National Mental Health Strategy Research Articles

Enacting policy in mental health promotion and consumer participation

AbstractObjective: Over the last decade Australia has established and endorsed sound policy and strategy documents under the National Mental Health Strategy. However, the enactment of proposed levels of consumer involvement in effective and respectful ways is yet to be fully witnessed in reality. This issue requires sustained attention where barriers need to be named and understood in order to move forward and build on past successes. This paper addresses this issue and offers some responses to the following question: What does a commitment to enacting consumer involvement mean for mental health promotion practice? Conclusions: Despite progress, consumer involvement in mental health promotion work, like the mental health field in general, is yet to reflect national visions. Barriers include: structural issues and insufficient education and training to support workers putting policy into practice; lack of clarity about who is a consumer; the many difficulties consumers face in progressing mental health con...

Drowning not waving: burnout and mental health nursing

Mental health nursing as one of the human services professions has frequently been associated with stress and burnout. The three dimensions of burnout; emotional exhaustion, depersonalisation and reduced personal accomplishment have major implications for the quality of the service that mental health nurses are capable of giving. Various studies have demonstrated mental health nurses suffer a high degree of burnout. Other studies have identified the stressors associated with mental health nursing that may be precursors to burnout. The Evaluation of the National Mental Health Strategy (1998) demonstrated that the Strategy was achieving many of its objectives. The objectives that have been achieved in service delivery have produced a work environment that has many of the identified stressors associated with burnout. Therefore, it is imperative that strategies are implemented that address the problem of stress and burnout in the current mental health system.

Mental health issues for rural and remote Australia.

The burden of mental health problems and disorders is high and rising both in Australia and globally. In response, the Commonwealth Government has moved to implement a national mental health strategy as the basis for a coordinated national approach to underpin initiatives designed to promote mental wellbeing and address mental ill health. This article outlines the nature and extent of mental health problems, provides an overview of changes in mental health policy and service delivery in Australia over the past decade, highlights issues in these areas of particular relevance for rural and remote Australia and calls for the development of a National Rural Mental Health Strategy.

MENTAL HEALTH ISSUES FOR RURAL AND REMOTE AUSTRALIA

ABSTRACT: The burden of mental health problems and disorders is high and rising both in Australia and globally. In response, the Commonwealth Government has moved to implement a national mental health strategy as the basis for a coordinated national approach to underpin initiatives designed to promote mental wellbeing and address mental ill health. This article outlines the nature and extent of mental health problems, provides an overview of changes in mental health policy and service delivery in Australia over the past decade, highlights issues in these areas of particular relevance for rural and remote Australia and calls for the development of a National Rural Mental Health Strategy.

A conceptual review of functioning: implications for the development of consumer outcome measures.

Australia's National Mental Health Strategy aims to achieve improved consumer outcomes. The development and refinement of consumer outcome measures is targeted within the Second National Mental Health Plan. The National Standards for Mental Health Services identify measures of functioning, quality of life and satisfaction with services as relevant to assessing and monitoring consumer outcome. Consumers have described gauging their own recovery through the achievement of functional goals in everyday life. This paper reviews how functioning is viewed within the mental health field, and implications for developing better functional outcome measures. Literature describing the development of measures of functioning, principles of outcome measurement, and functional outcomes for people with severe mental illness was identified, using PsycLIT. A review yielded themes reflecting a number of assumptions about the concept of functioning. Functioning is inadequately defined, raising issues about what is focused on, and from whose viewpoint, each of which has implications for using measures of functioning to monitor consumer outcome. Conflation of dissimilar functional domains, and flawed assumptions about the importance of symptomatology in influencing functional outcome limit the sensitivity to meaningful change of functional measures. Consumer perspectives are relatively neglected in functional tool development. A conceptual framework that recognizes lived experience and the interaction between persons and their environment is much needed to guide the development of functional outcome measures. Qualitative and quantitative research methodologies should be used to advance understanding of functioning and to address limitations of current approaches to functional outcome measurement.

The nature of schizophrenia: signposts to prevention.

To describe the characteristics of schizophrenia relevant to conducting indicated preventive interventions. A systematic review of the literature informed by experiences at the Personal Assistance and Crisis Evaluation (PACE) clinic. Primary prevention requires a sophisticated knowledge of key causal risk factors relevant to the expression of a disorder. The causal risk factors most useful from an intervention standpoint may turn out to be somewhat removed from the neurobiology of the disorder and may even be relatively non-specific, so that tackling them could reduce the risks for a range of mental disorders. The frontier for more specific prevention in schizophrenia and related psychosis is currently represented by indicated preventive interventions for subthreshold symptoms. Again, these may be relatively broad spectrum early in the prepsychotic phase but more proximal to onset, greater treatment specificity can be explored. However, this can be viewed more as preventively orientated treatment rather than primary prevention per se. Early detection of first episode psychosis and optimal intensive treatment of first episodes and the critical early years after diagnosis also represent increasingly attractive preventive foci in psychotic disorders. As evidence accumulates, implementation of evidence-based practice in real work settings is a major challenge as it is throughout the mental health service system. The momentum of preventively orientated treatment must be maintained through the 2nd National Mental Health Strategy and in the face of recent misleading polemic regarding the treatability of psychotic disorders, especially schizophrenia. The evidence demonstrates that schizophrenia and related disorders have never been more treatable.

The Nature of Schizophrenia: Signposts to Prevention

Objective To describe the characteristics of schizophrenia relevant to conducting indicated preventive interventions. Method A systematic review of the literature informed by experiences at the Personal Assistance and Crisis Evaluation (PACE) clinic. Results Primary prevention requires a sophisticated knowledge of key causal risk factors relevant to the expression of a disorder. The causal risk factors most useful from an intervention standpoint may turn out to be somewhat removed from the neurobiology of the disorder and may even be relatively non-specific, so that tackling them could reduce the risks for a range of mental disorders. The frontier for more specific prevention in schizophrenia and related psychosis is currently represented by indicated preventive interventions for subthreshold symptoms. Again, these may be relatively broad spectrum early in the prepsychotic phase but more proximal to onset, greater treatment specificity can be explored. However, this can be viewed more as preventively orientated treatment rather than primary prevention per se. Early detection of first episode psychosis and optimal intensive treatment of first episodes and the critical early years after diagnosis also represent increasingly attractive preventive foci in psychotic disorders. Conclusion As evidence accumulates, implementation of evidence-based practice in real work settings is a major challenge as it is throughout the mental health service system. The momentum of preventively orientated treatment must be maintained through the 2nd National Mental Health Strategy and in the face of recent misleading polemic regarding the treatability of psychotic disorders, especially schizophrenia. The evidence demonstrates that schizophrenia and related disorders have never been more treatable.

Australia's national mental health strategy

Aim: To inform Fellows on aspects of the work being carried out in the Commonwealth's Mental Health Branch.Method: The goals, background and processes used in the Mental Health Branch are compared with the perspective of psychiatrists in private or public practice settings, and with the population-based approach in public health. The author's appointment in 1999 and again in 2000 as Clinical Adviser in Mental Health has provided this opportunity.Findings: The Mental Health Branch continues to have outstanding leadership and administrative abilities. It is internationally recognised for the quality of its programmes, exemplified by its influential publications, the National Survey of Mental Health and Well-being and the recent visit of the US Surgeon General. The Branch's broad strategy is to focus on three levels: the general population of all ages, with particular reference to mental health literacy, prevention and promotion; the mental health component in general practice and other areas of primary care...

Building a platform for partnership between St Vincent's mental health service and divisions of general practice — Systemic approach

A National Mental Health Strategy promoted the development of a partnership between the Area Mental Health Service and general practitioners. These shared care programs were based on an ad hoc proj...

Training for the mental health workforce: a review of developments in the United Kingdom.

Implementation of the National Mental Health Strategy has important implications for education and training of the Australian mental health workforce. This paper discusses relevant developments in the United Kingdom that may provide some lessons for Australia. A review was undertaken of a number of specific clinical education and training programs for mental health workers in the United Kingdom which have been subjected to published evaluation. A finite mental health resource base dictates that education and training activity should: (i) be evaluated; (ii) target those clients most in need; (iii) include evidence-based approaches such as assertive community treatment, medication management, cognitive-behaviour therapy and family interventions; and (iv) prepare mental health workers in the core competencies needed to implement these approaches. Two programs, developed in the United Kingdom, which meet these criteria are presented as examples of best practice: the nurse therapy model established by Isaac Marks; and the Thorn initiative established in association with the Institute of Psychiatry, London and the University of Manchester.

Psychiatry Registrars' Attitudes to Service Evaluation—Implications for Training

Since the introduction of the National Mental Health strategy in 1992, significant service reform has taken place. This has not only included structural reform of mental health services but also a push towards improved service quality, introduction of innovative models of service delivery and a greater demand for accountability and service monitoring [ 1 ]. The Second National Mental Health Plan has as one of its key themes the further development of effective, quality service delivery [ 2 ]. Strategies to achieve this goal include development of standards of care, service evaluation and introduction of outcome measures.

The Impact of Mental Health Reform on General Hospital Psychiatry: Unintended Consequences

Over the last decade, there have been substantial changes in the funding of mental health services in Australia. For example, during the period 1992-1996, there was a 22% decrease in expenditure on stand alone psychiatric hospitals; a 16% increase on spending on acute psychiatric units in general hospitals and a 54% increase in community based expenditure [1]. The implementation of the National Mental Health Strategy has generated considerable discussion at the level of broad policy direction, the impact of such budgetary changes and changes to psychiatrists' work practices [2–4]. However, there has been less comment from the ‘coal face’ as to the impact of these changes, particularly from the perspective of those involved with clinical care and teaching in the setting of general hospital psychiatric clinics.

Sphere: A National Depression Project

Although 18% of Australians suffered a psychiatric disorder in the last 12 months, only 38% presented to health services. Of these, the vast majority (76%) consulted their general practitioner [1]. While two-thirds of those who present to primary care have significant psychological symptoms, at least 30% have psychological disorders that result in disability, long-term morbidity and/or mortality [2–4]. These disorders are often co-morbid with other medical disorders and/or substance abuse [1]. Despite the advances in pharmacological and non-pharmacological therapies available [5,6] less than half of the patients who present receive a psychiatric diagnosis and less than half of these receive any specific treatment [7]. Recommendations under the National Mental Health Strategy [8] recognise the urgent need for educational programs and practice support mechanisms to correct these major public health deficits.

New Futures: Comment from the Faculty of Child & Adolescent Psychiatry

‘Young people have long been a neglected group in mental health, but now the spotlight is on them’, writes College President, Janice Wilson in New Futures. We hope that the spotlight continues to stay on them and that the Second National Mental Health Strategy in Australia can develop and sustain a similar national commitment to children and young people's mental health. Similarly, the priority our College gives to die mental health and well-being of children and young people will be critical to ensure appropriate clinical care, training, education, research, policy directions [1] and advocacy.

The Second National Mental Health Plan: an opportunity to take stock and move forward.

In the first five years of Australia's National Mental Health Strategy (including the National Mental Health Plan), there has already been a 55% increase in spending on community health services, and overall funding for mental health services has increased by 24%. However, the broadening of the Plan's objectives warrants further increases in mental health funding. The focus has been on people with psychotic disorders (who represent a minority of those with mental disorders); in the Second National Mental Health Plan, endorsed in July 1998, the focus is broadened to include depressive disorders, and promotion of mental well-being in the broader community is a key theme. These initiatives will require partnerships, particularly with primary care.

The Momentum Builds: Mental Health Reform in Australia

In June 1998 Australia's National Mental Health Strategy [1] concluded. Since it's inception in 1992 there have been considerable changes to public and some changes to private sector mental health services, generally in the directions outlined in the Strategy. Not everybody is happy with what has been achieved. Some don't like the directions and some, especially the consumers, think we haven't gone far and fast enough. Clearly much remains to be done and the Strategy has now been renewed for a further 5 years beginning in July 1998. The 1996 National Mental Health Report [2] outlines the progress since 1992 and some of the findings are discussed below.

‘If Psychosocial Rehabilitation is So Wonderful, Why Don't More People use It?’

‘The consumer has a right to a coordinated and ongoing range of adequately resourced … rehabilitation, information and support services’, states Australia's National Mental Health Strategy [1].

The New Zealand Mental Health Strategy: Is it Making Any Difference?

In June 1994, Government announced i the National Mental Health Strategy entitled ‘Looking Forward’ [1] outlining the goals and strategic directions for the development of mental health services in New Zealand for the next ten years, and which would underpin the on-going development and delivery of mental health services in this country. This strategy not only gave Government's policy directions for mental health, but provided the framework for resourcing mental health service (Table 1). In simple terms the strategy was about more and better services within Government's resources.

National Advocacy in Mental Health: What is a Balanced and Effective Approach?

The national perspective on mental health which is evident in the National Mental Health Strategy was a long time coming. It is a perspective which arose as a consequence of long term and concerted lobbying from many non-government and professional sources and is in large part, a response to the interest taken by the Human Rights and Equal Opportunity Commission.

The National Mental Health Strategy: Is it Making Any Difference?

In April 1992, the Health Ministers of all Australian states, territories and the Commonwealth endorsed, for the first time, a National Mental Health Policy.