‘Problematising’ Australian policy representations in responses to the physical health of people with mental health disorders

Abstract

Australia, like other jurisdictions, is recognising the poorer physical health of people with mental health disorders. This paper explores policy responses to this issue through discourse analysis of 22 Australian Federal and State government policy documents published in 2006-2011. The paper utilises Bacchi's 'what's the problem represented to be?' approach to explore policy solutions in relation to the representation of the issue, enabling identification of issues which are not problematised and policy solutions that have not been considered. The poor physical health of people with mental health disorders is attributed in policy to poor lifestyle habits and limited access to monitoring of physical health care. Three policy solutions are offered: collaborative care delivery involving greater use of fee-for-service primary care to manage physical health; the monitoring of physical health status by mental health teams; and the promotion of lifestyle change. These solutions fail to address ongoing issues with collaboration between specialist mental health and primary care services. Reliance upon fee-for-service primary mental health care may, in fact, reduce rather than increase access to services. The strategies are discussed in light of neoliberal ideals of governance and personhood which are underpinned by informed consumer choice and personal responsibility for health.

Regional responses to the challenge of delivering integrated care to older people with mental health problems in rural Australia

“…In response, mental health policy has promoted integrated care provided by public and private service providers (Banfield et al, 2012). Integrated care has been identified in mental health policy as a means of improving access to care and preventing people from falling through service gaps, of overcoming clinical siloing and improving the physical health of people with mental health problems (Henderson & Fuller, 2011). The study was undertaken at a time of upheaval.…”

“…One response has been increasing use of private and non-government (NGO) service providers (Henderson, 2005) leading to fragmentation of service delivery (Petrich, Ramamurthy, Hendrie, & Robinson, 2013). Governments have sought means to integrate care between service providers.…”

“…Banfield et al (2012) argue that integrated care has been on the mental health policy agenda since the release of the first National Mental Health Plan in 1992 but became a priority from the Fourth Plan released in 2008. To support integrated care in mental health the 2011 Federal Budget targeted resources to support service planning through Medicare Locals (organisations coordinating primary health services at a regional level) (Henderson & Fuller, 2011). The change of government in 2013 resulted in the replacement of Medicare Locals by larger planning bodies called Primary Health Networks (PHNs), which are responsible for commissioning primary mental health services (Department of Health & Ageing, 2015).…”

Racionalidades leigas e governação da Saúde Mental em Portugal

“…As respostas oferecidas pelos serviços de Saúde Mental, quando organizadas para atender a pressupostos de políticas formuladas sem a participação das comunidades e de seus saberes e contextos locais, diminuem consideravelmente sua legitimidade, como atestam, por exemplo, os estudos de Henderson e Fuller 18 . Segundo os pesquisadores australianos, as políticas de saúde criam um quadro discursivo para a compreensão das questões sociais por meio da produção dos problemas de determinado modo, excluindo representações alternativas da questão (principalmente em relação à população beneficiária) e limitando as possibilidades de intervenção.…”

Fragmentation in Australian Commonwealth and South Australian State policy on mental health and older people: A governmentality analysis

“…In relation to policy, what is problematised and how it is constructed as a problem reflect existing governmental rationalities, with policy solutions following from the manner in which the issue is constructed. Policy, from this perspective, ‘is not considered simply a response to existing social problems’; what is problematised is related to current ideas about citizenship and ‘postulated solutions are seen to frame “problems” in such a manner that the recommended interventions become self-evident’ (Henderson and Fuller, 2011: 188).…”