Evaluation of the national mental health strategy

Appendix 2: Summary of progress against national mental health strategy objectives

Page last updated: December 1997

The following pages summarise the committee's conclusions about progress on each of the 38 National Mental Health Strategy objectives. These are drawn primarily from two sources – data provided to the Commonwealth by the States and Territories for the 1996 National Mental Health Report; and the information collected by the committee during the course of the current evaluation.

Progress on each objective was graded on a four-point scale:

  • 1 - Substantial progress
  • 2 - Moderate progress
  • 3 - Minor progress
  • 4 - Minimal or no progress
Where the evidence is insufficient or ambiguous, a rating of 'Not known' was made.

Policy category - consumer rights
Policy category - relationship between mental health services and the general health sector
Policy category - linking mental health services with other sectors
Policy category - service mix
Policy category - promotion and prevention
Policy category - primary care services
Policy category - carers and non-government organisations
Policy category - mental health workforce
Policy category - legislation
Policy category - research and evaluation
Policy category - standards
Policy category - monitoring and accountability

Policy category - consumer rights

Objectives 1 and 2

Objective 1- To have the rights contained in the Australian Health Ministers' Statement of Rights and Responsibilities and in the UN Resolution on the Protection of Persons with Mental Illness and the Improvement of Mental Health Care affirmed in mental health legislation.

Objective 2- To ensure that the Commonwealth Government and all State and Territory Governments have mechanisms for protecting those rights.

Moderate progress
  • Mental health legislation reviewed in all States and Territories, with amendments either enacted or currently before the relevant Parliaments.
  • Anti discrimination legislation in place in the Commonwealth and the majority of States and Territories, providing protection against discrimination on the grounds of mental illness.
  • Consumer Advisory Groups established in all States and Territories and at the national level to advise governments and health authorities on planning and service delivery issues.
  • Minimum Standards for Mental Health Services released 1996, including relevant service delivery standards for ensuring protection of consumer rights.
  • Despite these changes, consumers continue to report significant stigma, discrimination and related breaches of their rights.
Top of page

Policy category - relationship between mental health services and the general health sector

Objective 3

To expand the proportion of acute psychiatric inpatient care provided in general hospitals rather than separate psychiatric hospitals so that most acute care is delivered in general hospitals and ensure that psychiatric units in general hospitals are appropriately designed for the patient population.

Moderate progress
  • Data provided by the States and Territories for the 1996 National Mental Health Report indicates that in the first four years of the Strategy:
    • acute psychiatric beds in general hospitals increased by 20%; and
    • acute beds in stand alone psychiatric hospitals decreased by 28%
  • By June 1996, 66% of total acute psychiatric beds were co-located in general hospitals compared with 55% at June 1993

Objective 4

To maintain or establish an identifiable and integrated mental health program at the State/Territory and area/regional levels. This program would be responsible for the overall planning of all specialised mental health services and would advise on the allocation of resources between components of mental health services.

Minor progress
  • By July 1996, less than half of the jurisdictions had implemented organisational arrangements consistent with the integration objective.
Top of page

Objective 5

To include integrated mental health services with the mainstream organisational arrangements for general health services such as area/regional management systems.

Substantial progress
  • By July 1996, mental health services in all States and Territories were mainstreamed with the general health system.

Objective 6

To introduce systems, such as case management, which improve continuity of care and comprehensive services for people with mental disorders who receive services on an ongoing basis from numerous agencies and locations.

Minimal progress
  • Although all jurisdictions have described a range of initiatives to improve continuity of care, no evidence has yet been published to demonstrate positive impact for consumers.
  • Reports of consultations with consumers in fact suggest that, at the service delivery level, minimal real progress has been made in this area.

Policy category - linking mental health services with other sectors

Objective 7

To eliminate any explicit or implicit discrimination against those with severe mental health problems and mental disorders in programs and services within and outside the health sector.

Minor progress
  • Significant progress has been made to ensure legislation promotes non discriminatory practices and prohibits discrimination on the grounds of mental illness – see comment above re anti discrimination legislation
  • However, consumers report considerable implicit discrimination continues to restrict their access to human service programs.

Objective 8

To develop formalised policy and planning arrangements at Commonwealth, State, Territory and area/regional levels to ensure that all programs relevant to those with severe mental health problems and mental disorders adequately address their needs.

Moderate progress
  • Significant action taken at central administrative level by all jurisdictions to improve access and relevance of human service programs for people affected by mental illness.
  • Evidence was presented in the 1995 National Mental Health Report of movement by many general human service programs from exclusion or neglect of people with mental illness to a position where this group is included as a priority.
  • Considerable consensus is evident in reports of national consultations that access to housing and employment remain the highest priority services for improvement.
Top of page

Objective 9

To encourage interagency links and service delivery arrangements at the local and area/regional level to ensure that access to services for people with severe mental health problems and mental disorders reflect their relative need for those services.

Minor progress
  • The Area Case Studies concluded that, at the service delivery level, least progress has been made in linking mental health services with other services.
  • Protocols developed at central level have not yet been translated to local service delivery levels.

Policy category - service mix

Objective 10

To ensure each State, Territory and area/region has a plan for the mix of services available to its population and that this plan is developed through a consultative process and takes account of the needs of special groups.

Substantial progress
  • By June 1997, seven of the eight jurisdictions had released a comprehensive mental health services plan that was prepared in the context of the National Mental Health Strategy.

Objective 11

To reduce the size or close existing psychiatric hospitals and at the same time provide sufficient alternative acute hospital, accommodation and community based services.

Substantial progress
  • In the four years to June 1996 there was:
    • a 31% reduction in the number of beds located in separate psychiatric hospitals; and
    • a 55% increase in expenditure on community and general hospital-based services.
  • Institutions have become less central to mental health services, reducing from 49% to 35% of total expenditure over the four year period 1992-1996.
  • Spending on mental health services has generally been maintained, with savings gained from institutional downsizing used to develop alternative services.
Top of page

Objective 12

To upgrade the remaining psychiatric facilities which are needed to provide treatment or care on a medium or long-term basis for those whose appropriate placement is in separate specialist psychiatric hospital facilities.

progress not known
  • At June 1996, 60% of total beds remained in separate institutions.
  • By February 1995, only 6 of the 25 longer term institutions had received accreditation with the Australian Council on Health Care Standards.
  • However, specific data on the quality of these services is not available.

Objective 13

To decentralise the provision of psychiatric hospital services to ensure adequate access across all areas/ regions to general hospital inpatient services and community based services including crisis, assessment and treatment, rehabilitation/support and domiciliary and outreach services.

Minor progress
  • Although there is evidence of significant relocation of resources between regions, data collected for the National Mental Health Report suggest considerable disparity between communities in service availability.
  • By June 1996, few of the jurisdictions had implemented a full population-based funding model to guide resource transfer.

Objective 14

To increase the number and range of community based supported accommodation services and ensure a range that provides a level of support appropriate to the needs of the consumer.

Moderate progress
  • Significant action has occurred to increase community-based accommodation.
  • But the lack of housing continues to be a major source of concern voiced by consumer and carer groups.

Objective 15

To identify areas where the separation of Commonwealth and State funding for mental health treatment services compromises the targeting, integration and distribution of mental health services and to introduce measures to overcome this.

Minimal or no progress
  • Although several steps have been taken to coordinate Commonwealth, State and Territory spending on medical practitioners in mental health services, the separation of funding streams that was present at the commencement of the National Mental Health Strategy continues to be a major barrier to change.
Top of page

Policy category - promotion and prevention

Objective 16

To develop programs which educate the public on mental disorders including those initiated through mainstream health promotion activities.

Minor progress
  • The national campaign ('Community Awareness Program') to educate the community was initiated under the Strategy and has few precedents internationally.
  • Evaluation of CAP suggests that it was well received within the community; the Area Case Studies support this.
  • However, consumers and staff report that the campaign made little inroad to changing community attitudes or behaviour.

Objective 17

To develop and evaluate primary, secondary and tertiary preventive programs as an essential component of all care provided for people at risk of mental disorder.

Minimal progress
  • Relatively minor initiatives in primary prevention have been taken. Unresolved debate continues amongst mental health professionals regarding the priority that should be given by specialist mental health services to primary prevention activities.
  • Little published evidence has been produced during the Strategy as to the effectiveness of any new secondary and tertiary prevention programs introduced as a result of the Strategy.

Objective 18

To encourage further research into the causes of mental disorders and the development and evaluation of primary prevention interventions in response to emerging scientific knowledge.

Moderate progress
  • Spending on mental health research increased by 22% in the first year, although definitional difficulties reduce the reliability of this finding.
  • Approximately $11.4 million was spent on mental health research by the Commonwealth, States and Territories in 1994-95, representing 0.7% of total expenditure on mental health services. A nationally agreed target to guide mental health research investments has not been set.
Top of page

Policy category - primary care services

Objective 19

To ensure that educational programs for primary health care professionals and others with a primary care role contain, within their curriculum and continuing education programs, adequate coverage of mental health issues.

Minimal or no progress
  • Major concern was evident during the national Stakeholder consultations regarding
    1. loss of mental health expertise arising from the introduction of generic training programs and
    2. low skill levels amongst many mental health professional staff.
  • Discriminatory and stigmatising attitudes by staff was reported by consumers to be one of the major problems inhibiting service quality improvements.

Objective 20

To provide support to primary carers by ensuring that they have access to specialist mental health resources particularly in rural and remote communities.

Minor progress
  • The Commonwealth, States and Territories have taken specific initiatives, targeted at general practitioners.
  • Other innovative initiatives also have attempted to improve access in rural and remote communities.
  • Evaluative data on the impact of these initiatives is not available.
  • Promising joint initiatives have begun to emerge through collaborative work between the bodies representing general practitioners and psychiatrists.12

Policy category - carers and non-government organisations

Objective 21

To support the development and expansion of non-government organisations to assist carers and promote self-help and consumer advocacy, through information provision, opportunities to participate in mental health service decision making and funding.

Minor progress
  • Allocations to non government organisations specialising in the mental health area increased by 178% between 1993 and 1996 years but accounted for only 3.2% of total State/Territory mental health spending in 1995-96
  • Considerable initiatives have been taken to establish peak Consumer Advisory Groups at national, State and Territory levels. However, no equivalent mechanisms for consumer/carer participation have been established in about half of Australia's public mental health service organisations.
  • Consumers strongly promote the strengthening of the non government sector, due to their emphasis on 'the person not the illness'.
Top of page

Objective 22

To expand community based support for carers.

Minimal or no progress
  • Carers widely report that support services have largely been neglected during the first National Mental Health Strategy

Policy category - mental health workforce

Objective 23

To achieve a better distribution of psychiatrists between States and Territories, geographic areas within States, public and private practices and within sub-specialities.

Minor progress
  • Following many years of ongoing movement by psychiatrists from public to private sector employment, evidence presented in the 1996 National Report suggests a slowing of this trend.
  • Inequities in access by rural and communities to private psychiatrists continues, averaging at 20% of the national per capita rate.

Objective 24

To ensure that the number of graduates and their level of skills from tertiary based programs of nurse education meet the service requirements of specialised mental health services.

Minimal or no progress
  • All jurisdictions report that they have introduced specialist mental health postgraduate courses for nurses.
  • But professional groups report that there has been a significant decline of the number of nurses with specialist psychiatric qualifications employed in mental health services. This may have been influenced to some extent by the transfer of nursing education to the tertiary sector and the replacement of specialist training with comprehensive nursing curricula.
  • There is particular concern that neither the current salary schedules nor employer assistance schemes give any incentive for general trained nurses to complete specialist psychiatric qualifications.
Top of page

Objective 25

To ensure an adequate supply and a more equitable distribution of allied health staff.

Progress not known
  • Allied health staff in public mental health services increased by 21% between 1994-1996, but no data are available to assess their distribution in relation to community need.
  • Consumers reported in the Area Case Studies that accessing to counselling and related programs usually provided by allied health workers is very difficult.

Objective 26

To encourage continuing education for all mental health professionals.

Progress not known
  • No data relevant to these objectives have been published.

Policy category - legislation

Objective 27

To ensure that mental health legislation across Australia is consistent and that it affirms the rights contained within the Australian Health Ministers' Statement of Rights and responsibilities and UN Resolution on the Protection of Persons with Mental Illness and the Improvement of Mental Health Care

Moderate progress

Objective 28

To ensure that legislation in other sectors is consistent with the principles set out in the National Mental Health Policy

Moderate progress

Policy category - research and evaluation

Objective 29

To promote increased basic and applied mental health research and its application in prevention and intervention programs.

Minor progress Top of page

Objective 30

To institute regular review of outcomes of services provided to persons with serious mental health problems and mental disorders as a central component of mental health service delivery.

Moderate progress
  • Work has commenced to develop national standards for outcome evaluation.
  • Routine assessment of consumer outcomes has been established in very few mental health services.
  • Strategies directed to improving service quality and effectiveness are the priority for future years.

Objective 31

To develop a national mental health data strategy.

Minor progress
  • A National Mental Health Information Strategy has been in place since 1993 to guide information development activities.
  • Agreement achieved on a minimum data set for mental health inpatient services, but not yet for community-based services.
  • Information infrastructure to support service development and quality improvements is grossly undeveloped in most mental health services in Australia.

Policy category - standards

Objective 32

To encourage the development of national outcome standards for mental health services and systems for assessing whether services are meeting these standards.

Moderate progress

Objective 33

To ensure all mental health services have quality assurance programs

Minor progress
  • Several jurisdictions have introduced quality assurance as a condition of funding for mental health services.
  • See also Objective 30 and Objective 35.

Objective 34

To support appropriate professional bodies in developing protocols for clinical treatment.

Minimal or no progress
  • Few professional bodies have developed mental health clinical protocols.
  • Major concerns regarding service quality suggest that this needs to be a priority in future years.
Top of page

Objective 35

To encourage each mental health facility to be fully accredited by an independent and recognised accreditation body.

Moderate progress
  • By February 1996, 25% of stand alone psychiatric hospitals and 67% of colocated psychiatric units were accredited by the Australian Council on Healthcare Standards.
  • New national standards for mental health services were released in 1996, covering both inpatient and community services.
  • Implementation of these by the States and Territories will determine extent of progress over the next few years.

Objective 36

To ensure that all services satisfy the standards and rights contained in the UN Resolution on the Protection of Persons with Mental Illness and the Improvement of Mental Health Care and the Australian Health Ministers mental health statement of rights and responsibilities.

Minimal progress
  • Despite significant legislative change, consumers report that these do not ensure that treatment is delivered with an emphasis on dignity and respect.
  • The need to be treated with dignity and respect was identified as the highest future priority by consumers responding to the Area Case Studies survey.

Policy category - monitoring and accountability

Objective 37

To develop nationally agreed measures of performance in relation to each of the objectives in this policy and others which the Commonwealth, States and Territories regard as indications of performance in relation to thispolicy.

Substantial progress
  • Performance measures to monitor the National Mental Health Strategy were agreed in 1992. and have been regularly published in the annual National Mental Health Report.
  • Accountability arrangements for the National Mental Health Strategy are often cited as a model for other public policy areas.

Objective 38

To report annually and publicly, in a timely fashion, on the progress of the Commonwealth and each State and Territory in relation to these performance indicators and to compare them to their previous performance.

Substantial progress
  • Performance measures to monitor the National Mental Health Strategy were agreed in 1992. and have been regularly published in the annual National Mental Health Report.
  • Accountability arrangements for the National Mental Health Strategy are often cited as a model for other public policy areas.
Top of page