Western Australia's mental health court liaison service

Jailing is failing: psychiatry can help

There is accumulating evidence that imprisonment is expensive but does little to address the underlying drivers of offending. At the same time, it is now recognised that a large proportion of prisoners are diagnosable with significant psychiatric disorders. In this piece we explore the potential role of psychiatry in addressing the societal challenge of a failing prison system. We argue that core psychiatric skills of engaging in balanced, values-based thinking and implementing sound clinical processes can play an important role in reducing reoffending risk. We briefly discuss some of the key challenges involved and outline several relevant service models.

Admissions to the Western Australian state forensic hospital from court on hospital orders over a 10-year period from 2007 to 2016

OBJECTIVE

To investigate trends in admissions to the state forensic hospital (Western Australia (WA)) from court on hospital orders from 2007 to 2016.

METHOD

A retrospective survey was undertaken. Demographic, clinical and legal data were obtained from hospital records. Hospital orders referred on less serious charges or without a primary diagnosis of major mental illness were identified as 'non-forensic'.

RESULTS

There were 890 hospital orders representing 40% of total admissions. Eighty-one per cent were male and 50% had a diagnosis of schizophrenia; 22% were Indigenous; 421 (47%) were admitted on less serious (non-Schedule 1) charges; 199 (22%) did not have a primary diagnosis of a major mental illness recorded on the discharge summary; 82 (9%) had neither major mental illness nor serious charges. Overall, 539 hospital orders (60%) were identified as non-forensic; 243 (45%) of these were made with no input from the Court Liaison Service (CLS).

CONCLUSIONS

Hospital orders make up a significant proportion of admissions to the forensic unit in WA. Many do not require secure forensic care. Developing alternative diversion pathways is essential.

Key performance indicators for Australian mental health court liaison services

OBJECTIVES

The aim of this paper is to describe the development and technical specifications of a framework and national key performance indicators (KPIs) for Australian mental health Court Liaison Services (CLSs) by the National Mental Health Court Liaison Performance Working Group (Working Group).

METHODS

Representatives from each Australian State and Territory were invited to form a Working Group. Through a series of national workshops and meetings, a framework and set of performance indicators were developed using a review of literature and expert opinion.

RESULTS

A total of six KPIs for CLSs have been identified and a set of technical specifications have been formed.

CONCLUSIONS

This paper describes the process and outcomes of a national collaboration to develop a framework and KPIs. The measures have been developed to support future benchmarking activities and to assist services to identify best practice in this area of mental health service delivery.

What is needed to deliver collaborative care to address comorbidity more effectively for adults with a severe mental illness?

OBJECTIVE

Innovative models of care for people with a severe mental illness have been developed across Australia to more effectively address comorbidity and disability by enhancing the collaboration between clinical and non-clinical services. In particular, this review paper focuses on collaboration that has occurred to address comorbidities affecting the following domains: homelessness; substance addiction; physical ill-health; unemployment; and forensic issues.

METHOD

The identification of relevant collaborative care models was facilitated by carrying out a review of the published peer-reviewed literature and policy or other published reports available on the Internet. Contact was also made with representatives of the mental health branches of each Australian state and territory health department to assist in identifying examples of innovative collaborative care models established within their jurisdiction.

RESULTS

A number of nationally implemented and local examples of collaborative care models were identified that have successfully delivered enhanced integration of care between clinical and non-clinical services. Several key principles for effective collaboration were also identified. Governmental and organisational promotion of and incentives for cross-sector collaboration is needed along with education for staff about comorbidity and the capacity of cross-sector agencies to work in collaboration to support shared clients. Enhanced communication has been achieved through mechanisms such as the co-location of staff from different agencies to enhance sharing of expertise and interagency continuity of care, shared treatment plans and client records, and shared case review meetings. Promoting a 'housing first approach' with cross-sector services collaborating to stabilise housing as the basis for sustained clinical engagement has also been successful.

CONCLUSIONS

Cross-sector collaboration is achievable and can result in significant benefits for mental health consumers and staff of collaborating services. Expanding the availability of collaborative care across Australia is therefore a priority for achieving a more holistic, socially inclusive, and effective mental health care system.