S64: Promoting Change in the Mental Health System

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By September 28, 2023 No Comments

Authors: Graham Meadows, Frances Shawyer, Thomas Yeatman, Joanne Enticott, Geoffrey Smith & Sarah Knauf

Year: 2023

Event: 2023 The MHS conference - Adelaide

Subject: Promoting Change in the Mental Health System

Type of resource: Video

Presentation 1: Mental health inequities and Medicare – shifting winds of change?
Authors: Graham Meadows, Frances Shawyer, Thomas Yeatman and Joanne Enticott
The United Nations identified medical care and necessary social services as universal human rights seventy-five years ago. But Australian mental health care discriminates starkly against people with lower incomes and living in socioeconomically deprived areas. Affordability and distribution of specialist practitioners play roles in this. We have demonstrated that services funded through the Medicare Benefit Schedule flow especially towards those with greater socioeconomic advantage, while mental health problems are much more common in those with relative disadvantage. A nine-fold range in service delivery is found based on broad socioeconomic categories of areas. We will present findings based on analyses using the Concentration Index showing how these inequities have increased through time and how COVID-19 related expansion of telehealth did nothing to improve the situation, rather in the case of video-based consultation, this made things worse.
Medicare reform has for long sat in a doldrums with neither side of politics wishing to challenge the status quo and the influence of sectional groups trumping public interest considerations. But media and political rhetoric is changing. Surveying recent and current research and political directions, we will chart possible ways forward in righting a pervasive and enduring wrong being done to the Australian community.
Learning Objective There is increased political and media recognition of the dysfunction of the Medicare Benefit Schedule as a vehicle for delivering mental health care equitably. Equitable mental health care delivery is increasingly being seen as an aspect of responsible government and the sector should position itself behind this opportunity for change.
Meadows, G., Enticott, J., Inder, B., Russell, G., & Gurr, R. (2015). Better access to mental health care and the failure of the Medicare principle of universality. Medical Journal of Australia, 202(4), 190-195.
Meadows, G. N., Prodan, A., Patten, S., Shawyer, F., Francis, S., Enticott, J., Rosenberg, S., Atkinson, J.-A., Fossey, E., & Kakuma, R. (2019). Resolving the paradox of increased mental health expenditure and stable prevalence.

Presentation 2: Attempts to reduce or eliminate seclusion and restraint have stalled: finding a way forward.
Author: Geoffrey Smith
Seclusion and restraint have negative consequences for both consumers and staff and damages the therapeutic relationship between them. Reducing and, where possible, eliminating these practices has been a national priority since 2005 and this has been supported by the establishment of a national data collection.
The national data demonstrated a 23% reduction nationally in the rate of seclusion within acute public inpatient services in the five years 2011/12 to 2015/16. However, the rate has plateaued since 2016/2017 and the question arises, “are we approaching the limits of what is achievable with the current strategies”?
Two common programs for reducing seclusion, the Six Core Strategies and the Safewards models, have demonstrated that they can be effective, but this finding has not been consistent across the literature.
Unexpected variations in outcomes for the same intervention are generally attributed to incorrect execution and it is argued that better fidelity will improve the outcome. We contend this variability is not a transfer problem, but rather reflects the degree of engagement and commitment of staff, consumers and carers in the decision-making process. We need a significant shift in our thinking about leadership and how change is introduced.
Learning Objective
This presentation will explore what has been achieved to date in reducing seclusion and restriant and the current challenge and then look at why attempts to reduce seclusion and restraint have stalled and what strategies might help in overcoming this problem. References
1) Wright M, Crowe J, Huckshorn K, et al (2017) Review of seclusion, restraint and observation of consumers with a mental illness in NSW Health facilities. NSW Health, NSW.
2) Smith, G, Williams, T (2021). Harnessing motivation for sustainable practice change: From passive receivers to active co-creators. Australian and New Zealand Journal of Psychiatry, 55, 569-576

Presentation 3: Reducing conflict and containment in an adult acute inpatient mental health service.
Author: Sarah Knauf
Aim and objectives: To develop a New Zealand Safewards model in an inpatient mental health unit at Te Whatu Ora Waikato, New Zealand and evaluate its acceptability, and impact on incidents of conflict, containment and ward atmosphere.
Background: The Safewards model was developed in the United Kingdom by Professor Len Bowers to reduce rates of conflict (including violence, suicide, self-harm and absconding) and containment (including PRN medication, special observations and seclusion) in mental health units through ten interventions. As Māori are overrepresented in mental health services it is important that Safewards is adapted for the New Zealand context.
Design/Methods: Semi-structured focus groups will be used to co-design this New Zealand model: Staff focus (registered and unregistered); Māori focus group (service users, family and Māori staff). Primary outcome measures are conflict, containment and coercion rates. The secondary outcome is ward climate. The developed model will be implemented for 12 months.
Results: Anticipated outcomes are reduced rates of conflict and containment, enhanced approach to least restrictive practices, strengthening of therapeutic staff-patient relationships and improved ward atmosphere.
Conclusion: The study aims to maximise the therapeutic environment, support least restrictive care and promote organisational change.
Learning Objective
1. Delegates will learn the importance of least restrictive practices, therapeutic ward environments and therapeutic relationships.
2. This study will help to develop safe and inclusive mental health services.
Bowers, L. (2014). Safewards: a new model of conflict and containment on psychiatric wards. Journal of psychiatric and mental health nursing, 21(6), 499-508.
Safewards. (n.d.). Interventions. Retrieved June 26, 2021 from

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