South Western Sydney Local Health District

Winner​: Excellence in the Provision of Mental Health Services Award

Despite making up 2% of the population, Aboriginal people continue to be overrepresented in mental health services in South Western Sydney LHD (SWSLHD). They represent:

• 7.83% of all mental health inpatients
• 8.5% of all community mental health consumers
• more than 10% of those using the Infant Child and Adolescent Mental Health Service.

To address this, SWSLHD created the Aboriginal Mental Health Transfer of Care (AMHTOC) team. This team uses new and innovative methods to provide early support, help navigate care, and manage discharge for Aboriginal and Torres Strait Islander patients with mental health needs.

The AMHTOC was designed with input from a diverse Steering Committee, which included:

• clinical leaders
• mental health services (both inpatient and community)
• community organisations
• carers and consumers
• The Aboriginal Health Unit.

This led to creating the AMHTOC model, which provides short-term (6-8 week) support to help patients move from hospital to community care.

Since starting, the AMHTOC team has helped 328 patients, improving their care and reducing the rate of unplanned readmissions from 26% to 18%.

This approach could also be used in other high-risk areas and adapted for different groups, including people from diverse cultural backgrounds, ethnic minorities, and LGBTQI+ communities.​