| Synopsis : |
Consumers, families, clinicians, services and governments all assess the outcomes of mental health services. Often this an informal process, with limited discussion of the findings. Many now want to do it better and to see the results used appropriately. This is part of a wide movement in health care and other areas of public life in Australia and other countries. It is linked with concerns that services are accountable, are engaged in a constant endeavour to improve the quality of their work, and use the available resources in the best and fairest way possible.
This includes the drive to ensure that evidence influences practice in an appropriate way. In mental health care, all of the above groups are especially concerned that the effects of discrimination are not perpetuated, and that the nature of mental illnesses, their broad effects, and the need for continuing care to maintain as well as to improve quality of life is recognised and included in calculation of resource provision.
The project reported here is part of the work commissioned by the Commonwealth to address two key objectives of the first National Mental Health Strategy relating to outcomes assessment (see p1). The first phase of the work (Andrews et al, The Measurement of Consumer Outcome in Mental Health, 1994) provided a clear review of the field and recommendations for further testing of six outcome measures. Three of the recommended measures use self reports from consumers, and three are based on clinician assessments. This was the starting point for the present project. The formation of the Project Advisory Group allowed a group of people with a range of expertise and representative views to engage in dialogue with the project group who had successfully tendered to undertake the work. This process allowed consumers, a carer, service providers in several specialist mental health and primary health care settings, and experts in measurement, evaluation and information systems to learn from and influence the project. The project group provided remarkable and consistent leadership in the project, as well as a willingness to be flexible.
The project has a clear set of findings which form the basis for a series of recommendations for the next phase of the work. The recommendations take account of the pressing need to make practical advances in the field in the face of competing pressures for health care and social resources, and the equally important need to avoid simplification and stultification in the assessment of outcomes. Both of these sets of pressures point in the same direction: the need to integrate this area with developments in quality management and evidence-based practice in mental health care, and the introduction of local information systems.
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