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Adult specialist mental health services (16-64 years)

• An introduction to Victoria's specialist clinical mental health services - January 2006 (PDF file 507KB)
• Victorian Mental Health Service System - May 2005 (PDF file 149KB)
• Specialist mental health service components - May 2005 (PDF file 91KB)

Target group

Adult specialist mental health services are aimed primarily at people with serious mental illness or mental disorder who have associated significant levels of disturbance and psychosocial disability due to their illness or disorder. Commonly these will be people with a diagnosis of a major mental illness, such as schizophrenia or bipolar disorder, but will 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 disturbance and impairment. Increasingly, adult mental health service consumers have more than one disorder, with drug and alcohol related disorders (dual diagnosis) being most prevalent.

Service components

All specialist mental health services are required to provide a range of components so that consumers have access to similar service responses and functions wherever they live. However the health services and hospitals deliver their public specialist mental health services differently depending on the local service environment and catchment area. Some services have separate teams for each component function; others operate ‘integrated teams’ which perform a number of functions by rostering staff to undertake the required activities for a given period. The critical factor is that all area mental health services provide the full range of functions.

Specialist services are usually provided on a regional or statewide basis.

Crisis Assessment and Treatment Teams

These services operate 24 hours a day and provide urgent community-based assessment and short-term treatment interventions to people in psychiatric crisis. CAT services have a key role in deciding the most appropriate treatment option and in screening all potential inpatient admissions. CAT services provide intensive community treatment and support, often in the person’s own home, during the acute phase of illness as an alternative to hospitalisation. CAT services also provide a service to designated hospital emergency departments through an onsite presence.

Mobile Support and Treatment Teams

These services provide intensive long-term support to people with prolonged and severe mental illness and associated high-level disability. They utilise an assertive outreach approach and operate extended hours seven days a week. MSTS’s differ from continuing care services in the frequency and intensity of intervention offered and work more closely with psychiatric disability rehabilitation and support services.

Continuing care, clinical and consultancy

These are the largest component of adult community based services. These services provide non-urgent assessments, treatment, case management, support and continuing care services to people with a mental illness in the community. The length of time case management services are provided to a person varies according to clinical need. Continuing care services may be involved with people for extended periods of time or may provide more episodic care. Continuing care clinicians frequently liaise with, and refer to, generalist services including general practitioners for ongoing support and provision of services to people with a mental illness.

Clinical residential rehabilitation services (Community Care Units)

Community care units provide medium to long-term accommodation, clinical care and rehabilitation services for people with a serious mental illness and psychosocial disability. Located in residential areas, they provide a 'home like' environment where people can learn or re-learn everyday skills necessary for successful community living. While it is envisaged that people will move through these units to other community residential options, some consumers require this level of support and supervision for a number of years.

Prevention and Recovery Care services

Adult prevention and recovery care (PARC) services framework and operational guidelines 2010 - July 2010(PDF file 383KB)

PARC services are a new supported residential service for people experiencing a significant mental health problem but who do not need or no longer require a hospital admission. In the continuum of care, they sit between adult acute psychiatric inpatient units and a client’s usual place of residence. PARC aims to assist in averting acute inpatient admissions and facilitate earlier discharge from inpatient units. They are not a substitute for an inpatient admission, rather they provide clinical treatment and short-term residential support. PARC services are usually a partnership between PDRSS and clinical services. PARCs are not currently available in all catchment areas.

Early intervention services

These teams support and enhance the capacity of primary care providers, especially general practitioners and community health services, to recognise and respond to mental disorders more effectively. They provide consultation, liaison, education and training services to primary care providers for both low and high prevalence disorders. The teams have a particular focus on disorders such as depression and anxiety, and also provide some short-term direct care treatment and assessment for these high prevalence disorders.

Early Psychosis Program

Early psychosis services focus on providing service to young people between 16-25 who are experiencing a first episode of psychosis. They aim to provide for earlier and more intensive treatment as well as minimising disability associated with psychosis, including the impact of distress/trauma on both the young person and their family. These services are sub-specialty programs within the specialist clinical adult area mental health service, with close links to child and adolescent mental health services, primary care services and other community services and organisations. Early psychosis services are not currently available in all catchment areas

Carer and consumer consultants

Family where parents have a mental illness program

Acute inpatient services

These services provide voluntary and involuntary short-term inpatient management and treatment during an acute phase of mental illness, until the person has recovered enough to be treated effectively and safely in the community. These units are located within acute general hospitals. People admitted to an inpatient unit from the community are usually assessed by a CAT service to see if a less restrictive option is possible.

Consultation and liaison services

Consultation and liaison psychiatry is the diagnosis, treatment and prevention of psychiatric morbidity among physically ill patients who are patients of an acute general hospital. This includes the provision of psychiatric assessment, consultation, liaison and education services to non-psychiatric health professionals and their clients/patients. This service is not currently available in all general hospitals.

Secure extended care inpatient services

These services provide medium to long-term inpatient treatment and rehabilitation for consumers who have unremitting and severe symptoms of mental illness, together with associated significant disturbance, that inhibit their capacity to live in the community. These services are provided on a regional basis, and are gazetted to take involuntary consumers. They are typically located on hospital sites with acute mental health units or other extended care bed based services. They represent the highest level of care on the continuum of mental health services and provide extended clinical treatment, supervision and support.

Homeless outreach services

Homeless outreach psychiatric services (HOPS) provide a specialist clinical and treatment response for people who do not engage readily with mental health services. HOPS work in partnership with homelessness services and use assertive outreach to locate and engage with their clients to create a pathway out of homelessness by providing early and appropriate treatment. HOPS link clients into the mental health service system, including access to long-term housing augmented with outreach support, and improve the coordination and working relationships between mental health and homelessness services. HOPS also provide assessment and secondary consultation to homelessness services and other mental health workers. HOPS are not currently available in all catchment areas