The Integrated Atlas of Psychosocial Care in the Western Sydney Primary Health Network Region

Abstract

The Australian mental health system has undergone profound change in recent years, both at national and regional level. Key reforms include the establishment of Primary Health Networks (PHNs) in 2014 to act in a commissioning role to improve regional co-ordination of health care; as well as the late inclusion of mental health into the progressive rollout out of the National Disability Insurance Scheme (NDIS). These changes have arisen in the context of a system described in a national review in 2014 as siloed and fragmented, with people unable to consistently access the appropriate level of support for their need (National Mental Health Commission, 2014). In its response to these and other challenges in the system, The Fifth National Mental Health and Suicide Prevention Plan (Commonwealth of Australia, 2017) has prioritised a person centred approach based on integrated regional planning and a stepped care model of service availability. In the complex mental healthcare landscape, PHNs, working in the space between policy makers and service providers, are well positioned to take a key role in the implementation of this vision. An important part of their role in this is the development of regional plans, key to which is the mapping of current service levels and workforce.

Integrated Atlases of Mental Health have already mapped and documented 20 PHN regions in Australia, including the Western Sydney region in 2014 (Salvador-Carulla et al., 2016), using the Description and Evaluation of Services and Directories for Long Term Care (DESDE- LTC) to provide a snapshot of service provision (Fernandez et al., 2015). The use of a standardised tool enables comparison, both with other jurisdictions and in the same jurisdiction over time. This second Atlas of the Western Sydney Primary Health Network (WSPHN) region will provide a picture of current psychosocial service provision in Western Sydney, as well as a comparison to that provided in 2014 in the first Integrated Mental Health Atlas of Western Sydney. It is the first in Australia to provide an analysis of the evolution of a system over time, and is particularly relevant given the period of intense change since the first Atlas in 2014. While this Atlas is focussed on psychosocial services, excluding care provided by the public health sector, this type of care and the Non- Government Organisation (NGO) sector as a whole is in the frontline of the impact of system reform.

Data collection for this atlas was from January 16 to April 30, 2019. Twenty-two services were interviewed, providing a total of 69 teams and 81 Main Types of Care (MTC). In addition, we identified 13 satellites or secondary sites where teams were providing care, bringing the total number of MTC in the region to 98. This can be compared to our findings in 2014 of 22 services providing 40 teams and 42 MTCs. This increase in availability, however, is evident in the number but not the diversity, of types of care available.

As anticipated, we have found evidence of significant and sometimes unexpected change in the system. Our main findings are an almost threefold increase in the availability of psychosocial services, and a trend towards more health related than social care. We found increased system complexity and fragility, with the presence of a number of satellite teams in the region being a pattern more characteristic of rural areas, and in fact not previously identified in urban region such as this; and with almost half of services lacking funding stability for more than 12 months. We found increases in availability of care for most population groups and in all branches of care, but particularly so in the areas of the Transition to Adulthood age group, services for Culturally and Linguistically Diverse (CALD) communities, and non- mobile health related Outpatient care. With a population younger than the national average and a relatively high rate of people in the region born overseas, services for these populations have been identified as priority areas for mental health care by the PHN (WentWest, 2018). The increase in overall availability appears to be partly attributable to the increased presence Integrated Atlas of Psychosocial Care in the WSPHN region 2019 of larger national organisations in the region, with new providers moving in and current providers increasing their service provision. Interestingly, despite this, we found no significant change in the number of smaller service providers in the region. On the other hand, similar to the previous Atlas, we found gaps in the provision of Daycare, particularly health related Day care, Residential care and Outpatient social care. We also identified gaps in some of the other priority areas identified by the PHN, namely those for the Lesbian, Gay, Bisexual, Transgender, Intersex and Queer (LGBTIQ) population, for older people and for people with mental illness experiencing homelessness.

Taken together, the information in this atlas can be used to provide an insight into the evolution of the mental health system during a time of great change. It provides one measure of the extent and direction of the change being experienced in a complex mental health care landscape.