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Table 4 Attributions of ‘Success’ and ‘Failure’ in relation to second 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)

Second National Mental Health Plan

Policy Lever

Policy Objective

Proposal(s)

Success

Failure

Organisation

RCN

Formalise consumer/carer consultation

Increase public and private sector organisations with formal consumer/carer consultation

O- Substantively met

R- Low level of genuine involvement or consultation

TG- Public/consumer dissatisfaction (perceived change as insufficient)

R&SA

Increase early intervention services for youth

Provide specialist centres for youth early intervention, including assessment and treatment

O- Partially met

R- Specialist centres and early intervention services increased

R- Not all groups’ needs met

TG- Not all groups’ needs met

R&SA

Improve service provision for special needs populations

Develop new specialised service models

 

O- Not met

R- Interventions underdeveloped

Needs of CALD population not met

Lack of service integration

TG- Consumers not satisfied with level of change achieved/scale of impact

R&SA

Improve mental health curricula for Indigenous health workforce

Improve mental health curricula for Indigenous health workforce

O- Partially met

R- Mental health curricula and culturally appropriate service models developed

O- Not met

R- Shortage of health workers

Ongoing need to improve links with mainstream services

SS

Shift acute beds to general hospitals

Relocate beds in stand-alone facilities to general hospitals

O- Substantively met

R- Beds from stand-alone facilities relocated to general hospitals

 

SS

Improve coordination of care across service providers

Formal protocols and agreements to support continuity of care

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

SQ&E

Increased accountability for reform outcomes

Develop and apply new outcome measures

O- Partially met

R- Mental health workforce remain reluctant to participate in routine outcome monitoring

TG- Consumers dissatisfied with progress

SQ&E

Improve service quality and standards

National Standards for Mental Health Services

O- Partially met

R- Mental health workforce remain reluctant to participate in routine outcome monitoring

TG- Consumers dissatisfied with progress

SS

Improve coordination of care across sectors

Review interagency protocols to support continuity of care

O- Partially met

R- Lack of accountability

Inadequate progress

Finance

R&SA

Increase Federal and State/Territory expenditure on mental health

Review allocations under the general health budget for Federal and State/Territory Governments

O- Partially met

R- Size of sector did not increase

Variable spending across jurisdictions

R&SA

Increase the size of community-based service sector

Grow 24-h staffed community based residential services

Increase government spending on community services

O- Partially met

R- Low increase in services compared with closure of hospital services

TG- Consumers report dissatisfaction with improvements

Community Education

HR&CA

Reduce discrimination and stigmatisation of mental health consumers

Review media portrayal of mental illness

O- Partially met

R- Review conducted

Strategies implemented

I- Use of innovative approach to engage general public in monitoring

R- No outcome measures collected to compare with baseline

HR&CA

Improve mental health literacy (health workers)

Provide mental health training to frontline workers

O- Partially met

R- Education materials developed

Strategies implemented

R- Consumers and carers continue to experience stigmatisation and discrimination (by professionals both inside and outside health sector)

HR&CA

Improve mental health literacy (general public)

Frontline service providers to distribute mental health brochures to patients

Educate school children about mental health

O- Partially met

O- Information material availability and distribution improved

Community telephone survey suggested that people consider mental health to be a serious problem and to be more prevalent than in previous decades

O- Little or no substantial improvement in health literacy

R- Materials do not suit all groups (i.e. exclude CALD and other minority groups)

Payment

SS

Ensure better links between primary and secondary providers

Introduce new funding models

Review existing MBS items

O- Substantively met

 

R&SA

Improve service provision in rural/remote areas

Introduce new specialised funding models

O- Partially met

R- Increase in dedicated service programs

Improvement in recognition of special needs of this group

O- Most of NMHS objectives tailored to metropolitan areas

R- Service gaps and workforce shortages in rural and regional areas remain

  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