activity work plan 2019-2022 - wapha

Approved by the Australian Government Department of Health, September 2019 Version 1

Activity Work Plan 2019-2022: Primary Mental Health Care Funding

Country WA PHN

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(a) Planned activities for 2019-20 to 2021-22

– Primary Mental Health and Suicide Prevention

Funding

– Indigenous Mental Health Funding

– Response to PFAS Funding

Proposed Activities

Mental Health Priority Area

Priority area 7: Stepped care approach

ACTIVITY TITLE MH1.01a: Development of a Standardised Comprehensive Initial Clinical Assessment and Referral Pathway to a Virtual Assessment Clinic

Existing, Modified, or New Activity

New Activity

PHN Program Key Priority Area

Mental Health

Needs Assessment Priority

Priority:

• CMHP2.4 Increase access to low cost-local mental health services in areas with limited service availability but high demand. (p.101)

Possible Option:

• Support integrated online, telehealth and face to face services i.e. online and telehealth services (p.101)

Priority:

• CMHP2.7 Build capacity with General Practice to recognise and support patients with mental health conditions and ensure General Practitioners are aware of appropriate clinical pathways and referral processes. (p.102)

Priority:

• CMHP2.11 Promote integrated and coordinated care pathways for clients with comorbid chronic conditions and mental health conditions. (p.104)

Possible Options:

• Ensure commissioned services have appropriate referral pathways for clients with mental health conditions and other comorbid chronic condition. (p. 103)

• Strategies to develop integrated care pathways in partnership with Local Hospital Networks, Health Services, General Practice and other clinicians

Aim of Activity

The aim of this activity is to develop a standardised comprehensive intake assessment process (based on the PHN Initial Assessment and Referral in Mental Healthcare guidance) to enable general practitioners (GPs), other primary care clinicians and their patients to make informed treatment choices to improve the targeting of psychological interventions within an explicit shared decision-making framework.

The draft initial assessment and referral guidance makes specific recommendations concerning the form, scope and required skills necessary to

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ensure all patients can receive a standardised comprehensive initial assessment by a suitably qualified and experienced clinician at the point of entry into stepped-care. The development of the standardised process to a virtual initial assessment clinic will be aimed at supporting GP decision-making and referrals to psychological treatment services, including Better Access and WA Primary Health Alliance commissioned services. The establishment of such a process will also provide recommendations concerning possible treatment supports necessary to promote equitable access to psychological treatment services for the target group.

Moreover, this activity will be aimed at providing a consistent, standardised initial assessment by suitably skilled clinicians, no matter the location of the individual across the Country WA PHN regions. The standardised initial assessment process for the virtual clinic will also provide GPs with a central point of access and provide a clinical formulation and specific recommendations for an individual within the stepped care strata. Thereby, promoting equitable access for all individuals, particularly in areas of low service availability and high demand, as well as coordinated care for people with multiple morbidities and treatment support needs.

Description of Activity

A priority of the standardised intake process is to enable patients to receive a comprehensive initial assessment that will ensure identified treatment options are proportionate to need and can be aligned, discussed and decided upon within a shared decision-making approach. This will minimise treatment burden and maximise therapeutic and other benefits.

This activity recognises the central role that GPs have in both guiding and supporting treatment decisions that not only consider potential benefits and risks, but also the values, circumstances and preferences of patients. This activity is linked to MH1.02 – the development of regional service maps that specify available treatment and care options within the stepped-care strata (low, moderate, high intensity), as well as other relevant groupings (age, gender, etc.), and to a virtual assessment clinic - that can provide GPs with a standardised core assessment with identified treatment options and recommendations.

This development of a standardised intake process will provide referring GPs with a standardised comprehensive assessment report including formulation and specific recommendations, and local service options. The comprehensive initial assessment will be undertaken by an appropriately qualified health professional (clinical psychologist, social worker/occupational therapist/registered psychologist with specific experience in mental health, mental health nurse, or equivalent). This will also meet the requirement for a GP Mental Health Care plan or equivalent for referral into PHN commissioned psychological therapy services.

The initial assessment report will be stored in a secure form that can be accessed remotely by authorised individuals (GPs and clinicians involved directly in the provision of treatments), incorporated into GP practice software, and My Health Record, as appropriate.

Work will be undertaken to develop and implement the standardised intake process through a staged project management approach, including comprehensive organisational change management. The latter will be required to modify current processes within the Country WA PHN to align with the Initial Assessment and Referral in Mental Healthcare Guidance and this activity, so

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that commissioned treatment and support services maintain the capability to meet demand and accommodate the workflow changes required to meet the new design.

Target population cohort

This activity will be targeted at those who are:

• at risk of, or with mild to moderate mental illness, and, in some circumstances, severe mental illness who can be most appropriately managed in primary care

• from an underserviced population

• unable to equitably access MBS treatments due to overlapping factors indicating disadvantage, including: o low income or inability to access services during business hours o job insecurity o material disadvantage o limited personal resources o social isolation o poor health literacy o other social, economic, cultural and personal reasons

• residing in rural and remote areas of Country WA or experiencing locational disadvantage.

Indigenous specific No

Coverage Country WA PHN, which includes the Kimberley, Pilbara, Mid-West, Wheatbelt, Goldfields, South West and Great Southern regions.

Consultation

The Country WA PHN will continue to engage and consult with a range of key stakeholders to continue to build trusting relationships, shared ownership and a common understanding of this activity.

Stakeholder consultation and engagement will occur with:

• GPs

• nurse practitioners

• Royal Australian College of General Practice

• WA Country Health Services

• WA Mental Health Commission

• Australian Government Department of Health

• WA Department of Health

• Women and Newborn Health Service

• Child and Adolescent Health Services

• PHN commissioned mental health service providers

• primary mental health professionals

• Regional Clinical Councils

• Country Community Advisory Councils

• District Health Advisory Councils

• Clinical and academic experts

• Australian Digital Health Agency

• consumer and carer peak bodies and consumer associations.

The consultation and engagement activities will be conducted through a range of methods including face-to-face and group sessions, and online platforms.

Collaboration Country WA PHN will continue to collaborate with a range of key stakeholders to formulate solutions, define roles, responsibilities and likely outcomes,

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and incorporate their advice and recommendations into the final model.

The role of key stakeholder will be:

• GPs and clinical editors who will assist in the scoping of the design and implementation of the initial standardised assessment process

• WA Country Health Service, Child and Adolescent Health Service, Women and Newborn Health Service, and the WA Mental Health Commission who will support to strengthen regional strategic partnerships and provide information and clarity regarding transition points into state based mental health services

• community and consumer groups who will enhance the PHNs understanding of consumer needs and desired consumer experience.

• PHN commissioned service providers will assist to determine the impact of the new standardised assessment on current practices and seek input in its design and implementation

• relevant peak bodies representing local community organisations and associations will assist to inform decisions and formulate solutions where required.

Activity milestone details/ Duration

Activity start date: 1/07/2019

Activity end date: 30/06/2022

Service delivery start date: July 2021

Service delivery end date: June 2022

It is envisaged that the key milestones for this activity will be:

• recruitment of an external project consultant to scope/plan the initial project specification

• completion of a project plan outlining workstreams with detailed timelines including: o undertaking all consultation and engagement activities o formulation of process to develop a virtual assessment clinic o development of a change management plan o implementation of change management activities / processes o development of a framework to assess the process’s impacts and

efficacy o implementation of the completed intake and assessment process.

Commissioning method and approach to market

1. Please identify your intended procurement approach for commissioning services under this activity:

☒ Not yet known

2a. Is this activity being co-designed?

Yes

2b. Is this activity the result of a previous co-design process?

No

3a. Do you plan to implement this activity using co-commissioning or joint-commissioning arrangements?

No

3b. Has this activity previously been co-commissioned or joint-commissioned?

No

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Decommissioning No This activity does not include any decommissioning of services.

Data collection Yes Once fully implemented, this activity is in scope for data collection under the Mental Health National Minimum Dataset.

Total Planned Expenditure

The following activities will be conducted under operational/administrative activity funding and have been included as a total (for all activities listed) in the table below: MH1.01a MH1.01b MH1.02 MH1.03a MH1.03b MH1.04 MH1.05 MH1.06 MH4.02 MH5.02 MH8 Note: Once the development, planning and implementation stage has been finalised and activity costs have been determined, funding for commissioned services under the Activity Work Plan will be reviewed to allow funding of the activities (if required).

Funding Source 2019-2020 2020-2021 2021-2022 Total

Administration $1,894,669 $1,942,569 $1,980,631 $5,817,869

Total Planned Commonwealth Expenditure

$1,894,669 $1,942,569 $1,980,631 $5,817,869

Proposed Activities



ACTIVITY TITLE MH1.01b: Development of a Standardised Comprehensive Initial Clinical Assessment for People with Mental Illness in Residential Aged Care Facilities


New Activity


Mental Health


Priorities:

• CMHP 2.7 Build capacity with General Practice to recognise and support patients with mental health conditions and ensure General Practitioners are aware of appropriate clinical pathways and referral processes. (p.102)

• CMHP 2.9 Support the mental health of older people and assist primary care providers to identify older people who may need additional support or referrals to services. (p.103)

No suitable option available

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Aim of Activity

The draft initial assessment and referral guidance makes specific recommendations concerning the form, scope and required skills necessary to ensure all patients can receive a standardised comprehensive initial assessment by a suitably qualified and experienced clinician at the point of entry into stepped-care. This aligns with the guidance for Psychological Treatment Services for People with Mental Illness in Residential Aged Care Facilities (RACF), which also identifies the requirement to consider the specific needs and circumstances of older adults who are resident in aged-care facilities.

The aim of this activity is to develop a standardised initial comprehensive assessment and treatment pathway, that considers the complexities of ageing and multi-morbidities. This will assist GPs, other primary care clinicians and residents to make informed treatment choices to improve the targeting of psychological interventions within an explicit shared decision-making framework.

A standardised comprehensive initial assessment process will also be aimed at building capacity and capability in general practice to identify and support people with or at risk of mental illness who are living in RACF, and to utilise appropriate care pathways and referral processes to services that are tailored to meet the mental health and wellbeing needs of residents.


A priority of this activity is to ensure that residents of identified RACFs can receive a comprehensive initial assessment. This will ensure that the identified treatment options are proportionate to need and can be aligned, discussed and decided upon within a shared decision-making approach with a resident and their family – thereby, minimising the treatment burden and maximising therapeutic and other benefits. This activity recognises the key role that GPs have in guiding and supporting treatment decisions for people living in RACFs, that not only consider potential benefits and risks, but also the values, circumstances and preferences of residents.

This activity aligns the assessment guidance in Psychological Treatment Services for people with mental illness in RACFs with the more detailed requirements of the initial clinical assessment and referral guidance. The standardised assessment process will be undertaken by suitably qualified and supervised practitioners, for residents referred with, or at risk of, mental illness, particularly depression and anxiety.

Work will be undertaken to develop and implement the standardised intake assessment through a staged project management approach, building upon the learnings and evaluation results from the first phase / trial of the roll out of psychological treatment services in RACFs and recognising the circumstances of provision in rural and remote settings may require a different model than developed for metropolitan settings.


The activity is targeted at individuals who:

• live in a RACF

• present as mildly depressed or anxious, but do not have a diagnosis or, are having trouble adjusting to changes / transitioning or coping with grief and/or loss

• have a former or new diagnosis of mild to moderate mental illness

• have a diagnosis of severe mental illness, which is episodic in nature, may include pre-existing conditions, and is not being managed by Older Adult Mental Health Services.

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Consultation

The Country WA PHN will continue to engage and consult with a range of key stakeholders to effectively develop a standardised assessment process linked to treatment options for residents of RACFs.

A comprehensive consultation process will be undertaken to obtain information from, and keep stakeholders informed of the progress and outcomes of the project.


• GPs working in RACFs

• nurse practitioners


• Consumer and carer peak bodies and consumer associations

• Council on the Ageing WA

• Leading Age Services Australia

• RACFs where indicated

• Psychological service providers and PHN commissioned service providers

• Older Adult Mental Health Services

• clinical and academic experts.


Collaboration

The Country WA PHN will work with key stakeholders to plan and co-design and implement a viable, sustainable and practical solution that meets the identified needs, priorities and objectives of the project group for an effective initial comprehensive assessment process for RACFs. This work will be undertaken in collaboration with similar activities being planned for metropolitan RACFs as detailed in the Perth North PHN and Perth South PHN Activity Work Plans. Collaboration will occur with:

• Older Mental Health Services will support to strengthen regional strategic partnerships and provide information and clarity regarding transition points to and from state based older adult mental health services.

• psychological service providers and PHN commissioned service providers will work together to design and implement an effective process.

• GPs and HealthPathways clinical editors will assist in the scoping of the design and implementation of the initial standardised assessment process.

• community and consumer groups will enhance the PHNs understanding of the consumer needs and desired consumer experience.






It is envisaged that the key milestones will be:

• recruitment of external project consultant to scope/plan the initial project specification

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• development of a project plan outlining workstreams with detailed timelines including: o completion of consultation and engagement activities o formulation of process o development of change management plan o implementation of change management activities/processes o development of a framework to assess the process’s impacts and

efficacy o implementation of the completed intake and assessment process



☒ Not yet known


Yes

2b. Is this activity this result of a previous co-design process?

No


No


No

Decommissioning No

This activity does not include any decommissioning of services.

Data collection

Yes

This activity is in scope for data collection under the Mental Health National Minimum Dataset.


Included in Operational/Administrative funding. Please refer to Funding Source table under MH1.01a.

Proposed Activities



ACTIVITY TITLE MH1.02: Classifying Services to Align with the Initial Clinical Assessment Domains and Target Population (MH1.01a) within a virtual directory


New Activity


Mental Health


Priority:

• CMHP2.7 Build capacity with General Practice to recognise and support patients with mental health conditions and ensure General Practitioners are aware of appropriate clinical pathways and referral processes. (p.102)

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Priority:


Possible Option:

• Ensure commissioned services have appropriate referral pathways for clients with mental health conditions and other comorbid chronic conditions. (p.104)

Aim of Activity

The draft guidance for initial clinical assessment identifies two principal assessment domains, medical complexity and personal context, each with four sub-domains that should be assessed to identify the service(s) that are best able to meet individual need (from self-care to secondary care). To achieve this, available services need to be mapped to the domain and sub-domain assessment outputs of the standardised intake assessment to provide appropriate treatment options (considering medical complexity) and associated treatment support (considering personal context). Whilst some services are associated with a single type and level of care, most services contribute to multiple levels and/or types of care. Through classification, more effective matching of services and populations, groups can occur to meet the needs of individuals and enhance the shared decision making with a person’s GP.

The aim of the classification of services is to develop sub-regional service maps that specify available treatment and care options within the stepped-care strata (low, moderate, high intensity) and are aligned with the MH1.01a assessment domains, as well as other relevant groupings (age, gender, etc.).

This activity will aim to improve care pathways, provide a more seamless continuum of care that is flexible and responsive to individuals’ needs, and build capability in primary care to align the right care, at the right time and in the right place. This includes the facilitation of self-management (where viable and appropriate) through the incorporation of voluntary associations within the service support aspects of the framework.


To ensure the initial assessment has real world utility for clinicians and the target population it needs to be linked to services than can support the treatment decisions that follow. To enable this, it is necessary to develop a directory of locally-based and locally-available services (both physically and virtually present) that can meet the identified needs.

Potential solutions will be explored during 2019-20 in terms of feasibility, cost-benefit, utility, likely user acceptance and other criteria. In 2020-21 an initial version of the service directory will be developed as a working prototype that can be user tested and iteratively improved by incorporating new information, where available. Implementation will occur in 2021-22.

Among the options to be considered will be the development of an Application Program Interface solution enabling service specifications from a variety of existing directories to be drawn in to interactively populate a new directory. This will be contrasted with other options such as the development and maintenance of a new purpose-built directory. This activity is linked to MH1.01a, & MH1.04.


This activity will be targeted at those who are:

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• at risk of, or with mild to moderate mental illness, and, in some circumstances, severe mental illness who can be most appropriately managed in primary care






Consultation

The PHN will continue to engage and consult with a range of key stakeholders to develop a detailed and practical service typology, stakeholder engagement and consultation will be undertaken at a regional level.

This process will be used to outline the proposed purpose of the service directories, determine the services in each region that are available in each care profile, and establish an agreed common language to describe the services. Information regarding referral pathways and the detail and level of mapping to be undertaken will also be addressed during the consultation and engagement activities.

The following services will be consulted as part of this activity:

• Mental health service providers and community services organisations




• Children and Adolescent Health Service

• Aboriginal Controlled Community Health Organisations

• Volunteer organisations and associations

Consultation and engagement activities will be conducted through a range of methods including face-to-face and group sessions, and online platforms.

Collaboration

The Country WA PHN will continue to build on existing relationships with key stakeholders to strengthen and consolidate regional collaboration and cooperation in planning and delivering mental health care services.

Collaboration will occur with:

• PHN commissioned service providers and mental health service providers who will assist to determine service scope and specifications delivered. GPs and clinical editors who will provide recommendations regarding how best to present the information so that it is easily used and portable.

• My Community directory and the WA Mental Health Commission directory to determine how best to utilise information resources already available.

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• completion of engagement and consultation

• collection of available and relevant service information

• development of service typology

• creation of Application Program Interface data platform

• user testing of the service directories.



☒ Not yet known


Yes


No


No


No

Decommissioning No


Data collection

No

This activity is not in scope for data collection under the Mental Health National Minimum Dataset.



Proposed Activities



ACTIVITY TITLE

MH1.03a: Preliminary exploration on the establishment of a Streamlined Referral Process for the Provision of Specialist Bulk Billed Consultation under MBS


New Activity


Mental Health


Priority:

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• CMHP2.3 Increase access to early intervention services to prevent escalating acuity and reduce the burden on acute and emergency department services. (p.100)

Possible Option:

• Support alternative services to the Emergency Department for people with moderate mental health conditions. (p.103)

Priority:

• CMHP2.4 Increase access to low cost- local mental health services in areas with limited service availability but high demand. (p.101)

Possible Option:

• Support integrated online, telehealth and face to face services i.e. online and telehealth services. (p.104)

Aim of Activity

The aim of the establishment of a streamlined referral process to specialist services is to improve and increase access to bulk-billed MBS funded consultant specialist services such as a psychiatrist (including telehealth) for initial assessment, consultations, and reviews, for patients with or at risk of developing mental illness who can be appropriately managed in primary care by a GP.

The development of this process, particularly for individuals with multi-morbidities, is aimed at providing accessibility to, and support for decisions in instances where very specific clinical knowledge is required that is outside of the core primary care health team.

This activity will support GPs to manage more complex patients in a primary care setting by providing a single point of referral for accessing specialist support under MBS.


This activity will establish a streamlined referral process to a consultation system of expert clinical professionals, bulk-billed under MBS. This will involve the development and incremental implementation of an effective and efficient referral pathway/s no matter the location of the referring GP, and the assembling of a consultancy of specialists who can provide advice, guidance and support to GPs where indicated.

The ability to avail specialist services through a straightforward process at no cost to the individual, will ensure the effective management in primary care of people with more complex and severe mental illness and/or multi-morbidities where indicated, or referral to acute or state-based care when required.


This activity will be targeted at those who:

• in most cases, have a moderate mental illness, and, in some circumstances, severe mental illness who can be most appropriately managed in primary care

• are from an underserviced population

• are unable to equitably access MBS treatments due to a constellation of overlapping factors, including: o low income or inability to access services during business hours o job insecurity o material disadvantage o limited personal resources o social isolation

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o poor health literacy o other social, economic, cultural and personal reasons

• reside in rural and remote areas of Country WA or experiencing locational disadvantage

• require additional assessment and/or support outside of that readily available in primary care settings.

Indigenous specific

Yes

MBS item 288, which includes referrals from AMSs and ACCHOs is in scope for this activity.

Noting that there will be Indigenous specific components to this activity, but also non-indigenous individuals are in scope and will also benefit.

Coverage Country WA PHN - noting area specific requirements for general tele-health services.

Consultation

The PHN will continue to engage and consult with a range of key stakeholders to build trusting relationships that will result in shared ownership and common understanding.


• Interested Specialists e.g. Psychiatrists in private practice

• GP


• WA Country Health Service

• Child and Adolescent Health Service


• Aboriginal Health Council of WA

• Consumer and Carer Peak Bodies

As per MH1.01a and MH1.03b, the development of a referral process to specialists will involve stakeholder consultation and engagement.


Collaboration

The Country WA PHN will continue to build on existing relationships with key stakeholders to design and implement an effective specialist referral process.

The Country WA PHN will identify and involve key stakeholders and organisations who will utilise, or have the capacity to influence, its operations. Activities will involve working with key stakeholders such as specialists to secure their buy-in to provide their consultancy and cultivate collaboration in the process’s development.

The role of the key stakeholders will be as follows:

• interested specialists will assist to provide clarity regarding role definition and scoping of the process and the consultancy service parameters

• selected GPs will assist in determining the support required and scoping of a streamlined and transparent referral process

• representative professional bodies will provide clarity of how the process will be aligned with other similar processes and with professional standards

• WA Country Health Services and the WA Mental Health Commission will provide information and clarity regarding transition points into state-based mental health services.

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• development of a project plan outlining workstreams with detailed timelines including:

o completion of consultation and engagement activities

agreement with an organisation to manage an empanelment of specialists

o development of a referral pathway to specialist services

o development of a framework to assess the pathway’s impacts and efficacy.



☒ Not yet known


Yes


No


No


No

Decommissioning No


Data collection

Yes




Proposed Activities



ACTIVITY TITLE

MH1.03b: Preliminary exploration on the establishment of a Streamlined Referral Process for the Provision of Specialist Bulk Billed Consultation under MBS for Residential Aged Care Facilities


New Activity

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Mental Health


Priority:

• CMH P2.9 Support the mental health of older people and assist primary care providers to identify older people who may need additional support or referrals to services. (p.103)

Possible Option:

• Work with local communities and service providers to support services that address identified need. (p.103)

Priority:


Possible Option:

• Ensure commissioned services have appropriate referral pathways for clients with mental health conditions and other comorbid chronic condition. (p.104)

Aim of Activity

The aim of the establishment of a streamlined referral process to bulk-billed MBS funded consultant specialist services is to improve and increase access for residents in RACFs, with or at risk of developing mental illness. Services may include specialist older adult psychiatrist or geriatrician (including telehealth specialist services) for initial assessment, consultations, medication management plans and reviews.

This process is also aimed at providing integrated and coordinated pathways for residents with multi-morbidities who require specialist care. Further, to negate any duplication with Older Adult Mental Health Services, the Country WA PHN will aim to work with the service to establish a clear and streamlined process that provides a continuum of care for the resident.


This activity will establish a streamlined referral process for GPs for the provision of specialist consultation by a specialist bulk-billed under MBS. This will involve the development and implementation of an effective and efficient referral pathway/s no matter the location of the referring GP, and the assembling of a consultancy of specialists who can provide advice, guidance and support to GPs where indicated related to residents with or at risk of mental illness in a RACF.

The ability to avail specialist services through a straightforward process at no cost to the individual, will ensure the effective management of residents with multi-morbidities (and associated poly-pharmacy) or referral to state-based services when indicated.


The activity is targeted at individuals who:

• live in a RACF

• present as mildly depressed or anxious, but do not have a diagnosis or, are having trouble adjusting to changes / transitioning or coping with grief and/or loss

• have a former or new diagnosis of mild to moderate mental illness

• have a diagnosis of severe mental illness, which is episodic in nature which may include pre-existing conditions, and who is not being managed by Older Adult Mental Health Services.

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Coverage Country WA PHN, which includes the Kimberley, Pilbara, Mid-West, Goldfields, Wheatbelt, South West and Great Southern regions.

Consultation

The PHN will continue to engage and consult with a range of key stakeholders to build trusting relationships that result in shared ownership and a common understanding of the anticipated purpose and scoping of the consultancy. Consultation and engagement activities will be conducted through a range of methods including face-to-face and group sessions, and online platforms.


• interested specialists e.g. older adult psychiatrists in private practice

• GPs

• Older Adult Mental Health Service


• selected RACFs

• representative professional bodies


Collaboration

To establish an effective streamlined referral process to specialist MBS funded services for residents of RACFs, the Country WA PHN will collaborate with a diverse mix of stakeholders to inform decisions around the design and implementation of the process, and to agree upon the necessary steps required to underpin its establishment.

The role of the key stakeholders will be:

• Interested specialists, who will assist to provide clarity regarding role definition and scoping of the process and the consultancy service parameters

• GPs who will assist to determine the support required and scoping of a streamlined and transparent referral process

• Older Adult Mental Health Services, who will assist to provide clarity regarding transition points into state based mental health services and strategies to negate duplication

• RACFs will provide information on access points and ease of use of a referral process to specialist services for residents






• completion of a project plan outlining workstreams with detailed timelines including:


o agreement with an organisation to manage an empanelment of specialists

o development of a referral pathway to specialist services

o development of framework to assess the pathway’s impacts and efficacy.

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☒ Not yet known


Yes


No


No


No

Decommissioning No


Data collection

Yes




Proposed Activities



ACTIVITY TITLE MH1.04: Establishment of a Service Model Framework for Perinatal Women


New Activity


Mental Health


Priority:

• CMHP 2.5 Increase access to mental health specific services to support women and mothers with babies. (p.101)

Possible Options:

• Provide support and education to General Practice to identify women at risk of perinatal mental health issues. (p.101)

• Work with local communities and service providers to support and develop services that address identified needs. (p.101)

Priority:

• CMHP 2.3 Increase access to early intervention services to prevent escalating acuity and reduce the burden on acute and emergency department services (p.100)

Possible Option:

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• Support short-term, low intensity services for vulnerable people with mild or moderate mental health conditions. (p.101)

Aim of Activity

The aim of this activity is to establish a service model framework that provides evidence-based early intervention services for perinatal mothers, who are experiencing mild to moderate anxiety and/or depression, and who can be appropriately managed in primary care.

This activity aims to identify service gaps in order to develop an easily accessible and mainstream evidence-based short-term psychological intervention model perinatal mother, to enhance mental health and wellbeing during this vulnerable developmental stage of life.

The establishment of a service model will provide:

• diagnostic support to GPs and other clinicians such as community health nurses, using the referral pathways developed to access MBS bulk-billed specialists as per MH1.03a

• short-term evidence-based, structured low intensity and psychological therapy services as per MH2 and MH3

By establishing a service model framework for this target group, individuals will be able to obtain improved access to free, culturally suitable early intervention services that aim to prevent the escalation of acuity, reduce unnecessary emergency department presentations, and support GPs to better detect and manage maternal perinatal mental health issues.


Evidence indicates that maternal perinatal mental health, particularly among women experiencing disadvantage, impacts a child’s emotional behavioural development and that mental health inequalities widen as children commence school.i Therefore, the development of an integrated, holistic and multimodal service model that recognises the higher rates of mental disorders in families experiencing multiple drivers of disadvantage, and affords additional forms of treatment support to ameliorate them, is integral to this activity.

This activity will involve the establishment of a viable and appropriate early intervention service framework that addresses the needs of perinatal mothers with, or at risk of, anxiety and/or depression. The service model framework will be established using a co-design approach involving selected GPs, the Women and Newborns Health Service, and WA Country Health Services.

It is envisioned that the proposed service model will include the provision of evidence based early intervention low intensity and psychological therapy services (as per MH2 and MH3). Part of the establishment of the service model will also be in identifying and forming partnerships with stable and existing service centres that are accessed by perinatal women. This will be to improve access and utilisation of the service, particularly those from underserviced groups, and to reduce stigmatisation by integrating mental health services within general health care. Central to the model will be referrals to the new services from GPs, psychiatrists or paediatricians, as well as those facilitated by relevant healthcare clinicians such as community child health nurses. It is envisioned that the service model will be delivered by suitably skilled and qualified health professionals, including clinical psychologists, mental health competent registered psychologists, occupational therapists, social workers, and registered nurses.

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The service model framework will also be aligned to the initial intake and assessment activity (as per MH1.01a) to help determine the intensity of care required and to inform referral decisions.

It is envisioned that once established, the service model framework will be piloted in one region of the Country PHN to assess its viability, integrity and sustainability. i Rutherford C, Sharp H, Hill J, Pickles A, Taylor-Robinson D (2019) How does perinatal maternal mental health explain early social inequalities in child behavioural and emotional problems? Findings from the Wirral Child Health and Development Study. PLoS ONE 14(5): e0217342. https://doi.org/10.1371/journal. pone.


The activity is targeted at individuals who are:

• perinatal women

• from an underserviced group

• unable to equitably access MBS treatments due to overlapping factors indicating disadvantage, including: o low income or inability to access services during school / business

hours o job insecurity o material disadvantage o limited personal resource o social isolation o poor health literacy o other social, cultural, spiritual, economic, cultural and personal

reasons

• living in a rural or remote area of Country WA or experiencing locational disadvantage.


Coverage Country WA PHN, which will include the Kimberley, Pilbara, Mid-West, Wheatbelt, Goldfields, South West and Great Southern regions.

Consultation

Consultation and engagement activities will be undertaken to facilitate information exchange, explore collaborative opportunities and mitigate the risk of gaps or duplication in the provision of existing services for this target group.

The Country WA PHN will consult in the first instance with:

• GPs and Nurse practitioners

• Royal College of General Practice

• consumer and carer peak bodies and consumer associations

• Aboriginal Advisory Groups



• Commissioned service providers of services for this target group



The consultation and engagement activities will be conducted through a variety of methods including face-to-face and group sessions, and online platforms.

Collaboration The Country WA PHN will continue to build on existing relationships with key stakeholders to co-design the service model framework. Collaboration will be

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vital in determining roles, responsibilities, and likely outcomes of the co-design of the service model framework.

The role of key stakeholders will be as follows:

• GPs and clinical editors who will make recommendations regarding scope of the design and implementation of the service.

• Women and Newborn Health Service and WA Country Health Service who will assist to strengthen regional strategic planning and seek input regarding service needs and implementation strategies.

• PHN commissioned service providers who will provide input regarding decisions about its design and implementation.








• completion of a project plan outlining workstreams with detailed timelines including:


o establishment of a Co-design Steering Committee

o development of a service model framework

o procurement of services to pilot the service model framework.



☒ Not yet known 2a. Is this activity being co-designed? Yes 2b. Is this activity this result of a previous co-design process? No 3a. Do you plan to implement this activity using co-commissioning or joint-commissioning arrangements? No 3b. Has this activity previously been co-commissioned or joint-commissioned? No


Data collection Yes This activity is in scope for data collection under the Mental Health National Minimum Dataset.



22

Proposed Activities


Priority area 6: Aboriginal and Torres Strait Islander mental health services

ACTIVITY TITLE MH1.05: Establishment of Patient Navigators to support individuals overcome barriers to accessing PHN commissioned treatment services


New Activity

This is the continuous service improvement and review of service delivery models for PHN commissioned treatment services. Not the actual commissioned services.


Mental Health


Priority:

• CMHP 2.3 Increase access to early intervention services to prevent escalating acuity and reduce the burden on acute and emergency department services. (p.100)

Possible Option:


Priority:

• CA 4.4 Assist Primary Health Care Providers to adopt culturally appropriate models of care for Aboriginal populations, Culturally and Linguistically Diverse groups. (p.109)

Possible Option:

• Support general practices and Aboriginal Community Controlled Health Organisations to refer Culturally and Linguistically Diverse groups to identified culturally appropriate services. (p.109)

Aim of Activity

The aim of this activity is to establish a patient navigators’ service design to support and assist individuals to overcome barriers to accessing available PHN commissioned mental health care services. This will facilitate patients’ transitions into and out of primary mental health care services, create efficiencies in care integration and coordination, and ensure that a patient’s individualised mental health treatment and treatment support needs (as per MH1.01a) are adequately met. Ultimately, the patient navigators will aim to provide a more seamless and patient-centred level of care, that encompasses a clearer navigation of the primary mental health care system.

This activity links with MH6: Indigenous Mental Health.

The establishment of patient navigators will also aim to reduce the broader impact of mental illness in underserviced groups such as Aboriginal and Torres Strait Islander and CaLD communities, by improving timely access to evidence-based treatments, as well as building capacity and capability in the sector to address material and immaterial factors that reduce equitable access to care. These will include cultural appropriateness, disability access and inclusion, and contextual environmental, social and economic factors.

Patient navigators will:

• establish links with local communities to promote access to, and utilisation of, commissioned mental health services.

23

• provide information, and practical assistance where indicated, to support individuals to access, attend and complete recommended treatment (within the context of an agreed episode of care).

• identify both the barriers and solutions to the delivery of contextually appropriate commissioned mental health services.

• facilitate communication between the patient, family members, and commissioned providers to ensure patient satisfaction and understanding of their treatment regime.

• support and address cultural, language and spiritual needs where indicated, for individuals accessing commissioned mental health services.

• advocate to, and work with, commissioned providers to provide flexible and tailored services to meet individual’s needs and goals.


This activity aligns closely with Action Area Three of the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023i (the Framework) which seeks to build capacity and resilience in people and groups at risk. A key strategy within Action Area Three is to support access to cultural liaison officers and language interpreters.

Services will be delivered by locally based and specified navigators who are suitably trained (Certificate III or IV level) to facilitate access to low intensity services or psychological therapies, address barriers, and assist individuals with health literacy and practical and functional challenges. It is envisaged that services available will include a variety of navigators to meet patients’ needs, such as a peer worker or a cultural navigator, in areas where there is a significant population of people from Aboriginal and Torres Strait Islander backgrounds or who are Culturally and Linguistically Diverse (CaLD), or other target populations where appropriate.

The establishment of patient navigators presents an opportunity for the Country WA PHN commissioned services to deliver culturally appropriate care as a core activity of the service delivery model without this being a cost to the core treatment activity. The Country WA PHN will utilise the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP), PHN Aboriginal mental health co-design reportsii and other key policy to inform commissioned providers application of the service and how activity will be reported, measured and evaluated. It is envisaged that the percentage of uncompleted episodes of care and unattended appointments, and the ensuing service costs, will be reduced. i Commonwealth of Australia 2017. National Strategic Framework for Aboriginal and

Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing. Canberra: Department of the Prime Minister and Cabinet.

ii https://www.wapha.org.au/404-2/


The patient navigator services will be targeted at Aboriginal and Torres Strait Islander individuals who:

• are at risk of, or living with, mild to moderate mental illness, and in some cases severe mental illness (who can be appropriately managed in primary care)

• are unable to equitably access MBS treatments due to overlapping factors indicating disadvantage, including:

https://www.wapha.org.au/404-2/

24

o low income or inability to access services during school / business hours

o job insecurity o material disadvantage o limited personal resources o social isolation o poor health literacy o other social, cultural, spiritual, economic, cultural and personal

reasons

• live in a rural or remote area of Country WA or experience locational disadvantage.

Indigenous specific Yes


Consultation

Consultation and engagement activities will be undertaken through a range of methods including face-to-face and group sessions, and web-based platforms to inform key stakeholders about the patient navigation service, and to understand their aspirations and explore their local needs.

The Country WA PHN will consult with:

• PHN commissioned service providers

• GPs


• Aboriginal Community Controlled Health Organisations


• selected Elders and community leaders

• Ethnic Community Council of Western Australia

• relevant community, consumer and carer advisory groups and associations

• clinical and academic experts

Collaboration

The Country WA PHN will collaborate with the following key stakeholders:

• PHN commissioned service providers who will assist to determine the cultural navigation services required to support access to, and use of, commissioned treatment, and

• selected local communities/Elders/consumers who will assist to identify key cultural barriers that limit access and utilisation of commissioned mental health services.






• completion of a project plan outlining workstreams with detailed timelines.

This will include:

o completion of consultation and engagement activities o definition of the roles and responsibilities of the expected role o development of framework to assess the activities impacts on referral

rates and treatment completion

25

o development of a procurement plan for the activity.



☒ Not yet known


Yes


No


No


No





Proposed Activities



ACTIVITY TITLE MH1.06: Integrated Primary Mental Health Care Program (“Portals”)


Existing Activity This is the continuous service improvement and review of the PORTALS service delivery model (with description of model). Not the actual commissioned services.


Mental Health


Priority:

• CMHP 2.3 Increase access to early intervention services to prevent escalating acuity and reduce the burden on acute and emergency department services. (p.100)

Possible Options:



• Support alternative services to the Emergency Department for people with moderate mental health conditions. (p.101)

Priority:

26

• CMHP 2.2 Provide medium intensity services to assist in care coordination and management for people with moderate to severe mental health conditions managed by General Practice. (p.100)

Possible Option:

• Support mental health providers to deliver medium intensity services.

• Commission community-based care coordination services for people with moderate to severe mental health conditions. (p100)

Priority:

• CMHP 2.4 Increase access to low cost- local mental health services in areas with limited service availability but high demand. (p.101)

Possible Options:

• Work with local communities and service providers to support services that address identified needs. (p.101)

• Support integrated online, telehealth and face to face services i.e. online and telehealth treatments. (p.101)

Priority:

• CMHP 2.8 Increase access to mental health services for youth at risk of experiencing moderate to severe mental illness. (p.103)

Possible Option:


Aim of Activity

The Integrated Primary Mental Health Care program is aimed at improving access to, and providing coordinated multi-disciplinary treatment for people with, or at risk of, mental health conditions that can be appropriately managed in primary care.

This activity is aimed at providing a consistent organising framework for an integrated stepped care model throughout the Country WA PHN by the provision of a single point of referral for place-based services within each of the Country WA PHN regions.


The Integrated Primary Mental Health Care program is delivered across the seven regions of the Country WA PHN and provides access to primary care treatment services for people with, or at risk of mental illness.

It is an organizing framework that uses a stepped care approach to provide three core interacting components:

• clinical care coordination (MH4.01)

• low intensity and psychological therapy phone-based and web-based services via a Virtual Clinic by the Practitioner Online Referral Treatment Service (PORTS) (MH2 and MH3)

• structured treatment services including low intensity face to face services and psychological therapies, that in the absence of a negotiated pathway are for individuals who are at low risk of suicide (MH2 and MH3)

The establishment of, and need for alignment with, a standardised intake and referral process (MH1.01a) affords opportunities for further service improvement initiatives in the Integrated Primary Mental Health Care framework across the Country regions and with the sector more broadly. The

27

Country WA PHN will provide oversight of the efficiency and effectiveness of the commissioned providers’ who are operating within the Integrated Primary Mental Health Care organisational framework through ongoing analysis of PMHC-MDS data, calculation of unit costs, and regular contact between contract managers and providers.


The activity is targeted at individuals who are:

• at risk of, or living with mild mental illness






Consultation

The PHN will continue to engage and consult with a range of key stakeholders to inform key stakeholders regarding the impact of the new activities to be implemented on current service provision and to listen to concerns. The Country WA PHN will consult with:





• PHN commissioned providers

• GPs

• Regional Clinical Committees



• Aboriginal Advisory Groups.


Collaboration

The Country WA PHN will collaborate with the following key stakeholders:

• GPs who will assist to determine the most accessible referral pathways to the service and work to improve feedback regarding interventions during and when exiting the service.

• WA Country Health Services, Child and Adolescent Health Service, Women and Newborn Health Service and the WA Mental Health Commission who will assist in determining referral pathways to and from state-based services, and partner to ensure effective regional planning and integration

• PHN commissioned service providers who will work together to improve systems and processes to ensure accessible and quality service provision.

28


Activity start date: 1/07/2019 Activity end date: 30/06/2022 Service delivery start date: July 2019 Service delivery end date: June 2022



☒ Not applicable 2a. Is this activity being co-designed No 2b. Is this activity this result of a previous co-design process? No 3a. Do you plan to implement this activity using co-commissioning or joint-commissioning arrangements? No 3b. Has this activity previously been co-commissioned or joint-commissioned? No





Proposed Activities


Priority area 1: Low intensity mental health services

ACTIVITY TITLE MH2: Low Intensity Services


Existing Activity (Previous AWP reference: MH1 Low Intensity Mental Health Services 2018/19)


Mental Health


Priority

• CMHP2.3. Increase access to early intervention services to prevent escalating acuity and reduce the burden on acute and emergency department services. (p.100)

Possible Options:

• Support short-term, low intensity services for vulnerable people with mild or moderate mental health conditions (p.100)

• Support integrated online, telehealth and face to face services. (p.101)

Priority:

• CMHP2.4 Increase access to low-cost local mental health services in areas with limited service availability but high demand. (p.101)

Possible Options

29

• Work with local communities and service providers to support services that address identified needs (p.101)

• Support integrated online, telehealth and face to face services. (p.101)

Aim of Activity

The aim of the low intensity services is to provide an easily accessed and lower intensity, structured brief psychological treatments for individuals who have, or are at risk of, mild mental disorder (primarily anxiety and depression), and who do not require more intensive psychological services.

Low intensity services also aim to provide, age appropriate services that are tailored to meet the individual’s needs and are a core component of a stepped care approach. By providing structured early intervention services through both face to face (including groups) and virtual clinic options, individuals from underserviced groups may obtain improved access to free low intensity psychological treatments.

The Country WA PHN will aim to:

• Integrate low intensity treatments into a stepped care approach

• Promote service partnerships and a seamless continuum of care between GPs and primary care practitioners

• Promote equitable access and improved mental health and wellbeing outcomes

• Promote evidence-based practice and the collection of data that demonstrates impact of interventions

• Promote low intensity psychological treatments to GPs, other referring health professionals and consumers

• Address service gaps and support sustainable primary mental health care provision

• Make best use of the available workforce

• Monitor the quality and integrity of the services being commissioned including workforce capability.


Low intensity treatment services will be delivered through a range of modalities including face to face or web-based and telephone interventions and be consistent with a best practice stepped care approach.

The services are premised on being short-term (up to three individual or group equivalent sessions) and structured (manualised), evidence-based early intervention, that emphasises skill development. Treatments delivered are to be based upon robust evidence as found in the Australian Psychological Society’s 2018 systematic review of psychological interventions. i The low intensity services are also highly focused and easily accessed with or without a referral from a GP.

The services will be delivered in a cost-effective manner by suitably qualified and skilled health professionals who will assess and target the intensity of the service to meet the needs of the specified target group. These will include:

• Mental health competent Registered Psychologists, Registered Nurses, Occupational Therapists and Social Workers

• Aboriginal and Torres Strait Islander health workers (suitably qualified and supervised)

• vocationally trained (Cert IV) non-clinicians under appropriate clinical supervision and governance.

30

The Practitioner Online Referral Treatment Service (PORTS), a state-wide GP referral option providing telephone and web-based assessment and evidence-based treatment, will play a central role in ensuring parity of equity across the Country WA PHN to low intensity services for all those who are in need and not able to access face-to-face services, with GPs across the Country WA PHN having the option of referring directly to the service. This will assist in providing an integrated model of care and fidelity of the intervention, no matter the location of the individual who is accessing it.

The level of care provided in this activity will be determined by the individualised standardised clinical intake assessment (as per MH1.01a and b), which will provide a formulation of the treatment and treatment support needs of individuals. The provision of treatment supports (such as patient navigators MH 1.05), however, will be commissioned only as an adjunct to an individual’s treatment. Accordingly, it is envisioned that that some change management and/or service improvement may be required to modify commissioned low intensity services to align with the standardised clinical intake assessment, and so that commissioned services have the capability to respond to evolving changes, and emerging trends in the sector more broadly.

The Country WA PHN will ensure that effective monitoring and evaluation systems and processes based on analysis of PMHC-MDS data in relation to:

• the proportion of the regional population receiving commissioned low intensity services

• clinical outcomes of these services

• average cost of the low intensity interventions per service contact and episode of care

• completion rates for the clinical outcome measures reported in the PMHC- MDS.

It is proposed that the following will be commissioned:

• telephone and web-based services through the Practitioner Online Referral Treatment Service (PORTS)

• face to face interventions offered as part of community treatment services

• psychological treatment services in RACFs (does not include PORTS)

• services provided through headspace.

As further guidance and information is released, the processes required of the commissioned services will be refined and modified as required. This will be conducted in partnership and collaboration with the commissioned service providers. If it is determined in the implementation of the refined processes that the current service provider does not have the capacity or capability to continue/undertake the service, then the WA Primary Health Alliance will consider the most appropriate commissioning method and approach to the market to support or find another suitable service provider. i Australian Psychological Society Evidence-based psychological interventions in the treatment of mental disorders: A review of the literature. 2018.


The low intensity services will be targeted at those who are:

• at risk of, or living with mild mental illness


• unable to equitably access MBS treatments due to overlapping factors indicating disadvantage, including:

31

o low income or inability to access services during business hours o job insecurity o material disadvantage o limited personal resources o social isolation o poor health literacy o other social, economic, cultural and personal reasons




Consultation

WA PHA has undertaken a wide range of stakeholder consultation and engagement activities to support the provision of low intensity services in the WA Country PHN. These have been conducted at both a national, state, regional and local level, and are used to inform, strengthen and build capacity and capability in the services that have been commissioned and to ensure that the best use is made of the available resources and investment in mental health services.

The Country WA PHN consults and engages a variety of stakeholders to ensure that all commissioned services complement and add value to the impact and contribution of other mental health activity at a state, national and regional level. These include:






• Rural Health West

• GPs


• WA Local Governments




The consultation and engagement activities will be conducted through a range of methods including face-to-face and group sessions, and online platforms

Collaboration

The Country WA PHN will continue to seek and share, information and expertise with stakeholders, networks, and the community to enhance collaboration, develop and consolidate partnerships, and implement low intensity service activities. This will ensure consistent and effective service reach and impact with a combination of skills, expertise, knowledge and evidence to assist in improving the health outcomes for those who have, or are at risk of, mild mental illness in the community, and to build capacity within the sector.

All collaborative activities are aimed at ensuring the commissioning of effective and sustainable low intensity face to face and virtual services (within the terms and definitions in the PHN guidance), building capacity and capability and

32

integration across the sector, consolidating and strengthening care pathways within primary care, as well as involving consumers and carers where possible.

The role of the key stakeholders in the implementation of this service will be:

• WA Mental Health Commission, Child and Adolescent Health Service, and WA Country Health Service who will support the building of capability and will promote integration across the sector

• GPs who will support the development and strengthening of referral pathways across primary care, and to promote the Head to Health web-site

• Aboriginal Health Council of WA and Aboriginal Medical Services who will assist to promote and strengthen culturally appropriate and accessible primary mental health care services.

• PHN commissioned service providers who will strengthen partnerships and integration of services into the stepped care strata.






Key milestones will be:

• February 2020, 2021, 2022 - Six monthly review of services following receipt of service provider reports

• August 2019, 2020, 2021 - Six monthly review of services following receipt of service provider reports.



☒ Continuing service provider / contract extension


No


No


No


No




Planned Commonwealth Expenditure – Mental Health and Suicide Prevention Funding

$3,839,759 $4,116,209 $4,271,776 $12,227,744


$3,839,759 $4,116,209 $4,271,776 $12,227,744

33

Proposed Activities


Priority area 3: Psychological therapies for rural and remote, under-serviced and / or hard to reach groups

ACTIVITY TITLE MH3: Psychological Therapy Services


Existing Activity

(Previous AWP reference: MH7 Stepped Care Approach 2018/19)


Mental Health


Priority:

• CMHP. 2.4 Increase access to low cost-local mental health services in areas with limited service availability but high demand. (p.101)

Possible Options:



Aim of Activity

The aim of the commissioned psychological therapy services is to provide short term, evidence-based structured interventions for people with a diagnosable mild or moderate mental illness or for people who have attempted, or are at low risk of, suicide and self-harm and who require follow-up within seven days of referral (i.e., risk level deemed acceptable for primary care-based intervention).

Further, age and culturally appropriate psychological therapy services that are a core component of the stepped care approach, will aim to increase access to free treatment for underserviced populations with linkages to other services; thereby aiming to meet an individual’s clinical needs and improve their mental health.

This activity aims to ensure that the level of care provided is determined by an individualised standardised clinical assessment (as per MH1.01 a and b) that will be used to assign a corresponding appropriate level of care and inform a referral decision.


• Integrate psychological therapy services into a stepped care approach

• Consolidate and strengthen linkages to other services

• Address service gaps and optimise equitable access to psychological therapies for underserviced groups

• Strengthen local regional mental health and suicide prevention planning

• Commission services that meet the needs of the target group and use innovative service delivery models

• Ensure clinical governance of commissioned services is in situ

• Promote partnerships with GPs, other stakeholders and consumers

• Foster linkages to local crisis services and pathways

• Promote evidence-based practice and the collection of data that demonstrates impact of interventions.


Psychological treatments are premised on being a short term (up to 10 individual and 10 group sessions) cost effective, evidence-based structured (follow a defined treatment protocol) psychological treatments. All

34

commissioned psychological treatments require a GP Mental Health Plan (or equivalent) or referral from a psychiatrist or paediatrician, where the treatment plan is primarily based around the delivery of psychological therapy by one or more health professionals.

Psychological therapy services are to be protocol based supported by evidence as found in the Australian Psychological Society’s 2018 systematic review of psychological interventions, i and delivered by suitably qualified mental health professionals as part of a team approach (involving the patients GP) to primary mental health care.

Services will be delivered by:

• clinical psychologists

• mental health competent registered psychologists, registered nurses, occupational therapists and social workers

• mental health competent Aboriginal and Torres Strait Islander health workers.

The psychological therapy services will be designed to complement the role of the Better Access funded MBS psychological services (i.e., up to 10 individual and 10 group sessions per year) and provide a level of service intensity that is commensurate with the clinical needs of the individual.

As per MH2, the Practitioner Online Referral Treatment Service (PORTS), a state-wide GP referral option providing telephone and web-based assessment and evidence-based treatment, will play an important role in ensuring parity of equity across the Country WA PHN to psychological therapy services for all those who are in need and not able to access face-to-face services. A PORTS intake assessment is deemed equivalent to a GP Mental Health Care Plan for access to PHN commissioned psychological therapies. This will assist in providing an integrated model of care and fidelity of the intervention, regardless of the location where an individual is accessing it.

The level of care provided in this activity will be determined by the individualised standardised clinical intake assessment (as per MH1.01a and b), which will provide a formulation of the treatment and treatment support needs of individuals. The provision of treatment supports, however, will be commissioned only as an adjunct to an individual’s treatment. Accordingly, it is envisioned that that some change management and/or service improvement may be required to modify commissioned psychological services to align with the standardised clinical intake assessment, and so that commissioned services have the capability to respond to evolving changes, and emerging trends in the sector more broadly.

Continuity of care for individuals receiving psychological services, will be assured by strengthening the key transition points with state-based services, and the referral pathways to support and follow up between primary care and acute services. This will also include linkages to other relevant services such as alcohol and other drugs.

The Country WA PHN will ensure that effective monitoring and evaluation systems and processes are in situ to obtain data regarding the:

• proportion of the regional population receiving commissioned psychological therapies delivered by mental health professionals

• clinical outcomes of these services

35

• average cost of the psychological therapy interventions per service contacts and episode of care

• completion rates for the clinical outcome measures reported in the PMHC MDS.

It is proposed that the following will continue to be commissioned:


• telephone and web-based services through the Practitioner Online Referral Treatment Service (PORTS).

As further guidance and information is released, the processes required of the commissioned services will be refined and modified as required. This will be conducted in partnership and collaboration with the commissioned service providers. If it is determined in the implementation of the refined processes that the current service provider does not have the capacity or capability to continue/undertake the service, then the WA Primary Health Alliance will consider the most appropriate commissioning method and approach to the market to support or find another suitable service provider. i Australian Psychological Society Evidence-based psychological interventions in the treatment of mental disorders: A review of the literature. 2018.


The psychological therapy services will be targeted at those who are:

• diagnosed with mild to moderate mental illness and who are not clinically suited to lower intensity services requiring self-referral

• at low risk of suicide

• living with a severe mental illness and who may benefit from short term, focused psychological intervention



• living in a rural and remote area or experiencing locational disadvantage.


Coverage Country WA PHN, which includes the Kimberley, Pilbara, Mid-West, Wheatbelt, South West, Great Southern and Goldfields regions.

Consultation

WA Primary Health Alliance has undertaken a wide range of stakeholder consultation and engagement activities to support the provision of psychological therapy services in the Country WA PHN. These have been conducted at both a national, state, regional and local level, and are used to inform, strengthen and build capacity and capability in the services that have been commissioned and to ensure that the best use is made of the available resources and investment in mental health services.

The Country WA PHN consults and engages a variety of stakeholders to ensure that all commissioned services complement and add value to the impact and contribution of other mental health activity at a state, national and regional level. These include:

36


• National Mental Health Commission





• GPs





• Australian Medical Association (WA)


Ongoing consultation and engagement activities will be conducted through a range of methods including face-to-face and group sessions, and online platforms.

Collaboration

All collaborative activities are aimed at ensuring the commissioning of effective and sustainable face to face and virtual psychological therapy services, building capacity, capability and integration across the sector, consolidating and strengthening care pathways within primary care, and involving consumers and carers where possible.

The role of the key stakeholders in the implementation of the psychological therapy service will be:

• GPs who will assist to develop and strengthen referral pathways across primary care, and to specialist services where indicated.

• PHN commissioned service providers who will strengthen working relationships to enhance service delivery and clinical governance.

• Aboriginal Health Council of WA and Aboriginal Medical Services who will promote and strengthen culturally appropriate and accessible primary mental health care services.

• WA Mental Health Commission, the Child and Adolescent Health Service, Women and Newborn Health Service, and the WA Country Health Service will build capability and promote integration across the sector.


Activity start date: 1/07/2019 Activity end date: 30/06/2022 Service delivery start date: July 2019 Service delivery end date: June 2022 Key milestones will be:

• February 2020, 2021, 2022 - Six monthly review of services following receipt of service provider reports.






No


37

No


No


No





$3,903,686 $3,919,420 $3,919,420 $11,742,526


$3,903,686 $3,919,420 $3,919,420 $11,742,526

Proposed Activities


Priority area 4: Mental health services for people with severe and complex mental illness including care packages

ACTIVITY TITLE MH4.01: Mental Health Services for People with Severe and Complex Mental Illness – Clinical Care Coordination


Existing Activity



Mental Health


Priority:

• CMHP2.2 Provide medium intensity services to assist in care coordination and management for people with moderate to severe mental health conditions managed by General Practice. (p.100)

Possible Option:

• Commission community-based care coordination services for people with moderate to severe mental health conditions. (p.100)

Aim of Activity

The aim of the clinical care coordination services for people with severe and complex mental illness is to support individuals to effectively manage their illness and avoid unnecessary hospitalisation. The primary focus of this activity is to support GPs managing individuals who would benefit from additional clinical support and needs-based care planning and coordination and who can be appropriately supported in a primary care setting as part of a stepped care approach.

Furthermore, this activity aims to ensure that the level of care provided through clinical care coordination is determined by an individualised

38

standardised clinical assessment (as per MH1.01a) that will be used to assign an appropriate level of care and inform referral decisions.


• support GPs and their patients with severe mental illness who can most appropriately be managed in primary care settings (i.e. individuals who do not require more specialised and intensive service delivery within the state and territory managed specialised mental health system

• integrate mental health services for people with severe and complex mental illness into a stepped care approach

• work collaboratively with all related service providers to improve the integration and coordination of care

• consolidate and strengthen relationships and linkages with providers of healthcare, social and other related services including alcohol and other drugs

• promote the use of multiagency care plans

• plan for the provision and support of services for people across the lifespan, including youth (from 18 years)

• promote referral pathways for the physical health needs of people with severe mental illness, particularly via GPs

• establish linkages between clinical services and psychosocial supports

• develop clear assessment and referral pathways with state-based mental health services

• make best use of available workforce.


The clinical care coordination services will be premised upon a GP-led model using a single, standardised multi-provider/agency GP-care plan. Commissioned providers will conduct a comprehensive initial and ongoing assessment of an individual’s mental health and alcohol and other drug, physical health and personal support needs, and care and treatment planning using standardised treatment outcome measures.

Additionally, this activity will provide a liaison role with an individual’s support network, linking into community services including alcohol and other drug providers, and facilitating specialist consultation, including supporting shared-care arrangements as appropriate. This activity will also involve the proactive management of clinical deterioration.

Other clinical care coordination activities will include:

• provision of clinical support, review, monitoring of mental and physical health needs of people with severe and complex mental illness

• evidence based structured psychological therapies, where indicated, as per MH3.

A central access point will be used to assess and refer to the most suitable service that is commensurate to the individual’s clinical needs (as per MH1.01a). This will include clear referral pathways to and from both state mental health services and private psychiatrists. Both face to face and telepsychiatry services will also be promoted through the establishment of a central referral point to improve access to clinical services, particularly in rural and remote areas.

39

Clinical care coordination services for people with complex and severe mental illness will be delivered by a suitably skilled and qualified registered nurses working within the scope of their practice.

Continuity of care for individuals receiving clinical care coordination services, will be assured by strengthening the key transition points with state-based services, and the referral pathways to support and follow up between primary care and acute services. This will also include linkages to other relevant services such as alcohol and other drugs.

The Country WA PHN will ensure that effective monitoring and evaluation systems and processes use analysis of PMHC MDS data in relation to:

• proportion of the regional population receiving commissioned clinical care coordination services for people with severe and complex mental illness

• average cost of PHN commissioned clinical care coordination services for people with severe mental illness

• completion rates for the clinical outcome measures reported in the PMHC MDS.


• clinical care coordination services

• psychological therapies, where indicated, as part of community treatment services (refer to MH3).

As further guidance and information is released, the processes required of the commissioned services will be refined and modified as required. This will be conducted in partnership and collaboration with the commissioned service providers. If it is determined in the implementation of the refined processes that the current service provider does not have the capacity or capability to continue/undertake the service, then the WA Primary Health Alliance will consider the most appropriate commissioning method and approach to the market to support or find another suitable service provider.


The clinical care coordination services for people with severe and complex mental illness are targeted at those who:

• are 18years or older

• have severe and episodic mental illness that can be appropriately managed in primary care

• have severe and persistent mental illness that can be appropriately managed in primary care

• have severe and persistent mental illness with multiagency needs that can be appropriately managed in primary care


• are unable to equitably access MBS treatments due to overlapping factors indicating disadvantage, including: o low income or inability to access services during business hours

o job insecurity

o material disadvantage

o limited personal resources

o social isolation

o poor health literacy

o other social, economic, cultural and personal reasons

40

• live in a rural and remote area of Country WA or experience locational disadvantage.



Consultation

The WA Primary Health Alliance has undertaken a wide range of stakeholder consultation and engagement activities to support the provision of mental health services for people with severe and complex mental illness in the Country WA PHN. These have been conducted at both a national, state, regional and local level, and are used to inform, strengthen and build capacity and capability in the services that have been commissioned and to ensure that the best use is made of the available resources and investment in mental health services.

The Country WA PHN consults and engages a variety of stakeholders to ensure that all commissioned services complement and add value to the impact and contribution of other mental health activity at a state, national and regional level. These have included primary health care providers, acute health, emergency services, rehabilitation and support services or other agencies that have some level of responsibility for the individual’s clinical outcomes and wellbeing. This includes:




• Office of the Chief Psychiatrist


• The National Centre of Excellence in Youth Mental Health (Orygen)


• GPs



• Consumer and carer peak bodies and consumer associations.


Collaboration

All collaborative activities are aimed at ensuring the commissioning of effective and sustainable mental health services for people with severe and complex issues, building capacity, capability and integration across the sector, consolidating and strengthening care pathways within primary care, and involving consumers and carers where possible.

The role of key stakeholders in the implementation of this service will be:

• WA Mental Health Commission, Child and Adolescent Health Service and WA Country Health Service who will assist to build capacity and to promote integration across the sector, particularly in relation to follow up and postvention care

• GPs who will assist to develop and strengthen referral pathways across primary care, and to specialist services where indicated

• Aboriginal Health Council of WA and Aboriginal Medical Services who will assist to promote and strengthen culturally appropriate and accessible primary mental health care services

41

• PHN commissioned service provider who will work to improve clinical systems and processes where indicated to ensure quality service provision.








• August 2019, 2020, 2021 - Six monthly review of services following receipt of service provider reports





No


No


No


No

Decommissioning No


Data collection

Yes




$2,067,555 $2,199,397 $2,199,397 $6,466,349


$2,067,555 $2,199,397 $2,199,397 $6,466,349

Proposed Activities


Priority area 4: Mental health services for people with severe and complex mental illness including care packages

ACTIVITY TITLE MH4.02: Mental Health Services for People with Severe and Complex Mental Illness (linked to MH8)

42


Existing Activity



Mental Health


Priority:

• CMHP 2.1 Engage with Primary Health Care providers, Local Hospital Networks and Community Mental Health Services to improve transitions of care, care coordination and service linkages. (p.100)

Possible Option:

• Strategies to develop integrated care pathways in partnership with Local Hospital Networks, Health Services, General Practice and other clinicians (p.100)

• Lead development and modelling of innovative approaches to regional planning, integration and stepped care in primary mental health care. (p.100)

Priority:

• CMHP 2.6 Encourage and promote a regional approach to suicide prevention including community-based activities and liaise with mental health providers to ensure appropriate follow-up and support arrangements for individuals after a suicide attempt and for people at high risk of suicide. (p.102)

Possible Option:

• Work with health services, state governments, Aboriginal health services, consumer organisations, and NGOs to create regional mental health and suicide prevention plans. (p.102)

Priority:

• CMHP 2.11 Promote integration and coordinated care pathways for clients with comorbid chronic conditions and mental health conditions. (p.103)

Possible Options:

• Ensure commissioned services have appropriate referral pathways for clients with mental health conditions and other comorbid chronic condition. (p.104)

• Strategies to develop integrated care pathways in partnership with Local Hospital Networks, Health Services, General Practice and other clinicians. (p. 104)

Aim of Activity

The aim of this activity is to:

• undertake planning that demonstrates the coordination of the treatment and support of individuals with severe and complex mental illness

• plan for the support required by GPs to provide effective management of people with severe and complex mental illness who can be appropriately managed in primary care.

This activity will link to three areas:

1. Supporting providers to coordinate and better integrate recovery orientated clinical care and physical health care services across a range of sectors and agencies as part of a stepped care approach

43

2. Negotiating pathways with state-based services for individuals who have had a recent suicide attempt and can be appropriately managed in primary care

3. Joint regional planning to promote integration (MH8).


• support GPs and their patients with severe mental illness who can most appropriately be managed in primary care settings (i.e. individuals who do not require more specialised and intensive service delivery within the state and territory managed specialised mental health system

• plan for the provision and support of services for people across the lifespan, including children and youth

• promote referral pathways for the physical health needs of people with severe mental illness particularly via GPs

• establish linkages between clinical services and psychosocial supports

• develop clear assessment and referral pathways with state-based mental health services, particularly following a recent suicide attempt

• facilitate a seamless continuum of care through cross-sectoral and agency service integration.


Central to the provision of mental health services for people with severe mental illness, is a service system that is coordinated and integrated, and able to meet individual needs.

As per MH1.01a, this activity is concerned with establishing robust processes through effective systemic planning for people with severe mental illness. This will include the negotiation of referral pathways with state-based services for individuals with severe mental illness who are showing clinical deterioration and/or who are at risk of suicide, and who can be appropriately managed in primary care. Where there is a clear negotiated pathway, individuals who are assessed as being at moderate risk according to the initial intake and assessment domains will receive services commissioned by the Country WA PHN, however in the absence of a negotiated pathway, eligibility for services will be restricted to individuals deemed to be low risk.

Planning with state-based services will also be undertaken as part of this activity (as per MH8) where there is shared care for an individual’s health outcomes, through the provision of both mental health services and those treating comorbid physical health conditions and/or alcohol and other drug use.

As per MH8, this activity will ensure that planning is undertaken to integrate mental health and suicide prevention services using a stepped care approach and to improve the coordination of mental health and suicide prevention services, including the identification of any gaps in commissioned service provision and pathways.


Mental health services for people with severe and complex mental illness are targeted at those individuals who:

• have severe and episodic mental illness that can be appropriately managed in primary care

• have severe and persistent mental illness that can be appropriately managed in primary care

• have severe and persistent mental illness with multiagency needs that can be appropriately managed in primary care

44


• are unable to equitably access MBS treatments due to overlapping factors indicating disadvantage, including: o low income or inability to access services during business hours

o job insecurity



o social isolation



• live in a rural and remote area of Country WA or experience locational disadvantage.



Consultation

To effectively develop systemic planning processes, a broad range of consultation and engagement activities will be undertaken with the following key stakeholders:



• GPs and clinical editors


• Australian College of Rural and Remote Medicine

• Regional Development Australia


• Commissioned mental health providers



• WA Network of Alcohol and other Drug Agencies

• Aboriginal Medical Services



• Consumer and carer peak bodies and consumer associations.


Collaboration

All collaborative activities are aimed at ensuring the commissioning of effective and sustainable mental health services for people with severe and complex issues, building integration across the sector, and negotiating care pathways with state-based services to address clinical deterioration and suicide risk.

The role of the key stakeholders in the planning of services for people with severe and complex mental illness will be:

• WA Mental Health Commission, Child and Adolescent Health Services and WA Country Health Services who will negotiate referral pathways, particularly in relation to follow up and postvention care, and promote integration and coordination of services.

• GPs who will assist to develop and strengthen referral pathways across primary care, and to specialist services where indicated.

45

• Aboriginal Medical Services who will promote and strengthen culturally appropriate and accessible primary mental health care services.

• PHN commissioned mental health service providers who will assist to clarify and consolidate the referral pathways and level of risk to be addressed in service provision.











☒ Not applicable


No


No


No


No


Data collection No This activity is not in scope for data collection under the Mental Health National Minimum Dataset.



Proposed Activities


Priority area 5: Community based suicide prevention activities

ACTIVITY TITLE MH 5.01: Community Based Suicide Prevention


Existing Activity

(Previous AWP reference: MH5 Community Based Suicide Prevention Activities 2018/19)

46


Mental Health


Priority:

• CMHP2.6. Encourage and promote a regional approach to suicide prevention including community-based activities and liaise with mental health providers to ensure appropriate follow-up and support arrangements for individuals after a suicide attempt and for people at high risk of suicide. (p.102)

Possible Option:

• Work with health services, state governments, Aboriginal health services, consumer organisations, and NGOs to create regional mental health and suicide prevention plans.

Aim of Activity

The aim of the community-based suicide prevention activities is to support and strengthen collaborative regional planning and co-design strategies to reduce suicide rates in the community, with a particular priority on negotiating clear postvention pathways. Best practice and evidence obtained through the suicide prevention trials in the Perth South, Kimberley and Mid-West, as well as information from other PHN trials, will be used to inform and consolidate suicide prevention activities, whilst identifying gaps in local systems and primary care services.

The community-based suicide prevention activities will also aim to provide continuity of care for individuals at risk of suicide or who have had a recent suicide attempt or self-harm, particularly focussed on transition points from acute services or on presentation to primary care; thereby increasing access to, and strengthening referral pathways to support and follow up between primary care and acute services for underserviced groups with linkages to other services such as mental health and alcohol and other drugs.

All activities will be aimed at providing locally tailored, flexible, age and culturally appropriate care that is funded on a need’s basis, takes a regional approach to service planning and integration, and delivers effective evidence-based early intervention across the lifespan.


• plan and commission regional activities that are integrated with mental health or alcohol and other drug services

• define roles and responsibilities in the provision of postvention care to ensure that there is no ambiguity of responsibility in this care

• facilitate better links between discharge services and relevant primary mental health care services

• identify gaps and opportunities for efficient commissioning and targeting of services

• support an integrated whole of community approach to treatment and support for people with severe and complex mental illness which includes their physical health

• facilitate access to culturally appropriate, integrated services for Aboriginal and Torres Strait Islander people and communities

• partner and liaise with local Aboriginal people and Aboriginal Community Controlled Health Services and mainstream providers to plan, integrate and target local suicide prevention funding where possible

• engage people with lived experience where indicated

47

• address barriers to help seeking such as stigma and discrimination.


Community based suicide prevention activities will be delivered by commissioned services across the Country WA PHN using an integrated and systems-based approach, in partnership with Local health Networks (to be referred to as Health Service Providers herein) and other local organisations. Evidence-based activities will be focussed on improvements in follow up support for those who have self-harmed or had a recent suicide attempt, particularly during transition to community care following discharge from hospital or following presentation to a community based or specialist primary care service.

Specifically, Country WA PHN will lead the co-creation of an agreement with regional health service providers, including state-based services, that details the follow-up care to individuals who have self-harmed or attempted suicide, and ensures that there is no ambiguity in the responsibility for provision of this care.

The activity will also strengthen joint regional planning and commissioning of suicide prevention activities that are integrated and linked to alcohol and other drug use, mental health, and social and emotional wellbeing activities. This will assist in building the breadth of capability of local providers in suicide prevention.

All implemented strategies will be person centred, culturally and age appropriate and where indicated - community led and support Aboriginal and Torres Strait Islander communities that are at high risk of suicide. Efforts will also be made to build the capacity and capability of local health professionals and primary care practitioners regarding suicidal behaviour and the treatment of mental illness in a community-based setting.

The Country WA PHN will ensure that effective monitoring and evaluation systems and processes are in situ to obtain data regarding the proportion of people who were referred to a commissioned service due to a recent suicide attempt or were at risk of suicide and who were followed up within seven days of referral.


• a planning exercise to identify and clarify the referral pathways and clinical handover mechanisms between primary care and state-based health services for people who have had a recent suicide attempt

• workforce development strategies to build the capacity and capability of primary health practitioners to identify and manage people who are at risk of or have had a recent suicide attempt

• the development of an agreed regional care pathway for individuals at risk of suicide or following a recent suicide attempt.


The community-based suicide prevention activities will be targeted at those who:

• are at risk of, or who have had a recent suicide attempt or self-harm and require follow-up within seven days of referral

• have co-occurring mental health and/or alcohol and other drug issues


• are unable to equitably access MBS treatments due to overlapping factors indicating disadvantage, including:

48

o low income or inability to access services during business hours

o job insecurity



o social isolation



• live in some rural or remote areas of Country WA or experience locational disadvantage.



Consultation

WA Primary Health Alliance has undertaken a wide range of stakeholder consultation and engagement activities to support the provision of community-based suicide prevention in the Country WA PHN. These have been conducted to inform, strengthen and build capacity and capability in the community, commissioned services, and the sector and to ensure that the best use is made of the available resources and investment in mental health services.

The Country WA PHN consults and engages a variety of stakeholders to ensure that all suicide prevention activities complement and add value to the impact and contribution of other state, national and regional activities. These include:

• Department of Health





• selected GPs








• District Health Advisory Councils.


Collaboration

All collaborative activities are aimed at ensuring the commissioning of effective and sustainable community-based suicide prevention activities, building capacity, capability and integration across the sector, consolidating and strengthening referral pathways within primary care, and involving consumers, carers and the community where possible.

The role of the key stakeholders in the design and implementation of the community-based suicide prevention activities will be:

• GPs who will assist to develop and strengthen referral pathways across primary care, and to specialist services, where indicated

49

• Aboriginal Health Council of WA and Aboriginal Medical Services who will assist to promote and strengthen culturally appropriate and accessible primary mental health care services

• WA Mental Health Commission and Health Service Providers who will assist to improve and inform best practice, develop strategic partnerships, support regional planning, provide leadership and engagement in the sector, build capability and promote integration across the sector.








• August 2019, 2020, 2021 - Six monthly review of services following receipt of service provider reports





No


No


No


No

Decommissioning No


Data collection

No




$1,176,029 $1,194,845 $1,212,767 $3,583,641


$1,176,029 $1,194,845 $1,212,767 $3,583,641

50

Proposed Activities


Priority area 5: Community based suicide prevention activities

ACTIVITY TITLE MH5.02: Establish a WA Alliance Against Depression Framework


Modified Activity

(Previous AWP reference: MH5 Community Based Suicide Prevention Activities 2018/19)


Mental Health


Priority:

• CMHP2.6. Encourage and promote a regional approach to suicide prevention including community-based activities and liaise with mental health providers to ensure appropriate follow-up and support arrangements for individuals after a suicide attempt and for people at high risk of suicide. (p.102)

Possible Option:

• Work with health services, state governments, Aboriginal health services, consumer organisations, and NGOs to create regional mental health and suicide prevention plans. (p.102)

Aim of Activity

The aim of this activity is to establish a Western Australian Alliance Against Depression (AAD) Framework that will be organised by a stand-alone central coordination office and governance structure, to promote the care of people living with depression and to prevent suicidal behaviour within local communities.

The AAD Framework will be aimed at aligning the operations of the Country WA PHN’s commissioned activities to facilitate local alliances, and with the broader strategic regional suicide prevention and mental health planning activities – thereby, shaping service supply in primary care of people accessing mental health care via their local general practice.

The potential of the Alliance model, including the community activation component, extends well beyond the Suicide Prevention Trial sites. The implementation of a framework will aim to support and facilitate healthy, mental health promoting environments, and the earlier identification of people who are at risk of, or who have, depression and anxiety.


Established in 2008, the European Alliance Against Depression (EAAD) is an international non-profit organisation that utilises world’s best practice to optimise the care of people with depression in the local community and prevent suicide by initiating community-based intervention programs.

The WA Primary Health Alliance, in the capacity of an umbrella agency, introduced the AAD model into Western Australia in 2017 due to its proven fidelity in the prevention and treatment of depression and suicidal behaviour. To date, parts of the Alliance’s approach have been implemented in the Suicide Prevention Trial Site in the Midwest region of the Country WA PHN.

This activity (with proportionate co-funding from Perth North PHN and Perth South PHN) will create a stand-alone central coordination office to oversee the facilitation and establishment of a WA AAD framework by providing resources and support to place-based alliances against depression throughout the Country

51

WA PHN regions. The central office will undertake a raft of operational responsibilities using an enhanced stepped care model that is aligned with the overall mental health activities of the Country WA PHN, as well as the broader stepped care strata as outlined in MH2 and MH3. The envisioned AAD approach is evidence based and grounded in the ‘Patient Centred Medical Home’ (PCMH) model that encapsulates an integrated team-based wrap around service centred on the person and their GP, that is comprehensive, accessible, coordinated, continuous and committed to quality and safety.

The central coordination office will undertake:

• induction activities

• maintenance of information resources and materials

• didactic communication with the EAAD head office

• support of local alliances to ensure implementation fidelity of the model

• oversight of the guidance and web-site

• coordination of alliance partners to work with self-nominated consortia who want to form a local place-based alliance.

Further, to support local community activation initiatives consistent with the alliance model, a suitable and viable governance structure will be established as part of this activity. This will include the formation of a WA AAD Steering Committee to promote the Alliance model and build support across government and community for its implementation. The role of the Country WA PHN will be facilitatory in nature, to support the work of the central coordination office of the WA AAD and that of the Steering Committee.


The AAD activities will be targeted at those who:

• are at risk of, or have a depressive disorder

• are at risk of, or who have had a recent suicide attempt or self-harm, and require follow-up within seven days of referral

Indigenous specific

No


Consultation

To establish a framework to facilitate the roll out of the WA AAD model, the Country WA PHN will engage with government, non-government and philanthropic bodies in WA, to raise awareness of the model, its evidence-base and experiences in other contexts.

Key stakeholders to be engaged include:

• European Alliance Against Depression

• WA Department of Premier & Cabinet (as lead State agency for WA’s Supporting Communities Forum initiative)

• WA Department of Health


• Department of Communities (WA)

• Department of Education (WA)

• WA Police Force

• Association of Mental Health

52

• Aboriginal Health Council of Western Australia

• Health Consumers’ Council

• Department of Local Government, Sport and Cultural Industries

• Volunteering WA

• St John Ambulance (WA)

• Royal Flying Doctor Service

• interested companies/other corporate entities with known philanthropic interest in mental health.

The consultation and engagement activities will be conducted through a range of methods including a group session / forum.

Collaboration

The role of the key stakeholders in the establishment of a WA AAD framework will be:

• Mental Health Commission: Memorandum of Understanding signed in relation to the WA AAD model

• Healthway WA: partner to promote and facilitate good health

• Mentally Healthy WA: partner to increase individual and community wellbeing by strengthening connections between community members

• Country WA PHN Relationship Managers / Primary Health Liaison Officers: work with GPs and local alliances to promote AAD model.





• development and initiation of AAD Framework communications plan

• introductions and meetings held with all key stakeholders

• establishment of membership of Steering Group

• organisation and completion of Steering groups meeting organised and conducted

• completion of Stakeholder forum.



☒ Not Applicable 2a. Is this activity being co-designed? No 2b. Is this activity this result of a previous co-design process? No 3a. Do you plan to implement this activity using co-commissioning or joint-commissioning arrangements? No 3b. Has this activity previously been co-commissioned or joint-commissioned? No


Data collection No This activity is in scope for data collection under the Mental Health National Minimum Dataset.

53



Proposed Activities


Priority area 6: Aboriginal and Torres Strait Islander mental health services

ACTIVITY TITLE MH6: Indigenous Mental Health


Existing Activity

(Previous AWP reference: MH6 Aboriginal and Torres Strait Islander Mental Health Services 2018/19)


Mental Health


Priority:

CA 4.2 Increase access to Aboriginal specific services with an Aboriginal approach to cultural wellbeing, healing and community empowerment. (p.108)

Possible Options:

• Engage Aboriginal organisations and the wider Aboriginal community in consultation, co-design and decision-making opportunities to help shape models of care. (p.108)

• Ensure commissioned services have undertaken cultural awareness and/or safety training and promote cultural competency training to other mental health service providers. (p.108)

• Partner with other sectors e.g. education, justice and social care (State-Government, Local Government, Non-Government Organisations and other agencies.) (p.108)

Priority:

• CA 4.4 Assist Primary Health Care Providers to adopt culturally appropriate models of care for Aboriginal populations, Culturally and Linguistically Diverse groups. (p.109)

Possible Option:

• Engage Aboriginal organisations and the wider Aboriginal community in consultation, co-design and decision-making opportunities to help shape models of care. (p.109)

Aim of Activity

The aim of the Aboriginal and Torres Strait Islander primary mental health services is to provide a holistic and seamless continuum of care for Aboriginal and Torres Strait Islander people that are integrated within a stepped care approach to meet individual and local needs.

This activity will aim to ensure that services are supported to target the mental health and social and emotional wellbeing needs of Aboriginal and Torres Strait Islander people. It will also be aimed at commissioning culturally appropriate services that provide clear referral and care pathways with mental health, alcohol and other drug, social and emotional wellbeing and other community support services. This activity will link with MH1.05 Patient Navigators.

54

In addition, this activity aims to ensure that the level of care provided is determined by an individualised standardised clinical assessment that will be used to assign an appropriate level of care and inform referral decisions.


• integrate Aboriginal and Torres Strait Islander mental health services into a stepped care approach

• engage local Aboriginal and Torres Strait Islander people and communities, where possible, in the co-designing of locally driven regional plans and service delivery

• improve referral pathways between GPs, Aboriginal Community Controlled Health Services, social and emotional wellbeing, alcohol and other drug, and mental health services

• maintain clear collaborative structures to optimise partnerships to enhance

the penetration, quality, integration and effectiveness of services. The PHN

will utilise the WA Primary Health Alliance and Aboriginal Health Council of

WA Memorandum of Understanding to inform delivery of culturally

appropriate mental health treatment and treatment supports in the

Aboriginal controlled sector and mainstream sectors

• recognise and promote Aboriginal and Torres Strait Islander leadership by

supporting Gayaa Dhuwi (Proud Spirit) Declaration implementation

• continue to implement the Aboriginal and Torres Strait Islander Suicide

Prevention Evaluation Project (ATSISPEP) principles in the Kimberley

Suicide Prevention Trial site as a guide to ensuring services are culturally

appropriate

• promote the sharing of information between agencies using informed consent as an enabler of clinical care coordination and service integration

• develop strategic joint regional planning for mental health and suicide prevention services with Health Service Providers and the WA Mental Health Commission

• ensure clinical and cultural competency of the workforce

• strengthen linkages between primary care services and other services provided by state, national and non-government organisations

• strengthen both intra- and cross-regional service partnerships.


The Aboriginal and Torres Strait Islander mental health services will be an integral part of a stepped care approach using a range of evidence-based early intervention strategies, such as those programs that have been developed or implemented in accordance with the nine guiding principles underpinning the National Strategic Framework for Aboriginal and Torres Straits Islander Peoples’ Mental Health and Social and Emotional Wellbeingi [2017–2023].ii

This will involve a seamless continuum of care involving low intensity, psychological therapy, clinical care coordination and community-based suicide prevention services that encourage connection to culture, community and country, self-determination and community governance, healing and community resilience.

The WA Primary Health Alliance will support commissioned providers to deliver culturally appropriate services, that are holistic and tailored to meet local needs, and focussed on recovery and trauma informed practice. Interdisciplinary approaches using partnerships with the Aboriginal community-

55

controlled sector, alcohol and other drug, and other community support services will be supported to integrate locally driven regional planning and service delivery. This will improve access to high quality, evidence-based services using culturally appropriate models of care that have both culturally informed mental health clinical care, and social and emotional wellbeing services.

The services will be delivered by an appropriately skilled workforce including:

• GPs


• mental health competent registered psychologists, occupational therapists and social workers

• mental health competent Aboriginal health workers

• Aboriginal peer support workers.

This activity will ensure that commissioned mental health treatment services (as per MH2 and MH3) for Aboriginal and Torres Strait Islander individuals are provided within a holistic framework that encompass their overall physical, social, emotional, spiritual and cultural wellbeing and involves their family and/or community.


• proportion of the regional population receiving commissioned mental health services that were culturally appropriate.



• clinical care coordination services

• suicide prevention services

• telephone and web-based services through the Practitioner Online Referral Treatment Service (PORTS)

• psychological treatment in Residential Aged Care Facilities (RACFs)

• services provided through headspace

• Aboriginal and Torres Strait Islander specific mental health services.

As further guidance and information is released, the processes required of the commissioned services will be refined and modified. This will be conducted in partnership and collaboration with the commissioned service providers. If it is determined in the implementation of the refined processes that the current service provider does not have the capacity or capability to continue/undertake the service, then the WA Primary Health Alliance will consider the most appropriate commissioning method and approach to the market to support or find another suitable service provider.

i Dudgeon P, Walker R, Scrine C, Shepherd C, Calma T and Ring I. 2014 Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people. Australian Institute of Health and Welfare. Cat no IHW: 143, No 12.

ii https://pmc.gov.au/resource-centre/indigenous-affairs/national-strategic-framework-mental-health-social-emotional-wellbeing-2017-23


Aboriginal and Torres Strait Islander mental health services will be targeted at individuals who are:

https://pmc.gov.au/resource-centre/indigenous-affairs/national-strategic-framework-mental-health-social-emotional-wellbeing-2017-23

https://pmc.gov.au/resource-centre/indigenous-affairs/national-strategic-framework-mental-health-social-emotional-wellbeing-2017-23

56

• with, or at risk of developing mild to moderate and, in some circumstances, severe mental illness who can be most appropriately managed in primary care


• unable to equitably access MBS treatments due to a constellation of overlapping factors, including: o low income o job insecurity o material disadvantage o limited personal resources o social isolation o poor health literacy o other social, economic, cultural and personal reasons


Indigenous specific

Yes

This activity will engage with the sector through consultation and collaboration where indicated, and by using Memoranda of Understanding agreements with key stakeholders.


Consultation

The WA Primary Health Alliance has undertaken a wide range of stakeholder consultation and engagement activities to support the provision of Aboriginal and Torres Strait Islander mental health services in the WA Country PHN.

Stakeholder engagement has occurred at both a national, state, regional and local level, and are used to inform, strengthen and build capacity and capability in the services that have been commissioned and to ensure that the best use is made of the available resources and investment in mental health services.

The Country WA PHN consults and engages a variety of stakeholders to ensure that all commissioned services complement and add value to the impact and contribution of other mental health activity at a state, national and regional level.

Key stakeholders include:







• GPs

• Practitioner Online Referral Treatment Service





• Telethon Kids Institute


• WA Network of Alcohol and other Drug Agencies

57



Collaboration

All collaborative activities are aimed at ensuring the commissioning of effective and sustainable Aboriginal and Torres Strait Islander mental health services, building capacity, capability and integration across the mental health and alcohol and other drug sectors, consolidating and strengthening referral pathways within primary care, and involving consumers, carers and the community, where possible.

The role of the key stakeholders in the design and implementation of these services will be:


• The Aboriginal Health Council of WA and Aboriginal Medical Services who will assist to promote and strengthen culturally appropriate and accessible primary mental health care services

• WA Mental Health Commission, the Child and Adolescent Health Service, and the WA Country Health Service who will build capability and promote integration across the sector

• mental health service providers who will work to strengthen partnerships and ensure services are culturally appropriate and connected to country and culture

• alcohol and other drug service providers who will work to strengthen cross-sectoral working.













No


No


No


No

58

Decommissioning No


Data collection

No

This activity is not in scope for data collection under the Mental Health National Minimum Dataset


Planned Commonwealth Expenditure – Indigenous Mental Health Funding

$2,145,941 $2,505,507 $2,217,340 $6,868,788


$2,145,941 $2,505,507 $2,217,340 $6,868,788

Proposed Activities


Priority area 2: Child and youth mental health services

ACTIVITY TITLE MH7: Youth Mental Health Primary Care Services


Existing Activity

(Previous AWP reference: MH2 Youth Mental Health Services 2018/19)


Mental Health


Priority:

• CMHP2.3. Increase access to early intervention services to prevent escalating acuity and reduce the burden on acute and emergency department services. (p.100)

Priority:

• CMHP2.4 Increase access to low cost, local mental health services in areas with limited service availability but high demand. (p.101)

Possible Option:

• Work with local communities and service providers to support services that address identified needs.

• Support integrated online, telehealth and face to face services i.e. online and telehealth services.

Aim of Activity

The aim of the Youth Mental Health services is to commission providers to deliver easily accessible, family-friendly evidence based early intervention services for young people, starting at as young an age as practicable. Where indicated, this will comprise of low intensity and psychological therapy services, early youth psychosis services and clinical care coordination activities.

This activity will aim to provide services for young people that are developmentally and culturally appropriate and are integrated with local services to prevent the escalation of acuity, and unnecessary emergency department presentations. This approach will enhance the mental health and wellbeing outcomes of children and young people and prevent suicidal behaviour, particularly in areas of limited service availability and high demand.


59

• integrate the youth services into a stepped care approach

• consolidate and strengthen linkages and referral pathways between headspace centres with primary care services, educational and vocational providers and other local community support services

• strengthen local regional planning for mental health services and suicide prevention for children and young people

• promote locally driven regional partnerships between primary care providers and state, non-government services, private practitioners, other services such as alcohol and other drugs, and educational/social providers

• promote evidence-based practice and the collection of data that demonstrates the impact of interventions

• address service gaps and support sustainable primary mental health care provision for children and young people

• monitor the quality and integrity of the services being commissioned, including workforce capability.


The Youth mental Health Services activity will be an integral part of a best practice stepped care approach and are premised on being a developmentally appropriate early intervention, which will be linked to local educational, vocational and community services. A region specific, cross sectoral approach will be implemented for young people with, or at risk of, mental illness that is integrated, equitable, person-centred and optimistic.

Services will be supported to deliver flexible and responsive models of care to meet the needs of young people and their families, who are at risk of, or living with, mental illness and co-occurring substance misuse. The Country WA PHN will work in partnership, where indicated, with Health Service Providers, Child and Adolescent Health Services, Family Support Service providers, Aboriginal Medical Services and other local services to consolidate and foster local regional planning and integration.

All commissioned services will be supported to provide evidence-based clinical best practice models, such as those described by the National Centre of Excellence in Youth Mental Healthi, that are culturally sensitive. The youth services will be delivered by a suitably skilled workforce including:


• mental health competent registered psychologists, occupational therapists’ nurses, and social workers

• mental health competent Aboriginal Health Workers.


• proportion of the youth regional population receiving youth specific commissioned mental health services, including headspace services

• completion rates for the clinical outcome measures reported in the PMHC MDS

It is proposed that the following commissioned services to be continued:

• headspace centres - discussions on the establishment and roll out of new satellite headspace offices will commence initially with current local lead agency headspace providers

• face to face low intensity, psychological therapy, and clinical care coordination services offered as part of community treatment services

60

• services for youth (18+) with, or at risk of severe mental illness and will be based in all seven country regions. These services will provide a holistic person centred and recovery focused for young people aged 12-25 years of age

• early youth psychosis services.

As further guidance and information is released, the processes required of the commissioned services will be refined and modified. This will be conducted in partnership and collaboration with the commissioned service providers. If it is determined in the implementation of the refined processes that the current service provider does not have the capacity or capability to continue/undertake the service, then the WA Primary Health Alliance will consider the most appropriate commissioning method and approach to the market to support or find another suitable service provider. 1 The National Centre of Excellence in Youth Mental Health 2018. Youth mental health service models and approaches: Considerations for primary care. Victoria.


The youth services will be targeted at individuals who are:

• at risk of mild to moderate mental illness

• at risk of, or with severe mental illness if able to be appropriately managed in primary care from an underserviced group

• unable to equitably access MBS treatments due to overlapping factors indicating disadvantage, including: o low income or inability to access services during school / business

hours o job insecurity o material disadvantage o limited personal resources o social isolation o poor health literacy o other social, economic, cultural and personal reasons




Consultation

The WA Primary Health Alliance has undertaken a wide range of stakeholder consultation and engagement activities to support the provision of services for children and young people in the Country WA PHN. These have been conducted at both a national, state, regional and local level, and are used to inform, strengthen and build capacity and capability in the services that have been commissioned to ensure the best use of the available resources and investment in mental health services.

The Country WA PHN consults and engages a variety of stakeholders to ensure that all commissioned services complement and add value to the impact and contribution of other mental health activity at a state, national and regional level.

Stakeholders consulted and engaged include:



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• selected GPs








Collaboration

The Country WA PHN will continue to build on existing and new relationships to ensure the commissioning of effective and sustainable services for children and young people, building capacity, capability and integration across the sector, consolidating and strengthening care pathways within primary care, and involving children, young people and their families, where possible.

The role of the key stakeholders in the implementation of this service will be:


• State-based Health Service Providers (LHNs) will assist to strengthen partnerships, regional planning and clarify transition points into state-based services

• Aboriginal Health Council of WA and Aboriginal Medical Services who will support and inform to promote and strengthen culturally appropriate and accessible primary mental health care services.












☒ Direct engagement


No


No

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No


No

Decommissioning No


Data collection

Yes

This activity is in scope for data collection under the Mental Health National Minimum Dataset



$7,502,695 $6,196,697 $6,705,841 $20,405,233


$7,502,695 $6,196,697 $6,705,841 $20,405,233

Proposed Activities


Priority area 8: Regional mental health and suicide prevention plan

ACTIVITY TITLE MH8: Regional Mental Health and Suicide Prevention Plan


Existing Activity


Mental Health


Priority:

• CMHP 2.1. Engage with Primary Health Care providers, Local Hospital Networks and other health service providers to improve transitions of care, care coordination and service linkages. (p.100)

Possible Options:

• Strategies to develop integrated care pathways in partnership with Local Hospital Networks, Health Services, General Practice and other clinicians. (p.100)

• Lead development and modelling of innovative approaches to regional planning, integration and stepped care in primary mental health care(p.100)

Aim of Activity

Endorsed by the Council of Australian Governments (COAG) Health Council in August 2017, a pivotal theme underpinning the success of the Fifth National Mental Health and Suicide Prevention Plan (5th Plan) is integration and is concerned with building relationships between organisations that are similarly aiming to improve the outcomes and experiences of mental health consumers and carers at the local level. The First Priority area in the 5th Plan is the development of Joint Regional Plans (JRPs) and recognises that PHNs and Local

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Hospital Networks (HSPs) provide the core architecture to support integration at the regional level. The Commonwealth, together with State and Territory Governments have agreed that Public Health Services and PHNs will develop and publicly release joint regional mental health and suicide prevention plans by mid-2020.

The aim of the joint regional mental health and suicide prevention planning is to develop, in partnership with Local Hospital Networks (Health Service Providers or HSPs in WA) and other stakeholders (the WA Mental Health Commission), a foundational plan for shared decision making that will lead to comprehensive Regional Mental Health and Suicide Prevention Plans for the Country WA region. This will be achieved by working in close collaboration with the WA Country Health Service, Child and Adolescent Health Service, and the WA Mental Health Commission, along with peak bodies, local service providers and other key stakeholders in each region of Country WA.

The WA Primary Health Alliance (WAPHA), the WA Mental Health Commission (MHC), and the five state-based Health Service Providers (HSPs) have a vested interest in undertaking joint regional planning to make better use of existing resources and improve sustainability. These stakeholders have agreed to work together to develop a foundational blueprint for shared decision making that will lead to localised integrated mental health service delivery from prevention through to the interface with acute care, bringing together primary care and local public health services to achieve a cohesive system approach that ensures those needing care can access the right services at the right time, in the right place by the right team.


There are two stages to the joint regional plans – the development of a

Foundational Plan (due: 30 June 2020) – which will precede and inform our

work on the second stage Comprehensive Service Development Plans (due: 30

June 2022), to address identified service gaps and deliver on regional priorities

in partnership with local communities.

The stage one Foundational Plan is intended to provide a blueprint for

collaborative action for service development between WAPHA, the MHC and

the HSPs to reduce the impact of mental illness, alcohol and other drug use,

and suicidal behaviour within the Perth South region. In particular, it will focus

on ways to:

• reduce fragmentation and duplication

• address shared priorities, including opportunities for joint commissioning

• integrate pathways for people with mental illness and/or AoD issues within the current health system.

Subsections of the Foundational Plan will include:

a. Stakeholder endorsement – a suite of forward statements endorsing

the context and content of the plan will be sought from the Director

General of the WA Department of Health; the Mental Health

Commissioner of the WA MHC; the Chief Executive of WAPHA; and a

selection of consumer and carer peak body groups.

b. Background and context – an overview of relevant mental health issues

and priorities identified within National and State-based policies,

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reviews, strategies and plans, while drawing on the matters raised by

consumers and carers.

c. System overview – an outline of the current regional mental health

service system, including a demarcation of funding and care.

d. Priority areas for collaboration – viewed through the prism of

integration, areas of focus will reference priority and key action areas

within the 5th National Plan; Western Australian Mental Health,

Alcohol and Other Drug Services Plan, 2015-2025; Suicide Prevention

2020; the WA Sustainable Health Review; and existing HSP-based

strategies (eg, WA Country Health Service Mental Health and Wellbeing

Strategy 2019-24). This will include the development and

implementation of more integrated, connected and visible service

pathways across regions; a coordinated approach to follow up after a

suicide attempt; addressing the physical health care needs of mental

health patients within the community context; coordinating treatment

and supports for people with severe and complex mental illness,

including multimorbidity needs; enhancing indigenous social and

emotional wellbeing through access to culturally appropriate and safe

services; and ensuring that consumers and carers are at the centre of

planning, delivery and review of services.

e. Collaborative framework – a description of the methodology for

implementing systemic regional cooperation, and the development of

indicators to monitor and evaluate our progress.

The WAPHA Strategy and Engagement Team will be resourced to develop the Foundational Plan in collaboration with the above-mentioned key stakeholders. A joint WAPHA-MHC-WA DoH control group will meet monthly to monitor overall progress and provide guidance during the development of the plans. Each sectional draft will be distributed to control group members and HSP representatives for review and input, with draft JRP compilations circulated for consumer and carer contributions via various peak body groups.

Country WA will ensure that it demonstrates evidence of progress towards the development and release of the Joint Regional Mental Health and Suicide Prevention Plan.


The Joint Regional Mental Health and Suicide Prevention Plan will be targeted at individuals who within the Country WA PHN region who require access to mental health and/or alcohol and other drug services.



Consultation

The WA Primary Health Alliance will undertake significant stakeholder consultation and engagement activities to support joint regional planning in the Country WA PHN.

Stakeholder consultation and engagement activities will be conducted at many levels and will be aimed at determining the most effective strategies to deliver an integrated, evidence based, and responsive mental health care system. The

65

Country WA PHN will consult and engage with various experts and colleagues in the sector, including:







• selected GPs






• the National Centre of Excellence in Youth Mental Health (Orygen)

• Suicide Prevention Australia

• WA Association of Mental Health

• WA Network of Alcohol and other Drug agencies


The consultation and engagement activities will be conducted through a range of methods, including face-to-face and group sessions, and online platforms such as the Primary Health Exchange.

Collaboration

The Country WA PHN will work in close collaboration and partnership with the WA Mental Health Commission and regional Health Service Providers to undertake integrated, systemic regional planning in relation to mental health and suicide prevention activities. The Country WA PHN will seize opportunities for cross-sectoral collaboration with stakeholders to enhance the integration of pathways and service delivery, decrease fragmentation in the system and help to shape service planning and development. This process will also involve securing the input of consumers, carers and others with lived experience to ensure that their needs, expectations and priorities are at the centre of service planning and delivery.

Our initial focus in the developmental phase will be on building a collaborative understanding of the joint regional planning process between the three organisational stakeholders (ie, WAPHA, WA MHC and the five HSPs), followed by engagement with WA’s peak consumer, carer and sector bodies to ensure that they can both contribute and provide a level of oversight in the production of the plan. In light of the recent report on Access to State-Managed Adult Mental Health Services (August 2019) conducted by the WA Office of the Auditor General – which found little progress in the implementation of the WA mental health plan since its release in 2015, resulting in limited progress in overall mental health service reform – Country WA PHN takes a pragmatic approach to the joint regional planning activity. It will be an iterative process that will initially focus on a few region specific priority areas that are within the stakeholders’ realm of influence, in the hope that early collaborative success will promote sustained partnerships and achieve a level of integration that to date, has yet to be realised.

The role of the key collaborative in the joint regional planning will be:

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• Health Service Providers who will assist to promote collaborative planning and commissioning to enhance capability across the sector and negotiate referral pathways to and from state based mental health services

• The WA Mental Health Commission who will promote integration and capability across the sector

• consumers and carers who will inform the planning process and provide valuable experience and knowledge of lived experience-related issues and modes of service delivery.







• negotiation of referral pathways

• delineation of roles and responsibilities between Health Service Providers, WA Mental Health Commission, and the Perth South PHN

• completion of the Mental Health and Suicide Prevention Foundation Plan by 30 June 2020.

• completion of the Mental Health and Suicide Prevention Comprehensive Service Development Plan by 30 June 2022.



☒ Not applicable

The Country WA PHN will work in collaboration with the Mental Health Commission and local Health Service Providers to implement joint regional planning.


Yes


No


No


No

Decommissioning No


Data collection

No




activity work plan 2019-2022 - wapha

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