Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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Mid North Coast
Mental Health Services
Clinical Services Plan
ADDENDUM 2015
September 2015
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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Mid North Coast Mental Health Services Clinical Service Plan DRAFT ADDENDUM 2015
prepared for the Mid North Coast Local Health District by:
richard gilbert consulting
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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TABLE OF CONTENTS
Table of Contents .................................................................................................................................... 3
1 EXECUTIVE SUMMARY & RECOMMENDATIONS ..................................................................... 5
1.1 Introduction .................................................................................................................................... 5
1.2 Projected Service Requirements ..................................................................................................... 5
1.3 Current and Future Role ................................................................................................................. 8
1.4 Recommendations .......................................................................................................................... 9
2 INTRODUCTION .................................................................................................................. 11
2.1 The Mid North Coast Mental Health Service Clinical Service Plan 2013 ...................................... 11
2.2 Developments Since 2013 ............................................................................................................. 12
2.3 The MNC Mental Health Service Clinical Service Plan Addendum 2015 ...................................... 12
3 BACKGROUND .................................................................................................................... 14
4 POLICY & PLANNING FRAMEWORK ..................................................................................... 15
4.1 NSW State Health plan and Rural Health Plan .............................................................................. 15
4.2 National Mental Health Reforms .................................................................................................. 17
4.3 NSW Mental Health Commission .................................................................................................. 19
4.4 Mid North Coast Mental Health Literature Review ...................................................................... 20
5 SERVICE NEED ..................................................................................................................... 22
5.1 Mid North Coast ............................................................................................................................ 22
5.2 Current and Projected Population Profile ..................................................................................... 22
5.3 Service Demand ............................................................................................................................ 24
6 CURRENT ACTIVITY ............................................................................................................. 34
6.1 Acute Inpatient Mental Health Services ....................................................................................... 34
6.2 Non-Acute Inpatient Mental Health Services ............................................................................... 36
6.3 Community Mental Health Services ............................................................................................. 36
7 PROJECTED DEMAND .......................................................................................................... 38
7.1 Current Capacity measured against NSW Planning Benchmarks ................................................. 38
7.2 Projected Capacity Requirements................................................................................................. 42
8 CURRENT SERVICES AND NEW SERVICE MODELS .................................................................. 45
8.1 Mid North Coast Local Health District .......................................................................................... 45
8.2 New Service Models ...................................................................................................................... 47
8.3 Acute Inpatient Units .................................................................................................................... 48
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8.4 Rehabilitation Unit ........................................................................................................................ 51
8.5 Community Mental Health Services ............................................................................................. 52
8.6 Older Persons ................................................................................................................................ 59
8.7 Younger Persons ........................................................................................................................... 60
8.8 General Practitioners and North Coast Primary Health Network ................................................. 61
8.9 Non-Government Organisations ................................................................................................... 61
8.10 Aboriginal Medical Services .......................................................................................................... 62
8.11 Private Services ............................................................................................................................. 63
9 FUTURE ROLE OF PORT MACQUARIE MENTAL HEALTH INPATIENT UNIT AND FUNCTIONAL SPACE
REQUIREMENTS .................................................................................................................. 64
9.1 Hastings Macleay Clinical Network ............................................................................................. 64
9.2 Port Macquarie Mental Health Inpatient Unit ............................................................................ 65
10 References.......................................................................................................................... 73
11 Appendix ............................................................................................................................ 76
11.1 Appendix 1 .................................................................................................................................. 77
11.2 Appendix 2 ……………………………………………………………………………………………………………………..…….79
11.3 Appendix 3 .................................................................................................................................. 83
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1 EXECUTIVE SUMMARY &
RECOMMENDATIONS
1.1 INTRODUCTION
A Clinical Services Plan utilises the latest available data to effectively plan service delivery by identifying current service needs whilst also projecting future service needs. Notably, it remains a living document and, accordingly, may be revised overtime in response to changing circumstances and emerging challenges.
The development of the 2015 Mid North Coast Mental Health Service Clinical Services Plan ADDENDUM
builds on the earlier Mid North Coast Mental Health Services Clinical Services Plan 2013-2021. It provides
the opportunity to review population needs against current service capacity utilising updated population
projections, and plan for the range of Acute and Non-Acute Inpatient and ambulatory services required to
meet the needs of the Hastings Macleay Clinical Network (HMCN), and broader Mid North Coast
community, to 2021 and beyond. Additionally, it presents an opportunity to review and update the
models of care and review previous service enhancement priorities and determine which should have the
highest priority in the context of current and projected community demand and available resources.
The 2015 Mid North Coast Mental Health Service Clinical Services Plan ADDENDUM (ADDENDUM) has
been prepared with advice from key stakeholders to determine the service directions and capacity
requirements for the mental health service, with a focus on inpatient services at Port Macquarie Base
Hospital over the next five to ten years. The development of this ADDENDUM has drawn upon:
consultations with local clinical staff and management, as well as consumers, carers and
members of the local Aboriginal Community from April-June 2015 (see Appendix 1 for
Consultation Profile and Appendix 2 for the Aboriginal Health Impact Statement and checklist);
previous consultation with key stakeholders including service providers, Non-Government
Organisations (NGOs), Commonwealth funded services, and consumers and carers at Planning
Workshops in October 2012;
review of National, State and MNCLHD policies, plans and Service Level Agreements with the
Ministry of Health; and
planning projections using modelling tools and benchmarks as endorsed by NSW Mental Health
and Drug & Alcohol Office (MHDAO).
1.2 PROJECTED SERVICE REQUIREMENTS
In projecting future service capacity requirements to 2020/2025, the ADDENDUM has been informed by
the use of the latest Mental Health – Clinical Care and Prevention (MH-CCP) (2010) methodology1, the
results of which have been summarised in Table 1.1 (shown over page) (see Appendix 3 for MNCLHD
Estimated Needs Met Using MH-CCP (2010), provided July 2015 by MHDAO).
1 MHDAO (2012) MH-CCP 2010.
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Table 1.1 Mid North Coast Local Health District - Current and Projected Inpatient Bed
Requirements
Current
Bed
Numbers
2015 2020 2025
Children & Adolescents (0-17)*
Mid North Coast0* 3 3 3
Adults (18-64)
Mid North Coast52** (42) 37 37 37
Older Persons (65+)
Mid North Coast0 14 16 19
ACUTE TOTAL 52** (42) 54 56 58
Children & Adolescents (0-17)
Mid North Coast0 2 2 2
Adults (18-64)
Mid North Coast20 ̂ (8) 6 6 6
Older Persons (65+)
Mid North Coast0 7 9 10
NON-ACUTE TOTAL 20 ̂ (8) 16 17 18
Children & Adolescents (0-17)
Mid North CoastNA NA NA NA
Adults (18-64)
Mid North Coast0 16 16 16
Older Persons (65+)
Mid North Coast0 6 7 8
VERY LONG STAY TOTAL 0 22 23 24
GRAND TOTAL 72 91 96 101
Very Long Stay
Age Group
MH-CCP (2010)#
2015
Acute
Non-Acute
# Small inconsistencies in figure summation are due to issues associated with rounding; * Acute Child and Adolescent Beds for
Mid North Coast currently provided within Lismore Base Hospital CAMHU; ** As the 10 Acute Beds at Kempsey District Hospital
are non-gazetted and are affected by issues of rurality, the MNC’s total of practicable Acute Adult Beds is 42; ^ The catchment for
North Coast Rehabilitation Unit Beds currently covers MNC and Northern NSW LHDs. The MNCLHD utilises 40 per cent (8) of
these Beds, whilst Northern NSW utilises the remaining Beds.
Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010
Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).
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When comparing the Mid North Coast’s current mental health inpatient bed capacity with the MH-CCP
(2010) estimates provided by MHDAO in July 2015, the following may be noted
The MNCLHD has no Older Persons (65+ years) beds of any description (Acute, Non-Acute, or
Very Long Stay (VLS)), whilst estimates indicate the need for 14 Acute beds, seven Non- Acute
beds, and six VLS beds in 2015, increasing to 19 Acute, 10 Non-Acute and 8 VLS beds,
respectively, by 2025.
The MNCLHD has no Younger Persons (0-17 years) beds, whilst estimates indicate the need for
three Acute beds and two Non-Acute beds in 2015 through to 2025.
The MNCLHD has no VLS beds, although estimates indicate the need for 16 Adult VLS beds and
six Older Person VLS beds in 2015, increasing to a total of 24 VLS beds by 2025. While the
provision of 42 HASI Places within the MNCLHD offsets this need to some degree, such places are
not commensurate with the 24 hour intensive support provided in VLS units. For instance, 26 of
the MNCLHD HASI packages provide consumer assistance for a total of five hours/week, four
packages provide assistance between two and three hours per day, and 12 packages provide
assistance for five hours/day. Also impacting this service space is the new Metal Health Hospital
to Community Initiative given that, wherever possible, individuals previously requiring an
extended long stay in one of the residential mental health facilities in NSW will be gradually
transitioned to the community. A small number of Mid North Coast residents form part of this
cohort and it is expected they will be returned to the LHD for appropriate transitioning. In
response to the existing service need as well as emerging needs, and the absence of very long
stay beds in the Mid North Coast, the MNCLHD may need to secure capital funding to provide
required services.
According to the estimates, the MNCLHD has an adequate supply of Non-Acute beds through to
2025. Presently, however, the catchment for the North Coast Rehabilitation beds covers MNC and
Northern NSW LHDs, with Northern NSW utilising 60 per cent of the available 20 beds. This
means the MNCLHD utilizes eight of the beds. Importantly, the premise whereby the MNCLHD
has an adequate supply of Non-Acute beds is grounded in the expectation that by mid-2017
Northern NSW will no longer require access the MNCLHD Non-Acute beds given the new Byron
Bay Hospital currently under development includes a 20 bed Non-Acute Inpatient Unit.
The MNCLHD has an adequate supply of Adult Acute beds given there are presently 52 Acute
Adult beds in the MNCLHD and estimates indicate the need for 37 Acute Adult beds in 2015
through to 2025. Three factors, however, mitigate the adequacy of this supply. The first is that
there are no Acute Older Persons or Younger Persons beds within the MNCLHD; if the estimated
need for these beds were included, the total number of Acute beds required by the MNCLHD
becomes 54. Secondly, although the 10 beds located at Kempsey District Hospital are Acute beds,
the consequences of rurality, including their distance from the Port Macquarie Inpatient Unit and
associated specialist workforce, means that these non-gazetted beds are not utilised as Acute
beds, per say. Therefore the total number of practicable MNCLHD Adult Acute beds is 42 rather
than 52 beds. Finally, as noted in the CSP 2013, whilst the 2011 MH-CCP (2010) data estimated
158.0 FTE were required to meet the MNC’s need for ambulatory (community) mental health
services, the workforce comprised 76.8FTE. Additional pressure is placed on Acute Adult beds as a
consequence because of the resulting limited capacity for post-discharge follow-up and assertive
treatment within the community setting leading to increased readmission rates. The transition to
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new models of care will allow the MHS to make the best possible use of existing resources
including FTE which may alleviate some of this additional pressure.
1.3 CURRENT AND FUTURE ROLE
The population of the Mid North Coast is projected to increase by 13 per cent between 2011 and 2026.
The population aged over 65 years is projected to increase by 53 per cent over the same period. These
demographic changes will place a substantial additional demand on mental health services within the Mid
North Coast.
Over the next ten years to 2026, Mid North Coast LHD Mental Health services are expected to be
managed and networked on a district-wide basis. Such networking provides the critical mass to provide
for the full range of services of secondary level mental health services, both hospital Inpatient and
ambulatory community based services, and tertiary services such as the Non-Acute Rehabilitation
Inpatient Unit at Coffs Harbour Campus.
As recommended in the Mid North Coast Mental Health Service Clinical Services Plan 2013-2021, the Mid
North Coast Mental Health Service has embarked on a process of reviewing service models of care. The
review has been premised on the need to implement contemporary service delivery models and also by
the recognition that, in an environment of limited resources, MNCLHD Mental Health Services must be
targeted to the achievement of a sustainable method of responding to the mental health needs of the
Mid North Coast population.
Within the LHD, the provision of Mental Health hospital and ambulatory services for the catchment
population will be managed within the Clinical Networks of Hastings Macleay and Coffs Harbour.
In terms of Inpatient bed capacity, the Coffs Harbour Clinical Network has a sufficient overall bed capacity
to meet population requirements for the next ten years. The ageing of the population will result in an
increased need for specialist mental health beds for older persons within this bed complement. It is
foreseen that 10 of the 30 existing Acute Adult beds at Coffs Harbour will, in due course, provide for this
service need.
The North Coast Rehabilitation Unit, located within the Coffs Harbour Clinical Network, currently provides
for the needs of a tertiary population catchment covering the Mid North Coast and Northern NSW LHDs.
Currently the Mid North Coast uses 40 per cent (8 of the 20) available beds. The projected service need
for the MNCLHD alone is for 16 beds across all ages in 2015, increasing to 18 beds in 2025.
The Hastings Macleay Clinical Network does not have sufficient Inpatient bed capacity for mental health
services. There are currently only 12 beds appropriate for providing Acute Inpatient Services:
The Units at Port Macquarie Base Hospital (PMBH) and Kempsey District Hospital (KDH) do not
meet Australasian Health Facility Guidelines in their current design and layout and as such
represent a current and future clinical and corporate risk.
Both Units at PMBH (12 beds) and KDH (10 beds) are of sub-optimal size. The optimal size for an
Acute Adult Unit for efficiency of operation and safety and quality of care is around 18-35 beds.
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1.4 RECOMMENDATIONS
In making the following recommendations it should be noted that this ADDENDUM has reviewed updated
population projections against current service capacity and identified where there are significant
shortfalls in available resources. Achievement of attracting these resources is dependent upon funding
submissions and enhancement funding provided via the Ministry of Health.
Recommended is the development of a 24-bed purpose designed Acute Mental Health Inpatient Unit at
Port Macquarie Base Hospital. Of the 24 beds, 12 will replace the existing 12-bed Adult Acute Unit,
resulting in a total of 12 new beds. At 12 beds the current Inpatient Unit is of sub-optimal size and does
not meet Australian Facility Guidelines.
Space for this development is available on the PMBH campus and would be designed as a gazetted unit to
provide care for involuntary patients. Voluntary patients could also be admitted.
The design of the proposed Inpatient Unit would allow beds to be used flexibly as ‘swing beds’ (beds that
can alternate between different types of care). As such, the proposed Inpatient Unit would contain 24
Acute Adult beds with the capacity to support the admission of eight older persons and four younger
persons.
The function of the Unit would be to provide, in a safe and therapeutic environment, appropriate facilities
for the reception, assessment, admission, diagnosis, observation, treatment and recovery of often acutely
unwell consumers, presenting with known or suspected psychiatric conditions and behavioural disorders.
The requirements of this Unit are outlined on the following page in Table 1.2.
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Table 1.2 Recommended Requirements for the Proposed 24 Bed Port Macquarie Inpatient Unit
Future Requirements to 2025 Current Beds/Facility Comment
24 Acute Adult beds including:
- 4 close observation beds
- 4 beds built to facilitate and support
the admission of younger persons, as
required, as per Australian Health Facility
Guidelines B-0132 Child and Adolescent
Mental Health Unit (2012)
- 8 beds built to facilitate and support
the admission of older person, as
required, as per Australian Health Facility
Guidelines B-0135 Older Persons Acute
Mental Health Unit (2012)
12 beds
- which include 2 close
observation beds
- nil beds able to support the
admission of younger persons
or older persons
Close observation beds - Complex behaviours can require observation of consumers
by staff and discreet security. This should, however, be achieved with a
therapeutic focus so that while necessary measures for safety and security are in
place, they are non-intrusive and do not convey a custodial ambience.
Younger persons admission - Presently, tertiary inpatient services for Mid North
Coast children and adolescents are provided at the CAMHS Inpatient Unit at
Lismore Base Hospital. The nine-hour return journey and resulting family impact
means some families reportedly opt not to seek treatment. Feedback throughout
the ADDENDUM’S consultation process emphasised the significance of being able
to respond effectively to the first episode of acute psychosis or suicidal intentions;
acute crisis and intensive family therapy is critical. The capacity to support the
admission of ounger persons within the proposed Unit would enable crisis
interventions to be commenced both locally and promptly.
Older persons admission - This community has one of largest concentrations of
older people in NSW, a population expected to increase by 53% between 2011 and
2026. The development of Specialist Mental Health Services for Older Persons
(SMHSOPs) was identified as a high priority throughout the consultation and
planning undertaken during the development of the ADDENDUM. The proposed
Unit provides the opportunity to establish purpose-designed inpatient beds for
older persons within the Mid North Coast. There would also be a close
collaboration with the Geriatric Evaluation and Management (GEM) Unit on site at
PMBH, to best utilise the linkages with clinical services including acute medical
and aged care services.
Seclusion Room 1 Consumers may be agitated, aggressive and potentially a risk to themselves or
others, and may where necessary, require temporary containment.
A contemporary mental health
facility compliant with Australian Health
Facility Guidelines.
Non-compliant This represents a current and future clinical and corporate risk.
ECT suite Nil Currently, ECT is provided in Coffs Harbour for patients of both the Coffs Harbour
and Hastings Macleay Networks. The requirement to cover both areas reduces
access to this treatment for the patients of the Coffs Harbour Acute Mental Health
Unit. The timely provision of ECT for patients such as those with psychotic
depression improves patient outcomes and reduces length of stay. It is also a
recommendation of the SMHSOP's Acute IPU Model of Care Project Report (2012:
p. 56) that "all SMHSOP AIU should have local access to ECT."
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2 INTRODUCTION
2.1 THE M ID NORTH COAST MENTAL HEALTH SERVICE CLINICAL
SERVICE PLAN 2013
In 2012-13 the Mid North Coast LHD developed a Clinical Service Plan for Mental Health Services. The Mid
North Coast Mental Health Services Clinical Services Plan 2013-2021 (CSP 2013) outlined current and
projected population needs for mental health services in the Mid North Coast and presented a series of
recommendations for further review and development of these services including the need for capital
development of enhanced mental health service capacity.
The CSP 2013 identified a shortfall in the provision of mental health services in the Hastings Macleay
Network to meet population needs. There is a need to enhance Inpatient capacity and replace out-dated
facilities with contemporary buildings that support contemporary models of care, including a greater
emphasis on primary, community and ambulatory care services.
In particular the CSP 2013 outlined a case for the establishment of a 25 bed consolidated Inpatient mental
health unit for the Hastings Macleay Clinical Network at Port Macquarie Base Hospital (PMBH) with 19
Adult Acute beds, including four Intensive Care Beds, and six Older Persons Acute beds.
Other key recommendations included:
establishment of an Older Persons Inpatient Unit at Kempsey District Hospital;
establishment of a Consortium of Service Providers for Mid North Coast mental health
services, including MNCLHD Mental health Services, NGOs, Commonwealth funded services,
Aboriginal Community Controlled Health Services and other key stakeholders, as an
overarching body to oversee the development and implementation of mental health services
in a collaborative partnership;
undertake a thorough review of models of care operating in both Inpatient and ambulatory
settings across the Mid North Coast, with the aim of updating these on the basis of latest
evidence as to what works best for consumers including new models of care that have been
implemented successfully in other locations, under the guidance of the Consortium of Service
Providers; and
redevelop Ellimatta Lodge at Port Macquarie as a location for day programs and outpatient
clinics for Youth and Family Services.
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2.2 DEVELOPMENTS S INCE 2013
Since the CSP 2013 was completed and endorsed by the LHD in May 2013, the MNC LHD Mental Health
service has begun the process of implementing key recommendations. Implementation has been guided
by a recognition that, while demand will continue to grow driven by population growth, ageing and
increasing prevalence of people living with mental health issues in the community, and with limited
access to significant new recurrent funding, the LHD will need to develop a more sustainable approach
that enables the Mental Health Service to respond more effectively to consumer needs within available
resources.
The Mid North Coast Mental Health Service has begun the process of reviewing mental health models of
care in operation on the Mid North Coast in collaboration with key service partners. This work has
resulted in the establishment of the Mid North Coast Mental Health Integrated Care Collaborative.
Other key progress to date includes:
development of a Feasibility Study for the potential expansion of adult Acute mental health beds
and child and adolescent mental health unit on the Port Macquarie Base Hospital campus;
development of a Models of Care for Mental Health Services on the Mid North Coast of NSW
Discussion Paper which was circulated for discussion and feedback in November 2014 with
implementation of the new Models of Care occurring from July to December 2015; and
endorsement of proposal to develop Ellimatta Lodge as a centre for Mental Health youth and
family ambulatory care services with capital works planning commenced and works to proceed
from July to December 2015.
2.3 THE MNC MENTAL HEALTH SERVICE CLINICAL SERVICE PLAN
ADDENDUM 2015
In order to inform the proposed development of a Business Case for the development of Mental Health
Service Inpatient capacity at PMBH, the ADDENDUM will incorporate the following:
recent plans and policy directions including:
- NSW Mental Health Commission Strategic Plan (2014)
- Rural mental health service delivery models – literature review (2014);
updating of population estimates and population projections for the Mid North Coast;
updating of data on current utilisation of mental health services in MNCLHD;
updating of population requirements for mental health services using the MH-CCP;
identification of Inpatient bed requirements to meet the projected population demand; and
review of relevant MNCLHD and related NGO and Commonwealth-funded services models of care
impacting on the provision of Inpatient mental health services at PMBH.
The development of the ADDENDUM presents an opportunity to incorporate updated population
projections and latest activity data in the review of population needs and future service requirements for
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the Mid North Coast to 2020 and 2025. It presents an opportunity to review and update the models of
care and review previous service enhancement priorities and determine which should have the highest
priority in the context of current and projected community demand and available resources.
In the development of the ADDENDUM, a range of NSW Health endorsed planning tools have been used
to project future service needs including MH-CCP (2010), FlowInfo Version 14.0, HIE data and information
provided by the Health Service. These have been used for trend analyses and NSW Statistical Local Area
(SLA) Population Projections 2014 have been used to define local and regional populations.
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3 BACKGROUND
The Mid North Coast Local Health District provides a range of hospital Inpatient and community mental
health services. Mental health services are managed on a LHD basis and provided in each of the two
Service Networks, Hastings Macleay and Coffs. Mental health services provided in each Network include:
Hastings Macleay Network
Port Macquarie Mental Health Inpatient Unit
Port Macquarie Community Mental Health Service
Kempsey Mental Health Inpatient Unit
Kempsey Community Mental Health Service
Coffs Network
Coffs Harbour Acute Mental Health Unit
North Coast Mental Health Rehabilitation Unit
Coffs Harbour Acute Care Service Community Mental Health
Coffs Harbour Extended Care Service Community Mental Health
These services are the focus of this planning process. The ADDENDUM will focus in particular on service
provision within the Hastings Macleay Network. In addition to these public mental health services, there
is a range of non-government and private mental health services provided in the Mid North Coast.
In developing the ADDENDUM, the Mid North Coast Local Health District has been guided by the
following principles which were identified in the CSP 2013:
I. recovery focus of treatment and care;
II. consumer involvement – engagement of consumers and carers in care;
III. prevention and early intervention – emphasis on reducing the burden of illness caused by mental
health conditions;
IV. quality and excellence – in the provision of mental health care;
V. effective partnerships – collaboration with key partners including NGOs and Commonwealth
funded services;
VI. recognition of cultural diversity – delivery of appropriate services to culturally and linguistically
diverse consumers; and
VII. commitment to Closing the Gap in health outcomes for Aboriginal people and families on the Mid
North Coast.
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4 POLICY & PLANNING FRAMEWORK
4.1 NSW STATE HEALTH PLAN AND RURAL HEALTH PLAN
NSW State Health Plan Towards 2021
The NSW State Health Plan: Towards 2021 builds upon the NSW State Health Plan Strategic Direction
bringing together existing State Health Plans, programs and policies to further develop the NSW
healthcare system to focus on the delivery of ‘the right care, in the right place, at the right time’ for
everyone. It is intended this will be delivered through the following three Strategic Directions:
Keeping People Healthy – supporting people to live healthier, more active lives and reducing the
burden of chronic disease. NSW Health will continue to invest in effective public health programs
in the areas of smoking, obesity, risky alcohol use and early intervention.
Providing World Class Clinical Care – providing timely access to safe, quality care in our hospitals,
EDs and in the community. NSW Health will continue to focus on streamlining ED processes,
reducing unwarranted variation in care, reducing re-admission rates and introduce models of care
to address emerging health issues.
Delivering Truly Integrated Care – creating a connected health system, so that patients and their
carers can more easily navigate the healthcare system, get the care they need, where and when
they need it. NSW Health will invest in integrated care and partnering with health service
providers to avoid unplanned hospitalisations, improve transfer of care, patient and carers
experiences and work towards better health outcomes.
These Strategic Directions will be delivered through implementation of the following key strategies:
Supporting and Developing Our Workforce – developing a strong, skilled workforce to deliver
first class, patient-centred care within our CORE values framework. NSW Health will further
implement The Health Professionals Workforce Plan 2012-2022, establish the Health Education
and Training Institute (HETI) to help drive skills and leadership development and improve
workforce planning at the LHD level.
Supporting and Harnessing Research and Innovation – pursuing cutting edge medical, health
research and innovation. NSW Health will create a dedicated Office for Health and Medical
Research to fast-track the development of innovative ideas, products, drug therapies and
evidence based treatments to deliver improved healthcare.
Enabling eHealth – improving digital connectivity for a smart, networked health system in our
hospitals, in the community and in the future. Implement the Blueprint for eHealth in NSW to
improve technology in clinical care, business services, infrastructure and community outreach.
Designing and Building Future-Focused Infrastructure – improving facilities and equipment to
support the delivery of care and meet growing and evolving healthcare needs of local
communities and changing service delivery models.
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NSW Rural Health Plan: Towards 2021
The NSW Rural Health Plan: Towards 2021 complements the NSW State Health Plan Strategic Direction
and the NSW State Health Plan to improve the delivery of health services for people living in regional and
rural communities.
Building truly integrated rural health services is a priority of the Rural Health Plan and sets the direction
for greater collaboration and the building of stronger partnerships between public and private health
service providers, Medicare Locals and General Practitioners (GPs), Aboriginal Medical Services (AMSs)
and other primary health organisations to provide more coordinated and seamless health service delivery
to rural and regional communities closer to home. The Rural Health Plan sets the direction over the next 7
years for further developing the rural health workforce, investment in infrastructure, new models of care,
research and eHealth technology.
The NSW Rural Health Plan: Towards 2021 further promotes the requirements of regional, rural and
remote NSW to keep the focus on placing sustainable contemporary services closer to where people live
through the following three Strategic Directions and three key Strategies:
Healthy Rural Communities – Strengthen health promotion, disease prevention and community
health services to ensure people in rural communities are healthy with a focus on priority areas
including Aboriginal, maternal, child youth, mental, sexual and oral health services as well as
investing in prevention and health promotion programs to reduce burden of disease associated
with smoking, alcohol use and poor nutrition.
Access to High Quality Care for Rural Populations – improve access to health services as close to
home as possible and enable the provision of high quality care in local rural health services. The
focus is to strengthen service networks, develop eHealth solutions and better support those who
have to travel to access healthcare.
Integrated Rural Health Services – ensure services and networks work together, are patient-
centred and planned in partnership with local communities and heal service providers, and
provide better continuity of care. Improve service integration with services planned and
developed in partnership with rural communities and local health service providers.
These Strategic Directions will be delivered through implementation of the following key Strategies:
Strategy 1: Enhancing the Rural Health Workforce – continue to build the health workforce in
rural areas through enhanced recruitment, training, career development and support. Further
implement Health professionals Workforce Plan 2012-2022 and continue to develop a more
skilled workforce, increase the Aboriginal health workforce, implement innovative workforce
models and strengthen the provision of training and development.
Strategy 2: Strengthening Rural Health Infrastructure, Research and Innovation – invest in
facilities, models of care and research and innovation to ensure the provision of high quality
health services in rural communities. Support the growth of research and innovation in rural
areas to develop and implement local solutions that meets the healthcare needs of local
communities.
Strategy 3: Improve Rural eHealth – implement eHealth solutions and strategies to transform
connections between and access to health services in rural NSW. Implement the Rural eHealth
Program that invests in eHealth infrastructure, improved governance arrangements to support
integration and connectedness of health services.
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There are specific goals in the Rural Health Plan to improve rural mental health including:
Implement the NSW suicide prevention toolkit for small towns.
Expand mental health outreach services via hub and spoke service delivery models and other
locally appropriate models.
Develop community based approaches to mental health to increase provision of services closer to
consumer’s homes.
Promote community mental health literacy, enhanced access and pathways to care for smaller
communities.
Develop initiatives that address the physical health needs of people with mental health issues.
Continue to develop and implement initiatives targeting people with dual drug and alcohol and
mental health diagnosis.
Improve and enhance quality of, and access to, child and youth mental health services.
4.2 NATIONAL MENTAL HEALTH REFORMS
In December 2008, the Australian Health Ministers endorsed an overarching vision for the mental health
system in Australia through the National Mental Health Policy of
… a mental health system that enables recovery, that prevents and detects mental
illness early and ensures that all Australians with a mental illness can access effective
and appropriate treatment and community support to enable them to participate fully
in the community2.
The Fourth National Mental Health Plan (2009-2014) was released by the Commonwealth Government in
20093. The Fourth National Mental Health Plan adopts a population health framework which
acknowledges the importance of mental health issues across the lifespan from infancy to old age and
recognises that mental health and illness result from the complex interplay of biological, social,
psychological, environmental and economic forces at all levels.
2 Commonwealth of Australia (2008) National Mental Health Policy.
3 Commonwealth of Australia (2009) Fourth National Mental Health Plan – An agenda for collaborative action in mental health
2009-2014.
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The Fourth Plan operationalises the population health framework through a whole of government
approach to mental health reform that recognises the need for greater collaboration across
Commonwealth and State/Territory levels of responsibility. The Fourth Plan is underpinned by eight key
principles and focuses actions in five key priority areas:
social inclusion and recovery;
prevention and early intervention;
service access, coordination and continuity of care;
quality improvement and innovation; and
accountability – measuring and reporting progress.
One of the key initiatives in the Fourth National Mental Health Plan is the development of a National
Mental Health Service Planning Framework (NMHSPF) which will provide a population based planning
model for mental health that will better identify service demand and care packages across the sector in
both Inpatient and community environments.
The Fourth National Mental Health Plan highlighted that, while there had been an increase in funding
over the past five years, the mental health system in Australia remains fragmented and as a
consequence presents problems to consumers and carers in continuity of care and gaining access to
services actually needed and promotes system inefficiency through inappropriate funding allocation —
resulting in service duplication and / or service gaps. In summary:
“… despite increased funding to primary and specialist services, treatment rates for people
with mental illness remain low compared with the prevalence of illness. For access to the right
service to be improved, there needs to be an agreed range of service options, across both
health and community support sectors. This should be informed by population based planning
frameworks that specify the required mix and level of services required, along with resourcing
targets to guide future planning and service development that are based on best practice
evidence4.”
The Report of the National Review of Mental Health Programmes and Services was released by the
Commonwealth Government in 20155. This Review also highlighted the structural shortcomings of the
national mental health system with poorly planned and badly integrated systems of care.
This report proposed a reallocation of funding from downstream to upstream services including
prevention and early intervention. To achieve the required system reform, the National Mental Health
Commission has recommended changes to improve the longer term sustainability of the mental health
system based on three components:
1. person-centred design principles;
2. a new system architecture; and
3. shifting funding to more efficient and effective “upstream” services and supports6.
4 Op cit.
5 Commonwealth of Australia (2014) Report of the National Review of Mental Health Programmes and Services, National Mental
Health Commission. 6 Op. cit.
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The components of a comprehensive mental health service have been described as part of the modelling
that resulted in the afore-mentioned National Mental Health Service Planning Framework. The range of
services that need to be delivered include:
assessment (including physical exam and investigations, second opinions, tertiary service assessment (e.g. for early psychosis, forensic, eating disorders, neuropsychiatric, affective disorders, post-natal depression, personality disorders, dual diagnosis));
review (including for acute and stable / maintenance stages);
individual therapy (including medication, psychotherapies, living skills, social skills, rehabilitation);
group therapy; tertiary service treatment;
consultation / liaison;
supported accommodation; and
mental health prevention / promotion.
The model is not prescriptive on the settings in which these services can be delivered and allows for the following locations:
community based outpatient services;
extended hours / crisis services;
Acute Inpatient Services including general Acute beds, observation beds and Tertiary Service Acute beds;
Non-Acute Inpatient Services (up to 90 days);
very long stay Inpatient Services (365 days);
forensic beds (long term); and
supported community accommodation (“step down”).
Following the review of Medicare Locals in 2014, the Commonwealth Government established 31 Primary
Health Networks (PHNs) from 1 July 2015. The North Coast PHN will replace the current North Coast
Medicare Local and is expected to work closely with general practices and public and private health
providers. The National Review of Mental Health Programmes and Services indicated that the PHNs may
be renamed as Primary and Mental Health Networks, and will enable a better targeting of mental health
resources to meet population needs on a regional basis7.
4.3 NSW MENTAL HEALTH COMMISSION
NSW established the NSW Mental Health Commission of NSW in 2012. The Commission’s remit is to
consider the whole person, recognising that a person’s mental illness does not define them. The
Commission has recently developed a Strategic Plan for Mental Health in NSW. In developing the
Strategic Plan and the companion report Living Well: Putting People at the Centre of Mental Health
7 Commonwealth of Australia (2014) Report of the National Review of Mental Health Programmes and Services, National Mental
Health Commission.
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Reform in NSW8, the Commission is recognising the importance of putting people at the centre of any
future mental health reforms. A related goal is to keep the concept of recovery at the centre of the Plan.
Recovery means different things to different people, but it is principally concerned with supporting
people to find the help they need and want to make their lives better on whatever terms they choose.
Accordingly the Plan considers physical health, housing, employment, education, social participation and
a range of other issues central to people’s lives.
The Strategic Plan sets out directions for reform of the mental health system in NSW over the next ten
years9. Similar to the national reform documents, the NSW Strategic Plan for Mental Health indicates that
a shift is required in government mental health services, from crisis-driven responses towards prevention
and early intervention. In particular the Plan indicates that:
“we must recognise that there is strenuous work ahead to reorient a system that has
emphasised hospital beds for too long at the expense of other forms of support offered in
or close to people’s homes. Our supports are still, in many places, inflexible, ineffective,
outdated and under-resourced, and often do not join up well when people’s needs are
complex and continuing. The situation is made all the more complex by the lack of clarity
about state and Commonwealth responsibility for funding and service quality10.”
4.4 M ID NORTH COAST MENTAL HEALTH L ITERATURE REVIEW
In 2014 the Mid North Coast LHD commissioned the Centre for Rural and Remote Mental Health to
undertake a literature review of mental health models of care11.
The Literature Review identified the importance of achieving a balanced approach to service delivery
with an optimal mix of mental health services including specialist mental health services (including
Inpatient facilities, specialist psychiatric services and community mental health teams) and mental
health services provided through primary health care services, and self-care.
In particular, the report identified the need to build the capacity of the primary (health) care sector as the
best known way to significantly and pragmatically increase service access for a greater proportion of
persons with a mental health problem in the Mid North Coast, as well as improving the delivery of mental
health promotion and the likelihood of earlier intervention.
The Review identified the need for specialist mental health services to work in closer collaboration with
primary health services, and identified the importance of developing strong governance structures to
underpin this collaborative form of working.
8 Mental Health Commission of NSW (2014) Living Well: Putting people at the centre of mental health reform in NSW.
9 Mental Health Commission of NSW (2014) A Strategic Plan for Mental health in NSW 2014-2024.
10 Op cit.
11 Centre for Rural and Remote Mental health (2014) Rural mental health service delivery models – a literature review.
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In developing this collaborative model of care, a c l e a r division of labour between service components
will be required. The role of the specialist mental health services, in the public and private sector and the
not for profit organisation sector, w i l l require more attention, as it is the specialist services that have
most influence over the direction but more importantly quality of delivery of the mental health services
system.
A more complete description of the role of specialist mental health services would include:
almost exclusive responsibility for delivering Acute Services;
prime responsibility for crisis intervention;
providing a clinical response to, and managing all cases of, severe mental illness. Within the
specialist services there is likely to be a more calibrated division of labour, with the non-
government organisations through the Partners in Recovery (PIR) initiative taking most
responsibility of an ‘assertive’ case management role through specifically employed ‘support
facilitators’ and the public sector specialist services being the primary ‘go to’ resources for
clinical intervention;
providing an outreach clinical response through routinely organised and co-located clinics (in
general practices, community health clinics, youth services, etc.) that would primarily target
cases of severe and moderate mental illness but would also provide time for consultation
and training with primary mental health care workers;
providing consultant support (community liaison) to general practitioners and other primary
mental health care providers for specific cases; and
building the capacity of primary mental health care workers to manage more independently
high prevalence disorders and contribute more to treatment of moderate cases of mental
illness. Capacity building would occur in many ways including structured formal training
processes, communities of practice, team learning opportunities and self-directed learning
resources. In this regard it may be worthwhile adopting the Victorian PMHEI Team model,
and assigning dedicated workers within the broader community mental health service to this
role. The functions of this team would be to provide education, training and secondary
consultation to primary health care workers and promote shared care arrangements
between specialist mental health services and primary care providers.
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5 SERVICE NEED
5.1 M ID NORTH COAST
The Mid North Coast consists of the five local government areas of Kempsey, Port-Macquarie-Hastings,
Nambucca, Bellingen and Coffs Harbour.
Figure 5.1 Mid North Coast Local Health District
5.2 CURRENT AND PROJECTED POPULATION PROFILE
In 2011, the estimated resident population of Mid North Coast was 207,490 persons. The Mid North
Coast population increased by 4.1 per cent in the five years between 2006 and 2011. Table 5.1 (shown
over page) presents the population projections to 2026 using the approved Ministry of Health population
projections. The Mid North Coast population is projected to increase by 13 per cent to 235,419 in 202612.
12
NSW State and Local Government Area Population Projections (2014 Final).
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The Hastings Macleay Network and the Coffs Network are of comparable size, both having a population
of around 103,000 to 104,000 in 2011. The projected population increase is higher for both Coffs Harbour
(19 per cent) and Port Macquarie -Hastings (16 per cent) than in the smaller Mid North Coast LGAs.
Table 5.1 Current and Projected Population, Mid North Coast, 2011-2026
LGA Age 2011 ERP 2016 2021 2026 % change 2011-2026
0-14 2,487 2,376 2,358 2,307 -7%
15-24 1,335 1,198 1,038 952 -29%
Bellingen 25-44 2,433 2,424 2,383 2,359 -3%
45-64 4,158 4,128 3,894 3,567 -14%
65-84 2,184 2,504 2,933 3,324 52%
85+ 326 360 393 433 33%
Total Bellingen 12,923 12,990 12,998 12,942 0%
0-14 13,561 14,141 14,976 15,531 15%
15-24 8,803 8,759 8,591 8,865 1%
Coffs Harbour 25-44 15,759 16,831 17,840 18,648 18%
45-64 20,263 20,817 20,903 20,678 2%
65-84 10,860 12,971 15,430 17,865 65%
85+ 1,726 2,054 2,292 2,666 54%
Total Coffs Harbour 70,972 75,572 80,033 84,253 19%
0-14 5,730 5,694 5,731 5,680 -1%
15-24 3,260 2,993 2,767 2,692 -17%
Kempsey 25-44 5,757 5,781 5,797 5,740 0%
45-64 8,748 8,542 8,150 7,636 -13%
65-84 4,908 5,797 6,742 7,569 54%
85+ 725 840 893 1,056 46%
Total Kempsey 19,128 29,648 30,079 30,373 4%
0-14 3,444 3,443 3,407 3,318 -4%
15-24 1,875 1,725 1,627 1,603 -15%
Nambucca 25-44 3,330 3,320 3,246 3,240 -3%
45-64 5,946 5,875 5,722 5,285 -11%
65-84 4,004 4,649 5,358 6,103 52%
85+ 636 724 782 899 41%
Total Nambucca 19,235 19,735 20,143 20,448 6%
0-14 13,281 13,728 14,222 14,556 10%
15-24 7,749 7,627 7,532 7,643 -1%
Port Macquarie-Hastings 25-44 14,859 15,449 15,990 16,477 11%
45-64 20,912 21,675 22,122 21,738 4%
65-84 15,934 18,036 20,331 23,106 45%
85+ 2,497 3,030 3,420 3,883 56%
Total Port Macquarie-Hastings 75,232 79,545 83,618 87,403 16%
0-14 38,503 39,383 39,383 41,392 8%
15-24 23,022 22,301 21,556 21,756 -6%
MNCLHD 25-44 42,138 43,804 45,257 46,464 10%
45-64 60,027 61,037 60,791 58,904 -2%
65-84 37,890 43,957 50,793 57,967 53%
85+ 5,910 7,007 7,780 8,936 51%
Total MNCLHD
207,490 217,489 226,870 235,419 13%
Source: NSW State and Local Government Area Population Projections (2014 Final).
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A profile of the population served by the Mid North Coast LHD is provided below:
Significant Characteristics
Population Growth: The Mid North Coast population is projected to increase by 13 per cent
between 2011 and 2026.
Aged population: A feature of the Mid North Coast is the substantial aged population. Over one-
fifth (21.1 per cent) of the total Mid North Coast population in 2011 were aged 65 years and over.
This compares with 13.5 per cent of the total NSW population aged 65 years and over in 2006.
The aged population is projected to increase by 52.7 per cent to the year 2026, at which time this
population group will comprise 28.4 per cent of the total population of the Mid North Coast. The
population aged 85 years and over is projected to increase by 52 per cent between 2011 and
2026.
Aboriginal population: In 2011, 5.8 per cent of the Mid North Coast population were Aboriginal13.
In NSW 2.9 per cent identify as Aboriginal and Torres Strait Islander14. Kempsey LGA has the
largest number (3,715) and proportion of Aboriginal residents (12.8 per cent) of any LGA on the
mid north coast14.
Paediatric population: In 2011 18.6 per cent of the Mid North Coast population were aged 0-14
years. This population is projected to increase by 7.7 per cent to 2021. In 2021, the 0-14 population
will comprise 17.2 per cent of the total population of the Mid North Coast.
Socio-economic status: Using the SEIFA scores (reference score for Australia is 1,000) all Mid
North Coast LGAs have scores under 1,000, ranging from 880 (Kempsey) to 969 (Port Macquarie-
Hastings)14. NSW has an IRSD score of 1,003 and an IEO score of 1,00515.
Tourist population: The Mid North Coast is a popular tourist destination which places additional
demand on emergency services during peak holiday periods.
A detailed epidemiological profile of the Mid North Coast population is provided in the CSP 2013.
5.3 SERVICE DEMAND
There are several methods for identifying the population demand for mental health services. The Mental
Health Clinical Care and Prevention (MH-CCP) methodology provides an estimate of population need
using epidemiological and treatment data for population groups16. It also allows for the projection of
future service requirements in NSW. The MH-CCP model, originally developed in 2001, has recently been
reviewed and an updated methodology provided by the Mental Health and Drug & Alcohol Office in 2012.
This latest model, referred to as MH-CCP (2010), has been approved for use in the purpose of developing
estimates and projections of prevalence rates and resource requirements for the ADDENDUM.
13
Australian Bureau of Statistics. (2011). 3238.0.55.001 - Estimates of Aboriginal and Torres Strait Islander Australians, June 2011. http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3238.0.55.001June%202011?OpenDocument (accessed Nov 2013). 14
ABS: 2033.0.55.001_ Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA). Australia, 2011. 15
Population Health Division. The health of the people of New South Wales - Report of the Chief Health Officer 2008. Sydney: NSW Department of Health.
16 Ministry of Health (2012) Mental Health Clinical Care and Prevention Model, 2010.
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It is also possible to analyse current patterns of utilisation of mental health services by residents of the
Mid North Coast Local Health District.
5.3.1 Mental Health Clinical Care and Prevention Estimates of Current and Projected
Population Need
The MH-CCP was developed as a tool to assist systematic consideration of the requirements of
comprehensive integrated mental health care and prevention across the lifespan in a population mental
health framework. It utilises epidemiological and treatment data to estimate the proportion of the
population at risk of needing care over a twelve month period17. The MH-CCP (2010) model is in draft
form and it should be noted that any estimates may be subject to change.
The Mental Health Clinical Care and Prevention model indicates that overall rates of mental health
problems in the community are relatively high at around 20 per cent. However a relatively smaller
number of people require specialist treatment for mental health issues. The model indicates that a full
range of mental health programs are required across the life span from early childhood to old age and
across the intervention spectrum from promotion, prevention and early intervention to Acute Care,
Continuing Care and Rehabilitation.
The MH-CCP presents age-specific prevalence estimates for varying levels of severity of mental health
risks and disorders across the lifespan. For the purpose of informing the Mid North Coast Mental Health
Plan, the three age groups are used:
children and adolescents (age 0-17 years);
adult (age 18-64 years); and
older People (age 65 years and over).
Overall, the MH-CCP (2010) projects prevalence of mental health problems with 17.2 per cent of the
population projected to experience a clinically diagnosable mental disorder. This translates to more than
37,000 people in 2015 for the population of the Mid North Coast (as indicated in Table 5.2 shown over
page), increasing to over 40,000 people in 2026.
The MH-CCP (2010) estimates that, for the projected Mid North Coast population of 232,728 people in
2025, 38,280 people, or 16.4 per cent of the population, would experience a clinically diagnosable mental
disorder: 7,552 people aged 0-17 years; 20, 959 people aged between 18-64 years; and 9,769 people
aged 65 years and over.
17
Mental Health and Drug & Alcohol Office, NSW (2001) Mental Health Clinical Care and Prevention Model Version 1.11 a
population mental health model; Ministry of Health (2012) Mental Health Clinical Care and Prevention Model (draft version), 2010.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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Table 5.2 Projected Populations and Estimated Prevalence* of Mental Disorder by Networks, MNCLHD 2016-2026
Age group
Projected
population
2016
Est. pop'n
with mental
disorder
Projected
population 2021
Est. pop'n
with mental
disorder
Projected
population 2026
Est. pop'n
with mental
disorder
Children (0-11) 15.50% 15.50% 15.50%
Hastings Macleay 15,299 2,364 15,668 2,421 15,871 2,453
Coffs Harbour 15,783 2,439 16,310 2,521 16,628 2,570
Mid North Coast 31,082 4,803 31,978 4,942 32,499 5,023
Adolescents (12-17) 15.40% 15.40% 15.40%
Hastings Macleay 7,838 1,205 7,952 1,222 8,165 1,255
Coffs Harbour 8,124 1,249 8,254 1,269 8,567 1,317
Mid North Coast 15,962 2,454 16,207 2,491 16,732 2,572
Adults 18.50% 18.50% 18.50%
Hastings Macleay 58,231 10,749 58,608 10,819 58,139 10,732
Coffs Harbour 60,959 11,253 61,322 11,320 61,118 11,282
Mid North Coast 119,190 22,002 119,929 22,139 119,257 22,015
Older people 14.80% 14.80% 14.80%
Hastings Macleay 27,318 4,032 30,998 4,575 35,169 5,191
Coffs Harbour 22,885 3,378 26,771 3,951 30,856 4,554
Mid North Coast 50,203 7,409 57,769 8,526 66,025 9,744
All Ages 17.20% 17.20% 17.20%
Hastings Macleay 108,685 18,741 113,226 19,524 117,345 20,234
Coffs Harbour 107,751 18,580 112,657 19,426 117,169 20,204
Mid North Coast 216,436 37,321 225,882 38,949 234,513 40,438
* Prevalence rates (%) are derived from MH-CCP 2010 V2.05b
Population source: Department of Planning and Environment 2014 population series customised by NSW Health.
Population is based on intercensal interpolation and projection. Years are financial year, e.g. 2016 signifies 2015-2016.
5.3.2 Current Utilisation of Community Mental Health Services by Mid North Coast
Residents
The Mid North Coast LHD has information on the total number of Mental Health Clients who are seen by
the LHD Community Mental Health Service during the year. In 2013/14, the MNC Community Mental
Health Service saw a total of 4,373 clients. The total number of clients has increased by 10 per cent since
2010/11.
Over three out of four (76.3 per cent) of total clients were adults between the age of 18-64 years (refer
Table 5.3 over page). Older people aged 65 years and over, who comprised 21 per cent of the total Mid
North Coast population in 2011, accounted for 8.7 per cent of total community mental health clients.
There were only 26 clients aged less than 12 years in 2011/12, and there were 631 clients aged 12-17
years, accounting for 14 per cent of the total Mid North Coast community mental health client base.
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Table 5.3 Individual Clients of MNC Mental Health Service by Clinical Network*, 2013/14
Age Group Coffs Hastings Macleay Mid North Coast %
0-11 years 10 11 5 26 0.6
12-17 years 241 238 152 631 14.4
18-64 years 1,470 1,085 780 3,335 76.3
65+ years 144 165 72 381 8.7
TOTAL 1,865 1,499 1,009 4,373 100
* Although comprising one MNCLHD Network, Community Mental Health data is collected and reported separately for the Hastings and Macleay. Source: Mid North Coast Information Exchange Mental Health Community Ambulatory (CHAMB) data, 2015. Note: The network totals of individual mental health clients in Table 5.3 will not add up to the LHD total as some individuals were
active in more than one network. Also, the Coffs individual client total was down from 2011/12. The data collection issues at
Coffs Harbour during 2013/14 involved the extended care services managing clients 18-64 years. It is likely that the number of
clients reported to be in this age group was affected by missing data.
5.3.3 Inpatient Separations for Mid North Coast Residents
In 2013/14, residents of the Mid North Coast utilised a total of 2,402 hospital Inpatient separations for
mental health (refer Table 5.4). The majority (98 per cent) of these separations were for Acute psychiatry
(2,348 separations). The 54 separations for Sub-Acute or Non-Acute Inpatient mental health had an
average length of stay of 74 days and accounted for 4,017 bed-days which is equivalent to a daily average
of 11 occupied beds.
The 2,348 Acute Inpatient separations had an average length of stay (ALOS) of 10 days and resulted in a
total of 23,500 Inpatient bed-days. These Acute Inpatient bed-days are equivalent to approximately 76
beds at 85 per cent occupancy. It should be noted that these are the total Inpatient separations for
mental health for Mid North Coast residents. They include hospital separations in general hospital beds as
well as in designated mental health units and they include use of private hospital facilities and hospitals in
other local health districts outside of the Mid North Coast.
Table 5.4 Mid North Coast Resident Demand by LGA for Inpatient Mental Health Services, 2013/14
MNC Resident Activity 2013/14 %
LGA Separations Beddays Separations Beddays Separations Beddays Total Separations
10600 Bellingen (A) 65 1,003 1 48 66 1,051 2.7%
11800 Coffs Harbour (C) 537 8,918 30 2,367 567 11,285 23.6%
15700 Nambucca (A) 100 1,578 4 401 104 1,979 4.3%
Sub-Total Coffs Network 702 11,499 35 2,816 737 14,315 30.7%
14350 Kempsey (A) 244 3,384 3 270 247 3,654 10.3%
16380 Port Macquarie-Hastings (A) 1,402 8,617 16 931 1,418 9,548 59.0%
Sub-Total Hastings Macleay Network 1,646 12,001 19 1,201 1,665 13,202 69.3%
Grand Total 2,348 23,500 54 4,017 2,402 27,517 100.0%
Total Psychiatry83 Psychiatry - Non Acute82 Psychiatry - Acute
Source: NSW Ministry of Health (2015) FlowInfo 14.0.
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The resident demand by LGA is presented in Table 5.4, and aggregated for the two Clinical Networks. In
2013/14, the residents of Hastings Macleay Clinical Network utilised 1,646 separations and 12,001 bed-
days for Inpatient mental health services. Residents of the Coffs Harbour Clinical Network utilised 702
separations and 11,499 bed-days. It can be seen that the volume of Acute separations is much higher for
Hastings Macleay residents, but the average length of stay is much shorter. Accordingly, the overall
volume of Inpatient bed-days utilised by residents of the two Networks is comparable. In 2013/14 there
was a significantly higher utilisation of Non-Acute Inpatient separations for residents of the Coffs Clinical
Network. In 2013/14, there were 54 separations for Non-Acute Rehabilitation for Mid North Coast
residents and these had an average length of stay of 74 days.
The diagnosis related groups for these mental health Inpatient separations is presented in Table 5.5
below. Patients with a primary diagnosis of major affective disorders accounted for 10.8 per cent of the
total separations and 20 per cent of the total bed-days. The primary diagnosis of schizophrenia accounted
for a further 8.6 per cent of separations and 16 per cent of bed-days.
Table 5.5 Mid North Coast Resident Demand by Diagnosis Related Group for Inpatient Mental Health Services, 2013/14
MNC Resident Activity 2013/14
AR-DRGs Separations Beddays Separations Beddays Separations Beddays Separations Beddays
U63B Major Affective Disorders Age <70 W/O Catastrophic or Severe CC 1 1 199 4036 61 1371 261 5408
U61B Schizophrenia Disorders 1 24 200 4234 6 151 207 4409
Z60Z Rehabilitation 50 3804 50 3804
U61A Schizophrenia Disorders, Involuntary Admission 112 3090 112 3090
U67Z Personality Disorders and Acute Reactions 1 1 188 1184 60 1282 249 2467
U63A Major Affective Disorders Age >=70 or W Catastrophic or Severe CC 26 840 30 655 56 1495
U64Z Other Affective and Somatoform Disorders 101 1325 6 98 107 1423
U60Z Mental Health Treatment W/O ECT, Sameday 2 11 981 981 983 992
U62A Paranoia & Acute Psyc Disorders, Involuntary Admission or W Cat or Sev CC 1 5 19 676 20 681
V61Z Drug Intoxication and Withdrawal 1 1 50 539 51 540
U62B Paranoia & Acute Psyc Disorders W/O Cat or Sev CC 1 29 33 503 34 532
U66Z Eating and Obsessive-Compulsive Disorders 5 155 8 338 13 493
X62B Poisoning/Toxic Effects of Drugs and Other Substances W/O Cat or Sev CC 67 382 67 382
V62Z Alcohol Use and Dependence 11 75 17 290 28 365
U65Z Anxiety Disorders 24 260 4 43 28 303
B63Z Dementia and Other Chronic Disturbances of Cerebral Function 10 226 1 17 11 243
V60B Alcohol Intoxication and Withdrawal W/O CC 18 105 18 105
X60B Injuries W/O Catastrophic or Severe CC 17 99 17 99
X62A Poisoning/Toxic Effects of Drugs and Other Substances W Cat or Sev CC 12 84 12 84
X64B Other Injuries, Poisonings and Toxic Effects W/O Catastrophic or Severe CC 7 72 7 72
X06A Other Procedures for Other Injuries W Catastrophic or Severe CC 1 64 1 64
Z64A Other Factors Influencing Health Status 23 61 23 61
U68Z Childhood Mental Disorders 2 55 2 55
V64Z Other Drug Use and Dependence 7 19 3 30 10 49
Other Diagnoses 1 1 26 250 8 50 35 301
Grand Total 7 62 1208 22094 1187 5361 2402 27517
1 Episode in Public
Psych Hospital
2 Episode in Other
Public Hospital
3 Episode in
Designated Private
Hospital
TOTAL
Source: NSW Ministry of Health (2015) FlowInfo 14.0.
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Of the 3,365 total mental health Acute Inpatient separations for Mid North Coast residents in 2013/14,
2,402, or 71 per cent, were provided within designated mental health Inpatient Units (refer Table 5.6a
below). A further 963 separations were provided in non-designated units, i.e. general beds in public and
private hospitals (refer Table 5.6b over page).
Around 45 per cent of the Inpatient mental health separations in designated units for Mid North Coast
residents in 2013/14 were provided within Mid North Coast public hospital facilities (refer Table 5.6a
below). In 2013/14 Coffs Harbour Hospital provided 620 separations for Mid North Coast residents, PMBH
provided 253 separations and Kempsey District Hospital, 215 separations, within their designated mental
health Inpatient units.
Table 5.6a Mid North Coast Resident Demand by Facility for Inpatient Mental Health Services (Designated Psychiatric Wards)
MNC Resident Activity 2013/14 %
Hospital Separations Beddays Separations Beddays Separations Beddays Total Seps
Coffs Harbour 575 9,961 45 3,515 620 13,476 25.8%
Port Macquarie 253 3,920 253 3,920 10.5%
Kempsey 215 2,615 215 2,615 9.0%
Sub-Total Mid North Coast LHD 1,043 16,496 45 3,515 1,088 20,011 45.3%
Private(excl DPCs) Hospitals 1,187 5,361 1,187 5,361 49.4%
Lismore(excl. Coll. Care) 49 917 49 917 2.0%
Royal Prince Alfred 3 117 3 117 0.1%
Manning 19 113 19 113 0.8%
Queensland Hospitals 7 68 7 68 0.3%
Cumberland 2 53 2 53 0.1%
Orange 1 49 3 260 4 309 0.2%
Victorian Hospitals 1 45 1 45 0.0%
Wyong 1 41 1 41 0.0%
Tweed Heads 5 38 5 38 0.2%
Northern Territory Hospitals 2 32 2 32 0.1%
St. Vincents - Public 4 25 4 25 0.2%
Tamworth 5 25 5 25 0.2%
Wingham 6 242 6 242 0.2%
John Hunter Hospital 2 15 2 15 0.1%
Other Hospitals 97 1,508 9 502 106 2,010 4.4%
Grand Total 2,348 23,500 54 4,017 2,402 27,517 100.0%
82 Psychiatry - Acute 83 Psychiatry - Non Acute Total Psychiatry
Source: NSW Ministry of Health (2015) FlowInfo 14.0.
A further 1,187 separations for Mid North Coast residents were provided in private hospital facilities,
comprising 19.5 per cent of the total bed-days for Mid North Coast residents. A further 98 separations
were provided in various other public hospital designated units within NSW, including 49 separations at
Lismore Base Hospital, 19 separations at Manning Base Hospital, Taree and four separations at Bloomfield
Hospital, Orange.
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Table 5.6b Mid North Coast Resident Demand by Facility for Inpatient Mental Health Services (Non-Designated Psychiatric Wards)
MNC Resident Activity 2013/14 %
Hospital Separations Beddays Total Seps
Private(excl DPCs) Hospitals 454 2431 47.1%
Coffs Harbour 216 440 22.4%
Port Macquarie 154 253 16.0%
Kempsey 66 134 6.9%
Wauchope 16 31 1.7%
Macksville 13 37 1.3%
Grafton 6 6 0.6%
Bellinger River 5 12 0.5%
Lismore Base 4 4 0.4%
Other Hospitals 29 64 3.0%
Grand Total 963 3412 100%
82 Psychiatry - Acute
Source: NSW Ministry of Health (2015) FlowInfo 14.0.
Of the 963 mental health separations provided in non-designated mental health beds for Mid North Coast
residents, 470, or 49 per cent, were provided within Mid North Coast public hospitals including 216
separations at Coffs Harbour, 154 separations at Port Macquarie and 66 separations at Kempsey hospitals
(refer Table 5.6b above). There were also 454 separations and 2,431 bed-days provided by private
hospitals within non-designated mental health beds. These comprise 71 per cent of total mental health
Inpatient bed-days for Mid North Coast residents in non-designated beds.
Across all hospitals, public and private, designated mental health units and non-designated wards, there
were a total of 3,365 separations for Mid North Coast residents in 2013/14. An age breakdown of these
separations is provided in Table 5.7.
Table 5.7 MNC Resident Demand Psychiatry Separations in All Hospitals (Public and Private) 2013/14
Acute Psychiatry Separations
MNC Residents Acute Psychiatry Non-Acute Psychiatry Total Designated Wards in Non-Designated Wards2013/14 Separations Beddays Separations Beddays Separations Beddays Separations Beddays Separations Beddays
0 - 14 years 7 118 7 118 40 98 47 216
15 - 19 years 110 1,636 7 434 117 2,070 70 231 187 2,301
20 - 24 years 134 2,107 7 501 141 2,608 54 265 195 2,873
25 - 64 years 1,668 16,423 34 2,840 1,702 19,263 552 1,923 2,254 21,186
65 years + 429 3,216 6 242 435 3,458 247 895 682 4,353
Grand Total 2,348 23,500 54 4,017 2,402 27,517 963 3,412 3,365 30,929
Psychiatry Separations in Designated Wards Total Psychiatry
Source: NSW Ministry of Health (2015) FlowInfo 14.0
Residents aged between 20 and 64 years accounted for 2,449 separations, representing 73 per cent of
total psychiatry separations for MNC residents. In 2013/14 there were 234 separations for children and
young people aged less than 20 years. Of these separations, 227 were Acute and these separations had
2,083 Inpatient bed-days which correspond with 6.7 beds at 85 per cent occupancy. Young people aged
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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20 to 24 years accounted for a further 188 Acute separations and 2,372 bed-days (7.6 beds at 85 per cent
occupancy).
Children and adolescents requiring tertiary Inpatient admissions for Acute mental health services access
the Child and Adolescent Mental Health Units at Lismore Base Hospital and John Hunter Hospital (Nexus
Unit). The activity data for 2013/14 indicates that there were 49 separations at Lismore Base Hospital for
Mid North Coast residents with an average length of stay of 18.7 days. The 917 bed-days at Lismore are
equivalent to 3 occupied beds on average at 85 per cent occupancy. There were only two separations for
Mid North Coast residents at John Hunter Hospital in 2013/14.
Residents aged 65 years and over accounted for 676 Acute separations in 2013/14. The 4,111 bed-days
associated with these separations is equivalent to 13.2 beds at 85 per cent occupancy. Over three-
quarters (78 per cent) of these Acute separations were provided in designated mental health wards.
5.3.4 Aboriginal Mental Health
The 2014 National Mental Health Commission’s Report of the National Review of Mental Health
Programmes and Services has reported a significant mental health gap between Aboriginal and Torres
Strait Islander peoples and non-Indigenous people, with Aboriginal peoples more likely to experience
psychological distress, hospitalisation for mental illnesses and death from intentional self-harm18. Indeed,
in 2011-2012 nearly one-third (30 per cent) of Aboriginal and Torres Strait Islander adults (18+ years) had
high or very high levels of psychological distress, almost three times (2.7) the rate of other Australians19,
whilst Aboriginal and Torres Strait Islanders aged 15 years and older reported stressful events at 1.4 times
the rate of non-Indigenous people20. This finding has implications for mental health service demand in the
MNDLHD given the District’s significant Aboriginal population. As noted previously, the Mid North Coast
has a higher proportion of Aboriginal residents than the figure recorded for all of NSW (5.8 per cent of
residents compared with 2.9 per cent)21. Table 5.8 (over the page) indicates the MNCLHD Aboriginal
population per Local Government Area (LGA).
18
Commonwealth of Australia (2014) Report of the National Review of Mental Health Programmes and Services, Summary.
National Mental Health Commission. 19
ABS (2013) Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-12. Cat.no
4727.0.55.006. Canberra: ABS. 20
Ibid. 21
ABS 3238.0.55.001, op. cit.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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Table 5.8 MNCLHD Aboriginal Population by LGA, 2011
LGA Aboriginal Population % of LGA Population
Coffs Harbour 3,405 4.80%
Bellingen 455 3.50%
Nambucca 1,617 8.40%
Kempsey 3,715 12.80%
Port-Macquarie-Hastings 2,895 3.80%
Total 12, 087
Source: ABS. (2011). Estimates of Aboriginal and Torres Strait Islander Australians, 3238.0.55.001. http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3238.0.55.001June%202011?OpenDocument (accessed Nov 2013).
In terms of service demand and utilisation, Aboriginal residents of the MNCLHD were 2.4 times more
likely to be hospitalised for mental and behavioural disorders than non-Aboriginal residents during
2011/201222. It has been noted, however, that “despite having greater need, Aboriginal and Torres Strait
Islander people experience lower access to mental health services than the rest of the population … in
part because services and programmes designed for the general population are not culturally appropriate
within a broader context of social and emotional wellbeing as understood by Aboriginal and Torres Strait
Islander peoples23”. The MNCLHD Mental Health Service acknowledges this circumstance and is aware of,
and attends to, the need for culturally appropriate mental health services. Importantly, the Mental Health
Service recognises “the integration of family and community into all aspects of mental health planning is
essential in order to incorporate the social and cultural realities of Indigenous people’s lives, beliefs and
circumstances24”. Indeed, this recognition of the centrality of kinship is one of the nine guiding principles
contained within the National Strategic Framework for Aboriginal and Torres Strait Islanders People’s
Metal Health and Social and Emotional Wellbeing 2004-09 (2004)25.
Further, the MNCLHD utilises the NSW Child and Adolescent Mental Health Services (CAMHS) Competency
Framework26 and acknowledges the importance of Competency 4: Working with Aboriginal children,
adolescents, families and communities. This competency notes the importance of staff developing: an
understanding of Aboriginal history; communicating in a culturally sensitive and respectful way; the use
of culturally sensitive language and preferred terminology in line with current policy directives; the
22
Centre for Epidemiology and Evidence, NSW Ministry of Health. Health Statistics New South Wales, http://www.healthstats.nsw.gov.au (accessed May 2014). 23
Commonwealth of Australia (2014) Fact Sheet 2 – What this means to Aboriginal and Torres Strait Islander people. Report of
the National Review of Mental Health Programmes and Services, Summary. National Mental Health Commission. 24
Gee. G., Dudgeon P., Schults C., Hart A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing.
In Dudgeon, P., Milroy, H., & Walker, R. (eds.). Working Together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. (2
nd ed.). In Australian Institute of Health and Welfare. (2014). Effective strategies to strengthen
the mental health and wellbeing of Aboriginal and Torres Strait Islander people, Issues paper no. 12, Closing the Gap Clearinghouse. Canberra: Australian Government. 25
National Aboriginal and Torres Strait Islander Health Council and National Mental Health Working Group. (2004). National
strategic framework for Aboriginal and Torres Strait Islander peoples' mental health and social emotional wellbeing (2004-2009). Canberra: Australian Government. 26
NSW Ministry of Health. (2011). NSW Child and Adolescent Mental Health Services (CAMHS) Competency Framework. NSW
Health.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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implementation of culturally specific practices as described in policy documents and guidelines when
working with Aboriginal people; the respectful collection and recording of information identifying
Aboriginal status in line with current policy directives; the ability to access Aboriginal cultural advisors
where appropriate regarding appropriates care; seeking to understand and work within kinship structures
of Aboriginal communities; and seeking to understand and work within local cultural protocols.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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6 CURRENT ACTIVITY
6.1 ACUTE INPATIENT MENTAL HEALTH SERVICES
There are three Acute Adult Inpatient Mental Health Units on the Mid North Coast: Coffs Harbour Health
Campus (30 beds); Port Macquarie Base Hospital (12 beds); and Kempsey District Hospital (10 beds).
These Units provide intensive psychiatric care for people who are experiencing the effects of mental
illness and mental disorder. These units have the capacity to accommodate both voluntary and
involuntary patients, except for Kempsey which provides for voluntary admissions only.
In 2013/14 these three units provided a total of 1,043 separations (refer Table 6.1 below). The average
length of stay was 15.8 days, ranging from 12.2 days at Kempsey District Hospital to 17.3 days at Coffs
Harbour. These units had a high occupancy of close to 90 per cent.
Table 6.1 Inpatient Activity for MNCLHD Acute Mental Health Units, 2011/12 – 2013/14
Hospital Separations Beddays Separations Beddays Separations Beddays ALOS Beds @ 90%
Coffs Harbour 476 8,776 476 9,802 575 9,961 17.3 30
Kempsey 215 2,477 246 2,818 215 2,615 12.2 8
Port Macquarie 175 3,807 217 4,173 253 3,920 15.5 12
Grand Total 866 15,060 939 16,793 1,043 16,496 15.8 50
2011/12 2012/13 2013/14
Source: NSW Ministry of Health (2015) FlowInfo 14.0.
The Coffs Harbour Acute Mental Health Unit primarily serves the Coffs Harbour, Nambucca, Bellingen (92
per cent of admissions) with a small number of separations (4 per cent for each) from Kempsey and Port
Macquarie LGAs (refer Table 6.2 over page).
The Port Macquarie Base Hospital Inpatient Unit primarily serves the local Port-Macquarie-Hastings LGA
(78 per cent) and Kempsey LGA (18 per cent). Kempsey District Hospital provides for residents of both
Kempsey (63 per cent) and Port-Macquarie-Hastings (32 per cent).
The age of patients admitted to these units is summarised in Table 6.3 (over the page). In 2013/14 adults
aged 25 to 64 years comprised 77.6 per cent of total separations across the three Inpatient Units.
Younger persons aged 15 to 19 years comprised 6.1 per cent of total separations and the bed days
associated with these separations was equivalent to an average utilisation of 2.4 beds at 90 per cent
occupancy. Younger persons aged 20 to 24 years comprised 10.5 per cent of total separations and the
bed days associated with these separations was equivalent to an average utilisation of 5.6 beds at 90 per
cent occupancy, and a combined 8 beds across the two younger person age groups. Older persons aged
65 years and over comprised 5.8 per cent of total separations and the bed days associated with these
separations was equivalent to an average utilisation of 4.8 beds at 90 per cent occupancy.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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Table 6.2 Inpatient Activity for MNCLHD Acute Mental Health Units by LGA of Residence for Mid
North Coast Residents, 2011/12-2013/14
2011/2012 2012/2013 2013/2014
Hospital / LGA of Residence Separations Bed days Separations Bed days Separations Bed days
Coffs Harbour 476 8,776 476 9,802 575 9,961
10600 - Bellingen (A) 50 851 28 328 53 794
11800 - Coffs Harbour (C) 328 6,183 344 7,429 418 7,179
14350 - Kempsey (A) 17 224 22 526 20 429
15700 - Nambucca (A) 68 1,258 67 1,190 66 1,128
16380 - Port Macquarie-Hastings (A) 13 260 15 329 18 431
Kempsey 215 2,477 246 2,818 215 2,615
10600 - Bellingen (A) 1 1 1 11
11800 - Coffs Harbour (C) 3 32 4 40 5 49
14350 - Kempsey (A) 124 1,508 131 1,382 135 1,823
15700 - Nambucca (A) 5 32 10 116 6 39
16380 - Port Macquarie-Hastings (A) 82 904 100 1,269 69 704
Port Macquarie 175 3,807 217 4,173 253 3,920
10600 - Bellingen (A) 1 16
11800 - Coffs Harbour (C) 1 2 7 297 4 37
14350 - Kempsey (A) 43 813 57 1,231 45 532
15700 - Nambucca (A) 1 6 3 14 5 62
16380 - Port Macquarie-Hastings (A) 130 2,986 150 2,631 198 3,273
Grand Total 866 15,060 939 16,793 1,043 16,496
Source: NSW Ministry of Health (2015) FlowInfo 14.0.
Table 6.3 Inpatient Activity by Age Group for MNCLHD Acute Mental Health Units, 2011/2012 -
2013/14
Acute Separations
Hospital / Age Separations Beddays Separations Beddays Separations Beddays
% of total
Separations Beds @ 90%
Coffs Harbour 476 8,776 476 9,802 575 9,961 55.1% 30.3
15 - 19 years 30 627 30 400 39 561 3.7% 1.7
20 - 24 years 66 1,212 42 838 63 1,145 6.0% 3.5
25 - 64 years 353 6,275 370 7,457 439 7,208 42.1% 21.9
65 years + 27 662 34 1,107 34 1,047 3.3% 3.2
Kempsey 215 2,477 246 2,818 215 2,615 20.6% 8.0
15 - 19 years 15 78 4 18 7 34 0.7% 0.1
20 - 24 years 12 93 34 256 21 323 2.0% 1.0
25 - 64 years 171 2,016 183 1,964 173 2,047 16.6% 6.2
65 years + 17 290 25 580 14 211 1.3% 0.6
Port Macquarie 175 3,807 217 4,173 253 3,920 24.3% 11.9
15 - 19 years 5 69 9 27 18 199 1.7% 0.6
20 - 24 years 16 272 23 161 26 358 2.5% 1.1
25 - 64 years 139 3,124 176 3,806 197 3,029 18.9% 9.2
65 years + 15 342 9 179 12 334 1.2% 1.0
Grand Total 866 15,060 939 16,793 1,043 16,496 100.0% 50.2
2013/14 2011/12 2012/13
Source: NSW Ministry of Health (2015) FlowInfo 14.0.
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6.2 NON-ACUTE INPATIENT MENTAL HEALTH SERVICES
The Rehabilitation Unit at Coffs Harbour Health Campus (20 beds) provides the only Sub-Acute or Non-
Acute Inpatient mental health services on the Mid North Coast. In 2013/14, there were 45 separations
with an ALOS of 78 days for residents of the Mid North Coast. The 3,515 bed-days associated with these
separations is equivalent to an average daily utilisation of 11 beds at 90 per cent occupancy.
Patients were predominantly residents of the Mid North Coast (75 per cent) or Northern NSW (25 per
cent) as indicated in Table 6.4 below.
Table 6.4 Inpatient Activity for Mid North Coast Mental Health Rehabilitation Unit by LGA of Residence for Mid North Coast and Northern NSW Residents
2011/12 2012/13
Hospital/ LGA of Residence Separations Beddays Separations Beddays Separations Beddays ALOS Beds @ 90%
Coffs Harbour 24 2524 39 3537 45 3515 78.1 11
11800 Coffs Harbour (C) 8 573 16 1481 28 2220 79.3 7
16380 Port Macquarie-Hastings (A) 12 1702 10 1218 10 611 61.1 2
15700 Nambucca (A) 1 74 5 265 4 401 100.3 1
14350 Kempsey (A) 3 175 4 143 2 235 117.5 1
10600 Bellingen (A) 4 430 1 48 48.0 0
Total MNC Residents 24 2524 39 3537 45 3515 78.1 11
Total Northern NSW Residents 10 1,040 13 1,108 15 934 62.3 3
Grand Total 34 3564 52 4645 60 4449 74.2 14
2013/14
Source: NSW Ministry of Health (2015) FlowInfo 14.0.
6.3 COMMUNITY MENTAL HEALTH SERVICES
In 2013/14, the Mid North Coast Community Mental Health Services had a total of 4,373 individual
clients, as presented in Table 5.4. Service contact counts are the primary means of determining the
activity of the community ambulatory mental health services. In 2013/14 the community mental health
services provided a total of 67,488 contacts for these 4,373 clients, an average of 16 contacts per client.
Both Macleay and Hastings MH ambulatory contacts have increased since 2011/12. Due to data
collection issues in the Coffs Clinical Network during 2013/14 the Coffs MH ambulatory contacts appear
to have decreased. During 2011/12 the ambulatory contacts recorded were 100.4 per cent of expected27,
during 2013/14 only 72.6 per cent of expected were recorded.
The Coffs Network provided 25,991 contacts, representing 38 per cent of the total MNC community
ambulatory contacts, and an average of 14 contacts per individual client. The Hastings Network provided
19,760 contacts, representing 29 per cent of the total MNC community ambulatory contacts, and an
27
The expected number of MH ambulatory contacts is determined by the ‘MH Clinical Care and Prevention Model, v1.1 July
2001’. The expected number of contacts is based upon the assumption that 1 FTE will conduct 984 ambulatory contacts during a 12 month period.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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average of 13 contacts per individual client. The Macleay Network provided 21,737 contacts, representing
32 per cent of the total MNC community ambulatory contacts, and an average of 21 contacts per
individual client.
Table 6.5 Mental Health Ambulatory Contacts with Identified Individual Clients by Clinical Network,
2013/14
Age Group Coffs Hastings Macleay Mid North Coast %
0-11 years 27 100 54 181 0.3
12-17 years 3,454 3,218 2,667 9,339 13.8
18-64 years 19,944 13,529 18,506 51,979 77
65+ years 2,566 2,913 510 5,989 8.9
TOTAL 25,991 19,760 21,737 67,488 100
Source: Mid North Coast Information Exchange Mental Health Community Ambulatory (CHAMB) data, 2015.
Note: Although comprising one MNCLHD Network, in this instance data is collected and reported separately for the
Hastings and Macleay. Additionally, this information excludes contacts with non-identified clients. Clinical contacts
that are not attributed to an individual client are also excluded.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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7 PROJECTED DEMAND
The approved planning tool in NSW that can inform Mental Health Planning is the Mental Health-Clinical
Care and Prevention Model 2010 (MH-CCP (2010)).
The MH-CCP (2010) model is currently in draft form. The NSW Mental Health and Drug & Alcohol Office
(MHDAO) have, upon request, provided the MNCLHD Mental Health Services Director with select outputs
from MH-CCP (2010) (see Appendix 3 for MNCLHD Estimated Needs Met, provided July 2015).
The MH-CCP methodology is the recognised tool for both comparing current mental health resources
against estimated prevalence in the community, and for projecting future service requirements, in NSW28.
The methodology was described in Section 5.3.
The MH-CCP (2010) planning tool is a population-based model. It provides estimates of resource (e.g.
staff FTE, beds) demand per 100,000 of population, by age group and severity. These ‘per 100,000’
estimates can then be extrapolated to other population sizes.
The MH-CCP (2010) presents age-specific prevalence estimates for varying levels of severity of mental
health risks and disorders across the lifespan. For the purpose of informing the Mid North Coast Mental
Health Plan, three age groups are used:
children and adolescents (age 0-17 years);
adult (age 18-64 years); and
older people (age 65 years and over).
The estimated prevalence is based on the average prevalence for NSW as a whole. Some parts of NSW
would have a higher burden of disease as a result of demographic and socio-economic factors and
historical factors such as the “drift” of people with mental illness to surrounding areas of the former Fifth
Schedule mental health Inpatient facilities.
7.1 CURRENT CAPACITY MEASURED AGAINST NSW PLANNING
BENCHMARKS
The MH-CCP (2010) model provides an estimate of capacity requirements (Inpatient beds) to provide
services for this estimated level of prevalence, by target age group.
28
Mental Health and Drug & Alcohol Office, NSW (2001) Mental Health Clinical Care and Prevention Model Version 1.11 a
population mental health model; Ministry of Health (2012) Mental Health Clinical Care and Prevention Model, 2010.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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7.1.1 Inpatient Beds
The estimated Acute mental health Inpatient bed numbers required for the Mid North Coast population
based on the estimated prevalence in the MH-CCP (2010) are presented, by age group, in Table 7.1
below, compared to the current available beds.
Table 7.1 Current Acute Bed Numbers and MH-CCP (2010) Estimated Requirements, 2015
Current Bed
NumbersMH-CCP (2010)
Children & Adolescents (0-17)*
Mid North Coast0* 3
Adults (18-64)
Mid North Coast52** (42) 37
Older Persons (65+)
Mid North Coast0 14
ACUTE TOTAL 52** (42) 54
Age Group
2015 2015
* Child and Adolescent Beds for Mid North Coast currently provided within Lismore Base Hospital CAMHU.
** As the 10 Acute Beds at Kempsey District Hospital are non-gazetted and are affected by issues of rurality, the MNC’s total of
practicable Acute Adult Beds is 42.
Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010
Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).
The comparison of current Acute Inpatient mental health beds in the Mid North Coast Local Health
District against the MH-CCP (2010) benchmarks indicates that, although the District has an adequate
supply of adult beds for those aged between 18 and 64 years, there are no Acute Older Persons or
Younger Persons beds within the MNCLHD. As shown in Table 7.1, if the estimated need for these beds
were to be included, the total number of Acute beds required by the MNCLHD becomes 54. The MH-CCP
(2010) estimate of 54 beds in 2015 compares with the estimate of 53 beds in 2011 that was reported in
the CSP 2013.
It should be noted too that the 10 Adult beds at Kempsey District Hospital are not declared under the
Mental Health Act 2007 and are therefore unable to accept involuntary mental health patients. The
consequences of rurality, including the distance from the Port Macquarie Inpatient Unit and associated
specialist workforce, means that these non-gazetted beds are not utilised as Acute beds, per say.
Therefore the total number of practicable MNCLHD Adult Acute beds is 42 rather than 52 beds.
Additionally, as noted in the CSP 2013, whilst the 2011 MH-CCP (2010) data estimated 158.0 FTE were
required to meet the MNC’s need for ambulatory (community) mental health services, the workforce
comprised 76.8FTE. Additional pressure is placed on Acute Adult beds as a consequence because of the
resulting limited capacity for post-discharge follow-up and assertive treatment within the community
setting leading to increased readmission rates.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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The Mid North Coast LHD would appear from this analysis to be under-resourced in terms of Acute
mental health Inpatient beds.
The 14 beds estimated by the MH-CCP (2010) for Acute Inpatient care for Older Persons includes four
beds in general Adult Acute mental health units and ten beds in designated Specialist Mental Health
Services for Older People (SMHSOP) units. At present approximately seven per cent of Acute Adult mental
health Inpatient beds are being used to admit older patients. The admission of frail older people and
people with dementia to Acute Adult Inpatient Units is not appropriate, however, and there is a
demonstrated need for a designated mental health Inpatient Unit for Older Persons on the Mid North
Coast.
The MH-CCP (2010) planning tool indicates the need for three beds for the child and adolescent
population of the Mid North Coast (0-17 years). At present the Lismore Base Child and Adolescent Mental
Health Unit has 8 beds and is funded to provide this service for the Mid North Coast.
The estimated Non-Acute mental health Inpatient bed numbers required for the Mid North Coast
population based on the estimated prevalence in the MH-CCP (2010) are presented, by age group, in
Table 7.2 below, compared to the current available beds in the designated Inpatient Unit.
The draft MH-CCP (2010) benchmarks indicate a need for 16 Non-Acute Adult Inpatient beds to provide
for the mental health needs of the Mid North Coast population in 2015. These include 2 beds for Younger
Persons, 6 beds for Adults and 7 beds for Older Persons.
Table 7.2 Current Sub/Non-Acute Bed Numbers and MH-CCP (2010) Estimated Requirements, 2015
Current Bed
NumbersMH-CCP (2010)#
Children & Adolescents (0-17)
Mid North Coast0 2
Adults (18-64)
Mid North Coast20 ̂ (8) 6
Older Persons (65+)
Mid North Coast0 7
NON-ACUTE TOTAL 20 ̂ (8) 16
2015
Age Group
2015
# Small inconsistencies in figure summation are due to issues associated with rounding; ^ The catchment for North Coast
Rehabilitation Unit Beds covers MNC and Northern NSW LHDs. The MNCLHD utilises 40 per cent (8) of these Beds, whilst
Northern NSW utilises the remaining Beds.
Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010
Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).
Although the MH-CCP (2010) estimate indicates an adequate supply of Non-Acute beds on the Mid North
Coast, it should be noted that the 20 bed North Coast Rehabilitation Unit at Coffs Harbour Health Campus
was built to provide for the Mid North Coast (40 per cent) and Northern NSW (60 per cent) population.
The MNCLHD currently utilises eight of these beds, whilst Northern NSW utilises the remaining. The
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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premise whereby the MNCLHD has an adequate supply of Non-Acute beds is grounded in the expectation
that by mid-2017 Northern NSW will no longer require access the MNCLHD Non-Acute Beds given the
new Byron Bay Hospital currently under development includes a 20 bed Non-Acute Inpatient Unit.
The previous MNC Mental Health Service Clinical Service Plan, CSP 2013, indicated that the total
population need for Non-Acute Adult Inpatient beds across both Mid North Coast and Northern NSW in
2011 was for 32 beds in 2011 for Adult and Older Persons combined. Additionally, there are no
designated Non-Acute Inpatient beds for Older Persons on the Mid North Coast and the most recent MH-
CCP (2010) indicates a population need for 7 beds in 2015.
7.1.2 Long Stay Patients
As shown in Table 7.3, there are currently no Very Long Stay (VLS) beds in the Mid North Coast although
the MH-CCP (2010) methodology indicates the need for 16 beds for adults and 6 beds for Older Persons in
2015. While the provision of 42 HASI Places within the MNCLHD offsets this need to some degree, such
places are not commensurate with the 24 hour intensive support provided in VLS units. For instance, 26
of the MNCLHD HASI packages provide consumer assistance for a total of five hours/week, four packages
provide assistance between two and three hours per day, and 12 packages provide assistance for five
hours/day (refer Table 7.4 over page).
Table 7.3 Current Very Long Stay Bed Numbers and MH-CCP (2010) Estimated Requirements, 2015
Current Bed
NumbersMH-CCP (2010)
Children & Adolescents (0-17)
Mid North CoastNA NA
Adults (18-64)
Mid North Coast0 16
Older Persons (65+)
Mid North Coast0 6
VERY LONG STAY TOTAL 0 22
Age Group
2015 2015
Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010
Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).
Also impacting this service space is the small number of people whose mental health condition is such
that they are unable to function in the community. Previously, these people have required an extended
long stay in one of the residential mental health facilities in NSW, such as the long stay / extended care
units at Bloomfield Hospital in Orange, Macquarie Hospital, Morriset Hospital and Cumberland Hospital at
Westmead. A new program, the Mental Health Hospital to Community Initiative, is currently being
developed whereby these individuals, some 380 in total, will be gradually transitioned to the community,
wherever possible. New services and models of care are being developed to create a range of residential
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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support options for these persons with complex mental illness. A small number of Mid North Coast
residents form part of this cohort and it is expected they will be returned to the LHD for appropriate
transitioning.
In response to the existing service need as well as emerging needs, and the absence of very long stay
beds in the Mid North Coast, the MNCLHD may need to secure capital funding to provide required
services.
Table 7.4 Mid North Coast HASI Package Numbers for 2014-2015
BH Total
Local Health District Very High High Low Med Low High Med Low Low 16 hour 24 hour
8 hrs/d 5 hrs/d 5 hrs/wk 2-3 hrs/d 5 hrs/wk 5 hrs/d 2-3 hrs/d 5 hrs/wk 5 hrs/d 16 hrs/d 24 hrs/d
Mid North Coast 4 8 2 14
Mid North Coast 4 7 1 3 15
Mid North Coast 4 3 6 13
Mid North Coast Total 0 12 15 4 9 0 0 2 0 0 0 42
HASI HASI in the Home Aboriginal HASI HASI Plus
Source: Mental Health and Drug and Alcohol Office, NSW Health - 2014-2015 HASI Package Numbers by LHD.
7.2 PROJECTED CAPACITY REQUIREMENTS
Projected bed requirements for Acute Services are presented in Table 7.5 below. This table indicates the
number of beds required in 2020 and 2025 using the MH-CCP (2010) methodology.
The estimation of Inpatient bed requirements based on the projected population growth and ageing in
the Mid North Coast indicates the need for an increase in total Acute beds, from the current 52, to 58
beds in 2025. The major increase in bed capacity requirements is for Acute Inpatient beds for Older
Persons. The MH-CCP (2010) indicates the need for 19 beds in 2025 which includes 13 SMHSOP beds and
6 beds for Older Persons in general Adult Acute Units. At present there are no designated Inpatient
mental health beds for Older Persons in the Mid North Coast LHD.
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Table 7.5 Current and Projected Acute Bed Numbers and MH-CCP (2010) Estimated Requirements, 2015- 2025
Current
Bed
Numbers
2015 2020 2025
Children & Adolescents (0-17)*
Mid North Coast0* 3 3 3
Adults (18-64)
Mid North Coast52** (42) 37 37 37
Older Persons (65+)
Mid North Coast0 14 16 19
ACUTE TOTAL 52** (42) 54 56 58
Age Group
MH-CCP (2010)#
2015
# Small inconsistencies in figure summation are due to issues associated with rounding; * Child and Adolescent Beds for Mid
North Coast currently provided within Lismore Base Hospital CAMHU; ** As the 10 Acute Beds at Kempsey District Hospital are
non-gazetted and are affected by issues of rurality, the MNC’s total of practicable Acute Adult Beds is 42.
Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010
Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).
With respect to the estimated requirements for Non-Acute beds it is important to note that the current
catchment for the North Coast Rehabilitation beds covers both the MNC and NNSW LHDs, with NNSW
utilising 60 per cent of the available 20 beds in accordance with formal agreements between the two
LHDs. The figures provided in Table 7.6 (over the page) regarding the MNCs projected Non-Acute bed
requirements therefore require special consideration because they refer solely to MNCLHD requirements.
By mid-2017 NNSWLHD will have a new 20 bed Non-Acute Unit at Byron Central Hospital and further
detailed planning is required to determine the impact, if any, of this Unit on NNSWs use of Coffs
Harbour’s Rehabilitation Inpatient Unit. A review of the aforementioned formal agreements currently in
place will also be required. Should NNSWLHD no longer require access to 60 per cent of the Rehabilitation
beds at Coffs Harbour, the MNCLHD has an adequate supply of Non-Acute beds through to 2025.
Importantly, however, the previous MNC Mental Health Service Clinical Service Plan, CSP 2013, indicated
that, when combined, the total population need for Non-Acute Adult Inpatient beds across the Mid North
Coast and Northern NSW for adult and older persons would increase to 39 beds in 2021.
As shown in Table 7.7 (over the page), the MNCLHD currently has no Very Long Stay beds although the
MH-CCP (2010) estimates indicate the need for a total of 22 such beds in 2015, increasing to 24 beds in
2025.
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Table 7.6 Current and Projected Non-Acute Bed Numbers and MH-CCP (2010) Estimated Requirements,
2015-2025
Current
Bed
Numbers
2015 2020 2025
Children & Adolescents (0-17)
Mid North Coast0 2 2 2
Adults (18-64)
Mid North Coast20 ̂ (8) 6 6 6
Older Persons (65+)
Mid North Coast0 7 9 10
NON-ACUTE TOTAL 20 ̂ (8) 16 17 18
Age Group
MH-CCP (2010)#
2015
# Small inconsistencies in figure summation are due to issues associated with rounding; ^ The catchment for North Coast
Rehabilitation Unit Beds currently covers MNC and Northern NSW LHDs. The MNCLHD utilises 40 per cent (8) of these Beds,
whilst Northern NSW utilises the remaining Beds.
Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010
Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).
Table 7.7 Current and Projected Very Long Stay Bed Numbers and MH-CCP (2010) Estimated
Requirements, 2015-2025
Current
Bed
Numbers
2015 2020 2025
Children & Adolescents (0-17)
Mid North CoastNA NA NA NA
Adults (18-64)
Mid North Coast0 16 16 16
Older Persons (65+)
Mid North Coast0 6 7 8
VERY LONG STAY TOTAL 0 22 23 24
2015
Age Group
MH-CCP (2010)
Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010
Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).
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8 CURRENT SERVICES AND NEW SERVICE
MODELS
8.1 M ID NORTH COAST LOCAL HEALTH D ISTRICT
Specialist Mental Health Services operate across the Mid North Coast Local Health District (MNCLHD) as a
dedicated service, or “clinical stream”. The mental health clinical stream is part of a broad range of
clinical services within the LHD that deliver services to mental health patients – including emergency
departments and community health services.
The Director, Mental Health and Drug & Alcohol is responsible for overall management of MNCLHD
Mental Health Services. In the provision of clinical leadership to the service the Director is supported by:
the Director Medical Services/Clinical Director, Mental Health; the District Manager, Mental Health
Services; and the Manager, Nursing and Service Development.
The Hastings Macleay Clinical Network has a District Manager of Mental Health Services who is
responsible for managing Mental Health services across the Network and for strengthening partnerships
and liaison with other services. There are service managers in the clinical networks who are responsible
for managing a unit of the Mental Health service, either Inpatient or community. They are also
responsible for strengthening partnerships and liaison with other services. In Coffs Harbour, due to the
size of the services there, a site manager oversees the unit managers across the clinical network.
A range of State and LHD-wide initiatives are developed, implemented, coordinated and evaluated from
the LHD service. There are four “units” within the LHD Mental Health and Drug & Alcohol Service:
Mental Health Services;
Drug & Alcohol Services;
Nursing and Service Development; and
Business Support.
The MNCLHD provides a range of hospital Inpatient and community mental health services. Mental health
services are managed on a LHD-wide basis and provided in each of the two clinical networks, Hastings
Macleay and Coffs Harbour. Mental health services provided in each clinical network include:
Hastings Macleay Clinical Network
Port Macquarie Mental Health Inpatient Unit Kempsey Mental Health Inpatient Unit
Port Macquarie Community Mental Health
Service
Kempsey Community Mental Health
Service
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Coffs Harbour Clinical Network
Coffs Harbour Acute Mental Health Unit North Coast Mental Health Rehabilitation
Unit
Coffs Harbour Acute Care Service Community
Mental Health
Coffs Harbour Extended Care Service
Community Mental Health
The current role of these services is described in the CSP 2013.
Rural and regional districts have special factors to consider in the provision of mental health services
including the range of services available, geography and the spread and density of the population. In
recognition of these factors, the staff of public sector mental health services are required to be flexible in
working across service teams when needed. Despite the need to structure a health service
organisationally into teams with identified roles and functions and distinct managers, all mental health
staff in a rural area should be ready and prepared to deploy to other service areas on a daily basis,
depending on clinical need.
It is generally accepted that specialist public sector mental health services have a priority to direct
their resources towards the severe end of the spectrum of mental health problems. Specialist
mental health services should include:
responsibility for delivering Acute Services;
prime responsibility for crisis intervention;
clinical responses to severe mental illness;
outreach clinical response through regular co-located clinics;
providing consultant support to GPs and other primary mental health care providers;
building capacity of primary mental health care workers; and
specialist clinical support for people with complex mental illness conditions.
While the Mid North Coast Mental Health Service is primarily focussed in responding to the needs of
consumers at the more severe end of the spectrum, there is a strong and increasing imperative for
these services to work closely in collaboration with the broader set of health and welfare providers in
the mental health field. These include GPs, non-government organisations (NGOs), Aboriginal-
controlled health organisations, the new North Coast Primary Health Network, and private
psychologists to name a few.
These services all have a role to play and, in some cases, there are overlaps in roles. Moderate and mild
problems can generally be adequately managed in special interest services (NGOs, GPs, D&A services) and
primary care services (GPs). Different levels of expertise are expected and it is important that service
providers work within their levels. Highly skilled specialists should minimise the work they do in general
support and care coordination, and less skilled or more generic mental health workers should not attempt
to respond alone to acute illness. Recognition of respective roles and their effective demarcation will
support the efficient provision of a network of services across the Mid North Coast. The roles of these
external partners are described later in this section.
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8.2 NEW SERVICE MODELS
As recommended in the CSP 2013, the Mid North Coast Mental Health Service has embarked on a process
of reviewing service models of care. The review has been premised on the need to implement
contemporary models of care and also by the recognition that, in an environment of limited resources,
MNCLHD Mental Health Services must be targeted to the achievement of a sustainable method of
responding to the mental health needs of the Mid North Coast population.
The costs of health care continue to increase at a rate far greater than any other government service.
Increases in funding for health are likely to be very limited in future, with the emphasis shifting towards
more practical and efficient ways to use existing resources. Avoidance of preventable and
unnecessary hospital admissions through better care in the community is a key part of this shift, and
these result in better outcomes and experiences for consumers.
The specific context or rationale underpinning the proposed reconfiguration of service models of care for
mental health services on the Mid North Coast has two major components:
Firstly, based on prevailing models of care, the LHD is short of capacity to meet the
current needs of the District’s population and is facing substantial expected growth in
demand; and
Secondly, the clear strategic signal from both NSW Health and the NSW Mental Health
Commission is that the prevailing models of care in NSW, as a whole, are hospital-centric
and need to be rebalanced, with increased capacity in more community based systems of
care.
A future strategy based on increasing Inpatient bed numbers alone is not likely to be sustainable. The only
viable pathway forward lies in creating a more integrated system that enables the LHD hospital-based
specialist services to concentrate on an Acute/stabilisation role. This will require its integration with other
services so as to establish a continuum from ‘front end’ community-based support for emerging needs
through to stronger post- hospitalisation community based recovery.
In recognition of these imperatives the CSP 2013, proposed the establishment of a consortium of mental
health service providers on the Mid North Coast.
The Mid North Coast Mental Health Integrated Care Collaborative (MHICC) was established in May 2014
in response to a recommendation of the CSP 2013 wherein a consortium of services providers was
proposed. The idea for a collaborative group was also supported by a conference of the local Mental
Health sector in March 2014. The purpose of the MHICC is to establish partnerships between all
mental health service providers in the area to maximise efficient use of existing resources and
improve the consumer journey. This group will be formalised in structure including formal establishment
of a governance structure in the second part of 2015, and will guide the future planning of mental health
services in the Mid North Coast.
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The development of the MNCLHD Model of Care Review has progressed since 2013 with a number of key
outcomes. These have included:
The MNCLHD commissioned a literature review to explore evidence based models for Rural
Mental Health Services.
Staff forums were held across the LHD with two general staff Forums in Port and Coffs Harbour.
One Specialist Older Persons Clinical Staff Forum and one Youth Clinical Staff Forum and an
Inpatient Model of Care Staff Forum were held.
A Discussion Paper was published and Staff feedback on the paper obtained.
A draft Model of Care Implementation Plan (Blueprint) was subsequently developed and
distributed to mental health service staff for feedback in May 2015. Implementation is expected
to be finalised by 1 January 2016.
The new models of care are described in the following section of the ADDENDUM.
8.3 ACUTE INPATIENT UNITS
Under the new model the Inpatient and Community will form one integrated mental health service across
the District. Medical teams will be structured so that they work across both Inpatient and community
services. Clinicians will provide in-reach and outreach support across both Inpatient and community
services.
8.3.1 Port Macquarie Mental Health Inpatient Unit
Port Macquarie Mental Health Inpatient Unit (Ward 1A) is currently a 12 bed gazetted mental health
Inpatient Unit with 10 low dependency beds and 2 observation/ low stimuli beds. Whilst there has been a
significant growth in the local population over the last 15 years to well over 80,000 people there has only
been an associated increase of 2 Inpatient beds since the unit opened in the nineties.
The Unit is staffed 24 hours a days, 7 days a week, with 3 nurses working each shift; inclusive of the CNS 2
Monday to Friday who carries a clinical load in addition to overseeing bed management etc. The Nursing
Unit Manager Level 2 (NUM 2) works day duty, Monday to Friday. The morning and evening shifts are 8
hours long and the nights are 10 hour shifts.
The treating team is also made up of 2 Psychiatric VMOs, 1 Registrar on 3 month rural rotation, a Junior
Medical Officer, as well as a full-time Social Worker and the Activity Officer Role, currently occupied by a
nurse. Health Services Assistants (HSAs) work in the morning and evening shifts 7 days a week. One
administration officer works full-time, Monday to Friday.
The catchment area for the MHIPU extends from Johns River in the south to Macksville in the north
ostensibly and out to the west as far as Gingers Creek. The Port Macquarie and Kempsey hospital
Inpatient Mental Health Units operate as a single service for the Hastings Macleay Clinical Network. In
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view of the situation that PMMHIPU has gazetted beds and KDH MHIPU does not, patients are admitted,
and transferred between, the two units based on patient need and severity.
In the broader context, the Mental Health Inpatient Units throughout the MNCLHD are required to cover
periods of high bed pressure and patients sometimes require relocation under a reciprocal arrangement
with the other mental health units in the MNCLHD, to best manage those periods of significant bed
pressure.
The proposed future role of the Port Macquarie Mental Health Inpatient Unit is described in Section 9 of
this ADDENDUM.
8.3.2 Kempsey Mental Health Unit
The Kempsey Mental Health Inpatient Unit is a ten (10) bed voluntary unit. The Unit operates as an
integrated service with the Port Macquarie Mental Health Inpatient Unit and gazetted patients are
admitted to the Port Macquarie Inpatient Unit or the Coffs Harbour unit. The Kempsey Inpatient Unit
accepts voluntary patients from the Port Macquarie-Hastings area, and at times from the Coffs Harbour
area.
With the proposed expansion of mental health Inpatient beds at PMBH there will need to be a review of
the ongoing role of the Kempsey Mental Health Unit. It is acknowledged that the Unit is of sub-optimal
size and there are deficits in the design and functional state of infrastructure, however the Unit will
continue to provide an ongoing and complementary role in meeting the needs of the local and broader
MNCLHD population in the provision of Inpatient care for voluntary patients. If its future role were to
involve the provision of specialised services, such specialisation would be dependent upon funding
submissions and enhancement funding provided via the Ministry of Health.
Model of Care
Current Models of Care include:
bio-psycho-social assessment and intervention;
individual care plans with inclusion of social system intervention and recovery;
integration of Inpatient Units and community care to ensure seamless transition of care; and
collaboration with other support services to provide stable accommodation and support.
A significant component of the model of care at Kempsey District Hospital is the regular multidisciplinary
clinical review meeting where progress is reviewed against the recovery model and discharge plans
developed.
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8.3.3 Coffs Harbour Acute Mental Health Unit
The Coffs Harbour Acute Mental Health Unit (CHAMHU) is a gazetted 30 bed Acute Mental Health Inpatient Unit with 6 observation beds (inclusive). The catchment area for the Unit is primarily between Eungai Rail south of Coffs Harbour and Red Rock to
the north. Within the Coffs Harbour catchment there are 3 Local Government Areas (LGAs): Nambucca
LGA covering Macksville and Nambucca Heads; Bellingen LGA covering Bellingen and Dorrigo; and Coffs
Harbour LGA covering Coffs Harbour and Woolgoolga.
In terms of Inpatient bed capacity, the Coffs Harbour Clinical Network has a sufficient overall bed capacity
to meet population requirements for the next ten years. The ageing of the population will result in an
increased need for specialist mental health beds for Older Persons within this bed complement. Any
future changes in the configuration of bed numbers at Coffs Harbour may occur to complement the
proposed service developments at Port Macquarie Mental Health Inpatient Unit such as the development
of specialised beds for Older and/or Younger Persons if and when there is sufficient critical mass to
support such developments.
Model of Care
Bed occupancy, average length of stay and workload for CHAMHU is impacted by the requirement to
accept some Hastings Macleay Network clients whom require a gazetted mental health bed, due to the
limited gazetted beds in Port Macquarie and the non-gazetted beds in Kempsey. This also impacts on the
Coffs Harbour Emergency Department.
Due to the ongoing pressure for beds over the area there are times when care is limited to crisis management only. Currently, ECT is provided in Coffs Harbour for patients of both the Coffs Harbour and Hastings/Macleay areas. The requirement to cover the latter area reduces access to this treatment for the patients of the CHAMHU and would be alleviated by the proposed establishment of ECT at Port Macquarie Mental Health Inpatient Unit.
8.3.4 Overview of Acute Inpatient Services
The current configuration of Acute beds in the MNCLHD is less than ideal. Although the MNCLHD
currently has sufficient Acute involuntary beds for people aged 18-65, the 12-bed unit in Port
Macquarie is difficult to manage due to its size and layout, and there are no dedicated Acute beds for
the over 65 age group. The voluntary unit in Kempsey adds another layer of complexity due to its
inability to admit people on an involuntary basis, its unsuitability for converting to an involuntary or
older persons’ unit, and its size. On a population basis, by 2020 each clinical network would ideally be
serviced by twenty dedicated Acute beds for the 18-65 year age group, and nine to ten dedicated
Acute beds for over 65 years, with the capacity for detention under the Mental Health Act. The
projected population requirement for beds for people under 18 years on the Mid North Coast is 3 to 4
beds.
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The difference in occupancy between the two clinical networks is pertinent. With only twenty-two
beds in the Hastings Macleay Network - and only 12 of these capable of being used for involuntary
admissions - occupancy is generally lower than that of Coffs Clinical Network where there are thirty
Acute beds, despite similar populations being served and similar rates of presentation to Emergency
Departments.
Current admission rates of older people for Acute Inpatient care in the Mid North Coast are well below that which is expected on population proportions, possibly due to the lack of specialised beds of this nature and the concomitant coping realised in other community services and Registered Aged Care Facilities for this age group. The need for an effective community response to this age group is required in order to complement any proposed Inpatient beds and to avoid unnecessary admissions.
In planning future Acute Inpatient bed requirements there is a need to provide some balance across the clinical networks, across the age groups and across the voluntary and involuntary need, to manage the population needs in the Mid North Coast.
8.4 REHABILITATION UNIT
The North Coast Mental Health Rehabilitation Unit (NCMHRU) is a 20 bed Inpatient Mental Health Rehabilitation Unit. The Unit is a declared unit under the Mental Health Act. It accepts both voluntary and detained patients. The expected length of admissions is three to six months. Currently, the NCMHRU provides a service for the whole of the north coast region covering MNCLHD and Northern NSWLHD, with 8 and 12 beds nominally allocated to the LHDs respectively. By mid-2017, however, Northern NSW may no longer require access to the MNCLHD Non-Acute beds given the new Byron Central Hospital (currently under development) includes a 20 bed Non-Acute Inpatient Unit. Presently the North Coast Mental Health Rehabilitation Unit provides a recovery focussed Inpatient Mental Health Rehabilitation Service to both the Mid North Coast and the Northern New South Wales Local Health Districts. The referral process has expanded to include clients from any location where a psychiatrist has responsibility for that client; this includes private psychiatrists and many non-government organisations that provide mental health care. All referrals are channelled through the local mental health rehabilitation coordinators, who provide a screening and support service to referrers. Direct referrals are accepted from both Districts’ Acute Mental Health Units, and these referrals are prioritised and admissions are fast tracked to minimise the potential of bed block preventing care to other Acute clients.
Model of Care
The Unit provides a tertiary service. Referrals are accepted from any current provider in the north
coast region, and are channelled through the MNCLHD and NNSWLHD mental health rehabilitation
coordinators for admission assessment. Direct referrals are accepted from both LHDs’ Acute Inpatient
Units, and admissions are fast-tracked from these units when a bed is available. The length of stay is,
on average, 150 days. With direct referrals from Acute Inpatient Services, it is critical to ensure
suitability through adequate assessment at the originating Unit and avoid transfer too early.
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The focus of admission is on functional gain with mental health recovery. Recovery in mental health is a
model of care which aims to help the client achieve their potential despite their illness, not by focussing
on their illness.
The NCMHRU model of care involves referral and admission protocols, care coordination during
treatment, and on-going assessment including the use of MHOAT and Recovery Star tools plus ongoing
assessment of strengths, physical health, neuropsychological functioning, social circumstances,
occupational functioning, risks and substance use. Care planning occurs in collaboration with consumers
and informed by all assessment processes, but in particular by the consumers self-identified goals and
domains identified in the Recovery Star assessment and the Stages of Change approach. It involves a wide
range of therapeutic interventions including a comprehensive linked activity program, behavioural
reinforcement, talk-based therapies, medication, specialist professional interventions, daily living
interventions and structured leave as an intervention modality. Care planning and delivery is reviewed
regularly, particularly when incidents occur and at handover, but also at timed regular events such as
MDT reviews, psychiatrist reviews, and monthly regular reviews.
The Rehabilitation Unit has a local relationship with Coffs Harbour Acute Mental Health Unit, managing
overflow clients.
8.5 COMMUNITY MENTAL HEALTH SERVICES
The recent review of the MNCLHDs mental health service models of care has largely been about
remodelling community mental health services and revising how they relate to the rest of the service
system, including Inpatient Units, GPs, NGOs and Aboriginal Medical Services. The new models of care
will provide more comprehensive mental health outreach service to our consumers and service
partners in the community. It will also provide an in-reach service to the LHDs Inpatient Units to
facilitate a seamless transition to the community during discharge. Residential Aged Care Facilities will
also be provided with an in-reach service as required.
The new models of care will see a redistribution of staff in each locality. The changes will include a move
to a model of Rapid Response Services (RRS) and Integrated Treatment Services (ITS). The majority of
staff positions will be working within the RRS with a smaller number of positions focussing on the ITS.
One manager will oversee both the RRS and ITS to enable disposition of staff, movement and flexibility of
the service in response to need promptly. On a daily basis, community mental health managers will be
able to allocate staff and resources in a flexible manner across the services to meet the emerging need.
The key to providing a flexible and responsive service is the ability to allocate staff quickly to where the
need is.
The community mental health teams in the Coffs Clinical Network (CCN) will be restructured into
geographically-based teams, servicing the northern and southern sectors of the network, respectively.
Transition
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The movement to the new models of care will require a process of review and transition for some staff
and consumers. Care co-ordination and non-clinical support in NGO services will be an important
component and require a focus on managing the change involving all service providers. The increased
responsiveness of the RRS will provide the NGO sector with significant incentives to review their roles and
capacities.
Any future funding enhancements for the Mid North Coast area, particularly those associated with the
NSW Mental Health Commission Strategic Plan, are likely to be focussed in the non-government sector to
enhance these components of community care. As contracts and service agreements with NGO partners
are reviewed under the Partnerships for Health process, the MNCLHD is expected to be involved in
developing how we will work with NGO partners in a collaborative way to achieve this transition.
Discussions are ongoing with key partners, consumers, carers and community members to ensure a
successful transition.
8.5.1 Rapid Response Service
The RRS will provide assessment, care planning and treatment promptly in the community to reduce
progression of symptoms. This will ensure that communities, services, families and carers will not have to
wait until the individual is unwell enough to require acute intervention through hospital-based pathways.
Referral and triage
Referral will be possible through:
the Mental Health Line;
police;
family and carers;
other government agencies;
non-government services;
General Practices;
Primary Health Networks;
health professionals; and
self-referrals.
Response times will be in accordance with NSW triage guidelines.
Assessment
The RRS will be mobile and will undertake assessments in a variety of settings. Involvement of family,
carers, and/or other service providers in the assessment is highly desirable both in terms of improving
the accuracy of the assessment and ensuring that a support plan is developed that is appropriate and
meets with the identified needs and agreement of those involved.
The assessment will inform the development of the care plan. Where another service provider is
already engaged with the person, the care plan will be a joint plan including the roles of each provider
and the type of treatment and/or support to be provided, and a seamless clinical pathway for the
person to navigate between the services when required.
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All referrals will receive a care plan articulating the initial intervention and the ancillary support
needed. If the assessment determines that treatment by MNCLHD mental health services is not
required, advice will be given to the referrer as to the appropriate service, and the referrer will be
supported to access that service as required.
If the assessment determines that clinical intervention is required, the plan should include the initial
treatment and the level of care that will be provided, as well as the involvement of other providers in
a support or care coordination role. A risk assessment should always be undertaken and shared with
appropriate people/services. The care plan should involve the active consent and input of the
consumer and family/carer/service provider.
The care plan and ongoing assessment must be flexible enough to allow for changing response
depending on clinical need.
Treatment
If the assessment determines that an Acute Admission or more intensive community treatment is
required then the Rapid Response Service will ensure this occurs, either through its own means or
through the structured engagement with other clinical staff. The service will provide intensive follow
up and support that will be determined by the risk assessment and care plan. It will be the role of the
Rapid Response Service to work closely with the Inpatient Services to reduce hospital stays and ensure
rapid transition of care to a less restrictive environment or less intensive service. This will be done by
closely monitoring the course of the Inpatient treatment and developing community treatment and
support options for individual patient’s early discharge.
8.5.2 Integrated Treatment Service
For those requiring it, further specialist mental health treatment interventions may be provided through
an ITS. The Service will provide:
Community treatment order (CTO) management
The role of CTO Management within the service will be to co-ordinate and monitor CTO compliance. It
is important to note that managing the care outlined on the CTO may go to another service. It will be
the role of CTO Management in the ITS to monitor care and treatment compliance, not necessarily to
provide it.
Youth and Early Psychosis service provision (12 – 24 year olds)
Some Youth positions will become part of the ITS and will expand to include treatment for young
people up to 24 years and those who are experiencing first episode psychosis.
Specialist mental health individual and group interventions
Clinicians will provide specialist individual and group interventions. These may include:
psychometric assessment;
time bound evidence based individual therapy sessions in response to targeted goals;
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development and evaluation of therapeutic groups;
consultancy for complex clients;
expert clinical education and training to internal and external partners; and
comprehensive DBT program.
Integration Coordinator
The Network Mental Health Rehabilitation Coordinator roles in each Network will be renamed and
focus on supporting partnerships and integration across the networks with all government and non-
government agencies in a boundary spanning role. This position will be important in supporting and
facilitating the RRS and ITS clinicians to establish and maintain integrated links with services.
8.5.3 Medical Teams
Medical teams will be aligned between community teams and Inpatient beds to try to ensure that any
given person is treated by the same team in both settings. Specialist consultation will be provided
through case-based discussion, supervision of RRS/ITS team members, and face-to-face assessments of
patients when appropriate. The role of the psychiatrist will be more consultative and acute in nature in
keeping with the new rapid response model of care. Input from a psychiatrist would be expected during
the stabilisation phase prior to a transition of care to primary care for longer term follow up.
8.5.4 Consultation Liaison
CNC ED positions will provide an assessment service to the Emergency Departments in Coffs Harbour,
Kempsey and Port Macquarie. This will be consistent across the LHD and the CNC ED will participate in
the ED handover each morning. The RRS clinicians will assist in ED assessments and provide them in
Macksville and Bellingen as required.
Consultation liaison services will be extended through the RRS and Medical teams to provide support to
the generalist wards in the hospitals. RRS clinicians and medical staff will provide consultation liaison
support to the hospital wards including to younger and older persons.
8.5.5 Aboriginal Services
Specialist Aboriginal Mental Health Workers are part of the Rapid Response Service and they will support
clinicians to undertake assessments and develop care plans for Aboriginal people. The Aboriginal Clinical
Leader position will provide a coordination role across the MNCLHD for Aboriginal Mental Health
Workers. As well as providing support to individual Aboriginal Mental Health Workers, this position will
bring together all Aboriginal Mental Health Workers as a ‘virtual team’ for regular support and meetings.
This position covers Aboriginal Mental Health and Drug & Alcohol Service and will work closely with
managers and other Service Development Unit staff in regard to service improvement, development,
reporting and integration.
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A pilot service model for Aboriginal mental health and drug and alcohol services is currently being
planned for Coffs Harbour in collaboration with Galambila Aboriginal Health Service Inc., an Aboriginal
Medical Service. The intention is for this model to be transferable to other sites in time.
8.5.6 Co-Located Services
Under the new model of care, it is expected that some of the RRS and ITS will be co-located with other services off the hospital sites in community settings. The LikeMind Pilot project in Coffs Harbour and the Ellimatta Lodge facility in Port Macquarie will provide an ideal opportunity to implement this. The expanded use of the Wide Street house in Kempsey represents a similar opportunity. These initiatives are in development and will require more discussion and input at a local service centre level.
LikeMind
LikeMind is a mental health service model being piloted in NSW in a number of sites. LikeMind hubs
have already been established in Penrith and Seven Hills, and the NSW Ministry of Health has
announced that the MNCLHD and Western NSWLHD will be included in the pilot to provide a regional
and rural perspective on this concept. At the time of writing, tenders are being considered and an
announcement on the successful NGO lead agency is imminent.
The model involves the NGO lead agency providing the community site, administration, coordination
and infrastructure services to a range of service providers, such as GPs, psychiatrists, psychologists,
housing and employment consultants, and LHD community mental health staff. It is expected that
about seven Community Mental Health and Drug & Alcohol staff will be co-located at the site from
early 2016.
Ellimatta Lodge
This site will be utilised to house the majority of the youth mental health team in Port Macquarie, and
opportunities for the co-location of NGO, primary care and private specialist services will also be
explored. A small training facility will also be established in the site to provide cross-sector and on-line
training and clinical supervision to maintain linkages with our service partners and assist them to build
their workforce capacity. Some mobile adult community mental health staff will also be housed here,
providing outreach services to their consumer group.
A program of refurbishment is planned for Ellimatta Lodge in order to achieve the outlined change.
8.5.6 Comorbidity: Mental Health and Substance Use
Presentations of co-occurring disorders to health services are common, reflecting the high prevalence of
co-occurring disorders in the community and the increased use of health services by people with
comorbid problems. People with these comorbidities have more complex needs, are more cost-intensive
for the health system, and generally show poorer health outcomes than those with single disorders. The
NSW Health Mental Health and Substance Use Comorbidity Guidelines serve as a resource for clinicians
and services in the fields of Drug and Alcohol and Mental Health. At the treatment level, the guidelines
provide an overview of practice principles, treatment processes, assessment procedures, and treatment
strategies for the various comorbid presentations. At the service level, the guidelines emphasise the need
for better coordination and integration of MH and D&A services and delineate the expectations for
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service delivery from both MH and D&A clinicians and services. The guidelines refer to the collaboration
between local MH and D&A services as crucial for improving services to people with co-occurring
problems.
The MNCLHD has drafted a Mental Health and Substance Use Comorbidity Implementation Plan which
outlines the model of care for this group of people.
Comorbidity continues to create challenges to the overall service system on a local level across the
MNCLHD, with a substantial proportion of people presenting to either service having co-occurring
problems. Comorbid substance use is a common factor in many of the completed suicides of mental
health consumers in the community.
The key to achieving strategic targets in relation to improving the health outcomes of clients with a dual
diagnosis lies with a coordinated approach across the multiple levels of the service system. The three
main levels of the service system, and the strategies relating to these levels, are:
Support systems
Formal agreements between MH and D&A services outlining the strategic directions and shared undertakings in relation to the treatment of comorbid presentations.
Meeting structures involving senior staff across the sectors for developing and maintaining collaboration strategies. To effect targeted changes in practice across the sectors requires organisational change, which in turn requires leadership and support from management.
The specification of key principles and standards of practice for the treatment of this client group, as well as the specification of the intended collaboration between MH and D&A services.
Service structures
Joint implementation groups at the local level to develop the workforce and clinical protocols.
Locally agreed and implemented referral mechanisms and clinical pathways between MH and D&A services.
Clinical review groups at the local level.
Joint clinical and evaluation projects.
Integrated care
The main principle of integrated care in comorbidity is the treatment for both problems in the one service setting through the collaboration of clinicians rather than parallel or sequential treatment in two separate settings.
District-wide clinical protocols for: intake and assessment; treatment; and transfer of care.
Clear service delineation specifying the role of services and the delineation of responsibilities for assessment and treatment over the course of treatment.
Monitoring and evaluation of agreed treatment strategies across sectors.
The no wrong door approach to triaging people who present to health services. This emphasises the responsibility of the initial contact service facilitating access to the required range of services.
Staff should at no time work beyond their level of expertise. Consultation with relevant clinicians across sectors should be accessed as soon as possible.
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8.5.7 Telehealth and Services in Small Population Centres
Wherever possible, clinical services in small population centres will be provided via Telehealth from the
related service hub. Each small service site where staff are out-posted or clinics are provided on a
sessional basis, such as Bellingen and South West Rocks will have Telehealth facilities installed. Small
towns that are not currently serviced by sessional clinics will be considered for Telehealth clinics. Staff
currently out-posted on a full-time or regular basis will, in future, be based predominantly at their service
hub.
Better use will be made of the existing CAPTOS Telehealth Services for the younger age groups.
The new St Vincent’s Hospital Psychogeriatric SOS (Specialist Outreach Service) is a clinician-to-clinician
service offering advice, supervision, case conferencing, and education via on-line video facilities, for any
clinician involved in psychogeriatric care in rural or remote NSW.
8.5.8 After-hours Presentations and Assessments
Out-of Hours Rosters
The current group of staff in Acute Care Service teams who work seven-day, 14-hour rosters will
continue to do so, and by inclusion in the RRS, will provide out-of-hours response in the community
and hospital. Where position descriptions currently provide for, 16-hour rosters will be introduced for
specific positions, and other positions will gradually be extended to 16 hour rosters, through
negotiation and turnover of staff. Other ways to extend further the out-of-hours response will be
considered in consultation with individual staff in the RRS.
Northern Telehealth Emergency Assessment Hub
This new service will be established in Newcastle and cover the north coast of NSW from Newcastle to
Tweed Heads, and inland to the rural areas of the Hunter New England Local Health District (HNELHD).
It will be commissioned and operated by the HNELHD on behalf of the MNCLHD and NNSWLHD. It will
provide 24/7 mental health assessment to smaller hospital EDs in the rural areas where a declared
mental health Inpatient Unit is not available. The purpose is to assess and decide whether admission
(through transport to a declared unit) or discharge is clinically indicated. The service is currently in
early development phase and more detail on how this will operate within the MNCLHD is still to be
finalised. The way in which the RRS will link with this service will be part of that development. It is
expected that the hub will be commissioned early in 2016.
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8.6 OLDER PERSONS
A key service need for older persons with mental illness in MNCLHD is timely, efficient and effective
triage and assessment of older persons who are referred to public sector mental health services.
Specialist assessment should provide clear diagnosis and direction for the development of treatment,
care planning and referral pathways.
Twenty-two percent of the current population of the Mid North Coast is aged 65 years and
older, and is expected to grow by 75 per cent by 2031, bringing the overall proportion of this age
group to 30.3 per cent at that time. Of all admissions to Acute Inpatient Services from the MNCLHD
population, 6 per cent are aged 65 years and over. Of the total number of people in contact with
MNCLHD community mental health services, 9 per cent are aged 65 years and over.
Specialist Mental Health Services Older Persons (SMHSOPS) clinicians will be part of the Rapid Response
Service and will undertake assessments for people over 65 years and 45 years for Aboriginal people.
SMHSOPS clinicians will also provide comprehensive consultation and liaison with Aged Care services
including Residential Aged Care Facilities and GPs. The mobile nature of the Rapid Response Service is
ideal for servicing the Aged Care sector in this way.
To carry out this model of care, the seven clinicians of the Specialist Mental Health Services for Older
Persons (SMHSOP) would be brought together as a virtual team involving regular clinical and
supervisory meetings. The SMHSOPS CNC role will provide a clinical lead position across the MNCLHD.
It will be the role of the SMHSOPS CNC to bring together all the SMHSOPS clinicians as a ‘virtual team’
for regular clinical support and meetings. The meetings would identify new referrals and allocate
tasks, and plan support that may be required by the team members. The CNC position will work closely
with the Service Development Co-ordinator – Operations and Planning, medical teams and all managers
in regard to service improvement, development and reporting.
The new St Vincent’s Hospital Psychogeriatric SOS (Specialist Outreach Service) is a new clinician-to-
clinician web-based service soon to be provided by St Vincent’s Hospital Psychogeriatric multidisciplinary
team to rural and remote NSW. It will offer advice, supervision, case conferencing, and education via on-
line video facilities, for any clinician involved in psychogeriatric care in rural or remote NSW. It is ideally
placed to provide extra support and resources for the SMHSOPS clinicians particularly in developing the
‘virtual team’ across the District.
Consultation liaison is a key role that should be provided by public sector mental health services,
including within the base and district hospitals and community aged care services, as well as residential
aged care facilities, NGOs and general practices. This would involve identifying and recommending
treatment and care plans, but in this particular role not the direct provision of the treatment or care.
Furthermore, education and support to the services is an important part of consultation liaison and an
efficient and effective use of specialist skills. A role in supporting Aged Care Assessment Teams (ACAT)
will be crucial.
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Services to older persons will also be provided by other mental health team members as required on a
flexible basis, to be determined on clinical need and risk assessment, including medical, nursing and
allied health staff working in adult mental health services. Given the expected growth in the older
population in the Mid North Coast, we should consider shifting resources over time towards this target
group and focussing any bed changes on providing older persons’ beds in existing units.
8.7 YOUNGER PERSONS
Thirty percent of the current population of the Mid North Coast is aged between 0 and 24 years,
and is expected to grow by 10 per cent by 2031; however, even with this growth, the overall
proportion of this age group will reduce to 26 per cent because of greater growth in the over 65 age
group. Of all admissions to Acute Inpatient Services from the MNCLHD population, 17 per cent are aged
up to 24 years. Of the total number of people in contact with MNCLHD community mental health
services, 30 per cent are aged up to 24 years.
The ideal service model for meeting the needs of young people with mental health problems would
involve a fully integrated service for ages 0-24 years, including clinical pathways agreed between the
service providers, multiple access points and co-location of services where possible to provide a
youth-friendly “hub”. This would provide direct response to acute illness as well as early intervention
and prevention services.
In the new model of care, specialist Youth clinicians will be part of the Rapid Response Service and will
undertake assessments for 12 – 24 year olds. The District Service Development Coordinator - Youth will
provide a coordination role across the MNCLHD. This coordination role will assist in bringing together all
Youth Mental Health clinicians as a ‘virtual team’ for regular clinical support and meetings. This position
will work closely with the Youth Clinicians, medical staff, all Managers, and other government and non-
government Youth services in regard to service improvement, development and integration.
The core business of public sector mental health services for young people includes responding to
severe and complex problems and consultation liaison with other government and non-government
services in the field to assist them in keeping young people well.
Services for children aged 0-12 years in the Hastings Macleay and Coffs Harbour Clinical Networks are
provided by the MNCLHDs Community Health Services. When clinically required the MNCLHD Mental
Health Service does provide an initial clinical response to under 12s by way of triage and acute
assessment. The Mental Health Service then determines the best service response and makes referrals, as
appropriate.
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8.8 GENERAL PRACTITIONERS AND NORTH COAST PRIMARY HEALTH
NETWORK
The literature review found that integrating GPs into services for people with mental health
problems is critical to expanding and improving the quality of mental health care, and a number of
models are well-supported by evidence. In particular, access to mental health services in smaller
towns can be driven through general practices and contribute substantially in a rural area. At the
same time, better use of general practices in regional centres can reduce the exacerbation of
illness and acute presentations to Acute Care Services, thereby allowing more specialist time for
acute and crisis intervention.
Mild and, to some degree, moderate mental health problems are already managed in many general
practices, but few GPs are involved in the care of severely ill people who are not in an acute phase of
illness. Probably the best way to improve this involvement is through strongly supported shared-
care models, and enhancing general practice involvement should be an important focus for
remodelling the way we do business.
North Coast NSW Primary Health Network is a not-for-profit organisation and part of the
Commonwealth Government's health reform package. It was established through a partnership of
Hastings Macleay General Practice Network, Many Rivers Aboriginal Medical Services Alliance, Mid
North Coast Division of General Practice, North Coast GP Training, Northern Rivers General Practice
Network and Tweed Valley General Practice Network. Its purpose is to create strong links to local
communities, health professionals, service providers, consumers and patient groups and to respond
effectively to local health care needs. It is responsible for making it easier for patients and service
providers to navigate their way through the health care system. North Coast NSW Primary Health
Network is independent from the Local Health Districts which are responsible for hospitals and other
services. It works closely with both the Northern NSW Local Health District and the Mid North Coast
Local Health District in developing and linking services.
8.9 NON-GOVERNMENT ORGANISATIONS
Non-government organisations have a key role in the range of mental health services in any given
area, and the mental health field has a higher proportion of non-government sector involvement
compared with most other parts of the health industry. Some of these organisations specialise
exclusively in mental health service provision, and for others, mental health is a major part of
their stable of services. Non-government mental health services depend upon a system where
they can seek prompt assistance when their clients’ problems periodically move out of their range
of expertise. Without this ready responsiveness from Acute mental health services, the clinical
pathway is often disrupted and the experience of the service user is compromised.
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On the Mid North Coast, non-government organisations provide specialist living support including:
housing assistance and support;
personal helpers and mentors;
recovery and resources services program;
support facilitation and care coordination;
supported accommodation;
community outreach;
Headspace services for people aged 12-24;
disability employment services; and
services to service users with the dual disabilities of intellectual and mental health disability.
Headspace (Coffs Harbour) offers early intervention service for 12-25 year olds. The service has 4 GPs and
4 psychologists (all P/T), 2 youth workers and 2 visiting psychiatrists. The service is already facing demand
management issues. A Headspace service opened in Port Macquarie in 2013.
Personal Helpers and Mentors (PHAMS) services assist people recovering from a mental illness episode to
build their confidence and overcome social isolation through a strength-based recovery program. These
services provide group work as well as individual support. The two services operating within the Mid
North Coast are:
Coffs Harbour Employment Support Service (CHESS) which operates from Yamba to Stuarts Point
and has approximately 70 people on its books at any one time; and
New Horizons (Hastings Macleay) which operates from Hat Head to Laurieton and has
approximately 60 people on its books at any one time.
8.10 ABORIGINAL MEDICAL SERVICES
Aboriginal medical services have both a general practice primary care role as well as a special interest
role as they generally employ specialist positions such as psychiatrists and mental well-being workers.
Their core business, of course, is looking after people in Aboriginal communities who have mental
illnesses and mental health problems, but they need to work in closely with specialist public sector
services for those times when illness becomes acute. Given the employment of Aboriginal mental
health workers in public sector services, such a partnership is best achieved through agreed models
of care and clinical pathways for this special population. There are also benefits in quality
improvement for both services, on the one hand, by building the clinical capacity of Aboriginal
organisations and, on the other, by improving the cultural sensitivity of public sector services.
Aboriginal Medical Services in NSW are a strong and effective intervention point for Aboriginal people
with a mental illness. Galambila AMS, for example, delivers an integrated primary mental health care
model that provides clinical interventions, community-based recovery orientated support, care co-
ordination, employment services, comprehensive physical health care and preventative health programs.
This delivery model is evidence-based, grounded in over 40 years of Aboriginal Medical Service modelling
and aligns with newer mainstream one-stop shop models like Headspace and Like Minds Pilot that is being
implemented and evaluated in New South Wales.
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8.11 PRIVATE SERVICES
The Baringa Private Hospital at Coffs Harbour has a 12 bed mental health facility, the Bindarray Clinic. All
patients are admitted on a voluntary basis to the clinic under the care of a Specialist Psychiatrist and
supported by a team including psychologists, nursing and allied health staff.
Advanced Personnel Management (APM) co-located two days per week at Coffs Harbour Mental Health
Service. This program was established in late 2012 and has already assisted 13 people to gain
employment.
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9 FUTURE ROLE OF PORT MACQUARIE
MENTAL HEALTH INPATIENT UNIT AND
FUNCTIONAL SPACE REQUIREMENTS
Over the next ten years to 2025, Mid North Coast LHD Mental Health services will continue to be
managed and networked on a district-wide basis. Such networking provides the critical mass to provide
for the full range of services of secondary level mental health services, both hospital Inpatient and
ambulatory community based services, and tertiary services such as the Non-Acute Rehabilitation
Inpatient Unit at Coffs Harbour Campus. Models of care are reviewed, clinical services are planned and
workforce strategies developed for the whole of the Mid North Coast by the LHD Mental Health Service.
Within the LHD, the Hastings Macleay and Coffs Harbour Clinical Networks will manage the provision of
hospital and ambulatory services for the catchment population served by these networks.
Section 9 describes the future role and functional space requirements of the Port Macquarie Mental
Health Inpatient Unit that will be required to deliver the projected level of services to the community
over the next five to ten years. The proposed role of the PMBH MHIPU would complement, and operate
in collaboration with, the new role of MNCLHD Mental Health Services and key service partners as
described in Section 8.
9.1 HASTINGS MACLEAY CLINICAL NETWORK
The analysis of current Inpatient capacity against population needs has indicated the need for additional,
purpose-built Inpatient capacity for mental health services in the Hastings Macleay Clinical Network. In
terms of the current available Inpatient bed capacity in Hastings Macleay, the CSP 2013 identified the
following needs, and these needs have been confirmed in the 2015 ADDENDUM:
There are only 12 Acute Adult beds for involuntary patients within the Network, and these beds
at Port Macquarie Base Hospital do not meet Health Facility Guidelines in relation to a number of
design aspects;
The ten beds at Kempsey District Hospital do not permit the admission of gazetted or involuntary
patients, requiring that such patients must be transferred to the Port Macquarie or Coffs Harbour
Acute Adult Inpatient Units;
These two Acute Adult Units are of sub-optimal size. The optimal size for an Acute Adult Unit for
efficiency of staffing and operation is 18-35 beds29;
29
Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0134 Adult Acute Mental Health
Inpatient Unit, Rev 5.0, 11 April 2012.
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There are no designated Inpatient beds for Older Persons mental health care within the Mid
North Coast LHD; and
Access to the specialist child and adolescent beds located in Lismore is problematic due to the
distance and round trip of over nine hours for patients and their families. Reported obstacles
include the financial costs of travel and accommodation, missing paid work, and the difficulties
arranging alternative care arrangements for younger children.
There is clearly a need on the Mid North Coast to develop an improved range of options for the care of
people with more severe psychogeriatric disorders that result in behaviours that place either themselves
or others at risk, as well as for people with less severe psychogeriatric disorders including the frail elderly
who are not appropriate for admission to Acute Adult Units. The development of service options for
people with psychogeriatric disorders will involve collaboration across primary health, aged care and
mental health service sectors. The development of a designated mental health Inpatient Unit for Older
Persons on the Mid North Coast is justified on the basis of population demand.
9.2 PORT MACQUARIE MENTAL HEALTH INPATIENT UNIT
The current Acute PMBH Mental Health Inpatient Unit is of sub-optimal size at 12 beds and does not
meet key facility design guidelines for service; this non-compliance represents a current and future
clinical and corporate risk. As indicated above, the most efficient size is around 18-35 beds. The larger
sized unit provides a critical mass of service for both staffing and general operation. Given the existing
design issues and the identified service need for 24 beds at Port Macquarie Base Hospital, it is
appropriate to plan for a new purpose designed Acute Mental Health IPU containing a total of 24 beds at
Port Macquarie Base Hospital. Of the 24 beds, 12 will replace the existing 12-bed Adult Acute Unit,
resulting in a total of 12 new beds.
The new 24 bed IPU will be designed to allow beds to be used flexibly as ‘swing beds’ (beds that can
alternate between different types of care). As such, the proposed Inpatient Unit would contain 24 Acute
Adult beds with the capacity to support the admission of eight older persons and four younger persons.
Importantly, the design would comply with current Australasian Health Facility Guidelines30 including B-
0132 Child and Adolescent Mental Health Unit31, B-0134 Adult Acute Mental Health Inpatient Unit32
, and
B-0135 Older Persons Acute Mental Health Unit33 as well as NSW Health PD2010_033 Children and
30
NSW Ministry of Health. (2008). GL2008_017 Health Facility Guidelines: Australasian Health Facility Guidelines in NSW. NSW Health. 31
Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0132 Child and Adolescent Mental Health Unit, Rev 5.0, 11 May 2012. 32
Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0134 Adult Acute Mental Health Inpatient Unit, Rev 5.0, 11 April 2012. 33
Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0135 Older Persons Acute Mental Health Unit, Rev 1.0, 31 May 2012.
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Adolescents – Safety and Security in NSW Acute Health Facilities34, and NSW Health PD2010_034 Children
and Adolescents – Guidelines for Care in Acute Care Settings35.
This Unit should be developed on the PMBH campus which has space for such a development. The Unit
would be designed as a gazetted unit to provide for involuntary patients. The function of the unit is to
provide, in a safe and therapeutic environment, appropriate facilities for the reception, assessment,
admission, diagnosis, observation, treatment and recovery of often acutely unwell consumers, presenting
with known or suspected psychiatric conditions and behavioural disorders. Consumers may be admitted
on a voluntary or involuntary basis.
Consumers may be agitated, aggressive and potentially a risk to themselves or others. Therefore the
environment should be conducive to the management of complex behaviours offering the capacity for
observation of consumers by staff, discreet security, and where necessary temporary containment.
However, this should be achieved with a therapeutic focus so that while necessary measures for safety
and security are in place, they are non-intrusive and do not convey a custodial ambience.
The recommended requirements for this unit include:
24 Acute Adult beds (four of which will be Observation beds) with the capacity to support the
admission of eight older persons and four younger persons (12-17 years of age), as required;
a seclusion room;
a contemporary mental health facility compliant with Australian Health Facility Guidelines; and
an ECT Service.
The proposed role and model of care for these functions are described in more detail below. (Table 1.2
also provides further detail regarding these recommendations).
9.2.1 Older Persons Beds
The population demographics of the Mid North Coast indicate that in 2026, 28 per cent of the population
will be aged over 65 years and 4 per cent will be aged over 85 years. There is an imperative to develop
greater capacity in both community based mental health services for older persons and specialist mental
health Inpatient services for older persons. At present there are no designated Specialist Mental Health
Services for Older Persons (SMHSOP) Inpatient beds in the Mid North Coast LHD.
34
NSW Ministry of Health. (2010). PD2010_033 Children and Adolescents – Safety and Security in NSW Acute Health Facilities. NSW Health. 35
NSW Ministry of Health. (2010). PD2010_034 Children and Adolescents – Guidelines for Care in Acute Care Settings. NSW Health.
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There is a need to develop Inpatient facilities to provide for the growing population of older persons on
the Mid North Coast who will require treatment for acute psychogeriatric disorders. The MH-CCP
Planning Framework estimates a need for 14 Acute beds for Older Persons and 7 Non-Acute beds in 2015
for the Mid North Coast population, increasing to 19 Acute beds and 10 Non-Acute beds in 2025.
The activity data presented in Table 5.8 indicates that, in 2013/14, Mid North Coast older persons utilised
an average 10.4 beds (at 85 per cent occupancy) in Acute designated mental health beds, 0.8 Non-Acute
mental health beds and 3 beds in general hospital Inpatient beds for psychiatric diagnoses. There is a
population need for Older Persons beds in both Hastings Macleay and Coffs Clinical Networks.
Since CSP 2013 was prepared, PMBH has opened a 13 bed Geriatric Evaluation and Management (GEM)
Unit. This Sub-Acute unit provides care for older people with chronic conditions and co-morbidities
including dementia, delirium, behavioural difficulties as well as falls, incontinence and other medical
issues. On average around 25-30 per cent of admissions, or around 3-4 beds, are utilised by older people
with psychogeriatric conditions.
In the management of these conditions the GEM works closely with the PMBH Mental Health Inpatient
Unit who provide consultation liaison for these patients.
In the provision of Inpatient mental health services for older people, the current major service deficit is in
the provision of services for older people with acute psychiatric conditions, and for frail elderly with
mental health conditions. At present, these tend to be admitted to general medical wards or to the GEM
Unit, but neither of these wards are designed for this purpose and these patients are not suitable for
these wards. This situation will only exacerbate with the ageing of the population and the lack of
specialist mental health beds for Older Persons.
The CSP 2013 recommended the development of 8-10 beds in the Hastings Macleay Network. The option
of developing these at Kempsey District Hospital was considered but found to be inappropriate due to the
design and functional layout of the Inpatient facility at KDH.
It is now appropriate to include up to eight beds that have the capacity to manage older persons within
the proposed expansion of mental health beds at PMBH. It is proposed that two of the pods (eight beds)
be designed and purpose built as suitable and appropriate for the admission and treatment of Older
Persons (over the age of 65 years). The primary focus of such a service is restoring the health of older
persons with a psychiatric disorder to an optimal degree of mental function by addressing the patient’s
psychological, physical and social needs. The development of up to eight beds for Older Persons within
the proposed Inpatient Unit at PMBH will also enable the provision of ECT services for older people, a
significant deficit in the current model of care.
These eight beds would be designed to provide for the special needs of older people including space to
walk and be separate from the Adult Inpatients, but the design should be flexible to revert to adult use at
times of lower demand from older persons. There would also be a close collaboration with the GEM Unit
on site at PMBH, to best utilise the linkages with clinical services including Acute medical and aged care
services.
The role and function of a SMHSOP Acute Inpatient Unit including a description of target population,
interventions and service models and practice is provided in the SMHSOP Acute Inpatient Unit Model of
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Care Project Report36. This report explains that the Acute Inpatient Unit will be part of the continuum of
care that also includes mental health promotion, prevention and early intervention,
ambulatory/community services, Sub-Acute and Non-Acute Inpatient care and community residential
care.
The primary functions of the Acute Inpatient Unit include: assessment; clinical review and care planning;
management of acute risk; treatment focused on clinical symptom reduction with a reasonable
expectation of improvement in the short term; and transfer of care from the unit as soon as feasible.
Discharge to the usual place of residence is the primary goal of management, but transfer to an
alternative longer term facility such as an aged care facility, extended care, specialised residential aged
care facility, or Inpatient Unit, may be required.
These units should be able to manage both voluntary and involuntary patients under the Mental Health
Act.
The NSW SMHSOP Service Plan37 defines the SMHSOP target population as older people (65 years and over) who:
develop, or are at high risk of developing, a mental health disorder at the age of 65 years and over, such as depression, acute psychosis, anxiety, late onset schizophrenia or a severe adjustment disorder;
have had a lifelong or recurring mental illness, and now experience age-related problems causing significant functional disability (i.e. become ‘functionally old’);
have had a prior mental health problem but have not seen a specialist mental health service for at least five years and now have a recurrence of their illness or disorder that can be optimally managed by SMHSOP; and
present with severe behavioural or psychiatric symptoms associated with dementia (BPSD) or other long-standing organic brain disorder and would be optimally managed with input from SMHSOP. This may include people who are deemed at risk of harm to themselves or to others.
In National Older Person Mental Health Benchmarking Forums the average length of stay in 2006/07 was
45 days.
In terms of ideal size, smaller clusters are more appropriate for older persons mental health units, as
older persons are more prone to confusion, particularly in the case of patients with moderate dementia.
Accordingly units of between 8-12 beds are recommended38. Larger facilities may be more confusing for
older consumers and high quality care is easier to provide in small groups. Groups of eight beds have
been found to be sufficiently small for the care of mobile, confused and disturbed older people.
36
Ministry of Health (2012) SMHSOP Acute Inpatient Unit Model of Care Project Report. 37
Ministry of Health (2006) Specialist Mental Health Services for Older People (SMHSOP) - NSW Service Plan - 2005-2015. 38
Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0135 Older Persons Acute Mental
Health Unit, Rev 1.0, 31 May 2012.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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The Acute Inpatient Unit Project Report makes it clear that, in order to provide basic services for optimal
treatment, new SMHSOP AIUs need to develop effective partnerships with a range of other services,
particularly SMHSOP community teams, aged care services and adult mental health services. Functional
relationships with SMHSOP community teams are fundamental and the Acute Inpatient Unit and its
models of care must support integrated service provision across Inpatient, community and residential
settings.
The proposed development of a 24 bed Acute Adult Inpatient Unit, with the capacity to facilitate and
support the admission of older persons, will require the recruitment of a Psycho-Geriatrician to provide
clinical care at this Unit and to provide leadership for the provision of older persons mental health
services in the MNCLHD including outreach services to the other major hospital facilities and community
health services.
9.2.2 Adult Acute Inpatient Beds
The proposed expansion of Acute mental health beds at PMBH will provide the capacity for the PMBH
Mental Health Inpatient Unit to be self-sufficient in the provision of Acute Adult Inpatient Services and
remove the current necessity to utilise beds for Hastings-Port Macquarie residents at the Kempsey
Mental Health Inpatient Unit.
9.2.3 Observation Beds
A pod of four beds would be designed as Observation beds. These beds would be purpose-designed to
provide the capacity for observation and management of the more unwell patients in a secure
environment.
9.2.4 Services for Younger Persons
Core business in the provision of mental health services for children, adolescents and youth is prevention
and early intervention for children and young people who may be having their first experience of a
mental health problem. There is greater recognition of the need to provide earlier detection of psychosis
in young people and to provide early intervention services including information, assessment and
treatment. The aim as much as possible is to provide services in an ambulatory care environment away
from the acute hospital environment which can be a confronting environment for young people
experiencing a first episode of mental illness.
The priority for MNCLHD Mental Health Service in Hastings Macleay is to develop a community mental
health service hub with a predominant focus on youth mental health services at Ellimatta Lodge in Port
Macquarie. There is an opportunity to develop the site as a location for the provision of day programs,
outpatient clinics and the co-location of NGO service partners. A program of refurbishment works to
facilitate this change has commenced.
For children and young people having their first experience of more acute mental health symptoms, there
is a need for early effective response including acute crisis and intensive family therapy. At present
tertiary Inpatient services for children and adolescents living in the Mid North Coast is provided at the
CAMHS Inpatient Unit at Lismore Base Hospital. The activity data presented in Table 5.6a indicates that,
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
70
on average, children and adolescents from the Mid North Coast are utilising three beds out of the eight
beds in this unit.
The current demand is in line with the MH-CCP (2010) estimated need for three beds for the 12-17 years
population of the Mid North Coast (refer Table 7.1).
The feedback from staff consultations in the process of developing the ADDENDUM was that the most
significant current issue for staff was the ability to respond effectively to the first episode of acute
psychosis or suicidal intentions. As there are no designated Child and Adolescent Mental Health Inpatient
Unit in the Mid North Coast, young people in crisis who present in the ED at PMBH are occasionally
admitted to a single-bed room in the Paediatric Unit for an initial period. This option is not always
available or suitable for some patients.
In the provision of treatment and intensive family therapy, access to the CAMHS unit in Lismore (or
occasionally the Nexus Unit in Newcastle) is sought however a bed may not be available at short notice.
Additionally, staff report that in some cases young people and families opt not to seek treatment located
so far from Port Macquarie. Reported barriers include the financial costs of travel and accommodation,
missing paid work, and the difficulties arranging alternative care arrangements for younger children.
The development of an Inpatient Service that would improve the management of younger persons needs
within the Mid North Coast would be in keeping with the NSW Rural Health Plan Towards 202139. For
instance, one goal of the Plan’s strategic direction for healthy rural communities entails improving and
enhancing the quality of, and access to, child and youth mental health services. Further the strategic
direction of access to high quality care for rural populations states “people living in rural communities
should be able to access high quality health care as close to home as possible”. The benefits of such
access would include the following: less travel time and associated costs for the families of the young
person hospitalised; the greater involvement of families in therapy and treatment could be achieved; the
younger person would remain nearer their usual supports including friends and extended family; there
would be easier follow-up and transfer of care to community mental health services; and importantly
acute crisis and intensive family therapy, which are critical crisis interventions for the first episode of
acute psychosis or suicidal intentions, could be commenced both locally and promptly.
The key principles of Policy Directive PD2011_016 Children and Adolescents with Mental Health Problems
Requiring Inpatient Care40 have guided the planning for younger persons’ services. For instance, Inpatient
care must be (1) the least restrictive alternative and must consider the safety of younger persons and that
of others, (2) the closest available to home and usual supports wherever possible, especially for younger
children and Aboriginal families, and (3) the most developmentally and clinically appropriate care given
available resources. The emotional impact of Inpatient treatment on both the younger person and their
parents should also be recognised as well as the need for parents to remain close by their young child or
adolescent for the duration of Inpatient treatment.
39
NSW Ministry of Health. (2014). NSW Rural Health Plan: Towards 2021. NSW Health. 40
NSW Ministry of Health. (2011). PD2011_016 Children and Adolescents with Mental Health Problems Requiring Inpatient Care. NSW Health.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
71
In reviewing Inpatient requirements for younger persons, two options have been considered.
One option is to develop a designated Younger Persons Inpatient Unit at PMBH. A pod of four beds would
be designed as Child Adolescent and Youth beds. The design of such a four-bed pod would be important
and separation from the Adult Inpatient beds would be required to conform with Ministry of Health
Facility Guidelines for the hospitalisation of children.
The development of such a unit would require the recruitment of a Child and Adolescent Psychiatrist and
a registrar. This position would also provide valuable support and leadership to the Community Child and
Youth Mental Health teams.
The major difficulty associated with this option is the feasibility and cost effectiveness of establishing a
four bed unit which would be expensive to manage and there would be difficulties in attracting a Child
and Adolescent Psychiatrist given the nationwide shortage in supply of these. A four-bed unit is not a
sufficient critical mass in terms of the size of the unit to support adequate rostering of specialist staff and
there are no units of this size currently operating in NSW.
The alternative and preferred option is to utilise four of the 24 Adult Acute beds flexibly in one pod as
‘swing beds’ for the short term management of younger persons. This would enable the urgent admission
of young people enabling crisis interventions to be commenced locally and decisions to be made
concerning options for ongoing acute treatment. Employing this option would mean maintaining the
current provision of tertiary Inpatient care at other supra-district facilities such as the Lismore Base
Hospital CAMHS unit for Mid North Coast residents. The practice of admitting appropriate younger
persons with mental health issues to the PMBH Paediatric Unit would also be continued. This Unit
provides an effective option for admission of younger people with mental health issues such as
depression and eating disorders (the primary mental health diagnoses for children under the age of 16
years). These admissions are managed collaboratively with Consultation Liaison provided through the
PMBH Mental Health Inpatient Unit staff.
Importantly, the design for the proposed flexible-use four-bed pod would need to comply with current
Australasian Health Facility Guidelines41 including B-0132 Child and Adolescent Mental Health Unit42 and
PD2010_033 Children and Adolescents – Safety and Security in NSW Acute Health Facilities43. In terms of
bed numbers, the MH-CCP (2010) estimates indicate the need for three beds for 12-17 year olds (see
Table 7.1). Given, however, considerations around design practicalities and nursing to patient ratios, as
per NHPPD, the MNCLHD submits four of the 24 beds be built to allow for their flexible use as younger
persons beds.
Seclusion Room
At present the PMBH Mental Health Inpatient Unit has a seclusion room with low stimuli for patients in
agitated state. The need for one seclusion room would remain in the expanded unit.
41
NSW Ministry of Health. (2008). GL2008_017 Health Facility Guidelines: Australasian Health Facility Guidelines in NSW. NSW
Health. 42
Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0132 Child and Adolescent Mental Health Unit, Rev 5.0, 11 May 2012. 43
NSW Ministry of Health. (2010). PD2010_033 Children and Adolescents – Safety and Security in NSW Acute Health Facilities.
NSW Health.
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9.2.5 ECT Suite
The lack of ECT at PMBH was identified as a deficit in the CSP (2013). The development of an expanded
Mental Health Inpatient Unit provides the opportunity to reintroduce the provision of electroconvulsive
therapy (ECT) at PMBH. Timely provision of ECT for patients such as those with psychotic depression will
improve patient outcomes and reduce length of stay. The provision of an ECT Service at PMBH will be in
accordance with PD2100_003 Electroconvulsive Therapy: ECT Minimum Standard of Practice in NSW44 and
require appropriate fittings, fixtures and equipment. It is expected the service will utilise PMBH operating
theatres and perioperative facilities which will necessitate a clear Service Agreement with PMBH.
44
NSW Ministry of Health. (2011). PD2011_003 Electroconvulsive Therapy: ECT Minimum Standard of Practice in NSW. NSW Health.
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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10 REFERENCES
Australian Bureau of Statistics. (2011). Community Profiles (Census 2011). Available from http://www.abs.gov.au/websitedbs/censushome.nsf/home/communityprofiles Australian Bureau of Statistics. (2011). Estimated resident populations (Census 2001 and 2006) (HOIST). Australian Bureau of Statistics. (2011). 2033.0.55.001 Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA). Australia, 2011. Available from http://www.abs.gov.au/ausstats/[email protected]/mf/2033.0.55.001/ Australian Bureau of Statistics. (2011). 3238.0.55.001 - Estimates of Aboriginal and Torres Strait Islander Australians, June 2011. Available from http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3238.0.55.001June%202011?OpenDocument Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0132 Child and Adolescent Mental Health Unit, Rev 5.0, 11 May 2012. Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0134 Adult Acute Mental Health Inpatient Unit, Rev 5.0, 11 April 2012. Australasian Health Infrastructure Alliance. (2012). Australian Health Facility Guidelines: B-0135 Older Persons Acute Mental Health Unit, Rev 1.0, 31 May 2012. Centre for Epidemiology and Evidence, NSW Ministry of Health. Health Statistics New South Wales, http://www.healthstats.nsw.gov.au Commonwealth of Australia. (2008). National Mental Health Policy. Available from http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-pol08 Commonwealth of Australia. (2009). Fourth National Mental Health Plan – An agenda for collaborative action in mental health 2009-2014. Available from https://www.health.gov.au/internet/main/publishing.nsf/Content/9A5A0E8BDFC55D3BCA257BF0001C1B1C/$File/plan09v2.pdf Commonwealth of Australia. (2014). Report of the National Review of Mental Health Programmes and Services, National Mental Health Commission. Available from http://www.mentalhealthcommission.gov.au/our-reports/review-of-mental-health-programmes-and-services.aspx Commonwealth of Australia. (2014). Fact Sheet 2 – What this means to Aboriginal and Torres Strait Islander people. Report of the National Review of Mental Health Programmes and Services, Summary. National Mental Health Commission. Gee. G., Dudgeon P., Schults C., Hart A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. In Dudgeon, P., Milroy, H., & Walker, R. (eds.). Working Together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. (2nd ed.). In Australian Institute
Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
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of Health and Welfare. (2014). Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people, Issues paper no. 12, Closing the Gap Clearinghouse. Canberra: Australian Government. Mental Health and Drug & Alcohol Office, NSW. (2001). Mental Health Clinical Care and Prevention Model Version 1.11 a population mental health model. Ministry of Health. (2012). Mental Health Clinical Care and Prevention Model (draft version), 2010. Mental Health and Drug & Alcohol Office, NSW (2001) Mental Health Clinical Care and Prevention Model Version 1.11 a population mental health model; Ministry of Health (2012) Mental Health Clinical Care and Prevention Model, 2010. MHDAO. (2012). MH-CCP 2010. Available from http://www.health.nsw.gov.au/mhdao/Pages/pe-mhccp.aspx Ministry of Health. (2012). Specialist Mental Health Services for Older People (SMHSOP) Acute Inpatient Unit Model of Care Project Report. Available from http://www.health.nsw.gov.au/mhdao/publications/Publications/smhsop_aiu_moc.pdf Ministry of Health. (2006). Specialist Mental Health Services for Older People (SMHSOP) -NSW Service Plan - 2005-2015. Available from http://www0.health.nsw.gov.au/policies/gl/2006/GL2006_013.html Ministry of Health. (2012). Mental Health Clinical Care and Prevention Model, 2010. Available from http://www.health.nsw.gov.au/mhdao/Pages/pe-mhccp.aspx National Aboriginal and Torres Strait Islander Health Council and National Mental Health Working Group. (2004). National strategic framework for Aboriginal and Torres Strait Islander peoples' mental health and social emotional wellbeing (2004-2009). Canberra: Australian Government. NSW Mental Health Commission. (2014). A Strategic Plan for Mental health in NSW 2014-2024. Sydney, NSW Mental Health Commission. NSW Mental Health Commission. (2014). Living Well: Putting people at the centre of mental health reform in NSW. Sydney, NSW Mental Health Commission. NSW Department of Health, Population Health Division. (2008). The health of the people of New South Wales - Report of the Chief Health Officer 2008. Sydney: NSW Department of Health. NSW Ministry of Health. (2008). GL2008_017 Health Facility Guidelines: Australasian Health Facility Guidelines in NSW. NSW Health. NSW Ministry of Health. (2010). PD2010_033 Children and Adolescents – Safety and Security in NSW Acute Health Facilities. NSW Health. NSW Ministry of Health. (2010). PD2010_034 Children and Adolescents – Guidelines for Care in Acute Care Settings. NSW Health. NSW Ministry of Health. (2011). NSW Child and Adolescent Mental Health Services (CAMHS) Competency Framework. NSW Health.
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NSW Ministry of Health. (2011). PD2011_016 Children and Adolescents with Mental Health Problems Requiring Inpatient Care. NSW Health. NSW Ministry of Health. (2011). PD2011_003 Electroconvulsive Therapy: ECT Minimum Standard of Practice in NSW. NSW Health. NSW Ministry of Health. (2014). NSW Rural Health Plan: Towards 2021. NSW Health. NSW State and Local Government Area Population Projections. (2014).Final. Pilbeam V, Ridout L, Rich J, Perkins D. (2014). Rural mental health service delivery models: a literature review. Report prepared for Mid North Coast Local Health District. Centre for Rural and Remote Mental Health.
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11 APPENDIX
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11.1 APPENDIX 1
Consultation Profile - Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015
Extensive consultation occurred during the development of the Mid North Coast Mental Health Clinical
Services Plan 2013-2021, including Planning Workshops held in October 2012 with input sought from key
stakeholders comprising service providers, NGOs and Commonwealth funded services, consumers and
carers, and MNCLHD Mental Health Staff. A draft of the plan was also sent to 170 organisations and
individuals, from both the Mid North Coast and further afield, for comment.
With respect to the Mid North Coast Mental Health Clinical Services Plan ADDENDUM 2015, small group
consultations were held from April – June, 2015. As shown in Tables 1- 6 (below) the groups invited to
participate reflect the Addendum’s specific interest in the service directions and capacity requirements
for the mental health inpatient services at Port Macquarie Base Hospital over the next five to ten years.
Table 1 Small Group Consultation: Acute Adults
Invitees Designation
Dean Bilton NUM, PMQ In-patient Unit
Anitta Kocijan Social Worker Mental Health
Trish Hunter MH Nurse
Dr Tim Amor Staff Specialist Mental Health
Ian Dennis Manager, PM Community Mental Health
Nick Bannon A/NUM KDH In-patient Unit
Matt Eldridge Manager, Kempsey Community Mental Health
Table 2 Small Group Consultation: Younger Persons
Invitees Designation
Derek Moore Service Development Coordinator- Child and Family
Ruth Reynolds CAMHS- CL Nurse
Darryl Ford MH RN
Ute Morris Clinical Psychologist
Matt Eldridge Manager, Kempsey Community Mental Health
Ian Dennis Manager, PM Community Mental Health
Nick Bannon A/NUM KDH In-patient Unit
Dean Bilton NUM, PMQ In-patient Unit
Tayt Rosenbaum Occupational Therapist - Youth Mental Health
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Table 3 Small Group Consultation: Older Persons
Invitees Designation
Judy O'Mara Service Development Coordinator Operations and Planning
Dean Bilton NUM, PMQ In-patient Unit
Matt Eldridge Manager, Kempsey Community Mental Health
Diana Lentz Older Persons Mental Health Worker
Ian Dennis Manager, PM Community Mental Health
Nick Bannon A/NUM KDH In-patient Unit
Table 4 Small Group Consultation: Integrated Care / Community, Carers, Consumers
Invitees Designation
Dean Bilton NUM, PMQ In-patient Unit
Matt Eldridge Manager, Kempsey Community Mental Health
Judy O'Mara Services Development Coordinator Operations and Planning
Darcy Budden Rural Adversity Mental Health Coordinator
Ian Dennis Manager, Port Macquarie Community Mental Health
Crystal Davis PMBH Aboriginal Mental Health Worker
Natalie Scaysbrook PMBH Mental Health Rehabilitation Coordinator
Dave Bobongie KDH Aboriginal Mental Health Worker
Elizabeth Ingram Community member
Mike Daley Community member
Wendy Beck Community member
Nick Bannon A/NUM KDH In-patient Unit
Table 5 Small Group Consultation: PMBH and MH Executive
Invitees Designation
John Leary Director, Mental Health and Drug & Alcohol Services
Dr Robert Pegram PMBH GM & HMCN Coordinator
Vicki Simpson PMBH DON
Barry Hunter Manager, Mental Health Service
Karen Allen (Darrin Cowan) Manager, Nursing & Service Development
Colin Bisco Capital Works Project Manager
Table 6 Individual Consultations with Clinicians unable to attend the Small Group Sessions
Attendees Designation
Dr Andy Hughes Clinical Director, Mental Health Hastings Macleay, Psychiatrist
Dr David McDonald Paediatrician Staff Specialist
Dr Matt Kinchington Head of Medicine, PMBH; VMO Geriatrition
Dr Meredith Hinds Psychiatrist
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11.2 APPENDIX 2
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11.3 APPENDIX 3
Mid North Coast LHD Estimated Needs Met using MH-CCP 2010, July 2015
Draft
NSW MH-
CCP 2010
Estimate
s
Draft
NSW MH-
CCP 2010
Estimate
s
Draft
NSW MH-
CCP 2010
Estimate
s
Actual
Funded
beds
Projecte
d Funded
beds
Projecte
d funded
beds Variance Variance Variance
% NSW
MH-CCP
2010
Estimate
d Need
Met
% NSW
MH-CCP
2010
Estimate
d Need
Met
% NSW
MH-CCP
2010
Estimate
d Need
Met
Age Category Details 2015 2020 2025 2015 2020 2025 2015 2020 2025 2015 2020 2025
A B C D E F G H I = F - C J = G - D K= H - E L = F / C %M = G / D %N = H / E %
All Ages 1. Population 214,359 223,932 232,728 214,359 223,932 232,728 214,359 223,932 232,728 214,359 223,932 232,728
All Ages 3. Beds 91 96 101 72 72 72 -19 -24 -29 79% 75% 71%
All Ages A Acute IP Beds 54 56 58 52 52 52 -2 -4 -6 97% 93% 89%
All Ages B Non-Acute IP Beds 16 17 18 20 20 20 4 3 2 125% 117% 108%
All Ages C VLS beds 22 23 24 0 0 0 -22 -23 -24 0% 0% 0%
All Ages Sub Acute beds Not estimated under NSW MH-CCP 2010N/A N/A N/A N/A N/A N/A N/A N/A N/A
65+ 1. Population 48,703 56,182 64,292 48,703 56,182 64,292 48,703 56,182 64,292 48,703 56,182 64,292
65+ 3. Beds 28 32 36 0 0 0 -28 -32 -36 0% 0% 0%
65+ A Acute IP Beds 14 16 19 0 0 0 -14 -16 -19 0% 0% 0%
65+ B Non-Acute IP Beds 7 9 10 0 0 0 -7 -9 -10 0% 0% 0%
65+ C VLS beds 6 7 8 0 0 0 -6 -7 -8 0% 0% 0%
65+ Sub Acute beds Not estimated under NSW MH-CCP 2010N/A N/A N/A N/A N/A N/A N/A N/A N/A
18-64 1. Population 118,731 119,810 119,414 118,731 119,810 119,414 118,731 119,810 119,414 118,731 119,810 119,414
18-64 3. Beds 59 60 59 72 72 72 13 12 13 122% 121% 121%
18-64 A Acute IP Beds 37 37 37 52 52 52 15 15 15 142% 140% 141%
18-64 B Non-Acute IP Beds 6 6 6 20 20 20 14 14 14 314% 311% 312%
18-64 C VLS beds 16 16 16 0 0 0 -16 -16 -16 0% 0% 0%
18-64 Sub Acute beds Not estimated under NSW MH-CCP 2010N/A N/A N/A N/A N/A N/A N/A N/A N/A
0-17 1. Population 46,924 47,940 49,022 46,924 47,940 49,022 46,924 47,940 49,022 46,924 47,940 49,022
0-17 3. Beds 5 5 5 0 0 0 -5 -5 -5 0% 0% 0%
0-17 A Acute IP Beds 3 3 3 0 0 0 -3 -3 -3 0% 0% 0%
0-17 B Non-Acute IP Beds 2 2 2 0 0 0 -2 -2 -2 0% 0% 0%
Analysis:
1 The LHD have an adequate supply of Adult Acute beds at the 80% level or higher, for their population through to 2025
2 The LHD have an adequate supply of Adult Non Acute beds for their population through to 2025
3 The LHD does not have any Very Long Stay (VLS) beds. (Note; The Draft National Mental Health Service Planning Framework (NMHSPF) models only
for Acute, Sub Acute and Non Acute beds)
4 The 42 HASI Places within the Mid North Coast LHD offset to some extent the lack of VLS beds wihin the LHD.
5 The LHD does not have any Older Persons 65+ beds of any description, (Acute, Non Acute or Very Long Stay).
6
7 Source File: MH-CCP 2010 Calculator v2.05b Sept 2014_PopulationUpdateFinYr_HP.xlsx.
8
Key:
Less than 60% of draft NSW MH-CCP 2010 estimated need met
60% to 79 % of draft NSW MH-CCP 2010 estimated need met
80% to 100% of draft NSW MH-CCP 2010 estimated need met
Greater than 100% of draft NSW MH-CCP 2010 estimated need met
For MH-CCP 2010 purposes Sub Acute MH beds are counted as Non Acute MH beds.
Population Source - Department of Planning and Environment 2014 population series
Source: Mental Health and Drug and Alcohol Office, NSW Health - Program Modelling and Planning - Draft MH-CCP 2010
Calculator V2.05b Sept 2014 PopulationUpdateFinYr (July 2015).