National Mental Health Benchmarking Project November 2008 Peter Brann Eastern Health CAMHS

1. 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. Warning: There will be graphs

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 National Mental Health Benchmarking Project CAMHS - November 2008

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 National Mental Health Benchmarking Project CAMHS - November 2008

5. The participating CAMHS • Sneezy – OPAdol. 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 National Mental Health Benchmarking Project CAMHS - November 2008

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 National Mental Health Benchmarking Project CAMHS - November 2008

7. What, you don’t have to wait for a year!!! National Mental Health Benchmarking Project CAMHS - November 2008

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

9. National Mental Health Benchmarking Project CAMHS - November 2008

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 National Mental Health Benchmarking Project CAMHS - November 2008

11. after all that, any difference? National Mental Health Benchmarking Project CAMHS - November 2008

12. And in inpatient settings? National Mental Health Benchmarking Project CAMHS - November 2008

13. and is that just self serving clinicians? National Mental Health Benchmarking Project CAMHS - November 2008

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 National Mental Health Benchmarking Project CAMHS - November 2008