1. A joint Australian, State and Territory Government Initiative Adding substance to the myths: Responsiveness, appropriateness and effectiveness according to the CAMHS discharges project National Mental Health Benchmarking Project November 2008 Peter Brann Eastern Health CAMHS Dept of Psychological Medicine Monash University

2. A joint Australian, State and Territory Government Initiative Warning: There will be graphs

3. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 3 Background Challenge to CAMHS about efficiency Long standing perception that CAMHS is viewed through the narrow focus of Adult Mental Health Aside from outsiders such as Andrews, severity seen as synonym for a few diagnostic groups Case management seen as antonym to treatment However efficiency irrelevant if the population is neither appropriate nor treatments effective Discharges project

4. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 4 History Forum agrees to detail the nature of CAMHS clients  Demographic  Waiting time  Length of Episode  Diagnostic profiles  Outcomes First retrospective audit  All clients discharged April – June 06 ambulatory services Results highly engaging and provocative  Audit repeated April- June 07  Contact time and who with  Carer and Client Outcomes  In-patient Units

5. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 5 The participating CAMHS Sneezy – OP Adol. IP and Day Program Sleepy – OP plus Adol. IP Happy – OP and Adol. IP Dopey – OP teams only Grumpy – OP only Bashful – OP and for younger age weekday IP

6. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 6 Demographics  Dataset complete with some missing values Numbers Four Inpatient Units  Separations 24 to 56  Mean age 8.6 to 16.1 (mean 15.1 for Adol Units)  Gender 55% female (Adol Units) 17% (Child Unit) Ambulatory  Discharges 44 to 1110  Mean age 9.6 to 14.1  Gender 47% female

7. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 7 What, you don’t have to wait for a year!!!

8. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 8 And don’t they stay with CAMHS forever… But intriguing variation And difference between the two indicators suggests paperwork delays

9. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 9

10. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 10 Diagnostic issues Aside from the tier question Why such different profiles? Is this what we want from CAMHS? Provoked extensive discussions Value of diagnosis Labelling and stigma Clinician practices and dwarf procedures Models of care

11. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 11 after all that, any difference?

12. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 12 And in inpatient settings?

13. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 13 and is that just self serving clinicians?

14. Peter Brann EH CAMHS & Monash University National Mental Health Benchmarking Project CAMHS - November 2008 Page 14 And at the end of all our travels? All the obtained data prompted activity to improve collection All myths are assisted with data CAMHS clients are not waiting as long as believed CAMHS has a large amount of variability in diagnostic profiles Models of care Diagnostic practices Belief systems CAMHS is effective However variability in effectiveness that warrants exploration Clinician rates heading towards being adequate Parent/Client completion rates require work Jurisdictional and National data underestimate completion rates CAMHS benefit from having this material available even though its potential misuse and separation from funding levels is a risk