PowerPoint Presentation

Integrating online and offline support through a stepped-care approach in the Western NSW LHD: A pilot project

PresentersDeb Howe (Mental Health Commission of New South Wales)Lorraine Ivancic (ReachOut Australia)

NSW Mental Health Commission

The Mental Health Commission of NSW was established in July 2012 as an independent statutory agency.The Commission is working with Government and the community to secure better mental health for everyone.We are putting people at the centre of mental health reform.

It is the Commissions role to advocate, educate and advise about positive change to policy, practice and systems.We partner with others to develop better approaches to the provision of services, improved community wellbeing and promote their adoption.

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The journey to develop a NSW strategic plan for mental health

The biggest and most immediate piece of work is to date has been the development of a draft Strategic Plan for Mental Health in NSWEngagement with people is at the heart of the Commissions operations. The Commission wanted to be sure that everyone in the community had an opportunity for their views to be heard. This involved numerous public meetings and more targeted engagement Over 2,000 people provided us with their views. This has allowed us to collect the broadest, most representative range of views from the community, mental health workforce and policy specialists who have contributed vast personal and professional experience, It also enabled us to identify and fully understand the gaps and weaknesses of the system, of which there are many.

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Released December 2014

The aim is for all of us to live well, on our terms, in the community.

Living Well: A Strategic Plan for Mental Health in NSW 2014 2024

On 15 December 2014 the NSW Government adoptedLiving Well: A Strategic Plan for Mental Health in NSW 2014-2024, developed by the NSW Mental Health Commission following an unprecedented program of consultation and engagement with Government, mental health professionals and the community, in which more than 2000 people participated.

The Strategic Plan includes 141 actions across seven key directions. 4

The NSW Government today committed to a once-in-a-generation overhaul of mental health care service delivery ... The Government has accepted all actions outlined in the Commissions Plan.

NSW Premier Mike Baird,15 December 2014

A commitment to reform

The NSW Government today committed to a once-in-a-generation overhaul of mental health care service delivery The Government has accepted all actions outlined in the Commission's plan.

15 December 2014 Premier along with Minister for Health and Minister for Mental Health launched the plan in December - coincided with day of the Sydney siege so it did not receive a high profile in the media.

But since the release, it has received wide support from various levels of government, health professionals, and people with lived experience of mental illness and their families, and the general public.

In all actions the Commission expects that people who experience mental illness will be at the centre of reforms in legislation, in service design, delivery and evaluation. The needs of families and those who support them must also be met.

Caring for everyone means we need to ensure these reforms are meaningful for people in rural and regional locations, people from culturally and linguistically diverse backgrounds, LGBTI people, and people with additional health needs or disabilities.

Supporting reform. Our workforce and information systems will need to adapt to the challenge of the change. We will need to ensure the community-managed sector has the resources to take on more of this work. We need to be serious about the challenge of research and knowledge sharing.

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Strengthening prevention and early intervention- a stronger focus on services for children and young people;A greater focus on community based care- phased transition of long-stay psychiatric hospital patients into community care and providing more community based services;Developing a more responsive system- through improved specialist services for people with complex needWorking together to deliver person-centred care- including better integration between mental health services, mainstream health, and justice and human services; Building a better system including by developing the mental health workforce, and investing in research.Once in a Generation

This is a once in a life-time generation opportunity for NSW with the Government accepting all of the actions outlined in the Commission's plan, which includes:

Getting in earlier through mental health promotion, prevention of mental illness and early intervention when someone is becoming unwell.

Making sure people get the services they need to keep them well and avoid crisis. This means making sure hospital beds are available when people need them, but its also about setting up strong community supports so that people who have been living in institutions for many years can instead live as part of the community.

Better responses. The service response cannot be just about the mental health system. We must see integrated and holistic care across sectors.

Making it local by empowering communities to develop their own responses, across agencies. Its also about developing meaningful partnerships with Aboriginal communities

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Better use of technologyProviding the best mental health care in the 21st century means embracing new technologies to help deliver care and to expand access to it.

Providing the best mental health care in the 21st century means embracing new technologies to help deliver care and to expand access to it. It means harnessing new technology to promote self-agency and consumer choice and supporting clinicians and service providers with new tools to improve care, data collection and information sharing.

For people who experience mental illness, online access to care and support has the potential to make a real difference. This is particularly true for people in rural and remote areas and for those who prefer not to use face-to-face professional services for cultural reasons or because of stigma. An overwhelming majority of Australians 86 per cent use the internet, with 44 per cent using it more than five times a day.

Ninety-five per cent of young people use the internet daily.

Young people are not only comfortable with the online world: it is a primary means of communication and a hub through which they plan their lives, connect, contribute, share and interact.

New technologies are transforming health care and the delivery of human services more widely. One recent report suggests at least 8800 extra mental health professionals may be required to meet Australias rising mental health care needs during the next 15 years, resulting in a cumulative cost of $9 billion if we rely on todays methods only to bridge the gap in mental health care.

The availability of new technologies that support consumers in their recovery will allow specialist mental health services to be more focused on people with severe and debilitating illness. In addition, better clinical information systems and decision-making supports will improve the quality of care and open up opportunities for sharing information among service providers to achieve more integrated care. New technologies also provide possibilities for better collection, analysis and sharing of data.

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A rapidly changing landscapeOn-line access to care and support has the potential to make a real difference.

Australia is at the forefront in the development of e-mental health initiatives. For people experiencing distress and mental illness, their families and carers, a growing array of quality online information, forums, support and counselling and self-help tools and apps is available. These include ReachOut.com, eheadspace, myCompass by the Black Dog Institute, Lifeline, Kids Helpline, MindSpot, beyondblue, MoodGYM, e-couch, Beacon 2.0, THIS WAY UP Clinic, to name a few.

While online supports are often discussed in economic terms that is, the lower cost of online delivery the more pertinent point is that many people prefer online information or support because it is convenient, fast and private. Online services provide greater control for individuals than traditional services, can be easier to tailor and can be available at any time anywhere. For many of us, the first port of call for information or reassurance when we have a worry or query is the internet.

Many of us may never go further than the internet to seek care and, for some, online information and support may provide all we need. This is recognized in the NSW Government Information and Communications Technology Strategy which seeks to improve government services through convenient, real-time online-based tools, including mobile devices.

In line with this there are a number of actions in the Strategic Plan which relate to the use of technology. One specifically talks about partnering with Reachout to explore an approach that integrates technology-based services with traditional clinical services in a stepped care framework. Today we will be discussing the Pathways to Mental Health Care in Western NSW project which aims to develop, implement and evaluate a trial to examine a stepped model of care.

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Western NSW LHD

Primary Project AimAim: Develop tool based on stepped care approach that facilitates help seeking in young people in Western LHD

Stepped care model: Most effective but least resource-intensive treatment offered Only step up to more intensive treatment as required

SCM should result in:more targeted service provisionmore efficient help-seeking pathwaysmore appropriate use of health professionals

Can SSCM be incorporated into localised area

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Stakeholder engagementAcceptability of SCMTool developmentTool based on prior work done in partnership with Young and Well CRC , ReachOut.com and Melbourne University Service and support mapping Online service mapping: done in collaboration with service partnersLocal service mapping: local resource in collaboration with Western NSW LHDUser testing Develop and implement targeted marketing campaign Restricted to Western LHD Community outreach, cinema advertising, social media campaigns, collateral to local services

Project Components

- Mapping of online support was done in collaboration with service partners

- Mapping of local services was done by local resource in collaboration with the Western NSW LHD10

Interviews: local service providers and young peopleAcceptability of a stepped care modelUser testing of toolAcceptability of tool developed for this project Google analytics dataHow many people go to landing page, access tool, and what people click on within tool Pre-post survey for tool usersParticipant evaluation of toolImpact on help seeking Community intercept surveyDid young people in targeted community hear about the tool?If so, where from.Data Sources

12 issues:Feeling stressed, anxious, worried or downWorried about drug/alcohol useStressed about body image, food or exerciseThinking about ending your lifeGetting bulliedProblems with people close to youThinking about hurting yourselfDealing with sexuality/genderSexual health issuesWorried about the futureSeeing or hearing strange thingsBeen through something really horrible

ReachOut Next Step: Issues

5 levels of severity:Its a huge dealIts really toughIts a lot to handleIts bad but Im OKIts no big deal

ReachOut Next Step: Severity

Gives localised recommendationSupport nameHow to accessWhat to expect Also gives user other support options for them

ReachOut Next Step: Recommendations

Also gives user other support options for their situation

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Please note that the following slides report on preliminary data.Some slides from the original presentation have been removed, as the data they reported have now been superseded.ReachOut Next Step: Preliminary results

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Interviews: 6 interviews employees from a mix of government and NFP organisationsGenerally impressed with the tool and it had met their expectations

I played with a few different scenarios trying to think of young people that I work with - and it was great.

Tool was better than I expected. It was comprehensive. The options were appropriate. It was clean, the colours were good, It wasnt too busy but not boring. Easy to use. I was very impressed with it.

It gives you the options and information ahead of time. Young people dont want to wait. They want the information when they need it.

ReachOut Next Step Acceptability: Service Providers

How the quiz could be improved:I believe that there is a lot of information on the opening page which would make this difficult to navigate for those with an urgent need to find information, literacy issues or visual perceptual problems.

Possibly more culturally appropriate relevant information and graphics for Aboriginal people. I believe that Aboriginal and Torres Strait Islander and perhaps those from an impoverished background may not engage with the visual display as well.

- Two service providers suggested emergency button needed to be more visible

ReachOut Next Step Acceptability: Service Providers

Full analysis of the dataMeetings with a range of stakeholdersLook for funding opportunities to trial the tool in more communitiesThe commission will continue to explore technology as an option in the service systemNext Steps

Mental Health Commission of New South Walesnswmentalhealthcommission.com.auTwitter: @MHCNSW facebook.com/mhcnswQuestions?