Submission to the Social Development Committee regarding the Inquiry into Mental Health and the NDIS
Adelaide Primary Health Network (APHN) welcomes the opportunity to provide a written submission for the Social Development Committee’s Inquiry into Mental Health Services and the National Disability Insurance Scheme (NDIS).
APHN is a membership-based organisation focussed on improving health outcomes, and the experience of primary health care within the Adelaide metropolitan region. Our membership is made up of GP’s, Allied Health professionals, service providers, carers and people accessing primary health. This membership helps to inform the organisation’s decision-making processes, develop our iterative Needs Analysis, set our local priorities, and provide ongoing clinical, community and stakeholder input to our programs, services, and activities.
Our response to the inquiry has been informed by community consultations, our membership, attendance at the NDIS Mental Health Implementation Group, facilitated by SA Health, and at the SA NDIS Psychosocial Disability Transition Taskforce, and consultations, forums and engagement and then, utilising all of this community input, our development of the National Psychosocial Support Measure.
Other submissions to this Inquiry by service providers, carers and mental health practitioners have adequately described the myriad of issues that are arising for people with mental health conditions as a result of the transition process. Therefore, APHN would like to focus our submission to the Social Development Committee on the availability of alternate services for people with a psychosocial disability while they are waiting for the outcome of their NDIS application, or after their eligibility has been determined. This relates to the Terms of Reference: Any other relevant matters.
Access to the NDIS is only a part of the story for people with a mental health condition. A coordinated approach to service availability across mental health, primary health, social support, employment supports, housing and access to the community, all need to be considered as part of a holistic, wrap-around support system for the person. Anecdotal evidence detailed in community forums and Community of Practice meetings indicates that preparing for the application and waiting for an outcome is a particularly stressful time for potential participants of the NDIS which can exacerbate symptoms of a person’s mental health condition and prevent them from managing other areas of their lives.
APHN commissions a wide range of Primary Mental Health Care Services, the need for which was determined using population health data and the iterative Needs Assessment. These services provide access to a wide range of supports, ranging from early intervention services for children and young people to services targeted at people experiencing mild, moderate or chronic/ complex mental health conditions. These services are available based on need and are not reliant on whether a person has been assessed as eligible for to the NDIS. People can access these services with a referral from a GP or other health professionals. Some services such as headspace and the National Psychosocial Supports Measure can be accessed by self referral.
Please find below an overview of the services which can support people experiencing a mental health condition who may be waiting for their NDIS eligibility outcome or their planning meeting. Note that some of these services may continue to be useful once the person’s plan has been implemented to ensure that the person is able to access suitable services and supports to ensure they can live well in the community.
Services for Youth
- headspace Centres - These programs are designed to assist people aged 12-25 who are experiencing, or who are at risk of developing, a mental health condition. The available services have an early intervention focus. Young people do not need a GP Mental Health treatment plan or a GP referral to access the program. The young person, their family, schools and concerned others can refer into this program.
- headspace Youth Early Psychosis Program provides early intervention, responsive and recovery focused care for young people who are at risk of, or are experiencing, a first episode of psychosis. Young people can directly refer themselves into the program or can be referred by a family member, GP, school psychologist/ counsellor or any other medical professional.
Services for people with Mild or Moderate Mental Health Conditions
- General Psychological Therapies – This program is targeted at people who face barriers to accessing mental health services. This program has relevant supports for people experiencing mild, moderate and chronic or complex levels of need. This program could be useful for people who are waiting for services thought the NDIS or who are finding the application process stressful. It may also be able to assist people who have limited contact with the clinical services sector to gather the evidence they need to support their NDIS application.
- People from Aboriginal and/or Torres Strait Islander backgrounds can access culturally sensitive, specifically designed psychological supports. Different kinds of support are available across the spectrum of need from mild to more complex. This program is linked to the Aboriginal Community Connect service and a range of mainstream services providers, ensuring that Aboriginal people have service choice.
Services for people with Chronic / Complex Mental Illness
- APHN commissions specialised mental health support services for people who are experiencing or at risk of, homelessness. People need to be referred to the program by a GP or other Health Professionals and can access psychological therapies and clinical-care coordination.
- Psychiatric assessments can be difficult to organise. Currently SA is experiencing a significant crisis in the ability for people to access psychiatric service in the primary care sector. Whilst we have the highest per capital of psychiatric FTE in Australia, we note that there are exceedingly long wait lists to access this in the community (over 6 months). The APHN has recently written to the Chief Psychiatrist, Dr John Brayley to alert him to this situation. Whilst the APHN has the GP PASA service, we are unable to source the necessary number of Psychiatrists to provide these one off psychiatric assessment (MBS Item number 291). Historically this program worked well, providing GPs needing to access a once off psychiatric assessment for patients. This service was particularly useful for people with psychosocial disability who may have no formal diagnosis or formal assessments to support their NDIS application process – however is currently untenable due to the lack of psychiatric support in SA.
Access to several Group-Based Therapies
- group based Cognitive Behavioural Therapy (CBT) and individual support to help people treat the symptoms of trauma and Post Traumatic Stress Disorder (PTSD).
- MI-DBT (Dialectical Behaviour Therapy) for women in the perinatal period who live with borderline personality disorder. This program supports mothers who may need support to improve emotional regulation, interpersonal effectiveness and parenting skills during the first 1001 days of their infant’s life.
Psychosocial / Peer Supports
- The Lived Experience Telephone Support Service (LETSS) provides peer based non-clinical support to provide information and support for people living with a mental health condition, their family and friends.
- People with psychosocial disability can access this line 365 days per year from 5.00pm to 11.30pm. While the peer workers cannot assist people with their applications, they can assist with any feelings and concerns which arise because of the application process.
- People living with a disability who experience gender dysphoria or gender identity concerns can access confidential counselling and a peer worker to provide short-term, goal-oriented support tailored to their individual need.
- The National Psychosocial Support Measure provides non-clinical psychosocial support to people living with a chronic/complex mental health condition who are not better supported by the NDIS. This program will be available between 7am and 7pm Monday to Friday from March 2019 across the Metropolitan area. It does not require a formal diagnosis, nor a GP referral. The support will be a mix of 1:1 and group supports with associated care coordination provided by peer workers and coaches.
Suicide Prevention
- APHN commissions programs to support people who have attempted suicide and their families. There are three programs available which support the individual themselves or their families:
- Families and individuals who have been bereaved by suicide can access free practical and emotional support to talk about their loss.
- A program specifically for people who have either already experienced a suicide attempt or who have strong suicidal ideations. People can access this program for up to 3 months and the main aim is to prevent future suicide attempts.
- A Suicide Intervention Program (SIPS) uses Cognitive Behaviour Therapy to provide person-centred intervention which runs alongside their other mental health treatment and provides individuals with an understanding of their suicidal crisis, potential triggers and a safety plan.
Adelaide PHN would like to see as an outcome of this inquiry a commitment, at a state level to work towards an integrated, person-centred approach to people experiencing a mental health condition. This would include primary, and acute mental health, services delivered by NDIS providers and other wrap around services such as housing, employment providers, psychosocial support providers and mainstream services. This response would include easy movement and referral pathways between services to ensure people get the right services by the right people at the right time.
A solution to the complete lack of access to psychiatric services, assessment and management plans in the primary care sector is also urgently sort.