Western Victoria PHN Winter Symposium 2018Geelong

June 2018

“The fact that people with serious mental illness die an average of

20 years earlier than the rest of the population, the majority from preventable causes,

is one of the biggest health scandals of our time, yet it is very rarely talked about.”

Professor Sue Bailey

2https://equallywell.org.au/

Physical health of people living with SMI

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Risk of premature death

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0 0.5 1 1.5 2 2.5 3

People with a psychoticdisorder

People with a mental illness

General population

Relative risk of early deathABS, September, 2017

5

0

100

200

300

400

500

600

700

800

900

1000

Stan

dar

dis

ed d

eath

rat

e

General Population

Mental Illness

MI and disadvantage

MI and rural

MI and male

MI and not in workforce

Percentage with physical illness

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0

5

10

15

20

25

30

35

Cancer Diabetes CardiovascularDisease

Asthma

Perc

ent

People with no mental health condition All people with mental health conditions

People with a psychotic disorder

Number of deaths in a 13 month period(ABS, Table 12, 2017)

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0 1,000 2,000 3,000 4,000 5,000 6,000

Heart failure

Dementia, including Alzheimer's disease

Diseases of the urinary system

Prostate cancer

Transport accidents

Cirrhosis and other diseases of liver

Diabetes

Cerebrovascular diseases

Blood and lymph cancer

Breast cancer

Intentional self-harm

Chronic lower respiratory diseases

Colon, sigmoid, rectum and anus cancer

Trachea, bronchus and lung cancer

Ischaemic heart diseases

Mental Health Gen pop'n

Relative risk of early death, by disease type(Percentage, ABS, Table 12, 2017)

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Percentage of total population who accessed

mental health mbs and/or pbs

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Transport accidents

Ischaemic heart diseases

Cerebrovascular diseases

Heart failure

Cirrhosis and other diseases of liver

Dementia, including Alzheimer's…

Blood and lymph cancer

Colon, sigmoid, rectum and anus…

Diseases of the urinary system

Intentional self-harm

Diabetes

Trachea, bronchus and lung cancer

Breast cancer

Prostate cancer

Chronic lower respiratory diseases

Mental Health Gen pop'n

Procedures, hospitalisations and death rates

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0 0.5 1 1.5 2 2.5 3

Schizophrenia

Affective Psychosis

Other psychosis

Personality disorders

Depression

Gen Population

Procedures Hospitalisation Death

Comorbidities

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• 80% of people living with a mental illness have a chronic physical illness (ABS,2017)

• 55% have two or more co-existing conditions(AIHW, 2017)

• 20% of people with a physical illness have a co-existing mental illness (ABS, 2015)

•Total cost $15 Billion pa

•1 % of GDP

• Interactions increases cost by 45%

(RANZCP, 2016)

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Poorer physical health costs

What is the gap in life expectancy?-that depends…

• Those with any contact with state mental health services 12 years for women,16 years for men (Lawrence et al., 2013)

• Schizophrenia 28.5 years (Suetani et al., 2015)

• Severe mental illness clients of UK mhs, 14 years (Chang et al., 2011)

• US between 13 and 30 years (depending on state) (Colton and maderschieid, 2006)

• Int’l: 15 years for women, 20 years for men (Thornicroft, 2013)

• Lawrence, review of 3500 studies – all found excess mortality (Lawrence et al., 2015)

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THE NATIONAL ALLIANCE FOR

RURAL AND REMOTE

MENTAL HEALTH

0 5000 10000 15000 20000 25000 30000

GPs

MH Nurses

Psychologists

Psychiatrists

Pharmacists

Ots

State Private Other

HWA, 2014

There are a lot of professions…and a lot of employers

Stepped Care:There are a lots of types of care provided

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A health system… or a health miasma?

There are a lot of lifestyle risks

•Smoking

•Antipsychotic medications

•Lack of exercise

•Poor diet

•Drugs and alcohol

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There are a lot of system challenges

•Diagnostic overshadowing

•Poor access

•Medication effects

•Inadequate screening and intervention

•Service coordination

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19

WE are here

Stakeholder interviews

Grey Literature

Review

Published literature Review

Draft

Workshop Materials

Consensus Building Workshop

AdditionalStakeholder interviews

Grey Literature

ReviewCont.Broad Consultation

Draft

Background Paper

DraftConsensusStatement

FinalConsensus

Statement and Background Paper

Endorsement by OrganisationsMental Health Drug and Alcohol

Principal Committee

EWIC

ExpertAdvisory

Group

Implementationand

collaboration

Building on a strong base

• 6 focused reports (Australian)

• 10 state and territory mental health plans

• 6 national mental health plans

• 7 Australian consensus statements

• 41 state and territories mental health/physical health clinical guidelines and related policy documents

• 8 international ph-mh statements/plans/platforms

• 125 reviews, reports, research papers.

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Working in partnership

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1

2

3

4

5

6

7

Av All Items

7

P

o

i

n

t

R

a

t

i

n

g

S

c

a

l

e

COMPARISON RATINGS OF 80 CONSENSUS ITEMS FOR 8 WORKSHOP GROUPINGS AND TOTAL SAMPLE N=54

Av Total sample Psychiatrist -clinician (3) Service Provider (10) National Organisation (7) Other - misc (4)

Academic Researcher (3) Professional Colleges (8) State Terrritory MH (11) Carer -Consumer (8)

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The launch of the national consensus statement

The essential elements

• A holistic, person centred approach

• Promotion, prevention and early intervention

• Equity of access

• Improved quality of health care

• Better care coordination

• Monitoring and targets

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Implementation Group

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Members

Elida Meadows, Co-Chair National Mental Health Consumer & Carer Forum

Russell Roberts, Co-Chair Charles Sturt University

Alexis Mohay Australian Government, Department of Health

Arthur Papakotsias Neami National

Carol Turnbull Ramsay Health Care, South Australia

Cate Howell Royal Australian College of General Practitioners

Grant Sara Mental Health Information Strategy Standing Committee

Janine Mohamed Congress of Aboriginal and Torres Strait Islander Nurses and Midwives

John Allan Queensland Government, Department of Health

Josh Fear Mental Health Australia

Kim Ryan Australian College of Mental Health Nurses

Libby Dunstan Brisbane North Primary Health Network

Malcolm Hopwood Royal Australian and New Zealand College of Psychiatrists

Murray Wright Safety and Quality Partnership Standing Committee

Peggy Brown National Mental Health Commission

Richard Weston Healing Foundation

EW

Resources Initiatives

Issue

Promote

Awareness

•Stakeholder database

•Coms strategy

•Website

•Digital communications

•Newsletters

•Symposium

Facilitate Collaboration

•Audit of activities

•ID commonalities

•Website

•Newsletters

•Social media

•Symposium

Resources

•Build resource repository

•Draw on audit tool

•Identify gaps

•Support resource development

Measure Progress

•Audit tool. Test-retest

•MHISSC data/targets

•ABS monitoring

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NMHCCFMHISSC

MHPC

SQPSC

Constellation model of collective impact

Implementation coordination

• Mobilising commitment • 70+ national, state and local organisations have pledged support so far

• Collating commitments • National audit of current initiatives and those planned

• Identifying best practice across Australia• Facilitating collaboration and cooperation

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Implementation coordination(continued)

• Locating, identifying and sharing the best resources for• Consumers• Carers• Clinicians• Service planners, quality and innovation managers

• Developing new resources and tools

• Showcasing best practice and innovation• National and international

• Tracking progress

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1) A common agenda

2) Shared measurement systems

3) Mutually reinforcing activities

4) Continuous communication

5) A backbone support organisation

Current policy directions

• National Consensus Statement

• The Fifth National Mental Health and Suicide Prevention Plan (and accountabilities)

• National Mental Health Commission Report Card

• ACSQHC – Health care standards – Health service standards

• Equally Well Implementation Committee

• ABS tracking and reporting (Sept 2017)

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For PHNs and LHNs….

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New projects

• ACSQHC – Health care standards – Health service standards

• Consumer and carer resource –Co-designed-broadly endorsed

• Mental Health Service Standards

• Revision of the GP redbook

• Developing national indices and national targets(Eg half the number of early deaths due to respiratory disease)

• Ongoing ABS tracking and reporting (Sept 2017)

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What can you do on Monday?Don’t just screen… intervene

• Check, screen…• Complete physical examination in last 12 months?

• Medication review – type, dose, polypharmacy?

• Smoking? Offer support and advice to help

• Community participation?

• Have a recovery focus…

• Arrange: Collaborate, initiate, advocate, expectorate!

• Join us!

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https://equallywell.org.au/

“Contact us” - Get involved!

Sign upsignup@equallywell.org.au

Commit lcobb@csu.edu.au

Get updates/newslettershttps://equallywell.org.au/

Put the link on your webpagehttps://equallywell.org.au/

Share your innovation and evidence