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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
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Part 1
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
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
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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