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MHCSA Submission: Transforming Health Proposal Paper: Meeting the Clinical Standards
The Mental Health Coalition SA (MHCSA) welcomes the opportunity to provide feedback on the
Transforming Health: Meeting the Clinical Standards proposal paper.
The Mental Health Coalition of South Australia (MHCSA) is the peak body for the nongovernment mental health sector in South Australia (SA). Our vision is that ‘all South
Australians affected by mental illness are receiving the support they need to live well in the
community’. Our mission is to influence the development, range and responsiveness of
services to support people affected by mental illness by:
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Working to reduce stigma and increase an understanding of mental illness and its
prevention;
Representing and working with the community mental health service sector (non
government) to support people affected by mental illness; and
Promoting and building the role of the community mental health service sector (non
government).
The MHCSA notes that Minister Snelling has stated that mental health will be treated separately, with
development of a Mental Health Plan as a priority. The MHCSA welcomes this and believes that the
vehicle for development of a comprehensive Mental Health Plan is through an independent Mental
Health Commission which should be established as a priority.
For mental health “Best Care. First Time. Every Time” does not necessarily mean contact with EDs and
the hospital system.
Transforming Health deals specifically with hospitals, however mental health requires transformation
across the whole health sector. SA has the highest level of investment in hospital based care in the
country and yet this does not translate into better health outcomes. Mental illness burden is 13% of the
total illness burden and the SA and Commonwealth spend on mental health services is closer to 7 or 8% 1
of the total health spend. For over 20 years, national mental health policies and plans have aimed to
increase the proportion of investment in community and NGO services. In South Australia, whilst we
have made significant progress over recent years in a range of areas, the area of most significant underinvestment remains outside the acute hospital based services.
SA Health must focus on why people present at EDs in the first place. Given that in 2011-2012 63% of
mental health presentations at ED did not result in admission and 55% episodes were completed and
the patient discharged (Report on Government Services (ROGs) (2015), Mental Health Management
Table 12A.322 2 it is likely that more focused investment in community-based and sub-acute services will
1
2
http://www.aihw.gov.au/australias-health/2012/spending-on-health/
2 http://www.pc.gov.au/research/recurring/report-on-government-services
MHCSA Submission: Transforming Health 2015
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keep a significant proportion of these people out of EDs when they have more appropriate and
accessible alternatives.
For people living with mental illness, acute care should be a last resort rather than an entry point to
appropriate clinical and psychosocial support. While the statement indicating that under Transforming
Health “mental health patients will (where appropriate) be directly admitted to a mental health bed”,
there is no indication of where these beds are coming from. We note that there is no intention to
increase the number of mental health beds, thereby making this goal difficult to achieve without a range
of alternative services and supports to free up existing/reconfigured beds. A commitment to on-going
sub-acute services and intensive support in the community, such as the current Intensive Home Based
Support Service (IHBSS) program would assist to meet this goal, combined with an effective
communication strategy so that clinicians, and consumers and carers know about these services.
MHCSA notes that both IHBSS and other sub-acute services are in jeopardy due to changes in
Commonwealth funding under the COAG Agreement. Failure to fund sub-acute services will result in
more ED presentations.
Another example of effective community support, which has been evaluated, is the NGO-run IPRSS
program which is delivered in partnership with Community Mental Health Services 3. The evaluation
shows significant impact on supporting people to build better lives in the community and reducing their
demand for bed-based services both in number of admissions (39%) and length of stay (16%). For every
54 people supported during the period of the study, there was a reduced demand for hospital services
by the equivalent of one hospital bed per year.
The patient journey story bears no relation to the targets described and assumes that all people living
with mental illness are connected in some way to clinical services. The MHCSA agrees that hospital EDs
should not be the entry point for mental health services and that continued work in partnership
between the Health and NGO sectors will make significant in-roads to make the “transformed” version
of the story achievable.
Standard 93 states that “In mental health, community care is central to care”- there is no indication in
the body of the report about how this Standard may be enacted. Many of the challenges listed in
Transforming Health cannot be resolved without improving community options that reduce the flow
into emergency and unplanned acute care. Better consumer and family experience can be achieved by
reducing incidence and severity of crisis and consequently reducing need for use of emergency and
unplanned acute care.
The MHCSA has continued to advocate strongly for more investment in services that assist people with
mental illness to build good lives in the community. Our document 'Top Ten' gives a framework to
identify areas for investment that would create a more recovery-oriented system 4. The Productivity
3
http://www.sahealth.sa.gov.au/wps/wcm/connect/d03c5c004c3ed23d9066b4e408a887aa/IPRSS+Final+Report++for+distribution.pdf?MOD=AJPERES&CACHEID=d03c5c004c3ed23d9066b4e408a887aa
4
http://mhcsa.org.au/wp-content/uploads/Top-Ten-FINAL1.pdf
MHCSA Submission: Transforming Health 2015
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Commission Report into the contribution of the not for profit sector provides good information on how
to get better value from more effective partnerships with NGOs 5. In recent years, the SA Department of
Health and Ageing and the MHCSA have made considerable progress in building innovative models and
partnership, such as the IPRSS and IHBSS programs noted above.
The MHCSA would welcome opportunities to discuss the key role that the NGO sector already plays in
providing innovative, effective and efficient community care and to discuss how we can do more
together to assist with reducing unnecessary hospitalisation/re-hospitalisation and discuss how to
reduce the unplanned use of Emergency Departments and acute hospital care services.
Paul Senior
President, MHCSA
5
http://www.pc.gov.au/__data/assets/pdf_file/0003/94548/not-for-profit-report.pdf
MHCSA Submission: Transforming Health 2015
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