DR

A
FT
Metro North Mental Health
CLINICAL
SERVICES PLAN
2018–2023
DRAFT FOR CONSULTATION

Note: pictures are indicative and may change.

© 2018 State of Queensland, Metro North Hospital and Health Service

Mental Health Clinical Services Plan 2018–2023 by Metro North Hospital and
Health Service is licensed under a Creative Commons Attribution 3.0 Australia
licence. In essence, you are free to copy, communicate and adapt this report as
long as you attribute the work to the Metro North Hospital and Health Service.

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contact [email protected]

To attribute this material, cite the Metro North Hospital and Health Service
Mental Health Clinical Services Plan 2018–2023.

Public availability
Where possible, readers are encouraged to download the report online at:
www.health.qld.gov.au/metronorth/publications

Where this is not possible, printed copies are available using one of the
contact options below:

Physical address: RBWH, Butterfield Street, Herston Qld 4029

Postal address: Post Office, Herston Qld 4029
General phone: (07) 3646 8111
Office hours: 8am to 5pm, Monday to Friday
General e-mail: [email protected]

Interpreter Services Statement

Metro North Hospital and Health Service is committed to providing
accessible services to the community from culturally and
linguistically diverse backgrounds.

If you have difficulty in understanding this Report, please contact

us on 07 3646 6102 and we will arrange an interpreter to
communicate the report to you effectively.

Version 5 Effective: 05/2017 Review: 05/2018

2 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
 Contents
Foreword – Prof Brett Emmerson............................................................................................................................................................................................................................................. 4

Scope of this Plan.............................................................................................................................................................................................................................................................................................. 5

Part A: The clinical services plan............................................................................................................................................................................................................................................ 6

The care continuum........................................................................................................................................................................................................................................................................................ 8

Why do we need this Plan?............................................................................................................................................................................................................................................................ 10

Focus areas for the next five years..................................................................................................................................................................................................................................13

1 Empowering consumers and clients to live healthy and well...............................................................................................................................15

2 Responsive best practice health care for all people with severe and complex symptoms................................17

3 Responding to unique life stages, cultural needs and circumstances..................................................................................................21

4 Culture, teamwork and leadership....................................................................................................................................................................................................................25

5 Research and innovation...................................................................................................................................................................................................................................................27

Part B – Implementation, monitoring and review.................................................................................................................................................................................. 29

Appendix 1: Metro North HHS Planning Hierarchy ............................................................................................................................................................................ 30

Appendix 2: National, State and Local Policy Context .................................................................................................................................................................31

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 3
 Foreword
Assoc. Prof Brett Emmerson AM
I am pleased to present this There is a commitment from all levels of government
Metro North Mental Health in Australia to transform services to support people
Clinical Services Plan 2018-23 to remain healthy and well in their local community.
(the Plan) for mental health, Preventing mental illness and/or substance use
alcohol and other drugs services across Metro disorders is a national priority. Our commitment to
North Hospital and Health Service (Metro North work with partner organisations, including Brisbane
HHS). This Plan has been developed as a proactive North PHN, to connect and coordinate care for people
response to better manage the demand challenges living with mental illness and/or substance use
faced by our service. It demonstrates Metro North disorders across the care continuum is also described
HHSs commitment to delivering care in line with in this Plan.
the Planning for Wellbeing: A draft regional Plan for
North Brisbane and Moreton Bay focusing on mental Outcomes for the future—our commitment to
health, suicide prevention and alcohol and other consumers and clients
drug treatment services (which will be referred to as Over the next five years, Metro North HHS will continue
‘Planning for Wellbeing’ from this point on). This Plan to enhance our delivery of high quality best practice
has also been informed by, and describes, Metro care and strengthen the connectivity, integration and
North HHS’s commitment to deliver on ‘Connecting coordination between services and service settings
care to recovery 2016-2021’ and the national policies; in Brisbane North. Working collaboratively with our
‘The Fifth National Mental Health and Suicide partners, we will ensure that all consumers, clients,
Prevention Plan, The National Drug Strategy 2017- families, carers and support networks have access to
2026 and The National Alcohol Strategy 2018-2026.’ the care and support they require.
Informed by a comprehensive assessment of health Our commitment to enable and deliver individually
need, current and future service activity, literature, tailored care across all services delivered by Metro
targeted consultation with Metro North HHS staff and North HHS continues. We drive a recovery orientated
consumer and community partner input including service system where there is no wrong door for
Brisbane North PHN. This comprehensive Plan will people living with mental illness and substance use
guide Metro North HHS mental health and alcohol disorders. Care in all of our services is:
and other drug services over the next five years, with • free from stigma and discrimination
a ten year outlook. • empowering people to be in charge of their own
We recognise the diverse health needs of the recovery with treatment and supports that are
catchment populations cared for by our mental health responsive to what people need
and alcohol and other drug services, and the need to • tailored to the needs of the individual, holistically
deliver different models of care that are tailored to considering physical, mental health and substance
individual needs. use disorder care needs together with cultural,
spiritual, linguistic, sexual/gender and social
With a focus on health and recovery rather than determinants of health
illness, this Plan includes actions to improve the
• evidence based with a focus on quality and safety
care for all people (adults and children) who access
services in Metro North HHS who are experiencing • connected with people having access to the right
symptoms of: services and supports at the right time and in the
right place
• severe and complex mental illness
• enabling the least restrictive treatment and
• substance use disorders
environment
• suicide ideation
• integrated and coordinated with people able to
• dual diagnosis i.e. substance use disorders and transition seamlessly across different services and
mental illness; and/or supports as their needs change
• physical health conditions together with mental • informed by people who have experience being
illness and/or substance use disorders. cared for in our services and translated to all
I am committed to implementing the actions levels of policy, planning, delivery and evaluation
identified in this Plan over the next five years noting • delivered by highly skilled staff committed to
some actions requiring additional resources will be quality and safe care.
subject to normal budgetary processes.

4 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
Scope of this Plan
What is the scope of this Plan? service improvements for people living with mental
illness and/or substance use disorders over the next
The scope of this Plan includes current and future
five years.
mental health and alcohol and drug services
for children, youth and adults across the care Part B: Implementation, monitoring and review –
continuum. The focus of the Plan and the associated details the implementation, monitoring and review
actions are for services delivered by Metro North process that will be implemented on approval of this
HHS in our facilities. Planning for services provided Plan.
by private hospitals, non-government organisations,
The Plan has been informed by, and will enable,
and service delivery in the primary and community
Metro North HHS to deliver key actions contained
service settings (not provided by Metro North HHS)
in the Health Service Strategy together with
are not considered in scope for the Plan, however,
contributing to delivery of Metro North HHS Strategic
the interdependencies between such services are
Plan (see Appendix 1 for planning hierarchy in
considered.
Metro North HHS). The Plan also describes Metro
How to read this Plan North HHS’s commitment to delivering on the key
objectives of the Planning for Wellbeing.
The Plan has been prepared in two parts:
Many actions in the Plan will be achieved by doing
Part A: The clinical services plan – provides an things differently within existing resources. Some
overview of the policy context, current service actions will require resources to progress. It is
arrangements, a review of the population and health important to recognise that mental health and
status of people living with mental illness and/or alcohol and other drug services operate within a
substance use disorders and residing in Brisbane health service system with competing needs and
North together with a summary of the issues and finite resources and that allocation of new resources
challenges facing the current service environment. required to progress the actions will be subject to
Building on this context five focus areas and normal budgetary processes.
supporting actions are described that will guide

Terminology used in this Plan

For the purpose of this Plan the following terminology is used. Metro North HHS recognises this terminology
may not be consistent with other policy or planning documents.

Terminology Description
Metro North HHS Metro North Hospital and Health Service.
Metro North Mental Health (MNMH) Includes all mental health and alcohol and other drugs services
provided by Metro North HHS.
Brisbane North The geographical area in which Metro North HHS, Brisbane North
PHN and other service providers deliver care.
Hospital catchment area The geographical area in which each Metro North HHS hospital
delivers care.
Consumer Refers to a person who accesses services for treatment and support
for their mental illness.
Client Refers to a person who accesses services for treatment and support
of their substance use disorder or substance misuse behaviours.

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 5
Part A: The clinical services plan
Metro North HHS delivers a comprehensive range All five public hospitals – Royal Brisbane and
of public mental health and alcohol and other drug Women’s Hospital (RBWH), The Prince Charles
services that support people who have severe and Hospital (TPCH), Caboolture Hospital, Redcliffe
complex care needs or are in crisis. Our services Hospital and Kilcoy Hospital provide emergency
deliver care to a local catchment, a regional response assessment in a crisis situation and
catchment including neighbouring HHSs and a are linked to specialist mental health and alcohol
state-wide catchment for complex and specialised and other drugs services for assessment and
services. The local catchment of Metro North HHS is care. Dedicated mental health inpatient services
one of the most populous catchments in Queensland are at the RBWH, TPCH and Caboolture Hospital.
with a population of over 980,000 in 2016. The Dedicated alcohol and other drug inpatient services
catchment is projected to grow by almost 15 per cent are at the RBWH.
by the year 2026 to approximately 1.2 million people.
Across all of these facilities there are 340 inpatient
Metro North HHS includes urban and regional areas
beds comprising of 186 acute adult, 10 sub-acute,12
crossing the local government areas of Brisbane City
adolescent, 40 Secure Mental Health Rehabilitation
Council northern suburbs, the entire Moreton Bay
(SMHRU), 60 Community Care Unit (CCU), 16 long
Regional Council area and parts of Somerset Regional
stay nursing home psycho-geriatric and 16 state-wide
Council – Kilcoy.
alcohol and drug detoxification beds.
Care is delivered to people of all ages in the
Metro North HHS is also the host site to a range of
community, in the hospital and in specialist
services provided to a state-wide catchment for both
accommodation settings. The services for people
mental health and alcohol and other drug services.
experiencing mental illness include a range of
These state-wide catchment services operate in both
specialist assessment, treatment, rehabilitation
the hospital and community setting.
and recovery services that also consist
of emergency, consultation liaison,
forensic, substance use disorders, eating
disorders, community mental health
and inner city homeless services. For
people experiencing substance use
disorders, we provide evidence based
treatments including opioid maintenance,
substance withdrawal management,
and counselling. For people experiencing
substance misuse issues, we provide
a range of harm minimisation and brief
intervention services.
MNMH services deliver care to children in
the northern part of the Brisbane North.
Children who live in the southern end of
the catchment who require services
Caboolture
are cared for by Children’s Health Hospital
Queensland (CHQ) HHS.
Community services are delivered
from facilities located in Brisbane
City, Fortitude Valley, Herston, Redcliffe
Hospital
Nundah, Chermside, Strathpine, Brighton Health Campus
Caboolture and Redcliffe with
outreach services to Kilcoy. The Prince
Royal Brisbane Charles Hospital
and Women’s
Hospital

6
Figure 1: Metro North HHS Mental Health Directorate Service System

COMMUNITY COMMUNITY SUPPORT HOSPITAL BED-BASED COMMUNITY

TREATMENT SERVICES SERVICES SERVICES BED-BASED SERVICES
SERVICES
MENTAL HEALTH MENTAL HEALTH MENTAL HEALTH MENTAL HEALTH
RBWH/TPCH Seven community mental RBWH RBWH
health support services PEC– 4 beds Community Care Unit
Acute Care Teams provided funded by Department
Adolescent MHU – 12 beds – 20 beds
Continuing Care Teams of Health to deliver recovery
Mobile Intensive Rehabilitation Teams oriented and consumer focused Adult MHU – 60 beds
services. A range of specialist Older persons–10 beds TPCH
Early Psychosis Service services are also delivered in
Consultation Liaison Service Community Care Unit
CYMHS (provided by CHQ) the community through non- – 20 beds
Older Persons MH Teams government organisations.
TPCH
Caboolture/Redcliffe Hospital Nundah House
Adult MHU – 50 beds – 10 beds(TPCH and RBWH
Acute Care Team
Older persons–10 beds catchments)
Continuing Care Teams
Consultation Liaison Service
Mobile Intensive Rehabilitation Team
SMHRU – 20 beds (TPCH and Caboolture/Redcliffe
CYMHS (provided by MNMH) RBWH catchments) Hospital
Older Persons MH Team Community Care Unit
Metro North Caboolture Hospital – 20 beds
Perinatal Mental Health Service Adult MHUs – 37 beds
MH Call Older persons – 10 beds
Homeless Health Outreach Team Consultation Liaison Service
(delivered to an inner city catchment) SMHRU – 19 beds (shared
with Sunshine Coast HHS

ALCOHOL AND OTHER DRUGS ALCOHOL AND OTHER DRUGS ALCOHOL AND ALCOHOL AND
Biala Acute Care Service Services to support individuals OTHER DRUGS OTHER DRUGS
Roma Street Clinic and families in the community Drug & Alcohol Brief Bed-based services in
including early intervention, Intervention Team (RBWH) the community including
Needle and Syringe Programs harm reduction, information
Consultation Liaison Service withdrawal management,
Melaleuca and Chermside and education and peer pre and post treatment
– (all hospitals)
Allied Health Service support programs delivered support. This is primarily
Biala and Youth Allied Health Service across providers, settings delivered by non-government
and modalities A range of specialist alcohol organisations
Redcliffe/Caboolture Allied Health Service
and other drug treatments
Redcliffe/Caboolture are also delivered in the
withdrawal management community through non-
Opioid Replacement Therapy Program government organisations
Queensland Magistrates Early Referral into
Treatment (QMERIT) Program
Brisbane City Watch House AOD Consult
Liaison Service

STATE-WIDE STATE-WIDE STATE-WIDE

CATCHMENT SERVICES CATCHMENT SERVICES CATCHMENT SERVICES
Queensland Forensic Mental Health Queensland Health Victim Hospital Alcohol and Drug
Service Support Service Service (HADS) – 16 beds
Queensland Eating Disorder Service Alcohol and Drug Information (RBWH)
Service Queensland Eating Disorder
Insight Training and Education Service – 5 beds (RBWH)
Dovetail – Youth alcohol and
drug training and education

Note: Child and Youth Mental Health Service (CYMHS), Secure Mental Health Rehabilitation Unit (SMHRU), Mental Health (MH), Mental Health Unit (MHU),
Children’s Health Queensland (CHQ), Psychiatric Emergency Care Centre (PEC).
Note: MNHHS has a community bed-based psycho-geriatric service (16 beds) however this is not governed by MNMH
Source: Adapted from Connecting Care to Recovery 2016-2021

Metro North Hospital and Health Service | Health Service Strategy 2015–20: 2017 Refresh 7
The care continuum
MNMH is one of many service providers who deliver 6. People living with severe mental illness/
care and support for people who experience mental substance use disorder/ physical illness – People
illness and substance use disorders. Building on the are diagnosed with a problem or illness which
stepped care approach described in the Planning for is very disruptive to daily life, wellbeing and
Wellbeing the following care continuum describes functioning. The problem or illness may also
the care system across Brisbane North. It recognises include risks to personal safety and is considered
people will move across the care continuum as their to be either persistent or episodic. This may also
care needs change. include increased complexity due to comorbid
physical health conditions.
The care system across Metro North HHS geographic
area includes: 7. People living with severe and complex mental
illness/ substance use disorder/ physical illness
1. Keeping healthy and reducing harm – The whole
– People are diagnosed with a problem or illness
population can benefit from being physically and
which is severe in its impact on wellbeing and
mentally healthy throughout their lives
functioning and which brings with it additional
2. Community and family support – Family, friends complexities such as difficulties with housing,
and peers form natural support networks in the employment, social connectivity and daily living.
community and those providing support may have This may also include increased complexity due to
their own support needs. comorbid physical health conditions.
3. Early intervention for people at risk – People with 8. People presenting in a crisis situation – This
signs of distress, including from life events such group includes people with or without a
as a relationship breakup or job loss, may be at diagnosed problem or illness who are in crisis and
increased risk if support isn’t provided early. who require immediate assistance. These crises
4. People living with mild mental illness/ substance may have occurred as a result of self-destructive
use disorder – People are diagnosed with a behaviour, suicidal behaviour, and/or harm to
problem or illness that impacts on wellbeing and themselves or others.
functioning to a level that is concerning but not Figure 2 represents the majority of service types
overwhelming and is often less than 12 months that people with a mental illness and/or substance
duration. use disorders may need access to across the care
5. People living with moderate mental illness/ continuum. Services that are considered to be
substance use disorder – People are diagnosed MNMH’s core business have been identified in blue.
with a moderate problem or illness which causes
significant disruption to daily life, wellbeing
and functioning and can be of over a 12 month
duration.

8
Figure 2: The Brisbane North care continuum for people with mental illness and/or substance use disorders
(adapted from Planning for Wellbeing)

Note: Planning for Wellbeing: A draft regional Plan for North Brisbane and Moreton Bay focusing on mental health,
suicide prevention and alcohol and other drug treatment service describe actions for the areas shaded in light green

Metro North Hospital and Health Service | Health Service Strategy 2015–20: 2017 Refresh 9
 Why do we need this Plan?
The mental health and alcohol and other drug across hospital catchment areas. Parts of Metro
services service system is rapidly evolving, and North HHS have higher levels of socio-economic
whilst Metro North HHS continually strives to deliver disadvantage, higher rates of risky lifestyle
excellent care, we face a number of challenges over behaviours and have a higher rate of physical
the next five years. How we deliver our services in comorbidities. Further to this, more people are living
the future will be impacted by: with co-occurring mental illness and substance use
disorders. Evidence identifies poor physical health,
Consumer, client, carer and together with prolonged severe and complex mental
family expectations illness and/or substance use disorders, results in
poorer health outcomes with people dying much
Increasingly, consumers and clients expect to
earlier than people without a mental illness and/or
receive more timely and individualised care.
substance use disorder.
Consumers, clients, carers and family generally
want to be more informed and involved in the Growing and ageing population (local,
management of their own care. People in our care
more than ever before have access to information
regional and statewide) increasing demand
about themselves and their illness and now have for services
higher expectations including what is reasonable in Metro North HHS currently has a population of over
terms of access, safety and outcomes. We recognise 980,000 people. By 2026, our local population
families and carers are often the mainstay of care is anticipated to grow to over 1.2 million. This
for many people living with mental illness and/ population growth will not be equally distributed,
or substance use disorders. Taking note of what with a high population growth expected in the
matters to consumers, clients, families and carers older ages and in the northern part of Metro North
and responding to holistic care requirements must HHS around Caboolture and Redcliffe Hospitals.
be a central focus in how we deliver our care. Metro North HHS also delivers services to regional
and statewide catchments for complex specialist
Attitudes towards providing health care for services. Approximately 20 per cent of consumers
people living with mental illness and/or and clients cared for in Metro North HHS hospitals
substance use disorders reside in other HHSs and, as a result, are referred
from outside Metro North HHS. Population growth
Whilst public attitudes towards people living with
and ageing will continue to drive increases in service
mental illness and/or substance use disorders are
demand into the future.
beginning to change, the stigma associated with
such a diagnosis can affect the quality of care Increasing complexity of care requirements
people receive. Metro North HHS clinicians are
increasingly in contact with people who are living Across Metro North HHS, admissions to inpatient
with mental illness and/or substance use disorders, care are increasing. The number of people being
however many clinicians have not had appropriate cared for on a Treatment Authority is increasing. The
education or training to deliver optimal care to number of people being cared for with comorbid
meet consumer’s, client’s and carer’s needs. This health conditions is increasing. Providing safe,
sometimes results in barriers to care and consumer effective, evidence based and least restrictive care
and client recovery. It also marginalises and for people with severe and complex mental illness
disempowers people who are already vulnerable. and/or substance use disorders is challenging,
particularly within outdated infrastructure at some
Increasing numbers of people living with sites in Metro North HHS. Outdated infrastructure,
poor physical health, mental illness and/or together with increasing complexity of care, makes
substance use disorders maintaining safety for consumers, clients and
staff difficult.
The physical health status and burden of disease
of Metro North HHS residents varies significantly

10 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
Changing policy environment Service system integration
Mental health and alcohol and other drug services and coordination
are operating within a complex and changing Across Metro North HHS, access to services, models
policy environment. There is a current priority and of care and workforce skillsets are inconsistent.
commitment at all levels of government to create Services are largely organised based on a historical
an integrated and functioning service system that approach to delivering care rather than a HHS-wide
enables timely support to the multiple issues faced health needs basis, making integration difficult and
by people living with mental illness and substance creating access and workload variations between
use disorders. National strategies and policies services. The lack of integration between services,
drive for system wide improvement, that reduces both within MNMH and across the broader HHS,
harms associated with substance use, keep people together with the broader services system, results
well, reduce service fragmentation and provide in a risk of poorer health outcomes and fragmented
timely services in the least restrictive environment. care for already vulnerable consumers, clients,
Nationally the policy environment includes two carers and families.
distinct strategies targeting mental illness and
suicide prevention and substance misuse. These The capability of our staff
policy directions have informed this Plan and are
Metro North HHS staff are highly capable and
summarised in Appendix 2.
committed to delivering excellent care, however
The introduction of the National Mental Health caring for people with mental illness and/or
Service Planning Framework (NMHSPF) further substance use disorders can be challenging. We
contributes to the National policy environment. The must support our staff to enhance and grow their
NMHSPF is a strategic planning tool designed to skills to provide responsive recovery focused care to
project resources required for mental health services our diverse community. Enabling all staff to receive
with the appropriate level and mix of services across appropriate, timely and tailored education and
the care continuum to meet population needs. For training (appropriate to their position) in caring for
Metro North HHS, the tool primarily identifies the people living with mental illness and/or substance
need to strengthen ambulatory and community use disorders is required. All staff will understand
based services. Metro North HHSs commitment to delivering care to
achieve the outcomes described earlier. We value
Evolving service system our specialist mental health and alcohol and other
Metro North HHS recognises over the next five years drug workforce.
the service system that supports people with mental
illness and/or substance use disorders will change.
There will be greater emphasis on keeping people
healthy and well and providing early intervention
and support in the community. Resources will be
invested towards this approach aiming to improve
health outcomes, care for people in the community
and reduce demand on inpatient service provision.
Slowing demand is complex and will not be a
quick fix. We recognise as services delivered in
the community grow, aimed at keeping people
healthy, providing early and timely intervention
and treatment, Metro North HHS services will need
to evolve.

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 11
Key facts for Brisbane North

15 .5% 5 %
50 %

ALMOST
of adults
consume
alcohol at high
risk levels
of adults have a long
of people term health condition
use illicit
drugs

Of mental health and substance use related admissions

88 6 .7%
.8% older people

4
(65+)

.5%
adults children (0–17)
(2016/17)

Population of Mental health and substance use related

4
more than presentations to Metro North HHS EDs increased by

980,000
20 %
of QLD
.2%
per annum
(2016)

29
(2014/15-2016/17)

In 2016
,466 20 .7%
per annum increase
in admissions relating
to mental health and
people who live in Brisbane North accessed substance use
treatment for severe mental illness (2014/15-2016/17)
Focus areas for the
next five years
Over the next five years Metro North HHS will and equitable high quality care across the HHS.
enhance delivery of timely, high quality, tailored Service system capacity will also grow to better
and recovery focused care that is free from stigma meet demand including new and expanded child
for all people living with a mental illness and/or and adolescent services in the northern corridor,
substance use disorders across our health service increased step up and step down services across
system. We will empower clients and consumers to Metro North HHS, expanded community based
communicate what is important to them. Our care alcohol and drug services, enhanced alcohol
will be respectful and responsive to what matters and drug consultation liaison services and
to individuals designing recovery journeys inclusive establishment of new evidence based models
of mental health, physical health, social, emotional of care. This networked approach will improve
and spiritual care needs. Families and carers will access to care and support people to transition
be recognised as having a key role in supporting between services to recover in the least restrictive
consumer and client care. environment, with the least restrictive treatment.
We have heard from many of our staff across Metro MNMH will be responsive to changes in the
North HHS that caring for people with mental illness community service sector. We will continue
and/or substance use disorders can be challenging. to partner with the Brisbane North PHN and
Growing all staffs awareness and confidence to care services provided by private, non-government
for people with a mental illness and/or substance and community agencies across Brisbane North.
use disorder will be a focus across the HHS. We Working in partnership with these agencies we
will continue to foster a culture of high quality and will work to deliver joined up care and the shared
safe care, holistic care, respect and dignity for objectives described in Planning for Wellbeing.
consumers, clients, families and carers as well as
This Plan describes five focus areas for Metro
our staff. Improving the consumer, client, families
North HHS. Each focus area describes actions to
and carers experience of care in Metro North HHS is
be progressed over the next five years. Each area is
a priority.
interconnected and we will need to balance efforts
MNMH will champion and promote excellent to ensure our resources align with our focus areas.
high quality evidence based care for people with Each focus area describes actions which we deliver
severe and complex mental illness and substance and quality service standards for which we will
use disorders across the HHS. Within MNMH, the monitor our progress towards achieving the focus
networked and coordinated service system will are as over the life of the Plan.
continue to be enhanced to promote consistent

Figure 3: MNMH Focus areas

for the next five year
R ES

EMPOWERING CONSUMERS
HIP

AND CLIENTS TO LIVE RESPONSIVE

EAR
MW O R K , L E A D E R S

HEALTHY AND WELL BEST PRACTICE

CARE FOR PEOPLE
CH AND I NOVATION

with severe and

– SELF
GP -
complex symptoms of:
– mental illness
PPORT –

CA

– suicidal ideation
RE – FAM

– substance use disorder

– comorbid health
SU

conditions
– state-wide services
, TEA

ILY
– PEER
RE
LTU
CU

RESPONDING TO UNIQUE LIFE

STAGES, CULTURAL NEEDS
AND CIRCUMSTANCES

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 13
1 Empowering consumers
and clients to live healthy
and well
Metro North HHS recognises health and wellbeing What we will do:
is a complex combination of a person’s physical,
• Educate and empower consumers, clients,
mental, emotional, social, cultural, spiritual and
families and carers to actively contribute to
environmental health factors. For people with assessment and care plans to ensure they reflect
mental illness and substance use disorders, living their goals of care, treatment and recovery.
healthy and well often requires support from a These will be reviewed regularly and shared (as
range of service providers across health, housing, appropriate) with other service providers across
education, employment and social services. the care continuum.
Consumer and clients who have complex health
and social needs, and require multiple agencies to • Advance evidence based recovery models of care
in MNMH that incorporate excellent mental health
work together to support them to remain healthy
and substance disorder care together with care
and well, are challenged to navigate the service
that focuses on individual health, social, cultural,
system. We commit to working in partnership
spiritual wellbeing needs.
with consumers, clients, families and carers to
navigate the service system and empowering • With consumers, clients, families and carers,
them to actively participate in all aspects of their develop and/or review resources available to
recovery journey. inform consumers, clients, families and carers of
mix and breadth of community support services
Metro North HHS supports the current policy available to support holistic care.
agenda to enhance and grow community support
services to enable people with a mental illness • Recognise, promote and support the important
role of families and carers in providing care to
and/or a substance use disorder to live healthy
people with mental illness and/or substance
and well in the community. As the community
use disorders.
services system evolves, MNMH will review and,
as required, reorientate our care to complement • Actively partner with Brisbane North PHN
rather than duplicate care. We will forge strong and partners to advance actions contained in
links with partners building a culture of trust and Planning for Wellbeing.
respect between clinicians and organisations. • Improve health literacy of consumers, clients,
families and carers through:
– promotion of the My Mental Health portal
– working with partner agencies regarding online
content and potential links to MNMH services
– education and information regarding common
care pathways across care continuum, care
approaches and escalation pathways
– continuing to develop/enhance information,
education and training tailored to needs
of people from Aboriginal and Torres Strait
Islander and culturally and linguistically diverse
(CALD) communities
– identifying opportunities to be involved in co
designing care.

14 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
• Enhance information sharing and minimise Brisbane North regarding best practice care of
the need for consumers and clients to repeat people with mental illness and/or substance use
information by: disorders.
– contributing to the development of electronic • Monitor the introduction of the National Disability
shared care records that can be accessed by Insurance Scheme to ensure Metro North HHS
the HHS, primary health care practitioners residents are supported in line with care needs.
and non-government services whilst ensuring • Advocate to, and where possible collaborate
people’s privacy with, the broader human services sector to
– improving the compilation and sharing of Police improve access to other social determinant
and Ambulance Intervention Plans and Acute services that support consumers and clients to
Management Plans remain living healthy and well in the community.
• Where appropriate, investigate the potential for
– improving the rate of discharge summaries
joint commissioning of services with primary
completed within 48 hours.
care providers.
• Further develop Memorandum of Understanding • Continue to implement consumer and client
(MOU) partnerships with NGO providers satisfaction surveys across settings to evaluate
to enhance community based access, care services provided. Feedback is collated and
coordination and avoid service duplication. reported on with the aim of improving services.
• Enhance opportunities for shared education and
training with MNMH, MNHHS staff, primary care What we will measure:
and community based service providers across TO BE COMPLETED

DESIGNED BY JAVI_INDY / FREEPIK

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 15
2 Responsive best practice
health care for all people with
severe and complex symptoms
As a specialist care provider for severe and complex What we will do:
mental illness and substance use disorders, MNMH
• Establish step up step down services for adults in
is committed to providing evidence based best
the Redcliffe/Caboolture Hospitals catchment and
practice care that is responsive to the holistic care
the RBWH hospital catchment.
needs of all consumers and clients. Acknowledging
we have a solid foundation within our service • Review the distribution of current resources across
system, more can be done to maximise efficiency MNMH in line with the National Mental Health
and clinical effectiveness and ensure responsive Service Planning Framework. Based on outputs,
best practice care is accessible by all. reorientate resources as required and/or advocate
for additional resources to support growth in
While it is critical that mental health and alcohol and ambulatory and community care.
other drug services are integrated, Metro North HHS
also acknowledges the distinct differences between • Enhance the capacity of the MNMH Early Psychosis
them in regards to consumer and client needs and Service to deliver care to people who live in the
strategic directions. Redcliffe/Caboolture Hospitals catchment area.

For the purpose of this plan actions have been • Review, and where appropriate, realign the Acute
themed as follows: Care Team geographical catchment areas to
better align with the Metro North HHS hospital
• mental illness catchment areas.
• suicidal ideation • Grow capacity of acute home based care across
• substance use disorders Brisbane North as part of the Acute Care Team model
of service.
• comorbid health conditions
• Standardise formal handover processes between
• statewide services hosted by Metro North. emergency department services, inpatient services
and community teams both within catchment areas
Mental illness and across MNMH.
A recovery focused approach to care for people • Advance the peer support workforce for consumers,
living with mental illness in line with the national clients, families and carers through:
and state agenda will drive MNMH service
– defining roles and responsibilities
improvement over the next five years. MNMH will
enhance the level and mix of mental health services – expanding capacity across MNMH
that are provided in the least restrictive environment – contributing to planning, service development,
and that support active recovery in the community. education and training programs.
This will be achieved by enhancing service capacity
• For all Emergency Departments supported by an
and where appropriate, reorientating services to
Acute Care Team establish and document agreed
maximise efficiency and enable a community first
and standardised processes to improve quality of
response culture. Further, MNMH will ensure that all
care and system efficiency when caring for people
models of care are best practice and appropriately
who present to the Emergency Department with
match the local health and treatment needs of
mental illness. This will include:
the population. All services will aim to support
people to recover and transition to live well in – care pathways inclusive of roles and
the community. responsibilities of MNMH and Emergency
Department staff, noting components of care will
be tailored for each Emergency Department
– a referral process for mental health assessment by
the Acute Care Team

16 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
 – communication of mental health assessment Suicidal ideation
outcomes. This should include a record in the
As recognised in Planning for Wellbeing suicide
Emergency Department Information System
prevention is complex and requires an integrated
(EDIS) and Consumer Integrated Mental Health
system wide approach. Metro North HHSs priority
Application (CIMHA) at TPCH and investigation of
is to improve identification, assessment and
system solutions at other facilities.
follow up care for people in a suicidal crisis. We
• Explore alternate models of care in Emergency recognise our care must be tailored and responsive
Departments to assist in triage, referral and to meet the needs of vulnerable population groups
management of people with a mental illness. including adolescents, Aboriginal and Torres Strait
• Advance multidisciplinary best practice models Islanders, LGBTI, men, older people and perinatal
of care on an extended hours basis to deliver and postnatal women. We will actively collaborate
therapeutic programs of care that minimise and with our partners to enhance access to high quality
prevent seclusion and restraint of people in our care. evidence-based care.

• Establish regular information and education What we will do:

sessions for new clinical staff to understand
• Across Metro North HHS we will:
Emergency Department and Acute Care Team
care pathways inclusive of agreed roles – strengthen staff confidence and competence
and responsibilities. to identify, screen, assess and manage
suicide risk through participation in
• Improve access, care and transition through
statewide education and training.
mental health services for Lesbian, Gay, Bisexual,
Transgender and/or Intersex (LGBTI) people – comply with clinical guidelines/processes
who require acute care in both community and for engaging with, and responding to,
hospital settings. consumers and clients presenting with
• Develop, document and implement models of care suicide risks.
to support consumers and clients with intellectual – strengthen partnerships with NGOs to
disabilities and a mental illness. improve referral and effective follow up for
• Improve implementation of, and standardise, people who are at risk of or have attempted
existing models of care relating to the management suicide.
of consumers and clients with eating disorders. – advance models of care to enable assertive
• Continue to collaborate with the Brisbane North outreach for people discharged from
PHN and NGO partners to develop a whole of Emergency Departments and inpatient units.
system approach to caring for people with a mental • Identify and rectify risks within facilities to
illness including transition from hospital to the strengthen safety and mitigate risks related to
community based service provision to enable suicide and self-harming behaviour.
timely and appropriate patient flow and prevent
unnecessary readmissions. • Implement suicide prevention initiatives such
as the ‘Zero Suicide Project’ in the Redcliffe
• Enhance the consistency, credibility and and Caboolture Hospital catchment area.
transparency of mental health information
collection and management by: • Engage in suicide prevention research that
contributes to a stronger evidence base to
– ensuring that all data custodians have the drive continuous improvement in policy,
adequate skillsets and access to education, practice and service delivery.
training and support
– facilitate the migration of CIMHA and Alcohol, Substance use disorders
Tobacco and Other Drug Information System
(ATOD-IS) systems. Metro North HHS has a proud history delivering
excellent high quality alcohol and other drug
• Continue to explore opportunities to collaborate
services. Our commitment to minimising
with Community, Indigenous and Subacute
harm for people experiencing substance use
Services (CISS) to support the sub-acute needs of
disorders in Metro North HHS will be advanced
older persons, persons with challenging behaviours
through actively driving evidence based service
and Aboriginal and Torres Strait Islander people.
improvements across the HHS and the State.
• Promote a quality improvement service We will continue to work in partnership with
environment that continues to provide safe, high other government, non-government and human
quality care in line with the National Standards in service agencies.
Mental Health Service Accreditation process.

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 17
 What we will do: • Enhance the consistency, credibility and
transparency of information collection and
• Review models of care to deliver integrated management by:
multidisciplinary care plans to match the holistic
needs of the client. – ensuring that all data custodians have the
adequate skillsets and access to education,
• Investigate options to increase the Alcohol and training and support
Other Drug Consultation Liaison service to enable
coverage seven days a week from 7 am to 7pm – facilitate the migration of Alcohol, Tobacco amd
with sustainable and appropriate workforce at other Drug Information System (ATOD-IS) and
TPCH, Redcliffe and Caboolture Hospital. Consumer Integrated Mental Health Application
(CIMHA) systems.
• To enable succession planning, promote
Alcohol and Other Drug Consultation Liaison Comorbid conditions
services to senior clinical staff as a professional
development program. For consumers and clients presenting with comorbid
conditions, care will be integrated and conditions
• Investigate opportunities to expand the Drug and
will be treated together rather than in isolation.
Alcohol Brief Intervention Team (DABIT) model
Establishing new models of care and implementing
of care across all sites in Metro North HHS in line
co-response care pathways will ensure that
with growth and demand.
consumers and clients not only receive best practice
• Develop a model of care that acknowledges and care but also that care is provided within an optimal
responds to best practice care for drug induced time and in a care setting that is appropriate to
psychosis consumers and clients presenting to their needs.
Emergency Departments.
People presenting with comorbid conditions include:
• Review the current distribution of alcohol and
drug disorder services across Metro North HHS • co-occurring mental and physical illness
geographic area to better align resources with • co-occurring substance use disorders and
local health needs. physical illness
• co-occurring substance use disorders and
mental illness.

18 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
What we will do: • Review service activity demand for Queensland
Health Victim Support Service and explore
• Promote and increase the utilisation of the MNMH
need for additional resources.
Dual Diagnosis Guidelines.
• Investigate new models of care to better support • Continue to develop effective partnerships with
people presenting to the Emergency Department key government and non-government agencies
with physical illness, mental illness and/or in the justice, health, mental health, forensic
substance use disorders. mental health and victim services sectors to
provide early and coordinated services for
• Expand mental health and alcohol and other drug
consumers and clients
consultation liaison services to improve holistic
care for consumers and clients admitted to general • Support innovative approaches that contribute
medical wards. to the longer term wellbeing of victims, their
• Improve care for people with mental illness and families and others who have been harmed.
substance use disorders through:
• Grow statewide eating disorder services
– integration of alcohol and other drug treatment in governed by Queensland Eating Disorder
routine mental health case management Services (QuEDS) by establishing services in
– enhancing the capacity and confidence of mental the Sunshine Coast and Northern Queensland
health clinical staff in delivering alcohol and other in line service demand.
drug treatment through education and training
• Develop, endorse and implement assessment
and expert telephone support by alcohol and
and treatment guidelines for community
other drug treatment services.
clinicians, in partnership with the State-wide
– enhancing the capacity and confidence of alcohol Eating Disorder Advisory Group.
and other drug treatment staff in delivering
mental health care through education and • Collaborate with research institutes to progress
training and expert telephone support by mental research trials specific to eating disorders.
health services. • Expand capacity of Forensic Mental Health
• Develop agreed guidelines to assist with Service including Court Liaison Services and
collaborative care between mental health and Community Forensic Outreach Services to
alcohol and other drug services including internal deliver efficient high quality services in line
handover pathways and escalation processes. with population need.

• Enhance and expand Indigenous Mental

Statewide services hosted by
Health Intervention Programme provided by
Metro North HHS the Forensic Mental Health Service to further
Metro North HHS is the host site for several statewide advance evidence base for culturally capable
services. MNMH will continue to support and service delivery.
advocate for these to meet the growing statewide
demand for evidence based speciality care for people • Establish and grow a Forensic Mental Health
experiencing severe, complex and crisis situations Research in partnership with the Queensland
due to mental illness and/or substance use disorders. Forensic Mental Health Service and the
In line with the MNHHS direction this will include Queensland Centre for Mental Health Research
continual service improvement and provision of best (QCMHR).
practice care. What we will measure:
What we will do: TO BE COMPLETED
• Expand the specialist statewide Alcohol and Drug
Clinical Advisory Service (ADCAS) which is currently
provided from 8am to 11pm. This service will be
expanded to deliver clinical advice regarding the
management of clients with alcohol and drug
concerns 24/7.
• Work with Queensland Health Victim Support
Service to capture service activity information
and use it to improve communication with HHSs
regarding awareness of the services, the services
provided in their areas and how to refer people to
the support service.

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 19
3 Responding to unique life
stages, cultural needs
and circumstances
The ability of our service to respond to all people • Work with The Queensland Centre for Perinatal
including those with unique needs will be improved and Infant Mental Health to deliver evidence
through the provision of care that is timely, based care that provides services for families
targeted, accessible and coordinated. This focus that are in need of infant mental health care.
area aims to improve care and inclusiveness of
our diverse community. We understand that Young people
people from all life stages, cultural backgrounds
and circumstances that access our services will Supporting child and youth mental health and
have different expectations of our services. By wellness, including physical, cognitive, social
identifying the unique needs of these groups and and emotional development, is critical to achieve
customising our service responses we will strive to benefits into adulthood. Providing children and
improve the overall mental health and wellbeing of young people aged 0-18 with timely high quality
vulnerable groups. holistic specialist assessment, treatment and
management has the potential to create long
We also recognise the interdependency between term benefits. We will actively work with families
health of these vulnerable groups and the social and carers, together with education, social and
determinates of health including social connectivity, justice services, to support integrated innovative
access to housing, employment, education and approaches to care. Supporting young people as
finance. Many of these vulnerable groups are also they transition into adulthood is also a priority.
marginalised in one or more of the determinants
of health. For this reason many of the actions will What we will do:
only be successful if delivered in partnership with • Confirm and document roles, responsibilities and
consumers, clients, families, carers and the broader referral arrangements for child and youth mental
services system. health services delivered across Metro North HHS
by Children’s Health Queensland and Metro North
Mothers, infants and families HHS to improve service integration.
Perinatal and infant mental health goes hand in • Increase child and adolescent community based
hand and can be described as the mental health early assessment, identification and support
and emotional wellbeing of women, their infants, for young people with a mental illness, alcohol
partners and families. The relationship between and drug addiction in Redcliffe and Caboolture
a parent and their infant is of key importance to Hospital catchments.
perinatal and infant mental health.
• Improve collaboration between child and youth
What we will do: mental health services and general practice to
develop integrated care pathways that improve
• Build the capacity of primary care and non-
referral and discharge continuity of care for
government providers through Metro North HHS
children and young people with a mental illness.
led education and training.
• Plan and develop community residential service
• Establish formal referral pathways to improve
(including Step Up Step Down) for young people
the connectivity for consumers and clients
with a mental illness in Caboolture catchment.
transitioning in and out of our services.
• In partnership with the Brisbane North PHN
• Expand the capacity of the perinatal specialist
advocate and support community providers
community team.
to deliver care to young people across Metro
• Investigate the establishment of a regional North HHS.
mother and baby mental health inpatient unit in
Metro North HHS.

20 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
• In collaboration with Children’s Health Queensland When older people do require care, we will
and all appropriate MNHHS representatives, undertake comprehensive and evidence based
establish clinical guidelines for mental health screening, assessment, early intervention and
and alcohol and other drug care for adolescents discharge planning, commencing from time of
including age ranges, care requirements, admission, aiming to prevent functional decline
responsibilities location of care. and loss of independence following an illness and
• Develop agreed protocols and referral pathways hospitalisation. We will actively work with older
within Metro North HHS for young people receiving people, carers and family to enable people to
mental health care from child and youth mental return home as soon as clinically appropriate with
health services to transition to continuing care community service support if required.
within the adult mental health system.
• Enhance youth alcohol and drug services by
increased capacity to provide mobile, assertive What we will do:
outreach. • Develop and implement an integrated, evidence-
based model for screening, assessing, managing
Older people and supporting older people with mental illness by:
Mental illness, including depression and anxiety, is – implementing an agreed screening tool to
often poorly recognised in older people. We know enable early diagnosis, timely and appropriate
that many older people with mental illness are management
often admitted to hospital because of challenges
– developing a risk management approach for the
in providing care in the community that, if provided
detection of older people at suicide risk.
early, can reduce the need for hospital care. Building
on the joint commitment between the Brisbane North • Develop and implement a training program that
PHN and Metro North HHS outlined in ‘A five year educates clinicians and service providers on best
health care plan for older people who live in Brisbane practice approaches to care for older people who
North’, over the next five years we will work in have mental illness.
partnership with primary health, residential services • Develop an integrated model of care for
and community organisations to support optimal assessment, management and accommodation for
care for older people in the community. A recovery older people with mental illness (psychogeriatric)
approach to care will be a focus, which will include with complex behavioural needs with the aim
working together across sectors such as health, of optimising function and prepare consumer
social, housing, income support to deliver care when and clients for transition to an appropriate
needed. Delivering care in the most appropriate and accommodation option.
least restrictive care setting will be a priority.

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 21
 • Improve access to alcohol and other drug People involved with the criminal
consultation liaison services for older people justice system
admitted to hospital who also have alcohol and/
or substance addiction. When compared to the general population,
people in contact with the criminal justice system,
• In collaboration with CISS, obtain funding for and including those in correctional facilities and people
develop an evidence based model of care to meet transitioning back into the community have higher
the subacute needs of psychogeriatric consumers prevalence rates of mental illness, substance use
and clients as well as consumers and clients with disorders and are at an increased risk of suicide or
challenging behaviours. self-harming behaviour. We will continue to work
collaboratively with our partners in the criminal
Cultural diversity justice system to provide appropriate best practice
Metro North HHS is home to diverse communities. care to this population.
We will work to:
What we will do:
• Enhance our capacity and capability to be leaders
• In partnership with the Department of Corrective
in delivering respectful, tailored, holistic and
Services and in line with increasing demand
appropriate services in the community and
continue to expand the opioid treatment program
hospital settings will continue. Working together
(OTP) for individuals transitioning through
with consumers and clients, peak bodies and
correctional facilities. This will include advocating
partners, we will develop innovative solutions to
for appropriate resourcing growth and the
deliver responsive services.
establishment of joint governance to support and
What we will do: oversee the program.

• Early engagement with family to make decisions, • Work in partnership with other government
plan care and better address any specific needs agencies (including, but not limited to, housing,
that may arise from diversity, cultural values and corrections and social services) to develop
beliefs about health and illness in the consumers a holistic individual approach to support
and client’s care. consumers and clients transitioning from
correction facilities into the community.
• Review and as required update/develop
models of care tailored to the needs of specific • Continue to enhance workforce safety by
communities in partnership with peak bodies, developing their capability in clinical risk
consumer and client advisory groups and assessment and management for consumers and
consumers and clients. clients with offending related risks.

• Provide appropriate information to Aboriginal and What we will measure:

Torres Strait Islander people and CALD consumers
• TO BE COMPLETED
and clients and carers in their preferred language.
• Involve key support organisations as requested
by consumers and clients and families through
their care journey, including discharge planning to
enable timely referral to community support.
• Educate front line service staff regarding
resources available to assist diverse consumers
and clients who may not reach the threshold
for acute mental health services, but who
would benefit from support and linkage to
other services.

• Enhance culturally capable service delivery by

increasing the number of Aboriginal and Torres
Strait Islander workers within MNMH services.

22 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
4 Culture, teamwork
and leadership
Guided by the Metro North HHS leadership team our • Actively work in partnership with Metro North
care across our HHS will be delivered by a workforce HHS Streams and Directorates to deliver excellent
who treat consumers and clients living with mental high quality care for people with mental illness
illness and substance disorders with dignity, and/or substance use disorders.
compassion and respect; who treat their colleagues • Advance the MNMH Clinical Practice Improvement
and partner organisations with respect to foster Committee group to:
teamwork; and who is well supported to effectively
provide best practice care through improved – review and approve all proposed new evidence
education, training, safety and quality programs. based projects, models of care and service
improvements
MNMH will actively drive this culture through the
Directorate recognising and rewarding staff who – lead a review of all current projects within
display the values of Metro North HHS. Through our the Directorate to determine alignment with
culture, teamwork and leadership, we will attract, evidence based best practice
develop and retain a workforce with the necessary – based on outcomes of the review consider
attitudes, knowledge and skills to support consumers disinvestment of project where current
and clients and then, families and carers throughout evidence based best practice is not identified
their recovery.
– Monitor implementation of projects to
What we will do: ensure value based outcomes for clients
and consumers.
• Work with Metro North HHS leadership team to
advance information and education for all staff • Improve safety for consumers, clients, their
to feel comfortable and competent in caring for families and carers, as well as our staff, through
people with mental illness and substance use active promotion and consistency of safe and
disorders. respectful environments, care, procedures
• MNMH leadership will drive a one team culture and processes.
across the Directorate promoting the outcomes • Improve the capacity of safety and quality roles
described in this Plan. across facilities for both mental health and
• Value and respect the health and wellbeing of our alcohol and other drug services.
staff through access to support services and tools • Improve MNMH orientation training for mental
to develop self-care plans, maintain wellbeing, health and alcohol and other drug staff
identify signs of difficulty to build a resilient by enhancing:
workforce. – consumer, client and carer lived experience/
• Develop and implement a MNMH reward and recovery stories
recognition program that encourages positive
– staff experiences of working in a recovery
workplace cultures and acknowledges the value of
framework
staff and teams within MNMH.
– a MNMH culture that values and respects all
• Review, audit and document staff compliance
services and colleagues
with education and training standards relating to
service specific core competencies for all mental – presentations by local primary care and
health and alcohol and other drug staff. NGO providers
• In partnership with MNMH staff, identify and What we will measure:
explore service models that more effectively utilise
the expertise and scope of both clinical and non- • TO BE COMPLETED
clinical staff.
• Enhance the peer workforce and empower this
workforce to share their lived experiences across
Metro North HHS services and settings.
Metro North Hospital and Health Service | Mental Health Clinical Services Plan 23
5 Research and innovation
Metro North HHS has a strong culture of research – increase the number of research
and evidence based health improvement. MNMH will programmes across MNHHS facilities
continue to embrace this strong culture and strive to
– increase consumer and client access to
embed it as the foundation of the service to ensure
innovative care and treatment options
consumers and clients have the best access to
innovative therapies and advanced health services. – utilise clinical research to inform MNMH
models of care and service models.
With a consumer and client centred approach MNMH
will not only build its capacity to undertake high • Collaborate with education bodies to:
quality research that will translate to enhanced
consumer and client outcomes but also engage – develop mental health and alcohol and
with the academic industry to nurture the clinical other drug specific nursing and allied health
workforce and advocate for greater expertise in qualifications
mental health and substance misuse issues. – increase student placement programs and
graduate programs
What we will do:
– encourage student placement within one
• Develop a MNMH research strategy with a
organisation throughout the duration of the
5 year outlook.
education period
• Establish a HHS wide mental health and alcohol
– promote MNMH as a career of choice to
and other drugs research registration database to
students and new graduates.
enhance information sharing, developing linkages,
preventing duplication and promoting awareness • In partnership with Genetics Health
of current research activities. Queensland, explore opportunities
• Establish a research governance structure that to establish joint clinics and provide
enables both local facility and MNMH wide psychology/psychiatric support for
research decision making and facilitation. genetic councillors.
• Develop a research mentoring program across What we will measure:
MNMH that:
TO BE COMPLETED
– provides guidance and advice to develop
research ideas or questions, methodologies,
grant proposals, available funding opportunities,
ethics applications etc. in both individual and
group meetings
– develops tools that assist, support and
encourage staff to participate in research
– promotes collaboration and provides links to
enable staff to engage with and contribute to
other research project
– supports staff in the management of research
and workplace commitments, including access to
information regarding working arrangements and
scholarship opportunities.

• Actively promote current research through

presentations at local, national and
international levels.
• Actively partner with research bodies to:

24 24 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
Part B: Implementation,
monitoring and review
Implementation Resource implication
Implementation of the Plan will be led by MNMH The process of planning did consider resource
in a staged process to allow ongoing refinement implications of the strategy. Service actions were
over the next five years. At the local level the Plan prioritised based on available information regarding
will guide the health service priorities of MNMH the ability to resource or negotiate for resources
program areas and will be integrated into their local for actions and prioritised service needs. Service
operational plans. development will require resourcing over time
through organisational budgetary processes.
The MNMH Leadership Team will oversee the
implementation process. Monitoring, reporting and review
All local plans relating to health services should Monitoring, evaluating, reporting and reviewing
align with the service directions and service implementation of the Plan, including reporting on
objectives in the Plan. For the actions, each program progress towards achieving the identified objectives
lead nominated as responsible is required to lead will be coordinated by MNMH.
the action in the timeframe proposed.
Given the rapid change and growth in health
The Plan will also assist MNMH to establish a needs the Plan will be monitored and reported
platform for discussion and negotiation with on an annual basis (end of financial year) in
Metro North HHS and other agencies around line with operational plan reporting. These
particular issues. processes will allow changes in direction during
the implementation of the Plan to ensure ongoing
Risks to successful implementation
relevance and provide information upon which
The success of the Plan relies on each responsible future service planning may be based. This will
party determining an approach to implementing the also allow the findings and recommendations of
actions aligned with the focus areas. The key risks of statewide planning frameworks currently under
not achieving the actions include: development to be considered and actions updated
• inability to accurately inform service enablers, as required.
including infrastructure, workforce, support
services
• insufficient future resources allocated to deliver
actions resulting in inability to meet health
service demand at Metro North HHS
• information technology requirements
• inability to plan the allocation of future resources
in MNMH.

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 25
 Appendix 1 Metro North HHS Planning Hierarchy

The MNHHS Strategic Plan describes Metro North HHS vision, purpose and service objectives. The Health Services
Strategy describes four focus areas which reinforce MNHHS commitment to providing high quality care centred
around individual need and preferences. This Mental Health Clinical Services Plan 2018-23 will assist in delivering
key actions contained in the Health Service Strategy together with contributing to delivery of MNHHS Strategic Plan.
The relationship and cascade of strategic documents and health service plans is described below.

Hospital and health

service strategic plan

Strategy
Putting people first Strategy
Introduction Putting people first: the organisational frame
The Putting people first Strategy enables all our hospitals
Patients and the Communi
and services to improve the patient experience, support and ty

develop staff and work with partners to better connect care Metro North Hospita
and improve health outcomes. l and
Hea
lth
Se
rvi
ce
Oral Health
With a strong focus on improving systems, better engaging rge
ry
Su
our people, and enabling a positive culture, the strategy Cri
tic
al
supports us to:
Ca
re
ing

S Re
CIS dc
ag

lif
l Im

f
• partner with our patients to provide high quality health
eH
ica

os
Med

Med

care;
pit
al

icine

• enable, support and professionally develop our staff; and

Services

• engage with our partners to improve the patient experience.

H os a n d
p i ta l s

Menta
TPCH

coy ture
ity

tie
Pa

un
This is done through an interconnected organisational frame nts
and the Co m m
Kilabool

l He

that embraces the diversity, traditions, histories and identities

Wo

altn
C
m

of our local facilities, services and streams, and unifies us

en
’s

under the identity of Metro North Hospital and Health Service.

an
d

hi R BW H
C

ld e
re r
n ’s r Ca
ce
Can
The Strategy is led by the Metro North Hospital and Health Heart
and Lung
Service Chief Executive and Executive. It is a living document
and ongoing engagement with staff will continue to identify Me
tro N
orth H ce
ospital and Health Servi
initiatives to bring it to life.
Patie
nts and the mmunity
Co

Putting people first: the strategy

MNHHS VISION
MNHHS VALUES
OUR VISION AND VALUES Changing the face of health care through compassion,
Respect, Teamwork, Compassion, High performance, Integrity
commitment, innovation and connection

OUR ROLE AND POSITION Putting people first – Support and enable our people to lead and deliver excellent patient-centred care and high quality services

OUR PATIENTS OUR PEOPLE OUR PARTNERS

OUR PROMISE To partner with our patients to provide To enable, support and professionally To engage with our partners to improve
high quality health care develop our people the patient experience

We embrace the diversity of our facilities and services and recognise this is reflective of the communites they serve

OUR DIVERSITY Caboolture & Kilcoy Hospitals Redcliffe Hospital CISS TPCH RBWH

Through Clinical Streams and Directorates, we will strive to ensure our patients have equity of access, outcomes and experience

SYSTEMS ENGAGEMENT CULTURE

We enable active patient participation in health We foster a culture where people develop pride in
We engage with patients, their families and
OUR PATIENTS care by providing up to date systems and integrated their local facility and health services
carers, and the community
processes that deliver patient-centred care

We enable employees by providing up to date systems

consistent with the delivery of patient-centred care, We engage, reward, recognise, and We foster a culture that attracts people and where
OUR PEOPLE opportunities in career progression and learning and consult our staff people have pride in their role at MNHHS
professional development

We enable meaningful partner participation by We engage our partners to improve the We foster a culture of partnership to better
OUR PARTNERS providing integrated systems and processes patient experience deliver patient-centred care

The strategy is approved and progress reviewed by the Board

OUR GOVERNANCE
The strategy is led, implemented, performance monitored and escalated by the Chief Executive and Executive

Health Safety and Research Putting Clinical Consumer

services quality people first engagement engagement

Health service plans

Palliative Care Cancer Care Rehabilitation Older Person’s Children’s Plan Facility plans Mental Health

Other plans

Data ICT Workforce Allied Health Operational

management

26 Metro North Hospital and Health Service | Mental Health Clinical Services Plan
Appendix 2 National, State and Local Policy Context

The policy direction seen in the figure below have shaped and informed this plan. By cascading these policy
directions, the principles and actions are translated into the business of MNMH services. The figure below
identified national, state and local policies that have informed this plan.

NATIONAL POLICY
Priority Areas Strategic Principles
1. Achieving integrated regional planning and service delivery 1. Promote the mental health and
2. Suicide prevention well-being of the Australian
3. Coordinating treatment and supports for people with severe and community
complex mental illness 2. Reduce the impact of mental
4. Improving Aboriginal and Torres Strait Islander mental health and health problems and mental
suicide prevention illness
5. Improving the physical health of people living with mental illness 3. Promote recovery from mental
and reducing early mortality health problems and mental
6. Reducing stigma and discrimination illness
7. Making safety and quality central to mental health service delivery 4. Promote recovery from mental
8. Ensuring that the enablers of effective system performance and health problems and mental
system improvement are in place illness

1. Demand reduction 1. Partnership

2. Supply reduction 2. Coordination and collaboration
3. Harm reduction 3. National direction, jurisdictional
implementation
4. Evidence-informed responses

STATE POLICY
Priority Areas Strategic Principles
1. Better service 1. Person centred
2. Better prevention and early intervention 2. Shared responsibility
3. Better engagement and collaboration 3. Rights and dignity
4. Better transparency and accountability 4. Quality of life
5. Responsive and effective
6. Diversity and respect
7. Fair, accessibly and equitable

1. Access to appropriate services as close to home as practicable 1. Person centred

and at the optimal time 2. Shared responsibility
2. Workforce development and optimisation of skills and scope 3. Rights and dignity
3. Better use of ICT to enhance clinical practice information sharing, 4. Quality of life
data collection and performance reporting 5. Responsive and effective
4. Early identification and intervention in response to suicide risk 6. Diversity and respect
5. Strengthening patients’ rights Mental Health Act 2016 7. Fair, accessibly and equitable

1. LOCAL POLICY
Priority Areas Strategic Principles
1. Be leaders in delivering evidence based quality care to people 1. Always put people first
with mental illness and/or alcohol and other drug dependence 2. Improve health equity access,
2. Increase access to recovery focused mental health and alcohol quality, safety and health
and drug services available in Metro North HHS outcomes
3. Elevate the focus on physical health, psychological and social 3. Deliver value based health
wellbeing to support consumers and carers in their recovery services through a culture of
journey research, education, learning
4. Work with partners to increase and facilitate access to a broader and innovation
range of whole of life services, including community based
alternatives to hospital admission and provision of meaningful
vocational opportunities

Metro North Hospital and Health Service | Mental Health Clinical Services Plan 27
www.health.qld.gov.au/metronorth