Shape your service

Shape your service

Experience based co-design

Murray PHN and the University of Melbourne conducted an experience based co-design project in 2017, that focused on the future primary health care needs of people living in our region with severe mental illness.

The National Mental Health Commission describes severe mental illness as complex and chronic conditions such as severe depression, schizophrenia, bipolar disorder and eating disorders. Severe mental illness accounts for approximately 3.1 per cent of the population.

During the project we worked with clients, carers and mental health organisations and staff, to ensure future services in our region are accessible, targeted, evidence based and shaped by the people who use these services.

Applied ethicist Dr Victoria Palmer, a Senior Research Fellow in the mental health program at The University of Melbourne, said that the voices of consumers, carers and staff  in regional and rural areas were not always heard in system reforms.

"Murray PHN has taken up the challenge of embedding consumers and carers at the heart of service design and improvement for mental health reforms," Dr Palmer said.

This co-design project involved three steps (explained below) which clients, carers and staff were invited to take part in.


Information for client and carer participants

This co-design project has three steps:

Step 1: Have your say
We want you to tell us about the experiences you have had with primary mental health service, as well as all the things (big and small) that could make your experiences better. Once you have provided us with your contact details we will call at a time that suits to talk for about 30 minutes.

Step 2: Share your view
We will bring a small group of people together to discuss what people told us in your region during Step 1. There will be separate groups; one for clients, one for carers and one for service staff.

How will the meetings work?
Staff from the University of Melbourne will help everyone to share their views. Together you will talk about what people said worked, and what people thought could be different. We will work out a good time and place to meet, allowing about two hours.

How will my information be used?
We will audio record the group meetings for the research team to listen and capture everyone's point of view. This unidentifiable information will be provided to Murray PHN for future service considerations.

Step 3: Shape services
A series of meetings where clients, carers and staff of services all work together to consider key issues/themes and develop suggestions for services in the future. Training will be provided prior to these meetings for clients and carers to support them in this process.

Information gathered from Steps 1 and 2 will be used during these meetings

How will step 3  meetings work?
There will be a one day  meeting (in each region). Training will be provided prior to these meetings to ensure there is a shared approach.
There will be 8-10 people in each meeting (a mix of clients, carers, staff and the facilitators).

You will all work together to come up with some ideas on how mental health services could be delivered in the future. We will audio record these meetings so we can listen and understand.

Click here for more information about what the focus groups will include.

Getting support during this project
If you become distressed at any time during your involvement in this project, please call or speak with a member of the University of Melbourne team and they will arrange for you to talk with a local independent person.

Your privacy and confidentiality is important:

  • you don't have to answer any questions you don't want to
  • your information is kept confidential and secure
  • we use a code, not your name, when reporting on the research
  • you can leave the project at anytime.

Consideration of ethics for this project
This service improvement project is being coordinated by the Mental Health Research Program in the Department of General Practice at The University of Melbourne in partnership with Murray PHN. Ethical review from a Human Research Ethics Committee (HREC) was not required as all information collected within the project is to be used solely for the purposes of development and improvement of primary care mental health services in the Murray PHN region.

All processes for inviting feedback and collection of information, including the modified co-design approach used with the project, are based on a University of Melbourne HREC approved study called CORE working with people living with severe mental illnesses in Victoria to explore service improvement and psychosocial recovery outcomes.

What are the timelines?
The co-design project will occur from May - July 2017 and will inform service design and future models of care.

How do I get involved?
Call now on 1800 431 212 or email us at codesign-mphn@unimelb.edu.au and we will call you back at a time that suits you.

What are primary mental health care?
Primary mental health care is clinical care provided in the community and includes general practitioner (GPs), psychiatrist, psychologists, mental health nurses and other allied health professional working with a general practitioner.

Primary mental health services are not: based in hospitals, an emergency response or psychosocial support services.


Information for staff and services

The University of Melbourne will collect information from consumers, carers and service providers in this collaborative approach to shaping mental health services.

The co-design project will involve three steps:

Step 1: Have your say

For clients and carers: We invite some of your clients and their carers to tell us about the experiences they had with services, as well as all the things (big and small) that could have made their experiences better.   This part of the project will involve a trained researcher asking questions by telephone for around 30 minutes.

For service providers: We invite Mental Health Nurse Incentive Program (MHNIP) clinicians, general practitioners and other mental health staff to fill in online questionnaires to help us understand the clinician's and service provider's experience of primary mental health services for people living with severe mental illnesses. The survey should take no more than 20 minutes.

Step 2: Share your view

Once we know more about experiences, we will hold separate focus groups for clients, carers and staff/clinician in each of the four Murray PHN regions. This is your opportunity to discuss information and themes gathered in your region during Step 1.

Step 3: Shape services

After the focus groups, we will ask people to come to a  co-design meeting to consider key issues/ themes and develop service recommendations through action plan development. Training will be provided prior to these meetings for clients, carers and staff to support them in this process.

Information gathered from Steps 1 and 2 will be used during these co-design meetings.

Click here for more information about what the focus groups will include.

Consideration of ethics for this project
This service improvement project is being coordinated by the Mental Health Research Program in the Department of General Practice at The University of Melbourne in partnership with Murray PHN.   Ethical review from a Human Research Ethics Committee (HREC) was not required as all information collected within the project is to be used solely for the purposes of development and improvement of primary care mental health services in the Murray PHN region.

All processes for inviting feedback and collection of information, including the modified co-design approach used with the project, are based on a University of Melbourne HREC approved study called CORE working with people living with severe mental illnesses in Victoria to explore service improvement and psychosocial recovery outcomes.

What are the timelines?
The co-design project will occur from May - July 2017 and will inform service design and future models of care.

What are primary mental health care?
Primary mental health care is clinical care provided in the community and includes general practitioner (GPs), psychiatrist, psychologists, mental health nurses and other allied health professional working with a general practitioner. Primary mental health services  have a central role in providing assessment, treatment and referral to other services for their clients. Primary mental health services are generally funded by the Commonwealth.

Primary mental health services are not: based in hospitals, an emergency response or psychosocial support services.

What are primary mental health services for people living with severe mental illness?
Primary Health Networks (PHNs) have been funded to develop and commissioned primary mental health services for people living with severe mental illness who can be appropriately managed in the primary care setting.  Murray PHN currently fund community-based general practices, private psychiatric practices and other appropriate organisations (e.g. Aboriginal Medical Services) through the Mental Health Nurse Incentive Program (MHNIP) that was established in 2007.

Click here for other  Frequently Asked Questions.


The broad context

The Mental Health Commission's Contributing Lives, Thriving Communities Report in 2014 provided key recommendations for future mental health services in Australia. The Australian Government welcomed the findings and recommended a new approach to primary mental health services within a stepped care model. This involves the delivery of evidence‐based services that increase, or decrease, in intensity according to the level of need.

The Government's National guidelines for flexible and locality based mental health service design recognises the rights of clients and carers and ensures relevance to local communities.

Severe mental illness
The National Mental Health Commission describes severe mental illness as:

complex and chronic conditions. such as severe depression, schizophrenia, bipolar disorder and eating disorders, as well as severe and persistent psychosocial disability, including those with complex multi-agency needs.

Severe mental illness accounts for approximately 3.1 per cent of the population.

This population can be classified broadly into three groups:

  • severe episodic (about two-thirds of the overall severe population)
  • severe and persistent (about one-third of the overall severe population
  • severe and persistent illness with complex multiagency needs .This is a relatively small group (approximately 0.4 per cent of the adult population) and is likely to be the focus of the National Disability Insurance Scheme (NDIS) Tier 3 individual support packages.1

The Commission notes that people with more severe conditions often end up in hospital, when this might be avoided with access to community based services and support through primary mental health care.

Government priorities
In 2015 the Government tasked PHNs around the country with the commissioning of primary mental health services.

The guidelines provided by the Government for services for severe mental illness highlighted the following requirements:

  • Develop and commission clinical mental health services to support the needs of people with severe and complex mental illness who are best managed in primary health care.
  • Promote better integration of primary care services with community-based, private psychiatry, state mental health services, Partners in Recovery (PIR) and the emerging National Disability Insurance Service (NDIS).
  • Engage with the private mental health care sector to ensure links are in place with private hospitals and psychological services to support care coordination.
  • Ensure referral pathways are in place to enable and support patients in seamless transition between services as their needs change.
  • That future models of care consider the impact of severe mental illness on of physical health
  • The mental health needs of Aboriginal and Torres Strait Islander people are significantly higher than those of other non-Indigenous Australians, and thus all services must be culturally safe and competent and some services may need specific targeting2.

In addition to these key factors there is a mandate for consumer and carer engagement and participation to:

  • establish and foster collaborative partnerships with consumers and carers throughout the commissioning cycle
  • apply principles of experience-based co-design, with a focus on a recovery-orientated approach
  • recognise the rights of consumers and carers and seek to recognise and reduce stigma and discrimination in primary health care settings3.

References
[1] National Mental Health Commission, (2014):   National Review of Mental Health Programmes and Services, Sydney: NMHC

2 PHN Primary Mental Health Care Flexible Funding Pool Implementation Guidance: Primary Mental Health Care Services for People with Severe Mental Illness, 2015.

3 PHN Primary Mental Health Care Flexible Funding Pool Implementation Guidance: Consumer and Carer Engagement and Participation, 2015.


MHNIP Service background

The existing MHNIP program
The Mental Health Nurse Incentive Program (MHNIP) was initiated in July 2007 and operates across all Australian states and territories. MHNIP funds community-based general practices, private psychiatric practices and other appropriate organisations (e.g. Aboriginal Medical Services) employing credentialed mental health nurses (CMHNs) to provide coordinated, clinical care for patients with severe and enduring mental health disorders.

Mental health nurses work with psychiatrists and general practitioners to provide services including: monitoring a patient's mental state; managing their medication, and improving links with other health professionals and clinical service providers.1

An evaluation of MHNIP was conducted during 2012. Feedback from GPs, psychiatrists and mental health nurses reported that patients experienced improved health outcomes. However, the report highlighted areas for improvement including the need to address the uneven geographic spread of MHNIP services, the lack of control over program expenditure, and the need to strengthen operational guidelines and improve data collection2.

The evaluation findings and options to redesign the MHNIP are considered in the context of the National Mental Health Commission's review of mental health programs. The PHNs were asked to support existing MHNIP services for the 2016/2017 financial year and to design future services beyond this period.

The Murray PHN context for MHNIP
The catchment area of Murray PHN is significant in both size and diversity. Spanning northern Victoria, and including Albury, NSW, the Murray PHN covers an area of almost 100,000 square kms, with health services that are accessed by more than 563,000 people.

Murray PHN is divided into four regions with offices based in Mildura (North West), Albury (North East), Shepparton (Goulburn Valley) and Bendigo (Central Victoria). The Mental Health Team is based at the Corporate Office located in Bendigo, working with the regional teams on stakeholder engagement, consultation and service design.

The following list and map identifies the current locations of MHNIP in Murray PHN.

North West
Buloke Shire -
Mildura RC Council Mildura
Swan Hill RC Council Swan Hill
Central Victoria
Gannawarra Shire Cohuna
Loddon Shire -
Campaspe Shire Echuca
City of Greater Bendigo Bendigo, Epsom, Kangaroo Flat, Eaglehawk, Heathcote
Mt Alexander Shire Castlemaine
Macedon Ranges Shire Woodend
Buloke Shire -
Goulbourn Valley
City of Greater Shepparton -
Mitchell Shire -
Moira Shire Yarrawonga
Murrindindi Shire Yea (via Eastern PHN)
Strathbogie Shire Nagambie

 

North East
City of Albury Wodonga
Alpine Shire Myrtleford, Bright, Mount Beauty
Benalla Shire Benalla/Glenrowan, Goorambat, Cheshunt, Whitlands
Indigo Shire Beechworth
Mansfield Shire Mansfield
Towong Shire Corryong
RC of Wangaratta Wangaratta
City of Wodonga Wodonga


MHNIP locations

Map of MHNIP locations as at January 2017


References

[1] Australian Government Department of Health (2016): Mental Health Nurse Incentive Program Guidelines.

2 Evaluation of the Mental Health Nurse Incentive Program, Final Report. Department of Health and Ageing, 2012

 

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