Consumers and the local community Examples of supporting evidence Data collection tools for collecting feedback from the workforce and people who use the service Committee or meeting records that demonstrate to the workforce and people who use the service the incorporation of feedback into improvements Diversity and high-risk groups Action 1.15 The health service organisation: Identifies the diversity of the consumers using its services Identifies groups of patients using its services who are at higher risk of harm Incorporates information on the diversity of its consumers and groups into the planning and delivery of care How does this action apply to people with mental health issues? Many processes in the delivery of health care are developed to facilitate the effective delivery of health care to the majority of people. They do not necessarily reflect individual needs or preferences. Once these processes are routinely implemented, they can seem to be immutable, and the logic that led to their development can impede flexible implementation. Health service organisations have recognised that diversity can influence how people experience health care. This has frequently involved identifying specific groups that people belong to, for example, Aboriginal and Torres Strait Islander, or lesbian, gay, bisexual, transgender and intersex (LGBTI) communities, and working with representatives from these groups to deliver health services that reflect diverse needs. People can belong to multiple groups, and there are intersections and tensions that must be taken into account. For instance, people who identify as Aboriginal and LGBTI report experiencing homophobia from some Aboriginal community members, and racism from some members of LGBTI communities. This exposes them to increased risk of harm. Similarly, many groups within broader society hold particular stigmatising views about people with mental health issues. There are national resources available that address mental health for Aboriginal and Torres Strait Islanders, LGBTI community members, and people from culturally and linguistically diverse backgrounds. People with mental health issues have frequently reported experiencing sub-optimal care in health services., This includes people who experience stigma from members
Examples of supporting evidence Documented clinical pathways for responding to risks identified through screening Training programs for workforce in person-centred approaches to comprehensive assessment Developing the comprehensive care plan Action 5.13 Clinicians use processes for shared decision making to develop and document a comprehensive and individualised plan that: Addresses the significance and complexity of the patient’s health issues and risks of harm Identifies agreed and actions for the patient’s treatment and care Identifies any support people a patient wants involved in communications and decision making about their care Commences discharge planning at the beginning of the episode of care Includes a plan for referral to follow-up services, if appropriate and where available Is consistent with best practice and evidence How does this action apply to people with mental health issues? People maintain their mental health in a range of ways. This can include minimising exposure to stress, ensuring regular sleep and exercise, and taking medication. All of these strategies are disrupted by admission to hospital for treatment for physical health, potentially leading to deterioration in the person’s mental state. The stress of physical illness alone can precipitate changes in a person’s mental health. Using shared decision making to collaborate on the development of a comprehensive care plan can mitigate the risk of poor mental or physical health outcomes for people. Ensure that the plan is comprehensive Health care has been characterised as operating in siloes; if a person is admitted for cardiac symptoms, care can be focused simply on treating those symptoms, with other aspects of the person’s health ignored, or presumed to be someone else’s responsibility. At times, this responsibility is left with the person themselves, or their family or carers, without their capacity to take this responsibility being determined. is increasing evidence of the links between physical and mental illness, including correlations between depression and cardiac problems, and anxiety and chronic pain. For example, for people with eating disorders, physical and mental health are inseparable, and treatment must reflect this. Successful implementation of this strategy will be supported by, or rely on, the following actions:
Clinical Governance Governance, leadership and culture Governance, leadership and culture 1.1 1.9, 1.15, 2.7 Organisational leadership 1.3 2.11 Clinical leadership 1.6 5.5 Patient safety and quality systems Policies and procedures 1.7 1.20, 2.4, 5.35 Measurement and quality improvement 1.9 1.3, 1.8, 2.11 Risk management 1.10 1.5, 1.15, 1.20, 1.29, 5.31, 5.33, 5.34 Incident management 1.11 1.9, 1.12, 1.20, 5.35, 5.36, 6.10, 8.7 Feedback and complaints management 1.13 1.9, 2.9 Diversity and high-risk groups 1.15 1.20, 5.10, 2.7 Safe environment for the delivery of care Safe environment 1.29 2.11 1.30 1.29, 5.33 Partnering with Consumers Partnering with patients in their own care Healthcare rights and informed consent 2.4 1.7 2.5 1.7 Sharing decisions and planning care 2.6 1.15, 5.13 2.7 1.5, 1.15, 1.20, 1.26 Medication Safety Medication reconciliation 4.5 1.15, 4.3 4.6 4.3, 6.8
Documentation of patient information Adverse drug reactions 4.7 2.6 Comprehensive Care Developing the comprehensive care plan Screening of risk 5.10 1.15, 1.20, 5.3, 8.6 Clinical assessment 5.11 1.16, 2.6, 8.12 Developing the comprehensive care plan 5.13 5.3, 5.6 Delivering comprehensive care Using the comprehensive care plan 5.14 1.6, 1.16, 5.3, 5.5, 5.6, 6.9, 6.10, 8.6 Minimising patient harm Predicting, preventing and managing and suicide 5.31 1.15, 1.21, 2.13, 5.3, 5.13 5.32 5.3, 5.13, 6.8 Predicting, preventing and managing aggression and violence 5.33 1.1, 1.6, 1.11, 1.29, 1.30, 5.34 5.34 1.20, 1.29, 1.30, 5.1, 5.3, 5.33 Minimising restrictive practices: restraint 5.35 1.1, 1.7, 1.11, 1.20, 2.11, 5.33, 5.34 Minimising restrictive practices: seclusion 5.36 1.7, 1.29, 2.11, 5.33, 5.34