaluation Melbourne University evaluation – released in October 09 showed that: • Some Divisions commenced service delivery in October 2008 –others had not yet started as at July 09. • Delay due to a range of factors – ie need to establish operating policies and procedures around new client group. • Management of consumer risk a key issue • Engagement of GPs, AHPs and new external referrers (ie emergency departments and local MH services) also identified • Divisions reported that – more stability around the funding would provide reassurance for AHPs and GPs – and enable Divisions to more confidently market and implement the services.
Perinatal Depression Initiative • Funding to Divisions: - service linkages & care pathways - service delivery under ATAPS • Funding to beyondblue: resource development; identification of appropriate E & T; development of clinical pathway • Funding to state health: - training for state health workers in maternal services • Edinburgh Postnatal Depression Scale – (psychosocial screening tool for use by GPs) • PND Guidelines Expert Advisory Group – developing new guidelines – expected to be published March – May 2010. • Aware that training courses are needed for GPs in this area – Mental Health Skills Training (MHST)
Young Minds • AGPN funded by beyondblue: the national depression initiative to develop Young Minds • A prevetnion & early intervention program for GPs, practice nurses and AHPs focusing on skills development in the diagnosis, management and treatment of high prevalence mental health disorders occurring in young people 12-24 yrs • Face to face and on line available.
Young Minds: • Accredited for Mental Health Skills Training (MHST) by GPMHSC – approved and endorsed by: Royal Australian College of GPs (6 hour Active Learning Module, 40 CPD points on completion) the Australian College of Rural and Remote Medicine, the Australian Assn of Social Workers and the Royal College of Nursing Australia. • Young Minds launched in early September • Already 72 Divisions have signed up to deliver • 13 Divisions in Queensland
Mental Health Nurse Incentive Program (MHNIP) • Number of nurses increasing – approx 460 credentialed. • 150 nurses who have not submitted proposals for credentialing • Shared employment model with area health popular • Credentialing deadline – 31 December 2009 • Divisions reporting that MH nurses are providing mentoring to practice staff – (scope for more formal relationship between MHN & PNs)
MHNIP • Credentialing deadline: • The College of Mental Health Nurses has submitted a proposal to the Dept of Health and Ageing for a more streamlined credentialing process. • DoHA currently conducting an evaluation of the MHNIP
Better Access: Federal Budget changes • from 1 July 2009 – mental health care plans to be known as mental health treatment plans and must include a diagnosis • from 1 Jan 2010 – introduction of differential rebates for MH treatment plans – GPs will be required to undergo mental health skills (level 1) training to access the higher rebate • AGPN working closely with the GPHMSC (General Practice Mental Health Standards Collaboration) to communicate changes and training requirements
Better Access: Mental Health Skills Training • Further announcement in October by the Department of Health and Ageing: from 1 January 2010 new schedule fee Medicare item of $125.95 will be introduced for GPs who have not undertaken accredited MHST. • Mental Health Skills Training courses can be found at: www.gpmhsc.org.au or contact GPMHSC on 03.8699 0554 • For those who have completed a GPMHSC accredited Mental Health Skills Training course since 1 July 2001 (previously Level 1 MHST) – further MHST training is not required to qualify for the higher rebate. • As a network, we would encourage continuing professional development (CPD) mental health skills training.
Mental Health & Substance Use Comorbidity • Comorbidity network well established – 12 month pilot project with 8 state and territory Comorbidity Coordinators across the country • Comorbidity Grants program: $2 m over 12 months • 4 categories of funding: - prevention, early intervention & education - maintenance of networks at the local level - Enhanced Skills Development (eg clinical attachments incl practice staff) - consumer & carer support
Grants funding breakdown: • NSW 6 • Vic 9 • Qld 7 • WA 4 • SA 3 • Tas 1 • ACT 1 • NT 1
Mental Health & Substance Use Comorbidity: • The Comorbidity Network is aiming to build primary care partnerships with the alcohol and other drug (AOD) sector at national and state level, and • To foster multicisciplinary approaches to the management of people with comorbidity • Comorbidity leaders in each state/territory supporting local Divisions who have received funding under the Building on Can Do Grants program. • In Qld – estimated that approx 22% of Queenslanders are affected by mental disorders with a coexisting condition of alcohol and/or drug use in any year.
Comorbidity Mental Health Skills Training • AGPN currently working to develop: - Mental Health Skills Training package for comorbid patients, and - a separate complex patients training module based on the multidisciplinary network approach – accommodating front of house staff, practice managers, and others such as Centrelink, drug and alcohol services. This would focus on people management and support in an aim to keep people in treatment – and preventing marginalisation – rather than clinical practice.
Headspace • 30 sites, with divisions involved in all – 17 as lead agencies. • 4 sites in Queensland • Headspace refunded to June 2013 - $35 million over 4 years • YMHI (service delivery funding) to be administered by headspace from 1 January 2010 direct to lead agencies. • potentially useful model of PHC reform and integration – National Health and Hospitals Reform Commission recommended an extension of this type of model.
Mental Health Support for Drought Affected Communities Initiative • Drought Initiative is funded in 43 Divisions in: Qld, NSW, Vic, SA – to provide: - community outreach and crisis intervention for distressed individuals and families - raise community awareness and understanding of mental health issues to help build resilience - provide education and training to enable health workers and community leders to recognise and respond to the early warning signs of emotional stress.
Mental Health Support for Drought Affected Communities Initiative • Funded for 2 years initially: 2007-2009 - $10.1 million • 2009 federal budget announcement of extension for a further 12 months to June 2010: $5.2 million • Change of language: …..continuing provision of psychosocial and mental health support to people in areas experiencing extreme climatic events (eg drought) • National Workshop of CSWs in August – Workshop focus on community ownership – supported by Divisions of General Practice • AGPN will develop federal budget submission for a continuing program to support communities under stress.
Questions Joy Thomas Principle Network Adviser Mental Health Australian General Practice Network (AGPN) Tel: 02 6228 0838 Email: email@example.com