Are mental health, alcohol and other drug (AOD), and homelessness services equitably distributed? Does service location align with population demographic and socioeconomic need? What are mental health health, AOD, and homelessness services actually providing to the community, and is there an appropriate mix of service diversity for the community? These questions (and many, many more) ConNetica has tackled by systematically classifying, coding and mapping mental health, AOD and homelessness services across South Eastern Melbourne.
The Integrated Atlas of Mental Health, Alcohol and Other Drug and Homelessness Services was recently delivered to South Eastern Melbourne PHN. It is a comprehensive document detailing the universally accessible social services throughout the region, stretching from the inner south east of Melbourne all the way down to the Mornington Peninsula. It is the first service mapping project in the world to employ the DESDE coding system to homelessness services.
Why map services?
As healthcare services push to become increasingly integrated there is a pressing need to understand not just where services are located in relation to population need, but also to understand the core activities that these services provide to the community. With this knowledge, it becomes easier to understand a system of care in a given geographic region, and to optimise planning and commissioning of future services to better meet the needs of the community and drive service integration.
Utilising the Description and Evaluation of Services and Directories in Europe for Long Term Care (DESDE-LTC) methodology we were able to systematically classify over 250 services providing care for those experiencing mental illness, AOD issues and/or homelessness in the South Eastern Melbourne PHN region. The DESDE-LTC is an internationally validated and standardised method of classifying services, which has been used in Europe, the UK and now in several areas across Australia. As the methodology uses the same language to classify services (and the core function they serve) regardless of location, we can then compare, contrast and discuss different systems of care with an unprecedented level of comparison. At present there are over 100 different service classifications that can be applied to a team delivering care.
In the figure to the left we can see a comparison of number of mental health services per 100,000 adults in South Eastern Melbourne (blue line) and Finland (green line). There are greater numbers of Residential (inpatient) services (particularly high intensity residential rehabilitation services) in Finland when compared with the South Eastern Melbourne PHN region. However, there is quite a strong presence of Non Acute Mobile Outpatient services run by NGOs in South Eastern Melbourne PHN, much more than Finland.
Patterns of care provide a snapshot of what a system looks like in a given area, however, there is generally no 'right' pattern of care. A health system will ultimately depend upon population characteristics, funding models, and the health system climate at the time. Furthermore, another factor to consider is the size of teams delivering care - in our Atlas reports we do extensive work in understanding the workforce capacity of the service system, including levels of full time equivalent staffing, qualification levels of staff, and service capacity analyses.
What did we find? A Snapshot
Of the 414 different types of mental health, AOD and homelessness care, mental health services made up 49% of service delivery teams. In total, we identified 17 organisations providing mental health specific care across the South Eastern Melbourne PHN region. This included 178 service delivery teams providing 204 types of care across 31 DESDE code classifications. Of these mental health services, 65% were run by Non-Government Organisations whilst the remaining 35% were run by Health Services.
Mental Health Services by Age Group
Mental Health Services by Type of Care
The majority (76%) of mental health services were providing care to adults, 17% were providing specialised care for children and adolescents, whilst 6% of services were providing specialised care for older adults in the community or Residential facilities. Outpatient Care was the most prominent type of care being delivered by mental health services, followed by Residential Care, Accessibility and finally, Information and Guidance services.
Through this comprehensive mapping project we were able to identify specific gaps in service provision across mental health, AOD and homelessness services. We were also able to gather rich qualitative data related to service provision and key issues raised by service organisations. In particular, it was found that homelessness services were highly integrated, and this is almost a necessity, with homelessness being strongly associated with mental illness and AOD problems.
Where to from here?
It is widely accepted that mental and physical illness are close bedfellows. If we are to truly work toward an integrated system that is patient centred rather than disease or illness oriented then we need to understand our health system as a dynamic and interdependent system. A system where chronic illness and mental illness will overlap and health professionals will be required to work in innovative ways. For service planners, understanding the work being done on the ground, not just for mental health but also for chronic diseases such as Diabetes, Cardiovascular Disease, and Chronic Obstructive Pulmonary Disease, will be a positive step toward future service planning and design. Health professionals work in diverse and complex systems of care. Those working in innovative ways need to understand the community needs, as they shift and evolve over time, in order to deliver place based care which is integrated and patient-centred. The bridging of chronic and mental health atlases aims to provide this rich contextual information to health professionals and planners alike.
ConNetica is nearing completion of the first ever Chronic Care Atlas, running as a pilot in Dubbo and Coonamble, utilising the DESDE-LTC methodology. It is hoped that this will be yet another tool to employ in making decisions about what the future of health care will look like in Australia, and indeed, throughout the world.
ConNetica Consulting would like to thank the support of the South Eastern Melbourne PHN. In particular, the support provided by General Manager of Systems Outcomes, Chris Wood and his team was essential to the delivery of a project of this scale. ConNetica would also like to thank the stakeholders, service providers and organisations who contributed data to the Atlas, and for their extensive feedback provided on drafts which ensured quality data was being presented.