Since Australia’s first National Mental Health Policy was released in 1992, the focus of mental health reform has shifted, as old objectives have been met and new priorities adopted to reflect changing industry practice and community expectations.
In the intervening years there have been four five-year national mental health plans, the Council of Australian Governments’ (COAG) National Action Plan on Mental Health in 2006, a revised National Mental Health Policy in 2008, and COAG’s 10-year Roadmap for National Mental Health Reform in 2012, which commits all Australian governments to work together to develop ‘well-coordinated and person-centred’ mental health services and support across all relevant government departments.
Mental health responsibilities and funding
The Victorian Government is responsible for the funding, delivery and management of specialised acute, sub-acute and residential public mental health services in hospital and community settings. It also funds Mental Health Community Support Services (MHCSS) that are delivered by non-government organisations to provide a range of rehabilitation and support services for people with a psychiatric disability arising from a mental illness.
Through Medicare and the Pharmaceutical Benefits Scheme, the Commonwealth Government funds general practitioners, private psychiatrists and allied health professionals in the primary care sector, to provide mental health treatment and support. The Commonwealth Government also funds psychosocial support programs that assist people with a mental illness.
Mental health plans and reforms
Since the launch of the First National Mental Health Plan in 1993, structural reforms have sought to reduce the reliance on stand-alone psychiatric hospitals in favour of community-based care alternatives and acute inpatient care in public hospitals. Subsequent plans have emphasised mental health promotion and mental illness prevention, and sought to foster partnerships between primary care providers and specialist services across different sectors of government and the community.
The 2008 National Mental Health Policy continued this whole-of-government approach in an overarching vision for a mental health system that enables recovery, prioritises early intervention and ensures that all Australians with a mental illness can access support to participate more fully in the community. In 2009, the Fourth National Mental Health Plan refined this in a series of specific reform actions designed to improve social inclusion and recovery, prevention and early intervention, service access and coordination, innovation and accountability.
In January 2012, the Australian Government established the National Mental Health Commission within the Prime Minister’s portfolio to monitor mental health reforms in conjunction with consumers, carers and other stakeholders. Later that year, COAG’s ‘Roadmap’ set out new governance and accountability arrangements to directly engage stakeholders and ensure that governments are held to account.
With a change of government in 2014 and the Fourth National Mental Health Plan ending in 2015, the Commonwealth Government committed to a review of mental health services, with the review undertaken by the National Mental Health Commission. A final report was publicly released on 16 April 2015.
The review focussed on the efficiency and effectiveness of Commonwealth services and programs, and overall investment and spending patterns. State and Territory funded programs, services and systems were not evaluated.
The review found that the Commonwealth’s main program focus was on benefits and programs and noted that the greatest level of funding goes into high-cost areas, such as acute care, the criminal justice system and disability support.
The Commission’s recommended approach is to catch people before they fall, keep them out of hospital and crisis care and put support into communities, to take the pressure off state hospital systems and drive long-term cost savings.
In response, the COAG Health Council agreed that its Mental Health, Drug and Alcohol Principal Committee would establish a working group to develop a Fifth National Mental Health Plan and report back in 12 months (April 2016).