Background to Oakden – the mental health facility

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The quality of care delivered at Oakden has been independently verified to be regularly well below any acceptable standard.

With that statement it is important to understand the nature of the facility when using it as a benchmark against the 3,000 residential aged care facilities across Australia (and the 300,000 staff).

We don’t have the full facts – they will emerge as a result of the investigation launched this week.

However three weeks ago the Chief Psychiatrist of SA Health, Dr Aaron Groves, delivered a 115 page report on Oakden following mounting media attention from the ABC. It is worthwhile reading as it clarifies that Oakden is not representative of residential aged care homes across Australia.

Dr Groves points out it is a mental facility with the wrong resources and support. He says:

“In summary, Oakden is not providing the right care, at the right time from the right team”.

The blame is slated back to the bureaucracy not adopting a Model of Care developed in 2012:

“The Executive of OPMHS in all LHNs has relied on the 2012 Model. This has contributed to the deficits now evident at the Oakden Campus because of the disconnection between an unfunded aspirational document and the real-world challenges of the service, when no process to identify the resources needed to implement a new model is made”.

Here is some background to frame your thoughts.

The correct name is the Oakden Older Person Mental Health facility (OPMHS is the service provided). It is operated by the Aged Mental Health Care Service, part of the South Australian government’s Department of Health. Dr Groves reports:

“The Services at Oakden primarily provide care for two groups of older people as follows:

  • older people with enduring and/or severe mental illness, who require transitional care due to barriers to their accessing community based or mainstream residential aged care; and
  • people with dementia or other neurodegenerative conditions with very severe and extreme Behavioural and Psychological symptoms, consistent with Brodaty Tiers 6 and 7 that are unable to be cared for in non-government dementia specific aged care environments”.

“OPMHS are therefore provided to distinctly different groups of individuals, ranging from those with mental illnesses such as Psychosis, Depression and severe Anxiety Disorders through to people who are severely and persistently affected by challenging behaviours of Dementia such as agitation; aggression; psychosis; depression; inappropriate sexual behaviours; or are otherwise at risk of harm to themselves or others”.

“The first indication that Oakden may have been experiencing quality issues was in 2001. From that time until 2007, Oakden was only accredited for 12-month periods, apart from one 2-year accreditation period. These periods of accreditation that were less than should have been achieved should have raised attention.”

“However, following the Commonwealth review of Oakden in December 2007, the facility failed 25 of the Commonwealth’s 44 standards for aged care and sanctions were imposed. ACH Group entered into a joint partnership with the Health service to assist with the operations of the services through until 2010”.

“In 2010, the facility returned to the full responsibility of the local Mental Health Services with Commonwealth funding …. At that time Oakden was found by the Aged Care Safety and Accreditation Agency to have met all 44 standards”.

“In the late 2000s, a fourth unit at Oakden, Zweck House was closed and Howard House moved off site to a new building at the Lyell McEwen Hospital (Ward 1H). This added to the staff’s convictions that the service would close and as a result it is reported that attracting new staff was increasingly difficult. Anyone who wanted permanent, secure employment did not consider Oakden a viable option and staff reported a sense of inevitability that both their workplace and their employment were limited”.

“From 2010, the Review heard that requests for maintenance of the building and replacement of broken, damaged or new equipment from staff were regularly responded to with statements such as;

‘there’s no funding for that’, ‘borrow it from next door’, ‘it’s not going to happen in this financial year’.

The Review was also told that there was pressure on all areas of mental health to operate within their budget; any allied health taking leave were not back-filled, and when some key staff members resigned they did not appear to be replaced”. In 2012 the State-wide Older Persons Mental Health Future Service Model (an MOC) was drafted – but critically not adopted.

“The unendorsed Model was framed within an approach that aligned with a person-centred approach to service delivery that placed consumers and their carers as active participants in decision-making and choices about services. It articulated commitment to consumer rights, consumer-focused principles and a recovery approach”.

“The Model articulated a number of underpinning principles including; the uniqueness of the individual; having real choices; fostering recovery oriented attitudes and rights; dignity and respect; partnership and communication and evaluating recovery.

“The Executive of OPMHS in all LHNs has relied on the 2012 Model. This has contributed to the deficits now evident at the Oakden Campus because of the disconnection between an unfunded aspirational document and the real-world challenges of the service, when no process to identify the resources needed to implement a new model is made”.

The review discusses this lack of a Model of Care (MOC) at Oakden, and thus staff not having a meaningful guide.

“The only reference to a MOC that could be found at Oakden was in materials that the Review discovered within the OPMHS training topics for Orientation and Induction of staff The Review accepts that this is an important opportunity for new staff to be aware of the Model of Care in a service. However the material provides only a brief overview of the MOC and appears to be designed for a different purpose rather than any attempt to outline a MOC”.

“Consequently the Review ultimately found no MOC that related specifically to Oakden”.

“As such Oakden has continued to provide services that should be consistent with TCUs and ICBUs, on behalf of the State, without a plan that supports the level of resources it needs to provide such a Service”.

“This is compounded by a widespread view, held by the staff, which the Review heard repeatedly, that Oakden (in particular Makk and McLeay Nursing Home), is a place for the rest of the consumer’s life. This resulted in an attitude among staff that there was less effort and emphasis that needed to be placed on managing the consumer’s challenging behaviours as there was little prospect that any improvement would help facilitate their discharge. This became a self-fulfilling prophecy for many in Oakden”.

“The Review team was repeatedly informed by a variety of staff of statements made by Mental Health Executive members during the last five years, stating that investment in resources at Oakden was not made because the service was to be outsourced to a private provider. The Review also heard that staff believed this was likely to be unsuccessful as the most severely unwell residents in Oakden were unable to be managed by these services”.

“Finding 1:

The Review makes the following finding in relation to the Model of care at Oakden:

  • It was unable to find a satisfactory, specific MOC that has been developed for the types of services provided at Oakden, in particular, this issue was not satisfactorily addressed in the unendorsed 2012 Model of Service for OPMHS.
  • There has been no clear articulation of the cohorts for whom services on the Oakden Campus are to be provided and how this should be achieved with regard to staffing profiles, resources or infrastructure.
  • Further, expectation of a CMHT-led, in-reach model as described in the unendorsed 2012 Model has not been supported by the degree of commensurate change within the Review of Oakden Older Persons Mental Health Service resources; skills and capacity; or changes in practice; within the OPMHS community teams that would be necessary, if the changes aspired to in the Model were to be achieved.
  • As a result, the Model described in 2012 has been unable to prevent ongoing deterioration in the Oakden service. This is as a result of two factors; namely the Model was not endorsed, is largely unknown in the OPMHS sector and it has not been implemented in a systematic manner; and secondly it identified aspirations that have not been supported by further strategic planning, resource allocation or investment.
  • The Executive of OPMHS in all LHNs has relied on the 2012 Model. This has contributed to the deficits now evident at the Oakden Campus because of the disconnection between an unfunded aspirational document and the real-world challenges of the service, when no process to identify the resources needed to implement a new model is made.
  • All other LHNs have continued to rely on the Oakden service without having made any arrangements to provide sub-acute and non acute Tier 6 and 7 BPSD services and Transitional Care for older consumers within their own catchment areas.
  • The unendorsed 2012 Model of Care as it relates to both Tier 6 and 7 BPSD is not in keeping with International or National Best practice and in particular is not supported by the best practice examples in New South Wales, Victoria and Western Australia.
  • The Model of Care that is provided at Oakden is not in keeping with current best practice for the people they intend to serve who have functional mental illness and there is no relationship between best practice for people with Tier 6 and 7 BPSD and what is currently provided”.

As Dr Groves said: “In summary, Oakden is not providing the right care, at the right time from the right team”. For a mental facility, not an aged care home.

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