Sara, Grant 2023 04 04

Grant Sara

Prof Grant Sara is a psychiatrist with roles in clinical care and data. Grant is an Associate Professor at the University of New South Wales Discipline of Psychiatry and Mental Health, and as a Clinical Associate Professor at the University of Sydney he is involved in caring for young people with recent onset of psychosis. He is Director of InforMH, NSW Ministry of Health and Chair of the national Mental Health Information Strategy Standing Committee. In those roles he works to see health system data used to understand variation and improve care.

Abstract 1

Title: Vaccine-preventable hospitalisations in adult mental health service users: A population study

Author(s): Grant Sara, Patrick Gould

Introduction: Mental health service users experience significant health inequalities, including less access to preventative care and higher rates of physical health conditions. This study investigates the risks of hospitalisation for vaccine-preventable conditions among mental health service users in New South Wales, Australia.

Method: Using linked population data, we identified all hospitalisations for 19 vaccine-preventable conditions between 2015 and 2020 for adult mental health service users and other NSW residents. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated to determine the relative risks of VPH, after standardising for age and sex. A secondary analysis examined admissions including the NSW COVID-19 delta wave up to September 2021.

Results & Findings: We identified 94,180 vaccine preventable hospitalisations. Mental health service users had more than three times the rate of vaccine-preventable hospitalisations compared to other NSW residents (aIRR 3.2, 95% CI 3.1 - 3.3). Risks were highest for hepatitis B (aIRR 4.4, 95% CI 4.3 – 4.6) but elevated for all conditions, including influenza, herpes zoster and COVID-19 (aIRR 2.0, 95% CI 1.9 – 2.2). Mental health service users were younger at the time of their first VPH admission, with the largest age gap observed for vaccine-preventable pneumonias (11-13 years younger).

Discussion: High VPH rates may reflect lower vaccination rates, greater risk of severe illness, or barriers in accessing community care. The findings highlight the importance of vaccine-preventable illness as a contributor to health inequalities. MH service users need equal access and prioritisation in vaccination policies and strategies. Collaborative approaches, with mental health services, physical health services and lived experience experts working together, are crucial if we are to succeed in "Becoming an Equally Well Country”.

Abstract 2

Title: Building data to support action on physical health gaps.

Author(s): Grant Sara, Fred Wu, Wendy Chen, Jennifer Humphrey

Introduction: Complex change requires data. NSW Health’s “Mental Health Living Longer” project develops data on physical health gaps in NSW mental health consumers. The project is currently developing integrated physical health dashboards for NSW Local Health Districts and Primary Health Networks.

Method: NSW Health’s InforMH team have developed data on a range of physical health issues including life expectancy, breast and cervical cancer screening rates, potentially preventable hospitalisations, and vaccine preventable hospitalisations. Findings from these analyses are being combined into physical health report cards for each region. For each variable, the dashboard includes the NSW Mental Health Average, the NSW population average, the area (LHD or PHN) population, the area (LHD or PHN) mental health consumers, and the gap between the area MH consumers and the area population. To integrate diverse types of data, standardised (Z) scores are calculated comparing mental health service users to other residents in each region and comparing each region to the NSW average. The data are aligned to reflect desired outcomes. The dashboards are intended to be screening tools, prompting local investigation and enquiry.

Results & Findings: Dashboards are currently being developed and presented to LHDs and PHNs. Services have fed back that they consider localised integrated dashboards an effective approach to displaying physical health data to inform local change initiatives.

Discussion: Closing physical health gaps and becoming an “Equally Well Country” will require many change efforts, with sustained allocation of time and resources from physical and mental health services, and the trialling and evaluation of diverse service models for different health issues, consumer groups or regions. Access to detailed local data is an essential support for these change efforts. By providing localised physical health dashboards, the project aims to present the right data, at the right time, to the right people to enable change.

Abstract 3

Title: Cervical cancer screening participation in women using mental health services in NSW

Author(s): Michael Impelido, Kate Brewer, David Currow, Grant Sara

Introduction: Cervical cancer is a preventable disease that remains a significant public health priority. Vulnerable populations, including women living with mental health conditions, experience low cervical cancer screening rates and higher cervical cancer mortality. This study describes cervical cancer screening participation in NSW mental health service users, and identifies sub-groups at higher risk of late detection.

Method: We used a population-wide screening register and linked data to identify 114,022 women who had received recent specialised mental health care in New South Wales and were in the target age range (25-74 years) for Australia’s national cervical cancer screening program. Screening rates and incidence rate ratios were calculated after standardisation for age, socioeconomic disadvantage, and rural location.

Results & Findings: Only 40.3% of women using mental health services participated in cervical screening, compared to 54.3% of other women in NSW (aIRR 0.74, 95% CI 0.74–0.75). Screening rates were only slightly lower than population rates in MH service users under 35, declined in service users aged 35 to 65 and were extremely low (15%) in MH service users aged over 65.

Discussion: Cancer strategies aim to eliminate cervical cancer through vaccination, screening and effective care. For this to occur we need strategies which support women living with mental health conditions to choose to participate in cervical cancer screening. Women aged over 65 years are at particularly increased risk. A range of flexible and tailored approaches are likely to be needed to overcome personal, cultural and health system barriers. We are developing local data and reporting to support improvement efforts by NSW services.