Presentation by Auditor General - Caroline Spencer, An audit of access to State-managed adult mental health services. Presented at the Western Australian Mental Health Conference 2019.

1. 1
An audit of access to State-managed adult
mental health services
WA Mental Health Conference – 20 November 2019
Auditor General – Caroline Spencer

2. 2
Role of the Auditor General

3. 3
Audit objective and methodology
Audit objective
To assess whether people can access State-managed adult mental
health services efficiently and effectively
Data analytics exercise
Engaged a data analytics expert to link individual mental health care
events across the 3 services to create anonymised patient journeys
over 5 years from 2013
Outcomes
Proof of concept
Audit team member seconded to DoH
Additional report to Parliament

4. 4
Better Choices. Better Lives: Western Australian Mental Health,
Alcohol and Other Drug Services Plan 2015-2025
Key objective: changing the service mix

5. 5
There have been a number of barriers to effectively implementing the Plan
Lack of implementation
plan
Not yet clear if
implemented services are
delivering planned benefits
Not clear who is
responsible for efficient
and effective
management of mental
health services
No agreed funding plan

6. 6
Mental Health Care – DoH’s & MHC’s activity-based view
ED
presentation
Person 1
ED
presentation
Person 1
ED
presentation
Person 1
ED
presentation
Person 2
ED
presentation
Person 2
ED
presentation
Person 2
ED
presentation
Person 4
ED
presentation
Person 1
ED
presentation
Person 4
Inpatient
stay
Person 2
Inpatient
stay
Person 2
Inpatient
stay
Person 2
Inpatient
stay
Person 2
Inpatient
stay
Person 1
Inpatient
stay
Person 4
Inpatient
stay
Person 1
Inpatient
stay
Person 1
Inpatient
stay
Person 3
Inpatient
stay
Person 3
Community
treatment
Person 3
Community
treatment
Person 3
Community
treatment
Person 3
Community
treatment
Person 3
Community
treatment
Person 2
Community
treatment
Person 2
Community
treatment
Person 1
Community
treatment
Person 1
Community
treatment
Person 1
Community
treatment
Person 4
Community
treatment
Person 1
Emergency Department
9 presentations
Hospital Beds
10 admissions
Community Services
11 contacts

7. 7
Mental Health Care – episodes of care view
ED
presentation
Person 1
ED
presentation
Person 1
ED
presentation
Person 1
ED
presentation
Person 1
Inpatient
stay
Person 1
Community
treatment
Person 1
Community
treatment
Person 1
Community
treatment
Person 1
Person 1
ED
presentation
Person 2
ED
presentation
Person 2
ED
presentation
Person 2
Inpatient
stay
Person 2
Inpatient
stay
Person 2
Inpatient
stay
Person 2
Community
treatment
Person 2
Community
treatment
Person 2
Person 2
Inpatient
stay
Person 3
Inpatient
stay
Person 3
Community
treatment
Person 3
Community
treatment
Person 3
Community
treatment
Person 3
Community
treatment
Person 3
Person 3
ED
presentation
Person 4
ED
presentation
Person 4
Inpatient
stay
Person 4
Community
treatment
Person 4
Person 4
4 People
Time

8. 8
Person-centred view of one episode

9. 9
People’s pathways through mental health services - macro

10. 10
People’s pathways through mental health services - micro

11. 11
212,679 people used the three services from 2013-2017
4.8 million care events
28,690
38,081 7,222
8,061
43,700
81,662
5,263
Community Treatment
Services
Emergency
Departments
Inpatient
212,679
Total number of people who
accessed WA State-managed
services 2013-2017

12. 12
Current mix of mental health services does not work as intended
for some people
• 17% increase in number of people accessing community treatment
• No increase in number of hours of treatment
Increased pressure on community treatment services
Acute mental health beds not being used as intended
• 126 people spent more than 365 consecutive days in acute hospital beds
• Reduces effective capacity of system, making it difficult to access acute
inpatient care
EDs are acting as ‘front door’ for care and hospital care is difficult to access
• Almost half of people accessing care had first contact in ED
• People with mental health issues spend longer in ED

13. 13
Financial implications – costs of current State-managed services

14. 14
10% of people used 90% of hospital care and almost half of ED
and community treatment

15. 15
Recommendations
Analyse people’s pathways across all State mental health
services to better understand the capacity, effectiveness and
efficiency of care options currently provided, then prioritise
the initiatives in the Plan accordingly
Clarify their roles and responsibilities
Develop an implementation and funding plan to support the
Better Choices. Better Lives: Western Australian Mental Health and
Drug Services Plan.
The MHC and DoH should:

16. 16
Thank you
Caroline Spencer
Auditor General for Western Australia
www.audit.wa.gov.au