3. Background

  1. The regular assessment of outcomes has been an aim of the National Mental Health Strategy since it was first agreed by all Australian Health Ministers in 1992. Two of the 38 objectives outlined in the original 1992 National Mental Health Policy related specifically to outcomes, and stated that the Policy would:
  • “institute regular reviews of outcomes of services provided to persons with serious mental health problems and mental disorders as a central component of mental health service delivery”; and
  • “encourage the development of national outcome standards for mental health services, and systems for assessing whether services are meeting these standards”. [1]
  1. These concepts were simple but ambitious in the context of the poor status of information in mental health services in the early 1990s. Most services did not routinely collect basic clinical and service delivery data nor have systems capable of timely analysis and reporting of such data to inform clinical care. Simple and reliable instruments for measuring consumer outcomes were not available at the commencement of the Strategy, nor was a set of candidate measures evident. Perhaps more significantly, there were few precedents to follow as no other country had established routine consumer outcome measures comprehensively across their publicly funded mental health services.
  2. In response, a research and development program was initiated early in the Strategy to identify measures of outcome that were feasible for use in routine clinical practice with adult consumers, resulting in the selection of a small set of standard measures that were put to trial. [2], [3] Similar work was undertaken in relation to outcome measures for use in child and adolescent mental health services. [4]
  3. Implementation of the selected measures in public sector mental health services commenced under the Second National Mental Health Plan (1998-2003). Recognising the complexity of the work required and its national significance, the Australian Government contributed substantial funding to assist States and Territories in implementing their plans and support a range of related quality and safety initiatives in specialist mental health care. This was made available through bilaterally negotiated ‘Information Development Agreements’, and later, ‘Quality Through Outcomes’ Agreements.
  4. Implementation of the ‘simple concept’ articulated in 1992 has taken the mental health sector into a period of major industry re-development and involved all public mental health services. By June 2003, approximately 60% of Australian public mental health services had commenced the process of consumer outcome measurement and an estimated 10,000 clinicians had participated in training sessions for the collection and use of outcome information.
  5. Since 2003, the work has advanced substantially. A national body has been established (the Australian Mental Health Outcomes and Classification Network) to support the initiative through a range of industry development activity, and national data analysis and reporting of the outcomes data. More widely, national mental health information development expert advisory panels have been set up to provide clinician, consumer and carer perspectives. Internationally, Australia is recognised as leading the field in the use of consumer outcome measures in mental health services.
  6. Version 1 of the Mental Health National Outcomes and Casemix Collection (NOCC) specifications was released in August 2003, to guide States and Territories in the implementation of routine consumer outcomes measurement. Developed collaboratively between the jurisdictions, the NOCC specifications set the agreed ‘ground rules’ for how consumer outcomes should be collected locally and reported nationally. The document was later revised (version 1.5, released December 2003) to incorporate new measures for children and young people.
  7. There have been five subsequent revisions (including the current revision):
  • Version 1.60, released February 2009, and Version 1.70, released November 2013, were designed to: (i) align aspects of the NOCC collection with the National Minimum Data Sets for Mental Health Care that are also collected and reported nationally by all States and Territories; and (ii) remove inconsistencies, redundancies and errors in the earlier documentation.
  • Version 1.80, released May 2015, and Version 1.90, released April 2016, were designed to: (i) incorporate changes to the collection of consumer-self report for Adults and Older Persons in inpatient settings; (ii) incorporate changes to clinician and consumer rated measures at discharge from ambulatory episodes; and (iii) incorporate new data elements (County of Birth, Indigenous Status & Area of Usual Residence) for the Collection Occasions Details Record. Several of these changes were based upon recommendations arising from the NOCC Strategic Directions 2014 – 2024 Final Report, published October 2013, that were considered to make the collection more efficient and fit better with current clinical practice.
  • Version 2.0, released July 2017, resulted from identification of the need to have closer alignment between the NOCC and the Australian Mental Health Care Classification, which was developed by the Independent Hospital Pricing Authority (IHPA) and is based upon the collection of the Mental Health Phase of Care (PoC). PoC was seen to be similar to the NOCC measure, Focus of Care (FoC). However FoC was a retrospective rating and PoC is a prospective rating. Given the broad collection of PoC for activity based finding purposes, the potential for confusion if both FoC and PoC were collected concurrently, and the limited uptake and use of the FoC, it was agreed that FoC would be removed from the NOCC suite of measures and PoC would be added as a data element.
  • Version 2.01 was designed to further align aspects of the NOCC with the National Minimum Data Sets for Mental Health Care, specifically in relation to reporting of International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) (10th Edition).
[1]Australian Health Ministers (1992). National Mental Health Policy. Australian Government Publishing Service, Canberra.
[2]Andrews G, Peters L and Teeson M (1994). The Measurement of Consumer Outcome in Mental Health: A Report to the National Mental Health Information Strategy Committee. Australian Government Publishing Service, Canberra.
[3]Stedman T, Yellowlees P, Mellsop G, Clarke R., and Drake S (1997). Measuring Consumer Outcomes in Mental Health: Field Testing of Selected Measures of Consumer Outcomes in Mental Health. Department of Health and Aged Care, Canberra.
[4]Bickman L, Nurcombe B, Townsend C, Belle M, Schut J, Karver M. (1999). Consumer Measurement Systems for Child and Adolescent Mental Health. Department of Health and Aged Care, Canberra.