Mental Health & Better Access Quality Improvement - Activity 2

June 24, 2026

The purpose of the activity is to ensure all patients with a coded mental health diagnosis are reviewed for eligibility and, where appropriate, offered a Mental Health Treatment Plan (MHTP), supporting better access to care and compliance with quality improvement standards.

Preparation

  1. Assemble your QI/data team: Include clinical, admin, and IT staff.
  2. Back up your database: Always back up before making bulk changes.
  3. Ensure access to POLAR or equivalent audit tool: For reporting and cross-checks.
  4. Review relevant guides:

Step-by-step guide

Step 1: Identify Patients with a Mental Health Diagnosis

Best Practice Premier

  • Use the Past History Cleanup tool to ensure all mental health diagnoses are coded (not free text).
  • Go to Utilities > Past History Cleanup.
  • Review and map free text entries to coded diagnoses.
  • Use Search to find patients with a coded mental health diagnosis:
  • Go to Utilities > Search > Patients.
  • Set criteria for mental health diagnoses (e.g., depression, anxiety, bipolar, schizophrenia).
  • Export or print the list for review.
  • Best Practice  

Medical Director

  • Ensure all diagnoses are coded:
  • Go to Patient > Past History.
  • Link or replace free text with a coded diagnosis.
  • Use Search to find patients with a coded mental health diagnosis:
  • From the main menu, click Search > Patients.
  • Filter by diagnosis (e.g., depression, anxiety, bipolar, schizophrenia).
  • Export or print the list for review.
  • Medical Director

Step 2: Identify Patients Without a Mental Health Treatment Plan (MHTP)

Best Practice Premier

  • Use the Search function to cross-check for patients with a mental health diagnosis but no MHTP:
  • Go to Utilities > Search > Patients.
  • Add criteria: “Mental health diagnosis” AND “No MHTP in past 12 months.”
  • Use the “Not recorded” or “Missing” filter for MHTP item numbers.
  • Export the list for clinical review.

Medical Director

  • Use the Search function to cross-check for patients with a mental health diagnosis but no MHTP:
  • Go to Search > Patients.
  • Add criteria: “Mental health diagnosis” AND “No MHTP in past 12 months.”
  • Use the “Not recorded” or “Missing” filter for MHTP item numbers.
  • Export the list for clinical review.

Step 3: Clinical Review and Action

  • Review the list with clinicians:
  • Determine if each patient is eligible for an MHTP.
  • Exclude patients with a recent plan or those not clinically indicated.
  • Contact eligible patients:
  • Invite for a review appointment to discuss and initiate an MHTP.
  • Document actions:
  • Record outcomes in the patient record.
  • Update the register to reflect new or updated MHTPs.

Step 4: Monitor and Reflect

  • Track the number of patients identified, contacted, and who received an MHTP.
  • Use an audit worksheet (see below) to document baseline and post-intervention numbers.
  • Reflect as a team: What worked? What could be improved for the next cycle?

Key Tips and Resources

Summary table

Step Best Practice Premier Medical Director
1. Identify Diagnoses Utilities > Past History Cleanup, Search Patient > Past History, Search
2. Find No MHTP Search > Patients, filter by “No MHTP” Search > Patients, filter by “No MHTP”
3. Clinical Review Review/export list, clinician review Review/export list, clinician review
4. Contact & Document Recall, update records Recall, update records
Sample Audit Worksheet: Patients with a Mental Health Diagnosis Without a Mental Health Treatment Plan

Latest news

November 10, 2026
Do you know a First Nations carer supporting a loved one experiencing challenges related to alcohol and other drugs, or mental health? Delivered by Windana and funded by SEMPHN, the First Peoples’ Carers Program is a free group program that offers an opportunity to connect with others in a safe, culturally supportive environment.
November 9, 2026
New statewide referral criteria for 7 children’s medicine conditions come into effect from 1 December 2026 in all Victorian public hospitals.
October 29, 2026
From 28 October 2026, rubella and congenital rubella will change from being ‘routine’ to ‘urgent’ notifiable conditions in Victoria under the Public Health and Wellbeing Regulations 2019.