Banksia Mental Health Unit: children's services ruled not 'economies of scale' in plan for new mental health unit

NSW Parliament forced the government to make the unit's clinical services plan - its primary planning document - public, last week.

Large parts of the section comparing expected service demand with the national mental health service planning framework are redacted.

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But in an unredacted section, the final New England Clinical Services Plan rules that building a very small mental unit for children "may not be practical as economies of scale may not be achieved".

"The travel distance between young people's homes in the NE [New England] catchment and the NEXUS unit [in Newcastle] are challenging," according to the CSP.

"Consideration should be given to how children and their families in the NE [New England] region can be further supported when accessing specialist care."

Shooters, Fishers and Farmers MLC Mark Banasiak, who sponsored the parliamentary motion which made the documents public, said the "economies of scale" terminology made him think of steel manufacturing, not mental healthcare.

"Essentially we're comparing kids that have serious mental health conditions to a dollar, and products on a shelf. That's how we refer to businesses that produce products - in terms of economies of scale. We're essentially comparing our kids to products on a shelf for sale. It's pretty disgusting," he said.

"Kids that are going through this stuff should still be close to home. They shouldn't be shipped off to Newcastle and forgotten about. How is that going to be great for their mental health when they're that far away from their family and their network? It actually goes against solid principles around treating mental health."

He also criticised government for hiding most of the modelling from the public, which he said showed a lack of faith in the estimates, and committed to appeal for additional transparency through the parliamentary process.

The new unit will be built attached to the Tamworth hospital's emergency room, and will add eight beds to the existing Banksia unit's 25 beds. All eight new beds are dedicated as specialist older person's mental health beds.

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Some 382 children below the age of 18 presented to hospitals in the New England region with a principle diagnosis of a mental health problem in the four years between 2015 and 2019, according to the CSP.

A lack of child mental healthcare in the region was one of the primary reasons behind an enormous community campaign for a better Banksia led by the Tamworth Mental Health Carers' Group. It was also raised repeatedly during the consultation process over the new unit, the CSP documents show.

"During the diagnostic phase the issue of child and adolescent presentations to general pediatric wards was consistently raised noting appropriate, timely, accessible treatment options for child and adolescent consumers, especially when an inpatient admission is indicated, is often difficult to facilitate," the CSP reads.

The documents show the government currently estimates the new Banksia upgrade to cost about $40 million.

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"The current 12 bed [NEXUS] unit has adequate beds to meet current demand in 2019-20 and estimated demand in 2030-31 for Hunter New England LHD and the New England catchment," the CSP claims.

"Banksia unit operates on average at 85 per cent capacity with a client mix that includes older people, and as the only gazetted unit in the catchment, should maintain the capacity to flex up."

A spokesperson for NSW Health did not answer eight questions put by the Leader, including why large sections of the document were redacted.

"The new Banksia Unit will be able to support approximately 30 per cent more patients each year, with additional beds for older people," she said.

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"The Hunter New England Local Health District is confident the new Banksia Unit as part of a district wide network of mental health services will address likely future demand for mental health services, including acute beds, in the region to 2030-31. Planning projections are based on ABS population data.

"Clinical Services Planning for the New England region of Hunter New England Local Health District, including the Banksia Unit, started in 2018 and has involved extensive consultation with more than 350 staff, consumers and community members."

A term from the field of economics, economies of scale refer to the cost advantages that a large enterprise obtains by producing more outputs, driving the cost per unit of output down.

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