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Royal Commission into Victoria’s Mental Health System

Case study:

The Alfred’s integrated model with headspace

The Alfred Child and Youth Mental Health Service has operated a vertically integrated service in conjunction with headspace since 2010 to provide support to young people with mental health issues.

Dr Paul Denborough, Clinical Director of Alfred Child and Youth Mental Health Service and headspace, said that because the same service provider is accountable for operating both services, it allows them to provide different levels of support to help a broader range of people than a non‑integrated service.

Being responsible for all levels means that we have to make a call. We can’t say it’s not us because we’re accountable for the service delivery for both. headspace is a service for mild to moderate problems, and the state‑funded child and youth mental health service is for more severe problems that need a multidisciplinary team.

The integrated service is staffed by a multidisciplinary team including psychiatrists, peer workers, psychologists and allied health professionals. It is available free of charge and can provide support to GPs, school counsellors, community health centres and headspace.

Dr Denborough said an advantage of the integrated model was that it prevented people from having to repeat their story to multiple agencies when they are trying to find the correct service for help.

It has very deep implications, the main one is if someone rings for help, we try and link them to who’s going to do it, rather than ask questions about eligibility and whether they met a certain threshold. This approach changes the whole tone of the conversation, which is around welcoming them and listening deeply to what the concerns are, rather than trying to work out whether they are eligible for service and then turning them away so they have to repeat their story to the next person.

Dr Denborough said while infrastructure and IT supports are shared between the two organisations, there are separate intake processes to determine the level of care needed.

We have a shared intake with the headspace early psychosis and the headspace primary service. We have another intake with the child and youth mental health service, but because staff all work for the Alfred they speak daily—there’s a very close alliance. We decided not to just have one intake mainly because there’s different catchment area and age boundaries.

Dr Denborough said using the same provider also reduces the risk of a ‘missing middle’ gap, which happens when a young person’s mental health and wellbeing challenges aren’t complex enough to meet the threshold for treatment, care and support at the public specialist mental health services but are too complex to be helped in headspace.

The advantage of having one governance is by us providing tertiary‑level support directly into headspace, we can manage to see people with more complicated problems because the headspace team know that if they really are struggling, we will back them up.

Source: RCVMHS, Interview with Dr Paul Denborough, November 2020; Alfred Health, ‘Child Youth Mental Health Service’ [accessed 10 November 2020].