Managing Mental Health in the ACT

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Managing Mental Health in the ACT

• Dr Peggy Brown

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ACT

• Small jurisdiction - single public mental health
  service
• Population 333,000
• Mental health budget 57.5M (Currently input
  funded but under review)
• Total health budget 802M
• Mental health as a percentage of health budget
  7.2
• Community spending 75
• Non-government agency spending 13

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ACT Demographics

• Significant transitory population
• Higher than national average on disposable income
• Highest rate of private health insurance (gt52)
• Higher than average rate of electing to be cared
  for in public sector facilities despite the
  higher rate of private health insurance
• Ageing population

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National Survey of Mental Health and Wellbeing
(1997)

• Almost 1 in 5 experience a diagnosable mental
  illness over a 12 month period
• 62 sought no treatment from a health service
• Large unmet need
• 35 who did seek treatment had no diagnosable
  mental illness
• Significant met un-need

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Mental Health Status in the ACT (NSMHWB)

• Higher percentage with some form of mental
• disorder than national average (21.1 cf.
  17.7)
• Higher substance use disorders (males but
• not females)
• Higher anxiety disorders (males and females)
• - generalised anxiety disorder for all
• - social phobia for males
• - post traumatic stress disorder for
• females
• Higher affective disorder (males and females)
• Much lower agoraphobia

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Mental Health Status in the ACT

• 63,000 people (all ages) with some form of
  mental illness in 2006
• 40,000 - 47,000 adults made up of
• 24,300 - 28,640 mild MI
• 9,400 - 11,000 moderate MI
• 6,300 - 7,360 severe MI
• 2,100 - 2,450 severe and persistent MI
• 900 - 1,100 high and complex needs

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Guiding Documents in ACT

• National
• National Mental Health Plan 2003 2008
• COAG National Action Plan 2006 2011
• ACT
• ACT Mental Health Strategy and Action Plan
• ACT Action Plan for Mental Health Promotion,
  Prevention and Early Intervention
• Suicide Prevention Managing the risk of suicide
  in the ACT 2005 - 2008

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Public Mental Health Services in the ACT

• 4 adult community mental health teams
• 2 mobile intensive care teams
• 2 child and adolescent mental health teams
• 1 older persons mental health team
• Crisis team
• Forensic team
• Range of other subspecialty teams
• Total 320 FTE ( 290 clinical 140 community)

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Mental Health Facilities in the ACT

• The Canberra Hospital 30 public adult acute
  beds (operates at 26 beds for staffing reasons)
• scheduled for replacement 2010
• Calvary Hospital 20 public adult acute beds
  (operates at 18 beds for staffing reasons) and 20
  public older persons mental health beds
• Hyson Green (Calvary private) 20 beds
• Brian Hennessy Rehabilitation Centre 30 beds
• ( 50 indefinite care)
• 15 secure mental health beds to be built
  forward design announced in 2007 budget
  available 2010
• No dedicated child/adolescent mental health beds
• Supported accommodation beds in the community
  plus NGO outreach services

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Mental Health Professionals in the ACT

• 316 GPs (significantly less in FTEs) working in
  122 practices
• Lowest number of GPs per capita in Australia
• Lowest rate of bulk billing GPs in Australia
• 35 psychiatrists in ACT (13 private not all
  are full time)
• 706 registered psychologists in ACT in 2005
• but number practising is difficult to
  determine

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2005/06 MHACT Service Data

• 3000 registered clients at any point in time
• 6500 clients throughput over 12 months
• Occasions of service increasing
• CAMHS 35,000
• Adult 162,500
• OPMHS 12,700
• CATT 23,000

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2005/06 Inpatient Service Data

• Admissions 1189 separations (728 individuals)
• Occupancy rates 101
• ALOS TCH 13.1 days
• Calvary 14.6 days
• 10 of admissions by 10 consumers

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2006/07 service data

• 28 day unplanned readmissions 8 16
• 7 day preadmission reviews 85
• 7 day post-discharge reviews 72

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In 12 months to August 2006

• ED waits
• 627 patients presented to ED mental health
• in 12 months
• 95 transferred within 7 hours of decision
• to admit
• 4 patients waited more than 24 hours
• Longest wait in ED for a bed 39.5 hours

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Other Success Stories

• Dual disability service (Part funded by
  Disability services)
• Better General Health Program
• Adolescent day program
• Eating disorders day program
• COPMI (Children of Parents with Mental Illness)
• MHAGIC (electronic medical record)
• Good media stories!
• (Local champions)

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• There are advantages in recognising a just
  principle even when events are not ripe enough
  for its application, when it looks Utopian and
  excites the derision of practical men for it
  slowly modifies feelings and ideas, acts as a
  solvent of prejudices, and notwithstanding
  seemingly insuperable difficulties, tends by
  hardly perceptible degrees to its realisation in
  action
• Henry Maudsley, Responsibility in Mental
  Disease, 1898

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Pre-COAG reform challenges

• Unmet need and how to meet it
• Service range
• Acknowledged service deficits
• Workforce challenges (recruitment, retention)
• Staff mix
• Co-morbidity
• Role of public sector services (PP vs EI vs
  severe and enduring MI)

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Pre-COAG reform challenges

• Case management model (demands vs available
  resourcing loss of discipline specific skills
  impact on workforce morale and retention)
• Small community (NGO) sector a degree of
  fragility requires development
• Engagement of broader government sectors (ACT and
  AG)
• Consumer and carer participation

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Post-COAG reform challenges

• Implementation workload
• New players new priorities
• Communication across sectors
• Community expectations mental health/wellbeing
  (and everything that encompasses) vs treatment
  of mental illness Whose role is it to do what?
• Resilience vs Symptom reduction vs Recovery
  Rights vs responsibilities?
• In the absence of clearly articulated roles and
  responsibilities, expectations fall onto the
  mental health service
• Do the goal posts for mental health services keep
  shifting? Does this set services up for
  inevitable failure?

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Post-COAG challenges

• Care coordination effective model required
  across a broad range of agencies potential for
  target group creep
• Workforce losses challenges to creatively
  compete in short timeframes
• PPEI how to maximise this? Legislated
  requirement? Is there sufficient investment in
  self-help?
• Role of the public sector early intervention vs
  severe and enduring
• Increased access through MBS but is it meeting
  unmet need or is it further met un-need?
• Appropriately measuring the return on investment
  measuring recovery

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General Challenges

• Reporting requirements
• Information sharing working together vs
  constraints of privacy legislation
• Information systems to support business processes
  and data requirements
• Commonwealth vs state alignment 1,2 or 3
  plans? oversighting groups
• Buy in from all government departments
  collaborative effort but working to different
  masters

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General Challenges

• Setting priorities
• Community expectations for order
• Maximum treatment gain (i.e. best buys) vs
  chronic care
• Community engagement in the tough decisions

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Proposals to Meet the Challenges

• Mental Health Services Plan
• Service/process redesign
• Workforce development plan including workforce
  redesign
• Community sector development
• Consumer and care participation framework
• Review of Mental Health Act
• Single oversighting process if possible
• Enhance electronic medical record

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• Knowing is not enough, we must apply.
• Willing is not enough, we must do
• - Goethe