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PHN Mental Health Outcomes Phase One Project Deliverable: Preliminary Report
30 June 2017
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Contents
Acknowledgements 3
Introduction 4
Method 7
Findings 10
Discussion 30
References 35
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Acknowledgements
Gippsland PHN gratefully acknowledges the National Mental Health Commission (NMHC) for funding this project.
Thank you also to the Project Steering Committee members for their involvement and guidance:
Marianne Shearer, CEO, Gippsland PHN (Chair)
Ms Liz Craig, Senior Project Manager, Gippsland PHN
Ms Catherine Brown, Director, NMHC
Ms Emily Clay, Director, NMHC
Mr John Lawrence, mental health carer and PHN Community Advisory Committee representative
Mr Warren Bartlett, mental health consumer
Dr Daniel Rock, Western Australian Primary Health Alliance
Mr Michael Struth, Western Victoria PHN
Ms Lesley Maher, Gold Coast PHN
Finally and importantly, thank you to all participants from PHNs across Australia, who volunteered their time,
knowledge and experience.
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Introduction
Primary care can be defined as the day to day care, first point of contact and principal point of continuing care
within the health system, usually delivered within the community. A sustainable primary care system is
underpinned by a number of ideologies, one of which views the individual and their family/carers as active
partners at the centre of decision making about their health and wellbeing (Primary Health Care Advisory Group,
2015).
National policy reform saw the establishment of 31 Primary Health Networks (PHNs) on 1 July 2015 to increase
the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health
outcomes, and to improve coordination of care to ensure patients receive the right care in the right place at the
right time. PHNs work with general practitioners, other primary health care providers, secondary care providers
and hospitals to facilitate improved outcomes for patients.
The PHN model represents a regional approach to analysis, planning, delivery and review of primary care services.
This model offers flexibility to deliver place based primary care to improve health outcomes for individuals,
communities and the regional population. Moreover, PHNs collectively have the opportunity to improve
outcomes at a program and system level, uniting key elements of integration, accessibility and value, across six
key priorities: Aboriginal and Torres Strait Islander health, population health, health workforce, eHealth, aged
care and mental health. Considering the definition of primary care above, the term ‘outcome’ and how to
measure outcome, PHNs must stay clear about their role and purpose. Keeping the individual, families and
populations in front of mind is crucial to developing a sustainable primary care system, inclusive of mental health.
Mental health is universally accepted as fundamental to the concept of health. The World Health Organisation
(2013) has paved the way for global action on mental health, acknowledging the essential role of mental health in
the wellbeing of people. It is based on a lifespan approach, seeks to achieve equity through access to universal
health care, and highlights the importance of prevention strategies.
The Australian mental health system is in many ways illustrative of the global challenges faced in improving
mental health systems. The 2014 National Review of Mental Health Programmes and Services identified the gaps,
complexity and urgent need of reform (National Mental Health Commission: NMHC, 2014a). The term ‘nothing
about us, without us’ is a compelling phrase that touches the essence of the reform agenda.
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The reform platform was outlined in the Government response to the review (Commonwealth Government,
2015a), describing nine interconnected areas of reform:
Locally planned and commissioned mental health services through Primary Health Networks (PHNs) and
the establishment of a flexible primary health care funding pool.
A new easy to access digital mental health gateway.
Refocusing primary mental health care programmes and services to support a stepped care model.
Joined up support for child mental health.
An integrated and equitable approach to youth mental health.
Integrating Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing
services.
A renewed approach to suicide prevention.
Improving services and coordination of care for people with severe and complex mental illness.
Generational and transformational change to the mental health system requires structural support for evidence
based care (McGorry and Hamilton, 2016), and must be accountable to consumers, carers, service providers and
community as well as Government (Rosenberg et al., 2015). How to measure and monitor change is the timely
question behind this project, especially within the context of the imminent release of the Fifth National Mental
Health and Suicide Prevention Plan.
The PHN Mental Health Outcomes Project was funded by the NMHC to:
Inform the NMHC’s approach to its monitoring and reporting of PHNs in relation to mental health and
suicide prevention reforms and on outcomes for mental health consumers and carers.
Review PHNs’ experiences of regional integration and reform implementation and processes concerning
mental health and suicide prevention.
Review PHNs’ consumer and carer participation in mental health and suicide prevention policy and
practice.
Identify options for how the NMHC can assist PHNs in relation to PHNs’ roles in mental health and suicide
prevention.
This report is the project’s Phase One deliverable, providing initial analysis and advice on options for the NMHC’s
monitoring and reporting on PHNs in mental health and suicide prevention. Phase One brought together a review
of relevant frameworks and literature, with PHN engagement and consultation, in a thematic analysis.
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This report is designed to be a preliminary report of progress against project objectives, specifically in order to
provide initial analysis to NMHC regarding monitoring and reporting, and is structured accordingly. An overview
of methodology is presented, followed by a description of key findings from the review and consultation with
PHNs. These findings are interpreted in light of project limitations and work to follow, and discussed with a set of
early recommendations presented.
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Method
The Phase One methodology was three-fold:
Rapid review
Stakeholder engagement and consultation
Thematic analysis
A desk top review was conducted to:
Identify and review previous and current work regarding consumer and carer mental health outcomes.
Identify and review other mental health outcomes frameworks that could be applicable to PHN context.
Review developments in the measurement of consumer and carer experiences including quantitative and
qualitative methodologies.
A combined method of snowballing and electronic data base search was applied. Snowballing is a method of
gathering, scanning and aggregating references from other known documents or sources, and can be particularly
useful to identify grey literature. An electronic search of multiple portals and databases (e.g., Medline, PsychInfo,
Proquest) was restricted to English language citations only, publications in the last ten years and Australian
literature unless otherwise indicated. Search terms included Primary Health Network, PHN, mental health,
outcome, monitoring, framework, integration, regional, consumer, carer, engagement, policy, reform, stepped
care, and measurement.
The steps and tasks employed in the stakeholder engagement and consultation methodology are outlined in
Table 1.
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Table 1. Stakeholder Consultation Methodology.
Step Tasks and actions
Stakeholder analysis Review communication plan and identify key stakeholder groups.
Analyse level of influence and interest in project.
Map analysis of stakeholders.
Communication and
engagement
Prepare dissemination plan and initial communication material.
Disseminate via a number of mechanisms to maximise reach.
Follow up with individuals and organisations as required to engage in the
project.
Data domains Define data domains according to project objectives.
Develop key questions to explore stakeholder views and experiences.
Data collection tools Develop semi-structured interview and survey tools.
Quality check and test tools.
Set up online survey, with consent implied if survey completed.
Data collection
process
Provide preamble about background and objectives of project.
Obtain verbal consent of interviewees before proceeding.
Thematic analysis offers an applied qualitative method more applicable for research in policy or practice arenas
(Braun and Clarke, 2014). Thematic analysis is a method for identifying, analysing, and reporting patterns
(themes) within data. It organises and describes a data set in detail. It can also go further than this, interpreting
various aspects of the research topic (Boyatzis, 1998). In line with best practice, thematic analysis was conducted
according to the phases described in Table 2. The final stage of the analysis brought together consultation
findings and reviewed literature.
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Table 2. Phases of Thematic Analysis.
Phase Description of the process
Preparing data Collection of responses. Transcribing data, reading and re-reading the data, noting down
initial ideas.
Generating
initial codes
Coding interesting features of the data in a systematic fashion across the entire data set,
collating data relevant to each code.
Searching for
themes
Collating codes into potential themes, gathering all data relevant to each potential
theme. Produce initial template.
Reviewing
themes
Apply template to full data set. Revise template as a piece of text does not fit
comfortably in an existing theme. Generate a thematic ‘map’ of the analysis.
Defining and
naming themes
Ongoing analysis to refine the specifics of each theme, and the overall story the analysis
tells; generating clear definitions and names for each theme. Quality check of analysis via
respondent validation.
Producing the
report
Use final template to help interpret and write up findings. Selection of compelling extract
examples, final analysis of selected extracts, relating back of the analysis to the research
question and literature.
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Findings
The data corpus (collection of data sets for the entire project) includes a range of stakeholders and two modes of
data collection: interview and survey. The current report analysed the data set of PHN interview respondents
only. A total of 28 interviews were conducted, across 25 PHNs, 2 State PHN Coordinators and 41 individuals. This
represented a response rate of 80% (25 PHNs from possible total of 31).
The representation across States and Territories is depicted in Figure 1.
Figure 1. State/Territory Representation in PHN Interviews.
All levels of PHN work role were represented in the interviews (depicted in Figure 2), with the majority of
respondents representing senior management.
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85
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2
Number of PHN respondents by State/Territory
VIC/TAS (n=5/7) NSW/ACT (n=8/11)
WA/SA (n=5/5) QLD/NT (n=7/8)
State Coordinators (n=2/3)
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Figure 2. Work Role Representation among PHN Respondents.
The method of thematic analysis was applied to the PHN interview data set, as per Table 2. Notably, in the
‘defining and naming themes’ step, a quality check of the analysis was sought via respondent validation. This
resulted in five responses, representing 20% of the data set, endorsing the coding and initial grouping of themes.
Five overarching or organising themes emerged, each with its own set of sub-themes. A thematic map was
developed to illustrate the themes, and is presented in Figure 3. The map shows that while the organising themes
represented heterogeneous groups of sub-themes, there were significant relationships between themes that
required delineation.
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23
9
2
Number of PHN respondents by work role
CEO/Exec (n=7) Senior Manager (n=23)
Coordinator/Officer (n=9) Other (n=2)
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Figure 3. Thematic Map of Aspects of PHN Mental Health Outcomes.
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Theme 1: Consumers and Carers
Participation and methods for engagement
The Consumers and Carers organising theme understandably resonated through other themes. All PHNs
acknowledged the fundamental need for consumers and carers to participate in reform work, planning and
outcome measurement, in order to uphold the ‘nothing about us, without us’ principle. A few PHNs described
sophisticated processes developed over many years, with some directly employing staff who have a lived
experience to coordinate consumer and carer engagement. Others utilise existing functions (e.g., advisory
committees) or groups that have evolved over a period of time (e.g., Partners in Recovery, headspace). In
particular it was noted that headspace is a good example of how not to do tokenistic engagement.
Some PHNs acknowledged challenges in engaging and involving consumers and carers, particularly in terms of
internal knowledge and capacity, and identified the opportunity for increased guidance to help PHNs achieve
meaningful and reliable consumer and carer engagement.
PHNs called for assistance in this domain despite many examples of best practice guides to consumer and carer
engagement. For example, the National Standards for Mental Health Services (Commonwealth of Australia, 2010)
provided guidance regarding methods for consumer and carer participation. The NMHC Paid Participation Policy
(2014b) also provided focused advice on participation for people with a lived experience of mental health
difficulties, their families and support people. The Department of Health provided a high level guidance document
to PHNs on consumer and carer engagement and participation relevant to the Primary Mental Health Care
Flexible Funding Pool (Commonwealth of Australia, 2016). Finally, individual PHNs have posted consumer and
“If we really want to co-design we should be involving (consumers and carers) in co-design of outcome measures as well.” [PHN19]
“I think the National and State Mental Health Commissions could support the PHNs in better consumer and carer involvement. It's a particular skill set and not one which PHNs have in spades.” [PHN23]
“We have a consumer consultant who is an employed staff member…..to ensure we bring that consumer voice to everything we're doing.” [PHN7]
“We are about to commence someone in a mental health peer coordinator position to assist with modelling to our service providers that we want them to be consumer focused.....and have more robust consultation.” [PHN9]
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carer engagement models on their websites (e.g., WentWest partnership with Health Consumers NSW developed
a Consumer and Community Engagement Model aimed at a consumer centred, top down-bottom up approach to
engagement).
The NMHC Consumer and Carer Engagement Project brought together mental health experts with a lived
experience of mental illness and/or suicide to enhance opportunities for participation, and is currently in
progress. It could potentially provide some intelligence to guide PHNs in improved engagement methods, so will
be useful to learn more as the NMHC Consumer and Carer Engagement Project develops.
Diversity
The challenges and risks of 'hand-picking' consumers and carers was raised. Many PHNs described the importance
of consulting and involving a range of diverse groups, from individuals, to groups, to peak bodies representing
consumer and carers. Some PHNs highlighted that they would appreciate support to do this well.
There are multiple consumer and carer peak bodies and advocacy groups across Australia, and as noted in the
previous sub-theme, many consumer and carer engagement guides. The reported gap could be interpreted as a
variability between PHNs in internal capacity to conduct consumer and carer engagement, or as a lack of time and
resource investment in the activities involved in consumer and carer engagement due to competing demands.
What is clear from PHN responses is that they are seeking support to engage with, and encourage participation
from, a range of diverse groups. What is meant by ‘support’ may differ across PHNs depending on their maturity,
and could be as simple as ensuring best practice guidelines are posted on the national PHN web portal for all
PHNs to access. Mandating evidence of best practice consumer and carer engagement methods in PHN Activity
Work Plans and reports to the Department of Health could ensure a level of reliability in across all PHNs.
"I think we've got room to improve. The difficulty is inviting people in who might have an uncomfortable way of expressing themselves. It's who we invite versus the open market. At the moment, it's all very white gloves. At some point we need to make ourselves vulnerable to hear the whole gamut, and there might be ways to do that to protect people.” [PHN4]
“Our region is vast and very diverse in geography with a lot of rural with metro too. You can't just run one workshop and expect to obtain information about the quality of services.” [PHN9]
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Feedback for service improvement
PHNs described plans to use an experience or feedback tool to obtain consumer and carer feedback on services
and performance, and also to build it into contracts as a performance measure. How to get good feedback to
inform system improvement and monitoring was highlighted as crucial to measuring some of the service system
level outcomes. Working with other key stakeholders in the sector was acknowledged as vital to the feedback
process. The importance of capturing patient journey was also raised, particularly in terms of how PHNs can
retain the richness of patient journey data to inform service growth.
Language and stigma
Attention to use of language by PHNs when engaging with consumers and carers was identified, and the
importance of not reinforcing the narrative of stigma or deficit when measuring outcomes for people
experiencing mental health conditions. One PHN questioned why we continue to talk in terms of statistical data
which can be overwhelming, when all we really want to know is if the service has helped. The need to be aware
of, and apply population specific language was noted, along with specific stigma issues for rural and remote
communities.
The Expert Reference Group on Mental Health Reform (2013) recommended the inclusion of a stigma domain,
specifically “Fewer people will experience stigma and discrimination”. Griffiths, Mendoza, and Carron-Arthur
(2015) further argued that to see true mental health reform, a coordinated implementation of solutions was
“One of our biggest issues is working with ACCHOs (Aboriginal Community Controlled Health Organisations) and developing the social and emotional wellbeing model that can support mental health outcomes for Aboriginal people. Why are we talking about suicide prevention and not social and emotional wellbeing?" [PHN22]
“We need the consumer and carer voice to help us understand what it is they need in a service, and sometimes interpret that and to provide information back to consumers. Also listen to what's going right and what's delivered well, it's not just about negative experiences or the experiences from 20 years ago.” [PHN16]
"Looking at the data gives you a systems view of need. Looking at the literature gives you an academic, clinical paradigm view of need. But PHNs need to look at the system response which is where the qualitative evidence of lived experience will give you key understandings around the roadblocks in the patient journey that literature and data won't give you.” [PHN18]
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required to address ‘structural stigma’. PHN experiences universally indicated a willingness to be part of this
implementation, although there are multiple other systemic parts of the structure that must also be accountable.
Theme 2: Commissioning
Co-design and shared values
Most PHNs used the term ‘co-design’ when talking about commissioning mental health services and defining
mental health outcomes. PHNs were aware of the difficulties in undertaking quality co-design with all
stakeholders (including service providers, community, consumers and carers), with some acknowledging the
planning of more intensive co-design efforts in the next financial year.
This sub-theme was linked closely to the Consumer and Carer theme, and particularly the sub-theme of
Participation and Methods for Engagement. There is a strong policy and literature focus on increasing
opportunities for people with a lived experience, their carers and families, to contribute to the design,
implementation and evaluation of mental health services (e.g., Council of Australian Governments, 2012; NMHC,
2014a). Nevertheless, the translation of policy and intent to practical implementation appeared to be at the root
of PHN frustrations. PHNs have been tasked with implementing reform activities across multiple domains, not just
mental health and suicide prevention, and in a very short time have achieved a great deal. In the context of
limited time, finite human resources, multiple competing priorities, and potential gap in consumer engagement
capability, it is understandable that PHNs are seeking are an instructional, step-by-step ‘how to’ guide to
conducting co-design across and inclusive of a range of stakeholders, each with their own needs and agendas.
"…(we have held) some stepped care workshops with the mental health team, someone facilitating co-design workshops….and those have been discrete moments and not very many of them.” [PHN3]
“We took the whole year in 2016 to decide which programs to focus on with co-design. We did a lot of co-design with service users, we did a lot of journey mapping.” [PHN21]
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Regional needs
PHNs have been using their regional planning to engage with service providers and communities, and commence
discussions about outcome focus versus output. Varied levels of progress was reported, due in part to the
maturity and skill level within PHNs, but also the readiness of the sector within PHN regions. Some PHNs have
found Local Hospital Districts/Local Hospital Networks (LHDs/LHNs) keen and willing to partner and share the
regional planning process, while others have found it a challenge. The aspect of ‘rural and remote’ was
mentioned by several PHNs as important when considering how to plan and commission.
The impact of geographic and demographic variation across the country was an important contributing factor in
the development of the mental health reform platform (NMHC, 2014a). The buy-in from all relevant parties to the
regional planning process will underpin progress against reform activities, with some PHNs already seeing the
benefits of a shared approach to understanding regional needs. As Robinson, Dickinson, and Durrington (2016)
noted, for PHNs to achieve the vision of ‘right care, right place, right time’, strong support and governance
structures will be required between and among regional stakeholders.
Contracts and funding
Some PHNS talked about moving towards outcomes based commissioning and funding (e.g., United Kingdom
models), specifically about contracting for mental health outcomes (Schwartzkoff and Sturgess, 2015), and how
we are very early in process. The use of the contracting process to elicit discussions and shared understanding of
outcomes was indicated by several PHNs. Gardner et al. (2016), in their review of the impact of commissioning
and implications for Australian policy, argued that high quality nationally standardised performance measures
and data requirements should be built into contracts, alongside monitoring and evaluation components.
“We're doing our regional plan in partnership with our local hospital service rather than just getting their sign-off, which is better from an outcomes point of view because they've agreed to share that data.” [PHN26]
“We're not there yet....we want to get to the point of our regional planning process where each of the cohorts are looking at indicators they'd like to identify.” [PHN24]
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Commissioning for stepped care
This sub-theme could arguably have been grouped under the Frameworks and Models organising theme. While
certainly related, it was the inclusion of the commissioning component to stepped care that defined it under the
Commissioning organising theme. Many PHNs identified that there is no uniform framework of stepped care
beyond the high level understanding from the NMHC review and other policy documents. Some PHNs noted that
they use the NMHC review documents in their planning work and socialisation of new staff. Concerns were voiced
around 31 versions of stepped care, and while acknowledging the importance of regional flexibility and
localisation, saw a gap in a nationally consistent approach to how "stepped care" is understood and
communicated across the country. The concept of a standardised decision tool to assist with stepped care
assessment was raised, as a tangible resource for referrers, service providers and individuals.
Theme 3: Frameworks and Models
Levels and models
This was one of the most frequently cited themes, as PHNs described the role of PHNs in measuring mental health
outcomes across levels - individual, service, and system/population.
"I expect once we're more comfortable with our approach to measurement of outcomes, we will look to include outcomes as a way to fund..... If you're not aligning your funding to outcomes, then it's an uphill battle.” [PHN23]
"We came up with a funding matrix as benchmarking guidance, not as a hard guide, but we set targets, so we cross reference against population, rurality, and level of disadvantage.” [PHN5]
"I would like to have a funding model that has a sequence…interested in the UK models where they incentivise quality.” [PHN10]
“Another challenge is around the stepped care model - there is no footprint on how you buy that. We have the guidelines and workshops and training about what the model is, but not about how to commission it. We've never done it before, so we don't know, so that's frustrating.” [PHN10]
“What would be great would be a universal system for stepped care approach… that universal system had the technology already out there to write the code, to plug into the system and for us to access dashboard reports into those KPIs and performance areas.” [PHN16]
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PHNs identified a number of frameworks that could be applied to inform the development, measurement,
monitoring and reporting of mental health outcomes and experiences. A handful of PHNs have investigated and
are implementing a specific outcomes framework.
The PHN data reflected the variability in the literature on outcomes frameworks. While there was nuance in
preferred models, general agreement regarding the concept of “levels” of outcome measurement echoed policy
and literature (e.g., Brown and Oliver-Baxter, 2016; Bywood, Brown & Raven, 2015; Rosenberg et al., 2015;
Schwartzkoff and Sturgess, 2015), and affirmed that PHNs are thinking and moving in the right direction. Mature
PHNs with strong internal expertise and experience suggested that a PHN Mental Health Outcomes Framework
would be best aligned with, or piggy-backed from, existing infrastructure, such as the Australian Mental Health
Outcomes and Classification Network (AMHOCN, 2015). The outcome domains in the AMHOCN work range across
recovery, cognition and emotion, functioning, social inclusion, quality of life, experience of service and
multidimensional such as the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS: Slade,
Thornicroft, Loftus, Phelan & Wykes, 1999). This would seem a sensible and efficient approach, and could also
"We need an evidence based outcomes framework with a variety of suggestions around monitoring - individual, organisation, client, provider, system, and having a set of guidelines that each PHN can draw on......the best ways to look at how to measure that and draw on research and expertise." [PHN11]
"How do we look at quality indicators for system work? Good quality indicators - outcomes based - that are across levels: individuals, service providers, programs, systems and so on." [PHN25]
"We think of outcomes at a system level, a program level and an individual level. I think PHNs have a role at each of those levels." [PHN23]
“The outcomes our providers talk about fall into four general areas, which coincide with the Quadruple Aim model." and "Our outcomes framework has five domains with each domain a set of measurements with examples, and that document is used as a negotiation tool in contracting. It's a menu of options.” [PHN14]
“We'd be interested to see how the work of the primary mental health fits or connects in with the Australian Mental Health Outcome Classification Network......Rather than us PHNs setting up a separate parallel process, when there's already a well-established national infrastructure for mental health outcomes that we might be able to tap into.” [PHN24]
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allow for other evidence-based model principles such as the Quadruple Aim framework (Bodenheimer & Sinsky,
2014) or the Value Based Health Care Delivery framework (Porter, 2010) to be incorporated into the logic behind
a national mental health outcomes framework.
A small proportion of respondents noted that models of care are important when defining and measuring mental
health outcomes. The link to the National Mental Health Service Planning Framework here was noted by some
PHNs, and interest in the planning framework going even further to provide modelled estimates on care
requirements for populations within a stepped care approach. A review of the literature on primary mental health
care models by Harris et al. (2016) supported the view of PHNs that consideration of models of care is integral to
planning and implementing outcomes measurement.
Functional recovery, goal setting and quality of life
Many PHNs described the value of the Partners in Recovery (PIR) service model to taking a recovery oriented
approach to mental health care, and the potential benefits of applying such a model more broadly across the
Primary Mental Health Care priority areas. Some spoke about recovery tools that could be useful measures of
mental health outcomes, such as functionality tools like the Work and Social Adjustment Scale (WSAS: Mundt,
Marks, Shear & Greist, 2002) or the Living in the Community Questionnaire (LCQ: Commonwealth of Australia,
2015b) or recovery-focused tools such as the Stages of Recovery Instrument (STORI: Andresen, Caputi & Oades,
2006).
“The K10 and K5 are very situational, but I'm not sure if they are good measures to use. You want to measure actually how the person is going through their journey. We need outcome tools to measure clinical improvement rather than situational change. The Australian Mental Health Outcomes and Classification Network validated tool - Living in the Community - measures holistic impact around lifestyle rather than a snapshot on the day.” [PHN1]
“There are models of care and clinical staging that could inform an outcomes framework, and I had hoped that the National Mental Health Service Planning Framework would offer what those care profiles might look like......and then we could do some cost modelling.” [PHN16]
"We've been looking at the National Mental Health Service Planning Framework which does set some targets around access to services.... but the challenge is it's not broken down......the responsibility of provision of services (to a cohort) doesn't sit solely with primary care. So we need to figure out where our portion of that is.” [PHN24]
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PHNs suggested that a functional recovery approach to outcome definition and measurement at the individual
level could provide a mechanism to focus more on outcomes rather than outputs with the aim of quality
improvement, a view well supported by the literature (e.g., AMHOCN, 2015).
Quality of life (QOL) was a concept discussed by a few PHNs as more important than output measures or
symptom measures. Particularly in considering population variation, QOL was proposed as a potential universal
way of measuring improvement. A small number of PHNs also identified patient goal setting as an important
component in setting outcomes for treatment, but not always included in measurement and reporting. Progress
against identified goals may not be about reducing clinical symptoms necessarily and may be more holistic (e.g.,
obtaining permanent housing), but significantly impact on mental health outcome.
The AMHOCN (2015) work was reinforced by PHN interest in domains such as experience of service, recovery and
quality of life. The AMHOCN infrastructure affords organisations and service systems the flexibility to implement
and build an outcome measurement approach according to local need. Examples of QOL measures include the
World Health Organisation Quality of Life – Brief (WHOQoL-BREF: World Health Organisation, 2002).
Goal setting, if implemented effectively and according to best practice, can provide opportunity to support a
person-centred method of outcome definition and measurement. Good clinical practice should automatically
include goal setting as a component of shared treatment planning between consumer, carers/families and
“We don't talk about goal setting at all or measure outcome and experience against goals. How are we going to know the clinicians are working with the client on their goals and linking this to the recommended length of service?" [PHN1]
“PIR could give us a good framework for how we measure outcomes and experiences. It has been really profound to ask those consumers and carers as part of the PIR evaluation.” [PHN3]
“We're interested in the notion of recovery, where the consumer identifies their own outcomes.” [PHN24]
"I think there is potential to work on a shared understanding of quality of life across the care team. The power of quality of life as a universal, multi-sectoral indicator can help shift thinking to a more holistic view of person.” [PHN18]
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clinicians. Moreover, responses from PHNs indicated that there is potential to use the goal itself as a measure of
individual outcome progress and recovery.
Tools and measures
PHNs identified a number of tools that can be applied at the individual or clinical outcome level such as the K10
(Kessler et al., 2002), the HONOS (Wing, Curtis & Beevor, 1996), disorder-specific, and patient experience
measures. A small number of PHNs have been considering the value of introducing alternative tools such as the
Outcome Rating Scale (Miller, Duncan, Brown, Sparks & Claud, 2003), which allows consumers and carers to rate
a visual analogue scale. The majority of PHNs were working with regional service providers and community to
define appropriate measurement tools.
The AMHOCN Outcome Measurement Project (AMHOCN, 2015) proposed that a starting point for outcome
measurement consistency in the Community Managed Organisation sector could be a universal experience of
service measure, and from there add appropriate other measures for the service type or according to outcomes
defined by consumers and carers. The Your Experience of Service (YES) tool originally developed by the Victorian
Department of Health (2013) has now been further refined for use in the community sector. Therefore, the time
is opportune for a decision regarding uniform application of the YES tool across PHNs given that many PHNs are
already contemplating its use.
This sub-theme was related closely to the Systems and Data sub-theme of Monitoring, Reporting and the
Minimum Data Set, in that the new Primary Mental Health Care-Minimum Data Set (PMHC-MDS) data model is
being established and rolled out to facilitate capture of data across PHN primary mental health programs. The
PMHC-MDS currently only mandates the K10, or the shortened version K5, or Strengths and Difficulties
Questionnaire (SDQ) for children (Goodman, 1999). PHN responses have indicated that there is scope for
considering a more flexible and population-specific approach to choice of tool or measure.
“The K10 probably doesn't cut it for someone who doesn't speak English. Our CALD (culturally and linguistically diverse) providers have a much more culturally appropriate approach......it's a lot more community driven." [PHN25]
"We really like quantifiable data from a valid source or a measure that's been validated. We need a mix with a Satisfaction Rating Scale because a clinical indicator doesn't always give you an idea of the whole client experience." [PHN4]
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Theme 4: Systems and Data
Monitoring, reporting and the Minimum Data Set
Reporting was raised by several PHNs as an important consideration in outcome measurement and monitoring, in
terms of the requirements and expectations of sector, community and funder. Challenges in reporting against
multiple program areas while simultaneously applying a flexible, regional approach to service commissioning
(e.g., mental health, Alcohol and Other Drugs, Aboriginal services) were highlighted by many.
The PHN arguments for a more rounded view of reported data at multiple levels were supported by literature
recommending the inclusion of qualitative data in addition to quantitative process and outcome measures
(Gardner, Sibthorpe & Longstaff, 2008; Harris et al., 2016). Harris et al. (2016) suggested key ‘domains of
relevance’ for monitoring and reporting to be access to health care, effectiveness of health care, safety, equity
and cost/value, and that indicators should account for different stages of the life cycle and allow for
measurement of person-centred care.
As noted under the Tools and Measures sub-theme above, most PHNs cited potential challenges with the new
PMHC-MDS. While a need for a national system and some level of consistency was recognised, there was parallel
unease around the potential inflexibility of the new MDS system to be flexible according to local priority
communities. Some PHNs were also concerned about the potential challenges in engaging service providers in the
use of the new MDS, and the burden of data collection. The burden on the provider was echoed by Schwartzkoff
and Sturgess (2015), who highlighted the complexity of translating an agreed set of targets and indicators (Expert
Reference Group on Mental Health Reform, 2013) into meaningful service provider contract outcomes.
"One half (of the PHN) does things one way and one does things another way, so that makes it difficult to collect information.....so reporting is tricky." [PHN20]
"We don't (want to) just submit numbers, that we can put annotation on context around the numbers. The MDS (Minimum Data Set) - we just submit the numbers and that might be interpreted in Canberra, and the devil is in the detail. We need the opportunity to give the context.” [PHN4]
"If we wanted anything done differently, one would have been for the MDS....they really missed the boat, in a few ways. One, what's appropriate in the mental health space, let's get the professionals around the table. Two, what's technically appropriate and available. Three, thinking about PHNs, they've only just realised that PHNs do things differently and sometimes for good reason. It needs good national effort to come together.” [PHN22]
24
A handful of PHNs talked about the challenges with conducting good evaluation and review, and ensuring
monitoring of services is sufficient to ascertain achievement of outcomes. PHNs expressed a desire to see an
efficient and streamlined monitoring system for not only PHN, provider and regional needs, but also for
integration with Department reporting requirements. This echoed the literature (Gardner et al., 2016; Harris et
al., 2016; Schwartzkoff & Sturgess, 2015) regarding the importance of finding the balance between levels of
outcome measurement as well as translating targets and indicators into contract outcomes that can be applied.
Technology
Most PHNs highlighted the importance of technology in facilitating outcome measurement, monitoring and
reporting. Some PHNs are using a Client Information Management System (e.g. FIXUS) to support the collection
and monitoring of mental health outcome data. Many PHNs talked about the challenges in finding the right
technology to bring all the requirements together and where possible, sharing systems.
PHN examples of innovations in program delivery pointed to refreshing approaches to individual level outcome
measurement, reinforced by the Griffiths et al. (2015) argument that creative information technology is required
to support the mental health reform platform. However, the quest for system and population level outcomes
appear more challenging to PHNs, supporting McGorry and Hamilton’s (2016) view that strong national
leadership in areas such as data collection is vital.
"We're doing a trial with a university in our headspace centres…..it's a web based tool or on tablets or mobiles. It's potentially scalable to other populations.” [PHN8]
"Our PHN view is to have a portal that is broader than just mental health for providers to upload reports.” [PHN16]
"We're looking at .....having a clinical provider do clinical work by I-pad, and the I-pads are held at the school.” [PHN14]
“We need to know what a patient's experience of a service is…. We haven't got the tools to do that yet but we have wanted to develop an active, formative evaluation approach to things.” [PHN1]
"We're putting in more services especially low intensity services, so we may see an increase in number of people accessing services because they're accessing low intensity services earlier. So the difficulty will be how do you actually measure that, how do we predict that and how effective is that for preventing people from moving on to more intense services?” [PHN7]
25
Data access and sharing
PHNs reported an urgent need for access to SA3 level data to measure change in regional populations. Feeding up
of data and aggregating, collating and benchmarking to enable measurement was also described. The flexibility
afforded PHNs to respond to regional needs to be balanced against the importance of a linking mechanism to
ensure standardization and comparison where relevant.
PHNs discussed the need for sharing data across the sector, including PHNs, LHDs/LHNs, community mental
health, General Practitioners (GPs), private providers, and Medicare funded services. Many PHNs highlighted how
important this data sharing would be to measuring outcomes at a service, population and system level, and in the
context of monitoring and measuring impact of reforms. While there were some examples of data-sharing
between LHDs/LHNs and PHNs, the complexity of this issue was clear, with no consistent method across the
country to facilitate these discussions.
Data access and sharing was strongly linked by the notion of collaboration between jurisdictions, relating this sub-
theme to the Integration and Partnership organising theme. The challenges of knowing what data PHNs need,
where and how to access it, and then what to do with it, were voiced by many PHNs. Rosenberg (2012) noted that
defining and collecting the data needed to measure performance against the mental health reform platform is
“The report that comes back (from headspace National Office)… aggregates the data…. How does that cohort track through time rather than aggregated data which tells us nothing?” [PHN12]
"There's a piece of work to do to look at which indicators can be reported down to the PHN level? Which are only at the national level, and which are at the State level, and which ones are available down to the PHN, and most PHNs would want it down to SA3 level. Who's collecting them and where do you go for them? So that we don't have lots of duplication happening where the feds and the states and the PHNs are all going out collecting the same piece of data.” [PHN24]
"The patients that are shared between state and federal funded services - how do we track their progress and outcomes? Surely there needs to be a better way to do that... LHDs have been around for a long time, have lots of outcome measures and indicators and systems and infrastructure... It would be nice to have access to that and learn from it and not re-invent the wheel." [PHN8]
"Where it becomes more challenging......we need to get data from our state system and from the community sector. We're still in the process of looking at how that works but we have identified the types of outcomes we're looking for and the types of data we need, and we're looking to now see where we can get that data from.” [PHN26]
26
integral to moving towards a suitable benchmarking process (Rosenberg, 2012). As the NMHC advocated in the
2012 Contributing Life report card:
"Data must be rationalised and the right data collected. This will free up valuable time and resources that could be
used to link data held by disability services, coroners, police, ambulance services, housing and employment
agencies, prisons, hospitals, community services and between government, private and non-government service
providers." (NMHC, 2012)
Theme 5: Integration and Partnership
Consistency and silos
Consistency in order to improve integration was one of the most frequently cited themes. PHNs highlighted a
desire to see some increased reliability in how PHNs are being guided and supported to implement the mental
health reforms, as well as clarity around roles and responsibilities across all sectors. A national mental health
outcomes framework was commonly raised as a gap. Many PHNs identified the challenges of specialised
populations within their regions, especially Aboriginal, CALD, rural and remote, and the importance of working
flexibly to best meet the needs of those populations. The lament of ‘working in silos’ also came through strongly,
in the context of each PHN, as well as the regional sector/elements of the system, and then again levels of
Government (state, federal, local) with state and national peak bodies.
The literature echoed PHN responses (Bywood et al.; 2015), in particular around the challenges in working
towards integration, and how to measure integration. PHN concerns also reflected the literature in terms of
perpetuating difficulties in navigating a complicated system (Whiteford, Harris & Diminic, 2013). It spoke to the
"Where I believe PHNs will get to with integration is seeing the health care home model ideology and conceptual framework as the vehicle to integration.” [PHN1]
"What's lacking is that national approach and bringing things together. So while our brief is to be regional and local, there's a piece of work to pull information together and provide support to PHNs in collecting data and providing that support. We'd be happy for any support at this stage!” [PHN9]
"I don't know whether PHNs have been actively involved in reform development. Question is, is that a product of the lack of collective voice? So the model becomes ad hoc. We don't have that mechanism to represent Statewide voice, and then clearly articulate across the country. So in some ways the Government are realising the benefits of pushing down, but not realising the benefits of pulling those learnings up.” [PHN18]
27
importance of building inter-jurisdictional governance as a planned exercise rather than afterthought to influence
effective commissioning (Addicott, 2014). Finding a mechanism to enable a more coordinated, systematic
approach for PHNs to work in partnership with state and national bodies appears fundamental to achieving long
term reform outcomes.
Workforce skills and capacity
This sub-theme reflected the capacity and capability of the PHN workforce, but also sector development and an
accessible workforce to deliver a stepped care mental health model. The importance of building an internal
organisational capacity within PHNs was evident. Moreover, the potential was muted for PHNs to do joint work
with other PHNs or advisory groups, particularly in rural and remote areas. PHNs talked about how to best
support GPs as gatekeepers to accessing primary mental health services, and how to bring workforce along the
reform journey. Rural and remote areas and specialised populations often struggled to maintain workforce, which
impacts on outcomes.
Brown and Oliver-Baxter (2016) argued that workforce is an integral element to combat the impact of silos, and
to encourage organisational or meso-level integration. An adequate workforce with appropriate skills and
capacity is fundamental to addressing community need.
Department of Health and timeliness
The relationship with the Department of Health featured for most PHNs, in terms of how it intersects and
overlays all the work PHNs do. A desire to see increased leadership from the Department of Health in the context
of supporting national and state functions and processes was commonly cited. Some PHNs described the
importance of maintaining PHN objectives at the forefront of any activity to ensure outcomes are the focus.
“One of the biggest challenges we have in mental health is that our primary gate keepers are GPs and they aren't mental health clinicians…. One of the things we've really struggled with is the mental health treatment plan.... in terms of culture change, we almost need to build the bridge between GPs and mental health clinicians, rather than asking the GPs to be the mental health clinicians.” [PHN4]
"We want to build cultural competence of our primary health sector...Aligned to Health Care Home principles, care team approach, providers see themselves as collaborative... And we need to build up our Aboriginal health workforce.” [PHN22]
28
Communication methods were described frequently as necessary to helping PHNs achieve their objectives, with a
desire to see standardised communication at state and national level where possible. PHNs reported frustration
at the lack of understanding of the PHN role in the sector. An opportunity for information sharing and
communication between PHNs was reported to be lacking apart from at the Executive level.
PHNs mentioned the challenge of timeframes and expectations in implementing mental health reforms, in
particular in terms of not having sufficient time for the analysis, planning, co-design and sector development
required to effectively commission. While acknowledging the difficulties for the Department, there was
frustration that timeframes were not always realistic and often did not align with requirements. PHNs also noted
how much had been achieved in a short space of time, managing complex change while building capacity within
PHNs and in the sector.
The vision for the mental health reform platform has been clearly described as long term (NMHC, 2014a), and
PHNs acknowledged this in their responses. Nevertheless, respondents indicated the impact of rapid change and
challenges to quickly build internal capacity and capability to deliver the early components of the reform
platform. As Robinson et al. (2016) aptly noted, “If rushed, there is a risk that this ‘new agenda’ might not deliver
anything very different at all”.
"...helping us get together with other PHNs who are dealing with rural and remote issues in a central way… (There is a) lack of coordination over the top, we're an outcomes commissioning body, we haven't had any leadership or formalised advice about which outcomes, no central roll out, so all PHNs had to work individually.” [PHN15]
“It's really hard to look at integrating a brand new innovative service model that meets all of the requirements of our priority areas within the timeframes the Department have given us, while ensuring they're integrated with the broader health system. So we've focused on ensuring our primary mental health services are integrated with tertiary mental health services and community mental health services....and integrated with general practice. That's where we've started." [PHN26]
”PHNs need some level of showcase, being able to hold up the amazing stories of co-commissioning, alliances, because we are leading change in the sector around value and impact not volume, around non-competitive but cooperative. Anything that can help support that ongoing leadership and change…would be great.” [PHN27]
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Quality, safety and equity
Many PHNs raised questions about the measurement of quality, safety and equity in the reform process, and how
this could be introduced in a systematic way across all PHNs. Some PHNs suggested the need for a review of the
National Standards for Mental Health Services (Commonwealth of Australia, 2010), while others talked about the
challenges in ensuring service providers are meeting standards across all their programs, particularly in rural and
remote locations. It was noted that the risk of pushing business models to drive price down could put quality and
clinical governance at risk.
In their scoping study on the implementation of the National Standards for Mental Health Services, the Australian
Commission on Safety and Quality in Health Care (ACSQHC, 2014) noted that the standards reported by
organisations as most difficult to implement were Standard 5: Promotion and Prevention, and Standard 9:
Integration. This reinforced PHNs’ frustration in considering how to build capacity and expertise for more
equitable, safe and quality mental health services in their regions. This sub-theme was related to the Consumers
and Carers organising theme, in that quality, integrated services that are accessible for all people and give
valuable and meaningful results are the cornerstones of the PHN function.
"Lack of leadership around taking the risks required to make the reform work. There's a policy in place but when they try to implement, there is so much concern around reputational risk that there's delayed information, changed information, changed action. That really sets PHNs up to potentially fail and look bad, and massive disruptions to services.” [PHN17]
“We'd be interested in having a forum with our providers about what they think about seeking accreditation, what impost it would be. Lead agencies can seek accreditation across a range of programs, where no individual program meets all standards. It's about working alongside agencies and matching up with outcomes framework.” [PHN14]
“What we want to do is create a quality service environment where when we put something to tender, we have quality applicants who can deliver things really well.” [PHN4]
"The implementation (of reforms) is tough, and we've inherited a system that is not in a future state….. We don't have the benefit of an integrated system, we have lots of silos and we've got to point them all to that point on the horizon to mobilise people in the direction we're all conceptually heading towards.” [PHN1]
30
Discussion
Phase One of the PHN Mental Health Outcomes Project highlighted the strong passion and interest of many PHNs
and their staff in contributing to implementing mental health reforms. The key findings revealed by the thematic
analysis are summarised in Table 3.
Table 3. Summary of Phase One Key Findings.
Organising theme Key findings
Consumers and
Carers
Although dependent on the maturity of the PHN, engagement with consumers and
carers could largely be improved.
Practical guidance could assist PHNs to engage with peak bodies, advocacy groups,
communities and individuals, especially to ensure diverse and specialised
communities are included. Where there are state or national groups, this could be
done more effectively and efficiently at a state or national level.
PHNs must consider how to close the feedback loop when engaging with consumers
and carers to assist in co-design, defining outcomes, or monitoring and evaluating
outcomes and experiences.
PHNs could learn from each other about how to engage and work with consumers
and carers.
Commissioning PHNs are still in their infancy in the development as commissioning agents and are
growing rapidly in capacity and capability to commission effective and efficient
mental health services.
There is strong interest from PHNs in building expertise in outcomes based
commissioning, while ensuring that regional communities and sectors are brought
along on the journey also.
A high proportion of diversity within and between PHNs reinforces the policy of a
regional approach to stepped care, but needs to be underpinned by a shared
understanding and even implementation in commissioning for stepped care.
PHNs could learn from each other and share commissioning resources and tools, to
avoid duplication and build efficiency.
31
Frameworks and
Models
There are a number of existing frameworks and models of care that could inform the
development of a mental health outcomes framework. Previous work undertaken by
the NMHC, the Expert Reference Group on Mental Health Reform, and the AMHCON
provide foundational pieces.
Outcomes definition, measurement, monitoring and reporting should occur at the
individual or clinical level, the service level, and the system or population level.
There are a range of tools beyond the mandated Minimum Data Set tools that could
add value to how PHNs measure and monitor outcomes and experiences, providing
greater flexibility to monitor services delivered to diverse communities.
The inclusion of domains beyond disorder specific, such as goal setting, quality of
life, and functional recovery could add value to how outcomes and experiences are
measured.
Systems and Data Mental health outcomes measurement, monitoring and reporting requires efficient
and interconnected technology in order to meet PHN and sector needs.
There is great opportunity to align data sets into one system that can provide a fuller
picture across national, state services and private mental health services, allowing
for more effective monitoring of outcomes. Data access and sharing agreements
could be addressed at state/national levels to avoid duplicated effort by each PHN.
The Minimum Data Set has the potential to support a national approach to PHN
funded services collecting and reporting data, however PHNs have lingering
questions and doubts regarding its effectiveness.
The burden of data collection and reporting must be weighed against the nature and
context of the intended outcomes.
Integration and
Partnership
Achieving integration within a PHN region could be influenced and assisted by
national and state functions to break down silos between levels of government, and
between public and private services.
Greater definition is needed of roles and responsibilities across all stakeholders in
the mental health reform platform, and it is not yet clear whether the Fifth National
Mental Health and Suicide Prevention Plan will provide this clarity.
32
Achieving the intended reform is dependent on appropriate time, support, and all
parts of the system working in tandem – PHNs are only one component.
Investment is needed to build capacity and capability in workforces within PHNs, in
general practice, within the mental health sector, Aboriginal health, and within other
sectors, and also to build enabling mechanisms for communication and coordination
across those workforces.
PHNs have an opportunity to investigate greater uptake and implementation of the
National Standards for Mental Health Services, through the commissioning of
primary mental health services, and specifically in contracting for quality outcomes.
The key findings presented in this report should be interpreted with project limitations in mind. The method for
the rapid literature review was not systematic, and therefore important literature may not have been included in
the analysis. An inconsistent use of definitions in the literature (e.g., primary care versus primary health) may also
have contributed to a reduced yield, given the choice of search terms. Furthermore, while the response rate from
PHNs was high, it is not clear whether the findings can be generalised across all 31 PHNs. How would this analysis
resonate with the experiences of the six PHNs who did not participate? Is there any pattern across the six PHNs
who did not participate that should be investigated and considered for this project?
Phase One findings should also be considered in the context of the whole project, and what activities will be
undertaken in Phase Two. These include:
Consultation with non-PHN stakeholders to test and compare against findings from the PHN interview
data set. This will include collation, analysis and interpretation of survey data and semi-structured
interviews with a small sample of consumers, carers, peak bodies and service providers.
Follow up consultation with participating PHNs for feedback against findings and preliminary
recommendations. This will allow for the inclusion of realistic implementation guidance, such as timelines
for recommended actions, in the final project report.
Consideration of the Terms of Reference of the newly formed Mental Health Advisory Panel and how to
utilise findings from this project to inform the Panel’s work.
Convergence of all elements of Phases One and Two of the project to provide critical analysis and final
recommendations.
33
In light of the key findings from Phase One of the project, and considering Phase Two activities, Table 4 lists
preliminary recommendations for the Commission’s consideration.
Table 4. Preliminary Phase One Recommendations.
Recommendation 1 – PHNs sharing learning experiences with other PHNs
PHNs with well-developedfunctional models and approaches to consumer and carer participation share
their learnings with other PHNs. There is much knowledge and skill within some PHNs and grouping
PHNs with similar geographic and demographic characteristics‘like with like’ PHNs could offers a
collegiate and efficient approach to building capacity. This recommendation could be achieved via
uploading models of practice or case studies to the PHN website, via planned PHN national forums
and/or connecting similar ‘like with like’ PHNs to work together and share resources.
Recommendation 2 – Instructional guide for PHNs on co-design and participation
Department of Health, on advice from the National Mental Health Commission, considers the
development of a ‘how to’ guide to instruct and advise PHNs on consumer and carer co-design and
participation. This could be a by-product from the Commission’s current Consumer and Carer
Engagement Project, or alternatively achieved via by bringing together a working group of PHNs with
relevant expertise to draft a simple guide based on their experiences. Peak bodies and consumer and
carer advocacy groups could be offered the opportunity to provide input to a draft. PHN Community
Advisory Committees could provide a uniform mechanism across all PHNs to assist with development
and implementation of a guide.
Recommendation 3 – Nationally consistent definition of stepped care
National Mental Health Commission work with Department of Health, PHNs, peak bodies, consumers,
and carers to operationalise a nationally consistent version of stepped care, with implementation
actions, interim and long term achievement targets and allowable localisation thresholds. This would
ensure that the Commission’s planned Monitoring and Reporting Framework measures against key
elements of a stepped care mental health model. It could be linked to a national outcomes framework,
and would also need to align with the Mental Health Service Planning Framework.
34
Recommendation 4 – National mental health outcomes monitoring and reporting framework
Department of Health, on advice from theThe National Mental Health Commission, considers the
develops ment of aa national mental health outcomes monitoring and reporting framework that can be
regionally applied by PHNs and other stakeholders in the mental health sector. This would need to align
with existing work such as the Fifth National Mental Health and Suicide Prevention Plan, PHN
performance framework and the Primary Mental Health Minimum Data Set. It, and could include
recommended evidence based tools and methods, models of care, indicators etc. against the domains
of levels of measurement – individual, service, and system/population.
Recommendation 5 – Data access and sharing
Department of Health , on advice from the National Mental Health Commission, utilises government
processes to facilitate agreements between levels of governments, non-government organisations, and
other key data hosts to enable increased data sharing with PHNs. This could include access to real-time
(where possible) data sets down to SA3 SA2 level. Utilise examples where data sharing agreements
have been facilitated (e.g., Victorian PHN Alliance). It is acknowledged that data and reporting is an
action item in the draft Fifth National Mental Health and Suicide Prevention Plan, and that intersection
with the proposed PHN Performance Framework and Commission’s Monitoring and Reporting
Framework may help facilitate improved data access and sharing.
Recommendation 6 – Collective PHN knowledge sharing mechanism
Department of Health, on advice from and the National Mental Health Commission together, considers
the opportunity for a national mechanism to draw together knowledge, resources, learnings, and
experiences from PHNs, as well as to support improved communication across PHNs, levels of
government, national peak bodies, state services etc. This could be achieved via a website portal,
national forums or through engaging an existing peak body to facilitate such a mechanism.
Recommendation 7 – Share the findings from this project
The National Mental Health Commission share the findings from this project with the PHN Mental
Health Advisory Panel, to enable learning from PHNs experiences and building collaborative
relationships between PHNs and the Commission.
35
36
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