Not Centralisation but Decentralised Integration through Australia's National Mental Health Policy

Smullen, Amanda

doi:10.1111/1467-8500.12153

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…Delivery of services within the Australian healthcare system is complex in part due to the different roles and responsibilities of various arms of government. [19, 20] For example, the Commonwealth government funds community-based primary (e.g. general practitioners) and secondary healthcare clinicians (e.g.…”

Section: Introductionmentioning

confidence: 99%

Strengthening care for children with complex mental health conditions: Views of Australian clinicians

Paton

Hiscock

2019

PLoS ONE

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Objectives Improving mental health outcomes for children and young people has become a priority for policy makers in the developed world. In Australia, up to half of all children and adolescents meeting criteria for mental health disorders receive suboptimal levels of treatment (or no treatment at all) despite the availability of effective treatments. Children with complex mental health conditions are particularly at risk of inadequate treatment as optimal care requires coordination from medical, educational and social services. In Australia, clinicians including pediatricians, psychologists and child and adolescent psychiatrists deliver the bulk of mental health care for children with complex mental health conditions. We aimed to determine perspectives of these Australian clinicians on barriers and enablers within the current system and components of an optimal model of care. Methods Inductive content analysis was used to analyse 30 semi-structured interviews with key clinicians managing the care of children with complex mental health conditions across Australia. Interviews were conducted using vignettes with Attention Deficit Hyperactivity Disorder (ADHD) and Autism as exemplars. Findings Multiple barriers to optimal care exist at a systemic, clinician and family level. However, regional health systems provide an enabling environment from which metropolitan models could learn. Transitioning to adult services was highlighted as the most compromised area of care. Clinicians identified short (e.g. empowering parents to advocate for and deliver their child’s care, case conferencing with schools) and long term (e.g. co-locating disciplines to deliver care, workforce training) solutions. Conclusions Whilst multiple barriers to optimal care for children with complex mental health conditions exist, clinicians identify several enablers including developing networks with other disciplines and empowering parents to advocate for and co-ordinate care. Systemic changes based on multidisciplinary, co-located and integrated care services should be developed as longer term solutions.

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Section: Introductionmentioning

confidence: 99%

Strengthening care for children with complex mental health conditions: Views of Australian clinicians

Paton

Hiscock

2019

PLoS ONE

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“…Managing substantive reform is challenging, particularly given the complex nature of the history of mental health in Australia and the split responsibility for governance in health care more generally (Smullen, 2016). However, as stated, there is opportunity to conduct ‘natural experiments’ to test novel planning approaches and evaluate comparative performance.…”

Section: Discussionmentioning

confidence: 99%

Centralisation versus regionalisation: Designing the Sixth National Mental Health Plan

2022

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In response to the recent Productivity Commission report into mental health, the previous Federal Government announced its intention to produce a new national agreement that lays the platform for Australia's sixth national mental health plan. It has been recommended mental health move to a more regional model of governance and planning, away from a centralised, top-down approach, partly in response to broader reforms affecting health care, and partly in direct response to consistent inquiry evidence that the mental health system remains in crisis. The past 30 years of mental health planning have been centralised. Successive national plans set a broad framework, with real decisions about mental health funding and service allocation made in the health departments of our capital cities. Will the next plan sponsor or inhibit regionality in mental health planning? This paper assesses Australia's historical approach to health planning particularly as it affected mental health and the costs arising. In learning these lessons, we propose the necessary ingredients to facilitate a regional, innovative, and effective approach to decentralised planning, for better mental health outcomes. We cannotThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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“…The pursuit of even this rather limited dataset was challenging enough-obtaining agreement on data collection standards and definitions between nine Australian jurisdictions is difficult. The process requires consensus across governments [17].…”

Section: Limited Aims Limited Performancementioning

confidence: 99%

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

Rosenberg

Salvador‐Carulla

Meadows

et al. 2022

IJERPH

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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.

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Not Centralisation but Decentralised Integration through Australia's National Mental Health Policy

Cited by 10 publications

References 20 publications

Strengthening care for children with complex mental health conditions: Views of Australian clinicians

Strengthening care for children with complex mental health conditions: Views of Australian clinicians

Centralisation versus regionalisation: Designing the Sixth National Mental Health Plan

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

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