As part of Southern Grampians Glenelg PCP’s commitment to systems improvement, we have undertaken a small referral pathways mapping project to identify current services available, key referral pathways and opportunities to further develop partnerships in this area.  The project involved:

  • Interviews with a range of service providers from the mental health sector
  • Assessing pathways and ease of access to services
  • Identifying key referral linkages and opportunities to enhance these linkages

Key Findings

  • Emergency/Crisis/After hours mental health management is an ongoing area for improvement, particularly with relationship to policy and procedure for management of acutely unwell psychiatric presentations to Hamilton Base Hospital and other organisations.
  • There are historical relationships which in many cases are an asset to partnership development but in some cases are inhibiting potential of working relationships and referral pathways.
  • Complex clients who do not fit selection criteria are falling through the system (e.g. not acutely unwell enough for psychiatric services, limited other inpatient/community options).
  • There is a range of services available, some are overloaded with referrals and caseload, and others are lacking referral numbers.  It appears that as some clinicians are not fully aware of the breadth of available services, therefore may not be referring on to other services equipped to provide an appropriate service.  Issues of trust between clinicians was raised by several respondents as an area of concern with lack of referrals.
  • Lack of youth services and connectivity back into the community is also identified as a key factor, solutions for enhancing opportunity to engage young people with mental illness are sought after in the region.
  • Private psychology services play a pivotal role in integrated care for complex clients.


(1)    Clearly established and communicated policy and procedure for emergency mental health presentations to Hamilton Base Hospital (e.g. updated acute policies actioned and communicated appropriately to all relevant staff).  Ongoing mental health disorder professional development for staff as required.

(2)    Clearly established, communicated and implemented policy and procedure for emergency mental health presentations at community organisations.

(3)    Review of existing networks and partnerships (Mental Health Professionals Network, Emergency services network, Strategic Partnership for Youth, SGG Primary Care Partnership) and potential to enhance their role in harnessing open communication and relationship development between services.

(4)    Development and distribution of A3 one-pager highlighting current Mental Health services available in the Southern Grampians Shire to promote knowledge among service providers and opportunities for referral partnerships (led by Southern Grampians Glenelg PCP)

(5)    A whole of community approach to build on new and existing relationships in the mental health sector (e.g. An integrated knowledge forum for consumers and service providers discussing key topics, community ideas/innovations, creative opportunities to promote good mental health) led by Southern Grampians Glenelg PCP.

(6)    Further exploration of youth specific services in Southern Grampians and opportunities for reconnecting disengaged youth with mental illness.

Mental Health Service Coordination in Southern Grampians 2015 FULL REPORT

MH Services in Southern Grampians Directory

If you would like any further information, please contact Claire Nailon (Project Officer); (03) 5551 8562.

MHSC Project on a page