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Reform of Mental Health Care System and Development of Community Mental Health Services in Australia Coercive to recovery orientated care Professor David Crompton OAM MBBS Grad Dip Soc Sci [Psych] FRANZCP FAChAM [RACP] Executive Director, Addiction and Mental Health Services Metro South Health Griffith University, Queensland University Technology and UQ Consultant Translational Research Institute 1
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Reform of Mental Health Care System and Development of ... · Fourth National Mental Health Plan Priority area 1. Social inclusion and recovery Outcome Community understanding the

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Page 1: Reform of Mental Health Care System and Development of ... · Fourth National Mental Health Plan Priority area 1. Social inclusion and recovery Outcome Community understanding the

Reform of Mental Health Care System and Development of Community Mental Health

Services in Australia

Coercive to recovery orientated care

Professor David Crompton OAM MBBS Grad Dip Soc Sci [Psych] FRANZCP FAChAM [RACP]

Executive Director, Addiction and Mental Health Services Metro South Health

Griffith University, Queensland University Technology and UQ

Consultant Translational Research Institute

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Part 1

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Personal Journey

Mental Health Care Journey

Policy Change

Metro South Addiction and Mental Health Transformation

Research and impact on the system.

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Coercive to recovery orientated care

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The Journey

As a student disliked mental health

How treated Saw the worst People in hospital

As junior doctor it was about the urgency of surgery, medical emergencies, delivering babies.

Psychiatry/Mental Health care was what we did The care of people with cancer Distressed mothers Dealing with death

General Practice – began to see what never taught

Studied psychology

Then psychiatry training

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Part2

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A journey in pictures – what it tells us

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The beginning 1901 Asylum for the Insane

Today The Kangaroos

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The dungeons Story of travel by boat

1936

Today

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MH facility

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The old

The new

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Part 4 recovery

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New York State Office of Mental Health 2008-2009 Executive Budget Testimony

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Fourth National Mental Health Plan

Priority area 1. Social inclusion and recovery

Outcome

Community understanding the role of mental health and

wellbeing, recognition of impact of mental illness.

People with mental health problems and mental illness have

improved outcomes in relation to housing, employment,

income and overall health and are valued and supported by

their communities.

Service delivery is organised to provide more coordinated

care across health and social domains.

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Fourth National Mental Health Plan

Priority area 2. Prevention and early intervention

Outcome

Better understanding and recognition of mental health

problems and mental illness.

Supported to develop resilience and coping skills.

People are better prepared to seek help for themselves

and to support others to prevent or intervene early in the

onset or recurrence of mental illness.

Greater recognition and response to co-occurring alcohol

and other drug problems, physical health issues and

suicidal behaviour.

Generalist services have support and access to advice

and specialist services when needed.

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Priority area 3. Service access, coordination

and continuity of care

Fourth National Mental Health Plan

Outcome

Improved access to appropriate care, continuity of

care and reduced rates of relapse and re-presentation to

mental health services.

An adequate level and mix of services through

population based planning and service development

across sectors.

Governments and service providers work together to

establish organisational arrangements that promote the

most effective and efficient use of services, minimise

duplication and streamline access.

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Fourth National Mental Health Plan

Priority area 4. Quality improvement and innovation

Outcome

Community has access to information on service

delivery.

Reporting against agreed standards of care including

consumer and carer experiences and perceptions.

Mental health legislation meets agreed principles

Explicit support for emerging and current leaders to

implement evidence based and innovative models of

care.

Foster research and dissemination of findings.

Workforce development and reform.

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Fourth National Mental Health Plan

Priority area 5. Accountability: measuring and reporting

progress

Outcome

• Informed public judgments.

• Consumers and carers have access to information about

the performance of services responsible for their care.

• National benchmarks.

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Part 5 Recovery

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To support change what is required?

An independent research unit that evaluates:

• mental health policy analysis

• service development

• productivity impact of mental illness

• cost effectiveness

• mental health financing

• consumer outcome measurement

• determinants of vocational outcome

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Societal

Organisation

and Culture

Public Policy

Governance

Population Need

and Demand

Financing

Human

Resources

Physical

Capital

Consumables

Social Capital

Personal

Mental Health

Services

Population Based

Mental Health

Services

Intersectoral

Linkages

Health

* Population

* Individual

Service

Outcomes

Economic

Outcomes

Social

Outcomes

CONTEXT RESOURCES PROVISION OUTCOMES

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What about Metro South Addiction and

Mental Health Services

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Organisational Excellence is about the human touch, teaching,

collaboration, generous acts, personal courage, and

core values that guide decision making and inspire extra effort. Cortese – Mayo Clinic 2002

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Transformation of Metro South AMHS

Factors influencing need for change.

1. Medical

Culture

Change Management

Budget

Clinical Redesign

2. HHS, AHSC or Commission.

3. Multiple reports.

4. Factors adversely impacting on consumer and carer consumer

and carer journey and outcome.

5. Owning Leadership.

6. Accountability and responsibility issues at all levels.

7. The measures of our performance.

8. Data is not necessarily confirming our views on who attends

the service.

9. Data does not support our perception of LOS in the Service.

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What did consultation told us?

1. Some staff are concerned about roll change and impact on

them.

2. Varying views by consumers and carers.

3. Some express idea there should not be a diagnosis.

4. The many changes happening.

5. Consumer and carer staff are not being listened to at some

services.

6. Repeated identification that we are not meeting the

expectations of consumers and carers.

7. Independent Consultant reports have identified multiple

problem areas related to service we provide.

8. Metro South MHS Clinical Redesign Program has identified

similar issues.

9. Perception of other elements of the health care system.

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Literature some comments.

• Staff should deliver care that works.

Implementation of best practice treatment.

Education should be provided for all disciplines.

Staff should be trained to provide best practice care.

Impact of hierarchical structure that disempowers

clinicians, consumers and carers. [Better Mental

Health Care.

G Thornicroft & M Tansella 2009]

• Multiple adverse impacts of Social Exclusion.

Schizophrenia and other psychoses have low rate of

employment. [Social Inclusion and Mental Health. J

Boardman et al 2010]

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Literature some comments.

• Community mental health system as it has evolved is failing

consumers and carers.

Most consumers will not receive evidence based care.

Change is slow to occur.

There is a need for transformational reform.

Expectation of greater involvement of consumers and carers in

care decisions and integration with primary care.

Need for person centered care.

Unlike other disciplines MH clinicians infrequently uses

objective measures or assessments.

[Mental Health Services – a public health perspective 3rd Ed. B

Levin et al 2010]

• Management requires a new way of thinking to develop a

organizational resilience and an adaptive management.

A resilient organization requires an adaptive management to

use challenges as an opportunity to build capacity. [Handbook

of Adult Resilience. J Reich et al 2010.]

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Metro South Mental Health Services Review

Change Management Considerations

Objective:

To provide Leadership and Operationalise

the implementation of the Clinical Academic

Unit based model of service delivery across

Metro South AMHS.

Improving the Journey

Improving Outcomes

Improving Accountability

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Part 6 recovery

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Inpatient Services

Academic Clinical Unit

Addiction Services

Academic Clinical Unit

Transcultural Mental Health

Academic Clinical Unit

Consultation Liaison

Academic Clinical Unit

Rehabilitation

Academic Clinical Unit

Psychosis

Academic Clinical Unit

Child and Youth

Academic Clinical Unit

Older Adult

Academic Clinical Unit

Resource and Access Services

Academic Clinical Unit

Mood

Academic Clinical Unit

Information

Management

Quality

Patient Safety

Clinical

Governance

Data and Literacy

Education,

Training and

Research

Mental Health

Act 2000

Nursing Specific

Leadership

Inpatient Unit

Operations

Nursing specific

Education,

Training and

Research

AH Profession

Specific

Leadership

Management

AH Professional

Governance

AH Professional

Support

AH Profession

specific

Education,

Training and

Research

Therapies

Governance and

Evidence Based

Practice

Consumer

Workforce

Consumer

Engagement

Consumer

Feedback

Carer Workforce

Consumer

Participation

Education,

Training and

Research

Medical

Recruitment

Medical Admin

Medical

Education,

Training and

Research

Director of

Corporate

Governance

Director of

Medical

Services

Director of

Social

Inclusion and

Recovery*

Corporate

Services

Workforce

Services

(OH&S and Fire)

Finance

Corporate

Education and

Training

Executive Director

Addiction and Mental Health Services

Me

tro

So

uth

Ad

dic

tio

n

an

d M

en

tal H

ea

lth

Se

rvic

es

Ex

ec

uti

ve

Director of

Therapies and

Allied Health

Director of

Nursing

Director of

Clinical

Governance

Chief Executive Officer

Metro South Health

* under establishment

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Personal recovery and involuntary mental health

admissions: The importance of control,

relationships and hope (Wyder, Bland & Crompton. 2013, doi.org/10.4236/health.2013.53A076 )

Seven overarching dimensions either hinder or facilitate

recovery:

1. having input into own treatment

2. shared humanity

3. power imbalance/ balance

4. freedom and control

5. ability/inability to incorporate the episode/experience

6. treatment factors

7. importance of relationships.

Conclusions: The recovery framework, in particular, the

concepts of hope, relationships and control are very relevant in

the context of involuntary settings.

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Therapeutic relationships and involuntary

treatment orders: Service users’ interactions with

health-care professionals on the ward.

• There is increasing evidence that an involuntary hospital

admission and treatment can undermine the therapeutic

relationship.

• Good relationships with staff are important factors

influencing long-term recovery, there is little information

on how people experience their relationships with staff

while under an involuntary treatment order (ITO).

• Twenty-five involuntary inpatients were interviewed

about their experiences of an ITO.

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Participants described the following themes:

(i)the ITO admission was a daunting and frightening experience;

(ii)staff behaviours and attitudes shaped their experiences in hospital;

(iii)importance of staff listening to their concerns;

(iv)importance of having a space to make sense of their experiences;

(v)importance of staff ability to look beyond their illness and diagnosis;

(vi)importance of staff working in partnership.

These findings highlight that when using recovery principles:

Empathic engagement with the patients’ lived experience,

Forging partnerships with patients in treatment decision-making to

enhance agency, an involuntary treatment order does not have to limit

the ability to establish positive relationships.

Wyder, Bland, Blythe, Matarasso and Crompton, International Journal of Mental

Health Nursing (2015) 24, 181–189

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‘You were my treating psychiatrist, right from the

word go you told me it is possible to get well.

Your words struck a deep chord inside me.

You explained to me that you and the hospital

could provide me with the tools I needed to get

well, but it up to me whether I used them or not.

Thank you for giving me the choice.”

From author ‘My Mum is Amazing’ 2013

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Policy is easy, the trick is in the implementation.

The first 25 years are always the hardest.

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