Forensic Mental Health in Community Health (FMHiCH)

The Forensic Mental Health Implementation Plan (FMHIP) is a reform element of Victoria’s 10 Year Mental Health Plan. The Forensic Mental Health in Community Health (FMHiCH) program is one of 10 FMHIP initiatives funded in the 2017-18 state budget. FMHiCH is a new program and is being delivered from the community health platform in partnership with the Department of Justice and Community Safety. Service delivery commenced in late 2018. FMHiCH will be evaluated during the first three years of operation.

What problem is being addressed?

Individuals on a Community Correction Order or a parole order with a Mental Health Treatment and Rehabilitation condition with a moderate severity mental illness (the majority) are referred to a general medical practitioner (GP) to be assessed for a Commonwealth funded Mental Health Care Plan. However, many individuals do not have a regular GP and there can be barriers to accessing GP care. As a result, the offender may not receive the mental health care they require, thereby compromising their rehabilitation outcomes and increasing the risk of non-compliance with their order.

Currently, individuals on a Community Correction Order or a parole order with a Mental Health Treatment and Rehabilitation condition who have a serious mental illness or are acutely unwell are referred to public mental health services for assessment and treatment and this will not change with the introduction of FMHiCH.

What are the goals of FMHiCH?

By providing access to mental health and health care for individuals in the target group, FMHiCH aims to:

• improve their mental and physical health
• support their compliance with their order conditions specifically, the Mental Health Treatment and Rehabilitation condition
• assist them successfully complete their order or parole.

Who is in the target cohort and how is the service accessed?

Adults (over 18 years) who meet all the criteria below:

• are on a community-based disposition, such as a Community Correction Order or parole order with a Mental Health Treatment and Rehabilitation condition
• have a moderate severity mental health condition or disorder
• are at high to medium risk of re-offending.

The sole referral source into FMHiCH is Community Correctional Services. Once referred, an intake assessment determines the individual’s service need and the most appropriate evidence-based mental health therapies and treatments required. Clients have a range of mental health care and treatment needs in terms of type, intensity and duration and often have other significant health and social support needs. Some clients require medical supervision while others have less complex service needs that can be managed by the multi-disciplinary mental health clinical team. Referrals to social support services in collaboration with the Community Correctional Services case manager can also be arranged by the FMHiCH clinical team. It is expected that a majority of the cohort will not be clients registered with public mental health services. However, referral and escalation criteria between the GP/FMHiCH clinical team and the Area Mental Health Services for clients who may need specialist mental health care is in place.

What does the new service look like?

The service delivers a forensic mental health service to address the mental health needs of people in the target cohort in the community. As part of offering a holistic service, other health issues will be identified and managed often in collaboration with general practice within the community health service or with private GPs.

Key elements of the service include:

• active engagement with clients including development of a care plan with client identified goals
• assessment (multi-disciplinary where required) and care plan approach that is appropriate for the severity/complexity of the presenting mental illness and other health and support issues. For Aboriginal clients, cultural input about the most appropriate care plan or treatment options is integrated into the model of care
• medical supervision by a GP when required and referral through to psychiatry when needed referral to other mental health, health and support services as appropriate including for ongoing care and support once the Mental Health and Treatment Rehabilitation condition is completed
• clinical care coordination
• collaborative practice engagement with Community Correctional Services case manager.

Where is the service being offered?

There are five lead community health services, two partnering community health services and six Aboriginal organisational partners, which are listed in Table 1.

Table 1: Community health service lead providers, Aboriginal organisation partners and Community Correctional Services office locations

DDACL – Dandenong and District Aborigines Co-operative Ltd, BADAC – Ballarat and District Aboriginal Co-operative, BDAC – Bendigo District Aboriginal Co-operative, LEAHA – Lakes Entrance Aboriginal Health Association

Forensic Mental Health Implementation Plan