Abstract

Authors:
Irene McCarthy¹, Brett Emmerson¹, Melissa Anzolin¹, John Allan²

Affiliations:

1. The Qld Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, Australia.
2. Mental Health Alcohol and Other Drug Branch, Queensland Health, Brisbane, Australia.

Aims:
Despite well-documented poor physical health outcomes for mental health consumers the provision of routine physical health assessment and smoking care is not the norm in mental health facilities. The following outlines a service improvement initiative applied across Queensland public mental health facilities to introduce routine six-monthly physical health assessment for people with Schizophrenia and universal screening of smoking with delivery of a brief smoking cessation intervention to identified smokers.

Methods:
Over a five-year period, sixteen adult mental services across Queensland voluntarily participated in the statewide Queensland Mental Health Clinical Collaborative (Qld MHCC) to improve clinical practice in physical health. In 2012 services prioritised six-monthly routine physical health assessment for people with a diagnosis of Schizophrenia in community mental health services. Then in 2015 the provision of smoking care in inpatient services was introduced with universal smoking screening and delivery of clinical pathway brief intervention for identified smokers. In 2017 routine smoking care was extended to community mental health services. Services were supported to implement local clinical practice changes by the Qld MHCC through development of clinical indicators to monitor progress and promote benchmarking and in the delivery of six-monthly statewide forums to share experiences, hear from experts and set service-specific goals.

Results:
Improvements across all three areas were seen during the staggered implementation of practice change. The MHCC physical health assessment indicator demonstrated a significant statewide improvement over a five-year period from 12% to 65%. The delivery of smoking cessation in inpatient services also demonstrated significant statewide improvement over a two-year period moving from 38% to 73% and early results from the community implementation of routine smoking care delivery indicate promising improvements.

Conclusions:
The improvements seen support the application of a service improvement collaborative approach to achieving widespread clinical practice change across multiple services. Given the dire physical health outcomes for people with a serious mental illness, mental health services need to implement approaches that can support policy and demonstrate real-world changes. The next step will be to determine whether the clinical practice change translates to improved physical health outcomes for consumers.