Mental Health Metrics : Australia Grant Sara John Allan Matthew James Lisa Fawcett Happy to acknowledge all the Australian participants - details to be added Overall have tried to keep the slides as brief as possible to encourage some questions / interaction

Aims Overview the collection and use of data and indicators in Australian health system National data collection, coordination, analysis and reporting What works well ? What are our challenges? What issues are relevant when interpreting Australia’s comparative indicators? Overall IIMHL encourages a “brag and steal” approach. Include discussion of issues that we are challenged by to encourage opportunities to learn from others who are tackling these issues

Context - Australian governments Federated government States and Territories Delivery of services Commonwealth Taxation (+ some services) Aim to give as brief an overview as possible – issue of Cwlth/State roles is critical. Relevant/similar to Canada, US, Sweden. Contrasts to Netherlands, England etc

The Australian Mental Health System Insurance (c 5%) National - Commonwealth (30%) State and Territory (55%) Direct (c 10 %) Private hospitals “Private” psychiatry care Primary care Community Mental Health Public hospitals Psychology & counselling NGO support, clinical care Simplified view of system as it was c10 years ago. Percentages refer to national spending … need updating

The Australian Mental Health System Insurance (c 5%) National - Commonwealth (30%) State and Territory (55%) Direct (c 10 %) Private hospitals “Private” psychiatry care Primary care Community Mental Health Public hospitals Psychology & counselling NGO support, clinical care Planned and low acuity hospital care Acute, emergency and involuntary hospital care System as it currently is, briefly highlighting the more complex mix of Commonwealth and State roles Office-based “private” care Emergency and long term community care High prevalence disorders Severe and enduring illness Providers as small businesses Providers in regional Local Health Networks Capped subsidies + out of pocket gap Free to consumer High consumer choice Low consumer choice

Reforms and structural change Mental Health Beds (per 100,000 population) State Community MH Staffing (per 100,000 population) Broad reforms.

Data collection Shared national data standards Broad and integrated data collections Increased support for data linkage (e.g. NHISI project) National MBS, PBS National MDS Linkage States Lack of integration in clinical care (national eHR under construction) No national person identifier Commonwealth data limited, focus on billing Limited links to other collections: welfare, disability, housing, police, deaths Primary Health Networks Health Networks Hospital & community eMRs Individual providers Population and household surveys Health status, prevalence, drug and alcohol use, employment, disability, caring

National coordination & integration POLICY FRAMEWORK ENABLING ORGANISATIONS COORDINATING STRUCTURES Clear framework National information agenda Info development priorities being revised Capable and trusted national agencies National committees with broad representation Good coordination between Quality/Safety and Information Strategy Long term planning in a fast- moving environment New technology, new capacities, new roles Integrating Hospital, Community and Population approaches Integrating Mental Health and general health approaches Links and coordination outside health (Disability, Welfare, Housing)

Data analysis and reporting Consistent national indicators National comparative data reports National reporting combining service and population perspectives Data to support reform (eg seclusion and restraint) Balance of inputs & outcomes Breadth: recovery, physical health, … Coverage of private and NGO services Resolution to local or individual services Transparency for consumers and public

Interpreting Australia’s metrics ? CULTURE AND PRACTICE Use of seclusion (but not restraint )? SERVICE ORGANISATION Mental health low % of total health Low bed base – frequent brief admissions – high acuity Forensic services mainly limited to people convicted of serious offences DATA Community data excludes provate psychiatry & psychology Readmission isn’t limited to emergency / unplanned and includes any hospital in state/territory. Beds and admissions exclude private hospitals (c25%) Will update if second draft report available before the match

Expected and unexpected associations? Beds per capita Occupancy Clinical acuity Proportion psychosis Involuntary legal status Making the point that different structures lead to different metrics Restrictive practice Length of stay

Expected and unexpected associations? Beds per capita Occupancy Clinical acuity Proportion psychosis Involuntary legal status Making the point that different structures lead to different metrics Restrictive practice Length of stay

Expected and unexpected associations? Beds per capita Occupancy Clinical acuity Low bed base due to structural reform High turnover, short LOS Proportion psychosis Involuntary legal status Making the point that different structures lead to different metrics Restrictive practice Can this explain relatively high rates of involuntary care and seclusion? Length of stay

Questions and discussion