The outcomes and cost effectiveness of Australia's Partners in Recovery Initiative

Background: Individuals with Severe and Persistent Mental Illness [SPMI] have multiple and complex needs which are often beyond the scope of what traditional mental health services can address. As a result, such individuals often fall through the service gaps. Australia’s Partners in Recovery initiative [PIR] was a national program trialled from 2014 to 2017, which aimed to improve referral pathways and strengthen partnerships between different services through a care coordination model.
Aims of the study: The aims of this presentation are threefold: 1. To describe the change in felt needs of persons with SPMI who enrolled in the PIR initiative in Gippsland, Victoria; 2. To describe the views and experiences of stakeholders on the PIR initiative and 3. To estimate the cost effectiveness of the PIR initiative.
Methods: Change in felt needs will be measured by comparing unmet needs (as measured by the Camberwell Assessment of Needs Short Assessment Schedule -CANSAS) recorded at entry with that documented at exit from the initiative. Differences between enrolment and final follow up will be analysed using Wilcoxen signed rank tests, effect sizes and logistic regression if required. Views and experiences were be obtained from semi-structured interviews of clients, carers and health professionals. Cost effectiveness was estimated as a total and per client cost at start-up and ongoing of the initiative and was compared with potential downstream cost savings obtained through literature review.
Results: Change in needs is currently being undertaken and will be presented at the workshop. Qualitative outcomes included those of the service system and client. Service system outcomes included better interservice collaboration, team approach to patient care, no duplication of services, and better understanding of client’s history and needs. Client outcomes included more client driven care, clients feel valued, clients feel more confident in managing their illness, improved service access and better quality of life. The total cost of providing the service for a consumer per year (set-up and ongoing) was estimated to be AUD$15,755 and the ongoing cost per year was estimated to be AUD$13,434. The cost of doing
nothing is likely to cost more in the longer term, with poor mental health outcomes such as hospital admission, unemployment benefits, prison, homelessness and psychiatric residential care.
Discussion: The PIR initiative was associated with better client and service outcomes and was cost effective. It is a useful model to provide recovery oriented services for persons with an SPMI.
Implications for health-care provision: Care coordination is a useful way to enable interagency collaboration when designing recovery-oriented services for people with an SPMI. The PIR initiative is a care coordination model, which can be replicated in high-income countries.
Implications for Health Policies: It might be worth it for local and federal governments to fund trials of care-coordinated models for recovery-oriented services.
Implications for Further Research: Randomised controlled trials in different settings will establish the economic benefit of care coordination models as well as their ability to facilitate inter agency collaboration and improve client outcomes.