TheMHS Summer Forum
Session 2 – Steps to Personalising the System
Chair: Cath Chapman Blogger: Tully Rosen
Session 2 expanded on steps to personalising the mental health system. Presentations by Karen Mellanby (Director of Networks and Communities at Mind, UK), Ed Mantler (Vice President of Programs and Priorities at the Mental Health commission of Canada) and Eddie Bartnik (Strategic Adviser on Mental health, Local Area Coordinating and Community Capacity Building, National Disability Insurance Agency) drew from the international experience of personalisation and compared and contrasted Australia’s experience with that of the UK and Canada. The session presented a number of key issues that will be important to consider as Australia adapts to the NDIS and a more personalised mental health system.
Below are some notes from each of the presentations:
UK National Policies on Personalisation
Key drivers and policies
Personalisation has been a fundamental change in culture, systems and organisation, said Karen Mellanby in Session 2 of TheMHS Summer Forum 2017. Karen is the Director of Networks and Communities at Mind, UK. Mind was formed in 1947 and has seen big changes throughout its 60 year history. Up to 1990 the United Kingdom deinstitutionalised its mental health service system, however similar to the Australian experience, community mental health care was never properly funded. After 1990 the National Health Service (NHS) separated its purchasers of public services from its providers of services through a network of health trusts.
The disability movement in the UK was focused on self-determination, and ultimately led to the development of a disability package-of-care system. Most recently the NHS is experimenting with health services packages-of-care. However, over the past decade the number of beds and packages for people with health and disability needs have reduced.
The UK continues to shift toward integrated care and integrated service commissioning, with personalisation and choice at the centre of these reform agendas.
Some of the impliciations and challenges
In actual practice, personalisation and recovery-orientation are rooted in the same social movement. The policy has well and truly shifted towards personalisation. This means that people want professionals on tap, not on top.
Unfortunately personalisation has ended up being linked at times with UK budget cuts. This has muddied up the ability to assess the effectiveness of personalisation and the uptake has not been as high as had been originally hoped.
The implications on culture have been wide.
Through major consultations with subsidiary Mind organisations, it was revealed that there were varying levels of preparation. Some organisations had done well in their paths to adaptation. Others however, had not even thought about the financial and organisational consequences.
Mind UK undertook major service redevelopments for personalised services, and brought together all manner of training, resources and marketing materials. Mind UK observed the effect of these changes through the transformations in the lives of people with mental illness, and all manner of the new ways they can be supported.
While these new developments are proving successful, Karen noted that the results are still highly variable depending on the level of trust and organisation, and that there is still a long way to go.
Canada’s approach to personalising the mental health system
Canada released its mental health strategy in 2013, based on a massive effort of consultation. Its development was influenced by forerunners in Australia and other countries. The Canadian Commission has spent a substantial amount of time on mental health in the workplace, culminating in a national, voluntary standard for mental health in the workplace. The standard has been downloaded 39,000 times – to put that into perspective, most standards are downloaded approximately 100 times in their lifetimes.
The Commission estimated that 500,000 Canadians call in sick each week due to mental health problems. They believe this is an under representation because it doesn’t count school-aged children, unemployed people, people claiming a physical health problem (when it isn’t) and “presentee workers”.
Justin Trudeau, the Canadian Prime Minister has set performance pay for his Ministers to be determined partially on their outcomes for psychological injury rates in their portfolios. The Commission has documented the experience of companies who has adopted the national standard. A number of them have enjoyed measurable productivity improvements.
The Canada Mental Health Commission has recently released a set of guidelines for recovery-oriented practice, based on the best information around the world. They are also developing a youth-contextualised version with a council of young people.
NDIS 2017: How will personalisation and personal budgets improve peoples’ lives
The narrative around choice and control has really been around for up to 20 years. However with real reforms comes a shift in power, and traditional workers are struggling with this.
Staff of the National Disability Insurance Agency (NDIA) have been visiting participants across the country who are having very different experiences with their personal budgets.
The new Local Area Coordination services of the NDIS is based on programs that have existed in Australia and the UK for over 20 years. The NDIS is the largest disability insurance scheme of its kind. It was 10 years in the making, originating from Prime Minister Kevin Rudd’s 2020 ideas summit.
Three years of trials have now finished and governments across the country have signed up to the full scheme. The data being collected as part of this scheme is far superior to anything that has come before. We will know how many people are receiving services, what those services are and what outcomes they are having. Data is heavily used to keep the scheme on track – providing quality services within the funding envelope.
The scheme itself is heavily person-centred. The money is attached to the participant, not the provider. Participants have clearer rights, control and responsibilities.
Key changes include a new consistent national eligibility criteria, the guaranteeing of timely access to support for those who are eligible and new plans that are transportable anywhere in Australia.
Eddie Bartnik estimates another 5-10 years of scheme development before it really stabilises and the whole service scheme is mature. However most major implementation hurdles are expected to be complete within the next couple of years. The National Recovery Framework and the NDIS are strongly aligned. A Recovery training suite is provided to every staff member of the NDIA. There are a range of sector development and consultation initiatives.
Eddie Bartnik presented the NSW Mental Health Commission’s youtube video on the NDIS – http://www.youtube.com/watch?v=9X-ea-O50Vg
Following the three presentations by Karen, Ed and Eddie, the floor was opened up for discussion. A delegate commented that the subjects of the NDIS video would like to be re-filmed to discuss some of the struggles they have been through since it was filmed 3 years ago. Eddie Bartnik acknowledged the struggle – he has noticed that when things used to go wrong people would fall into a big black hole. He believes there are better ways to get back on track with the NDIS at the moment.
Karen was asked about how UK participants have their eligibility determined. She commented that the UK system is more of a benefits-fund system. It has become harder to extract substantial funds for any individual as recent budgets cuts and localised processes have occurred. “It’s complicated.” The UK has a complicated “stepped-care” system, where people with complex needs are not receiving individual packages. It is a similar situation to Australia, but with a much starker financial situation. Without enough money for all the steps, including the “missing middle step”, we are still missing out on the most effectible treatment group.
Karen Mellanby and Eddie Bartnik commented about the major professional changes that are needing to occur as enormously different models of care are being experimented with.