1. A joint Australian, State and Territory Government Initiative Forensic Benchmarking Across Australia: A Journey Monica Taylor and Dale Owens National Mental Health Benchmarking Project 27 November 2008

2. Introduction Four states participated in the Forensic National Mental Health Benchmarking Project: –New South Wales –Queensland –Victoria –Western Australia All provide state-wide forensic mental health services

3. Introduction We were the same yet different Found variability of service models due to differing legislation and resources Acknowledgement of service differences but also commonality of service aims Still had ability to compare clinical services and practices

4. Introduction Collected the 13 National KPI’s plus supplementary ACHS Clinical indicators of seclusion and assault Collected,collated and reported 3 years of data: 2004-05 2005-06 2006-07

5. Site visits Site Visits Site visits to all inpatient facilities assisted in providing some context to the discussions Immeasurable opportunity for networking 6 States and 2 Territories

6. Evaluation of the 13 national KPI’s for suitability in Forensic Mental Health Sevices 1. What was learnt about the indicator? 2. Is the indicator relevant to the program area? 3. Does the indicator measure what is intended within the program area? 4. Is the national indicator definition appropriate to your program area? 5. Are the National data Specifications for the indicator appropriate to your program area? 6. Can uniform targets be set for this indicator that apply across all program areas? 7. If targets are set for this indicator for your program area, are they on the basis of relativities (who is the best of the group) or absolutes (based on some standard) 8. Can the indicator be interpreted and understood by people who need to act? 9. Can performance on the indicator be influenced by local decisions by people who have power to act? 10. Is it feasible to collect the required data and report this indicator at an organisational level, on a regular basis? 11. Is additional contextual information critical to the interpretation of an organisation’s performance on this indicator? 12. Is the indicator relevant to understanding performance? 13. What are the recommendations of the consensus view of the forum?

7. Evaluation of the 13 national KPI’s for suitability in Forensic Mental Health Services Is the indicator relevant to understanding performance? KPIService UnitIndividual clinician 28-day readmission rateNO National Standards compliance NO Average LOSNO Cost per acute inpatient episode NO Treatment days per 3- month community care YES Cost per 3-month community care period YESNO Population under careNO Local access to inpatient care NO

8. Evaluation of the 13 national KPI’s for suitability in Forensic Mental Health Services Is the indicator relevant to understanding performance? KPIService UnitIndividual clinician New client indexYESNO Comparative area resources YESNO Pre-admission community care YES Post-discharge community care YES Outcome readinessYES

9. Evaluation of the 13 national KPI’s for suitability in Forensic Mental Health Services Of the 13 National KPI’s only one indicator was found not to be relevant to forensic mental health ‘Local access to inpatient care’. This was due to difficulties with the term ‘local’ as it pertains to state-wide services Of the 13 National KPI’s it was found that 7 had utility at a service unit level and 4 had utility at the individual / clinician level

10. Other projects undertaken Review of Court Liaison Services Census of Community Forensic Mental Health Services Review of Prison Mental Health Services* Seclusion and Assault* Inpatient psychotropic medication audit

11. “Sharing Information to Improve Outcomes" A joint Australian, State and Territory Government Initiative Review of Court Liaison Services

12. Areas reviewed 1. Count of submitted records 2. Gender 3. Ethnicity 4. Diagnosis 5. Recommendations by court liaison 6. Activity of court liaison 7. Magistrates decisions 8. Source of referral 9. Custody / Access 10. Most serious offence

13. Outcomes Count of records Total records submitted:1305 Range from 97-510 Gender Males: Mean: 79.9% Range: 76.3 - 83.6% Female:Mean: 20.1% Range: 16.4 – 23.7% Ethnicity CALD:Mean: 12.8% Range: 6.1 - 21.4% ATSI:Mean: 10.4% Range: 0.9 – 18.4%

14. Outcomes Recommendations by court liaison: Psychiatric: Care inpatient4.55 – 17.84% Psychiatric: Care community12.3 – 41.76% D & A4.12 – 14.51% Other: NGO’s3.09 – 26.34% No recommendations20.4 – 40.45%

15. Outcomes Magistrates decisions: Refer to Psychiatric care: Inpatient3.6 – 13.14% Refer to Psychiatric care: Community1.26 – 32.55% D & A0.21 – 8.18% Other: NGO’s0.21 – 6.82% No recommendations17.8 – 43.72%

16. Outcomes Most serious offence: B & E3.3 – 6.25% Theft2.1 – 10.45% Robbery4.2 – 6.86% Road / Traffic0.00 – 7.32% Property2.93 – 5.19% Homicide0.59 – 5.21% Sexual2.2 – 4.60% Acts intended to cause injury25.1 – 32.29% Against justice procedures0.20 – 31.25%

17. “Sharing Information to Improve Outcomes" A joint Australian, State and Territory Government Initiative Census of Community Forensic Mental Health Services

18. Areas reviewed 1. Gender 2. Age group 3. Major index offence 4. Most serious known offence 5. Primary diagnosis 6. Legal status 7. Co-occurring mental illness 8. Co-occurring substance abuse 9. Previous episode of care 10. Models of care

19. Areas reviewed 11. Referral source 12. Number of Indigenous clients 13. Country of birth 14. Main language spoken 15. Interpreter required 16. Days since episode start 17. Time since last contact

20. Areas reviewed 18. HoNOS collections –Admission HoNOS profiles –Review HoNOS profiles –HoNOS Total Scores –Percentage clinically significant HoNOS ratings –Mean HoNOS organisational comparison

28. Lessons learnt Acceptance that benchmarking is a key process in improving service quality That there is a need to continue and to further develop the benchmarking of forensic mental health services That benchmarking can assist with the evaluation of equivalence of forensic mental health service provision We have a greater awareness of service models used by each of the benchmarking partners The importance of good baseline data collection The importance of adequate resource provision for benchmarking processes That benchmarking is imperative to identifying ‘best practice’ and for the progression of specialist mental health services