Living Well - Actions for reform

The Actions for reform contained in Living Well reflect what the Commission heard during the long consultation period and the enormous scope of the changes that are needed in NSW. 

The agenda for change is ambitious because that is how we can ensure everyone has the best opportunity for achieving good mental health and wellbeing.

The Actions are distributed through Living Well, alongside the chapters and sections to which they refer. For easy reference, they are also collected together here. They are numbered according to the chapters and sections of Living Well to which they correspond. The numbering begins with 2 as there are no Actions in the first section.

Download the full version of Living Well or relevant section here.

On this page

2. Making it local
3. Getting in earlier
4. Putting people first
5. Providing the right type of care
6. Better responses
7. Care for all
8. Supporting reform
9. Governance of mental health within NSW

2. Making it local

2.1 Strengthening local action

2.1.1 Ensure all NSW districts have effective co-ordination structures to support population-based planning and action across local, state and Commonwealth agencies, to support the reform directions established by this Plan. These structures may be linked to existing Department of Premier and Cabinet Regional Coordination Groups or OCHRE Local Decision Making co-ordination groups.

2.1.2 Ensure district co-ordinating structures have access to timely, local and comparative data on the mental health and wellbeing of their populations, including in housing, health, justice and welfare. Districts should set up arrangements for the appropriate sharing of individual-level data for shared clients who have high rates of service access.

2.1.3 Two districts should act as demonstration sites to analyse the data they require and identify and resolve local, state and Commonwealth barriers to data access, including any issues relating to:

  • privacy, which will be tested with the NSW Privacy Commissioner 
  • access to Commonwealth data.

2.1.4 Develop and implement a consumer experience feedback system across all services. For NSW Health, this will include the further development of the Mental Health – Consumer Perceptions and Experience of Services (MH-CoPES), which allows consumers to evaluate their experience of the public mental health system.

2.1.5 Ensure that data informs planning and review cycles and that reports are provided regularly to the community about its mental health and wellbeing.

2.1.6 Link local responses to broader efforts so that statewide policy and planning is informed by local experience and innovation is shared.

2.2 Aboriginal communities

2.2.1 Strengthen partnerships and relationships among Aboriginal communities and service providers by assessing the quality and effectiveness of the relationships and taking steps to improve them. The strategies for evaluating and strengthening the relationships are to be determined in partnership by the Aboriginal communities and service providers.

2.2.2 Establish mechanisms by which non-Aboriginal organisations can access expert, practical advice from Aboriginal people on strategies to improve the cultural appropriateness of their services.

2.2.3 Measure and publicly report: -perceptions of service quality and workplace supports of Aboriginal mental health and social and emotional wellbeing workforces -Aboriginal consumer and carer experience of services.

2.2.4 Strengthen Aboriginal participation in the design, implementation and evaluation of NSW Government policies and initiatives to improve the mental health and social and emotional wellbeing of Aboriginal people.

2.2.5 Encourage Aboriginal people to train as mental health professionals to work in all settings, including by continuing to support and develop the NSW Aboriginal Mental Health Workforce Program and vocational and educational training initiatives.

2.2.6 Enhance culturally appropriate mental health first aid and mental health literacy training for Aboriginal communities, including programs delivered by Aboriginal trainers with a lived experience of mental illness.

3. Getting in earlier

3.1 Building community resilience and wellbeing

3.1.1 Establish a NSW Wellbeing Collaborative to support wellbeing initiatives among organisations, share knowledge and promote innovative and successful activities.

3.1.2 Implement local mental health and wellbeing promotion activities, complementary to national activity.

3.1.3 Promote the use of wellbeing impact assessments to determine the impact of initiatives on the wellbeing of the community.

3.1.4 Implement and further develop the Department of Education and Communities’ Wellbeing Framework for Education which:

  • sets out the role of education in building and improving wellbeing
  • establishes wellbeing standards for school communities and evidence-based approaches for improving wellbeing
  • considers both students and staff, to help build their capacity to enhance the wellbeing of themselves and others
  • builds the staff’s capacity to support students with more targeted needs and provide direct services to students with more complex needs
  • promotes online wellbeing and self-management tools for children and young people, such as those developed by the Young and Well Co-operative Research Centre
  • establishes local partnerships and uses community assets, such as cultural, recreational and sporting groups, to support student wellbeing
  • encourages joined-up responses from government and community organisations to support student need through networks of specialised support.

3.2 Promoting self-agency

3.2.1 Develop and implement a mental health promotion campaign along the lines of Act-Belong- Commit to improve mental health literacy and self-agency with a strong focus on local initiatives.

3.2.2 Health and other relevant services such as housing, education and justice should promote the use of online and other self-management tools as a legitimate pathway to care.

3.2.3 Explore the potential for social media approaches to keeping people connected and supported, drawing on lessons from other sectors such as the NSW Police eyewatch (Neighbourhood Watch online).

3.2.4 Leverage off the successful national eSmart Libraries’ digital literacy and cyber safety program and support efforts to improve e-literacy for older people.

3.3 Prevention and early intervention for children and young people

3.3.1 We must build on the NSW Government’s priority for improving the prevention and early intervention system for vulnerable children and their families and establish a youth alliance which:

  • considers holistic prevention and early intervention approaches across mental health, trauma and behavioural issues for children and adolescents 
  • comprises representatives from all relevant sectors, including child and adolescent mental health services, paediatrics, alcohol and drug services, education, community services and justice 
  • draws on relevant expertise from specialists such as the Brain and Mind Research Institute and the Black Dog Institute, ReachOut by the Inspire Foundation and national bodies such as the Young and Well Co-operative Research Centre, beyondblue, Butterfly Foundation and headspace.

The youth alliance will help guide the effective targeting of prevention and early intervention efforts by examining:

  • the risk factors affecting children, young people and their families at different life stages and how these risks are responded to within the present system 
  • how the existing system could be better aligned to eliminate gaps and have an earlier impact 
  • opportunities for better co-ordination of services and service innovation in practice 
  • how the interaction between mainstream and targeted services could improve opportunities presented by other reform activity, such as data and information work, already under way.

3.4 Suicide prevention

3.4.1 Establish a NSW Suicide Prevention Forum comprising public, industry and community sector leaders, including those with lived experience of suicide, to strengthen the planning, monitoring and co-ordination of statewide suicide prevention efforts.

3.4.2 Prepare a NSW Suicide Prevention Implementation Plan to: -strengthen the common vision for suicide prevention efforts -set directions based on a rigorous review of data, evidence and need; -strengthen connections among community, regional, statewide and national activities.

3.4.3 Ensure that suicide prevention efforts reflect the unique needs and higher rates of suicide in particular communities and populations, especially young people, and that the responsibilities of all agencies to support Aboriginal community responses to suicide are recognised.

3.4.4 Work with the Commonwealth and national suicide prevention agencies to improve the planning, co-ordination and delivery of nationally funded or delivered suicide prevention activities in NSW

3.4.5 Assess the coverage of suicide prevention activities in NSW regions, cities and communities and ensure local responses are supported by local and statewide specialist supports.

3.4.6 Assess the data needs of local communities and service providers and provide timely reports to meet those needs, including by considering the recommendations of the National Committee for the Standardised Reporting on Suicide, working with first responders and assessing whether a suicide register should be established in NSW.

3.4.7 Ensure that front-line emergency, hospital, primary care and crisis personnel have access to good training about responding to suicidal behaviour, and that this training is strongly supported or mandated by employers.

3.4.8 Assess and improve the identification and response to suicidal people in hospital and community services, and at points of care or service transition, such as discharge from hospital.

3.5 Employment and the workplace

3.5.1 Explore the potential to reduce stigma in the workplace by developing a network of ambassadors who work at various levels across a range of agencies and industries and have a lived experience of mental illness.

3.5.2 Support the recruitment and retention of people who experience mental illness including: -Commonwealth-funded programs that provide tailored advice and support to managers and employees where an employee requires support to gain or retain employment -Resources that provide advice to public sector agencies about workplace adjustments and other considerations for managing employees who experience mental illness.

3.5.3 Ensure that public sector reforms increase workforce participation among people with a mental illness through explicit consideration of this population in agency workforce planning. This planning should ensure agencies are equipped to sensitively and appropriately manage employees who experience transient periods of mental illness.

3.5.4 Improve the collection of data that relates specifically to employees who experience mental illness. This should include efforts to increase self-reporting among employees who experience transient, episodic or continuing mental illness. The Public Service Commission’s People Matter Employee Survey is one example of how this might be done.

3.5.5 Ensure that agencies that provide services to people who experience mental illness, whether directly or through the community-managed sector, respond to the individual aspirations of clients living with a mental illness for education, training and employment, including through referral to Commonwealth-funded employment services.

3.5.6 Develop a better understanding of the economic impact on NSW associated with mental illness in the workplace (including absenteeism and presenteeism) and under-employment.

4. Putting people first

4.1 Families and carers

4.1.1 Consistent with the requirements of the NSW Carers (Recognition) Act 2010, embed the principles of the NSW Government’s Carers Charter in policy, service design and care delivery and, for public sector agencies, report annually on compliance with the Act.

4.1.2 Ensure that workers have clear guidance on legislative and policy arrangements for information sharing with families and carers, and that they can work confidently within those arrangements. The appropriateness of families and carers being provided with information about the consumer will vary depending on the circumstances and, at times, may be as simple as knowing that the person they care for is safe.

4.1.3 Define the intervention points – such as hospital discharge planning or a change in a person’s housing situation – at which a person's carer and family circumstances and preferences must be considered

4.1.4 Ensure that in assessing a person’s family and carer circumstances, advice is always provided about where to find more information and support for family members and carers, and that where required, assistance is provided in accessing these. This will include access to respite care, Centrelink benefits and return-to-work programs for carers, and information and advice on family and carer support groups.

4.1.5 Assess client data collections to ensure that information on family and carers is being captured and that, where appropriate, regular assessments of circumstances and need are undertaken.

4.2 Engaging consumers and carers in service design

4.2.1 Ensure that the development and evaluation of policies, services and programs include the participation of consumers and carers and that supports are provided so that participation is meaningful, including through remuneration for time and costs and participant training.

4.2.2 Agencies should identify multiple ways in which consumers and carers can influence policy, services and programs.

4.2.3 In recognising the challenges presented by power and status imbalances among consumers, carers, service providers and policymakers, agencies should routinely evaluate their efforts to achieve the meaningful participation of consumers and carers. This includes ensuring that the numbers of consumers and carers is sufficient to give full voice to their views.

4.2.4 Beyond the work of individual agencies, cross-agency collaborations, must foster and model the participation of consumers and carers.

4.3 Recovery-informed legislation and policy

4.3.1 All NSW government agencies should: -develop a mechanism to include Mental Health and Wellbeing Impact Assessments in the development or review of policy and legislation -review existing policies and legislation to assess the extent to which they are consistent with the aims of this Plan. The NSW Mental Health Commission will review progress on the above in the third year of the Plan.

4.3.2 In anticipation of the development of mental health services in accordance with the principles set out in this Plan, the NSW Government should work towards addressing the following issues in mental health legislation: -mirroring the human rights provisions of the Disability Inclusion Bill 2014 -strengthening the recognition of the principles of recovery at all stages of a person’s journey through the mental health system, including when subject to mental health legislation -exploring the potential to focus on people rather than places -better reflecting the cultural and spiritual needs of Aboriginal people -better addressing the sometimes conflicting needs of people with lived experience of mental illness and their carers.

4.4 Build the capacity of services to respond therapeutically

4.4.1 Strengthen the responsiveness of services to people who experience mental illness and their families and carers through a ‘no wrong door’ approach to services. For all services, this involves a new determination to support those seeking assistance to find the right entry point for the services they need, even if not provided by that agency itself

4.4.2 Ensure that suitable, basic training in mental health literacy is available and promoted to all public sector employees who provide services directly to the public (such as nurses and counter staff of public services), or whose work involves making decisions related to people’s welfare, such as human services assessment officers and members of the judiciary).

4.4.3 Ensure that tailored training is provided to public sector employees whose work requires more frequent or specialist contact with people who experience mental illness, including housing, drug and alcohol, community services and emergency services workers. This includes mental health first aid training as well as training that supports therapeutic approaches in settings such as housing and justice or recovery-oriented and trauma-informed responses among emergency services personnel.

4.4.4 Explore the opportunities to better integrate the front-line service response of FaCS agencies.

4.4.5 Implement the National Framework for Recovery-Oriented Mental Health Services in Local Health Districts and community-managed sector mental health services.

4.4.6 Explore the potential to create more therapeutic environments for the delivery of services where there is frequent or specialist contact with people who experience mental illness, including in the design of new facilities and those being refurbished

5. Providing the right type of care

5.1 Shift to community

5.1.1 Rebalance our mental health investment to transform NSW from the lowest spending to the highest spending Australian jurisdiction, per capita, on community mental health by 2017. This will involve:

  • The NSW Ministry of Health directing all mental health growth funding to community mental health.
  • The NSW Ministry of Health using its service agreements with Local Health Districts to purchase greater community activity volumes to rebalance existing investments.
  • Local Health Districts adjusting the mix of local services to achieve the rebalancing required and reporting regularly on activity levels and against service performance measures established with the NSW Ministry of Health 
  • Local Health Districts forging new partnerships with community-managed organisations and/or the private sector to: coordinate mental health care in the community; leverage and integrate with general practice, and private psychiatry and psychology; and explore opportunities for new models and service arrangements that offer efficiencies and meet the needs of people with mental illness and their families and carers.
  • The NSW Ministry of Health providing leadership to the reforms through the articulation of a new framework for a contemporary NSW community mental health system, underpinned by recovery-oriented values.
  • Supporting the development of innovative community-based alternatives to hospital admissions. This could include the use of social benefit bonds and other mechanisms.

5.1.2 Local Health Districts will work with the National Disability Insurance Agency to ensure that eligible people with a psychosocial disability obtain packages under the National Disability Insurance Scheme.

5.2 De-institutionalisation

5.2.1 NSW Health, in partnership with the NSW Department of Family and Community Services, should complete the work of finding appropriate community accommodation and support for individuals still in long-stay psychiatric institutions by 2018. This work should consider the availability of community-based supports to be provided under the National Disability Insurance Scheme.

5.2.2 The recurrent funding which supports individuals in long-stay beds should, in the first instance, be used to provide the appropriate level of community-based or other support for those who are discharged. Any remaining funding should be redirected to expand community-based mental health services more generally.

5.2.3 Any planning process for the realisation of the value of the Schedule 5 hospital assets should:

  • engage consumers, carers, clinical professionals and the local community in the decision making 
  • ensure, through a transparent mechanism, that the proceeds of any sale are fully directed to the development of mental health services in accordance with the reform priorities.

5.3 Addressing inequalities

5.3.1 Local Health Districts should implement strategies to ensure that scarce clinical skills are employed to best effect by maximising their face-to-face time with consumers. This could include employing more peer workers and utilising community-managed organisations to provide non-clinical services.

5.3.2 NSW Health should use the draft National Mental Health Services Planning Framework to determine the right level and mix of services to cater for needs at the local level and, over time, redistribute funding in accordance with need.

5.3.3 Local Health Districts should examine their pathways to care and ensure there is reliable and accessible information about these to assist people in navigating the mental health system.

5.3.4 Build on initiatives such as the Mental Health Emergency Care – Rural Access Program to ensure communities have access to the full range of services through improved technology and specialist mental health support of general health services. Community-based services should be provided with advice and support, through good consultation, liaison, and integration of care arrangements.

5.3.5 Consider the development of specialist tertiary referral and advice centres for the provision of care to people who experience serious mental illness, including psychosis, and the treatments for mental illness, such as electro-convulsive therapy.

5.3.6 Support initiatives to track and publicly report on clinical variation in NSW.

6. Better responses

6.1 Integrated care

6.1.1 The NSW Ministry of Health will implement its Integrated Care Strategy 2014-2017 which provides: -new funding for systems that support integrated care -seed funding for innovative, local integrated-care initiatives -contributions to the cost of demonstration sites.

6.1.2 Local Health Districts to pursue opportunities for better integration between mental health and primary care providers.

6.1.3 The Agency for Clinical Innovation, in partnership with the NSW Mental Health Commission and the NSW Ministry of Health, will establish a Mental Health Clinical Network and a Drug and Alcohol Clinical Network:

  • The networks will bring together a wide range of clinicians, service providers and consumer and carer representatives, to improve care through innovation in clinical practice. 
  • The networks’ focus will include the establishment of links with other clinical networks, including those concerned with chronic care, intellectual disability and endocrinology.

6.2 Physical health and mental health

6.2.1 Implement the HeAL declaration in NSW Local Health Districts to ensure physical health needs are prioritised from the first episode of psychosis.

6.2.2 Ensure all access points for people experiencing severe mental illness assume responsibility for facilitating physical health assessments and monitoring of physical health status.

6.2.3 Ensure that locally based mental health and wellbeing promotion activities developed under Building community resilience and wellbeing promote healthy and active lifestyles.

6.2.4 Ensure that the local co-ordination structures established under Strengthening local action include partnerships with local government and facilities such as gyms and swimming centres to facilitate referral and access to such facilities by people who experience mental illness.

6.2.5 Build connections with and learn from work in chronic disease prevention already under way in NSW and Australia.

6.2.6 Ensure that population health activities appropriately target people with a lived experience of mental illness, including interventions to address smoking, physical activity, nutrition and use of alcohol and other drugs.

6.2.7 Encourage and support GPs in a holistic approach to treat people with both mental and physical illness, including improved collaboration across general practice and specialist mental health and acute services. These mechanisms will need to consider issues such as appropriate access to information to support collaborative approaches.

6.2.8 Advocate for continuing professional development training for GPs in mental health to assist with early diagnosis, continuing training in emerging therapies, and opportunities for placements in mental health services.

6.3 Integrating mental health and drug and alcohol responses

6.3.1 Strengthen mental health and drug and alcohol health promotion through better alignment and integration with responses to other population health and healthy-lifestyles priorities, including tobacco, healthy weight, physical activity and sexual health.

6.3.2 Provide a ‘no wrong door’ approach in a wider range of agencies so that stepped care is more widely available to people with mental health and drug and alcohol issues. As well as specialist mental health and drug and alcohol services, this will include increased access points through general practice, social services, community health centres and community-managed organisations.

6.3.3 Strengthen the management of critical transition points between mental health and drug and alcohol care settings or after release from jail, including by increasing the accountability of services for assessment, planning and formal referral and support of people between services.

6.3.4 Recognise the philosophical and language differences between the mental health and drug and alcohol sectors and ensure services and care for people who experience mental illness and drug and alcohol issues are not compromised as a result of these differences.

6.3.5 Prioritise the workforce, information and other infrastructure requirements that will support a co-ordinated and integrated mental health and drug and alcohol response. This will include collaboration between the NSW Agency for Clinical Innovation’s forthcoming Mental Health and Drug and Alcohol Clinical Networks.

6.4 Housing and homelessness

6.4.1 Build on the success of the Housing Accommodation and Support Initiative (HASI) by increasing the number of packages and expanding the model to include new cohorts. Develop a model to support people who experience mental illness to maintain their tenancies, such as through the provision of lower-intensity HASI-style packages.

6.4.2 Improve referral pathways to state and Commonwealth-funded housing, homelessness and mental health services. This will require district implementation and co-ordinating committees to work with specialist homelessness services to develop a better understanding of the mental health system.

6.4.3 Investigate mechanisms that assist people with mental illness to access the private rental market. This will require working with business and community-managed organisations, and consideration of economic disadvantage and discrimination in the private rental market.

6.4.4 Develop and implement therapeutic models for public, community and Aboriginal housing where a substantial number of tenants experience mental illness. This will require consideration of:

  • the physical environment
  • the local community environment and support structures
  • the relationship between housing staff and tenants.

6.4.5 Use cross-agency data to identify issues and provide support to people with mental health and housing needs. This will require improved cross-sector, interagency information collection and sharing. The data collected must identify:

  • people with a mental illness who are homeless 
  • public housing, Aboriginal housing and boarding house tenants with a mental illness 
  • people with a mental illness using crisis accommodation services
  • the housing status of people leaving mental health care facilities and people with a mental illness leaving corrective service facilities.

6.5 Bringing a holistic therapeutic approach to youth justice

6.5.1 Complete a needs analysis for this cohort over 12 months. It will be important to identify the data that needs to be collected on a continuing basis to inform and support service development and evaluation.

6.5.2 In the following 12 months, use the results of the analysis, review the relevant literature and do a cost-benefit analysis of evidence-based programs to develop options for holistic, therapeutic, cross-agency responses, including from NSW Health, the Department of Family and Community Services and Juvenile Justice. These responses should:

  • aim to promote normal developmental trajectories, reduce aggressive behaviour and help young people acquire vocational and basic social skills
  • help to improve the way mainstream community services respond to the needs of young people who have been in contact with the justice system
  • help build a young person’s connections with family and community as appropriate and safe
  • be flexible enough to apply to a range of custody periods
  • consider opportunities to improve training for specialist child and adolescent mental health practitioners, including links with the Sydney Children’s Hospitals Network.

6.5.3 Examine the potential for enhancing therapeutic responses in secure juvenile justice environments. Appropriate governance models will be needed to support this, together with any associated law reform.

6.6 Improving access to services for adults in custody

6.6.1 Develop models that facilitate interaction between community mental health services and prisons. Implement those models in two demonstration sites – potentially Broken Hill and the Mid North Coast. After an evaluation of these sites, statewide application of the models will be considered. These models will take into account the:

  • needs of the local inmate population, noting the particular needs of Aboriginal and female inmates
  • need to ensure that treatment for mental illness is integrated with interventions aimed at reducing criminal behaviour, such as social skills and vocational training
  • experience of similar, existing models, including those operated by Aboriginal Medical Services.

6.6.2 To improve our understanding of the interaction between mental illness and offending, the NSW Mental Health Commission has contracted with the University of NSW to do research on the population impact of mental illness on offending behaviour. The research will be informed by a data linkage study drawing on NSW Health, the NSW Bureau of Crime Statistics and Research and Corrective Services NSW datasets.

Special considerations and future directions

Future work will be required to address the needs of three particular cohorts within the justice system – forensic patients, Aboriginal people and women:

  • Plans should be developed and implemented to invert the mix of services, by increasing the availability of medium- and low-security placements, focusing on the recovery needs of individuals. 
  • Barriers which prevent Aboriginal offenders accessing mental health care within the correctional system should be identified and potential solutions explored. 
  • Barriers which prevent female offenders accessing mental health care within the correctional system should be identified and potential solutions explored.

7. Care for all

7.1 Lesbian, gay, bisexual, transgender and intersex mental health

7.1.1 Agencies should ensure that the needs of LGBTI communities are considered in mental health and suicide prevention planning and that policies, tools and health promotion resources are inclusive of LGBTI communities.

7.1.2 Ensure that health providers, employers and other organisations are aware of the availability of LGBTI cultural awareness and inclusion training and that staff receive training.

7.1.3 Improve the accessibility of services by reaching out to LGBTI communities and tailoring services where necessary.

7.1.4 Continue to improve partnerships with LGBTI organisations, promote inclusion and respond to evidence and data showing unmet population need.

7.1.5 Improve research, population surveys and routine data collections by including appropriate gender and sexuality indicators.

7.2 Multicultural NSW

7.2.1 Consider the needs of CALD communities in the development of local mental health and wellbeing promotional activities as described under Building community resilience and wellbeing. These activities should look to strengthen the capacity of ethno-specific community organisations to support people with mental illness within their communities. These activities should provide community organisations with appropriate referral pathways to mental health services.

7.2.2 Ensure that the development of mental health and suicide prevention policies, tools and health promotion resources take into account the particular needs of CALD communities. This will include the use of inclusive language that expressly acknowledges CALD communities. Such considerations should form part of service planning, especially in locations where there are larger CALD communities and in relation to issues that are of special concern to CALD communities, such as trauma-informed care.

7.2.3 All staff responsible for the delivery of services where there is a significant cohort of people with a lived experience of mental illness should receive cultural competency training in relation to the mental health needs of CALD communities. Given the higher incidence of exposure to trauma within CALD communities, this training is to have particular regard to the principles of trauma-informed care.

7.2.4 Develop tools to enable a more objective measurement of access and equity for mental health services by CALD communities. These tools will need to be responsive to the needs of CALD populations and readily accessible by the workforce. Information gathered should be incorporated into the population-based planning undertaken by local action groups to inform service development and responses.

7.2.5 Given the changing demographics of CALD communities, not only with emerging communities from new patterns of migration but the intergenerational effects of culture and trauma, there is a need to improve our understanding of:

  • the prevalence of mental illness among CALD communities
  • the capacity of CALD communities to identify and respond to their mental health needs
  • the systemic requirements to enable the mental health and broader service sector to respond appropriately.

These issues should be considered in the context of setting priorities under the NSW Mental Health Research Framework.

7.3 Mental health and intellectual disability

7.3.1 Ensure that Local Health Districts and community-based services implement Accessible Mental Health Services for People with an Intellectual Disability: A Guide for Providers.

7.3.2 Ensure that adequate training in the recognition, assessment, referral pathways and treatment for people with an intellectual disability and mental illness is given to all staff in mental health and disability services. Such training will need to include particular reference to adopting reasonable adjustments in clinical approaches and adopt a recovery-oriented approach.

7.3.3 As part of the NSW implementation plan for the National Disability Insurance Scheme, develop strategies to change from the present partnership between NSW Health and other state services with Ageing, Disability and Home Care to one with the community-managed and private sectors. This will need to take account of the impact on:

  • joint projects
  • memorandums of understanding
  • co-developed guidelines
  • relationship management 
  • dispute resolution
  • systemic and strategic planning.

7.3.4 Develop a recovery-oriented model of care for the provision of public mental health services to people with an intellectual disability that:

  • builds the capacity of mainstream community and inpatient mental health services
  • increases specialist capacity to meet more complex needs
  • facilitates joint planning by disability services, mental health and other relevant services, including in relation to referral and treatment pathways and collaborative responses where intellectual disability and mental disorders coexist.

7.3.5 Develop accessible information for people with an intellectual disability and their families and carers about mental health services.

Future direction

A sharper focus is required on policy and program development for the mental health needs of children and young people with an intellectual disability. This should include tailored prevention and early intervention programs and services that offer timely and skilled mental health assessment and intervention.

7.4 Eating disorders

7.4.1 Ensure the statewide implementation of the NSW Service Plan for People with Eating Disorders 2013-2018 with priorities including: improved data collection; nurturing and disseminating a strong evidence base; workforce development; and promoting integrated and collaborative approaches.

7.4.2 Ensure that local mental health and wellbeing promotion activities and the basic training in mental health literacy provided to government employees and service providers include material about eating disorders.

7.4.3 Ensure that adequate training in the recognition, assessment, referral pathways and treatment of eating disorders is provided to all staff in mental health services.

7.4.4 Prioritise the development of community-based models of care for eating disorders from early intervention, to treatment, to recovery-focused services.

7.4.5 Advocate for the Commonwealth Government to fund uncapped or a minimum of 40 extra psychology sessions per calendar year for people diagnosed with an eating disorder under existing programs (such as Access to Allied Psychological Services – ATAPS – and Better Access) to enable them to access individual and group sessions.

7.4.6 Advocate for the Commonwealth Government to fund extra sessions with dietitians for people diagnosed with an eating disorder under existing programs (such as the Chronic Disease Management program) to enable them to access appropriate care.

7.5 Borderline personality disorder (BPD)

7.5.1 Ensure that Local Health Districts and community-based mental health services adopt and implement the Clinical Practice Guideline for the Management of Borderline Personality Disorder (2012).

7.5.2 Ensure that the local mental health and wellbeing promotion activities and the basic training in mental health literacy provided to government employees and service providers include material in relation to BPD.

7.5.3 Ensure that adequate training in the recognition, assessment and treatment of BPD is provided to all staff in mental health and drug and alcohol services.

7.5.4 Promote and progressively roll out community-based models of care for the treatment of BPD, such as that developed by the Project Air Strategy.

7.5.5 Advocate for the Commonwealth Government to fund extra psychology sessions per calendar year for people diagnosed with BPD under existing programs, such as Access to Allied Psychological Services (ATAPS) and Better Access, to enable people to access both individual and group sessions.

8. Supporting reform

8.1 Investing in our workforce

8.1.1 NSW Health, in consultation with the NSW Mental Health Commission, will develop a NSW Mental Health Workforce Plan. This will include:

  • the peer workforce 
  • the community-managed workforce
  • the Aboriginal mental health workforce
  • training and workforce support for the mental health workforce including recovery-oriented practice and trauma-informed care
  • training and workforce support for mainstream service providers and frontline workers, including to better support responses to crisis, including suicide.

8.2 Peer workforce

8.2.1 NSW Health will implement the Framework for the NSW Public Mental Health Consumer Workforce

8.2.2 In developing the NSW Mental Health Workforce Plan NSW Health, in consultation with the NSW Mental Health Commission, will incorporate the needs of the peer workforce informed by the lived experience of people with mental illness. This would include:

  • education, training and accreditation of peer workers
  • the full spectrum of roles that peer workers may fill (such as educators, support workers, advocates and managers)
  • recognition and integration of peer workers as team members in the delivery of mental health services
  • the governance structures that will be required to support peer workers in the workplace, including pathways for career progression.

8.2.3 Family and Community Services will develop peer worker roles in its front-line services. This could be through a partnership with one or more community-managed organisations which have a developed peer workforce.

8.2.4 Benchmarks must also be set to stipulate peer worker numbers across the public mental health system, the community-managed sector and the broader government service sector, including housing, disability and justice.

8.3 Developing the community-managed sector

8.3.1 Strengthen the partnership between the public and CMO mental health sector, including arrangements for purchasing services, by reforming existing arrangements. NSW Health’s Grant Management Improvement Program will be an important mechanism for some of this work.

8.3.2 The NSW Ministry of Health will establish a community-managed sector development plan which includes strategies to strengthen and expand the community sector workforce, and improve the management and collection of data. The plan should be modelled on the successful development work being undertaken in the disability sector and supported through National Disability Services.

8.3.3 Establish directions and priorities for education and training of the CMO workforce through the NSW mental health workforce plan.

8.3.4 Ensure that the NSW Initiative for Mental Health Leadership supports further development of community-sector leadership and sharing of knowledge more broadly across the community sector workforce.

8.4 Better use of technology

8.4.1 Ensure that NSW Government information and communications technology planning considers the needs and benefits for mental health consumers, carers and service providers of new technology, and include planning for mental health in the priorities of eHealth NSW.

8.4.2 Develop a statewide strategy for the provision and continual improvement of technology infrastructure for the mental health sector and to promote the integration of new technologies with traditional service arrangements.

8.4.3 Scope opportunities for new technologies to improve care through better information sharing among service providers.

8.4.4 Develop and implement a training program for health care leaders, clinicians and front-line staff on emerging technologies in e-mental health. In particular, education and training will need to focus on how evidence-based decision supports can be incorporated into everyday practice within a collaborative, recovery-focused care context.

8.4.5 Explore the use of e-mental health systems to enhance the capabilities of primary health and other service sectors to appropriately identify, support, and refer on people experiencing mental illness to mental health services. This could include trialling real-time mental health assessments and surveys in general practice waiting rooms via tablets which can immediately refer the person to relevant online resources and guide the GP’s consultation with the individual.

8.4.6 Closely monitor and review the evidence supporting e-mental health and publish regular updates relevant to NSW.

8.4.7 The NSW Mental Health Commission will partner with ReachOut.com by Inspire Foundation, the Black Dog Institute and the Brain and Mind Research Institute to explore an approach that integrates technology-based services with primary health care providers and traditional clinical services in a stepped-care framework. They will work with NSW Health to develop, implement and evaluate a trial to examine whether the integration of technology services can increase the scalability, effectiveness and outcomes of mental health care.

8.5 Research and knowledge exchange

8.5.1 The NSW Mental Health Commission will establish a research co-ordination unit to oversee the implementation of the Research Framework for Mental Health in NSW.

8.5.2 Establish a model for developing and supporting consumer researchers that takes the principles of recovery into account.

8.5.3 Establish effective mechanisms within NSW, between NSW and the Commonwealth, and between NSW and other states, to ensure NSW’s research activity improves knowledge sharing, maximises opportunities to leverage from the broader research field and minimises duplication of effort.

8.5.4 The NSW Mental Health Commission will establish a NSW Initiative for Mental Health Leadership, built on the International Initiative for Mental Health Leadership model, to strengthen reform capability of mental health in NSW through:

  • knowledge exchange
  • innovation sharing
  • transfer and adaptation of successful policy and service design
  • use of comparative data to drive service improvement
  • problem solving
  • support for change management
  • leadership development and networking.

9. Governance of mental health within NSW Health

To establish new governance and accountability mechanisms for mental health service delivery the NSW Government, in consultation with the Commission, will establish formal governance and accountability arrangements to oversee the implementation of this Plan and its alignment with other reform activity across the NSW Government.

As part of these governance and accountability arrangements, NSW Health and the Commission will develop:

9.1 A new outcomes agenda for mental health services in NSW. This will include a set of clear key performance indicators (KPIs) for LHDs under the NSW Health Performance Framework, including in relation to community mental health services. These should also be reported publicly, increasing the transparency of mental health spending, and the extent to which services are meeting need. For example, KPIs might include budgets and expenditure, staffing levels and vacancy rates in each LHD. These KPIs will also be implemented with community-managed organisations where relevant.

9.2 Clearer service and performance agreements, which include clear performance parameters, between the Ministry and LHDs.

9.3 Clearer purchasing arrangements particularly in relation to community mental health care and community alternatives to inpatient care and including the liaison between specialist mental health services and general health services both hospital-based and in the community.

9.4 Mechanisms for more robust mental health budget transparency, including acquittal and reporting processes, including considering the role of audit and risk committees.

9.5 Strengthened stakeholder engagement, particularly of people with a lived experience of mental illness, their families and carers, around mental health service planning and review by LHDs. If, within two years, the Commission is not satisfied that progress against these actions is sufficient, it retains the authority under the Mental Health Commission Act 2012 to report and make further recommendations to Government, for example around providing the NSW Mental Health Commission with independent audit powers and/or regarding the implementation of alternative funding models.

Last updated: 5 April 2017

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