Mental Health Commission
The Mental Health Commission (MHC) appreciates the work of the Office of the Auditor General for completing this review of Access to State-Managed Adult Mental Health Services. The MHC agrees and notes the findings and is committed to working with the Department of Health, Health Service Providers and other providers in the mental health system to address the recommendations.
The Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025 (The Plan) released in December 2015 was developed to guide investment decisions for the optimal mix and level of mental health, alcohol and other drug services required to meet the needs of Western Australians until the end of 2025.
The Plan brought together the views of government and non-government organisations, including consumers and carers, to outline a whole-of sector guide for investment. The MHC notes that this review covers only a portion of the mental health, alcohol and other drug (AOD) system, with the work of non-government organisations and AOD services not covered.
The MHC is currently developing a proposal for immediate investment towards the Plan for the consideration of Government and will develop further proposals for additional investment in the future. Actions that can be progressed by the MHC as part of normal business will continue to be initiated and completed. Projects already well underway include the MHC’s establishment of step up/step down services, the Accommodation Strategy and Workforce Strategic Framework. These projects and additional work done by the MHC will provide a good foundation for additional investment and system improvements over the next six years.
The MHC acknowledges there remains important and valuable work to be done within the public health system to optimise patient flows and services for individuals. The MHC thanks the Office of the Auditor-General for their proof-of-concept work regarding patient pathways, a concept that had not been possible to date due to data accessibility. MHC looks forward to working collaboratively with the DoH to develop this concept further in partnership, so that planning and purchasing decisions can take into account the pathways and aggregate data of people using services in the public health system. Work has already commenced through a revised Data Memorandum of Understanding the MHC has entered into with the DoH in early 2019, that will facilitate the analysis of people’s pathways across mental health services.
Department of Health
The Department of Health supports Recommendations 1 and 2 of the audit. As you are aware in relation to Recommendation 2, the Department is working to develop an enduring linked data repository that will be utilised by Health Service Providers, the Mental Health Commission and the Department of Health as System Manager. We see enormous value in the data set developed by the OAG and recognise the benefits that an enduring linked data set will bring, particularly in assisting with mental health services planning, and enabling a greater understanding of the needs of patients, effectiveness of services, and our engagement with providers. This important body or work is aligned with Recommendation 2.
The Department of Health notes Recommendation 3 but can only partially accept it. While the Department supports the prioritisation of initiatives within the Better Choices. Better Lives: Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025 Plan (the Plan); the Plan has not been fully funded to enable full implementation. That said, the Department of Health will work with the Mental Health Commission, as the lead agency, and the Department of Treasury, to secure either full or phased funding for the implementation of the Plan.
The EMHS is constantly seeking opportunities to improve the way mental health services are delivered, as well as enhancing the patient experience. EMHS recognise that the provision of excellent mental health care can be supported by better understanding the movement of the patient through their journey of care, which for many patients, extends to the community, emergency department and inpatient settings, often for long periods of time.
EMHS welcomes the opportunity to take a longitudinal view of patient interactions with MH services, in order to better understand patient need.
Just preceding this audit, EMHS had explored the use of a data analytics service to understand the variation occurring during the mental health patient journey and identifying unwanted variation. This was deferred, pending the outcome of this audit and associated data availability.
Once transitioned, EMHS is keen to work with the Department of Health to further develop and use this data in the prioritisation of initiatives towards more effective and efficient care for those groups of people most in need.
North Metropolitan Health Service
We have reviewed the summary of findings and confirm there are no additional comments or concerns from a North Metropolitan Health Service perspective.
South Metropolitan Health Service
Thank you for the opportunity to review the revised version of the summary of findings. SMHS is satisfied that you have considered our feedback and accept the summary with changes as documented.
WA Country Health Service
As consultation was extensive with WACHS Mental Health and its clinicians, there are no concerns about the general content or any identified inaccuracies in the report. WACHS supports the overall findings of the report and the process that has been undertaken by the Office of the Auditor General (OAG) in the performance of this audit. We would like to take the opportunity to note the following matters.
In the report, the OAG draws a clear distinction between community based services and hospital based services. In regional WA the distinction between hospital based Mental Health (MH) care in emergency departments and community mental health (CMH) teams is less clear, and that in-reach of CMH teams is commonplace in regional WA hospitals.
WACHS supports the OAG’s conclusion that this imbalance in the mix of services and settings is a consequence of broader system-wide complexity in funding, accountability and governance. Such imbalances are often further amplified in rural settings where State-managed Mental Health services are sometimes the only provider of care, and where, for urgent and emergency presentations, rural hospitals are frequently the only point of access to MH care. Often it is the only “accommodation” available to a consumer at that point in time.
WACHS supports the finding that a better understanding of how individuals interact with existing services should enable targeted, lower cost care options to be developed. However, such a reconfiguration needs to have sufficient capacity to manage redirected demand, as WACHS has seen previous efforts to meet specific needs overwhelmed as the rest of the system seeks to move people elsewhere. This has occurred with early psychosis services, personality disorders, ADHD clinics and with secure extended care beds. Demand booms, waiting lists develop, responsiveness wanes, confidence is lost and services are mainstreamed again – failures from their own success.
The level of data analysis undertaken by the OAG exceeds WACHS and most likely all other HSPs capacity to produce. The application of business intelligence processes to MH service delivery is still quite rudimentary and leveraging it for meaningful planning and evaluation is not yet well developed. It is our understanding that access to further data analysis and breakdown into HSP level data may be available in the future and WACHS would welcome the opportunity this presents.