WQPHN Mental Health Collaboratives

1. WQPHN Mental Health Collaboratives 20 October 2018 Roma Mark Goddard and Simone Xouris

2. WHAT IS MENTAL HEALTH?

3. WHAT IS MENTAL ILLNESS? • A diagnosable illness which: • affects a person’s thinking, emotional state and behaviour, and • disruptsthe person’s ability to: • - work • - carry out daily activities, and • - engage in satisfying relationships.

4. IMPACT OF MENTAL ILLNESS Often presents in adolescence or early adulthood- First episode? • 50% by age of 18 • 75% by age of 25 Largest cause of disease burden for 15-24 years- Page 3- AIHW

5. MENTAL HEALTH DIAGNOSIS Q- Who can diagnose a Mental Illness? A- Psychiatrist, GP or Clinical Psychologist Q- How is a diagnosis formulated? A- Comparison of assessed findings against the ICD 10 or DSM V Q- What does a diagnosis mean to a patient? A- Relief, Grief, Stigmatising, Denial, Irrelevance, Life trajectory, Employment

6. PERCENTAGE OF AUSTRALIANS aged 16-85 WITH A COMMON MENTAL ILLNESS IN ONE YEAR 10.8 7.2 5.3 17.6 22.3 Another 0.5% people havea psychotic disorder in any one year.- Page 28 AIHW report

7. PROFESSIONAL HELP SEEKING • Q-What percentage of people seek help? Answer- 35% • Q-Which Diagnosis is more likely to seek help? • Answer- • Depressive Disorders 59% • Anxiety Disorders 38% • Substance Use disorders 24%

8. Coexisting Illnesses Are people living with a Mental Health Condition likely to experience poor physical health? Yes- 11.7 % of people living with a MH illness in the last 12 months reported a physical disorder- (Page 4- AIHW data)- 1:5 @- http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-m-mhaust2-toc~mental-pubs-m-mhaust2-hig~mental-pubs-m-mhaust2-hig-men Why? Diagnosis, Medication, Socio-economic impacts

9. What impact does this have on your General Practice? General Discussion • Correct diagnosis- clean data therefore understand your business and referral pathways • Correct use of MBS item numbers • ? High DNA rates • Time consuming • Managing comorbidities • Pro-active medicine vs reactive medicine • Prescribing rates

10. MORNING TEA

11. Maximising Care- Maximising Business Refer to hand outs

12. Annual Cycle of Care Total Minutes spent: 220 Total Income generated: $924.55(Bulk bill) WHERE DOES THE CYCLE OF CARE COMMENCE? NB – This chart does not include additional available services, chronic disease item and other Mental Health Treatment plan items- MBS Item 900 When completed by Pharmacist reviewwith GP Consider engagement in Hospital Discharge planning utilising MBS item 729 PSYCHIATRIST Consider utilising Telehealth Why not?

13. Discussion Points • Whole of Practice Approach- Who does what & when- recall reminders? • Engaging the patient on the journey- Consent, Patient Information? • Orientation for new staff members? • Is the role of the ‘General Practitioner” changing? • Patient Register- Knowing your business?

14. Mental Health Treatment Plans Question- Why complete a Mental Health Treatment Plan? Answer- I have to to make a referral under Better Access X=WRONG MYTH BUSTING

15. WHAT CONSTITUTES A MHTP?

16. WHY COMPLETE A MHTP? • NOT JUST A REFERRAL DOCUMENT • HELPS THE PATIENT TO FOCUS ON SETTING AND ACHIEVING GOALS-CULTURALLY APPROPRIATE • EVERYONE IS WORKING TOWARDS ACHIEVING THESE GOALS • PLANNING DOCUMENT FOR ALL INVOLVED • MONITOR PROGRESS- REGULAR REVIEWS • A WAY OF FOCUSSING ON IMPROVING AND MAINTAINING HEALTH RATHER THAN DEALING WITH PROBLEMS AS THEY ARRIVE • LIFE SAVING INFORMATION FOR CRISIS INTERVENTION • http://www.racgp.org.au/education/gpmhsc/gps/gp-mental-health-treatment-plan-templates/ • https://www.menzies.edu.au/page/Resources/Stay_Strong_Plan__two_page/

17. LETS DO LUNCH!!!

18. MENTAL HEALTH STEPPED CARE APPROACH THE RIGHT CARE AT THE RIGHT TIME, BY THE RIGHT PERSON FOR THE RIGHT DURATION The Australian Governments Response to Contributing Lives, Thriving Communities- Review of Mental Health Programs and Services A Stepped Care approach to mental health services involves the following four core elements Stratification of the population into different ‘needs groups’ Setting interventions for each group Defining a comprehensive ‘menu’ of evidence based services Matching service types to the treatment targets for each needs group National Mental Health Services Planning Framework- http://www.nmhspf.org.au

19. Moderate mental illness Severe mental illness At risk groups (Early symptoms, previous illness) Mild mental illness Well population

20. What does this mean for you locally as the WQPHN commissions services against the Stepped Care Approach?? • WQPHN holding less than 10% of MH budget!!!! • P1-LOW INTENSITY MH SERVICES • P2-CHILD AND YOUTH MH SERVICES- Youth Severe • P3- PSYCHOLOGICAL SERVICES FOR HARD TO REACH PEOPLE • P4- MH SERVICES FOR HARD TO REACH PEOPLE- National Psycho Social Support & Continuity of Support-NDIS • P5- COMMUNITY RESPONSE TO SUICIDE PREVENTIONS • P6- MH SERVICES FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES • ENABLERS • Web Based Referral and Data Collection Tool- RefeRHEALTH • My Community Directory • Local Directories • Partnerships

21. Service Delivery Options? P1- Low Intensity- New Access- www.headtohealth.gov.au P2- Child & Youth- e-headspace, developing Youth Severe referral pathways from schools P3-Psych Services for Hard to Reach P4-Care Coordination for Severe- Mental Health Nurses, NPS funding P5- Low/Med Risk Suicide- P3 P6- ATSI Mental Health- SEWB; • OTHER OPTIONS • Better Access- psychology services delivered by telehealth or f2f, including GPs • Psychiatry services- Tele-health • QH- Community MH teams- Adults and CYMHS • NGO services • HMR’s and pharmacist engagement in health care team • Gaps?????

22. ENSURING THE GP REMAINS AT THE CENTRE OF STEPPED CARE? • CARE COORDINATION ROLE IDENTIFIED WITHIN GENERAL PRACTICE? • CASE CONFERENCING? • MENTAL HEALTH CLINIC? • CO-LOCATION? • refeRHEALTH • SHARED RECORD/MY HEALTH RECORD?? • WHERE DOES THE PATIENT AND FAMILY SIT?

23. EAT AGAIN???

24. THE COLLABORATIVES Where are you up to? What are you going to do? Thankyou!!