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Stratification of Clinical Load in a Community Mental Health Setting

1
D. Cowan and K. Edwards 1

1 Mental Health, NSW Health, Australia

Background: Nurses are often at the forefront of providing individualized care and the concept of
‘case management’ is one that most community mental health nurses would be familiar with. What
remain unlear is the way in which ‘case management ‘ is operationalised. There is general agreement
that the nature of community mental health nursing has changed in recent years, with high numbers
of acutely unwell consumers and a focus on brief interventions that revolve around risk. Given this, the
question must be aksed whether the traditional approaches to ‘case management ‘ are warranted in
such an environment.

Objective: This paper describes a stratification model that aims to rationalise the operational aspects
of managing large numbers of community mental health clients.

Methods: The notion of ‘zoning’ is a pragmatic system used to ensure that consumers recieve
appropriate levels of support while they are engaged with community mental health services by
facilitating the delivery of targeted interventions according to need. A tretment need guideline was
developed to assist staff to ‘flag’ consumers who required differeing levels of care on a shift to shift
basis. The syudy was conducted in a district that contained three different community mental health
teams. Oral Presentation Abstracts

Results: The stratification flagging system resulted in significant redistribution of clients within the
service. A reduction of 80% in some locations. Effectively this meant moving large numbers of clients
who were included as acute or high needs, into categories that didnt require as much clinical input.
As such, the clients who had the most need were able to be clearly identified and given the service
they required.

Conclusion: The stratification of treatment need as differentiated from the potentially
counterproductive approach of intervention in response to risk is a way to ensure equitable matching
of nursing care to consumer needs and improved service capability.

Keywords: mental health

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Correspondence: Darrin Cowan, Mental Health, NSW Health, Australia
E-mail: daz1333@hotmail.com

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