Speakers' Presentations - Day One

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Day One - Wednesday, 3 October, 2007

  

Stream One - Using Outcomes

Paper 1: Readmission and length of hospital stay for patients with suicidal ideation
and behaviour. (Paper Unavailable)

Dr Hilarie Tardiff, Senior Programme Officer, WA Department of Health, AUSTRALIA

This study investigated the influence of suicidal ideation and behaviour on length of stay and readmission in Western Australia's sixteen public mental health inpatient units. Admission HoNOS scores were linked to inpatient episodes occurring between 2003 and 2006. Admissions resulting from hospital transfers and data from patients who were readmitted after leaving against medical advice were excluded from the analysis. Responses to HoNOS item two, which assess non-accidental self-harm, were used to categorise patients into three groups - those who had made a suicide attempt, those with suicidal ideation, and patients who reported no suicidal thoughts or behaviour. The results indicate that patients who reported suicidal ideation and behaviour have shorter lengths of stay than those who did not, consistent with the findings of Smith, Fisher and Goldney (2002) who demonstrated this association with a smaller data set in two private psychiatric hospitals. In addition however, the present study revealed that the length of time between subsequent admissions was significantly less for the patients with suicidal behaviour and ideation. Therefore, after accounting for hospital transfers and other factors which influence length of stay and readmission rates, the results of this study indicate that those with suicidal ideation and behaviour were likely to be hospitalised for a shorter period than those without suicidal behaviour or ideation, but also readmitted within a shorter period of time. Implications and possible explanations for these findings will be discussed.

Paper 2:  Monitoring progress in mental health consumers with high and complex needs

Jeff Symonds RPN, MHSc., Mental Health Nurse Consultant, Waikato District Health Board, NEW ZEALAND

Mental Health service consumers with high and complex needs are increasingly recognised as a small, but very significant group contributing to their own and to service risks. 95 people were identified in the Midland region of New Zealand in 2004 and were systematically followed up during 2006. Some standardised assessments were performed in both 2004 and 2006. The value of those particular standardised assessments of psychopathology and functionality as contributors to service planning, and as monitors of outcome are illustrated in this report. The results also bring to light the centrality of impaired functioning and of personality variables as contributors to this service user group.
This presentation describes the quantitative aspects to the follow-up study using the Health of the Nations Outcomes Scale (HoNOS), the Global Assessment Scale and the Personal and Social Performance Scale (PSP). The study gives an evidence base to service planning for this high needs group which is supporting local and regional development in the Midland Region. Also the study has now continued with initiatives into integrating outcome scales with risk assessment and the need for an evidence base with ongoing monitoring of high needs consumers.

Paper 3: Merging two into one: Using outcome measures in a broad mental health information context for service development.

Liz Prowse, Director, mental health rehabilitation & recovery; Cheryl Lambert, Director, mental health service improvement and Tania Geyer, mental health project officer, Southern Adelaide Health Service, AUSTRALIA

Learning objectives:
1. An understanding of a comprehensive mental health information structure.
2. How mental health information can support service development.
3. Use of the national outcome measures within a broader information context.
Southern mental health is a new service structure which incorporates two previously independent community mental health services. This paper describes building on mental health information structures previously developed at one of the sites to move towards a single regional service. The information structures include comprehensive reporting across a number of domains, including the national mental health outcome measures. Through consistent use of information separate services have been able to compare client profiles and acuity, referral and discharge rates, and review relative caseloads. Outcome measures are also being used to support appropriate discharge practice and to allocate disability support. A range of mental health information has been vital in the development of the region being able to operate as a single service.

Paper 4: Te Puna Waiora nurses use outcomes tool in daily nursing practice

Please note: Helen Bingham is happy for people to use any of the ideas presented, but she would like to be informed about how they are used.

Helen Bingham, Clinical Nurse Educator, Acute Mental Health Te Puna Waiora, Taranaki District Health Board, NEW ZEALAND

Workload for nurses in acute mental health continues to grow, with direction from the Ministry of Health to use outcomes measures. Again nurses are allocated another task. The HoNOS tool now has become part of the acute mental health nurse's daily practice. The nurses at Te Puna Waiora are always open to change in practice if this results in better outcomes for clients. The HoNOS is an objective tool measuring presenting symptoms for the first group of scales, the resulting scores flag clinical significance. If there is a symptom of clinical significance then there must be a resulting nursing intervention. The HoNOS scales forms the basis of nursing intervention planning. Using the outcomes tool focuses on client needs from presenting symptoms, there is a high interrelater reliability resulting in more consistent nursing practice. The level of clinical significance flagged by HoNOS has been intertwined with policy and procedure within Te Puna Waiora, including the use of ORM medication, assessment, management of risk, use of restraint, seclusion and intensive psychiatric care. It is well imbedded into teaching systems in acute mental health.
The HoNOS tool is used daily in IPC assessing client progress, effect of treatment, client pathways of care, acuity level, staffing mix and risk management, forming the basis of clinical discussions with medical staff and feedback to clients on goals of IPC treatment.
Outcomes tools can result in faster progress to least restrictive care environment, better management of risk and provision of best treatment options by acute mental health nurses.

Paper 5: Using outcome measurement as an adjunct to caseload management improves clinical interventions and reduces case load demands

Sandra Keppich-Arnold, Associate Director of Nursing and Operations, Alfred Psychiatry, AUSTRALIA

In 2003 the Caulfield Aged Psychiatry Service had an average length of stay within the community program of greater than 500 days. Demand for extended case management was considerable, in part because there was reduced community confidence of the service's capacity to provide brief, intensive treatment even when identified as a priority. Turnaround required specific clinical attention with improved clinical accountability and transformation operationally from an extended care case management service to a pro-active community treatment programme. Embedding outcome measures into driving change, prescribing clinical interventions and determining contact frequency contributed to significant improvements in clinical care, resource management and case load management sustained into 2007. This paper aims to describe the process and outcomes achieved when introducing outcome measures in a community mental health setting. Service reviews sought to achieve consumer satisfaction through improving clinical inputs and reducing total case load numbers. This paper will demonstrate how the opportunity was seized to utilize existing data and interpret clinical information available through outcome measurement to advise therapeutic interventions for consumers of a community team. Over time the service has been able to demonstrate real reduction in consumer numbers whilst service audits reveal a shift in clinical care from the provision of monitoring and maintenance to delivering a range of psychological treatments, agency consultations and discharge planning.

Stream Two - Measures in Development

Paper 6 and 7: Tāku Reo, Tāku Mauri Ora: My Voice, My Life


Mrs Sarah Gordon, Managing Director, Case Consulting Ltd, NEW ZEALAND

Tāku Reo, Tāku Mauri Ora: My Voice, My Life is a three year project to develop a consumer self-assessed measure for Aotearoa/New Zealand which will then become part of the suite of measures being implemented through MH-SMART. This presentation will provide an overview of the project to date and highlight some of the initial analysis which suggests that Tāku Reo, Tāku Mauri Ora is going to be more robust, more relevant and more acceptable than existing self-assessed measures currently being used.
Much of the work on outcome measurement has been carried out by those intimately involved with service delivery, so it is not surprising that the most often cited purpose of mental health outcome measurement is focused on service improvements, in particular, increasing service effectiveness and efficiency, and this is important. However, changes in outcomes reflect far more than the impact of service interventions alone. This wider view includes an explicitly consumer focused agenda.
The primary purpose of mental health outcome measurement, in line with general principles of best practice, should be on the direct potential benefits of such to the consumer, particularly in providing them with an additional tool to support participation in their mental health care. Obviously assessing the impact of service interventions is also important so the secondary purpose of outcome measurement should be: collecting and aggregating information from many individuals over a significant period of time to support detection of trends. Factors explaining these trends can then be explored to inform decision-making and ongoing personal and service development in relation to mental health at individual, organisational, regional and national levels.
This is a unique study which is being lead by mental health consumers/tāngata whaiora. The measure developed will provide them with participation in their care and it will inform ongoing service development by allowing reflection and communication on their mental health outcomes. It is already becoming clear, midway through this project, that the development approach being taken with Tāku Reo, Tāku Mauri Ora, in terms of both the primary purpose and the leadership, is quite significant.

Paper 8: Pacific Island outcome measurement tool for the health of Pacific nations: Please don't use the HoNOS

David Lui, Senior Consultant and Director, Focus on Pacific Ltd and Dr Monique Faleafa, Pacific Clinical Consultant, NEW ZEALAND

Learning objectives
1. Unique culture and perspectives of Pacific People.
2. How to utilise the culture in development of outcome tools.
There are significant mental health issues faced by Pacific Islanders in New Zealand. For many years admissions of Pacific people to mental health services have continued to increase; the number of Pacific people in mental health inpatient and forensic units are disproportioned to population census figures. Three of the main issues are: access to mainstream mental health services, high readmission rates and overrepresentation in negative statistics. Many of the tools used in mental health services in New Zealand were designed by Palagis (European People) utilising their experience and culture. These tools, including outcome measurement tools, are not appropriate for Pacific people. Te Rau Hinengaro - The NZ Mental Health Survey released in September 2006 showed that Pacific people have a higher incidence of 25 per cent of mental illness when compared to 20 per cent for the general population.
New Zealand Mental Health Classification and Outcomes Study (CAOS) published in July 2003 revealed that Pacific episodes are more costly than mainstream and Maori. This could be due to a variety of factors some of which are cultural. The CAOS Study also exposed a real deficiency in that the current MH-SMART suite of outcome measurement tools which does not have a cultural measurement tool that can accurately measure Pacific outcomes.Developmental work on a Pacific Island outcome measurement tool began in 1999 by Pacific Island Mental Health Services at Lotofale. A preliminary report on Pacific outcome measures was commissioned by MHRDS in 2005 to look at this earlier work as well as other work and to make recommendations to the Ministry of Health on the best way forward. The report was published in mid-2006. This presentation will be based on the findings from that report.

Paper 9: The SDQ and SACS working together to measure outcome in a youth AOD service

Dr Grant Christie, Consultant Child & Adolescent Psychiatrist, CADS Youth Service - Altered High, Waitemata District Health Board, NEW ZEALAND

The Substances and Choices Scale (SACS) is a newly developed self-report questionnaire which assesses alcohol and other drug (AOD) difficulties in young people. The SACS has been designed in a similar format to the Strengths and Difficulties Questionnaire (SDQ) so that the two instruments can be used together to provide a broad overview of a young person's psychosocial functioning. CADS Altered High, a youth AOD service, is implementing an outcome measurement system utilising the SDQ and SACS and other collated discharge information. This presentation will describe the systems developed to collect and record the data, and discuss issues related to the implementation of the system. Preliminary results from the first six months of data collection will be detailed and the strengths and weaknesses of the findings discussed.

Paper 10: Hua Oranga

Te Kani Kingi, Director, Te Mata o te Tau, The Academy for Maori Research and Scholarship, Massey University, NEW ZEALAND

Hua Oranga was the first measure of health outcome designed to specifically consider cultural outcomes of mental health treatment and care. And, has usefully described the manner in which Māori concepts of health and well-being can be considered within a routinely administered measure of outcome. While the ideas described within the measure have done much to advance and broaden the notion of what a positive outcome from care might be - a number of important challenges remain. This presentation will provide a brief background on the design and development of Hua Oranga as well as some of the challenges faced in terms of its application. Progress on the validation of the measure will also be detailed and in particular the innovative way in which concepts such as ‘wairua', ‘tinana', ‘hinengaro' and ‘whanau' can be considered.

Stream Three - Training

Paper 11: The challenge of demonstrating change: Different views from different rooms

Philip Burgess, Professor, Mental Health Services Research, School of Population Health, The University of Queensland, Brisbane, Queensland, AUSTRALIA

Australia's National Mental Health Strategy, adopted initially in 1992, emphasises the continued improvement of the quality and effectiveness of treatment for people with mental illness. It recognises that sound information is necessary to support these endeavours and, as a result, all Australian state/territory governments are collecting and reporting outcomes and casemix data with a view to improving clinical practice and developing a research and evaluation culture within public sector mental health services.
It is almost five years since the process of routine outcome measurement commenced. In some ways, this ambitious plan is still in its infancy although there are emerging patterns of how there has been a shift from it being perceived as an ‘initiative' towards it being accepted as ‘standard, day to day, clinical'. While there remains variability regarding data coverage, completeness and compliance, routine outcome and casemix measurement is beginning to demonstrate utility and value in terms of benchmarking and understanding service variation. This paper considers the substantive findings of how practice has informed consumer outcomes, how our understanding of outcomes are dependent on other factors such as ‘case complexity' and how these are related to the perspective taken (e.g., the clinician's perspective, the consumer's perspective, the carer's perspective, etc). Lessons can be learned from the implementation of routine outcomes and casemix measurement in mental health. Specific consideration must be given to the challenges of industry change and the risks and benefits to all stakeholders.


Paper 12: Changing clinical cultures: Outcomes of implementing MH-SMART training

Dr David Turner. MH-SMART Utilisation Facilitator, Waitemata District Health Board, NEW ZEALAND

MH-SMART implementation has sought to change the culture in which mental health clinicians think about their work. In particular, the introduction of an outcomes focussed culture was seen as something new for many clinicians. However, this paper sets out to explore clinicians' attitudes to such issues and whether their beliefs changed following receipt of the MH-SMART training. A self-rated questionnaire was developed by the District Health Board MH-SMART implementation team. Its purpose was to enquire about clinician attitudes to a range of statements regarding outcomes, evidence-based practice and the HoNOS suite of tools. In addition, demographic information about the trainees was also collected. The questionnaire was given to over 500 clinicians prior to and at the end of their MH-SMART training session. Subsequently, the same questionnaire was given to clinicians at their 12 month refresher training session. 402 forms were collected prior to training and 426 post-training. 60 per cent of respondents were from nursing with the remaining 40 per cent being made up of medical and allied staff. Average years of experience was 9.35 years (range, <1 - 35 years). Comparisons of responses were made in a SPSS statistical package. There appeared to be a proportion of respondents with positive attitudes to the underlying principals of this initiative before training had commenced. Following training, there were some significant changes in respondent's attitude to outcomes and their use in the clinical setting. There were some differences noted between professional groups and years of service.

Paper 13: Co-facilitation of outcome measurement training: The experience of consumers, carers and clinicians

Jennifer Black, Tania Lewis and Tim Coombs, Australian Mental Health Outcomes and Classification Network, AUSTRALIA

The major focus of the Western QUATRO project was to engage consumers and carers in dialogue with clinicians around the outcome measurement (OM) agenda. This presentation will outline the ways this was done including open forums and training sessions. The Project joined forces with AMHOCN (Australian Mental Health Outcomes and Classification Network) and national trainers to develop OM training materials that specifically considered the clinical use of OM. The project was specifically requested to contribute consumer and carer perspectives to this process. The training component on ‘Consumer Self Assessment' was designed to be delivered by consumer and carer consultants. A major component of this training was the production of a DVD to accompany the training, which highlighted the views of consumers and carers as well as showcasing some clinicians within the cluster who were doing innovative work with outcome measures. Although consumer and carer consultants were keen to be involved in the training of clinicians in their local areas, many had indicated that they would need some specific training to confidently contribute to training. A two-day workshop was specifically designed to meet the needs of this group and was attended by 11 consumer and carer consultants.Consumer and/or carer consultants have subsequently been involved in training for the project nationally and within nine of the 11 mental health area services within the Western Cluster of Victoria. This presentation will outline the process of developing and delivering training. We will also share qualitative data and anecdotal evidence of this experience for consumers and carers and clinicians as trainers, and clinicians participating in training.

Paper 14: The calorific effect on mental health outcomes collection training

Tania McConachie and Nicola Brandsen-Caldwell, Southland District Health Board, NEW ZEALAND

Learning objectives
• For the audience to appreciate the difficulty in providing sustainable nationally consistent outcomes training in a remote environment.
• To highlight the innovations of coercion.
• Highlight to consumers the outcomes learning environment.
Southland Mental Health Services introduced mental health outcomes on 1 July 2005. The first team experienced direct training from the National team and this was Southland District Health Board's (SDHB) preferred chosen method, so sustainable resources were not further developed. The provision of national direct training was withdrawn leaving SDHB isolated and with little option other than to quickly change tack and develop a sustainable resource with its environs. Join us as we overcame the isolation, technical difficulties and competing internal projects to achieve sustainability and tolerable training.

Paper 15: National training evaluation: Training the "MH-SMART way"

Kathy Stapley, Acting Team Leader, Area Clinical Information Team, Queensland Health, AUSTRALIA and Marihi Langford, Business Consultant, NZN8IV Business Consultancy, NEW ZEALAND

The principal goal of introducing routine outcome measurement in Aotearoa/New Zealand was to support recovery by promoting and facilitating the development of an outcome focussed culture in the mental health sector. The MH-SMART initiative was clearly focussed on the dual requirements of linking collection of routine outcome measures to supporting recovery and addressing the need to be responsive to Maori. Consultation about the potential measures led to a decision to commence collection using the HoNOS family of measures. This decision led to the fact that clinicians would be the initial collectors of the measures and therefore the key target of training. However it was clear that the involvement of consumers/tangata whaiora and Maori cultural workers in both the provision and receipt of training provided a vital opportunity to benefit from that input as well as inform key stakeholders about the initiative.  A training package which focuses on training in the HoNOS, the need to ensure that outcome information collection is responsive to Maori and that information use directly supports recovery of consumers/tangata whaiora was developed.
MH-SMART employed dual strategies in the training roll out, a ‘Train the Trainer' approach and the provision of Direct Training. The training aimed to provide the trainees with the knowledge and skills required to incorporate the new outcomes approach into their practice. This paper will discuss the issues, benefits and challenges of the training process elicited from a recently completed evaluation survey and highlight key learnings from that evaluation.

Stream Four - Understanding an Outcome

Paper 16: Attributions to recovery: What assists and hinders better outcomes

Pernilla Vis af Vivere, National Consumer Advisor, Te Pou, NEW ZEALAND

The presentation covers findings of a qualitative study examining attributions of recovery and mental disorders. All respondents had professional mental health sector experience, and a majority had personal experience of severe and long-term mental health issues. Factors contributing to the emergence and maintenance of mental disorders were linked to unmet universal human needs, e.g., the effect of trauma and absence of good interpersonal relationships. Other factors contributing to symptoms of mental illness were effects of hospitalisation and the use of medication. Having basic human needs being met, e.g., feeling safe, was identified as essential for recovery. Good interpersonal relationships, whether found inside or outside of mental health services, was the single most important factor assisting recovery. Individuals with severe mental illness can recover, and the process of recovery can both be assisted and hindered by mental health services. Mental health services would better assist consumers in their recovery process if an alternative model of mental well-being and unwellness was used. A paradigm that is less reductionist and considers a broad range of factors impacting on mental wellness would better reflect the human condition and better assist mental health consumers. If mental health services considered the importance of universal human needs in relation to the emergence and course of mental disorders and the recovery process, individuals experiencing mental distress would be better supported to develop their capacity for "living well and having a life worth living".

Paper 17: The meaning of change in clinician instruments

Please acknowledge the author in any use of this material


Dr Peter Brann, Director Research and Evaluation Program, Eastern Health Child and Adolescent Mental Health Service, AUSTRALIA

Purpose: Many clinicians, managers, parents and children will be wondering about the meaning of change on the routine outcome measures being collected across Australia and New Zealand. This paper presents a number of approaches for examining change and discusses the implications.Method: A large-scale dataset collected under routine conditions at a public CAMHS was examined. Repeated observations on HoNOSCA from 911 clients were examined from the perspective of change over time, changes in clinical significance, changes in treatment status, effect sizes, and reliable and clinically significant change. Results: Overall statistically significant changes in symptom severity were found. Moreover, these changes were related to treatment status and to changes in the number of clinically significant scales. An effect size of almost one standard deviation was noted. The extent of change varied with diagnosis. As well as changes in mean scores, the proportion of clients who improved was examined. Change in HoNOSCA was compared with clinicians' global view of change with the former being more likely to identify deterioration. While the reliable change index for the total score was calculated, there are some critical issues around statistical assumptions and client engagement accompanying this approach. The extent to which total scores relate to changes on specific scales illustrates a critical issue.
Conclusion: From a number of perspectives, change in the HoNOSCA total and scale scores is valid. However, there are a number of clinical dilemmas that must be faced in deciding which approaches to change will be adopted and disseminated. The implications of these choices may affect clinicians, consumers and managers in understanding change in this world of mandated outcome measurement.

Paper 18: Effective models of consumer representation

Please note: This paper ("Effective Models of Consumer Representation"), which was previously presented in Wellington, New Zealand, October 2007 (at an Australasian Mental Health Workforce Conference entitled "He Kakano"), has the sole copyright and restriction of use statement as per instructed by the Author. It is to remain completely unaltered and retained in its original version. 

Gary Watts, Project Manager, Sigjaws, NEW ZEALAND

This presentation will include:
1. An outline of relevant and important amounts of very interesting, factual and historical knowledge regarding this unique subject.
2. Summaries in the differing amounts of successful and also non-successful consumer representation that has been ongoing throughout New Zealand (e.g., for a significant number of years).
3. Information concerning some of the excellent obtained achievements derived through successful outcomes produced through the utlilisation of effective consumer representation.
4. Also mentioned is some of the more recently introduced, very innovative strategies currently utilised by consumer representation (e.g., descriptions of how this new form/type of service has assisted in vastly improving many, various and differing provided mental health services throughout New Zealand).
5. Brief explanations in some of the important work currently undertaken by the highly recognised international consumer movement.

 

Paper 19: Let's go outside and check the foundations.

Jim Burdett, Director, Mind and Body Consultants Ltd, NEW ZEALAND

The primary purpose for measuring outcomes in mental health services is to discover what measurable change, if any, is occurring in the lives of the users. Furthermore, it is assumed that service use has contributed to that change (or lack of it) and, most importantly, that services are provided in such a manner that we can anticipate positive outcomes. A set of tacit assumptions underpin the measuring process: that services have a philosophical/ethical basis, that services are structured in a manner consistent with that basis, as is the process of service provision and, finally, that the instruments used will measure the areas in which change will happen (given the philosophy, structure and process of service provision). In my presentation I will make explicit and critically examine these assumptions putting forward a clear, simple ethical foundation for the planning and provision of services and then discuss what this means for outcome measurement, including what might constitute a positive outcome.He Kakano - Planting the Seeds: Australasian Mental Health Outcomes Conference

 

Paper 20: Kiwi ACE: A school-based resilience programme

Please note: Permission must be given by the author before use of any material from this presentation

Barbara Woods, Senior Lecturer, Wellington Institute of Technology, NEW ZEALAND

This study set out to determine the efficacy of a school-based indicated resilience programme with adolescents identified as experiencing depressive symptoms. Using techniques drawn from Cognitive Behavioural Therapy and Motivational Interviewing, students learnt to understand the relationship between thinking, feeling and behaviour, to challenge beliefs and unrealistic thinking and to problem-solve.The programme was modified for New Zealand conditions and was co-facilitated by mental health professionals working with school counsellors.1,344 secondary school students were screened for depressive symptoms, and selected students were randomly assigned to groups. Using the Children's Depression Inventory and the Adolescent Coping Scale, 130 students were retested at four points to assess changes in depressive symptoms and coping skills. At the one-year follow up participating students had significantly improved scores on the CDI. This was effective across gender and ethnicity, and findings were supported by data from teachers and student focus groups.

Stream Five - Extending Outcome Measures

Paper 21: How do you measure social inclusion?

Marion Blake, CEO Platform, NEW ZEALAND

This presentation will discuss the tensions that emerge when evaluation meets innovation. It is evident that a person's experience of mental illness can be significantly influenced by a range of social impacts. Community mental health and addictions organisations in New Zealand are agents that support and encourage individuals to engage with the complexity of ordinary community activities. The sector has been described by the Mental Health Commission as diverse, dynamic and promoting innovative social inclusion initiatives. Many traditional evaluative and measurement regimes rely on consistency, repetition and often separation. The service solutions of NGOs are often non-linear, complexity based and developmental. This is a complex environment and sometimes we need to stand back and look at the whole system to see how things work. Perhaps frameworks offered by complexity theory or chaos theory or thinking about whole and living systems can engage our curiosity about what's working, for whom, in what ways and from what perspectives.

Paper 22: Real outcomes for Māori: Management of symptoms or reasserting rangatiratanga to address causation?

Terry Huriwai, Project Manager, Matua Raki, NEW ZEALAND

"The highest level of success is when a client who has experienced whānau, hapu and iwi alienation feels comfortable about returning to their tribal roots." This vision by a kaupapa Māori alcohol and other drug treatment service in the 1980s is based on the notion that colonisation is at the root of problems for Māori. Recovery of rangatiratanga was seen by many to be the ‘cure'. Using addiction treatment as the context for this presentation, outcomes for Māori and the implications for service and workforce development will be discussed. They say ‘one size doesn't fit all' but what might a Māori measuring tool of outcome need to be cognisant of.

Paper 23: Routine measurement of cannabis use in mental health and addictions settings

Screening tool

Dr Simon Adamson, National Addiction Centre, Christchurch School of Medicine and Health Sciences, University of Otago, NEW ZEALAND

Cannabis is the most commonly used illicit drug in New Zealand and Australia by a substantial margin. In New Zealand, cannabis dependence is the second most common drug, after alcohol, for which people seek treatment in specialist addiction settings, while in mental health settings use and dependence on cannabis are common, but often overlooked. This failure to routinely identify and track cannabis use in mental health patients is of concern given the established links between cannabis use and poor outcome for patients with psychotic symptoms, whilst cannabis has also been implicated in poorer outcome for depressed mood. This paper will review this area and describe our own work in developing a brief measure of cannabis use and associated problems - the Cannabis Use Disorders Identification Test (CUDIT), which can be used for both screening and monitoring of cannabis-related problems.

Paper 24: What has been learnt from benchmarking forensic mental health outcome measures? (Paper Unavailable)

Rebecca Halsey, Mental Health Benchmarking Project Officer, Justice Health, AUSTRALIA

Learning objectives:
1. Brief overview of forensic mental health services in New South Wales provided by Justice Health.
2. Provide background information on the introduction and collection of mental health outcome measures in Justice Health.
3. Demonstrate usage of the outcome measures at a clinical, organisational and state-wide level.
4. Application of outcome measures in the National Benchmarking Project.
5. Outcomes for Justice Health from participation in benchmarking.

Justice Health provides and coordinates a comprehensive range of health care services for people who come into contact with the New South Wales (NSW) Justice System. It introduced the collection of mental health outcome measures in January 2002. Since this time, over 18,200 measures have been collected from a number of treatment settings including Court Liaison, Adolescent Health, Adult Ambulatory and Inpatient and Community Forensic Mental Health Services. In 2006 Justice Health joined a national forensic mental health benchmarking forum. Via this forum the organisation has commenced the benchmarking of various measures including rates of seclusion and aggression, medication prescribing patterns, patient acuity, court liaison diversion rates, and uptake of outcome measures, treatment days, and inpatient length of stay, readmission rates and costs. Participation in national benchmarking has highlighted the need to develop service specific key performance indicators (KPIs). During this presentation the authors will demonstrate the processes undertaken in the development, preparation, collection, collation and reporting of KPIs. In addition, outcomes data will be presented along with a discussion of how this information has been applied to improve service provision.

Paper 25: Is anyone better off?": Measuring outcomes for people with mental health issues and/or an intellectually disability

Louise Carr, Chief Executive Officer; Donald Shand, Director of Operations and Taryn Knox, Analyst, PACT, NEW ZEALAND

The idea of measuring the efficacy of mental health organisations is not a new phenomenon. During the 1970s and 1980s, the emphasis was on measurement of health and safety regulations, the frequency and length of hospital stays, mortality rates and so on. Over recent times, support services have recognised that it is not enough to measure such systems - organisations also need to measure whether their actions have had a positive, neutral or negative effect on the client's quality of life. PACT is developing a set of person-centred measurements for a range of clients with mental health problems and/or an intellectual disability. PACT makes use of Schalock's eight areas of measurement, and adds the additional domain of organisational wellbeing, to ensure that both the quality of life and quality of systems are measured. We also adapt the measurements for different sets of clients to ensure that they are suited to the individual needs of clients, including the capability of the client, the opportunities available to them and our understanding of what works. These measurements aim to ensure that PACT (throughout all levels of the organisation including management and direct support) takes learned and deliberate actions to enhance the quality of life of the people we support.

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Page last updated: 7 April 2008