Planning and Evaluation

Planning, Monitoring and Evaluation at Mental Health and Drug & Alcohol Office (MHDAO)

At the core of the State Health Plan is a commitment by the NSW Government to make the most productive use of the finite resources available for health care. The NSW health system, like health systems in other Australian states and developed nations, faces a number of significant challenges in the years ahead, among these being the growth and ageing of the population, an increasing prevalence of chronic disease, health workforce shortages, increasing consumer expectations and keeping up with advances in medical, communications and information technology.

The size and level of investment of NSW Health's mental health and drug and alcohol programs require the MHDAO to have a clearly articulated approach to planning, project and program management and evaluation to ensure alignment with National and State Priorities.

The MHDAO has developed a transparent and structured process of planning, monitoring, resource allocation and performance management. The framework builds on the well documented processes within which the MHDAO plans, allocates resources, manages projects/programs, monitors and evaluates the performance of its programs. The framework includes a description of the interactions between and within the MHDAO and other branches of NSW Health.

Mental Health Clinical Care and Prevention Model (MH-CCP)

The Mental Health Clinical Care and Prevention model (MH-CCP) is a population-based mental health planning model that provides the clinical and epidemiological evidence base to estimate the need for mental health services in NSW, including mental health promotion, illness prevention and early intervention. The model produces average state-level estimates and is not a resource distribution formula or a prescription. Area planners take local factors into account when applying it.

A key feature of MH-CCP is that the population prevalence of mental illnesses is stratified by age group and by defined levels of severity, described as mild, moderate and severe. Appropriate average care packages are assigned to groups within each level of severity. This broadly corresponds to a division of service responsibility between Commonwealth funded primary mental health care for mild and moderate mental illnesses, and State funded specialised mental health programs for people who experience severe illnesses. This simply reflects the limitations of the historical role and funding of State mental health services, and is not limited to NSW. As the 2005 Senate Inquiry into Mental Health noted: “… most jurisdictions have adopted the Mental Health-Clinical Care and Prevention (MH-CCP) model, where state and territory funds aim to address high need, severe illnesses, leaving the high prevalence disorders, such as anxiety and depression, to be carried by federal government initiatives.”

MH CCP version 1

MH-CCP was developed by the former Centre for Mental Health, NSW Department of Health and Version 1.0 was released for comment in April 2000. After review by mental health and planning staff from NSW Area Health Services (AHS), Version 1.1 was released as a planning tool in January 2001. It contained specific predictions of the resources required (beds by type, clinical staff) and the expected outputs of services per 100,000 population aged 0-1, 2-4, 5-11, 12-17, 18-64, and 65+. The 2005 NSW Audit Office report on Emergency Mental Health Services noted MH-CCP as an instance of “Good Practice”. Indicators of “per cent mental health need met” based on the model, appeared in the Department Annual Reports of 2004-05 and 2005-06. The target of achieving 80% of MH-CCP predicted need for acute inpatient beds in each AHS was met by 2007-08.

Unexpectedly, the publicly available model was used by many other jurisdictions in

Australia

as a planning guide. In 2007, a review of MH-CCP against 31 other mental health planning processes from Australia, Canada, New Zealand, United States of America and the United Kingdom was funded by the Commonwealth Department of Health and Ageing (Pirkis J. Harris M. Buckingham W. Whiteford H. Townsend-White C. International planning directions for provision of mental health services. Administration & Policy in Mental Health, 2007; 34(4):377-87). MH-CCP and a 1998

New Zealand

model were the only ones with a quantitative connection to epidemiological evidence.

MH CCP version 2

The development of new types of services in NSW after 2000 made a revision of MH-CCP increasingly necessary. During 2008, the Mental Health and Drug & Alcohol Office reviewed the model, and sub-committees of the NSW Health Mental Health Program Council were invited to propose revisions to the service elements and care packages. A discussion document titled "MH-CCP Version 2.008" was released in March 2009. The changes are indicated below:

Status of Version 1

A number of issues that were contentious and discussed at length in Appendices of Version 1.11 remain generally relevant and have not been repeated in Version 2. Thus Version 1 is a reference document for Version 2, though the quantitative predictions no longer apply.

General Epidemiology

To simplify future maintenance and standardise the model, all the general epidemiology in Version 2 is based on age-sex-illness-specific prevalence data from the Australian Burden of Disease (AusBoD) study (Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD. The burden of disease and injury in Australia 2003. PHE 82. Canberra: Australian Institute of Health and Welfare, 2007.) This includes estimates of illnesses identified by the Senate Inquiry of 2005 as neglected in mental health planning, such as eating disorders and personality disorders.

Comorbidity

Estimates of additional mental illness associated with autism, intellectual disability, substance use conditions, and dementia were included, which addresses other concerns raised by the Senate Inquiry and by NSW subcommittees. The overall effect was to increase all-age prevalence from 16.6% in Version 1 to 17.2% in Version 2.

Severity Stratification and Application of the DSM-IV Disorder Threshold

The severity stratification of Version 1 was retained and made consistent with the disorder threshold of DSM-IV for all age groups, reflecting evidence that a large proportion of adults meeting criteria for the low-threshold diagnoses used in psychiatric epidemiology are not functionally impaired and do not regard themselves as ill or in need of treatment, and likewise the parents of many children and adolescents who meet low-threshold diagnostic criteria do not regard them as ill or as needing treatment. Since there is evidence that these groups are in fact at risk, they form an Indicated Prevention group in Version 2 (5.6% of population). The remainder (11.6% of population) receive the clinical services modelled in MH-CCP.

NSW Service Mapping

The wider use of the model has been recognised by separating the general epidemiology from the division into groups who need particular packages of care (Need Groups). This part of the model is tailored to the particular service elements and care packages used in NSW and it relies strongly on local estimates of service use. Keeping it separate makes the model easier to adapt to other service configurations.

NSW Care Packages

The care packages in MH-CCP describe the types and quantities of care for each Need Group. Specifically, they define adequate care for an average individual in the Need Group during a 12 month period. The more extensive clinical input obtained for Version 2 has generally increased the number of Need Groups and the complexity and intensity of the NSW Care Packages.

NSW Service Elements

The provision of real services requires organised structures for service delivery, such as inpatient units of different types, or ambulatory care teams, or supported accommodation. Service Elements are models of these real-world components. The modelling includes the parameters (such as average length of stay, or ambulatory care workload, or staffing profiles) that allow the calculation of the resources needed to deliver the NSW Care Packages.

NSW Resources and Outputs

This component of the model is mechanical once the other components are specified. It presents the predictions in terms of resources (beds or places or staff per 100,000 age-specific populations) and the outputs to be expected from those resources (separations, occupied bed-days, community contact hours). For many users these things are the "bottom line" in the model, or "targets". However, it is important to remember that the predictions of MH-CCP are not "targets".

DA-CCP: Drug & Alcohol Clinical Care and Prevention Model

The Mental Health and Drug & Alcohol Office has commenced the planning for a drug & alcohol model similar to MH-CCP. This work is long term and it is anticipated that it will not be available until 2011.