Mental Health Redesign - History, Development and National Direction


Hunter New England Central Coast Primary Health Network (HNECC) currently commissions a number of mental health services – primarily under two programs: Primary Mental Health Clinical Services (PMHCS) and Mental Health Nurse Incentive Programs. While both programs deliver a high level of clinical care, there are opportunities to redesign these programs to improve service integration, increase access for consumers and create a continuum of services in a stepped care framework.


Primary Health Networks have been established to improve the efficiency and effectiveness of primary health care delivered to individual patients, and reduce health system costs across the country. PHNs achieve this by working directly with general practitioners, other primary care providers, secondary care providers and hospitals to ensure improved outcomes for patients. Among other responsibilities, HNECC leads mental health and suicide prevention planning, commissioning and service integration at a regional level to improve outcomes for people with, or at risk of, mental illness and/or suicide.

These areas of delivery contribute to HNECC’s vision of Healthy People and Healthy Communities.

As part of this remit, the PHN is implementing a model of Mental Health Stepped Care. The Commonwealth Department of Health has published guidance on Stepped Care implementation, as a part of the national Mental Health reform development in the 5th National Mental Health Plan.

In response to this guidance, the model that HNECC is implementing is inclusive of three levels of care: Low Intensity, Moderate Intensity and High Intensity.

In implementing the new model, HNECC aims to progressively address the challenges of equity of service access, availability of services, and consumers being able to move between levels of service, regardless of where they live.

Importantly, HNECC aims to develop longer contracts and relationships with commissioned service providers delivering this model, in order to achieve better outcomes for patients and people across the region.


HNECC acknowledges that changes to the mental health system are of interest to many people, including consumers and their carers, General Practitioners, service providers and the community. To gain the insights of a range of stakeholders, HNECC engaged Nexus Management Consultants to facilitate a co-design process. The process undertaken consisted of:

  • Literature Review
  • National review of current service models
  • Strategy workshop
  • Three regional workshops considering a proposed model
  • GP focus groups

After gathering all this information and considering the HNECC comprehensive Mental Health and Suicide Prevention Needs Assessment, a resulting model was developed that includes a Central Access and Referral point and a suite of integrated services in a Stepped Care Framework.

For the first component of this model, HNECC has requested proposals from organisations interested in delivering a Central Access and Referral Service.  HNECC will work with the successful applicant to develop a service that is suitable for local conditions, is appropriate for clinicians and referrers and enables a consumer’s treatment journey to be more integrated to meet their needs.

The second component of the model involves the integrated delivery of low, moderate and high intensity services across a region. This structure will allow a wider range of services to be accessed by more people, including additional services for people experiencing symptoms of mild mental illness and residents of Aged Care Facilities.

What is Happening Now?

The new access and referral service will start from July 1, 2019 and will be provided by a consortium of locally-based and experienced primary care providers.

  • Central Coast - Central Coast Primary Care
  • New England North West - HealthWISE
  • Hunter and Mid Coast - Hunter Primary Care.

They will be coordinating the delivery of mental health services, including services to Residents in Aged Care Facilities and Clinical Care Co-ordination services.  More information relating to these services will be sent to GPs in the next few weeks.

To ensure a smooth transition to this new service you can download a list of FAQs and GP desktop guide for each region below.

Central Coast New England North West Hunter and Mid Coast
GP Desktop Guide GP Desktop Guide GP Desktop Guide

More information?

Contact Leah Eddy on 0418 938 152