ADULT COMMUNITY MENTAL HEALTH TEAMS: AVAILABILITY, ACCESSIBILITY AND EFFECTIVENESS OF SERVICES

Background

Mental illness will affect 20 per cent of Australian adults in any one year. One-fifth of those will suffer from a severe mental illness.

The consequences of not providing care for people suffering from mental illness are likely to be significant for them and the community. Mental illness can affect a person’s capacity to interact with their family and friends, look after themselves and to get and keep a job and a place to live. In more severe cases and without adequate help, people with mental illness can be hospitalised for long periods, be at higher risk of self-harm and suicide, and be more likely to be homeless or in jail.

The approach to providing mental health care has moved away from providing care in institutions to community-based care. Each year three times more mental health care consumers are cared for in the community than in hospitals. This places different demands on the way services are planned and provided, and changes the ways consumers access them. To deliver the majority of community mental health services, WA Health relies on Community Mental Health Teams (CMHTs) at 39 locations across the state. They provide initial assessment, treatment and referral services. In 2007-08, these teams provided services to 28 500 adults, approximately 2.1 per cent of the state’s population.

We examined adult (age 18 to 64) CMHTs and focused on three key questions:

• Are the CMHT services available – are the services that consumers might need consistently in place and offered to them?
• Are the services offered by CMHTs accessible to consumers – can consumers get the services they need when they need them?
• Are CMHT services effectively delivered to provide quality care and achieve good outcomes – is care well planned, are consumers and carers engaged, and are measures of effectiveness defined and monitored?

Examination conclusion…

The geographical spread of the CMHTs ensures that general mental health services are available locally in most communities. However, WA Health does not have the planning and resourcing mechanisms in place to ensure that the mix of services provided by CMHTs consistently reflects the consumer needs they are trying to meet.

The consumer experience of CMHTs varies. Consumers recognise the efforts of individual clinicians, but often have difficulty in finding and getting the right services at the right time. This can lead to consumers being in crisis before they get help. The care consumers receive can depend more on where they live than their needs. Consumers and carers are not adequately involved in the planning and review of care.

What CMHTs are trying to achieve, beyond providing care to individual consumers, is unclear. WA Health has not put in place consistent overall objectives for CMHTs. WA Health does not have a framework for evaluating CMHT service delivery and does not monitor their overall effectiveness. It is not clear that the increased investment in community mental health is being targeted to the most efficient and effective services.

What the examination recommended...

WA Health should:

• define the standard set of services which should be available from CMHTs
• revise its planning processes so that service availability and resource allocation explicitly reflect community need
• help consumers avoid deteriorating into crisis by:
  • providing an appropriate mix of services
  • identifying ways of providing CMHT services to consumers with a severe mental illness without a diagnosis if a consumer has an assessed need
• provide consistent access to CMHT services regardless of where a consumer lives
• contact consumers within seven days of hospital discharge in line with agreed national good practice targets
• effectively coordinate access to clinical and support services so consumers receive all the services they need
• ensure that every consumer has a consistent care plan which is agreed with them and is regularly reviewed and updated
• develop and implement a framework and suite of performance measures for monitoring and reporting the efficiency and effectiveness of CMHT services.

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