Using National Mental Health Service Planning Framework (NMHSPF) to guide

service development

Presented at Sharing learnings from early implementation of stepped care:

A PHN collaborative workshop

Kevin Fjeldsoe School of Public Health, The University of Queensland

What does the NMHSPF actually provide ? • A well organised, contemporary, integrated structure to support service analysis

– What would a decent mental health service for this population look like – What types of services need to be in place

• A series of reports which provide estimates of the quantum of each of the service

types which need to be provided to a defined population

– Which bits am I responsible for – How much is required, how much should it cost, what types and numbers of staff are

required to deliver it – How do the bits that I’m responsible for relate to other parts of the service system ? Are there

likely to be interdependencies

• Information which can be used to – Identify priorities for service development – Inform the development of strategic and operational plans

What the NMHSPF will not provide ? • An analysis of the local sociodemographic characteristics and the impact these might

have on the need for services • Service modelling for populations with special needs • A measure of the impact of geographic location • An understanding of the local capacity to recruit and retain staff or the economies of

scale associated delivering services to particular population groups • The unique history and expressed needs of a population • The current level of integration and co-ordination of services • An analysis of the current utilisation and capacity of services • The impact of services expressed as expected, measurable outcomes. The

NMHSPF considers inputs and outputs.

The outputs from the NMHSPF need to be considered in this context.

A worked example. A partnership between a PHN and local public sector mental health services

• Public Sector Ambulatory MHS

• Public and Private MH beds

• General Practitioner MBS MHS

• Structured Psychological Services

• Mental Health Nurses in Primary Care

• Community Support Sector Services

Public Sector Ambulatory MHS NMHSPF projected demand for public sector ambulatory mental health services, workforce FTEs 2021

Child and

Youth Early

Intervention Consultation

Liaison

Adult Continuing Care and

MITT

Acute Care Services

Early Psychosis

Older Persons

Total

LHN 1 35 4 9 69 25 5 16 163

LGA 1 2 0 1 4 1 0 1 10

LGA 2 5 1 1 11 4 1 1 24

LGA 3 10 1 2 20 7 1 4 46

LGA 4 17 2 5 34 12 2 10 83

LGA 5 0 0 0 0 0 0 0 1

LHN 2 30 4 10 63 24 4 24 158

LGA 1 14 2 5 30 12 2 12 77

LGA 2 13 2 4 27 10 2 11 69

LGA 3 1 0 0 3 1 0 1 7

LGA 4 1 0 0 2 1 0 1 5

LHN 3 54 7 17 114 43 8 40 283

LGA 1 47 6 15 101 38 7 35 249

LGA 2 7 1 2 14 5 1 5 34

Public sector ambulatory mental health services, workforce FTEs 2015

Child and Youth

Early Intervention

Consultation Liaison

Adult Continuing

Care and MITT

Acute Care Services

Early Psychosis

Older Persons

Total % of

Target

LHN 1 31 - 1 53 11 - 4 101 62%

LGA 1 1 - - 3 - - - 4 41%

LGA 2 2 - - 4 - - - 6 27%

LGA 3 4 - - 16 - - - 20 45% LGA 4 24 - 1 30 11 - 4 70 85% LGA 5 - - - - - - - 0%

LHN 2 22 - 2 39 19 - 4 86 54%

LGA 1 10 - 1 18 9 - 2 40 52% LGA 2 10 - 1 16 9 - 2 38 55% LGA 3 2 - - 5 1 - - 8 119% LGA 4 - - - - - - - -

LHN 3 56 - 4 81 41 - 14 197 69%

LGA 1 50 - 4 72 38 - 11 175 70%

LGA 2 6 - - 9 3 - 3 22 64%

QLD 399 - 62 1,009 419 27 111 2,027 61%

Public and Private MH beds NMHSPF projected demand for public and private beds 2021 Perinatal and

Infant Mental Health

Acute - Child & Youth

Acute Adult Acute - Older

Adult Step Up/ Step

Down Sub-Acute

Older Adult Non-Acute - Older Adult

Secure Extended care

Community Care Unit

Private Acute Beds

LHN 1 2 4 29 6 5 5 12 9 36 15

LGA 1 0 0 2 0 0 0 1 1 2 1

LGA 2 0 0 5 0 1 0 1 1 5 2

LGA 3 0 1 8 1 2 1 3 2 10 4

LGA 4 1 2 14 4 3 3 7 5 18 7

LGA 5 0 0 0 0 0 0 0 0 0 0

LHN 2 1 3 27 8 5 7 18 9 36 14

LGA 1 1 1 13 4 2 3 9 4 18 7

LGA 2 1 1 12 4 2 3 8 4 16 6

LGA 3 0 0 1 0 0 0 1 0 2 1

LGA 4 0 0 1 0 0 0 0 0 1 0

LHN 3 3 6 49 14 9 11 29 16 65 25

LGA 1 2 5 43 12 8 10 26 14 57 22

LGA 2 0 1 6 2 1 1 3 2 8 3

PHN 6 12 105 28 19 23 59 34 137 54

QLD 32 68 589 132 104 109 280 188 752

Public and private available beds 2015

Perinatal and Infant Mental

Health

Acute - Child & Youth

Acute Adult Acute - Older

Adult Step Up/ Step

Down Sub-Acute

Older Adult Non-Acute - Older Adult

Secure Extended Care

Community Care Unit

Private Acute Beds

LHN 1 - - 23 8 - - 2 - 20 15

LGA 1 - - - - - - - - - -

LGA 2 - - - - - - - - - -

LGA 3 - - - - - - - - - -

LGA 4 - - - - - - - - - -

LGA 5 - - - - - - - - - -

LHN 2 - - 26 - - - - - 20 -

LGA 1 - - 14 - - - - - - -

LGA 2 - - 12 - - - - - - -

LGA 3 - - - - - - - - - -

LGA 4 - - - - - - - - - -

LHN 3 - 6 45 12 - - 9 - 43 51

LGA 1 - - - - - - - - - -

LGA 2 - - - - - - - - - -

PHN 0 6 94 20 0 0 11 0 83 66

% of NMHSPF Target 0% 50% 90% 72% 0% 0% 19% 0% 60% 120%

QLD 0 74 672 59 34 16 122 114 339 511

% of NMHSPF Target 0% 109% 114% 45% 33% 15% 44% 61% 45%

General Practitioner MBS MHS NMHSPF projected demand for GP physical health services, occasions of service and workforce FTE costs ($M) 2021

Brief Physical Assessment

Comprehensive Physical Assessment

General Physical Health Monitoring & Ongoing Management

Workforce FTE cost $M

LHN 1 1,764 7,518 45,876 $4.41

LGA 1 97 441 2,722 $0.26 LGA 2 181 1,060 6,790 $0.64 LGA 3 419 2,021 12,647 $1.21 LGA 4 1,064 3,972 23,557 $2.28 LGA 5 3 24 161 $0.02

LHN 2 2,417 8,022 45,909 $4.49

LGA 1 1,179 3,901 22,300 $2.18 LGA 2 1,060 3,513 20,109 $1.97 LGA 3 112 354 1,996 $0.20 LGA 4 66 254 1,504 $0.15

LHN 3 4,056 14,143 82,102 $8.00

LGA 1 3,585 12,473 72,352 $7.06 LGA 2 472 1,670 9,750 $0.95

PHN Total 7,995 27,358 158,392 $15.47

Actual GP MBS mental health specific services by location of patient address, 2014/2015

Populations Patients per

1000 Services per 1000 Fees Charged $

Fees Charged $ per capita

LHN 1 56.9 85.9 $ 1,784,544 $ 7.59

LGA 1 49.3 75.9 $ 101,534 $ 6.54

LGA 2 38.7 55.7 $ 180,149 $ 5.29

LGA 3 52.8 81.3 $ 432,714 $ 7.00

LGA 4 65.1 98.0 $ 1,064,218 $ 8.67

LGA 5 42.4 61.1 $ 5,929 $ 5.80

LHN 2 66.5 110.6 $ 2,156,265 $ 9.32

LGA 1 74.1 117.8 $ 1,094,452 $ 9.91

LGA 2 60.7 107.1 $ 993,178 $ 9.02

LGA 3 47.4 72.9 $ 68,635 $ 6.27

LHN 3 84.4 147.0 $ 5,055,627 $ 12.37

LGA 1 86.4 152.5 $ 4,567,176 $ 12.77

LGA 2 70.6 108.5 $ 488,451 $ 9.53

PHN 77.4 129.5 $ 8,996,436 $ 11.00

Queensland 71.4 123.2 $ 51,721,525 $ 10.76

Australia 71.6 124.9 $ 254,841,379 $ 10.92

Structured Psychological Services NMHSPF estimated demand for structured psychological therapy occasions of service 2021

Clinician Led Web-based Psychological Interventions

SPT - Low Intensity Intervention - Individual

SPT high intensity - Individual, Group and Family

Number Rate per 1,000 Number Rate per 1,000 Number Rate per

1,000

LHN 1 76,350 325 38,145 162 121,377 516

LGA 1 4,591 296 2,291 148 7,300 470

LGA 2 11,977 352 5,955 175 18,092 531

LGA 3 21,604 350 10,722 174 33,861 548

LGA 4 37,886 309 19,037 155 61,638 502

LGA 5 293 287 140 137 486 476

LHN 2 71,002 307 36,154 156 118,864 514

LGA 1 34,442 312 17,546 159 57,687 522

LGA 2 33,527 305 17,055 155 56,079 509

LGA 3 3,032 277 1,554 142 5,097 466

LHN 3 129,178 316 65,477 160 212,514 520

LGA 1 113,755 318 57,681 161 186,940 523

LGA 2 15,423 301 7,796 152 25,574 499

PHN 276,530 316 139,776 160 452,755 517

Estimated structured psychological therapy, occasions of service 2014/2015 and 2015/2016

MBS (2014-15) ATAPS (2015-16) Headspace (2015-16) Total Funding

Number Per 1,000 pop Number Per 1,000

pop Number Per 1,000 pop Number Per 1,000

pop

LHN 1 28,376 120.7 4,127 17.6 1,099 4.7 33,602 142.9

LGA 1 1,401 90.2 211 13.6 - 0.00 1,612 103.8

LGA 2 1,824 53.6 1,166 34.3 - 0.00 2,990 87.8

LGA 3 5,973 96.7 1,128 18.3 - 0.00 7,101 114.9

LGA 4 19,117 155.7 1,614 13.2 1,099 12.3 21,830 177.8

LGA 5 61 59.7 8 7.8 - 0.00 69 67.6

LHN 2 36,492 157.7 3,939 17.0 1,459 6.3 41,890 181.0

LGA 1 18,521 167.7 2,738 24.8 1,459 19.8 22,718 205.7

LGA 2 16,766 152.3 1,137 10.3 - 0.00 17,903 162.6

LGA 3 1,205 110.2 64 5.9 - 0.00 1,269 116.0

LHN 3 99,831 244.2 9,527 23.3 1,433 3.5 110,791 271.0

LGA 1 91,171 255.0 7,675 21.5 1,433 11.8 100,279 280.4

LGA 2 8,660 169.0 1,852 36.1 - 0.00 10,512 205.1

PHN Total 164,698 201.4 17,493 21.4 3,991 4.9 186,182 227.7

Queensland 909,673 189.3 80,877 16.8 n/a - - -

Australia 4,515,284 193.5 384,160 16.5 117,122 5.0 5,016,566 215.0

Mental Health Nurses in Primary Care NMHSPF estimated demand for mental health practice nurses, workforce FTE 2021

Centre Based Monitoring & Management

Physical Health Monitoring & Management

Home Based Monitoring & Management

Monitoring & Management

Total

LHN 1 0.1 0.1 2.0 3.8 6.0

LGA 1 0.0 0.0 0.1 0.2 0.4

LGA 2 0.0 0.0 0.3 0.6 0.9

LGA 3 0.0 0.0 0.6 1.1 1.7

LGA 4 0.0 0.1 1.0 1.9 3.0

LGA 5 0.0 0.0 0.0 0.0 0.0

LHN 2 0.1 0.2 2.0 3.5 5.8

LGA 1 0.0 0.1 1.0 1.7 2.8

LGA 2 0.0 0.1 0.9 1.5 2.5

LGA 3 0.0 0.0 0.1 0.1 0.2

LGA 4 0.0 0.0 0.1 0.1 0.2

LHN 3 0.1 0.2 3.7 6.4 10.4

LGA 1 0.1 0.2 3.2 5.6 9.2

LGA 2 0.0 0.0 0.4 0.8 1.2

PHN 0 0 8 14 22

2021 NMHSPF projected demand for MHNIP services and actual 2015 occasions of service

NMHSPF Occasions of Service 2021

MHNIP Reported Services 2015

Relative Level of Service 2015

LHN 1 8,763 1,070 12%

LGA 1 522 92 18%

LGA 2 1,326 392 30%

LGA 3 2,429 394 16%

LGA 4 4,455 179 4%

LGA 5 31 13 42%

LHN 2 8,640 1,473 17%

LGA 1 4,196 1,342 32%

LGA 2 3,782 124 3%

LGA 3 375 7 2%

LGA 4 288 - 0%

LHN 3 15,504 1,849 12%

LGA 1 13,663 1,160 8%

LGA 2 1,841 689 37%

PHN 32,907 4,392 13%

Queensland 165,562 62,546 38%

Australia 869,904 308,084 35%

Community Support Sector Services NMHSPF projected demand for community support services, workforce FTE costs ($M) 2021

Day Respite Family Support Services

Flexible Respite

Group Based Peer Work

Group Carer Support Services

Group Support and Rehabilitation

Individual Carer Support Services

Individual Peer Work

Individual Support and Rehabilitation

Residential Crisis & Respite Services

Total

LHN 1 $ 0.06 $ 0.28 $ 0.55 $ 0.66 $ 0.05 $ 0.05 $ 0.06 $ 2.59 $ 13.84 $ 0.43 $ 18.55

LGA 1 $ 0.00 $ 0.02 $ 0.03 $ 0.04 $ 0.00 $ 0.00 $ 0.00 $ 0.15 $ 0.82 $ 0.03 $ 1.10

LGA 2 $ 0.01 $ 0.04 $ 0.07 $ 0.10 $ 0.01 $ 0.01 $ 0.01 $ 0.38 $ 2.04 $ 0.06 $ 2.73

LGA 3 $ 0.02 $ 0.08 $ 0.15 $ 0.18 $ 0.01 $ 0.01 $ 0.02 $ 0.71 $ 3.80 $ 0.12 $ 5.09

LGA 4 $ 0.03 $ 0.14 $ 0.29 $ 0.33 $ 0.02 $ 0.02 $ 0.03 $ 1.33 $ 7.13 $ 0.23 $ 9.57

LGA 5 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.01 $ 0.05 $ 0.00 $ 0.06

LHN 2 $ 0.06 $ 0.26 $ 0.60 $ 0.65 $ 0.05 $ 0.05 $ 0.06 $ 2.60 $ 14.03 $ 0.47 $ 18.83

LGA 1 $ 0.03 $ 0.13 $ 0.29 $ 0.32 $ 0.02 $ 0.02 $ 0.03 $ 1.26 $ 6.81 $ 0.23 $ 9.15

LGA 2 $ 0.03 $ 0.12 $ 0.26 $ 0.28 $ 0.02 $ 0.02 $ 0.03 $ 1.14 $ 6.14 $ 0.21 $ 8.25

LGA 3 $ 0.00 $ 0.01 $ 0.03 $ 0.03 $ 0.00 $ 0.00 $ 0.00 $ 0.11 $ 0.61 $ 0.02 $ 0.82

LGA 4 $ 0.00 $ 0.01 $ 0.02 $ 0.02 $ 0.00 $ 0.00 $ 0.00 $ 0.09 $ 0.46 $ 0.01 $ 0.61

LHN 3 $ 0.11 $ 0.47 $ 1.04 $ 1.16 $ 0.09 $ 0.08 $ 0.11 $ 4.65 $ 25.01 $ 0.82 $ 33.54

LGA 1 $ 0.10 $ 0.41 $ 0.91 $ 1.03 $ 0.08 $ 0.07 $ 0.09 $ 4.10 $ 22.05 $ 0.72 $ 29.56

LGA 2 $ 0.01 $ 0.06 $ 0.12 $ 0.14 $ 0.01 $ 0.01 $ 0.01 $ 0.55 $ 2.96 $ 0.10 $ 3.98

PHN Total $ 0.22 $ 0.94 $ 2.03 $ 2.24 $ 0.17 $ 0.16 $ 0.20 $ 8.95 $ 48.18 $ 1.60 $ 64.70

Queensland Health and Commonwealth Health and Social Services, service contract specifications 2016

Day Respite Family Support Services

Flexible Respite

Group Based Peer Work

Group Carer Support Services

Group Support and Rehabilitation

Individual Carer Support Services

Individual Peer Work

Individual Support and Rehabilitation

Residential Crisis & Respite Services

Other (flexible, high risk, suicide prev., eat)

Total

LHN 1 - $252,390 - $16,225 - $ 126,669 - - $871,030 - - $1,266,315

- - - - - - - - $2,772,108 - - $2,772,108 LGA 1 - - - - - - - - - - - - LGA 2 - - - - - $107,000.00 - - - - - $107,000 LGA 3 - - - - - - - - - - - - LGA 4 - - - - - $404,000.00 - - - - - $404,000 LGA 5 - - - - - - - - - - - -

LHN 2 - $11,721 - $759,060 - $40,732 - - $997,103 $78,720 - $1,887,337

- $1,167,355 - - - - - - $5,256,405 - - $6,423,761

LGA 1 - - - - - - - - - - - - LGA 2 - - - - - $324,694 - - - - - $324,694 LGA 3 - - - - - - - - - - - - LGA 4 - - - - - - - - - - - -

LHN 3 - $66,844 - $391,340 - $267,314 - - $1,481,085 $83,675 - $2,290,258

- - $10,739,406 - - - - - $4,971,372 - $11,049,296 $26,760,075 LGA 1 - - - - - - - - - - - - LGA 2 - - - - - - - - - - - -

State-wide Services

- - - - $187,112 - - - - - $187,673 $374,785

PHN - $1,498,311 $10,739,406 $1,166,625 $187,112 $1,270,410 - - $16,349,104 $162,396 $11,236,969 $ 42,610,333

Summary - Outcomes

– Relative levels of service capacity across programs measured against NMHSPF, National

and State benchmarks

– Priorities for service development established

– Opportunities for collaborative service delivery identified

– Improved understanding of the inter-sectoral impacts of un-coordinated service development

– Information used to inform the development of Strategic Plan

Data sources • Australian Government - PHN Data – all MBS data

Department of Health. Medicare Benefits Schedule Data, MBS Data by ABS SA3. Australian Government, Department of Health; 2016. http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-MBS_Data.

• Mental Health MBS Data – all disciplines Department of Health. Mental Health Data, MBS Mental Health Data by ABS SA3. Australian Government, Department of Health; 2016. http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Mental_Health_Data#MBSDATA

• Mental Health MBS Data – ATAPS and MHNIP Department of Health and Ageing. Mental Health Data, Access to Allied Psychological Services (ATAPS) Data. Australian Government, Department of Health; 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Mental_Health_Data#ATAPSDATA.

• PHN Secure Area Department of Human Services. Mental Health Data, Mental Health Nurse Incentive Programme (MHNIP) Data. V2a. In: Secure Series: Australian Government, Department of Health; 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Secure.

Data Sources (Other) • State Programs

Source from local heath service or state office

• Community Support Sector Local health service or state office reporting Commonwealth Government Departments of Health and Social Services grants reports

• Headspace Headspace National Office. Headspace Centres Activity Reports, Melbourne: headspace National Youth Mental Health Foundation; 2016.