National Mental Health Strategy

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National Mental Health Strategy

• Dr Peggy Brown
• Director of Mental Health

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• 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.

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• 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)

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• 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)

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• 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

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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.

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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

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Priority Areas under the National Mental Health
Strategy

• Primary care services
• Carers and non government agencies
• Mental health workforce
• Legislation
• Research and evaluation
• Standards
• Monitoring and accountability

• Consumer rights
• Relationship between mental health sector and
  general health sector
• Linking mental health with other sectors
• Service mix
• Promotion and prevention

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Number of Psychiatric Inpatient Beds Prior to the
National Mental Health Strategy
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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

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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.

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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.

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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.

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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.

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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)

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• 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

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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

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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.

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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.

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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.

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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.

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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.

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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.

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• 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

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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

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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
  

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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.

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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.

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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')

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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

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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

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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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National Mental Health Report 2007
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Change in Age Profile of Nursing Workers,
Australia, 1987 and 2001
National Review of Nursing Education, DETYA, 2001
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Summary statistics
by age and hours worked per week for

Nursing Professionals, Australia, 1987 and 2001
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2009 Report on Government Services
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2009 Report on Government Services
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2009 Report on Government Services
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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.
  

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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.

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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.

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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.

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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.

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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

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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

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• 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)

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• 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.

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• 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

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• 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.

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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.

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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

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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

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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

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• 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

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Fourth National Mental Health Plan

• Priority Areas
• Social inclusion and recovery
• Prevention and early intervention
• Service Access, coordination and continuity of
  care
• Quality improvement and innovation
• Accountability measuring and reporting progress

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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

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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

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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)

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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

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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

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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