Health Status and Outcomes in Victoria's Mental Health Services
(February 1999)
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Introduction
The Mental Health Outcomes Project
Mental health services in Victoria have undergone significant
change over recent years resulting in a redeveloped service system
with a clearly articulated structure and a strong focus on community-based
services. Service provision is supported by new management arrangements
and a consistent case management framework.
Mental health services are increasingly turning their attention
towards developing systems that drive and ensure higher quality
services and better outcomes for consumers and carers.
The aim of the Mental Health Outcomes Project is to develop a
suite of outcome measures for clients of public mental health
services. This discussion paper specifically addresses the mental
health services for adults (aged 16-64). Separate discussion papers
will be developed for other age groups.
From the start, the development of outcome measures has occurred
in consultation with consumers and carers and in collaboration
with the field. A reference group was convened in September 1997,
with its membership drawn from a range of stakeholders (Appendix
1).
This Discussion Paper has been developed in partnership with
the reference group and aims to provide a basis for wider consultation
with consumers, carers and other interested parties on the suite
of measures which is proposed for adult mental health services.
An overview of the proposed 'suite' can be found in Appendix 3;
the measures are described in detail in the paper itself.
If you have any queries, please contact Gilbert
Van Hoeydonck on (61 3) 9616 7486.
A Commitment to Quality
The impetus for measuring outcomes in public mental health services
comes from a number of sources. It is underpinned by the Victorian
State Government's principles for service delivery as follows:
- To put people first, rather than institutions or systems
- To ensure a fairer distribution of limited resources
- To obtain value for taxpayers' funds
- To provide a better health status and outcome for all Victorians.
The focus upon consumers and the commitment to quality are the
dual imperatives underpinning these principles. This has a number
of implications for outcome measurement. Putting people first
means ensuring that their needs are met and also involving them
in making that assessment. Consumers of mental health services
need to have the opportunity to be actively involved in the design,
planning, delivery and evaluation of services. The principles
also imply that, if consumers are entitled to expect the best
from their service provider, it is essential that consumers and
their carers (and the Department of Human Services as the purchaser
of services on their behalf) are well-informed about their services'
clinical practice.
Measuring outcomes can only realistically be done by comparing
consumers' health status over time. Collecting additional information
about individual consumers is crucial for the purposes of developing
a quality service but may give rise to concerns about confidentiality.
These concerns will be addressed through stringent information
management protocols.
It is important that routine outcome measurement is implemented
in mental health services in a spirit of partnership with all
stakeholders. This paper describes the ways in which outcome measurement
will be of benefit to consumers, carers, clinicians, managers
and planners. The Department is keen for the proposed uses of
outcome measurement to be critically tested during (and beyond)
the period of public consultation. The Department will continue
to seek input from consumers and carers. The dialogue with clinicians
will continue, to ensure that outcome measurement is seen as a
core component of their work, which can enrich rather than intrude
on clinical practice. Liaison with service providers will occur
in order to develop an implementation strategy which addresses
local needs in the areas of education, training, data entry and
analysis.
These are some of the challenges which need to be met in order
to implement successful outcome measurement and it is important
to acknowledge that its implementation will be a developmental
process, with continuing improvement over time.
Some Key Concepts Defined
A range of measures of various levels of sophistication have
been developed over time in order to meet the needs of clinicians,
managers, and administrators for monitoring and evaluation of
mental health care.
Inputs
are the resources provided such as numbers of staff, buildings,
numbers of beds. While easy to measure, there is a poor relationship
between inputs and service activity, quality of care or health
outcomes. Comparison between services based on inputs will provide
little information about the quality of the service provided.
Outputs
are the products or services produced such as numbers of admissions
or community contacts, numbers of occupied bed days, length of
stay. These activity measures reflect met demand, but give little
indication of need, quality of service provided or health outcomes.
For example, growth in inpatient admissions may be due to greater
numbers of readmissions, growth in the local catchment population,
or less than optimal functioning of community-based services.
Outcomes
are 'results or visible effects'. Outcomes are measures of change
over time. These may be categorised more specifically as consumer
outcomes or service outcomes.
Consumer Outcomes
are the effects on a consumer's health status that are attributable
to an intervention. Various scales have been developed to measure
these changes. These scales may be consumer-rated or clinician-rated.
Consumer outcome measures in the absence of information about
service outcomes and outputs may give misleading information about
the service provided.
Service Outcomes
are the range of effects and the global impact of service provision
on stakeholders including the consumer, the service system, or
the broader community. Service outcome measures may include quantitative
aspects of service provision as well as broader, qualitative aspects
such as service timeliness, responsiveness, consumer satisfaction
or a given population's health.
Updated 6 January 2000
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