These chapters have presented the results of a literature review of publicly-available documents from selected relevant national and international jurisdictions. In the case of definitions used by Australian states and territories, the analysis of definitions should not at this point be regarded as complete since there are a number of parallel processes within the Stage A work, all of which have the potential to inform the way the material uncovered through this literature review is ultimately synthesized. These other processes are:
• Information and opinions received from stakeholders in response to the Consultation Paper; and
• Completion of the NMDS questionnaire templates by jurisdictions, including the definitional information included therein.
Part B. Summary 43
Table 8.1: Summary of findings of the literature review relevant to the consultation questions
UK USA New
Zealand Consultation paper question England Medicare Veterans New York Texas SAMHSA
1. National Mental Health Care Type
- Does the jurisdiction have a mental health 'care type' or equivalent? no no no no no no yes - Does the jurisdiction have a clear boundary around a reasonably well-
defined 'mental health services' for funding purposes? yes yes yes yes yes yes yes - Does the jurisdiction have a clear boundary around a reasonably well-
defined set of services for reporting 'mental health services'? yes no yes yes yes yes
2. Establishing criteria for the definition of services within a national mental health Care Type
- For clinical services, is the designation or recognised speciality of the treating facility or unit as 'mental health' the principal basis for the
definition of 'mental health services'? yes yes ?? yes yes - yes
- Does the jurisdiction classify admitted patient care in non-specialised units for patients with a mental health diagnosis on the same basis as
admitted patients in specialised MH units? no
same DRG
system only -
same DRG
system only ?? - no
- Does the jurisdiction classify treatment for patients with acquired brain
injury as mental health services? yes ?? ?? no ?? ??
3. Applying the definition of ‘mental health services’ to community- based mental health services
- Does the jurisdiction define clinical community-based specialised mental health care (i.e., neither 'inpatient', nor 'residential' nor booked
clinic) as 'outpatient' care? yes n/a yes yes yes - no
- Does the jurisdiction identify 'psychosocial support' provided by NGOs
for people with a mental disorder as 'mental health services'? yes yes yes yes yes yes yes - Does the jurisdiction identify provision of housing for homeless people
with a mental disorder as a 'mental health service'? no no no yes no - no
- Does the jurisdiction identify provision of supported housing people
with a mental disorder as a 'mental health service'? yes no
emergency
only yes yes - yes
- Does the jurisdiction identify provision of employment support for
Part B. Summary 44
UK USA New
Zealand Consultation paper question England Medicare Veterans New York Texas SAMHSA
- Does the jurisdiction identify treatment for compulsive gambling as a
'mental health service'? no no no yes no no no
4. Defining primary mental health services delivered by public hospitals
- Does the jurisdiction include primary mental health services in its
classification for funding purposes of mental health services? no no no no no n/a no
5. Services for people whose primary problem is an alcohol or drug- related disorder
- Does the jurisdiction services for people whose primary problem is an alcohol or drug-related disorder in its classification for funding
purposes of mental health services? no no yes no no no yes
6. Classifying specialised ‘non-acute’ bed-based mental health services
- Does the jurisdiction classify non-acute bed-based clinical services for voluntary patients needing long-term care as 'admitted patient', or 'community-based' services? probably residential probably residential ?? probably residential probably
admitted n/a admitted
7. Setting the boundary with aged inpatient Care Types
- Are dementia and 'organic' brain disorders classed as mental health
services? yes yes ?? yes ?? no yes
8. Emergency department care for patients with a mental disorder
- nothing in the review specifically about this issue
9. Jurisdictional differences in the reporting of mental health services
in the mental health patient-level NMDSs n/a n/a n/a n/a n/a n/a n/a
10. New data elements needed in current NMDSs to enable the development and implementation of a mental health service
classification framework n/a n/a n/a n/a n/a n/a n/a
Notes:
?? – Could not be ascertained form the material reviewed
Part B. Appendices 45
Appendix 3.1: United States of America
- SMHA links
State Link AL Alabama http://www.mh.alabama.gov/ AK Alaska http://www.hss.state.ak.us/dbh/ AZ Arizona http://www.azdhs.gov/bhs/ AK Arkansas http://humanservices.arkansas.gov/dbhs/Pages/dbhs_docs.aspx CA California http://www.dmh.ca.gov/ CO Colorado http://www.colorado.gov/cs/Satellite/CDHS- BehavioralHealth/CBON/1251578892077 CT Connecticut http://www.ct.gov/dmhas/site/default.asp DE Delaware http://www.dhss.delaware.gov/dhss/dsamh/ FL Florida http://www.myflfamilies.com/service-programs/mental-health GA Georgia http://dbhdd.georgia.gov/ HI Hawaii http://amhd.org/ ID Idaho http://www.healthandwelfare.idaho.gov/Medical/MentalHealth/tabid/103/Default.aspx IL Illinois http://www.dhs.state.il.us/page.aspx?item=29728 IN Indiana http://www.in.gov/fssa/dmha/index.htm IA Iowa http://www.dhs.state.ia.us/mhdd/ KS Kansas http://www.kdads.ks.gov/CSP/MH_Index.html KY Kentucky http://dbhdid.ky.gov/dbh/default.asp LA Louisiana http://new.dhh.louisiana.gov/index.cfm/page/97/n/116 ME Maine http://www.maine.gov/dhhs/mh/ ME Maine http://www.maine.gov/dhhs/ocfs/cbhs/index.shtml MD Maryland http://dhmh.maryland.gov/SitePages/Home.aspx MA Massachusetts http://www.mass.gov/eohhs/gov/departments/dmh/ MI Michigan http://www.michigan.gov/mdch/0,4612,7-132-2941---,00.html MN Minnesota http://mn.gov/dhs/people-we-serve/ MS Mississippi http://www.dmh.state.ms.us/ MO Missouri http://dmh.mo.gov//index.htm MT Montana http://www.dphhs.mt.gov/mentalhealth/index.shtml NE Nebraska http://dhhs.ne.gov/behavioral_health/Pages/behavioral_health_index.aspx NV Nevada http://mhds.state.nv.us/NH New Hampshire http://www.dhhs.nh.gov/dcbcs/bbh/index.htm
NJ New Jersey http://www.state.nj.us/humanservices/dmhs/home/index.html NM New Mexico http://www.bhc.state.nm.us/
NY New York http://www.omh.ny.gov/
NC North Carolina http://www.ncdhhs.gov/mhddsas/
ND North Dakota http://www.nd.gov/dhs/services/mentalhealth/index.html OH Ohio http://www.mh.state.oh.us/
OK Oklahoma http://ok.gov/odmhsas/
OR Oregon http://cms.oregon.gov/OHA/amh/pages/index.aspx
Part B. Appendices 46
State Link
PA Pennsylvania http://www.dpw.state.pa.us/forchildren/omhsas/index.htm
PA Pennsylvania http://www.dpw.state.pa.us/fordisabilityservices/mentalhealthservices/index.htm RI Rhode Island http://www.bhddh.ri.gov/
SC South Carolina http://www.state.sc.us/dmh/
SD South Dakota http://dss.sd.gov/behavioralhealthservices/community/ TN Tennessee http://www.state.tn.us/mental/ TX Texas https://www.dshs.state.tx.us/mental-health/ UT Utah http://www.hsmh.state.ut.us/ VT Vermont http://mentalhealth.vermont.gov/ VA Virginia http://www.dbhds.virginia.gov/ WA Washington http://www.dshs.wa.gov/dbhr/mh_information.shtml WV West Virginia http://www.dhhr.wv.gov/bhhf/Pages/default.aspx WI Wisconsin http://www.dhs.wisconsin.gov/mentalhealth/index.ht WY Wyoming http://www.health.wyo.gov/mentalhealth/index.html
Part B. Appendices 47
Appendix 3.2: Canadian mental health
authorities – links
The links in the table below were obtained by Google searches and exploration. In a number of cases there are different provincial agencies responsible for different aspects of mental health. This has been shown for British Columbia. In the other cases, any other responsible bodies should be readily locatable from the links given.
# Province/ Territory Link/s AB Alberta http://www.albertahealthservices.ca/mentalhealth.asp BC British Columbia http://www.health.gov.bc.ca/mhd/ http://www.bcmhas.ca/default.htm http://www.mcf.gov.bc.ca/mental_health/ MB Manitoba http://www.gov.mb.ca/healthyliving/mh/index.html NB New Brunswick http://www.gnb.ca/0055/mental-health-e.asp NL Newfoundland
and Labrador http://www.health.gov.nl.ca/health/mentalhealth/index.html NT Northwest
Territories http://www.hlthss.gov.nt.ca/english/services/addictions/default.htm NS Nova Scotia http://www.gov.ns.ca/health/mhs/
NV Nunavut http://www.hss.gov.nu.ca/en/Home.aspx ON Ontario http://www.health.gov.on.ca/english/public/program/mentalhealth/mentalhealth_mn.html PE Prince Edward Island http://www.healthpei.ca/mentalhealth QC Quebec http://www.msss.gouv.qc.ca/sujets/prob_sante/sante_mentale/index.php?accueil_en SK Saskatchewan http://www.health.gov.sk.ca/mental-health YT Yukon http://www.hss.gov.yk.ca/mental_health.php
Part B. Appendices 48
Appendix 4.1: Public hospital ‘mental
health’ separations (ICD-10 F20-F99)
outside specialised mental health units,
Australia, 2009-10
ICD-10 code
ICD-10 descriptor
Separations
Proportion not in
specialised units
F32 Depressive episode 24,647 47%
F20 Schizophrenia 24,515 20%
F43 Reaction to severe stress and adjustment disorders 14,127 33%
F31 Bipolar affective disorders 11,479 24%
F25 Schizoaffective disorders 7,823 22%
F41 Other anxiety disorders 6,667 76%
F60 Specific personality disorders 5,403 23%
F33 Recurrent depressive disorders 4,785 38%
F21, F24, F28, F29 Schizotypal and other delusional disorders 3,149 39%
F23 Acute and transient psychotic disorders 2,461 41%
F50 Eating disorders 1,643 64%
F22 Persistent delusional disorders 1,344 37%
F44 Dissociative (conversion) disorders 1,125 87%
F34 Persistent mood (affective) disorders 1,058 19%
F51–F59 Other behavioural syndromes associated with physiological disturbances and physical factors 983 83%
F91 Conduct disorders 868 56%
F30 Manic episode 854 34%
F92–F98 Other and unspecified disorders with onset in childhood or adolescence 741 50%
F80–F89 Disorders of psychological development 675 58%
F45, F48 Somatoform and other neurotic disorders 472 84%
F99 Mental disorder not otherwise specified 451 38%
F70–F79 Mental retardation 394 51%
F42 Obsessive-compulsive disorders 328 23%
F61–F69 Disorders of adult personality and behaviour 286 29% F38–F39 Other and unspecified mood (affective) disorders 237 36%
F90 Hyperkinetic disorders 134 26%
F40 Phobic anxiety disorders 106 24%
Total F20-F99
116,755
36%
Source: Australian Institute of Health and Welfare, 2012. Mental Health Services in Australia (internet site only).90
90
Australian Institute of Health and Welfare, 2012. Mental Health Services in Australia (internet site only). Tables 7.7 and 7.12. Available at: mhsa.aihw.gov.au (Accessed November 2012).
Part B. Appendices 49
Appendix 4.2: National mental health
service types used in the former
NSMHS, Australia, 1993-200591
Target Populations
General adult mental health services
General adult mental health services principally target the general adult population (18-65 year range) but may provide services to children, adolescents or the aged. General adult services therefore are those services that cannot be described as specialist child and adolescent, older persons’ or forensic services. General adult inpatient services include hospital units in which the principal function is the provision of some form of specialised service to the general adult population (e.g., inpatient psychotherapy) or which focus on specific clinical disorders within the adult population (e.g., post-natal depression, anxiety disorders).
Child and adolescent mental health services
Child and adolescent mental health services principally target children and young people up to the age of 18 years. Classification of services in this category requires a recognition by the regional or central funding authority of the special focus of the inpatient service on children and adolescents.
Older persons’ mental health services
Older persons’ mental health services principally target people in the age group 65 years and over. Classification of services in this category requires a recognition by the regional or central funding authority of the special focus of the inpatient service on aged persons. This category does not include general adult services that may treat older people as part of a more general service.
Forensic mental health services
Forensic mental health services principally provide assessment, treatment and care of mentally
disordered individuals whose behaviour has led them to commit criminal offences or makes it likely that they will offend in the future if not adequately treated and contained.
Subprograms in mental health inpatient services and community based
residences
Acute services
Acute services provide specialist psychiatric care for people who present with acute episodes of mental illness. These episodes are characterised by recent onset of severe clinical symptoms of mental illness that have potential for prolonged dysfunction or risk to self and/or others. The key characteristic of acute services is that the treatment effort is focused upon symptom reduction with a reasonable expectation of substantial improvement. In general, acute psychiatric services provide relatively short term treatment. Acute services may be:
•
focused on assisting people who have had no prior contact or previous psychiatric history, or individuals with a continuing psychiatric disorder for whom there has been an acute exacerbation of symptoms; and• targeted at the general population, or be specialist in nature, targeted at specific clinical populations.
91
Australian Department of Health and Ageing. 2007. National Mental Health Report 2007. pp.90-94. (accessed November 2012 from www.health.gov.au)
Part B. Appendices 50
The latter group include psychogeriatric, child and adolescent, and forensic psychiatry services. Rehabilitation services
Rehabilitation services have a primary focus on intervention to reduce functional impairments that limit the independence of patients. Rehabilitation services are focused on disability and the promotion of personal recovery. They are also characterised by an expectation of substantial improvement over the short to mid term. Patients treated by rehabilitation services usually have a relatively stable pattern of clinical symptoms.
Extended care services
Extended care services provide care over an indefinite period for patients who have a stable but severe level of functional impairment and inability to function independently without extensive care and support. Patients of extended care services usually show a relatively stable pattern of clinical symptoms, which may include high levels of severe unremitting symptoms of mental illness. Treatment effort is focused on preventing deterioration and reducing impairment. Improvement is only expected over a long time period. Mobile acute assessment and treatment
Refers to mental health services which provide home-based assessment, treatment or intervention primarily for people experiencing an acute psychiatric episode and who, in the absence of home based care, would be at risk of admission to a psychiatric inpatient service. Essential characteristics of these services are their 24 hour, 7 day per week availability and focus on short term intervention. Services of this type are known under various titles, such as psychiatric crisis intervention services or community assessment and treatment services.
Mobile intensive treatment/assertive case management
Refers to community services which focus on the provision of intensive long term community support to people with substantial and prolonged mental illness and associated psychiatric disability. Such clients are characterised by their propensity for relapse and readmission to hospital. Key characteristics of services in this category are the mobile nature of the services provided and availability seven days per week, usually on an extended hours basis. Typically, services in this category provide intensive services to a small number of clients over prolonged periods.
Outpatient services - hospital based
Refers to services primarily provided to non inpatients on an appointment basis and delivered from clinics located within hospitals. Services provided may also include outreach or domiciliary care as an adjunct to services provided from the clinic base.
Outpatient services - community based
Refers to services primarily provided to non inpatients on an appointment basis and delivered from health centres located in community settings, physically separated from hospital sites. Services provided may also include outreach or domiciliary care as an adjunct to services provided from the centre base. Day or partial day programs
Refers to services that provide individual or group activities on a whole or part day basis, that require the client to attend the centre. Generally, day/partial day programs are aimed at assisting people with
psychiatric disability to learn or re-learn the social and everyday living skills necessary for their successful living in the community.
Rural outreach service
Refers to services provided on a visiting, outreach basis to areas characterised by sparse, dispersed populations where people live considerable distances from comprehensive health services.
Other ambulatory care mental health services
Refers to all other ambulatory care mental health services that cannot be adequately described by the categories defined above.
Part B. Appendices 51
Appendix 4.3: Mental health service
definitions in Australian jurisdictions
Jurisdiction New South Wales
Primary source Mental Health and Drug & Alcohol Office, New South Wales Ministry of Health: http://www.health.nsw.gov.au/mhdao/pages/default.aspx
Documents The NSW Community Mental Health Strategy 2007-201292 is New South Wales’ main planning document for mental health that builds upon the 2006 NSW: A new direction for mental health93 document. The NSW Service Plan for Specialist Mental Health Services for Older People (SMHSOP) 2005–201594 provides an updated plan for the older population. The Mental Health Clinical Care and Prevention Model95 (MH-CCP) is used as a tool for guiding overall state-wide resource needs, and provides some information about service types.
Definition(s) of mental health services
According to the NSWCommunity Mental Health Strategy, mental health services deliver specialist mental health assessment and care across both community and inpatient settings through the public mental health and Non-Government
Organisation (NGO) sectors. These are delivered in partnership with a range of other service providers including General Practitioners (GPs), private psychiatrists and psychologists, NGOs, other government agencies, consumers and families and carers. 96
Scope/inclusions/exclusions The Strategy identifies the following target populations for mental health care: 97
Age-specific populations
• Children and adolescents (0-17 years) • Young people (14-24 years)
• Adults (18+ years) • Older (65+ years)
Special populations
• Aboriginal and Torres Strait Islanders • Culturally and linguistically diverse (CALD) • Rural and remote
• Forensic
92
NSW Department of Health. NSW Community Mental Health Strategy 2007-2012. From prevention and early intervention to recovery. Sydney: NSW Department of Health, 2008. Available at:
http://www.health.nsw.gov.au/pubs/2008/pdf/mental_health_strategy.pdf (Accessed November 2012). 93
NSW Department of Health. NSW: A new direction for mental health. Sydney: NSW Department of Health, 2006. Available at: http://www.health.nsw.gov.au/pubs/2006/pdf/mental_health.pdf (Accessed November 2012).
94
NSW Department of Health. NSW Service Plan for Specialist Mental Health Services for Older People (SMHSOP) 2005–2015. Sydney: NSW Department of Health, 2006. Available at:
http://www0.health.nsw.gov.au/policies/gl/2006/pdf/GL2006_013.pdf (Accessed November 2012). 95
New South Wales Department of Health. Mental Health Clinical Care and Prevention Model: A Population Mental Health Model (MH-CCP Version 1.11). Sydney: New South Wales Department of Health, 2001. Available at: http://www.health.nsw.gov.au/resources/mhdao/pdf/MHCCP.pdf (Accessed November 2012).