NHMRC Centre of Research Excellence in Mental Health

Systems Improvement (CREMSI)Translating evidence into

policy and services

Harvey Whiteford Kratzmann Professor of Psychiatry and Population Health

The University of Queensland

The problem …• Mental disorders are a leading cause of disease burden• We do not know the best way to configure our mental health

service system • For an equitable, efficient and sustainable system, we require

knowledge about: – The extent and distribution of disorder epidemiology and

burden – Effective and cost-effective interventions to reduce burden– How to organise these interventions in an equitable way– How to adapt policy settings to move from the current to the

optimal service system

Previous work in this area …

ACE Mental Health • Concluded a more efficient and cost-effective system

would require reallocation of funds between interventions, between disorders and between service providers, as well as different funding mechanisms

Tolkien II • Concluded that reorganising the system using a stepped

care model with a 30% increase in budget could treat 60% more people across 15 major disorders and produce a 90% increase in health gain

however…

• Evidence and policy-maker engagement is not enough

• Policy-makers think more in terms of service platforms than

disorder level interventions

• epidemiology across the lifespan is often not considered

• The intervention evidence is fragmented

• cost-effectiveness alone rarely influences priority-setting

• integrative interventions cannot compete with service silos

Our CRE …

… develop an integrated evidence base for a

model service system, recognising and

exploiting the realities within which policy and

planning take place

Our goals…• Design a model mental health service system for Australia

that would optimally reduce the burden of mental disorders

• Analyse how that model differs from the existing service system, and what policy levers governments can use to move to the new model

• Develop a knowledge transfer strategy to translate the evidence into policy and practice

Our Chief Investigators…• Harvey Whiteford University of Queensland• Louisa Degenhardt University of NSW• Jane Pirkis University of Melbourne• Cathy Mihalopoulos Deakin University • Kathy Eagar University of Wollongong• Gavin Andrews University of NSW• Brian Head University of Queensland • Jane Gunn University of Melbourne• Wayne Hall University of Queensland• George Patton University of Melbourne

Components of CREMSI

• Research program with 3 streams:– Stream 1: Priority setting for cost-effective mental

health interventions and service platforms– Stream 2: Mental health system planning to maximise

the delivery of evidence-based services– Stream 3: Translation of evidence-based service

system planning into policy• Knowledge translation strategy• Capacity building strategy

Assemble burden and cost-effectiveness data for interventions by disorder

Our work plan

Our work plan

• Develop a service platform taxonomy

• Translate cost-effectiveness data from the intervention level to service platform level

• Describe the service system in which disorders are prevented or treated on the platform that equitably and efficiently reduces maximum burden

• Developing planning targets for the optimal service

model

Examining the policy instruments and policy making mechanisms in the Australian context

Adapted from Felix HC. The rise of the community based participatory research initiative at the National Institute for Environmental Health Sciences: an historical analysis using the policy streams model. Prog Community Health Partnership. 2007; 1(1):31–39.

Making recommendations on evidence based policy adoption

Knowledge translation and capacity building to ensure:

• The CRE is informed by expertise and priorities of end-users• Multimodal dissemination of findings• Monitoring the uptake of CRE outputs into policy

instruments• A research intensive exchange program• Targeted integration into tertiary courses and seminar series

To find out more……www.mhsystems.org.au