An analysis of policy levers used to implement mental health reform in Australia 1992-2012.

Francesca C Grace,Meredith G Harris,Georgia Carstensen,Carla S Meurk,Wayne D Hall,Brian W Head,Harvey A Whiteford

doi:10.1186/s12913-015-1142-3

Abstract

BackgroundOver the past two decades, mental health reform in Australia has received unprecedented government attention. This study explored how five policy levers (organisation, regulation, community education, finance and payment) were used by the Australian Federal Government to implement mental health reforms.MethodsAustralian Government publications, including the four mental health plans (published in 1992, 1998, 2003 and 2008) were analysed according to policy levers used to drive reform across five priority areas: [1] human rights and community attitudes; [2] responding to community need; [3] service structures; [4] service quality and effectiveness; and [5] resources and service access.ResultsPolicy levers were applied in varying ways; with two or three levers often concurrently used to implement a single initiative or strategy. For example, changes to service structures were achieved using various combinations of all five levers. Attempts to improve service quality and effectiveness were instead made through a single lever-regulation. The use of some levers changed over time, including a move away from prescriptive, legislative use of regulation, towards a greater focus on monitoring service standards and consumer outcomes.ConclusionsPatterns in the application of policy levers across the National Mental Health Strategy, as identified in this analysis, represent a novel way of conceptualising the history of mental health reform in Australia. An improved understanding of the strategic targeting and appropriate utilisation of policy levers may assist in the delivery and evaluation of evidence-based mental health reform in the future.

Highlights

Over the past two decades, mental health reform in Australia has received unprecedented government attention
Whilst acknowledging the importance of all phases of the agenda setting process, including the role of advocacy, this paper focuses on mapping policy problems to solutions, the use of tools, or policy levers, applied under the National Mental Health Strategy (NMHS)
The present analysis focuses on the implementation of key initiatives from the commencement of the NMHS in 1992, until 2012, in terms of the five policy levers defined by the World Bank Institute and others [21]

Summary

Introduction

Over the past two decades, mental health reform in Australia has received unprecedented government attention. This study explored how five policy levers (organisation, regulation, community education, finance and payment) were used by the Australian Federal Government to implement mental health reforms. The organisation of tax collection in Australia creates a ‘vertical fiscal imbalance’; the Federal Government collects more tax than it needs to discharge its constitutional responsibilities, while the States and Territories do not collect enough. This imbalance allows the Federal Government to influence State and Territory policies by attaching conditions to its allocation of funds. Grace et al BMC Health Services Research (2015) 15:479 while mental health reforms have been progressed by both Federal and State/Territory Governments, the Federal Government has played an increasingly important role in mental health policy

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