TASMANIAN COMORBIDITY FRAMEWORK

Transcription

1 Alcohol and Drug Services & Mental Health Services TASMANIAN COMORBIDITY FRAMEWORK 2011 October 2011 Department of Health and Human Services

2 Contents Introduction 1 Comorbidity A National Context 2 Comorbidity A Tasmanian Context 4 The Guiding Principles 5 Outcomes and Areas for Ongoing Cross-Sector Focus 5 References 6 Annexure A 7 Annexure B 7 Annexure C 8

3 Introduction The purpose of the Comorbidity Framework ( Framework ) is to provide an agreed set of principles and priorities for the delivery of relevant services to Tasmanians. Comorbidity means the co-existence of one or more diseases or disorders in an individual. For the purposes of this document, the disorders of concern are substance use disorders and mental disorders. The concept of comorbidity has gained prominence in the last two decades but has always existed. Use of alcohol and illicit substances amongst people requiring treatment for mental illness has been an area of concern for a long time; although there is some evidence that rates of substance use are now greater than they have been in the past and that the nature of substance use has changed resulting in increased complications from their use. Comorbidity is widespread and often associated with poor treatment outcomes, severe illness course and high service use. This presents a significant challenge with respect to the most appropriate identification, prevention and management strategies (Teeson et. al., 2001, 1). People with comorbidity often have serious functional impairments and can present significant challenges for the service system. Common comorbidities have significant public health implications and consequences for both the individual and the wider community. For example, tobacco use and dependence is a common and often neglected form of comorbid substance use amongst people with a mental illness or disorder. Given its adverse impact on the health of individual smokers it is an issue that is of major public health importance. Populationbased health promotion is vital in the prevention of comorbidity and advertising campaigns and education programs play a vital role in this. Less frequent, but potentially very serious comorbidities include significant alcohol and/or substance misuse and serious mental illness, including drug-induced psychosis. Some substance use and/or dependence can cause or exacerbate mental disorders, some mental disorders can increase substance use (i.e., people with anxiety or affective disorders may use substances to selfmedicate (Teeson et al 2001, 11)). This interconnectedness of various risk factors such as smoking, excessive alcohol consumption and harmful drug use with chronic disease, mental illness and suicide is increasingly being examined in order to more clearly define pathways and appropriate intervention points (Inter Governmental Committee on Drugs, Nov 2002, 14). Similarly, people whose primary problems have been related to substance misuse have always been at risk of developing other disorders of their mental health, requiring particular assessment and intervention in addition to the attention to the substance misuse. There have been difficulties at times arising from differing philosophies between services, however the Framework assumes that these differences can, and must, be overcome and that coordinated care must occur when comorbid conditions exist. The Framework assumes that despite different interventions to comorbidity resulting from the location in which treatment is occurring and differences in client acuity and severity, there is still a need for common whole-of-sector approaches with associated skill development in all service settings. In addition, the duty of care requires staff to act reasonably to protect people from foreseeable harm. People cannot therefore be excluded from services simply because of disorders that complicate treatment of a condition that is ordinarily the focus of attention in that service. Effective clinical care would suggest not only should harm be prevented, but a positive duty exists to attempt to minimise ongoing harm through engagement and implementation of an intervention plan. 1

4 COMORBIDITY A NATIONAL CONTEXT The National Comorbidity Collaboration (NCC) was established as a result of an agreement between the Intergovernmental Committee on Drugs (IGCD) and the Mental Health Standing Committee (MHSC) for the purpose of assisting the Commonwealth, States and Territories to focus on comorbidity issues and identify opportunities for progressing shared priorities and interests on a whole-of-government basis. The NCC was comprised of senior Commonwealth, State and Territory alcohol and other drug (AOD) and mental health officials. Terms of Reference Purpose of the committee is to provide advice to the Australian Health Ministers Conference (AHMC) and the Ministerial Council on Drug Strategy (MCDS), through their relevant subcommittees, on options for improved linkages between the National Mental Health Strategy and the National Drug Strategy. Immediate Priorities To develop principles/models that support sustainable linkages between state services and the broader health network, including primary care and the non-government organisation health and community support providers. To enhance workforce development and training approaches, with priority given to the development of nationally recognised competencies, for the various types of workforces employed in the management and treatment of comorbidity. Longer Term Priorities To develop a model for a national quality framework, consisting of national minimum standards associated with the treatment of comorbid conditions to ensure integrated care in the alcohol and other drug and mental health treatment sectors. This model would be developed with a view to recommending a national approach to AHMC and IGCD through their sub-committees, which may inform future accreditation approaches in individual jurisdictions. To develop comorbidity priority action areas to guide jurisdictions, with a view to making recommendations to AHMC and MCDS, through their relevant sub-committees, regarding the development of a National Comorbidity Strategy. To share information and better coordinate comorbidity initiatives across sectors and jurisdictions, including the identification and dissemination of evidence-based practices. In 2011, the NCC was disbanded with the work referred back to the Intergovernmental Committee on Drugs and the Mental Health Standing Committee. 2

5 COAG AHMC (SCOH) Mental Health Standing Committee Intergovernmental Committee on Drugs 4th National Mental Health Plan National Drug Strategy Tasmanian Comorbidity Steering Committee Tasmanian Comorbidity Framework SMHS Comorbidity Project ATDC Cross-Sectorial Strategic Support Partnership 4 th Mental Health Plan: Action Area 20: Improve linkages and coordination between mental health, alcohol and other drug and primary care services to facilitate earlier identification of, and improved referral and treatment for mental and physical health problems. Current at: 31/10/2011 3

6 COMORBIDITY A TASMANIAN CONTEXT Historically there were a number of attempts to coordinate service provision for clients with mental health and alcohol and drug comorbidities. Due to the complex nature and increasing prevalence of comorbidity, clients continue to present to many service settings. Current issues in dealing with comorbidity include: Inconsistent and ineffective referral processes / pathways; peer to peer relationships mitigating against making referrals; concerns about professional skills and qualifications; barriers to access services; knowledge of services; ineffective communication and continuity of care processes between services and sectors; lack of education and training; knowledge of the conditions (clinical); inconsistencies in the use of diagnostic screening, assessment tools and approaches; lack of direction with referral entry points causing situations where clients present to sector providers at any point in time; community understanding the stigmas associated with comorbidity; awareness and knowledge of agreed national clinical guidelines; and challenging behaviours exhibited by some clients. In 2009 a Statewide Comorbidity Steering Committee was established to bring together public, primary health and non government sector efforts in relation to comorbidity in an integrated and coordinated manner. This committee includes representatives from: DHHS Statewide and Mental Health Services (SMHS) DHHS Alcohol & Drug Service SMHS Comorbidity Working Group Mental Health Council of Tasmania Alcohol Tobacco and Other Drugs Council Tasmania General Practice Tasmania network Department of Health and Ageing Annexure A Statewide Comorbidity Steering Committee Membership Annexure B Statewide Comorbidity Steering Committee Role and Function Annexure C Tasmania s Comorbidity Framework: A summary of priorities and linkages to key state and national policy & planning documents The ongoing role of the Statewide CSC is to encourage and facilitate the adoption of the Framework across all relevant sectors. 4

7 The Guiding Principles The following principles have been developed to guide service planning, development and provision for clients with comorbidity: Promotion, prevention and early intervention; Client and family involvement; A duty of care to all clients regardless of where they present; Consistent assessment and management; A highly skilled, capable and sustainable multi-disciplinary workforce; and Consultation, collaboration and networking between service providers. Outcomes and Areas for Ongoing Cross-Sector Focus Outcomes Client: Improved outcomes Focus Areas Ensuring that services are accessible and client focused. Increasing multi-disciplinary collaboration of all relevant service providers. Delivering services which are informed by evidence. Maintaining data regarding service utilisation and client outcomes. Sector: Sustainable and skilled service system Adequately resourcing services within the comorbidity sector. Fostering understanding, collaboration and partnerships across all sectors through: Sharing relevant information and training opportunities. Developing seamless service pathways and referral processes. Clarifying the roles and responsibilities of service providers within the sector. Improving service coordination Gathering data and information regarding comorbidity to: Inform policy, planning and service development. Research and implement new models of care. Adhering to state and national standards of service delivery to: Ensure safe and high quality systems of care. Achievement of service accreditation. Community: Raising community awareness of comorbidity Through education and publicity highlighting: Comorbidity issues and prevalence. Comorbidity services and service access arrangements. Decreasing stigmas associated with substance abuse and mental illness. 5

8 References Teeson, M. & Proudfoot, H. (eds), Comorbid mental disorders and substance use disorders: epidemiology, prevention and treatment. NDARC Australia Teeson, M., & Burns, L. (eds) National Comorbidity Project. Commonwealth Department of Health. 6

9 TERMS OF REFERENCE Annexure A Membership Chair: Membership: Alcohol and Drug Service (SMHS) DHHS, Statewide and Mental Health Services Alcohol Tobacco and Drugs Council Tasmania Mental Health Council of Tasmania General Practice Tasmania Department of Health and Ageing TERMS OF REFERENCE Annexure B Role and Function To oversee issues impacting on the implementation of the Statewide Comorbidity Framework. To set standards and guidelines which address the implementation of the Statewide Comorbidity Framework. Coordinate the activities in the Government and Non Government sectors around the Statewide Comorbidity Framework. Provide advice to both Alcohol and Drugs and Mental Health Services regarding activity and decisions that will impact on the revised Implementation Plan of the Comorbidity Framework. The Steering Committee will receive, consider and endorse (or otherwise) reports, recommendations and Action Plans against the Implementation Framework. Each organisation shall have governance over their respective Project Plans and Working Parties whilst at the same time making report on their plans and actions to the Statewide Comorbidity Steering Committee. Each project to review how their plans align with the Statewide Comorbidity Framework. To facilitate communication about Comorbidity activities within the State. 7

10 TASMANIA S COMORBIDITY FRAMEWORK: A Summary of Priorities and Linkages to Key State and National Policy & Planning Documents Annexure C