Post on 27-Jul-2020
Using National Mental Health Service Planning Framework (NMHSPF) to guide
service development
Presented at Sharing learnings from early implementation of stepped care:
A PHN collaborative workshop
Kevin Fjeldsoe School of Public Health, The University of Queensland
What does the NMHSPF actually provide ? • A well organised, contemporary, integrated structure to support service analysis
– What would a decent mental health service for this population look like – What types of services need to be in place
• A series of reports which provide estimates of the quantum of each of the service
types which need to be provided to a defined population
– Which bits am I responsible for – How much is required, how much should it cost, what types and numbers of staff are
required to deliver it – How do the bits that I’m responsible for relate to other parts of the service system ? Are there
likely to be interdependencies
• Information which can be used to – Identify priorities for service development – Inform the development of strategic and operational plans
What the NMHSPF will not provide ? • An analysis of the local sociodemographic characteristics and the impact these might
have on the need for services • Service modelling for populations with special needs • A measure of the impact of geographic location • An understanding of the local capacity to recruit and retain staff or the economies of
scale associated delivering services to particular population groups • The unique history and expressed needs of a population • The current level of integration and co-ordination of services • An analysis of the current utilisation and capacity of services • The impact of services expressed as expected, measurable outcomes. The
NMHSPF considers inputs and outputs.
The outputs from the NMHSPF need to be considered in this context.
A worked example. A partnership between a PHN and local public sector mental health services
• Public Sector Ambulatory MHS
• Public and Private MH beds
• General Practitioner MBS MHS
• Structured Psychological Services
• Mental Health Nurses in Primary Care
• Community Support Sector Services
Public Sector Ambulatory MHS NMHSPF projected demand for public sector ambulatory mental health services, workforce FTEs 2021
Child and
Youth Early
Intervention Consultation
Liaison
Adult Continuing Care and
MITT
Acute Care Services
Early Psychosis
Older Persons
Total
LHN 1 35 4 9 69 25 5 16 163
LGA 1 2 0 1 4 1 0 1 10
LGA 2 5 1 1 11 4 1 1 24
LGA 3 10 1 2 20 7 1 4 46
LGA 4 17 2 5 34 12 2 10 83
LGA 5 0 0 0 0 0 0 0 1
LHN 2 30 4 10 63 24 4 24 158
LGA 1 14 2 5 30 12 2 12 77
LGA 2 13 2 4 27 10 2 11 69
LGA 3 1 0 0 3 1 0 1 7
LGA 4 1 0 0 2 1 0 1 5
LHN 3 54 7 17 114 43 8 40 283
LGA 1 47 6 15 101 38 7 35 249
LGA 2 7 1 2 14 5 1 5 34
Public sector ambulatory mental health services, workforce FTEs 2015
Child and Youth
Early Intervention
Consultation Liaison
Adult Continuing
Care and MITT
Acute Care Services
Early Psychosis
Older Persons
Total % of
Target
LHN 1 31 - 1 53 11 - 4 101 62%
LGA 1 1 - - 3 - - - 4 41%
LGA 2 2 - - 4 - - - 6 27%
LGA 3 4 - - 16 - - - 20 45% LGA 4 24 - 1 30 11 - 4 70 85% LGA 5 - - - - - - - 0%
LHN 2 22 - 2 39 19 - 4 86 54%
LGA 1 10 - 1 18 9 - 2 40 52% LGA 2 10 - 1 16 9 - 2 38 55% LGA 3 2 - - 5 1 - - 8 119% LGA 4 - - - - - - - -
LHN 3 56 - 4 81 41 - 14 197 69%
LGA 1 50 - 4 72 38 - 11 175 70%
LGA 2 6 - - 9 3 - 3 22 64%
QLD 399 - 62 1,009 419 27 111 2,027 61%
Public and Private MH beds NMHSPF projected demand for public and private beds 2021 Perinatal and
Infant Mental Health
Acute - Child & Youth
Acute Adult Acute - Older
Adult Step Up/ Step
Down Sub-Acute
Older Adult Non-Acute - Older Adult
Secure Extended care
Community Care Unit
Private Acute Beds
LHN 1 2 4 29 6 5 5 12 9 36 15
LGA 1 0 0 2 0 0 0 1 1 2 1
LGA 2 0 0 5 0 1 0 1 1 5 2
LGA 3 0 1 8 1 2 1 3 2 10 4
LGA 4 1 2 14 4 3 3 7 5 18 7
LGA 5 0 0 0 0 0 0 0 0 0 0
LHN 2 1 3 27 8 5 7 18 9 36 14
LGA 1 1 1 13 4 2 3 9 4 18 7
LGA 2 1 1 12 4 2 3 8 4 16 6
LGA 3 0 0 1 0 0 0 1 0 2 1
LGA 4 0 0 1 0 0 0 0 0 1 0
LHN 3 3 6 49 14 9 11 29 16 65 25
LGA 1 2 5 43 12 8 10 26 14 57 22
LGA 2 0 1 6 2 1 1 3 2 8 3
PHN 6 12 105 28 19 23 59 34 137 54
QLD 32 68 589 132 104 109 280 188 752
Public and private available beds 2015
Perinatal and Infant Mental
Health
Acute - Child & Youth
Acute Adult Acute - Older
Adult Step Up/ Step
Down Sub-Acute
Older Adult Non-Acute - Older Adult
Secure Extended Care
Community Care Unit
Private Acute Beds
LHN 1 - - 23 8 - - 2 - 20 15
LGA 1 - - - - - - - - - -
LGA 2 - - - - - - - - - -
LGA 3 - - - - - - - - - -
LGA 4 - - - - - - - - - -
LGA 5 - - - - - - - - - -
LHN 2 - - 26 - - - - - 20 -
LGA 1 - - 14 - - - - - - -
LGA 2 - - 12 - - - - - - -
LGA 3 - - - - - - - - - -
LGA 4 - - - - - - - - - -
LHN 3 - 6 45 12 - - 9 - 43 51
LGA 1 - - - - - - - - - -
LGA 2 - - - - - - - - - -
PHN 0 6 94 20 0 0 11 0 83 66
% of NMHSPF Target 0% 50% 90% 72% 0% 0% 19% 0% 60% 120%
QLD 0 74 672 59 34 16 122 114 339 511
% of NMHSPF Target 0% 109% 114% 45% 33% 15% 44% 61% 45%
General Practitioner MBS MHS NMHSPF projected demand for GP physical health services, occasions of service and workforce FTE costs ($M) 2021
Brief Physical Assessment
Comprehensive Physical Assessment
General Physical Health Monitoring & Ongoing Management
Workforce FTE cost $M
LHN 1 1,764 7,518 45,876 $4.41
LGA 1 97 441 2,722 $0.26 LGA 2 181 1,060 6,790 $0.64 LGA 3 419 2,021 12,647 $1.21 LGA 4 1,064 3,972 23,557 $2.28 LGA 5 3 24 161 $0.02
LHN 2 2,417 8,022 45,909 $4.49
LGA 1 1,179 3,901 22,300 $2.18 LGA 2 1,060 3,513 20,109 $1.97 LGA 3 112 354 1,996 $0.20 LGA 4 66 254 1,504 $0.15
LHN 3 4,056 14,143 82,102 $8.00
LGA 1 3,585 12,473 72,352 $7.06 LGA 2 472 1,670 9,750 $0.95
PHN Total 7,995 27,358 158,392 $15.47
Actual GP MBS mental health specific services by location of patient address, 2014/2015
Populations Patients per
1000 Services per 1000 Fees Charged $
Fees Charged $ per capita
LHN 1 56.9 85.9 $ 1,784,544 $ 7.59
LGA 1 49.3 75.9 $ 101,534 $ 6.54
LGA 2 38.7 55.7 $ 180,149 $ 5.29
LGA 3 52.8 81.3 $ 432,714 $ 7.00
LGA 4 65.1 98.0 $ 1,064,218 $ 8.67
LGA 5 42.4 61.1 $ 5,929 $ 5.80
LHN 2 66.5 110.6 $ 2,156,265 $ 9.32
LGA 1 74.1 117.8 $ 1,094,452 $ 9.91
LGA 2 60.7 107.1 $ 993,178 $ 9.02
LGA 3 47.4 72.9 $ 68,635 $ 6.27
LHN 3 84.4 147.0 $ 5,055,627 $ 12.37
LGA 1 86.4 152.5 $ 4,567,176 $ 12.77
LGA 2 70.6 108.5 $ 488,451 $ 9.53
PHN 77.4 129.5 $ 8,996,436 $ 11.00
Queensland 71.4 123.2 $ 51,721,525 $ 10.76
Australia 71.6 124.9 $ 254,841,379 $ 10.92
Structured Psychological Services NMHSPF estimated demand for structured psychological therapy occasions of service 2021
Clinician Led Web-based Psychological Interventions
SPT - Low Intensity Intervention - Individual
SPT high intensity - Individual, Group and Family
Number Rate per 1,000 Number Rate per 1,000 Number Rate per
1,000
LHN 1 76,350 325 38,145 162 121,377 516
LGA 1 4,591 296 2,291 148 7,300 470
LGA 2 11,977 352 5,955 175 18,092 531
LGA 3 21,604 350 10,722 174 33,861 548
LGA 4 37,886 309 19,037 155 61,638 502
LGA 5 293 287 140 137 486 476
LHN 2 71,002 307 36,154 156 118,864 514
LGA 1 34,442 312 17,546 159 57,687 522
LGA 2 33,527 305 17,055 155 56,079 509
LGA 3 3,032 277 1,554 142 5,097 466
LHN 3 129,178 316 65,477 160 212,514 520
LGA 1 113,755 318 57,681 161 186,940 523
LGA 2 15,423 301 7,796 152 25,574 499
PHN 276,530 316 139,776 160 452,755 517
Estimated structured psychological therapy, occasions of service 2014/2015 and 2015/2016
MBS (2014-15) ATAPS (2015-16) Headspace (2015-16) Total Funding
Number Per 1,000 pop Number Per 1,000
pop Number Per 1,000 pop Number Per 1,000
pop
LHN 1 28,376 120.7 4,127 17.6 1,099 4.7 33,602 142.9
LGA 1 1,401 90.2 211 13.6 - 0.00 1,612 103.8
LGA 2 1,824 53.6 1,166 34.3 - 0.00 2,990 87.8
LGA 3 5,973 96.7 1,128 18.3 - 0.00 7,101 114.9
LGA 4 19,117 155.7 1,614 13.2 1,099 12.3 21,830 177.8
LGA 5 61 59.7 8 7.8 - 0.00 69 67.6
LHN 2 36,492 157.7 3,939 17.0 1,459 6.3 41,890 181.0
LGA 1 18,521 167.7 2,738 24.8 1,459 19.8 22,718 205.7
LGA 2 16,766 152.3 1,137 10.3 - 0.00 17,903 162.6
LGA 3 1,205 110.2 64 5.9 - 0.00 1,269 116.0
LHN 3 99,831 244.2 9,527 23.3 1,433 3.5 110,791 271.0
LGA 1 91,171 255.0 7,675 21.5 1,433 11.8 100,279 280.4
LGA 2 8,660 169.0 1,852 36.1 - 0.00 10,512 205.1
PHN Total 164,698 201.4 17,493 21.4 3,991 4.9 186,182 227.7
Queensland 909,673 189.3 80,877 16.8 n/a - - -
Australia 4,515,284 193.5 384,160 16.5 117,122 5.0 5,016,566 215.0
Mental Health Nurses in Primary Care NMHSPF estimated demand for mental health practice nurses, workforce FTE 2021
Centre Based Monitoring & Management
Physical Health Monitoring & Management
Home Based Monitoring & Management
Monitoring & Management
Total
LHN 1 0.1 0.1 2.0 3.8 6.0
LGA 1 0.0 0.0 0.1 0.2 0.4
LGA 2 0.0 0.0 0.3 0.6 0.9
LGA 3 0.0 0.0 0.6 1.1 1.7
LGA 4 0.0 0.1 1.0 1.9 3.0
LGA 5 0.0 0.0 0.0 0.0 0.0
LHN 2 0.1 0.2 2.0 3.5 5.8
LGA 1 0.0 0.1 1.0 1.7 2.8
LGA 2 0.0 0.1 0.9 1.5 2.5
LGA 3 0.0 0.0 0.1 0.1 0.2
LGA 4 0.0 0.0 0.1 0.1 0.2
LHN 3 0.1 0.2 3.7 6.4 10.4
LGA 1 0.1 0.2 3.2 5.6 9.2
LGA 2 0.0 0.0 0.4 0.8 1.2
PHN 0 0 8 14 22
2021 NMHSPF projected demand for MHNIP services and actual 2015 occasions of service
NMHSPF Occasions of Service 2021
MHNIP Reported Services 2015
Relative Level of Service 2015
LHN 1 8,763 1,070 12%
LGA 1 522 92 18%
LGA 2 1,326 392 30%
LGA 3 2,429 394 16%
LGA 4 4,455 179 4%
LGA 5 31 13 42%
LHN 2 8,640 1,473 17%
LGA 1 4,196 1,342 32%
LGA 2 3,782 124 3%
LGA 3 375 7 2%
LGA 4 288 - 0%
LHN 3 15,504 1,849 12%
LGA 1 13,663 1,160 8%
LGA 2 1,841 689 37%
PHN 32,907 4,392 13%
Queensland 165,562 62,546 38%
Australia 869,904 308,084 35%
Community Support Sector Services NMHSPF projected demand for community support services, workforce FTE costs ($M) 2021
Day Respite Family Support Services
Flexible Respite
Group Based Peer Work
Group Carer Support Services
Group Support and Rehabilitation
Individual Carer Support Services
Individual Peer Work
Individual Support and Rehabilitation
Residential Crisis & Respite Services
Total
LHN 1 $ 0.06 $ 0.28 $ 0.55 $ 0.66 $ 0.05 $ 0.05 $ 0.06 $ 2.59 $ 13.84 $ 0.43 $ 18.55
LGA 1 $ 0.00 $ 0.02 $ 0.03 $ 0.04 $ 0.00 $ 0.00 $ 0.00 $ 0.15 $ 0.82 $ 0.03 $ 1.10
LGA 2 $ 0.01 $ 0.04 $ 0.07 $ 0.10 $ 0.01 $ 0.01 $ 0.01 $ 0.38 $ 2.04 $ 0.06 $ 2.73
LGA 3 $ 0.02 $ 0.08 $ 0.15 $ 0.18 $ 0.01 $ 0.01 $ 0.02 $ 0.71 $ 3.80 $ 0.12 $ 5.09
LGA 4 $ 0.03 $ 0.14 $ 0.29 $ 0.33 $ 0.02 $ 0.02 $ 0.03 $ 1.33 $ 7.13 $ 0.23 $ 9.57
LGA 5 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.01 $ 0.05 $ 0.00 $ 0.06
LHN 2 $ 0.06 $ 0.26 $ 0.60 $ 0.65 $ 0.05 $ 0.05 $ 0.06 $ 2.60 $ 14.03 $ 0.47 $ 18.83
LGA 1 $ 0.03 $ 0.13 $ 0.29 $ 0.32 $ 0.02 $ 0.02 $ 0.03 $ 1.26 $ 6.81 $ 0.23 $ 9.15
LGA 2 $ 0.03 $ 0.12 $ 0.26 $ 0.28 $ 0.02 $ 0.02 $ 0.03 $ 1.14 $ 6.14 $ 0.21 $ 8.25
LGA 3 $ 0.00 $ 0.01 $ 0.03 $ 0.03 $ 0.00 $ 0.00 $ 0.00 $ 0.11 $ 0.61 $ 0.02 $ 0.82
LGA 4 $ 0.00 $ 0.01 $ 0.02 $ 0.02 $ 0.00 $ 0.00 $ 0.00 $ 0.09 $ 0.46 $ 0.01 $ 0.61
LHN 3 $ 0.11 $ 0.47 $ 1.04 $ 1.16 $ 0.09 $ 0.08 $ 0.11 $ 4.65 $ 25.01 $ 0.82 $ 33.54
LGA 1 $ 0.10 $ 0.41 $ 0.91 $ 1.03 $ 0.08 $ 0.07 $ 0.09 $ 4.10 $ 22.05 $ 0.72 $ 29.56
LGA 2 $ 0.01 $ 0.06 $ 0.12 $ 0.14 $ 0.01 $ 0.01 $ 0.01 $ 0.55 $ 2.96 $ 0.10 $ 3.98
PHN Total $ 0.22 $ 0.94 $ 2.03 $ 2.24 $ 0.17 $ 0.16 $ 0.20 $ 8.95 $ 48.18 $ 1.60 $ 64.70
Queensland Health and Commonwealth Health and Social Services, service contract specifications 2016
Day Respite Family Support Services
Flexible Respite
Group Based Peer Work
Group Carer Support Services
Group Support and Rehabilitation
Individual Carer Support Services
Individual Peer Work
Individual Support and Rehabilitation
Residential Crisis & Respite Services
Other (flexible, high risk, suicide prev., eat)
Total
LHN 1 - $252,390 - $16,225 - $ 126,669 - - $871,030 - - $1,266,315
- - - - - - - - $2,772,108 - - $2,772,108 LGA 1 - - - - - - - - - - - - LGA 2 - - - - - $107,000.00 - - - - - $107,000 LGA 3 - - - - - - - - - - - - LGA 4 - - - - - $404,000.00 - - - - - $404,000 LGA 5 - - - - - - - - - - - -
LHN 2 - $11,721 - $759,060 - $40,732 - - $997,103 $78,720 - $1,887,337
- $1,167,355 - - - - - - $5,256,405 - - $6,423,761
LGA 1 - - - - - - - - - - - - LGA 2 - - - - - $324,694 - - - - - $324,694 LGA 3 - - - - - - - - - - - - LGA 4 - - - - - - - - - - - -
LHN 3 - $66,844 - $391,340 - $267,314 - - $1,481,085 $83,675 - $2,290,258
- - $10,739,406 - - - - - $4,971,372 - $11,049,296 $26,760,075 LGA 1 - - - - - - - - - - - - LGA 2 - - - - - - - - - - - -
State-wide Services
- - - - $187,112 - - - - - $187,673 $374,785
PHN - $1,498,311 $10,739,406 $1,166,625 $187,112 $1,270,410 - - $16,349,104 $162,396 $11,236,969 $ 42,610,333
Summary - Outcomes
– Relative levels of service capacity across programs measured against NMHSPF, National
and State benchmarks
– Priorities for service development established
– Opportunities for collaborative service delivery identified
– Improved understanding of the inter-sectoral impacts of un-coordinated service development
– Information used to inform the development of Strategic Plan
Data sources • Australian Government - PHN Data – all MBS data
Department of Health. Medicare Benefits Schedule Data, MBS Data by ABS SA3. Australian Government, Department of Health; 2016. http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-MBS_Data.
• Mental Health MBS Data – all disciplines Department of Health. Mental Health Data, MBS Mental Health Data by ABS SA3. Australian Government, Department of Health; 2016. http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Mental_Health_Data#MBSDATA
• Mental Health MBS Data – ATAPS and MHNIP Department of Health and Ageing. Mental Health Data, Access to Allied Psychological Services (ATAPS) Data. Australian Government, Department of Health; 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Mental_Health_Data#ATAPSDATA.
• PHN Secure Area Department of Human Services. Mental Health Data, Mental Health Nurse Incentive Programme (MHNIP) Data. V2a. In: Secure Series: Australian Government, Department of Health; 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Secure.
Data Sources (Other) • State Programs
Source from local heath service or state office
• Community Support Sector Local health service or state office reporting Commonwealth Government Departments of Health and Social Services grants reports
• Headspace Headspace National Office. Headspace Centres Activity Reports, Melbourne: headspace National Youth Mental Health Foundation; 2016.