In 2013 Central Coast Health District reconfigured acute mental health services to provide more opportunities for consumers to be seen before they reach the emergency department. The goal of this change was to provide as much care as possible within the community setting.

The change involved promoting the use of the services Mental Health Line to consumers and other stakeholders. As part of this process, changes were made converting the Home Based Treatment Team to the Acute Care Team and the Emergency Assessment Team to the Emergency Department Mental Health Team.
The Mental Health Line was able to identify those people who could be offered assessment quickly in the community without having to go to the Emergency Department. When deemed clinically appropriate consumers were offered an appointment with the Acute Care Team.

The approach was developed, implemented and monitored closely. Eighteen months later the results are indicating an increase of 15% referrals to the Acute Care Team and a reduction in presentations to the Emergency Department. The goal of the program has been achieved and represents significant service and cultural change for staff. The presentation will review these results in the context of the patient, carer and clinician experience.

The transfer of information between mental health staff is essential to the delivery of good quality mental health care. Indeed a breakdown in communication has been seen as contributing to 70% of hospital sentinel events. While there has been work to understand clinical handover occurrences in general health, there is little understanding of practice in mental health. The current paper aims to fill this gap by exploring the content and quality of verbal handover practice in community mental health care. The current paper will outline the development of an observer checklist of verbal handover practice designed to understand the type of information being shared during clinical handover, the level of detail that takes place during discussions and the adoption of the ISBAR communication format. In a small proof of concept trial, we observed 36 verbal clinical handovers the majority followed the ISBAR format with assessment information focusing on relationships, medication and substance use. The majority of discussion was observed as brief, with more detailed discussion focusing on risk, psychotic phenomena and mental state. The current paper will outline the further development of this observer checklist, including inter-rater reliability along with the use of the checklist as a quality improvement tool.

It is widely recognised that there is a significant translation gap between clinical policy development and its implementation into clinical practice. This is partly attributable to an over-reliance on linear models of policy-making that are often highly prescriptive and implemented through a top-down approach.

This paper describes an alternative approach, which combines both top-down ‘governance’ and bottom-up ‘policy-making’, recognising that implementation is enacted locally and contains a major element of bottom-up policy-making. This novel approach to policy-making, aimed at maximising engagement of ‘frontline’ stakeholders (including clinicians, consumers and carers), was developed by the authors in designing a Statewide Clinical Policy Framework for the WA mental health system.

Unlike the traditional approach to policy-making in which implementation is a discrete step that is often treated more as an ‘afterthought’, this Framework embeds it in the process from day one and policy development groups retain a key role throughout the policy implementation process.

In this presentation, the authors will describe the key components of the Framework and explore its theoretical underpinnings, which they believe have broad application for the science of implementation.

Evidence-informed policy implies the use of new approached to decision making, taking into account local factors (Bosch-Capblanch et al., 2012). Within this context, Atlases of Health are essential tools. They include detailed information on social and demographic characteristics, as well as data on services availability and care capacity. They allow comparison between areas, highlighting variations of care, and detecting gaps. However, they mainly rely on the lists of services based on their official names. The main problem of this approach is related to the wide variability in the terminology of services. To overcome these limitations, we used the "Description and Evaluation of Services and Directories in Europe for long-term care" (DESDE-LTC) (Salvador-Carulla et al., 2013) to map two Local Health Districts: Western Sydney and South Western Sydney and compare them to models of community mental health. Three main care gaps were found: 1) absence of high intensity day care; 2) absence of acute and non-acute residential care provided outside the hospital but with 24-h physician cover; and 3) absence of non-acute, 24 h support (but not medical support) residential care. This pattern of care is related with a reactive system, rather than a proactive system based on long term planning.