National Mental Health Strategy Dr Peggy Brown Director of Mental Health.

National Mental Health Strategy

Dr Peggy Brown

Director of Mental Health

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

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

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.


• 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.


• 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.


• 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.


• 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.


• 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.


• Intersectoral collaboration has not developed in a systematic or coordinated way.

• Progress in implementing standards for mental health care has not met expectations.


• 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.



• 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

http://www.hreoc.gov.au/disability_rights/notforservice/cover.html

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')


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


• 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

National Mental Health Report 2007

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

2009 Report on Government Services

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.


• 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.


• 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.


• 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.


• 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



• 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

National Mental Health Strategy Dr Peggy Brown Director of Mental Health.

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