Recommendation 03

Please note this transcript is for reference only as an accompaniment to the recording of the briefing session. This document has been edited for accuracy and readability.

INTRODUCTION

I would like to begin by acknowledging that I am hosting this session from the lands of the Wurundjeri People of the Kulin Nation. I also acknowledge the Traditional Custodians of the various lands on which you are all working on today. Excellent recording is in progress. I pay my deep respects to elders past and present. I would also like to acknowledge any Aboriginal people joining us for this session today. I'd like to also warmly welcome people with lived and living experiences and thank you for working in partnership to achieve system transformation. My name is Alex Krummel and I'm the Director of Statewide Programs and Implementation within the Mental Health and Wellbeing Division of the Department of Health. Thank you so much for taking the time for joining us this morning. There has been a lot of interest in today's briefing, and I'll do my best to take you through the service framework in the next 45 minutes.

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So let me start by giving you a quick rundown of what today’s information session will cover. Firstly, I’ll give a brief overview of the Service Framework and how it was developed, then a quick introduction to Local Adult and Older Adult Mental Health and Wellbeing Services, or Local Services for short. And finally, I’ll take you through a description of the Service Framework in accordance with the chapters. Now before I start, I would like to highlight that the purpose of today’s briefing is to focus on the Service Framework itself. I won’t be talking to other matters such as the advertised call for submission for the next tranche of Local Services. I’d also like to note that this morning’s briefing will be recorded and will be made available on the department’s website. Now let’s help support you to navigate your way through the rather large document that is the Service Framework.

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The purpose of the Service Framework is to guide the operation and delivery of Local Services across the state. The Framework outlines: the objectives; key operational principles; service features and functions; components of the service model and the workforce; data reporting and operational requirements for Local Services. The Department expects that Local Service providers will adhere to the service specification and operational requirements in the Framework.

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Now, I’m not going to read each slide verbatim but to highlight: the Service Framework reflects the direction of the Royal Commission’s findings; the Department stood up a Technical Advisory Group to help design the service model, which is the service framework. The Service Framework was strengthened with input from many sectors including lived and living experience, clinical experts and service providers. The consultations via Engage Victoria and localised place-based consults across the state have also shaped the Framework. I’d like to note that the Service Framework is and will continue to be an iterative document. It will be refined over time to ensure continued alignment with the broader reform program. Next, for those who don’t already know what the Local Services are, I will give a very quick overview.

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This slide shows Local Services in the context of a reformed 6 tier mental health and wellbeing system as described in the Royal Commission’s final report. Local Services are the new ‘front-door’ and are where most people will receive treatment, care and support. As you can see Local Services are the fourth tier in a new six tier system.

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This slide is getting into some of the features of Local Services. Again, I won’t read every point. I’ll just highlight a few things. The establishment of 50-60 Local Services across Victoria is a flagship reform recommended by the Royal Commission. Local Services will ensure adults and older adults experiencing mental illness or psychological distress, including those with co-occurring substance use or addiction, can access integrated treatment, care and support in the community, and closer to their support networks. Local Services will support consumers, their families, carers, apologies I just, there we are, sorry, their families, carers and supporters. Local Services will act as a welcoming front door to the public mental health and wellbeing system, which includes Area Adult and Older Adult Mental Health and Wellbeing Services. I will however note, that whilst it is a welcoming front door, it won’t be the only door to Area Services. People will also be able access Area Services via a medical referral, emergency response or a psychiatric triage service delivered by another Area Service. Now I’d like to move us to the overview of the different chapters in the Service Framework. I do acknowledge it is a very long and comprehensive document. I won’t be taking a deep dive into any particular section, but I will be providing you with the information on what to expect when reading each section, but I will be providing you with the information on what to expect when reading each section and guidance to find the information you are looking for. OK. Now into the substance of this presentation.

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First, we're covering off chapters one to three. Chapters one and two provide background on Local Services. These chapters also outline the purpose of the document in providing a policy and operational framework to support planning, delivery and monitoring of Local Services. Chapter 3 provides additional context, as described by the Royal Commission, that situates Local Services in the reform, mental health and wellbeing system and the key interface with other areas of the system. Section 3.1 - It provides background on the Royal Commission and planned system reform over the next 10 years. Section 3.2 outlines the six levels in the reformed mental health system where Local Services will be the 4th level, interfacing with Area Services as the 5th tier, and primary and secondary mental health related services as the third tier. Section 3.3 describes how Local Services must integrate lived experience perspectives through all aspects of governance and service delivery, including those of consumers and their families, carers and supporters.

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Additional subsections in Chapter 3 include section 3.4. This describes the key collaborative relationship between local and Area Services to support warm referrals and smooth transitions when a consumer's mental health needs change, and they need to move between these levels of the mental health and well-being system. Section 3.5. Describes the clarity of relationship Local Services are required to have with primary and secondary mental healthcare providers in the local community to support smooth referral pathways between the service systems. This section will be of key interest to Primary Health networks and primary and secondary providers. Section 3.6 highlights the needs for Local Service providers to have a contemporary understanding of local needs and the delivery environment in the area where Local Services operate. This is to enable effective support for consumers with multiple needs who may need to be referred to local community and support services such as housing, homelessness, disability services, alcohol and other drug services, or other community health services.

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Chapters 4 to 6. Chapter 4 provides an overview of the expected benefits and outcomes of Local Services and reporting expectations for service providers on outcomes achieved for consumers, their family, carers and supporters against the mental health and wellbeing outcomes performance framework which is in development at the moment. Chapter five sets out the, the key objectives of Local Services while Chapter 6 provides service delivery principles that will guide and inform the way quality, accessible and responsive, Local Services are planned and delivered to consumers, their families, carers and supporters.

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Chapter 7 describes the target group and consumer support streams for Local Services. Section 7.1 identifies the target group which Local Services will primarily deliver support to. These are people 26 years of age and over experiencing mental illness or psychological distress. As well as how Local Services will work with interfacing areas of the system to support other consumers, such as those who require more intensive treatment; those with high-risk presentations, young people; consumers, families, carers and their supporters. Section 7.2 outlines the five consumers support streams as identified by the Royal Commission, and the priority consumer support streams for Local Services. Section 7.3 explains that Local Services will not provide compulsory treatment to consumers. This chapter is useful not only for providers of Local Services, but other sector stakeholders who want a deeper understanding of who is in and out of scope to, to receive support from a Local Service.

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Chapter 8. provides detailed information on key features and core service components of Local Services. Section 8.1 details the core service components of integrated treatment, care and support that all Local Services will deliver, as well as out of scope services. Section 8.2 provides the key features of the Local Services model. Section 8.3 provides information on the core functions of the Local Service model. Here it's worth noting that the Royal Commission was very specific about these requirements, which was based on its extensive consultation. This section of the framework is useful for current and future providers of Local Services in understanding the key service delivery requirements.

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Chapter 9. is on the service model. It describes access and referral pathways, initial engagement and assessment processes and the core components of the service model. Section 9.1 describes entry and referral pathways across primary and secondary care, healthcare services and Local and Area Services. It also provides a list of potential referring service providers from across the health and social service system. This section is particularly useful to understand the breadth of potential pathways into Local Services. It also highlights the central point in which the Local Services sits within a reformed mental health and wellbeing system. Section 9.2. Provides information on how Local Services staff will undertake the initial screening assessment. To identify a consumer's initial needs when they first access the service. It also includes information on the initial assessment and referral decision support tool and details around wait list management. Section 9.3 provides information on how providers will use evidence based or evidence informed biopsychosocial assessment tools and processes to assess the presence of mental illness, substance use or addiction, disability, or other factors that contribute to consumer’s distress. Section 9.4 defines the understanding of lived and living experience, as well as peer support. It sets out how Local Services will employ people with, lived or living experience of mental health concerns, this includes consumers, their families, carers and supporters, but also people with substance use or addiction, as an integral part of a multidisciplinary team. Section 9.5 provides guidelines on the supports provided by Local Services to help consumers return or progress to independent living and good quality of life by working with them and their family, carers or supporters.

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Chapter 9 continued. Section 9.6 provides information on the types of clinical treatments and interventions that are provided by Local Services. Providers are required to have the clinical governance, clinical supervision and workforce capability to provide safe and effective treatment and care to all consumers. As well as their supporters, family and carers. Section 9.7 provides guidance on how Local Services will deliver integrated treatment, care and support for people with co-occurring mental illness and substance use or addiction. The needs of consumers with co-occurring mental illness and substance use or addiction will be fully integrated into all service components and the overall delivery model for a Local Service. Section 9.8 outlines the aim of care coordination and describes the core functions of care coordinators in supporting consumers to meet their individual care needs. Section 9.9 relates to social prescribing. It describes the social prescribing trials that will be undertaken in select Local Services to support consumers, particularly older adults to engage in local social and community activities as well as online communities. Section 9.10 provides information on supporting shared care arrangements for consumers receiving concurrent treatment and support from other service providers. Section 9.11. It relates to brokerage funding. It provides details on what brokerage funding is and what it should be used for.

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Chapter 10 provides details around workforce. It provides information on the multi-disciplinary workforce needed to operate a Local Service. It also outlines how the professional disciplines and expertise are matched to workforce roles and functions. Section 10.1 outlines the requisite skills and competencies required by Local Services workforce and describes the expected staff skills for each of the functions of the service model and suggested disciplines. Noting the core functions of Local Services will be delivered by a multidisciplinary team. Here it is important to note that the workforce configuration will not be identical across all Local Services, as this will depend on the required response to meet the needs of the local community. Section 10.2 relates to training and development. It provides information to support providers in ensuring their workforce receives the training, professional development and clinical supervision needed to deliver safe, high quality clinical treatment and care.

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This chapter, and by this chapter, I mean Chapter 11 outlines the roles and responsibilities for government and sector stakeholders that have a key role in the delivery of Local Services. Roles that it covers include the role of the Department of Health in section 11.1 as the Department of Health has a role as the relevant funding body, but also the body responsible for the strategic oversight of Local Services. Section 11.2 talks about the role of lead service providers and funded partners. Given their role in implementation and service delivery leads in line with the service model. Section 11.3 is about working with the Networked Health Service and Area Services. This relates to the provision of tertiary level, high intensity mental health treatment care and access to secondary consultation. Section 11.4 relates to the interface with local primary and secondary mental healthcare providers and collaboration with Local Services to facilitate smooth transitions between these services. Section 11.5 relates to the role of the Office of the Chief Psychiatrist. The Chief Psychiatrist has an important role in the provision of clinical leadership and advice to service providers, as well as the promotion of continuous improvement in quality and safety. Section 11.6 relates to the role of Safer Care Victoria in working with consumers, clinicians and health service managers to monitor and improve quality and safety in Victorian healthcare. It is really important to note that while the service framework lists the roles and responsibility of some key stakeholders in the service framework, there are of course many other organisations across the whole mental health and wellbeing system that have a role to play in the effective provision of services to consumers, their family, carers and supporters. While you may not see your organisation as part of the service system here this section may be useful to gain a deeper understanding the expectations of each of these parties in the delivery of Local Services in this reformed system.

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Chapter 12 starts to really get into the finer detail of service delivery and expectations around operating a Local Service. These sections are particularly important for incumbent providers of Local Services to ensure that there is consistent delivery of the operating service model, noting that there will be local difference across the state. This chapter provides the specific details on what is expected when operating a Local Service. It covers in section 12.1 service zones, which is the geographical area or zone where a Local Service will operate, which aligns with the local government areas. 12.2 relates to service operating hours and outlines expectations around the operating hours for a Local Service. Section 12.3 is about branding, and it outlines branding and naming requirements for Local Services. And here it's important to note that there is going to be a new name, brand and style guide for Local Services. The new name and brand will be announced at a public launch for the first six Local Services soon. The style guide will be issued to service providers to support consistent use of the name and brand. We look forward to sharing more details with you about this soon. Section 12.4 relates to the funding model and provides details on how Local Services will be funded. Section 12.5 relates to targets and outputs. It outlines the performance targets and requirements service providers will be monitored against. Section 12.6. Describes the expectations to ensure the core functions of the Local Service are delivered by a multidisciplinary workforce supported by appropriate clinical governance structures and processes. 12.7 outlines the expectations to ensure robust clinical governance is established for Local Services, including clinical supervision systems and processes.

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Other subsections of chapter 12 to support the operation of Local Services include section 12.8, which relates to the risk management. It describes the need for risk management to be embedded in all levels of operations and business processes. 12.9 outlines the requirement for service providers to be compliant with relevant accreditation standards and safety and quality frameworks to ensure consistent delivery of high quality and safe services. 12.10 relates to incident management and reporting. It describes the processes and requirements to be adhered to in reporting consumer related incidents. Section 12.11 relates to feedback and complaints. It outlines the requirements to develop protocols in recording, collecting and reporting all complaints and compliments and how complaints are resolved. 12.12 is about insurance obligations. It stipulates the requirement to have appropriate insurance to cover operational and business risks. Section 12.13 relates to information management. It describes the requirements providers must have established and tested processes and systems to collect, securely store and report consumer and service delivery data for both individual consumer and aggregate levels.

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Chapters 13 to 14. Chapter 13 relates to legislative requirements. It describes the legislative context relevant to Local Services. These chapter includes, section 13.1, which refers to the Mental Health Act. This describes Victoria's Mental Health Act 2014, which currently apply to Local Services. Here it's important to note that at the time of publishing the service framework, which was in early August. The Bill for the new Mental Health and Wellbeing Act had not yet passed through Victorian parliament. You will now likely be aware that the new Mental Health and Wellbeing Bill has passed Parliament, and that was at the end of last month. The new legislation is due to commence in one year. This provides time for the mental health and wellbeing sector to prepare for the changes coming forward in the new Act. Section 13.2. relates to other legislative requirements that Local Services providers are required to adhere to. It is just a list of reference points, and we are aware that there would be other requirements in place that providers would be required to abide by in addition to legislation. Service providers are also required to consider the Fifth National Mental Health and Suicide Prevention plan. Section 13.3 relates to additional policies and procedures. It outlines the requirement for service providers to be compliant with relevant accreditation standards and safety and quality frameworks, as well as guidelines and policies to ensure consistent delivery of high quality and safe services to consumers, their families, carers and supporters. Chapter 14 relates to governance and accountability. It outlines the organisational requirements in terms of what type of entity can operate a Local Service and guidance on governance arrangements.

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Chapters 15 to 16. Chapter 15 relates to data reporting requirements. It describes requirements for data reporting to monitor performance and ensure accountability for delivering tangible outcomes for Local Services, consumers and their families, carers and supporters. This chapter includes section 15.1 which is related to data reporting. This outlines at a high level the data sources that will be used to measure achievements and expectations around frequency of data reporting from Local Services. Section15.2 relates to performance domains. It outlines 6 performance domains within which provider performance will be measured. The domains are consistent with other health performance frameworks. Section 15.3 is related to performance indicators. It describes expectations around development and use of agreed indicators to monitor and manage performance. Chapter 16. Performance monitoring and management. This chapter includes section 16.1 which describes the way in which service performance monitoring will be managed by the department. 16.2 accountabilities and requirements, outlines what providers are accountable for as part of their relevant funding service agreement and how the department will support providers in the delivery of Local Services.

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Chapters 17 and 18. Chapter 17 relates to evaluation. It outlines the department's planned approach to evaluating the impacts and outcomes of Local Services and expectations of providers on involvement in evaluation. Chapter 18 relates to knowledge sharing and learning. It outlines department's role in facilitating collaboration across the broader mental health and wellbeing reform program, to enable continuous improvement and refinement of the service model for Local Services overtime.

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Appendices. Supporting information to the service framework can be found in the appendices. So, Appendix 1 is a glossary of terms. This provides definitions of key terms used throughout the service framework. Appendix 2 outlines consumer support streams. This outlines indicative consumer support streams, typical presentation of an individual, and responsibilities of different levels of the mental health and wellbeing service system. Appendix 3 is about the initial assessment and referral tool. It provides detail on what the IAR tool is and how general practitioners and clinicians can use it. Appendix 4 is the data reporting requirements. It provides further detail on the expectations of what types of data Local Services will collect. Appendix 5. The guiding principles for the Royal Commission into Victoria's Mental Health System. These were outlined in the Royal Commission's interim report. Appendix 6 provides useful resources, links and contact details for further information and support for service providers.

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Now that concludes the overview of the service framework for Local Services. Again, I'd like to reiterate that this framework is an iterative document that will evolve overtime as a service model matures alongside the rollout of other reform initiatives. Thank you for listening and I really hope that this information session was valuable for you all.

Question and Answer

Q: A question about whether or not the slides will be shared.

A: Yes, the slides will be shared. We've recorded this session and we'll share the presentation. We'll place a link and further information on the department's website.

Q: There's a question about how will Local Services act as front doors? Will they provide referrals?

A: Each Local Service will be formally networked to an area mental health and wellbeing service and will provide warm referrals for consumers whose treatment, care and support needs can be better supported by an area service. Local Services will also work with consumers, primary and secondary mental healthcare providers in shared care arrangements where appropriate.

Q: How do the therapies and care provided by Local Services not contradict those from the Area Services?

A: Local Services will not seek to duplicate treatment, care and support a consumer is already receiving from other parts of the system. But rather it seeks to complement them. Local Services will work with Area Services and other levels of the system as needed to ensure continuity of care without duplication.

Q: There is a question about those that are under 26 and what happens for support for them?

A: The Royal Commission recommended Local Adult and Older Adult Mental Health and Wellbeing Services support people aged 26 years and above. The equivalent Local Service for young adults is headspace, however, in line with the philosophy of ‘no wrong door’ if a young person were to access an adult and an older adult Local Service they will be supported to access appropriate services to support their needs.

Q: How will the department consistently manage to ensure the Local Services are seeing the right people and referring on others?

A: We, the department, will be monitoring the delivery of Local Services and evaluating their performance. This will be inclusive of utilising feedback mechanisms such as the YES survey, (Your Experience of Services Survey), to understand how consumers are experiencing the service.

Q: (What is) the difference between services provided by the local layer and those being provided by us in the area layer?

A: So, the core functions delivered between a Local Service and Area Service, as outlined by the Royal Commission, are the same. However, the intensity of need determines which level of the new system will be most appropriate to support a consumer. Some consumers may access complementary supports from different parts of the system at the same time.

Now, I'm sure that there's more questions coming through, but I think that it's really important for me to just take a moment to note that if you do have any further questions that we haven't touched on today, please get in touch with us via that email address: localservices@health.vic.gov.au.

Q: I can see that there's a question about the style guide and the branding and what that means in terms of the department's role in communicating about Local Services and ensuring broad access across the community.

A: It's important to reflect for a moment that Local Services will eventually be available statewide. If you recall, this is going to the government's commitment to the Royal Commission's recommendation that there are 50 to 60 Local Services established across the state. There will be a joint role in communicating Local Services between the department and with Local Service providers themselves. These will evolve over time. But one thing that we are really keen to ensure is that there is consistent experience for people visiting a Local Service. One way to do that is actually by having a consistent name and brand and that's what we're hoping to achieve through this brand and new name as well.

Q: Now. I think that there's also a question coming up about integrated alcohol and other drugs and the integrated care that can be provided.

A: You can also find details in the service framework itself, but there's also the guidelines that were released about the same time as our service framework as well, which can provide more details about the expectations associated with integrated care.

[Addendum: Integrated treatment, care and support for people with co-occurring mental illness and substance use or addiction needs: Guidance for Victorian mental health and wellbeing and alcohol and drug services available at: https://www.health.vic.gov.au/mental-health-reform/recommendation-35]

Q: There is another question which relates to the anticipated length of stay and course of care that underpins the model of care.

A: Keen here to advise that there is no minimum course of care length. It is really dependent on what the needs of the consumer are or what the needs of their family, carers and supporters are. That is, I guess we really want to make sure that there's flexibility to ensure that the consumer's needs are met, whatever they may be. So, for some people that may be, one session, for other people that may be multiple sessions and Local Services that provide really flexible care and make sure that people get this support they need closer to home.

Q: There is question around support services such as the Australian Taxation Office, Centrelink, Tenancy Victoria, etcetera and managing advocacy from multiple layers of the service system and possibly on behalf of the same consumer.

A: There was a chapter which relates to the integrated care and the need for service providers to work with other service system providers. That is certainly our expectation and we'll certainly be providing more support as we can to help ensure that there's seamless pathways in between, different service providers but also different service layers as well.

[Addendum: See sections 3.6 Collaboration in the local delivery environment, 9.8 Care co-ordination and care planning]

Q: Now there is a question about the location and time frame for tendering for the next round of Local Services.

A: As mentioned earlier, this presentation isn't related to that process. Rather this presentation is regards to the service framework. We really wanted to provide you with a walkthrough of all the details of the service framework given that it is such a lengthy and comprehensive document. There will be more information coming soon about the next tranche, and if you haven't done so already, I would highly recommend that you register on the buying for Victoria Tender portal to receive immediate updates. But thank you very much for your interest and we look forward to sharing more information when we can.

Q: Another question has actually been asked saying that they've actually got more questions.

A: So again, really keen for us to be able to provide you with the information that you require. So please get in touch with us at localservices@health.vic.gov.au.

Q: I can see that there's another question about accessing headspace help, especially noting that there's been a lot of this, we all know that there's significant waiting list for these important services, so will the locals be able to support a young person while waiting for a place in headspace? And how long does this support last for?

A: I think I just want to provide assurance that there will be support provided to a young person when they walk through the door. Local Services are to operate by the model of there's no wrong door. And so, I think that there is going to be a bit of a flexibility required and adaptability required by Local Service providers to make sure that every person that walks through the door or contacts them gets the support they require and that includes those that are under 26 years of age.

Q: There is another question here about individual clinicians and mental health workers. How can they collaborate with Local Services?

A: Local Services, as they come online, will engage with service providers in their local communities. This will facilitate share care arrangements and collaboration.

Q: Will the draft performance and outcomes framework be shared?

A: Yes, that's a very good question and I can share that that work is being overseen by our colleagues in the Mental Health and Wellbeing Division. I know that there's consultation that's now opened to provide your feedback on the draft mental health and well-being outcomes performance framework. If you are interested to provide details or provide advice on that, please visit the engage Victoria website for more information. I understand the consultation closes in coming days.

[Addendum: Consultation closed on 2 October 2022, visit https://engage.vic.gov.au/MHW-outcomes-and-performance-framework for more information]

I think we've covered off most of the questions there, but if we haven't been able to answer your question this morning, please contact us at localservices@health.vic.gov.au. Thank you so much again for making the time this morning to dial into this information session. I wish everyone who joined us this morning has a great week ahead and thank you. Thank you very much.