Output 1.2 - Mental Health, Justice Health and Alcohol and Drug Services

The Health Directorate provides a range of Mental Health, Justice Health and Alcohol and Drug Services through:
  • the public and community sectors in hospitals

  • community health centres and other community settings

  • adult and youth correctional facilities

  • people’s homes across the territory.

These services work to provide integrated and responsive care to a range of services, including:

  • hospital-based specialist services

  • therapeutic rehabilitation

  • counselling

  • supported accommodation services

  • other community-based services.

The key priorities for Mental Health, Justice Health and Alcohol and Drug Services are ensuring that:

  • people’s health needs are met in a timely fashion

  • care is integrated across hospital, community, and residential support services.

This means focusing on:

  • ensuring timely access to emergency mental health care

  • ensuring that public and community mental health services in the ACT provide people with appropriate assessment, treatment and care that result in improved mental health outcomes

  • providing community- and hospital-based alcohol and drug services

  • providing health assessments and care for people detained in corrective facilities.

Overview

Mental Health, Justice Health and Alcohol and Drug Services provide health services directly and through partnerships with community organisations. The services provided range from prevention and treatment to recovery and maintenance and harm minimisation. Consumer and carer participation is encouraged in all aspects of service planning and delivery.

The division delivers services at a number of locations, including:

  • hospital inpatient and outpatient settings

  • community health centres

  • detention centres

  • other community settings, including people’s homes.

During 2014–15, a significant number of the recommendations from the Child and Adolescent Mental Health Services (CAMHS) Model of Care were implemented, including:

  • establishing a Bimberi CAMHS liaison role

  • establishing a child early intervention program

  • addressing comorbidity through training

  • enhanced and routine screening

  • establishing and strengthening liaison and consultation pathways with youth alcohol and drug services

  • providing secondary consultation.

The services provided by the division include:

Adult Mental Health Services

Adult Mental Health Unit (AMHU)

Belconnen Mental Health Team

City Mental Health Team

Gungahlin Mental Health Team

Mental Health Assessment Unit (MHAU)

Tuggeranong Mental Health Team

Woden Mental Health Team

ACT-Wide Mental Health Services

Aboriginal and Torres Strait Islander Mental Health Services

Adult Mental Health Day Service

Brian Hennessy Rehabilitation Centre

Crisis Assessment and Treatment Team

Mental Health Comorbidity Clinician

Mental Health Service for People with Intellectual Disabilities

Mental Health Consultation Liaison—the Canberra Hospital (TCH) and Calvary Hospital

Mobile Intensive Treatment Team- North

Neuropsychology

Older Persons Mental Health Team

Justice Health Services

Forensic Mental Health Services

Justice Health Primary Health

Secure Mental Health Unit (in development)

Child and Adolescent Mental Health Services (CAMHS)

CAMHS South

CAMHS North

Dialectical Behaviour Therapy Program

Early Intervention Team

Eating Disorders Program

Perinatal Mental Health

The Cottage

Alcohol and Drug Program

Consultation and Liaison

Counselling and Treatment Services

Police and Court Diversion Services

Opioid Treatment Service

Withdrawal Services

 

The Mental Health, Justice Health and Alcohol and Drug Services workforce is facing a challenge associated with the increase in growth across the service. A workforce plan will oversee the development of a workforce strategy, planning and development framework.

Mental Health, Justice Health and Alcohol and Drug Services commenced the preparatory phase of the Workforce Development for the Secure Mental Health Unit (SMHU). A workforce development and recruitment plan has been developed, which includes staging staff recruitment in line with the commissioning/staging of beds. Training opportunities, such as scholarships, will be offered to staff to facilitate their development in the area of Forensic Mental Health.

Performance against accountability indicators

Against the accountability indicators, Mental Health, Justice Health and Alcohol and Drug Services have:

  • Exceeded the target of 109,000 occasions of service within the Adult Mental Health Services Program by 4 per cent. This achievement is in response to the demand for services and improvements in staff resourcing to meet this demand.

  • Achieved 100 per cent against the target of 65,000 occasions of services within CAMHS.

  • Exceeded the target of 100,000 occasions of service within the ACT-Wide Mental Health Services Program by 6 per cent. This higher than expected level of activity was predominately achieved due to the high levels of contact with the Crisis Assessment and Treatment Team.

  • Achieved 100 per cent of all detainees admitted to the Alexander Maconochie Centre (AMC) having a completed health assessment within 24 hours of detention.

  • Achieved 94 per cent against the target of 100 per cent of all young people admitted to Bimberi Youth Justice Centre having a completed health assessment within 24 hours of detention. This was due to four health assessments not being undertaken within the 24 hour period where:

    • one was due to a potential security risk of the young person as advised by Bimberi management and was completed approximately 48 hours after admission

    • three were due to health staff not being advised of the admission of the three young people, and were completed at 24.5, 27 and 27.5 hours after admission.

  • Exceeded the target of 105,000 occasions of service within the Justice Health Services Program by 9 per cent. This can be attributed to an increased demand related to an increased muster at the AMC.

  • Achieved the target of 98 per cent of all new clients on pharmacotherapy treatment for opioid dependency having a completed management plan.

  • Achieved 97 per cent against the target of 70, 000 occasions of services within the Alcohol and Drug Services Program.

More information: For additional information, see C.6 Statement of performance, Output 1.2: Mental Health, Justice Health and Alcohol and Drug Services.

Emergency mental health care

A review of the Mental Health Assessment Unit (MHAU) Model of Care is underway. A workshop was held in April 2015 and provided an opportunity to review current governance arrangements and clinical pathways. Final sketch plans have been completed for the mental health space within the Emergency Department. The AMHU Model of Care was reviewed in the context of the Canberra Hospital Emergency Department expansion, which is due for completion in 2016. The new footprint will support both an emergency assessment and mental health short-stay functions.

Mental health services

An Adult Community Mental Health Model of Care redesign project delivered a preliminary Model of Care and high-level implementation plan. It is anticipated that this redesign will support community mental healthcare that is evidence-based, contemporary and better meets the needs of the expanding Canberra community.

An Adult Mental Health Rehabilitation Unit (AMHRU) and an interim Adult Mental Health Day Service (AMHDS) Model of Care were both developed and finalised as part of the overall Service Delivery Plan for the University of Canberra Public Hospital (UCPH). The purpose of a specialist AMHRU is to deliver effective recovery-based treatment and rehabilitation to people whose needs cannot be met by less intensive community-based adult mental health services.

An AMHDS began operating from the BCHC in July 2014. This is an interim measure until an enhanced AMHDS is commissioned in the UCPH. The AMHDS provides treatment for adults aged 18–65 years and offers:

  • subacute support services

  • programs aimed at preventing an acute psychiatric admission

  • day treatment therapies

  • transitional support for those people exiting acute services and reintegrating back into the community

  • intensive psychological therapy

  • extended treatment and recovery programs.

A plan was developed in August 2014, to transition the residents of the Brian Hennessy Rehabilitation Centre (BHRC). The aim is to establish individual plans for the people currently supported at BHRC to access appropriate accommodation, supports and services to enable them to successfully reside in the community in the future. Information sessions were held to inform key stakeholders, family, carers and peak bodies of the transitional arrangements and plan.

Alcohol and Drug Services

Alcohol and Drug Services (ADS) continue to implement the pharmacist-led Nicotine Replacement Clinic for clients of the Opioid Treatment Service and withdrawal services. Opportunistic smoking cessation interventions are provided to clients:

  • accessing alcohol and drug services

  • accessing the AMHU

  • in the BHRC.

ADS are part of a national research project, Tackling Nicotine Together, through Newcastle University.

Justice Health Services

The Model of Care for the SMHU was finalised in May 2014 and the facility design finalised in 2015. Significant work has occurred on the workforce plan for the SMHU.

Forensic Mental Health Services provided training on mental health awareness and processes to the magistrates of the ACT Law Courts. It is planned that this initiative will be further expanded to other agencies, such as:

  • the Office of the Director of Public Prosecutions

  • Magistrates Associates

  • Legal Aid services.

A streamlined induction process was established at the Bimberi Youth Justice Centre. A review of this change is ongoing and is being supported by extra staff supervision and training.

Forensic Mental Health Services has also continued to provide mental health awareness and education training to Bimberi youth workers as part of their training inductions.

Justice Health Services has commenced the 2015–2016 Young Persons in Custody Health Survey. The survey will run from February 2015 to February 2016. The results from 50 or more young people who participate will provide further information regarding the health, sexuality, education, employment, social circumstances, alcohol and other drugs exposure of the young people. This information will be used to inform future service provision.

Future directions

Mental Health, Justice Health and Alcohol and Drug Services will be undertaking work to boost a range of services in the areas of:

  • emergency mental health care

  • mental health services

  • alcohol and drug services

  • justice health Services.

Emergency mental health care

As part of redesigning the Adult Community Mental Health Model of Care, the Crisis Assessment and Treatment Team will be expanded. This will provide additional intensive in-home support for people experiencing acute mental health problems.

Mental health services

The Mental Health (Treatment and Care) Amendment Bill 2014 will be implemented on March 2016. A training program is being developed to ensure that all staff is familiar with their responsibilities under the new Act.

A new initiative will be established within the CAMHS and in partnership with education that will provide:

  • early identification and treatment of children presenting with emerging mental illnesses/disorders

  • mental health consultation and in-reach into primary health services targeted at children.

To improve pathways of care for Canberra Hospital patients with mental illness, Mental Health, Justice Health and Alcohol and Drug Services will also collaborate with Critical Care Services at Canberra Hospital. Representatives from the Adult Mental Health Services and ACT-wide Mental Health Services programs will also meet regularly with Critical Care.

The current community Adult Model of Care will be redesigned to ensure an improved integrated flow of patients from both inpatient and community settings—crisis, assertive outreach, clinic and home-based care.

A community mental health team will be established for the Gungahlin region. Currently services are provided to this area as an extension from the Belconnen Mental Health Team.

Staff will be recruited to develop the therapeutic program, provide training, and develop policy and standards for the new 25-bed SMHU.

The existing Consultation and Liaison service for people admitted to the general wards of Canberra Hospital who have mental health-related issues will be expanded. This will enable the service to operate after hours seven days per week

A 20-bed, 24-hour supportive accommodation service will be established for people with significant chronic and severe mental health issues. This initiative is a collaborative partnership with the Community Services Directorate (CSD).

Mental Health, Justice Health and Alcohol and Drug Services will also provide intensive support to people with psycho geriatric conditions living in residential care, or transitioning from an acute inpatient unit. This will provide assertive clinical assessment and treatment for Older Persons Mental Health Service (OPMHS) consumers residing in residential aged care facilities. The aim is to circumvent an acute psychiatric inpatient admission, wherever possible. Additionally, the service will assist in gradually transitioning consumers from an inpatient admission back into the community. It is envisaged that this service will reduce demand on inpatient beds.

The AMHU has experienced challenges in the timely discharge of some patients. Primarily this is related to accessing appropriate housing options. Work is progressing to improve inter-agency relationships, particularly with ACT Housing, Disability ACT and the NDIA taskforce, to:

  • ensure the needs of these people are appropriately met in the community

  • reduce the impact on acute mental health inpatient beds.

Alcohol and Drug services

In terms of alcohol and drug services, Mental Health, Justice Health and Alcohol and Drug Services will enhance the Alcohol and Drug Service Consultation and Liaison services at Canberra Hospital. This includes expanding to a seven day per week service and introducing a nurse practitioner to enhance expertise within this service.

Specialist Drug Treatment Services will:

  • expand the outreach specialist medical, counselling and case management services provided at community health centres

  • complement the existing services provided at Canberra Hospital.

Justice Health Services

The primary health team within Justice Health Services will be expanded to enable the effective delivery of health services within the AMC. This incorporates the proposed expansion of beds at the AMC between 2015 and 2016.