The National Mental Health Commission’s › policy-projects... · The development of the National Mental Health Commission Vision 2030: Key Concepts Consultation Paper follows a

The National Mental Health Commission’s

2 Vision 2030; Key Concept Consultation Paper | National Mental Health Commission | 14 November 2019

Purpose

Vision 2030 is a long-term blueprint for a successful, connected and well-functioning mental health

and suicide prevention system meeting the needs of all Australians.

Vision 2030 will be delivered in two phases. The Commission has committed to completing the initial

work in producing the Vision 2030 report before the end of 2019. This will be followed by a

Roadmap to be completed by mid-2020.

The development of the National Mental Health Commission Vision 2030: Key Concepts Consultation

Paper follows a consultation project, Connections, undertaken by the Commission in July –

September 2019 with a wide range of stakeholders including mental health consumers, carers,

government and non-government service providers across 26 communities and online.

This document is intended to share they key concepts of Vision 2030 with those who participated in

Connections consultation meetings in 2019. It is intended for review only by those who participated

in the Connections consultation process and is not for wider distribution.

This document is not intended to represent the final content of the Vision 2030: Blueprint for Mental

Health and Suicide Prevention. All information is given in good faith and believed to be accurate at

the time of release.

Acknowledgement

The National Mental Health Commission gratefully acknowledges the time, effort and insight

provided by all the consumers, carers and professionals who have been involved in sharing their

experience with the Connections Project to inform Vision 2030.

As Vision 2030 seeks to find themes and commonality, some individuals may feel the details of their

own experience are not reflected in this document. We acknowledge that everyone’s story is unique

and that this has an impact on their needs, goals and strengths. Vision 2030 seeks to establish a

person-centred system of mental wellbeing for Australia which has the capacity to acknowledge,

value and respond to the experience of each individual.

Next Steps

Feedback from this consultation will be considered and incorporated as appropriate. Vision 2030 will

be finalised by the end of 2019. In 2020, the National Mental Health Commission, guided by Vision

2030, will engage with states, territories and other key stakeholders to

develop a Roadmap that considers specific steps and strategies, roles,

methods and oversight requirements to enable implementation.


Connections – A National Conversation about Mental Health Care.

Everyone experiences mental wellbeing and mental ill-health is common. We know that over 4

million Australians in any one year experience mental ill health and need treatment, and a further 6

million could benefit from support for their mental wellbeing.

There have been challenges to achieving effective mental health care. The split of responsibilities

across governments and sectors does not adequately address community care resulting in programs

and services that are disconnected, reactive and do no cover the essential components of care. Data

and capacity to inform local planning and delivery of services has been lacking and difficult to

develop.

Despite these challenges, mental Health is a priority for the federal government and state and

territory governments. Significant investment has been made in mental health and suicide

prevention in recent years resulting in promising initiatives and change. There is an opportunity to

harness this commitment and ensure all components of the system are working together towards a

commonly held Vision for mental health and suicide prevention.

From July – September 2019 the National Mental Health

Commission conducted a consultation about the future

of mental health care, suicide prevention and wellbeing

in Australia. The Commission held 26 Town Hall

meetings and 17 service provider stakeholder meetings;

connecting with over 1,300 individuals including

representatives from approximately 86 organisations.

This was accompanied by an online consultation which

received 2090 responses.

In reviewing the feedback provided during this consultation it is important to note that participants

self-selected to engage with Connections. Their reasons for choosing to participate may influence

their ability to represent all those with mental health concerns in Australia.

The consultations highlighted the diversity of experience, between communities and among

individuals within communities. Many people discussed positive interactions with individual

supports and gave examples of services they hoped to see implemented or expanded. However,

largely people discussed challenges in their current experience.

Information was analysed to identify key themes and consensus about the barriers experienced,

community needs and opportunities to improve the experience of mental health care. The following

themes were consistently raised across the consultations. These themes were used to inform the

development of Vision 2030 Key Concepts.


Mental health is not well understood and this results in shame, stigma and

discrimination.

There is significant variability in services’ capacity to deliver appropriate, quality care

across the country.

The system creates barriers to identifying need and providing quality care that is

accessible to all.

Individuals experience self-stigma (shame) that decreases their ability to identify concerns and

seek care.

Individuals experience stigma and its consequences within their community.

Individuals experience structural stigma and its consequences in formal settings e.g. service

providers, government, workplaces.

Services are not providing consistent, quality care.

Services are not providing care which is culturally appropriate.

Consumers do not consistently have a voice in their own care, or the development of service

responses to need.

Individuals are not able to access available services.

Individuals have poor experiences that decrease trust.

Care is not financially, geographically or practically accessible.

Services are not available across the spectrum of care when/where people need them – gaps.

Workforce does not have capacity to deliver suitable quality services.

Services are not well coordinated or easily navigable.

Service system does not focus on community-wide prevention and identification.

Mental health is not treated with equality and parity with physical health.


A Vision for Mental Wellbeing and Care in 2030.

Vision 2030 imagines an Australia in which:

• Everyone is supported to be mentally well.

• Mental health is well understood and there is no shame in acknowledging mental ill health.

• People with mental health issues are respected and able to live a contributing life; working,

studying and engaging in ways that are meaningful to them, without experiencing stigma or

discrimination.

• People with mental ill health have positive life experiences and reach their own potential.

• People suffer less avoidable harm as a result of mental health concerns.

• Communities are at the centre of identifying their needs, designing responses and delivering

care.

• Services are delivered in a well-functioning, integrated system with consistent, appropriate

quality care available across all steps in the spectrum to every individual; right care, right

time, right place

• People with a lived experience have a voice in their own care, and in the design and delivery

of services that support them.

• Mental Health is prioritised by all levels and sectors of government and receives parity and

respect within the broader health system.


A System to enable effective care. A person-centred system which implements national mechanisms to deliver regionally operated,

community designed and based services that are sufficiently resourced and properly integrated.

Mechanisms for a National System

National Agreement: The system is clearly

defined and implementable through formal

agreement(s) that outline mental health

funding, delivery and outcome responsibilities

for all levels of government.

Leadership: Coordination and monitoring of

diverse local responses to ensure consistency,

quality and effectiveness.

Investment: The system is able to be

delivered sustainably and develop with future

need. Funding is at a level commensurate

with prevalence and cost of mental ill health

and recognises the value of prevention and

early intervention.

National Standards; Clear benchmarks for the

delivery of consistent, quality care. National

standards identify key elements of best

practice from regional design to individual

care and are accompanied by methods for

measurement and reporting.

Community Design and Delivery: Care is

community led. Services are designed and

delivered at a community level with regional

coordination. System includes capability

building and mechanisms for need analysis,

co-design, implementation and evaluation.

Vehicles to Enable Effective Service

Delivery

Data and Information Management: National

collection and sharing of mental health and

social determinants data, at point in time and

longitudinally, to inform current and future

decision-making.

Integration: Shared responsibilities,

connected information and interoperability of

systems within and across sectors to provide

consistent care and enable the sharing of

information in real time.

Multidisciplinary Workforce: Care is

delivered by a diverse workforce that includes

clinicians, peer workers, allied health, primary

health and community support professionals.

Team approaches are taken, including

multidisciplinary teams, co-location, virtual

teams and tertiary consultation.

The workforce is actively recruited,

appropriately trained, retained and

incentivised to take up regional and rural

work.

Those working in other areas of human

service are considered part of the broader

mental health workforce and provided with

training and support appropriate to their role.


Research and Evaluation: Interventions and

services are evidence-based, effective and

replicable where appropriate. Research is

translated to practice in a timely way.

Priority Populations: The needs of vulnerable

people are met in ways that are safe and

meaningful to them. Services are delivered by

providers able to demonstrate their capacity

to understand and meet these needs.

These groups include but are not limited to:

Aboriginal and Torres Strait Islanders,

veterans, those from culturally and

linguistically diverse communities, those who

have experienced crisis or natural disaster,

and those who identify as LGBTIQ+.

Age Streams: Services are provided as early as

possible in a developmentally appropriate

way and are streamed to focus on the needs

of children, young people, general adult

populations and older Australians.

Focusing on Outcomes

The mental health system will focus not only

on outputs but on the outcomes delivered for

individuals, families and communities. A cycle

of continuous improvement and integration of

emerging evidence is key to a long term

approach to mental health care.

Measurement and information:

National and/or comparable datasets

on mental health attitudes,

treatment and outcomes as well as

related health and wellbeing

outcomes in physical health,

housing, employment, education,

child protection and justice.

Monitoring and accountability:

Methods for demonstrating

achievement of standards and

agreed outcomes and reporting on

these. Monitoring of implementation

of agreements and community-led

approaches is regularly undertaken.

Evaluation and research: Program

and policy evaluation is an

appropriately resourced

requirement. Research is focused on

innovation and emerging evidence as

well as translation and real world

effectiveness.


Delivery of the Essential Components of Care

Stepped Care takes a person centred

approach, acknowledging the

interactions between steps and the

services which span individual steps

including:

community/welfare supports

primary healthcare

connection/navigation supports

recovery psychosocial care

care planning/case coordination.

Separate steps prioritise wellbeing,

carer support and crisis intervention

regardless of the intensity of ongoing

care needs.

There are a range of essential components of care to be delivered under these steps.

Prevention; universal programs that promote

mental wellness and address social

determinants and risk factors targeting

community environments including education

and workplace settings. Communication

strategies address stigma and understanding

to decrease distress and promote acceptance

and early help-seeking.

Screening and Assessment; universal

screening at key touchpoints throughout the

lifespan including, early childhood, parenting,

starting primary and secondary school,

retirement, registration of a death, applying

for income benefits. Opportunities for

assessment included in navigation and front

line services.

Psychoeducation/Information and Self-

guided Care; easily accessible and well-

advertised low intensity packages of

information and self-guided interventions to

address mild concerns, enable early help

seeking and entry into other treatments.

Early Intervention; coordinated

multidisciplinary care programs provided early

in onset or period of mental health concerns.

These may be general or diagnosis specific.


Connection and Coordination; universal

services providing general navigation and

connection to appropriate care for everyone

and care planning and coordination for those

with more complex needs.

General Psychological Interventions; range of

therapies provided or supported by suitably

qualified practitioners to meet mild to

moderate needs.

Specialist Psychological Interventions; range

of therapies provided by suitably qualified

clinicians to meet moderate to high needs.

Occupational Rehabilitation and Recovery;

services which provide supports to enable

recovery and independence with a focus on

individual goals and strengths.

Psychosocial Engagement and Support;

services which engage individuals and connect

them with peers and community in ways that

are meaningful to them, providing positive life

experiences and reducing isolation.

Intensive Team Care; coordinated

multidisciplinary care programs provided to

those with complex and/or high intensity

needs.

In-patient and Residential; 24/7 intensive

care for all who need it. This could be

delivered in a community, home-like setting

or hospital setting.

Crisis Resolution; services based in the

community which respond to mental health

crisis situations. This includes provision of

tertiary suicide prevention, consultation and

support to first responders, delivery of crisis

response services in community hubs and at

home and after care services.

Emergency; mental health presentations

receive timely assessment and response in a

suitable environment, cared for by staff with

training in mental health.

Carer Supports; services that provide

psychological and psychosocial support and

respite specific to the needs of carers.

There are many ways these essential components of care can be delivered to meet each individual

community’s capacities, needs and strengths. The choice of delivery method may relate to

appropriateness, suitability, the needs of individual and communities, geography and availability,

intensity, cost and consistency. Using a multimethod approach at each level of care can ensure the

lowest restrictive setting possible. Methods for delivering care include:

Digital and telehealth; services that utilise technology in their delivery.

Community Hubs; coordinated delivery of mental health care in single service centres

Community integrated; services delivered using organisations, services and spaces that are

already operating in a community for example schools, local government community spaces.

Professional Practices; individual professionals providing care in private and public practices

Home and flexible; care delivered in the home or other flexible locations

Residential; community home-like environments providing 24/7 care and support.

Hospital; emergency, general medical and mental health in-patient care.


Taking a Balanced Community-based Approach.

While there was a clear plan for the shift away from institutional care for people with mental illness,

there has not been as clear a vision for development of community approaches to meet the needs

that resulted.

Central to Vision 2030 is a revision of the mental health and suicide prevention system towards a

cohesive community-based approach.

Balanced Community-Based Care means that everyone has access to care in their community in the

least restrictive environment possible. This enables safe recovery while supporting a person’s

connections to family, culture, social supports, work, education and community. It puts the person

at the centre of the process.

This approach is not about one type of care, or one type of service, but about the way that we

deliver all aspects of prevention, assessment, treatment and recovery.

Documents

The National Mental Health Commission’s › policy-projects... · The development of the National Mental Health Commission Vision 2030: Key Concepts Consultation Paper follows a