Structural Reform in Mental Health: Area Mental Health Services AMHS

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Structural Reform in Mental HealthArea Mental
Health Services (AMHS)

• Janice Chesters
• Paul ONeal

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Introduction

• Brief history of AMHS.
• Key features of AMHS.
• Gippsland AMHS.
• Is the AMHS model the most effective approach?
• PEARL questions over to you.

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Brief History of AMHS

• Part of reforms implemented in the mid-to-late
  1990s and driven by
• Economic Rationalism and The New Managerialism
• Deinstitutionalization and community-based care
  seen as a self-evident good
• Free market principles such as Compulsory
  Competitive Tendering (CCT) and purchaser and
  provider split.

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Key Features of AMHS

• Grouping of clinical and PDRSS services into a
  geographical area called Area Mental Health
  Service (AMHS).
• Stand-alone psychiatric institutions replaced
  with mental health services that are
  mainstreamed and collocated with general
  hospitals.
• Continuity of care.
• Self-sufficiency.
• Regional budgets.

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Key Features of AMHS

• Main conduit for DHS low prevalence-high impact
  illness mental health funding into a region.
• Preferential funding arrangement that
  paradoxically reduces competition for funding
  this can be seen as positive or negative.
• Accountability for resources is critical. Fiscal
  monitoring important.
• Unit costs and weighted population funding.

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Key Features of AMHS

• Business management approach based on fiscal
  responsibility.
• Managers dont have to know anything about mental
  illness or mental health per se.
• Quality based on numbers, throughput, good
  management of funds, rather than client outcomes.

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Gippsland AMHS

• All of Gippsland is one AMHS.
• Latrobe Regional Hospital Mental Health Services
  is the sole clinical AMHS provider for Gippsland.
• One of only two Victorian AMHS that arent set up
  as mental health networks or trusts.

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Is the AMHS Model the Most Effective Approach?

• Members of the mental health sector have
  suggested that the area mental health service
  (AMHS) model may not be sustainable in all
  locations, and that resource pressures are
  already leading to movement away from the
  originally prescribed structures (New
  Directions for Victorias Mental Health Services)

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Over to You

• Does the current AMHS structure suit Gippsland?
• Does the current AMHS structure help or hinder
  recovery?
• Whose interests are served by the current AMHS
  structure in Gippsland?
• Imagine you could redesign the mental health
  system. What structural changes would you make?