Fit for Purpose—Re-Designing Australia’s Mental Health Information System

Abstract

Background: Monitoring and reporting mental health is complex. Australia’s first National Mental Health Strategy in 1992 included a new national commitment to accountability and data collection in mental health. This article provides a narrative review of thirty years of experience. Materials and Methods: This review considers key documents, policies, plans and strategies in relation to the evolution of mental health data and reporting. Documents produced by the Federal and the eight state and territory governments are considered, as well as publications produced by key information agencies, statutory authorities and others. A review of this literature demonstrates both its abundance and limitations. Results: Australia’s approach to mental health reporting is characterised by duplication and a lack of clarity. The data available fail to do justice to the mental health services provided in Australia. Mental health data collection and reporting processes are centrally driven, top–down and activity-focused, largely eschewing actual health outcomes, the social determinants of mental health. There is little, if any, link to clearly identifiable service user or carer priorities. Consequently, it is difficult to link this process longitudinally to clinical or systemic quality improvement. Initial links between the focus of national reform efforts and mental health data collection were evident, but these links have weakened over time. Changes to governance and reporting, including under COVID, have made the task of delivering accountability for mental health more difficult. Conclusion: Australia’s current approach is not fit for purpose. It is at a pivotal point in mental health reform, with new capacity to use modelled data to simulate prospective mental health reform options. By drawing on these new techniques and learning the lessons of the past, Australia (and other nations) can design and implement more effective systems of planning, reporting and accountability for mental health.

Towards Youth Mental Health System Reform: An Evaluation of Participatory Systems Modelling in the Australian Capital Territory

“…Thus, the focus in the ACT should now be on maintaining that trust and empowering all regional stakeholders-led by the site-to realise their potential on how they could both contribute to and hold regional leaders accountable for regional youth mental health change in order to support the sustainable implementation of the model. National leaders should also be held accountable to support regional models of governance and decision-making, through improvements to systemic challenges that can limit the system dynamics model, such as current data infrastructure and information collection systems [21]. Strategies on how to support sustainability were identified by stakeholders during follow-up interviews.…”

“…Most recently, the Productivity Commission's Inquiry report on mental health has noted regional planning to be "patchy", with a lack of accountability and strategy undermining the impact on mental health outcomes [6,[18][19][20]. Youth mental health system reform also requires the consideration of broader social and economic factors, such as housing and employment, which impact youth mental health outcomes [6,21].…”

“…Systems modelling via a participatory approach (referred to as participatory systems modelling (PSM)) has been recognised as a useful method to support complex system reform, particularly in the field of environmental sciences [22]. This approach has the potential to increase capacity to support youth mental health reform by offering sophisticated forecasting and decision support tools to prospectively simulate mental health reform options through the consideration of complex and interconnected areas of health, social, and economic systems [21,23]. PSM can also improve accountability through transparent tracking of such mental health reform options [16,24].…”

Mental health systems modelling for evidence-informed service reform in Australia

“…The Commission recommended that each regional plan developed jointly by PHNs and LHNs reports a ‘gap analysis’, comparing current services with what services are required , and a schedule detailing the level and mix of services that would be provided over the following 3-year period. The need for evidence-informed recommendations to support effective change and inform resource allocation, makes more imperative the use of decision support tools to guide systemic and individual improvement (Rosenberg et al, 2022).…”

Health Statistics in Australia: What We Know and Do Not Know

“…The paper in this issue by Rosenberg et al [33] describes the development of mental health statistics since the 1990s. This development occurred outside the processes established under the National Health Information Agreement, even though the Australian Government and State health agencies were cooperating through their mental health experts.…”