Integrated Mental Health Care - Report Example

Integrated Mental Health Care Abstract The strength of integrated mental health care in Australia lies in the five year plans as part of National Mental Health Strategy. The plans which started in 1992 have witnessed sustained delivery of integrated mental health care throughout Australia. Though some studies have found that evaluation of the efficacy of the system is difficult due to its complexity, the efficiency has not suffered given the fact that percentage of the affected population remains stable at twenty percent for the past 12 years, though the percentage is not a happy index of the mental well-being of Australians. The point which this paper tries to drive home is that absent the timely initiated strategies, the epidemiology of the disease would have been out of proportions. Sustained efforts would henceforth bring about the decline in incidence of mental health disorder and illness Australian population. National Mental Health Strategy’s broad aims are promotion of mental health of Australian community, prevention of development of mental disorder, mitigation of mental disorder on individuals, families and community and recognising the rights of persons with mental disorders. Part of the strategy is the National Mental Health Plan formulated once in five years, the first one being the health plan of 1992-97 which was the National Mental Health Policy was first agreed upon by all the Health Ministers of Australian States. This was the first ever attempt to evolve mental health care reform by the activities at the national level. The first health plan provided for community based care through general hospitals on the national mainstream, a move aimed to have decreased reliance of localised psychiatric hospitals. The areas of priority were consumer rights, integration of mental health services with general health sector, integration of mental health services with other sectors among others. The review of the plan in 1997 provided for further development by consolidation of reform activities set in motion by the first national plan. The second national plan focussed on mental health promotion and prevention of metal illness characterised by national public hospitals aligning with private psychiatrists, general health sector and general practitioners. Additional areas of priority in second plan were promotion and prevention among others. The plan for 2003-2008 reviewed the performance the first two plans and identified the gaps in achievement. National Mental Health Strategy was restated gaining from the experience of the previous plans to make it an ongoing agenda for effective integration of mental health care services though partnership among the key stakeholders in mental health. This third plan contained federal government’s commitment in the following manner. . (National Mental Health Plan 2003-2008) 1) To finance and administer the programmes such as Medicare Benefits Schedule, Pharmaceutical benefits schedule, the Australian Health Care Agreements and income support payments. 2) To ensure against any discrimination towards people suffering from mental health problems or mental illness and their families and carers in the matter of access to health care, community support, justice, community support and employment training opportunities and any such programs which the federal Government is committed to. 3) Facilitate linkages of national reform agendas and partnerships with national stake holders. 4) To provide an environment conducive to participation of consumers, their families and carers in decision making at all levels. 5) Facilitate development of research in mental health. 6) Supply of high quality personnel in consultation with States and Territories. 7) Establishment of a Working Group including representatives of consumers and carers to monitor implementation the restated National mental Health Strategy. The Working Group should recommend and report on the newly arsing mental health issues to the Health Ministers besides involving national stakeholders and evaluating the plan as a whole. . (National Mental Health Plan 2003-2008) Accountability for the use of the resources and quality of services as the main theme of the second national mental health plan was to have been ensured by establishment of appropriate mechanisms. National monitoring was intended to be continuous through national reporting at the Federal level in addition to the reporting systems of States and Territories. Indicators of achievement on the four priority themes were to be formulated sufficiently early in life of the plan. As many as thirty four outcomes have been spelt out to be achieved through the four main theme areas of the national mental health strategy. (National Mental Health Plan 2003-2008) National Action Plan on Mental Health 2006-20011 The National Action Plan on Mental Health in 2006 for the next five years up to 2011 Agreed upon by the Council of Australian Governments (COAG) envisages coordination and collaboration among government, private and non-government service providers aimed at delivery of seamless and integrated care system to enable participation of mentally ill people in the community. The COAG”s report of 2006 says that although the governments in Australia together have spent $ 3.2 billion in 2002-03 on mental health care delivery, they are inadequate. It admits that more time will be needed to enhance the capability of the Australian mental health services and estimates a total expenditure of $ 4 billion during these five years of the action plan through individual implementation of the respective state Governments. (COAG) According to the report, mental illness that interferes with personal development, education and career thus diminishing the quality of life, has affected twenty percent or more than three million Australians at any time though severe mental illness affects around 2.5 percent of the population at any point of time. Victorian Government’s estimate is that Australia incurs a loss of over $ 20 billion as cost of mental illness inclusive of loss of productivity and labour participation. The four outcomes expected of the National Action Plan are (1) mitigating severity and incidence of mental illness in Australia. (2) mitigation of the risk factors responsible for the onset of mental illness and hindering recovery in the longer term.(3) increasing number of people who can have access to health care. And (4) Increasing the mentally ill people’s ability to participate in the community, employment, education and training. The action plan has two parts. The first part contains outcomes, indicators, areas of action numbering five agreed upon by the governments. The second part contains individual implementation plans of the respective Governments. This is in alignment with COAG’s National Reform agenda envisaging enhanced productivity, participation and well being of the Australians. (COAG) Promotion, prevention and early intervention Mental illness if identified and treated early becomes less severe and lasts for shorter duration. Early intervention is therefore critical to achieve the outcomes envisaged by the plan. Children and young people are targeted to achieve early prevention by building resilience and coping skills in them and their families. Besides creating community awareness, providing for increased capacity of services for early identification and response to the early onset of the disease in children and young children an investment in mental health research form part of the measures for promotion, prevention and early intervention. The plans of the State Government at their respective individual levels will include types of actions such as (1) Suicide prevention programmes, (2) educating the local community for identifying mental health risk factors, (3) supporting the children of mentally ill parents with appropriate investment, (4) investment on health services for early intervention in young people, (5) investment on health services for primary care, maternal and child health and counselling focussed on early intervention, (6) expansion of mental health research through research centres, universities including beyondblue, (7) programmes for identifying early psychosis and conduct disorder in youth by specialist services, (8) specialist services for older people, (9) provision of 24 hour 7 days a week services accessible through phone connected National Health Call Centre Network. Aborigines and Torres Strait Islander people will receive greater attention in the above proposals. (COAG) Pursuant to the plan, Commonwealth funding of over $ 1.9 billion for five years from 2006 was provided for by the Prime Minister on 5 April 2006. This was in addition to funds already announced from the commonwealth. It comprised of $ 158.3 million for promotion, prevention and early intervention, $ 1,196.9 million for integration and improvement of care system, $ 370 million for participation in the community and employment including accommodation and $129.9 million for increasing workforce capacity. The individual plans of the respective state governments over five years from 2006-11 are $ 938.9 million by NSW, $ 472. 4 million by Victoria, $ 366.2 million by Queensland, $ 1800 million by Western Australia (six years from 2004-05 to 2009-10), $ 116.2 million by South Australia for four years, $ 43 million by Tasmania for years from 2008-20011, $ 20.6 million by ACT and $ 14.5 million by Northern Territory. (COAG) An evaluation of integrated mental health care as a case study was done by Pirkis et al(2001) As seen above in respect of National Mental health Strategy, treatment and rehabilitation are provided by State-funded health services, private psychiatrists, GPs, community health centres and consumer/carer services. According to them liaison between these agencies is sub-optimal and that literature suggests that poor linkages could result in poor outcomes in care delivery. Besides, there has been no empirical literature as yet on the effect of improving collaboration on consumer outcomes. (Hoge and Howenstine, 1997) There were a number initiatives involving collaboration between mental health services and GPs through shared arrangements. (Keks, Altson, Sacks, Hustig and Tanaghow, 1997) As per the National Mental Health Plans, Commonwealth funded various demonstration projects for more flexible service delivery in order overcome existing organizational and financial barriers. In Victoria, St.Vincent’s Mental Health Service (SVMHS) and The Melbourne Clinic (TMC) collaborated in one of the projects namely Public and Private partnerships in Mental Health Project. (Yung and Grigg, 2000) SVMHS is a State-funded organisation for multidisciplinary care catering to Melbourne’s inner urban east through an acute inpatient unit, a residential community care unit and community mental health services. The TMC is a private psychiatric hospital with 200 accredited psychiatrists providing broad range of general and specialised services both in inpatient and outpatient settings. The poor linkage is not unique to Australia alone. .(Hoge and Howenstine, 1997) In the U.S.A mental health services has been poorly linked to substance abuse services and public health agencies as a collaborative measure.( Barreira, Espey, Fishbein, Moran, Flannery, 2000) However Pirkis et al (2001) in their study have found that although collaboration is hard to conceptualise with the programmes having many players and components and operating within the already complex systems making it difficult to evaluate, the collaborative model is functioning well due to the strong conceptualisation. This partnership model characterised by strong conceptualisation could be extended to the other programmes envisaged in the national mental health strategy with success. (Pirkis et al 2001) In the U.S.A.where primary care is the ideal site for accessing mental health care, nurses at the primary care level are not well prepared give treatment to the complex needs of the mentally ill patients. Nursing graduates are therefore required to be made to equip themselves to provide holistic mental health care. WHO has spelt out that one way of strengthening mental health care is to strengthen the available mental health care expertise at the primary care which is the common entry point for mental health system. (Roberts, Robinson, Stewart and Smith, 2009) Their study has found that the integrated mental health clinical rotation is a viable method of improving nursing skills for provision of mental health care. (Roberts, Robinson, Stewart and Smith, 2009) Another one worth noting is the cultural barrier in providing integrated mental health care (IMCHC) as experienced Maori cultures. (Allen, 2001) The study states that integrated mental health care for Maori must be provided by a Maori. The majority of 35 IMCH training recipients felt that culture was important and ten of twelve interviewed felt the IMCHC lacked sensitivity to culture of Maori/Pacific Island or non-Anglo-Saxon Cultures. Parallels can be assumed in Australia also. Callaly and Fletcher (2005) also share that culture plays an important role in health delivery. Further , their study reveals that there is mixed evidence about the outcomes of the integration and only a few studies have been undertaken for the effectiveness which are as yet inconclusive or incomplete. (Fleury and Mercier, 2002) The difficulty in evaluation stems from the fact of differences in various models. It will be therefore better to focus in the short-term “research and evaluation efforts on integration strategies, the factors associated with their success in transforming health care systems, changes in consumer access, and satisfaction with services.”(Fleury and Mercier, 2002) The authors conclude that expansion of specialist services alone will not be sufficient for consumer satisfaction. Integration could be achieved by integration and improved continuity of service at the primary care level. (Fleury and Mercier, 2002) The Australian Government’s report on mental health services for 2006-2007 was only recently released in August 2009. This is quite evident of the complex evaluation the mental health services. (Australian Institute of Health and Welfare, 2009) The report says that there are about 3.2 million or 20 percent of the population who have experienced symptoms of metal health disorder. This is the figure taken 12 months before the survey conducted in 2007 by the Australian Bureau of Statistics. GP’s are invariably the first contact for mental health issues. BEACH survey of 2007-2008 has estimated that there were about 11. 9 million GP-Patient encounters representing an increase of 4.4 % from 2003-2004. There were about 550,000 claims in 2006-07 which increased to 1.2 million claims in 2007-2008 handled by Medicare Benefits Schedule relating to subsidised mental health items scheme of which was introduced in November 2006. Around the same time, MBS was also extended to mental health services, claims for which numbered 2.6 million in 2006-07 in terms of subsidised psychiatrist, psychologist and other allied health professionals as against 3.9 million of such claims in 2007-08. Community mental health services and hospital outpatient services catered close to 6 million mental health consumers in 2006-07 representing an increase of 5.3 percent from 2005-06. Inpatient services in public acute, public psychiatric and private hospitals numbered about 209,000 of admitted patients for 2006-07 showing an increase of 2.2 percent on the average of the previous five years. In 2007-08, there were 20 million mental health related prescriptions subsidised by the Pharmaceutical Benefits Scheme, representing ten percent of all prescription claims amounting to $ 700 million. This comprised of antipsychotic (49%) and antidepressants (43%) forming the majority of the spend. Expenditure for the State and territory mental health services increased by 5.6 % from 2002-03 to 2006-07 i.e around $ 3,040 million. Specialised wards incurred an increase of 7.2% and community mental health care services, 5.9 %. The stand alone public psychiatric hospitals’ expenditure was some what stable. An amount of $ 549 million was paid in 2007-08 for Medicare subsidised mental health services provided by mental health medical professionals. Per capita expenditure was $ 25.91 for the year 2007-08. The annual spending increased by 22.4 % from 2003-04 to 2007-08. Newly introduced items for psychologists and allied health professionals were responsible for the increase. (Australian Institute of Health and Welfare, 2009, p 9-10) The report further states that 45 % of Australians aged between 16 and 85 years experienced a mental disorder at some point of time in their life. The figure twenty percent of the population experiencing symptoms of mental disorder as in 2006-07 was also the same in 1997. About 14.4 % of Australian population suffered anxiety disorders and 6.2 % by affective disorders and 5.1 % by substance abuse disorders just 12 months before the survey now reported. More than 26 % of age group 16-24 years experienced mental illness. This shows lesser prevalence rates in the older age groups. In the case of one parent family with children, defacto relationship without being married, the unemployed, the homeless for ever, those who get incarcerated, those without friends, those without family and others, the severity of the disorder is very high rendering the patients to unable to carry on their activities by themselves. Women had higher rate of disorders than men i.e 22 % and 18 % respectively. (Australian Institute of Health and Welfare, 2009, p 14-15) Conclusion The latest report seen above shows an ever increasing trend of expenditure and reported incidence of mental health disorders and mental illness. The National Mental Health Strategic plan was introduced in 1992 and even after 17 years of its operation, the incidence of twenty percent of the population surveyed in 1997 still remains the same as in 2009. This shows that the mental health disorder has been under control without being allowed to explode, though the figure should reduce over a period of time by sustained implementation of the five year plan. The increasing expenditure evidences improved quality of life for those affected. It can not be said that increase represents growing epidemiology of the disease. It is hoped that with even more concerted and more coordinated implementation of the plans, Australia would emerge the best country providing world class services for the mentally ill. References Allen Ruth, 1997, Response to Turbott’s comments on ‘Integrated mental health care: practitioner’s perspective’ Australian and New Zealand Journal of Psychiatry, 31:496-503 Australian Institute of Health and Welfare 2009. Mental health services in Australia 2006– 07. Mental health series no. 11. Cat. no. HSE 74. Canberra: AIHW., available at accessed 31 August 2009 Barreira P, Espey B, Fishbein R, Moran D, Flannery RB. Linking substance abuse and serious mental illness service delivery systems: initiating a statewide collaborative. The Journal of Behavioural Health Services and Research 2000; 27:107–113. COAG, 2006, National Action Plan on Mental Health 2006-2011, available at accessed on 30 Aug 2009. Fleury M, Mercier C, 2002, Integrated local networks as a model for organising Mental Health Services, Administration and Policy in Mental Health, 30:55-73 Hoge MA, Howenstine RA. Organizational development strategies for integrating mental health services. Community Mental Health Journal 1997; 33:175–187. Keks NA, Altson BM, Sacks TL, Hustig HH, Tanaghow A. Collaboration between general practice and community psychiatric services for people with chronic mental illness. Medical Journal of Australia 1997; 167:266–271. National Mental Health Plan 2003-2008, National Mental Health Strategy, Mental Health & Suicide Prevention, Department of Health & Ageing, available at accessed on 30 August 2009 Pirkis Jane, Herrman Helen, Schweitzer Isaac, Yung Alison, Grig Margaret, Burgess Phillip, 2001, Evaluating Complex, collaborative programmes: the partnership project as a case study. Australian and New Zealand Journal of Psychiatry, 35:639-646 Roberts T Kay, Robinson M.Karen, Stewart Christopher and Smith Felicia, 2009, An Integrated Mental Health clinical Rotation, Journal of Nursing Education, August Vol 48 No 8 Callaly Tom, Fletcher Anna, 2005, Providing integrated mental health services: a policy and management perspective, Australian Psychiatry, Vol 13 (4) December Yung A, Grigg M. Developing partnerships between public and private psychiatry. Australasian Psychiatry 2000; 8:332–334.16. Read More