Mental Health Commission of Western Australia
Feedback on the Consultation Paper
Definition and Cost Drivers for Mental Health Services
prepared by the University of Queensland for the Independent Hospital Pricing Authority to assist the
development and specification of a mental health classification system
Thank you for the opportunity to provide feedback on the above consultation paper.
The Mental Health Commission is responsible for strategic policy development,
service planning, funding and performance monitoring of specialised mental health
services in Western Australia and is very committed to ensuring that mental health
services and related activity are appropriately defined, counted, classified and
costed. The consultation paper provides a useful foundation for facilitating
discussions on these important issues.
We look forward to the outcomes of this work
Consultation questions
Section 1: National Mental Health Care Type
Consultation Question:
Is a Mental Health Care Type the best way of encompassing those admitted services
that should form part of a new national mental health classification? If not, what
alternative would you propose?
Response:
The proposed approach of using a Mental Health Care Type to identify admitted
mental health services is supported. However, there needs to be clear criteria and a
decision making tree/agreed protocols for assigning the mental health care type(s)
based on an agreement of what is the definition of mental health services in scope
for ABF.
In addition, a new care type category (e.g. 11.0 Mental health care - admitted care)
may need to be complemented by sub levels such as: 11.1 Mental health acute care;
11.2 Mental health sub acute care; 11.3 Mental health non acute care, unless the
mental health classification itself will be capable of categorising different sub types
on the basis of some other data items.
It may also be important to consider target populations receiving care (Children and
Adolescents, Youth, Adults and Older Adults) in a new mental health classification
system.
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Section 2: Establishing criteria for the definition of services within a national
mental health Care Type
Consultation Question:
What should be the criterion, or criteria, for the definition of services within a national
mental health Care Type?
Response:
As indicated in the Consultation paper, it would seem reasonable to define the
mental health care type to include treatment provided in specialised mental health
units or by a specialised mental health program.
Section 3: Applying the definition of ‘mental health services’ to communitybased mental health services
Consultation Question:
What community-based mental health services should be defined as mental health
services for casemix classification purposes?
Response:
All ambulatory services provided by a specialised mental health program including
outpatient services and outreach. Special consideration should also be given to
mental health consultation liaison services.
Section 4: Defining primary mental health services delivered by public
hospitals
Consultation Question:
Are there any services that are provided by specialised mental health units or
programs that can be considered primary mental health?
Response:
Generally, primary mental health services are provided outside specialised mental
health units or programs. However, there is a small component of services provided
by specialised mental health services that would be considered to be primary care
e.g. services in some rural and remote areas where a GP service is not available.
This is a real concern in Western Australia.
Section 5: Services for people whose primary problem is an alcohol or drugrelated disorder
Consultation Questions:
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Should the mental health classification include alcohol and drug-related disorders? If
so, is it the diagnosis or specialised treatment setting that is used as the decisive
criterion for inclusion in the definition?
Response:
It is recommended that the mental health classification include alcohol and drugrelated disorders, however specialised treatment setting is used as the decisive
criterion for inclusion in the definition.
Section 6: Classifying specialised ‘non-acute’ bed-based mental health
services
Consultation Question:
Should long-term non-acute bed-based clinically-staffed mental health public hospital
services be classed as residential, admitted mental health or admitted maintenance
care?
Response:
Long-term non-acute bed-based clinically-staffed mental health public hospital
services should be classed as admitted mental health. In Western Australia mental
health residential services are predominately provided by NGOs with in reach clinical
services provided by mental health community teams.
Section 7: Setting the boundary with aged inpatient Care Types
Consultation Question:
Should the Psychogeriatric Care Type continue to exist or should all of the mental
health care of older people be defined as Mental Health for classification purposes?
Response:
All Older Adult mental health inpatient care should be classified as Acute, Sub Acute
or Non Acute. These definitions need some clarification, but the main principles
would be that:
Acute mental health care for the elderly relates to assessment and treatment of
acute and/or unstable mental health conditions.
Sub-acute mental health care for the elderly relates to ongoing assessment and
treatment of a patient whose acute mental health issues have been addressed and
treated, but that full recovery has not been completed and/or significant psychosocial
issues are present that require resolution before the patient can return to
accommodation in the community
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Non-acute care relates to ongoing assessment and treatment of a patient whose
mental health issues have been addressed and are stable, but that complex care
needs preclude placement in available community accommodation
This approach would mean that the term “psychogeriatric care” will become
redundant as it is often inconsistently understood and applied.
Section 8: Emergency department care for patients with a mental disorder
Consultation Question:
Should mental health care in the emergency department (ED) be defined as ED or
Mental Health for classification purposes?
If mental health encompasses emergency department care services, how should
these services be classified (e.g., diagnosis based on MDCs?)
Response:
There should be a diagnostic code/flag for mental health patients in ED. The new
classification for mental health could include a sub-classification for ED.
URG classification is of limited value for mental health.
Consideration should be given to the role of mental health consultation liaison
services in EDs.
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