MONASH Health’s psychology director Dr Melissa Carey saw a problem with mental health services and produced an award-winning solution. Her community-based clinic in Berwick has been rated a success by staff and patients and is set to open two more branches next month. The answers came when the clinic’s founders put their patients’ needs first. CAMERON LUCADOU-WELLS reports.
INTUITIVELY it makes sense for any hospital or GP centre to put patients first.
That’s even more important if the patients have suffered a mental health crisis, and are perhaps suicidal.
Sadly, despite best intentions, it has not always been the case.
In one instance, a middle-aged man was referred to a hospital emergency department after a suicide attempt.
In the next two months, he went through 13 case managers who recorded 70 case updates, 18 hand-offs between staff, and was listed on five IT systems and 15 sets of paper records.
Despite all the attention, after two months of steady improvement, the man attempted suicide again.
Dr Melissa Casey, director of psychology at Monash Health, uses the case study to illustrate why she has overseen an award-winning change.
In terms of service delivery, the man’s intensive treatment had met its targets, Dr Casey said.
But the question was asked: what value did all of that activity have for the human being?
One change was to install a sensory room for under-25s – an ambient place of soft music and meditation exercises as an alternative to an emergency department.
There were high numbers of mental health patients at crisis point arriving at Monash Health hospital emergency departments – not ideal environments for a person needing calm.
“People can be quite agitated and there can be quite a lot of sensory stimulation – a lot of people coming and going, bright lights, lots of noises. It’s not a calm environment.
“We knew we had to do something.”
But more significant has been the pilot of an agile psychological medicine clinic in Berwick in February 2012.
As of last week, it has had 222 referrals – about 90 per cent of whom had attempted suicide and were in great distress.
Many of the patients’ conditions were complicated by ice, alcohol and other drug addictions.
The clinic, formed by Dr Casey with Professor David Clarke, was also set up in the hub of a much-documented suicide cluster afflicting City of Casey youth.
Early results are encouraging.
The 59 patients surveyed had shown significant clinical improvement and gave on average a 97 per cent satisfaction rating for their therapists.
Staff satisfaction was also high because they could see they were making a difference, Dr Casey said.
There has been a significant reduction in those patients presenting in crisis at the emergency department.
More are living safely within the community.
The trial has expanded into two further clinics that are set to open at Eastern Medical Centre in Cleeland Street, Dandenong, and at Clayton Community Mental Health next month.
The program won a Victorian Public Healthcare Award in the mental health category for its innovative program.
At the heart of the clinic’s success is the strong patient-therapist relationship, Dr Casey said.
The patient is linked to a GP – not 13 case managers – throughout their specialist psychological treatment.
If there’s a crisis, the clinician becomes the go-to point, not through several sets of nurses and specialists’ hands at the emergency ward.
She said the aim was to improve the relationship between patient and therapist.
Once there’s trust, patients are more willing to buy in to a change, to tackle the underlying issues causing them distress.
“If the patient has faith, hope and trust that the clinician has the expertise, has listened and is working with them in partnership, that produces the best possible outcome.”
The guiding question was also whether clinicians were meeting their patients’ needs, rather than simply service-delivery targets.
To find out, they mapped clients’ experiences and got their constant feedback after each session.
“We want every session to be worthwhile,” Dr Casey said.
“We asked patients: ‘if it’s not working for you, what can we do?’”
Unexpectedly, the program germinated at the Australian Taxation Office.
Dr Casey had once helped design a service model in the midst of significant change to the income tax system.
Consumers and ATO staff’s input were enmeshed in its co-design.
The process demonstrated that while a lot of corporate and public sector change comes from the top down, true innovation also needed more input from the bottom up – from the frontline staff and consumers.
“People talk all the time about ‘true innovation’.
“But it’s so hard to change and it’s because there’s not a system that supports the top down and bottom up processes.”
It’s a change of approach that could be applied across all health services, Dr Casey said.
To access the clinics call the 24/7 psychiatric triage service on 1300 369 012.
In an emergency, go to Monash Health’s three emergency departments at Monash Medical Centre, Dandenong Hospital or Casey Hospital.