In 1992, all governments in Australia endorsed the first National Mental Health Strategy, foreshadowing a major reform process over the next six years in the way services are provided to people affected by mental illness. This agreement defined both a national direction and a framework for governments to work together to change a system that was widely acknowledged as inadequate and long neglected by policy makers.
The Strategy was articulated in four major documents.
- The National Mental Health Policy1 outlined the new approach to mental health care, promoting a move from an institutional to a community-oriented approach. The Policy, endorsed by Health Ministers in April 1992, defined the broad aims and objectives to guide the reform process.
- The National Mental Health Plan2 charted the 'action plan' and described how Commonwealth and State and Territory governments would implement the aims and objectives of the National Mental Health Policy.
- The Mental Health Statement of Rights and Responsibilities3 embraced the principles of the United Nations Resolution 98B (Resolution on the Protection of Rights of People with Mental Illness) and outlined the philosophical underpinning of the National Mental Health Strategy on civil and human rights. The Statement of Rights and Responsibilities was agreed by Health Ministers in 1991.
- The Medicare Agreements set out the Commonwealth, State and Territory roles in achieving reform of mental health services and defined the conditions for the transfer of Federal funding to assist in the reform.
The changes advocated were ambitious by international standards. Although governments in other countries have charted similar policy courses for their mental health services, many are seen to have failed in achieving the intended goals. The overseas experience highlights that good intentions do not translate easily to good outcomes in the mental health field. Successful policy requires change in many systems that operate beyond the boundaries of the traditional mental health industry.
Misconceptions and stigma about mental health issues add to the difficulties faced by governments in promoting an accurate understanding of what is being attempted. While there is much scope for improvement in mental health reform, the risks for government of controversy and failure are high.
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It is significant therefore that the Australian governments' agreement to the National Mental Health Strategy included a strong commitment to evaluate both the progress and outcomes of the various initiatives through two principal means.
First, progress would be reported annually through the publication of a National Mental Health Report. The report, prepared by the Commonwealth using data provided by the States and Territories, aims to monitor the yearly progress of each jurisdiction in implementing the Strategy. National Mental Health Reports have now been produced for each of the first three years of the Strategy (1993, 1994 and 1995), with the fourth report due for release early in 1998.4, 5, 6 These reports make a major contribution to understanding the changes in Australia's mental health services.
Second, Ministers agreed that an independent evaluation would be conducted, to complement the annual reporting process by focusing on the Strategy's overall impact and outcomes. An Evaluation Steering Committee was appointed by the Australian Health Ministers' Advisory Council (AHMAC) in June 1995 to plan and direct the evaluation.
The committee's terms of reference split the evaluation process into two phases.7 The first phase, completed in June 1996, reviewed progress in the implementation of the Strategy.8 The final phase reviewed the outcomes of the Strategy and addressed:
- how effectively the Strategy has met its stated objectives
- whether the processes of reform were the most appropriate for meeting the policy objectives and
- the strategies required to continue the process of mental health reform.
The current report summarises the key findings of the evaluation and brings together conclusions and recommendations formed by the committee during its two years of activity. Consistent with the committee's brief, it presents a national view of the changes introduced under the Strategy rather than individualising the performance of each of the States and Territories.
Reports on each of the research streams are being released together with this report, providing full details of the method and results of the evaluation.
Table 1: Priority areas for reform under the national mental health strategyTable 1 is presented as a list in this HTML version for accessibility reasons. It is presented as a table in the PDF version.
- Consumer rights
- The relationship between mental health services and the general health sector
- Linking mental health services with other sectors
- Service mix
- Promotion and prevention
- Primary care services
- Carers and non-government organisations
- Mental health workforce
- Research and evaluation
- Monitoring and accountability