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Characteristics of clients with a mental health diagnosis: Understanding the clients of the RDNS community nursing service in Melbourne, Victoria Dr Joanne Enticott Dr Marissa Dickens Dr Amee Morgans Ms Barbara Williams

Prof Colette Browning

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Project Goal:

• The aim is to profile the mental health issues in users of a large community health services provider. We will do this in order to better understand the demands on the RDNS services and develop better approaches for these clients.

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Method

• Creation of a health and wellbeing profile:

– Unique registry of longitudinal community care clients

• Diagnoses (primary dx & other)

• Care received

• Financial, accommodation & social activity too

– 24,663 clients commenced an episode of care in 2014

– predominantly in Greater Melbourne

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Mental health diagnoses

3,975, 17%

19,832, 83%

Proportion of Individuals with Any Mental Health Diagnosis

Mental Health Diagnosis All Others

Client profile:

• Average age: 71 years

• Over two-thirds were aged 65+ years

• Two-thirds lived in the least disadvantaged areas of Melb, Victoria

• 17% had a mental health diagnosis

– One-in-six

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Mental health diagnoses

3,975, 17%

19,832, 83%

Proportion of Individuals with Any Mental Health Diagnosis

Mental Health Diagnosis All Others

- National prevalence is one-in-five

- prevalence increases in clinical samples

- prevalence decreases in older people

One-in-six

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Mental health diagnoses

937, 4%

3,038 , 13%

19,832, 83%

Proportion of Individuals with Primary and Secondary Diagnoses

Primary Secondary None

3,975, 17%

19,832, 83%

Proportion of Individuals with Any Mental Health Diagnosis

Mental Health Diagnosis All Others

In clients with a mental health diagnosis:

• One quarter had primary diagnosis (pink slice),…

• ...meaning that mental health was designated as the reason(s) for which the nurse was visiting the client

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Mental Health Diagnoses

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

F30-F39Mood [affective]

disorders

F40-F48Neurotic, stress-

related and

somatoform disorders

F20-F29Schizophrenia, schizotypal and

delusional disorders

F10-F19Mental and behavioural

disorders due to psychoactive

substance abuse

F70-F79Mental

retardation

F90-F99Unspecified

mental disorder

F80-F89Disorders of

psychological

development

F60-F69Disorders of

adult personality

and behaviour

F90-F98Behavioural and

emotional

disorders with onset usually occurring in

childhood and

adolescence

F50-F59Behavioural syndromes

associated with physiological disturbances and physical

factors

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ICD-10 Code Category

Mental Health Diagnoses by ICD-10 F10—F99 Code Category

% 39.1 24.1 12.7 11.4 7.3 1.8 1.5 1.3 0.5 0.4

N 2,227 1,373 724 650 413 101 87 75 27 20

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Mental health diagnoses

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Socio-demographic profile • People with a mental health dx were more likely to be…

– Female, 57%* (*52%, no mental health)

– Under the age of 65 years, 42%** (**24%, no mental health)

– Born in Australia, 60%* (*50%, no mental health)

– Of Aboriginal or Torres Strait Islander descent (ATSI), 1.4%* (*0.5%, no mental health)

– Accessing the Homeless Person’s Project (HPP), 13%*

(*2%, no mental health)

– Alive at January 2016, 92%* (*86%, no mental health)

– Not accessing Department of Veterans’ Affairs (DVA) Services, 5%* (*8%, no mental health)

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Visit & Activity Profile

• Average episodes of service did not differ between groups – Both groups averaged 1.2 episodes in 2014

– (with a range of 1-24 episodes)

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Visit profile

55.2

12.4

8.77.8

2.81.7

54.0

12.1

9.4 9.2

3.02.1

0

10

20

30

40

50

60

Visit At Home Consultation (telephone or other)

Telephone CSC client related

Client documentation Fax CSC Client related Direct care - face to face

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Visit Type

Most Common Visit Types for Those with and Without a Mental Health Diagnosis

Mental Health Diagnosis

All Others

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Visit & Activity Profile

• Average episodes of service did not differ between groups – Both groups averaged 1.2 episodes in 2014 (with a range of 1-24 episodes)

• Profile of visits did not differ between groups – Visit type profile was similar too (previous slide)

• But..

• Number of client-related activities did differ – The yearly client-related activities logged by RDNS staff were, on average:

• 50 per client with no mental health dx

• 69 per client with mental health dx

• 87 per client with mental health as Primary dx

– Individuals with a mental health diagnosis received more activities than those without…

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Visit & Activity Profile

• Client-related activities for clients with a mental health diagnosis Activities conducted during ‘Visit at a Home’

Monitoring and surveillance 130,460 (30.8)

Medication 120,698 (28.5)

Counselling and support 49,380 (11.7)

Tech Care - Wound 26,949 (6.36)

Client care coordination/collaboration 17,364 (4.1)

Assessment - Other 10,743 (2.5)

General Nursing Care (GNC) 10,185 (2.4)

Personal Care 6,074 (1.4)

Tech Care - Other 5,553 (1.3)

Documentation (HPP only) 4,678 (1.1)

Various other general nursing activities (all these

individually are <1%) 41,422 (9.8)

Total 423,506 (100.0)

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Conclusion

• One-in-six had mental health diagnosis

– lower than the Australian national prevalence of one-in-five

– higher than the aged-adjusted one-in-ten prevalence estimate.

• These RDNS figures may represent significant under-reporting

– Particularly given the link between chronic disease and poorer mental health

• Consistent with population findings, mood and anxiety disorders were most common in our sample

• Clients with mental health disorders require 40% more client-related activities by RDNS,

– and 80% more if primary dx is mental health disorder