Level Health

Presenters Tanya Ewart

Elida Meadows

Russell Roberts

Equally Well - together we can make a difference

#EquallyWell

www.equallywell.org.au

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The Facts:People who experience mental health conditions have:

Cunningham et al. NZMJ 2014 127:1394 www.equallywell.org.au

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Physical health of people living with SMI

3

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Comorbidities

• 80% of people living with a mental illness have a chronic physical illness (ABS,2017)

• 55% have two or more co-existing conditions(AIHW, 2017)

• 20% of people with a physical illness have a co-existing mental illness (ABS, 2015)

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Number of premature deaths is high in Australia for peopleliving with mental illnessABS 2017

0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000

Trachea, bronchus and lung cancer

Ischaemic heart diseases

Chronic lower respiratory diseases

Colon, sigmoid, rectum and anus cancer

Breast cancer

Intentional self-harm

Blood and lymph cancer

Cerebrovascular diseases

Diabetes

Annual number of premature deaths of persons with mental illness in Australiaby cause

Mental illness Rest of the population

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The risk of premature death is high in Australia for peoplewith mental illnessAbs 2017

51

51

52

52

55

56

56

61

64

13

0% 20% 40% 60% 80% 100%

Blood and lymph cancer

Colon, sigmoid, rectum and anus cancer

Diseases of the urinary system

Intentional self-harm

Diabetes

Trachea, bronchus and lung cancer

Breast cancer

Prostate cancer

Chronic lower respiratory diseases

Persons accessing MBS/PBS mental health related treatment

mental illness

rest of pop'n

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Relative risk of early deathABS, September, 2017

7

0

1

2

3

4

5

6

7

8

9

10

Stan

dar

dis

ed d

eath

rat

e

General Population

Mental Illness

MI and disadvantage

MI and rural

MI and male

MI and not in workforce

www.equallywell.org.au

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Relative risk of early deathABS, September, 2017

8

0

1

2

3

4

5

6

7

8

9

10

Stan

dar

dis

ed d

eath

rat

e

General Population

Mental Illness

MI and disadvantage

MI and rural

MI and male

MI and not in workforce

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The Paradox - Dying for a Life Worth Living…

“Many people are spending years living with undetected

but treatable physical health problems and people are losing their lives because

things have been picked up too late”

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The Drivers of Inequities

Health systems

Workforce issues

Exposure to known risk

factors

Psychotropic Medication

Socio-economic

status

Adverse childhood

experiences

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Taking Action

Health Systems >

Integrate practice

Address Stigma & discrimination

Workforce Issues >

Address diagnostic overshadowing

Exposure to known risk factors >

Support healthy lifestyles

Psychotropic Medication >

Prescribe for wellbeing

Socio-economic status >

Support employment aspirations

Adverse Childhood Experiences >

Trauma informed care

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2014: A Call to Action

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WE are here

Stakeholder interviews

Grey Literature

Review

Published literature Review

Draft

Workshop Materials

Consensus Building Workshop

AdditionalStakeholder interviews

Grey Literature

ReviewCont.Broad Consultation

Draft

Background Paper

DraftConsensusStatement

FinalConsensus

Statement and Background Paper

Endorsement by OrganisationsMental Health Drug and Alcohol

Principal Committee

EWIC

ExpertAdvisory

Group

Implementationand

collaboration

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Building on a strong base

• 6 focused reports (Australian)

• 10 state and territory mental health plans

• 6 national mental health plans

• 7 Australian consensus statements

• 41 state and territories mental health/physical health clinical guidelines and related policy documents

• 8 international ph-mh statements/plans/platforms

• 125 reviews, reports, research papers.

15https://equallywell.org.au/

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Working in partnership

16

1

2

3

4

5

6

7

Av All Items

7

P

o

i

n

t

R

a

t

i

n

g

S

c

a

l

e

COMPARISON RATINGS OF 80 CONSENSUS ITEMS FOR 8 WORKSHOP GROUPINGS AND TOTAL SAMPLE

Av Total sample Psychiatrist -clinician (3) Service Provider (10) National Organisation (7) Other - misc (4)

Academic Researcher (3) Professional Colleges (8) State Terrritory MH (11) Carer -Consumer (8)

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EW

Promote

Awareness

• Stakeholder database

• Communication strategy

• Website

• Social media campaigns

• Newsletters

• Symposium

Facilitate Collaboration

• Virtual communities

• Social and digital media

• Connecting initiatives

• Symposium

Set Targets & Measure Progress

• National snapshots

• MHISSC data/targets

• ABS monitoring

• Self evaluation

• Web-based analytics

• Stakeholder consultation

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EW

Measure Progress

• Audit tool. Test-retest

• MHISSC data/targets

• ABS monitoring

• Self evaluation

• Web based analytics

• Stakeholder consultation Promote

Awareness

• Stakeholder database

• Communication strategy

• Website

• Social media campaigns

• Newsletters

• Symposium

Facilitate Collaboration

• Audit of activities

• Symposium

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A health system…?

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in the universe of Australian health and human services

Shared vision

Pro

mo

te awaren

ess

SQPSCNT

SA

WA

QldNSW

Vic

Tas

ACTCom

MHISSC

NT

SA

WA

QldNSW

Vic

Tas

ACTCom

NMHCCFNT

SA

WA

QldNSW

Vic

Tas

ACT

MHPCNT

SA

WA

QldNSW

Vic

Tas

ACTCom

Com

AMSs

GPs

ANMF

APS

PHNs

Faci

litat

e co

llab

ora

tio

n

HeAL

Measure progress

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A Growing Movement

Since November 2014,

it has grown from 8

organisations to more than 200

in ANZ

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Aust

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Te Pou o te Whakaaro Nui

• 2014 Evidence review

• 2017 Evidence update

National Mental Health Commission

• 2018 Narrative review

Evidence Informed

www.equallywell.org.au

1981 2013

Over 20,000research publications

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Increasing access to primary care: Canterbury’s Equally Well extended GP consults

Four extended consultations per year for everyone who has been, or is expected to be, on antipsychotics for more than 3 months

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Diabetes strategy (p.21)

• By 2020 there should be routine diabetes screening for all people who experience mental health and addiction issues.

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Current policy directions

• National Consensus Statement

• National Mental Health Commission Report Card

• ACSQHC – Health care standards – Health service standards

• ABS tracking and reporting (Sept 2017)

30https://equallywell.org.au/

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Involve patients in co-

designing service or practice solutions

Offer “stepped” solutions –

alternative and complementary

medicine, not just pharmacological

Empower Patients to

Self-research solutions and bring

them to you

Screen for deficiencies

(i.e. B12) and Inflammatory Conditions/

Autoimmunity

Connect people with

formal or informal Peer

Support

Offer longer appointments,

employ nursing or admin for

holistic/root cause screening questions

What can YOU do to improve people’s wellbeing?

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WHO Multilevel ModelLiu et al. (2017) Roberts, Locket, Bagnall, Maylea, Hopwood (2018)

Individual-focused interventionsMental health disorder management•Early detection and appropriate treatment•Interventions delivered at critical time points (e.g., within first year of discharge from hospital)•Recovery-oriented treatment (e.g., service-user involvement, informed choice)Physical health treatment•Early detection and appropriate treatmentLifestyle behaviour interventions•Tobacco cessation•Behavioural weight management programmes, including healthy diet, physical activity•Interventions addressing substance abuse and risky sexual behaviour

Health system-focused interventionsService delivery•Screening for medical conditions•Care coordination or collaborative care strategies (e.g., nurse care manager)•Guidelines for integrated delivery of mental and physical health care

Community level and policy-focused interventionsSocial support•Peer support programmes•Family support programmes•Mental health and consumer advocacy groupsSigma reduction interventions•Directed toward communities with SMD and general publicLifestyle behaviour interventions•Comprehensive health care packages, insurance parity and quality•Public health programmes(tobacco cessation, HIV prevention, suicide prevention)•Employment, housing, and social welfare sector involvement

Level Health

Get your organisation and/or professional body to endorse the consensus position paper

Sign up to receive the Equally Well e-news

Be part of the discussions on the Equally Well online

Spend some time today thinking about one or two actions you can start tomorrow…

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Join the conversation

Equally Well Symposium

Melbourne,

28, 29 March 2019

Supported by RMIT, CSU, NMHC

www.equallywell.org.au