That will include extra day programs – firstly at north Brisbane – and then a network of new outreach services and live-in facilties modelled on similar services in Victoria.
However, that will cost Queensland more than $20 million a year and many of the new facilities are still being planned, let alone built.
The new model has frustrated some parents, who took their children to the Barrett Adoelscent Centre at Wacol for 30 years. “The Barrett” was Queensland’s sole live-in youth adolescent pyschiatric centre.
Stephen Stathis, the medical director of Queensland’s child and youth mental health services, this week explained Queensland’s new youth mental healh model.
Dr Stathis conceded the full model was not yet “fully out there”.
“But sometimes changes in models of care take time to be embedded in the minds of care providers,” he said.
The Queensland government closed the Barrett Centre youth adolescent psychiatric service at Wacol in January 2013, promising to have replacement models of care in place.
Some parents have questioned the closure but the government has decided not to reopen the centre.
The psychiatrist’s main concern was the length of stay for the 12-to-15 bed Barrett facility had crept up from four months to 17 months, and the queue of people waiting to be accepted at the centre was growing.
Dr Stathis has about $4.2 million “to run” the new adolescent mental health system, which will cost five times that to run when it is fully in place.
However he says he has been promised a “favourable hearing” by the Board of Childrens’ Health Queensland when he asks for capital expenditure to build new centres.
Dr Stathis said he told the board he could do two things; develop a model of care that was set to a specific budget, or a model that was best for young people, “within reason.”
“And they said ‘Give us the Rolls Royce, within reason. What do you think we could provide across Queensland?”
“We will bat for you. We will push this through.”
Neither of his models included a new Barrett Centre, which he said was an out-moded form of care.
This is what is proposed under Queensland new five-tiered adolescent mental health plan.
Tier 1 – Mental health day programs extended from three to six
Day programs for young people with social difficulties and a history of school refusal or exclusion will be increased from three to six.
Queensland has just three day mental health programs for adolescents; at the Mater Hospital, Toowoomba and Townsville.
New services will open at North Brisbane. Extra courses will start at the Gold Coast and Logan when funding becomes available. Five North Brisbane sites are being examined.
“The critical areas that were identified were North Brisbane,” Dr Stathis said.
“And we have also proposed that if funding becomes available a program should also be set up at the Gold Coast and at Logan,” he said.
The need for a mental health outreach service was identified earlier this week by Gold Coast homeless care chief executive Liz Fritz, who said mental health issues were emerging as the number of homeless on the Gold Coast doubled since 2011.
Queensland has about 38 ‘general’ mental health beds per 100,000 in population, about 7 ‘youth’ mental health care beds per 100,000 and about 33 mental health beds per 100,000.
Tier 2: Sub acute beds – “Step Up, Step Down” service – a transition “to and from” hospital care.
Queensland’s new “Step Up, Step Down” service is modelled on Melbourne’s successful Y-PARC type adolescent mental health services.
There are none operating in Queensland but four in Victoria.
The Victorian Government has set aside $3.8 million to establish Y-PARC and will spend more than $7 million over four years to run the service.
“There is about four of them in Melbourne and they have had favourable reviews,” Dr Stathis said.
“These are young people who can’t be managed once a week at a one-hour consultation, or twice a week at an one-hour consultation. But they are not unwell enough to require admission into hospital.”
“We don’t want to hospitalise young people – because it is not good for them and because it is too expensive.”
Queensland’s Step Up Step Down centres will be custom-built residences for up to 12 young people.
They are run by non-government organisations (NGOs), but there is planning input from the state government.
“So there are psychiatrists on site, there are nurses on site, there are social workers on site. But the running of the facility and some of the youth work is managed by the NGOs.”
There is no money set aside in Queensland to build these facilities, let alone to run them.
Level 3 – Assertive Mobile Youth Outreach Service (AMYOS), modelled on Victoria’s Intensive Mobile Youth Outreach Service or IMYOS.
Queensland has three of these new services, but plans seven in 12 months and ultimately 18, running in each Hospital and Health region.
In Victoria there are 17 and the service has been running for 10 years.
Here the mental health service goes to the young person rather than have them travel to a clinic.
Dr Stahis has toured IMYOS facilities in Victoria to learn how they operate.
“There are young people in the community who do not want to engage, they can’t make it, or are indigenous and don’t like to come into a room.
“There are lots of young people like this out there.
“They (in Victoria) visit young people in the schools, at the homes, in the park in the local coffee shop, down by the river. Wherever.
“This is running in Victoria. It is very effective and there is evidence behind it. It is very good.”
They would have two mental health staff with a visiting psychiatrist once-a-week, backed by teleconferencing facilities to a pool of senior psychiatrists.
Level 4 – RESI Programs
RESI centres are live-in care centres run by NGOs. They offer accommodation, but have mental health care for young people with severe and complex mental health problems.
However, there is only one in Brisbane.
There is also a youth accommodation facility in Cairns, which could be adapted to become Queensland’s second RESI centre.
“It is specifically for severe and complex mental illness, not mild to moderate.”
This was also identified as a “clear gap” by everyone in Queensland’s adolescent mental health care, Dr Stathis said.
“These are young people who are linked to child and youth mental health services by definition. They have serious and complex mental health problems, but for whatever reason they are unable to live at home,” he said.
“Many of these young people couch surf or become homeless and engage in drug and alcohol use.
“Now these things are just going to magnify and perpetuate their mental health problems.”
Victoria has 17 “RESI Programs” looking after 167 young people. In Victoria it looked after people between 16 and 25. About 70 per cent are over 22 years of age.
Dr Stathis said in Queensland, they again want to deal with younger people; 16 to 19 years of age.
A recent report in Australia’s emerging mental health care – the NOUS Report – gave the RESI program a positive review.
Level 5 – transition or ‘sub-acute’ beds, actually in Queensland hospitals
There will be eight beds set aside in a specific youth mental health ward in the new Lady Cilento Hospital soon to open at South Brisbane, next to the Mater Children’s Hospital.
Now there are two beds set aside in the Mater Hospital at South Brisbane.
The new model of care at the Lady Cilento Hospital will be a different model to the Barrett Adolescent Mental Health facility, Dr Stathis said.
“When young people are accepted, part of the program there will be an assumption that parents will come to the Lady Cilento Hospital for a week of intensive family therapy,” Dr Stathis said.
“Because if you are going to move them back into the family, they need some family therapy.”
This article first appeared on The Canberra Times on 8 August 2014.