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Why CoAT was Started?

As I became aware of the issues of mental health service reform, I studied the policy documents that were being released by both the Commonwealth and State Governments, and surprisingly enough even though on large doses of lithium, he developed the ability to remember and record important pieces of information from the jigsaw puzzle.


The National Standards for Mental Health Services (NSMHS), (Commonwealth Department of Health and Family Services 1996), contains a forward from Dr Harvey Whiteford, at the time the Chair of the Australian Health Ministers' Advisory Council's National Mental Health Working Group.


It says in part

"It is widely recognised that service standards and quality assurance programs within health services are an essential part of achieving high standard health care. This applies equally to mental health services. Implementation of national mental health service standards represents an important opportunity to improve the quality of mental health care in Australia."

Section 1 of the Standards had some more words of importance:

"The standards inform consumers and carers about what to expect from a mental health service. Therefore consumers and carers could use the standards to feed-back into a service's planning, development and evaluation processes."
"Mental health services, consumers and carers may choose to develop a tool for rating attainment of the standards locally."
"The standards are outcome oriented with an emphasis on the end result for consumers and carers. The standards are also intended to reflect a strong values base, related to human rights, dignity and empowerment. The development of these standards has been guided by the principles contained in the National Mental Health Policy and the United Nations Principles on the Protection of People with Mental Illness."

At the time, these statements were taken as a promise and a commitment by the mental health professional's to make things better.

The Development of CoAT

CoAT came from the premise that the NSMHS were a minimum requirement. Douglas worked in the Greater Murray Mental Health Service in 1999 and found they had just finished an audit using Tools for Reviewing Mental Health Services (TRAMHS) (Commonwealth Department of Health and Family Services 1998). It was difficult for consumers and carers to access this process - a consumer and carer tool needs to be simple to use.


I knew it was important for consumer and carer participation to happen in the process. We had permission from Harvey Whiteford to develop an audit tool to improve the mental health service to have better outcomes for consumers and cares.


CoAT has been used regularly since June 2000 in NSW. The CoAT tool used the same scoring system developed and tested for TRAMHS.


An example of the use of CoAT is shown in the graph below. NSMHS 3 (Consumer and Carer Participation) was evaluated at two public workshops, one held in Wellington, NZ during the 2000 TheMHS conference and one in the Northern Sydney Area Health Service during 2002. Also CoAT audits on Standard 3 Consumer and Carer Paeticipation were done in South East Sydney Area Health Service for 4 years by Lynda Hennessy, Area Consumer Participation Coordinator. The tool was found to be flexible, fair, reliable and valid by all stakeholders (the 2 reports are on http://www.coatconsulting.com.au/index.php/resources.html).


The tool was used to demonstrate that the service had improved Consumer and Carer participation.


coat scores


The graph reinforces the anecdotal evidence of a very inconsistent application of the standard and echoes the findings in the report on the Evaluation of the Second National Mental Health Plan (Australian Health Ministers’ Advisory Council 2003).


The score of 44%, in column 19 is an average of the other 18 sites scores involved in the early development of CoAT.