Table 3.

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

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

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

Bold letters are used to indicate the evaluation measures