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Auditor General - Caroline Spencer: An Audit of access to State-managed adult mental health services

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Presentation by Auditor General - Caroline Spencer, An audit of access to State-managed adult mental health services.
Presented at the Western Australian Mental Health Conference 2019.

Published in: Healthcare
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Auditor General - Caroline Spencer: An Audit of access to State-managed adult mental health services

  1. 1. 1 An audit of access to State-managed adult mental health services WA Mental Health Conference – 20 November 2019 Auditor General – Caroline Spencer
  2. 2. 2 Role of the Auditor General
  3. 3. 3 Audit objective and methodology Audit objective To assess whether people can access State-managed adult mental health services efficiently and effectively Data analytics exercise Engaged a data analytics expert to link individual mental health care events across the 3 services to create anonymised patient journeys over 5 years from 2013 Outcomes Proof of concept Audit team member seconded to DoH Additional report to Parliament
  4. 4. 4 Better Choices. Better Lives: Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025 Key objective: changing the service mix
  5. 5. 5 There have been a number of barriers to effectively implementing the Plan Lack of implementation plan Not yet clear if implemented services are delivering planned benefits Not clear who is responsible for efficient and effective management of mental health services No agreed funding plan
  6. 6. 6 Mental Health Care – DoH’s & MHC’s activity-based view ED presentation Person 1 ED presentation Person 1 ED presentation Person 1 ED presentation Person 2 ED presentation Person 2 ED presentation Person 2 ED presentation Person 4 ED presentation Person 1 ED presentation Person 4 Inpatient stay Person 2 Inpatient stay Person 2 Inpatient stay Person 2 Inpatient stay Person 2 Inpatient stay Person 1 Inpatient stay Person 4 Inpatient stay Person 1 Inpatient stay Person 1 Inpatient stay Person 3 Inpatient stay Person 3 Community treatment Person 3 Community treatment Person 3 Community treatment Person 3 Community treatment Person 3 Community treatment Person 2 Community treatment Person 2 Community treatment Person 1 Community treatment Person 1 Community treatment Person 1 Community treatment Person 4 Community treatment Person 1 Emergency Department 9 presentations Hospital Beds 10 admissions Community Services 11 contacts
  7. 7. 7 Mental Health Care – episodes of care view ED presentation Person 1 ED presentation Person 1 ED presentation Person 1 ED presentation Person 1 Inpatient stay Person 1 Community treatment Person 1 Community treatment Person 1 Community treatment Person 1 Person 1 ED presentation Person 2 ED presentation Person 2 ED presentation Person 2 Inpatient stay Person 2 Inpatient stay Person 2 Inpatient stay Person 2 Community treatment Person 2 Community treatment Person 2 Person 2 Inpatient stay Person 3 Inpatient stay Person 3 Community treatment Person 3 Community treatment Person 3 Community treatment Person 3 Community treatment Person 3 Person 3 ED presentation Person 4 ED presentation Person 4 Inpatient stay Person 4 Community treatment Person 4 Person 4 4 People Time
  8. 8. 8 Person-centred view of one episode
  9. 9. 9 People’s pathways through mental health services - macro
  10. 10. 10 People’s pathways through mental health services - micro
  11. 11. 11 212,679 people used the three services from 2013-2017 4.8 million care events 28,690 38,081 7,222 8,061 43,700 81,662 5,263 Community Treatment Services Emergency Departments Inpatient 212,679 Total number of people who accessed WA State-managed services 2013-2017
  12. 12. 12 Current mix of mental health services does not work as intended for some people • 17% increase in number of people accessing community treatment • No increase in number of hours of treatment Increased pressure on community treatment services Acute mental health beds not being used as intended • 126 people spent more than 365 consecutive days in acute hospital beds • Reduces effective capacity of system, making it difficult to access acute inpatient care EDs are acting as ‘front door’ for care and hospital care is difficult to access • Almost half of people accessing care had first contact in ED • People with mental health issues spend longer in ED
  13. 13. 13 Financial implications – costs of current State-managed services
  14. 14. 14 10% of people used 90% of hospital care and almost half of ED and community treatment
  15. 15. 15 Recommendations Analyse people’s pathways across all State mental health services to better understand the capacity, effectiveness and efficiency of care options currently provided, then prioritise the initiatives in the Plan accordingly Clarify their roles and responsibilities Develop an implementation and funding plan to support the Better Choices. Better Lives: Western Australian Mental Health and Drug Services Plan. The MHC and DoH should:
  16. 16. 16 Thank you Caroline Spencer Auditor General for Western Australia www.audit.wa.gov.au

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