The Federal Government is expected to announce within weeks the lead sites to implement its new ‘stepped care’ approach to mental health care, after seeking expressions of interest from Primary Health Networks (PHNs).
The PHNs, which have been made central to the Government’s mental health shake up announced in November, have begun creating regional mental health plans as part of the reform package.
The Government’s response to the Review of Mental Health Programmes and Services includes no new funding and instead redirects existing funding, particularly via the PHNs, which will commission contestable mental health services for the stepped care approach.
Phased implementation
Under the stepped model – which will match patients to the “intensity of service they need” – only patients assessed as having moderate or “severe and complex” mental illness will be referred for face-to-face services, while those assessed as having mild illness will be referred to a “digital gateway”.
PHNs will receive additional funding and have been asked to develop regional mental health plans immediately and commission services for their regions over the next three years. In the meantime, some trial PHN sites will be selected for a phased implementation of stepped care.
A Department spokeswoman said PHNs had been invited to submit expressions of interest in becoming lead sites to implement the new approach and decisions would be made following assessment of submissions. The Government was “likely to announce the lead sites in mid- to late February”.
The spokeswoman said funding arrangements for developing the regional plans were still being finalised.
“There will be a period of transition as existing funding arrangements between the Department and organisations are replaced by commissioning arrangements managed by PHNs,” she said.
Digital gateway
Youth mental health, now funded through headspace and the early psychosis youth service, would be managed by PHNs from 1 July 2016, she said, and “transition arrangements” for those services were still being considered.
The digital gateway will replace some face-to-face services – now funded through Medicare via the Better Access program and other programs – with “low-intensity” telephone and web-based services, and is due to go live in 2017.
Asked about the future of the Better Access program, the Department spokeswoman said the Government was “exploring options only at this point”. Any future changes would be considered in consultation with stakeholders and guided, in part, by the lead PHN sites. The Primary Health Care Advisory Group would also inform and support the development of new models of mental health service delivery.
Consumer involvement
Josh Fear, Policy Director at Mental Health Australia, said the challenge for PHNs was to ensure they worked across systems, and with a broad range of stakeholders, to ensure they were commissioning the most appropriate mix of services, and that services were well integrated.
“A great way of doing this, and the best test of success, is to involve people with lived experience of mental illness in all aspects of this work – from planning and commissioning to service delivery and evaluation. We are yet to see details on how the Department of Health and PHNs will be facilitating this kind of consumer and carer involvement.”
Several PHNs contacted by PHRP said mental health was already incorporated in their regional plans but the additional funding would allow them to expand their roles.
Hunter New England and Central Coast PHN CEO, Richard Nankervis, said significant preparatory work had already been completed, including developing health profiles for 27 local government areas in the region.
“We recognise that mental health is an intersectoral issue that requires the involvement of many different players and as such we are engaging and consulting widely,” he said.
CEO of the Australian Healthcare and Hospitals Association, Alison Verhoeven, said as new models of care were rolled out in the lead sites, a focus on improving health outcomes, and including evaluation as a key project element, were required. “Consideration must also be given to scalability, transferability and relationships with broader health system reforms,” she said.
