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Table 3 Attributions of ‘Success’ and ‘Failure’ in relation to first National Mental Health Plan initiatives

From: An analysis of policy success and failure in formal evaluations of Australia’s national mental health strategy (1992–2012)

First National Mental Health Plan
Policy Lever Policy Objective Proposal(s) Success Failure
Organisation RCN
Involve consumers/carers in policy review and formulation
Formalise the inclusion of consumers and carers within working committees O- Met to some degree
R- Improvement in formalised participation
O- Met for only half of public sector organisations
Not translated to private sector
R- Participation but not leading to intended ‘good’ outcomes in terms of respect
TG- Public/political dissatisfaction
SS
Mainstream mental health service management
Merge mental health into mainstream health management O- Substantively met
R- Mainstream management arrangements adopted across all jurisdictions
 
SS
Shift acute beds to general hospitals
Shift psychiatric beds from stand-alone facilities to general hospitals O- Substantively met
R- Decrease in use of hospital-based services
Funding shifted to community service sector
R- Resource reallocation and service availability is variable across jurisdictions
Little adoption of population-based funding model to facilitate resource transfer
TG- Community and public dissatisfaction
High reports of areas of unmet need
SS
Improve access to community crisis services
Increase ambulatory workforce O- Met
R- Significant increase in ambulatory workforce
 
SS
Improve coordination of care across service providers
Introduce case management system O- Partially met – system introduced R- Under-utilisation of case managers service
Little measurable improvement in continuity of care
TG- Community and public dissatisfaction
Regulation HR&CA
Reduce discrimination and stigmatisation of mental health consumers
Review anti-discrimination legislation O- Substantively met
R- Improvement in anti-discrimination legislation.
TG- Public/political dissatisfaction
HR&CA
Adhere to UN Resolution 9B and Mental Health Statement of Rights and Responsibilities
Review consumer rights and responsibilities as per State/Territory and Federal legislation O- Substantively met (or in progress)
R- Improvement in State/Territory and Federal legislation
 
R&SA
Simplification of cross-border treatment
Identify and remove cross-border anomalies in diagnosis and treatment   O- Not met
R- No change in cross-border anomalies
TG- Low impact
SQ&E
Improve service quality and standards
Introduce nationally consistent standards for mental health care O- Met
R- Standards adopted across all jurisdictions
Quality assurance programs introduced in some jurisdictions
O- Considerable ongoing development work required to see Standards fully accepted and implemented across all jurisdictions
SQ&E
Introduce independent evaluation body
Introduce an independent evaluation steering committee O- Met
R- Independent evaluation steering committee and National Mental Health Commission established
 
SQ&E
Ongoing accountability and evaluation
Publish progress within annual Mental Health Reports
Develop a National Mental Health Information strategy and minimum data set
O- Substantively met (at least for inpatient services)
R- Accountability standards used as an example for other public policy
O- Not met for community based services (no minimum data set)
R- No qualitative measure of ‘accountability’
No outcome measures yet recorded to evaluate intervention effect
Routine assessment established in very few mental health centres
SS
Improve coordination of care across sectors
Review of interagency protocols O- Substantively met R- Under-utilisation of case managers service
Little measurable improvement in continuity of care
Not translated to local service level
TG- Community and public dissatisfaction
Finance R&SA
Increase mental health budget
Increase recurrent mental health spending for Federal and State/Territory Governments O- Substantively met
R- Funding increases observed
R- Variable increase in funding across jurisdictions
R&SA
Increase community-based and general hospital funding
Increase community-based and general hospital funding for mental health O- Substantively met
R- Funds shifted to community service sector
Significant increase in non-institutional spending
 
R&SA
Modify funding allocations for mental health
Review Medicare Agreements O- Substantively met
R- Agreements more clearly outline bilateral funding arrangements
 
SQ&E
Ensure fiscal accountability for mental health spending
Create a separate budget for mental health O- Met R- Funding continues to be allocated on historical basis
Mental health sector-specific outcome-based funding tools remain underdeveloped and under-utilised
Community Education HR&CA
Improve mental health literacy (general public)
National Community Awareness Program O- Partially met
R- National community awareness program implemented
O- No substantial benefit achieved
R- No measurable change in attitudes
TG- Public dissatisfaction
Approach not appropriate for minority groups
No opportunity for local groups to coordinate promotional activity with the national campaign
  1. Key: Reform Priority Area: HR&CA Human Rights and Community Attitudes, RCN Responding to Community Need, SS Service Structures, SQ&E Service Quality and Effectiveness and R&SA Resources and Service Access; Evaluation Measure: O Objectives, R Results, I Innovation, TG Target Group Impact; Unequivocal Successes and Failures appear in bold
  2. Bold letters are used to indicate the evaluation measures