It is estimated that 45% of Australians will experience a mental health issue in their lifetime, with around 20% reporting experience of a mental health issue over any 12 month period. These figures clearly demonstrate the significance of mental health in the health care setting. However, it is well documented that people with serious mental illness access physical health services less, and receive less care when they do access services. This leads to poorer health outcomes and contributes to the significant gap in life expectancy between people with mental health issues and those without.
The Royal Australian and New Zealand College of Psychiatrists report that the life expectancy for adults with serious mental illness is up to 30% shorter than the general population. Around 80% of the excess deaths in people with serious mental illness are due to physical health conditions, rather than the mental illness. One large retrospective analysis demonstrated that the most common causes of death in people with mental illness were also common causes of death in the general population (i.e. cardiovascular disease, respiratory disease, and cancer).
The Australian Commission on Safety and Quality in Health Care (the Commission) developed the National Safety and Quality Health Service (NSQHS) Standards to provide a nationally consistent description of the standard of care that should be expected in an Australian healthcare facility. The second edition of the NSQHS Standards, released in 2017, contains the following eight standards:
- Clinical governance;
- Partnering with consumers;
- Preventing and controlling healthcare-associated infection;
- Medication safety;
- Comprehensive care;
- Communicating for safety;
- Blood management; and
- Recognising and responding to acute deterioration.
While these standards are applicable to all Australian healthcare facilities, the Commission has identified a number of actions that will be particularly useful to improve the delivery of healthcare to people with mental health issues. These actions, shown in Table 1, are highlighted in the recently published NSQHS Standards User Guide for Health Services Providing Care for People with Mental Health Issues. While this guide contains information that may be useful to specialist mental health services, it is also intended for healthcare facilities that do not specialise in mental health services to support the provision of care to people with existing or emerging mental health issues.
Table 1. NSQHS Standards of particular importance to mental health
|1. Clinical governance||Governance, leadership and culture||Governance, leadership and culture||1.1|
|Patient safety and quality systems||Policies and procedures||1.7|
|Measurement and quality improvement||1.9|
|Incident management systems and open disclosure||1.11|
|Feedback and complaints management||1.13, 1.14|
|Diversity and high-risk groups||1.15|
|Safe environment for the delivery of care||Safe environment||1.29, 1.30|
|2. Partnering with consumers||Partnering with patients in their own care||Healthcare rights and informed consent||2.4, 2.5|
|Sharing decisions and planning care||2.6, 2.7|
|4. Medication safety||Documentation of patient information||Medication reconciliation||4.5, 4.6|
|Adverse drug reactions||4.7|
|5. Comprehensive care||Developing the comprehensive care plan||Screening of risk||5.10|
|Developing the comprehensive care plan||5.13|
|Delivering comprehensive care||Using the comprehensive care plan||5.14|
|Minimising patient harm||Predicting, preventing and managing self-harm and suicide||5.31, 5.32|
|Predicting, preventing and managing aggression and violence||5.33, 5.34|
|Minimising restrictive practices: restraint||5.35|
|Minimising restrictive practices: seclusion||5.36|
|6. Communicating for safety||Communication at clinical handover||Clinical handover||6.8|
|Communication of critical information||Communicating critical information||6.9, 6.10|
|8. Recognising and responding to acute deterioration||Detecting and recognising acute deterioration, and escalating care||Recognising acute deterioration||8.5|
|Responding to acute deterioration||Responding to deterioration||8.12|
The user guide provides detailed discussion, suggestions and examples on how health service organisations can integrate the above actions into their usual practice. For example, Standard 4 (Medication Safety) highlights the importance of taking a best possible medication history (BPMH). While this is important for all patients, studies have identified variance for the reconciliation of medications for physical and mental health conditions. Interruption to the provision of a patient’s regular medications may result in a deterioration of the original condition being treated and withdrawal symptoms. In the case of mental health, this may impact a patient’s decision making ability and result in poorer mental and physical health outcomes. It is recommended that a structured BPMH is taken by appropriately trained clinicians in a manner that does not stigmatise mental health issues or unintentionally discourage patients from revealing their existing treatment.
The overarching principles of the NSQHS Standards are that caring for a person’s mental and physical health must be an integrated process. It is now mandatory for health services assessed under the NSQHS Standards to address the actions detailed in the second edition of the standards. For services also using the National Standards for Mental Health Services (NSMHS), the Commission produces a map to demonstrate the alignment of the two standards.
- Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards User Guide for Health Services Providing Care for People with Mental Health Issues. Sydney: ACSQHC; 2018.
- Cross S, Srivastava V, Shotton H, Butt A, Protopapa K, Mason M. Treat as One: Bridging the gap between mental and physical healthcare in general hospitals. London: National Confidential Enquiry into Patient Outcome and Death; 2017.
- Lawrence D, Hancock KJ, Kisley S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ. 2013; 346: f2539.
- Royal Australian and New Zealand College of Psychiatrists. Keeping Body and Mind Together: Improving the physical health and life expectancy of people with serious mental illness. Melbourne: RANZCP; 2015.