WQPHN Mental Health

Collaboratives
20 October 2018

Roma

Mark Goddard and Simone Xouris

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

 PERCENTAGE OF AUSTRALIANS aged 16-85
WITH A COMMON MENTAL ILLNESS IN ONE YEAR
% MALE % FEMALE % TOTAL
Any Anxiety disorder 10.8 17.9 14.4
Any Mood Disorder
(including Depression) 5.3 6.2
7.2
Any Substance Use
Disorder 7.0 3.3
Any Common Mental 5.3
Disorder 20.0
17.6 22.3

Another 0.5% people have a psychotic disorder in any one year.- Page 28 AIHW report
 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%
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-mha
ust2-toc~mental-pubs-m-mhaust2-hig~mental-pubs-m-mhaust2-hig-
men
Why?
Diagnosis, Medication, Socio-economic impacts
 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
MORNING TEA
Maximising Care- Maximising Business
Refer to hand outs

WQPHN (Services) National (Services)

4,500 4,000,000
4,000 3,500,000
3,500 3,000,000
3,000 42% 12% 7%
1% 3% 11%
2,500
-6% 3,889 2,500,000
12
%
3,001 2,000,000 6%
2,000
2,615 -8% 2,754 37% 30%
8% 10%
10%
1,500 2,443 47%
13%
1,500,000
6%
15% 14% 1,000,000 9% 11%
1,000 33% 12%
500 500,000
0 0
2012-13 2013-14 2014-15 2015-16 2016-17 2012-13 2013-14 2014-15 2015-16 2016-17

MHTP Review Consult MHTP Review Consult

 Annual Cycle of Care
Initial
Consult
2713 -
Mental
Consider Health
engagement in
Hospital Consultatio
Discharge n ASAP(prese
planning utilising
20 mins ntation
MBS item 729

Consider specific) Total Minutes spent: 220

Consider MBS item 2715 - GP
engagement in
Hospital
Discharge
900 referal
DMMR
Mental
Health Total Income generated: $924.55(Bulk bill)
planning utilising
MBS item 729 Treatement
MBS Item 900 Plan
20 mins Between 4-6
When completed by
weeks after
Pharmacist review with
GP
MHTP WHERE DOES THE CYCLE OF CARE
2712 - Review
48 weeks
743 - Case
Consider engagement in Hospital Mental COMMENCE?
Conference Health
40 mins Treatment
Discharge planning utilising MBS item Plan NB – This chart does not include additional
729 20 mins
available services, chronic disease item and other
Mental Health Treatment plan items-
PSYCHIATRIST
8 Weeks
42 weeks
2713 - Mental
Health
Consider utilising 743 - Case  
Consultation Telehealth Conference
20 mins
40 mins

Why not?
20 Weeks
2712 -
34 weeks Review
2712 - Review Mental
Mental Health
Treatment Plan Health
20 mins 28 Weeks Treatment
2713 - Mental
Health
Plan
Consultation 20 mins
20 mins
 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?

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
WHAT CONSTITUTES A MHTP?
 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-temp
lates
/
https://www.menzies.edu.au/page/Resources/Stay_Strong_Plan__two_page/
LETS DO LUNCH!!!
 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
1. Stratification of the population into different ‘needs groups’
2. Setting interventions for each group
3. Defining a comprehensive ‘menu’ of evidence based services
4. Matching service types to the treatment targets for each needs group

National Mental Health Services Planning Framework- http://www.nmhspf.org.au

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

What do we need to achieve?

Focus on promotion and Increase early intervention through Provide and promote access to lower Increase service access rates maximising Improve access to adequate level of primary
prevention by providing access to access to lower cost, evidence-based cost, lower intensity services the number of people receiving evidence- mental health care intervention to maximise
information, advice and self-help alternatives to face-to- face based intervention recovery and prevent escalation.
resources psychological therapy services
Provide wrap-around coordinated care for people
with complex needs

What services are relevant?

(Service level matched to individual clinical need and suitability)
Mainly publically available Mainly self-help resources, including Mix of resources including digital Mainly face-to-face primary care Face to face clinical care using a combination of GP
information and self-help digital mental health mental health services and low services, backed up by Psychiatrists or care, , Psychiatrists, Mental Health Nurses,
resources intensity face-to-face services links to broader social supports Psychologists and Allied Health
Psychological services for those Clinician-assisted digital mental health Coordinated, multiagency services for those with
who require them services and other low intensive services severe and complex mental illness
for a minority

What are the typical workforce requirements?

No workforce required Low-intensity workforce with Low intensity workforce as well as some Central role of GPs with contribution of Central role of private psychiatrists, paediatricians
appropriate skills, training and services by GPs, psychologists and other psychological therapy provided by and GPs
qualifications to deliver evidence based appropriately trained and qualified allied psychologists and other allied health
mental health services, but not at the health professionals professionals Psychological therapy provided by psychologists
level required for recognition as a mental and other allied health professionals
health professional, e.g: Peer workforce to supplement higher Private psychiatrists and paediatricians
intensity workforce, as appropriate involved for some, particularly for Mental health nurses involved in coordinating
• Certificate III or IV equivalent clinical care and supporting the role of GPs and
recommended entry point assessment and review of clinical needs
private psychiatrists
• Completion of recognised training in Peer workforce to complement clinical
delivery of cognitive behaviour therapy services provided by other workforce Peer workforce to complement clinical services
Peer workforce to supplement higher provided by other workforce
intensity workforce, as appropriate
 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
 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?????
 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?

EAT AGAIN???
 THE COLLABORATIVES
Where are you up to?

What are you going to do?

Thankyou!!