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Preventing mental illness: closing the evidence-practice gap through workforce and service planning
Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in the policy dialogue and also in service delivery, the prevention of mental illness remains a neglected area. There is accumulating evidence that mental illness is at least partially preventable, with increasing recognition that its antecedents are often found in infancy, childhood, adolescence and youth, creating multiple opportunities over the lifespan for prevention. Developing valid and reproducible methods for translating the evidence base in mental illness prevention into actionable policy recommendations is a crucial step in preventing mental illness.
In this project we are developing and applying a needs-based workforce and service planning framework to determine the optimal workforce mix and service structures required to deliver best practice preventive care in mental illness. Specifically, the primary goal of this project is to estimate the workforce and service structures required for a given regional population (Australia) to effectively address core risk factors implicated in the development of mental illness in adults (>25 years of age) and thus reduce the incidence and prevalence of adult mental illness. These estimates are then converted into specific policy recommendations for local and national governments.
Prof Leonie Segal, Dr Gareth Furber, Prof Patrick McGorry, Dr Matthew Leach, Prof Nicholas Proctor, Ms Catherine Turnbull, Mr Mark Diamond, Ms Stephanie Miller
The Mental Health Workforce Project is an NHMRC (APP1055351) and SA Health funded project.
Furber, G., Segal, L., Leach, M., Turnbull, C., Procter, N., Diamond, M., … McGorry, P. (2015). Preventing mental illness: closing the evidence-practice gap through workforce and services planning. BMC Health Services Research, 15(1), 283. doi:10.1186/s12913-015-0954-5
Guy, S., Furber, G., Leach, M., & Segal, L. (2016). How many children in Australia are at risk of adult mental illness? Australian & New Zealand Journal of Psychiatry. doi:10.1177/0004867416640098
Economic evaluation of the intensive chronic care management delivered by Indigenous Health Workers to Indigenous adults with diabetes in 12 remote communities in North Queensland – Getting Better at Chronic Care Project
The life expectancy gap between Indigenous and non-indigenous people in Australia is 13-17 years, and most of this gap is due to preventable chronic disease in adults (e.g. diabetes, heart, lung and renal problems). Once people have these conditions, many complications can be prevented with good primary-level chronic care.
This project is a trial of an intensive chronic care management intervention delivered by Indigenous health workers to Indigenous adults with diabetes in 12 rural communities in North Queensland. Study participants who have diabetes and at least another chronic condition are offered a detailed clinical assessment at baseline, a care plan with a locally trained Indigenous health worker, and support from an Indigenous professional outreach team. The management plan includes nutrition advice, smoking cessation assistance where appropriate, and instruction in the proper use of medicines, including insulin, if needed.
The trial will follow participants for eighteen months after the commencement of the intervention. Intervention sites will be compared to control sites receiving usual care. Main outcomes include glucose and BP control, hospitalizations and wellbeing. After two years, control sites will be offered the program if it is shown to be successful.
Proposed economic evaluation components include:
- Cost and financial analysis
- To estimate the differential cost of care between intervention and usual care groups
- To estimate costs by disease severity/stage and for intervention and usual care groups
- To estimate budget impacts of the intervention model on governments (separately for the Commonwealth and State governments).
- Cost-effectiveness analysis
- To estimate differential cost per unit of differential effect (change in different health outcomes) between intervention and usual care groups.
- Cost-utility analysis
- To estimate differential cost per differential QALY gained between intervention and usual care groups.
- To model downstream impact on QALYs for intervention and usual care groups based on rates of disease progression or rates of transition between disease stages (state-transition Markov model)
Prof Leonie Segal, Dr Ha Nguyen, Prof Robyn McDermott, Prof Adrian Esterman, Dr Ashim Sinha , Ms Barbara Schmidt, Dr Mark Wenitong, Prof Wendy Hoy
NHMRC partnership grant (NHMRC and Queensland Health)
Segal L, Nguyen H, Schmidt B, Wenitong M, McDermott R. Economic evaluation alongside a cluster-randomised-controlled trial of intensive management by Indigenous Health Workers of Indigenous people with poorly controlled type 2 diabetes in rural and remote Australia. (2016) Med J Aust. 204 (5), 196. doi: 10.5694/mja15.00598
Economic Evaluation of the Family-focused Comprehensive Primary Care Model and Selected Programs - A collaboration project with Central Australian Aboriginal Congress Aboriginal Corporation – Alice Springs
Health disparities between Indigenous and non-indigenous populations are well documented. Various programs and trials have been implemented to improve Indigenous health. With a long history of providing health services to the indigenous community in Alice Springs, Central Australian Aboriginal Congress Aboriginal Corporation (Congress) could be considered as an exemplar of national endeavours to close the gap in indigenous health. The Congress comprehensive primary care model, which is unique in the extent to which it is cross-portfolio and family-centred, offers an innovative way forward for primary care, but the evidence regarding performance is yet to be generated.
This collaboration is designed to generate this evidence. HESPG is working with Congress in both the evaluation of individual health and well-being services, and to assess the performance of the comprehensive primary health care model as a whole. This should enable Congress to better serve its catchment population but also inform a range of audiences, including policy makers, funders, others in the community controlled sector, practitioners and researchers about the performance of comprehensive, cross-portfolio, family-centred primary care. In addition the economic evaluation approach developed will provide a framework for the on-going evaluation of the Congress model and of individual programs. A focus on productivity (outcomes per units of inputs) is the key to maximising health improvements for the Aboriginal population served by Congress and in attracting the continued funding required to deliver the Congress model.
This collaboration is initiated under an NHMRC Program Grant ‘Improving chronic disease outcomes for Indigenous Australians: Causes, Interventions, System Change’ led by Prof Kerin O’Dea on which Prof Leonie Segal is a Chief Investigator (with Prof Robyn McDermott, Dr Kevin Rowley, Prof David Roder). The broad focus of Segal’s research program within this Grant concerns systems for the delivery of primary health care and economic evaluation of programs, taking a holistic view of health.
Prof Leonie Segal, Dr Ha Nguyen, Dr John Boffa, Ms Yvonne Ginifer
NHMRC program grant
Health and social consequences of child abuse and neglect: an analysis using South Australian linked data
Children subject to abuse and neglect are highly vulnerable, with documented impacts on mental and physical health, as well as poor social and economic outcomes. But, the size of these impacts, especially early in life and risk profiling is poorly understood. Most research on the consequences of child maltreatment is based on surveys that necessarily exclude those who suffer the worst outcomes in their youth - homelessness, incarceration, low literacy, intellectual disability, major mental illness or death. Administrative data can provide valuable insights about vulnerable populations that surveys do not reach. In this project we are examining for the first time in an Australian setting a population cohort of South Australians, born since 1986, using linked administrative records across child protection, health, education, youth justice and registries of births and deaths. Mortality and morbidity (to age 28) and core social outcomes will be examined for populations defined by their pattern of involvement with the child protection (CP) system and compared with those with no such involvement. Budget impacts will be estimated by combining findings across health and social domains with published unit costs of service provision and modelling long-term economic outcomes from early mortality and education attainment. Stratification and multivariate modelling will be used to explore the interaction of child protection history with socioeconomic risk factors. This project is the largest and most comprehensive of its kind worldwide, with ~450,000 children/young adults, of whom ~100,000 will have had some contact with the CP system. This project will improve our understanding of the more severe early mortality, morbidity, social and economic impacts of child maltreatment. It will help identify the most vulnerable populations, their support needs and current service access to support effective strategies to address child maltreatment and associated harms.
Prof Leonie Segal, Prof David Preen, Prof Paul Delfabbro, Professor Derek Brown, James Doidge
NHMRC Project Grant