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MHCC ACT Sector Development Forum Australia’s mental health initiatives David Crosbie May 2010. Context and meaning. Mental health problems. Mental health problems and mental illness refer to the range of cognitive, emotional and behavioural disorders that interfere with the lives and

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mhcc act sector development forum australia s mental health initiatives david crosbie may 2010
MHCC ACT Sector Development Forum

Australia’s mental health initiatives

David Crosbie

May 2010

mental health problems
Mental health problems

Mental health problems and mental

illness refer to the range of cognitive,

emotional and behavioural disorders

that interfere with the lives and

productivity of people”

National Mental Health Plan 2003–2008 Australian Health Ministers, July 2003

3 tiers of mental illness

Key Disorders

Typical Example

Prevalence

Tier 3

Tier 2

Tier 1

3 TIERS OF MENTAL ILLNESS

37 yr old male who episodically hears voices. He also has severe depression and has attempted suicide several times. He is unemployed, lives in public housing and is alienated from friends and family.

  • 3-400,00 cases
  • Psychotic Disorder
  • Bipolar Disorder
  • Severe Depression
  • Severe Anxiety
  • Severe Eating Disorder

< 3%

(Severe Disability)

  • 4-700,000 cases
  • Moderate Depression
  • Moderate Anxiety Disorder
  • Personality Disorders
  • Substance-Related Disorder
  • Eating Disorders
  • Adjustment Disorder

27 yr old male with chaotic behaviour and complex problems. He is suicidal, uses drugs heavily, and experiences panic attacks. Gets into fights and was arrested for assault 4 weeks ago. He can not hold onto a job and is currently unemployed.

4%

(Moderate Disability)

  • Approx 2m cases/year
  • Mild Depressive Disorder
  • Mild Anxiety Disorder

42 yr old female who feels down, tearful, irritable and has withdrawn from friends over the past 4-6 months. She takes many sick days because she feels down.

12%

(Mild Disability)

Source: Boston Consulting Group, 2006

burden of disease top 10
Burden of disease – top 10

Years of life lost (YLL)

Years of lost to disability (YLD)

Source: Source: AIHW, The Burden of Disease and Injury in Australia 2003

Figure 7: Burden of disease for top 10 disease groups in Australia: 2003

the largest single cause of disability

39%

18 Other Diseases(1)

9%

Cardio- Vascular

9%

Chronic

Respiratory

16%

Nervous System

27%

Mental Disorders

THE LARGEST SINGLE CAUSE OF DISABILITY
  • For example, includes diabetes, oral health, skin diseases, unintentional injuries, musculoskeletal diseases
  • Note: Years lived with disability is a measure of disability burden
  • Source: AIHW, Burden of disease (2001)

Total YLDS(%)

Mental health is largest single contributor to disability burden, especially among youth and the prime working age population

(0 - 14)

(15 - 24)

(65+)

(25 - 44)

(45 - 65)

Source: Boston Consulting Group, 2006

male and female prevalence age
Male and Female Prevalence / age

Per cent of

disorders

Source: ABS 4326.0, Mental Health and Wellbeing: Profile of Adults, Australia

Figure 4: NSMHWB: Prevalence of disorders by age by gender

health system hospitals

Approx 4% of hospital presentations

Approx 12% of hospital bed days

Approx 3 million hospital bed days for people with mental illness as primary presentation

Approximately 3 million hospital bed days for people with co-existing mental health problems (approx 4 times longer stays for cancer, diabetes, stroke, coronary heart disease)

Health system - hospitals
health system gps

Approx 11% of all consultations

Depression the 4th most common GP problem with 80% patient repeat rate

Approx 20% of all prescriptions (20 million per year) - antidepressants, antipsychotics, anti-anxiety

Over 1,5 million GP mental health plans in last 3 years

Health system - GPs
overall health system impact

Mental health accounts for 36% of all health costs for people aged 15 – 44

Indirect costs are almost certainly equal or higher than direct costs - e.g. co-morbidity

93% of mental health burden is disability (not premature mortality)

Mental health accounts for 24% of the total burden of disability for all diseases

Overall health system impact
operating in blind service systems
operating in blind service systems
  • Output based funding
  • Little attempt to review need and service use
  • Funding not tied to even the most basic of outcome indicators
  • No real support for agency based research or follow-up
  • Limited support for broader need and outcome indicators
initial outcomes

The Better Access program is being evaluated and this will reveal more information

Increase in access has been less than anticipated in the early stages – 1997 compared to 2007 access figures suggest little or no change

Consumers and professionals using these items indicate they support the new services

Access has largely matched professional group distribution

Groups outside traditional primary care not well represented

Initial outcomes
government responses to rapid uptake

The Rudd Government increased the budget initially allocated for the Program from $538m for the period 2006-11 to $753m in the 2008-09 Federal Budget. The actual figure will be closer to $2 billion

In the 2009-10 budget the government sought to slow down the program by introducing a new requirement for GPs to have met training requirements to be eligible to receive the full rebate for item 2710

Government responses to rapid uptake
government responses to rapid uptake1

The 2010 Budget - Social Workers and Occupational Therapists removed from the Better Access Program - argued collaborative care being better than fee for service – the savings (roughly $60 million) redirected into increased funding for Access to Allied Psychological Services program

This measure has now been put on hold until at least April 2011

Government responses to rapid uptake
a national health and hospitals network

The failure to provide adequate care in the community puts pressure on our hospital services. Australia’s hospitalisation rate is higher than many comparable countries. (pg.14)

... many patients – particularly those with chronic and complex conditions and those who are most disadvantaged – end up in hospital when they could have received better care in the community. (pg. 13)

A national health and hospitals network
2010 federal budget initiatives

Increased funding for Headspace ($20 million per annum)

Increased funding for early psychosis intervention ($7 million per annum)

Increased support for ATAPS ($15 million)

Increased funding for mental health nurses ($7 million next 2 years

Subacute and primary care initiatives that have some potential to increase mental health services

2010 Federal Budget INitiatives
federal government commitments

PBS $750 million per annum

MBS Better Access $500

PHAMS $60m

Respite $50mm

Training places / workforce dev. $50m

Keeping people in work / education $20

Suicide prevention $15m

Phone /web counselling $15m

Federal government commitments
guess who

“.. We also face a serious problem of rising mental illness in our community. Some 65% of people who need mental health care go untreated. .. A lack of early identification and intervention, forces people suffering from acute mental illness to turn to hospitals ... as their first and only option for help.”

...“Why is it that mental health problems are so often picked up by our Police and AOD workers, not our health services? .... This is the problem today, but it will become a greater problem in the future ...”

December 2009

guess who?
crisis and mental health

There were over half a million psychiatric presentations at public and private hospital emergency departments in 2006/07 that were turned away without admission

Hospitals simply do not have community placements to discharge people to. Over 40% of people in acute hospital mental health beds would not be there if a community bed was available.

The average hospital stay is 9 days, but many patients will be re-admitted within 4 weeks

Crisis and mental health
the community option

Despite the obvious need for community residential mental health treatment options, in the last 15 years state and territory governments have halved the number of community beds available

The lack of community-based options has ensured mental health treatment becomes a series of intensive crisis-driven episodes in acute settings followed by periods of limited or no care, relying on consumers and carers to make their own way through disconnected service systems

the community option
conclusion

Although people engaged in their GP primary care services are receiving better services, mental health remains largely crisis driven

Hospital emergency departments and other systems are failing to respond adequately to mental health issues

We need a new model of community mental health care that incorporates what consumers and carers need with direct linkages to clinical health services

conclusion