APPENDIX A

CONDUCT OF THE AUDIT

AUDIT OBJECTIVES

The objectives of this audit were to determine:

• whether Area Mental Health Services (AMHSs) were providing timely and appropriate services to people aged 16 to 64 years who were experiencing a crisis associated with their mental illness, or who were at significant risk of experiencing a crisis;

• the impact of the current mental health service system on carers and families of people with a mental disorder;

• whether the rights of patients subject to community treatment orders and involuntary admission to hospital have been adequately protected;

• whether funds allocated to public mental health services have been distributed according to need; and

• whether an effective framework was in place to measure and monitor the effectiveness of mental health crisis prevention and response, at a Statewide and individual hospital level.

AUDIT SCOPE

Adult services were chosen because they are the biggest component of public mental health services in Victoria, absorbing three-quarters of total annual mental health funding. The audit focuses on crisis prevention and response within the Adult Mental Health Services because this is an area which has significant social and cost implications for the community. Moreover, consultations with key stakeholders indicate that people often experience difficulty accessing appropriate services during a mental health crisis.

The following services are not subject to examination as part of this audit:

• services for children under the age of 16 years;

• adults held within the correctional services system; and

• services for people over the age of 64.

The following agencies were subject to audit examination:

• Department of Human Services - the focus of examinations was within the Mental Health Branch and covered strategic planning, monitoring and funding; and

• Adult Area Mental Health Services (including individual public hospitals) – 6 out of 21 AMHSs were chosen for detailed examination:

• Barwon Mental Health Services;

• Dandenong Area Mental Health Services;

• Gippsland Area Mental Health Services;

• Goulburn Valley Area Mental Health Services;

• Mid-West Area Mental Health Service; and

• St Vincent’s Mental Health Services.

This sample of hospitals provide coverage of metropolitan Melbourne, rural areas and the fringe of metropolitan Melbourne. It includes hospitals in varying demographic areas, including those with high populations of people from non-English speaking backgrounds.

Operations examined at each AMHS include Crisis Assessment and Treatment teams, Duty services, community-based services, inpatient services, patient rights, discharge procedures and case management.

At the Mental Health Review Board, review and appeal procedures for involuntary patients were examined to determine whether patient rights are being adequately protected.

AUDIT METHODOLOGY

The audit methodology comprised interviews with key stakeholders, consumer and carer consultations, a comprehensive file and policy/observation audit at each of the 6 AMHSs selected, and a review of relevant national and Statewide data sources.

Interviews with key stakeholders included:

• consumer and carer peak bodies;

• Department of Human Services (Mental Health Branch staff);

• directors of clinical services (in both Victoria and other States);

• AMHS;

• non-government organisations concerned with provision of mental health services;

• mental health research institutes;

• government departments (including the Health Services Commissioner, Office for the Public Advocate, Office of the Chief Psychiatrist);

• Aboriginal Health Service;

• directors of Psychiatric Disability Support Programs; and

• public hospital managers.

Consumers who had received services in the previous 12 months were invited to participate in audit interviews conducted by independent consultants using a semi-structured interview schedule. In total, 87 individual interviews with mental health service consumers were completed.

Six carer focus groups (with 12 to 15 participants in each) were conducted to gather information about the service needs of family members and carers. Participants were recruited through peak carer bodies located in different regions of Victoria.

A family/carer survey was mailed to 780 persons involved in the care of a mental health service consumer. Survey respondents were randomly selected from each of the 6 AMHSs audited and this was supplemented by a small number of additional respondents identified through peak carer bodies. A total of 338 surveys were returned for a response rate of 43 per cent.

Five contractors with considerable experience in the evaluation of mental health services were employed to conduct a comprehensive file, policy and observation audit at each of the selected AMHSs. The contractors were FLP Associates, Westwick Consulting Services, Beyond the Limits Training and Development Services, Robyn Guiney Pty Ltd, and Robyn Mills Pty Ltd. Contractors focused on the following issues:

• Service entry and access processes (triage) were examined through an audit of 150 triage records at each of the 6 AMHS. Observations of triage and service entry procedures, including links with emergency departments, were also recorded to enable comparisons between services;

• A comprehensive audit of 935 clinical files (approximately 150 at each AMHS) was conducted to determine whether important processes in the assessment, treatment and discharge of patients receiving services within the previous 12 months had been documented. This included an assessment of intake processes, individual service plans, discharge plans, evidence of medical reviews, and communication with patients and carers regarding rights; and

• A policy and observation tool was developed to assess whether key policies were in place at each of the 6 AMHSs audited. Observations within AMHSs and Emergency Departments (EDs) determined whether practice was consistent with policy, national standards and State legislation. Interviews with AMHS and ED staff were also conducted.

Comprehensive examinations of relevant administrative processes and management data at the selected AMHSs were conducted.

The statistics contained in this report were obtained from a range of Australian agencies, research bodies and international organisations. Key sources of data were the Department of Human Services (Mental Health Branch), the Commonwealth Department of Health, and reports published by government and private organisations.

The National Standards for Mental Health Services and the Mental Health Act 1986 were used to guide the assessment of service quality, effectiveness and efficiency.

PERIOD COVERED BY THE AUDIT

The audit considered relevant developments in Victorian mental health policy since 1994, while fieldwork at AMHSs covered the period January 2000 to March 2002.

COMPLIANCE WITH AUSTRALIAN ACCOUNTING STANDARDS

The audit was performed in accordance with Australian Accounting Standards applicable to performance auditing, and included such tests and procedures considered necessary to conduct the audit.

ASSISTANCE TO THE AUDIT TEAM

Reference group

A reference group comprising 7 mental health experts, including consumer and carer representatives, provided ongoing advice and feedback during the course of the audit. We would like to thank the following individuals for their assistance:

• Professor Harvey Whiteford, Chair, Australian Health Minister’s Advisory Council, National Mental Health Working Group;

• Dr David Barton, Honorary Chair, Royal Australian and New Zealand College of Psychiatrists (Victorian branch);

• Ms Valerie Gerrand, private consultant;

• Mr Peter Waters, Executive Officer, Eastern Region Mental Health Association, (the largest provider of psychiatric disability support services in Victoria);

• Mr David Mithen, Information Officer Victorian Mental Illness Awareness Council;

• Ms Nina McDonough, Victorian Mental Illness Awareness Council; and

• Ms Robyn Duff, Program Manager, Mental Health Services for Youth and Kids.