PROJECT EVIDENCE for Continuing Care of Persons with Mental Disorders. The project coordinator is Dr Allan Mawdsley. The version can be amended by consent. If you wish to contribute to the project, please email admin@mhyfvic.org
[8] Long-term care
a) Residential services
b) Occupational and ancillary supports
[8 b ] Occupational and ancillary supports
The best known summary is the following article from Australasian Psychiatry.
Enabling choice, recovery and participation: evidence-based early intervention support for psychosocial disability in the National Disability Insurance Scheme
Laura Hayes, Research Specialist, Parenting Research Centre, Melbourne, VIC, Australia
Lisa Brophy, Associate Professor, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, and; Principal Research Fellow, Mind Australia Limited, Melbourne, VIC, Australia
Carol Harvey, Professor, Department of Psychiatry, The University of Melbourne, VIC, and; Consultant Psychiatrist, North West Area Mental Health Service, Coburg, VIC, Australia
Juan Jose Tellez, Research Assistant, Graduate School of Education, Melbourne Social Equity Institute, The University of Melbourne, Melbourne, VIC, Australia
Helen Herrman, Professor, Orygen, National Centre of Excellence in Youth Mental Health, Parkville, VIC, and; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
Eoin Killackey, Associate Director, Orygen, National Centre of Excellence in Youth Mental Health, Parkville, VIC, and Graduate Research and Education Head, Functional Recovery in Youth Mental Health, Melbourne, Melbourne, VIC, Australia
Australasian Psychiatry 2018, Vol.26(6), 578-585.
Abstract
Objectives: The aim of this study was to identify the most effective interventions for early intervention in psychosocial disability in the National Disability Insurance Scheme (NDIS) through an evidence review.
Methods: A series of rapid reviews were undertaken to establish possible interventions for psychosocial disability, to develop our understanding of early intervention criteria for the NDIS and to determine which interventions would meet these criteria.
Results: Three interventions (social skills training, supported employment and supported housing) have a strong evidence base for effectiveness in early intervention in people with psychosocial disability, with the potential for adoption by the NDIS. They support personal choice and recovery outcomes. Illness self-management, cognitive remediation and cognitive behavioural therapy for psychosis demonstrate outcomes to mitigate impairment. The evidence for family psycho-education is also very strong.
Conclusions: This review identified evidence-based, recovery-oriented approaches to early intervention in psychosocial disability. They meet the criteria for early intervention in the NDIS, are relevant to participants and consider their preferences. Early intervention has the potential to save costs by reducing participant reliance on the scheme.
The National Disability lnsurance Scheme (NDIS) has the potential to lead a significant national reform in the provision of community-based support for people with psychosocial disability. The scheme is designed to enable people with permanent needs due to disability, the opportunity to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports.[1]
The National Mental Health Consumer and Carer Forum refer to psychosocial disability as ’the disability experience of people with impairments and participation restriction related to mental health conditions’, [2] although the term is contested. For instance, the NDIS refer to ‘disabilities that may arise from mental health issues’.[3]
Social models of disability also recognise social determinants such as stigma, social exclusion and discrimination as contributing to people’s experience of disability.[4] Functions of daily life, participation in community activities including employment, thinking clearly, the experience of full physical health and managing the social and emotional aspects of life may be affected.[2]
Early intervention in clinical mental health practice is well developed, aiming to promote early recovery and minimise and prevent psychosocial disability.[5] Robust evidence now suggests that significant improvements in disability can occur after two years post-diagnosis.[6] The idea that people with severe mental health problems will experience decline in function over time is now discredited as for all fields of disability.
Figure 1 demonstrates the points where early intervention can support psychosocial functioning. The NDIS can provide individualised supports for early intervention that are designed to promote improvement, or prevent decline, in psychosocial functioning for people with a current psychosocial disability or at high risk of developing a psychosocial disability. The NDIS does not provide services that substitute for those supplied appropriately by the health system, but does provide capacity-building supports for individuals eligible for the scheme.[7]
Capacity-building supports include a focus on relationships, employment and lifelong learning, enabling eligible participants to build skills focused on social and economic participation. The provision of early intervention support in the NDIS must be “likely to benefit the person by reducing the person’s future needs for supports relating to disability”.[7]
However, reports from trial sites indicate that few early intervention plans have been developed to support participants over the age of 18 years who are living with psychosocial disabilities.[8] It is unclear whether early intervention has been considered for those who have a current plan to prevent further deterioration in functioning or marginalisation for those with a current plan, and hard to predict who might be eligible for a specific early intervention plan. Despite estimates that 64,000 could be eligible, there are already indications that people with psychosocial disability may have more difficulty establishing their eligibility and may be at risk of poorer outcomes in the scheme compared to participants with other disabilities.[9]
To understand current challenges and opportunities in defining and implementing early intervention within the NDIS, a series of rapid literature reviews were conducted that aimed to identify possible early interventions for adults experiencing psychosocial disability and evaluate the evidence for each.
Method
A rapid review [10] was conducted to provide a timely response for policy development during NDIS implementation.
Firstly, we identified the full range of evidence-based psychosocial interventions for people with severe mental illness (SMI) and psychosocial disability. Secondly, literature related to rehabilitation, recovery, early intervention and participant preference was reviewed in order to elaborate on early intervention criteria within the NDIS. Thirdly, we determined which interventions would specifically meet these criteria for early intervention. The full details are described in a recently published report.[11] Table 1 summarises our procedures.
Results
Step one
Nine publications [4, 12-19] and three Cochrane reviews [20-22] were retained that reported on the range of interventions that are evidence-based treatments for SMI (Table 2).
Step two
This review identified six important approaches for understanding early intervention, including the early intervention criteria within the NDIS guidelines.[11]
Firstly, NDIS policy requires that an intervention is a support rather than treatment, and NDIS principles of citizenship and partnership stress the importance of personal choice in all arenas of life. Secondly, approaches for treating first-episode SMI stress the importance of preserving role functioning and supporting personal goal achievement.
Thirdly, evidence suggests that positive change may occur at any phase of living with a mental illness, especially when interventions are individually tailored. Fourthly, stepped care approaches illustrated the benefits of adequate interventions tailored to the level of need in preventing deterioration in social and economic participation.
The fifth area concerned recovery and rehabilitation, emphasising the wide range of possibilities for everyone with psychosocial disability. Sixthly, participant views indicated the linkage between unmet need and their likely preferences for support. We concluded that three important concepts — personal choice and goals, evidence-based interventions and interventions supporting recovery — were essential features to achieve the goals of early intervention in the NDIS.
Step three
Three interventions (supported employment, supported housing and social skills training) meet evidence base, personal choice and recovery criteria, and are likely to reduce future support needs (Table 3). Additionally, they meet commonly expressed goals and preferences for participants.
Discussion
Supported employment, supported housing and social skills training appeared most strongly aligned with NDIS early intervention criteria. Outcomes evidence for another four interventions (cognitive remediation, cognitive behavioural therapy (CBT) for psychosis, physical health management, and illness self-management) indicates they can assist with mitigation of impairment and, thus, have a role to play. It is unclear if these latter interventions would be the immediate choice of NDIS participants, but they can assist through enhancing capacity for chosen activities and participation roles (Table 4).
The evidence for family psycho-education is very strong, suggesting it has a useful role in early intervention, but it is unclear if it would be a priority for participants. It may rely on the skills of planners in seeing the relevance and potential of a family intervention. Peer support may improve recovery associated with all interventions.[25] Assertive community treatment/assertive outreach, while not a directly funded support of the NDIS, could be adapted to assist in the engagement and coordination of supports for people who are reluctant to engage with supports.
Conclusions
Early intervention is aligned with the underlying principle of the NDIS — being prepared to offer lifetime support while also enabling people to achieve their individual recovery goals.
This literature review provides a strong evidence base for what the NDIS terms capacity-building support for people with psychosocial disability, especially early in their experience of disability or early in the implementation of their plan.
While this requires more investigation, the findings of this review suggest that early intervention in the NDIS may enable people to reduce their reliance on the scheme in the future, hence reducing costs for the scheme or reducing pressure on other health and welfare services. Many people with psychosocial disability could benefit from an early intervention approach, although for how many of the estimated 64,000 entrants to the scheme is unclear.[26]
The results support the value of increased expert knowledge in NDIS planning and a specialised pathway for people with psychosocial disability.[9] The identified supports have the potential to offer significant gains in people’s capacity to participate when applied early in their experience of psychosocial disability, or early in their NDIS plans, so should be routinely considered during NDIS planning.
These findings suggest that future research could focus on interventions that more clearly meet participant needs such as the challenge of loneliness and isolation. Interventions may also require re-designing (and re-evaluating) to provide a greater emphasis on recovery, participant choice, personal goals and individualised service provision.
As with all insurance schemes, containing long-term costs to ensure the sustainability of the scheme is a concern for the NDIS and for the Australian people. When this can be achieved through alleviating people’s functional loss and building their capacity to participate in society through early intervention, there are potential personal gains for those people, their families and carers.
Limitations
Stream-lining in rapid reviews may mean that not all trials and reviews are located by the literature search. We endeavoured to minimise bias by drawing on recent systematic reviews and meta-analyses.
Acknowledgements
This paper is based on a report prepared by The Centre for Mental Health at Melbourne School of Population Health, The University oi Melbourne, for Mind Australia in March 2016. The authors wish to thank Mind Australia and Dr Margaret Grigg, Dr Gerry Naughtln, Ms Judy Hamann and Dr Georgina Sutherland for their support.
Disclosure
The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The report was commissioned and funded by Mind Australia Limited.
References
1. National Disability Insurance Scheme independent Advisory Council. Choice and control: reflections on the implementation of the principle of choice and control under the NDIS, https://www.ndis.gov.au/html/sites/default/fiIes/documents/council_reflections_on_choice_and_control.pdf (2013, accessed 6 September 2017).
2. National Mental Health Consumer and Carer Forum. Unravelling psychosocial disability, http://nmhccf.org.au/sites/default/files/docs/nmhccf_psychosociaI_disability_booklet_web_version_27oct11.pdf (2011, accessed 6 September 2017).
3. National Disability Insurance Scheme. Psychosocial disability, recovery and the NDlS, https://www.ndis.gov.au/medias/documents/heb/h21/8799160959006/Fact-Sheet-Psychosocial-disability-recovery-and-the-NDIS-PDF-774KB.pdf (2016, accessed 8 November 2017).
4. KiIlackey E, Harvey C, Amering M, et al. Partnerships for meaningful community living; rehabilitation and recovery-informed practices. In; Tasman A, Kay J, Lieberman JA, et al. (eds). Psychiatry. 4th ed. Chichester: John Wiley and Sons Ltd, 2015, pp.1959-1982.
5. Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N ZJ Psychiatry 2016; 50; 410-472.
6. Bertelsen M, Jeppesen P, Petersen L, et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness; the OPUS trial. Arch Gen Psychiatry 2008; 65: 762-771.
7. National Disability Insurance Scheme Act 2013, no. 20, https://www.legisIation.gov.au/Details/C2016C00934 (2016, accessed 8 November 2017).
8. National Disability Insurance Authority. 9th quarterly report to COAG Disability Reform Council, https://www.ndis.gov.au/html/sites/default/fiIes/documents/Quarterly-Reports/9th-Quarterly-Report.pdf (2015, accessed 6 September 2017).
9. Mental Health Australia. Response to the Productivity Commission National Disability Insurance Scheme (NDIS} costs position paper. Deakin, ACT; Mental Health Australia, 2017.
10. Grant MJ and Booth A. A typology of reviews; an analysis of 14 review types and associated methodologies. Health lnfo Libr.J 2009; 26: 91-108.
11. Hayes L, Brophy L, Harvey C, et al. Effective, evidence-based psychosocial interventions suitable for early intervention in the National Disability Insurance Scheme (NDlS): promoting psychosocial functioning and recovery. Melbourne: The Centre for Mental Health, Melbourne School of Population Health & Mind Australia, 2016.
12. Addington J, Piskulic D and Marshall C. Psychosocial treatments for schizophrenia. Curr Dir Psychol Sci 2010; 19; 250-253.
13. Bond GR and Campbell K. Evidence-based practices for individuals with severe mental illness. J Rehabil 2008; 74: 33-44.
14. Buchanan RW, Kreyenbuhl J, Kelly DL, et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull (Bp} 2010: 36:71-93.
15. Corrigan PW. Recovery from schizophrenia and the role of evidence-based psychosocial interventions. Expert Rev Neurother 2005; 5; 993-1004.
15. Gibson RW, D’Amico M, Jaffe L, et al. Occupational therapy interventions for recovery in the areas of community integration and normative life roles for adults with serious mental illness; a systematic review. Am J Occup Ther 2011; 65: 247-255.
17. McGorry P. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust NZJ Psychiatry 2005; 39: 1-30.
18. Menear Mand Briand C. Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 1—review of major initiatives and implementation strategies. Can J Psychiatry 2014; 59 :178-186.
19. Mueser KT, Beavers E, Penn DL, et al. Psychosocial treatments for schizophrenia. Annu Rev Clin Psychol 2013; 9: 465-497.
20. Kinoshita Y, Furukawa TA, Kinoshita K, et al. Supported employment for adults with severe mental illness. Cochrane Database Syst Rev 2013; 9, Art. No.: CD008297. DOI: 10.1002/14651858,CD008297.pub2.
21. Pharoah F, Mari J, Rathbone J, et al. Family intervention for schizophrenia: 2010 update. Cochrane Database Syst Rev 2010; 12, Art. No.: CD000088. DOI: 10.1002/14651858.CD000088.pub3.
22. Pitt V, Lowe D, Hill S, et al. Consumer-providers of care for adult clients of statutory mental health services. Cochrane Database Syst Rev 2013; 3. Art. No.: CD004807. DOI: 10.1002/14651858.CD004807.pub2.
23. Australian Government. Evaluatron of disability employment services interim report reissue March 2012. Canberra: Department of Education, Employment and Workplace Relations, 2012.
24. Lawrence D, Hancock KJ and Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. Brit Med J 2013; 346; f2539.
25. Repper J and Carter T. A review of the literature on peer support in mental health services. J MentHealth 2011; 20: 392-411.
26. National Mental Health Commission. Submission to the productivity commission issues paper on National Disability Insurance Scheme (NDIS) costs, https://www.pc.gov.au/_data/assets/word_doc/0004/215860/sub0153-ndis-costs.docx (2017, accessed 8 November 2017).
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Last updated 23 December 2018
POLICIES for Continuing Care of Persons with Mental Disorders
[8] Long-term care
a) Residential services
b) Occupational and ancillary supports
[8 b ] Occupational and ancillary supports
MHYFVic advocates that State and Federal governments should provide funding and administrative support for agencies to provide:
Last updated 26/12/2018
BEST PRACTICE MODELS for Continuing Care of Persons with Mental Disorders
[8] Long-term care
a) Residential services
b) Occupational and ancillary supports
[8 b ] Occupational and ancillary supports
The literature provides a strong evidence base for what the NDIS terms capacity-building support for people with psychosocial disability, especially early in their experience of disability or early in the implementation of their plan.
The findings suggest that early intervention in the NDIS may enable people to reduce their reliance on the scheme in the future, hence reducing costs for the scheme or reducing pressure on other health and welfare services. Many people with psychosocial disability could benefit from an early intervention approach.
Three interventions (supported employment, supported housing and social skills training) meet evidence base, personal choice and recovery criteria, and are likely to reduce future support needs.
Additionally, they meet commonly expressed goals and preferences for participants. Outcomes evidence for another four interventions (cognitive remediation, cognitive behavioural therapy (CBT) for psychosis, physical health management, and illness self-management) indicates they can assist with mitigation of impairment and, thus, have a role to play.
Further interventions that more clearly meet participant needs such as the challenge of loneliness and isolation should also be considered.
The identified supports have the potential to offer significant gains in people’s capacity to participate when applied early in their experience of psychosocial disability, or early in their NDIS plans, so should be routinely considered during NDIS planning.
Non-government agencies, such as ‘MIND’, may assist in coordinating provision of these services.
Last updated 26/12/2018
We welcome discussion about any of the topics in our Roadmap epecially any wish to develop the information or policies.
Please send your comments by email to admin@mhyfvic.org
Speak about issues that concern you such as gaps in services, things that shouldn’t have happened, or things that ought to happen but haven’t; to make a better quality of service…….
Help achieve better access to services & better co-ordination between services together we can…….
Mental Health for the Young & their Families in Victoria is a collaborative partnership between mental health & other health professionals, service users & the general public.
MHYFVic
PO Box 206,
Parkville, Vic 3052
