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Northern Queensland Primary Health Network (NQPHN) does not provide mental health services directly, but administers funding that is commissioned through a range of primary health services, general practices, and community-managed organisations who deliver the programs detailed below. These are based on Stepped Care – providing a range of services for people with mild mental health issues through to severe and complex issues
In an emergency call triple zero (000)

If someone has attempted, or is at immediate risk of attempting to harm themselves or someone else, call triple zero (000) immediately. 

GPs and other primary health care providers can refer all eligible individuals to Stepped Care services through the central intake service Connect to Wellbeing, operated by Neami National. Connect to Wellbeing provides assessments and referrals to the components of stepped care, and to other mental health, social, and community organisations where patients may have a number of needs and requirements.

GPs and other referrers can download referral forms in PDF and RFT for Best Practice and Medical Director at

Wherever people are on their mental health journey, Head to Health (H2H) is here to help find the information, resources, and services that most suit their needs. Individuals may want to improve their overall sense of wellbeing, need help with something that is concerning them, or are helping someone they care about—Head to Health can point individuals to great online mental health resources.

Head to Health currently contains around 370 mental health services and resources funded by the Australian Government. For many people with mental health conditions such as depression and anxiety, online mental health resources can be as effective as face-to-face treatment, particularly if there is additional practitioner support. There are a number of online resources in different formats, to suit individual needs and preferences. These include online courses and apps.

Psychological Therapies provide short-term free evidence-based mental health psychological services to individuals who have limited access to Medicare subsidized mental health services and/or may not be able to afford mental health services in the private sector. This program replaces the previous Access to Allied Psychological Services (ATAPS) and Mental Health Services for Rural and Remote Areas (MHSRRA).

Individuals must hold a current Health Care Card, Low Income Health Care Card, or Pension Card.

Individuals who do not have these concessions but are experiencing financial difficulties and cannot access Medicare-funded services such as Better Access, will be assessed by the Intake Assessment Triage and Referral (IATR) provider on a case-by-case basis where the referrer identifies exceptional circumstances apply in relation to the individual’s financial situation.

Priority groups for Psychological Therapies include:

  • children under the age of 12 years
  • young people aged 12-25 years
  • people in rural and remote locations
  • people who have self-harmed or attempted suicide or are at risk of suicide
  • women experiencing perinatal depression and/or anxiety
  • people who are veterans and their families
  • Culturally and Linguistically Diverse (CALD) refugee communities
  • Aboriginal and Torres Strait Islander people
  • people who are experiencing, or at risk of, homelessness.

The focus of the program structure is short-term intervention (referral for up to 10 individual sessions with a possible additional six available in special circumstances).

Referral details: individuals need to have a referral and mental health treatment plan from their GP or a primary health care provider, who forwards their details through Connect to Wellbeing- the intake service, for allocation to a provider.

Connect to Wellbeing website for GP referral forms:

Psychological therapies for remote areas

Individuals and families living in remote areas of the NQPHN region can access local or visiting Psychological Therapies services without the requirement of a referral through Connect to Wellbeing.

Referrals in these areas can come from a range of primary health and social services directly to the organisations listed below. Individuals and families can also self-refer.

Psychological Therapies are available in the following areas:

Hughenden and Richmond areas – North and West Remote Health

Croydon and Etheridge Shires – North and West Remote Health

Cape York and Northern Peninsula Area – Royal Flying Doctors (Qld)

Torres Strait – Wakai Waian Healing

The Mental Health Integrated Complex Care (MHICC) program (formerly the Mental Health Nurse Incentive Program (MHNIP)) funds community based general practices, and other appropriate primary health organisations to enable them to employ mental health nurses to help provide coordinated clinical care for people with severe mental disorders. Mental health nurses work with psychiatrists and GPs to provide services, including monitoring a patient’s mental state, managing their medication, and improving links to other professionals and clinical service providers.

Referral to a MHICC service must be actioned by a GP and directed through the Connect to Wellbeing.

MHICC programs service a hub of general practices located in the following practices:




headspace provides early intervention and mental health services to 12-25 year olds, along with assistance in promoting young peoples’ wellbeing. This covers four core areas:

  • mental health
  • physical health
  • work and study support
  • alcohol and other drug services.

headspace centres are located across metropolitan, regional, and rural areas of Australia, and have a trauma informed counselling clinic in each centre. They are built and designed with input from young people so they don’t have the same look or feel as other clinical services. The centres are there to help people access health workers – whether it’s a GP, psychologist, social worker, alcohol and drug worker, counsellor, vocational worker, or youth worker.

Services at a headspace centre are either free, or have a low cost.

headspace Referral System

GPs can refer young people and their families directly to headspace. Young people wishing to access headspace can do so by contacting their closest headspace centre. These are located in Cairns, Townsville, and Mackay.

NQPHN funds a number of Aboriginal Medical Services (AMSs) and Aboriginal Community Controlled Organisations (ACCHOs) to provide services in the region.

These include:

Operation Compass is the operational name given to the ex-ADF and Families Suicide Prevention Project launched in Townsville in 2017. 

Funded by NQPHN and run by The Oasis Townsville, the project focuses on ex-serving members and their families to help prevent suicide and suicidal behaviour. The vision is to reduce the rates of suicide within our ex-ADF community and their families, through transition, connection, and adapting to life in Townsville.

The project’s steering committee and advisory groups include ex-ADF members, families, carers, and service providers and have a commitment to work closely with the local community.

Operation Compass brings together the best evidence-based strategies and models and will trial innovative approaches to better target people at risk of suicide and ensure a more integrated regionally-based approach to suicide prevention. Operation Compass is utilising the Black Dog Institute Lifespan Model to target the needs of the ex-ADF community.

Operation Compass has developed an Operation Plan with six campaigns. The six campaigns include:

Clinical Support

  • GP and alternate mental health pathways to those currently provided by DVA.
  • GP and alternate mental health support external to current DVA contracts.
  • After hours response to people with emergent MH/AOD needs.

Enduring Connections

  • Volunteering.
  • Advocacy Development Training Program (ADTP) and Establishing Communities of Practice (CofP) to provide holistic case management.
  • Transition.


  • A better understanding of the ex-ADF and families community in Townsville in order to focus efforts to provide better and enduring health outcomes.
  • A better understanding of local suicide trends to ensure that local suicide services and activities are informed as to what is actually happening in the community.

Innovative Programs

  • Codesign a program between ex-ADF members, families, and clinicians to support those effect by Acquired Brain Injury (ABI) and Traumatic Brain Injury (TBI). This includes people who believe they are suffering long-term side effects as a result of anti-Malarial treatment.
  • A wide range of programs or activities that will support ex-ADF members and their families through transition, assist connection in, and adapting to life in the community.
  • Things we haven’t even envisioned yet.

Community Response

  • Reduce the gaps between services, by increasing community service provider awareness of the availability and eligibility for defence specific community support services.
  • Enhancing the skill set of community members to respond to at risk or vulnerable individuals/families.
  • Early engagement in help seeking behaviour through enhanced awareness.

Evidence-based Programs

  • Will include a number of proven Suicide Prevention Programs including:
    • QPR-Question Persuade, Refer
    • Mindframe Plus Training
    • YAM-Youth Aware of Mental Health
    • Roses in the Ocean
    • Suicide Prevention Training-ASIST-Applied Suicide Intervention Skills Training.

The National Psychosocial Support measure is a mental health program that provides non-clinical support to individuals not supported by the National Disability Insurance Scheme (NDIS) or Queensland Health community mental health, who require short-term and targeted psychosocial support. This program can help with recovery-oriented activities, including:

  • psychoeducation
  • life skills
  • financial management and budgeting
  • day-to-day living skills
  • vocational skills and goals
  • maintaining physical wellbeing
  • building confidence and resilience.

Referrals can be made through your GP.

A key priority for NQPHN is to encourage and promote a regional approach to Mental Health and Suicide Prevention, including community-based activities, and liaison with local Hospital and Health Services (HHSs).

A robust and representative engagement with key community and sector stakeholders is a critical resource required to inform and support the planning and implementation of these approaches.

Suicide Prevention Community Action Plans (SPCAPs)

Development and implementation of Suicide Prevention Community Action Plans in each HHS district will provide a vital resource to the regions to support integrated delivery of suicide prevention activities in community and linking the continuum of care.

The Black Dog Institute’s Lifespan model is being used as a framework for an evidence-based systems approach to integrated suicide prevention strategies, and to assist evaluation and alignment with the national Primary Health Network Suicide Prevention Program Guidelines.

Local Suicide Prevention Networks have been established and operate in the NQPHN region to guide development, implementation, and evaluation of these plans. Contact details are below:

NQPHN and the four HHSs in the region are jointly working with stakeholders to develop the foundational NQPHN Mental Health, Alcohol, and Other Drugs and Suicide Prevention Regional Plan. The final plan will be released by mid-2022. The objectives of joint planning are:

  • to embed integration of mental health and suicide prevention services and pathways for people with or at risk of mental illness or suicide through a whole of system approach
  • joint regional plans should drive and inform evidence-based service development to address identified gaps and deliver on regional priorities.

As a response to mental health reforms introduced by the Commonwealth Government from 2016 onwards, Northern Queensland Primary Health Network (NQPHN) is commissioning the following elements of a stepped care model of mental health services.

Low intensity needs for services

These are early intervention services that are targeted to people with mild mental illness, or who are at risk of developing a mental illness, but do not require acute clinical services.

Moderate intensity needs for services

These are Psychological Therapies providing short-term interventions for financially disadvantaged people with non-crisis, common mental health conditions of moderate severity, or to people who have attempted, or who are at risk of suicide or self-harm.

Severe and complex need for services

These are services that support people through care coordination and community-based support by qualified mental health professionals.

Youth mental health services

These are extending across the stepped care framework.

Aboriginal and Torres Strait Islander services

These are extending across the stepped care framework.

Suicide prevention – regional approaches

The Australian Government has tasked PHNs to take a lead role in planning community-based suicide prevention activity through a more integrated and systems-based approach, in partnership with Hospital and Health Services (HHSs) and other local organisations.


Mental Health Stepped Care Services Operational Guidelines

Click on the link below to download the operation guidelines PDF.

Full Mental Health Stepped Care Services Operational Guidelines.

Mental Health Reforms

New Models in Mental Health

The Stepped Care Model is central to the Australian Government’s mental health reform agenda and is used by Primary Health Networks (PHNs) to guide mental health activity. Northern Queensland Primary Health Network (NQPHN) is committed to achieving an equitable, comprehensive primary health care system driven by community needs, informed by needs-based planning and evidence-based research. Regional mental health planning and commissioning of services is founded on a stepped care approach.

What is Stepped Care?

Stepped Care is defined as an evidence-based, staged system comprising a hierarchy of interventions from the least to the most intensive, matched to the individuals’ needs. In a stepped care approach, a person presenting to the mental health system is matched to the intervention level that most suits their current need. A person does not have to start at the lowest, least intensive level of intervention in order to progress to the next step. They enter the system and have their service aligned to their requirements.

The below figure demonstrates the estimated prevalence of mental illness, graded according to levels of need.

Stepped care with severity classification diagram

An independent not-for-profit medical research institute providing clinical services, education, and e-health resources.

A national institute dedicated to reducing mental ill-health, reducing suicide, and improving wellbeing.

Sets the standards and accredits mental health education and training for GPs. The GPMHSC is a multidisciplinary body funded by the Commonwealth Government and includes representatives from general practice, psychiatry, psychology, and the community.

The Commission monitors and reports on investment in mental health and suicide prevention initiatives, provides evidence based policy advice to Government and disseminates information on ways to continuously improve Australia’s mental health and suicide prevention systems, and acts as a catalyst for change to achieve those improvements.

Directory for NDIS organisations delivering a support or a product.

Support members and the wider mental health community in meeting the needs of people who have lived experience with mental health issues by championing the values and professionalism of mental health providers and their vital role in the broader health system.

A capacity building project that works with Primary Health Networks (PHNs) and contracted community mental health providers to streamline their National Disability Insurance Scheme (NDIS) processes and support clients to transition to the NDIS.


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15 July 2021