Dr Andrew McDonald: The Pathways to Community Living Initiative, or PCLI, is now in its sixth year after being established by NSW Health in July 2015.
In 2015 NSW still had 380 people with severe and persistent mental illness who were inpatients in our mental health hospitals for over a year. Many had lengths of stay of well over 10 to 15 years. And data showed that more people were coming into hospital than were leaving. The bigger hospitals were often seen as ‘homes’ rather than as places of active treatment and rehabilitation. And pathways to appropriate services in the community were limited for people at this level of complex illness.
Coordinated by the Ministry of Health with the Local Health Districts, the PCLI has two aims.
The first aim is to transition people who are long-stay or at risk of being long-stay to appropriate community services, and develop new services as required.
The second is to change practice across all our hospital and community settings to sustainably reduce the number and length of long-stay admissions into the future.
Evidence shows that, with the right level of support, people who experience severe and complex mental illness can do well in the community, enjoying a social and connected life the same as us all.
Where are we now?
Jemima Isbester: In our sixth year, with investment by the government of over $10M recurrent we have a complex care group of over 43 practitioners, for people with significant ageing issues (PCLI Stage One), there are 80 funded community-based beds in mental health aged care partnership services.
Our operational services have successfully supported over 60% of the initial group of people, many of whom had been in hospital for years, to live successfully in the community.
The PCLI is also now working with treating teams to ensure newer groups of people with complex illness can move through hospital more rapidly to appropriate accommodation with clinical support services in their local areas.
While mental health care is always available for people in inpatient settings, hospitals are no longer seen as ‘homes’.
Independent evaluation of the first 5 years of the PCLI shows that it is a flagship program for value based mental health care, integrated across hospital and community settings.
Where to next?
Dr Andrew McDonald: PCLI Stage Two services for people 18 years and upwards, have been designed and costed. Under the Statewide Mental Health Infrastructure Program planning is in place for community-based built and therapeutic environments with 24/7 clinical and support programs. These services will be part of a statewide complex care rehabilitation program for people living with the impacts of severe and persistent mental illness.