The first essential implementation action is planning to determine population needs relevant to each of the 4As of the Framework. This requires a population health approach, which assesses needs at the population level. This information can be used to determine corresponding needs for different types of services. The capacity of current services to meet population demand and gaps in the service system are then evident.
Planning that takes a population health approach requires information at several levels. Firstly, it requires information that reveals a local area's need for services. Better population health data would enable planning to meet population needs for varying levels of care. The UK has adopted a three-tier model that recognises the different levels of care that a community need to provide to support people with longterm conditions:10
- Level 1: With the right support, most people can learn to self-manage by actively participating in their own health care.
- Level 2: For people who require support for on-going illness management through agreed protocols and pathways to ensure that their ongoing care needs are met.
- Level 3: For people with complex conditions, care coordination becomes necessary, with a key worker actively managing and joining up the care provided by multiple services and sectors.
When needs have been identified and matched with services provided, it becomes evident which needs are currently met, partly met and unmet. However, while there are significant developments in determining population service needs with data that are currently available,11 significant further progress is required before most jurisdictions have the type of information required to plan effectively.
As many communities have multiple unmet needs related to continuing care, it is necessary to prioritise. Priorities should be determined by people who have been seriously affected by mental illness themselves, along with their families and carers, and through consultation with the local community.
A SWOT analysis (strengths, weaknesses, opportunities and threats) can be used to help identify possible opportunities and solutions. This must identify the resources required to make changes and from where these resources will be obtained. It is also necessary to determine a timeline for actions, by identifying short, medium and longer-term goals. It is especially important to set achievable short-term goals, as these will motivate further action. Finally, responsibilities must be allocated and progress monitored through regular review.