This audit assessed whether people can access adult State-managed mental health services efficiently and effectively. We focused on the following questions:
- Are mental health services being effectively managed to deliver the service mix outlined in the Better Choices. Better Lives: Western Australian Mental Health, Alcohol and Other Drug Services Plan?
- Do people access the service they need when and where they need it?
We assessed the progress made to implement the changes required under the Plan. Our data analysis focused on the 90% of the MHC’s mental health expenditure that delivers hospital bed-based care and community treatment services, both of which are delivered by HSPs. We also analysed mental health presentations at hospital EDs, which are delivered by HSPs without MHC funding.
Our data analysis exercise did not include data about non-clinical community support services that the MHC purchases from non-government organisations providers. Nor did we analyse community bed services, which the MHC also purchases from non-government organisations.
Care provided by primary health care providers was outside of the scope of this audit because it is not funded or managed by the State. This includes care provided by general practitioners and private providers such as psychiatrists, psychologists and private mental health hospitals. The audit also did not review forensic mental health services or specialised Statewide services such as programs for eating disorders, perinatal mental health care, homelessness or youth mental health services.
In conducting the audit, we:
- reviewed policies, procedures and key documents
- interviewed key staff across the North, South and East Metropolitan Health Services and WA Country Health Service, Mental Health Commission and the Department of Health
- liaised closely with a key group of clinicians from these Health Services
- interviewed key staff at the Office of the Chief Psychiatrist
- met with the Mental Health Clinical Governance Review Panel
- met with key advocacy bodies for Mental Health in Western Australia – WA Association for Mental Health, the Consumers of Mental Health Western Australia and the Mental Health Advocacy Group
- reviewed the funding model for mental health care.
In addition, we carried out an extensive data analysis exercise. This included WA Health data from 2013 to 2017, the latest full 5-year period available at the time of our data request. Doing this involved:
- WA Health extracting data from the Emergency Department Data Collection, the Hospital Morbidity Data Collection, the Mental Health Information Data Collection and PSOLIS (Health’s mental health clinical information system). WA Health removed the names and addresses for all people and provided a unique identifier and linked the data which allowed us to build a data model for patient journeys
- using this data to describe people’s pathways in accessing care. This allowed us to identify how many people had used mental health services over this period and how they used services
- analysing journeys to identify where services were not being utilised for their intended purpose or where patterns of access did not follow the intended models of care.
We did not include MHC-funded community support services or community bed-based services provided by non-government organisations in our data analysis because the MHC did not have detailed data on those services that could be combined with data from other services. These services accounted for 10% of the MHC’s total funding for mental health services in 2017-18.
We will publish more information about our analysis in a separate volume to enable wider access to the approach and results. The data model will also be provided to WA Health to enable them and the MHC to use and further develop our analysis to understand consumer needs and inform service planning and reform, in both mental health and potentially general health.
This was a performance audit, conducted under section 18 of the Auditor General Act 2006 and in accordance with the Australian Standards on Assurance Engagements ASAE 3500 Performance Engagements. We complied with the independence and other ethical requirements related to assurance engagements. Performance audits focus primarily on the effective management and operations of agency programs and activities. The approximate cost in undertaking the audit and reporting was $501,800. The cost of the patient-centred data model which, in addition to being made available to WA Health, is expected to have enduring benefit for future audits by this Office was $301,855. Further costs associated with additional analysis will be included in a separate supporting report.