Community Visits 2016 Nepean Blue Mountains April June 2016
Table of contents 1. Nepean Blue Mountains NSW... 4 2. Meeting summaries... 5 3. Making change: opportunities and challenges... 11 4. Options for the Commission... 12 5. In conclusion... 13 2
In early 2016, the Commission launched One Year On which took stock of progress made so far on the whole ofgovernment, whole-of-life and whole-of-community vision for mental health in NSW, as set out in Living Well. In mid- 2016, the Commission took the opportunity to build upon this knowledge to gain insight at a local level. The Commission was keen to hear about examples of excellence in person-focused, recovery-oriented mental health care. It was also interested to hear about barriers to change as government agencies, community managed (non-government) organisations (CMOs), clinicians and other stakeholders look for better ways to work together to provide timely, person-centred care for people living with mental illness. As in previous years, Commission staff undertook a number of community visits across NSW. In 2016 four metropolitan local health districts were selected for visits; Central Coast, Nepean Blue Mountains, Western Sydney and South Western Sydney. The visits were conducted over a number of trips between April and June. This summary profiles the Commission s visit to Nepean Blue Mountains. 3
1. Nepean Blue Mountains profile The Nepean Blue Mountains Local Health District (NBMLHD) consists of both urban and semi-rural areas, covering almost 9,179 square kilometres. The NBMLHD is responsible for providing community health and hospital care for people living in the Blue Mountains, Hawkesbury, Lithgow and Penrith Local Government Areas (LGAs) and tertiary care to residents of the Greater Western Region. The demographic data profile of Nepean Blue Mountains does not show any significant outliers, though it does display a lower than usual diversity of ethnicity. Figures from 2011 put the resident population around 345,564. This includes an Aboriginal community which forms 2.6% of the total population. The Dharug, Gundungurra and Wiradjuri people are acknowledged as the traditional owners of the land covered by the NBMLHD and the largest Aboriginal community resides in Penrith. The Aboriginal population is younger than the wider community with 55.6% under 25 years of age. The NBMLHD has Local Government Areas at both ends of the socio-economic spectrum with Lithgow considered among the most disadvantaged areas in NSW and the LGAs of the Blue Mountains, Hawkesbury, and Penrith at the other end of the spectrum. The proportion of the population aged less than 10 years is expected to remain steady (from 14.1% to 14.2%) heading towards 2021, while the proportion of older residents will increase from 7% to 10%. The increasing populations of older people foreshadow new and unique challenges in health care planning, service delivery and access to specialised care. 4
2. Meeting summaries A team from the Commission visited the Nepean Blue Mountains district during May and June 2016. They attended meetings with NBMLHD staff the Nepean Blue Mountains Primary Health Network (NBMPHN) local Headspace and LikeMind service managers. and presented to the Penrith Community Care Forum were part of a Commission-hosted event to showcase local practice and future plans. 5
2.1 Nepean Blue Mountains Local Health District staff The Commission team met mental health staff at the NBMLHD, including managers, clinical and project staff, and the General Manager for Mental Health. Most staff expressed the view that, after its split from Western Sydney Area Health Service, the mental health service s outreach had reduced and its practice approach seemed to stop developing. This had an impact on both staff and policy. The General Manager was appointed in 2014 and in 2015 began a service realignment using Living Well as the primary planning document. The executive team at the NBMLHD s mental health service was mostly new and strongly supportive of the directions in Living Well. This was apparent through a range of projects related to the Plan; by a concerted shift to help long-stay patients transition back to the community; and the adoption of a new Consumer and Carer Framework led by an executive level Consumer Consultant whose task it was to develop the NBMLHD s future peer workforce. There did not appear to be a multi-year mental health service plan. Many other LHDs had a clinical service plan, or similar, outlining the longer-term strategy regarding progressing mental health service redesign. In the coming years the Commission would expect to see real shifts in NBMLHD service provision toward the community, in partnership with CMOs. It was unclear if the NBMLHD had a plan for psychosocial disability services for people ineligible for the NDIS. The NBMLHD had hired a Senior Consumer Consultant to develop with executive input the Consumer and Carer Framework. The General Manager also outlined their concerns about the nutritional quality of food provided to long-stay mental health patients and patients lack of access to the internet, reducing quality of life and complicating exit planning. Mental Health Centre, Nepean Hospital 6
2.2 Penrith headspace and LikeMind services Headspace and LikeMind operate under similar models designed to provide communitybased clinical and psychosocial services and facilitation to different age groups. Headspace targets 12-25 year olds while LikeMind is a service for adults. The Penrith Headspace also runs a Youth Early Psychosis Program (YEPP) funded by the Commonwealth Government. The Commission met senior staff of the Penrith Headspace and LikeMind services as well as the CEO of their lead agency, UnitingRecovery. The Penrith LikeMind service experienced a difficult beginning and reported challenges in its partnership with the NBMLHD. The NBMLHD had co-located an acute mental health team at the LikeMind site whereas a community mental health team would have been considered more appropriate for the LikeMind model. The Commonwealth s establishment of a youth early psychosis team outside of the NSW health system seems to have affected staff attitudes and culture across agencies. 2.3 Primary Health Network and Partners in Recovery The Nepean Blue Mountains Primary Health Network (NBMPHN) controls the contracts of most Commonwealth mental health services. It is also the local provider of the Partners in Recovery (PIR) program, which aims to facilitate choice and access to services for people with severe and persistent mental illness. It has been in operation since 2014, and is planned to be absorbed by the National Disability Insurance Scheme (NDIS) by the end of 2018. There was a view in the PHN that the roll-out was rushed, and although there were many good outcomes, the funded client numbers did not meet the needs of the majority of the target population. PIR was never really marketed, nor did it have the scope to encourage referrals this affected the initial demand. RichmondPRA (now Flourish Australia), Uniting Recovery and Aftercare were the subcontractors. A high turnover of facilitators was reported. The facilitators who typically came from PHaMS (Personal Helpers and Mentors) and HASI (Housing and Accommodation Support) backgrounds, found the case conferencing element difficult. There was a lot of one-to-one work not originally envisaged as part of the model. PIR, managed by Sally Reagan, continued to provide care coordination for people not receiving NDIS packages. PIR were contracted to manage a minimum of 76 clients with individual packages by June 2017. The number of consumer places was capped from 1 July 2016, intake was reduced and some clients were dropped. A major concern from the PHN was that PIR closing would leave a gap for care coordination. Along with the new combined funding for mental health, the PHN received new funding for an Alcohol and other Drugs service. There was the capacity for flexible funding with separate contracts, which could potentially be combined with mental health and other funding streams. 7
2.4 Penrith Community Care Forum The presentation by the Commission provided an overview of the organisation and the Living Well reforms. He highlighted that many concurrent reforms, e.g. the NDIS and PHNs, were influencing the progress of NSW mental health reform. Concerns were raised about the many barriers for people in the Nepean area with mental health issues to accessing employment as well as a lack of peer support workers. There were also concerns about funding stability, the NDIS, and the undetermined role of PHNs. Overall, those in attendance appreciated being provided with a big picture view of the NSW mental health strategic plan Living Well. 2.5 Commission-hosted event to highlight local practice The Commission invited mental health consumers, family members, carers, workers and interested community members to a special half-day event on new services and other changes coming to the Nepean Blue Mountains region. The event, held on the Monday 27th June 2016, at the Blue Mountains Community Hub, Springwood, provided an opportunity to meet and talk to representatives from: The NBMLHD Mental Health Service LikeMind headspace The NBM Primary Health Network The National Disability Insurance Agency The Mental Health Coordinating Council. 2.5.1 headspace The headspace team leader, presented on the headspace model and range of services available. Headspace is the National Youth Mental Health Foundation providing early intervention mental health services to 12-25 year olds, along with assistance in promoting young people s wellbeing. These cover four core areas: mental health; physical health; work and study support; and alcohol and other drug services. Headspace provides free services, in a youth friendly welcoming environment. It brings together a range of medical professionals including a GP, psychiatrists, psychologists, social workers, occupational therapists, alcohol and drug workers, a vocational consultant and an exercise physiologist. 8
2.5.2 NDIS The NDIA representative explained that the Commonwealth and New South Wales governments and the NDIA were working together to roll out the NDIS. These agencies, along with other organisations were helping to deliver the NDIS, would contact people transitioning to the NDIS with more information specific to them. Many people in the room reported a lack of knowledge of NDIS and engagement with NDIA. 2.5.3 Nepean Blue Mountains Primary Health Network Nepean Blue Mountains Primary Health Network (NBMPHN) is dedicated to supporting health services that are appropriate for the local community. Its role is to identify what health services are needed in the Nepean and Blue Mountains communities and how to bridge any gaps in their provision. NBMPHN highlighted three products: The Mental Health Navigation Tool developed with PIR in response to a significant need for people to access quickly and easily the right mental health services for them. It is designed for people experiencing mental health problems, and their carers, living in the Hawkesbury, Blue Mountains, Lithgow and Penrith regions. A set of wellness libraries available at 25 sites across the region. These libraries are located in community centres and mental health services and provide a range of material on mental health wellbeing and recovery. A set of resource cards developed in consultation with members of the community available through partner agencies. These cards provide telephone numbers for crisis or emergency services, housing and accommodation, welfare and financial support, alcohol, drugs and gambling and other health specific services. Springwood Neighbourhood Centre 9
2.5.4 Peer workforce Peer workers from the NBMLHDt and Aftercare co-presented an informal session on developing the peer workforce. They talked about the differing definitions of peer worker and the stigma and discrimination towards peer workers from degree-qualified workers. 2.5.5 Mental Health Coordinating Council NDIS The Mental Health Coordinating Council presented on the experience of the Hunter NDIS trial site. They referred to stories of people previously stuck in hospital beds successfully gaining access to the community with sufficient supports. They emphasised, that the Early Intervention eligibility pathway, as stated in Section 25 of the NDIS Act, was a possible access point. Consumers were encouraged to keep trying even though it was not originally envisioned as an access point for adults with psychosocial disability. 10
3. Making change: opportunities and challenges Opportunities The major changes that followed the NBMLHD s Mental Health Service s adoption of Living Well as its guide for service development, were expected to lead to the roll-out of better service provision. Especially promising was the NBMLHD s employment of a senior executive Consumer Consultant which led to minimum peer workforce employment standards and to the establishment of a number of new participation processes. In a first for NSW, the NBMLHD was piloting an Advance Statements project to develop a set of resources and policies for use by mental health services in the region. An advance statement sets out a person s treatment preferences in case they become unwell and their capacity to make decisions may be affected by their mental distress. The NBMLHD received funding through the PIR Innovation Fund. The project is a collaborative partnership with the NBMLHD Mental Health Service, Aftercare, and the Social Policy Research Centre at UNSW. NBMPHN, with PIR, developed The Mental Health Navigation Tool in response to a significant need in the region, for people to be able to access the right mental health services quickly and easily. It is designed for people experiencing mental health problems and their carers, who are living in the Hawkesbury, Blue Mountains, Lithgow and Penrith regions. Coemployment of planners and coordinators between the NBMLHD and PHN has proved to be a productive innovation. NBMLHD was developing a specific Consumer and Community Participation Framework. The NBMLHD was committed to involving consumers in the design and delivery of health services. It had a Health Consumer Engagement team and established Health Consumer Working Groups, providing consumers and carers the opportunity to participate in the delivery of health services. Carers and consumers were recognised as different and separate stakeholders. There was also a commitment to hiring more peer workers. NBMLHD began without any peer workers. 11
Challenges Communication and trust issues between NBMLHD staff and staff at the Penrith LikeMind and headspace services tended to undermine to the ability to support referrals in both directions. The PHN was concerned in particular that the closing of PIR left a gap in care coordination service provision. PIR will be a Tier 3 activity in the NDIS, however, consumers not eligible for the NDIS would continue to receive PIR support until June 30 2018. HealthShare NSW exclusively provided food services in public hospitals in the Nepean Blue Mountains. The food provided did not appear to consider the dietary needs for long-stay patients in mental health facilities. A study undertaken by the mental health service found an alarming proportion of patients were displaying physical signs of poor nutrition. Hospital-based mental health facilities did not have access to the internet. This had an impact on consumer quality of life and prevented access to crucial exit planning activities, e.g. looking for accommodation or employment. NBMLHD was established after splitting from Western Sydney LHD, but took with it some outdated policies and procedures. The NBMLHD had managed to supplement its budget by more than $1 million by charging patients for their stay in mental health facilities. While this resulted in many extra facilities, the details of these arrangements were unclear. 4. Options for the Commission Support the NBMLHD s major program initiatives and recovery-orientation changes made over since 2014. Support NBMLHD with correspondence about access to the internet and nutrition standards. The Commission could support the NBMLHD to facilitate the coordination of inter-lhd bed management, supporting the development of policies and procedures relating to consumer/carer participation and nutritious food for inpatients. The Commission could play a supportive role in enabling the NBMPHN to access mapping of service, needs assessment and justice data. 12
5. In conclusion The Commission heard first hand from consumers, family members and other stakeholders about the impact of and experience with mental health reform in local communities, including what was working and what the challenges were. Despite issues on the front line between the NBMLHD and community managed organisations, the community showed signs of innovation through initiatives including the Mental Health Navigation Tool; the Consumer and Carer Framework; and the Advance Statements pilot project. The leadership at the NBMLHD and NBMPHN seemed to be engaged embracing innovation, alert to challenges and actively seeking to meet and overcome them. The Commission thanks all those from the Nepean Blue Mountains LHD, community managed organisations, consumers and carers as well as all those from the district who took the time to come together with us to exchange knowledge and experience, and to share their concerns, strengths and plans for mental health reform. 13
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