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Service Monitoring

• Service Specifications
• Output and Activity Indicators
• Clinical Reviews
• Quality Incentive Strategy
• Consumer and Carer Satisfaction
• Standards and Accreditation
• Conclusion

It is essential that the Mental Health Outcomes Project be seen in the context of the broader quality and effectiveness strategy for mental health services in Victoria. Public mental health services are already expected to comply with a range of performance monitoring requirements. These initiatives, which are briefly outlined below, provide a context for the development of the Mental Health Outcomes Project. The project will add to the range and depth of information available concerning the quality and effectiveness of mental health services provided. This will also result in a progressive reorientation of the existing reporting mechanisms from input/output-focused to outcome-focused.

Service Specifications

Service specifications for registered funded agencies providing mental health services are largely drawn from the policy document Victoria's Mental Health Service-The Framework for Service Delivery (March 1994). For example, Crisis Assessment and Treatment (CAT) services are required to be available 24 hours per day seven days a week. Services are monitored on a routine basis to ensure their compliance with the relevant specifications.

Output and Activity Indicators

As part of the service contract, providers commit themselves to deliver a specified service at an agreed price. Performance indicators have been established and are undergoing further development.

Examples of performance indicators include measures of inpatient activity (such as readmission rate, length of stay) and community-based services activity (such as community treatment rates or contacts per client per month).

Performance indicators provide feedback to the area mental health services to enable them to compare performance over time, against targets and with peers, and to examine the possible causes for variations in performance.

Performance indicators at this time are largely measures of service activity and throughput.

Clinical Reviews

The Chief Psychiatrist is responsible for the medical care and the treatment of mentally ill people pursuant to the Mental Health Act 1986. In exercise of this responsibility, Clinical Reviews are undertaken by the Office of the Chief Psychiatrist to ensure that treatment and care of people with a mental illness is consistent with the objectives and principles set out in the Act and with established clinical best practice.

Clinical Reviews are undertaken to ensure continuous improvement in the quality of mental health services. They are an effective means of examining and improving the quality of treatment and care, and enabling service providers to critically evaluate the ways in which they fulfil their clinical responsibilities.

Each area mental health service is reviewed by a small team of senior mental health practitioners with extensive experience and expertise in service provision in Victoria. A three-year rotating program of Clinical Reviews has been established.

Clinical Reviews are undertaken in the context of a quality improvement framework, with reports provided to the Chief Executive Officer of the agency for action.

Quality Incentive Strategy

In 1996-97, the Mental Health Branch introduced a Quality Incentive Strategy to provide financial incentives for the provision of high quality mental health services. The incentives consisted of additional payments for each of the adult mental health services dependent upon satisfactory performance on the three measures identified. In 1996-97 these included measures of consumer and carer satisfaction, service responsiveness to people of a non-English-speaking background and data timeliness. In the 1997-98 Quality Incentive Project, adult mental health services were assessed against the above measures as well as an additional measure concerning the responsiveness of services to meeting the needs of women. The focus in 1998-99 and 1999-2000 will be upon service responsiveness to the needs of children/young persons who may be at risk and statutory clients of Child Protection or Juvenile Justice services and their families and carers.

The Quality Incentive Strategy complements the work being undertaken on performance indicator development and consumer outcome measurement and adds significantly to the range of data available to enhance service delivery and to inform policy and service development.

Consumer and Carer Satisfaction

Consumer and Carer Satisfaction Surveys are routinely undertaken as part of the Quality Incentive Strategy. Gauging customer (that is, consumer and carer) satisfaction with public mental health services is an important part of service evaluation as satisfaction with services is strongly related to a client's willingness to be involved in treatment.

The survey process seeks consumer and carer opinion on key areas of service delivery such as service availability, information provision, the quality of treatment and assistance, staff attitudes, opportunities for consumer participation and issues specific to hospital-based services.

An individual report detailing survey outcomes is prepared for each service and is available to regions. Aggregated statewide data providing insights into the consumer and carer experience of public mental health services is also prepared.

Standards and Accreditation

In the National Mental Health Policy and Plan (1992), Commonwealth, State and Territory Health Ministers endorsed the development of national outcome standards for mental health services and of quality assurance programs for mental health services. They also expressed support for an independent system of assessing whether services are meeting standards.

It was felt that specific standards were required for mental health services in order to address the specific service requirements associated with mental health treatment.

The national standards project was undertaken jointly by three organisations with experience in developing and assessing health care standards, namely the Australian Council on Healthcare Standards (ACHS), the Community Health Accreditation and Standards Program (CHASP) and the Area Integrated Mental Health Service Standards (AIMHS) and produced a set of mental health service standards which can be applied to all mental health services across Australia.

Accreditation is an important component of the development of a quality system. It can provide an independent measure of a quality organisation and is typically intended to convey that the organisation meets specified standards of care. Hospitals undertake accreditation within this context. Following their mainstreaming, Victoria's mental health services now participate in accreditation. With the National Standards finalised, work in Victoria will now focus on incorporating the National Standards into the accreditation process.

Conclusion

Performance monitoring-whether by consumers, carers, service providers, hospitals, networks or the Department of Human Services-serves a number of important purposes, including the measurement of service effectiveness and performance outcomes and contract monitoring.

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