Activity-based funding: implications for mental health services and consultation-liaison psychiatry

Abstract

Activity-based funding may provide an opportunity for mental health services to be more equitably resourced, but much needs to be done to demonstrate that the funding model works in mental health. It is important to ensure that data collected is meaningful and accurate and reflects the diverse roles of mental health clinicians, including in CL. Inpatient and community services should be integrated in the model, as well as safeguards against potential abuse. Clinicians, in partnership with initiatives such as the Australian Mental Health Outcomes and Classification Network, are best placed to guide the development of an ABF system for mental health which appropriately recognises the complexity and variability between patients in different settings.

Activity-based funding in mental health: a disastrous path

“…Wand 4 recently warned Australia about this potential scenario which, according to Derksen, 14 a psychotherapist and professor of clinical psychology, became reality in the Netherlands, wherein the preference of mental health providers becomes to extend their patient profile to include people with mild problems (mild forms of mood and personality disorders, burnout, moderate substance abuse, behavioural and developmental disorders such as ADHD and Asperger's Syndrome) as their new patients and then focus their efforts on these people rather than providing care to those who mostly need their attention (people with a severe psychotic, bipolar or mood disorder), in other words, those for who mental health care was developed in the first place back in the late 19 th century. That there is more attention for the treatment of other mental discomfort than the so-called classic psychiatric disorders is also evidenced by the cost development study of Bijenhof et al 13:7 It is easier to achieve progress with patients who are struggling with mild problems than with those who suffer from serious psychiatric disorders.…”

“…ince 2011 the financing of mental health care in Australia has been directed towards activity-based funding (ABF). [1][2][3][4] As Solomon 5 proposes, ABF 'is payment for the number and mix of patients treated, reflecting the workload and giving hospitals an incentive to provide services more efficiently' (p. 564). The supposed benefits of this new form of budgeting are, in my opinion, over-inflated.…”

Quality indicators for a consultation-liaison psychiatry service

“…In fact, 63 per cent of CLP specialists surveyed do not use any quality indicator identified in the literature (Lavakumar et al, 2013). This situation needs to be rectified to demonstrate CLP service effectiveness in an increasingly economically driven hospital system (Wand, 2014). Quality indicators should allow important clinical processes to be monitored and may be used to improve accountability and standards (McGlynn, 2003).…”