National Mental Health Strategy Dr Peggy Brown Director of Mental Health
Dec 26, 2015
The first asylum in Australia was commissioned by Governor Macquarie, with the instruction that there was to be:
‘cleanliness, kindness, nutrition, medical attention, recreation and good record keeping’.
• In NSW alone, there have been approximately 40 inquiries into psychiatric facilities and services since the first recorded case of mental illness in 1801.
• The majority of State and Territory investigations examined issues such as maladministration, under-resourcing, overcrowding, abuse and harassment, and inadequate legislation.
• “An historical review of those Inquiries does not leave one with many precedents for change or with optimism for the future.”
Report of the National Inquiry into the Human Rights of
People with Mental Illness (1993)
“Governments seem peculiarly immobile in implementing progressive development for the betterment of the mentally ill.”
Report of the National Inquiry into the Human Rights
of People with Mental Illness (1993)
• A joint initiative of the Australian and state and territory governments to improve mental health outcomes for the community.
• Adopted by all Australian Health Ministers in April 1992
Aims of the National Mental Health Strategy
• Promote the mental health of the Australian community and, where possible, prevent the development of mental health problems
• Reduce the impact of mental health problems on individuals, families and the community
• Assure the rights of people with mental illness.
Key Documents comprising the National Mental Health Strategy
• Statement of Mental Health Rights and Responsibilities (1991)
• National Mental Health Policy (1992)• National Mental Health Plan (1993 - 1998)• Medicare Agreement 1993 - 1998
Priority Areas under the National Mental Health Strategy
• Consumer rights• Relationship between
mental health sector and general health sector
• Linking mental health with other sectors
• Service mix• Promotion and
prevention
• Primary care services• Carers and non
government agencies• Mental health workforce• Legislation• Research and
evaluation• Standards• Monitoring and
accountability
First National Mental Health Plan
• Mainstream services• Integration• Intersectoral linkages• Funding reform• Workforce• Legislation• Monitoring, service standards, data and performance
indicators• Consumer rights and consultation• Special needs groups• Roles of carers and advocates• Financial accountability
Evaluation of the National Mental Health Plan
• Substantial change has occurred in the structure and mix of public mental health services.
• The range and quality of mental health services improved substantially.
• They are seen to be more responsive, more community oriented and better integrated with general health care than five years ago.
• The National Mental Health Strategy has provided leverage to change human service systems operating outside the traditional mental health boundary, which have been previously reluctant to accept responsibility for mental health clients.
Evaluation of the National Mental Health Plan
• Consumers continue to report problems with access to services, poor service quality and stigmatising staff attitudes.
• Many feel disenfranchised by the new focus on ‘serious mental illness’.
• Carers feel they have been left behind.• Providers struggle to respond to an apparent
escalation of demands upon their limited resources. • Primary care practitioners complain of the insularity
of mental health providers, both public and private. • The community remains relatively fearful of mental
illness and continues to stigmatise and discriminate against those affected by mental illness.
Evaluation of the National Mental Health Plan
• The National Mental Health Strategy has raised awareness of previously hidden problem areas and encouraged an expectation, if not a demand, that ‘things should be better than this’.
National Survey of Mental Health and Well-Being 1997
• Almost 1in 5 adult Australians and 1in 7 children/adolescents met criteria for a mental disorder at some time during the prior 12 months.
• Only 38% of adults and one quarter of children/adolescents with a mental disorder had used health services.
• Of people who seek help for a mental disorder, the overwhelming majority (77%) consult their general practitioner.
• This suggests a large unmet need for mental health services.
The Burden of Mental Illness
Mental disorders account for: • ~ 1% of deaths • ~ 11% of disease burden worldwide (projected to rise
to 15% by the year 2020).
Within Australia, mental disorders represent:• 13% of total disease burden • 3rd leading cause of disease burden (after heart
disease and cancer) • 24% of total years lost due to disability • Largest single cause of disability (24%)
• Mental Health Statement of Rights and Responsibilities 1991
• National Mental Health Policy 1992
• Second National Mental Health Plan 1998.
• Australian Health Care Agreement 1998 - 2003
Second National Mental Health Plan
• Building on achievements and expanding into additional areas of reform
Priorities for Future Activity • The client focus • A focus on depression
3 Key Themes• Promotion and Prevention • Partnerships in Service Reform and Delivery • Quality and Effectiveness
Evaluation of the Second National Mental Health Plan
• Growth in mental health expenditure has simply mirrored overall health expenditure trends and is not sufficient to meet the level of unmet need for mental health services.
• Structural reform has largely taken place.• Progress has been made towards improving
consumer rights and consumer and carer participation, but human rights issues remain and full and meaningful participation for consumers and carers has not yet been achieved.
Evaluation of the Second National Mental Health Plan
• Community treatment options are still seen as unavailable or inadequate.
• Growth in resources to the non-government and residential sectors has not kept pace with their increased role.
• The mental health agenda has been broadened to include a wider range of mental health problems and mental illnesses, as well as comorbidity.
Evaluation of the Second National Mental Health Plan
• An impressive focus on promotion, prevention and early intervention.
• Australia leads the world in mental health promotion, mental illness prevention, early intervention initiatives, and stigma reduction.
• While much has been achieved, people with mental illness still experience stigma and discrimination.
Evaluation of the Second National Mental Health Plan
• Many advances have been made in forming partnerships; however the complexity of the system reform required to deliver integrated care has become increasingly evident.
• It is still the case that consumers are frequently unable to access mental health care as and when they need to.
• Continuity of care remains an elusive goal for the complex systems that deliver mental health care.
Evaluation of the Second National Mental Health Plan
• Intersectoral collaboration has not developed in a systematic or coordinated way.
• Progress in implementing standards for mental health care has not met expectations.
Evaluation of the Second National Mental Health Plan
• Australia has continued to pursue and make progress implementing the objectives of the National Mental Health Strategy.
• However, the extent and pace of progress has not universally been viewed as satisfactory.
• National consultations revealed a high level of dissatisfaction.
• The failures have not been due to lack of clear and appropriate directions, but rather to failures in investment and commitment.
• Mental Health Statement of Rights and Responsibilities 1991
• National Mental Health Policy 1992
• National Mental Health Plan 2003 - 2008
• Australian Health Care Agreement 2003 - 2008
National Mental Health Plan 2003 - 2008
Priority Themes• Promoting mental health and preventing mental
health problems and mental illness• Increasing service responsiveness• Strengthening quality• Fostering research, innovation and sustainability
Not for Service Report (2005)
• Inadequate access to quality mental health services
• Lack of respect for persons with mental illness or their families
• Poor resources and inadequate facilities
• Reduced safety within mental health care services
Not for Service Report
“It is now urgent for all governments to work together and commit to a process of genuine and adequately resourced reform. In simple terms this will involve:
• a recognition that mental health reform is a national priority;
• real leadership (political and bureaucratic) to drive change through a whole-of-government response;
• real increases in funding to align mental health and disability burden with funding;
• an emphasis on accountability; and • urgent and resolute action to address the looming
crisis in the mental health care workforce.”
Senate Select Committee on Mental Health: A national approach to mental health –
from crisis to community (2006)
“There is much work to do in the area of mental health. There needs to be more money, more effort and more care given to this neglected part of our health care system.”
“Most recently this groundswell of interest has resulted in a commitment by the Council of Australian Governments (CoAG) to look at mental health reform.”
COAG National Action Plan on Mental Health 2006 - 2011
Action Areas • Promotion, prevention and early intervention • Integrating and improving the care system • Participation in the community and employment,
including accommodation • Increasing workforce capacity • Coordinating care ('Coordinating care' and
'Governments working together')
COAG National Action Plan on Mental Health 2006 - 2011
Agreed Outcomes• Reducing the prevalence and severity of mental illness in
Australia • Reducing the prevalence of risk factors that contribute to the
onset of mental illness and prevent long term recovery • Increasing the proportion of people with an emerging or
established mental illness who are able to access the right health care and other relevant community services at the right time, with a particular focus on early intervention
• Increasing the ability of people with a mental illness to participate in the community, employment, education and training, including through an increase in access to stable accommodation
COAG National Action Plan on Mental Health 2006 - 2011
• Medicare extended to cover psychologists, social workers, OTs and mental health nurses
• Personal Helpers and Mentors• Day to Day Living Support• More respite care places to help families and carers• Improved services for people with drug and alcohol problems
and mental illness• Alerting the community to links between illicit drugs and mental
illness• More education places, scholarships and clinical training in
mental health• Helping young people stay in education• Expanding suicide prevention programs
Change in Age Profile of Nursing Workers, Australia, 1987
and 2001
National Review of Nursing Education, DETYA, 2001
Summary statistics by age and hours worked per week for
Nursing Professionals, Australia, 1987 and 2001 Percentage 45
and
years of age
over
% Who Worked
Hrs /
More Than 35
Week
Occupation 1987 2001 1987 2001
Nursing Professionals
20 37 55 49
Nurse Managers 22 45 54 75
Nurse Educators and Researchers
26 34 37 50
Registered Nurses
20 38 55 49
Registered Midwives
20 25 53 31
Registered Mental Health Nurses
17 36 65 68
Summative Evaluation of the National Mental Health Plan 2003 - 2008
• Significant progress in reforming mental health services has been made throughout Australia.
• The concept of ‘recovery’ has had a major impact to frame public policy, to shape services and service delivery and to develop outcome measures.
Summative Evaluation of the National Mental Health Plan 2003 - 2008
• However, there was a level of dissatisfaction expressed on the part of a range of constituents that not enough progress was made in some parts of the current Plan.
• The Plan did not give specific guidance towards actionable and measurable items.
• The Plan tried to ‘be all things to all people’.• Many consumers and carers had less sense of
ownership of the Third Plan as compared to the previous two Plans.
Summative Evaluation of the National Mental Health Plan 2003 - 2008
• There has been an increased level of awareness around promoting mental health and specific mental health problems.
• The attitudes of the public and providers still had not changed to any great degree.
• Need to continue to work toward a ‘seamless’ continuum of care for the consumer.
Summative Evaluation of the National Mental Health Plan 2003 - 2008
• The recruitment and retention issues in the mental health workforce pose the major challenge to the mental health system.
• The research agenda is not clearly defined or prioritised and many research results are not connected in a meaningful way regarding the effectiveness of services and the emergence of evidence based practices.
Summative Evaluation of the National Mental Health Plan 2003 - 2008
• There is an overwhelming consensus that a further National Mental Health Plan is necessary.
• However, the next Plan should provide clarification on the structure of the National Mental Health Strategy, Policy and Plan in the context of recent developments involving the Council of Australian Governments and the whole of government focus on mental health issues.
2007 National Survey of Mental Health and Wellbeing
• 1 in 5 adults experience a mental disorder in any year
• 45.5% of adults have experienced a mental disorder at some point in their lifetime
• Prevalence rates vary across the lifespan
• Highest rates in the early adult years
2007 National Survey of Mental Health and Wellbeing
• Only 1/3 of those with a MI receive mental health services
• 90% of those who did not use services reported they did not need services
• Mental illnesses remain the largest single cause of disability in Australia
• Account for 24% of the burden of non-fatal disease (measured by total years of life lived with disability)
• Of 6 major health conditions (cancer, cardiovascular, major injury, mental illness, diabetes, arthritis), mental illness is associated with the lowest likelihood of being in the labour force.
• People with MI are overrepresented in the homeless and prison populations.
• Up to 75% of homeless adults have a mental illness (approx. 1/3 or 29,000 have a severe MI).
• ~40% of prisoners have a mental illness and 10 – 20% are affected by severe disorders
• Direct health costs of mental illness in 2006-07 (governments and health insurers): $4.7 billion
• 7.3% of all government health spending• Estimated annual productivity losses
attributable to MI = $10 – 15 billion• It is not known how much spending on
mental health services is required to meet the priority needs of the Australian population.
Aims of the National Mental Health Policy (2008)
• Promote the mental health and well-being of the Australian community and, where possible, prevent the development of mental health problems and mental illness
• Reduce the impact of mental health problems and mental illness, including the effects of stigma on individuals, families and the community
• Promote recovery from mental health problems and mental illness
• Assure the rights of people with mental health problems and mental illness, and enable them to participate meaningfully in society.
Recovery
• Not about an absence of symptoms • A goal but not an endpoint• Having hope and something to look forward to
despite the fact that you may have a mental illness• Empowering people with MI to make real choices for
the future themselves, and growing and taking responsibility for themselves
• Helping people with MI to get their self-respect back, to believe in themselves, to rebuild their connections with their hopes and dreams
• A process of transformation, discovery and renewal• Recovery also requires carers and service providers
to organise service delivery around the goals of recovery
National Mental Health Policy (2008) Directions:
• The rights and responsibilities of people with mental health problems and mental illness
• Mental health promotion• Preventing mental health problems and mental
illness, and reducing suicide risk• Early intervention• Access to the right care at the right time• Participation and inclusion• Carers• Workforce• Quality and outcomes• Building and using the evidence base
Fourth National Mental Health Plan
• A whole-of-government approach• A partnership approach• A population health framework • Targets the full spectrum of people living with
mental health problems and mental illness, as well as their carers and families
• Mental Health Statement of Rights and Responsibilities 1991
• National Mental Health Policy 2008
• Fourth National Mental Health Plan 2009 – 2014
• National Healthcare Agreement 2009 - 2014
Fourth National Mental Health Plan
Priority Areas:
1. Social inclusion and recovery
2. Prevention and early intervention
3. Service Access, coordination and continuity of care
4. Quality improvement and innovation
5. Accountability – measuring and reporting progress
Challenges
• Implementation plan• Whole of government engagement (Cross-
sector working party)• Indicator development• Reporting, especially on cross-sectoral
indicators• Governance• ?Role of COAG• ?Future of COAG National Action Plan on
Mental Health beyond 2011
Implementation in the ACT
• ACT Mental Health Services Plan 2009 – 2014• Managing the Risk of Suicide: A Suicide Prevention
Strategy for the ACT 2009 – 2014• Building a Strong Foundation: A Framework for
Promoting Mental Health and Wellbeing 2009 - 2014• Address all the priority areas of the Fourth Plan• Strategic Oversight Group – cross-sectoral• Ministerial Advisory Council
Key documents developed during the National Mental Health Strategy
• National Standards for Mental Health Services (1996)
• National Practice Standards for the Mental Health Workforce (2002)
Key documents developed during the National Mental Health Strategy
• National Mental Health Information Priorities (2005)
• National safety priorities in mental health: a national plan for reducing harm
National Partnership Agreements
1. Activity Based Funding
will be informed by: • MH-CASC Study• National Outcomes and Casemix Classification• Mental Health Interventions Coding (pilot in the ACT)
2. No discharge to homelessness
National Health and Hospitals Reform Commission
• Recognises mental health as 1 of 5 priority areas requiring action to improve access and equity
• 12 specific recommendations relating to mental health
• Proposal for Commonwealth to take over policy and funding for primary health care may include community mental health services and is a major concern