In August 2015 a presentation to the 16th International Mental Health Conference by Sandy Thomson from GovernancePlus provided delegates with an overview of the opportunities and challenges for public and private Mental Health services in Australia in meeting the National Standards and the National Mental Health Standards requirements for accreditation purposes. Included in the presentation were observed examples of how use of the Standards were improving systems of mental health care and client care outcomes.
Since this time GovernancePlus has continued to work with public mental health services and we are now also involved in working with community organisations providing mental health services to achieve their first ever accreditation. To date over 100 health care organisations across Australia and have used our pre accreditation support services.
So what if anything has changed since 2015?
Use of the standards and understanding the benefits of a robust accreditation and continuous improvement program for Mental Health services is steadily maturing with many great innovations being observed. From a clinical and corporate governance perspective monitoring of performance outcomes continues to improve as with use of data to drive improvements. There is also a higher focus on ensuring skills and competencies of mental health practitioners is aligned to service requirements. Managing mandatory training and audit requirements to demonstrate compliance continues to be challenge, particularly for large services which can be spread over wide distances and many sites.
Consumer engagement and representation in governance systems is a strength for Mental Health services and is an area where most mental health services do very well. There is however a need to maintain the same level of engagement with carers and to recognise the responsibilities of children as carers for family members with a mental illness.
While many services demonstrate a client centred partnership approach to care and treatment the quality of medical record documentation remains variable particularly in risk assessments on admission, metabolic screening, monitoring of physical observations and documenting and assessing effectiveness of agreed recovery strategies. Medical records are integral in managing the client journey and the complexity of documentation requirements (medico legal and audit) makes this a continuing challenge for many organisations.
Internal care coordination and coordination between the acute system, the inpatient and community mental health systems also continues to be a challenge for those responsible for managing handover. Our workshops on “Understanding Handover Systems and Mapping all Points of Handover have been really well received with evaluations indicating an improved understanding of internal and external communication and care coordination requirements. The maps provide an easy reference point for identifying areas which are working well or where improvement is needed.
With many ongoing reforms, managerial and other staff turnover and budgetary challenges our experience continues to be that a pre-survey assessment is a collaborative approach which identifies risks both for client safety and accreditation requirements but also enables confirmation as to the level of continuous improvement. Undertaking a risk assessment at least 6 months prior to survey means organisations and staff are still much better prepared.
By Sandy Thomson, GovernancePlus