This project considered issues contributing to long wait times and implemented service-wide interventions to enhance access to mental health support services for young people.
View a poster from the Centre for Healthcare Redesign graduation April 2022.
Aim
Goal
To improve access to high quality youth friendly mental health support at headspace Bondi Junction for young people aged 12-25 years by 30 June 2022.
Objectives
- Decrease wait times by 30 June 2022 at three points of care:
- Intake triage be completed within 24-48hrs compared to eight days
- Initial assessment to be completed within two weeks compared to four weeks
- Psychological treatment to start within one month compared to three months.
- Reduce the percentage of young people reporting ‘waiting too long’ from 82% to 30% by 30 June 2022.
- Increase percentage scores on Your Experience of Service (YES) survey to align with NSW health community benchmark in two domains by 30 June 2022:1
- Participation: improve to 95% benchmark from 91%
- Impact: improve to 70% benchmark from 65%.
Benefits
Consumer benefits
- Reduced wait times for comprehensive assessment and mental health intervention
- Increased consumer participation and collaboration in decision making related to care
- Improved satisfaction and experience of service.
Staff benefits
- Reduced risk of burnout, vicarious trauma and compassion fatigue
- Increased opportunity for meaningful and therapeutic engagement with young people and families
- Increased workplace satisfaction, and positive cultural change.
Service benefits
- Reduced wait times across all levels of service delivery
- Improved service delivery and better identification of community needs
- Increased treatment and intervention pathways that align with stepped care models.
Background
headspace Demand Management and Enhancement Program is an enhanced investment from the Federal Government to reduce wait times at headspace services. The Central and Eastern Sydney Primary Health Network supported headspace Bondi Junction grant application was awarded $541,264.52 to be acquitted 2020-23. South Eastern Sydney Local Health District has enabled the project to be initiated under the guidance and support from the ACI redesign program. This project at headspace Bondi Junction will involve a co-designed methodology with consumers and stakeholders, using an evidenced based framework towards this projects goals for improvement and innovation.
Since headspace Bondi Junction started in 2016 we have experienced increased demand for services each year. When reviewing the average monthly intake data per year, there has been a 50% increase between 2016 and 2019. 2020 shows fluctuations in data trends reflective of the significant adjustments that both community and services experienced during the COVID-19 pandemic.
The increased demand for services has led to longer waiting times for young people aged 12-25 to access high quality mental health support. A young person contacting the service for the first time, cannot speak to a clinician at time of initial contact and are required to wait for a call back to discuss support options. Initial investigations indicate that approximately half of new young people who contact headspace Bondi Junction to seek support do not receive care. Approximately 1 in 4 of these people stated the main reason was “the wait time was too long”. Of further concern, 80% of those who were accepted into the service reported waiting too long for their first appointment, with the average wait time 4-6 weeks.
This delay in receiving care is assumed to significantly impact the effectiveness of a young person’s experience and health outcomes when accessing headspace Bondi Junction and goes against principles of early intervention. The impact of this for a young person who may be experiencing mental ill-health, such as depression, means that the wait for help may exacerbate their ill-mental health and feelings of hopelessness and despair. The exacerbated hopelessness and despair and a growing disenfranchisement with metal health services were demonstrated in consumers stories collected in the centre.
Our current assumption is that young people who are not receiving care after seeking support are either not receiving care or are presenting to other services, such as emergency departments, in acute distress or might not receive any support or care at all.
Implementation
Diagnostics
Diagnostic tools used included service mapping, journey mapping, staff surveys, file audits and analysis of intake and referral data, minimum data sets collected at headspace and YES and Carer Experience of Service (CES) surveys.2
Four issues were identified through thematic-analysis and root-cause-analysis:
- workload and resources
- workforce
- decision making
- service delivery.
Solutions
Workshops, literature reviews and cost-benefit analysis were used to prioritise a final three solutions.
Digital health and information technology
The use of an innovative digital health and information technology to support functions of triage and assessment. This technology should be accessible 24/7 for consumers and can support decision making and clinical staging within a stepped care model.
- Scoping of digital health technologies available. Agreed upon InnoWell platform.
- Weekly consultations with InnoWell, headspace management team and other stakeholders.
- Service mapping and process development of new pathways; transition from ‘as is’ to ‘desired’ prototyping with stakeholders.
- Facilitation of pre-implementation education and training
- Go live with InnoWell platform 10 Jan 2022.
- Ongoing development with teams doing plan-do-study-act cycles.
- Final processes and flow documented and distributed.
Peer digital navigator
Establishment of a new role that includes a peer digital navigator to support and promote the use of innovative technology in youth mental health and to support clinical decision making from a lived experience perspective.
- Scoping and development of role.
- Recruitment and orientation.
- Ongoing role development.
- Established links with peer support network.
Group interventions
Development of group-based interventions that would expand the current pathways of care offered and introduce the idea of ‘active waiting’ for 1:1 mental health intervention. This would include the recruitment of a lived experience peer worker to co-design and facilitate programs to support clinical decision making and align service delivery with what young people need.
- Scoping and development of role of group coordinator.
- Recruitment and orientation.
- Co-design of programs with clinicians.
- Mapping and development of pathways into groups.
- Established links with peer support network.
Status
Implementation – The project is currently being implemented or is currently being implemented, piloted or tested.
Dates
- Project Initiation: Jan 2021
- Project completion: June 2022
Implementation site
headspace Bondi Junction
Partnerships
- Centre for Healthcare Redesign
- South Eastern Sydney Local Health District
- Central and Eastern Sydney Primary Health Network
- headspace National Office
- Mindgardens Neuroscience Network
Evaluation
A full evaluation of change will be carried out by June 2022. This will involve both quantitative and qualitative data.
Quantitative
- Monitoring of average monthly wait times for the difference points of care that align with objectives.
- Monitoring of wait time date and percentage of young people reporting ‘waiting too long’ for their first appointment.
- Collection of YES survey results to asses increase in participation in care and impact of care.
- Collection of CES survey results to assess increase in participation in care for family, friends and carers and the impact of this.
- Use of Professional Quality of Life fifth version, to measure changes in staff in burnout, compassion fatigue and vicarious trauma.
Qualitative
- Semi-structured interviews with young people, family, carers and staff.
- Collection of anecdotal feedback raised throughout implementation.
Lessons learnt
- The decision for an ethics application should be prioritised from the onset of initiation, the process of ethics can be challenging and halt project progress.
- Take every opportunity you can to discuss, promote or even sell your project, no matter how small or big, formal or informal the situation. It can help create discussion and momentum in a positive way and alleviate anxiety associated with change.
References
- Australian Mental Health Outcomes and Classification Network. Your Experience of Service Surveys. Sydney: AMHOCN: 2015.
- Australian Mental Health Outcomes and Classification Network. Mental Health Carer Experience Survey. Sydney: AMHOCN: 2017.
- Hudnall Stamm, B. Professional Quality of Life: Compassion satisfaction and fatigue version 5 (ProQOL). 2009.
Further reading
- headspace National Youth Mental Health Foundation. headspace strategy 2021 to 2024 [internet]. headspace; 2021.
- headspace National Youth Mental Health Foundation. Increasing demand in youth mental health: A rising tide of need [internet]. headspace; 2019.
- Hickie I, Davenport TA, Burns JM. Project Synergy: co-designing technology-enabled solutions for Australian mental health services reform. Med J Aust 2019;211(7):S3-S39. DOI: 10.5694/mja2.50349.
- Leamy M, Bird V, Le Boutillier C, et al. Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. Br J Psychiatry 2011 Dec;199(6):445-52. DOI: 10.1192/bjp.bp.110.083733.
- NSW Mental Health Commission. Strategic Framework for Suicide Prevention in NSW 2018-2023 [internet]. Sydney: NSW Mental Health Commission; 2018.
- NSW Mental Health Commission. Living Well: A Strategic Plan for Mental Health in NSW [internet]. Sydney: NSW Mental Health Commission; 2014.
- Orygen. Clinical Practice in Digital Technology and Youth Mental Health. The digital age: does digital technology work in youth mental health settings? [internet] Orygen; 2019.
- Orygen. Brief interventions in youth mental health toolkit: A clinical resource for headspace centres. Orygen; 2016.
- Thomas K. Review of demand management and waitlist strategies for application in the headspace centre network. Headspace Youth Mental Health Foundation; 2019.
Contact
Paul Rich
Demand Management Project Lead
headspace Bondi Junction
Phone: 02 936 8800
paul.rich@health.nsw.gov.au
