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The road to reform
Associate Professor Russell Roberts University of Sydney
THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
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My patch
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
• Flexible Funding
• Promotion and prevention approach (again)
• Identified gaps and stepped care
• Systemic issues – need a systemic approach
• A plausible solution
• Local coordination and local planning.
Summary
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
• PHNs undertake comprehensive planning
• Pool mental health funding
• PHNs develop and implement innovative models
• Regional planning and service integration
• Telephone and internet based MH services
Rural Recommendations (No. 10)
THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
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The national tail wagging the federated dog
THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
States/Terr 41%
[CATEGORY NAME] [PERCENTAGE]
Medication 14%
Private health 5%
GP 7%
Corporate 2%
Other 3%
Aust Gov 6%
Percentage of Direct Funding for Mental Health (NOUS)
THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
States/Terr 43%
[CATEGORY NAME] [PERCENTAGE]
[CATEGORY NAME] [PERCENTAGE]
Private Health 4%
GPs 6%
Aust Govt NGOs 6%
Aust Govt State Hosp 9%
Aust Govt State Prog 1%
NMHC Review Data
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
0 5000 10000 15000 20000 25000 30000
GPs
MH Nurses
Psychologists
Psychiatrists
Pharmacists
Ots
Professions by income source
State Private Other
HWA, 2013
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
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State Plan (x8) LHD Priorities
ED KPIs/Budget tightening/ABF Other State Agencies
Housing/Education/Com Services
The national tail wagging the federated dog
THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
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What is local?
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
Policy
Outcomes
Chance and change
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
• Charm and churn
• Locally – eg new attractive initiatives.
• Nationally
Charm and churn
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
What is a PHN again?
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
• Clinicians
• Deals with one person/family
• Undergraduate specialist training
• Continuing Professional Ed
• Clinical Supervision
• Case review
• Case Study Presentation
•Managers
• Deals with their manager, their staff, consumer concerns,
partnership issues, community expectations
• No undergrad training • No CPE
• No Supervision or mentoring • Manager support
• No case study presentation
The manager in the middle
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
Chance and change
Policy
Outcomes
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
Bourke Human Services Accord
DRUG AND ALCOHOL
BROKERAGE – 20K
HOUSING
ALLOCATION
HASI
ALLOCATION –
50K
COMMUNITY
DEVELOPMENT
BROKERAGE – 10K
CLIENT SYSTEMS
BOUNDARY
SIGNIFICANT
CULTURAL/SOCIAL
WELLBEING
NETWORK
M/H
D/A
RICHMOND
FELLOWSHIP
(NGO)
&HOUSING
SE
RV
ICE
ST
AK
EH
OL
DE
RS
NE
TW
OR
K
* CULTURAL
COMPETENCE 1
* MARVIN
* CULTURAL
COMPETENCE 2
HASI PACKAGE CLIENTHASI PACKAGE SERVICE
PROVIDERS
SERVICE DELIVERYJOINT SERVICE
PLANNING
CULTURAL
KNOWLEDGE
TRANSFER AND
CULTURAL MAPPING
TARGETTED HASI PACKAGE
MENTAL HEALTH AND DRUG AND ALCOHOL COMMUNITY
MODEL – bourke nswA
BO
RIG
INA
L
CO
NS
UL
TA
NT
S
REFERRED
HASI
CLIENT
PACKAGEHOUSING ALLOCATION
RECURRENT HASI SUPPORT 50k
ONE OFF - D/A BROKERAGE 40k – 20k pa
ONE OFF - COMMUNITY DEVELOPMENT
BROKERAGE – 20k - 10k pa
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
International Evidence Review: Enabling factors (Fuller et al., 2009)
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
• Essentially asking the PHNs to lead a massive change management project • Possibly without the experience, expertise or CAPACITY?
• Pop needs • Mapping local capacity duplication with LHD and States. • Planning • Procurement processes/tender specs • Contracting • Managing
“Implementation the missing step”
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
Single Digital Mental Health Gateway
Single phone line and website • Information • Triage • Crisis Support • Online programs
• Great idea • Many (most) states have most of it already
• Requires massive resources • Struggles to scale-up –seamless referral?
• NO AUTOMATED SUB MENUS!!
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
• Great start – many cautions
• Policy direction is spot on
• Implementation needs more work • PHNs will need help, capacity and time
• State cooperation critical
• Small business incentives vital
• Please consult eg NRHA, NARRMH
• Please stop “short-termism”
• Give time to form before re-form
Conclusions
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
Email: rrmh@anzmh.asn.au URL: http://anzmh.asn.au/rrmh/
Copy of powerpoint slides or references.
The 8th Australian Rural and Remote Mental Health Symposium. 2 – 4 Nov, 2016, Salt Mantra Resort Kingscliff (Gold Coast/Tweed)
Email: admin@kumano.com.au URL: http://kumano.com.au/ Twitter: rus_l https://au.linkedin.com/in/russell-roberts-b4609a82
Continue the discussion…
As Chair, I would love to welcome you to…….
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THE NATIONAL ALLIANCE FOR
RURAL AND REMOTE
MENTAL HEALTH
• General nurses 207,000
• Social Workers 10,346
• Dieticians 2,800
• Speech Pathologists 5,200
• Aboriginal Health Workers 1,256
• Peer Workers 305*
*(2014)
Other Professional Groups in the Mental Health Workforce (HWA, 2014. 2014)
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