The Australian Mental Health System

International Journal of Law and Psychiatry, Vol. 23, No. 3–4, pp. 403–417, 2000Copyright © 2000 Elsevier Science LtdPrinted in the USA. All rights reserved

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The Australian Mental Health System

Harvey Whiteford,* Ian Thompson,† and Dermot Casey‡

The Australian Health System

Australia has a land mass roughly the same size as the continental UnitedStates. Settlement of Australia, by people now known as Aborigines andTorres Strait Islanders, occurred some tens of thousands of years ago. Settle-ment by people from Great Britain and subsequently other countries, began in1788 resulting in a present-day population of about 19 million, from a diversityof ethnic backgrounds. Australia has an established market economy, a highstandard of living and life expectancy for boys born in 1994 of 75 years and80.9 years for girls born in that year. Government is a federated system withsix states and two territories.

Australia has a mixed public and private health system. The states and terri-tories are responsible for delivering public sector services funded from stateand federal taxes. The source of Federal (Commonwealth) contributions tothe states, and outpatient private medical services, is universal taxpayerfunded health insurance and Federal income tax. Private hospital and a rangeof nonmedical out-of-hospital services are funded through private health in-surance or other sources of funding, such as workers’ compensation insuranceor individual co-payments. All Australians are eligible to be treated in publichospitals free of charge and under the national health insurance system to re-ceive rebates on private medical practitioner consultations (Australian Insti-tute of Health and Welfare, 1998a). Approximately 32% of the population hasprivate health insurance.

Capital and recurrent health expenditure in Australia in 1996–97 totaledA$43.2 billion, and comprised 8.4% of gross domestic product (GDP) (Aus-tralian Institute of Health and Welfare, 1998b). As a percentage of GDP,health expenditure grew from 7.8% in 1989–90 to 8.6% in 1991–92, but has

*Mental Health Specialist, The World Bank, Human Development Network, Washington, DC, USA.

†Assistant Director, Mental Health Branch, Commonwealth Department of Health and Aged Care,Canberra, Australia.

‡Director, Mental Health Branch, Commonwealth Department of Health and Aged Care, Canberra,Australia.

Address correspondence and reprint requests to Harvey Whiteford, Professor of Psychiatry, The Uni-versity of Queensland, Toowong Private Hospital, P.O. Box 822, Toowong Q4066, Australia.

404 H. WHITEFORD, I. THOMPSON, and D. CASEY

been steady at around 8.4% since 1993–94. Major expenditure contributions in1996/97 were commonwealth government 45.5%, state and territory govern-ments 23.2%, and nongovernment, including private health insurance, 31.3%(Australian Institute of Health and Welfare, 1998b).

Broadly (Australian Institute of Health and Welfare, 1998a), the Common-wealth provides:

• Medical benefits for private medical practitioner services (85% rebate ona government schedule fee), including private psychiatrists on a timebased fee for service. Although this Medicare Benefits Scheme (MBS)pays on a largely uncapped fee for service basis, Australia has supply sidecontrols on the number of medical practitioners by limiting the number ofplaces in Australian medical schools, all of which are in public universi-ties. Also, to attract MBS rebates, all consultations with specialists mustbe referred from another medical practitioner, usually a general practitio-ner (family physician).

• Pharmaceutical benefits for about 500 kinds of drugs in more than 1,800formulations (including subsidies for a wide range of psychotropic drugs).Around 65% of all prescriptions in Australia are subsidized under thisscheme, and in 1996/7 124 million prescriptions were subsidized (6.73 forevery person in Australia) (data supplied to the authors by Pharmaceuti-cal Benefits Branch, Australian Department of Health and Aged Care in1998).

• Additional, complementary programs for war veterans and their depen-dants and Aboriginal and Torres Strait Islanders, who also remain eligi-ble for mainstream health programs.

State and territory governments provide:

• Inpatient services provided in public hospitals, including psychiatric hos-pitals and psychiatric beds in general hospitals;

• Community-based health services, including mental health services;• Community residential services, including mental health residential services;• Accommodation, rehabilitation, and social support services provided by

nongovernment organizations (to which people with mental illness andpsychiatric disability have access).

Private health insurance and other nongovernment sources provide:

• Private hospital services (all private health funds must cover psychiatricservices, at least in their basic table);

• Rebates for selected services provided by nonmedical private practitio-ners, for example, psychologist services.

Mental Health Services in Australia

Services for people with mental illness are provided through a range ofhealth and welfare programs funded by commonwealth and state and territory

THE AUSTRALIAN MENTAL HEALTH SYSTEM 405

governments, private health insurance and by individual co-payments. In thepublic sector, the typical specialized mental health service delivery model in-volves services being provided for a defined catchment population, with theservice integrated across hospital and community settings. Inpatient servicesare provided in general hospitals and in separate psychiatric hospitals. Com-munity-based services comprise a range of service types, including clinic-based, mobile follow-up and treatment, and mobile crisis response services.Case management is often used to coordinate services provided in differentsettings. Housing, disability support, employment, and income security ser-vices are funded under other government programs.

Annually since 1993, a National Mental Health Report has published dataon recurrent mental health service expenditure funded by commonwealth,state and territory governments and private health insurance (Whiteford,1994). In 1996/97, total expenditure by these sources on mental health serviceswas $2.07 billion (Commonwealth Department of Health and Aged Care,1998a). Outlays for the commonwealth government were $650 million(31.4%), for state and territory governments $1,267 million (61.1%) and forthe private sector $156 million (7.5%).

When compared to the total recurrent health expenditure funded fromthese sources, mental health services accounts for 6.3% of expenditure. Therelative importance of each sector is also substantially different, with state andterritory governments funding a greater proportion of expenditure.

Financing Mental Health Services

Financing arrangements vary between different mental health service deliv-ery programs and between the government and nongovernment sectors. State-funded specialized mental health services are largely funded through grantsbased on the previous year’s level of funding. Such mechanisms contain no ar-rangements to link funding to performance or efficiency. One state, Victoria,funds specialized mental health services on the basis of unit costs—that is thenumber of beds available and staff employed. These funding arrangements re-quire providers to meet specific input requirements, but do not link funding tooutputs or to outcome.

The model used by the Victorian government for purchasing mental healthservices is outlined in Figure 1 (Victorian Department of Human Services,1998). Services are largely organized on a regional basis, with a few services,such as long-term care for forensic patients, covering the state as a whole.Within regions, services are purchased according to the target population, thatis, children and adolescents, adults, or aged persons. The minimum targets setfor funding of child and adolescent, and aged persons’ services reflect the his-torical funding base of these services. Once funding has been allocated for thetarget populations, it is used to purchase inpatient and community services, witha minimum target of 55% of total funding allocated to community services.

Casemix Funding

Within the mental health allocation, three states and territories fund acuteinpatient services on a casemix basis. The classification system used is Version


3 of the Australian National Diagnosis Related Groups (AN-DRGs) (Com-monwealth Department of Health and Family Services, 1996a). Under thesearrangements, providers are funded according to the number and type of pa-tients treated. This model has the potential to promote efficiency and equity, bycreating incentives to reduce length of stay in hospital, and to provide greaterreimbursement for services treating patients with more complex needs. How-ever, as with such systems throughout much of the world, there is an incentiveto discharge patients prematurely resulting in poor quality of care.

FIGURE 1. Victorian government mental health services purchasing model, 1998.


In addition, where casemix funding is restricted to acute inpatient care, andcommunity-based services are funded on block grants irrespective of the num-ber or type of patients treated, incentives are created to admit patients to hos-pital, contrary to the policy objectives of the current national mental healthpolicy (Australian Health Ministers, 1992).

To address these concerns, the Commonwealth commissioned the MentalHealth Classification and Service Costs (MH-CASC) Project (Buckingham etal., 1998) to develop a national casemix classification, with associated costweights, for specialist mental health services that:

• Would be consistent with the National Mental Health Policy (describedfurther below);

• Could be used to classify mental health patients in the various treatmentsettings; and

• Would include an appropriate number of casemix classes, each of whichcomprises consumers with similar clinical conditions and similar resourceuse needs.

The Project found that there is an underlying episode classification, not justin inpatient services but also in community mental health care. The level of ser-vice provided to patients bore a clinically and statistically logical relationship tothe patient’s clinical status. Figure 2 shows an overview of the classification.

As Figure 2 shows, the classes are defined according to a range of patientcharacteristics; primarily age, diagnosis, clinical severity, level of functioning,

FIGURE 2. Summary of Mental Health Classification and Service Costs setting-specific classification.RIV: explanation of variance; HoNOS: Health of the Nation Outcomes Scale for Adults; RUG-ADL:Resource Utilization Group-Activities of Daily Living; HoNOSCA: Health of the Nation Outcomes Scalesfor Children and Adolescents; CGAS: Children’s Global Assessment Scale; LSP: Life Skills Profile.


and mental health legal status. Clinical severity was measured using theHealth of the Nation Outcomes Scales (HoNOS) for adults (Wing et al., 1998),the child and adolescent version of the same instrument for children and ado-lescents (Gowers et al., 1998) and the Children’s Global Assessment Scale(CGAS; Schaffer et al., 1983). Level of severity was measured using the LifeSkills Profile for adults (LSP; Rosen, Parker, Hadzi-Pavlovic, & Hartley,1987), and the Resource Utilisation Groups—Activities of Daily Living(RUG-ADL) scale for people aged over 65, or with organic brain syndrome(Williams, Fries, Foley, Schneider, & Gavazzi, 1994). Mental health legal sta-tus indicated whether a patient had been under an involuntary treatment orderfor some period of the episode of care. A final variable used in the communityclassification related to the focus of care and classified the patient’s primaryneed for treatment and the treatment objective. The four goals of care wereacute, functional gain, intensive extended, or maintenance treatment.

The relationship between clinical factors and cost appeared to be con-founded by variations in the practice of different providers. Some of these pro-vider factors may be structural or financial, and others may be under the con-trol of individual clinicians. Further work is required to disentangle thesefactors. However, the Project developed a first version casemix classificationmodel which included 42 patient classes—19 for community episodes, and 23for inpatient episodes. While explanation of variance (RIV) was found to belower than Australian National Diagnosis Related Groups (AN-DRGs) stan-dards in the general health system, the overall explanation of variance of theclassification is higher than that achieved using the AN-DRG mental healthclasses. Adoption of this classification schema would require routine use of asmall number of clinical scales, applied at periodic intervals. The classificationmay be used for both management information and funding purposes and isconsidered to have potential to advance the National Mental Health Policy.As a first version casemix classification, it will require ongoing clinical refine-ment and further research.

Medicare Benefits Schedule

The incentive under the Medicare Benefits Schedule (MBS) is for practitio-ners to provide more services. This has led to concerns about clinically unnec-essary provider-driven demand. Another concern relates to the time-based na-ture of MBS reimbursement. Under time-based reimbursement, practitionerpayment is not linked to the severity or complexity of the patient’s condition,and practitioners do not have a financial incentive to treat these patients. Af-ter 50 treatment sessions in a 12-month period, rebates to private psychiatristsunder the MBS are halved unless the patient meets certain clinical criteria(Commonwealth Department of Health and Aged Care, 1998b).

Private Health Insurance

Private health insurance pays for private hospital care on a bed day rate.The bed day rate differs according to whether a patient is classified as acute ornonacute, and “step-down” rates apply whereby the level of funding is re-


duced after a specified number of days in hospital. Day programs are alsofunded by private hospital insurance, but there are financial barriers for insur-ance to cover out-of-hospital services. Funds require psychiatric programswith agreed parameters to be in place in order to make their payments. Poten-tial incentives created by the private insurance arrangements are for providersto admit patients and for length of stay in hospital to match the “step-down”periods. The barriers to providing out-of-hospital services are also contrary tonational mental health policy objectives.

Australia’s National Mental Health Strategy

In 1992, Australia started it’s first nationally coordinated National MentalHealth Strategy when a national mental health policy and plan was adopted bythe Health Ministers of all states, territories, and the commonwealth (Austra-lian Health Ministers, 1992; Whiteford, 1993). A collaborative framework topursue the agreed 12 priority areas (Table 1) over a 5-year period was estab-lished and strategies were set for the implementation of 38 objectives are out-lined in the policy (Whiteford, 1994).

Broadly, the National Mental Health Strategy aimed to:

• Promote the mental health of the Australian community and where possi-ble, prevent the development of mental health problems and mental dis-orders;

• Reduce the impact of mental disorders on individuals, families, and thecommunity; and

• Assure the rights of people with mental illness.

The Strategy recognized the complementary but different roles of the com-monwealth, states and territories. The Commonwealth coordinated the systemreform on a national basis, monitored the reform process, and disseminatedinformation in annual reports on the national progress in achieving the agreedoutcomes (Whiteford, 1994). As well as providing additional mental healthfunding for the states and for national programs, the commonwealth gradually

TABLE 1Priority Areas Under the National Mental Health Strategy

1. Consumer rights2. The relationship between mental health services and the general health sector3. Linking mental health services with other sectors4. Service mix5. Promotion and prevention6. Primary care services7. Carers and nongovernment organizations8. Mental health workforce9. Legislation

10. Research and evaluation11. Standards12. Monitoring and accountability


increased access to nursing homes, emergency relief and accommodation, vo-cational rehabilitation, disability services, and income support for people withmental illness and psychiatric disability. The states and territories, which oc-cupy the primary position in Australia’s public mental health system, were re-sponsible for the bulk of public sector reform.

National Spending Trends

Total spending on mental health services increased by 25% between 1992and 1997 in constant 1997 prices (Commonwealth Department of Health andAged Care, 1998a). This approach evens out fluctuations that may occur on ayear-by-year basis, as well as removing the effects of inflation. Combined stateand territory funding increased by 14%, or $157.5 million, commonwealth al-locations increased by 49%, $212.9 million and spending on private hospitalsby 38%, or $42.8 million, all in 1997 dollars.

The bulk of the commonwealth increase has been in the specific allocationsmade for national projects, state funding under the National Strategy andgrowth in the costs of psychiatric drugs provided under the PharmaceuticalBenefits Scheme. The growth rate in private psychiatry services funded underthe MBS was consistently over 10% per annum in the period 1984–85 to 1992–93, fell to under 5% in 1994–95 and 1995–96, and actually decreased by 3.1%in 1996–97. The specific reason for this trend is unclear. However, a key objec-tive of the National Strategy was to increase the number of psychiatrists work-ing in the public sector and staffing in this sector increased by 8% since 1992–3. Given the supply-side controls on physician numbers mentioned earlier, thisis likely to have contributed to the slowing growth in private psychiatry.

Changes in Service Mix

In the public sector, the National Strategy advocates the development of lo-cal, comprehensive service systems providing continuity of care across hospitaland community service delivery sites. The Strategy continued the direction,but greatly quickened the pace, of fundamental changes that had been occur-ring in a more ad hoc way. Acute inpatient care continued its move fromstand-alone psychiatric hospitals into general hospitals and community ser-vices expanded with a decreasing reliance on hospital services.

In 1992–93, only 29% of state mental health resources were directed towardcommunity-based care. Seventy-three percent of specialist psychiatric bedswere located in stand-alone psychiatric hospitals, Which consumed half of thetotal spending by the states and territories on specialist mental health care.Less than 2% of resources were allocated to nongovernment community pro-grams aimed at supporting people in the community with a psychiatric disabil-ity. Figure 3 shows the overall change in expenditure on different sectors ofpublic sector mental health services during the strategy. The impact of thesechanges on each sector is outlined below.

Community-Based Services.

Between 1992–93 and 1996–97, state and terri-tory spending on community mental health services grew by 76% or $248 mil-


lion in 1997 constant prices. Three broad groups of services are included in thisgrowth:

• “Ambulatory services” comprising outpatient services (hospital- andclinic-based), mobile assessment and treatment teams, day programs, andother services dedicated to the assessment, treatment, rehabilitation,and care of people who live in the community.

• Specialized residential services that provide accommodation in the com-munity staffed by mental health professionals on a 24-hour basis. Theseservices replaced many of the functions traditionally performed by long-stay psychiatric hospitals. They include two types of residential services—small purpose built or refurbished houses for severely disabled peoplewho require access to specialized psychiatric up to 24 hours a day andspecialized psycho-geriatric hostels or nursing homes for older peoplewith mental illness, or dementia with severe behavioral disturbance.

• Not-for-profit nongovernment organizations (NGOs), funded by govern-ments to provide support services for people with a psychiatric disabilityprovide a wide range of accommodation, rehabilitation, recreational, so-cial support, and advocacy programs. Expansion of this sector is pro-moted as an effective means to strengthen community support and de-velop service approaches as alternatives to inpatient care. Nationally,NGOs have increased their share of annual mental health expenditurefrom 1.9% to 4.3% over the period.

Inpatient Services.

The National Strategy advocated the reduction and re-placement of freestanding psychiatric hospitals with a mix of general hospital,residential, community treatment, and other support services. A continuingrole for a much reduced number of separate hospitals is described, but limitedto specialist care for that small number of people who are unable to maintaintheir quality of life or who are an ongoing danger to themselves or others inless restrictive settings. Substantial change in both the level and type of inpa-tient services occurred between 1992/3 and 1996/97. The number of public sec-tor beds decreased by 20% (1,623 beds) and patient days (previously referredto as “occupied bed days”) decreased by 21%. In 1992/93, 49% of total stateand territory mental health resources were allocated to stand alone psychiatrichospitals, accounting for 73% of available psychiatric beds. These hospitalshave been the main focus of bed reductions. Total beds in these hospitals de-

FIGURE 3. National summary of change in spending mix. NGO: nongoverment organization.


creased by 38% (2,181 beds) since commencement of the Strategy, while psy-chiatric beds located in general hospitals increased by 26% (558 beds).

By June 1997, beds located in separate psychiatric hospitals accounted for55% per cent of the Australia’s total psychiatric inpatient capacity, down fromthe 73% in June 1993, while the proportion of state and territory mentalhealth budgets dedicated to the running of these hospitals decreased from49% to 31% over the 4-year period.The National Strategy also proposed thereplacement of acute inpatient services traditionally provided in separate psy-chiatric facilities services with units located in general hospitals. This “main-streaming” of acute services was to reduce the stigma associated with psychiat-ric care as well as stimulating improvements in service quality. At thecommencement of the Strategy, 55% of acute psychiatric beds were located inspecialist mental health units in general hospitals. By June 1997, this had in-creased to 67%, both as a result of a reduction in stand alone acute services(405 beds) and the 26% growth in general hospital-based beds through thecommissioning of new or expanded units (526 beds).

The National Strategy did not stipulate an optimum number or mix of inpa-tient services. This recognized the different histories and circumstances ofeach jurisdiction and the need for plans to be based on an analysis of localpopulation needs. The final balance of services may differ substantially be-tween the states and territories. However, there is an emerging consensus for apublic acute bed provision level of 20 beds per 100,000 population. No clearconsensus on provision of nonacute beds has emerged. Disparities betweenthe jurisdictions are marked, with a fivefold difference between the highest-providing state (Tasmania) and the lowest (Victoria).

Any review of normative practice, or the level of nonacute beds the jurisdic-tions actually provide, needs to take account of alternative services that substi-tute for the functions of the longer term inpatient services. For example, Vic-toria provides substantially fewer nonacute inpatient beds than the nationalaverage, while no such beds are available in the Australian Capital Territory.However, each of these jurisdictions has developed levels of 24-hour staffedcommunity residential beds well in excess of the other states and territories.

Consumer and Career Involvement in Service Planning, Evaluation,and Delivery

Consumer participation in Australia has gone through a rapid maturationover recent years. The Human Rights and Equal Opportunity Commission(1994) pointed to abuses of the rights of consumers and advocated action tocorrect these. Governments responded with proposals for change, includingstrategies to empower consumers, which were taken forward in the frameworkof the National Strategy, which recognized accountability to consumers as animportant avenue to improve service quality and promote the rights of peoplewith a mental illness.

The Strategy required the establishment of consumer advisory groups at na-tional, state, and territory levels, which were representative of the range ofmental health consumers and careers. These groups provide advice to govern-ment on the implementation of the Strategy and facilitate consumer and care


involvement in decision-making. Additionally, the states and territories com-mitted to develop similar arrangements at the service delivery level for allpublic mental health services. Progress in these areas constituted a major out-come of the National Strategy.

A National Community Advisory Group comprised of consumers and car-ers from all States and Territories functioned effectively until it’s replacementby The Mental Health Council of Australia in November 1997. This latterpeak national body represents the mental health sector, by including not onlyconsumers and carers, but also NGO service providers, health and mentalhealth professionals and the private sector. The Council’s role includes provid-ing advice to governments on mental health matters, representing the interestsof its constituency, monitoring and analyzing national mental health policy, re-source allocation and outcomes, and facilitating strong relationships within themental health sector.

The Community Advisory Groups (CAGs) established in all states and terri-tories were to provide feedback on the implementation of the Strategy to Stateand Territory Governments. Empowering consumers and careers in local ser-vice planning and delivery challenges agencies to implement the National Strat-egy principles effectively at the “coalface.” It is arguable that the degree towhich services directly involve consumers and careers in local issues is a mostcredible test of whether the mental health system, an historically closed and iso-lated part of health care, has embraced the rights of those whom it serves.

Information describing the type of local arrangements in place for consum-ers and careers to contribute to local service planning and delivery is providedannually (Figure 4 from Commonwealth Department of Health and AgedCare, 1998a). For the purposes of monitoring changes over time, this informa-tion was grouped into four “rating levels,” based on the scope given to con-sumers and careers to influence local decisions. A “Level 1” rating was used todescribe agencies where consumers and carers were given a formal place in thelocal executive decision making structures. At the other extreme, Level 4 re-fers to agencies with no specific arrangements for career and consumer partic-ipation. The proportion of organizations with some formal mechanism in placefor consumer participation increased from 53% in 1994 to 66% in 1997. Orga-nizations with a “Level 1” rating increased from 17% in 1994 to 38% in 1997.While consumers and careers are beginning to participate directly in a numberof mental health services throughout Australia, there are a relatively largenumber of services that have yet to respond to this reform (Figure 4).

Mental Health Legislation

The stated aim of Australian mental health legislation, a state and territoryresponsibility, is to define and protect the rights of people with mental illnessand balance these rights with a person’s need for treatment and the commu-nity’s legitimate expectation to be protected from harm. Thus the purpose isprimarily twofold: to protect the human rights of people receiving mentalhealth services; and to define the circumstances and procedures for involun-tary treatment of people with mental illness. While the specifics vary betweenstates and territories, a range of mechanisms are mandated under legislation


to protect human rights, including community visitors to inpatient services,and independent bodies to investigate complaints. Involuntary treatment isgenerally only used when a person is believed to be a danger to themselves orothers due to mental illness. Involuntary treatment can take place in either in-patient or community settings. Independent tribunals are responsible for im-posing and reviewing compulsory treatment orders.

The Australian Government is a signatory to the

Principles for the Protec-tion of Persons with Mental Illness and the Improvement of Mental Health Care

(United Nations General Assembly, 1992). Along with the Australian HealthMinisters’ (1991)

Mental Health Statement of Rights and Responsibilities

, thesedocuments provided the benchmarks against which mental health legislation isjudged. The Strategy required that all mental health legislation across Austra-lia be consistent with the United Nations Principles and the Statement ofRights and Responsibilities. It also required legislation in other sectors to beconsistent with the principles set out in the National Mental Health Policy.

All states and territories have amended, or are in the process of amending,their mental health legislation to meet these requirements. To facilitate this,model mental health legislation was developed (University of Newcastle,1994), and a “Rights Analysis Instrument” was designed by the Federal Attor-ney-General’s Department to evaluate the compliance of state and territorymental health legislation (

http://www.health.gov.au/hsdd/mentalhe/pubs/mhs.htm

, accessed November 5, 1999). The latter is being used to indepen-dently assess all legislation and draft bills. In addition National Mental HealthServices Standards have been endorsed (Commonwealth Department ofHealth and Family Services, 1996b), and these are being adopted throughoutall public and private services having become the basis for accreditation.

Evaluation of the National Mental Health Strategy

An independent evaluation of the Strategy was conducted in 1996 and 1997.The evaluation committee reviewed the findings of earlier reports and con-

FIGURE 4. National trends in consumer participation in public sector mental health service orga-nizations.


ducted a selective review of those policy areas to determine the effectivenessof the Strategy more broadly. Specifically, the policy areas of promotion andprevention; linkages between mental health services and other sectors; servicemix; and the rights of consumers and carers were examined.

The data from sources gathered to monitor the National Strategy addressedonly some of these areas. Four supplementary research studies were thereforecommissioned:

• A set of area case studies of local populations, designed to assess the im-pact of service changes at the “ground level”;

• A national stakeholder survey with organizations providing national rep-resentation of one or more key groups;

• A review of all national data sets;• An international expert commentary, conducted by Dr. Ronald Mander-

scheid of the Center for Mental Health Services, United States Depart-ment of Health and Human Services.

The evaluation concluded that, while significant gains had been made inmental health reform, these had been uneven across and within jurisdictions,and that further action was required to maintain and build on the momentumgenerated under the Strategy (Commonwealth Department of Health andFamily Services, 1998). The report identified fourteen priority areas for futuremental health reform activity including: service standards, quality and out-comes; extending the role of consumers and careers; the place of the mentalhealth private sector in national reform; and population approaches to preven-tion and promotion.

Future Directions

Based on the outcomes from the evaluation, a Second National MentalHealth Plan was endorsed by all commonwealth, state and territory HealthMinisters in July 1998, and provides a 5-year (1998–2003) framework for activ-ity at the national and state/territory levels building on the achievements ofthe National Mental Health Policy and the first National Plan (AustralianHealth Ministers, 1998; Whiteford, 1998).

Three priority themes under the Second Plan are Promotion and Preven-tion; Partnerships in Service Reform and Delivery; and Quality and Effective-ness. The promotion and prevention theme will focus on mental health pro-motion, community education, prevention of mental illnesses, and earlyintervention. Promotion activity will aim to build resilience and enhance cop-ing mechanisms in populations for dealing with stresses, while strategies forthe prevention of mental illness will include those targeting high-risk groups,and early intervention at the first onset of mental illness. The key aim of thepartnerships in service reform theme is to continue to build coordinated sys-tems of care to meet the needs of individual consumers. Consumers and ca-reers must have an even stronger role in planning and evaluating the servicesthey use and must be able to influence the way in which their service needs aremet. The theme is also a recognition that specialized mental health services


can only meet some of the needs of people with mental illness, and that part-nerships with general health care, housing, home support, recreation, employ-ment, and education must be strengthened.

The third key theme focuses on the quality and effectiveness of mentalhealth services, with a particular emphasis on improved consumer outcomes.This theme will include work on routine consumer outcome measurement, im-plementation of national service standards, and preparation of clinical practiceguidelines and clinical care pathways. Other work will focus on identifying andpromoting models of best practice, and improving service access and appropri-ateness for Indigenous people, people from non-English-speaking back-grounds and people living in rural and remote areas.

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Documents

The Australian Mental Health System