1. 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

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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)

9. 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

10. 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

11. 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

12. 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

13. 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

14. Questions and discussion