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In a bid to prevent mental health patients from falling through cracks in the health care system, a new unit was established last year to improve the coordination of mental and physical care.

The Clinical Applications Unit (CAU), headed by Dr Daniel Rock at the Centre for Clinical Research in Neuropsychiatry (CCRN), translates mental health research findings into care coordination packages, leading to improved outcomes for patients.

Dr Rock said another result was cost savings to the health system.

“When a person has complex health needs which cross the jurisdictional boundary between mental and physical health care, they can be easily lost in the system,” he said. “Better coordination of care within and between agencies not only improves quality of life but at the same time spends health dollars more effectively.”

Research carried out by CCRN and the WA Department of Health has shown high levels of physical co-morbidity among people with mental illnesses. CCRN director Professor Assen Jablensky, who carried out some of the research, said the findings were disturbing.

“We found that the physical health status of psychiatric patients was exceptionally poor, people with schizophrenia and bipolar disorder faring worst,” he said.

Part of the problem was not so much under-detection or missed diagnoses but under-treatment.

“People with mental health problems are less likely to receive quality care for quite common physical problems,” he said.

CAU has four principal areas of focus - reproductive and sexual health, co-morbidity, suicide and deliberate self-harm,and clinical assessment of psychosis.

The Mental Health Early Life Program (M-HELP) is centred on reproductive and developmental health and its first package, Healthy Babies for Mothers with a Serious Mental Illness, was officially launched last year by Telethon Institute for Child Health Research director Professor Fiona Stanley (see story in MeDeFacts, September 2008).

Dr Rock said mental health case-management was fundamental to the M-HELP philosophy. Under the direction of midwife Professor Yvonne Hauck and child psychiatrist and paediatrician Dr Johanna Stefan, the MHELP projects aim to ensure adequate ante-natal care provision, child health nurse support of vulnerable women and their children in the immediate post-natal period, and practical help with bonding and attachment in the first two years of life.

CAU’s most recent package, which involves quick follow-up care for patients who deliberately self-harm, was launched last month (see story opposite page in this issue of MeDeFacts). It followed the CAU’s “Fast tracking care for deliberate self harmers in Sir Charles Gairdner Hospital emergency department” project, which aimed to develop and implement an integrated system of psychiatric triage and assessment, incorporating new clinical pathways for deliberate self harm presentations to SCGH’s ED.

Another directly related project was the “Modelling suicide following hospitalisation for self-inflicted injury (deliberate self harm) study”, which will generate a statistical model for suicide following hospitalisation for self-inflicted injury.

Dr Rock said although this group of patients was at overall increased risk for suicide, the composition of the group’s suicide risk-related characteristics was not known.

“A database, using de-identified information from a set of linked health registers, will be used to create the primary dataset for this study,” he said.

Dr Rock said cancer care coordination was another pressing issue. Mental health patients had the same chance of developing cancer as the general population but research in WA in 2000 showed that their chances of being cured were much lower.

“Conventional cancer treatment is complex, strictly timetabled and often tightly regimented, placing intense demands on a person’s family and support network,” he said. “But for someone who is also living with a mental illness and with limited social support, accessing adequate cancer care can become almost impossible.”

A person’s chance of surviving cancer is increased if they can successfully engage with treatment in the first few months after being diagnosed.

“If people with pre- existing mental illnesses can get practical support to manage their treatment, then their chance of surviving cancer will increase,” Dr Rock said.