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Rural - Metropolitan Child & Adolescent Mental health Services (CAMHS): Inpatient Arrangements (July 2003)

Purpose

To provide clear guidelines clarifying and formalising rural links with metropolitan CAMHS inpatient services.

Background

Inpatient services are an integral part of mental health service delivery in CAMHS. Ensuring access across the state to inpatient treatment and care is of fundamental concern to the Mental Health Branch. It is intended that both metropolitan and rural CAMHS have access to these inpatient units and that there is, as far as possible, equity in the availability and distribution of beds across the regions.

To date, metropolitan and rural services have developed their own agreements for inpatient access. These have been based on a range of historical connections, individual relationships, or geographical positioning. In the absence of a stated expectation by the Mental Health Branch about the proportion of metropolitan beds/bed days that should be available for rural clients, individual services appear to have developed their own, often ad hoc formulas for determining bed availability. This has resulted in some inpatient services admitting a greater proportion of rural clients from across the State while other services admit very few. The issue of access is of clear concern under this arrangement.

There also appear to be inconsistencies about charging rural services for inpatient admissions of their clients.

The Mental Health Branch recognises that a consistent approach to rural and metropolitan links across the State will reduce confusion and inequity and assist in the further development of positive working relationships between services that can be of mutual benefit.

In addition, clarification of capacity for inpatient services to charge for their services will assist rural services to better plan for the needs of their client population.

In late 2002, a discussion paper was distributed outlining a proposal for realigning current rural-metropolitan links.

Key Principles

The key principles for links between rural CAMHS and metropolitan CAMHS inpatient services are:

• All young people, regardless of their place of residence, should have access to inpatient services if it is determined to be necessary for their mental health treatment.


• Each CAMHS inpatient service should have an established link with a minimum of one rural catchment for which they have primary responsibility for the provision of inpatient care.
• Metropolitan services should not charge rural services for the cost of an inpatient admission.
• Rural services have the capacity to negotiate with all metropolitan services for the provision of non-inpatient services such as consultation and supervision. In practice there are a range of benefits in one metropolitan service offering the range of services to its rural link.

Re-organisation of Rural - Metropolitan Links

Components of Inpatient Admission

Admission:

Consistent with good practice principles, the admission of a young person into an inpatient unit should be based primarily on clinical need. Referrals for admission should be negotiated between the consultant psychiatrists of the metropolitan and rural services. However, as a number of rural services do not have regular access to a consultant psychiatrist, the senior clinician should be delegated responsibility for negotiating an admission.

The inpatient treatment plan should be made available to the referring service and that service should be actively engaged in the treatment process. It may be beneficial for written agreements outlining the treatment and discharge plan to be developed and signed by the referring service and the inpatient service (as is practice with the inpatient service and the young person and his/her family).

Should a bed not be available at the designated service, the referring agency has the responsibility to negotiate the inpatient admission with another CAMHS. CAMHS inpatient units are to be flexible in accepting referrals from outside their designated areas when the designated inpatient unit does not have a vacancy.

As all inpatient metropolitan beds are currently 100% funded, there is no justification for charging rural services for inpatient costs. Where unforseen treatment needs emerge that require additional expenditure, negotiations are to occur with the referring service (see Specialing below).

Specialing:

Current bed day rates are standard rates that have been calculated on an average level of need. The management of High Dependency Units have been costed into the current bed day rates. Rates for additional specialing should directly relate to the costs incurred by the employment of the additional staff required and be negotiated with the referring agency.

Additional Costs:

There are several other costs that may be incurred over and above the average level of need that specifically relate to inpatient admissions of rural clients. It is expected that during the time a client is receiving inpatient treatment, communication is maintained with the referring case manager. This is true whether or not the case manager is linked to a metropolitan or a rural service. In most instances it may be feasible for the case manager to physically attend screen sessions, clinical and planning meetings. Where this is not possible, teleconferencing provides the opportunity of ensuring all parties are engaged in the treatment process. The cost for such teleconferencing during the inpatient admission is the responsibility of the referring service.

Discharge Planning:

Consistent with good practice principles, discharge planning is a collaborative effort between the referring service and the inpatient unit and should commence at the beginning of the admission. In recognition of rural differences, it is vital that discharge plans take into account local resourcing and capacities. Responsibility for follow up care post discharge, rests with the referring consultant psychiatrist.