forensicare – strategic plan 2015-2017 · researchers in forensic mental health and forensic...

FORENSICARE – STRATEGIC PLAN 2015-2017

VisionClinical excellence and translationalresearch enable our consumers to leadfulfilling and meaningful lives in a safercommunity.

MissionWe will provide high quality, specialistclinical services that focus on the recoveryof our consumers, support our workforce,build our translational research capacityand work collaboratively with ourstakeholders to achieve better and saferoutcomes for our consumers and thecommunity.

ValuesResponsiveness, Integrity, Impartiality,Accountability, Respect, Leadership,Human Rights.

Contents

Vision, Mission and Values

Introduction 1

Who We Are and What We Do 2

Our Achievements 2010-2014 4

The Challenges We Face 7

How We Are Going to Succeed in 2015-2017 9

Alignment with the VictorianGovernment’s VHPF Health Priority Areas 12

Service Locations Back Cover

Victorian Institute of Forensic Mental Health

Yarra Bend RoadFairfield 3078

Tel 61 3 9495 9100

Fax 61 3 9495 9190

[email protected]

ABN 32 807 323 885

www.forensicare.vic.gov.au

Introduction

Forensicare has been providing services topeople with a serious mental illness in thecriminal justice system since 1997. Over thistime, we have sought to improve the lives of ourconsumers and to ensure that our serviceswithin the prison system, Thomas EmblingHospital and our community program areequivalent to those provided within the widercommunity.

We are now entering an exciting and challengingtime in mental health in Victoria, and particularlyso in forensic mental health. The introduction ofthe new Mental Health Act 2014 in the middle oflast year and the increasing prisoner populationhave provided us with a challenges andopportunities for ongoing service enhancement.It is within this environment that we havedeveloped our new Strategic Plan to guideForensicare through 2015-2017.

In developing the Strategic Plan we consultedwidely with our stakeholders, seeking input fromgovernment departments, consumers, criminaljustice and mental health agencies, non-government organisations and staff. As weexperienced when we developed our previousStrategic Plan, our stakeholders provided aninsightful assessment of our performance andhow the changing environment is shaping boththeir needs and our service delivery.

The views expressed by our stakeholders led usto critically review our existing Vision andMission. As a result we have developed a newVision and Mission that captures our role as aspecialist and contemporary mental healthprovider. Our Vision emphasises our consumerfocus and our Mission explains that this will beachieved through high quality services,translational research and collaborativerelationships with our stakeholders.

While developing the Strategic Plan we took theopportunity to critically review our progressagainst our former Plan. The changes to ourenvironment and our achievements over the pastfive years are extensive. The focus on recoveryand consumer participation had just started togain momentum in 2010, and it is rewarding tosee just how far we have come in this regard.

We now have in place a robust governanceframework that ensures that Forensicareremains transparent and accountable. We willcontinue to work closely with the Department ofHealth and Human Services and the Department

of Justice and Regulation so that our servicescontinue to reflect Government policies andpractices. In doing so, we will broaden ouroutreach to our stakeholder agencies to supportand promote an understanding of emergingforensic mental health knowledge gained fromour specialist research program.

The challenge facing Forensicare over thecoming three year life of the Strategic Plan ishow to best provide for our increasing consumerbase without compromising our level of care andtreatment. In 2013-2014 we experiencedunprecedented demand for our services acrossthe organisation, and this shows no sign ofabating. This is a troubling reflection of the highlevel of acuity of people in the prison and mentalhealth systems, and the limited capacity ofThomas Embling Hospital to meet the demandfor admissions for people acutely unwell.

While faced with a challenging and rapidlychanging environment, we are proud of ourachievements over the past five years. These arepredominantly due to the enthusiasm of ourconsumers and staff to adopt and embrace newstrategies to improve outcomes for all ourconsumers. This is an ongoing process, and ournew Strategic Plan ensures that these principlesremain at the forefront of our ongoingdevelopment.

The development of this Strategic Plan would nothave been possible without the support andinput from our stakeholders. It is invaluable to begiven the opportunity to listen to ourstakeholders, and we remain grateful to them fortheir time and their willingness to contribute toour forward planning. We look forward tocontinuing our work with all those we consultedover the coming years.

Bill HealyChair, Victorian Institute of Forensic Mental HealthBoard

Tom DaltonCEO

May 2015

1Victorian Institute of Forensic Mental Health Strategic Plan 2015-2017

Tom DaltonCEO

Bill HealyChairVictorian Institute of Forensic Mental Health Board

Forensicare was established in 1997 toprovide forensic mental health servicesin Victoria. These services seek to meetthe needs of mentally disorderedoffenders, the mental health and justicesectors and the community. While theprimary focus is the provision of clinicalservices through a recovery framework,which includes effective assessment,treatment and management of forensicpatients and clients, a comprehensiveresearch program operates and specialisttraining and professional education isprovided for our staff and the broadermental health and criminal justicesectors.

Forensicare is the only agency in Victoriawhose work spans both the mentalhealth and justice sectors, and as aresult, Forensicare has a uniqueperspective on mental health and publicsafety issues.

Forensicare is governed by a Board of upto nine Directors that is accountable tothe Minister for Mental Health. Directorsare appointed by the Governor in Councilfor 3 year terms, on the recommendationof the Minister for Mental Health.

LegislationThe principal legislation under whichForensicare operates is the Mental HealthAct 2014. Sections 328-345 establish theVictorian Institute of Forensic MentalHealth and detail the functions andrequirements of Forensicare and itsBoard. Other key legislation under whichwe operate includes the Crimes (MentalImpairment and Unfitness to be Tried) Act1997, Corrections Act 1986 andSentencing Act 1991.

Our ServicesForensicare has an integrated range ofclinical services for people with a seriousmental illness in the criminal justice andgeneral mental health systems. Forensicarehas a total staffing profile of 449 staff, or397.7 EFT (at 31 March 2015).

Forensicare provides clinical servicesthrough –

Thomas Embling HospitalFunded by the Department of Health andHuman Services we operate a 116 bedsecure hospital, consisting of sevenunits, providing Acute Care andContinuing Care Programs, including adedicated acute Women’s Unit. Patientsare generally admitted to ThomasEmbling Hospital from the criminaljustice system under the Mental HealthAct 2014, Sentencing Act 1991 or theCrimes Mental Impairment (Unfitness tobe Tried) Act 1997.

Prison Mental Health Service Delivered under contract with theDepartment of Justice and Regulation. In the men’s prison system we operate a16-bed Acute Assessment Unit, specialistclinics, outpatient services and areception assessment program atMelbourne Assessment Prison;Psychiatric Registrar Clinics, NursePractitioner Clinics and sessions by a visiting psychiatrist at the MetropolitanRemand Centre, together with a MobileForensic Mental Health Service (which isbased at the Centre); Nurse PractitionerClinics at Ararat and Loddon prisons; andsessions by a visiting psychiatrist atArarat, Barwon, Loddon, Middleton,Marngoneet and Dhurringile prisons.

In the Women’s prison system weoperate a 20-bed residential program inthe Marrmak Unit, intensive outreachprogram and therapeutic day program forwomen at Dame Phyllis Frost Centre andpsychiatrist sessions at Tarrengowerprison.

Community Forensic Mental HealthServiceFunded largely through the Departmentof Health and Human Services weoperate a statewide service, providingassessment and multidisciplinarytreatment to high risk clients referredfrom area mental health services,correctional providers, courts, the AdultParole Board, Thomas Embling Hospital,our prison services, government agenciesand private practitioners.

The programs include –

Community Forensic Mental HealthProgram

Problem Behaviour Program

Court Services Program

Community Integration Program

Non-custodial Supervision OrderConsultation and Liaison Program

Centre for Forensic BehaviouralScienceForensicare’s research program operatesunder the auspice of the Centre forForensic Behavioural Science, a jointventure established with SwinburneUniversity of Technology. The Centrebrings together academics, clinicians andresearchers in forensic mental health andforensic behavioural science research,teaching and practice development. It offers an inter-disciplinary staffingprofile, with representatives frompsychiatry, psychology, social work, law, nursing, occupational therapy andepidemiology.

The Centre focusses on transferringacademic and clinical excellence intopractice in the health, communityservices and criminal justice sectors. The training, consultation and researchundertaken by the Centre havestrengthened the field of forensicbehavioural science, both in Australia and internationally.

Who We Are and What We Do

2

Our CommunityWe provide forensic mental healthservices for people –

with a serious mental illness in thecriminal justice system

at risk of offending who pose a risk to themselves or others

referred from the general mentalhealth system for specialist advice,support and/or treatment.

Forensicare prides itself as anorganisation that provides care andtreatment to a broad range of consumersthat is equal to that provided within thewider community. We provide specialistforensic mental health services that arenot available elsewhere in the state. Ourconsumer base consists of –

prisoners referred for specialistassessment or ongoing care in aprison based residential unit orthrough an outpatient service

people with a serious mental illnesstransiting from the prison system tothe community

remanded or sentenced prisoners whoare transferred to Thomas EmblingHospital from the prison system

people who have had an order madeby a court under the Crimes (MentalImpairment and Unfitness to be Tried)Act 1997

patients admitted to Thomas EmblingHospital for specialist managementfrom other mental health services

people found guilty and referred bycourts for a psychiatric assessment

people receiving care from generalmental health services referred forspecialist assessment and advice

people on Orders referred forassessment or treatment fromCommunity Corrections or the AdultParole Board.

In 2013-2014

6,680 reception assessments conducted at Melbourne Assessment Prison

6,481 outpatient attendences at Melbourne Assessment Prison

115 admissions to Marrmak Unit, Dame Phyllis Frost Centre

93 admissions to the Acute Units at Thomas Embling Hospital

16,189 service hours at Community Forensic Mental Health Service


Our Strategic Plan 2010-2014 provided asound framework for Forensicare tofurther consolidate and develop ourclinical and support services and our rolein the mental health and criminal justicesystems.

The rapid growth of the prison populationin Victoria over the past five years hasimpacted on our ability to achieve someof the goals that we set in 2010, as weadjusted our service priorities to meetthe needs of the new environment. The

foundation laid by the Strategic Planenabled us to respond to these needswhile continuing to achieve the goals set.

Key Achievements from our Strategic Plan 2010-2014ACCESS AND RECOVERY We have -

Participated in the development of the Forensic Mental Health Service Plancommissioned by the Department of Health and Human Services to quantify futuredemand and capacity requirements for forensic mental health services to meet theincreased demand from the mental health and criminal justice systems.

Implemented a new model of care at Thomas Embling Hospital, which incorporates –

recovery integrated into clinical practice

strengthened clinical pathways

increased recognition of the roles of Family and Carer Advocates andConsumer Consultants

therapeutic programs (based on evidence based research) in the identifiedpriority areas – Mental Health Recovery, Dual Diagnosis, Offending andViolence, Occupational Function and Performance

a primary health care service (provided by a specialist General Practitionerand Practice Nurse)

community transition pathways for up to seven Thomas Embling Hospitalpatients at the new Community Recovery Program, Austin Health.

Reduced our rate of seclusion from 15.58 per 1,000 bed days in 2011-2012 to 11.85 in 2013-2014.

Contracted with Justice Health to provide prison based forensic mental healthservices for five years (to 2017) and substantially increased the scope of the servicesprovided.

Established a Nurse Practitioner model in our prison services.

Developed and received validation of a Stalking Risk Profile Tool which has beenadopted internationally.

Implemented organisation-wide –

Disability Access Plan

Aboriginal and Torres Strait Islander Policy and Action Plan

Committed to the introduction of a smoke free policy across all Forensicare sites on 1 July 2015 (consistent with the timeframe adopted by Corrections Victoria).

Our Achievements 2010-2014

4

SUSTAINABILITY We have –Achieved new service provision opportunities –

Appointed the provider of forensic mental health services at the new privateprison at Ravenhall, including 75 mental health beds and a large outpatientprogram (due to be completed in late 2017).

Contracted with the Department of Justice and Regulation to expand ourservice provision in the criminal justice system, including the provision of theMobile Forensic Mental Health Service based at Metropolitan Remand Centreand Suicide and Self Harm Training for prison officers.

Awarded three year contract with the Department of Health and HumanServices to provide assessments of sex offenders in relation to ChildProtection issues (to 2015).

Secured funding contribution for the Problem Behaviour Program work throughCorrections Victoria and mental impairment reports for the Office of PublicProsecutions through Department of Justice and Regulation.

Maintained accreditation by Australian Council on Healthcare Standards, throughorganisation wide survey in 2011 and periodic review in 2013.

Implemented the new Mental Health Act 2014.

Appointed a Clinical Director and Assistant Clinical Director, Prisons.

Established an organisation-wide clinical governance framework, integrating clinicalrisk management and quality improvement, consumer engagement and workforceeffectiveness.

Implemented electronic progress notes across the organisation.

Increased staff training by 55% in the three year period from 2010-2011. Newtraining included –

Short Term Assessment of Risk and Treatability (START) program for nursingstaff (92% trained)

Forensic Risk Assessment and Treatment (FRAT) program for clinical staff onthe Model of Offending

Trauma Informed Care.

Commenced collaborative research projects –

Evaluation of the outcome measures of relevance for offenders with a mentalillness (funded by National Forensic Mental Health Information DevelopmentExpert Advisory Panel - ongoing)

The prevalence of mental illnesses in Victorian prisoners (with the Centre ofForensic Behavioural Science and Justice Health – ongoing).


COLLABORATION AND ENGAGEMENT We have –Worked closely with Swinburne University of Technology to reestablish the Centre for Forensic Behavioural Science at the university with a broader mandate.

Established a successful external training program for stakeholders on forensicmental health issues.

Developed and implemented a Communication Strategy.

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The Challenges We Face

Demand ManagementThere has been considerable change in the mental health and criminal justiceenvironments in the period since our last Strategic Plan was developed.

Increasing demand across the mental health system and the rising use and emergingpresence of a new range of synthetic recreational drugs is having a major impact on allmental health services, particularly with the associated increased potential foraggravated violence.

Across the criminal justice system, the sentencing and parole changes introduced overthe past two years have contributed to a 24% growth in the prison population betweenJanuary 2013 and October 2014.

The impact of these changes continues to be felt across Forensicare, and indeed allmental health services. At Forensicare, the level of acuity and number of peoplerequiring services has grown and the balancing of demand and capacity is set to remaina key challenge over the coming years.

Service Plan for Forensic Mental Health Services – The next stepsIn 2013-2014 the Department of Health and Human Services engaged consultants todevelop a Service Plan for Forensic Mental Health Services in Victoria. Forensicare wasa major contributor to the development of the Service Plan and supports many of itsrecommendations. We will continue to work with the Department of Health and HumanServices to implement those intiatives from the Service Plan which the governmentelects to take forward.

Similarly, in the Department of Justice and Regulation, the Justice Health Branch hasbeen working to develop a roadmap for the future and we will continue to collaborateclosely with them to implement those initiatives which are developed. This will be ofcritical importance in the lead up to the commissioning of the prison to be built atRavenhall and the potential for future commissioning of health and mental healthservices in prisons, where many of the major contracts (including Forensicare’s ServiceAgreement with the Department of Justice and Regulation) expire in 2017.

Innovative model of care Linked to both the increasing prison population and the development of the ServicePlan, is the need to continue to review the model of care at Thomas Embling Hospital toensure that it meets the needs of our consumers. There is no single response to this asit requires us to address patient flow across our prison and inpatient services. Becauseof the length of time that prisoners are required to wait in prison for a bed to becomeavailable at Thomas Embling Hospital, the level of acuity on admission impacts heavilyon flow through, as patients who have experienced a delay in receiving treatment cantake longer to respond when this is able to commence.

The model of care must ensure that any internal blockages that hinder progress throughthe hospital are removed in a way that does not increase risk. The safety of ourconsumers, staff and the community must continue to remain a key element of ourservice. The challenge for Forensicare is to balance risk with a model of care that isagile, dynamic and recovery focussed.

Ravenhall and other service expansionsForensicare’s appointment as the provider of secondary forensic mental health servicesat the new prison to be built at Ravenhall was a major achievement of our previousStrategic Plan. These services will include a 75-bed mental health unit and outpatientservices for approximately 100 prisoners. We are working towards the timeframeannounced by Government that the prison will be completed in late 2017.


This is a major developmental initiative for Forensicare which will demand increasedattention as completion and the prison opening draws near. The immediate challenge weface with this and any service expansion plan is workforce planning and its associatedimplications. Forensicare requires a highly specialised workforce to deliver services, andthis will be the same for the new prison at Ravenhall. We will need to develop a range ofstrategic responses to support the necessary expansion of our workforce in time to meetthe operational deadlines of the prison opening (expected to be late 2017/early 2018) andto ensure that all our staff in all our settings are provided with training and skills toenable them to achieve clinical excellence.

The other workforce issue that requires consideration is the retention of our existingworkforce, which is key to achieving our projected staffing requirements. This can only beachieved by strengthening our existing staff wellbeing and incentive programs andensuring the resilence of our existing workforce. Strategies to address these areas overthe coming three years will need to be continued.

OutreachThe mental health environment has changed considerably over the last five years,becoming broader in scope and complexity. With these changes, our community partnersare requesting greater levels of clinical guidance and support and forensic mental healtheducation, together with research and evaluation opportunities. The clinical support andguidance required is primarily in relation to the management of high-risk and potentiallyviolent consumers, and closer collaboration in the lead up to and following discharge. TheForensic Clinical Specialist Program makes a major contribution to this area, but with onlyten Specialist positions across the state, they all have an enormous task.

It is becoming increasingly apparent that higher levels of community partnering andcollaborative relationships are required if we are to succeed in ensuring that consumersare safely managed in the community wherever possible. There is no sign of this demandabating, and strategies are required to ensure that this area is not neglected over thecoming three years.

ResearchForensicare must continue to use translational research as the foundation for newprograms and services. The recent move of the Centre for Forensic Behavioural Scienceto the Swinburne University of Technology provides an opportunity to strengthen ourresearch capability and partnerships in clinical and non-clinical disciplines withSwinburne and other agencies.

Forensicare and Swinburne share the view that our research program needs to have afocus on participatory research, identifying problems and effective solutions, undertakinghealth-risk appraisals using a bio-psycho social model and expanding into “beyondclinical” research areas. The area of risk will continue to be a focus, together with arobust approach to evaluation.

Strengthening our clinical leadership through the establishment of joint academic andclinical positions and developing new talent will be a key priority in consolidating ourresearch program. This consolidation will be fundamental to equipping Forensicare todeliver best practice programs and services, evaluating our existing programs, andsharing our expertise more widely.

Our IT Network Increased efficiencies in our Information and Communications Technology service deliverymodel are essential if our technology systems are to continue to provide the level ofsupport required by our current and expanding clinical services. Across the life of thisStrategic Plan we must continue to increase our ability to provide staff and consumerswith access to contemporary technology to aid and support recovery and ensure thesustainability of our organisation.8

How We Are Going to Succeed in 2015-2017

Strategic Goals, Objectives and Outcomes

Goal 1Greater accessibility to services

Goal 2Meet new challenges and drive change

Goal 3Innovation in everything we do

Goal 4Outstanding organisational performance


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Goal 1:Greater accessibilityto services

Outcome

Evidence basedforensic mental healthservices are deliveredto a wide range ofconsumers in theforensic mental healtharea

Goals

• Work with Government to achieve its vision for, andimplementation of, Service Plans in the mental healthand prison systems

• Increase early intervention and diversion opportunitiesfor consumers in the courts

• Meet emerging needs of consumers in the mentalhealth and justice systems

• Develop collaborative partnerships with stakeholders tomeet the full range of consumer needs

• Implement agile and dynamic approaches to managingpatient flow and throughput in Thomas EmblingHospital and prison services

• Actively share our knowledge, research findings andexpertise through the mental health and criminal justicesystems

• Advocate for our consumers’ needs.

Goal 2:Meet newchallenges and drive change

Outcome

Forensicareparticipates in theongoing developmentof mental healthservices

• Ravenhall – achieve commissioning of Forensicare’sspecialist mental health services at the prison atRavenhall in time for commercial acceptance

• Ensure the development of a culture of recovery, safetyand quality across all Forensicare services

• Be an authoritative source to Government and otherstakeholders on forensic mental health issues andpolicy

• Actively engage with stakeholders to meet consumerneeds.

Objectives


Goal 3: Innovation ineverything we do

Outcome

Our services are basedon best evidence anddeliver contemporarybest practice to ourconsumers andstakeholders

• Recovery, safety and quality are at the centre of all thatwe do

• Develop models of care that better respond to thebreadth of consumer needs

• There is a place for families and carers in our serviceand their role in recovery is supported

• Build a research program through our partnership withSwinburne University and collaboration with consumersand stakeholders that strengthens clinical practice andincreases knowledge

• Embed a culture of evaluation in existing anddeveloping programs.

Goal 4: Outstandingorganisationalperformance

Outcome

Forensicare isacknowledged as aneffective, innovativeservice that isaccountable,transparent andsupports safety andcontinuousimprovement

• Be an employer of choice, providing a safe and valuedwork environment and be engaged with our staff

• Our technology and E-health environment supports theachievement of our goals and objectives

• Our financial management and organisationalinfrastructure enables sustainability

• A best-practice governance framework supports ourservice and operates across the organisation.

Goals Objectives

Forensicare Strategic Health Priority Area (VHPF)Plan 2015-2017Goals and Objectives

Greater accessibility to services• Work with Government to achieve its

vision for, and implementation of, ServicePlans in the mental health and prisonsystems

• Increase early intervention and diversionopportunities for consumers in the courts

• Meet emerging needs of consumers in the mental health and justice systems

• Develop collaborative partnerships to meet the full range of consumer needs

• Implement agile and dynamic approachesto managing patient flow and throughputin Thomas Embling Hospital to increaseaccess from prisons and the community

• Actively share our knowledge, researchfindings and expertise through the mentalhealth and criminal justice systems

• Advocate for our consumers’needs

Meet new challenges and drivechange• Ravenhall – achieve commissioning of

Forensicare’s specialist mental healthservices at the prison at Ravenhall in timefor commercial acceptance

• Ensure the development of a culture ofrecovery, safety and quality across allForensicare services

• Be an authoritative source to governmentand other stakeholders on forensic mentalhealth issues and policy

• Actively engage with stakeholders to meetconsumer needs

Innovation in everything we do• Recovery, safety and quality are at the

centre of all that we do• Develop models of care that better respond

to the breadth of consumer needs• There is a place for families and carers in

our service and their role in recovery issupported

• Build a research program through ourpartnership with Swinburne University andcollaboration with consumers andstakeholders that strengthens clinicalpractice and increases knowledge

• Embed a culture of evaluation in existing and developing programs

Outstanding organisationalperformance• Be an employer of choice, providing a safe

and valued work environment and beengaged with our staff

• Our technology and E-health environmentsupports the achievement of our goals andobjectives

• Our financial management andorganisational infrastructure enablessustainability

• A best-practice governance frameworksupports our service and operates acrossthe organisation

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Improving everyVictorian’s healthstatus and healthexperiences

Developing asystem that isresponsive topeople’s needs

Expandingservice,

workforce andsystem capacity

Increasing thesystem’s financialsustainability andproductivity

Implementingcontinuousimprovementsand innovation

Increasingaccountabilityand transparency

Utilising e-healthand

communicationstechnology

Alignment with the Victorian Government’s VHPF Health Priority Areas

12

Service Locations

Thomas Embling HospitalYarra Bend RoadFairfield Vic 3078Australia

Tel 61 3 9495 9100Fax 61 3 9495 9199

Community Forensic Mental Health Service505 Hoddle StreetClifton Hill Vic 3068

Tel 61 3 9947 2500Fax 61 3 9947 2599

Forensicare Prison Mental Health ServiceMelbourne Assessment Prison317 Spencer StreetWest Melbourne Vic 3003

Tel 61 3 9321 4250Fax 61 3 9329 4820

Dame Phyllis Frost CentreRiding-Boundary Road Deer Park Vic 3023

Tel 61 3 9217 8400 Fax 61 3 9217 8480

Metropolitan Remand Centre134-154 Middle RoadRavenhall Vic 3023

Tel 61 3 9217 7903Fax 61 3 9217 7920

Email: [email protected]

www.forensicare.vic.gov.au

Metroplitan Remand Centre

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