ngo grant - successful mental health program in australia

7/29/2019 ngo grant - successful mental health program in Australia

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31 July 2012

ANNUAL REPORTNGO GRANT

NORTHCOASTLOCALHEALTHDISTRICT&

MIDNORTHCOASTLOCALHEALTHDISTRICT

1ST JULY 2011 - 31ST JULY 2012


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ABSTRACT

The following report is indicative of the success of the NGO Grant program for the

2011/2012 year. The results have been compiled through a comparative cost analysis

along with both qualitative and quantitative data of the services delivered. On Track

Community Programs have not only provided services as specified within the contract

from the NSW Health, but have clearly demonstrated a cost saving to the department forthe 2011/2012 financial year.

In addition to meeting all key performance indicators further evidence of the

effectiveness of the program have been exemplified through quantitative data collated

for 12 months pre and post intervention. This data was compiled through a snap shot

audit report utilising both internal and external records from NSW Health, Housing NSW

and On Track Community Programs. Further validity was attained through qualitative

data from direct interviews with ex-participants of the service.

On Track Community Program Snapshot Report 2 | P a g e


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OUTLINE IN BRIEF ALL SERVICES PROVIDED IN2011/2012

USING NSW HEALTH GRANTS

SERVICES PROVIDED

On Track Community Programs entered into an agreement with North Coast Area Health

Service to provide the following psychosocial support and rehabilitation services across

the Tweed/Byron and Lismore regions.

Residential Rehabilitation

Outreach accommodation support across the region

The funding allocation for the above supports is $1, 319,790 for North Coast Local Health

District, with an additional amount for the Mid North Coast of $424,500, an overall

allocation of $1,744,290 per annum.

KEY PERFORAMCE INDICATORS

The following Key Performance Indicators (KPIs) were developed by NSW Health in

collaboration with On Track Community Programs to measure both qualitative and

quantitative evidence to track program efficacy as well as inform service improvements.

The key performance indicators utilised below are those reported against during the

2011/2012 financial year before the newly agreed contractual obligations were

instigated.

1. Grant funding cost per consumer

a. Number of consumers / annual funding amount (annual cost) (divide by = quarterly cost)

2. Percentage of outreach hours in direct face to face care provided by fundedprogram

a. Benchmark 60% face to face hours

3. Percentage of 13 week clinical reviews attended for joint consumers

a. Benchmark 100%

4. Quality improvement activity collaboratively developed, implemented andevaluated with MHS over 12 months.

a. Benchmark; narrative of evidence of quality improvement activity progresseach quarter

5. NGO demonstrates compliance against 5 National Mental Health Standards forMental Health Services (2010)



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a. Benchmark; narrative evidence of specific occasions of service that meetfive different National Health Standards per quarter.

The key performance indicators have been reported against from July 2011 to June 2012

based on the previous contract and quarterly reporting templates advised from NSW

Health. The newly agreed contract which is awaiting Ministerial signature, with the

revised key performance indicators will begin in good faith as of July 1st 2012.

PERFORMACE AGAINST INDICATORS PER QUARTER

The tables below illustrate the performance per quarter for each area. There is a

discrepancy in average cost per consumer as a direct result of the unequal funding

allocation per site. Overall figures are calculated in table 3, and are indicative of overall

program costings. The additional KPIs of quality improvement and compliance against

National Mental Health Standards are articulated as met for the sake of brevity, and

evidenced by quarterly reports.

$627,505

Lismore

Number of

Consumer

s in 24/7

Support

Number of

Consumer

s in

Outreach

Support

Total

Number

of

Consume

rs

Percentag

e

face/face

hours

Cost per

Consumer

per

Quarter

1. July -

September

14 19 33 62% $

4,753.002. October -

December

16 14 30 63% $

5,229.003. January

March

17 12 29 62% $

5,409.004. April June 29 9 38 74% $

4,128.00

Quality Improvement activity collaboratively developed, implemented and evaluated

100% each quarter as evidenced in quarterly reports.

Compliance against 5 national Mental Health Standards 100% met each quarter as

evidenced in quarterly reports.

$692,285

Tweed

Heads/Byron Bay

Number of

Consumer

s in 24/7

Support

Number of

Consumer

s in

Outreach

Support

Total

Number

of

Consume

rs

Percentag

e

face/face

hours

Cost per

Consumer

per

Quarter

1. July -

September

5 24 29 56% $5,968 .

002. October -

December

7 24 31 65% $5,583 .

00



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3. January

March

3 26 29 66% $5,968 .

004. April June 5 27 32 74% $

5,409.00




evidenced in quarterly reports

$424,500

Coffs Harbour Number of

Consumer

s in 24/7

Support

Number of

Consumer

s in

Outreach

Support

Total

Number

of

Consume

rs

Percentag

e

face/face

hours

Cost per

Consumer

per

Quarter

1. July -

September

0 34 34 60% $

3,121.002. October -

December

0 36 32 63% $

3,316.003. January

March

6 19 25 66% $

4,245.004. April June 6 17 23 72% $

4,614.00




evidenced in quarterly reports

N.B It is noted that due to transitioning into a new model of support as per the request

of NSW Health, residential rehabilitation was not provided pre January 2012, therefore

the increased outreach statistic through the provision of a variety of day program

supports.

ANNUAL PERFORMACE AGAINST INDICATORS

Successfully working alongside of 346 consumers on the North Coast of NSW to reachtheir individual goals of wellbeing and recovery On Track Community Programs are

outcomes focussed whilst still reaching all KPIs exceeding face to face percentage by

over 5%, whilst keeping the annual cost per consumer to a minimum of just over $17,000

per annum.

Lismore & Tweed

Heads/Byron Bay

Combined

Number of

Consumer

s in 24/7

Support

Number of

Consumer

s in

Outreach

Support

Total

Number

of

Consume

rs

Percentag

e

face/face

hours

Average

Annual

Cost per

Consumer



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1. July 2011

June 2012

73 145 228 65.25% $18,935.

00

Coffs Harbour Number of

Consumer

s in 24/7

Support

Number of

Consumer

s in

Outreach

Support

Total

Number

of

Consume

rs

Percentag

e

face/face

hours

Average

Annual

Cost per

Consumer

1. July 2011

June 2012

12 106 118 65.25% $15,296.

00

NB: The differing amounts per region are a reflection to Coffs Harbour beingfunded at a lesser amount and with On Track agreeing for 12 months to fundthe shortfall.

OVERALL PROGRAM EFFECTIVENESS AND EFFICIENCIES

The effectiveness and efficiencies of the On Track Community Programs NGO Grant

program in the North and Mid North Coast Local Health Districts will be proven by the

wellbeing and stability of participants of this program across multiple key areas.

METHOD

Effectiveness and efficiencies were measured by assessing quantifiable indicators of

wellness for the 12 months prior to and 12 months post exit, along with a comparative

cost analysis between the cost of mental health support of NSW Health and the NGO

Grant program.

Figure 1 - Flowchart

Five wellness indicators were chosen to assess the program:

1. Hospital Admissions

2. Appointments kept with psychiatrists

3. Medication compliance

4. Accommodation stability

5. Accommodation type



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The wellness indicators cover areas of mental stability, compliance with medication and

housing stability. The additional qualitative data forwarded opportunity for the

participants themselves to add humanity to the figures through feedback and interviews.

Congregated data from primary and secondary sources were collated inclusive of; NSW

Community Mental Health Case Managers, NSW Housing, On Track Community Programs

database along with the participants themselves.

RESULTS

A snapshot review of 35 participants who exited the service during the last 12 months,

along with qualitative data from interviews conducted with 28 ex-participants of the

program.

Table 1 - Average responses to Indicators

Indicator 12 Months Prior to

Exit

12 Months Since

Exit

1. Hospital AdmissionsNumber of admissions to the mental health

unit

1.2 0.3

2. Appointments with

psychiatristsAppointments attended

3.2 4.9

3. Medication non-complianceNumber of times medication non-compliance

recorded

3.6 1.4

4. Accommodation stabilityNumber of relocations

2.7 0.8

5. Accommodation typeNumber of consumers in own accommodation

3 18

Table 2 - Transition through accommodation types

Accommodation type Prior To

Intake

On Exit 12 months post

intervention

Patient in Mental

Health Ward

18 0 0

Own Accommodation

3 13 18



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Staying With Family or

Friends

4 12 7

No accommodation

2 0 0

At 12 months post-intervention a 79% reduction in mental health unit episodes

clearly exemplifies not only the reduction in fiscal and human resources to the

NSW Government, but also demonstrates the increased dignity and independence

of these individuals.

The increased engagement of the consumers post intervention with the mental

health system is demonstrated through the 75% increase in appointments kept

with Psychiatrists.

Accommodation stability is a strong indicator of mental stability with the majority

of consumers entering the program under a status of homelessness, and exiting

in stable and sustainable housing is exemplary.

Figure 2 - Pre & Post Results for Assessed Indicators



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Figure 3 - Transition of Housing Types over Time

Accommodation Type

QUALITATIVE FEEDBACK

A concise collation indicating the large majority of consumer feedback is inclusive of the

following;



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Mandara decreases my stress

Makes me more relaxed

I can deal with my voices and hallucinations better

Helps me relax

I am not alone, I enjoy the company of other residents and staff

I no longer need any pills

I have been homeless for years, now I have my own place

COMPARITIVE COST ANALAYSIS

This cost analysis forwards a comparison of psychiatric hospital care and community care

within the NGO Grant Program. Expenditure and income data in both settings were

collected with costs analysed on an episode per consumer basis.

The NSW Health estimated bed cost per day across the region is $862, with the annualcost standing at $311,710 per annum. With an average hospital stay of seventeen days

per episode across North Coast and Mid North Coast Local health Districts, equates to

cost for NSW Health of $14, 654 per stay. This extensive cost presents an overwhelming

need to decrease the prevalent relapse rates, which will show a direct correlation to the

reduction of the fiscal and human costs associated with mental illness. At the 12 month

pre intervention rate of 1.2 hospital stays per consumer, as noted previously, equating to

$18,317 per consumer. For the 346 consumers currently supported across the region, an

average of 1.2 episodes per consumer equates to an overall cost of $ 6,337,682 to NSW

Health.

This figure is then extrapolated over the estimated 75% reduction in hospital stays from

1.2 average episodes to .3 stays 12 months post intervention from the NGO Grant

program, at $ 1,584,420. This equates to an estimated annual cost savings of $4,753,262

for the North and Mid North Coast Area Health Service.

According to a recent extensive national study undertaken by SANE, the average length

of hospital stay per consumer is 40 days per episode. An assumption is therefore made

that for consumers on the North and Mid North Coast, an early discharge is only

achievable due to the step down support available at the On Track 24/7 facilities.

Therefore an estimated saving of $19,826 per consumer per episode can be assumed.

An average cost per consumer supported through the NGO Grant is $17,000 per annum

per consumer. With the additional salary of community mental health staff of $66,200

holding an average client load of 17. Additional 30% on-costs = $87,600 / 17 = $5,152

clinical supports provided.



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Total cost per consumer in the community with both NGO Grant support coupled with

clinical supports from community mental health equates to $22,152 per consumer per

year.

OUTLINE ANY INTERACTION BETWEEN YOURORGANISATION, OTHER NGOS, GOVERNMENT

DEPARTMENTS AND HEALTH SERVICES

The overall success of the NGO Grant program can be attributed to the collaboration of

our partners across both the NSW Health system and the wider community sector. During

the last 12 months NSW Health provided high quality case management for program

participants, along with the clinical advice and support to On Track staff. The strong

partnership between North Coast Area Health Service and On Track Community

Programs have provided the opportunity for joint case planning, complex case

coordination and well planned entries and exits to the service has proven invaluable. This

partnership is demonstrated through ht following across the region;

The attendance of On Track key staff to 100% of the 13 week clinical reviews in

each location,

Attendance of On Track staff to 100% of ward rounds.

Attendance of On Track staff to Case conferences for complex cases as required.

100% attendance of all NSW Health partnership meetings.

Continual communication mediums through individual face to face meetings when

requested by either party, email and written correspondence.

Regular face to face meetings between the Manager Partnerships, NSW Health

and Executive staff of On Track Community Programs.

100% submission of all reporting requirements.

Attendance of annual program reviews across the region.

Cross invitation between On Track staff and Area Health staff on interview panels

100% attendance from On Track staff to all specific meetings, e.g. collaborative

discussions around recovery tools, cross department training and other

imperatives for improved service delivery.

Open door policy between On Track Community programs and our North Coast

and Mid North Coast Area Health partners

The above are just a few of the daily indicators of this partnership in action.



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Below are an example of the varied active partnerships with other community and

Government departments across the region.

PARTNERSHIPS IN ACTION

One of many examples, which clearly demonstrates the success of crossGovernment and community partnerships to support complex cases within the

NGO Grant program;

SP presented with a diagnosis of Bipolar disorder and frontal lobe damage from a recent

overdose. On Track liaised with a number of partners, including SPs Guardian, an

appointed advocate, and ADHC. The Department of Ageing, Disability and Aged Care

have assisted with costs associated with neuropsychologist assessments, at the Lismore

Adult Mental Health Unit, with psychiatrists compiling a full psychiatric assessment.

Whilst in care, NSW Housing have agreed to maintain SPs housing status to allow


Switch (NRSDC)

North Coast CommunityHousing

District Mental Health

Community Mental health

NSW Housing

LAMHU

Lived Experience Project(NRSDC)

On Track CommunityHousing

On Track HomelessnessService

New Horizons HASI

New Horizons PHAMS

New Horizons RRSP

Office of the ProtectiveGuardian

Commonwealth CarerRespite centre

Bugalweena

Nexus Mental Health Rehabilitation &Recovery Service

ADHC

Carers NSW

Gurgun Bulahnggelah

Tarmons House Mental Health Service

Lismore Sexual Health Service (SHAIDS)

Riverlands Drug & Alcohol Centre

Interrelate

On Track Australian Disability Enterprise

Prema House Medical Centre

On Track HASI

CASPA

Centrelink

Community Centres


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efficient time for On Track staff have worked alongside of SP to achieve her goals with

independent living skills.

Due to this partnership SP is able to live three days a week with her daughter in her own

NSW Housing property, and four days a week in On Tracks psychosocial residential

rehabilitation. The assessments have informed support levels across several Government

Departments and community services to ensure that SP will achieve her goal to live

permanently with her daughter. SPs daughter continues to receive specific Carer support

from Carers NSW.

CONCLUSION

The analysis demonstrated overall that with limited fiscal and human resources, the NGO

Grant program attained the overall objective to provide a continuum of care and support

that is efficient, effective and person centric. The provision of this fluidity of supports has

clearly reduced the inpatient episodes per consumer by 75%.

The economic imperative alone clearly communicates program efficiencies, when these

are coupled with wellness indicators and evidence of positive partnerships, provides

insight into the human aspect that the NGO Grant program is successful in assisting

people to increase their overall level of wellness.

ACKNOWLEDGEMENTS

On Track Community Programs acknowledges that the success of the NGO Grant

program has been through the ongoing support of our clinical partners across the LHD,

where many staff continues to work above and beyond the roles to work alongside On

Track to increase the wellness of our most vulnerable members of the community.

We also acknowledges the contributions to this report from the following staff; Chris

Maylea BSW MHSMP, Mental Health Services Manager, Jodi Watts, Residential Services

Coordinator, Christopher Tricker, Mental Health Support Worker.


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