Dollars needed, change preferred: reform through the Australian National Mental Health Strategy
In: http://hdl.handle.net/1885/13724
In 1992, following a decade of negative publicity and a series of public inquiries into mental health services, the Australian Federal, State and Territory Governments adopted a National Mental Health Policy. This policy, through a series of five year National Mental Health Plans (NMHPlans), became known as the National Mental Health Strategy (NMHS). The aims of the National Strategy were, and still are, to develop a framework of mental health care services which promotes mental health; prevents mental illness where possible; reduces the burden of mental illness on sufferers, carers and the general community; and treats persons with a mental illness in a way which satisfies the United Nation' s Principles for the Protection of Persons with Mental fllness and the Improvement of Mental Health Care. Upon release, this policy was widely acclaimed and considered an international benchmark. Now, more than a decade later, a recent review by the Canadian Senate, several evaluations of the Strategy, and a widespread review of the mental health sector show this opinion is still supported. However, in the case of mental health care in Australia, it is apparent that world class policy does not necessarily equate to world class outcomes. Despite increased investment, major structural changes, and a broadening of mental health services in line with the Strategy, the four major national evaluations of progress under the Strategy have exposed widespread unmet needs for even basic services. Restricted access, variable quality, poor continuity of care, lack of support for recovery, and overt and covert human rights abuses have been common themes in all evaluations. In the past two years alone, five major inquiries into mental health services in Australian States and Territories have supported these evaluations. In relation to the NSW Inquiry into Mental Health Services, the Chair of the NSW Legislative Council Select Committee Hon Dr Brian Pezzutti RFD MLC concluded : "The weight of evidence presented to the committee highlights that mental health services in NSW need revolutionary improvement. Deinstitutionalisation, without adequate community care, has resulted in a new form of institutionalisation: homelessness and imprisonment."* With three national inquiries underway or planned (directly or indirectly relating to problems with mental health services) it is clear that the five year plans are not achieving the aims of the Strategy. This report will discuss the differing yet complementary roles and responsibilities of the State, Territory and Federal Governments in implementing the National Strategy. In terms of the aims and division of responsibilities within the National Strategy, the major problems in Australia' s Mental Health System, as highlighted in the four national reviews and six inquiries, will be discussed. However, this report will not focus on failure, or the degree of failure across the varying States (although in some cases this will be discussed) as several other reviews have covered this extensively. Rather, this report will build on this mass of evidence and address the issue of why, 13 years since the commencement of the Strategy, Australia's mental health system is not achieving adequate levels of basic service, let alone the aims of NMHS. Given the collective acclaim for Australia's mental health policy, increased investment, and great structural and service changes towards community based care it appears that the problems with Australia's Mental Health Care are related to pace, extent and quality of change rather than lack of or direction of change. This report supports the finding of the major national evaluations and inquiries: an increase in State, Territory and Federal funding is imperative to achieving the aims of the Strategy. However, this alone will not solve the problems with Australia's Mental Health System. Instead, this report highlights the need for greater leadership, coordination of governance and accountability in terms of achieving outcomes. For the past 13 years the States and Territories have been accountable for inputs such as monetary investment, and outputs such as number of beds provided and quantity and styles of services. However, there has been no mandatory State/Territory based reporting of outcomes using consumer based measures. Therefore, governments have not been held directly accountable for achieving the consumer based aims of the NMHS. Furthermore, in the majority of States and Territories this data is not even collected or is inadequate. A fundamental shift in national mental health policy, to hold the State, Territory and Federal Governments accountable to consumer, carer and community based measures of outcomes is needed. This report proposes the development of specific targets in terms of real outcomes to be included in the NMHPlans. Furthermore, this report highlights the need for greater accountability by the States and Territories in terms of outcomes and transparency of funding. It suggests that all States and Territories be required to record and report on objective consumer welfare outcomes in addition to reporting on investment and service developments. Recommendations include the need for a national monitoring body and a commission model is suggested.