A Better System Helps the Person Recover from Mental Illness. There is mounting international evidence to support the following principles which underpin a continuum of mental health services, whether public, private or NGO. The needs and rights of consumers must always be central to service delivery and development.
- promote recovery to enable an optimal quality of life
- recognise the individuals’ unique human physical, developmental, emotional, social, cultural and spiritual dimensions
- improve community understanding and acceptance of mental illness to create supportive social environments that support the individual’s citizenship, civil rights, personal dignity and privacy
- offer specialised mental health treatment and support which imposes the least personal restrictions of rights and choice balanced with the need for safe and effective treatment
- enable consumer involvement in informed decision-making about their treatment and care
- co-ordinate planning and integration of service delivery to ensure sustainable community living for people with mental illness.
- focus on achieving evidence-based outcomes
- ensure equitable access to a comprehensive range of hospital and community-based high quality, safe and effective specialist and support services when and where they are needed and throughout the course of the exacerbations and remissions of illness.
- respond to the specific continuing and differing needs of various population groups across the their lifespan
- ensure that specialist mental health services work together with other public, private, government and non-government agencies in a coordinated manner to provide continuity of care and to meet the range of social, psychological and medical needs (including crisis intervention, assessment, acute care, ongoing care and rehabilitation).
- ensure consumer involvement in the planning and design of services appropriate to their needs
- provide cost-effective services that deliver the best value in terms of improved health
- ensure continuing investment in recruitment and the appropriate training of the workforce
- ensure Aboriginal and Torres Strait Islander involvement in the planning and development of services appropriate to their needs
A Service Model
A comprehensive mental health system includes a number of components which form a unified system, ensuring continuity of care for consumers.
- a single point or process of entry into a service
- specialist crisis intervention, assessment, acute care, ongoing care and rehabilitation care across the consumer’s lifespan
- a case management system
- multidisciplinary teams
- the active involvement of consumers
- a co-ordinated management system between inpatient and community services
These elements of a good service are still the basis for an integrated, comprehensive mental health service, whether the agency is public, private or NGO. However at present funding methodologies do not reward adherence to the evidence.
With the increase in the number of private service providers (psychologists, social workers, nurses, occupational therapists) who can work under the Medicare Benefits Scheme, it is essential that there is co-ordination and co-operation between these service providers and the rest of the mental health sector, but there is no mechanism to pay for this.
General Practitioners (GPs) have long been a most important treatment agency, often providing the ongoing care of those with mild-moderate disorders. Recent COAG policy and funding streams assist General Practitioners to provide clinic based services supported by on-site mental health nurses and with access to private psychiatrists, psychologists, occupational therapists and social workers, as a service broker.
Currently the range and choice of services is greater than in the past, but service delivery remains patchy and poorly coordinated. This can increase the consumer’s confusion, isolation and stress leading to relapse, self harm, and in a small minority of cases, risks to the public if appropriate support is not available.
An integrated service system must have:
- adequate funding to ensure services meet the needs of the moderate and most severely unwell in a given population
- reliable access to the right services at the right time, in, or as close to, consumers homes, as possible
- provision of effective clinical care delivered by highly trained professionals monitored for quality and fidelity
- continuity of care with as few repetitive assessments (ie by multiple professionals) as necessary
- appropriate transfer of information between relevant & involved service providers, as consumers move from service to service, and sector to sector
- efficient and effective coordination of assessment, treatment, care planning and case management through face to face meeting and electronic means
- coherent systems of governance and management between Commonwealth, State, Area/Region and Locality providers
- quality, effectiveness and efficiency measures to ensure accountability at all levels of the mental health system
- appropriate and effective training and supervision
Current and previous National Mental Health Strategies have made a great deal of progress towards reforming mental health services. However they have not gone far enough in terms of defining and making specific recommendations implementing the strategies. An effective method of increasing the specificity, uniformity and fidelity of nationwide implementation is to define individual service components and staffing levels required to deliver a comprehensive, locality based continuum of community care that addresses the needs of an average population of 100,000.
Service models need to be clearly defined; resourcing of services must be done on a rational basis, not simply an historical basis; quality measures and standards must be meaningful and ensure good practice across multiple providers.
Access to services
Communities and those individuals with specialised needs must have access to appropriate services when and where they are needed. There must be sufficient services with sufficient staff to meet individual and family/carer needs in a way that minimises impairment and disability.
Public mental health crisis services (and extended hours services) are a critical component of a mental health system and are most often the entry point to mental health services. Access to services can be via any, or all, of several components of this complex system, including mental health acute assessment teams (either based in the community or in emergency departments) Police, Ambulance, GP’s and private psychiatrists.
In accordance with international best practice, teams responding to people in crisis must have skilled staff with the ability to provide immediate access to:
- Clinical triage and assessment
- case management/care coordination
- intensive psychological and practical support
- medication management
- family/carer support
- cultural assessment
- relapse prevention
- crisis planning
- inpatient care
- respite care options
- links to ongoing care/support
- a range of psychological interventions
Continuity of Care
For those individuals who need it, continuity of care is achieved through a sustained relationship with a care provider (case manager), who delivers ongoing psychological care and support for the individual and their family/carers. Continuity of care is required through all stages of the clinical pathway.