NSW Health must listen to Aboriginal communities, says Auditor-General


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NSW Health is failing to form partnerships with Aboriginal communities to effectively deliver suitable mental health services, according to the state’s Auditor-General, Margaret Crawford.

The latest report from Crawford’s office found that the department “does not have a clear picture” of mental health service use patterns of Aboriginal people and lacks the mental health policy needed to inform a “complex service sector”.

“NSW Health is planning and coordinating its resources to support Aboriginal people in acute phases of mental illness in hospital environments,” the report concludes.

“However, it is not effectively planning for the supply and delivery of sufficient mental health services to assist Aboriginal patients to manage mental illness in community environments. Existing planning approaches, data and systems are insufficient to guide the $400 million investment into community mental health services announced in the 2018–19 Budget.”

According to the audit office, planning has failed to ensure mental health services are available in the places that need them, and there is limited case coordination as patients move between services or to recover in their own homes. There is also not enough support for those with mental illness who are on release from prison.

The report recommends that NSW Health develop a policy framework for Aboriginal mental health and wellbeing in partnership with Aboriginal mental health clinicians and policy experts.

By December 2020, NSW Health should:

  1. Create evidence-based models of culturally appropriate Aboriginal mental health care for use in local health districts.
  2. Publish a policy framework that includes: 
  • an implementation plan for the framework and a communication strategy to improve the visibility and priority of Aboriginal mental health care across the sector, 
  • methods, roles and responsibilities for collecting detailed data about Aboriginal service use and service demand by location, 
  • a process for local health districts to map services with primary health networks and non-government providers to locate service gaps and duplications, with a plan for fair distribution of services across locations, 
  • a strategy to increase services for those requiring high levels of clinical support, and clarification of mental health case management roles to ensure accountability and continuity of care across different service providers and types, 
  • actions to increase the number of Aboriginal workers across all levels and positions in the mental health workforce, 
  • new key performance indicators and performance reporting on follow-up actions that: ­support information sharing and referrals of Aboriginal people to community-based services; and, ensure follow-up support for mental health patients on release from prison so they receive one week of medication, referrals and discharge summaries.

Secretary of NSW Health Elizabeth Koff thanked Crawford for the report and accepted both recommendations in principle.

“NSW Health is committed to ensuring that Aboriginal people have a voice in planning and policy decisions that will affect Aboriginal communities,” she wrote. “NSW Health remains focused on providing care to all people experiencing acute and severe phases of mental illness in hospital and community service environments.”

“NSW Health collects reliable data that allows Local Health Districts to plan services that we are directly responsible for. However, it is also acknowledged that NSW Health is part of a broader system with Commonwealth and non-government organisations who have important roles in the delivery of mental health services.”

Mental illness is the main contributor to lower life expectancy and increased mortality in the NSW Aboriginal population.

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