Speakers: Louise Bradley, David Hall, Rob Warriner, Janice Wilson
This symposium comprised an introduction and overview by the session chair Janice Wilson, and then presentations by David Hall, the clinical lead for the mental health arm of the Scottish Patient Safety Programme (SPSP); and Louise Bradley, chief executive of the Canadian Mental Health Commission.
Janice opened with a challenge that resonated with me – across Australia and New Zealand we have pretty good healthcare services by international standards. Most of us feel confident when seeing a GP, physician or surgeon that we will access safe effective care. However we do not feel the same about mental health services.
Personally my bar for when we have good mental health services is “would I feel confident about myself or a loved one needing to access mental health services?” I have to say the answer remains no, so I agree with Janice in this regard and believe it is time we as a sector took the quality of services seriously.
Janice then went on to overview the Institute of Medicine six domains of quality that can be linked to indicators, commenting that mental health has worked on developing quality indicators, but in New Zealand at least we have not managed to develop indicators that address all these domains. She then referred to the IHI “triple aim” of population health state, cost, and patient experience, and linked this to the desired outcome most commonly articulated by people with mental health concerns – having a “life worth living”.
This introduction set the scene well for David’s brief overview of the work he leads which is focussed on improving safety for people using mental health services in Scotland. He pointed out our two nations have a lot in common – 4.5 million people and lots of sheep – so there is nothing to stop us implementing a similar programme here!
This national programme is part of a wider campaign to improve safety of healthcare across Scotland, and uses the Institute of Healthcare Improvement “collaborative” methodology, the heart of which is frontline clinicians co-designing improvements with service users, and using improvement science methods – testing and refining ideas for improvement using cycles of Plan-Do-Study-Act activities (PDSAs).
They initially focussed on inpatient care, as this is “highest risk” end of the service continuum, and through consultation with service users defined four kinds of harm in inpatient care – physical, psychological, social, and sexual. They then chose five areas to work on improving:
- safer medicines
- risk assessment and planning
- reducing violence restraint and seclusion
- communications at transitions
- an over-arching theme of leadership and culture.
Their work also revealed six principles found to be key across all the collaborative settings:
- data and how it is used (he stressed that data needs to be owned and used locally to drive improvement)
- engagement of service users, family and staff
- human factors
- human rights
- legislation
- training.
David finished by presenting a snapshot of some of their improvement results to date in the area of reducing violence restraint and seclusion, which were pretty impressive when compared to what we have achieved here in New Zealand to date. Generally rates had reduced at least 60 per cent and in some places over 80 per cent – results the teams involved were very proud of! They are now moving to extend the programme to community mental health services including CAMHS and MHSOP.
Louise then spoke of work the Canadian Mental Health Commission have done to improve the mental health of the workforce, including the health workforce. Her core message is one I strongly agree with – to provide quality healthcare we need healthy resilient staff who feel supported in their work. She highlighted the terrible irony that in Canada health is one of the most toxic environments to work in, and I have to say that sadly applies in New Zealand and Australia also.
In the Canadian context healthcare staff have 1.5 times the average levels of sick leave. Burnout of doctors is a big issue, and again this is equally true in our context. She also highlighted that most people with mental health issues have been disrespected and discriminated against in their workplace. Again this is worst in healthcare, and this along with self-stigma poses formidable barriers to people accessing early help and recovering, so they can return to being productive employees.
The Canadian Mental Health Commission have developed a national standard for workplace psychological and mental health. Uptake is voluntary, with good response from many sectors including one of Canada’s largest corporates (a Telco); and reassuringly the strongest interest, as measured by downloading of the Standard, has been from healthcare organisations. The Standard puts responsibility for workforce mental health onto employers and provides them with a toolkit to guide implementation.
Early results have been very positive with reduced sick leave, reduced staff turnover, and increased help-seeking for mental health issues and access to EAP services. The Canadian PM has recently directed the heads of all Govt Departments to implement the Standard – a great outcome!
The Standard has now been taken up by the legal profession in Australia in recognition of their profession having the highest rates of depression of any occupational group. In Canada they are building on the work to date by developing a programme for “first responder” (emergency) services to improve recognition and intervention for people who develop post-traumatic stress disorder.
The work described by David and Louise was inspiring and we would do well to emulate their work in Australia and New Zealand healthcare settings. They are in fact very complementary potential avenues to better quality of mental health and addiction services – first achieving better health and wellbeing of our workplaces and workforce; and second using the proven IHI methodology to improve safety and quality of the care we provide.
