Output 1.2 Mental Health, Justice Health and Alcohol and Drug Services
Mental Health, Justice Health and Alcohol and Drug Services provide a range of services in hospitals, community health centres, adult and youth correctional facilities and people’s homes across the territory.
They work with community partners to provide integrated and responsive care with a range of services, including hospital-based specialist services, supported accommodation services and community-based service responses.
The key strategic priorities for Mental Health, Justice Health and Alcohol and Drug Services are ensuring that clients’ needs are met in a timely fashion and that care is integrated across hospital, community and residential support services.
This means focusing on:
- ensuring timely access to emergency mental health care by reducing waiting times for urgent admissions to acute psychiatric units
- ensuring that public mental health services in the ACT provide consumers with appropriate assessment, treatment and care that result in improved mental health outcomes
- providing hospital and community-based alcohol and drug services and health care assessments for people detained in corrective facilities.
Mental Health, Justice Health and Alcohol and Drug Services provide health services directly and through partnerships with community organisations. The services provided range from prevention and treatment to recovery and maintenance and harm minimisation. Consumer and carer participation is encouraged in all aspects of service planning and delivery. The division works in partnership with consumers, carers and a range of government and non-government service providers to ensure the best possible outcomes for clients.
The division delivers services at a number of locations, including hospital inpatient and outpatient settings, community health centres, detention centres and community settings such as people’s homes. Services are outlined below.
Mental Health Services
- ACT-Wide Mental Health Services
- Child and Adolescent Mental Health Services
- Adult Mental Health Services
Justice Health Services
- Primary Health
- Forensic Mental Health
Alcohol and Drug Services
- Opioid Maintenance Treatment Services
- Withdrawal Services
- Counselling and Treatment Services
- Diversion Services
- Consultation and Liaison Services
- Mental Health Services continue to monitor and review all episodes of seclusion and restraint. In 2013 the Early Support and Intervention Team will be reintroduced in the Adult Mental Health Unit to assist in the identification of consumers who are escalating and to work one on one to de-escalate. This initiative will be introduced in partnership with Ward Services to reduce aggression and consumer distress. A training package that focuses on engagement and de-escalation has been developed collaboratively with Ward Services.
- The Mental Health Community Policing Initiative (MHCPI) was developed after a review of ACT Policing mental health practices and procedures in 2010. A pilot was commenced in April 2011. This project was funded in 2011‑12 and is now an ongoing initiative. In March 2013, the presence of Crisis Team clinicians in the Police Operations Centre was extended from four days per week to seven days per week. The clinicians are a dedicated resource for the police. They have access to the mental heath electronic clinical record, MHAGIC, and can provide information relevant to individuals.
- At the commencement of the MHCPI, there were, on average, 90 AFP-initiated emergency actions placed on consumers per month. This has dropped by 50 per cent, with an average over the past year of 45 per month. AFP, ambulance and MHCPI representatives are now providing mandatory in-service training to mental health teams.
- In April 2012, the Adult Mental Health Unit was commissioned. This is a purpose-built facility with an innovative model of care that has consumer engagement at its centre. The facility has a purpose-built High Dependency Unit, Low Dependency Unit and a therapy wing, which includes group therapy rooms, a gym and spiritual space. In 2013, additional allied health staff were employed in the Adult Mental Health Unit in the extended therapy program, and activities became available after hours and on the weekends.
- The Perinatal Mental Health Consultation Service provides specialist consultation and treatment planning for pregnant and postnatal women (up to 12 months postpartum). Since its inception, service demand has increased considerably. The program currently has approximately 80 registered clients. This year saw the implementation of a group program to support women with high levels of stress or distress. This group is co-facilitated with Child and Family Centre staff (Gungahlin) and has been beneficial for participants.
- The Child and Adolescent Mental Health Service (CAMHS) was reviewed in 2012 to develop a revised model of care in consideration of the mental health needs of children, adolescents and young adults up to the age of 25 years. The CAMHS Re-design Project was informed by consultation with staff members, service providers, consumers and carers to ensure the mental health needs of this client group could be met using evidence-based practices in the context of a recovery framework. The CAMHS Model of Care was endorsed by the ACT Health Re-development Committee in May 2013. Planning for a phased implementation process has commenced.
- At the Hume Health Centre, Justice Health Services have introduced:
- - a Suboxone Withdrawal and Maintenance Regime. This is the first time that buprenorphine has routinely been used to manage withdrawal and maintenance in an ACT correctional facility
- - Hepatitis C treatments, which are achieved through a shared care model with a referral pathway to the Gastroenterology Service of the Canberra Hospital. Up to 10 patients continue to be cared for under a complex treatment regime.
- In the Alcohol and Drug Services (ADS) program:
- – Following two pilot programs to implement influenza vaccination for clients of the Opioid Treatment Service, the program was rolled out as a yearly service in 2013.
- – The Alcohol and Drug Services overall program and the ADS Diversion team were the recipients of Aboriginal and Torres Strait Islander reconciliation awards, recognising the work being done across the program to provide access and service delivery to people from an Aboriginal and/or Torres Strait Islander background.
- – The ADS won the Quality in Health Care overall award in November 2012 for their opportunistic opioid treatment training program for community pharmacists, general practitioners and other health professionals.
- – In January 2013, counselling commenced in the Alexander Maconochie Centre. A dedicated counsellor employed by ADS is working with Alexander Maconochie Centre clients who have complex alcohol and other drug (AOD) issues to provide continuity of counselling care when they are discharged. A senior nurse also attends weekly to work with clients who are on opioid maintenance treatment and who are close to being released from the centre back into the community.
- – AOD psychotherapy and counselling are now provided at the Tuggeranong, Gunghalin, Hume and city health centres. Psychotherapy and counselling will commence at the enhanced Belconnen health centre when it opens later in 2013.
- Consumer and carer participation has remained a priority, and a number of consumers and carer consultants have been employed in the division. These roles support a cultural shift in Mental Health Services, particularly in recovery and consumer empowerment. Roles include systems advocacy for consumers, involvement in the review of the Mental Health (Treatment and Care) Act 1994, implementation of the recovery model, development and implementation of advance agreements, and staff training. The division also maintains full representation of consumers and carers on all relevant governance committees.
- The mental health services have been working to implement recovery principles and practices for a number of years. This work is supported through the actions of the ACT Mental Health Services Plan 2009–2014 and the National Standards for Mental Health Services 2010. The ACT has also been involved in consultations on the National Mental Health Recovery Framework, to be released over the next 12 months, and this framework will help to further consolidate a recovery orientation of services. Training and education are offered so that staff and stakeholders can develop an understanding of recovery and how services can assist through the implementation of practices and processes that promote a person-centred, strengths-focused and collaborative approach to the planning and delivery of the division’s services.
- The division implemented a smoke-free environment in response to concerns about passive smoking raised by consumers, carers and staff. On 1 January 2013, all areas of the division became smoke free. Staff completed training designed to assist consumers who smoke by providing education, support and access to a range of nicotine replacement therapies. The division won the 2013 Health Promotion Award for the Smoke-Free Initiative in the Outstanding Achievement to Address Unhealthy Behaviours category.
- Mental Health transitional clinicians have been employed in each of the four Adult Community Mental Health Teams. The primary function of these clinicians is to support the transition of, and coordinate care for, people exiting either of the two public ACT psychiatric inpatient units (the Adult Mental Health Unit or Calvary Psychiatry Ward 2N) into the community setting.
- A review of four Adult Community Mental Health Team catchment area boundaries was completed in late 2012. The boundaries between the City and Woden catchment areas were realigned and five suburbs were moved into the Woden catchment area. This will result in benefits of improved access to mental health services, including reduced waiting times for appointments, reallocation of clinical staff and reduced response time to referrals.
- The Aboriginal Liaison Service was expanded as a result of the recruitment of a senior mental health nurse to work with Winnunga Nimmityjah Aboriginal Health Service. The nurse provides direct mental health interventions and clinical management for consumers with mental health issues in that community who are seeking treatment and care.
Issues and challenges
- The review of the Mental Health (Treatment and Care) Act 1994 continues. The review aims to ensure that the Act remains consistent with contemporary mental health policy and service delivery. Working groups are addressing several areas of detailed content of the Act. The revised Act is scheduled for consideration by the ACT Legislative Assembly in late 2013.
- The division is facing some challenges in finding staff to fill clinical vacancies. Strategies include the implementation of health professional officer career pathways to ensure ongoing development, mentoring and sustainability for health professional officers in this sector.
- A streamlined induction process will be established at the Bimberi Youth Detention Centre, which will reduce duplication and engage specialist services when they are assessed as being clinically required.
- Strengthened medication management at Bimberi Youth Justice Centre has begun, with the recruitment of endorsed enrolled nurses who support a through-care model.
- Forensic Services will provide training on mental health awareness and processes to the magistrates of the ACT law courts. Preparation and organisation for the training have commenced. It is hoped this initiative will be expanded to other agencies, such as the Office of the Director of Public Prosecutions and Legal Aid services. Forensic Services has also continued to provide mental health awareness and education training to Bimberi youth workers as part of their training inductions.
- Alcohol and Drug Services are in the process of setting up a pharmacist-led Nicotine Replacement Clinic for clients of the Opioid Treatment Service. A pilot program will commence in August 2013 with an evaluation that will inform further development of this clinic.
- Funding for the enhancement of alcohol and drug outpatient services is in the planning phase, which includes consideration of a public opioid treatment clinic in the north of Canberra.
- The adult Mental Health Services Model of Care project is to review and develop mental health services currently provided to adults (18–64 years) within the ACT. The development of this model of care will inform the concept design of health infrastructure. The model of care will be based on evidence-based practice and comply with all relevant legislations.
- The implementation of the Child and Adolescent Mental Health Services (CAMHS) Model of Care is currently being planned for delivery during 2013‑14.