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The road to reform Associate Professor Russell Roberts University of Sydney THE NATIONAL ALLIANCE FOR RURAL AND REMOTE MENTAL HEALTH

MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

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Page 1: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

The road to reform

Associate Professor Russell Roberts University of Sydney

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

Page 2: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

www.kumano.com.au

My patch

Page 3: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

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

Page 4: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

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)

Page 5: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

www.kumano.com.au

The national tail wagging the federated dog

Page 6: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

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)

Page 7: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

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

Page 8: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

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

Page 9: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

Page 10: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

www.kumano.com.au

State Plan (x8) LHD Priorities

ED KPIs/Budget tightening/ABF Other State Agencies

Housing/Education/Com Services

The national tail wagging the federated dog

Page 11: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

www.kumano.com.au

What is local?

Page 12: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

Policy

Outcomes

Chance and change

Page 13: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

• Charm and churn

• Locally – eg new attractive initiatives.

• Nationally

Charm and churn

Page 14: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

What is a PHN again?

Page 15: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

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

Page 16: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

Chance and change

Policy

Outcomes

Page 17: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

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

Page 18: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

International Evidence Review: Enabling factors (Fuller et al., 2009)

Page 19: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

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”

Page 20: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

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!!

Page 21: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

Page 22: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

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

Page 23: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

Email: [email protected] 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: [email protected] 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…….

mailto:[email protected]
http://anzmh.asn.au/rrmh/
mailto:[email protected]
http://kumano.com.au/
http://kumano.com.au/
Page 24: MENTAL HEALTH RURAL AND REMOTE THE NATIONAL …o n e o f f - d /a b r o k e r a g e 4 0 k ± 2 0 k p a O N E O F F - C O MMU N I T Y D E V E L O P ME N T B R O K E R A G E ± 2 0 k

www.kumano.com.au

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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