Aaron Groves

Policy implications of the 2007 Australian National Survey of Mental Health and Wellbeing.

Objectives: To describe some of the policy implications of the Australian National Survey of Mental Health and Wellbeing. Methods: A review of the initial findings from the Survey published by the Australian Bureau of Statistics and the five papers in this issue of the Journal, was done. Results: Mental disorders are highly prevalent with the prevalence essentially unchanged since Australias 1997 mental health survey. Mental disorders are often comorbid with each other and with physical disorders. Despite the disability they cause, most people with disorders do not seek treatment. This is largely because they do not perceive a need for treatment. Conclusions: National epidemiological surveys are important for service planning. They are especially important in gaining an understanding of the population not accessing services. Innovative strategies, including action on mental health literacy, will be necessary to increase the treatment rates for common mental disorders.

Psychosis in Indigenous populations of Cape York and the Torres Strait

Objective: To describe and characterise treated psychotic disorders in the Indigenous populations of Cape York and the Torres Strait.

A place to live: housing needs for people with psychotic disorders identified in the second Australian National Survey of Psychosis.

Objective: Access to adequate housing consistent with personal preferences and needs is a human right and supports recovery from psychosis. This study aimed to: (1) describe people with psychosis living in different housing types, and their preferences and needs; (2) explore selected demographic and social inclusion correlates in relation to housing; and (3) compare two subgroups – participants living in supported group accommodation and supported housing – on key demographic, functional, clinical and social inclusion variables. Method: Current housing, preferences, needs and assistance, and housing-related social inclusion variables were assessed in a two-phase prevalence survey conducted within seven catchment areas across five Australian states. Two supported housing models were compared: supported group accommodation and supported housing (rental accommodation with in-reach support). Descriptive statistics were used. Results: Of the total participants (n = 1825), one half were living in public or private rented housing (48.6%) and 22.7% were waiting for public housing. Despite being the preferred form of housing, only 13.1% were living in their own home. One in 20 participants (5.2%) was currently homeless; 12.8% had been homeless in the previous 12 months. Residents of supported group accommodation felt safer in their locality than those in supported housing, but experienced less privacy and choice. Conclusions: Although fewer participants were homeless compared with the first Australian survey of psychosis, the proportion remains high. Housing difficulties are experienced by people with psychoses living in various accommodation and concern housing adequacy and safety as well as autonomy and choice. Access to public housing is restricted compared with the identified need. Since residents of supported group accommodation felt safer in their locality than those in supported housing, but experienced less privacy and choice, each supported housing model may offer different advantages to people with psychosis, and contribute to services that support and maintain recovery.

The Internal and External Boundaries of Obsessive–Compulsive Disorder

Objective: This study aims to explore the internal and external boundaries of obsessive–compulsive disorder (OCD). Method: Selected literature is reviewed. Results: Prevalence and incidence estimates for OCD vary markedly according to diagnostic criteria applied. External boundaries of the disorder are permeable, with a large degree of overlap with other psychiatric disorders, and an association with certain neurological disorders. Some cases of OCD appear to have a neurodevelopmental origin. Conclusions: Further delineation of disorders characterised by obsessional and compulsive symptoms can inform models of aetiology, pathophysiology and treatment.

Policy and service development implications of the second Australian National Survey of High Impact Psychosis (SHIP)

Objective: We consider insights from the second Australian National Survey of High Impact Psychosis (2010) in order to identify the key policy and service development implications. Method: The Survey of High Impact Psychosis (SHIP) provides an updated description of the experiences of people living with psychosis in Australia. We discuss the SHIP survey participants’ greatest challenges for the future in light of the strength of existing literature, highlighting prospective opportunities for policy and service planning. Results: Targets for future policy development and service initiatives are informed by the survey participants’ leading challenges: financial difficulties, social isolation, lack of employment, physical and mental ill health, accommodation, and access to services. Conclusions: Many of the areas of need identified by survey participants are supported by quality research that may be more widely translated into effective services. For areas of need where the evidence is lacking, more clinical research is urgently needed. A targeted approach is vital to secure necessary investment in the wider dissemination of efficacious interventions and their systematic evaluation in ordinary clinical practice, enabled by both research investment and active integration of the research effort within ordinary clinical settings.

Psychosis and its correlates in a remote Indigenous population

Objectives: The aim of this study was to describe prevalence and characteristics of psychotic disorders in a remote Indigenous population. Method: Clinical review of all patients with an active diagnosis of a psychotic disorder in remote communities of Cape York and the Torres Strait. Results: 170 patients were identified and demographic, social and treatment variables described. Conclusions: Psychotic disorders are common and more so among young adult Aboriginal men, with high rates of comorbid conditions including substance use, intellectual impairment and diabetes. In parallel to this case complexity, there are high rates of coercive treatments. Certain differences by ethnicity and location are described and possible explanations proposed.

Planning estimates for the provision of core mental health services in Queensland 2007 to 2017

Objective: To derive planning estimates for the provision of public mental health services in Queensland 2007–2017. Method: We used a five-step approach that involved: (i) estimating the prevalence and severity of mental disorders in Queensland, and the number of people at each level of severity treated by health services; (ii) benchmarking the level and mix of specialised mental health services in Queensland against national data; (iii) examining 5-year trends in Queensland public sector mental health service utilisation; (iv) reviewing Australian and international planning benchmarks; and (v) setting resource targets based on the results of the preceding four steps. Best available evidence was used where possible, supplemented by value judgements as required. Results: Recommended resource targets for inpatient service were: 20 acute beds per 100,000 population, consistent with national average service provision but 13% above Queensland provision in 2005; and 10 non-acute beds per 100,000, 65% below Queensland levels in 2005. Growth in service provision was recommended for all other components. Adult residential rehabilitation service targets were 10 clinical 24-hour staffed beds per 100,000, and 18 non-clinical beds per 100,000. Supported accommodation targets were 35 beds per 100,000 in supervised hostels and 35 places per 100,000 in supported public housing. A direct care clinical workforce of 70 FTE per 100,000 for ambulatory care services was recommended. Fifteen per cent of total mental health funding was recommended for community support services provided by non-government organisations. Conclusions: The recommended targets pointed to specific areas for priority in Queensland, notably the need for additional acute inpatient services for older persons and expansion of clinical ambulatory care, residential rehabilitation and supported accommodation services. The development of nationally agreed planning targets for public mental health services and the mental health community support sector were identified as priorities.

Issues Associated with the Implementation of Routine Outcome Measures in Public Mental Health Services

Objective: The purpose of this paper is to examine strategies that may facilitate the successful implementation of service-wide outcome measures in public mental health services. Conclusions: The available evidence suggests that a top-down approach to the introduction of state-wide routine outcome measurement across all public mental health services is likely to have only limited success. A centrally co-ordinated but locally directed bottom-up approach may be a more successful long-term strategy. Such an approach could make optimum use of a small team of “outcome experts”, while the use of strategies such as the development of local clinical guidelines would increase the co-operation and participation of the wider clinical community. An initial collection of clinical and social demographics could provide important contextual information on service populations and would initiate the administrative and communication networks that would need to be developed for later routine, multi-site data collection.

The Queensland Mental Health Clinical Collaborative and the Management of Schizophrenia

Objective: This paper describes the development of a collaborative group of mental health clinicians who have come together to improve practice in adult acute mental health settings for the inpatient management of schizophrenia. Method: Sixteen acute adult mental health inpatient services across Queensland worked together to develop clinical indicators related to the inpatient treatment of schizophrenia. Data collection was conducted by using information available on existing databases and through statewide chart audits using scannable form technology. Through a secure intranet site, and statewide forums, clinicians were able to access information on clinical indicators enabling them to compare their site data to peer and state data. Results: Available data from 15 of the 16 sites provided information on clinical indicators including average length of stay, 28-day readmission rates, antipsychotic prescribing, medication dose and the use of multiple antipsychotic medications at discharge. Conclusions: The formation of the Mental Health Clinical Collaborative has brought together clinicians across the State to develop clinical indicators and openly discuss ideas to inform and improve clinical practice. This process has been effective in improving the quality of routinely collected information across the State and in engaging clinicians in using health information to drive clinical practice.

Clinical Practice Improvement Payments: incentives for delivery of quality care

Objective: In 2008, Queensland Health mental health services participated in a quality incentive payment scheme referred to as the Clinical Practice Improvement Payment. Services across the state engaged in local improvement projects with the collective aim of improving the number of consumers, diagnosed with schizophrenia, followed up within seven days post discharge. This paper describes the application of this approach over two and a half years. Method: Sixteen mental health services across Queensland participated and were provided with the opportunity to receive incentive payments during the period between January 2009 and June 2011. Data collection was conducted using information available on existing Queensland Health databases. Services were provided with regular updates on their progress through a secure intranet site, state-wide forums and individual service presentations, enabling them to compare their individual service data with peer and state data. Results: State-wide results showed steady and continual improvement in the indicator over the reporting period. Conclusions: The results suggest that the implementation of incentive payments for routine clinical work in mental health can assist with state-wide service improvement. The impact of target setting and supporting activities remains unclear and improvements appeared to be robust to administrative challenges and unexpected external events.