Data and Indicators in Public Mental Health
Project start: March 2021
The project, which began in March 2021 and is run by Impulso.Gov, with collaborative vision and technical and financial support from the Cactus Institute, embarked on a pioneer intervention in Brazil. The primary objective is to establish key indicators for public mental health services, enabling the evaluation and subsequent enhancement of psychosocial care services provided by the Unified Health System (SUS).
The project began as a pilot program in the municipality of Aracaju, in the State of Sergipe, and was then scaled up for use by the local management centers of the Psychosocial Care Network (RAPS) in the city of Aparecida de Goiânia, State of Goias, and Recife, State of Pernambuco. In 2023, the initiative will continue to expand to dozens of Brazilian municipalities across the country’s five regions.
Building a culture of using data and indicators in public administration is a big step towards enhancing the implementation of quality public policies and the formulation of goals for mental health care. For example, thanks to the cross-referencing of data offered by the tool, managers can help reduce queues, actively search for users and manage the network’s human, financial and infrastructure resources more efficiently.
The initiative represents a joint effort between organizations of civil society and the public administration to support evidence-based decision making, benefiting society as a whole through access to better mental health services and care.
Data and indicators
Data is information which, in itself, cannot convey a clear message. For example, the gender of a health-system user, on its own, is a piece of data that, if not linked to others such as age, income, medical history, region and so on, does not constitute significant information.
In order for this information to help improve the quality of the services offered, we work with indicators, which are specific combinations and interpretations of data that help identify and highlight any points of concern, and help understand the local dynamics, characteristics and needs of different regions. Indicators act as a signpost to reality, guiding decision making and helping to map out the best actions to achieve objectives.
- Prioritization of demands: “I’m really in love with the tool. It gives us a guide: what do we need to improve? I’ve been in MH since 2009 and I’ve never had such a view of health as I did last week when I saw the dashboard. And everyone really liked the tool.”
- Measuring quality: “We were aware that the indicators used were only for production, but that’s not enough to say whether the services offered were good for users or not, and the project took a leap forward in terms of being able also to measure the quality of the service for the user.”
- Ease of use: “I really like this, we’ve always tried to do this with the units mapping on their own, now you’ve brought everything to us in such a simple way.”
- Analytical Capacity and Resource Optimization: “Look at the discrepancy between hospitalization and nighttime care in CAPS. Expenditure on hospitalization in psychiatric clinics is much higher than for night shelters.”
- Creation of a simple, accessible dashboard and development of managers able to prioritize problems, develop hypotheses, create and execute action plans and monitor indicators.
- The dashboard is already fully operational in several municipalities and is being expanded to dozens more.
- Dozens of managers have benefited directly from using the dashboard.
- The tool has been implemented in several municipalities across all five regions of the country.
- The use of indicators has supported decision making and has been incorporated into the Coordination area’s work routines, making the Network’s periodic meetings, such as the weekly meetings of the Management Board (coordination of all RAPS services), more strategic, in order to provide an overview of the progress of services.
- Realizing the relevance of data and indicators in routines and decisions, the service coordinators are seeking to improve data-collection processes in the services, taking this agenda to the professionals at the front line.
- City governments are seeking to promote digitalization and improvement of equipment to improve the use of the dashboard.
- There is still little standardization of indicators and definitions in public health management, and it is difficult for managers to identify and visualize what is happening in the region and what the mental health demands are.
- There is an excessive focus on production indicators, to the detriment of results.
- Diverse and complex systems that don’t interact with each other hinder the flow of data, registration and cross-referencing of information in the public administration. One of the biggest challenges is the lack of computerization.
- Being able to visualize the data to improve decision making at RAPS is important, but other tools need to be developed to measure the quality of the service at the front line in depth.