MENTAL HEALTH BENCHMARKING AND DATA – POSITION PAPER€¦ · Web viewMENTAL HEALTH BENCHMARKING AND DATA – POSITION PAPER. 11.01.15. Dr John Mitchell PMO. Aim. This paper seeks

MENTAL HEALTH BENCHMARKING AND DATA – POSITION PAPER11.01.15

Dr John Mitchell PMO

Aim

This paper seeks to summarise the current position regarding Mental Health Benchmarking and data used to measure performance and assist quality improvement. It overviews the national landscape and discusses opportunities for improved data collection and use.

Introduction and background

The assessment of Mental Health (MH) services’ quality of care has been evolving over the last decade in Scotland, the UK and internationally. Generally measurement has been applied along Donabedian principles:

“The Donabedian Model is a conceptual model that provides a framework for examining health services and evaluating quality of care. According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes”. Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment. Process denotes the transactions between patients and providers throughout the delivery of healthcare. Finally, outcomes refers to the effects of healthcare on the health status of patients and populations. Avedis Donabedian, a physician and health services researcher at the University of Michigan, developed the original model in 1966.”

The Mental Health National Benchmarking project 2007 created a suite of information indicators that would provide key aspects of MH service performance defined around the domains of quality, efficiency, sustainability and cost. The suite of indicators related primarily to general adult psychiatry services but included some information relating to older people services and some non-age specific information. This project led to the creation of a MH benchmarking implementation group (MHBIG) and a MH benchmarking board clinical contacts group (BCCG). The purpose of these groups were to deliver the process of collection, reporting and analysis of the key information. A toolkit of measures was developed and a balanced scorecard to allow health boards to measure and monitor their performance in comparison with each other, aiming for continuous improvement. The MHBIG no longer meets but the Board Clinical Contacts Group has continued to reconsider the toolkit and refine its contents.

Healthcare Improvement Scotland 90 day process report Board level measurement of Quality

This report was published in September 2014.

http://www.healthcareimprovementscotland.org/our_work/patient_safety/hsmr/measurement_of_quality_report.aspx

It had aimed to recommend a core set of indicator on the quality of healthcare to be used at Board level and to recommend how these indicators should be presented. The conclusions of the work were:

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A balanced suite of measures across all 6 domains of quality should be considered. Currently measurement focuses on activity with little measure of clinical effectiveness and patient experience.

Measures should cover primary, secondary and MH services and be expanded to social care.

There should be a core set of National measures supplemented by Board specific measures.

Boards should focus on contemporous data, data trends and data organisational/ departmental comparison.

Adult MH benchmarking and data (Appendix 1)

The Adult Mental Health Benchmarking Project has, over time, revised existing data fields, both in terms of their fitness for purpose and in response to external data changes. In response to the Quality strategy, the current 23 indicators have been reclassified to follow the 6 Quality strategy dimensions –

person centred safe effective efficient equitable timely

The toolkit is published by ISD as part of a National Benchmarking Project and can be accessed at the following link:

http://www.isdscotland.org/Health-Topics/Quality-Indicators/National-Benchmarking-Project/Mental-Health-Dashboard.asp

Validated data is published both in a toolkit format, largely Excel based, and in the form of a dashboard. The toolkit is published annually and the dashboard updated on a 6 monthly basis. At present we have data presented in parallel formats – the Excel based toolkit and the dashboard with data being provided by health board area of origin.

The last publication related to 2012-3 data. Incomplete SMR04 data returns from some health boards have delayed publication and prevented full balanced scorecard publication as the information about MH inpatient stays was incomplete.

Data collected generally relates to the adult 18-65 population although some data is not age specific and some specifically includes over 65.

The current Heat access target to psychological therapies is not age specific. It aims for over 90% access to psychological therapies for people with mental illness within 18 weeks.

Quarterly return are published by ISD of the psychology workforce.

National Suicide rates which are not age specific are published from a Scottish Suicide information database (ScotSID).

Medicines use in mental health is published annually by ISD from NHS prescriptions analysis.

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Electroconvulsive therapy use is Nationally published by the Scottish ECT accreditation network. This contains activity and effectiveness data using the montgomery asperg depression rating scale.

Annual reporting of psychiatric inpatient activity is done by ISD.

GP consultations for anxiety, dementia, depression and eating disorders were reported from a sample of 60 scottish GP practices in the past. In the future it is hoped that the SPIRE electronic information system in primary care will allow prevalence data to be collected.

The ISD publications in the last year are as below.Topic Nov

13Dec13

Jan14

Feb14

Mar14

Apr14

May14

Jun14

Jul14

Aug 14

Sep14

Oct14

Nov 14

Dec14

Key: A - Annual PublicationAr - Annual Publication RevisedQ - Quarterly publication

Adult Mental Health Benchmarking AChild and Adolescent (CAMHS) Benchmarking Q Q Q Q Q

Medicines for Mental Health APsychiatric Inpatient Activity AOutpatient Activity (Psychiatrist) Q Q Q Q Q

Scottish Suicide Information Database (ScotSID) A Ar Ar

Suicide - ScotPHO APsychological Therapies Waiting Times Q Q Q Q

Child and Adolescent (CAMHS) Waiting Times Q Q Q Q

Psychology Workforce Q Q Q Q

CAMHS Workforce Q Q Q Q

Dementia AGP Consultations AElectroconvulsive Therapy AAlcohol related discharges from Psychiatric Hospitals A

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Child and Adolescent MH benchmarking and data

In response to Commitment 9 of the MH strategy:

“We will work with a range of stakeholders to develop the current specialist CAMHS balanced scorecard to pick up all specialist mental health consultation and referral activity relating to looked after children.”

A data set has been agreed and published following 2011 consultation work. (Appendix 2). The 7 indicators are classified under 4 domains:

client/patient focus delivering best practice internal processes best use of resources

http://www.isdscotland.org/Health-Topics/Quality-Indicators/Publications/2014-03-25/2014-03-25-CAMHS-Balanced-Scorecard-Report.pdf

In response to commitment 12 of the MH strategy

“in addition to tracking variance and shorter lengths of stay we will focus on reducing admission s of under 18s to adult wards, with a new commitment to reduce figures across Scotland to a figure linked to current performance in the South of Scotland area.”

ISD have developed a Tier 4 CAMHS data set to monitor progress with an agreed definition of Tier 4 services. (Appendix 3). It follows discussions at Autumn 2013 Mental Health Implementation Review Visits and CAMHS Implementation & Monitoring Group and ongoing development work by ISD and regional CAMHS leads.

The data set was developed initially by the 3 regions following meeting between regional CAMHS leads and Mental Health Division in 2011. It was amended slightly to take into account comments from the CAMHS Implementation and Monitoring Group which met on 24 September 2013.

The intention is that NHS Boards will submit data to SG on a regular timescale (quarterly, alongside the CAMHS Balanced Scorecard) to allow us to track progress against the commitment, but more importantly to ensure that the regions have the information they need to develop tier 4 services. Data for the majority of the indicators is collected via SMR04 and will be automatically downloaded from that data set.

CAMHS IMG, lead clinicians and regional leads have been involved in finalising the data set, which has been developed with colleagues in ISD.

The current CAMHS Heat access target of 90% access to treatment by specialist CAMHS within 18 weeks is measured and reported.

Quarterly returns are published of CAMHS workforce numbers by ISD.

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Dementia benchmarking and Data

Work is underway to agree a dementia benchmarking toolkit through the Dementia strategy implementation and monitoring group. A draft set of 17 indicators exist classified under 6 key challenges:

Fear of dementia that means people delay in coming forward for diagnosis. Information and support after diagnosis of those with dementia and their carers is

poor or non-existent. General healthcare services do not always understand how to respond well to

people with dementia and their carers, leading to poor outcomes. People with dementia and their carers are not always treated with dignity and

respect. Family members and people who support and care for people with dementia do not

always receive the help they need to protect their own welfare and to enable them to go on caring safely and effectively.

Resources and financial.

A target of diagnosis of dementia in over 50% of the predicted population prevalence is currently set and reported on. This is based on QoF returns from primary care databases. The Heat treatment target of delivery of 1 year post diagnosis of dementia support to all newly diagnosed patients is reported.

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Community MH benchmarking and data

Commitment 25 of the MH strategy says:

“As part of the work to understand the balance between community and inpatient services, and the wider work on developing mental health benchmarking information, we will develop an indicator or indicators of quality in community services”

A specific data set has not been agreed but data is already available from a variety of sources:

the adult MH benchmarking tool contains some measures of community information.

The HEAT target for delivery of psychological therapies within 18 weeks is measured.

Clinical outcome measures across Boards have been surveyed and a recommendation given for general use of the CORE outcome measure supported by the CORE net IT system.

A Community Health Activity Data Project is being run by National Services Scotland with ISD. Phase 2 involves mental health. This has defined a draft data set to measure the activity of community psychiatric nurses. The intention is to use this data to map out community MH activity against spend in preparation for the integration of community health with social work. ( Appendix 4)

English indicators are described in Appendix 5. They include:

1. Number of new cases of psychosis services early intervention teams year to date2. Number of people under adult mental illness specialities on CPA who were followed up within 7 days of discharge from IP care.3. Number of admissions to acute wards that were gate-kept by crisis resolution treatment teams.

NHS England on 8 October 2014 announced new mental health standards from 2015/16: 75% of people referred for talking therapies for treatment of common mental health

problems, such as depression and anxiety, will start treatment within 6 weeks and 95% will start within 18 weeks.

At least 50% of people going through their first episode of psychosis will get NICE approved help within 2 weeks of being referred.

Crisis service benchmarking and data

Commitment 23 of the MH strategy says that:

“We will identify a core data set that will allow effective comparison of the effectiveness of different models of crisis resolution/home treatment services across NHS Scotland. We will use this work to identify the key components of crisis prevention approaches and as a basis for a review of the standards for crisis services.”

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The Scottish Crisis and Acute Care Network Improving Pathways Event 29 October 2013 led to several recommendations. Recommendation of their report was that Scottish Government took forward considering the list of key performance indicators harvested in workshops at the event to identify a core data set to fulfil commitment 23. ( Appendix 6)

It was agreed at the last meeting of the crisis and acute care network that a suggested core data set based on work done at the improving pathways event and with reference to data already collected would be considered at the next crisis and acute care network meeting. This was presented on 10 December 2014. It was thought that crisis specific indicators would best be developed alongside generic community and relevant patient safety work. This is in progress.

Learning disability benchmarking and data

There is no similar benchmarking tool in LD. QoF collects prevalence data. The 2020- local delivery plan work on tackling the health inequalities faced by people with learning disabilities recommends that CHI number databases of adults with learning disabilities exist for regional NHS Boards and the state hospital to allow other general data sets to be applied to LD populations.

Autism strategy benchmarking and data

There is no similar benchmarking tool in autistic spectrum disorder.

Alcohol and Drug service benchmarking and data

There is no similar benchmarking tool in alcohol and drug services.

A national drug and alcohol treatment waiting times report is published by ISD to report on the current Heat access target A11 – 90% of people will receive treatment within 3 weeks.

Local Alcohol and Drug partnerships have their own performance reporting arrangements.

There is a Scottish drugs misuse database (SDMD) which publishes an annual report through ISD this describes 25 population prevalence characteristics based on individuals presenting for a new drug treatment at specialist services. This uses information from the SMR 25a and 25b.

Annual rates of drug deaths are published from a national drug related deaths database.

Alcohol related discharges from psychiatric hospitals are annually reported from SMR04 returns.

Forensic service benchmarking and data (ian dewar to supply content)

Scottish Patient Safety Data

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The Scottish patient safety programme in mental health have a proposed measurement plan (v0.15 30.09.14) containing a set of 9 harm reduction outcome measures and 2 balancing measures. (Appendix 7)

Clinical Outcome indicators

Survey has been done of what specific measures are being used in Boards to measure clinical effectiveness. A wide variety of tools are used with different recording systems on web based or spreadsheet systems. Work has been done nationally recommending CORE as the best general clinical outcome measure for psychological therapies. This is being variably applied with only some Boards using CORE net to record this information.

The Scottish Recovery Indicator 2 is available for services to use to measure patient recovery in a broad sense.

Personal outcome indicators

The role of clinical outcomes and that of personal outcomes can often be complementary. Patient focussed outcomes exist in a wide range of areas at present and can link to service users, carers and professionals. The list of tools and their focus is included as an appendix and can be used in isolation or in combination.

( appendix 8)

Future Integration measures

The Draft Affirmative Regulations to support the integration of health and social care were laid in the Scottish Parliament on Friday October 3, 2014.

These relate to the Prescribed National Health and Wellbeing Outcomes.

Once approved by resolution of the Parliament, the Regulations will come into effect by December 2014.

The National Health and Wellbeing Outcomes are high-level statements of what health and social care partners are attempting to achieve through integration and ultimately through the pursuit of quality improvement across health and social care.

By working with individuals and local communities, Integration Authorities will support people to achieve the following outcomes:

Outcome 1: People are able to look after and improve their own health and wellbeing and live in good health for longer.

Outcome 2: People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.

Outcome 3. People who use health and social care services have positive experiences of those services, and have their dignity respected.

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Outcome 4. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services.

Outcome 5. Health and social care services contribute to reducing health inequalities.

Outcome 6. People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and well-being.

Outcome 7. People who use health and social care services are safe from harm.

Outcome 8. People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide.

Outcome 9. Resources are used effectively and efficiently in the provision of health and social care services

Local Authorities have collected mental health benchmarking data – published 24.09.14 looking at

number of people in care homes number receiving housing accommodation, clients/ carers receiving respite Average expenditure per client.

International MH benchmarking and dataThe international initiative for MH leadership IIMHL have been working on a project to identify key outcome measures of quality for services across a wide range of countries. (Appendix 9)

http://www.iimhl.com/iimhl-about-us#a3

Following harvesting of 656 examples of international measurement a filtration process identified a short list of 36 nationally agreed core quality measures. The process was published in 2014 by Parameswaran et al.

Ongoing contacts via the International Initiative of Mental Health Leadership and other routes suggests that Scotland is well placed to share information and learn from other countries. Suggestions includes Netherlands, England and New Zealand for their similarities of size and approach to improved data collection and mental health services, although health services delivery differs.

The World health organisation (WHO) publishes country specific profile data in their mental health atlas. (Appendix 10).

Additional Data Sources

Information about the performance and Quality of MH services is also available from:

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http://www.iimhl.com/iimhl-about-us#a3

Mental Health Legislation (MHA, AWI, ASP Acts) related data from the Mental Welfare Commission.

MH one day 29.10.14 inpatient census data. The annual Scottish Health Survey publishes population sample data on mental

health prevalence, wellbeing and alcohol consumption.

Discussion

This paper lists the current national sources of data about mental health. Data collection has grown historically in relation to strategic and policy direction. There is variance in approach to categorisation and between different subspecialties of mental health.

The current mental health strategy commits to new data sets.

The collection, analysis and use of benchmarking and data becomes inefficient if too much information is collected and if the information itself is not a valid and useful measure of importance.

The quality strategy dimensions have been nationally accepted as covering the breadth of quality and outcomes for NHS services. Collected data currently is more biased to measuring activity and efficiency than effectiveness and patient experience.

Integration means that data about mental health needs to fit not just into the quality strategy dimensions but also populate the integration indicators.

Outcome of Benchmarking Boards contact group 4.12.14

1. There was support to extend the membership of the existing boards contact group to include representation from dementia, LD / autism and addictions.

2. There was support to reconsider the purpose of MH data collection and thereafter identify what should be collected, how and with what support.

3. There was support to consider new indicators especially as measures of effectiveness and patient experience and to actively retire other indicators where possible.

4. This paper has been revised following this meeting to include forensic and personal outcomes information.

5. Prof McKnight from NHS Lothian has been asked to present to the next meeting on what and how data is collected for diabetes services and outcomes as a different chronic disease model example.

6. John Connor from ISD will present at the next meeting on the ISD “Discovery” project and how it might serve as a site for the display of various data suites including the possibility of integrating all MH benchmarking information/ data.

7. John Connor, Kirsty Licence, Mark Taylor and Joan Blackwood agreed to map existing indicators to the quality strategy dimensions and to the health and wellbeing indicators to identify how well we satisfy them and to note areas where we do not. Doug Adams agreed to the circulation of his paper from NHSGGC in which he divided each health and wellbeing indicator into its health and social components and specified beside these the mental health specific aspects of each. It was agreed this was a useful approach and mapping template.

8. John Mitchell would take this paper to the acute and crisis inpatient group with proposed crisis service key performance indicators for discussion.

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9. John Mitchell would take this paper and revision to the RCpsych medical managers meeting 29.1.14.

John Mitchell PMO

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Adult MH Benchmarking Toolkit 2014 Appendix 1

The overview table shows the list of the mental health benchmarking indicators by key domains with links to relevant tables. Key Domain Indicators Information Update

Efficiency

Total spend for mental health

Figure 1: Total spend for mental health 2012/13 by NHS BoardTable 1: Expenditure per head of population by NHS Board for 2012/13Figure 2: Trend in total spend for mental health 2008/09 to 2012/13 by NHS BoardTable 2: Trend in expenditure per head of population 2008/09 to 2012/13Table 3: General Psychiatric Expenditure as a percentage of Total Expenditure 2012/13

Total mental health spend in the community Figure 1: Total spend for community mental health 2012/13 by NHS BoardTable 1: Expenditure for community mental health 2012/13 (total and percentage)

Percentage community spend Figure 1: Percentage community expenditure for mental health - 2012/13Table 1: Trends in community expenditure by NHS Board (%) 2008/09 - 2012/13Figure 2: Trends in community expenditure for mental health (%) 2008/09 - 2012/13

Drugs Cost - Gross Ingredient Costs

Figure 1: Total gross ingredient cost for medicines used in mental health per head population (NRAC Adjusted) - 2012/13Figure 2: Proportion of gross spend by BNF category for NHS Boards - 2012/13Figure 3: Trends in gross ingredient cost for medicines used in mental health per head population - 2008/09 - 2012/13Table 1: Total GIC for medicines used in mental health per head NRAC adjusted population - 2012/13Table 2: Total GIC for medicines used in mental health per head NRAC adjusted population - 2011/12Table 3: Trends in GIC/head NRAC adjusted population for NHS Boards: 2008/09 - 2012/13

Drugs Cost - Defined Daily Doses

Table 1: Total DDD's for medicines used in mental health per head NRAC adjusted population - 2012/13Table 2: Total DDD's for medicines used in mental health per head NRAC adjusted population - 2011/12Table 3: Total DDD's for medicines used in mental health per head NRAC adjusted population - 2010/11Table 4: Total DDD's for medicines used in mental health per head NRAC adjusted population - 2009/10Table 5: Total DDD's for medicines used in mental health per head NRAC adjusted population - 2008/09

Total occupied care home beds per 100,000 population

Figure 1: Total occupied local authority funded mental health beds per 100,000 population 2012/13Table 1: Total occupied beds per 100,000 population - 2012/13Figure 2: Trends in occupied beds per 100,000 population 2008/09 - 2012/13Table 2: Trends in occupied beds per 100,000 population 2008/09 - 2012/13Table 3: Trends in bed occupancy rates 2006 - 2013

Total mental health staff numbers

Figure 1: Mental health staff per 100,000 population (NRAC adjusted) - 2013Table 1: Total mental health staff (WTE) by NHS Board - 2013Table 2: Total mental health nurses (WTE) by NHS Board - 2013Table 3: NRAC adjusted population estimates 2009 - 2013Table 4: Total mental health staff (WTE) - 2009 - 2013Table 5: Trends in mental health staff per 100,000 population - 2008 - 2013

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Allied Health Professionals

Figure 1: Total Allied Health professionals working in mental health (WTE) - per 100,000 population (NRAC adjusted) - 2013Table 1: Total Allied Health Professionals working in mental health (WTE) - per 100,000 population (NRAC adjusted) 2013Table 2: Total Allied Health Professionals working in mental health (WTE) - per 100,000 population (NRAC adjusted) 2012Table 3: Allied Health Professionals1 working in Mental Healthjob family as at 30 September 2013

Applied Psychologists

Table 1: Number (wte) of All Applied Psychologists employed in psychology services for adult (20-64 years) Mental health in NHS Scotland as at 30th September 2013Table 2: Number (wte) of All Applied Psychologists employed in psychology services for adult (20-64 years) Mental health in NHS Scotland as at 30th September 2012

Table 3: Number (wte) of All Applied Psychologists employed in psychology services for adult (20-64 years) Mental health in NHS Scotland as at 30th September 2011



Total psychiatric beds per 100,000 population

Figure 1: Total beds per 100,000 population (NRAC adjusted population) 2012/13Table 1: Total beds per 100,000 population 2012/13Figure 2: Trends in total beds per 100,000 population 2008/09 - 2012/13Table 2: Trends in total beds per 100,000 population 2008/09 - 2012/13Table 3: Annual trends in bed occupancy for psychiatric specialties 2000/01 - 2012/13

Effectiveness

Average length of stay

Figure 1: Average length of stay for mental health (specialties - G1 and G4) by NHS Board - 2012/13Table 1: Average length of stay - mean and median by NHS Board - 2012/13Table 2: Average length of stay by NHS Board and specialty - 2012/13Figure 2: Trends in average length of stay (mean) by NHS Board of treatment 2007/08 - 2012/13Table 3: Trends in average length of stay by NHS Board 2007/08 - 2012/13Table 4: Average length of stay by NHS Board and specialty 2007/08 - 2011/12Table 5: Average length of stay by description of primary mental health diagnosis (ICD10) - 2012/13*

Average length of stay: 80/20 split

Table 1: Average length of stay - 80/20 split by NHS Board 2007/08 - 2012/13Table 2: Average length of stay - 80/20 split by NHS Board and specialty 2007/08 - 2012/13Table 3: Average length of stay by description of primary mental health diagnosis (ICD10) - 2012/13*

Information quality and captureTable 1: SMR04 completeness records 2012/13Figure 1: SMR04 timeliness 2012/13Table 2: Timeliness of SMR04 discharge record submissions - 2012/13

Percentage readmissions within 28 days

Figure 1: Percentage readmissions within 28 days by NHS Board 2012/13Table 1: Percentage readmissions within 28 days by NHS Board 2007/08 - 2012/13Figure 2: Percentage of spells readmitted within 28 days by Diagnostic Group 2012/13*Table 2: Proportion of primary description of diagnosis for spells readmitted within 28 days - 2012/13*Table 3: Proportion of aftercare for spells readmitted within 28 days - 2012/13*

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Percentage readmissions within 133 days

Figure 1: Percentage readmissions within 133 days by NHS Board 2012/13Table 1: Percentage readmissions within 133 days by NHS Board 2007/08 - 2012/13Figure 2: Percentage of spells readmitted within 133 days by Diagnostic Group 2012/13*Table 2: Proportion of primary description of diagnosis for spells readmitted within 133 days - 2012/13*Table 3: Proportion of aftercare for spells readmitted within 133 days - 2012/13*

Person Centeredne

ss

Percentage delayed dischargesFigure 1: Delayed discharges for mental health specialties by NHS Board - 2012/13Table 1: Trends in delayed discharges for mental health specialties by NHS Board 2008/09 - 2012/13

Percentage of community CTO of Total CTO

Figure 1: Percentage community based compulsory treatment orders (CCTO) - 2012/13Figure 2: Trends in percentage community based compulsory treatment orders (CCTO) 2007/08 - 2012/13Table 1: Trends in CCTO 2007/08 - 2012/13 (total and percentages)

Safety

Percentage of voluntary inpatients and compulsory inpatients by Board

Figure 1: Percentage of voluntary and compulsory inpatients for general psychiatry specialty 2012/13Figure 2: Percentage of voluntary and compulsory inpatients for old age psychiatry specialty 2012/13Figure 3: Trends in percentage of voluntary inpatients for all MH specialties (G1 and G4) 2007/08 - 2012/13Table 1: Trends in the percentage of voluntary and compulsory inpatients for general psychiatry and old age psychiatry specialties 2007/08 - 2011/12Table 2: Percentage of voluntary and compulsory inpatients by NHS Board for all MH specialties (G1 and G4) 2007/08 - 2012/13

Number of practising mental health officers

Figure 1: Mental health officers per 100,000 population (NRAC adjusted population) 2012/13Table 1: Mental health officers 2012/13 (Staff - total numbers and WTE)Table 2: Trends in Mental Health Officers (staff and WTE) by NHS Board 2008/09 - 2012/13Figure 2: Trends in Mental Health Officers per 100,000 population by NHS Board 2008/09 - 2012/13Table 3: Trends in Mental Health Officers per 100,000 population 2008/09 - 2012/13

Suicide rates per 100,000 (crude and standardised rates)

Figure 1: Crude and European Age-Sex Standardised suicide rates per 100,000 population by NHS Board 2008 - 2012Table 1: Deaths caused by intentional self-harm and events of undetermined intent, registered in Scotland, by NHS Board and 5-year time period, persons 1998-2002, 2003-2007 and 2008-2012Table 2: Deaths caused by intentional self-harm and events of undetermined intent, registered in Scotland, by NHS Board and 5-year time period, males 1998-2002, 2003-2007 and 2008-2012Table 3: Deaths caused by intentional self-harm and events of undetermined intent, registered in Scotland, by NHS Board and 5-year time period, females 1998-2002, 2003-2007 and 2008-2012Table 4: Percentage of suicides within 30 days of discharge 2008 - 2012*

Training and supervision index

Figure 1: Staff (%) trained in suicide prevention, education and training as at December 2010Figure 2: Staff (%) trained in suicide prevention, education and training by NHS Board June 2009 - December 2010Table 1: Percentage of frontline staff trained in suicide prevention, education and training by NHS Board June 2009 - December 2010

Equity Persons on incapacity benefit/severe disablement allowance

Figure 1: Claimants with mental health diagnosis per 100,000 population (NRAC adjusted population) - 2012/13Table 1: Claimants with mental health diagnosis per 100,000 population - 2012/13Table 2: Trends in claimants with mental health diagnosis per 100,000 population

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2008/09 - 2012/13Figure 2: Trends in claimants with mental health diagnosis per 100,000 population 2008/09 - 2012/13Table 3: Proportion of claimants by mental health diagnosis - 2012/13

Relative risk of death for persons in contact with the mental health service

Table 1 - Age-sex standardised mortality rate for Scotland (directly standardised rate using standard Scottish male/females population mid 2012 estimates ONS)*Table 2 - Crude mortality rates and risk ratios by age group and sex - 2012/13, Scotland excluding Ayrshire & Arran*Table 3 - Crude mortality rates and risk ratios by NHS Board and sex - 2012/13 excluding Ayrshire & Arran*

* Removed due to SMR04 data issues.

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CAMHS Benchmarking Toolkit 2014/15 Appendix 2 Introduction The Child and Adolescent Mental Health Service (CAMHS) benchmarking toolkit aims to support the implementation of the Child and Adolescent Mental Health policy using national data benchmarking of CAMHS services across Scotland.

The overview table shows the list of the CAMHS benchmarking indicators by performance domain with links to relevant tables.

Performance Domain Indicators Information Update

Client/Patient Focus

% Waiting Times (< 26 weeks)

Figure 1: Percentage of patients who started their treatment within 26 weeks by NHS board of treatment, 1 April 2012 - 30 June 2014 with adjustmentsFigure 2: Percentage of patients who started their treatment within 26 weeks by NHS board of treatment, 1 April 2012 - 30 June 2014 unadjustedTable 1: Waiting times for people who started their treatment between 1 April 2012 - 30 June 2014, NHS ScotlandTable 2: Waiting times for people who started their treatment between 1 April 2012 - 30 June 2014 by NHS board - adjustedTable 3: Waiting times for people who started their treatment between 1 April 2012 - 30 June 2014 by NHS board - unadjusted

% Waiting Times (>= 26 weeks) Figure 1: Percentage of patients who were waiting for treatment and have waited 26 weeks or more by NHS board of treatment, 1 April 2012 - 30 June 2014 - adjustedFigure 2: Percentage of patients who were waiting for treatment and have waited 26 weeks or more by NHS board of treatment, 1 April 2012 - 30 June 2014 - unadjustedTable 1: Waiting times for people waiting at the end of the month in Scotland, 1 April 2012 - 30 June 2014Table 2: Waiting times for people waiting at the end of quarter 1 2012/13 (30 June 2012), quarter 2 (30 September 2012), quarter 3 (31 December 2012), quarter 4 (31 March 2013), quarter 1 (30 June 2013), quarter 2 (30 September 2013), quarter 3 (31 December 2013), quarter 4 (31 March 2014) and quarter 1 (30 June 2014) adjusted

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Table 3: Waiting times for people waiting at the end of quarter 1 2012/13 (30 June 2012), quarter 2 (30 September 2012) quarter 3 (31 December 2012), quarter 4 (31 March 2013), quarter 1 (30 June 2013), quarter 2 (30 September 2013) quarter 3 (31 December 2013), quarter 4 (31 March 2014) and quarter 1 (30 June 2014) unadjusted

Service Age Provision Figure 1: NHS Scotland CAMHS Service Age Provision as at 30 June 2014 by NHS Board

Delivering Best Practice Mental Health Inpatient Admissions

Due to issues of data completeness with the SMR04 dataset, the tables for this indicator have been removed. A summary of the nature of these problems and the work which has been carried out to resolve them is contained in Appendix 1 of the Mental Health Inpatient Care Report https://isdscotland.scot.nhs.uk/Health-Topics/Mental-Health/Publications/2014-07-29/2014-07-29-Mental_Health_Hospital_Inpatient_Care-Report.pdf?64478701354

Internal Processes Total Referrals to Specialist CAMHS

Figure 1: Referrals per 100,000 people under 18 to CAMHS Services by NHS board, 1 April 2012 - 30 June 2014Table 1: Referrals to Child and Adolescent Mental Health Services by NHS board, 1 April 2012 - 30 June 2014

Best Use of Resources

Community Clinicians per 100,000

Figure 1: Clinical staff employed in Scotland CAMHS, community working only WTE per 100,000 people under 18 by NHS board, 1 April 2012 - 30 June 2014Table 1: Clinical staff employed in Scotland CAMHS by professional group, community working only WTE per 100,000 people under 18 by NHS board, 1 April 2012 - 30 June 2014

Percentage Sickness Absence

Figure 1: Percentage sickness absence of dedicated NHS CAMHS clinicians by NHS board, 1 April 2012 - 30 June 2014Table 1: Percentage sickness absence of dedicated NHS CAMHS clinicians by NHS board, 1 April 2012 - 30 June 2014

Community CAMHS wages budget per 1,000

Figure 1: Community CAMHS wages budget per 1,000 people under 18 by NHS board, 30 June 2012 - 30 June 2014Table 1: Community CAMHS wages budget per 1,000 people under 18 by NHS board, 30 June 2012 - 30 June 2014

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Appendix 3Proposed Tier 4 CAMHS data set

Data item Data source1 Number of admissions to CAMHS Adolescent Inpatient

Units/National Child Inpatient Unit (by age grouping/Board of residence/unit)

SMR04

2 Number of admissions to CAMHS Adolescent Inpatient Units/National Child Inpatient Unit per 100,000 under 18 population (by NHS Board of residence)

SMR04 & population data

3 Number of readmissions within 28 days to CAMHS Adolescent Inpatient Units/National Child Inpatient Unit (by age grouping/Board of residence/unit)

SMR04

4 Waiting time from referral to admission to CAMHS Inpatient Unit CAMHS teams

5 Number of referrals which were not admitted (broken down into separate categories tbc)

CAMHS teams

6 Number of discharges from CAMHS Adolescent Inpatient Units/National Child Inpatient Unit (by age grouping/Board of residence/unit)

SMR04

7 Number of discharges from CAMHS Adolescent Inpatient Units/National Child Inpatient Unit per 100,000 under 18 population (by NHS Board of residence)

SMR04

8 Average length of stay in CAMHS Adolescent Inpatient Units/National Child Inpatient Unit (by Board of residence & region)

SMR04

9 Average length of stay excluding outliers (80:20 split) in CAMHS Adolescent Inpatient Unit/National Child Inpatient Unit (by Board of residence and region)

SMR04

10 Median length of stay in CAMHS Adolescent Inpatient Units/National Child Inpatient Unit (by Board of residence and region)

SMR04

11 Occupied bed days in CAMHS Adolescent Inpatient Unit/National Child Inpatient Unit (by unit and Board of residence)& occupied bed days by diagnosis (adult/c&a wards by region)

SMR04

12 Number of under 18 admissions to adult mental health beds (by age group/Board of residence/unit)

SMR04

13 Number of mental health admissions to paediatric beds (by age group/Board of residence/unit)

SMR04

14 Average length of stay in adult mental health beds (by Board of residence/region/unit)

SMR04

15 Average length of stay of mental health admissions to paediatric beds (by Board of residence/region/unit)

SMR04

16 Average length of stay for out-of-region patients in CAMHS Adolescent Inpatient Unit

SMR04

17 Delayed discharges from CAMHS Adolescent Inpatient Units/National Child Inpatient Unit

CAMHS Adolescent Inpatient Unit

18 Number of Tier 4 CAMHS patients in the community (by NHS Board)

Regional data/CAMHS teams

19 Number of out-of-Scotland referrals of CAMHS Learning Disability and Forensic CAMHS patients (by NHS Board and by destination hospital – including non-NHS)

CAMHS teams

20 Number of out-of-Scotland admissions of CAMHS Learning Disability and Forensic CAMHS patients (by NHS Board and by destination hospital – including non-NHS)

CAMHS teams

20.

Appendix 4Scottish Community Mental Health - Draft National Dataset:Sources:

Mental Health Dataset (ICIC) – ISD 2007 Data Collection Mental Health Benchmarking 2009 (DCMHB) Mental Health and Learning Disabilities Dataset (MHLDDS) – Health & Social Care

Information Centre – England QuEST DCAQ Workload tool Community Health Activity Data (CHAD)

Section 1: Patient Demographics

Data Item Source

1 Community Health Index (CHI) ICIC ISD 2007 /DCMHB

2 Surname ICIC ISD 2007 / DCMHB/ MHLDDS

3 Forename ICIC ISD 2007 / DCMHB/ MHLDDS

4 Date of Birth (DoB) ICIC ISD 2007 / DCMHB/ MHLDDS

5 Postcode ICIC ISD 2007 / DCMHB/ MHLDDS

6 Ethnicity ICIC ISD 2007 / DCMHB/ MHLDDS

7 Current Gender (Sex) ICIC ISD 2007 / DCMHB/ MHLDDS

Section 2: Background Health and Socio-environmental Information

8 Client Group – Dementia, Mental Health Problems, Learning Disability, Physical Disability, Addiction, Palliative Care

DCMHB

9 Accommodation Status DCMHB/ MHLDDS

10 Household Composition ICIC ISD 2007

11 Health problems and/or diagnosis

Section 3: Current Episode of Care

Data Item Source

12 Date Care Began in Current Episode DCAQ / MHLDDS

13 Date Care Finished in Current Episode MHLDDS

14 Outcome of Episode of Care MHLDDS

Section 4: Contacts in Current Episode

Data Item Source

15 Date Contact Started ICIC ISD 2007 / DCAQ

21.

16 Duration of Contact (hrs/mins) ICIC ISD 2007

17 Patient Attendance ICIC ISD 2007

18 Contact Location ICIC ISD 2007

19 Type of Contact – Individual, Group or Family ICIC ISD 2007 / DCAQ

20 Contact Category – Direct Contact, Indirect Contact ICIC ISD 2007 / DCAQ

21 Joint Contact (Number of Staff)

Section 5: Interventions

Data Item Source

22 Interventions – Assessment, Care planning and review, Social support, Housing support, Benefits/financial support, Healthy living and education, Medication management, Physical therapies, Psychosocial intervention, Legal actions, Risk management, Activities of daily living support, Spiritual support.

ICIC ISD 2007 / MHLDDS

Section 6: Staff Activity (including Discipline)

Data Item Source

23 Professional Discipline

24 Staff Activity Type (non patient related) CHAD

25 Staff Activity (non patient related) duration (minutes) CHAD

26 Staff Activity Type (non direct, patient related) CHAD

27 Staff Activity Type (non direct, patient related) duration (minutes)

CHAD

28 Travel Time CHAD

22.

Appendix 5

Mental Health Community Teams Activity – English Indicators – paper to adult MH benchmarking toolkit

The drive to capture more community focused indicators within the Adult Mental Health Benchmarking toolkit will be of interest to most members of the benchmarking group. This summary aims to promote a discussion on the merits of including similar measures within the Scottish benchmarking work and facilitate discussion on the likely data sources/data collection required to do this.In England, a mental health community teams activity return is collected and reported on a quarterly basis. Information on number of Early Intervention cases, follow up within 7 days and ‘gate keeping’ by Crisis Resolution Home Treatment Teams is provided.

The definitions for each of these indicators is shown below:

1: The number of new cases of psychosis served by early intervention teams year to date (YTD).

Detailed Definition:

Cases of First Episode Psychosis which have been taken on by Early Intervention teams for treatment and support since 1 April 2010 to 31 March 2011. Include all new cases taken on the caseload of an EI team from 1 April to the end of the latest Quarter. Patients who are being monitored for a limited period because they are suspected cases SHOULD NOT BE INCLUDED in this count.

2: The number of people under adult mental illness specialties on CPA who were followed up (either by face to face contact or by phone discussion) within 7 days of discharge from psychiatric in-patient care during the quarter (QA).Detailed Definition:

Of those cases recorded in question 3 (see below), the number of patients who were followed up either by face to face contact or by a phone discussion within 7 days of discharge from psychiatric in-patient care.

All patients discharge to their place of residence, care home, residential accommodation, or to non-psychiatric care must be followed up within 7 days of discharge. All avenues need to be exploited to ensure patients are followed up within 7 days of discharge. Where a patient has been transferred to prison, contact should be made via the prison in-reach team.

Exemption:

Patients who die within 7 days of discharge may be excluded. Where legal precedence has forced the removal of a patient from the country. Patients transferred to NHS psychiatric inpatient ward. CAMHS (child and adolescent mental health services) are not included

23.

The seven-day period should be measured in days, not hours, and should start on the day after the discharge

3: The number of admissions to the trust's acute wards that were gate kept by the crisis resolution home treatment teams during the quarter.Detailed Definition:

The number of admissions to the trust's acute wards that were gate-kept by crisis resolution home treatment teams.

An admission has been gate kept by a crisis resolution team if they have assessed the service user before admission and if they were involved in the decision-making process, which resulted in admission.

Total Exemption to CR/HT Gatekeeping

Patients recalled on Community Treatment Order. Patients transferred from another NHS hospital for psychiatric treatment. Internal transfers of service users between wards in the trust for psychiatry treatment. Patients on leave under Section 17 of the Mental Health Act. Planned admissions for psychiatric care from specialist units such as eating disorder

units are excluded.

Partial exemption:

Admissions from out of the trust area where the patient was seen by the local crisis team (out of area) and only admitted to this trust because they had no available beds in the local area. CR team should assure themselves that gatekeeping was carried out. This can be recorded as gatekept by CR teams.

Further information is available from the following web site:

http://webarchive.nationalarchives.gov.uk/20130402145952/http:/www.england.nhs.uk/statistics/mental-health-community-teams-activity/

24.



Appendix 6

Scottish Crisis and Acute Care Network - Improving Pathways EventRecommendation on data collection

29 October 2013

Action 2

The Crisis and Acute Care Steering Group and Scottish Government should have a further discussion as to how the information we gathered on the day from key stakeholders is taken forward or put to effective use.

In relation to gathering some evidence around what indicators and core data set could we put forward for further exploration and discussion there was a great deal of information coming forward that we need to distil into something that is more manageable in terms of data collection and analysis. However the following areas have emerged strongly;

Creative Possibilities for Crisis Services

Services will be responsive, compassionate with evidence of joined up working with health, social care, police and housing as key partners

Measured response times Service user and carer feedback that includes the service completing SRI2, Indicators for Use of the MH Act, Section 297 Evidence of joint training that involves service users and their families

Access to Crisis/Acute Care Response

Service response should be accessible 24hr seven days per week. Contact should take place within 4hrs of referral. Every Crisis Response will have an outreach function. Pathways should be simple and seamless between services. Independent Service user experience should be captured as routine. Service contact for Crisis should last on average 21days

The Interface between Crisis Response Team/Intensive Home Treatment Team and Acute In-patient Ward.

Timeframes for people to be seen from referral to be agreed as above Consistent approach to admission Crisis plan availability Readmission rates Input from Crisis Team to In-patient Multi-disciplinary Team meetings, Appointments/Waiting Times Crisis contact numbers accessible to people Patient Experience survey conducted regularly on whether crisis plan has been

followed

25.

Psychiatric and Acute Inpatient Service Discharge

Information and communication - Good quality information (standardised) to all key people prior to day of discharge

Access to medication - accurately and timeously issue correct discharge medication and identify appropriate person to follow up regarding medication

Evaluation of service - outcome measures in relation to hospital admission; feedback from patients on quality of service – did being in hospital meet the patient’s needs on admission. Patient experience of admission

Timeliness of follow up timely follow up that is evidenced - this must include face to face contact and timeframe within X days

Patient and carer involvement - patient and carer involved throughout the discharge planning and to agree to the discharge plan

The information gathered to date has not yet been distilled into a performance indicator or statement around core data to be collected, however the Steering Group would envisage that this would form part of the next phase of work around Commitment 23 in the Mental Health Strategy.

26.

Appendix 7Scottish Patient Safety Programme Mental Health

30.09.14 proposed measures

SPSP-MH Harm Reduction Outcomes Measures for Phase two Measure

Measures Operational definitionMHO1a

Rate of incidents of physical violence per 1000 occupied bed days

Physical violence is defined as the use of physical force that is intended to hurt or injure another. (Numerator: Total number of incidents/ Denominator: Total occupied bed days in index month) X1000

MHO1b % of patients who engage in physically violent behaviour

Physical violence is defined as the use of physical force that is intended to hurt or injure another. (Numerator: Total number of patients who engage in physically violent behaviour to both patients and staff/ Denominator: Number of unique patients on unit throughout index month) x100

MHO2a Rate of restraint incidents per 1000 occupied bed days

(Numerator: Total number of restraint incidents/ Denominator: Total occupied bed days in index month) X1000

MHO2b % of patients who experience one or more episodes of restraint

(Numerator: Total number of patients who experience one or more episodes of restraint/ Denominator: Number of unique patients on unit throughout index month) x100

MHO3 % of patients who experience seclusion Seclusion is defined as the supervised confinement of a patient, alone in a designated room / area which is locked to protect others from significant harm (Numerator: Total number of patients who experience one or more episodes of seclusion in the given index month/ Denominator: Number of unique patients on unit throughout index month) x100

MH04 % of patients who experience self-harm Self-harm is defined as an intentional act of self-poisoning or self-injury, and includes suicide attempts (Numerator Total number of patients who experience one or more episodes of self harm in the given index month. Denominator: Number of unique patients on unit throughout index month) x100

MHO5 Number of days since last inpatient suicide

This includes a suicide that: Occurs on the ward

27.

Anywhere off the ward (LOA,Pass, missing person) but whilst still an inpatient

MH06a % of patients who are subject to use of nurses holding power

(Numerator: Number of patients who experience use of nurse holding power on unit after having been voluntarily/informally admitted/ Denominator: Number of unique patients on unit throughout index month) x100

MH06b % of patients who have emergency detention

(Numerator: Number of patients who experience an episode of emergency detention on unit after having been voluntarily/informally admitted/ Denominator: Number of unique patients on unit throughout index month) x100

Balancing Measures

MHB1 Average length of stay (Numerator: Total occupied bed days for all patients discharged from ward during index month/

Denominator: number of patients discharged during the index month.

MHB2 % of patients on high observations High observation is defined as 1:1 or greater constant/high observation

% of patients on high observations:

(Numerator: Number of individuals receiving high observation levels/

Denominator: Number of unique patients on unit throughout index month ) x100

28.

Appendix 8 Personal Outcome indicators

Source Purpose Involving

Indicator

SRI2 Patient Care Service/Staff/Patient/Carer

Basic Needs are identified and addressed:Assessment/Care Plan/Personal perspective

SRI2 Patient Care Service/Staff/Patient

Goals are identified and addressed:Assessment/Care Plans/Personal perspective


Personalised services are provided:Assessment/Care Plans/Service Information/Personal Perspective


Service is Strength based:Assessment/Care Plans/Service Information/Personal Perspective


Service promotes social inclusion:Assessment/Care Plans/Service Information/Personal Perspective


Service promotes and acts on service user involvement:Service Information/Personal Perspective


Informal carers are routinely involved:Assessment/Care Plans/Service Information/Personal Perspective


Service encourages advanced planning and self-management:Assessments/Care Plans/Service Information/Personal Perspective


Staff are supported and valued:Service Information/Personal Perspective


Practice is Recovery focussed:Assessments/Care Plans/Service Information/Personal Perspective

Triangle of Care

Carer Involvement

Carer Carers and their essential role are identified at first contact or as soon after

Carer routinely identified with services when carrying out assessment

Special circumstances of carer recorded Carer views and knowledge sought throughout process Consent of service user routinely obtained and recorded* Carer regularly updated and involved re care

plans/treatment Treatments medication management explained to carer Carer has access to advice

Triangle Carer Staff Staff are carer aware and trained in carer engagement strategies

29.

of Care Involvement All staff have received carer awareness training (how many?)

Adequate range of subjects in training Training is delivered by carer trainers

Triangle of Care

Carer Involvement

Staff/Carer/Patient

Policy and practice protocols re confidential and sharing information are in place

Service user consent is sought to share confidential information*

Agreement is reached with service user about level of information*

If service user wishes no disclosure, regularly revisited Carer is offered support and general information when

no disclosure approved Carer is encouraged to share information to inform

assessment and treatment Carer’s careplan, notes and letters are kept in separate

section of note Advance statements or directives are routinely used* A recovery plan is in place* Practice guidelines re information sharing with carers are

in useTriangle of Care

Carer Involvement

Staff/Carer

Defined Posts responsible for carers are in place A carer lead is identified within the team or on the ward All members of staff are responsible for identifying,

involving and supporting carers A carer champion network or peer support forum is in

place locally

Triangle of Care

Carer Involvement

Service/Staff

Carer introduction to the service and staff is available First contact information Early appointment to hear carer’s story Ward has processes in place to reduce carer distress Carers routinely given information leaflet covering

immediate concerns Locally developed carer information packs are available Cultural and language needs addressed Format of pack flexible and regularly updated Member of ward or team is responsible for packs Carer is involved in discharge planning process Feedback on service is sought

Triangle of Care

Carer Involvement

Carer A range of carer support is available Carer support or young carer service is in place –

dedicated support worker Carer has access to local carer advocacy Carer has access to one to one support when needed New carers are automatically offered carer’s assessment

and support plan The carer’s needs and plans are regularly re-assessed Family therapy or talking therapies are offered to carers

and family if requiredTalking Points

Personal Outcomes

Service User

Quality of Life Outcomes Feeling safe Having things to do Seeing people Positive Relationships Living where you want

Talking Personal Service Process Outcomes

30.

Points Outcomes User Listened to Having a say Treated with respect Treated as individual Being responded to Reliability

Talking Points

Personal Outcomes

Service User

Change Outcomes Improved confidence Improved skills Improved mobility Reduced symptoms

I.ROC Personal Outcomes

Service User

Quality of Life Outcomes Mental Health (H) Physical Health (O) Personal network (P) Participation & Control (E)


Service User

Process Outcomes Life skills (H) Exercise & activity (O) Social network (P) Self management (E)


Service User

Change Outcomes Safety & Comfort (H) Purpose & Direction (O) Valuing Myself (P) Hope for future (E)

SPSP Patient Care Staff Safer Medicines Management No avoidable Clozapine treatment breaks Lithium protocols Rapid Tranquilisation/Oral PRN monitoring and

definitions Medicine Reconciliation Error free prescribing Knowledge & understanding of non-psychotropic

medication and relationships

SPSP Patient Care Staff Restraint & Seclusion Encourage input from patients and carers before, during

and after Patient and staff debrief Restraint Risk Assessments Communication-culture and human factors Trauma history Restraint care planning Restraint monitoring Safe management of violence and aggression training

SPSP Patient Care Staff Risk Assessment & Safety Planning Initial risk assessment and safety plan in place within 2

hours of admission Updated risk assessment and safety plan in place within

72 hours of admission Risk assessment and safety plan developed in

partnership with all Patient involvement in daily risk review and positive risk

testing

SPSP Patient Care Staff Communication at transition Regular, consistent and recorded safety briefs

31.

Integration and development of Pass Plans

SPSP Patient Care Staff Staff Climate ToolSPSP Patient Care Patient/

CarerPatient Climate Tool

Person Centred Health & Care Collaborative

Patient Care Patient What Matters to You Personal Goals and outcomes Utilisation of personal outcome tools – possibly one of

above!


Patient Care Patient/Carer

Who Matters to you Traditional family Friends Any number of forms Definition of level of engagement


What information do you need Shared process Transition points


Involvement in your care (information and discussion)


Personalised contact

* crosses over different groups

Other measurements exist around:

AHP specific action plans Rights Relationship and Recovery Action Plans Employability data (more quantative) QuEST Clinical Mandatory Data Set (CORE) SPSP measurement tools Service Improvement tools

Appendix 9

INTERNATIONAL BENCHMARKING INDICATORS IIMHL

32.

DOMAIN/MEASUREMENT CONCEPT

SUGGESTED NUMERATOR SUGGESTED DENOMINATOR

Seclusion – inpatients having seclusion

Total number of inpatients having seclusion

Total number of inpatientdischarges

Restraint - Percentage of clients restrained at least once during the reporting period

Total number of inpatients who were restrained at least once during the reporting period

Total number of inpatients who were inpatients at the facility during the reporting period

Adverse events - Safety Total number of adverse events (i.e., medication errors, falls, self-harm)

Total number of inpatient days

Inpatient Assaults – Inpatients assaulted by staff, visitors or other patients

Total number of inpatients who were assaulted during an admission

Total number of inpatients

Involuntary/ Compulsory Hospitalization - Involuntary (forced) admissions in psychiatric hospitalization (inpatient)

Number of involuntary (forced) admissions to inpatient stays

Total number of admissions to inpatient stays

7-Day Follow-up after Inpatient Discharge -Outpatient follow up after inpatient discharge

Number of episodes of hospitalization for primary mental health diagnosis in which the patient received a follow up outpatient visit (not ER visit) within 7 days after hospital discharge

All episodes of hospitalization for a patient with a primary MH diagnosis

Presence/ Adequacy of continuity of Care Plan/ Discharge Plan –Post discharge continuing care plan created

Psychiatric inpatients for whom the post discharge continuing care plan is created and contains all of the following: reason for hospitalization, principal discharge diagnosis, discharge medications and communication of recommendations to next level of care.

Psychiatric inpatient discharges

Medication Adherence – Use and adherence to antipsychotics among patients with schizophrenia in continuing care

Calculate the % of days covered by prescription fills for antipsychotic medications during the measurement year. Adherence will be measured by the medication possession ratio (MPR). Individuals with 0% MPR did not fill any prescription for antipsychotic medications.

Continuously eligible individuals ages 19 years or older by the end of the measurement year with schizophrenia

33.

Polypharmacy - Proportion of patients w/ schizophrenia receiving two or more antipsychotic medications

Patients in the denominator with simultaneous prescriptions for two or more oral antipsychotic agents for 90 or more days during the measurement period

All patients diagnosed with Schizophrenia prescribed at least one antipsychotic agent during the measurement period

Functioning (Change in the daily functioning of the client) – Percentage of clients per diagnosis group, where daily functioning measured both before and after: (1) has improved; (2) has stabilized

Number of clients per diagnosis group where daily functioning measured both before and after: (1) has improved; (2) has stabilized

Total number of patients per diagnosis group who were assessed with a standardized measure (e.g., GAF, HoNOS, etc.)

Symptom Reduction -Reduction in target symptoms during new treatment episode

Patients in the denominator who within the 3-months following a new treatment episode have a documented reduction in score based on a standardized measure/instrument

Patients with a new treatment episode and at least two standardized assessments using the same tool within 90 days of the start of the new treatment episode

Housing - Percentage of service users in independent housing

Number of mental health and addiction service users who were assessed to be in need of housing and who received housing services during the measurement period

Total number of mental health and addiction service users who were assessed to be in need of housing during the measurement period

Death Rates - The death rate by age group for people with severe and enduring mental illness compared to the average population (adjusted for demographic factors)

Death rate by age group for people with severe mental illness

Death rate by age group for average population (adjusted for demographic factors)

Wait Times - Average wait times for individuals referred to a MH provider

Number of days for all individuals from date of referral to date of first visit with a MH care provider

Total number of individuals referred minus those who never had a visit

Use of Services in Relation to Need - Number of people with severe mental illness using services in relation to mental health needs of defined denominator

Number of people using services

Number of people who are in need of MH services within a defined denominator/ population - e.g., country, region, catchment area/ local community, etc.

Screening for substance abuse - Percentage of persons screened for substance use disorder

Number of new patients screened for a substance use disorder with an evidence based instrument during a measurement period

Number of new patients during the measurement period

34.

Survey - Patient Involvement -Patient involvement in decisions about their own care

1) Patient involvement: “Were you involved as much as you wanted to be in decisions about your care and treatment?”2) Patient satisfaction: "Were you satisfied with the care you received?"3) Perceived availability of care: "Did you get care when needed?"

Total number of patients who indicated that they were 1) involved; 2) satisfied with their care; and 3) received care when needed (agree/ strongly agree)

Total number of patients responding

Readmission (non-transfer) Readmissions within 30 days

Total number of readmissions within 30 days of discharge

Total number of inpatient discharges

Total length of inpatient stay (days) for mental health specialties and principal mental health diagnosis divided by the episodes

Total length of inpatient stay (days) for mental health specialties and principal mental health diagnosis

Total number of episodes

Carer Involvement - Carers (i.e., family members or other designated individuals) involved in developing care plans

Total number of carers involved in developing care plans

Total number of registered consumers with the mental health service

35.

Appendix 10

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Documents

MENTAL HEALTH BENCHMARKING AND DATA – POSITION PAPER€¦ · Web viewMENTAL HEALTH BENCHMARKING AND DATA – POSITION PAPER. 11.01.15. Dr John Mitchell PMO. Aim. This paper seeks