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Victorian Mental Health Services

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Introduction

This guide was developed in 2023.

Feedback, or information related to additional service options or resources are most welcome. Please contact NDS through NDS contact.

Who is this guide for?

The mental health navigation guide is for disability providers and workers and has been collated to guide navigation of mental health services available in Victoria.

It has also been developed to support disability workers in identifying mental health service supports information for people with disabilities and their family members or carers or to assist a person with a disability to be referred to an appropriate service option. The information can be used to support:

  • a person with a psychosocial disability associated with a mental illness or mental health condition whether they are eligible for NDIS
  • any person with a disability who has an emerging or identified co-occurring mental illness or condition

While this guide has been written primarily for disability workers in relation to supporting people with disabilities the information is applicable for anyone who is experiencing a mental health need or living with a mental health condition. It can also be used by disability workers to identify mental health and wellbeing services for themselves or other people in their lives.

Overview of content

Disability workers are not experts in mental health concerns or conditions. However they do need to have some understanding of symptoms or behaviours that may indicate a mental health issue when working with people with disability to assist with identifying appropriate supports. Included are service options for different levels of mental health needs, how to identify and access services, eligibility, service model summary, referral requirements and costs Some of the mental health services are applicable to multiple symptoms or groups of needs and a link to the service details is provided where this has already been discussed in the guide.

A section on psychosocial disability and NDIS includes eligibility, information for application and information on supports for psychosocial needs when a person is not eligible for NDIS or waiting for an application to be assessed.

Identification of the processes to address a complaint or concern have been added with advocacy support links available for people with disabilities to access if needed. This section also includes links to supported decision making tools and the Office of the Public Advocate

Resources links have been included throughout to increase disability workers understanding of mental health conditions along with a section of specific tools focussed on maximising the health assessments for people with disability, improving information when attending GP and other health professional appointments and a checklist for hospital admissions

Consent and referring another person for a mental health assessment

There are services identified within this guide that have the option for a referral to be made on behalf of the person who has been identified with an emerging or existing mental health need At all times it is expected that any person referring another person for mental health support or assessment will be carried out with consent from the person this relates to. The exceptions to this would be in a crisis context where immediate emergency services interventions are required for the safety of all involved or consent has been given by an authorised representative.

The information in this document is not intended as a substitute for professional medical advice, diagnosis, or treatment instead aiming to identify options and how to link a person with them

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  Mental Health Definitions

What is mental health?

The World Health Organisation (WHO) defines mental health as ‘a state of well-being in which every person realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her or his community’.

Mental illness can affect anyone, of any age and background including people with disabilities. However, with support most people can and do recover. Achieving and maintaining good mental health and wellbeing is important for everyone

What is mental illness?

Mental illness refers to conditions or symptoms that can affect a person’s thinking or thoughts, perceptions, mood or behaviour, or the way they perceive the world around them. Mental illness can make it difficult for someone to cope with work, relationships, and other demands

The relationship between stress and mental illness is complex, but it is known that stress can worsen an episode of mental illness. Most people can manage their mental illness with medication, counselling, or both.

Mental health needs or symptoms are generally grouped by the mental health sector based on clincial diagnostic definations These have provided to assist disability workers to understand how mental health workers and the mental health system approach individaul symptoms and needs. The definitions and their relationship to service options are described in detail in the sections below:

  1. common or less severe mental health disorder
  2. serious mental health condition
  3. complex, severe, or episodic
  4. emergency or crisis mental health concern

 What is a mental health service?

A mental health service is defined as any service with the primary function of providing clinical treatment, rehabilitation or community support for people affected by mental illness and/or their families, carers, and support networks

These include public and private, government, state and commonwealth, hospital and community services and private mental health professionals

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 Common or less severe mental health conditions

A common but less severe mental health condition can include one or more of the following symptoms:

  • experience of anxiety or not feeling quite right
  • mild to moderate depression with/without current diagnosis
  • obsessive compulsive disorders with/without current diagnosis
  • trouble adjusting to changes or coping with loss.

The most common mental illnesses are depressive, anxiety and substance use disorders. These three types of mental illnesses often occur in combination. For example, a person with an anxiety disorder could also develop depression, or a person with depression might misuse alcohol or other drugs, to self-medicate

Identifying early signs that may indicate an emerging mental illness

Disability workers who have been engaged in the care of a person with a disability can reflect on their or team’s knowledge and observations of the person to consider if an emerging mental health need or illness should be investigated Early indications can also include a person expressing concerns about themselves. The following list are some indications:

  • changes in pattern of behaviour, mood (up or down), confusion, disorientation, hygiene, or appearance
  • exhibiting destructive or high-risk behaviour
  • exhibiting false beliefs or hallucinations
  • vocalising suicidal thoughts or engaging in acts of self-harm
  • the person stating they feel like something is not quite right with their thoughts, feelings, or actions
  • Workers' observation the person is not themselves regarding their expressed thoughts

The person’s physical health, other environmental or wellbeing reasons should always be considered for elimination before proceeding to investigation of an emerging mental health problem To eliminate any physical health influence unless this is immediately obvious or identified, should involve consultation with a General Practitioner (GP) for assessment and guidance. At any stage where a reason for a change cannot be identified by disability worker, the person themselves or family member or carers always seek advice from a GP

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Common mental health conditions: stress, depression, and anxiety

Stress, depression, and anxiety are the most common mental health conditions, and it is important for disability workers, a person with a disability, their family, and carers to have some understanding about how these differ. This assists with identifying what may be triggering the responses and when to seek support from a mental health professional

Stress

Stress is a common and normal physical response to challenging or new situations. Stress has both mental and physical aspects and can be triggered by different life experiences. Stressors can be external, related to environmental, psychological or social situations or internal such as an illness.

A small amount of stress from time to time is not a problem however when stress is intense and ongoing, it can start to impact a person’s physical and mental health.

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Depression

Depression is a common mental health condition which causes ongoing low mood, feeling sad or loss of pleasure or interest in things that someone would usually enjoy.

Many people will experience depression at some time in their lives. This may be directly linked to major life events such as stress, illness, abuse, bereavement, or trauma. Sometimes the cause is not clear, and in people with disability, depression may not be recognised as an illness on its own, due to incorrect assumptions the symptoms as directly linked to the person’s disability.

Depression often involves a range of other physical and psychological symptoms that can interfere with day-to-day life. It is also common for people living with depression to have other mental and physical health issues, such as anxiety disorders, substance use disorders, personality disorders, and chronic pain.

Signs or symptoms of depression

The signs and symptoms identified below indicate a discussion with a health professional should be arranged to determine if support or treatment is needed.

  • Psychological symptoms can include continuous low mood or sadness, feeling hopeless and helpless, low self-esteem, feeling tearful, loss of motivation or interest in things, difficulty to make decisions.
  • Physical symptoms can include fatigue, being tired all the time, feeling sick and ‘run down’, frequent headaches, stomach or muscle pains, sleep problems, loss or change of appetite, significant weight loss or weight gain.
  • Behavioural changes can include withdrawal from close family and friends, stopping their usual enjoyable activities, not get things done at work or school, rely on alcohol and sedatives.

Symptoms of depression can lead to increased risk of suicidal thoughts or behaviours.

Disability workers should always follow their organisations policy for the health or safety plan for any person they are supporting, especially if they are identifying suicidal thoughts or behaviours For urgent mental health needs also refer to the Emergency and Crisis Mental Health Concern section for more information.

Resources and useful information for depression

Anxiety

Anxiety is a natural and usually short-lived reaction to a stressful situation, associated with feelings of worry, nervousness, apprehension, dread that comes from thinking something bad is going to happen, or the person affected can’t cope with a situation. Anxiety can happen in response to a specific situation or event, but it continues after the situation has passed. Anxiety can also happen without a specific situation or event.

People with disability are more likely to experience anxiety, especially if their disability or condition is unpredictable, significantly affects their daily lives, or they experience difficulties with cognitive processing that makes it harder for them to understand what’s happening around them

Anxiety becomes a problem when the person feels anxious most of the time and about relatively minor things resulting in their level of worry becoming out of control and interfering with their day-to-day life. This may indicate an anxiety disorder and should be investigated by a medical (i.e., GP) or other mental health professional.

An Anxiety Disorder is diagnosed by a medical or other mental health professional. Anxiety disorders are characterised by feelings of persistent or intermittent fear, nervousness, tension, and unease. There are different types of anxiety disorders that are symptom dependent and vary in severity from mild to debilitating. Visit the Health Direct page for more information.

Signs or symptoms that indicate help might be needed:

  • Psychological symptoms: frequent or excessive worry, poor concentration, specific fears, or phobias e.g., fear of dying or fear of losing control
  • Physical symptoms: fatigue, irritability, sleeping difficulties, general restlessness, muscle tension, upset stomach, sweating and difficulty breathing
  • Behavioural changes: including procrastination, avoidance, difficulty making decisions and social withdrawal

Anxiety is treatable, and there are many services to both help with feeling better in the moment when anxiety arises, and long-term strategies such as therapeutic services to minimise anxious thoughts and feelings.

Resources and useful information for anxiety

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Service options for common and less severe mental health conditions

When the person you are supporting requires non-urgent help, and the indications suggest this could be the result of a developing mental health need or condition the following summaries and links about health professionals and services can be used to identify most appropriate options for assessment.

Where to find help and support in an emergency

Disability workers should always follow their organisation’s policy for the health or safety plan for any person they are supporting or call 000 for crisis support
For more information, refer to the Emergency and Crisis Mental Health Concern section.

General Practitioners

General Practitioners (GP) are often the first point of contact for people with any health concern including a mental health need, especially where a relationship has already been established with the person with a disability GPs may be more accessible than mental health specialists, and likely to know about local support services and able to offer ongoing general medical and psychiatric treatment GP’s can provide referrals to a range of services including private psychiatrists enabling a Medicare rebate to be claimed. It is important to note that fees can vary and some psychiatrists bulk bill. In rural areas, private psychiatrists may not be available.

GPs can bulk-bill for people eligible for Medicare rebates or other concessions or may charge a private fee. A Commonwealth program called the Better Access to Mental Health Care scheme has been funded to increase community access to GPs, psychiatrists, clinical psychologists, and other allied mental health professionals. The Better Access Scheme is only available if the person is receiving treatment for depression, bipolar disorder, or other anxiety-related conditions, such as panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, generalised anxiety disorder and phobias.

People who are not eligible for a Medicare card can be supported to access services. Please refer to the section Supporting a person who is not eligible for Medicare

Getting professional help from the GP, psychiatrist, psychologist, or other mental health professional, can support the person to reduce its effects of anxiety on their life and wellbeing

It is important for disability workers to identify with the person with a disability how they are feeling or to record from observations signs or symptoms that might indicate a mental health concern. Recording these in the time leading up to their appointments this may assist in explaining to a doctor or mental health professional about what they're going through

Mental Health Treatment Plan

A Mental Health Treatment Plan, is an annual plan, for people with mental illness who have several healthcare professionals working with them. The plan is prepared by a GP in collaboration with the person receiving the treatment. Under this plan, Medicare rebated care and treatment sessions can be accessed through a psychiatrist, clinical psychologists, mental health social worker, or mental health occupational therapist. The GP can assign a treating mental health clinician (i.e., psychologist) on the plan if the person does not have a specific health professional in mind.

Resources to assist with GP appointments

A disability worker may be required to assist a person with a disability or provide information and tools to families or cares to support their preparation for a GP appointment. Then tools below can assist with this preparation and have been detailed in the GP Appointment Tools section of this guide These are disability specific resources to maximise effectiveness and communication with GP’s and improve the health outcomes for people with disability Descriptions and links are provided for the following options:

Psychiatrists

Psychiatrists are medical doctors who have completed specialist training to help people with emotional and mental health problems. They diagnose and treat mental health issues. Psychiatrists can prescribe medication for mental health conditions, and some may also use talk-based therapies such as cognitive behavioural therapy

You need a referral from a GP to see a psychiatrist and to claim rebates through Medicare

  • Private psychiatrists mainly provide outpatients services from their consulting rooms or inpatient services to private hospitals. They might have specialist interests (e.g., working with particular age groups or disorders, and specific therapies).
  • Private psychiatrists and GPs may work together with case managers and others in developing a management plan.
  • The private sector incorporates private psychiatric hospitals, but these generally exist only in larger populations centres, and they do not take people who require involuntary admission.

Partners in Wellbeing

The Partners in Wellbeing program is funded by the Victorian Government and delivered by Neami National, EACH and the Australian Community Support Organisation (ACSO) across Victoria.

Partners in Wellbeing provide free one-on-one support for people in Victoria to help improve wellbeing, develop strategies to cope and receive emotional support when and as they need it. Services include wellbeing coaching, small business support and location and access information on the Mental Health and Wellbeing Locals and Hub services.

Partners in wellbeing contact details are available on Partners in Wellbeing or call 1300 375 330

Eligibility

Wellbeing Coaching eligibility:

  • you need to be 16 or over
  • live in Victoria
  • experiencing increased life stressors
  • usual coping strategies are not working
  • noticing signs of anxiety and/or depression that have lasted more than a few weeks

Small Business Support eligibility:

  • be 16 or over
  • own or run a small business in Victoria
  • experiencing increased stressors

Referrals

Referrals can be on behalf of another person with their consent or self-referral

Partners in Wellbeing encourage referrals from people who identify as LGBTIQ, culturally diverse, Aboriginal or Torres Strait Islander people, veterans and people experiencing homelessness

Cost

Services are provided at no cost

Mental Health and Wellbeing Locals

The Mental Health and Wellbeing Local Services are new, with the initial six services established in early in 2022 with approximately 50 in total to be open across Victoria by the end of 2026. Mental Health and Wellbeing Locals support Victorian adults to get mental health and wellbeing treatment, care, and support closer to home. These services include:

  • treatment and therapies
  • person-centred wellbeing supports
  • education, peer support and self-help
  • person-led care planning and coordination with other services.

Mental Health and Wellbeing Local Services will focus on listening and understanding the person’s concerns to work with them, family or carers and support workers, to design a care plan that meets their goals and preferences. This may involve connecting the person to other health and social services if they need them

Whilst the Mental Health and Wellbeing Local Services are being established; some services may not be available. This may result in specialist services and assessments needing to be conducted through private mental health clinicians or other services. The Mental Health and Wellbeing Local Service team will be able assist with referrals to appropriate external services.

It will take time for each service to be able to offer the full range of services, which will include face-to-face, telehealth and outreach services provided on one-to-one and group-based settings

Access to support through other services is occurring in regions where the Mental Health and Wellbeing Locals have not been established. These include Mental Health and Wellbeing Hubs, Partners in Wellbeing and Head to Health (Victoria) services

Eligibility

The Mental Health and Wellbeing Locals will care for people who need more support than a general practitioner or private mental health practitioner can offer, but do not need higher-intensity services, such as hospital-based support services.

These services are for people:

  • Aged 26 years and over experiencing mental health or wellbeing concerns. This includes anyone who is experiencing mental health and substance use concerns at the same time
  • Family members, carers, support workers of someone with mental health concerns for support to help in their caring role, or for their own mental health needs.

Anyone aged between 12 and 25 years old, can be supported to visit or contact their local Headspace centre for mental health and wellbeing support. People can also make contact with Headspace for themselves.

The Mental Health and Wellbeing Locals may provide support to young persons in some situations, including:

  • when they contact a Local looking for help
  • If they are having difficulty getting support through headspace or a hospital and need immediate assistance
  • If the family member, carer, friend, or supporter of a person would like to receive support from a Mental Health and Wellbeing Local
Referrals

To identify locations and contact details refer to Mental Health and Wellbeing Local Services. A referral, mental health treatment plan or Medicare card is not required to access and use the Locals services.

See the Preparing for a health or medical appointment section for a useful checklist and information to help prepare the person you are supporting attend their appointment.

Cost

Mental Health and Wellbeing Local Services are free of charge.

What to expect during the initial appointment

On the first visit to a Mental Health and Wellbeing Local, the person seeking support will talk to a mental health worker. This may be in person, online or over the phone. The mental health a worker will focus on listening to and understanding the person’s concerns so they can work with the person and/or their family, carers, and support workers to design a care plan that meets their goals and preferences

The plan might include a mix of supports and therapies based on their needs. Some of these supports might be provided on the first visit, and others during later visits. Support is delivered in a range of ways including in-person, telehealth, and outreach, depending on the person’s preferences. Peer workers will also be available to guide and support people.

Mental Health and Wellbeing Hubs

Mental Health and Wellbeing Hubs were established by the Victorian Government during the COVID-19 pandemic to provide supports for a range of different issues, including lowered mood, anxiety, substance use or addiction, or any distress experienced by any person. The Mental Health and Wellbeing Hubs continue to provide support for people to address life stressors such as homelessness, financial difficulties, and social isolation.

Mental Health and Wellbeing Hubs provide a mix of face-to-face support, telehealth, mobile outreach, and online delivery. Some Mental Health and Wellbeing Hubs also accept walk-ins.

Visit the Mental Health and Wellbeing website to locate a service as well as information relating to walk-in appointment availability or contact Partners in Wellbeing on 1300 373 330 (9:00 am to 10:00 pm weekdays and 9:00 am to 5:00 pm weekends) to identify the nearest Mental Health and Wellbeing Hub for the person you are supporting.

Eligibility

The Mental Health and Wellbeing Hubs are available to Victorians of all ages who have any mental health or wellbeing concerns. Support is also available for families, friends and carers of people who are experiencing mental health issues

Referrals

A GP referral or a mental health care plan is not required to access support through a Mental Health and Wellbeing Hub.

Cost

Support is free and available to everyone who lives in Victoria.

What happens after I support someone to access the Hub?

During first contact, whether by phone or in-person, a support worker will simply ask you or the person receiving care “How can we help?” Initial intake and assessments will occur to determine the persons eligibility and level of care.

Headspace

Headspace is the National Youth Mental Health Foundation and is funded through the Commonwealth government providing early intervention mental health services to 12–25-year-olds, along with assistance in promoting young peoples’ wellbeing. This covers four core areas: mental health, physical health, work and study support and alcohol and other drug

Headspace centres are located across metropolitan, regional, and rural areas of Australia. They are built and designed with input from young people, so they don't have the same look or feel as other clinical services. The centres are there to help people access health workers – whether it’s a GP, psychologist, social worker, alcohol and drug worker, counsellor, vocational worker, or youth worker

Online and telephone supports are available through eheadspace and require registration for first time users. To register, the person will need to provide some of their personal information such as their email address, postcode, and age. 

The online sessions generally go for 30 - 60 minutes, and if the person is receiving support from a Headspace centre or another service, they may ask for their permission to speak with their health worker to ensure eheadspace is providing the best support and to coordinate care. 

Contact details and locations of the services are available at headspace or call 1800 650 890. 

Eligibility

Headspace services are available for 12 to 25-year-olds

Referrals

A referral is not required for access to headspace services

If the Headspace team identify a support service for the young person that requires a GP referral the team will identify this at for the young person involved

Cost

Services at a Headspace centre are either free or have a low cost and this can be asked during initial contact when you make the appointment. Some services require the person receiving care to have a referral from a doctor; but headspace can help the person with this as well. 

Mental Health and Wellbeing Local Services may provide support to young persons in some situations, such as:

  • young person contacts a Mental Health and Wellbeing Local looking for help
  • young person is having difficulty getting support through headspace or a hospital and need immediate assistance
  • young person has a family member, carer, friend, or supporter of a person receiving support from a Mental Health and Wellbeing Local

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Access to Allied Psychological Services Program (ATAPS)

The Access to Allied Psychological Services (ATAPS) program is funded through the Commonwealth Government ATAPS provides access to low-cost treatment for people with common mental health conditions of mild to moderate severity.

Eligibility

Eligible people can access up to 12 individual sessions per calendar year, or in exceptional circumstances, up to 18 individual sessions with mental healthcare professionals.

Referrals

You do not need to organise a referral for the person you are supporting to see a psychologist. However, to claim rebates through Medicare or to use the ATAPS program, a mental health treatment plan needs to be developed by a GP. If the person has private health insurance, they may be able to claim part of a psychologist’s fee, depending on their policy and level of cover

Cost

Low cost or fully funded sessions for eligible people.

There are no costs in relation to compulsory treatment for mental illness.

Head to Health – Pathway to commonwealth funded mental health services

Primary Health Care Networks (PHN) are Commonwealth funded organisations located across all states and territories established to identify and commission primary health services in the areas they are located. Mental health service supports have been established in all PHN regions in Victoria to meet identified local needs

Head to Health Victoria is a pathway website to the PHN mental health services supports

Head to Health provides a central intake service that will assist Disability workers, Individuals with a disability, their family, carers or other health professionals to identify the most appropriate mental health support option available through the Commonwealth funded PHN regional services

Head to Health Team are available Monday to Friday 8:30 am to 5:00 pm , excluding public holidays. Call 1800 595 212

Referrals

Anyone can call Head to Health including individuals seeking support for themselves.

Head to Health will identify with the person calling what supports are available and specific referral requirements if any They have access to support services that are funded by the Commonwealth through the PHN’s for all ages including children, however specific options may vary from one regional to another regarding age groups and service models.

Cost

There are no costs associated with the Head to Health intake and referral processes.

Services identified by the Head to Health team available through the Primary Health Care Network regions are free services

Head to Health teams may advise of additional options available that incur a cost and would identify this when offering as suggestion for support.

Victorian Primary Health Care Network Regions

All regions offer mental health service supports and these vary depending on regional identified needs and local service models and workforce.

Disability workers, individuals with disability, family, carers and other health professionals can identify the full list of service options available in each region through the links below if they do not want to contact the Head to Health Team for a discussion of needs.

Metropolitan Region
  • Eastern Melbourne PHN
  • North Western Melbourne PHN
  • South Eastern Melbourne PHN
Regional Victoria
  • Gippsland PHN
  • Western Victoria PHN
  • Murray Region PHN

Online and phone mental health supports and resources

Telephone or telehealth, or online mental health resources can often be effective, especially if the person you are supporting is not able access a health service or find talking to someone face-to-face difficult. Here are some telephone and online resources to try:

  • SANE Australia (people living with a mental illness) call 1800 187 263
  • Beyond Blue (anyone feeling depressed or anxious) call 1300 22 4636 or chat online
  • Black Dog Institute (people affected by mood disorders) online help
  • Lifeline (anyone having a personal crisis) call 13 11 14 or chat online
  • Suicide Line Victoria* – (for anyone thinking about suicide) call 1300 651 251
  • Head to Health (Victoria) (for advice, assessment, and referral into local mental health services) call 1800 595 212
  • QLife provides a counselling and referral service for LGTIQA+ people. If the person you are supporting is experiencing mental health issues related to their sexuality or gender identity (LGBTIQA+) call 1800 184 527 or chat online.
  • Headspace online and phone counselling service for mental health treatment for 12 to 25-year-olds, including support for early psychosis, physical health, alcohol, and other drug services.
  • Kid’s Helpline (free 24/7, confidential and private counselling service specifically for children and young people aged 5 to 25 years) call 1800 55 1800
  • Anxiety Recovery Centre Victoria call (03) 9830 033. Please refer to your organisation’s policy or safety plan for this person.

Where to find help and support in an emergency

Disability workers should always follow their organisations policy for the health or safety plan for any person they are supporting or call 000 for crisis support
For more information, refer to the Emergency and Crisis Mental Health Concern section.

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Serious mental health conditions  

A serious mental health illness includes severe mood disorder, depression, mania, or psychotic illness. People with mild to moderate mental illness may need consultation and shared-care arrangements with primary health and other identified social service support providers.

Where to find help and support in an emergency

Disability workers should always follow their organisations policy for the health or safety plan for any person they are supporting or call 000 for crisis support
For more information, refer to the Emergency and Crisis Mental Health Concern section.

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Service options for serious mental health conditions 

 

General Practitioner

If the person you are supporting requires non-urgent help, and the indications suggest this could be the result of a developing mental health problem the first step is an appointment with their GP (doctor). The GP will either provide care during the appointment or organise a referral for care to be provided through the public and private system If they do not have a regular GP who they are familiar with, or the GP is not available refer to the service options below

 Mental Health and Wellbeing Local Services

Older adults can also access Mental Health and Wellbeing Local Services for mild to moderate mental health concerns as deemed appropriate by the health professionals conducting the intake or referral.

Area Mental Health Services

Area-based services are delivered by the Victorian Government and located across the state with 13 area services in metropolitan areas and eight in rural areas. Each region provides three streams of mental health service including:

  • Child And Adolescent Mental Health Services (age 0 to 18)
  • Adult Mental Health Services (16 to 64)
  • Aged Persons Mental Health Services (65 plus)

Within each stream there are:

  • Hospital Inpatient Services
    • Acute Inpatient Services
    • Secure/Extended Care Inpatient Services
  • Community Mental Health Services
  • Residential Services for Aged and Older Persons

Each of these service streams provide inpatient psychiatric services, in addition to a range of residential and other community-based services. The information below outlines each service type, a location-based provider, their eligibility, referral requirements and any costs associated. Information related to preparing or contacting a specific service for an appointment or assessment has been included to assist disability workers with their support for a person with a disability or in conjunction with family or cares.

Area Mental Health Services for each region in Victoria can be identified on the Victorian Agency for Health Information Mental Health Services Directory.

Child and Adolescent Mental Health Services

For all information on child and adolescent mental health services applicable to ages 0 to 18 years please open the weblink provided and select the appropriate section relevant to the child or adolescent who is in need.

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Adult Mental Health Services

Adults 16 to 64 years with serious mental illness, such as a severe mood disorder (depression or mania), or psychotic illness, are entitled to services and care from mainstream health services and Area Mental Health Services (AMHS).

All AMHS are responsible for assessing people who present with, or at risk of developing, a serious mental illness or a severe psychiatric condition. The Victorian Dual Disability Service is available to support the AMHS teams in the assessment and care of people with both intellectual disability and mental illness

The target group for AMHS are people with serious mental illness or disorder who have associated significant levels of disturbance and psychosocial disability. These are people with a diagnosis of a major mental illness, such as schizophrenia, bipolar disorder or serious depression. This group can also include some people with other conditions such as severe personality disorder, severe anxiety disorder, or those who present in situational crisis that may lead to self-harm or inappropriate behaviour towards others. The distinguishing factor is the level of severity of the health disturbance and impairment.

Aged Person’s Mental Health Services

Adults who have psychiatric or behaviour disorders related to an organic disorder associated with aging, such as dementia, are entitled to services and care from the Aged Persons Mental Health Teams. The target group for this service is usually over 65 years, but also includes people in whom changes associated with aging occur at an earlier age, such as people with Down Syndrome who develop Alzheimer’s dementia. The Victorian Dual Disability Service is available to support the Aged Persons Mental Health Service teams in the assessment and care of people with both intellectual disability and mental illness

The Aged Persons Mental Health services available are:

  • assessment and treatment services
  • associated nursing homes and hostels
  • acute inpatient services

Acute Inpatient Services

Acute Inpatient Services treat older people during an acute phase of mental illness until recovery enables them to be treated in a community-based setting. Acute inpatient services for older people are located with other aged care facilities and general hospitals. In some rural areas acute inpatient beds for older people are located with an adult inpatient unit. The Acute Inpatient Services provide care using a recovery-oriented approach. This means that a multidisciplinary team works with the person and their family/carer/advocate/support workers to articulate treatment goals and the process of working towards these goals.

Intensive Community Treatment Program

The intensive community treatment program in aged persons mental health (APMH) services is an alternative to acute inpatient beds

The program aims to:

  • provide older people with an alternative treatment setting to hospitalisation during an acute phase of their mental illness and prevent hospitalisation where possible
  • provide intensive treatment in the older person’s home during an acute phase of a mental illness, when the person and their family or carer expresses this wish
  • minimise the length of stay in an inpatient unit by providing ICT during an acute episode of illness

The program’s target group includes:

  • older people whose acute treatment for their mental illness can be delivered safely in their home as an alternative to being admitted to an aged persons mental health acute bed
  • older people who have family or other carer supports available for the period of treatment
  • older people whose length of stay in hospital can be minimised through intensive treatment at home
  • These services are not available in all catchments
Eligibility

Aged Persons Mental Health Services are for people:

  • with long-standing mental illness who are now 65 years or older
  • who have developed functional illnesses such as depression and psychosis in later life
  • with psychiatric or severe behavioural difficulties associated with organic disorders such as dementia
Referrals

Visit  Victoria Health older people webpage to find an Aged Persons Mental Health service in the area closest to the person you are supporting

All referrals should include:

  • demographic information
  • a description of the symptoms
  • any identified risks involved to help the team triage (assess) the level of need and risk management
  • Whether or not the person needing care is aware of the referral
  • Existence of any high level of medical co-morbidities or other health concerns.
Cost

The APMHS may be partly or fully covered by Medicare. APMHS fees may be covered by some private health funds, but the amount will depend on the person’s health insurance policy. Contact with the health insurer should be made to discuss if this is covered and any additional costs. Anyone can contact the APMHS to check if they will need to cover any costs or if they are eligible for full or partial Medicare rebates.

How to prepare for an appointment

The North Western Mental Health service have an information booklet for persons receiving treatment or support and their carers, detailing what to bring to the hospital and other relevant information pertaining to treatment. Access the booklet Preparing for a health or medical appointment here to help prepare the person you are supporting attend their appointment.

Where consent is available the inclusion of relevant information from the person’s medical record can aid the mental health service in determining what level of care the person will require, including any accessibility requirements. It is important to take a list of any medication the person is taking when they attend the initial appointment or assessment.

What to expect when calling triage

Hospital triage services are generally the first point of contact for people in metropolitan Victoria who are seeking support through a clinical mental health service. When someone calls Triage, the call will be answered by a mental health clinician. The caller will be asked a range of questions to gather information to ensure the most appropriate response is given

Initial assessment

A triage health professional will commonly ask the person or their family/carer or support worker for information including:

  • basic demographic details about the person who is needing the service support (E.g., name, age, residential address/suburb)
  • a brief description of what is happening (presenting problem, risk, concerns, or issues)
  • previous history, diagnoses and medications if relevant/known
  • who else might be involved in the care of the person (for example family and/or carers, a GP, private psychiatrist, or private psychologist)
  • any other issues the person may be experiencing (such as safety concerns, other health issues, drug, and alcohol issues)
  • when a person other than the person is speaking with triage, a question about whether the person the call is about is aware that the Triage service is being contacted on their behalf

This information contributes to the initial assessment and helps to determine the urgency of the response and type of response required from mental health or other services

If the situation is deemed an emergency or very serious, the call may be transferred to triple zero (000)

Further assessment

The triage process will identify whether the person needs further assessment by the specialist mental health service or other services and if this is needed Triage makes an appropriate referral

Support options

If specialist mental health services are not the most appropriate option, information about other appropriate services (for example private psychiatrists or another private mental health practitioner, a drug and alcohol service, gamblers help service or medical specialist) may be given including referral requirements or they may provide other advice

Resources

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Acute Community Intervention Services (ACIS)

The Acute Community Intervention Services (ACIS) also includes the Crisis Assessment and Treatment Team (CATT) provides urgent advice, referral and treatment programs to people experiencing a mental health crisis. These programs are intensive and community-based and offer an alternative to hospitalisation

ACIS responses are available 24 hours a day, seven days a week. They operate out of the Area Mental Health Services located across Victoria.

What services do the ACIS provide?

  • Urgent assistance, 24 hours a day
  • Services to people within the Area Mental Health Service target group
  • Urgent community-based assessment
  • Short-term treatment interventions to people with psychiatric crisis
  • Quick access to assessment over the phone (telephone triage)
  • Emergency department care (face-to-face)
  • Short- to medium-term evidence-based treatment
  • Recovery-oriented treatment and support.

How to access ACIS services?

An ACIS response is available 24 hours a day, seven days a week, for people of all ages through a locally relevant application. Application can occur through one of the following actions

  1. Telephone triage. This is through an initial telephone assessment to determine the urgency and nature of an ACIS response. The Department of Health website lists the Approved Mental Health Services contact details across Victoria
  2. Hospital emergency department care. A senior mental health practitioner is available to emergency department staff to support assessment, consultation, and advice. The Victorian Dual Disability Service (VDDS) is also available to support the AMHS teams (including ACIS teams) in the assessment and care of people with both intellectual disability and mental illness
  3. Acute Assertive Community Outreach. The ACIS response delivers short- to medium-term community treatment in the person’s home during the acute phase of illness as an alternative to hospitalisation or to support transition from inpatient services
Eligibility

Adults residing in Victoria with severe psychiatric disturbance or severe behaviour related to a psychiatric disorder where there is a risk of immediate danger to themselves or other people or property in their vicinity.

Referrals

If you believe that someone is unwell, suffering a mental illness and at risk of deterioration if this is not treated then you should make a referral Indicators can include the person:

  • telling you that they are depressed
  • appearing to be very tearful and withdrawn for a long period (weeks or months)
  • appearing to be quite confused or not making sense
  • presenting as overly fearful, worried or anxious
  • appearing to be having extreme highs and lows that aren’t resolving on their own
  • experiencing very odd thoughts that exist even when you have tried to ‘talk them out of it’
  • experiencing dramatic changes in their sleeping and eating patterns which are now affecting their lives.

The ACIS triage can go through all these concerns with you over the phone to help determine if there is a need for a referral at this point

Do not refer to ACIS:

  • when the person is already linked in with another public mental health service. Instead ask the other service to assist you and whether a referral to ACIS is appropriate
  • when the person lives in an area that is outside of our treatment boundaries
Cost

The ACIS may be partly or fully covered by Medicare. ACIS fees may be covered by some private health funds, but the amount will depend on the person’s health insurance policy. Contact with the health insurer should be made to discuss if this is covered and any additional costs. Anyone can contact the ACIS to check if they will need to cover any costs or if they are eligible for full or partial Medicare rebates.

What to do before the appointment

If you have a scheduled appointment, this will usually be with the ACIS team, and they will provide instructions when making the appointment or you can call to ask for these again.

See the Preparing for a health or medical appointment section for a useful checklist and information to help prepare the person you are supporting attend their appointment.

What to expect on the day

The ACIS team will provide instructions regarding where they will meet you at the appointment address. This may include an emergency department or reception area or other location within the service or hospital site. There are some appointments where they will come to your house.

The appointment, whether it be with ACIS team, a clinician in the Emergency Department or some other person from the service, can be short (a few minutes) or long (an hour or more) depending on the need during that time

What to expect after the service is over?

An appointment card will be provided identifying the next appointment time and date if this has not been given ask what happens next. It is also good to identify who can be contacted for any concerns between appointments and ask if there are any preferred times to make contact as this is usually through the triage phone number.

The ACIS team will make sure you are supported during the crisis. Once the crisis has passed, the ACIS team then provides referrals to health and community services that can provide longer-term care

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Specialist Mental Health Services

Specialist Mental Health Services offer support to people with clinical conditions or with high-level needs and conditions that severely impair their ability to function in daily life. The details for each of these specialist services are available through link Specialist Mental Health Services

These services are delivered statewide, on a regional basis, and include:

  • mother and baby
  • Aboriginal mental health
  • refugee mental health
  • personality disorder
  • brain disorder
  • eating disorder
  • neuropsychiatric disorder
  • dual disabilities

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Victorian Dual Disability Service (VDDS)

The Victorian Dual Disability Service (VDDS) is part of the Victorian Mental Health sector and aims to promote equitable access to mental health care for people with a dual disability (developmental disability and mental health problem).

The VDDS does not provide direct treatment but works with the specialist Area Mental Health Services in ensuring assessment and appropriate management

At a state-wide level, the VDDS:

  • provides consultation to staff working in Victoria about their consumers aged 16 plus who have intellectual disability and/or autism and a mental health problem
  • supports the Area Mental Health Service (AMHS) teams in the assessment and management of people who have both an intellectual disability and a mental illness
  • facilitates partnerships and collaborative treatment planning through consultation and liaison
  • provides training to staff working in the mental health and disability sectors
  • provides telephone advice to anyone needing information about the presentation, assessment, or management of people with intellectual disability and mental illness

The VDSS does not:

  • provide cognitive, neuropsychological or ADHD assessment's
  • have a dedicated inpatient unit.

See the Preparing for a health or medical appointment section for a useful checklist and information to help prepare the person you are supporting attend their appointment.

Eligibility

Eligibility for VDDS support includes the person must be 16 years or older and have both an intellectual disability and a mental illness

Referrals

For information about The Victorian Dual Disability Service (VDDS) click on these brochure

If you have been referred, please watch this video on how to prepare for the initial appointment: Consumer Information Video

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Centre for Developmental Disability Health (CDDH)

CDDH is a secondary consultation service with a team of clinicians who specialise in the field of developmental and intellectual disability in adults. CDDH clinicians assess and provide management strategies for complex presentations including behaviours of concern, mental illness, and physical ailments commonly associated with developmental disability

Eligibility

CDDH work with people who are living with a developmental or intellectual disability and initial contact with the team can identify supports available or other appropriate options as needed

Referrals

To make a referral, please complete the CDDH Intake Form and email to CDDH@monashhealth.org. Please contact CDDH offices on 03 9792 7888 if you require assistance with the form.

Once CDDH receive the referral, it is reviewed by their clinical team at the weekly clinic review meeting. Actions taken may include the scheduling of an appointment with one of their Senior Medical Officers, request for further information or interim clinical advice to the relevant parties

Costs

The CDDH service is covered by Medicare rebates.

See the Preparing for a health or medical appointment section for a useful checklist and information to help prepare the person you are supporting attend their appointment.

What to expect during the consultation

The initial consultation will usually last for one to one and a half hours and involves the person with a disability, a support person with a good knowledge of the person and their presenting concerns and other parties who may be able to contribute

What to expect after the consultation/service is over?

Within four to six weeks, a detailed report, including an assessment and management suggestions, is sent to the referring doctor and the person’s medical treatment decision maker, with copies sent to other parties with written consent

Resources

The resources below can be used by disability workers or mental health professionals, family members, carers, or other supports, with the person’s consent.

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Complex, severe, or episodic mental health conditions

Complex mental health issues are impactful, severe, enduring, or episodic where the person will experience periods of illness with other times with minimal symptoms and disability. The person may even have periods of symptoms related to their mental health concern or diagnosis decreases or a disappearance of signs and symptoms. This is decrease is known as remission

People experiencing emerging and potentially severe or complex mental illness will need early direct services

Illnesses considered complex include:

  • schizophrenia
  • bipolar disorder
  • personality disorders
  • eating disorders
  • dissociative disorders
  • post-traumatic stress disorder (PTSD) and complex PTSD
  • severe and enduring mood and anxiety disorders

Where to find help and support in an emergency

When caring for someone with a mental illness, there may be times when their health deteriorates to a point that immediate support is required. This may be because they have developed suicidal thoughts or have become agitated resulting in an increased risk to themselves or others. When this occurs, it is best to contact a specialist service that can assess the situation and help you to decide on the best course of action

Disability workers should always follow their organisations policy for the health or safety plan for any person they are supporting or call 000 for crisis support
For more information, refer to the Emergency and Crisis Mental Health Concern section.

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Service options for complex, severe, or episodic mental health conditions

The list of services below all provided for people with complex, sever or episodic mental health needs. Click on each link to open for all details discussed previously in this pathway guide.

Resources

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Emergency or crisis mental health concern

Where to find help and support in an emergency

When caring for someone with a mental illness, there may be times when their health deteriorates to a point that immediate support is required. This may be because they have developed suicidal thoughts or have become agitated resulting in an increased risk to themselves or others. When this occurs, it is best to contact a specialist service that can assess the situation and help you to decide on the best course of action

Disability workers should always follow their organisations policy for the health or safety plan for any person they are supporting or call 000 for crisis support

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Before an emergency or crisis occurs

If the person you are supporting and/or yourself are not in an emergency but perceive the risk of harm for the person or others around them is increasing and may be heading towards a crisis, ensure that you follow your organisations policy or safety plan for that person if documented.

For all other supports that can assist before a crisis or emergency occur refer to the sections in this guide for people with serious mental health conditions or complex, severe or episodic mental health conditions.

Resources

Mental Health First Aid: Suicidal thoughts & behaviours guidelines

This guideline includes outlines how to respond to someone who you think is suicidal

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Psychosocial supports and NDIS

What is Psychosocial Disability?

Psychosocial disability is a definition used by the National Disability Insurance Scheme (NDIS) to describe a disability that may arise from a mental health issue.

Psychosocial disability refers to the functional impact and barriers which may be faced by someone living with a mental health diagnosis or condition

A psychosocial disability arises when someone with a mental health condition interacts with a social environment that presents barriers to their equality and participation with others

Some psychosocial disabilities include:

  • Anxiety
  • Bipolar Disorder
  • Depression
  • Obsessive Compulsive Disorder
  • Post-traumatic stress disorder
  • Schizophrenia

What are NDIS psychosocial supports?

Psychosocial support refers to assistance for people with severe mental illness to participate in their community, manage daily tasks, undertake work or study, find housing, get involved in activities, and make connections with family and friends. Psychosocial supports are non-therapeutic interventions which are specific to each person and their needs. They may include one-to-one or group support.

NDIS can provide support to people with psychosocial disability, but there are eligibility criteria For example people who have severe episodic mental illness may not be eligible for NDIS support

Psychosocial supports may include:

  • developing social skills and friendships
  • building relationships with family
  • managing money
  • finding and looking after a home
  • building skills and qualifications
  • developing work goals
  • staying physically well, including exercise
  • support with drug, alcohol and smoking issues
  • building life skills, including confidence and resilience
  • exploring access to the NDIS

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Resources

Independent Mental Health Advocacy
A new Victorian government funded resource provides information for any person wanting to understand what they can advocate for with the NDIS, request advocate support, enquire about their rights in relation to assessment, treatment and recovery Calls can be made 24 hours a day on 1800 959 353 to hear a free recording of your rights under the Mental Health Act

Victorian Advocacy League for Individuals with Disability (VALID)
VALID have developed a collection of tip sheets to help people navigate the NDIS.

Reimagine
Reimagine today is co-designed resource with people living with mental health conditions including psychosocial disability. The information on the Reimagine website is tailored to people living with mental health conditions, as well as friends, family members and carers to assist them to understand:

  • The National Disability Insurance Scheme (NDIS), and
  • How to support people living with a mental health condition

The Reimagine website is categorised into sections to provide information that will help supporters who are not family members or carers but wish to assist; like GPs, other health care workers (like psychiatrists and allied health providers) and support workers

NDIS Mental Health Toolkit
The Independent Mental Health Advocacy (IMHA) is a Victorian state-wide advocacy service for people receiving compulsory treatment under Victoria's Mental Health Act 2014. IMHA supports people who are receiving compulsory psychiatric treatment to have as much say as possible about their assessment, treatment, and recovery.

The IMHA developed the NDIS Mental Health Toolkit designed for people with lived experience of the mental health system who use or are eligible for the NDIS under the psychosocial disability stream.  It has information and worksheets to help you know your rights, speak up for yourself and be the strongest advocate for what you want under the Scheme.

The toolkit is designed for people with lived experience of the mental health system who use or are eligible for the NDIS, but can also be used by supporters, such as carers, family of origin, family of choice, friends, community members and support workers.

It is free to use for all mental health service workers, people supporting NDIS participants, applying for the NDIS, and existing NDIS participants themselves

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Psychosocial supports available outside of NDIS funding

The health systems delivered through state and commonwealth governments provide mental health clinical support services for people with a disability including psychosocial disability or condition.

Psychosocial Support Services are non-clinical and are commissioned through Primary Health Care Networks and funded through the Commonwealth Government. These are provided for people receiving Adult Mental Health Services for support with severe mental illness and who do not qualify for the NDIS or who have experienced a delay or difficulty in accessing the NDIS.

Services are expected to be short term and provided for no longer than 12 months. They can include a mix of individual and group-based activities. The services are integrated with existing treatment and support systems and are specific to the person and the times they need them

Examples of supports may include community-based support for the person to achieve their recovery goals such as:

  • developing social skills and friendships
  • building family relationships
  • managing money
  • finding and looking after a home
  • developing work goals
  • improving educational skills
  • staying physical well, including with exercise
  • support with drug, alcohol and smoking issues
  • building broader life skills including confidence and resilience

Eligibility

To access support through Commonwealth Psychosocial Supports the person must have a severe mental illness:

  • reside in the region associated with the service provider
  • be aged 16/18 – 65 years of age
  • be expected to benefit from the provision of psychosocial supports
  • and not accessing psychosocial supports through NDIS

Referrals

Anyone can make a referral to the Psychosocial Support Service including:

  • people referring themselves
  • carers
  • friends and/or families
  • GPs and other service providers in the region

Any person who is wanting to access these services is recommended to speak to their mental health case manager as the treating Community Mental Health Service treatment team can provide advice regarding eligibility and assist with the referral. 

Cost

Free. These initiatives are funded by the Australian Government through the Primary Healthcare Network Program

Additional details regarding psychosocial support access can be discussed through the Head to health team who will identify most appropriate option for the individual in the Primary Health Care Network region associated with their residential location Refer to the section in this guide; Head to Health – Pathway to commonwealth funded mental health services.

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Supported decision making

Victorian Office of the Public Advocate (OPA)

The OPA defines Supported Decision Making as ‘a framework within which a person with disability can be assisted to make valid decisions. It is based on the premise that everyone has the right to make their own decisions and to receive whatever support they require to do so. Supported decision making promotes freedom of choice for people using public mental health services.

There is different legislation regulating the powers of support people in Victoria. The Office of the Public Advocate (OPA) website includes information, fact sheets and forms. An Advice Service is also available if you need clarification.

Refer to the OPA ‘Supported Decision-Making in Victoria’ guide which details the legal possibilities and best-practice regarding ways in which supported decision-making can occur in Victoria.

For information relating to Supported Decision-Making Policy, visit the NDIS website.

The supported decision-making policy covers:

  • The role of the NDIA and NDIS in supporting people with disability to make decisions
  • How the NDIA can help children, young people and adults with disability understand their rights to make decisions and support them to make decisions
  • The role of nominees, guardians, family members and others in supporting people with disability to make decisions about the NDIS

The resources below are tool kits to assist a person with a disability, their families, guardians and service providers to understand and learn about decision-making and choice

My Choice Tool Kit is a five-booklet toolkit developed by Inclusion Melbourne to assist people with a disability make choices about their life. The booklets can be downloaded from the website or ordered in hard copy.

Inclusion Australia’s Support Decision Making video resources and booklet provides information detailing information about people with intellectual disability talking about how they make decisions in their own life.

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Help with a concern or complaint about a mental health service

There’s a lot of trust in a mental health support relationship for any person who is receiving therapy, treatment or non-clinical support so it is important the person can feel comfortable with the health professional or care worker supporting them. Disability workers can support a person with a disability, their family or carers to identify important requirements to be met where this is possible.

The list of requirements could include consideration for:

  • options for telehealth appointments or home visits
  • accessible venues which may include low sensory waiting or appointment rooms
  • knowledge and experience with people with disabilities

It is important to remind anyone seeking support that a specific match with a mental health professional is not always possible however mental health service providers can be asked if they can accommodate any specific needs Some psychologists and mental health professionals would be able to speak to you and the person you are supporting over the phone before the first appointment.

Feeling safe with a mental health service provider can also be supported through more information about what to expect especially for a person who is seeking support for the first time. Peer workers are also a great contact to discuss expectations as they have lived experience with mental health issues and a Certificate IV in Mental Health Peer Work. Peer workers can provide the person seeking support, their family, carer’s or disability workers with a clinical picture of what is going to happen as part of your treatment or appointment. Peer workers will often have experience of navigating complex mental health systems and will be able to provide re-assurance and support for the person you are supporting. Peer workers are employed by many different mental health services, including inpatient and outpatient mental health facilities and the Mental Health and Wellbeing Hubs and Locals.

Sometimes a ‘right fit 'with a mental health professional and the person they are working with does not occur. In these instances where the relationship between the person seeking assistance and the health professional is not working it may be possible to identify another health professional or service. Anyone receiving any health support for a mental health or physical health need can explore the options of other service providers if the one they are attending does not feel right for them

Where the concerns are related to a complaint about the service, or the health professional refer to the details below for appropriate options for this process or to have an initial conversation about the concerns.

The Independent Mental Health Advocacy can also assist with any questions or concerns related to assessment, treatment and recovery including identification of an advocate if needed calls can be made 24 hours a day on 1800 959 353 to hear a free recording of your rights under the Mental Health Act

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Making a complaint

If a person is not happy with the mental health services they are receiving or has a concern they want to identify about the service or treatment they can call the Mental Health Complaints Commissioner and discuss whether or not to make a complaint This can also be identified on behalf of the person who has a concern or complaint. Any worker or family member or carer who is unsure about concerns or complaints related to a person who is receiving a mental health support can call the Commission and discuss the options with a member of their team about the service or treatment with their consent.

Complaints or concerns directed to the Mental Health Complaints Commissioner should be related to a negative experience while receiving mental health assessment or treatment, at any Victorian public mental health service. Complaints or concerns can also be directed to the mental health service itself through the organisation’s complaints or feedback processes.

To find out more about making a complaint with the MHCC on their website.

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Mental Health Tribunal

The Mental Health Tribunal is an independent tribunal that makes decisions about compulsory treatment orders and orders about electroconvulsive treatment (ECT). Read more about going to the Mental Health Tribunal.

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Health appointment and hospital admission tools

GP appointment tools

The tools listed below are disability specific resources to maximise effectiveness and communication with GP’s and improve the health outcomes for people with disability and include a description of each option and access link.

1: Comprehensive Health Assessment Program (CHAP)

The Adult Comprehensive Health Assessment Program (CHAP) is a two-part questionnaire that is designed to be used with people with intellectual disability and undertaken during annual health assessments. The first part of the questionnaire creates a comprehensive health history and is completed by the disability worker, family, member or /carer and/or the person with intellectual disability The health history is then taken with the person when they attend the GP appointment. Working with the person and their support (disability worker, family member, or carer), the GP fills in the second part of the questionnaire.

The Comprehensive Health Assessment Program questionnaire helps GPs to identify commonly missed, poorly managed or syndrome specific health conditions that may need to be addressed. The GP completes the second part of the questionnaire to create an agreed health action plan.

There are two versions of the Comprehensive Health Assessment Program: one for adults and another for adolescents. Both are regularly updated to ensure consistency with current clinical practice guidelines.

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Why use the Comprehensive Health Assessment Program tool?

The CHAP tool allows for better collaboration and involvement between the disability service, the person with disability, disability workers supporting the person, their family and other health services involved in their care The CHAP covers important health areas including dental care, vaccinations, and gender specific reviews related to breast, bowel and prostate screening

Regular comprehensive health assessments have been shown to prevent illness and maintain the health and wellbeing of people with disability. These outcomes are a result of identifying unmet health needs, preventing disease, engaging in regular health care, and improving communication with the GP.

How do I access the CHAP tool?

Disability service providers, carers and support persons can register to download the CHAP on behalf of their clients. Please note that it is advisable to download the latest version each time a request is made.

To download the 2023 version of the Adult Comprehensive Health Assessment Program (CHAP) – Annual Health Assessment for People with Intellectual Disability, visit the Australian Government Department of Health and Aged Care website to download the free pdf.

Where to got to get help with CHAP?

How to embed health assessments into service provision in disability organisation: View the video

For further information about intellectual disability and intellectual disability specific health care resources, please visit the Western Victoria Primary Health Network’s People with an Intellectual disability webpage.

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2: Signs and Symptoms Tracker

Signs and Symptoms Tracker for Your GP is a complimentary checklist to the CHAP guide, developed by Supporting People with an Intellectual Disability to Access Health (SPIDAH) team within the Western Victoria Public Health Network

You can access the Signs and Symptoms Tracker via the Western Vic PHN Intellectual Disability website.

3: Question Builder?

Question Builder is a tool to assist preparation for a medical appointment

By working through a series of steps, a person and their supports (disability worker, family member or carer) can create a list of the most important questions to ask the GP and prepare for the questions the GP may ask. 

Heart Direct Question Builder tool

Why use the Question Builder?

The best healthcare decisions are made when the person with disability, their support ( disability worker, family member or carer) and the doctor work together. One of the best ways to communicate with the doctor is by asking questions Being prepared for the appointment in advance and asking questions gives the doctor important information about the person with disability and what concerns they have about their health.

Question Builder helps people to ask their doctor specific questions that are important about their health including:

  • any new symptoms
  • need for a check-up
  • managing a chronic health condition
  • discussing a medicine, a test or surgery

General Practitioners can support a person who needs mental health support to access services at low or no cost through Medicare funded options through the development of a Mental Health Treatment Plan or the Better access to mental health care scheme. Each of these options enables eligible people to access a range of mental health professionals. The number of sessions available funded through Medicare will be identified by the GP as part of the planning process.

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Checklist to prepare for a health or medical appointment

The following checklist is a useful guide to prompt the disability provider to support a person with disability to bring the necessary documentation, medical history, and other information to the health appointment. This would ensure that the health professional has all the necessary information before the consultation Any provision of information about a person with a disability to a health or medical team should be given with full consent of the person or their authorised family/carer or guardian. Consent to share relevant medical or health information should be identified by the disability provider as part of service onboarding instead of workers trying to arrange this when the health or medical needs of the person may be requiring immediate support.

Preparing for a health or medical appointment

A checklist of items to take to any health or medical appointments for a person with disability:

  • Letter of referral from another doctor, if they have one (e.g., Mental Health Treatment Plan)
  • Medicare card
  • Pension card or healthcare card if they have one
  • Details of any existing private health insurance cover (i.e., for private psychologists)
  • Relevant or summary of medical records and test results unless they have been sent ahead
  • Names and contact details of other healthcare providers involved in their care
  • Names and contact details of the key workers involved in the person’s care (e.g., alcohol, and other drugs worker)
  • A notebook and pen/electronic device to record notes including questions to ask
  • List of medications or the actual medications including dose prescribed, when and how they are taken or administered something to do, eat or drink if the patient is likely to have to wait for a long time in the waiting room of clinic or specialist service.
    Always check with the medical or health service if food and drink can be consumed

Please note that some specialist centres will advise you if there are other specific information, they will like you to bring on the day of the appointment or treatment.

Preparing for inpatient mental health service admission

Similar to the above checklist, there may be extra items that will ensure that the person you are supporting is prepared for their care received in a hospital or specialist mental health service, including:

  • Comfortable day clothes
  • Nightwear
  • Low heeled, well-fitting, non-slip footwear
  • Toiletries
  • A small amount of money for minor purchases (e.g., for coffee, newspaper)
  • Aids and devices (please advise nursing staff if you have dentures, hearing aids, mobility aids or falls prevention aids)
  • Medicare Card: Repatriation File Number if you are eligible for Department of Veteran Affairs’ entitlements; Full details of your health insurance cover (if you have cover)
  • Any current medications must be handed to the nurse in charge on arrival

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Supporting a person who is not eligible for Medicare

What is a Medicare Ineligible Patient?

A Medicare Ineligible Patient is a person who:

  • Does not hold a valid Medicare card; or
  • Is not an Asylum Seeker; or
  • Is a person who is from a country that does not have a Reciprocal Health Care Agreement with Australia or is a person for which their countries Reciprocal Health Care Agreement with Australia does not cover their treatment. For further information please view the  Reciprocal Health Care Agreements with Australia

If the person you are supporting is not eligible for Medicare and attending a public health care facility, they will be required to pay for all hospital services they receive. This includes, but is not limited to, outpatient, emergency department, allied health services and admitted care, aids and equipment, interpreter services.

Charges related to services provided by the hospital may vary depending on the treatment provided, and whether the person you are supporting is covered by an Australian Health Insurance Policy. It is important to check the level of cover with the person’s health insurer prior to seeking services. If the person you are supporting does not have private health insurance, then they will need to pay the full estimate of their account on or before the day of admission.

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Eligibility

There are some instances where people without a Medicare care can receive free treatments, either as planned (elective) or emergency patient. A Medicare ineligible person is any visitor to Australia who does not hold a valid Medicare card, or does not fall under one of the classifications below:

  • Patients from countries with reciprocal rights. Patient Liaison Officers can assist you and the person you a supporting to determine the level of insurance cover and can provide you with the estimate of costs of the care prior to seeking services at the hospital
  • Asylum Seekers and Refugees

Anyone residing or working in Victoria is eligible to receive free support from the Mental Health and Wellbeing Hubs and Mental Health and Wellbeing Locals.

What services are asylum seekers eligible to receive

Asylum Seekers and Refugees are provided with free medical care (including diagnostic services) in Victorian hospitals. Asylum Seekers and Refugees will need to produce appropriate documentation confirming their status from the Department of Immigration and Citizenship or recognised asylum support agency, such as the Red Cross. If the documentation is not produced, the person you are supporting may be expected to pay for all associated medical costs related to their inpatient mental health treatment, however the fee will be waived once the documents are presented to Hospital Admissions Staff.

What information will I need to provide at the hospital?

If you are supporting someone to attend the hospital, you will need to provide the hospital staff with:

  • The passport and Visa status of the person you are supporting
  • Up-front payment for services
  • Relevant health insurance policy details
  • Overseas residential address and phone numbers
  • Residential details and sponsor details including any information during your stay in Australia.

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Page last updated 18 September, 2023.

Contact information

For any enquiries, please contact the Mental Health team, submit enquiry/feedback, show phone number