Final Report

SUMMARY OF RECOMMENDATIONS

A. Immediate Implementation

A1.The GMHS should immediately fund and establish a Regional Consumer Advisory Group to work with the Regional Director of Mental Health Services in the future development of the service system.

A2. The GMHS Director of Mental Health Services should immediately in consultation with the Regional Consumer Advisory Group:

• define achievable levels of consumer and carer involvement in the planning and evaluation of all services in the GMHS area;
• specify possible consumer and carer contributions to identifying levels of need and the quality of service outcomes.

A3.The GMHS should move immediately to establish after hours services by exploring two options:

• reviewing mental health staff rostering arrangements to provide extended hours and weekend services by Community Mental Health Teams in the four major centres - Albury, Wagga, Griffith and Deniliquin
• consolidating an after hours specifically staffed mental health telephone contact service in one of the major mental health centres in the area.

A4. The remuneration package for the Director of Mental Health Services in the GMHS area should be such, and the key selection criteria for the position should be framed so as to make likely the recruitment of a person who:

• is an effective change manager in mental health services
• has demonstrated ability in working in a multidisciplinary environment
• understands and has been involved in the practical implementation of the standards contained in the National Standards for Mental Health Services.

A5. The GMHS Mental Health Service should adopt for planning purposes the indicative allocation of psychiatrist EFTs shown below:

Location(EFT)	In-patient services	Community MH services	Psychiatrist	Psychiatric registrar, trainee
Albury [incl teleconf](3.5)	2.0	1.5	2.5	1.0
Wagga [incl C&Adolesc] (1.0)		1.0	1.0
Griffith(0.6)		0.6	0.6
Deniliquin(0.3)		0.3	0.3
Area widehelpline (0.5)		0.5	0.5
TOTALS	2.0	3.9	4.9	1.0
		5.9		5.9

A6. The GMHS should provide funds for a short term project to restore the functionality of the teleconferencing facilities already in place, and to provide staff training to ensure their use as a routine mechanism for legal processes, professional support and service delivery in the GMHS area.

A7. The GMHS Mental Health Service should embrace a lead agency role in suicide prevention as a targeted priority for the development of its services.

A8.The appointment of Aboriginal Health Service managers and their formal and active involvement in the planning and evaluation of mental health services should be a priority in the GMHS area.

A9. The GMHS should give priority to the retention of an Italian speaking psychiatrist and community mental health staff in community health services in Griffith.

A10. Consistent with the requirements of the National Standards for Mental Health Services all mental health services in the GMHS area should develop formal, documented processes to promote collaboration with other health service providers, particularly GPs.

A11.The GMHS should encourage the development of three models for the provision of community mental health services depending on network and staff needs:

1. stand alone services with 8 or more staff able to sustain their own management and administrative structures, with formal documented protocols for integration with generic health services and other agencies. This model would be appropriate in Albury and Wagga.
2. stand alone teams of 7 or less people managed day by day within the general public health system of the network to the policy, program advocacy, standards and overall resource allocation parameters set by the GMHS Mental Health Service. This model could be considered in Griffith, Cootamundra and Deniliquin.
3. community mental health workers co-located with other community health services, managed day by day within the general public health system of the network to the policy, program advocacy, standards and overall resource allocation parameters set by the GMHS Mental Health Service, formally linked for professional support to a stand alone team in another network. This model should be considered for Health Service Networks 2, 5, 6 & 8.

A12. The GMHS should give priority in any expansion of mental health services to the further development of community based services.

A13. The GMHS Mental Health Service should adopt for planning purposes the indicative allocation of community mental health worker EFTs shown below:

Location	EFT Current Staff	EFT Proposed	Proposed EFT /100,000
HSN1: Griffith CMHT	5.2	6.0	19.1
HSN2: Leeton	2.0	3.5	19.2
HSN3: Cootamundra CMHT	2.0	6.0	18.6
HSN4: Wagga CMHT	15.45	15.5 (incl C&Adolesc)	26.7
HSN5: Tumut CMHT	1.7	3.5	18.4
HSN6:	1.0	2.0	16.0
HSN7: Albury CMHT	14.5	13.0 (incl Helpline)	26.4
HSN8:	1.0	3.0	15.6
HSN9: Deniliquin/Wentworth CMHT	5.55	4.5	21.2
TOTALS GMHS	48.4	57.0	21.9

A14. The GMHS should consolidate its provision of acute and medium term inpatient facilities by locating 32 inpatient places at Albury Base Hospital.

A15. The GMHS should establish and widely disseminate guidelines to require all health services, but especially public hospitals through their Accident and Emergency Departments, to ensure that people with mental illnesses and suicide attempters gain timely access to care, referral and follow-up by:

1. establishing formal relationships with mental health services to assist with the assessment, management and development of referral plans for people with mental health problems or those who have attempted suicide
2. ensuring that family members and carers are consulted in the development of management and referral plans.

B. Short Term Strategies (6-18 months)

B1. Advised by the Regional Consumer Advisory Group, all services in the GMHS area should develop formal plans to encourage regular consumer and carer input about the state and future directions of their service.

B2. The GMHS Director of Mental Health Services should in consultation with the Regional Consumer Advisory Group:

• make provision for consumer involvement in advocacy, mental health prevention and community education at regional level, and where feasible, in each of the networks.

B3. The GMHS Mental Health Service should move towards implementation of the planning framework for psychiatric service provision by:

1. organising sessional psychiatric services in Griffith and Deniliquin within the funding allocation
2. providing 0.5EFT in Wagga for each of inpatient services and community mental health services and supplementing this with 0.5EFT for sessional child and adolescent services mainly in a community setting
3. providing 1.0EFT in Albury for each of inpatient services and community mental health services and supplementing this with 0.5EFT for clinical consultation and professional support by teleconferencing.

B4. Using information from the implementation of the teleconferencing system in Albury, Wagga and Griffith, the feasibility and usefulness of expanding teleconferencing facilities to Deniliquin, Tumut and Cootamundra should be investigated.

B5. A region wide specialist Children’s and Young People’s Mental Health Unit should be developed in Wagga

• to provide specialist clinical consultation where required
• to support, advise and train mental health workers in work with children and young people
• to spearhead the GMHS’s involvement in suicide reduction strategies
• to provide training to and to liaise with other agencies, such as the Department of School Education, NSW Police Service and others, to prevent mental illness and promote early intervention strategies.

B6.The specialist GMHS Children’s and Young People’s Mental Health Unit should take responsibility for planning, implementing and evaluating an area wide strategy based on a primary prevention, early intervention, crisis intervention and postvention model.

B7. Cross-cultural training programs for mental health workers should be developed in collaboration with Aboriginal health services in the area.

B8. All health mental health services in the GMHS area should develop formal operating policies and procedures to ensure equitable provision of services to indigenous people in collaboration with Aboriginal health services in the area.

B9. Formal protocols should be developed to guide the liaison between mental health services in the GMHS area and Aboriginal Health liaison workers, and their implementation routinely evaluated.

B10. All health mental health services in the GMHS area should develop formal operating policies and procedures to ensure equitable provision of services to people of non-English speaking backgrounds in their area.

B11. Cross-cultural training programs for mental health workers should be developed in collaboration with the Transcultural Mental Health Centre. Attention should be given to the possibility of conducting them in association with similar programs to encourage sensitivity to issues of importance in the Koori communities.

B12. In collaboration with local Divisions of General Practice, and incorporating the input of the GMHS Teleconferencing Coordinator/Educator, the GMHS Mental Health Service should fund, develop and provide opportunities for in-service training for GPs and other primary care providers focussed on the care of people living with psychiatric illness and disabilities.

B13. The GMHS should formally adopt the National Standards for Mental Health Services and from 1998 require from the Director of Mental Health Services an annual report on the performance of the mental health services of the area in terms of the standards, with specific reference to the performance of the different models of community mental health service provision against the integration standards.

B14. The GMHS Mental Health Service should move towards implementation of the planning framework for community mental health service provision by:

1. establishing a unit within the present Wagga Community Mental Health Team to provide regional child and adolescent services
2. establishing a unit within the Albury Community Mental Health Team to consolidate and expand the use of teleconferencing for clinical consultation and professional support
3. substantially increasing the operating resources of the Cootamundra Community Mental Health Team
4. implementing the management structures proposed in Recommendation A11.

B15. The GMHS Mental Health Service should trial Rooming In in local hospitals in some networks to see whether, with adequate staff training, it provides a viable, locally responsive option to the use of regional acute care facilities.

B16. The GMHS should review its aged care services with specific reference to:

1. the long term cost effectiveness of the CADE unit in Wagga as part of the psychogeriatric service system
2. encouraging local government and voluntary agencies to become involved in the provision of hostel accommodation especially considering the increased availability of resident contributions to fund capital expenditure
3. the development of specific psychogeriatric services in Albury, Wagga and Griffiths with access to adequate inpatient assessment, day care and respite facilities
4. the extended use of Community Aged Care Packages to provide support for people with psychogeriatric problems and their carers
5. the formal conversion of acute hospital beds in smaller community hospitals to Nursing Home status to more realistically reflect current usage.

B16. The GMHS Mental Health Consumer Advisory Group should have as a priority task the establishment of mechanisms for monitoring and evaluating the performance of network mental health services against the National Standards for the protection of the rights of people with psychiatric disabilities.

C. Medium Term Strategies (12-36 months)

C1.The GMHS should investigate (in association with other health services if helpful) funding options for and the operational feasibility of an out of hours telephone triage, information, advice and counselling service to facilitate access to and supplement existing mental health and community health services in the networks.

C2. The GMHS Mental Health Service should move to full implementation of the planning framework for psychiatric service provision by:

1. providing an additional 1.0EFT for inpatient services in Albury if acute services are consolidated there
2. seeking to have a full-time registrar’s position established as part of the consolidation
3. providing 0.5EFT to a region wide telephone triage, information, advice and counselling service.

C3. The GMHS should make provision for an area wide Mental Health Coordinator/Educator to:

• develop, coordinate, monitor and report on the use of teleconferencing in the mental health system and beyond;
• coordinate education for the mental health workforce, other health service providers and consumers and carers in the use of teleconferencing;
• developing intersectoral links between hospitals, primary care providers and community based health and welfare services to ensure teleconferencing is used to meet the unmet needs of special needs groups.

C4. Using the Wagga model, GMHS networks should explore options for providing flexible range of supervised, supported accommodation for people with long term mental health problems and for respite care.

C5. In addition to the development and implementation of the regional teleconferencing strategy, the role of the Mental Health Coordinator/Educator should include the development of a regional mental health prevention and community education plan.