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Characteristics of clients with a mental health diagnosis: Understanding the clients of the RDNS community nursing service in Melbourne, Victoria Dr Joanne Enticott Dr Marissa Dickens Dr Amee Morgans Ms Barbara Williams
Prof Colette Browning
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Project Goal:
• The aim is to profile the mental health issues in users of a large community health services provider. We will do this in order to better understand the demands on the RDNS services and develop better approaches for these clients.
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Method
• Creation of a health and wellbeing profile:
– Unique registry of longitudinal community care clients
• Diagnoses (primary dx & other)
• Care received
• Financial, accommodation & social activity too
– 24,663 clients commenced an episode of care in 2014
– predominantly in Greater Melbourne
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Mental health diagnoses
3,975, 17%
19,832, 83%
Proportion of Individuals with Any Mental Health Diagnosis
Mental Health Diagnosis All Others
Client profile:
• Average age: 71 years
• Over two-thirds were aged 65+ years
• Two-thirds lived in the least disadvantaged areas of Melb, Victoria
• 17% had a mental health diagnosis
– One-in-six
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Mental health diagnoses
3,975, 17%
19,832, 83%
Proportion of Individuals with Any Mental Health Diagnosis
Mental Health Diagnosis All Others
- National prevalence is one-in-five
- prevalence increases in clinical samples
- prevalence decreases in older people
One-in-six
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Mental health diagnoses
937, 4%
3,038 , 13%
19,832, 83%
Proportion of Individuals with Primary and Secondary Diagnoses
Primary Secondary None
3,975, 17%
19,832, 83%
Proportion of Individuals with Any Mental Health Diagnosis
Mental Health Diagnosis All Others
In clients with a mental health diagnosis:
• One quarter had primary diagnosis (pink slice),…
• ...meaning that mental health was designated as the reason(s) for which the nurse was visiting the client
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Mental Health Diagnoses
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
F30-F39Mood [affective]
disorders
F40-F48Neurotic, stress-
related and
somatoform disorders
F20-F29Schizophrenia, schizotypal and
delusional disorders
F10-F19Mental and behavioural
disorders due to psychoactive
substance abuse
F70-F79Mental
retardation
F90-F99Unspecified
mental disorder
F80-F89Disorders of
psychological
development
F60-F69Disorders of
adult personality
and behaviour
F90-F98Behavioural and
emotional
disorders with onset usually occurring in
childhood and
adolescence
F50-F59Behavioural syndromes
associated with physiological disturbances and physical
factors
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ICD-10 Code Category
Mental Health Diagnoses by ICD-10 F10—F99 Code Category
% 39.1 24.1 12.7 11.4 7.3 1.8 1.5 1.3 0.5 0.4
N 2,227 1,373 724 650 413 101 87 75 27 20
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Mental health diagnoses
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Socio-demographic profile • People with a mental health dx were more likely to be…
– Female, 57%* (*52%, no mental health)
– Under the age of 65 years, 42%** (**24%, no mental health)
– Born in Australia, 60%* (*50%, no mental health)
– Of Aboriginal or Torres Strait Islander descent (ATSI), 1.4%* (*0.5%, no mental health)
– Accessing the Homeless Person’s Project (HPP), 13%*
(*2%, no mental health)
– Alive at January 2016, 92%* (*86%, no mental health)
– Not accessing Department of Veterans’ Affairs (DVA) Services, 5%* (*8%, no mental health)
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Visit & Activity Profile
• Average episodes of service did not differ between groups – Both groups averaged 1.2 episodes in 2014
– (with a range of 1-24 episodes)
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Visit profile
55.2
12.4
8.77.8
2.81.7
54.0
12.1
9.4 9.2
3.02.1
0
10
20
30
40
50
60
Visit At Home Consultation (telephone or other)
Telephone CSC client related
Client documentation Fax CSC Client related Direct care - face to face
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Visit Type
Most Common Visit Types for Those with and Without a Mental Health Diagnosis
Mental Health Diagnosis
All Others
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Visit & Activity Profile
• Average episodes of service did not differ between groups – Both groups averaged 1.2 episodes in 2014 (with a range of 1-24 episodes)
• Profile of visits did not differ between groups – Visit type profile was similar too (previous slide)
• But..
• Number of client-related activities did differ – The yearly client-related activities logged by RDNS staff were, on average:
• 50 per client with no mental health dx
• 69 per client with mental health dx
• 87 per client with mental health as Primary dx
– Individuals with a mental health diagnosis received more activities than those without…
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Visit & Activity Profile
• Client-related activities for clients with a mental health diagnosis Activities conducted during ‘Visit at a Home’
Monitoring and surveillance 130,460 (30.8)
Medication 120,698 (28.5)
Counselling and support 49,380 (11.7)
Tech Care - Wound 26,949 (6.36)
Client care coordination/collaboration 17,364 (4.1)
Assessment - Other 10,743 (2.5)
General Nursing Care (GNC) 10,185 (2.4)
Personal Care 6,074 (1.4)
Tech Care - Other 5,553 (1.3)
Documentation (HPP only) 4,678 (1.1)
Various other general nursing activities (all these
individually are <1%) 41,422 (9.8)
Total 423,506 (100.0)
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Conclusion
• One-in-six had mental health diagnosis
– lower than the Australian national prevalence of one-in-five
– higher than the aged-adjusted one-in-ten prevalence estimate.
• These RDNS figures may represent significant under-reporting
– Particularly given the link between chronic disease and poorer mental health
• Consistent with population findings, mood and anxiety disorders were most common in our sample
• Clients with mental health disorders require 40% more client-related activities by RDNS,
– and 80% more if primary dx is mental health disorder