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. This service works with its community partners to provide integrated and responsive care to 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 clinical 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 people with appropriate assessment, treatment and care that result in improved mental health outcomes,
- providing hospital and community-based alcohol and drug services and healthcare 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 other community settings, including people's homes. These services include:
|Adult Mental Health Services|
|Adult Mental Health Unit (AMHU)|
|Belconnen Mental Health Team|
|City Mental Health Team|
|Gungahlin Mental Health Team|
|Mental Health Assessment Unit (MHAU)|
|Tuggeranong Mental Health Team|
|Woden Mental Health Team|
|ACT-wide Mental Health Services|
|Aboriginal Liaison Officer|
|Assertive Community Treatment Team|
|Brian Hennessy Rehabilitation Centre|
|Consultation Liaisonâ€”the Canberra Hospital (TCH) and Calvary Hospital|
|Crisis Assessment and Treatment Team|
|Mental Health Service for People with Intellectual Disabilities|
|Older Persons Mental Health Team|
|Justice Health Services|
|Forensic Mental Health Services|
|Justice Health Primary Health|
|Secure Adult Mental Health Inpatient Unit|
|Child and Adolescent Mental Health Services (CAMHS)|
|Dialectical Behaviour Therapy Program|
|Early Intervention Team|
|Eating Disorders Program|
|Perinatal Mental Health|
|Alcohol and Drug Program|
|Consultation and Liaison|
|Counselling and Treatment Services|
|Opioid Treatment Service|
Mental Health, Justice Health and Alcohol and Drug Services:
- exceeded its target of 100,000 occasions of service for the Adult Mental Health Services program by 15 per cent. This result reflects the response to increased demand for services and increased staff resourcing to meet this demand
- exceeded its target of 97,000 occasions of service for the ACT-Wide Mental Health Services program by 5 per cent. This higher than expected level of activity resulted primarily from the high levels of contact with the Crisis Assessment and Treatment Team
- achieved 9 per cent above its target of 103,000 occasions of service for the Justice Health Services program. This can be attributed to the increased demand related to an increased muster at the Alexander Maconochie Centre (AMC)
- met its target of 98 per cent of all new clients on pharmacotherapy treatment for opioid dependency having a completed management plan
- achieved 98 per cent against its target of 70,000 occasions of service for the Alcohol and Drug Services program
- met its target of 100 per cent of all detainees admitted to the AMC having a completed a health assessment within 24 hours of detention.
- achieved 98 per cent against the target of 100 per cent of all young people admitted to Bimberi Youth Justice Centre having a completed a health assessment within 24 hours of detention. The shortfall was the result of a refusal for the health assessment to be undertaken
- achieved 98 per cent against the target of 65,000 occasions of service for CAMHS. An increase in staffing levels will improve the ability to reach the target
- continues to be the national leader in reducing seclusion and restraint in mental health inpatient settings. In 2013 the ACT Chief Psychiatrist at the 9th National Seclusion and Restraint Forum showcased the work done with seclusion and restraint in the AMHU, which achieves the lowest rates across Australia. Seclusion reduction remains a high priority for the staff in the AMHU. There has been a continuation of the Early Support Intervention Team, a joint venture between hospital wardspersons and nursing staff that was started in 2011. Early identification of distress now invokes a supportive response to minimise the impact of the distress of the behaviour of the consumer and the general milieu of the ward environment. This work continues as part of the model of care implementation in the AMHU
- within the AMHU, continues to implement the model of care, which promotes consumer engagement at its centre. The therapy program has been extended, with activities being available after hours and on weekends. Planning is also underway to implement the High Dependency Unit activities program.
Other achievements are set out below.
- The transition clinicians embedded within the individual Adult Community Mental Health Teams now attend the Adult Mental Health Unit a half-day a week. The primary function of these clinicians is to support the transition and coordinate care for people exiting from either of the two public ACT Psychiatric Inpatient Units (Adult Mental Health Unit and Calvary Psychiatry Ward 2N) into the community setting.
- Belconnen Mental Health is now operating an extended service from the Gungahlin Community Health Centre three days a week. This service provides improved access for people who live in the most northern suburbs of Canberra.
- The Brian Hennessy Rehabilitation Centre (BHRC) Gym was opened in October 2013 as part of Mental Health Week celebrations in order to establish a health and fitness program for residents at BHRC. The gym currently provides a range of gym equipment, including bikes, a cross trainer and rowing machines. The gym also includes dedicated space for gait assessment and yoga/relaxation.
- The Scentenary Garden at Brian Hennessey Rehabilitation Centre was launched in December 2013. This was a collaborative project between ACT Health and the Centenary of Canberra through which a therapeutic garden was constructed for BHRC residents, carers and staff. Funding was provided by the Canberra Hospital Foundation and the Yulgilbar Foundation.
- The CAMHS new model of care was endorsed by the ACT Health Redevelopment Committee in 2013. Implementation has focused on establishing the Dialectical Behaviour Therapy (DBT) program, a consumer consultant within the service, and the CAMHS Bimberi liaison functions; enhancing the capacity of the Perinatal Infant Mental Health Consultation Service to respond to comorbid presentations, ultra high risk and early onset psychosis; working to build the capacity of CAMHS to provide mental health promotion prevention and early intervention across the age streams and illness continuum; strengthening partnerships with community stakeholders; and securing system responses to enhance access, effective transitions and seamless care within and at the interface of the service.
- The Eating Disorder Program provides specialised treatment for people of all ages. The service provides assessment and treatment through family-based therapy, young adult day programs and individual sessions. The program has benefited greatly from a trial of a nurse two days per week. The service also provides a significant amount of training in the community; it has provided 12 separate training sessions in 2014. A current goal for the service is to increase support for families and carers through education and support groups.
- Consumer and carer participation has remained a priority, with a number of consumers and carer consultants employed within the division. These roles support a cultural shift in Mental Health Services, particularly in regard to 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.
- At the Hume Health Centre, Justice Health Services (JHS) now has:
- a Suboxone withdrawal and pre-release regime. This is the first time Suboxone has routinely been used to manage opioid withdrawal and a pre-release regime in an ACT correctional facility. JHS continues to offer methadone for acute opioid withdrawal and maintenance. Currently, approximately 30 to 35 per cent of the detainee population is on opioid replacement therapy within the AMC.
- hepatitis C treatments, through a shared care model with a referral pathway with the gastroenterology service of the Canberra Hospital. Currently, up to 12 patients can continue to be cared for through a complex treatment regime.
- in partnership with Women's Health Service, a weekly women's counselling program, which commenced in January 2014 at the AMC
- a High Risk Assessment Team (HRAT) convened at the AMC. This is a multi-agency forum where Primary Health and Mental Health interface with ACT Corrective Services to discuss issues related to detainees' risk.
- Forensic Mental Health Services now provides:
- ongoing support to the Mental Health Community Policing Initiative (MHCPI)
- a Senior Mental Health Clinician employed at the AMC to increase oversight and improve collaboration between Health and Corrections staff, and to coordinate follow-up after release from custody
- an occupational therapist at the AMC, with the intention of developing a service within JHS
- Dialectical Behaviour Therapy based group sessions, in collaboration with ACT Corrective Services at the AMC
- a Consultant Psychiatrist, who liaises with magistrates to increase collaboration and understanding between Health and the judiciary
- training and information-sharing sessions with Chief Magistrate and Forensic Mental Health staff to increase collaboration and understanding between Health and the judiciary
- family meetings with clinicians and consultant psychiatrists at Bimberi Youth Justice Centre.
- In the Alcohol and Drug Services (ADS) program:
- influenza vaccination clinics are now established for clients of the Opioid Treatment Service and the Inpatient Withdrawal Services
- the ADS and the ADS Diversion team were the recipients of Aboriginal and Torres Strait Islander Reconciliation awards, recognising the work being done across the program in providing access and service delivery to people from Aboriginal and/or Torres Strait Islander backgrounds
- the ADS Interlock Program commenced in June 2014. Alcohol interlocks are breathalysers that are wired to the ignition of a car and prevent the driver starting the engine unless they return a reading of 0.00. ADS will receive referrals from ACT Policing to provide assessments and treatment recommendations and to refer people immediately into treatment. The person is required to undertake four mandatory counselling sessions before a probationary licence will be issued.
the ADS Pharmacist has introduced a nicotine dependence outpatient clinic for ADS. Forty-eight clients participated in the pilot study, with 166 interventions being made. Clients report appreciation of the clinic as an alternative option for smoking cessation. Several reported they had quit smoking, and many reported reducing their smoking.
- ADS psychotherapy and counselling is now provided from Tuggeranong, Belconnen, Gungahlin, Hume and City health centres.
The Mental Health, Justice Health and Alcohol and Drug Services division implemented a smoke-free environment in response to concerns around passive smoking raised by consumers, carers and staff. As of 1 January 2013, all areas of the division became smoke free. Staff have completed training designed to assist people 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 category 'outstanding achievement to address unhealthy behaviours'.
- The Mental Health Policy Unit has progressed the following initiatives:
- The Mental Health (Treatment and Care) Act 1994 has been under review and a draft amendment bill was tabled in the Legislative Assembly on 15 May 2014. The review has considered the relationship with the Human Rights Act as well as other changes in the human rights context, including the United Nations Convention on the Rights of Persons with Disabilities. The review has resulted in several changes which will increase people's control and voice in their own treatment decisions. However, the nature of mental illness and mental disorder can still at times require involuntary treatment which restricts people's human rights.
- New provisions were introduced for treatment of the small minority of people whose mental illness leads to offending behaviour and contact with the justice system. The Human Rights Commission and a range of mental health consumer and advocacy groups have been involved in the review since its inception. The ACT Legislative Assembly's Standing Committee on Justice and Community Safety released its scrutiny report on the bill on 27 May 2014, commending the effort and skill involved in the way the bill's explanatory statement explains the provisions of the bill against human rights standards identified in a number of international instruments and, more particularly, the Human Rights Act. Debate on the bill is planned for later in 2014.
- The most significant policy impact for people with disability in the ACT has come from the implementation of the National Disability Insurance Scheme (NDIS), which commenced in the ACT from 1 July 2014. The NDIS will provide people with disability, and their families and carers, assurances of a level of support to assist them to engage in activities of daily living, including community engagement. The National Disability Insurance Agency(NDIA) will be responsible for administering the NDIS. The NDIS will potentially have a significant positive impact in the lives of people living with serious and enduring mental illnesses and their families. The total funding associated with the NDIS will rise from an existing ACT investment of approximately $120 million per annum in 2013-14 to $342 million per annum in 2019-20. This is a doubling of the investment in disability services in the ACT, in real terms.
- In the area of community forensic mental health, the 2013-14 ACT Budget provided funding, under Growth in Community Mental Health Service initiatives, for short-term psychosocial support to people with mental illness exiting the criminal justice system. This service will assist people to re-engage with the community and regain independence after release. In February 2014 after a public tender process, the Mental Illness Fellowship Victoria was selected as the preferred provider. The Detention Exit Community Outreach Support (DECOS) program commenced operation in March 2014. It provides up to three months intensive transitional support for individuals with a diagnosed mental illness who are exiting correctional facilities. The DECOS model ensures a continuum of care for people through a seamless case management partnership between Mental Health, Justice Health and Alcohol and Drug Services Forensic Mental Health and the Mental Illness Fellowship of Victoria.
- In the area of promotion, prevention, early intervention and suicide prevention:
- The Let's Talk suicide prevention campaign aims to raise community awareness around suicide prevention and to provide information about where to seek help. The 2014 campaign focused on young people. Professor Diego De Leo from the Australian Institute for Suicide Research and Prevention was keynote speaker at a public forum about suicide prevention in young people, which was attended by approximately 40 parents, teachers and carers. Information about the Let's Talk campaign was also distributed at a public barbeque in Garema Place, and through a range of media outlets.
- The Men's Mental Health and Suicide Prevention Forum, a joint initiative between ACT Health and nongovernment agencies, aims to promote the education and training of service providers on engaging and working with men, with a particular emphasis on suicide prevention, and was attended by 120 members of the sector. Highlights included presentations from local sporting personalities Mark Vergano, CEO of ACT Cricket, and Clyde Rathbone of the ACT Brumbies, about the efforts being undertaken in sport to enhance the wellbeing of sportspeople.
- The 2011-12 and 2012-13 evaluation reports Managing the risk of suicide: a suicide prevention strategy for the ACT 2009-2014 and Building a strong foundation: a framework for promoting mental health and wellbeing in the ACT 2009-2014 were tabled in the Legislative Assembly. These reports indicate that:
>> there has been an increase in the number and range of activities agencies have embedded into their strategic plans and strategies to promote mental health and wellbeing and
>> the number of agencies providing clinical supervision for clinicians who respond to individuals who have attempted suicide or self-harm has increased to 100 per cent.
Issues and challenges
- 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 consideration of the sustainability of the health professional officers in this sector.
- The commencement of the NDIS and the associated planning and implementation requirements are significant for this division. An implementation plan has been developed to ensure appropriate services are available for eligible consumers for the transition of care arrangements to the NDIS and to support those people who may not be eligible or who may have difficulties accessing these services.
- An Adult Mental Health Day Service (AMHDS) began operating from the Belconnen Community Health Centre in July 2014. This is an interim measure until an enhanced AMHDS is commissioned in the University of Canberra Public Hospital. The AMHDS will include treatment for adults aged 18-65 years and will offer sub-acute support services, programs aimed at preventing an acute psychiatric admission, day treatment therapies, transitional support for those people exiting acute services and reintegrating back into the community, intensive psychological therapy, and extended treatment and recovery programs.
- A streamlined induction process will be established at the Bimberi Youth Detention Centre. The new process will reduce duplication and engage specialist services when they are assessed as clinically required.
- JHS will conduct the 2014-15 Young Persons in Custody Health Survey.
- Forensic Mental Health Services will provide training on mental health awareness and processes to the magistrates of the ACT law courts. Preparation and organisation for the training has commenced. This initiative will be further expanded to other agencies, such as the Office of the Director of Public Prosecutions and and Legal Aid services. Forensic Mental Health Services has also continued to provide mental health awareness and education training to Bimberi youth workers as part of their training inductions.
- ADS will continue to develop the pharmacist-led Nicotine Replacement Clinic for clients of the Opioid Treatment Service and withdrawal services. This clinic will work in collaboration with the Adult Mental Health Unit and Canberra Hospital campus. The pilot program is currently being evaluated.
- The Adult Mental Health Services Model of Care project will review and develop mental health services currently provided to adults (aged 18-64 years) within the ACT. The development of this Model of Care (MoC) will inform the concept design of health infrastructure. The MoC will be developed around evidence-based practice and comply with all relevant legislations. This project includes the development of Models of Care for Adult Mental Health Rehabilitation Services and the AMHDS as well as a review of adult community mental health services, including the roles of crisis assessment and assertive outreach components of mental health care.
- Implementation of the CAMHS MoC will continue, with a focus on promoting prevention and early intervention and addressing ultra high risk and early psychosis.
- The development of the MoC for the Secure Mental Health Unit was finalised in May 2014 and is now available on the ACT Health website. The facility design process is underway. Work will commence in 2014-15 on the workforce plan for this unit.
- The business case for the expansion of the Primary Health Service at the Hume Health Centre will be undertaken to ensure that staffing levels reflect the increasing demands on that team.