30 May Ms Fionnagh Dougan Health Service Chief Executive Children s Health Queensland Hospital and Health Services PO Box 3474 Brisbane QLD 4101

Transcription

1 30 May 2018 Ms Fionnagh Dougan Health Service Chief Executive Children s Health Queensland Hospital and Health Services PO Box 3474 Brisbane QLD 4101 By to: Jason.beem@health.qld.gov.au Dear Ms Dougan Re: The Queensland Branch of the Royal Australian and New Zealand College of Psychiatrists, RANZCP QLD Branch welcome the opportunity to provide input into the Children s Health and Wellbeing Services Plan The RANZCP QLD Branch consider the development and implementation of early intervention and prevention strategies for the prevention of mental illness in infants, children and adolescents is imperative to addressing adverse outcomes and preventing or reducing mental disorders in adulthood. Queensland s specialist mental health services for infant, children and adolescents are concentrated in South East Queensland and we would like to remind Children s Health Queensland that for individuals outside of this region, being able to access specialist services close to home is important and helps treatment and recovery. RANZCP QLD members provided feedback on mental health services in their area in relation to the External Engagement Pack s discussion questions. These are contained in the document overleaf. If you would like to discuss any of the matters raised in the document, please do not hesitate to contact the Queensland Branch Policy Officer, Bianca Phelan via ranzcp.qld@ranzcp.org or by phone on (07) Yours sincerely Dr Kirsten McMahon Secretary, RANZCP Queensland Branch Dr Laura Hamilton Chair, RANZCP Queensland Faculty of Child and Adolescent Psychiatry PO Box 261, RBH Post Office QLD 4029 Australia T F ranzcp.qld@ranzcp.org ABN

2 Children s Health Queensland Hospital and Health Service May 2018 improve the mental health of communities PO Box 261, RBH Post Office QLD 4029 Australia T F ranzcp.qld@ranzcp.org ABN

3 About the Royal Australian and New Zealand College of Psychiatrists The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is the peak body representing psychiatrists in Australia and New Zealand. Psychiatrists are clinical leaders in the provision of mental health care in the community and use a range of evidence-based treatments to support a person in their journey of recovery. This submission has been prepared in consultation with the RANZCP Queensland Branch (RANZCP QLD Branch) and the Queensland Branch of the Faculty of Child and Adolescent Psychiatry with feedback from RANZCP Queensland members. Introduction The RANZCP QLD Branch is concerned 14% of children and adolescents experience mental health problems (RANZCP, 2010a). We consider the development and implementation of early intervention and prevention strategies for the prevention of mental illness in infants, children and adolescents is imperative to addressing adverse outcomes and preventing or reducing mental disorders in adulthood. Mental health problems during early years can have enduring consequences if left unresolved, not only by placing individuals at increased risk of difficulties in adult life, but also by placing increased pressure on limited community service resources. For more background on the importance of prevention and early intervention of mental illness in infants, children and adolescence, please refer to RANZCP s Position Statement 64: The role of psychiatrists in the prevention and early intervention of mental illness in infants, children and adolescents (2010) and RANZCP s report Prevention and early intervention of mental illness in infants, children and adolescents: Planning strategies for Australia and New Zealand (2010). Discussion Questions 1. What are the main challenges you currently face in the delivery of paediatric services in your area? The RANZCP QLD Branch would like to highlight the following challenges in Queensland: lack of resources for infant, child and youth mental health services, disproportionately impacting areas outside of Brisbane s metropolitan region. In particular, members have pointed to: - a gap in mental health services and programs for children aged less than 5 years - a lack of intensive care services for adolescents with serious and persistent mental illness - a lack of community paediatric developmental clinics for assessment and follow up. lack of support services for children and adolescents with developmental disorders such as Autism Spectrum Disorder (ASD), and those with intellectual impairments or learning disabilities. Clinicians need more expertise and confidence in supporting mental health treatment for these young people, and the current service model does not provide this group with the ongoing care and support required. This group of young people are much more likely to require longer-term support, and developmental paediatrics does not appear to have a model that supports ongoing care. Therefore, this group of patients often end up in long-term Child and Youth Mental Health Service (CYMHS) care. Page 2 of 7

4 at present the disability sector has been impacted by the pending transition to the National Disability Insurance Scheme (NDIS) leading, in some cases, to poor delivery of care for young people with disabilities. This is particularly problematic for young people with disabilities who encounter the youth justice system, as they may not be receiving the required support. confusion regarding who can access public mental health support services. There is difficulty obtaining admissions for more vulnerable children and adolescents, and limited access to a team for the management of complex cases. There is a need for easy referral pathways to public child and adolescent mental health services, especially from private psychiatrists. fragmentation of services, including: - poor integration of the Child Development Program services and general paediatric services - poor coordination of child safety services and residential services - limited communication between child and adolescent psychiatrists and paediatricians - poor continuity of care when a patient is discharged from a public service to a private psychiatrist, for example, discharge summaries may not be provided to the private practice psychiatrist - lack of coordination of perinatal, infant and child mental health services with parenting support from conception to 5 years, particularly for at-risk groups. the education system is not well funded or supported to cater for children with developmental disorders and learning disabilities. It is a challenge to provide adequate care to young adolescents who have disengaged from school and are isolated in the context of their mental health disorders. 2. Which paediatric conditions/specialties have the highest growth in your local area? There are a number of paediatric conditions which RANZCP Queensland members have found to have experienced growth across the state: Attention Deficit Hyperactivity Disorder (ADHD), ASD, ASD-related behavioural disorders, and ASD with comorbidities, especially anxiety and ADHD trauma, including childhood trauma, developmental trauma, and trauma-related disorders self-harm, threatened self-harm, suicidal behaviour, and adolescent mood disorders infant mental health severe and complex mental illness anxiety, including school avoidance and school refusal depression, emerging personality vulnerabilities eating disorders/disordered eating gender dysphoria declines in physical health, including endocrine problems such as diabetes; often related to lifestyle factors such as poor diet, inactivity, and sleep disorders. Page 3 of 7

5 3. What can CHQ do to help build capacity and capability for paediatric services in your local area? To help build capacity and capability for paediatric services in Queensland, CHQ should: Ensure adequate funding for infant, child and adolescent mental health services relative to the proportion of the population experiencing disorders, with a focus on care in the community. Ensure staffing levels of appropriately trained staff are maintained and treatment teams have better support from consultants. Focus on specific prevention and early intervention programs to address key target groups: children with autism spectrum disorders, conduct disorders, anxiety disorders, depressive disorders; children who self-harm or who are at risk of suicide; children with a disability; children of parents with mental illness; children who identify as Lesbian, Gay Bisexual Transgender Intersex; children from a culturally and linguistically diverse background; and Aboriginal and Torres Strait Islander children. Coordinate and integrate care between health and other sectors (including the education sector) to identify high-risk children. Enhance the integration between child and adolescent and adult mental health services to ensure smooth transitions and handover of care. Develop workforce strategies for infant, child and adolescent mental health services to increase the capacity and competence of the workforce to engage in prevention and early intervention work, with a particular focus on rural and remote areas. Enable better liaison, shared care and referral pathways between mental health services, GPs and private practice psychiatrists. Improve access to appropriate public mental health services for families, infants, children and young people. It can be difficult for individuals who are not already clients of CHQ to access mental health services or who are referred by private psychiatrists. Clients may be referred to CYMHS unnecessarily to gain access to these services. Yet CYMHS is intended to care for severe and complex cases, so there is a gap in services for patients with non-severe, non-complex, and comorbid mental health problems. Provide multidisciplinary clinics which deliver child development services and mental health services for ongoing treatment of children and young people with disabilities, as their mental health needs are not being met by current services and service arrangements. Increase mother and infant units throughout the state, to meet demand and enable better access across the state. Better integrate acute care response teams and consultation liaison services for mental health issues, enabling a 24/7 responsive service. 4. What services should CHQ be providing more of in the next 3 5 years? Funding for psychiatric speciality services in regional areas, as families outside South East Queensland are unable or are reluctant to use the Brisbane-based speciality services due to the distance and cost involved to travel, and the separation of children from their family and community. Page 4 of 7

6 Increased resourcing and certainty of funding for mental health services for children and young people, including: - CYMHS to help infants, children and young people who have complex mental health needs - Evolve Therapeutic Services which provide specialist intensive mental health therapeutic interventions for children and young people on interim or finalised child protection orders in outof-home care, with severe and complex mental health support needs - the Assertive Mobile Youth Outreach Service - increases in numbers of acute mental health hospital beds and day program places. Specialist infant, child and adolescent mental health services that are resourced to support complex multi-problem families and are able to integrate and collaborate with other government and nongovernment services. Specialised units for neurodevelopmental disorders, including increased capacity for assessment and baseline testing, as costs for private assessments are often prohibitive to families. General paediatric services need improved capacity to assess and manage comorbid neurodevelopmental and mental health vulnerabilities. There should be more routine mental health screening for children and adolescents in general health-care settings, for example, individuals presenting to Lady Cilento Children s Hospital for medical problems could undergo mental health screening to capture comorbidity problems. CHQ services need stronger links with other stakeholders, such as NDIS and the Department of Child Safety to make systems work as smoothly as possible together. Improved training and professional development opportunities for staff in public mental health services, with an emphasis on supporting children and young people with neurodevelopmental problems, low intellect and/or learning disability. More specialist mother and baby units, including day programs. Programs to assist school reintegration, and better access to day programs for school avoidance and severe anxiety. More state-wide services and support for eating disorder/disordered eating cases. More state-wide services and support for gender dysphoria. Multidisciplinary clinics which deliver child development services and mental health services for ongoing treatment of children and young people with disabilities. 5. What services should CHQ be providing less of in the next 3-5 years? CHQ should not provide less of any of its current services in the next 3 5 years, in particular psychiatric services. Page 5 of 7

7 6. Within each Service Direction (1 5), what are the 3 most important strategies CHQ should drive? The strategies are listed in order of priority, as considered by RANZCP Queensland members. 1. Promoting Wellbeing and Health Equity Focus on improving priority wellbeing areas, including childhood obesity, nutrition, mental health, child safety, and immunisation. Target communities with high needs as determined by population profiles and trends e.g. birth rates and social risk factors. Implement targeted prevention, promotion and protection strategies. 2. Improving Services Design and Integration Develop integrated models of prevention and management, from maternity through to adolescence and adulthood. Ensure continuity of care across service providers, including implementing shared governance and data sharing arrangements where possible. Improve our interfaces with primary care, including referral and discharge management. 3. Evolving Service Models Trial and implement new evidence-based models of service delivery addressing drivers of demand to deliver sustainable solutions. Utilise clinical networks to strengthen partnership, and co-design and implement new networked service models across the state. Develop paediatric state-wide clinical guidelines with endorsement by clinical networks for statewide implementation. 4. Delivering Services Closer to Home Develop and expand specialist service capacity to support whole-system capability and access. Support paediatric workforce capability building through formalised state-wide training and education. Partner with other providers and communities to ensure integration of care and improved outcomes. 5. Pursuing innovation Lead cross sector partnerships to advance activities targeting child and youth wellbeing, underpinned by social determinants of health. Partner with other organisations to drive innovation underpinned by appropriate evaluation and research. Support clinicians to utilise new clinical techniques and technologies. 7. What general feedback do you have on the emerging service directions and strategies? Under emerging service direction number two Improving service design and integration, the strategies should include private mental health services provided by psychologists, psychiatrists, and other private health professionals as service providers, not just those services within the public sector. This will ensure Page 6 of 7

8 proper continuity of care and shared care arrangements for the individual which will aid in their journey to recovery. Closing remarks The proportion of funding allocated to infant, child and adolescent mental health does not match the proportion of the population experiencing problems. Responding to the mental health needs of the community requires adequate levels of services and staff, and a responsive and integrated health workforce that delivers quality and sensitive care. An effective multidisciplinary infant, child and adolescent mental health service includes expertise from a wide range of disciplines including psychiatry, nursing, psychology, social work, speech therapy and occupational therapy. References Royal Australian and New Zealand College of Psychiatrists (2010a) Position Statement 64: The role of psychiatrists in the prevention and early intervention of mental illness in infants, children and adolescents. Available at: (accessed 22 May 2018). Royal Australian and New Zealand College of Psychiatrists (2010) Prevention and early intervention of mental illness in infants, children and adolescents: Planning strategies for Australia and New Zealand. Available at: (accessed 22 May 2018). Page 7 of 7