Prior to the Commission of Inquiry into the Closure of the Barrett Adolescent Centre, the full suite of services for adolescents with severe and complex mental health issues offered through Queensland Health (beyond CYMHS) were through Children’s Health Queensland’s statewide Adolescent Mental Health Extended Treatment Initiative. These were:
Assertive Mobile Youth Outreach Services (AMYOS)
Multidisciplinary mental health clinicians deliver treatment in either the family home or the community. Currently in north Brisbane, south Brisbane, Redcliffe/Caboolture, Logan, Gold Coast, Darling Downs, Rockhampton, Townsville, and Cairns.
Adolescent day program units
Young people with social difficulties and a history of school refusal or exclusion can receive intensive individual/ group therapy and extended treatment options. Currently at north Brisbane, the Lady Cilento Children’s Hospital (south Brisbane), Toowoomba and Townsville.
Youth residential rehabilitation units (Youth Resi)
Long-term accommodation and recovery-oriented care provided by NGOs in partnership with mental health specialists. Aims to teach young people the life skills they need to maintain independence and emotional well-being; develop and maintain links with the community, their family, and social networks; as well as providing education and work opportunities. Currently in south Brisbane, Cairns and Townsville.
Medium-term, 24 hours per day, seven days per week care in a safe, secure, structured, hospital-based environment with access to onsite schooling. Currently at the Lady Cilento Children’s Hospital (south Brisbane).
Proposed future services
Step Up / Step Down Units
Short-term residential treatment in purpose-built facilities that are delivered by mental health specialists in partnership with NGOs for those who require a higher intensity level of treatment and care to reduce symptoms that cannot be adequately provided in the community (Step Up), but do not require acute inpatient care. This intensive safe and supportive sub-acute residential community program also operates as Step Down – enabling early discharge from acute inpatient units .
Following the election of the current state government, the Youth Mental Health Commitments Committee was established to look into extended inpatient care – particularly with respect to the gaps in services for those aged 18 to 24 – in order to honour the pre-election commitment to a 22-bed facility by Queensland Labour.
We’re also looking and costing up other options; for instance, potentially three seven-bed units, two units of, say, 10 beds each, where they might be. We’re looking at mapping of services across the State in terms of population mapping. We’re then going to undertake service mapping of where units or services should be across the state, and we’re doing that in parallel and in anticipation of the Commission’s findings so that a body of work would already be completed beforehand so that we can – so that any decisions in terms of future services may be expedited.
Dr Stephen Stathis, Youth Mental Health Commitments Committee
11 March 2016 (during Oral Hearings of Barrett Adolescent Centre Commission of Inquiry)
When the Commission of Inquiry’s report was presented to the Queensland government in June 2016, the Premier and Health Minister indicated that all six recommendations in the report would be acted upon. Those were:
- Review legislation that establishes the devolved Hospital and Health Service model in Queensland Health
- Improve service agreements Queensland Health uses to contract services provided by non-government organisations
- Improve the availability and use of evaluations to inform clinical interventions in mental health
- Consider a new building in south-east Queensland offering a range of mental health services for young people, including bed-based services
- Improve transitions for adolescents moving into adult mental health services
- Improve coordination between services designed to support young people who have both an intellectual disability and mental illness.
GOVERNMENT RESPONSE TO COI RECOMMENDATIONS
The Queensland Government reacted quickly to implement the six main recommendations from Commissioner Margaret Wilson following the Inquiry into the Closure of the Barrett Centre. A Steering Committee to oversee the implementation of the recommendations was set up in August 2016 under Deputy Director-General of Queensland Health, Dr John Wakefield. Working groups undertook planning on each of the individual recommendations with consumer and carer representatives on relevant groups.
As regards those Recommendations other than that referring to a new facility, a number of organisations were engaged to compile and report on the status of those issues and make recommendations on desired outcomes and the processes to achieve those. Consumer and carer representatives were also involved in discussions on all the Recommendations and continue to be so as the needs of young people are addresses in relation to transitioning to adult services, the lack of research into this cohort, supporting those with dual disability (intellectual disability and mental illness) etc.
The Health Minister, Cameron Dick twice stood before state parliament and reiterated the commitment to consult with “those families who were affected by the closure”, noting that a meeting was held on the 17th of August with those families.
A key outcome of that meeting is that the families agreed they would work with Health Consumers Queensland and Queensland Health in the ongoing planning of the new facility that will provide residential mental health care for young people.
Through this process, families will have the opportunity to be represented on various committees, finalising the clinical model and the building design alongside experts.
QLD Health Minister Cameron Dick, Ministerial Statement: Qld Parliament 18/08/2016
The Minister has also noted that “At least some of the planning already exists because prior to 2012 the then Labor government prepared a costed and funded plan to build a new facility at Redlands to replace the Barrett centre.” (The full text for the statements in parliament are on the Hansard records for 17/8 and 18/8.) The Queensland Health Minister’s final statement on the 18th is one that gives reassurance to all those affected by the gap in service provision for young people whose mental health issues that currently exists:
I intend to keep the House fully informed of this government’s actions in providing a replacement for the Barrett centre, a process that we are determined to get right.
NEW EXTENDED TREATMENT FACILITY
The Queensland Premier announced that a new facility for young people with severe and complex mental health issues would be built in the grounds of Prince Charles Hospital at Chermside in Brisbane’s northern suburbs. The Health Minister had met with families linked to the Barrett Centre the day before to update them on the progress of the government’s response to the recommendations from the Commission of Inquiry (COI) and reassure them that health service consumers and carers would continue to play a significant role in planning and developments. Minister Dick indicated that it was a priority that the statewide service to replace the support lost when Barrett closed was sustainable and embedded in the system and that the location for the new 12-15 bed facility had been chosen because of, among other things, its access to comprehensive medical support, transport (including Brisbane airport to enable easier access for regional families) and community amenities (recreational activities, shops, local schools).
The model of care will be developed in the coming months with workshops scheduled for October 20 & 27 and November 10 and a Project Oversight Group being assembled – both of which require significant involvement from people with lived experience of adolescent mental health issues. However the Minister stressed that, like the Barrett Centre before it, one of the key tenets of the new centre would be a focus on integrated education and training as well as health treatment services and his collaboration with the Minister of Education would be ongoing in order to achieve this.
To coincide with the site announcement, Health Consumer’s Queensland launched a webpage dedicated to the COI response and a SURVEY that they’re urging anyone with experience/ideas/feedback to complete. The commitment to “co-design” (balanced collaboration between service providers and consumers) is emphasised by the engagement of HCQ to facilitate community involvement in the actions responding to the Inquiry recommendations and, with the understanding that those who have important insights might also experience challenges with sustained in-depth participation, there are – and will be – a number of ways that the public can have their say and remain informed of progress of new developments and initiatives. The online survey has been developed to be easily accessible and can be completed anonymously with no ongoing contact required. But there are also options for greater involvement with consumers/carers encouraged to ‘have their say’ in the development of the most effective services and policies in the method that suits them best.
PROGRESS – QUEENSLAND HEALTH and HEALTH CONSUMERS QUEENSLAND
Queensland Health now have a website that deals specifically with their actions in relation to the Barrett Adolescent Centre Closure Commission of Inquiry. This will provide information on plans for the new extended treatment and education facility as well as other related developments and, along with this site and the dedicated page at Health Consumers Queensland, it’ll inform people of ways they can become involved in plans for future services and policies. Regular Communiqués will be posted on this page along with any other news and relevant information. (As of 8 November, the following two Communiqués have been released – Issue 1; Issue 2.)
Among the activities already underway are:
- workshops, facilitated by Qld Health’s Commission of Inquiry Implementation group, to create a draft Model of Service for the new centre on the site at Prince Charles Hospital where consumers, carers and practitioners are collaborating to establish the key attributes of the treatment, training, support and culture that will be available at the new centre
- co-design sessions where the architects of the new building and the consumers and carers discuss issues related to the layout and structure of the facility
- the HCQ survey has been live for almost four weeks and is getting some extremely valuable responses. (If you haven’t had your say yet, please head to the Survey Monkey page and give us your insights into what’s needed.)
- the HCQ Engagement Advisor, Leonie Sanderson, is immersed in planning a tour of regional Queensland in order to meet with young people, their families and communities to find out what’s needed throughout the state. If you wa
nt to be involved in those or give input via some other means – or sign up to receive regular updates on progress – you can contact Leonie at email@example.com
- the Consumer Reference Group, facilitated by HCQ, met for the first time following the meeting with the Health Minister on the 12th of October and will continue to meet to discuss the issues that will be taken by the representative to their Steering Committee, Oversight Group and Working Group meetings. (Anyone wanting to have input into these general Consumer Reference Group meetings can contact Leonie at HCQ.)
PROGRESS ON ALL RECOMMENDATIONS TO DATE
As the implementation of the Recommendations from the Commission of Inquiry reaches a key stage, reports on several of the recommendations were tabled at the 2nd June Steering Committee Meeting. One of these is Professor Harvey Whiteford’s report aimed to examine the capacity to “Improve the availability and use of evaluations to inform clinical interventions in mental health“ (Recommendation #3). [Available from this site at the link attached to the preceding text and also available – as with other documentation associated with the specific recommendations – at the Queensland Health page focusing on the Recommendations i.e. https://www.health.qld.gov.au/improvement/youthmentalhealth/implementation-activities] Also now available are two documents relating to Recommendation #4 – the development of a new adolescent extended treatment facility. The Thematic Analysis Report summarises the web feedback provided on the draft Model of Service for the AETF and the External Review of the Model of Service by Dr Paul Robertson, a Victorian based child and adolescent psychiatrist with 25 years of experience.
Where Recommendation #5 is concerned i.e. “Improve transitions for adolescents moving into adult mental health services“, Health Outcomes International have recently completed a number of consultations and focus group discussions – which included consumers and carers – as well as an online service mapping survey to assess current services, gaps in delivery and service innovation. Their review is due to be completed on 30 June.
Proposals from the reports on HHS legislation (Recommendation #1) and service agreements with NGOs (Recommendation #2) are currently under consideration and the Health Department is finalising a report on the coordination of services for dual diagnosis patients (Recommendation #6) to be presented at the next Steering Committee meeting.
The 12 Statewide Forums facilitated by HCQ, Qld Health and the Dept of Education and Training have concluded. A report on the input gathered from these will soon be made publicly available. (A link will be inserted here at that time.)
More detail on the current status of recommendation implementation can be found on Communiqué Issue #7. from Queensland Health, with the progress leading to this chronicled in the preceding Communiqués i.e. Issue 3; Issue 4; Issue 5; Issue 6. [All are also available from this QH website page.]
FINAL REPORTS & RECOMMENDATIONS TO GOVERNMENT ON IMPLEMENTATION OF COMMISSION OF INQUIRY RECS
The Mental Health, Alcohol and Other Drugs Branch within the Division of Clinical Excellence at Queensland Health are now wrapping up their work that has focussed specifically on the implementation of the recommendations extracted from Justice Wilson’s report of the Barrett Adolescent Centre Commission of Inquiry. A number of reports – some already listed in the June 2017 update below – will go / have gone to the Director General and/or the Health Minister. The government must then make final decisions regarding the conclusions/recommendations of these reports as to if/how things should proceed i.e. these reports are not yet government policy. As will be noted in an upcoming post, many of the reports are the foundation for future action following mapping activities, research, focus groups, forums and other forms of consultation. So in order for practical progress to be made in ways that will directly impact young people and their families and communities, there needs to be an ongoing commitment from government to continue the process by ensuring that the creation of services, approaches and strategies that have been indicated as important become a reality across Queensland.
The need to improve service agreements with NGOs (Recommendation #2) was undertaken by engaging Quality Innovation Performance Consulting Pty Ltd (QIP) to:
- assess the quality, safety and performance standards of funded service providers; and
- develop a framework for the future state of funded services standards
The final reports relating to Recommendation #5 i.e. “Improve transitions for adolescents moving into adult mental health services“, are also now available. Health Outcomes International have provided both an Environmental Analysis and a Final Report. [Available from this site at the links attached to the preceding text and also at the Queensland Health page on Recommendation #5 implementation activities.]
The action on Recommendation #6 to improve coordination between services for those young people with both mental health issues and an intellectual disability (a.k.a. ‘dual diagnosis’) has resulted in a Final Report [also at Qld Health site] produced from reviews, service mapping, consultation and data matching.
With these reports and recommendations now awaiting approval from government through commitment to the required future actions as stated policy, those who have put time and energy into the work throughout 2016/17 and those throughout the state who desperately need the changes in service provision can only hope that this early investment leads to the substantial change ‘on the ground’ that has long been advocated for.