mid north coast mental health clinical services...

Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

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Mid North Coast

Mental Health Services

Clinical Services Plan

ADDENDUM 2015

September 2015


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Mid North Coast Mental Health Services Clinical Service Plan DRAFT ADDENDUM 2015

prepared for the Mid North Coast Local Health District by:

richard gilbert consulting


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TABLE OF CONTENTS

Table of Contents .................................................................................................................................... 3

1 EXECUTIVE SUMMARY & RECOMMENDATIONS ..................................................................... 5

1.1 Introduction .................................................................................................................................... 5

1.2 Projected Service Requirements ..................................................................................................... 5

1.3 Current and Future Role ................................................................................................................. 8

1.4 Recommendations .......................................................................................................................... 9

2 INTRODUCTION .................................................................................................................. 11

2.1 The Mid North Coast Mental Health Service Clinical Service Plan 2013 ...................................... 11

2.2 Developments Since 2013 ............................................................................................................. 12

2.3 The MNC Mental Health Service Clinical Service Plan Addendum 2015 ...................................... 12

3 BACKGROUND .................................................................................................................... 14

4 POLICY & PLANNING FRAMEWORK ..................................................................................... 15

4.1 NSW State Health plan and Rural Health Plan .............................................................................. 15

4.2 National Mental Health Reforms .................................................................................................. 17

4.3 NSW Mental Health Commission .................................................................................................. 19

4.4 Mid North Coast Mental Health Literature Review ...................................................................... 20

5 SERVICE NEED ..................................................................................................................... 22

5.1 Mid North Coast ............................................................................................................................ 22

5.2 Current and Projected Population Profile ..................................................................................... 22

5.3 Service Demand ............................................................................................................................ 24

6 CURRENT ACTIVITY ............................................................................................................. 34

6.1 Acute Inpatient Mental Health Services ....................................................................................... 34

6.2 Non-Acute Inpatient Mental Health Services ............................................................................... 36

6.3 Community Mental Health Services ............................................................................................. 36

7 PROJECTED DEMAND .......................................................................................................... 38

7.1 Current Capacity measured against NSW Planning Benchmarks ................................................. 38

7.2 Projected Capacity Requirements................................................................................................. 42

8 CURRENT SERVICES AND NEW SERVICE MODELS .................................................................. 45

8.1 Mid North Coast Local Health District .......................................................................................... 45

8.2 New Service Models ...................................................................................................................... 47

8.3 Acute Inpatient Units .................................................................................................................... 48


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8.4 Rehabilitation Unit ........................................................................................................................ 51

8.5 Community Mental Health Services ............................................................................................. 52

8.6 Older Persons ................................................................................................................................ 59

8.7 Younger Persons ........................................................................................................................... 60

8.8 General Practitioners and North Coast Primary Health Network ................................................. 61

8.9 Non-Government Organisations ................................................................................................... 61

8.10 Aboriginal Medical Services .......................................................................................................... 62

8.11 Private Services ............................................................................................................................. 63

9 FUTURE ROLE OF PORT MACQUARIE MENTAL HEALTH INPATIENT UNIT AND FUNCTIONAL SPACE

REQUIREMENTS .................................................................................................................. 64

9.1 Hastings Macleay Clinical Network ............................................................................................. 64

9.2 Port Macquarie Mental Health Inpatient Unit ............................................................................ 65

10 References.......................................................................................................................... 73

11 Appendix ............................................................................................................................ 76

11.1 Appendix 1 .................................................................................................................................. 77

11.2 Appendix 2 ……………………………………………………………………………………………………………………..…….79

11.3 Appendix 3 .................................................................................................................................. 83


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1 EXECUTIVE SUMMARY &

RECOMMENDATIONS

1.1 INTRODUCTION

A Clinical Services Plan utilises the latest available data to effectively plan service delivery by identifying current service needs whilst also projecting future service needs. Notably, it remains a living document and, accordingly, may be revised overtime in response to changing circumstances and emerging challenges.

The development of the 2015 Mid North Coast Mental Health Service Clinical Services Plan ADDENDUM

builds on the earlier Mid North Coast Mental Health Services Clinical Services Plan 2013-2021. It provides

the opportunity to review population needs against current service capacity utilising updated population

projections, and plan for the range of Acute and Non-Acute Inpatient and ambulatory services required to

meet the needs of the Hastings Macleay Clinical Network (HMCN), and broader Mid North Coast

community, to 2021 and beyond. Additionally, it presents an opportunity to review and update the

models of care and review previous service enhancement priorities and determine which should have the

highest priority in the context of current and projected community demand and available resources.

The 2015 Mid North Coast Mental Health Service Clinical Services Plan ADDENDUM (ADDENDUM) has

been prepared with advice from key stakeholders to determine the service directions and capacity

requirements for the mental health service, with a focus on inpatient services at Port Macquarie Base

Hospital over the next five to ten years. The development of this ADDENDUM has drawn upon:

consultations with local clinical staff and management, as well as consumers, carers and

members of the local Aboriginal Community from April-June 2015 (see Appendix 1 for

Consultation Profile and Appendix 2 for the Aboriginal Health Impact Statement and checklist);

previous consultation with key stakeholders including service providers, Non-Government

Organisations (NGOs), Commonwealth funded services, and consumers and carers at Planning

Workshops in October 2012;

review of National, State and MNCLHD policies, plans and Service Level Agreements with the

Ministry of Health; and

planning projections using modelling tools and benchmarks as endorsed by NSW Mental Health

and Drug & Alcohol Office (MHDAO).

1.2 PROJECTED SERVICE REQUIREMENTS

In projecting future service capacity requirements to 2020/2025, the ADDENDUM has been informed by

the use of the latest Mental Health – Clinical Care and Prevention (MH-CCP) (2010) methodology1, the

results of which have been summarised in Table 1.1 (shown over page) (see Appendix 3 for MNCLHD

Estimated Needs Met Using MH-CCP (2010), provided July 2015 by MHDAO).

1 MHDAO (2012) MH-CCP 2010.


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Table 1.1 Mid North Coast Local Health District - Current and Projected Inpatient Bed

Requirements

Current

Bed

Numbers

2015 2020 2025

Children & Adolescents (0-17)*

Mid North Coast0* 3 3 3

Adults (18-64)

Mid North Coast52** (42) 37 37 37

Older Persons (65+)

Mid North Coast0 14 16 19

ACUTE TOTAL 52** (42) 54 56 58

Children & Adolescents (0-17)


Adults (18-64)

Mid North Coast20 ̂ (8) 6 6 6

Older Persons (65+)


NON-ACUTE TOTAL 20 ̂ (8) 16 17 18


Mid North CoastNA NA NA NA

Adults (18-64)


Older Persons (65+)


VERY LONG STAY TOTAL 0 22 23 24

GRAND TOTAL 72 91 96 101

Very Long Stay

Age Group

MH-CCP (2010)#

2015

Acute

Non-Acute

# Small inconsistencies in figure summation are due to issues associated with rounding; * Acute Child and Adolescent Beds for

Mid North Coast currently provided within Lismore Base Hospital CAMHU; ** As the 10 Acute Beds at Kempsey District Hospital

are non-gazetted and are affected by issues of rurality, the MNC’s total of practicable Acute Adult Beds is 42; ^ The catchment for

North Coast Rehabilitation Unit Beds currently covers MNC and Northern NSW LHDs. The MNCLHD utilises 40 per cent (8) of

these Beds, whilst Northern NSW utilises the remaining Beds.

Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010

Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).


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When comparing the Mid North Coast’s current mental health inpatient bed capacity with the MH-CCP

(2010) estimates provided by MHDAO in July 2015, the following may be noted

The MNCLHD has no Older Persons (65+ years) beds of any description (Acute, Non-Acute, or

Very Long Stay (VLS)), whilst estimates indicate the need for 14 Acute beds, seven Non- Acute

beds, and six VLS beds in 2015, increasing to 19 Acute, 10 Non-Acute and 8 VLS beds,

respectively, by 2025.

The MNCLHD has no Younger Persons (0-17 years) beds, whilst estimates indicate the need for

three Acute beds and two Non-Acute beds in 2015 through to 2025.

The MNCLHD has no VLS beds, although estimates indicate the need for 16 Adult VLS beds and

six Older Person VLS beds in 2015, increasing to a total of 24 VLS beds by 2025. While the

provision of 42 HASI Places within the MNCLHD offsets this need to some degree, such places are

not commensurate with the 24 hour intensive support provided in VLS units. For instance, 26 of

the MNCLHD HASI packages provide consumer assistance for a total of five hours/week, four

packages provide assistance between two and three hours per day, and 12 packages provide

assistance for five hours/day. Also impacting this service space is the new Metal Health Hospital

to Community Initiative given that, wherever possible, individuals previously requiring an

extended long stay in one of the residential mental health facilities in NSW will be gradually

transitioned to the community. A small number of Mid North Coast residents form part of this

cohort and it is expected they will be returned to the LHD for appropriate transitioning. In

response to the existing service need as well as emerging needs, and the absence of very long

stay beds in the Mid North Coast, the MNCLHD may need to secure capital funding to provide

required services.

According to the estimates, the MNCLHD has an adequate supply of Non-Acute beds through to

2025. Presently, however, the catchment for the North Coast Rehabilitation beds covers MNC and

Northern NSW LHDs, with Northern NSW utilising 60 per cent of the available 20 beds. This

means the MNCLHD utilizes eight of the beds. Importantly, the premise whereby the MNCLHD

has an adequate supply of Non-Acute beds is grounded in the expectation that by mid-2017

Northern NSW will no longer require access the MNCLHD Non-Acute beds given the new Byron

Bay Hospital currently under development includes a 20 bed Non-Acute Inpatient Unit.

The MNCLHD has an adequate supply of Adult Acute beds given there are presently 52 Acute

Adult beds in the MNCLHD and estimates indicate the need for 37 Acute Adult beds in 2015

through to 2025. Three factors, however, mitigate the adequacy of this supply. The first is that

there are no Acute Older Persons or Younger Persons beds within the MNCLHD; if the estimated

need for these beds were included, the total number of Acute beds required by the MNCLHD

becomes 54. Secondly, although the 10 beds located at Kempsey District Hospital are Acute beds,

the consequences of rurality, including their distance from the Port Macquarie Inpatient Unit and

associated specialist workforce, means that these non-gazetted beds are not utilised as Acute

beds, per say. Therefore the total number of practicable MNCLHD Adult Acute beds is 42 rather

than 52 beds. Finally, as noted in the CSP 2013, whilst the 2011 MH-CCP (2010) data estimated

158.0 FTE were required to meet the MNC’s need for ambulatory (community) mental health

services, the workforce comprised 76.8FTE. Additional pressure is placed on Acute Adult beds as a

consequence because of the resulting limited capacity for post-discharge follow-up and assertive

treatment within the community setting leading to increased readmission rates. The transition to


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new models of care will allow the MHS to make the best possible use of existing resources

including FTE which may alleviate some of this additional pressure.

1.3 CURRENT AND FUTURE ROLE

The population of the Mid North Coast is projected to increase by 13 per cent between 2011 and 2026.

The population aged over 65 years is projected to increase by 53 per cent over the same period. These

demographic changes will place a substantial additional demand on mental health services within the Mid

North Coast.

Over the next ten years to 2026, Mid North Coast LHD Mental Health services are expected to be

managed and networked on a district-wide basis. Such networking provides the critical mass to provide

for the full range of services of secondary level mental health services, both hospital Inpatient and

ambulatory community based services, and tertiary services such as the Non-Acute Rehabilitation

Inpatient Unit at Coffs Harbour Campus.

As recommended in the Mid North Coast Mental Health Service Clinical Services Plan 2013-2021, the Mid

North Coast Mental Health Service has embarked on a process of reviewing service models of care. The

review has been premised on the need to implement contemporary service delivery models and also by

the recognition that, in an environment of limited resources, MNCLHD Mental Health Services must be

targeted to the achievement of a sustainable method of responding to the mental health needs of the

Mid North Coast population.

Within the LHD, the provision of Mental Health hospital and ambulatory services for the catchment

population will be managed within the Clinical Networks of Hastings Macleay and Coffs Harbour.

In terms of Inpatient bed capacity, the Coffs Harbour Clinical Network has a sufficient overall bed capacity

to meet population requirements for the next ten years. The ageing of the population will result in an

increased need for specialist mental health beds for older persons within this bed complement. It is

foreseen that 10 of the 30 existing Acute Adult beds at Coffs Harbour will, in due course, provide for this

service need.

The North Coast Rehabilitation Unit, located within the Coffs Harbour Clinical Network, currently provides

for the needs of a tertiary population catchment covering the Mid North Coast and Northern NSW LHDs.

Currently the Mid North Coast uses 40 per cent (8 of the 20) available beds. The projected service need

for the MNCLHD alone is for 16 beds across all ages in 2015, increasing to 18 beds in 2025.

The Hastings Macleay Clinical Network does not have sufficient Inpatient bed capacity for mental health

services. There are currently only 12 beds appropriate for providing Acute Inpatient Services:

The Units at Port Macquarie Base Hospital (PMBH) and Kempsey District Hospital (KDH) do not

meet Australasian Health Facility Guidelines in their current design and layout and as such

represent a current and future clinical and corporate risk.

Both Units at PMBH (12 beds) and KDH (10 beds) are of sub-optimal size. The optimal size for an

Acute Adult Unit for efficiency of operation and safety and quality of care is around 18-35 beds.


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1.4 RECOMMENDATIONS

In making the following recommendations it should be noted that this ADDENDUM has reviewed updated

population projections against current service capacity and identified where there are significant

shortfalls in available resources. Achievement of attracting these resources is dependent upon funding

submissions and enhancement funding provided via the Ministry of Health.

Recommended is the development of a 24-bed purpose designed Acute Mental Health Inpatient Unit at

Port Macquarie Base Hospital. Of the 24 beds, 12 will replace the existing 12-bed Adult Acute Unit,

resulting in a total of 12 new beds. At 12 beds the current Inpatient Unit is of sub-optimal size and does

not meet Australian Facility Guidelines.

Space for this development is available on the PMBH campus and would be designed as a gazetted unit to

provide care for involuntary patients. Voluntary patients could also be admitted.

The design of the proposed Inpatient Unit would allow beds to be used flexibly as ‘swing beds’ (beds that

can alternate between different types of care). As such, the proposed Inpatient Unit would contain 24

Acute Adult beds with the capacity to support the admission of eight older persons and four younger

persons.

The function of the Unit would be to provide, in a safe and therapeutic environment, appropriate facilities

for the reception, assessment, admission, diagnosis, observation, treatment and recovery of often acutely

unwell consumers, presenting with known or suspected psychiatric conditions and behavioural disorders.

The requirements of this Unit are outlined on the following page in Table 1.2.


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Table 1.2 Recommended Requirements for the Proposed 24 Bed Port Macquarie Inpatient Unit

Future Requirements to 2025 Current Beds/Facility Comment

24 Acute Adult beds including:

- 4 close observation beds

- 4 beds built to facilitate and support

the admission of younger persons, as

required, as per Australian Health Facility

Guidelines B-0132 Child and Adolescent

Mental Health Unit (2012)

- 8 beds built to facilitate and support

the admission of older person, as

required, as per Australian Health Facility

Guidelines B-0135 Older Persons Acute

Mental Health Unit (2012)

12 beds

- which include 2 close

observation beds

- nil beds able to support the

admission of younger persons

or older persons

Close observation beds - Complex behaviours can require observation of consumers

by staff and discreet security. This should, however, be achieved with a

therapeutic focus so that while necessary measures for safety and security are in

place, they are non-intrusive and do not convey a custodial ambience.

Younger persons admission - Presently, tertiary inpatient services for Mid North

Coast children and adolescents are provided at the CAMHS Inpatient Unit at

Lismore Base Hospital. The nine-hour return journey and resulting family impact

means some families reportedly opt not to seek treatment. Feedback throughout

the ADDENDUM’S consultation process emphasised the significance of being able

to respond effectively to the first episode of acute psychosis or suicidal intentions;

acute crisis and intensive family therapy is critical. The capacity to support the

admission of ounger persons within the proposed Unit would enable crisis

interventions to be commenced both locally and promptly.

Older persons admission - This community has one of largest concentrations of

older people in NSW, a population expected to increase by 53% between 2011 and

2026. The development of Specialist Mental Health Services for Older Persons

(SMHSOPs) was identified as a high priority throughout the consultation and

planning undertaken during the development of the ADDENDUM. The proposed

Unit provides the opportunity to establish purpose-designed inpatient beds for

older persons within the Mid North Coast. There would also be a close

collaboration with the Geriatric Evaluation and Management (GEM) Unit on site at

PMBH, to best utilise the linkages with clinical services including acute medical

and aged care services.

Seclusion Room 1 Consumers may be agitated, aggressive and potentially a risk to themselves or

others, and may where necessary, require temporary containment.

A contemporary mental health

facility compliant with Australian Health

Facility Guidelines.

Non-compliant This represents a current and future clinical and corporate risk.

ECT suite Nil Currently, ECT is provided in Coffs Harbour for patients of both the Coffs Harbour

and Hastings Macleay Networks. The requirement to cover both areas reduces

access to this treatment for the patients of the Coffs Harbour Acute Mental Health

Unit. The timely provision of ECT for patients such as those with psychotic

depression improves patient outcomes and reduces length of stay. It is also a

recommendation of the SMHSOP's Acute IPU Model of Care Project Report (2012:

p. 56) that "all SMHSOP AIU should have local access to ECT."


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2 INTRODUCTION

2.1 THE M ID NORTH COAST MENTAL HEALTH SERVICE CLINICAL

SERVICE PLAN 2013

In 2012-13 the Mid North Coast LHD developed a Clinical Service Plan for Mental Health Services. The Mid

North Coast Mental Health Services Clinical Services Plan 2013-2021 (CSP 2013) outlined current and

projected population needs for mental health services in the Mid North Coast and presented a series of

recommendations for further review and development of these services including the need for capital

development of enhanced mental health service capacity.

The CSP 2013 identified a shortfall in the provision of mental health services in the Hastings Macleay

Network to meet population needs. There is a need to enhance Inpatient capacity and replace out-dated

facilities with contemporary buildings that support contemporary models of care, including a greater

emphasis on primary, community and ambulatory care services.

In particular the CSP 2013 outlined a case for the establishment of a 25 bed consolidated Inpatient mental

health unit for the Hastings Macleay Clinical Network at Port Macquarie Base Hospital (PMBH) with 19

Adult Acute beds, including four Intensive Care Beds, and six Older Persons Acute beds.

Other key recommendations included:

establishment of an Older Persons Inpatient Unit at Kempsey District Hospital;

establishment of a Consortium of Service Providers for Mid North Coast mental health

services, including MNCLHD Mental health Services, NGOs, Commonwealth funded services,

Aboriginal Community Controlled Health Services and other key stakeholders, as an

overarching body to oversee the development and implementation of mental health services

in a collaborative partnership;

undertake a thorough review of models of care operating in both Inpatient and ambulatory

settings across the Mid North Coast, with the aim of updating these on the basis of latest

evidence as to what works best for consumers including new models of care that have been

implemented successfully in other locations, under the guidance of the Consortium of Service

Providers; and

redevelop Ellimatta Lodge at Port Macquarie as a location for day programs and outpatient

clinics for Youth and Family Services.


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2.2 DEVELOPMENTS S INCE 2013

Since the CSP 2013 was completed and endorsed by the LHD in May 2013, the MNC LHD Mental Health

service has begun the process of implementing key recommendations. Implementation has been guided

by a recognition that, while demand will continue to grow driven by population growth, ageing and

increasing prevalence of people living with mental health issues in the community, and with limited

access to significant new recurrent funding, the LHD will need to develop a more sustainable approach

that enables the Mental Health Service to respond more effectively to consumer needs within available

resources.

The Mid North Coast Mental Health Service has begun the process of reviewing mental health models of

care in operation on the Mid North Coast in collaboration with key service partners. This work has

resulted in the establishment of the Mid North Coast Mental Health Integrated Care Collaborative.

Other key progress to date includes:

development of a Feasibility Study for the potential expansion of adult Acute mental health beds

and child and adolescent mental health unit on the Port Macquarie Base Hospital campus;

development of a Models of Care for Mental Health Services on the Mid North Coast of NSW

Discussion Paper which was circulated for discussion and feedback in November 2014 with

implementation of the new Models of Care occurring from July to December 2015; and

endorsement of proposal to develop Ellimatta Lodge as a centre for Mental Health youth and

family ambulatory care services with capital works planning commenced and works to proceed

from July to December 2015.

2.3 THE MNC MENTAL HEALTH SERVICE CLINICAL SERVICE PLAN

ADDENDUM 2015

In order to inform the proposed development of a Business Case for the development of Mental Health

Service Inpatient capacity at PMBH, the ADDENDUM will incorporate the following:

recent plans and policy directions including:

- NSW Mental Health Commission Strategic Plan (2014)

- Rural mental health service delivery models – literature review (2014);

updating of population estimates and population projections for the Mid North Coast;

updating of data on current utilisation of mental health services in MNCLHD;

updating of population requirements for mental health services using the MH-CCP;

identification of Inpatient bed requirements to meet the projected population demand; and

review of relevant MNCLHD and related NGO and Commonwealth-funded services models of care

impacting on the provision of Inpatient mental health services at PMBH.

The development of the ADDENDUM presents an opportunity to incorporate updated population

projections and latest activity data in the review of population needs and future service requirements for


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the Mid North Coast to 2020 and 2025. It presents an opportunity to review and update the models of

care and review previous service enhancement priorities and determine which should have the highest

priority in the context of current and projected community demand and available resources.

In the development of the ADDENDUM, a range of NSW Health endorsed planning tools have been used

to project future service needs including MH-CCP (2010), FlowInfo Version 14.0, HIE data and information

provided by the Health Service. These have been used for trend analyses and NSW Statistical Local Area

(SLA) Population Projections 2014 have been used to define local and regional populations.


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3 BACKGROUND

The Mid North Coast Local Health District provides a range of hospital Inpatient and community mental

health services. Mental health services are managed on a LHD basis and provided in each of the two

Service Networks, Hastings Macleay and Coffs. Mental health services provided in each Network include:

Hastings Macleay Network

Port Macquarie Mental Health Inpatient Unit

Port Macquarie Community Mental Health Service

Kempsey Mental Health Inpatient Unit

Kempsey Community Mental Health Service

Coffs Network

Coffs Harbour Acute Mental Health Unit

North Coast Mental Health Rehabilitation Unit

Coffs Harbour Acute Care Service Community Mental Health

Coffs Harbour Extended Care Service Community Mental Health

These services are the focus of this planning process. The ADDENDUM will focus in particular on service

provision within the Hastings Macleay Network. In addition to these public mental health services, there

is a range of non-government and private mental health services provided in the Mid North Coast.

In developing the ADDENDUM, the Mid North Coast Local Health District has been guided by the

following principles which were identified in the CSP 2013:

I. recovery focus of treatment and care;

II. consumer involvement – engagement of consumers and carers in care;

III. prevention and early intervention – emphasis on reducing the burden of illness caused by mental

health conditions;

IV. quality and excellence – in the provision of mental health care;

V. effective partnerships – collaboration with key partners including NGOs and Commonwealth

funded services;

VI. recognition of cultural diversity – delivery of appropriate services to culturally and linguistically

diverse consumers; and

VII. commitment to Closing the Gap in health outcomes for Aboriginal people and families on the Mid

North Coast.


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4 POLICY & PLANNING FRAMEWORK

4.1 NSW STATE HEALTH PLAN AND RURAL HEALTH PLAN

NSW State Health Plan Towards 2021

The NSW State Health Plan: Towards 2021 builds upon the NSW State Health Plan Strategic Direction

bringing together existing State Health Plans, programs and policies to further develop the NSW

healthcare system to focus on the delivery of ‘the right care, in the right place, at the right time’ for

everyone. It is intended this will be delivered through the following three Strategic Directions:

Keeping People Healthy – supporting people to live healthier, more active lives and reducing the

burden of chronic disease. NSW Health will continue to invest in effective public health programs

in the areas of smoking, obesity, risky alcohol use and early intervention.

Providing World Class Clinical Care – providing timely access to safe, quality care in our hospitals,

EDs and in the community. NSW Health will continue to focus on streamlining ED processes,

reducing unwarranted variation in care, reducing re-admission rates and introduce models of care

to address emerging health issues.

Delivering Truly Integrated Care – creating a connected health system, so that patients and their

carers can more easily navigate the healthcare system, get the care they need, where and when

they need it. NSW Health will invest in integrated care and partnering with health service

providers to avoid unplanned hospitalisations, improve transfer of care, patient and carers

experiences and work towards better health outcomes.

These Strategic Directions will be delivered through implementation of the following key strategies:

Supporting and Developing Our Workforce – developing a strong, skilled workforce to deliver

first class, patient-centred care within our CORE values framework. NSW Health will further

implement The Health Professionals Workforce Plan 2012-2022, establish the Health Education

and Training Institute (HETI) to help drive skills and leadership development and improve

workforce planning at the LHD level.

Supporting and Harnessing Research and Innovation – pursuing cutting edge medical, health

research and innovation. NSW Health will create a dedicated Office for Health and Medical

Research to fast-track the development of innovative ideas, products, drug therapies and

evidence based treatments to deliver improved healthcare.

Enabling eHealth – improving digital connectivity for a smart, networked health system in our

hospitals, in the community and in the future. Implement the Blueprint for eHealth in NSW to

improve technology in clinical care, business services, infrastructure and community outreach.

Designing and Building Future-Focused Infrastructure – improving facilities and equipment to

support the delivery of care and meet growing and evolving healthcare needs of local

communities and changing service delivery models.


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NSW Rural Health Plan: Towards 2021

The NSW Rural Health Plan: Towards 2021 complements the NSW State Health Plan Strategic Direction

and the NSW State Health Plan to improve the delivery of health services for people living in regional and

rural communities.

Building truly integrated rural health services is a priority of the Rural Health Plan and sets the direction

for greater collaboration and the building of stronger partnerships between public and private health

service providers, Medicare Locals and General Practitioners (GPs), Aboriginal Medical Services (AMSs)

and other primary health organisations to provide more coordinated and seamless health service delivery

to rural and regional communities closer to home. The Rural Health Plan sets the direction over the next 7

years for further developing the rural health workforce, investment in infrastructure, new models of care,

research and eHealth technology.

The NSW Rural Health Plan: Towards 2021 further promotes the requirements of regional, rural and

remote NSW to keep the focus on placing sustainable contemporary services closer to where people live

through the following three Strategic Directions and three key Strategies:

Healthy Rural Communities – Strengthen health promotion, disease prevention and community

health services to ensure people in rural communities are healthy with a focus on priority areas

including Aboriginal, maternal, child youth, mental, sexual and oral health services as well as

investing in prevention and health promotion programs to reduce burden of disease associated

with smoking, alcohol use and poor nutrition.

Access to High Quality Care for Rural Populations – improve access to health services as close to

home as possible and enable the provision of high quality care in local rural health services. The

focus is to strengthen service networks, develop eHealth solutions and better support those who

have to travel to access healthcare.

Integrated Rural Health Services – ensure services and networks work together, are patient-

centred and planned in partnership with local communities and heal service providers, and

provide better continuity of care. Improve service integration with services planned and

developed in partnership with rural communities and local health service providers.

These Strategic Directions will be delivered through implementation of the following key Strategies:

Strategy 1: Enhancing the Rural Health Workforce – continue to build the health workforce in

rural areas through enhanced recruitment, training, career development and support. Further

implement Health professionals Workforce Plan 2012-2022 and continue to develop a more

skilled workforce, increase the Aboriginal health workforce, implement innovative workforce

models and strengthen the provision of training and development.

Strategy 2: Strengthening Rural Health Infrastructure, Research and Innovation – invest in

facilities, models of care and research and innovation to ensure the provision of high quality

health services in rural communities. Support the growth of research and innovation in rural

areas to develop and implement local solutions that meets the healthcare needs of local

communities.

Strategy 3: Improve Rural eHealth – implement eHealth solutions and strategies to transform

connections between and access to health services in rural NSW. Implement the Rural eHealth

Program that invests in eHealth infrastructure, improved governance arrangements to support

integration and connectedness of health services.


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There are specific goals in the Rural Health Plan to improve rural mental health including:

Implement the NSW suicide prevention toolkit for small towns.

Expand mental health outreach services via hub and spoke service delivery models and other

locally appropriate models.

Develop community based approaches to mental health to increase provision of services closer to

consumer’s homes.

Promote community mental health literacy, enhanced access and pathways to care for smaller

communities.

Develop initiatives that address the physical health needs of people with mental health issues.

Continue to develop and implement initiatives targeting people with dual drug and alcohol and

mental health diagnosis.

Improve and enhance quality of, and access to, child and youth mental health services.

4.2 NATIONAL MENTAL HEALTH REFORMS

In December 2008, the Australian Health Ministers endorsed an overarching vision for the mental health

system in Australia through the National Mental Health Policy of

… a mental health system that enables recovery, that prevents and detects mental

illness early and ensures that all Australians with a mental illness can access effective

and appropriate treatment and community support to enable them to participate fully

in the community2.

The Fourth National Mental Health Plan (2009-2014) was released by the Commonwealth Government in

20093. The Fourth National Mental Health Plan adopts a population health framework which

acknowledges the importance of mental health issues across the lifespan from infancy to old age and

recognises that mental health and illness result from the complex interplay of biological, social,

psychological, environmental and economic forces at all levels.

2 Commonwealth of Australia (2008) National Mental Health Policy.

3 Commonwealth of Australia (2009) Fourth National Mental Health Plan – An agenda for collaborative action in mental health

2009-2014.


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The Fourth Plan operationalises the population health framework through a whole of government

approach to mental health reform that recognises the need for greater collaboration across

Commonwealth and State/Territory levels of responsibility. The Fourth Plan is underpinned by eight key

principles and focuses actions in five key priority areas:

social inclusion and recovery;

prevention and early intervention;

service access, coordination and continuity of care;

quality improvement and innovation; and

accountability – measuring and reporting progress.

One of the key initiatives in the Fourth National Mental Health Plan is the development of a National

Mental Health Service Planning Framework (NMHSPF) which will provide a population based planning

model for mental health that will better identify service demand and care packages across the sector in

both Inpatient and community environments.

The Fourth National Mental Health Plan highlighted that, while there had been an increase in funding

over the past five years, the mental health system in Australia remains fragmented and as a

consequence presents problems to consumers and carers in continuity of care and gaining access to

services actually needed and promotes system inefficiency through inappropriate funding allocation —

resulting in service duplication and / or service gaps. In summary:

“… despite increased funding to primary and specialist services, treatment rates for people

with mental illness remain low compared with the prevalence of illness. For access to the right

service to be improved, there needs to be an agreed range of service options, across both

health and community support sectors. This should be informed by population based planning

frameworks that specify the required mix and level of services required, along with resourcing

targets to guide future planning and service development that are based on best practice

evidence4.”

The Report of the National Review of Mental Health Programmes and Services was released by the

Commonwealth Government in 20155. This Review also highlighted the structural shortcomings of the

national mental health system with poorly planned and badly integrated systems of care.

This report proposed a reallocation of funding from downstream to upstream services including

prevention and early intervention. To achieve the required system reform, the National Mental Health

Commission has recommended changes to improve the longer term sustainability of the mental health

system based on three components:

1. person-centred design principles;

2. a new system architecture; and

3. shifting funding to more efficient and effective “upstream” services and supports6.

4 Op cit.

5 Commonwealth of Australia (2014) Report of the National Review of Mental Health Programmes and Services, National Mental

Health Commission. 6 Op. cit.


19

The components of a comprehensive mental health service have been described as part of the modelling

that resulted in the afore-mentioned National Mental Health Service Planning Framework. The range of

services that need to be delivered include:

assessment (including physical exam and investigations, second opinions, tertiary service assessment (e.g. for early psychosis, forensic, eating disorders, neuropsychiatric, affective disorders, post-natal depression, personality disorders, dual diagnosis));

review (including for acute and stable / maintenance stages);

individual therapy (including medication, psychotherapies, living skills, social skills, rehabilitation);

group therapy; tertiary service treatment;

consultation / liaison;

supported accommodation; and

mental health prevention / promotion.

The model is not prescriptive on the settings in which these services can be delivered and allows for the following locations:

community based outpatient services;

extended hours / crisis services;

Acute Inpatient Services including general Acute beds, observation beds and Tertiary Service Acute beds;

Non-Acute Inpatient Services (up to 90 days);

very long stay Inpatient Services (365 days);

forensic beds (long term); and

supported community accommodation (“step down”).

Following the review of Medicare Locals in 2014, the Commonwealth Government established 31 Primary

Health Networks (PHNs) from 1 July 2015. The North Coast PHN will replace the current North Coast

Medicare Local and is expected to work closely with general practices and public and private health

providers. The National Review of Mental Health Programmes and Services indicated that the PHNs may

be renamed as Primary and Mental Health Networks, and will enable a better targeting of mental health

resources to meet population needs on a regional basis7.

4.3 NSW MENTAL HEALTH COMMISSION

NSW established the NSW Mental Health Commission of NSW in 2012. The Commission’s remit is to

consider the whole person, recognising that a person’s mental illness does not define them. The

Commission has recently developed a Strategic Plan for Mental Health in NSW. In developing the

Strategic Plan and the companion report Living Well: Putting People at the Centre of Mental Health

7 Commonwealth of Australia (2014) Report of the National Review of Mental Health Programmes and Services, National Mental

Health Commission.


20

Reform in NSW8, the Commission is recognising the importance of putting people at the centre of any

future mental health reforms. A related goal is to keep the concept of recovery at the centre of the Plan.

Recovery means different things to different people, but it is principally concerned with supporting

people to find the help they need and want to make their lives better on whatever terms they choose.

Accordingly the Plan considers physical health, housing, employment, education, social participation and

a range of other issues central to people’s lives.

The Strategic Plan sets out directions for reform of the mental health system in NSW over the next ten

years9. Similar to the national reform documents, the NSW Strategic Plan for Mental Health indicates that

a shift is required in government mental health services, from crisis-driven responses towards prevention

and early intervention. In particular the Plan indicates that:

“we must recognise that there is strenuous work ahead to reorient a system that has

emphasised hospital beds for too long at the expense of other forms of support offered in

or close to people’s homes. Our supports are still, in many places, inflexible, ineffective,

outdated and under-resourced, and often do not join up well when people’s needs are

complex and continuing. The situation is made all the more complex by the lack of clarity

about state and Commonwealth responsibility for funding and service quality10.”

4.4 M ID NORTH COAST MENTAL HEALTH L ITERATURE REVIEW

In 2014 the Mid North Coast LHD commissioned the Centre for Rural and Remote Mental Health to

undertake a literature review of mental health models of care11.

The Literature Review identified the importance of achieving a balanced approach to service delivery

with an optimal mix of mental health services including specialist mental health services (including

Inpatient facilities, specialist psychiatric services and community mental health teams) and mental

health services provided through primary health care services, and self-care.

In particular, the report identified the need to build the capacity of the primary (health) care sector as the

best known way to significantly and pragmatically increase service access for a greater proportion of

persons with a mental health problem in the Mid North Coast, as well as improving the delivery of mental

health promotion and the likelihood of earlier intervention.

The Review identified the need for specialist mental health services to work in closer collaboration with

primary health services, and identified the importance of developing strong governance structures to

underpin this collaborative form of working.

8 Mental Health Commission of NSW (2014) Living Well: Putting people at the centre of mental health reform in NSW.

9 Mental Health Commission of NSW (2014) A Strategic Plan for Mental health in NSW 2014-2024.

10 Op cit.

11 Centre for Rural and Remote Mental health (2014) Rural mental health service delivery models – a literature review.


21

In developing this collaborative model of care, a c l e a r division of labour between service components

will be required. The role of the specialist mental health services, in the public and private sector and the

not for profit organisation sector, w i l l require more attention, as it is the specialist services that have

most influence over the direction but more importantly quality of delivery of the mental health services

system.

A more complete description of the role of specialist mental health services would include:

almost exclusive responsibility for delivering Acute Services;

prime responsibility for crisis intervention;

providing a clinical response to, and managing all cases of, severe mental illness. Within the

specialist services there is likely to be a more calibrated division of labour, with the non-

government organisations through the Partners in Recovery (PIR) initiative taking most

responsibility of an ‘assertive’ case management role through specifically employed ‘support

facilitators’ and the public sector specialist services being the primary ‘go to’ resources for

clinical intervention;

providing an outreach clinical response through routinely organised and co-located clinics (in

general practices, community health clinics, youth services, etc.) that would primarily target

cases of severe and moderate mental illness but would also provide time for consultation

and training with primary mental health care workers;

providing consultant support (community liaison) to general practitioners and other primary

mental health care providers for specific cases; and

building the capacity of primary mental health care workers to manage more independently

high prevalence disorders and contribute more to treatment of moderate cases of mental

illness. Capacity building would occur in many ways including structured formal training

processes, communities of practice, team learning opportunities and self-directed learning

resources. In this regard it may be worthwhile adopting the Victorian PMHEI Team model,

and assigning dedicated workers within the broader community mental health service to this

role. The functions of this team would be to provide education, training and secondary

consultation to primary health care workers and promote shared care arrangements

between specialist mental health services and primary care providers.


22

5 SERVICE NEED

5.1 M ID NORTH COAST

The Mid North Coast consists of the five local government areas of Kempsey, Port-Macquarie-Hastings,

Nambucca, Bellingen and Coffs Harbour.

Figure 5.1 Mid North Coast Local Health District

5.2 CURRENT AND PROJECTED POPULATION PROFILE

In 2011, the estimated resident population of Mid North Coast was 207,490 persons. The Mid North

Coast population increased by 4.1 per cent in the five years between 2006 and 2011. Table 5.1 (shown

over page) presents the population projections to 2026 using the approved Ministry of Health population

projections. The Mid North Coast population is projected to increase by 13 per cent to 235,419 in 202612.

12

NSW State and Local Government Area Population Projections (2014 Final).


23

The Hastings Macleay Network and the Coffs Network are of comparable size, both having a population

of around 103,000 to 104,000 in 2011. The projected population increase is higher for both Coffs Harbour

(19 per cent) and Port Macquarie -Hastings (16 per cent) than in the smaller Mid North Coast LGAs.

Table 5.1 Current and Projected Population, Mid North Coast, 2011-2026

LGA Age 2011 ERP 2016 2021 2026 % change 2011-2026

0-14 2,487 2,376 2,358 2,307 -7%

15-24 1,335 1,198 1,038 952 -29%

Bellingen 25-44 2,433 2,424 2,383 2,359 -3%

45-64 4,158 4,128 3,894 3,567 -14%

65-84 2,184 2,504 2,933 3,324 52%

85+ 326 360 393 433 33%

Total Bellingen 12,923 12,990 12,998 12,942 0%

0-14 13,561 14,141 14,976 15,531 15%

15-24 8,803 8,759 8,591 8,865 1%

Coffs Harbour 25-44 15,759 16,831 17,840 18,648 18%

45-64 20,263 20,817 20,903 20,678 2%

65-84 10,860 12,971 15,430 17,865 65%

85+ 1,726 2,054 2,292 2,666 54%

Total Coffs Harbour 70,972 75,572 80,033 84,253 19%

0-14 5,730 5,694 5,731 5,680 -1%

15-24 3,260 2,993 2,767 2,692 -17%

Kempsey 25-44 5,757 5,781 5,797 5,740 0%

45-64 8,748 8,542 8,150 7,636 -13%

65-84 4,908 5,797 6,742 7,569 54%

85+ 725 840 893 1,056 46%

Total Kempsey 19,128 29,648 30,079 30,373 4%

0-14 3,444 3,443 3,407 3,318 -4%

15-24 1,875 1,725 1,627 1,603 -15%

Nambucca 25-44 3,330 3,320 3,246 3,240 -3%

45-64 5,946 5,875 5,722 5,285 -11%

65-84 4,004 4,649 5,358 6,103 52%

85+ 636 724 782 899 41%

Total Nambucca 19,235 19,735 20,143 20,448 6%

0-14 13,281 13,728 14,222 14,556 10%

15-24 7,749 7,627 7,532 7,643 -1%

Port Macquarie-Hastings 25-44 14,859 15,449 15,990 16,477 11%

45-64 20,912 21,675 22,122 21,738 4%

65-84 15,934 18,036 20,331 23,106 45%

85+ 2,497 3,030 3,420 3,883 56%

Total Port Macquarie-Hastings 75,232 79,545 83,618 87,403 16%

0-14 38,503 39,383 39,383 41,392 8%

15-24 23,022 22,301 21,556 21,756 -6%

MNCLHD 25-44 42,138 43,804 45,257 46,464 10%

45-64 60,027 61,037 60,791 58,904 -2%

65-84 37,890 43,957 50,793 57,967 53%

85+ 5,910 7,007 7,780 8,936 51%

Total MNCLHD

207,490 217,489 226,870 235,419 13%

Source: NSW State and Local Government Area Population Projections (2014 Final).


24

A profile of the population served by the Mid North Coast LHD is provided below:

Significant Characteristics

Population Growth: The Mid North Coast population is projected to increase by 13 per cent

between 2011 and 2026.

Aged population: A feature of the Mid North Coast is the substantial aged population. Over one-

fifth (21.1 per cent) of the total Mid North Coast population in 2011 were aged 65 years and over.

This compares with 13.5 per cent of the total NSW population aged 65 years and over in 2006.

The aged population is projected to increase by 52.7 per cent to the year 2026, at which time this

population group will comprise 28.4 per cent of the total population of the Mid North Coast. The

population aged 85 years and over is projected to increase by 52 per cent between 2011 and

2026.

Aboriginal population: In 2011, 5.8 per cent of the Mid North Coast population were Aboriginal13.

In NSW 2.9 per cent identify as Aboriginal and Torres Strait Islander14. Kempsey LGA has the

largest number (3,715) and proportion of Aboriginal residents (12.8 per cent) of any LGA on the

mid north coast14.

Paediatric population: In 2011 18.6 per cent of the Mid North Coast population were aged 0-14

years. This population is projected to increase by 7.7 per cent to 2021. In 2021, the 0-14 population

will comprise 17.2 per cent of the total population of the Mid North Coast.

Socio-economic status: Using the SEIFA scores (reference score for Australia is 1,000) all Mid

North Coast LGAs have scores under 1,000, ranging from 880 (Kempsey) to 969 (Port Macquarie-

Hastings)14. NSW has an IRSD score of 1,003 and an IEO score of 1,00515.

Tourist population: The Mid North Coast is a popular tourist destination which places additional

demand on emergency services during peak holiday periods.

A detailed epidemiological profile of the Mid North Coast population is provided in the CSP 2013.

5.3 SERVICE DEMAND

There are several methods for identifying the population demand for mental health services. The Mental

Health Clinical Care and Prevention (MH-CCP) methodology provides an estimate of population need

using epidemiological and treatment data for population groups16. It also allows for the projection of

future service requirements in NSW. The MH-CCP model, originally developed in 2001, has recently been

reviewed and an updated methodology provided by the Mental Health and Drug & Alcohol Office in 2012.

This latest model, referred to as MH-CCP (2010), has been approved for use in the purpose of developing

estimates and projections of prevalence rates and resource requirements for the ADDENDUM.

13

Australian Bureau of Statistics. (2011). 3238.0.55.001 - Estimates of Aboriginal and Torres Strait Islander Australians, June 2011. http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3238.0.55.001June%202011?OpenDocument (accessed Nov 2013). 14

ABS: 2033.0.55.001_ Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA). Australia, 2011. 15

Population Health Division. The health of the people of New South Wales - Report of the Chief Health Officer 2008. Sydney: NSW Department of Health.

16 Ministry of Health (2012) Mental Health Clinical Care and Prevention Model, 2010.


25

It is also possible to analyse current patterns of utilisation of mental health services by residents of the

Mid North Coast Local Health District.

5.3.1 Mental Health Clinical Care and Prevention Estimates of Current and Projected

Population Need

The MH-CCP was developed as a tool to assist systematic consideration of the requirements of

comprehensive integrated mental health care and prevention across the lifespan in a population mental

health framework. It utilises epidemiological and treatment data to estimate the proportion of the

population at risk of needing care over a twelve month period17. The MH-CCP (2010) model is in draft

form and it should be noted that any estimates may be subject to change.

The Mental Health Clinical Care and Prevention model indicates that overall rates of mental health

problems in the community are relatively high at around 20 per cent. However a relatively smaller

number of people require specialist treatment for mental health issues. The model indicates that a full

range of mental health programs are required across the life span from early childhood to old age and

across the intervention spectrum from promotion, prevention and early intervention to Acute Care,

Continuing Care and Rehabilitation.

The MH-CCP presents age-specific prevalence estimates for varying levels of severity of mental health

risks and disorders across the lifespan. For the purpose of informing the Mid North Coast Mental Health

Plan, the three age groups are used:

children and adolescents (age 0-17 years);

adult (age 18-64 years); and

older People (age 65 years and over).

Overall, the MH-CCP (2010) projects prevalence of mental health problems with 17.2 per cent of the

population projected to experience a clinically diagnosable mental disorder. This translates to more than

37,000 people in 2015 for the population of the Mid North Coast (as indicated in Table 5.2 shown over

page), increasing to over 40,000 people in 2026.

The MH-CCP (2010) estimates that, for the projected Mid North Coast population of 232,728 people in

2025, 38,280 people, or 16.4 per cent of the population, would experience a clinically diagnosable mental

disorder: 7,552 people aged 0-17 years; 20, 959 people aged between 18-64 years; and 9,769 people

aged 65 years and over.

17

Mental Health and Drug & Alcohol Office, NSW (2001) Mental Health Clinical Care and Prevention Model Version 1.11 a

population mental health model; Ministry of Health (2012) Mental Health Clinical Care and Prevention Model (draft version), 2010.


26

Table 5.2 Projected Populations and Estimated Prevalence* of Mental Disorder by Networks, MNCLHD 2016-2026

Age group

Projected

population

2016

Est. pop'n

with mental

disorder

Projected

population 2021

Est. pop'n

with mental

disorder

Projected

population 2026

Est. pop'n

with mental

disorder

Children (0-11) 15.50% 15.50% 15.50%

Hastings Macleay 15,299 2,364 15,668 2,421 15,871 2,453

Coffs Harbour 15,783 2,439 16,310 2,521 16,628 2,570

Mid North Coast 31,082 4,803 31,978 4,942 32,499 5,023

Adolescents (12-17) 15.40% 15.40% 15.40%


Coffs Harbour 8,124 1,249 8,254 1,269 8,567 1,317

Mid North Coast 15,962 2,454 16,207 2,491 16,732 2,572

Adults 18.50% 18.50% 18.50%


Coffs Harbour 60,959 11,253 61,322 11,320 61,118 11,282

Mid North Coast 119,190 22,002 119,929 22,139 119,257 22,015

Older people 14.80% 14.80% 14.80%


Coffs Harbour 22,885 3,378 26,771 3,951 30,856 4,554

Mid North Coast 50,203 7,409 57,769 8,526 66,025 9,744

All Ages 17.20% 17.20% 17.20%


Coffs Harbour 107,751 18,580 112,657 19,426 117,169 20,204

Mid North Coast 216,436 37,321 225,882 38,949 234,513 40,438

* Prevalence rates (%) are derived from MH-CCP 2010 V2.05b

Population source: Department of Planning and Environment 2014 population series customised by NSW Health.

Population is based on intercensal interpolation and projection. Years are financial year, e.g. 2016 signifies 2015-2016.

5.3.2 Current Utilisation of Community Mental Health Services by Mid North Coast

Residents

The Mid North Coast LHD has information on the total number of Mental Health Clients who are seen by

the LHD Community Mental Health Service during the year. In 2013/14, the MNC Community Mental

Health Service saw a total of 4,373 clients. The total number of clients has increased by 10 per cent since

2010/11.

Over three out of four (76.3 per cent) of total clients were adults between the age of 18-64 years (refer

Table 5.3 over page). Older people aged 65 years and over, who comprised 21 per cent of the total Mid

North Coast population in 2011, accounted for 8.7 per cent of total community mental health clients.

There were only 26 clients aged less than 12 years in 2011/12, and there were 631 clients aged 12-17

years, accounting for 14 per cent of the total Mid North Coast community mental health client base.


27

Table 5.3 Individual Clients of MNC Mental Health Service by Clinical Network*, 2013/14

Age Group Coffs Hastings Macleay Mid North Coast %

0-11 years 10 11 5 26 0.6

12-17 years 241 238 152 631 14.4

18-64 years 1,470 1,085 780 3,335 76.3

65+ years 144 165 72 381 8.7

TOTAL 1,865 1,499 1,009 4,373 100

* Although comprising one MNCLHD Network, Community Mental Health data is collected and reported separately for the Hastings and Macleay. Source: Mid North Coast Information Exchange Mental Health Community Ambulatory (CHAMB) data, 2015. Note: The network totals of individual mental health clients in Table 5.3 will not add up to the LHD total as some individuals were

active in more than one network. Also, the Coffs individual client total was down from 2011/12. The data collection issues at

Coffs Harbour during 2013/14 involved the extended care services managing clients 18-64 years. It is likely that the number of

clients reported to be in this age group was affected by missing data.

5.3.3 Inpatient Separations for Mid North Coast Residents

In 2013/14, residents of the Mid North Coast utilised a total of 2,402 hospital Inpatient separations for

mental health (refer Table 5.4). The majority (98 per cent) of these separations were for Acute psychiatry

(2,348 separations). The 54 separations for Sub-Acute or Non-Acute Inpatient mental health had an

average length of stay of 74 days and accounted for 4,017 bed-days which is equivalent to a daily average

of 11 occupied beds.

The 2,348 Acute Inpatient separations had an average length of stay (ALOS) of 10 days and resulted in a

total of 23,500 Inpatient bed-days. These Acute Inpatient bed-days are equivalent to approximately 76

beds at 85 per cent occupancy. It should be noted that these are the total Inpatient separations for

mental health for Mid North Coast residents. They include hospital separations in general hospital beds as

well as in designated mental health units and they include use of private hospital facilities and hospitals in

other local health districts outside of the Mid North Coast.

Table 5.4 Mid North Coast Resident Demand by LGA for Inpatient Mental Health Services, 2013/14

MNC Resident Activity 2013/14 %

LGA Separations Beddays Separations Beddays Separations Beddays Total Separations

10600 Bellingen (A) 65 1,003 1 48 66 1,051 2.7%

11800 Coffs Harbour (C) 537 8,918 30 2,367 567 11,285 23.6%

15700 Nambucca (A) 100 1,578 4 401 104 1,979 4.3%

Sub-Total Coffs Network 702 11,499 35 2,816 737 14,315 30.7%

14350 Kempsey (A) 244 3,384 3 270 247 3,654 10.3%

16380 Port Macquarie-Hastings (A) 1,402 8,617 16 931 1,418 9,548 59.0%

Sub-Total Hastings Macleay Network 1,646 12,001 19 1,201 1,665 13,202 69.3%

Grand Total 2,348 23,500 54 4,017 2,402 27,517 100.0%

Total Psychiatry83 Psychiatry - Non Acute82 Psychiatry - Acute

Source: NSW Ministry of Health (2015) FlowInfo 14.0.


28

The resident demand by LGA is presented in Table 5.4, and aggregated for the two Clinical Networks. In

2013/14, the residents of Hastings Macleay Clinical Network utilised 1,646 separations and 12,001 bed-

days for Inpatient mental health services. Residents of the Coffs Harbour Clinical Network utilised 702

separations and 11,499 bed-days. It can be seen that the volume of Acute separations is much higher for

Hastings Macleay residents, but the average length of stay is much shorter. Accordingly, the overall

volume of Inpatient bed-days utilised by residents of the two Networks is comparable. In 2013/14 there

was a significantly higher utilisation of Non-Acute Inpatient separations for residents of the Coffs Clinical

Network. In 2013/14, there were 54 separations for Non-Acute Rehabilitation for Mid North Coast

residents and these had an average length of stay of 74 days.

The diagnosis related groups for these mental health Inpatient separations is presented in Table 5.5

below. Patients with a primary diagnosis of major affective disorders accounted for 10.8 per cent of the

total separations and 20 per cent of the total bed-days. The primary diagnosis of schizophrenia accounted

for a further 8.6 per cent of separations and 16 per cent of bed-days.

Table 5.5 Mid North Coast Resident Demand by Diagnosis Related Group for Inpatient Mental Health Services, 2013/14

MNC Resident Activity 2013/14

AR-DRGs Separations Beddays Separations Beddays Separations Beddays Separations Beddays

U63B Major Affective Disorders Age <70 W/O Catastrophic or Severe CC 1 1 199 4036 61 1371 261 5408

U61B Schizophrenia Disorders 1 24 200 4234 6 151 207 4409

Z60Z Rehabilitation 50 3804 50 3804

U61A Schizophrenia Disorders, Involuntary Admission 112 3090 112 3090

U67Z Personality Disorders and Acute Reactions 1 1 188 1184 60 1282 249 2467

U63A Major Affective Disorders Age >=70 or W Catastrophic or Severe CC 26 840 30 655 56 1495

U64Z Other Affective and Somatoform Disorders 101 1325 6 98 107 1423

U60Z Mental Health Treatment W/O ECT, Sameday 2 11 981 981 983 992

U62A Paranoia & Acute Psyc Disorders, Involuntary Admission or W Cat or Sev CC 1 5 19 676 20 681

V61Z Drug Intoxication and Withdrawal 1 1 50 539 51 540

U62B Paranoia & Acute Psyc Disorders W/O Cat or Sev CC 1 29 33 503 34 532

U66Z Eating and Obsessive-Compulsive Disorders 5 155 8 338 13 493

X62B Poisoning/Toxic Effects of Drugs and Other Substances W/O Cat or Sev CC 67 382 67 382

V62Z Alcohol Use and Dependence 11 75 17 290 28 365

U65Z Anxiety Disorders 24 260 4 43 28 303

B63Z Dementia and Other Chronic Disturbances of Cerebral Function 10 226 1 17 11 243

V60B Alcohol Intoxication and Withdrawal W/O CC 18 105 18 105

X60B Injuries W/O Catastrophic or Severe CC 17 99 17 99

X62A Poisoning/Toxic Effects of Drugs and Other Substances W Cat or Sev CC 12 84 12 84

X64B Other Injuries, Poisonings and Toxic Effects W/O Catastrophic or Severe CC 7 72 7 72

X06A Other Procedures for Other Injuries W Catastrophic or Severe CC 1 64 1 64

Z64A Other Factors Influencing Health Status 23 61 23 61

U68Z Childhood Mental Disorders 2 55 2 55

V64Z Other Drug Use and Dependence 7 19 3 30 10 49

Other Diagnoses 1 1 26 250 8 50 35 301

Grand Total 7 62 1208 22094 1187 5361 2402 27517

1 Episode in Public

Psych Hospital

2 Episode in Other

Public Hospital

3 Episode in

Designated Private

Hospital

TOTAL



29

Of the 3,365 total mental health Acute Inpatient separations for Mid North Coast residents in 2013/14,

2,402, or 71 per cent, were provided within designated mental health Inpatient Units (refer Table 5.6a

below). A further 963 separations were provided in non-designated units, i.e. general beds in public and

private hospitals (refer Table 5.6b over page).

Around 45 per cent of the Inpatient mental health separations in designated units for Mid North Coast

residents in 2013/14 were provided within Mid North Coast public hospital facilities (refer Table 5.6a

below). In 2013/14 Coffs Harbour Hospital provided 620 separations for Mid North Coast residents, PMBH

provided 253 separations and Kempsey District Hospital, 215 separations, within their designated mental

health Inpatient units.

Table 5.6a Mid North Coast Resident Demand by Facility for Inpatient Mental Health Services (Designated Psychiatric Wards)


Hospital Separations Beddays Separations Beddays Separations Beddays Total Seps

Coffs Harbour 575 9,961 45 3,515 620 13,476 25.8%

Port Macquarie 253 3,920 253 3,920 10.5%

Kempsey 215 2,615 215 2,615 9.0%

Sub-Total Mid North Coast LHD 1,043 16,496 45 3,515 1,088 20,011 45.3%

Private(excl DPCs) Hospitals 1,187 5,361 1,187 5,361 49.4%

Lismore(excl. Coll. Care) 49 917 49 917 2.0%

Royal Prince Alfred 3 117 3 117 0.1%

Manning 19 113 19 113 0.8%

Queensland Hospitals 7 68 7 68 0.3%

Cumberland 2 53 2 53 0.1%

Orange 1 49 3 260 4 309 0.2%

Victorian Hospitals 1 45 1 45 0.0%

Wyong 1 41 1 41 0.0%

Tweed Heads 5 38 5 38 0.2%

Northern Territory Hospitals 2 32 2 32 0.1%

St. Vincents - Public 4 25 4 25 0.2%

Tamworth 5 25 5 25 0.2%

Wingham 6 242 6 242 0.2%

John Hunter Hospital 2 15 2 15 0.1%

Other Hospitals 97 1,508 9 502 106 2,010 4.4%

Grand Total 2,348 23,500 54 4,017 2,402 27,517 100.0%

82 Psychiatry - Acute 83 Psychiatry - Non Acute Total Psychiatry


A further 1,187 separations for Mid North Coast residents were provided in private hospital facilities,

comprising 19.5 per cent of the total bed-days for Mid North Coast residents. A further 98 separations

were provided in various other public hospital designated units within NSW, including 49 separations at

Lismore Base Hospital, 19 separations at Manning Base Hospital, Taree and four separations at Bloomfield

Hospital, Orange.


30

Table 5.6b Mid North Coast Resident Demand by Facility for Inpatient Mental Health Services (Non-Designated Psychiatric Wards)


Hospital Separations Beddays Total Seps

Private(excl DPCs) Hospitals 454 2431 47.1%

Coffs Harbour 216 440 22.4%

Port Macquarie 154 253 16.0%

Kempsey 66 134 6.9%

Wauchope 16 31 1.7%

Macksville 13 37 1.3%

Grafton 6 6 0.6%

Bellinger River 5 12 0.5%

Lismore Base 4 4 0.4%

Other Hospitals 29 64 3.0%

Grand Total 963 3412 100%

82 Psychiatry - Acute


Of the 963 mental health separations provided in non-designated mental health beds for Mid North Coast

residents, 470, or 49 per cent, were provided within Mid North Coast public hospitals including 216

separations at Coffs Harbour, 154 separations at Port Macquarie and 66 separations at Kempsey hospitals

(refer Table 5.6b above). There were also 454 separations and 2,431 bed-days provided by private

hospitals within non-designated mental health beds. These comprise 71 per cent of total mental health

Inpatient bed-days for Mid North Coast residents in non-designated beds.

Across all hospitals, public and private, designated mental health units and non-designated wards, there

were a total of 3,365 separations for Mid North Coast residents in 2013/14. An age breakdown of these

separations is provided in Table 5.7.

Table 5.7 MNC Resident Demand Psychiatry Separations in All Hospitals (Public and Private) 2013/14

Acute Psychiatry Separations

MNC Residents Acute Psychiatry Non-Acute Psychiatry Total Designated Wards in Non-Designated Wards2013/14 Separations Beddays Separations Beddays Separations Beddays Separations Beddays Separations Beddays

0 - 14 years 7 118 7 118 40 98 47 216

15 - 19 years 110 1,636 7 434 117 2,070 70 231 187 2,301

20 - 24 years 134 2,107 7 501 141 2,608 54 265 195 2,873

25 - 64 years 1,668 16,423 34 2,840 1,702 19,263 552 1,923 2,254 21,186

65 years + 429 3,216 6 242 435 3,458 247 895 682 4,353

Grand Total 2,348 23,500 54 4,017 2,402 27,517 963 3,412 3,365 30,929

Psychiatry Separations in Designated Wards Total Psychiatry

Source: NSW Ministry of Health (2015) FlowInfo 14.0

Residents aged between 20 and 64 years accounted for 2,449 separations, representing 73 per cent of

total psychiatry separations for MNC residents. In 2013/14 there were 234 separations for children and

young people aged less than 20 years. Of these separations, 227 were Acute and these separations had

2,083 Inpatient bed-days which correspond with 6.7 beds at 85 per cent occupancy. Young people aged


31

20 to 24 years accounted for a further 188 Acute separations and 2,372 bed-days (7.6 beds at 85 per cent

occupancy).

Children and adolescents requiring tertiary Inpatient admissions for Acute mental health services access

the Child and Adolescent Mental Health Units at Lismore Base Hospital and John Hunter Hospital (Nexus

Unit). The activity data for 2013/14 indicates that there were 49 separations at Lismore Base Hospital for

Mid North Coast residents with an average length of stay of 18.7 days. The 917 bed-days at Lismore are

equivalent to 3 occupied beds on average at 85 per cent occupancy. There were only two separations for

Mid North Coast residents at John Hunter Hospital in 2013/14.

Residents aged 65 years and over accounted for 676 Acute separations in 2013/14. The 4,111 bed-days

associated with these separations is equivalent to 13.2 beds at 85 per cent occupancy. Over three-

quarters (78 per cent) of these Acute separations were provided in designated mental health wards.

5.3.4 Aboriginal Mental Health

The 2014 National Mental Health Commission’s Report of the National Review of Mental Health

Programmes and Services has reported a significant mental health gap between Aboriginal and Torres

Strait Islander peoples and non-Indigenous people, with Aboriginal peoples more likely to experience

psychological distress, hospitalisation for mental illnesses and death from intentional self-harm18. Indeed,

in 2011-2012 nearly one-third (30 per cent) of Aboriginal and Torres Strait Islander adults (18+ years) had

high or very high levels of psychological distress, almost three times (2.7) the rate of other Australians19,

whilst Aboriginal and Torres Strait Islanders aged 15 years and older reported stressful events at 1.4 times

the rate of non-Indigenous people20. This finding has implications for mental health service demand in the

MNDLHD given the District’s significant Aboriginal population. As noted previously, the Mid North Coast

has a higher proportion of Aboriginal residents than the figure recorded for all of NSW (5.8 per cent of

residents compared with 2.9 per cent)21. Table 5.8 (over the page) indicates the MNCLHD Aboriginal

population per Local Government Area (LGA).

18

Commonwealth of Australia (2014) Report of the National Review of Mental Health Programmes and Services, Summary.

National Mental Health Commission. 19

ABS (2013) Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-12. Cat.no

4727.0.55.006. Canberra: ABS. 20

Ibid. 21

ABS 3238.0.55.001, op. cit.


32

Table 5.8 MNCLHD Aboriginal Population by LGA, 2011

LGA Aboriginal Population % of LGA Population

Coffs Harbour 3,405 4.80%

Bellingen 455 3.50%

Nambucca 1,617 8.40%

Kempsey 3,715 12.80%

Port-Macquarie-Hastings 2,895 3.80%

Total 12, 087

Source: ABS. (2011). Estimates of Aboriginal and Torres Strait Islander Australians, 3238.0.55.001. http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3238.0.55.001June%202011?OpenDocument (accessed Nov 2013).

In terms of service demand and utilisation, Aboriginal residents of the MNCLHD were 2.4 times more

likely to be hospitalised for mental and behavioural disorders than non-Aboriginal residents during

2011/201222. It has been noted, however, that “despite having greater need, Aboriginal and Torres Strait

Islander people experience lower access to mental health services than the rest of the population … in

part because services and programmes designed for the general population are not culturally appropriate

within a broader context of social and emotional wellbeing as understood by Aboriginal and Torres Strait

Islander peoples23”. The MNCLHD Mental Health Service acknowledges this circumstance and is aware of,

and attends to, the need for culturally appropriate mental health services. Importantly, the Mental Health

Service recognises “the integration of family and community into all aspects of mental health planning is

essential in order to incorporate the social and cultural realities of Indigenous people’s lives, beliefs and

circumstances24”. Indeed, this recognition of the centrality of kinship is one of the nine guiding principles

contained within the National Strategic Framework for Aboriginal and Torres Strait Islanders People’s

Metal Health and Social and Emotional Wellbeing 2004-09 (2004)25.

Further, the MNCLHD utilises the NSW Child and Adolescent Mental Health Services (CAMHS) Competency

Framework26 and acknowledges the importance of Competency 4: Working with Aboriginal children,

adolescents, families and communities. This competency notes the importance of staff developing: an

understanding of Aboriginal history; communicating in a culturally sensitive and respectful way; the use

of culturally sensitive language and preferred terminology in line with current policy directives; the

22

Centre for Epidemiology and Evidence, NSW Ministry of Health. Health Statistics New South Wales, http://www.healthstats.nsw.gov.au (accessed May 2014). 23

Commonwealth of Australia (2014) Fact Sheet 2 – What this means to Aboriginal and Torres Strait Islander people. Report of

the National Review of Mental Health Programmes and Services, Summary. National Mental Health Commission. 24

Gee. G., Dudgeon P., Schults C., Hart A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing.

In Dudgeon, P., Milroy, H., & Walker, R. (eds.). Working Together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. (2

nd ed.). In Australian Institute of Health and Welfare. (2014). Effective strategies to strengthen

the mental health and wellbeing of Aboriginal and Torres Strait Islander people, Issues paper no. 12, Closing the Gap Clearinghouse. Canberra: Australian Government. 25

National Aboriginal and Torres Strait Islander Health Council and National Mental Health Working Group. (2004). National

strategic framework for Aboriginal and Torres Strait Islander peoples' mental health and social emotional wellbeing (2004-2009). Canberra: Australian Government. 26

NSW Ministry of Health. (2011). NSW Child and Adolescent Mental Health Services (CAMHS) Competency Framework. NSW

Health.


33

implementation of culturally specific practices as described in policy documents and guidelines when

working with Aboriginal people; the respectful collection and recording of information identifying

Aboriginal status in line with current policy directives; the ability to access Aboriginal cultural advisors

where appropriate regarding appropriates care; seeking to understand and work within kinship structures

of Aboriginal communities; and seeking to understand and work within local cultural protocols.


34

6 CURRENT ACTIVITY

6.1 ACUTE INPATIENT MENTAL HEALTH SERVICES

There are three Acute Adult Inpatient Mental Health Units on the Mid North Coast: Coffs Harbour Health

Campus (30 beds); Port Macquarie Base Hospital (12 beds); and Kempsey District Hospital (10 beds).

These Units provide intensive psychiatric care for people who are experiencing the effects of mental

illness and mental disorder. These units have the capacity to accommodate both voluntary and

involuntary patients, except for Kempsey which provides for voluntary admissions only.

In 2013/14 these three units provided a total of 1,043 separations (refer Table 6.1 below). The average

length of stay was 15.8 days, ranging from 12.2 days at Kempsey District Hospital to 17.3 days at Coffs

Harbour. These units had a high occupancy of close to 90 per cent.

Table 6.1 Inpatient Activity for MNCLHD Acute Mental Health Units, 2011/12 – 2013/14

Hospital Separations Beddays Separations Beddays Separations Beddays ALOS Beds @ 90%

Coffs Harbour 476 8,776 476 9,802 575 9,961 17.3 30

Kempsey 215 2,477 246 2,818 215 2,615 12.2 8

Port Macquarie 175 3,807 217 4,173 253 3,920 15.5 12

Grand Total 866 15,060 939 16,793 1,043 16,496 15.8 50

2011/12 2012/13 2013/14


The Coffs Harbour Acute Mental Health Unit primarily serves the Coffs Harbour, Nambucca, Bellingen (92

per cent of admissions) with a small number of separations (4 per cent for each) from Kempsey and Port

Macquarie LGAs (refer Table 6.2 over page).

The Port Macquarie Base Hospital Inpatient Unit primarily serves the local Port-Macquarie-Hastings LGA

(78 per cent) and Kempsey LGA (18 per cent). Kempsey District Hospital provides for residents of both

Kempsey (63 per cent) and Port-Macquarie-Hastings (32 per cent).

The age of patients admitted to these units is summarised in Table 6.3 (over the page). In 2013/14 adults

aged 25 to 64 years comprised 77.6 per cent of total separations across the three Inpatient Units.

Younger persons aged 15 to 19 years comprised 6.1 per cent of total separations and the bed days

associated with these separations was equivalent to an average utilisation of 2.4 beds at 90 per cent

occupancy. Younger persons aged 20 to 24 years comprised 10.5 per cent of total separations and the

bed days associated with these separations was equivalent to an average utilisation of 5.6 beds at 90 per

cent occupancy, and a combined 8 beds across the two younger person age groups. Older persons aged

65 years and over comprised 5.8 per cent of total separations and the bed days associated with these

separations was equivalent to an average utilisation of 4.8 beds at 90 per cent occupancy.


35

Table 6.2 Inpatient Activity for MNCLHD Acute Mental Health Units by LGA of Residence for Mid

North Coast Residents, 2011/12-2013/14

2011/2012 2012/2013 2013/2014

Hospital / LGA of Residence Separations Bed days Separations Bed days Separations Bed days

Coffs Harbour 476 8,776 476 9,802 575 9,961

10600 - Bellingen (A) 50 851 28 328 53 794

11800 - Coffs Harbour (C) 328 6,183 344 7,429 418 7,179

14350 - Kempsey (A) 17 224 22 526 20 429

15700 - Nambucca (A) 68 1,258 67 1,190 66 1,128

16380 - Port Macquarie-Hastings (A) 13 260 15 329 18 431

Kempsey 215 2,477 246 2,818 215 2,615

10600 - Bellingen (A) 1 1 1 11

11800 - Coffs Harbour (C) 3 32 4 40 5 49

14350 - Kempsey (A) 124 1,508 131 1,382 135 1,823

15700 - Nambucca (A) 5 32 10 116 6 39

16380 - Port Macquarie-Hastings (A) 82 904 100 1,269 69 704

Port Macquarie 175 3,807 217 4,173 253 3,920

10600 - Bellingen (A) 1 16

11800 - Coffs Harbour (C) 1 2 7 297 4 37

14350 - Kempsey (A) 43 813 57 1,231 45 532

15700 - Nambucca (A) 1 6 3 14 5 62

16380 - Port Macquarie-Hastings (A) 130 2,986 150 2,631 198 3,273

Grand Total 866 15,060 939 16,793 1,043 16,496


Table 6.3 Inpatient Activity by Age Group for MNCLHD Acute Mental Health Units, 2011/2012 -

2013/14

Acute Separations

Hospital / Age Separations Beddays Separations Beddays Separations Beddays

% of total

Separations Beds @ 90%

Coffs Harbour 476 8,776 476 9,802 575 9,961 55.1% 30.3

15 - 19 years 30 627 30 400 39 561 3.7% 1.7

20 - 24 years 66 1,212 42 838 63 1,145 6.0% 3.5

25 - 64 years 353 6,275 370 7,457 439 7,208 42.1% 21.9

65 years + 27 662 34 1,107 34 1,047 3.3% 3.2

Kempsey 215 2,477 246 2,818 215 2,615 20.6% 8.0

15 - 19 years 15 78 4 18 7 34 0.7% 0.1

20 - 24 years 12 93 34 256 21 323 2.0% 1.0

25 - 64 years 171 2,016 183 1,964 173 2,047 16.6% 6.2

65 years + 17 290 25 580 14 211 1.3% 0.6

Port Macquarie 175 3,807 217 4,173 253 3,920 24.3% 11.9

15 - 19 years 5 69 9 27 18 199 1.7% 0.6

20 - 24 years 16 272 23 161 26 358 2.5% 1.1

25 - 64 years 139 3,124 176 3,806 197 3,029 18.9% 9.2

65 years + 15 342 9 179 12 334 1.2% 1.0

Grand Total 866 15,060 939 16,793 1,043 16,496 100.0% 50.2

2013/14 2011/12 2012/13



36

6.2 NON-ACUTE INPATIENT MENTAL HEALTH SERVICES

The Rehabilitation Unit at Coffs Harbour Health Campus (20 beds) provides the only Sub-Acute or Non-

Acute Inpatient mental health services on the Mid North Coast. In 2013/14, there were 45 separations

with an ALOS of 78 days for residents of the Mid North Coast. The 3,515 bed-days associated with these

separations is equivalent to an average daily utilisation of 11 beds at 90 per cent occupancy.

Patients were predominantly residents of the Mid North Coast (75 per cent) or Northern NSW (25 per

cent) as indicated in Table 6.4 below.

Table 6.4 Inpatient Activity for Mid North Coast Mental Health Rehabilitation Unit by LGA of Residence for Mid North Coast and Northern NSW Residents

2011/12 2012/13

Hospital/ LGA of Residence Separations Beddays Separations Beddays Separations Beddays ALOS Beds @ 90%

Coffs Harbour 24 2524 39 3537 45 3515 78.1 11

11800 Coffs Harbour (C) 8 573 16 1481 28 2220 79.3 7

16380 Port Macquarie-Hastings (A) 12 1702 10 1218 10 611 61.1 2

15700 Nambucca (A) 1 74 5 265 4 401 100.3 1

14350 Kempsey (A) 3 175 4 143 2 235 117.5 1

10600 Bellingen (A) 4 430 1 48 48.0 0

Total MNC Residents 24 2524 39 3537 45 3515 78.1 11

Total Northern NSW Residents 10 1,040 13 1,108 15 934 62.3 3

Grand Total 34 3564 52 4645 60 4449 74.2 14

2013/14


6.3 COMMUNITY MENTAL HEALTH SERVICES

In 2013/14, the Mid North Coast Community Mental Health Services had a total of 4,373 individual

clients, as presented in Table 5.4. Service contact counts are the primary means of determining the

activity of the community ambulatory mental health services. In 2013/14 the community mental health

services provided a total of 67,488 contacts for these 4,373 clients, an average of 16 contacts per client.

Both Macleay and Hastings MH ambulatory contacts have increased since 2011/12. Due to data

collection issues in the Coffs Clinical Network during 2013/14 the Coffs MH ambulatory contacts appear

to have decreased. During 2011/12 the ambulatory contacts recorded were 100.4 per cent of expected27,

during 2013/14 only 72.6 per cent of expected were recorded.

The Coffs Network provided 25,991 contacts, representing 38 per cent of the total MNC community

ambulatory contacts, and an average of 14 contacts per individual client. The Hastings Network provided

19,760 contacts, representing 29 per cent of the total MNC community ambulatory contacts, and an

27

The expected number of MH ambulatory contacts is determined by the ‘MH Clinical Care and Prevention Model, v1.1 July

2001’. The expected number of contacts is based upon the assumption that 1 FTE will conduct 984 ambulatory contacts during a 12 month period.


37

average of 13 contacts per individual client. The Macleay Network provided 21,737 contacts, representing

32 per cent of the total MNC community ambulatory contacts, and an average of 21 contacts per

individual client.

Table 6.5 Mental Health Ambulatory Contacts with Identified Individual Clients by Clinical Network,

2013/14

Age Group Coffs Hastings Macleay Mid North Coast %

0-11 years 27 100 54 181 0.3

12-17 years 3,454 3,218 2,667 9,339 13.8

18-64 years 19,944 13,529 18,506 51,979 77

65+ years 2,566 2,913 510 5,989 8.9

TOTAL 25,991 19,760 21,737 67,488 100

Source: Mid North Coast Information Exchange Mental Health Community Ambulatory (CHAMB) data, 2015.

Note: Although comprising one MNCLHD Network, in this instance data is collected and reported separately for the

Hastings and Macleay. Additionally, this information excludes contacts with non-identified clients. Clinical contacts

that are not attributed to an individual client are also excluded.


38

7 PROJECTED DEMAND

The approved planning tool in NSW that can inform Mental Health Planning is the Mental Health-Clinical

Care and Prevention Model 2010 (MH-CCP (2010)).

The MH-CCP (2010) model is currently in draft form. The NSW Mental Health and Drug & Alcohol Office

(MHDAO) have, upon request, provided the MNCLHD Mental Health Services Director with select outputs

from MH-CCP (2010) (see Appendix 3 for MNCLHD Estimated Needs Met, provided July 2015).

The MH-CCP methodology is the recognised tool for both comparing current mental health resources

against estimated prevalence in the community, and for projecting future service requirements, in NSW28.

The methodology was described in Section 5.3.

The MH-CCP (2010) planning tool is a population-based model. It provides estimates of resource (e.g.

staff FTE, beds) demand per 100,000 of population, by age group and severity. These ‘per 100,000’

estimates can then be extrapolated to other population sizes.

The MH-CCP (2010) presents age-specific prevalence estimates for varying levels of severity of mental

health risks and disorders across the lifespan. For the purpose of informing the Mid North Coast Mental

Health Plan, three age groups are used:

children and adolescents (age 0-17 years);

adult (age 18-64 years); and

older people (age 65 years and over).

The estimated prevalence is based on the average prevalence for NSW as a whole. Some parts of NSW

would have a higher burden of disease as a result of demographic and socio-economic factors and

historical factors such as the “drift” of people with mental illness to surrounding areas of the former Fifth

Schedule mental health Inpatient facilities.

7.1 CURRENT CAPACITY MEASURED AGAINST NSW PLANNING

BENCHMARKS

The MH-CCP (2010) model provides an estimate of capacity requirements (Inpatient beds) to provide

services for this estimated level of prevalence, by target age group.

28

Mental Health and Drug & Alcohol Office, NSW (2001) Mental Health Clinical Care and Prevention Model Version 1.11 a

population mental health model; Ministry of Health (2012) Mental Health Clinical Care and Prevention Model, 2010.


39

7.1.1 Inpatient Beds

The estimated Acute mental health Inpatient bed numbers required for the Mid North Coast population

based on the estimated prevalence in the MH-CCP (2010) are presented, by age group, in Table 7.1

below, compared to the current available beds.

Table 7.1 Current Acute Bed Numbers and MH-CCP (2010) Estimated Requirements, 2015

Current Bed

NumbersMH-CCP (2010)


Mid North Coast0* 3

Adults (18-64)

Mid North Coast52** (42) 37

Older Persons (65+)

Mid North Coast0 14

ACUTE TOTAL 52** (42) 54

Age Group

2015 2015

* Child and Adolescent Beds for Mid North Coast currently provided within Lismore Base Hospital CAMHU.

** As the 10 Acute Beds at Kempsey District Hospital are non-gazetted and are affected by issues of rurality, the MNC’s total of

practicable Acute Adult Beds is 42.



The comparison of current Acute Inpatient mental health beds in the Mid North Coast Local Health

District against the MH-CCP (2010) benchmarks indicates that, although the District has an adequate

supply of adult beds for those aged between 18 and 64 years, there are no Acute Older Persons or

Younger Persons beds within the MNCLHD. As shown in Table 7.1, if the estimated need for these beds

were to be included, the total number of Acute beds required by the MNCLHD becomes 54. The MH-CCP

(2010) estimate of 54 beds in 2015 compares with the estimate of 53 beds in 2011 that was reported in

the CSP 2013.

It should be noted too that the 10 Adult beds at Kempsey District Hospital are not declared under the

Mental Health Act 2007 and are therefore unable to accept involuntary mental health patients. The

consequences of rurality, including the distance from the Port Macquarie Inpatient Unit and associated

specialist workforce, means that these non-gazetted beds are not utilised as Acute beds, per say.

Therefore the total number of practicable MNCLHD Adult Acute beds is 42 rather than 52 beds.

Additionally, as noted in the CSP 2013, whilst the 2011 MH-CCP (2010) data estimated 158.0 FTE were

required to meet the MNC’s need for ambulatory (community) mental health services, the workforce

comprised 76.8FTE. Additional pressure is placed on Acute Adult beds as a consequence because of the

resulting limited capacity for post-discharge follow-up and assertive treatment within the community

setting leading to increased readmission rates.


40

The Mid North Coast LHD would appear from this analysis to be under-resourced in terms of Acute

mental health Inpatient beds.

The 14 beds estimated by the MH-CCP (2010) for Acute Inpatient care for Older Persons includes four

beds in general Adult Acute mental health units and ten beds in designated Specialist Mental Health

Services for Older People (SMHSOP) units. At present approximately seven per cent of Acute Adult mental

health Inpatient beds are being used to admit older patients. The admission of frail older people and

people with dementia to Acute Adult Inpatient Units is not appropriate, however, and there is a

demonstrated need for a designated mental health Inpatient Unit for Older Persons on the Mid North

Coast.

The MH-CCP (2010) planning tool indicates the need for three beds for the child and adolescent

population of the Mid North Coast (0-17 years). At present the Lismore Base Child and Adolescent Mental

Health Unit has 8 beds and is funded to provide this service for the Mid North Coast.

The estimated Non-Acute mental health Inpatient bed numbers required for the Mid North Coast

population based on the estimated prevalence in the MH-CCP (2010) are presented, by age group, in

Table 7.2 below, compared to the current available beds in the designated Inpatient Unit.

The draft MH-CCP (2010) benchmarks indicate a need for 16 Non-Acute Adult Inpatient beds to provide

for the mental health needs of the Mid North Coast population in 2015. These include 2 beds for Younger

Persons, 6 beds for Adults and 7 beds for Older Persons.

Table 7.2 Current Sub/Non-Acute Bed Numbers and MH-CCP (2010) Estimated Requirements, 2015

Current Bed

NumbersMH-CCP (2010)#


Mid North Coast0 2

Adults (18-64)

Mid North Coast20 ̂ (8) 6

Older Persons (65+)

Mid North Coast0 7

NON-ACUTE TOTAL 20 ̂ (8) 16

2015

Age Group

2015

# Small inconsistencies in figure summation are due to issues associated with rounding; ^ The catchment for North Coast

Rehabilitation Unit Beds covers MNC and Northern NSW LHDs. The MNCLHD utilises 40 per cent (8) of these Beds, whilst

Northern NSW utilises the remaining Beds.



Although the MH-CCP (2010) estimate indicates an adequate supply of Non-Acute beds on the Mid North

Coast, it should be noted that the 20 bed North Coast Rehabilitation Unit at Coffs Harbour Health Campus

was built to provide for the Mid North Coast (40 per cent) and Northern NSW (60 per cent) population.

The MNCLHD currently utilises eight of these beds, whilst Northern NSW utilises the remaining. The


41

premise whereby the MNCLHD has an adequate supply of Non-Acute beds is grounded in the expectation

that by mid-2017 Northern NSW will no longer require access the MNCLHD Non-Acute Beds given the

new Byron Bay Hospital currently under development includes a 20 bed Non-Acute Inpatient Unit.

The previous MNC Mental Health Service Clinical Service Plan, CSP 2013, indicated that the total

population need for Non-Acute Adult Inpatient beds across both Mid North Coast and Northern NSW in

2011 was for 32 beds in 2011 for Adult and Older Persons combined. Additionally, there are no

designated Non-Acute Inpatient beds for Older Persons on the Mid North Coast and the most recent MH-

CCP (2010) indicates a population need for 7 beds in 2015.

7.1.2 Long Stay Patients

As shown in Table 7.3, there are currently no Very Long Stay (VLS) beds in the Mid North Coast although

the MH-CCP (2010) methodology indicates the need for 16 beds for adults and 6 beds for Older Persons in

2015. While the provision of 42 HASI Places within the MNCLHD offsets this need to some degree, such

places are not commensurate with the 24 hour intensive support provided in VLS units. For instance, 26

of the MNCLHD HASI packages provide consumer assistance for a total of five hours/week, four packages

provide assistance between two and three hours per day, and 12 packages provide assistance for five

hours/day (refer Table 7.4 over page).

Table 7.3 Current Very Long Stay Bed Numbers and MH-CCP (2010) Estimated Requirements, 2015

Current Bed

NumbersMH-CCP (2010)


Mid North CoastNA NA

Adults (18-64)

Mid North Coast0 16

Older Persons (65+)

Mid North Coast0 6

VERY LONG STAY TOTAL 0 22

Age Group

2015 2015



Also impacting this service space is the small number of people whose mental health condition is such

that they are unable to function in the community. Previously, these people have required an extended

long stay in one of the residential mental health facilities in NSW, such as the long stay / extended care

units at Bloomfield Hospital in Orange, Macquarie Hospital, Morriset Hospital and Cumberland Hospital at

Westmead. A new program, the Mental Health Hospital to Community Initiative, is currently being

developed whereby these individuals, some 380 in total, will be gradually transitioned to the community,

wherever possible. New services and models of care are being developed to create a range of residential


42

support options for these persons with complex mental illness. A small number of Mid North Coast

residents form part of this cohort and it is expected they will be returned to the LHD for appropriate

transitioning.

In response to the existing service need as well as emerging needs, and the absence of very long stay

beds in the Mid North Coast, the MNCLHD may need to secure capital funding to provide required

services.

Table 7.4 Mid North Coast HASI Package Numbers for 2014-2015

BH Total

Local Health District Very High High Low Med Low High Med Low Low 16 hour 24 hour

8 hrs/d 5 hrs/d 5 hrs/wk 2-3 hrs/d 5 hrs/wk 5 hrs/d 2-3 hrs/d 5 hrs/wk 5 hrs/d 16 hrs/d 24 hrs/d

Mid North Coast 4 8 2 14

Mid North Coast 4 7 1 3 15

Mid North Coast 4 3 6 13

Mid North Coast Total 0 12 15 4 9 0 0 2 0 0 0 42

HASI HASI in the Home Aboriginal HASI HASI Plus

Source: Mental Health and Drug and Alcohol Office, NSW Health - 2014-2015 HASI Package Numbers by LHD.

7.2 PROJECTED CAPACITY REQUIREMENTS

Projected bed requirements for Acute Services are presented in Table 7.5 below. This table indicates the

number of beds required in 2020 and 2025 using the MH-CCP (2010) methodology.

The estimation of Inpatient bed requirements based on the projected population growth and ageing in

the Mid North Coast indicates the need for an increase in total Acute beds, from the current 52, to 58

beds in 2025. The major increase in bed capacity requirements is for Acute Inpatient beds for Older

Persons. The MH-CCP (2010) indicates the need for 19 beds in 2025 which includes 13 SMHSOP beds and

6 beds for Older Persons in general Adult Acute Units. At present there are no designated Inpatient

mental health beds for Older Persons in the Mid North Coast LHD.


43

Table 7.5 Current and Projected Acute Bed Numbers and MH-CCP (2010) Estimated Requirements, 2015- 2025

Current

Bed

Numbers

2015 2020 2025


Mid North Coast0* 3 3 3

Adults (18-64)

Mid North Coast52** (42) 37 37 37

Older Persons (65+)


ACUTE TOTAL 52** (42) 54 56 58

Age Group

MH-CCP (2010)#

2015

# Small inconsistencies in figure summation are due to issues associated with rounding; * Child and Adolescent Beds for Mid

North Coast currently provided within Lismore Base Hospital CAMHU; ** As the 10 Acute Beds at Kempsey District Hospital are

non-gazetted and are affected by issues of rurality, the MNC’s total of practicable Acute Adult Beds is 42.



With respect to the estimated requirements for Non-Acute beds it is important to note that the current

catchment for the North Coast Rehabilitation beds covers both the MNC and NNSW LHDs, with NNSW

utilising 60 per cent of the available 20 beds in accordance with formal agreements between the two

LHDs. The figures provided in Table 7.6 (over the page) regarding the MNCs projected Non-Acute bed

requirements therefore require special consideration because they refer solely to MNCLHD requirements.

By mid-2017 NNSWLHD will have a new 20 bed Non-Acute Unit at Byron Central Hospital and further

detailed planning is required to determine the impact, if any, of this Unit on NNSWs use of Coffs

Harbour’s Rehabilitation Inpatient Unit. A review of the aforementioned formal agreements currently in

place will also be required. Should NNSWLHD no longer require access to 60 per cent of the Rehabilitation

beds at Coffs Harbour, the MNCLHD has an adequate supply of Non-Acute beds through to 2025.

Importantly, however, the previous MNC Mental Health Service Clinical Service Plan, CSP 2013, indicated

that, when combined, the total population need for Non-Acute Adult Inpatient beds across the Mid North

Coast and Northern NSW for adult and older persons would increase to 39 beds in 2021.

As shown in Table 7.7 (over the page), the MNCLHD currently has no Very Long Stay beds although the

MH-CCP (2010) estimates indicate the need for a total of 22 such beds in 2015, increasing to 24 beds in

2025.


44

Table 7.6 Current and Projected Non-Acute Bed Numbers and MH-CCP (2010) Estimated Requirements,

2015-2025

Current

Bed

Numbers

2015 2020 2025



Adults (18-64)

Mid North Coast20 ̂ (8) 6 6 6

Older Persons (65+)


NON-ACUTE TOTAL 20 ̂ (8) 16 17 18

Age Group

MH-CCP (2010)#

2015

# Small inconsistencies in figure summation are due to issues associated with rounding; ^ The catchment for North Coast

Rehabilitation Unit Beds currently covers MNC and Northern NSW LHDs. The MNCLHD utilises 40 per cent (8) of these Beds,

whilst Northern NSW utilises the remaining Beds.



Table 7.7 Current and Projected Very Long Stay Bed Numbers and MH-CCP (2010) Estimated

Requirements, 2015-2025

Current

Bed

Numbers

2015 2020 2025


Mid North CoastNA NA NA NA

Adults (18-64)


Older Persons (65+)


VERY LONG STAY TOTAL 0 22 23 24

2015

Age Group

MH-CCP (2010)




45

8 CURRENT SERVICES AND NEW SERVICE

MODELS

8.1 M ID NORTH COAST LOCAL HEALTH D ISTRICT

Specialist Mental Health Services operate across the Mid North Coast Local Health District (MNCLHD) as a

dedicated service, or “clinical stream”. The mental health clinical stream is part of a broad range of

clinical services within the LHD that deliver services to mental health patients – including emergency

departments and community health services.

The Director, Mental Health and Drug & Alcohol is responsible for overall management of MNCLHD

Mental Health Services. In the provision of clinical leadership to the service the Director is supported by:

the Director Medical Services/Clinical Director, Mental Health; the District Manager, Mental Health

Services; and the Manager, Nursing and Service Development.

The Hastings Macleay Clinical Network has a District Manager of Mental Health Services who is

responsible for managing Mental Health services across the Network and for strengthening partnerships

and liaison with other services. There are service managers in the clinical networks who are responsible

for managing a unit of the Mental Health service, either Inpatient or community. They are also

responsible for strengthening partnerships and liaison with other services. In Coffs Harbour, due to the

size of the services there, a site manager oversees the unit managers across the clinical network.

A range of State and LHD-wide initiatives are developed, implemented, coordinated and evaluated from

the LHD service. There are four “units” within the LHD Mental Health and Drug & Alcohol Service:

Mental Health Services;

Drug & Alcohol Services;

Nursing and Service Development; and

Business Support.

The MNCLHD provides a range of hospital Inpatient and community mental health services. Mental health

services are managed on a LHD-wide basis and provided in each of the two clinical networks, Hastings

Macleay and Coffs Harbour. Mental health services provided in each clinical network include:

Hastings Macleay Clinical Network

Port Macquarie Mental Health Inpatient Unit Kempsey Mental Health Inpatient Unit

Port Macquarie Community Mental Health

Service

Kempsey Community Mental Health

Service


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Coffs Harbour Clinical Network

Coffs Harbour Acute Mental Health Unit North Coast Mental Health Rehabilitation

Unit

Coffs Harbour Acute Care Service Community

Mental Health

Coffs Harbour Extended Care Service

Community Mental Health

The current role of these services is described in the CSP 2013.

Rural and regional districts have special factors to consider in the provision of mental health services

including the range of services available, geography and the spread and density of the population. In

recognition of these factors, the staff of public sector mental health services are required to be flexible in

working across service teams when needed. Despite the need to structure a health service

organisationally into teams with identified roles and functions and distinct managers, all mental health

staff in a rural area should be ready and prepared to deploy to other service areas on a daily basis,

depending on clinical need.

It is generally accepted that specialist public sector mental health services have a priority to direct

their resources towards the severe end of the spectrum of mental health problems. Specialist

mental health services should include:

responsibility for delivering Acute Services;

prime responsibility for crisis intervention;

clinical responses to severe mental illness;

outreach clinical response through regular co-located clinics;

providing consultant support to GPs and other primary mental health care providers;

building capacity of primary mental health care workers; and

specialist clinical support for people with complex mental illness conditions.

While the Mid North Coast Mental Health Service is primarily focussed in responding to the needs of

consumers at the more severe end of the spectrum, there is a strong and increasing imperative for

these services to work closely in collaboration with the broader set of health and welfare providers in

the mental health field. These include GPs, non-government organisations (NGOs), Aboriginal-

controlled health organisations, the new North Coast Primary Health Network, and private

psychologists to name a few.

These services all have a role to play and, in some cases, there are overlaps in roles. Moderate and mild

problems can generally be adequately managed in special interest services (NGOs, GPs, D&A services) and

primary care services (GPs). Different levels of expertise are expected and it is important that service

providers work within their levels. Highly skilled specialists should minimise the work they do in general

support and care coordination, and less skilled or more generic mental health workers should not attempt

to respond alone to acute illness. Recognition of respective roles and their effective demarcation will

support the efficient provision of a network of services across the Mid North Coast. The roles of these

external partners are described later in this section.


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8.2 NEW SERVICE MODELS

As recommended in the CSP 2013, the Mid North Coast Mental Health Service has embarked on a process

of reviewing service models of care. The review has been premised on the need to implement

contemporary models of care and also by the recognition that, in an environment of limited resources,

MNCLHD Mental Health Services must be targeted to the achievement of a sustainable method of

responding to the mental health needs of the Mid North Coast population.

The costs of health care continue to increase at a rate far greater than any other government service.

Increases in funding for health are likely to be very limited in future, with the emphasis shifting towards

more practical and efficient ways to use existing resources. Avoidance of preventable and

unnecessary hospital admissions through better care in the community is a key part of this shift, and

these result in better outcomes and experiences for consumers.

The specific context or rationale underpinning the proposed reconfiguration of service models of care for

mental health services on the Mid North Coast has two major components:

Firstly, based on prevailing models of care, the LHD is short of capacity to meet the

current needs of the District’s population and is facing substantial expected growth in

demand; and

Secondly, the clear strategic signal from both NSW Health and the NSW Mental Health

Commission is that the prevailing models of care in NSW, as a whole, are hospital-centric

and need to be rebalanced, with increased capacity in more community based systems of

care.

A future strategy based on increasing Inpatient bed numbers alone is not likely to be sustainable. The only

viable pathway forward lies in creating a more integrated system that enables the LHD hospital-based

specialist services to concentrate on an Acute/stabilisation role. This will require its integration with other

services so as to establish a continuum from ‘front end’ community-based support for emerging needs

through to stronger post- hospitalisation community based recovery.

In recognition of these imperatives the CSP 2013, proposed the establishment of a consortium of mental

health service providers on the Mid North Coast.

The Mid North Coast Mental Health Integrated Care Collaborative (MHICC) was established in May 2014

in response to a recommendation of the CSP 2013 wherein a consortium of services providers was

proposed. The idea for a collaborative group was also supported by a conference of the local Mental

Health sector in March 2014. The purpose of the MHICC is to establish partnerships between all

mental health service providers in the area to maximise efficient use of existing resources and

improve the consumer journey. This group will be formalised in structure including formal establishment

of a governance structure in the second part of 2015, and will guide the future planning of mental health

services in the Mid North Coast.


48

The development of the MNCLHD Model of Care Review has progressed since 2013 with a number of key

outcomes. These have included:

The MNCLHD commissioned a literature review to explore evidence based models for Rural

Mental Health Services.

Staff forums were held across the LHD with two general staff Forums in Port and Coffs Harbour.

One Specialist Older Persons Clinical Staff Forum and one Youth Clinical Staff Forum and an

Inpatient Model of Care Staff Forum were held.

A Discussion Paper was published and Staff feedback on the paper obtained.

A draft Model of Care Implementation Plan (Blueprint) was subsequently developed and

distributed to mental health service staff for feedback in May 2015. Implementation is expected

to be finalised by 1 January 2016.

The new models of care are described in the following section of the ADDENDUM.

8.3 ACUTE INPATIENT UNITS

Under the new model the Inpatient and Community will form one integrated mental health service across

the District. Medical teams will be structured so that they work across both Inpatient and community

services. Clinicians will provide in-reach and outreach support across both Inpatient and community

services.

8.3.1 Port Macquarie Mental Health Inpatient Unit

Port Macquarie Mental Health Inpatient Unit (Ward 1A) is currently a 12 bed gazetted mental health

Inpatient Unit with 10 low dependency beds and 2 observation/ low stimuli beds. Whilst there has been a

significant growth in the local population over the last 15 years to well over 80,000 people there has only

been an associated increase of 2 Inpatient beds since the unit opened in the nineties.

The Unit is staffed 24 hours a days, 7 days a week, with 3 nurses working each shift; inclusive of the CNS 2

Monday to Friday who carries a clinical load in addition to overseeing bed management etc. The Nursing

Unit Manager Level 2 (NUM 2) works day duty, Monday to Friday. The morning and evening shifts are 8

hours long and the nights are 10 hour shifts.

The treating team is also made up of 2 Psychiatric VMOs, 1 Registrar on 3 month rural rotation, a Junior

Medical Officer, as well as a full-time Social Worker and the Activity Officer Role, currently occupied by a

nurse. Health Services Assistants (HSAs) work in the morning and evening shifts 7 days a week. One

administration officer works full-time, Monday to Friday.

The catchment area for the MHIPU extends from Johns River in the south to Macksville in the north

ostensibly and out to the west as far as Gingers Creek. The Port Macquarie and Kempsey hospital

Inpatient Mental Health Units operate as a single service for the Hastings Macleay Clinical Network. In


49

view of the situation that PMMHIPU has gazetted beds and KDH MHIPU does not, patients are admitted,

and transferred between, the two units based on patient need and severity.

In the broader context, the Mental Health Inpatient Units throughout the MNCLHD are required to cover

periods of high bed pressure and patients sometimes require relocation under a reciprocal arrangement

with the other mental health units in the MNCLHD, to best manage those periods of significant bed

pressure.

The proposed future role of the Port Macquarie Mental Health Inpatient Unit is described in Section 9 of

this ADDENDUM.

8.3.2 Kempsey Mental Health Unit

The Kempsey Mental Health Inpatient Unit is a ten (10) bed voluntary unit. The Unit operates as an

integrated service with the Port Macquarie Mental Health Inpatient Unit and gazetted patients are

admitted to the Port Macquarie Inpatient Unit or the Coffs Harbour unit. The Kempsey Inpatient Unit

accepts voluntary patients from the Port Macquarie-Hastings area, and at times from the Coffs Harbour

area.

With the proposed expansion of mental health Inpatient beds at PMBH there will need to be a review of

the ongoing role of the Kempsey Mental Health Unit. It is acknowledged that the Unit is of sub-optimal

size and there are deficits in the design and functional state of infrastructure, however the Unit will

continue to provide an ongoing and complementary role in meeting the needs of the local and broader

MNCLHD population in the provision of Inpatient care for voluntary patients. If its future role were to

involve the provision of specialised services, such specialisation would be dependent upon funding

submissions and enhancement funding provided via the Ministry of Health.

Model of Care

Current Models of Care include:

bio-psycho-social assessment and intervention;

individual care plans with inclusion of social system intervention and recovery;

integration of Inpatient Units and community care to ensure seamless transition of care; and

collaboration with other support services to provide stable accommodation and support.

A significant component of the model of care at Kempsey District Hospital is the regular multidisciplinary

clinical review meeting where progress is reviewed against the recovery model and discharge plans

developed.


50

8.3.3 Coffs Harbour Acute Mental Health Unit

The Coffs Harbour Acute Mental Health Unit (CHAMHU) is a gazetted 30 bed Acute Mental Health Inpatient Unit with 6 observation beds (inclusive). The catchment area for the Unit is primarily between Eungai Rail south of Coffs Harbour and Red Rock to

the north. Within the Coffs Harbour catchment there are 3 Local Government Areas (LGAs): Nambucca

LGA covering Macksville and Nambucca Heads; Bellingen LGA covering Bellingen and Dorrigo; and Coffs

Harbour LGA covering Coffs Harbour and Woolgoolga.

In terms of Inpatient bed capacity, the Coffs Harbour Clinical Network has a sufficient overall bed capacity

to meet population requirements for the next ten years. The ageing of the population will result in an

increased need for specialist mental health beds for Older Persons within this bed complement. Any

future changes in the configuration of bed numbers at Coffs Harbour may occur to complement the

proposed service developments at Port Macquarie Mental Health Inpatient Unit such as the development

of specialised beds for Older and/or Younger Persons if and when there is sufficient critical mass to

support such developments.

Model of Care

Bed occupancy, average length of stay and workload for CHAMHU is impacted by the requirement to

accept some Hastings Macleay Network clients whom require a gazetted mental health bed, due to the

limited gazetted beds in Port Macquarie and the non-gazetted beds in Kempsey. This also impacts on the

Coffs Harbour Emergency Department.

Due to the ongoing pressure for beds over the area there are times when care is limited to crisis management only. Currently, ECT is provided in Coffs Harbour for patients of both the Coffs Harbour and Hastings/Macleay areas. The requirement to cover the latter area reduces access to this treatment for the patients of the CHAMHU and would be alleviated by the proposed establishment of ECT at Port Macquarie Mental Health Inpatient Unit.

8.3.4 Overview of Acute Inpatient Services

The current configuration of Acute beds in the MNCLHD is less than ideal. Although the MNCLHD

currently has sufficient Acute involuntary beds for people aged 18-65, the 12-bed unit in Port

Macquarie is difficult to manage due to its size and layout, and there are no dedicated Acute beds for

the over 65 age group. The voluntary unit in Kempsey adds another layer of complexity due to its

inability to admit people on an involuntary basis, its unsuitability for converting to an involuntary or

older persons’ unit, and its size. On a population basis, by 2020 each clinical network would ideally be

serviced by twenty dedicated Acute beds for the 18-65 year age group, and nine to ten dedicated

Acute beds for over 65 years, with the capacity for detention under the Mental Health Act. The

projected population requirement for beds for people under 18 years on the Mid North Coast is 3 to 4

beds.


51

The difference in occupancy between the two clinical networks is pertinent. With only twenty-two

beds in the Hastings Macleay Network - and only 12 of these capable of being used for involuntary

admissions - occupancy is generally lower than that of Coffs Clinical Network where there are thirty

Acute beds, despite similar populations being served and similar rates of presentation to Emergency

Departments.

Current admission rates of older people for Acute Inpatient care in the Mid North Coast are well below that which is expected on population proportions, possibly due to the lack of specialised beds of this nature and the concomitant coping realised in other community services and Registered Aged Care Facilities for this age group. The need for an effective community response to this age group is required in order to complement any proposed Inpatient beds and to avoid unnecessary admissions.

In planning future Acute Inpatient bed requirements there is a need to provide some balance across the clinical networks, across the age groups and across the voluntary and involuntary need, to manage the population needs in the Mid North Coast.

8.4 REHABILITATION UNIT

The North Coast Mental Health Rehabilitation Unit (NCMHRU) is a 20 bed Inpatient Mental Health Rehabilitation Unit. The Unit is a declared unit under the Mental Health Act. It accepts both voluntary and detained patients. The expected length of admissions is three to six months. Currently, the NCMHRU provides a service for the whole of the north coast region covering MNCLHD and Northern NSWLHD, with 8 and 12 beds nominally allocated to the LHDs respectively. By mid-2017, however, Northern NSW may no longer require access to the MNCLHD Non-Acute beds given the new Byron Central Hospital (currently under development) includes a 20 bed Non-Acute Inpatient Unit. Presently the North Coast Mental Health Rehabilitation Unit provides a recovery focussed Inpatient Mental Health Rehabilitation Service to both the Mid North Coast and the Northern New South Wales Local Health Districts. The referral process has expanded to include clients from any location where a psychiatrist has responsibility for that client; this includes private psychiatrists and many non-government organisations that provide mental health care. All referrals are channelled through the local mental health rehabilitation coordinators, who provide a screening and support service to referrers. Direct referrals are accepted from both Districts’ Acute Mental Health Units, and these referrals are prioritised and admissions are fast tracked to minimise the potential of bed block preventing care to other Acute clients.

Model of Care

The Unit provides a tertiary service. Referrals are accepted from any current provider in the north

coast region, and are channelled through the MNCLHD and NNSWLHD mental health rehabilitation

coordinators for admission assessment. Direct referrals are accepted from both LHDs’ Acute Inpatient

Units, and admissions are fast-tracked from these units when a bed is available. The length of stay is,

on average, 150 days. With direct referrals from Acute Inpatient Services, it is critical to ensure

suitability through adequate assessment at the originating Unit and avoid transfer too early.


52

The focus of admission is on functional gain with mental health recovery. Recovery in mental health is a

model of care which aims to help the client achieve their potential despite their illness, not by focussing

on their illness.

The NCMHRU model of care involves referral and admission protocols, care coordination during

treatment, and on-going assessment including the use of MHOAT and Recovery Star tools plus ongoing

assessment of strengths, physical health, neuropsychological functioning, social circumstances,

occupational functioning, risks and substance use. Care planning occurs in collaboration with consumers

and informed by all assessment processes, but in particular by the consumers self-identified goals and

domains identified in the Recovery Star assessment and the Stages of Change approach. It involves a wide

range of therapeutic interventions including a comprehensive linked activity program, behavioural

reinforcement, talk-based therapies, medication, specialist professional interventions, daily living

interventions and structured leave as an intervention modality. Care planning and delivery is reviewed

regularly, particularly when incidents occur and at handover, but also at timed regular events such as

MDT reviews, psychiatrist reviews, and monthly regular reviews.

The Rehabilitation Unit has a local relationship with Coffs Harbour Acute Mental Health Unit, managing

overflow clients.

8.5 COMMUNITY MENTAL HEALTH SERVICES

The recent review of the MNCLHDs mental health service models of care has largely been about

remodelling community mental health services and revising how they relate to the rest of the service

system, including Inpatient Units, GPs, NGOs and Aboriginal Medical Services. The new models of care

will provide more comprehensive mental health outreach service to our consumers and service

partners in the community. It will also provide an in-reach service to the LHDs Inpatient Units to

facilitate a seamless transition to the community during discharge. Residential Aged Care Facilities will

also be provided with an in-reach service as required.

The new models of care will see a redistribution of staff in each locality. The changes will include a move

to a model of Rapid Response Services (RRS) and Integrated Treatment Services (ITS). The majority of

staff positions will be working within the RRS with a smaller number of positions focussing on the ITS.

One manager will oversee both the RRS and ITS to enable disposition of staff, movement and flexibility of

the service in response to need promptly. On a daily basis, community mental health managers will be

able to allocate staff and resources in a flexible manner across the services to meet the emerging need.

The key to providing a flexible and responsive service is the ability to allocate staff quickly to where the

need is.

The community mental health teams in the Coffs Clinical Network (CCN) will be restructured into

geographically-based teams, servicing the northern and southern sectors of the network, respectively.

Transition


53

The movement to the new models of care will require a process of review and transition for some staff

and consumers. Care co-ordination and non-clinical support in NGO services will be an important

component and require a focus on managing the change involving all service providers. The increased

responsiveness of the RRS will provide the NGO sector with significant incentives to review their roles and

capacities.

Any future funding enhancements for the Mid North Coast area, particularly those associated with the

NSW Mental Health Commission Strategic Plan, are likely to be focussed in the non-government sector to

enhance these components of community care. As contracts and service agreements with NGO partners

are reviewed under the Partnerships for Health process, the MNCLHD is expected to be involved in

developing how we will work with NGO partners in a collaborative way to achieve this transition.

Discussions are ongoing with key partners, consumers, carers and community members to ensure a

successful transition.

8.5.1 Rapid Response Service

The RRS will provide assessment, care planning and treatment promptly in the community to reduce

progression of symptoms. This will ensure that communities, services, families and carers will not have to

wait until the individual is unwell enough to require acute intervention through hospital-based pathways.

Referral and triage

Referral will be possible through:

the Mental Health Line;

police;

family and carers;

other government agencies;

non-government services;

General Practices;

Primary Health Networks;

health professionals; and

self-referrals.

Response times will be in accordance with NSW triage guidelines.

Assessment

The RRS will be mobile and will undertake assessments in a variety of settings. Involvement of family,

carers, and/or other service providers in the assessment is highly desirable both in terms of improving

the accuracy of the assessment and ensuring that a support plan is developed that is appropriate and

meets with the identified needs and agreement of those involved.

The assessment will inform the development of the care plan. Where another service provider is

already engaged with the person, the care plan will be a joint plan including the roles of each provider

and the type of treatment and/or support to be provided, and a seamless clinical pathway for the

person to navigate between the services when required.


54

All referrals will receive a care plan articulating the initial intervention and the ancillary support

needed. If the assessment determines that treatment by MNCLHD mental health services is not

required, advice will be given to the referrer as to the appropriate service, and the referrer will be

supported to access that service as required.

If the assessment determines that clinical intervention is required, the plan should include the initial

treatment and the level of care that will be provided, as well as the involvement of other providers in

a support or care coordination role. A risk assessment should always be undertaken and shared with

appropriate people/services. The care plan should involve the active consent and input of the

consumer and family/carer/service provider.

The care plan and ongoing assessment must be flexible enough to allow for changing response

depending on clinical need.

Treatment

If the assessment determines that an Acute Admission or more intensive community treatment is

required then the Rapid Response Service will ensure this occurs, either through its own means or

through the structured engagement with other clinical staff. The service will provide intensive follow

up and support that will be determined by the risk assessment and care plan. It will be the role of the

Rapid Response Service to work closely with the Inpatient Services to reduce hospital stays and ensure

rapid transition of care to a less restrictive environment or less intensive service. This will be done by

closely monitoring the course of the Inpatient treatment and developing community treatment and

support options for individual patient’s early discharge.

8.5.2 Integrated Treatment Service

For those requiring it, further specialist mental health treatment interventions may be provided through

an ITS. The Service will provide:

Community treatment order (CTO) management

The role of CTO Management within the service will be to co-ordinate and monitor CTO compliance. It

is important to note that managing the care outlined on the CTO may go to another service. It will be

the role of CTO Management in the ITS to monitor care and treatment compliance, not necessarily to

provide it.

Youth and Early Psychosis service provision (12 – 24 year olds)

Some Youth positions will become part of the ITS and will expand to include treatment for young

people up to 24 years and those who are experiencing first episode psychosis.

Specialist mental health individual and group interventions

Clinicians will provide specialist individual and group interventions. These may include:

psychometric assessment;

time bound evidence based individual therapy sessions in response to targeted goals;


55

development and evaluation of therapeutic groups;

consultancy for complex clients;

expert clinical education and training to internal and external partners; and

comprehensive DBT program.

Integration Coordinator

The Network Mental Health Rehabilitation Coordinator roles in each Network will be renamed and

focus on supporting partnerships and integration across the networks with all government and non-

government agencies in a boundary spanning role. This position will be important in supporting and

facilitating the RRS and ITS clinicians to establish and maintain integrated links with services.

8.5.3 Medical Teams

Medical teams will be aligned between community teams and Inpatient beds to try to ensure that any

given person is treated by the same team in both settings. Specialist consultation will be provided

through case-based discussion, supervision of RRS/ITS team members, and face-to-face assessments of

patients when appropriate. The role of the psychiatrist will be more consultative and acute in nature in

keeping with the new rapid response model of care. Input from a psychiatrist would be expected during

the stabilisation phase prior to a transition of care to primary care for longer term follow up.

8.5.4 Consultation Liaison

CNC ED positions will provide an assessment service to the Emergency Departments in Coffs Harbour,

Kempsey and Port Macquarie. This will be consistent across the LHD and the CNC ED will participate in

the ED handover each morning. The RRS clinicians will assist in ED assessments and provide them in

Macksville and Bellingen as required.

Consultation liaison services will be extended through the RRS and Medical teams to provide support to

the generalist wards in the hospitals. RRS clinicians and medical staff will provide consultation liaison

support to the hospital wards including to younger and older persons.

8.5.5 Aboriginal Services

Specialist Aboriginal Mental Health Workers are part of the Rapid Response Service and they will support

clinicians to undertake assessments and develop care plans for Aboriginal people. The Aboriginal Clinical

Leader position will provide a coordination role across the MNCLHD for Aboriginal Mental Health

Workers. As well as providing support to individual Aboriginal Mental Health Workers, this position will

bring together all Aboriginal Mental Health Workers as a ‘virtual team’ for regular support and meetings.

This position covers Aboriginal Mental Health and Drug & Alcohol Service and will work closely with

managers and other Service Development Unit staff in regard to service improvement, development,

reporting and integration.


56

A pilot service model for Aboriginal mental health and drug and alcohol services is currently being

planned for Coffs Harbour in collaboration with Galambila Aboriginal Health Service Inc., an Aboriginal

Medical Service. The intention is for this model to be transferable to other sites in time.

8.5.6 Co-Located Services

Under the new model of care, it is expected that some of the RRS and ITS will be co-located with other services off the hospital sites in community settings. The LikeMind Pilot project in Coffs Harbour and the Ellimatta Lodge facility in Port Macquarie will provide an ideal opportunity to implement this. The expanded use of the Wide Street house in Kempsey represents a similar opportunity. These initiatives are in development and will require more discussion and input at a local service centre level.

LikeMind

LikeMind is a mental health service model being piloted in NSW in a number of sites. LikeMind hubs

have already been established in Penrith and Seven Hills, and the NSW Ministry of Health has

announced that the MNCLHD and Western NSWLHD will be included in the pilot to provide a regional

and rural perspective on this concept. At the time of writing, tenders are being considered and an

announcement on the successful NGO lead agency is imminent.

The model involves the NGO lead agency providing the community site, administration, coordination

and infrastructure services to a range of service providers, such as GPs, psychiatrists, psychologists,

housing and employment consultants, and LHD community mental health staff. It is expected that

about seven Community Mental Health and Drug & Alcohol staff will be co-located at the site from

early 2016.

Ellimatta Lodge

This site will be utilised to house the majority of the youth mental health team in Port Macquarie, and

opportunities for the co-location of NGO, primary care and private specialist services will also be

explored. A small training facility will also be established in the site to provide cross-sector and on-line

training and clinical supervision to maintain linkages with our service partners and assist them to build

their workforce capacity. Some mobile adult community mental health staff will also be housed here,

providing outreach services to their consumer group.

A program of refurbishment is planned for Ellimatta Lodge in order to achieve the outlined change.

8.5.6 Comorbidity: Mental Health and Substance Use

Presentations of co-occurring disorders to health services are common, reflecting the high prevalence of

co-occurring disorders in the community and the increased use of health services by people with

comorbid problems. People with these comorbidities have more complex needs, are more cost-intensive

for the health system, and generally show poorer health outcomes than those with single disorders. The

NSW Health Mental Health and Substance Use Comorbidity Guidelines serve as a resource for clinicians

and services in the fields of Drug and Alcohol and Mental Health. At the treatment level, the guidelines

provide an overview of practice principles, treatment processes, assessment procedures, and treatment

strategies for the various comorbid presentations. At the service level, the guidelines emphasise the need

for better coordination and integration of MH and D&A services and delineate the expectations for


57

service delivery from both MH and D&A clinicians and services. The guidelines refer to the collaboration

between local MH and D&A services as crucial for improving services to people with co-occurring

problems.

The MNCLHD has drafted a Mental Health and Substance Use Comorbidity Implementation Plan which

outlines the model of care for this group of people.

Comorbidity continues to create challenges to the overall service system on a local level across the

MNCLHD, with a substantial proportion of people presenting to either service having co-occurring

problems. Comorbid substance use is a common factor in many of the completed suicides of mental

health consumers in the community.

The key to achieving strategic targets in relation to improving the health outcomes of clients with a dual

diagnosis lies with a coordinated approach across the multiple levels of the service system. The three

main levels of the service system, and the strategies relating to these levels, are:

Support systems

Formal agreements between MH and D&A services outlining the strategic directions and shared undertakings in relation to the treatment of comorbid presentations.

Meeting structures involving senior staff across the sectors for developing and maintaining collaboration strategies. To effect targeted changes in practice across the sectors requires organisational change, which in turn requires leadership and support from management.

The specification of key principles and standards of practice for the treatment of this client group, as well as the specification of the intended collaboration between MH and D&A services.

Service structures

Joint implementation groups at the local level to develop the workforce and clinical protocols.

Locally agreed and implemented referral mechanisms and clinical pathways between MH and D&A services.

Clinical review groups at the local level.

Joint clinical and evaluation projects.

Integrated care

The main principle of integrated care in comorbidity is the treatment for both problems in the one service setting through the collaboration of clinicians rather than parallel or sequential treatment in two separate settings.

District-wide clinical protocols for: intake and assessment; treatment; and transfer of care.

Clear service delineation specifying the role of services and the delineation of responsibilities for assessment and treatment over the course of treatment.

Monitoring and evaluation of agreed treatment strategies across sectors.

The no wrong door approach to triaging people who present to health services. This emphasises the responsibility of the initial contact service facilitating access to the required range of services.

Staff should at no time work beyond their level of expertise. Consultation with relevant clinicians across sectors should be accessed as soon as possible.


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8.5.7 Telehealth and Services in Small Population Centres

Wherever possible, clinical services in small population centres will be provided via Telehealth from the

related service hub. Each small service site where staff are out-posted or clinics are provided on a

sessional basis, such as Bellingen and South West Rocks will have Telehealth facilities installed. Small

towns that are not currently serviced by sessional clinics will be considered for Telehealth clinics. Staff

currently out-posted on a full-time or regular basis will, in future, be based predominantly at their service

hub.

Better use will be made of the existing CAPTOS Telehealth Services for the younger age groups.

The new St Vincent’s Hospital Psychogeriatric SOS (Specialist Outreach Service) is a clinician-to-clinician

service offering advice, supervision, case conferencing, and education via on-line video facilities, for any

clinician involved in psychogeriatric care in rural or remote NSW.

8.5.8 After-hours Presentations and Assessments

Out-of Hours Rosters

The current group of staff in Acute Care Service teams who work seven-day, 14-hour rosters will

continue to do so, and by inclusion in the RRS, will provide out-of-hours response in the community

and hospital. Where position descriptions currently provide for, 16-hour rosters will be introduced for

specific positions, and other positions will gradually be extended to 16 hour rosters, through

negotiation and turnover of staff. Other ways to extend further the out-of-hours response will be

considered in consultation with individual staff in the RRS.

Northern Telehealth Emergency Assessment Hub

This new service will be established in Newcastle and cover the north coast of NSW from Newcastle to

Tweed Heads, and inland to the rural areas of the Hunter New England Local Health District (HNELHD).

It will be commissioned and operated by the HNELHD on behalf of the MNCLHD and NNSWLHD. It will

provide 24/7 mental health assessment to smaller hospital EDs in the rural areas where a declared

mental health Inpatient Unit is not available. The purpose is to assess and decide whether admission

(through transport to a declared unit) or discharge is clinically indicated. The service is currently in

early development phase and more detail on how this will operate within the MNCLHD is still to be

finalised. The way in which the RRS will link with this service will be part of that development. It is

expected that the hub will be commissioned early in 2016.


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8.6 OLDER PERSONS

A key service need for older persons with mental illness in MNCLHD is timely, efficient and effective

triage and assessment of older persons who are referred to public sector mental health services.

Specialist assessment should provide clear diagnosis and direction for the development of treatment,

care planning and referral pathways.

Twenty-two percent of the current population of the Mid North Coast is aged 65 years and

older, and is expected to grow by 75 per cent by 2031, bringing the overall proportion of this age

group to 30.3 per cent at that time. Of all admissions to Acute Inpatient Services from the MNCLHD

population, 6 per cent are aged 65 years and over. Of the total number of people in contact with

MNCLHD community mental health services, 9 per cent are aged 65 years and over.

Specialist Mental Health Services Older Persons (SMHSOPS) clinicians will be part of the Rapid Response

Service and will undertake assessments for people over 65 years and 45 years for Aboriginal people.

SMHSOPS clinicians will also provide comprehensive consultation and liaison with Aged Care services

including Residential Aged Care Facilities and GPs. The mobile nature of the Rapid Response Service is

ideal for servicing the Aged Care sector in this way.

To carry out this model of care, the seven clinicians of the Specialist Mental Health Services for Older

Persons (SMHSOP) would be brought together as a virtual team involving regular clinical and

supervisory meetings. The SMHSOPS CNC role will provide a clinical lead position across the MNCLHD.

It will be the role of the SMHSOPS CNC to bring together all the SMHSOPS clinicians as a ‘virtual team’

for regular clinical support and meetings. The meetings would identify new referrals and allocate

tasks, and plan support that may be required by the team members. The CNC position will work closely

with the Service Development Co-ordinator – Operations and Planning, medical teams and all managers

in regard to service improvement, development and reporting.

The new St Vincent’s Hospital Psychogeriatric SOS (Specialist Outreach Service) is a new clinician-to-

clinician web-based service soon to be provided by St Vincent’s Hospital Psychogeriatric multidisciplinary

team to rural and remote NSW. It will offer advice, supervision, case conferencing, and education via on-

line video facilities, for any clinician involved in psychogeriatric care in rural or remote NSW. It is ideally

placed to provide extra support and resources for the SMHSOPS clinicians particularly in developing the

‘virtual team’ across the District.

Consultation liaison is a key role that should be provided by public sector mental health services,

including within the base and district hospitals and community aged care services, as well as residential

aged care facilities, NGOs and general practices. This would involve identifying and recommending

treatment and care plans, but in this particular role not the direct provision of the treatment or care.

Furthermore, education and support to the services is an important part of consultation liaison and an

efficient and effective use of specialist skills. A role in supporting Aged Care Assessment Teams (ACAT)

will be crucial.


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Services to older persons will also be provided by other mental health team members as required on a

flexible basis, to be determined on clinical need and risk assessment, including medical, nursing and

allied health staff working in adult mental health services. Given the expected growth in the older

population in the Mid North Coast, we should consider shifting resources over time towards this target

group and focussing any bed changes on providing older persons’ beds in existing units.

8.7 YOUNGER PERSONS

Thirty percent of the current population of the Mid North Coast is aged between 0 and 24 years,

and is expected to grow by 10 per cent by 2031; however, even with this growth, the overall

proportion of this age group will reduce to 26 per cent because of greater growth in the over 65 age

group. Of all admissions to Acute Inpatient Services from the MNCLHD population, 17 per cent are aged

up to 24 years. Of the total number of people in contact with MNCLHD community mental health

services, 30 per cent are aged up to 24 years.

The ideal service model for meeting the needs of young people with mental health problems would

involve a fully integrated service for ages 0-24 years, including clinical pathways agreed between the

service providers, multiple access points and co-location of services where possible to provide a

youth-friendly “hub”. This would provide direct response to acute illness as well as early intervention

and prevention services.

In the new model of care, specialist Youth clinicians will be part of the Rapid Response Service and will

undertake assessments for 12 – 24 year olds. The District Service Development Coordinator - Youth will

provide a coordination role across the MNCLHD. This coordination role will assist in bringing together all

Youth Mental Health clinicians as a ‘virtual team’ for regular clinical support and meetings. This position

will work closely with the Youth Clinicians, medical staff, all Managers, and other government and non-

government Youth services in regard to service improvement, development and integration.

The core business of public sector mental health services for young people includes responding to

severe and complex problems and consultation liaison with other government and non-government

services in the field to assist them in keeping young people well.

Services for children aged 0-12 years in the Hastings Macleay and Coffs Harbour Clinical Networks are

provided by the MNCLHDs Community Health Services. When clinically required the MNCLHD Mental

Health Service does provide an initial clinical response to under 12s by way of triage and acute

assessment. The Mental Health Service then determines the best service response and makes referrals, as

appropriate.


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8.8 GENERAL PRACTITIONERS AND NORTH COAST PRIMARY HEALTH

NETWORK

The literature review found that integrating GPs into services for people with mental health

problems is critical to expanding and improving the quality of mental health care, and a number of

models are well-supported by evidence. In particular, access to mental health services in smaller

towns can be driven through general practices and contribute substantially in a rural area. At the

same time, better use of general practices in regional centres can reduce the exacerbation of

illness and acute presentations to Acute Care Services, thereby allowing more specialist time for

acute and crisis intervention.

Mild and, to some degree, moderate mental health problems are already managed in many general

practices, but few GPs are involved in the care of severely ill people who are not in an acute phase of

illness. Probably the best way to improve this involvement is through strongly supported shared-

care models, and enhancing general practice involvement should be an important focus for

remodelling the way we do business.

North Coast NSW Primary Health Network is a not-for-profit organisation and part of the

Commonwealth Government's health reform package. It was established through a partnership of

Hastings Macleay General Practice Network, Many Rivers Aboriginal Medical Services Alliance, Mid

North Coast Division of General Practice, North Coast GP Training, Northern Rivers General Practice

Network and Tweed Valley General Practice Network. Its purpose is to create strong links to local

communities, health professionals, service providers, consumers and patient groups and to respond

effectively to local health care needs. It is responsible for making it easier for patients and service

providers to navigate their way through the health care system. North Coast NSW Primary Health

Network is independent from the Local Health Districts which are responsible for hospitals and other

services. It works closely with both the Northern NSW Local Health District and the Mid North Coast

Local Health District in developing and linking services.

8.9 NON-GOVERNMENT ORGANISATIONS

Non-government organisations have a key role in the range of mental health services in any given

area, and the mental health field has a higher proportion of non-government sector involvement

compared with most other parts of the health industry. Some of these organisations specialise

exclusively in mental health service provision, and for others, mental health is a major part of

their stable of services. Non-government mental health services depend upon a system where

they can seek prompt assistance when their clients’ problems periodically move out of their range

of expertise. Without this ready responsiveness from Acute mental health services, the clinical

pathway is often disrupted and the experience of the service user is compromised.


62

On the Mid North Coast, non-government organisations provide specialist living support including:

housing assistance and support;

personal helpers and mentors;

recovery and resources services program;

support facilitation and care coordination;

supported accommodation;

community outreach;

Headspace services for people aged 12-24;

disability employment services; and

services to service users with the dual disabilities of intellectual and mental health disability.

Headspace (Coffs Harbour) offers early intervention service for 12-25 year olds. The service has 4 GPs and

4 psychologists (all P/T), 2 youth workers and 2 visiting psychiatrists. The service is already facing demand

management issues. A Headspace service opened in Port Macquarie in 2013.

Personal Helpers and Mentors (PHAMS) services assist people recovering from a mental illness episode to

build their confidence and overcome social isolation through a strength-based recovery program. These

services provide group work as well as individual support. The two services operating within the Mid

North Coast are:

Coffs Harbour Employment Support Service (CHESS) which operates from Yamba to Stuarts Point

and has approximately 70 people on its books at any one time; and

New Horizons (Hastings Macleay) which operates from Hat Head to Laurieton and has

approximately 60 people on its books at any one time.

8.10 ABORIGINAL MEDICAL SERVICES

Aboriginal medical services have both a general practice primary care role as well as a special interest

role as they generally employ specialist positions such as psychiatrists and mental well-being workers.

Their core business, of course, is looking after people in Aboriginal communities who have mental

illnesses and mental health problems, but they need to work in closely with specialist public sector

services for those times when illness becomes acute. Given the employment of Aboriginal mental

health workers in public sector services, such a partnership is best achieved through agreed models

of care and clinical pathways for this special population. There are also benefits in quality

improvement for both services, on the one hand, by building the clinical capacity of Aboriginal

organisations and, on the other, by improving the cultural sensitivity of public sector services.

Aboriginal Medical Services in NSW are a strong and effective intervention point for Aboriginal people

with a mental illness. Galambila AMS, for example, delivers an integrated primary mental health care

model that provides clinical interventions, community-based recovery orientated support, care co-

ordination, employment services, comprehensive physical health care and preventative health programs.

This delivery model is evidence-based, grounded in over 40 years of Aboriginal Medical Service modelling

and aligns with newer mainstream one-stop shop models like Headspace and Like Minds Pilot that is being

implemented and evaluated in New South Wales.


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8.11 PRIVATE SERVICES

The Baringa Private Hospital at Coffs Harbour has a 12 bed mental health facility, the Bindarray Clinic. All

patients are admitted on a voluntary basis to the clinic under the care of a Specialist Psychiatrist and

supported by a team including psychologists, nursing and allied health staff.

Advanced Personnel Management (APM) co-located two days per week at Coffs Harbour Mental Health

Service. This program was established in late 2012 and has already assisted 13 people to gain

employment.


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9 FUTURE ROLE OF PORT MACQUARIE

MENTAL HEALTH INPATIENT UNIT AND

FUNCTIONAL SPACE REQUIREMENTS

Over the next ten years to 2025, Mid North Coast LHD Mental Health services will continue to be

managed and networked on a district-wide basis. Such networking provides the critical mass to provide

for the full range of services of secondary level mental health services, both hospital Inpatient and

ambulatory community based services, and tertiary services such as the Non-Acute Rehabilitation

Inpatient Unit at Coffs Harbour Campus. Models of care are reviewed, clinical services are planned and

workforce strategies developed for the whole of the Mid North Coast by the LHD Mental Health Service.

Within the LHD, the Hastings Macleay and Coffs Harbour Clinical Networks will manage the provision of

hospital and ambulatory services for the catchment population served by these networks.

Section 9 describes the future role and functional space requirements of the Port Macquarie Mental

Health Inpatient Unit that will be required to deliver the projected level of services to the community

over the next five to ten years. The proposed role of the PMBH MHIPU would complement, and operate

in collaboration with, the new role of MNCLHD Mental Health Services and key service partners as

described in Section 8.

9.1 HASTINGS MACLEAY CLINICAL NETWORK

The analysis of current Inpatient capacity against population needs has indicated the need for additional,

purpose-built Inpatient capacity for mental health services in the Hastings Macleay Clinical Network. In

terms of the current available Inpatient bed capacity in Hastings Macleay, the CSP 2013 identified the

following needs, and these needs have been confirmed in the 2015 ADDENDUM:

There are only 12 Acute Adult beds for involuntary patients within the Network, and these beds

at Port Macquarie Base Hospital do not meet Health Facility Guidelines in relation to a number of

design aspects;

The ten beds at Kempsey District Hospital do not permit the admission of gazetted or involuntary

patients, requiring that such patients must be transferred to the Port Macquarie or Coffs Harbour

Acute Adult Inpatient Units;

These two Acute Adult Units are of sub-optimal size. The optimal size for an Acute Adult Unit for

efficiency of staffing and operation is 18-35 beds29;

29

Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0134 Adult Acute Mental Health

Inpatient Unit, Rev 5.0, 11 April 2012.


65

There are no designated Inpatient beds for Older Persons mental health care within the Mid

North Coast LHD; and

Access to the specialist child and adolescent beds located in Lismore is problematic due to the

distance and round trip of over nine hours for patients and their families. Reported obstacles

include the financial costs of travel and accommodation, missing paid work, and the difficulties

arranging alternative care arrangements for younger children.

There is clearly a need on the Mid North Coast to develop an improved range of options for the care of

people with more severe psychogeriatric disorders that result in behaviours that place either themselves

or others at risk, as well as for people with less severe psychogeriatric disorders including the frail elderly

who are not appropriate for admission to Acute Adult Units. The development of service options for

people with psychogeriatric disorders will involve collaboration across primary health, aged care and

mental health service sectors. The development of a designated mental health Inpatient Unit for Older

Persons on the Mid North Coast is justified on the basis of population demand.

9.2 PORT MACQUARIE MENTAL HEALTH INPATIENT UNIT

The current Acute PMBH Mental Health Inpatient Unit is of sub-optimal size at 12 beds and does not

meet key facility design guidelines for service; this non-compliance represents a current and future

clinical and corporate risk. As indicated above, the most efficient size is around 18-35 beds. The larger

sized unit provides a critical mass of service for both staffing and general operation. Given the existing

design issues and the identified service need for 24 beds at Port Macquarie Base Hospital, it is

appropriate to plan for a new purpose designed Acute Mental Health IPU containing a total of 24 beds at

Port Macquarie Base Hospital. Of the 24 beds, 12 will replace the existing 12-bed Adult Acute Unit,

resulting in a total of 12 new beds.

The new 24 bed IPU will be designed to allow beds to be used flexibly as ‘swing beds’ (beds that can

alternate between different types of care). As such, the proposed Inpatient Unit would contain 24 Acute

Adult beds with the capacity to support the admission of eight older persons and four younger persons.

Importantly, the design would comply with current Australasian Health Facility Guidelines30 including B-

0132 Child and Adolescent Mental Health Unit31, B-0134 Adult Acute Mental Health Inpatient Unit32

, and

B-0135 Older Persons Acute Mental Health Unit33 as well as NSW Health PD2010_033 Children and

30

NSW Ministry of Health. (2008). GL2008_017 Health Facility Guidelines: Australasian Health Facility Guidelines in NSW. NSW Health. 31

Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0132 Child and Adolescent Mental Health Unit, Rev 5.0, 11 May 2012. 32

Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0134 Adult Acute Mental Health Inpatient Unit, Rev 5.0, 11 April 2012. 33

Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0135 Older Persons Acute Mental Health Unit, Rev 1.0, 31 May 2012.


66

Adolescents – Safety and Security in NSW Acute Health Facilities34, and NSW Health PD2010_034 Children

and Adolescents – Guidelines for Care in Acute Care Settings35.

This Unit should be developed on the PMBH campus which has space for such a development. The Unit

would be designed as a gazetted unit to provide for involuntary patients. The function of the unit is to

provide, in a safe and therapeutic environment, appropriate facilities for the reception, assessment,

admission, diagnosis, observation, treatment and recovery of often acutely unwell consumers, presenting

with known or suspected psychiatric conditions and behavioural disorders. Consumers may be admitted

on a voluntary or involuntary basis.

Consumers may be agitated, aggressive and potentially a risk to themselves or others. Therefore the

environment should be conducive to the management of complex behaviours offering the capacity for

observation of consumers by staff, discreet security, and where necessary temporary containment.

However, this should be achieved with a therapeutic focus so that while necessary measures for safety

and security are in place, they are non-intrusive and do not convey a custodial ambience.

The recommended requirements for this unit include:

24 Acute Adult beds (four of which will be Observation beds) with the capacity to support the

admission of eight older persons and four younger persons (12-17 years of age), as required;

a seclusion room;

a contemporary mental health facility compliant with Australian Health Facility Guidelines; and

an ECT Service.

The proposed role and model of care for these functions are described in more detail below. (Table 1.2

also provides further detail regarding these recommendations).

9.2.1 Older Persons Beds

The population demographics of the Mid North Coast indicate that in 2026, 28 per cent of the population

will be aged over 65 years and 4 per cent will be aged over 85 years. There is an imperative to develop

greater capacity in both community based mental health services for older persons and specialist mental

health Inpatient services for older persons. At present there are no designated Specialist Mental Health

Services for Older Persons (SMHSOP) Inpatient beds in the Mid North Coast LHD.

34

NSW Ministry of Health. (2010). PD2010_033 Children and Adolescents – Safety and Security in NSW Acute Health Facilities. NSW Health. 35

NSW Ministry of Health. (2010). PD2010_034 Children and Adolescents – Guidelines for Care in Acute Care Settings. NSW Health.


67

There is a need to develop Inpatient facilities to provide for the growing population of older persons on

the Mid North Coast who will require treatment for acute psychogeriatric disorders. The MH-CCP

Planning Framework estimates a need for 14 Acute beds for Older Persons and 7 Non-Acute beds in 2015

for the Mid North Coast population, increasing to 19 Acute beds and 10 Non-Acute beds in 2025.

The activity data presented in Table 5.8 indicates that, in 2013/14, Mid North Coast older persons utilised

an average 10.4 beds (at 85 per cent occupancy) in Acute designated mental health beds, 0.8 Non-Acute

mental health beds and 3 beds in general hospital Inpatient beds for psychiatric diagnoses. There is a

population need for Older Persons beds in both Hastings Macleay and Coffs Clinical Networks.

Since CSP 2013 was prepared, PMBH has opened a 13 bed Geriatric Evaluation and Management (GEM)

Unit. This Sub-Acute unit provides care for older people with chronic conditions and co-morbidities

including dementia, delirium, behavioural difficulties as well as falls, incontinence and other medical

issues. On average around 25-30 per cent of admissions, or around 3-4 beds, are utilised by older people

with psychogeriatric conditions.

In the management of these conditions the GEM works closely with the PMBH Mental Health Inpatient

Unit who provide consultation liaison for these patients.

In the provision of Inpatient mental health services for older people, the current major service deficit is in

the provision of services for older people with acute psychiatric conditions, and for frail elderly with

mental health conditions. At present, these tend to be admitted to general medical wards or to the GEM

Unit, but neither of these wards are designed for this purpose and these patients are not suitable for

these wards. This situation will only exacerbate with the ageing of the population and the lack of

specialist mental health beds for Older Persons.

The CSP 2013 recommended the development of 8-10 beds in the Hastings Macleay Network. The option

of developing these at Kempsey District Hospital was considered but found to be inappropriate due to the

design and functional layout of the Inpatient facility at KDH.

It is now appropriate to include up to eight beds that have the capacity to manage older persons within

the proposed expansion of mental health beds at PMBH. It is proposed that two of the pods (eight beds)

be designed and purpose built as suitable and appropriate for the admission and treatment of Older

Persons (over the age of 65 years). The primary focus of such a service is restoring the health of older

persons with a psychiatric disorder to an optimal degree of mental function by addressing the patient’s

psychological, physical and social needs. The development of up to eight beds for Older Persons within

the proposed Inpatient Unit at PMBH will also enable the provision of ECT services for older people, a

significant deficit in the current model of care.

These eight beds would be designed to provide for the special needs of older people including space to

walk and be separate from the Adult Inpatients, but the design should be flexible to revert to adult use at

times of lower demand from older persons. There would also be a close collaboration with the GEM Unit

on site at PMBH, to best utilise the linkages with clinical services including Acute medical and aged care

services.

The role and function of a SMHSOP Acute Inpatient Unit including a description of target population,

interventions and service models and practice is provided in the SMHSOP Acute Inpatient Unit Model of


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Care Project Report36. This report explains that the Acute Inpatient Unit will be part of the continuum of

care that also includes mental health promotion, prevention and early intervention,

ambulatory/community services, Sub-Acute and Non-Acute Inpatient care and community residential

care.

The primary functions of the Acute Inpatient Unit include: assessment; clinical review and care planning;

management of acute risk; treatment focused on clinical symptom reduction with a reasonable

expectation of improvement in the short term; and transfer of care from the unit as soon as feasible.

Discharge to the usual place of residence is the primary goal of management, but transfer to an

alternative longer term facility such as an aged care facility, extended care, specialised residential aged

care facility, or Inpatient Unit, may be required.

These units should be able to manage both voluntary and involuntary patients under the Mental Health

Act.

The NSW SMHSOP Service Plan37 defines the SMHSOP target population as older people (65 years and over) who:

develop, or are at high risk of developing, a mental health disorder at the age of 65 years and over, such as depression, acute psychosis, anxiety, late onset schizophrenia or a severe adjustment disorder;

have had a lifelong or recurring mental illness, and now experience age-related problems causing significant functional disability (i.e. become ‘functionally old’);

have had a prior mental health problem but have not seen a specialist mental health service for at least five years and now have a recurrence of their illness or disorder that can be optimally managed by SMHSOP; and

present with severe behavioural or psychiatric symptoms associated with dementia (BPSD) or other long-standing organic brain disorder and would be optimally managed with input from SMHSOP. This may include people who are deemed at risk of harm to themselves or to others.

In National Older Person Mental Health Benchmarking Forums the average length of stay in 2006/07 was

45 days.

In terms of ideal size, smaller clusters are more appropriate for older persons mental health units, as

older persons are more prone to confusion, particularly in the case of patients with moderate dementia.

Accordingly units of between 8-12 beds are recommended38. Larger facilities may be more confusing for

older consumers and high quality care is easier to provide in small groups. Groups of eight beds have

been found to be sufficiently small for the care of mobile, confused and disturbed older people.

36

Ministry of Health (2012) SMHSOP Acute Inpatient Unit Model of Care Project Report. 37

Ministry of Health (2006) Specialist Mental Health Services for Older People (SMHSOP) - NSW Service Plan - 2005-2015. 38

Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0135 Older Persons Acute Mental

Health Unit, Rev 1.0, 31 May 2012.


69

The Acute Inpatient Unit Project Report makes it clear that, in order to provide basic services for optimal

treatment, new SMHSOP AIUs need to develop effective partnerships with a range of other services,

particularly SMHSOP community teams, aged care services and adult mental health services. Functional

relationships with SMHSOP community teams are fundamental and the Acute Inpatient Unit and its

models of care must support integrated service provision across Inpatient, community and residential

settings.

The proposed development of a 24 bed Acute Adult Inpatient Unit, with the capacity to facilitate and

support the admission of older persons, will require the recruitment of a Psycho-Geriatrician to provide

clinical care at this Unit and to provide leadership for the provision of older persons mental health

services in the MNCLHD including outreach services to the other major hospital facilities and community

health services.

9.2.2 Adult Acute Inpatient Beds

The proposed expansion of Acute mental health beds at PMBH will provide the capacity for the PMBH

Mental Health Inpatient Unit to be self-sufficient in the provision of Acute Adult Inpatient Services and

remove the current necessity to utilise beds for Hastings-Port Macquarie residents at the Kempsey

Mental Health Inpatient Unit.

9.2.3 Observation Beds

A pod of four beds would be designed as Observation beds. These beds would be purpose-designed to

provide the capacity for observation and management of the more unwell patients in a secure

environment.

9.2.4 Services for Younger Persons

Core business in the provision of mental health services for children, adolescents and youth is prevention

and early intervention for children and young people who may be having their first experience of a

mental health problem. There is greater recognition of the need to provide earlier detection of psychosis

in young people and to provide early intervention services including information, assessment and

treatment. The aim as much as possible is to provide services in an ambulatory care environment away

from the acute hospital environment which can be a confronting environment for young people

experiencing a first episode of mental illness.

The priority for MNCLHD Mental Health Service in Hastings Macleay is to develop a community mental

health service hub with a predominant focus on youth mental health services at Ellimatta Lodge in Port

Macquarie. There is an opportunity to develop the site as a location for the provision of day programs,

outpatient clinics and the co-location of NGO service partners. A program of refurbishment works to

facilitate this change has commenced.

For children and young people having their first experience of more acute mental health symptoms, there

is a need for early effective response including acute crisis and intensive family therapy. At present

tertiary Inpatient services for children and adolescents living in the Mid North Coast is provided at the

CAMHS Inpatient Unit at Lismore Base Hospital. The activity data presented in Table 5.6a indicates that,


70

on average, children and adolescents from the Mid North Coast are utilising three beds out of the eight

beds in this unit.

The current demand is in line with the MH-CCP (2010) estimated need for three beds for the 12-17 years

population of the Mid North Coast (refer Table 7.1).

The feedback from staff consultations in the process of developing the ADDENDUM was that the most

significant current issue for staff was the ability to respond effectively to the first episode of acute

psychosis or suicidal intentions. As there are no designated Child and Adolescent Mental Health Inpatient

Unit in the Mid North Coast, young people in crisis who present in the ED at PMBH are occasionally

admitted to a single-bed room in the Paediatric Unit for an initial period. This option is not always

available or suitable for some patients.

In the provision of treatment and intensive family therapy, access to the CAMHS unit in Lismore (or

occasionally the Nexus Unit in Newcastle) is sought however a bed may not be available at short notice.

Additionally, staff report that in some cases young people and families opt not to seek treatment located

so far from Port Macquarie. Reported barriers include the financial costs of travel and accommodation,

missing paid work, and the difficulties arranging alternative care arrangements for younger children.

The development of an Inpatient Service that would improve the management of younger persons needs

within the Mid North Coast would be in keeping with the NSW Rural Health Plan Towards 202139. For

instance, one goal of the Plan’s strategic direction for healthy rural communities entails improving and

enhancing the quality of, and access to, child and youth mental health services. Further the strategic

direction of access to high quality care for rural populations states “people living in rural communities

should be able to access high quality health care as close to home as possible”. The benefits of such

access would include the following: less travel time and associated costs for the families of the young

person hospitalised; the greater involvement of families in therapy and treatment could be achieved; the

younger person would remain nearer their usual supports including friends and extended family; there

would be easier follow-up and transfer of care to community mental health services; and importantly

acute crisis and intensive family therapy, which are critical crisis interventions for the first episode of

acute psychosis or suicidal intentions, could be commenced both locally and promptly.

The key principles of Policy Directive PD2011_016 Children and Adolescents with Mental Health Problems

Requiring Inpatient Care40 have guided the planning for younger persons’ services. For instance, Inpatient

care must be (1) the least restrictive alternative and must consider the safety of younger persons and that

of others, (2) the closest available to home and usual supports wherever possible, especially for younger

children and Aboriginal families, and (3) the most developmentally and clinically appropriate care given

available resources. The emotional impact of Inpatient treatment on both the younger person and their

parents should also be recognised as well as the need for parents to remain close by their young child or

adolescent for the duration of Inpatient treatment.

39

NSW Ministry of Health. (2014). NSW Rural Health Plan: Towards 2021. NSW Health. 40

NSW Ministry of Health. (2011). PD2011_016 Children and Adolescents with Mental Health Problems Requiring Inpatient Care. NSW Health.


71

In reviewing Inpatient requirements for younger persons, two options have been considered.

One option is to develop a designated Younger Persons Inpatient Unit at PMBH. A pod of four beds would

be designed as Child Adolescent and Youth beds. The design of such a four-bed pod would be important

and separation from the Adult Inpatient beds would be required to conform with Ministry of Health

Facility Guidelines for the hospitalisation of children.

The development of such a unit would require the recruitment of a Child and Adolescent Psychiatrist and

a registrar. This position would also provide valuable support and leadership to the Community Child and

Youth Mental Health teams.

The major difficulty associated with this option is the feasibility and cost effectiveness of establishing a

four bed unit which would be expensive to manage and there would be difficulties in attracting a Child

and Adolescent Psychiatrist given the nationwide shortage in supply of these. A four-bed unit is not a

sufficient critical mass in terms of the size of the unit to support adequate rostering of specialist staff and

there are no units of this size currently operating in NSW.

The alternative and preferred option is to utilise four of the 24 Adult Acute beds flexibly in one pod as

‘swing beds’ for the short term management of younger persons. This would enable the urgent admission

of young people enabling crisis interventions to be commenced locally and decisions to be made

concerning options for ongoing acute treatment. Employing this option would mean maintaining the

current provision of tertiary Inpatient care at other supra-district facilities such as the Lismore Base

Hospital CAMHS unit for Mid North Coast residents. The practice of admitting appropriate younger

persons with mental health issues to the PMBH Paediatric Unit would also be continued. This Unit

provides an effective option for admission of younger people with mental health issues such as

depression and eating disorders (the primary mental health diagnoses for children under the age of 16

years). These admissions are managed collaboratively with Consultation Liaison provided through the

PMBH Mental Health Inpatient Unit staff.

Importantly, the design for the proposed flexible-use four-bed pod would need to comply with current

Australasian Health Facility Guidelines41 including B-0132 Child and Adolescent Mental Health Unit42 and

PD2010_033 Children and Adolescents – Safety and Security in NSW Acute Health Facilities43. In terms of

bed numbers, the MH-CCP (2010) estimates indicate the need for three beds for 12-17 year olds (see

Table 7.1). Given, however, considerations around design practicalities and nursing to patient ratios, as

per NHPPD, the MNCLHD submits four of the 24 beds be built to allow for their flexible use as younger

persons beds.

Seclusion Room

At present the PMBH Mental Health Inpatient Unit has a seclusion room with low stimuli for patients in

agitated state. The need for one seclusion room would remain in the expanded unit.

41

NSW Ministry of Health. (2008). GL2008_017 Health Facility Guidelines: Australasian Health Facility Guidelines in NSW. NSW

Health. 42

Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0132 Child and Adolescent Mental Health Unit, Rev 5.0, 11 May 2012. 43

NSW Ministry of Health. (2010). PD2010_033 Children and Adolescents – Safety and Security in NSW Acute Health Facilities.

NSW Health.


72

9.2.5 ECT Suite

The lack of ECT at PMBH was identified as a deficit in the CSP (2013). The development of an expanded

Mental Health Inpatient Unit provides the opportunity to reintroduce the provision of electroconvulsive

therapy (ECT) at PMBH. Timely provision of ECT for patients such as those with psychotic depression will

improve patient outcomes and reduce length of stay. The provision of an ECT Service at PMBH will be in

accordance with PD2100_003 Electroconvulsive Therapy: ECT Minimum Standard of Practice in NSW44 and

require appropriate fittings, fixtures and equipment. It is expected the service will utilise PMBH operating

theatres and perioperative facilities which will necessitate a clear Service Agreement with PMBH.

44

NSW Ministry of Health. (2011). PD2011_003 Electroconvulsive Therapy: ECT Minimum Standard of Practice in NSW. NSW Health.


73

10 REFERENCES

Australian Bureau of Statistics. (2011). Community Profiles (Census 2011). Available from http://www.abs.gov.au/websitedbs/censushome.nsf/home/communityprofiles Australian Bureau of Statistics. (2011). Estimated resident populations (Census 2001 and 2006) (HOIST). Australian Bureau of Statistics. (2011). 2033.0.55.001 Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA). Australia, 2011. Available from http://www.abs.gov.au/ausstats/[email protected]/mf/2033.0.55.001/ Australian Bureau of Statistics. (2011). 3238.0.55.001 - Estimates of Aboriginal and Torres Strait Islander Australians, June 2011. Available from http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3238.0.55.001June%202011?OpenDocument Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0132 Child and Adolescent Mental Health Unit, Rev 5.0, 11 May 2012. Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0134 Adult Acute Mental Health Inpatient Unit, Rev 5.0, 11 April 2012. Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0135 Older Persons Acute Mental Health Unit, Rev 1.0, 31 May 2012. Centre for Epidemiology and Evidence, NSW Ministry of Health. Health Statistics New South Wales, http://www.healthstats.nsw.gov.au Commonwealth of Australia. (2008). National Mental Health Policy. Available from http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-pol08 Commonwealth of Australia. (2009). Fourth National Mental Health Plan – An agenda for collaborative action in mental health 2009-2014. Available from https://www.health.gov.au/internet/main/publishing.nsf/Content/9A5A0E8BDFC55D3BCA257BF0001C1B1C/$File/plan09v2.pdf Commonwealth of Australia. (2014). Report of the National Review of Mental Health Programmes and Services, National Mental Health Commission. Available from http://www.mentalhealthcommission.gov.au/our-reports/review-of-mental-health-programmes-and-services.aspx Commonwealth of Australia. (2014). Fact Sheet 2 – What this means to Aboriginal and Torres Strait Islander people. Report of the National Review of Mental Health Programmes and Services, Summary. National Mental Health Commission. Gee. G., Dudgeon P., Schults C., Hart A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. In Dudgeon, P., Milroy, H., & Walker, R. (eds.). Working Together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. (2nd ed.). In Australian Institute

http://www.abs.gov.au/websitedbs/censushome.nsf/home/communityprofiles

http://www.abs.gov.au/ausstats/[email protected]/mf/2033.0.55.001/

http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3238.0.55.001June%202011?OpenDocument

http://www.healthstats.nsw.gov.au/

http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-pol08

https://www.health.gov.au/internet/main/publishing.nsf/Content/9A5A0E8BDFC55D3BCA257BF0001C1B1C/$File/plan09v2.pdf

https://www.health.gov.au/internet/main/publishing.nsf/Content/9A5A0E8BDFC55D3BCA257BF0001C1B1C/$File/plan09v2.pdf

http://www.mentalhealthcommission.gov.au/our-reports/review-of-mental-health-programmes-and-services.aspx

http://www.mentalhealthcommission.gov.au/our-reports/review-of-mental-health-programmes-and-services.aspx


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of Health and Welfare. (2014). Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people, Issues paper no. 12, Closing the Gap Clearinghouse. Canberra: Australian Government. Mental Health and Drug & Alcohol Office, NSW. (2001). Mental Health Clinical Care and Prevention Model Version 1.11 a population mental health model. Ministry of Health. (2012). Mental Health Clinical Care and Prevention Model (draft version), 2010. Mental Health and Drug & Alcohol Office, NSW (2001) Mental Health Clinical Care and Prevention Model Version 1.11 a population mental health model; Ministry of Health (2012) Mental Health Clinical Care and Prevention Model, 2010. MHDAO. (2012). MH-CCP 2010. Available from http://www.health.nsw.gov.au/mhdao/Pages/pe-mhccp.aspx Ministry of Health. (2012). Specialist Mental Health Services for Older People (SMHSOP) Acute Inpatient Unit Model of Care Project Report. Available from http://www.health.nsw.gov.au/mhdao/publications/Publications/smhsop_aiu_moc.pdf Ministry of Health. (2006). Specialist Mental Health Services for Older People (SMHSOP) -NSW Service Plan - 2005-2015. Available from http://www0.health.nsw.gov.au/policies/gl/2006/GL2006_013.html Ministry of Health. (2012). Mental Health Clinical Care and Prevention Model, 2010. Available from http://www.health.nsw.gov.au/mhdao/Pages/pe-mhccp.aspx National Aboriginal and Torres Strait Islander Health Council and National Mental Health Working Group. (2004). National strategic framework for Aboriginal and Torres Strait Islander peoples' mental health and social emotional wellbeing (2004-2009). Canberra: Australian Government. NSW Mental Health Commission. (2014). A Strategic Plan for Mental health in NSW 2014-2024. Sydney, NSW Mental Health Commission. NSW Mental Health Commission. (2014). Living Well: Putting people at the centre of mental health reform in NSW. Sydney, NSW Mental Health Commission. NSW Department of Health, Population Health Division. (2008). The health of the people of New South Wales - Report of the Chief Health Officer 2008. Sydney: NSW Department of Health. NSW Ministry of Health. (2008). GL2008_017 Health Facility Guidelines: Australasian Health Facility Guidelines in NSW. NSW Health. NSW Ministry of Health. (2010). PD2010_033 Children and Adolescents – Safety and Security in NSW Acute Health Facilities. NSW Health. NSW Ministry of Health. (2010). PD2010_034 Children and Adolescents – Guidelines for Care in Acute Care Settings. NSW Health. NSW Ministry of Health. (2011). NSW Child and Adolescent Mental Health Services (CAMHS) Competency Framework. NSW Health.

http://www.health.nsw.gov.au/mhdao/Pages/pe-mhccp.aspx


http://www.health.nsw.gov.au/mhdao/publications/Publications/smhsop_aiu_moc.pdf

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NSW Ministry of Health. (2011). PD2011_016 Children and Adolescents with Mental Health Problems Requiring Inpatient Care. NSW Health. NSW Ministry of Health. (2011). PD2011_003 Electroconvulsive Therapy: ECT Minimum Standard of Practice in NSW. NSW Health. NSW Ministry of Health. (2014). NSW Rural Health Plan: Towards 2021. NSW Health. NSW State and Local Government Area Population Projections. (2014).Final. Pilbeam V, Ridout L, Rich J, Perkins D. (2014). Rural mental health service delivery models: a literature review. Report prepared for Mid North Coast Local Health District. Centre for Rural and Remote Mental Health.


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11 APPENDIX


77

11.1 APPENDIX 1

Consultation Profile - Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015

Extensive consultation occurred during the development of the Mid North Coast Mental Health Clinical

Services Plan 2013-2021, including Planning Workshops held in October 2012 with input sought from key

stakeholders comprising service providers, NGOs and Commonwealth funded services, consumers and

carers, and MNCLHD Mental Health Staff. A draft of the plan was also sent to 170 organisations and

individuals, from both the Mid North Coast and further afield, for comment.

With respect to the Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015, small group

consultations were held from April – June, 2015. As shown in Tables 1- 6 (below) the groups invited to

participate reflect the Addendum’s specific interest in the service directions and capacity requirements

for the mental health inpatient services at Port Macquarie Base Hospital over the next five to ten years.

Table 1 Small Group Consultation: Acute Adults

Invitees Designation

Dean Bilton NUM, PMQ In-patient Unit

Anitta Kocijan Social Worker Mental Health

Trish Hunter MH Nurse

Dr Tim Amor Staff Specialist Mental Health

Ian Dennis Manager, PM Community Mental Health

Nick Bannon A/NUM KDH In-patient Unit

Matt Eldridge Manager, Kempsey Community Mental Health

Table 2 Small Group Consultation: Younger Persons


Derek Moore Service Development Coordinator- Child and Family

Ruth Reynolds CAMHS- CL Nurse

Darryl Ford MH RN

Ute Morris Clinical Psychologist





Tayt Rosenbaum Occupational Therapist - Youth Mental Health


78

Table 3 Small Group Consultation: Older Persons


Judy O'Mara Service Development Coordinator Operations and Planning



Diana Lentz Older Persons Mental Health Worker



Table 4 Small Group Consultation: Integrated Care / Community, Carers, Consumers




Judy O'Mara Services Development Coordinator Operations and Planning

Darcy Budden Rural Adversity Mental Health Coordinator

Ian Dennis Manager, Port Macquarie Community Mental Health

Crystal Davis PMBH Aboriginal Mental Health Worker

Natalie Scaysbrook PMBH Mental Health Rehabilitation Coordinator

Dave Bobongie KDH Aboriginal Mental Health Worker

Elizabeth Ingram Community member

Mike Daley Community member

Wendy Beck Community member


Table 5 Small Group Consultation: PMBH and MH Executive


John Leary Director, Mental Health and Drug & Alcohol Services

Dr Robert Pegram PMBH GM & HMCN Coordinator

Vicki Simpson PMBH DON

Barry Hunter Manager, Mental Health Service

Karen Allen (Darrin Cowan) Manager, Nursing & Service Development

Colin Bisco Capital Works Project Manager

Table 6 Individual Consultations with Clinicians unable to attend the Small Group Sessions

Attendees Designation

Dr Andy Hughes Clinical Director, Mental Health Hastings Macleay, Psychiatrist

Dr David McDonald Paediatrician Staff Specialist

Dr Matt Kinchington Head of Medicine, PMBH; VMO Geriatrition

Dr Meredith Hinds Psychiatrist


79

11.2 APPENDIX 2


80


81


82


83

11.3 APPENDIX 3

Mid North Coast LHD Estimated Needs Met using MH-CCP 2010, July 2015

Draft

NSW MH-

CCP 2010

Estimate

s

Draft

NSW MH-

CCP 2010

Estimate

s

Draft

NSW MH-

CCP 2010

Estimate

s

Actual

Funded

beds

Projecte

d Funded

beds

Projecte

d funded

beds Variance Variance Variance

% NSW

MH-CCP

2010

Estimate

d Need

Met

% NSW

MH-CCP

2010

Estimate

d Need

Met

% NSW

MH-CCP

2010

Estimate

d Need

Met

Age Category Details 2015 2020 2025 2015 2020 2025 2015 2020 2025 2015 2020 2025

A B C D E F G H I = F - C J = G - D K= H - E L = F / C %M = G / D %N = H / E %

All Ages 1. Population 214,359 223,932 232,728 214,359 223,932 232,728 214,359 223,932 232,728 214,359 223,932 232,728

All Ages 3. Beds 91 96 101 72 72 72 -19 -24 -29 79% 75% 71%

All Ages A Acute IP Beds 54 56 58 52 52 52 -2 -4 -6 97% 93% 89%

All Ages B Non-Acute IP Beds 16 17 18 20 20 20 4 3 2 125% 117% 108%

All Ages C VLS beds 22 23 24 0 0 0 -22 -23 -24 0% 0% 0%

All Ages Sub Acute beds Not estimated under NSW MH-CCP 2010N/A N/A N/A N/A N/A N/A N/A N/A N/A

65+ 1. Population 48,703 56,182 64,292 48,703 56,182 64,292 48,703 56,182 64,292 48,703 56,182 64,292

65+ 3. Beds 28 32 36 0 0 0 -28 -32 -36 0% 0% 0%

65+ A Acute IP Beds 14 16 19 0 0 0 -14 -16 -19 0% 0% 0%

65+ B Non-Acute IP Beds 7 9 10 0 0 0 -7 -9 -10 0% 0% 0%

65+ C VLS beds 6 7 8 0 0 0 -6 -7 -8 0% 0% 0%

65+ Sub Acute beds Not estimated under NSW MH-CCP 2010N/A N/A N/A N/A N/A N/A N/A N/A N/A

18-64 1. Population 118,731 119,810 119,414 118,731 119,810 119,414 118,731 119,810 119,414 118,731 119,810 119,414

18-64 3. Beds 59 60 59 72 72 72 13 12 13 122% 121% 121%

18-64 A Acute IP Beds 37 37 37 52 52 52 15 15 15 142% 140% 141%

18-64 B Non-Acute IP Beds 6 6 6 20 20 20 14 14 14 314% 311% 312%

18-64 C VLS beds 16 16 16 0 0 0 -16 -16 -16 0% 0% 0%

18-64 Sub Acute beds Not estimated under NSW MH-CCP 2010N/A N/A N/A N/A N/A N/A N/A N/A N/A

0-17 1. Population 46,924 47,940 49,022 46,924 47,940 49,022 46,924 47,940 49,022 46,924 47,940 49,022

0-17 3. Beds 5 5 5 0 0 0 -5 -5 -5 0% 0% 0%

0-17 A Acute IP Beds 3 3 3 0 0 0 -3 -3 -3 0% 0% 0%

0-17 B Non-Acute IP Beds 2 2 2 0 0 0 -2 -2 -2 0% 0% 0%

Analysis:

1 The LHD have an adequate supply of Adult Acute beds at the 80% level or higher, for their population through to 2025

2 The LHD have an adequate supply of Adult Non Acute beds for their population through to 2025

3 The LHD does not have any Very Long Stay (VLS) beds. (Note; The Draft National Mental Health Service Planning Framework (NMHSPF) models only

for Acute, Sub Acute and Non Acute beds)

4 The 42 HASI Places within the Mid North Coast LHD offset to some extent the lack of VLS beds wihin the LHD.

5 The LHD does not have any Older Persons 65+ beds of any description, (Acute, Non Acute or Very Long Stay).

6

7 Source File: MH-CCP 2010 Calculator v2.05b Sept 2014_PopulationUpdateFinYr_HP.xlsx.

8

Key:

Less than 60% of draft NSW MH-CCP 2010 estimated need met

60% to 79 % of draft NSW MH-CCP 2010 estimated need met

80% to 100% of draft NSW MH-CCP 2010 estimated need met

Greater than 100% of draft NSW MH-CCP 2010 estimated need met

For MH-CCP 2010 purposes Sub Acute MH beds are counted as Non Acute MH beds.

Population Source - Department of Planning and Environment 2014 population series



mid north coast mental health clinical services...

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