Table 3 Attributions of ‘Success’ and ‘Failure’ in relation to first National Mental Health Plan initiatives
First National Mental Health Plan | ||||
|---|---|---|---|---|
Policy Lever | Policy Objective | Proposal(s) | Success | Failure |
Organisation | RCN Involve consumers/carers in policy review and formulation | Formalise the inclusion of consumers and carers within working committees | O- Met to some degree R- Improvement in formalised participation | O- Met for only half of public sector organisations Not translated to private sector R- Participation but not leading to intended ‘good’ outcomes in terms of respect TG- Public/political dissatisfaction |
SS Mainstream mental health service management | Merge mental health into mainstream health management | O- Substantively met R- Mainstream management arrangements adopted across all jurisdictions | ||
SS Shift acute beds to general hospitals | Shift psychiatric beds from stand-alone facilities to general hospitals | O- Substantively met R- Decrease in use of hospital-based services Funding shifted to community service sector | R- Resource reallocation and service availability is variable across jurisdictions Little adoption of population-based funding model to facilitate resource transfer TG- Community and public dissatisfaction High reports of areas of unmet need | |
SS Improve access to community crisis services | Increase ambulatory workforce | O- Met R- Significant increase in ambulatory workforce | ||
SS Improve coordination of care across service providers | Introduce case management system | O- Partially met – system introduced | R- Under-utilisation of case managers service Little measurable improvement in continuity of care TG- Community and public dissatisfaction | |
Regulation | HR&CA Reduce discrimination and stigmatisation of mental health consumers | Review anti-discrimination legislation | O- Substantively met R- Improvement in anti-discrimination legislation. | TG- Public/political dissatisfaction |
HR&CA Adhere to UN Resolution 9B and Mental Health Statement of Rights and Responsibilities | Review consumer rights and responsibilities as per State/Territory and Federal legislation | O- Substantively met (or in progress) R- Improvement in State/Territory and Federal legislation | ||
R&SA Simplification of cross-border treatment | Identify and remove cross-border anomalies in diagnosis and treatment | O- Not met R- No change in cross-border anomalies TG- Low impact | ||
SQ&E Improve service quality and standards | Introduce nationally consistent standards for mental health care | O- Met R- Standards adopted across all jurisdictions Quality assurance programs introduced in some jurisdictions | O- Considerable ongoing development work required to see Standards fully accepted and implemented across all jurisdictions | |
SQ&E Introduce independent evaluation body | Introduce an independent evaluation steering committee | O- Met R- Independent evaluation steering committee and National Mental Health Commission established | ||
SQ&E Ongoing accountability and evaluation | Publish progress within annual Mental Health Reports Develop a National Mental Health Information strategy and minimum data set | O- Substantively met (at least for inpatient services) R- Accountability standards used as an example for other public policy | O- Not met for community based services (no minimum data set) R- No qualitative measure of ‘accountability’ No outcome measures yet recorded to evaluate intervention effect Routine assessment established in very few mental health centres | |
SS Improve coordination of care across sectors | Review of interagency protocols | O- Substantively met | R- Under-utilisation of case managers service Little measurable improvement in continuity of care Not translated to local service level TG- Community and public dissatisfaction | |
Finance | R&SA Increase mental health budget | Increase recurrent mental health spending for Federal and State/Territory Governments | O- Substantively met R- Funding increases observed | R- Variable increase in funding across jurisdictions |
R&SA Increase community-based and general hospital funding | Increase community-based and general hospital funding for mental health | O- Substantively met R- Funds shifted to community service sector Significant increase in non-institutional spending | ||
R&SA Modify funding allocations for mental health | Review Medicare Agreements | O- Substantively met R- Agreements more clearly outline bilateral funding arrangements | ||
SQ&E Ensure fiscal accountability for mental health spending | Create a separate budget for mental health | O- Met | R- Funding continues to be allocated on historical basis Mental health sector-specific outcome-based funding tools remain underdeveloped and under-utilised | |
Community Education | HR&CA Improve mental health literacy (general public) | National Community Awareness Program | O- Partially met R- National community awareness program implemented | O- No substantial benefit achieved R- No measurable change in attitudes TG- Public dissatisfaction Approach not appropriate for minority groups No opportunity for local groups to coordinate promotional activity with the national campaign |