Standing Council on Health
Council of Australian
Governments
National Action Plan for Mental
Health 2006-2011
Final Progress Report
covering implementation to 2010-11
This report was prepared under the auspice of the Mental Health, Drug and
Alcohol Principal Committee of the Standing Council on Health
June 2013
Foreword
The Council of Australian Governments (COAG) National Action Plan on Mental Health,
endorsed in July 2006, represented an important milestone in the reform of mental health
services in Australia. Based on a broad recognition that renewed government effort was
needed to give greater impetus to the reform process, the Action Plan brought together the
heads of all governments to focus on the issue of mental health for the first time in COAG’s
history. Backing the Plan, a total of $4.1 billion was committed to a wide range of initiatives
over the 2006-2011 period, representing the largest collective investment in mental health by
Australian governments to date. The Action Plan was also unprecedented in that it addressed
not only health needs, but made commitments to activities in the other key areas of housing,
employment, education and correctional services, all of which have an important part to play
in addressing the mental health needs of Australians.
This is the fifth and final edition in the series of annual reports stipulated by COAG as a
requirement for monitoring implementation of the Action Plan and describes the progress
made in 2010-2011, the final year of the Action Plan. As with previous reports, this report
presents information about allocations to date in each of the priority areas, along with details
of additional funding commitments made by jurisdictions since the Action Plan was signed.
The report notes that, in the five years following the release of the Action Plan, all
governments made further commitments to mental health in one or more of the Action Areas.
The combined value of the additional commitments is $1.60 billion, taking the total value of
Action Plan initiatives to over $5.68 billion, 39 per cent above the original commitments. The
report notes that by the close of the Plan, all governments had exceeded their original funding
commitment made when the Action Plan was signed in July 2006.
The report also brings together new or updated information on eight of the 12 progress
indicators agreed by COAG for measuring the outcomes of the Action Plan. The recent data
continue to show substantial growth in access rates to mental health services, driven by the
‘Better Access’ Medicare-funded mental health services introduced by the Australian
Government as part of the Action Plan. Updated indicators data are also presented for each
state and territory on readmissions to hospital and rates of community follow-up after
discharge. The indicators continue to show significant variation between jurisdictions,
suggesting important differences in practices between mental health systems.
The five-year Action Plan concluded in July 2011, however mental health reform is a long
term process that requires continued government commitment and renewal. It is important to
note in this context that all governments renewed their commitment to further mental health
reform through the endorsement and release of the Roadmap for National Mental Health
Reform by COAG in December 2012. The Roadmap outlines the directions that will be taken
by governments over the next 10 years and sets out new governance and accountability
arrangements designed to directly engage stakeholders and ensure that governments are held
to account. These new arrangements include the establishment of a COAG Working Group
on Mental Health Reform that is required to develop, by mid‑2014, a successor to the Fourth
National Mental Health Plan that will set out how the Roadmap will be implemented.
While this report is the final in the annual progress report series, it is important to note that
the indicators developed for the COAG Action Plan were incorporated in the Fourth National
Mental Health Plan. As such, they will be reported in future National Mental Health Reports
prepared by the Australian Government Department of Health and Ageing, providing
continuity in the monitoring of progress of mental health reform beyond the Action Plan.
The current report is in fact being released simultaneously with the National Mental Health
Report 2013.
As noted in the Foreword to previous reports, publications such as this require considerable
work and coordination between governments. I offer thanks to my Health Minister
colleagues, other Ministers responsible for implementing the Action Plan and their respective
administrations for the cooperation shown in bringing together the information presented in
this report.
The Hon Michelle O'Byrne MP
Chair
Standing Council on Health
Contents
Foreword ................................................................................................................. 3
Contents ................................................................................................................. 5
PART A
National overview .................................................................................. 1
Chapter 1 Overview of the National Action Plan .......................................................................... 2
Action Plan in summary .................................................................................................................. 2
Commitment to annual reporting and review ................................................................................. 3
Action Plan in context ..................................................................................................................... 3
Chapter 2 Progress in implementation ......................................................................................... 4
Action Plan commitments and first year allocations ....................................................................... 4
Action Area 1: Promotion, prevention and early intervention ......................................................... 6
Action Area 2: Integrating and improving the care system ............................................................ 7
Action Area 3: Participation in the community and employment, including accommodation ......... 8
Action Area 4: Increasing workforce capacity ................................................................................ 9
Action Area 5: Coordinating care ................................................................................................. 10
Chapter 3 Progress towards outcomes ...................................................................................... 13
Indicator 1: Prevalence of mental illness in the community ......................................................... 15
Indicator 2: Rate of suicide in the community .............................................................................. 17
Indicator 3: Rates of use of illicit drugs that contribute to mental illness in young people ........... 19
Indicator 4: Rates of substance abuse ......................................................................................... 19
Indicator 5: Percentage of people with a mental illness who receive mental health care ............ 22
Indicator 6: Mental health outcomes of people who receive treatment from state and territory
services and the private hospital system ..................................................................................... 27
Indicator 7: Rates of community follow up for people within the first seven days of discharge
from hospital ................................................................................................................................. 30
Indicator 8: Readmissions to hospital within 28 days of discharge .............................................. 32
Indicator 9: Participation rates by people with mental illness of working age in employment ..... 34
Indicator 10: Participation rates by young people aged 16-30 with mental illness in
education and employment .......................................................................................................... 35
Indicator 11: Prevalence of mental illness among people who are remanded or newly
sentenced to adult and juvenile correctional facilities .................................................................. 36
Indicator 12: Prevalence of mental illness among homeless populations ................................... 37
PART B Jurisdiction reports on progress of Individual Implementation
Plans
............................................................................................................... 41
Australian Government ..................................................................................................................... 42
New South Wales ............................................................................................................................. 46
Victoria .............................................................................................................................................. 50
Queensland ....................................................................................................................................... 50
Western Australia.............................................................................................................................. 58
South Australia.................................................................................................................................. 62
Tasmania .......................................................................................................................................... 66
Australian Capital Territory ............................................................................................................... 70
Northern Territory.............................................................................................................................. 73
APPENDIX 1 Action Plan funding commitments and allocations ..................... 77
Australian Government ..................................................................................................................... 79
New South Wales ............................................................................................................................. 82
Victoria .............................................................................................................................................. 84
Queensland ....................................................................................................................................... 87
Western Australia.............................................................................................................................. 90
South Australia.................................................................................................................................. 92
Tasmania .......................................................................................................................................... 94
Australian Capital Territory ............................................................................................................... 96
Northern Territory.............................................................................................................................. 99
APPENDIX 2 Technical Notes ............................................................................. 101
PART A
National overview
This section of the report summarises the fifth and final year of
progress in implementation of the National Action Plan, along
with updated data available on agreed outcomes.
Chapter 1 Overview of the National Action Plan
Action Plan in summary
In July 2006, the Council of Australian Governments (COAG) agreed to the National Action
Plan on Mental Health 2006-2011, recognising the need for a change in the way governments
respond to mental illness. The Plan provided a strategic framework that emphasised
coordination and collaboration between government, private and non-government providers,
aimed at building a more connected system of health care and community supports for people
affected by mental illness.
The Action Plan outlined a series of initiatives to be implemented between 2006 and 2011,
described in Individual Implementation Plans prepared by each government. A total of 145
separate initiatives were described in the Individual Implementation Plans, with a combined
value of $4.1 billion.
While most initiatives represented additional commitments to expand ongoing programs,
many were new and moved the delivery of services for people with mental illness into areas
beyond the boundaries of traditional health care. Key human service programs operating
outside the health system that have major responsibilities under the Plan include housing,
employment, education and correctional services. Additionally, the initiatives funded under
the Plan emphasised the role of the non-government sector in the delivery of a wide range of
community support services. These aimed to provide the services needed by many people
affected by mental illness, complementing the role of health services.
The Plan identified five ‘Action Areas’ for combined government action, with specific policy
directions within each area. The Action Areas served as an organising framework for
grouping and understanding the relative investments by governments.
Governments also committed to four outcomes by which the success of the Plan could be
assessed. The Action Areas and outcomes are summarised below.
Figure 1: COAG Action Plan agreed Action Areas and outcomes
Action Areas agreed in the COAG Plan
Agreed outcomes

Promotion, prevention and early intervention


Integrating and improving the care system
Reducing the prevalence and severity of mental
illness in Australia

Participation in the community and employment,
including accommodation

Reducing the prevalence of risk factors that
contribute to the onset of mental illness and prevent
long term recovery

Increasing workforce capacity


Coordinating care (‘Coordinating care’ and
‘Governments working together’)
Increasing the proportion of people with an
emerging or established mental illness who are able
to access the right health care and other relevant
community services at the right time, with a
particular focus on early intervention

Increasing the ability of people with a mental illness
to participate in the community, employment,
education and training, including through an
increase in access to stable accommodation
2
COAG National Action Plan on Mental Health - Progress Report 2010-11
Commitment to annual reporting
Heads of Governments agreed to the discipline of annual reporting, stipulating regular
monitoring of the implementation of the Action Plan and progress against agreed outcomes.
Responsibility for this function is assigned to Health Ministers.
The primary role of the annual reports is to chart progress made under the Action Plan, and
monitor the extent to which the agreed initiatives are taking place, addressing the question of
‘Are we doing what we said we would’? Additionally, annual reports present data on Action
Plan outcomes, where data are relevant and available.
As the final report in the series, the current report describes the overall achievements over the
five years of the Action Plan.
Action Plan in context
In monitoring the progress of the Action Plan, Health Ministers believe that it is important to
recognise that the COAG funding commitments were directed to bolster an established
specialist health sector that has been the subject of an ongoing national reform framework
(the National Mental Health Strategy) since 1992. Substantial growth in services has
occurred under the Strategy, with government recurrent spending on mental health totalling
approximately $6.3 billion in 2009-10. Total government spending on mental health is
estimated to have exceeded $29 billion over the 5-year course of the Action Plan.
A total of $4.1 billion in new funding was originally committed by governments, on signing
of the Action Plan, on 14 July 2006, rising to $6.9 billion with a number of additional
commitments, as documented in Chapter 2. This represents an approximate 32% increase in
total spending on mental health over the 2006-11 period.
The Action Plan added much needed impetus to accelerate reforms and focuses on areas that
had not progressed sufficiently under the National Mental Health Strategy. As the Action
Plan continued to be implemented, it was necessary to not only monitor the progress of the
new initiatives, but also ensure that base commitments pre-dating the Plan were maintained.
Monitoring base spending is outside the scope of this report but has been achieved through
other national reports prepared regularly on mental health, in particular the National Mental
Health Report, the Australian Institute of Health and Welfare’s Mental Health Services in
Australia report, and the annual Report on Government Services.
The Action Plan expired in June 2011 but mental health reform is a long term, evolutionary
process that requires continued government commitment and renewal. To this end, Health
Ministers endorsed a new National Mental Health Policy in December 2008 and in November
2009, agreed to the Fourth National Mental Health Plan covering the period 2009-2014.
Most recently, in December 2012, COAG agreed to the Roadmap for National Mental Health
Reform that outlines the directions that will be taken by governments over the next 10 years.
The Roadmap set out new governance and accountability arrangements designed to directly
engage stakeholders and ensure that governments are held to account. These new
arrangements include the establishment of a COAG Working Group on Mental Health
Reform that is required to develop, for COAG’s consideration by mid-2014, a successor to
the Fourth National Mental Health Plan that will set out how the Roadmap will be
implemented.
COAG National Action Plan on Mental Health - Progress Report 2010-11
3
Chapter 2 Progress in implementation
Action Plan commitments and five-year allocations
Original commitments made by governments totalled $4.1 billion. While most of the
committed outlays were targeted at ongoing service delivery, funding commitments by
several governments included substantial capital components, largely directed at building
new facilities and expanding or upgrading hospitals and community care centres.
Subsequent to the release of the Action Plan, all governments made further commitments to
mental health in one or more of the Action Areas, announced through their annual budgets to
2010-11. The combined value of the additional commitments was $1.60 billion, taking the
total value of the Action Plan and related initiatives to $5.68 billion, 39% above the original
commitments.
Table 1: Action Plan funding commitments 2006-11 and actual allocations to 2010-11 (millions)
Funding commitments
2006-11
New funding
allocated
As reported
Subsequent Total funding
in the
new funding commitments 2006-07 2007-08 2008-09 2009-10 2010-11
Action Plan
commitments
2006-11
July 2006
Total
Australian Government
1,855.1
156.6
2,011.7
215.2
543.5
745.0
836.8
965.1
3,305.6
New South Wales
938.9
39.1
978.0
134.2
224.9
193.0
190.1
213.5
955.6
Victoria
472.2
316.7
788.9
103.8
125.1
142.1
168.0
247.1
786.0
Queensland
366.2
623.0
989.2
111.7
168.0
187.9
222.0
299.6
989.2
58.8
76.8
90.4
82.6
105.6
414.2
Western Australia
252.5
233.9
486.4a
South Australia
116.1
164.0
280.2
29.9
32.5
47.9
71.1
98.8
280.2
Tasmania
43.0
15.9
58.9
9.0
10.6
14.5
17.4
20.2
71.7
Australian Capital
Territory
20.7
41.4
62.0
3.8
4.3
8.3
16.7
26.7
59.8
14.5
4,079.2
5.9
1,596.5
20.4
5,675.6
2.9
669.2
3.8
1,189.6
4.3
1,433.3
5.2
1,609.9
5.8
1,982.3
22.1
6,884.3
Northern Territory
Total
a
The reported WA funding commitment 2006-11 is greater than total funding allocated for 2006-07 to 2010-11
because approximately $46 million expenditure prior to July 2006 was included in the original WA Individual
Implementation Plan to reflect a significant investment made in mental health reform just prior to the
commencement of the National Action Plan.
Combined allocations of $669 million were made in 2006-07, rising to $1,982 million in
2010-11. Total spending on COAG-related initiatives in the five years of the Plan ($6,884
million) substantially exceeded the original five-year commitment. By the end of the Plan,
all governments had substantially exceeded their original funding commitment.
Each government has provided a summary of its progress to 2010-11, primarily focusing on
the main developments in the fifth year. These are presented in Part B of the report.
Additionally, in keeping with the requirements of the Action Plan, governments have
submitted details of their funding commitments, annual allocations, and any new
commitments made since the Action Plan was agreed in July 2006. These are presented in
Appendix 1.
4
COAG National Action Plan on Mental Health - Progress Report 2010-11
Funding commitments made under the Action Plan were spread across four of the five Action
Areas, with about two thirds directed to Area 2 (Integrating and Improving the Care System).
The relative balance of investment in the Action Areas varies across the jurisdictions,
reflecting both differences between states and territories in the range and scale of services in
place prior to the Action Plan, as well as differences in how specific initiatives are classified.
Figure 2: Funding commitments by Action Area 2006-11, original and revised
Figure 3: Annual funding allocated to each of the Action Areas by year
COAG National Action Plan on Mental Health - Progress Report 2010-11
5
Action Area 1: Promotion, prevention and early intervention
Figure 4: Promotion, prevention and early
intervention – Action Plan policy directions
►
Building resilience and coping skills of
children, young people and families
►
Raising community awareness
►
Improving capacity for early
identification and referral to
appropriate services
►
Improving treatment services to better
respond to the early onset of mental
illness, particularly for children and
young people
►
Investing in mental health research to
better understand the onset and
treatment of mental illnesses
COAG agreed that promotion, prevention and
early intervention are critical to enabling the
community to better recognise the risk factors
and early signs of mental illness and to find
appropriate treatment. The Action Plan
identified this area as requiring increased
investment, based on growing evidence that
mental illnesses are less severe, of shorter
duration, and less likely to recur when
identified and treated early.
The Plan included five policy directions to
guide future investments in promotion,
prevention and early intervention (Figure 4).
Governments originally committed a combined
total of $454 million additional funding to
initiatives grouped under Action Area 1,
increasing to $589 million when more recent government budget announcements are
included. Based on the progress reports, $567 million of this new funding was allocated in
the five years of Action Plan implementation.
Funding directed to promotion, prevention and early intervention represents 10% of the total
revised Action Plan commitments and 8% of combined government allocations over the
2006-11 period.
Table 2: Action Area 1 - funding commitments 2006-11 and allocations (millions)
Funding commitments
New funding
2006-11
allocated
As reported
Subsequent Total funding
in the
new funding commitments 2006-07 2007-08 2008-09 2009-10 2010-11
Action Plan
commitments
2006-11
July 2006
Total
Australian Government
158.4
17.1
175.5
16.0
24.8
35.4
41.3
56.2
173.7
New South Wales
102.2
19.5
121.7
31.4
14.8
18.2
25.1
32.2
121.7
Victoria
80.3
25.6
105.9
13.1
23.9
18.1
22.1
26.4
103.6
Queensland
6.9
10.6
17.5
0.5
3.3
4.3
4.0
5.4
17.5
Western Australia
60.7
46.1
106.8
10.7
12.4
19.0
20.9
25.3
88.3
South Australia
39.5
10.6
50.1
3.8
8.1
12.9
14.4
10.8
50.1
Tasmania
2.0
0.4
2.4
0.2
0.2
0.6
0.2
0.5
1.7
Australian Capital
Territory
3.3
3.5
6.8
0.8
1.0
1.2
1.8
1.9
6.7
1.0
454.3
1.0
134.4
2.0
588.7
0.5
77.0
0.8
89.2
0.8
110.6
0.7
130.6
0.7
159.3
3.4
566.7
Northern Territory
Total
6
COAG National Action Plan on Mental Health - Progress Report 2010-11
Action Area 2: Integrating and improving the care system
Figure 5: Integrating and improving the
care system – Action Plan policy directions
►
Resourcing adequately health and
community support services to meet
the level of need
►
Developing ways of coordinating
and linking the range of care that is
provided across the continuum of
primary, acute and community
services by public, non-government
and private sector providers
Action Area 2 of the Plan promoted future
investment in mental health towards two policy
directions. The first concerned resources and
aimed to increase current provision of health
care and community support services to a level
where the needs of the Australian population are
being met. Reducing the high level of unmet
need for mental health care is paramount and
was focus of one of the key outcome indicators
COAG set for monitoring the overall success of
the Plan (Indicator 5 - see Chapter 3).
The second policy direction targeted the need to
better integrate and connect services by private, public and non-government health and
community providers who deliver care to people affected by mental illness.
Concerns about coordination between services accessed by people with mental illness were at
the forefront of a number of major reports on mental health care in Australia in the lead up to
the Action Plan. The Plan promoted improvements in all arrangements, both within the
health sector as well as between health and community service providers, such as
accommodation and employment services. Better coordinated and integrated services aimed
to prevent people in need from ‘slipping through the care net’, and experiencing the adverse
consequences that can follow such as unplanned readmissions to hospital, homelessness,
imprisonment or suicide.
To give prominence to the role of coordination, governments committed to two ‘flagship’
initiatives to better coordinate and link the range of care across the continuum of primary,
acute and community services, provided by public, non-government and private sector
providers. ‘Care coordination’ and ‘Governments working together’ are described under
Action Area 5.
Governments originally committed a combined total of $2.65 billion additional funding to
initiatives grouped under Action Area 2, increasing to $3.83 billion when more recent
government budget announcements are included. Individual progress reports indicate that a
total of $5.09 billion new funding was allocated in the five years of implementation, with
40% of the growth in funding attributable to new primary care mental health programs
introduced under through the Medicare Benefits Schedule. Funding directed to initiatives to
integrate and improve the care system comprised 67% of the total revised Action Plan
commitments and 74% of combined government allocations made over the five year period.
COAG National Action Plan on Mental Health - Progress Report 2010-11
7
Table 3: Action Area 2 - funding commitments 2006-11 and allocations (millions)
Funding commitments
New funding
2006-11
allocated
As reported
Subsequent Total funding
in the
new funding commitments 2006-07 2007-08 2008-09 2009-10 2010-11
Action Plan
commitments
2006-11
July 2006
Total
Australian Government
1,196.9
140.0
1,336.9
155.5
423.4
587.3
686.0
784.7
2,636.8
New South Wales
699.7
4.3
704.0
93.1
185.4
144.7
129.2
135.4
687.7
Victoria
284.8
271.8
556.6
63.4
79.7
104.0
120.3
192.6
560.0
Queensland
289.0
428.7
717.7
79.1
120.9
125.9
157.2
234.6
717.7
Western Australia
53.6
162.4
216.0
27.4
40.8
36.3
34.5
50.5
189.5
South Australia
75.6
132.4
208.0
25.0
24.1
33.7
45.7
79.4
208.0
Tasmania
21.1
15.5
36.6
5.1
5.1
8.5
10.3
12.8
41.8
Australian Capital
Territory
11.5
22.6
34.1
2.3
1.6
3.3
7.8
17.3
32.3
Northern Territory
13.0
3.7
16.7
2.0
2.5
2.8
3.9
4.7
15.8
Total
2,645.2
1,182.2
3,826.4
452.9
883.4
1,046.4
1,194.9
1,511.9
5,089.6
Action Area 3: Participation in the community and employment, including
accommodation
Figure 6: Participation in the community
and employment, including accommodation
– Action Plan policy directions
►
Enhancing support services for people
with mental illness to participate in the
community, education and employment
►
Enabling people with mental illness to
have stable housing by linking them with
other personal support services
►
Improving referral pathways and links
between clinical, accommodation,
personal and vocational support
programmes
Action Area 3 of the Plan emphasised the role
played by services that operate outside the
health sector in promoting recovery from
mental illness. People affected by mental
illness have the same requirements as other
people for stable housing, home support,
recreation, employment and education and
family relationships. When their disorder
results in disability, they may require access
to a range of supports to live independently
and participate fully in community life.
The Action Plan recognised that reform of the
specialised mental health sector alone will not
produce the broader change required to
► Expanding support for families and
improve services for mental health consumers
carers including respite care
in these areas. Four policy directions were
identified to accelerate the development of support services in the community, with a special
focus on employment, accommodation and services to assist carers (Figure 6).
Governments committed a combined total of $795 million additional funding to initiatives
grouped under Action Area 3, increasing to $969 million when more recent budget
commitments are included. Progress reports indicate that a total of $943 million new funding
was allocated over the life of the Action Plan.
8
COAG National Action Plan on Mental Health - Progress Report 2010-11
Funding directed to ‘participation in the community’ initiatives accounts for 17% of the total
revised Action Plan commitments and 14% of combined government allocations made to
date.
Table 4: Action Area 3 - funding commitments 2006-11 and allocations (millions)
Funding commitments
New funding
2006-11
allocated
As reported
Subsequent Total funding
in the
new funding commitments 2006-07 2007-08 2008-09 2009-10 2010-11
Action Plan
commitments
2006-11
July 2006
Total
Australian Government
370.0
-0.5
369.5
30.9
73.7
94.2
78.2
92.5
369.5
New South Wales
113.8
15.3
129.1
6.0
20.4
25.1
30.8
40.7
123.0
Victoria
102.7
12.4
115.1
26.5
20.6
19.1
23.1
23.9
113.1
Queensland
64.2
108.2
172.4
30.6
27.0
34.7
39.4
40.8
172.4
Western Australia
129.4
12.7
142.1
16.3
20.7
27.8
24.4
27.1
116.4
17.9
17.9
0.6
10.0
7.3
17.9
3.6
3.7
5.2
5.3
19.7
0.8
2.1
2.8
2.8
8.5
South Australia
Tasmania
11.3
Australian Capital
Territory
2.8
6.8
9.6
Northern Territory
0.5
1.1
1.6
0.4
0.6
0.6
0.5
0.3
2.4
Total
794.7
173.8
968.5
112.7
167.4
207.9
214.2
240.7
942.9
11.3
2.0
Action Area 4: Increasing workforce capacity
Figure 7: Increasing workforce capacity
– Action Plan policy directions
►
Increasing the mental health
workforce
►
Improving its ability to meet patient
needs across Australia, particularly
in rural and regional areas and for
Aboriginal and Torres Strait
Islander people
The Action Plan recognised that shortages across
the mental health workforce are a key limiting
factor to improving mental health services.
Additionally, distribution of the workforce,
particularly across rural and regional areas, were
identified as needing priority attention.
The nature of the workforce providing mental
health care in Australia has changed substantially
over the last decade. Complementing the
specialist public mental health services managed
► Supporting the non-government
and private sector to provide
by states and territories, primary care is now
quality services to people with
recognised as a critical element of comprehensive
mental illness
mental health services. New and expanded roles
have also developed for private and nongovernment providers. The skill mix to deliver
quality services is diverse and requires adequate numbers of psychiatrists, nurses,
psychologists, social workers, occupational therapists, other allied health providers, general
practitioners and Aboriginal and Torres Strait Islander health workers. More recently,
recognition is being to the central role of consumer and carer peer workers in developing a
recovery-oriented mental health service system.
COAG National Action Plan on Mental Health - Progress Report 2010-11
9
The Action Plan set three policy directions to target governments’ future workforce
investments (Figure 7), all aimed at building capacity in terms of supply, distribution and
skills.
A combined total of $185 million additional funding to initiatives grouped under Action
Area 4, increasing to $287 million when more recent government budget announcements are
included. Based on the progress reports, $280 million of this new funding was allocated in
five years of Action Plan implementation.
Funding directed to workforce initiatives represents 5% of the total revised Action Plan
commitments and 4% of combined government allocations made to date.
Table 5: Action Area 4 - funding commitments 2006-11 and allocations (millions)
Funding commitments
New funding
2006-11
allocated
As reported
Subsequent Total funding
in the
new funding commitments 2006-07 2007-08 2008-09 2009-10 2010-11
Action Plan
commitments
2006-11
July 2006
Australian Government
129.8
New South Wales
23.2
Victoria
4.4
Queensland
0.1
129.9
12.8
21.6
28.1
31.3
31.7
125.5
23.2
3.7
4.3
5.0
5.0
5.2
23.2
7.0
11.4
0.8
0.9
0.9
2.5
4.2
9.3
6.1
70.8
76.9
1.5
16.9
21.6
19.7
17.2
76.9
Western Australia
8.8
12.7
21.5
4.4
2.8
7.3
2.9
2.7
20.1
South Australia
1.0
3.2
4.2
1.0
0.4
0.7
0.9
1.2
4.2
Tasmania
8.6
8.6
1.7
1.7
1.7
1.7
1.7
8.6
Australian Capital
Territory
3.1
8.5
11.6
0.6
1.0
1.7
4.3
4.6
12.3
0.1
0.1
0.0
0.0
0.1
0.1
0.2
0.4
102.3
287.3
26.6
49.7
67.0
68.5
68.7
280.4
Northern Territory
Total
185.0
Action Area 5: Coordinating care
The Action Plan contained two flagship initiatives directed at providing more seamless and
coordinated health and community services for people with a mental illness. It was
anticipated that work in this area would be undertaken within existing resources with no
funding earmarked in the Action Plan.
Figure 8: Coordinating care - Action
Plan policy directions
Governments working together
►
Coordinating care
►
Governments working together
In the first year of the Action Plan, Premiers or
Chief Minister Departments in each State and
Territory and the Australian Government
Department of Health and Ageing convened COAG
Mental Health Groups to provide forums for oversight and collaboration in planning and
implementing initiatives under the Action Plan. The groups include representatives from
government departments with responsibility for implementation of initiatives. Nongovernment organisations, the private sector, and consumer and carer representatives are also
engaged.
10
Total
COAG National Action Plan on Mental Health - Progress Report 2010-11
On average, each group continued to meet quarterly throughout 2008-09 in an ongoing effort
to ensure that implementation of the Action Plan proceeded collaboratively across portfolios.
Subsequently, the groups have continued in some jurisdictions or transformed into new
groups, driven by the agenda of the Fourth National Mental Health Plan.
Coordinating care
Through the Action Plan, COAG committed to ensuring that care is coordinated for people
with severe mental illness and complex needs who are most at risk of falling through the gaps
in the system. This group of people have persistent symptoms and significant disability, have
lost social or family support networks and often need the support of multiple health and
community services to maintain their lives within the community. In particular, access to
clinical care needs to be complemented by access to accommodation support to ensure stable
housing, and a range of community support services focused on employment, income
support, education and social and family support. When one or more of these needs is not
met, the person’s recovery and their capacity to live in the community are jeopardised.
The aim was a new system, building upon existing coordination arrangements, whereby care
coordinators, with the support of clinical providers, will ensure the person is connected to
these services.
A set of high-level principles and implementation guidelines were developed in the first year
of the Plan to guide the work. The implementation by each jurisdiction was recognised as
needing to be flexible, reflecting differences between jurisdictions in local systems.
In the first three years of the Action Plan, work continued on the development of state-based
care coordination models in all states and territories through care coordination sub-groups of
the state-based COAG Mental Health Groups. State-based COAG groups considered how
their existing systems could be restructured to facilitate a care coordination model. This
included looking at governance arrangements, and considering issues relating to privacy and
information sharing across care providers (including the development of a paper-based or
electronic single integrated care plan), referral pathways, and ways to track clients
participating in the model.
The Australian Government participated in all state-based groups as well as undertaking
further consultations on the development and implementation of the Personal Helpers and
Mentors initiative, which complements services provided by states and territories
By 2010-11, all jurisdictions had made progress toward, or completed, the implementation of
their local care coordination models. Each jurisdiction has provided summary details of their
progress in implementing care coordination in Part B of this report. Table 6 summarises the
key developments reported by each of the states and territories.
In May 2011, the Australian Government announced a major new initiative specifically
directed to improve services for the group of people targeted by the Action Plan
‘Coordinating Care’ flagship. The 2011-12 Federal Budget provided $549.8 million over five
years for the Partners in Recovery program to address problems in the coordination of care
for people with severe and persistent mental illness with complex needs that require a
response from multiple agencies. The program aims to better support individuals, their carers
and families, by facilitating improved coordination of and more streamlined access to clinical
and community support services. The program aims to cover 24,000 people by 2015-16.
COAG National Action Plan on Mental Health - Progress Report 2010-11
11
Further information about the initiative is available on the Department of Health and
Ageing’s website www.health.gov.au/mentalhealth.
Table 6: Care coordination developments reported by states and territories
New South Wales
In the first four years
of the Action Plan - 8
demonstration sites
established to
implement the NSW
Care Coordination
initiative that provides
coordinated support for
persons with severe
mental illness at eight
sites in the Sydney
metropolitan area.
In 2010-11 - the NSW
Care Coordination
initiative continued at
eight sites in the
Sydney metropolitan
area.
South Australia
In the first four years
of the Action Plan Implementation of new
models of care for
mental health
commenced as part of
the new stepped
system of care; new
electronic care plan
was implemented.
In 2010-11 - continued
to implement the new
models of care as part
of the stepped system
of care. New
infrastructure started to
come on stream in
2010-11 and will
continue for the next
two years.
12
Victoria
In the first four years of the
Action Plan - 3 pilot sites
established to identify and
address barriers to integrated
care delivery. Lessons identified
to inform development of a
statewide care coordination
framework.
A new care coordination initiative
($8.3 million over four years)
was funded, to support clients
with multiple needs to access
the range of health, community
and social services they require.
Care coordination positions were
established to lead the
coordinated development and
monitoring of comprehensive
integrated care plans and
tailored support packages for
300 clients.
In 2010-11 - Victoria continued
to trial a new care coordination
to support 300 clients at any one
time with multiple needs to
access the range of health,
community and social services
they require.
Queensland
In the first four years of the
Action Plan - 20 (full-time
equivalent) Service Integration
Coordinators throughout
Queensland appointed to
engage local service
providers, government, nongovernment and private
sectors to participate in the
Care Coordination Model.
Tasmania
In the first four years of the
Action Plan - development of
Care Coordination Model using
existing ‘Mental Health Service
Maximising Recovery Panels’
(MRPs) as single points of entry
to determine the most suitable
community sector services for
mental health clients. The
Community Sector Interface
Group, established in 2008-09,
provided a resource to support
planning for a more integrated
service system. The MRP model
was reviewed in 2008-09.
In 2010-11 - Preliminary work to
develop a service planning
framework for Mental Health
Services to inform the
development of a new
Tasmanian Mental Health
Services Strategic Plan
Australian Capital Territory
In the first four years of the
Action Plan - ACT Care
Coordination Project
commenced in October 2007;
care coordination model
developed and piloted. Care
coordination is now embedded
into the practice of Mental
Health ACT clinicians, and is
the responsibility of all
clinicians with support and
monitoring from Team
Leaders.
Case management is
embedded into assessment,
recovery planning, case
review, and case closure that
identify services and referral
pathways.
In 2010-11 – Care
coordination continues to be
embedded in mental health
service practice.
Two statewide Care
Coordination forums were
held. An internal evaluation of
the implementation of the
model (Phase 1) was
conducted - 73% of
stakeholders identified that
collaboration between service
providers has improved; more
than 50% of stakeholders
rated the model as
sustainable.
In 2010-11 - 20 Service
Integration Coordinators
continued to develop working
relationships between
government, non-government
and the private sector.
Western Australia
In the first four years of
the Action Plan developed care
coordination framework; 6
pilot sites established
drawing on lead service
delivery organisations
(government and NGOs).
The People with
Exceptional Needs (PECN)
small pilot program
supported nine people with
complex needs.
Two targeted treatment and
support programs were
developed: a dedicated
Mental Health Clinical
Outreach team (MHCOT);
and the Mental Health
Housing Support Worker
initiative.
In 2010-11 - A number of
strategies to develop
effective integration
between primary health
care and specialist were
being developed.
Northern Territory
In the first four years of
the Action Plan - Care
Coordination Policy Paper
completed; care
coordination working
groups established
including an NT wide Care
Implementation of the
‘Shared Client Case
Management’ framework
across NT Department of
Health and Families
programs. Work completed
to adjust the NT electronic
client records system to
allow clinicians from
different departmental
health programs to be
notified if other service
providers are in contact
with the same client.
In 2010-11 – continued
implementation of the
Shared Client Case
Management’ framework.
COAG National Action Plan on Mental Health - Progress Report 2010-11
Chapter 3 Progress towards outcomes
The Action Plan identified four outcome areas targeted for long term change. Collectively,
the actions committed by governments aimed to improve the status of the population’s mental
health, stimulate better outcomes from health services, as well as achieve improvements at
the broader social and economic level. A total of 12 progress indicators were identified to
track improvements across the agreed outcome areas. The indicators are representative rather
than comprehensive, and designed to provide a snapshot of progress in key areas.
Figure 9: COAG Action Plan outcome areas and progress indicators
Four
Outcome Areas
Reducing the prevalence
and severity of mental
illness in Australia
Reducing the prevalence of
risk factors that contribute
to the onset of mental
illness and prevent longer
term recovery
Increasing the proportion of
people with an emerging or
established mental illness
who are able to access the
right health care and other
relevant community
services at the right time,
with a particular focus on
early intervention
Increasing the ability of
people with a mental illness
to participate in the
community, employment,
education and training,
including through an
increase in access to stable
accommodation
Twelve
Progress Indicators
1.
The prevalence of mental illness in the
community
2.
The rate of suicide in the community
3.
Rates of use of illicit drugs that contribute to
mental illness in young people
4.
Rates of substance abuse
5.
Percentage of people with a mental illness who
receive mental health care
6.
Mental health outcomes of people who receive
treatment from State and Territory services and
the private hospital system
7.
The rates of community follow up for people
within the first seven days of discharge from
hospital
8.
Readmissions to hospital within 28 days of
discharge
9.
Participation rates by people with mental illness
of working age in employment
10. Participation rates by young people aged 16-30
with mental illness in education and
employment
11. Prevalence of mental illness among people who
are remanded or newly sentenced to adult and
juvenile correctional facilities
What the progress
indicators tell us about
improved mental health
Population health
outcomes
Are we more mentally
healthy as a nation, with less
risk factors for mental
illness?
Health service delivery
outcomes
Are health services more
effective in the care they
provide to people with mental
illness?
Social and economic
outcomes
Have we increased
opportunities for participation
in community life for people
with mental illness? And
reduced the social impact of
mental illness
12. Prevalence of mental illness among homeless
populations
This section of the report presents the most up-to-date information for the 12 progress
indicators, drawn from currently available data.
The Action Plan indicators were designed on an understanding that not all indicators are
appropriate for annual collection and reporting, due to the complexity of the data collection
requirements, or because the underlying phenomenon being measured (e.g., prevalence of
mental illness in the population) requires change to be monitored over a longer period.
Primary data sources for five of the indicators are collected on an annual basis (Indicators 2,
COAG National Action Plan on Mental Health - Progress Report 2010-11
13
6, 7, 8, 12), while the remainder are collected periodically (3 to 5 yearly) through special,
sampled collections.
For this final report, new or updated data are incorporated in 8 of the 12 progress indicators.
The table below provides details on which indicators have been updated with more recent
data.
Table 7: Summary of updated data used to report on COAG progress indicators
Progress Indicator
Updated data
provided?
Details
1.
The prevalence of mental
illness in the community
No
Current report incorporates published results from 2007
National Survey of Mental Health and Wellbeing,
released by ABS Oct 2008.
2.
The rate of suicide in the
community
Yes
Indicator updated to 2011, based on ABS Causes of
Death publication, released March 2013.
3.
Rates of use of illicit drugs
that contribute to mental
illness in young people
No
Report incorporates the most recent data available from
the 2010 National Drug Strategy Household Survey,
released by AIHW July 2011. No new data available.
4.
Rates of substance abuse
No
As per indicator 3.
5.
Percentage of people with a
mental illness who receive
mental health care
Yes
Report incorporates new 2010-11 data and revised
estimates for previous years, provided by the Australian
Government, states and territories and the Private Mental
Health Alliance.
6.
Mental health outcomes of
people who receive treatment
from State and Territory
services and the private
hospital system
Yes
New data presented on consumer outcomes 2010-11,
provided by states and territories and Private Mental
Health Alliance. Indicator is presented at individual
jurisdiction level.
7.
The rates of community follow
up for people within the first
seven days of discharge from
hospital
Yes
Report incorporates new data for 2010-11 and updated
results for previous years, provided by states and
territories.
8.
Readmissions to hospital
within 28 days of discharge
Yes
As per indicator 7.
9.
Participation rates by people
with mental illness of working
age in employment
Yes
Report incorporates new data from the ABS Australian
Health Survey 2011-13, as reported in Report on
Government Services 2013.
10. Participation rates by young
people aged 16-30 with
mental illness in education
and employment
Yes
As per Indicator 9.
11. Prevalence of mental illness
among people who are
remanded or newly
sentenced to adult and
juvenile correctional facilities
No
This section includes results from the national census of
prison entrants, most recently undertaken in 2010. No
new data available.
12. Prevalence of mental illness
among homeless populations
Yes
Incorporates the most recently available data relating to
SAAP services covering to 2010-11, and interpretative
analysis presented in AIHW’s publication Australia’s
Welfare 2011.
14
COAG National Action Plan on Mental Health - Progress Report 2010-11
OUTCOME AREA 1:
Reducing the prevalence
and severity of mental
illness in Australia
Indicator 1: Prevalence of mental illness in the community
Mental illness is common in the Australian population, affecting the
lives of individuals, their carers and the wider community.
Awareness of the scale of mental illness and its extensive social
impact has increased substantially over the past decade, both within
governments and the general population.
National surveys undertaken in 1997 and 1998 provided the first comprehensive assessment
of mental illness in Australia. The surveys found that, in the preceding 12 months, about one
in five of the adult population were affected by one or more of the common mental disorders1
(anxiety, affective [mood] and substance use disorders) in any one year. One in four of these
individuals were reported to experience more than one illness. Just under a half also had a
chronic physical illness. A further 2-3% of adults are estimated to suffer from other less
prevalent mental illnesses such as schizophrenia, eating disorders and personality disorders
that were not specifically counted in the general population surveys.
The main survey – referred to as the National Survey of Mental Health and Wellbeing
(NSMHW) – was repeated in 2007, with some differences in methodology, to gather an
updated picture on Australia’s mental health. Preliminary results released by the Australian
Bureau of Statistics (ABS) in October 2008 mirror those reported a decade earlier, as well as
14%
providing additional insights to illnesses experienced over the
One in five (20%)
4-17lifespan.
*
n.a
Australians aged 16-85 years experienced one of the more common mental illnesses in the
preceding 12 months, equivalent to 3.2 million people. The 2007 survey also revealed that
** period in their lifetime, a
45% of adults experience one or more of these illnesses16/18-24
at some
figure that is consistent with similar surveys in comparable countries.
Overall, however, both the methods
used and the broad findings are very
similar, pointing to the relative stability
in patterns of mental illness in the
Australian community over the
decade.2
Both surveys showed prevalence of
mental illness varies across the life
21%
Age Group
25-34
Figure 10: Prevalence
of common mental disorders in the 25%
Australian population, 1997 and 2007 ***
4-17 *
20%
35-44
14%
23%
n.a
27%
45-54
16/18-24 **
Age Group
Some methodological differences
between the two surveys make caution
necessary when interpreting the results,
particularly small differences in
12-month prevalence rates. Methods
used to identify a person as
experiencing a mental illness over the
previous year were different, as were
the ‘rules’ applied to establish a
diagnosis.
27%
26%
21%
25-34
55-64
14%
23%
6%
65+
21%
12%
25%
20%
35-44
18%
8%
45-54
55-64
18%
26%
21%
All adult
population
65+ **
18%
12%
14%
20%
6%
2007
1997
8%
18%
All adult
population
20%
2007
1997
* Based on 1998 specific survey of children and adolescents. Equivalent data not
available for 2007.
** 1997 survey age range was 18-99 years; 2007 survey sampled 16 to 85 years.
*** Estimates include alcohol and drug use disorders. If these are excluded, overall
prevalence of mental illness in the adult population reduces from 20% to 17%.
‘Mental disorder’ is the term used to refer to mental illness in the various national population surveys.
See Appendix 2 Technical Notes, page 96 for further details on differences between the 1997 and 2007
surveys.
1
2
COAG National Action Plan on Mental Health - Progress Report 2010-11
15
span. Rates are higher in the early adult years, the period during which many people first
experience symptoms of illness. For people in the age range 16 to 24 years, the prevalence
of mental illness (26%) is one third higher than the average for the overall adult population.
This finding is consistent with the 1997 results, and highlights the need to strengthen early
intervention services that target younger Australians. Episodic or ‘binge’ drinking is a major
component of the reported high rates of mental ill-health in the youth population.
Mental illness impacts on people’s lives at different levels of severity (Figure 11). Based on
earlier analysis reported in previous COAG progress reports, an estimated 2-3% of
Australians have severe disorders, judged according to the type of disorder (diagnosis), the
intensity of symptoms, the length of time symptoms have been experienced (chronicity), and
the degree of disablement that is caused to social, personal and vocational functioning. This
group comprises about 600,000 Australians. A large group of people with severe mental
illness (approximately 40%) is made of people with severely disabling forms of anxiety
disorders and depression – this is contrary to popular understanding that assumes that anxiety
and depression are mild and moderate disorders only. People with a psychotic illness
represent about one third of those with a severe mental illness.
Figure 11: 12-month prevalence estimates of mental illness in the population by severity level,
based on diagnosis, disability and chronicity
SEVERE
2-3%
Approximately 600,000 Australians
MODERATE
4-6%
Approximately 1 million Australians
Severity
MILD
GENERAL POPULATION
WITH NO CURRENT
MENTAL ILLNESS
9-12%
80%
Approximately 2 million Australians
In addition to the
groups above, a further
25% of the population will
experience a
mental illness at some
point in their lives
The Action Plan aims to reduce both the prevalence and severity of mental illness. Reduction
in prevalence may be brought about by preventive efforts to stop an illness occurring in the
first place, or by increasing access to effective treatments for those in whom the illness has
begun. Reducing the severity of mental illness requires a range of services designed to
alleviate the disablement that may be caused to a person’s social, personal and vocational
functioning. A substantial proportion of the Action Plan initiatives target these areas.
Additional population surveys are necessary to complete the picture of the extent of mental
illness in the community. Specifically, surveys of the child and adolescent population, and of
people who suffer from the more uncommon (‘low prevalence’) severe disorders such as
schizophrenia, are needed to complement the 2007 general adult population survey and build
a stronger evidence base to inform future mental health policy. For the latter group, an
Australian Government-funded survey of people with psychotic illnesses commenced in late
2009, with results released November 2011. A national survey of children and adolescents is
currently being planned, and due to be undertaken in 2013.
16
COAG National Action Plan on Mental Health - Progress Report 2010-11
OUTCOME AREA 1:
Reducing the prevalence
and severity of mental
illness in Australia
Indicator 2: Rate of suicide in the community
While suicide accounts for only a relatively small proportion (1.5%)
of all deaths, it accounts for a much greater proportion of deaths
within certain population groups. For example, in 2011,
approximately one in every four deaths (28%) of males aged 15-24
years was due to suicide. Similarly for females, suicide deaths comprise a much higher
proportion of total deaths in younger age groups compared with older age groups. Each
represents not only a loss of a life, but also affects family and friends left behind and the
community as a whole.
Table 8: Suicide by state or territory, number of deaths 2007-2011
NSW
2007
2008
2009
2010
2011
Vic
Qld
WA
SA
Tas
ACT
NT
Total
611
474
520
266
205
66
32
55
2,229
620
545
553
300
175
73
36
38
2,341
623
576
525
279
185
79
32
37
2,337
639
536
583
315
197
64
41
45
2,420
566
483
559
306
209
73
34
43
2,273
There were 2,273 deaths in 2011, down (6%) from 2,420 the previous year. Over three
quarters (76%) of suicides were males.
In recent publications, the ABS has drawn attention to significant data quality problems that
impact on the apparent fluctuation in suicide rates, arising primarily from the increasing
number of ‘open cases’ that are the subject of coronial inquiry. Commencing with its 2008
Causes of Death publication (released March 2010), the ABS introduced changes to its
coding and reporting practices to reduce the impact of these problems and improve the
accuracy of overall statistics on causes of death in Australia. These changes particularly
affect suicide statistics. The changes implemented include revisions to historical data back to
2007, progressively implemented over a three year period. The ABS has previously
cautioned that, as a result of these changes, care should be taken when comparing 2007 and
subsequent suicide data with earlier years because much of the recorded increase is due to the
quality improvement process applied to the 2007 and future years data. Additionally, the
ABS noted in its most recent publication that the 2011 data had not yet been subjected to the
revisions process and are expected to increase when that process is complete. Additionally,
the figures for 2009 and 2010 are subject to further revision.
At the individual state and territory level, suicide rates vary over time, often greatly within
smaller jurisdictions due to the relatively small number of suicides registered annually. There
is also significant variation across jurisdictions in the finalisation of coronial processes. To
compare jurisdictions, suicide rates are best averaged over a number of years to reduce the
impact of these temporary fluctuations and identify underlying differences that endure over
time.
Figure 12 compares states and territories on average annual suicide rates over the 5-year
period 2007 to 2011.
COAG National Action Plan on Mental Health - Progress Report 2010-11
17
Figure 12: Prevalence of suicide by state or territory pre 100,000 people, age-standardised
annual rate 2007-2011
Source: ABS Causes of Deaths, Australia, 2011; Cat. no. 3303.0
The average annual suicide rates shown in Figure 12 highlights the rates for the Northern
Territory (19.3 per 100,000) as a major concern, nearly double the national rate of 10.6 per
100,000. Tasmania (14.1 per 100,000) had rates 33% above the national rate, and Western
Australia (13.1 per 100,000), Queensland (12.4 per 100,000) and South Australia (12.0 per
100,000) were 24%, 17% and 13% above the national rate respectively. New South Wales,
Victoria and ACT all had rates below the national average. Higher proportions of rural areas
and Indigenous peoples contribute to these differences.
18
COAG National Action Plan on Mental Health - Progress Report 2010-11
OUTCOME AREA 2:
Reducing the prevalence
of risk factors that
contribute to the onset of
mental illness and
prevent longer term
recovery
Indicator 3: Rates of use of illicit drugs that contribute to
mental illness in young people
Indicator 4: Rates of substance abuse
The National Action Plan reflects concern at the level of government
and the broader community level about substance abuse and its
perceived contribution to increased rates of mental illness and
associated demand upon health services. While national programs have been initiated under
the National Drug Strategy, further targeted efforts are required in reducing substance abuse,
particularly the use of illicit drugs that may contribute to mental illness, and in dealing with
the challenge of providing services to people presenting with comorbid mental health and
substance abuse problems.
Updates on the level of substance abuse and associated disorders have become available from
two recent sources – the 2007 National Survey of Mental Health and Wellbeing, conducted
by the ABS, and the 2010 National Drug Strategy Household Survey, a survey conducted
triennially by the Australian Institute of Health and Welfare (AIHW).
The NSMHW revealed that harmful substance abuse and substance dependence mental
disorders (mainly alcohol related) were common within the community in 2007, and present
in about 5% of the adult population. Rates for males (7.0%) were more than twice those for
females (3.3%). Overall rates of mental disorders associated with substance use were slightly
less in 2007 than 1997, although as noted in Indicator 1, differences in survey methodology
may have contributed to this.
The AIHW 2010 survey obtained
more general information on
substance use, based on responses
from approximately 26,000
households. When examined
against the results of earlier AIHW
surveys, a long term picture of drug
and alcohol use in the Australian
population can be built (Figure 13).
Figure 13: Trends in recent (past 12 months) drug use,
1998 to 2010, selected drugs, Australian population
aged 14 years or older
Alcohol
Alcohol is the most commonly used
and abused substance, and a major
cause of death, injury and illness in
Australia. The recent Drug Strategy
Household Survey suggests that the
proportion of the population aged 14
years or older who consumed
alcohol daily declined slightly
between 2007 (8.1%) and 2010
(7.2%). However, there was little
change in the proportion of people
who drink alcohol at levels that put
them at risk of harm over their
lifetime. One in five (20.3% in 2007
COAG National Action Plan on Mental Health - Progress Report 2010-11
19
and 20.1% in 2010) consume alcohol at a level that puts them at risk of harm from alcoholrelated disease or injury over their lifetime. About one in three (28.7% in 2007 and 28.4% in
2010) drink at levels at least once a month that put them at risk of harm from a single
drinking occasion. Males are far more likely than females to consume alcohol in risky
quantities, and those aged between 18–29 years are more likely than any other age group to
consume alcohol in quantities that placed them at risk. These patterns have been stable over
recent surveys.
Cannabis and methamphetamines remain the most widely used illicit drugs in Australia.
Usage rates for each of these drugs by younger people are of particular concern due to the
mental health problems often associated with their use.
Cannabis
Cannabis is the illicit drug most used in the community, across all age groups. In 2010, 35%
of the population aged 14 years reported having used cannabis at some stage in their lives,
equivalent to 5.6 million people. One in five teenagers (22% for 14–19-year-olds) reported
having used cannabis at some time.
The demand for interventions for cannabis-related problems is increasing with around one in
five alcohol and drug treatment episodes being for a primary cannabis use disorder. Research
evidence is accumulating that cannabis use may precipitate schizophrenia in people who have
a personal family history of the disorder, and increases the risk of psychotic symptoms for
those who have a vulnerability to psychosis. Cannabis use may also exacerbate symptoms of
schizophrenia, but it remains unclear whether or not cannabis causes additional cases of
schizophrenia. Cannabis use also poses a moderate risk for later depression, with heavy
cannabis use possibly posing a small additional risk of suicide.
After peaking in 1998, use of cannabis decreased over decade to 2007 (from 17.9% to 9.1%)
but increased slightly (to 10.3%) in 2010. Growth in the proportion of the population who
reported recent (last 12 months) usage of cannabis is evident across all age groups
(Figure 14) but the downward trend from the 1998 peak is the most notable feature of the
long term data.
While reduced use is evident across all age groups, it is particularly marked in young people.
Use of cannabis in the preceding 12 months by people aged 14-19 years dropped from 35% in
1998 to 13% in 2007. The rise in 2010 to 16% for this population points to the continuing
need for preventive action by governments, backed by ongoing population monitoring.
Figure 14: Prevalence of recent (past 12 months) cannabis use by age, 1998 to 2010
20
COAG National Action Plan on Mental Health - Progress Report 2010-11
Males continue to be more likely than females to use cannabis, to use with greater frequency
and to use the more potent parts of the plant. In 2010, recent cannabis use is most common
among males in the 20-29 year age group.
Methamphetamine use
Growth in use of methamphetamine in the 1990s, coupled with an increase in the use of
crystalline methamphetamine, has been associated with a range of mental health and related
problems arising from drug use. Symptoms of psychosis are one of the particularly troubling
consequences of methamphetamine use and dependent methamphetamine users also suffer
from a range of comorbid mental health problems. Among methamphetamine users who take
the drug monthly or more often, the prevalence of psychosis is 11 times higher than among
the general population. The symptoms usually last hours to days, and in severe cases, can
lead to hospitalisation. In rare cases, the condition can last weeks to months, or can remit and
recur over a longer period of time, contiguous with drug use and other life stressors.
Users who have schizophrenia, mania or other psychotic disorders are more likely to
experience the recurrence of psychotic symptoms, or more severe symptoms, making
treatment substantially more difficult.
Reported use of methamphetamine peaked in 1998, with 3.7% of people aged 14 or more
reporting use in the previous 12 months (see Figure 13). In 2004, 9% reported having used
the drug at some point in their life. These general statistics on overall use mask high use of
methamphetamine among young adults. In 2004, one in five people aged 20-29 years
reported having used the drug at some stage in their life.
The 2010 AIHW survey points to a decline in recent methamphetamine use in Australia. For
people sampled in 2010, use of the drug in the preceding 12 months was 2.2%, dropping from
and 2.4% in 2007 and 3.3% in 2004. For young adults aged 20-29 years, 5.9% reported using
methamphetamine in the previous year, dropping from 7.3% in 2007 and 10.7% in 2004.
Figure 15: Prevalence of recent (past 12 months) methamphetamine use by age, 1998 to 2010
Early onset of drug use is an important predictor of later problematic use patterns. The onset
of methamphetamine use typically occurs in the mid-to-late teens, and this is reflected in the
lifetime prevalence of 8% among 16-17 year old secondary school students. The 2010 survey
data also confirm a stable, reduced level of recent use of methamphetamines by teenagers
(14-19 years). A total of 1.6% reported using the drug in the previous year compared with
4.4% in 2004 and 5.9% in 1998.
COAG National Action Plan on Mental Health - Progress Report 2010-11
21
OUTCOME AREA 3:
Increasing the
proportion of people
with an emerging or
established mental
illness who are able to
access the right health
care and other
relevant community
services at the right
time, with a particular
focus on early
intervention
Indicator 5: Percentage of people with a mental illness who
receive mental health care
Widespread concern about access to mental health care and the need
for better coordinated services were key factors that placed mental
health as a priority issue on the COAG agenda.
First insights into the gap between need for mental health services and
services actually delivered were provided by national population
surveys undertaken in 1997 and 1998. The surveys revealed that only
38% of adults and one quarter of children and younger people with a
mental disorder received treatment from a health service. Of those
who received services, the majority (77%) consulted their general
practitioner, although about half also attended another health service.
The implication is that, ten years ago, about two thirds of the one in five adult Australians
who were experiencing a recent mental illness received no treatment for that illness from any
part of the health system.
An updated picture on the extent of unmet need for mental health care in the adult population
is now available from the 2007 National Survey of Mental Health and Wellbeing. Conducted
by the Australian Bureau of Statistics in 2007, results released in October 2008 suggest that
little change had occurred over the preceding decade in the overall rates of treatment for
people with mental disorders, with approximately two thirds (65%) continuing to receive no
treatment. However, the 2007 survey indicates that service use patterns had changed. People
receiving health care for their mental health condition in 2007 were twice as likely to see a
mental health professional than they were in 1997 (Figure 16).
Figure 16: Types of health services used by adults with a current mental disorder, 1997 and
2007
1997
Mental health
professional
12%
2007
Mental health
professional
22%
Other health
service
12%
General
practitioner
only
10%
General
practitioner
only
14%
No services
62%
Other health
service
3%
No services
65%
‘General practitioner only’ does not include an additional 15% in each year who saw both a GP and another health provider.
When the survey findings are scaled to the total population, they suggest that 2.1 million
adult Australians experienced the symptoms of a mental illness in 2007 but received no
health care for their conditions. Treatment rates varied according to the severity of the
person’s condition and type of disorder. Approximately two thirds (64%) of those with
disorders classified as severe according to the ABS methodology received some level of
22
COAG National Action Plan on Mental Health - Progress Report 2010-11
health care. About 39% of people with moderately severe disorders and only 17% of people
with milder (but still clinically significant) disorders were found to receive mental health
care. People with an affective disorder (mainly depression) were more likely to have
received services for their mental health condition than those affected by one of the various
anxiety disorders (59% and 38% respectively). These rates are similar to those observed in
1997.
The lack of change in overall treatment rates for mental illness was contrary to popular
expectation because substantial service growth occurred in the period 1997-2007. Alongside
these developments, steps were taken under the National Mental Health Strategy to increase
community awareness about mental illness and the availability of effective treatments.
Higher levels of access were expected to have resulted from these initiatives.
Since the release of the ABS 2007 survey results, a more considered understanding of the
data has emerged that make the stability of low treatment rates for mental illness between
1997 and 2007 more plausible in the context of mental health service developments. Three
lines of evidence contribute to a better understanding of the Australian mental health
epidemiological data.

The first concerns an appreciation of the
Table 9: Needs reported by people with a
current mental illness who received no health
relationship between service use and
services, 2007
perceived needs for care. Most people who
meet diagnostic criteria for mental illness do
Type of service
No
need
not experience a need for professional
Information
94%
assistance of any kind. The 2007 ABS survey
reported that nine out of ten of those
Medication
97%
experiencing mental illness symptoms in the
Talking therapy
89%
previous 12 months who were not receiving
Social intervention
94%
mental health care reported having no need
Skills training
96%
for any of a range of services, including
counselling, medication and information
No perceived need for any of the above
86%
services
(Table 9). The implication is that the lack of
health service use by people with mental
illness may be more related to their perception of personal needs than to the actual
availability of services. Further work is needed to tease out the extent to which this
finding is a function of factors such as lack of recognition by the person that they have
an illness, lack of awareness that effective treatments are available, negative
experiences of previous service use, and continuing stigma associated with mental
illness.

The second factor is about the nature of national mental health policy directions
between 1997 and 2007. Relatively little additional investment over that period was
made to improve treatment rates for people with common mental disorders. Most effort
was directed to reform of state and territory services to improve the quality of services
for people with severe mental illnesses. The Better Access program, a new initiative by
the Australian Government to expand the role of the primary health sector in providing
mental health care through Medicare, was the first major policy initiative to improve
treatment rates for mental illness in Australia. Commencing in November 2006, only
the early impact of the Better Access program was visible to the ABS 2007 population
survey. Since the ABS survey was conducted, the Better Access program has
COAG National Action Plan on Mental Health - Progress Report 2010-11
23
continued to grow, and the number of people receiving mental health services through
Medicare-funded service providers has more than doubled. The implication is that the
service access rates found in the 2007 survey do not reflect current rates.

The third factor concerns methodological differences between the 1997 and 2007
surveys. The diagnostic modules used in the 2007 survey identified more people with
mild mental disorders, particularly mild anxiety disorders, than in the 1997 survey. As
this subgroup is less likely to access services, these differences played a role in
reducing overall treatment rates relative to 1997.
Notwithstanding these factors, the similarity between treatment rates in 1997 and 2007
suggests that achieving significant improvements in the rates of treatment for people
experiencing mental illness will take sustained government effort and investment over the
long term.
Large scale population surveys provide snapshots of the level of mental illness in the
community but are not the only way to monitor access to care. To complement the periodic
population surveys, for the purposes of this report, health administrations within each
jurisdiction agreed to pool related data on the number of people receiving services through
government-funded clinical mental health care streams. The Private Mental Health Alliance
also agreed to contribute data on people treated in private hospitals.
Results at the national level over the five years of the Action Plan are presented in
Figure 17 below. Assuming minimal overlap between state/territory and Medicare-funded
person counts, the data suggest that approximately 1.9 million people, or 8.5% of the
population, received clinical mental health care in 2010-11, compared with 970,000 in the
first year of the Action Plan. Growth in the proportion of the population people seen by
Medicare-funded mental health services is the sole driver of the change over the three years.
Figure 17: Access to clinical mental health care – number of people and percentage of
population seen by each of the major mental health service streams, 2006-07 to 2010-11
24
COAG National Action Plan on Mental Health - Progress Report 2010-11
These figures highlight that the ABS estimates made in 2007 of access to mental health care
are unlikely to reflect the population’s current use of services. Analysis was undertaken by
the Australian Government Department of Health and Ageing as part of the national
evaluation of the Better Access program, that factored in the growth in the number of persons
treated by Medicare-funded Better Access services and incorporated estimates from other
service utilisation data. The analysis suggested that the percentage of the population with a
current mental illness who received care in 2009-10 was 46.1%, substantially higher than the
35% estimate found by the ABS in 2007. The growth occurring in 2010-11 evident in Figure
17 will have further increased treatment rates beyond those found in 2007.
Relative access figures across each of the state and territory jurisdictions are shown in
Figure 18. Several caveats need to be considered when interpreting these figures. First,
comparisons of relative coverage between state/territory mental health services and
Medicare-funded services need to take account of differences in the type and intensity of
services provided across these sectors, with states and territories having their main focus on
treating people severe mental disorders. Second, the growth in Medicare-funded services is,
in part, a function of the fact that the Australian Government Better Access to Mental Health
Care initiatives commenced only mid way (Nov 2006) into the first year of the Action Plan.
Thirdly, comparisons between state and territory services need to be made cautiously because
jurisdictions differ in the way in which they count the number of people under care. Victoria
in particular undercounts patients seen by clinical services when compared to other
jurisdictions because it only reports people who are seen and accepted for case management.
COAG National Action Plan on Mental Health - Progress Report 2010-11
25
Figure 18: Access to clinical mental health care – percentage of population seen by state/
territory and Medicare-funded mental health services, by jurisdiction, 2006-07 to 2010-11
GROUP A JURISDICTIONS
GROUP B JURISDICTIONS
Group B jurisdictions differ from those in Group A by having less capacity in their state/territory mental health
services to provide accurate counts of the number of unique persons seen. Note that this does not apply to the
counts of persons seen by Medicare-funded services which, for all jurisdictions, are accurate and unique counts.
LEGEND
State and territory mental health services
Medicare-funded mental health services
26
COAG National Action Plan on Mental Health - Progress Report 2010-11
n ongoing
unity care
arged from
y care
arged from
al
arged from
al
OUTCOME AREA 3:
Increasing the
proportion of people
with an emerging or
established mental
illness who are able to
access the right health
care and other
relevant community
services at the right
time, with a particular
focus on early
intervention
Indicator 6: Mental health outcomes of people who receive
treatment from state and territory services and the private
hospital system
Establishing a standardised system for the routine monitoring of
consumer outcomes has been the focus of extensive activity in
state/territory-funded mental health services and the private hospital
sector, with support from the Australian Government. The goal has
been to develop standard measures of a consumer’s clinical status and
functioning and apply these at entry and exit from care to enable
change to be measured. For consumers who require longer term care,
the measures are applied at three monthly review points. The outcome
measures provide both clinician and consumer perspectives on the
extent to which services are effective in achieving improvements.
The concept is simple but ambitious. Successful implementation required major overhaul of
clinical information systems as well as extensive training of the clinical workforce in the use
of the new outcome measures. International precedents have not been available to guide
Australia because no other country has established routine consumer outcome measures
comprehensively across their publicly and privately funded mental health services.
First steps to put these arrangements on the ground were taken in 2001, and are continuing
across all jurisdictions. Routine measurement of consumer outcomes is now in place in an
estimated 85% of public mental health services and 98% of private hospitals. Over 12,000
clinicians have received training. Systems have also been established to enable pooling and
analysis of the information at the national level as well as being made available via the
internet to support clinical staff in assessing the progress of individual consumers (see
www.amhocn.org).
The most current information about the clinical outcomes of consumers under care, extracted
from the national data, is shown in the figure below. The national picture can be summarised
as follows:
Figure
19: Clinical
outcomes
peopleHEALTH
receiving
various types of mental health care, 2010-11
STATE AND
TERRITORY
PUBLICof
MENTAL
SERVICES
28%
55%
55%
17%
39%
72%
5%
23%
6%
Based on
difference in
clinical ratings
at admission
and discharge
from hospital or
community care
PRIVATE HOSPITAL PSYCHIATRIC UNITS
79%
Significant improvement
No significant change
Significant deterioration
Based on difference
between first and
last clinical ratings
made in the year for
people in longer
term, ongoing
community care
17%
4%
Note: Indicators for all groups based on changes in ratings
on the Health of the Nation Outcome Scale ‘family’ of
measures (HoNOS and HoNOSCA), completed by clinicians
at various points over the course of a consumer’s treatment
and care.
COAG National Action Plan on Mental Health - Progress Report 2010-11
27

For people admitted to state and territory managed psychiatric inpatient units (Group C in
Figure 19), approximately three quarters (72%) have a significant reduction in the
symptoms that precipitated their hospitalisation. Notwithstanding the changes in
symptoms for this group, most remain symptomatic at discharge, pointing to the need for
continuing care in the community. For a small percentage (4%), their clinical condition is
worse at discharge than at admission. About one in four (23%) are discharged with no
significant change in their clinical condition.

Similar results are achieved for people admitted to private psychiatric hospital units
(Group D in Figure 19), with 72% experiencing a significant clinical improvement, 4%
deteriorating and 24% having no significant change during their hospitalisation.

The picture for people treated in the community by state and territory mental health
services is more complex because it covers a wide range of people with varying
conditions. Some people receive relatively short term care in the community, entering
and exiting care within the year (Group B in Figure 19). For this group, 50% experience
significant clinical improvement, 8% deteriorate and 42% experience no significant
clinical change.

A second group of consumers of state and territory community care are in longer term,
ongoing care (Group A in Figure 19). This group, representing a significant proportion of
people treated by state and territory community mental health services, are affected by
illnesses that are persistent or episodic in nature. More than half of this group (58%)
experience no significant change in their clinical condition, compared with approximately
one quarter (26%) who improve and 15% who undergo clinical deterioration. An
important caveat to understand for this group is that, for many, ‘no clinical change’ can
be a good result because it indicates that the person has maintained their current level and
not undergone a worsening of symptoms.
These results are both complex and challenging to policy makers who prefer to distil health
outcome indicators to a single message. The data suggest that consumers of state and
territory and the private hospital sector mental health care have a range of clinical outcomes
that are not simple to interpret. They also raise questions about what ‘best practice’ outcomes
should be expected by consumers treated in Australia’s mental health system.
For the third consecutive year, this report also presents the clinical outcomes data for each of
the jurisdictions (Figure 20). Caution is required in interpreting differences because the data
from each jurisdiction are of variable quality, and with different levels of coverage.
The picture derived from Australia’s investment in routine outcome measurement represents
‘work in progress’ that is both imperfect and incomplete. The main outcome measurement
tools being used describe the condition of the consumer from the clinician’s perspective and
do not address the ‘lived experience’ from the consumer’s viewpoint. Although consumerrated measures are included in Australia’s approach to outcome measurement, uptake by
public sector services has been poor to date. Additionally, there are many technical and
conceptual issues that are the source of extensive debate. Foremost among these is the fact
that the outcome measures are imprecise measurement tools. There is also concern that the
approach used to report outcomes separates a consumer’s care into segments (hospital vs
community) rather than tracking the person’s overall outcomes across treatment settings.
Continued government collaboration will be required to support the further development of
the national approach to measuring and reporting on mental health consumer outcomes.
28
COAG National Action Plan on Mental Health - Progress Report 2010-11
Figure 20: Clinical outcomes of people receiving various types of mental health care provided
by state and territory mental health services, 2010-11
New South Wales
Victoria
Queensland
Western Australia
South Australia
Tasmania
STATE AND TERRITORY PUBLIC MENTAL HEALTH SERVICES
eople in ongoing
community care
discharged from
mmunity care
28%
55%
55%
17%
39%
Australian Capital Territory
discharged from
hospital
72%
5%
Northern Territory
23%
6%
PRIVATE HOSPITAL PSYCHIATRIC UNITS
discharged from
hospital
79%
17%
4%
Insufficient observations - a minimum of 200 observations is required for a group to be regarded as suitable for reporting. For
the Northern Territory and the ACT, the number of valid episodes was below the minimum agreed number for some Groups.
LEGEND
Significant improvement
No significant change
Significant deterioration
COAG National Action Plan on Mental Health - Progress Report 2010-11
29
OUTCOME AREA 3:
Increasing the
proportion of people
with an emerging or
established mental
illness who are able to
access the right health
care and other
relevant community
services at the right
time, with a particular
focus on early
intervention
Indicator 7: Rates of community follow up for people within
the first seven days of discharge from hospital
Discharge from hospital is a critical transition point in the delivery of
mental health care. People leaving hospital after an admission for an
episode of mental illness have heightened vulnerability and, without
adequate follow-up, may relapse or be readmitted. It is also a period
of great stress and uncertainty for families and carers.
Evidence gathered in recent years from a number of consultations
around Australia suggests that the transition from hospital to home is
often not well managed. The inclusion of this indicator as a measure
of progress under the Action Plan targeted the performance of the
overall health system in providing continuity of care, recognising the
need for substantial improvement in this area. The standard underlying the measure is that
continuity of care involves prompt community follow-up in the vulnerable period following
discharge from hospital.
Results for the five years of the Action Plan, and the year immediately preceding are shown
in Figure 21 for state and territory-funded mental health services. They reveal substantial
variation. Across the jurisdictions in 2010-11, one-week post discharge follow-up rates
ranged from 19% to 79%. For most jurisdictions, follow-up rates show gradual but small
improvement over the five year period of the Action Plan, although greater improvement is
evident in two jurisdictions with low rates (Tasmania and South Australia). The extent to
which this is a result of improved clinical data systems is not known. Equivalent data for the
private and Medicare-funded sectors are not available for comparison.
Work undertaken as part of an Australian Government-funded initiative to support
benchmarking in public mental health services provided insights about the reasons
organisations, and jurisdictions, may vary on one-week post discharge follow-up rates.
Accuracy of information systems in tracking the movement of people between hospital and
community care, particularly across organisations, is critical. Lower follow-up rates may
also be the result of some consumers being managed outside the state/territory public system
(e.g., GPs, private psychiatrists, or Aboriginal/remote health services in the Northern
Territory). These activities are not captured by existing mental health information systems.
Overall, the variation in post-discharge follow-up rates suggests important differences
between mental health systems in their practices. An observation made by organisations
engaged in the benchmarking work is that, while there may be legitimate reasons for non
follow up of some consumers in the week after discharge, this group is small. The implication
is that the current national rate of 54% is well below what would be expected from best
practice services.
30
COAG National Action Plan on Mental Health - Progress Report 2010-11
%
%
Figure 21: Percentage of discharges receiving 7-day community follow up, state and territory
mental health services
GROUP A JURISDICTIONS
GROUP B JURISDICTIONS
Group B jurisdictions differ from those in Group A by having less capacity to track post-discharge follow up
between hospital and community service organisations, due to the lack of unique patient identifiers or data
matching systems. This factor can contribute to an appearance of lower follow-up rates for these jurisdictions.
GROUP AVERAGES
TAS
GROUP A
GROUP B
(Unweighted)
GROUP
A Average
2005-06
47%
30%
2006-07
49%
28%
2007-08
50%
28%
2008-09
50%
31%
2009-10
51%
35%
2010-11
55%
45%
Tasmania
COAG National Action Plan on Mental Health - Progress Report 2010-11
17.5%
15.8%
31
OUTCOME AREA 3:
Increasing the
proportion of people
with an emerging or
established mental
illness who are able to
access the right health
care and other
relevant community
services at the right
time, with a particular
focus on early
intervention
Indicator 8: Readmissions to hospital within 28 days of
discharge
Readmission rates can be regarded as a non-specific indicator of the
overall functioning of health systems. High rates may point to
deficiencies in hospital treatment or community follow-up care, or a
combination of the two.
Readmission rates are also affected by other factors, such as the cyclic
and episodic nature of some illnesses or other issues that are beyond
the control of the health system. Notwithstanding the complexity of
the indicator, it is used by many countries to monitor health system
performance. It has special relevance to areas of health care that
involve provision of services to people with longer term illnesses who
need a combination of hospital and community-based treatment. The underlying standard is
that, while multiple hospital admissions may be necessary over the course of a lifetime for
some people with ongoing illness, a high proportion of unplanned readmissions occurring
shortly after discharge largely reflects failures in the care system.
The greatest risk period for re-admission is in the month following discharge. Unplanned
readmissions following a recent discharge may indicate that treatment provided during the
inpatient stay was incomplete or ineffective, or that follow-up community care was
inadequate to maintain the person out of hospital.
Figure 22 shows the results for state and territory-funded mental health services in the five
years of the Action Plan and the year immediately preceding. As with the post-discharge
follow up indicator (Indicator 7), variation between jurisdictions is evident, with 28-day
readmission rates ranging from 5% to 16% in 2010-11. For most jurisdictions except the
ACT, readmission rates were relatively stable over the five year period of the Action Plan.
The ACT showed considerable improvement, more than halving its readmission rates.
Comparable data for the private and Medicare-funded sectors are not available.
Accurate monitoring of 28-day readmission rates depends on unique identifier information
systems that track the movement of people between hospitals. Seven of the eight
jurisdictions (“Group A’ jurisdictions in Figure 22) had achieved this capacity by 2010-11,
improving the comparability of the data.
Reasonable targets for readmission rates are the subject of considerable debate, and differ
within sub-specialities (adult, aged, child and adolescent and forensic mental health services).
32
COAG National Action Plan on Mental Health - Progress Report 2010-11
Figure 22: Percentage of discharges readmitted within 28 days of leaving hospital, state and
territory mental health services
GROUP A JURISDICTIONS
GROUP B JURISDICTIONS
Group B jurisdictions differ from those in Group A by having less capacity to track readmissions that occur
between hospitals, due to the lack of unique patient identifiers or data matching systems. This factor can contribute
to the appearance of lower readmission rates for these jurisdictions than actually occur. For Tasmania this applied
only for 2005-06 and 2006-07 – unique patient tracking across hospitals was in place for subsequent years.
GROUP AVERAGES
TAS
GROUP A
GROUP B
(Unweighted)
GROUP A Average
2005-06
14%
12%
2006-07
14%
11%
2007-08
14%
14%
2008-09
12%
12%
2009-10
12%
12%
2010-11
13%
12%
%
%
Tasmania
COAG National Action Plan on Mental Health - Progress Report 2010-11
17.5%
33
OUTCOME AREA 4:
Increasing the ability of
people with a mental
illness to participate in
the community,
employment, education
and training, including
through an increase in
access to stable
accommodation
Indicator 9: Participation rates by people with mental
illness of working age in employment
Mental illness can reduce participation in the workforce in two broad
ways. For those in employment, untreated mental illness can diminish
the person’s engagement and activity in the workplace. Annual losses to
national productivity caused by untreated mental illness in the Australian
workforce have been estimated at $6 billion in 2009.
For those not in the workforce, mental illness can act as barrier to the
person gaining or holding a job. Additionally, the absence of meaningful
vocational roles can compromise recovery from mental illness through the associated impacts of
social exclusion, welfare dependency, unstable housing and long-term poverty. An increasing
body of evidence is accumulating that vocational outcomes for people affected by mental illness
can be improved substantially, leading to better health outcomes
A range of Australian evidence points to the
scale of the problem. Data collected in the
2007-08 ABS National Health Survey
(Table 10) suggested employment rates for
Percent employed
working age Australians who report a
2007-08 2011-12
mental disorder (64%) were 20% lower than
those who do not report a mental disorder
Working age Australians with
63.8
61.7
a mental disorder
(79%). Figures from the more recent 201112 ABS Australian Health Survey suggests
Working age Australians without
79.4
80.3
a mental disorder
there has been no significant change over
the four year period between the two
Sources: ABS unpublished, 2007-08 National Health Survey and
surveys. Participation in the workforce
Australian Health Survey 2011-13, as reported in Report on Government
Services 2012 and 2013. In the National Health Survey, mental illness is
decreases in proportion to the severity of the
self identified. That is, people with a mental illness are defined as those
disorder. The 2007 National Survey of
who self-report a mental or behavioural problem that has lasted for six
months, or which the respondent expects to last for six months or more.
Mental Health and Wellbeing found that for
people with severe mental illnesses, only 55% were in the labour force. Analysis by the
Productivity Commission, based on alternative data gathered between 2001 to 2004, suggests that
of six major health conditions (cancer, cardiovascular, major injury, mental disorder, diabetes,
arthritis), mental disorders are associated with the lowest likelihood of being in the labour force.
Table 10: Employment rates for people aged
16-64 years with a mental disorder, 2007-08 and
2011-12
Of the 819,000 people on Disability Support Pensions (DSP) in June 2011, 29% (approximately
241,000 people) had a psychiatric or psychological condition recorded as their primary condition.
This group has been growing in number by an annual average of 6% since 2001, at more than
twice the rate of overall growth in DSP recipients. Based on the June 2011 data, for every 1,000
adults of working age, 17 are on a disability pension due to mental illness. Rates vary across the
states and territories.
Income support recipients are much more likely to experience mental disorders than those not
receiving payments. Across all categories of government income support recipients, the 2007
National Survey of Mental Health and Wellbeing indicated that one in three (34%) had a mental
disorder, 66% higher than the prevalence among Australian adults not receiving income support.
An implication of these overall findings is that approximately 800,000 working age Australians
who have a mental disorder are not in the workforce, and account for about one third of the
working age population not in employment or looking for work. The estimates highlight the
importance of initiatives to improve workforce participation by people affected by mental
disorders.
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COAG National Action Plan on Mental Health - Progress Report 2010-11
OUTCOME AREA 4:
Increasing the ability of
people with a mental
illness to participate in
the community,
employment, education
and training, including
through an increase in
access to stable
accommodation
Indicator 10: Participation rates by young people aged
16-30 with mental illness in education and employment
Mental disorders are more prevalent in early adult years (see
Indicator 1), frequently having their onset in late adolescence or early
adulthood. For those affected, education can be disrupted causing
premature exits from school or tertiary training, or disruptions in the
transition from school to work. When this occurs, the impact can be
long lasting, restricting the person’s capacity to participate in a range of
social and vocational roles over their lifetime.
Relatively little data have been published that directly address this indicator. For the current
report, data have been taken from the 2007-08 ABS National Health Survey and the more
recent 2011-13 Australian Health Survey, the same primary source used for Indicator 9
discussed on the preceding page. These surveys conducted by the ABS provide a means to
monitor population trends on a regular basis.
Table 11: Education and employment rates for
people with mental disorders aged 16-30 years,
2007-08 and 2011-12
Percent employed
and or enrolled in
formal secondary
or tertiary
qualification
2007-08
2011-12
Australians 16-30 years with
a mental disorder
79.6
79.2
Australians 16-30 years without
a mental disorder
89.7
90.2
Sources: ABS unpublished, 2007-08 National Health Survey and
Australian Health Survey 2011-13, as reported in Report on Government
Services 2012 and 2013.
Nationally, in 2007-08, the proportion of
people aged 16–30 years with a mental
illness who were employed and/or are
enrolled for study in a formal secondary
or tertiary qualification was 79%,
compared to 90% for those without a
mental illness (Table 11). Put another
way, one in five young people aged 16 to
30 who have a mental disorder are neither
in employment nor formal education,
compared with one in ten for those who
do not have a mental illness. Data from
the 2011-12 component of 2011-13
Australian Health Survey indicate no
significant change has occurred in the
intervening years.
In reviewing the ABS National Health Survey data, it is important to note that the approach
to identifying mental illness is based on self-report by the person that they have a mental and
behavioural problem that has lasted, or is likely to last, for six months or more. This
approach yields lower prevalence estimates of mental illness than methods that rely on
independent assessment against objective criteria (12.8% compared with 19.9% found in the
ABS National Survey of Mental Health and Wellbeing), because it is does not include people
who experience milder forms of mental illness that resolve with a six month period. The
NHS, like other household surveys, also does not provide good coverage of people with less
common and more severe mental illnesses who, based on other studies, are known to
experience significantly greater problems in maintaining education and employment
participation.
COAG National Action Plan on Mental Health - Progress Report 2010-11
35
OUTCOME AREA 4:
Increasing the ability of
people with a mental
illness to participate in
the community,
employment, education
and training, including
through an increase in
access to stable
accommodation
Indicator 11: Prevalence of mental illness among people
who are remanded or newly sentenced to adult and juvenile
correctional facilities
High levels of mental illness within the Australian prison population
prisoners have been documented in a number of research studies over
the past decade. These studies have suggested that that around 40%
of prisoners have a mental disorder and that 10-20% are affected by
severe disorders.
Early reports on progress of the Action Plan reported that no
Australia-wide, systematic collection of information on prisoners’ health was in place to
inform COAG on regular updates on this indicator. This changed in 2008-09, with the
conduct of a nationwide census of new entrants to Australian prisons taking place in July
2009, under the auspice of the Prisoners Health Information Group, a group established in
2004 by the Australian Health Ministers’ Advisory Council. The group has been tasked with
developing a range of policy-relevant health indicators for prisoners (including mental health)
and a national prisoner health dataset, to enable regular monitoring of the health status of
Australia’s prison population.
A second census was conducted during October and November 2010, with results published
by the AIHW in September 2011. The census covered 44 of the 45 public and private prisons
in all states and territories in Australia except New South Wales and Victoria. Data were
collected over a two week period on all prison entrants, all prisoners who visited a clinic, and
all prisoners who were taking prescribed medication while in custody.
Results from the second national census confirm the high levels of mental health problems in
the prisoner population. In 2010, one in three (31%) prison entrants reported having ever
been told by a health professional that they had a mental disorder (including drug and alcohol
abuse). Sixteen per cent of prison entrants reported that they were currently taking mental
health related medication; 21% reported a history of self-harm. On entry to prison, almost
one-fifth (19%) of prison entrants were referred to the prison mental health services for
observation and further assessment following the reception assessment.
For prisoners in custody, one in ten (9%) attended the prison clinic for a psychological or
mental health issue in the two week census period. A further 4% attended for assistance with
drug or alcohol related problems. One in five (20%) of prisoners in custody was taking
mental health related medication. Of all medications across drug categories, drugs for
treatment of depression or mood stabilisation were the most common type, accounting for
16% of all medications. Approximately one in ten (8%) prisoners in custody was taking
antipsychotic medication.
The AIHW report on the 2010 census indicates that further surveying of Australia’s prisoner
population is planned, with ongoing improvements in data quality expected. It is anticipated
that all jurisdictions will participate in future collections, providing a stronger basis for
monitoring the impact of reforms.
Comparable national-level data on juvenile correctional facilities is not available.
36
COAG National Action Plan on Mental Health - Progress Report 2010-11
OUTCOME AREA 4:
Increasing the ability of
people with a mental
illness to participate in
the community,
employment, education
and training, including
through an increase in
access to stable
accommodation
Indicator 12: Prevalence of mental illness among homeless
populations
Getting accurate estimates of the mentally ill homeless population is
difficult. Evidence cited in the first COAG Annual Progress report
2006-07 suggested that up to 75% of homeless people aged 18 years
and over have a mental disorder and, of these, about a third
(approximately 29,000 people) are affected by severe disorders.
Mental illness featured prominently in the community submissions
and consultations occurring in the lead up to the release of the
Australian Government White Paper on homelessness in December
2008.
While there is much evidence to suggest that homeless people are more likely than nonhomeless people to experience mental health conditions or substance use disorders, there is
disagreement as to the extent of these problems, suggesting that figures provided in earlier
COAG reports may be overestimates. The AIHW publication Australia’s Welfare 2011
reviewed the evidence and observed that while some studies estimated the prevalence of
mental illness in the homeless population to be between 72% and 82%, others have found this
to be between 12% and 44%. A key study cited in the AIHW publication, based on a review
of approximately 4,300 case histories, found that 31% experienced a mental health problem.
Of these, about half (47%) had a mental health problem prior to becoming homeless, while
the remainder developed mental health problems following homelessness.
Up to 2009, Australia’s primary services for homeless people have been delivered through
the Supported Accommodation Assistance Program (SAAP), a cost shared program between
the Commonwealth and state and territory governments. SAAP provided crisis
accommodation and related support services to people who are homeless or at imminent risk
of becoming homeless. Data were routinely collected on SAAP clients through a national
minimum dataset, which provides the main base for monitoring progress for the current
report.
Last year’s report summarised the then most available SAAP data, covering the 2009-10
year, and reported that 12% of the 135,700 users of SAAP services were deemed to seek
assistance due to mental health issues. These included clients who were referred from a
psychiatric unit; reported psychiatric illness and/or mental health issues as reasons for
seeking assistance; were in a psychiatric institution before or after receiving assistance;
and/or needed, were provided with or were referred on for support in the form of
psychological or psychiatric services. An additional 10% were identified with problematic
drug, alcohol and/or substance use as reasons for seeking assistance. A further 7% of clients
were considered to have both mental health and substance use problems (comorbidity).
The most recent SAAP data, covering 2010-11, show a similar picture (Figure 23). While the
overall number of SAAP clients increased to 142,500 in 2010-11, the relative proportions of
people presenting with mental health problems and mental health-substance use comorbidity
remained relatively stable (11% and 7% in 2010-11, respectively). People presenting to
SAAP-funded services with substance use problems but no other mental health problem was
also stable (from 10% to 9%) over the period.
COAG National Action Plan on Mental Health - Progress Report 2010-11
37
Figure 23: SAAP clients with mental health, substance use and comorbid problems, 2005-06 to
2010-11
In response to concerns that the data collected routinely by SAAP services may significantly
underestimate the number of people with mental illness who use those services, a special
census was undertaken across jurisdictions in June 2008. This aimed to gather more accurate
data on the proportion of SAAP clients with high and complex needs, and recorded new data
on approximately 10,500 SAAP clients.
The results confirmed that mental illness is more prevalent in the SAAP population than
suggested by the administrative data, with 34% of the survey sample identified as having
mental health issues. Of these, about half (56%) had a known diagnosis of a mental illness
and about a third (31%) were identified as current users of specialised mental health services
(Figure 24). This latter group represents about 10% of the overall SAAP sample.
Figure 24: SAAP high and complex needs census June 2008 – characteristics of the 34% who
were identified as having mental health problems
Mental health
issues
34%
No mental health
issues identified
66%
Known diagnosis of mental disorder
56%
Self reported mental illness
28%
Suspected to have a mental illness
29%
Current use of specialised mental
health service
31%
Note: More than one of the above factors could be
recorded for each client
Census sample – 10,683 SAAP clients
38
COAG National Action Plan on Mental Health - Progress Report 2010-11
The available data support the conclusion that homelessness remains a significant problem
for many with mental illness, and that the two issues often go hand in hand. Findings from
the 2007 National Survey of Mental Health and Wellbeing support this conclusion. The ABS
reported that more than half of those who had ever been homeless had a current mental
illness, defined as experiencing symptoms over the past 12 months. This was almost three
times the prevalence of current mental illness in those who reported they had never been
homeless.
The Commonwealth and state and territory governments replaced the Supported
Accommodation Assistance Program (SAAP) with the National Affordable Housing
Agreement (NAHA) in 2009, backed by several National Partnership Agreements, including
the National Partnership Agreement on Homelessness signed in December 2008. As a flow
on, from July 2011, a new data collection (the Specialist Homelessness Services collection)
has been established to provide better information about clients of homelessness assistance
services.
COAG National Action Plan on Mental Health - Progress Report 2010-11
39
PART B
Jurisdiction reports
on progress of
Individual
Implementation
Plans
This section of the report presents summary highlights, prepared
by each jurisdiction, of the final year of implementation of the
National Action Plan.
41
Australian Government
During 2010-11, the Australian Government portfolios of Health and Ageing (DoHA),
Families, Housing, Community Services and Indigenous Affairs (FaHCSIA), Education,
Employment and Workplace Relations (DEEWR), and Veterans’ Affairs (DVA) all made
significant progress in the implementation of the Council of Australian Governments
(COAG) National Action Plan on Mental Health 2006-2011.
In May 2011, the Australian Government announced a major package of mental health
initiatives as part of its 2011-12 Budget, totalling $1.5 billion over a five year period, to extend
and build upon the achievements made under the Action Plan. When combined with its 2010
Budget and election commitments, which delivered $624 million, the Australian Government
will be providing $2.2 billion over five years for improved mental health services.
ACTION AREA 1: PROMOTION, PREVENTION AND EARLY INTERVENTION
Expanding Suicide Prevention Programs: The National Suicide Prevention Program
(NSPP) funds 55 national and local community-based projects which aim to reduce the
incidence of suicide and self-harm and promote mental health and resilience. Direct support
for people at highest risk of suicide is provided via 33 local suicide prevention activities. The
Australian Suicide Prevention Advisory Council continues to provide advice on
implementation of the NSPP as does the National Centre of Excellence in Suicide Prevention,
hosted by the Australian Institute for Suicide Research and Prevention, Griffith University.
Alerting the Community to Links Between Illicit Drugs and Mental Illness: The mental
health effects of illicit drug use are being addressed in a range of illicit drug information and
health education materials.
New Early Intervention Services for Parents, Children and Young People: The
KidsMatter suite of initiatives aims to support mental health promotion, prevention and early
intervention through universal evidence-based primary school and early childhood programs.
During the 2010-2011 period, the number of schools participating in KidsMatter Primary
reached 427, the pilot of the KidsMatter Early Childhood initiative reached 105 preschools
and long day care centres while the KidsMatter Parenting: Transition to School initiative
continued in 16 primary schools. Initiatives have been further developed that targeted
identified high risk groups including Aboriginal and Torres Strait Islander children and young
people; children affected by severe trauma, loss or grief; and children of parents with a
mental illness.
Family Mental Health Support Services (FMHSS): Formerly known as Mental Health
Community Based Services, the FMHSS focuses on prevention and early intervention.
Vulnerable and at-risk children, young people, those from a culturally and linguistically
diverse background and Indigenous families are targeted. Services work alongside existing
family support services to offer a range of flexible, tailored services. During 2010-2011
services assisted 25,757 individuals. As part of the 2011-2012 Budget Delivering National
Mental Health Reform package, $61 million over 5 years will be allocated to establish 40
additional FMHSS.
ACTION AREA 2: INTEGRATING AND IMPROVING THE CARE SYSTEM
Better Access to Psychiatrists, Psychologists and General Practitioners (GPs) through the
Medicare Benefits Schedule (MBS): The Better Access initiative introduced in November 2006
new Medicare items on the MBS. As at 30 June 2011, approximately 3 million people had
benefited from these rebated services with over 19.7 million mental health services having been
42
COAG National Action Plan on Mental Health - Progress Report 2010-11
provided to patients. This includes 2.8 million GP Mental Health Care Plans; 4.1 million clinical
psychology items; 7.8 million Focussed Psychological Strategies services; and approximately
492,500 psychiatry services for new patients. As of 30 June 2011, almost 19,800 allied mental
health providers were registered to provide Better Access services.
Mental Health Nurse Incentive Program: This initiative commenced on 1 July 2007 and
provides an incentive payment to community based general medical practices, private
psychiatrist services and other eligible organisations who engage mental health nurses to
assist in the delivery of clinical care for people with severe and persistent mental disorders.
In2010-2011, 110,000 sessions were provided.
Mental Health Services in Rural and Remote Areas: Inequities in access to services are
being addressed by targeting areas where access to the MBS subsidised mental health items is
low. Workforce shortages are being tackled by providing flexible employment models suited
to local conditions to increase allied and nursing mental health services. In 2010-2011,
27,475 clients accessed 89,051 services provided by approximately 150 full time equivalent
allied and nursing mental health staff.
Improved Services for People with Drug and Alcohol Problems and Mental Illness:
This initiative comprises two key components - Capacity Building Grants (CBG) and the
Cross Sectoral Support and Strategic Partnership (CSSSP). The CBG provided up to
$500,000 to 122 non-government alcohol and other drug (AOD) services. Total funding for
this component was $44.8 million over three years from 2008-2009 to 2010-2011. The
CSSSP provided $5 million over three years until 2011 to the AOD Peak Bodies, or their
equivalents, in each state and territory to assist services to build partnerships and to identify
workforce development, training opportunities and service improvement activities.
The Australian Government established the Substance Misuse Service Delivery Grants Fund,
effective from July 2011 to consolidate activities from a number of programs including the
Improved Services initiative. During 2010-2011, services and AOD Peak bodies funded
under the Improved Services initiative were invited to submit funding proposals to extend
projects to 30 June 2012. This extension provided an additional $14.2 million to the
initiative.
Funding for Telephone Counselling, Self-help and Web-based Support Programs:
In 2010-2011, funded projects continued to deliver telephone and online services with new
projects such as myCompass developed by the Black Dog Institute coming online for users.
Funding was extended to June 2012 to create a suite of telephone and online services that
would link to the national mental health portal developed by the Commonwealth (commenced
in mid-2012, see www.mindhealthconnect.org.au).
Personal Helpers and Mentors (PHaMs): PHaMs is a strengths-based, recovery approach
to increase opportunities for recovery for people aged 16 years and over whose ability to
manage their daily activities and to live independently in the community is impacted due to a
severe mental illness. Services include those delivered by PHaMs remote servicing sites and
sites that focus on particularly vulnerable people: the homeless; humanitarian entrants; and
Indigenous Australians. In 2010-2011 PHaMs assisted 12,495 people, bringing the total to
16,530 since the commencement of the program.
As part of the 2011-2012 Budget an additional $154 million was provided for 425 new
PHaMs workers to assist around 3,400 people. A further $50 million was provided to assist
people with a mental illness who claim income support through the Disability Support
Pension and who are also working with employment services.
COAG National Action Plan on Mental Health - Progress Report 2010-11
43
Veterans' Mental Health Care: The DVA continues to produce a range of mental health
self-help information on the At Ease mental health website www.at-ease.dva.gov.au. The
DVA is piloting the Touchbase website aimed at keeping those leaving the Australian
Defence Force (ADF) in touch and linking them to mental health information and an online
interactive tool, the Wellbeing Toolbox, which is also being trialled.
Recommendations from the 2009 Review of Mental Health Care in the ADF and Transition
through Discharge and the Independent Study into Suicide in the Ex-Service Community are
being implemented, including a case coordination system for complex needs clients who may
be at risk of self-harm or harm to others. Outcomes from independent reviews of a number of
the Posttraumatic Stress Disorder treatment programs and the Operation Life suicide
awareness workshops are being considered.
In 2010 a ‘whole of life’ framework, the Support to Wounded, Injured or Ill Project,
commenced which includes a regular DVA on-base visiting advisory service to more than 35
ADF bases.
Mental Health Support for Drought Affected Communities Initiative: This initiative
finished on 30 June 2011 which reflects the diminished need for a national mental health
support initiative specifically aimed at drought affected areas. Remaining clients of the
measure who require continued clinical services have been referred to the Access to Allied
Psychological Services Program.
ACTION AREA 3: PARTICIPATION IN THE COMMUNITY AND EMPLOYMENT
INCLUDING ACCOMMODATION
Helping People with a Mental Illness Enter and Remain in Employment: The Personal
Support Program (PSP) ceased at the end of June 2009 and was replaced by Job Services
Australia (JSA). JSA is an uncapped program that delivers services to all eligible job
seekers. Other clients were also transitioned into the demand driven Disability Employment
Services (DES) in 2010 which replaced the previous Disability Employment Network and
Vocational Rehabilitation Services. The DES provides a significant improvement for
participants with a mental illness, offering access to tailored services that are flexible and
responsive to both their needs and those of employers.
Initiatives from the 2011-2012 Budget Delivering National Mental Health Reform package
aimed at increasing employment participation of people with a mental illness are also being
implemented. These include: increasing the expertise of employment services and
Department of Human Services front line staff to identify and assist people to gain
employment; expanding JobAccess information to include advice from professionals in
mental health regarding the employment of people with mental illness; and enhancing the
Supported Wage System to improve its applicability to job seekers with a mental illness.
Support for Day-to-Day Living in the Community: This program aims to improve the
quality of life for individuals with severe and persistent mental illness by providing places in
structured and socially based activities, to build confidence and social skills, and encourage
living at an optimal level of independence. Approximately 11,000 people access the program
annually which is provided at 60 sites across Australia. The 2011-2012 Budget provided an
additional $19.3 million expansion over 5 years which will enable an extra 3,650 people per
year to access services.
Helping Young People Stay in Education: Between 2007 and 2011, 8,619 young people
who identified as having a mental illness were assisted under Youth Pathways. Youth
Pathways along with a number of other programs were consolidated into a new program in
44
COAG National Action Plan on Mental Health - Progress Report 2010-11
2010 called Youth Connections. This program provides tailored case management and
support for youth to re-connect with education and training, build resilience skills and
attributes that promote positive life choices and wellbeing.
More Respite Care Places to Help Families and Carers: This initiative provides flexible
respite and family support options for carers of people with severe mental illness or
intellectual disability. In 2010-2011 more than 21,000 carers received respite services,
bringing the total number of carers who received assistance between2006-2007 and 20102011 to 80,217. As part of the 2011-2012 Budget an additional $54.3 million will be provided
over five years to assist 1,100 families.
ACTION AREA 4: INCREASING WORKFORCE CAPACITY
Additional Education Places, Scholarships and Clinical Training in Mental Health:
New places in Australian Universities for undergraduate and postgraduate study in mental
health professions continued during 2010-2011.
Mental Health in Tertiary Curricula: This program assisted several health profession
accreditation bodies to review their standards in relation to mental health along with the
provision of funding for a further 26 universities to review the mental health content within
their nursing degree curricula. Other universities have developed multidisciplinary training
modules for allied health, nursing and medical degrees.
Improving the Capacity of Workers in Indigenous Communities: This initiative provided
$20.8 million over five years from 2006-2007 to support practitioners identify and address
mental illness and substance use issues in Aboriginal and Torres Strait Islander communities.
In 2010-2011, funding provided ten mental health worker positions in remote locations
delivery of mental health training; Aboriginal Mental Health First Aid courses; cultural
competence training; a range of resources including an Indigenous tool kit and mental health
book.
ACTION AREA 5: COORDINATING CARE
Coordinating Care: National principles and implementation guidelines developed and
endorsed by the Mental Health Standing Committee in 2007 have guided jurisdictions in their
planning and evaluation approaches.
Coordinated Support and Flexible Funding for People with Severe and Persistent
Mental Illness with Complex Needs: As part of the 2011-2012 Federal Budget, $549.8
million was provided over five years for the Partners in Recovery (PIR) initiative, targeting
24,000 people with severe and persistent mental illness who have complex needs. PIR
organisations will work at a systems-level and drive collaboration between relevant sectors,
services and supports within specified regions to ensure the full range of needs of people in
the target group are met.
Governments Working Together: Alternate arrangements and mechanisms have been
established to ensure ongoing Commonwealth and state/territory collaboration in the
development and implementation of a range of mental health programs. This includes
$200 million from the National Partnership Supporting National Mental Health Reform
announced in the 2011-2012 Budget to encourage states and territories to invest more in
mental health priority areas and address service gaps, including in accommodation support
and presentation, admission and discharge planning in emergency departments.
COAG National Action Plan on Mental Health - Progress Report 2010-11
45
New South Wales
ACTION AREA 1: PROMOTION, PREVENTION AND EARLY INTERVENTION
A framework for reform. On coming to office in March 2011, the New South Wales
Government commenced work to establish a NSW Mental Health Commission to improve
the wellbeing and mental health of the NSW community. An expert Taskforce was
established in May 2011 that hosted state wide consultation and prepared a statutory
framework for a NSW Commission including the key function of developing a strategic plan
for mental health in NSW. The resulting NSW Mental Health Commission Act 2012 was
passed on 21 March and the new Commission commenced operations 2 July 2012.
Enhancing suicide prevention: The New South Wales Government committed $2 million
per annum to Lifeline NSW to enhance capacity of that organisation to provide support and
counselling for people at risk. Implementation also continued of the NSW whole of
government, whole of community Suicide Prevention Strategy that was launched in October
2010. This includes a $4.8 million raft of measures to be implemented over five years by the
Ministry of Health to strengthen community action and enable effective early responses to
individuals at risk. To help drive these initiatives, an expert Ministerial Advisory Committee
on Suicide Prevention has been established to advise the Government through the NSW
Minister for Mental Health and Healthy Lifestyles.
Expanding research. $1.075 million is being provided over 5 years from 2008/09 to fund
the full operation of the new on-line Schizophrenia Library that was launched in June 2010.
Guided by the NSW Mental Health Research Framework, NSW Health funds a broad
program of research targeting mood disorders, eating disorders, schizophrenia, trauma, stress
and anxiety disorders.
Early intervention – children and families. Implementation continues of the NSW Keep
Them Safe response to the Special Commission of Inquiry into Child Protection Services in
NSW with the establishment of Whole Family Teams in pilot sites at Gosford, Nowra,
Lismore and Newcastle to support families where carers have mental health problems and
parenting difficulties. As part of this, $10 million has been provided over four years for the
Getting On Track In Time schools-based early intervention initiative for children with
disruptive behaviour in Kindergarten to Year 2. This has been piloted at Newcastle, Dubbo
and Mt Druitt from first school term of 2011.
The SAFESTART program continues to provide screening for depression for all women
expecting or caring for a baby in NSW. New guidelines were released in March 2010 to
better support families early with more than 1,500 staff from maternity, child and family
health services undertaking the online Assessment and Screening Training program. The
statewide School Link program and Youth Mental Health Service Model continue to support
students in primary and high schools and other young people. Finally, the roll out of
specialist community mental health teams for older people was also completed state-wide.
Statewide Outreach Perinatal Service for Mental Health. Mothers and babies in regional
areas of NSW will have access to some of the top mental health doctors in the state under this
new pilot program. Mental Health Minister Kevin Humphries launched the $240,000
program at Westmead Hospital in Sydney on 22 June 2012.
46
COAG National Action Plan on Mental Health - Progress Report 2010-11
Responding to rural adversity. In 2010/11, the former NSW Drought Program expanded in
scope with $2.3 million provided to the NSW Centre for Rural and Remote Mental Health for
the broader Rural Adversity initiative. This raises awareness and responds to mental health
needs of people in rural and remote NSW resulting from the drought, fires and climate
change as well as to adapt to the social and economic pressures of rapidly changing rural
circumstances.
ACTION AREA 2: INTEGRATING AND IMPROVING THE CARE SYSTEM
New strategic plan for mental health services. In line with the New South Wales
Government’s commitment to establish a NSW Mental Health Commission, the Mental
Health Commission Act 2012 was passed on 21 March which gives statutory authority to the
Commission to develop and draft a strategic plan for the NSW mental health system. The
strategic plan is to be developed in consultation across the service system and with people
with mental illness, their carers and families. The Commission commenced operations on 2
July 2012 and it will better ensure a coordinated, accountable, “no wrong door” approach to
service delivery and enhance the experience of care.
Psychiatric Emergency Care Centres. Expansion continued in this program with the
service model primarily being specialist 4-6 bed units linked to emergency departments to
provide 24/7 mental health screening and assessment, as well as immediate care and
observation services for up to 48 hours. Thirteen Centres are now in operation providing
services at Prince of Wales, Liverpool, Royal North Shore, Nepean, Blacktown, St Vincent’s,
St George, Hornsby, Wyong, Campbelltown, Wollongong, Manly and the Calvary Mater
Newcastle Hospitals. An additional unit is planned for Royal North Shore Hospital in
2014/15.
Enhancing Community Mental Health Emergency Care Program. Rural emergency
responses continue to be enhanced through the Rural Critical Care Mental Health Emergency
Program. In 2010/11 the western and southern regions, resource centres at Orange,
Goulburn, Albury and Wagga Wagga provided 24/7 support for local clinicians, telepsychiatry links with 65 rural and remote hospitals so patients may be helped in their home
towns, transport assistance from smaller regional Emergency Departments to specialist
mental health facilities and specialist mental health telephone consultation for Emergency
Departments. Over 5,000 tele-psychiatry mental health assessments have been completed to
date. In northern regions, emergency responses continue to be enhanced through extended
nursing coverage and 24 hour mental health telephone services.
Enhancing capacity for inpatient care. At 30 June 2012, there were 2,772 funded mental
health inpatient beds in NSW, including 1,689 acute beds and 1,083 non acute beds. More
than 140 new mental health beds were established from 2010-2012. These included 6 beds at
the Shellharbour Child & Adolescent Inpatient Unit, 126 forensic and tertiary beds as part of
the Bloomfield redevelopment, 4 Older Persons acute beds at the Hunter New England Mater
Hospital, 4 psychiatric emergency care (PECC) beds at Manly Hospital, 2 additional PECC
beds at Liverpool Hospital and the establishment of a Carers’ Room to support carers of
people with mental illness at Maitland Hospital.
The Mental Health Line. A single state-wide 1800 number to provide 24/7 mental health
telephone triage assessment and referral services operations commenced statewide on
1 March 2012 and is improving access to expert advice and providing appropriate referrals.
Whole of person approaches – targeting physical health care. The state-wide rollout
continued of the new policy and guidelines for the Physical Health Care of Mental Health
COAG National Action Plan on Mental Health - Progress Report 2010-11
47
Consumers to support mental health services, families, carers and General Practitioners to
improve the physical health of individuals with mental health issues. This roll out was
supported through targeted training workshops for key stakeholders in 2011. A web resource
portal and an e-learning resource have since been launched as an additional tool to support
mental health staff and clinicians.
Specialist Mental Health Services for older people. In 2010/11 NSW Health commissioned
a mid-term evaluation for NSW Service Plan for Specialist Mental Health Services for Older
People (SMHSOP) to assess progress with implementation, determine if key objectives have
been met, and assist NSW Health in further implementation over the next 5 years. The report
was completed in December 2011 and the findings are being considered in the context of
implementation planning. During 2010/11 the Orange-Bloomfield Hospital added 12 Mental
Health Acute Older Persons beds and 16 Non-Acute Mental Health Older Persons beds.
During 2011/12 the Hunter New England Mater Hospital added 4 Mental Health Acute Older
Persons beds. The 14 bed Older Persons Unit continued operation in Wollongong.
Supporting people with mental illness in the criminal justice and corrections systems.
The 135 bed Forensic Hospital that became fully operational in 2009/10 at Long Bay
continues to respond to the complex mental health needs of the prison population.
In 2010/11, the Community and Court Liaison Service continued to screen and assess adults
coming before the local courts for mental health issues. There have been 6874 adults and
1966 adolescents diverted from court to community treatment - to April 2012. This is now a
key performance indicator in NSW2021 A Plan to Make NSW Number One.
Better integration of mental health and drug and alcohol services. The co-morbidity
clinical guidelines continue to provide a framework for the triage, assessment and management
of people with co-existing mental health and substance abuse disorders. In 2011/12, 6 Local
Health Districts were funded a total $2.6 million for Drug and Alcohol Consultation Liaison
services (CLS) to provide Emergency Departments and general hospital wards with readily
accessible, practical assistance from specialist drug and alcohol clinicians. An evaluation of
the CLS and specialist nurses in regional hospitals is underway and will be completed in 2013.
ACTION AREA 3: PARTICIPATION IN THE COMMUNITY AND EMPLOYMENT,
INCLUDING ACCOMMODATION
Housing Accommodation and Support Initiative (HASI). In 2010/11 this partnership
between Health, Housing and the NGO sector provided access to 1,111 integrated packages
to enable eligible people with mental illness to live quality lives in the community. In
2011/2012 the number of packages increased to 1,135 including 100 packages for Aboriginal
people that have been designed in consultation with key Aboriginal stakeholders to be
culturally appropriate and support reconnection within Aboriginal communities. Help
provided through HASI comprises both accommodation support and clinical mental health
services across the spectrum of support from very high to low where clinical support can be
provided in the individual’s own home. Work is now underway with the sector to identify
ways to enhance this program.
Community Rehabilitation Services. The rehabilitation program supports recovery of
people with mental illness and promotes their capacity to lead quality and productive lives in
the community. Programs including clinical rehabilitation services to support recovery in the
community continued in 2010/2011 under the NSW Community Mental Health Strategy. The
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Resources and Recovery Program operated to help people with mental illness connect with
their local communities through six specialist mental health NGOs in 19 priority areas. These
service delivery contracts have been extended into 2011/12. In 2010, a further $1 million
funding was received for the NGO Infrastructure Grant Program.
Enhance Family and Carer Program. This program is the first of its kind in Australia and
continued through Local Health Districts and NGO sector to enhance the education and training,
support and participation of families and carers in the care of people with mental illness.
ACTION AREA 4: INCREASING WORKFORCE CAPACITY
The Mental Health Workforce Program comprises a range of initiatives to improve the
capacity of the NSW workforce. Between 2006 and 2012, 962 mental health nursing
scholarships were offered, 150 nurses returned to the mental health workforce through
Mental Health Nurse Connect and 13 Mental Health Nurse Practitioners were appointed in
the Local Health Districts. In 2011, 29 students undertook a post graduate qualification,
fifteen in the Graduate Certificate course, ten in the Graduate Diploma course and four in the
Masters of Mental Health (General Practitioner) course.
Aboriginal Mental Health Workforce Program. This program is building a skilled
Aboriginal mental health workforce by supporting Aboriginal people to gain tertiary
qualifications in mental health and on-the-job training to provide mental health services in
their communities. In 2010 all 19 funded traineeship positions were recruited to and currently
remain filled and six Clinical Leaders in Aboriginal Mental Health positions were established
and also remain filled. In the same year 24 Aboriginal Mental Health Worker positions in the
Aboriginal Community Controlled Health Services were funded through the Program and are
currently mostly filled. The training Program is currently undergoing external evaluation
with a report due in August 2012.
New training. In 2010 a new course for GPs in Rural and Remote Mental Health was
established in NSW. A further $2.1m was allocated to continue the Rural Psychiatry Project
from 2008/09 to 2011/12 in order to expand access to mental health professional
development, training, mentorship and recruitment for psychiatrists in rural areas.
To support the specific skills required of clinicians to treat young people, NSW Health has
established a NSW Early Psychosis Program Working Group to promote practice and
develop training and education strategies.
The Online Anxiety Disorders Education Training Module was launched in January 2011 and
provides triennial training to GPs across NSW. In addition the Centre for Eating and Dietary
Disorders has produced an online training program on eating disorders identification,
assessment and care coordination on behalf of NSW Health.
ACTION AREA 5: COORDINATING CARE
In 2010/11, the NSW Care Coordination initiative continued to provide coordinated support
for persons with severe mental illness at eight sites in the Sydney metropolitan area.
VARIATIONS AND ADDITIONAL FUNDING COMMITMENTS
In 2010/11, there was a 5.2% increase in the NSW Mental Health budget to $1.231 billion
from 2009/10.
COAG National Action Plan on Mental Health - Progress Report 2010-11
49
Victoria
At the commencement of the National Action Plan in July 2006, the Victorian Government
committed funding of at least $472.2 million over five years. With further commitments,
including those made in the 2010-11 State Budget, Victoria’s commitment under the National
Action Plan to 2010-11 now totals approximately $789 million, with the Victorian Coalition
Government now investing just over $1 billion per annum in specialist mental health services
alone.
The Victorian Coalition Government is committed to improving the mental health and
wellbeing of all Victorians and delivering timely, effective care to those affected by mental
health problems.
New momentum for change has been generated to ensure that Victorians of all ages with
mental health problems receive help earlier and that the treatment and support they receive is
focused on reducing the often devastating health, social and economic impact of mental
illness.
This is a clear focus of the Coalition Plan for Mental Health released in October 2010. This
plan will guide investment and policy effort over the next three years, beginning with
improved access to hospital, community-based clinical treatment and eating disorder services
and a stronger focus on improving housing, education and employment outcomes. Strategies
are also being developed to strengthen suicide prevention; reduce workplace stress; better
recognise and involve carers; and build a more sustainable mental health workforce.
Key achievements from Victoria’s mental health investment over 2010-11 include:
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Development of clearer, easy to access pathways to public and private mental health
care by continuing to consolidate and enhance mental health triage services across the
state.
Better mental health care for older people by expanding the proven intensive clinical
treatment in the home service. This initiative will support 140 additional older people
each year who are acutely unwell to avoid where possible, admission to hospital.
Establishment of two new youth early intervention teams in rural Victoria to provide
650 young people each year with receive early and effective help for a broader range
of mental health conditions.
Establishment of a new community based crisis treatment and support response
targeted to teenagers and young adults who are highly distressed in the community
and creating risk for themselves and others.
A new youth suicide prevention initiative targeted to Same Sex Attracted and Gender
Questioning young people and Indigenous young people.
Funding to build workforce capacity in schools to better respond to children and
young people with mental health issues.
New funding to prepare for and implement mental health legislative reforms.
Capital funding for 42 new inpatient beds as part of the new Bendigo Hospital and a
new 22 bed Community Care Unit at Austin Hospital.
In addition, work is well progressed on a number of major service development priorities that
will lay the foundations to respond systematically to pressing issues and reshape existing
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COAG National Action Plan on Mental Health - Progress Report 2010-11
investment to align with the Government’s reform directions. This includes planning to
support the potential reform of some of the key structures that underpin effective and efficient
delivery across public mental health services.
Outlined below are 2010-11 implementation highlights.
ACTION AREA 1: PROMOTION, PREVENTION AND EARLY INTERVENTION
Mental Health Promotion
Action has been initiated on a number of fronts to reduce the prevalence of preventable
mental health problems and enhance the wellbeing of Victorians. This has focused on
expanding mental health promotion efforts in a more coordinated way across a broader range
of settings, and introducing greater awareness of mental health impacts into public policy
across government.
Key activities undertaken in 2010-11 include:
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$3.6 million over for years for a new youth suicide prevention and community support
program with a particular focus on same sex attracted young people and Indigenous
young people.
The development of Promoting healthy minds for living and learning resource which
provides guidance and evidence-based strategies to support schools and early education
and childhood settings to recognise their role in promoting mental health and act to create
environments where children and young people can thrive, grow and learn.
Launch of a new mental health promotion website and online network (MHpro) to
support the mental health promotion workforce and provide opportunities to share
information and ideas, collaborate and coordinate activity.
Development of a guide, Using policy to promote mental health and wellbeing, which
encourages policy makers to systematically consider the relationship between a broad
range of policy responses and mental health outcomes in the community.
The Victorian Public Health and Wellbeing Plan 2011-2015, developed in the later part of
2010-11, includes a specific focus on strengthening protective factors and reducing risk
factors for mental illness. Key areas include tackling stress in the workplace, preventing
violence against women, and promoting acceptance of diversity and social inclusion to build
more resilient and connected communities.
Planning commenced in 2010-11 to develop a new Victorian Suicide Prevention Strategy in
consultation with local families and communities, local government and non-government
organisations.
Earlier in Life
The development of a stronger, easier to access early treatment system for young people aged
12-25 years that are well linked with headspace services (where they exist), has been a key
focus of effort and targeted investment over the last three years. New services and models of
care have being progressively implemented, including new responses to young people
experiencing psychiatric emergencies and those with mental health problems in the youth
justice service system.
COAG National Action Plan on Mental Health - Progress Report 2010-11
51
Significant planning and developmental work has been undertaken, including the
redesign of specialist child and youth mental health services within a 0-25 years
framework, informed by two demonstration projects.
These projects emphasise age–appropriate responses, early intervention and effective
recovery support and have been complemented by the following initiatives funded in
2010-11 State Budget:
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$4.9 million over four years for two new youth early intervention teams in rural Victoria,
building on the platform provided by the successful Early Youth Psychosis Program. This
funding will ensure young people with a broader range of conditions receive early and
effective help for a broader range of conditions. A total number of eight youth early
intervention teams now operate in Victoria.
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$3.5 million over four years for a new crisis treatment response to support young people
aged 12-25 years who are highly distressed and at risk of self harm. Delivered through
two metropolitan based Intensive Mobile Youth Outreach Support Teams this initiative
will focus on young people involved in the child protection/out of home care service
system.
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A new sub-acute Youth Prevention and Recovery Care (Y-PARC) service model to be
delivered in Bendigo, Frankston and Dandenong.
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Stage 2 new youth justice mental health initiative ($3.0 million over four years, rolled out
over two years from 2009-10) which will provide clinical treatment and care coordination
support to young people involved with youth justice services, including those transiting
between custodial settings and the community.
ACTION AREA 2: INTEGRATING AND IMPROVING THE CARE SYSTEM
During 2010-11, the Department of Health undertook a comprehensive process of
information/data collection, analysis and consultation to identify the system developments
and reforms required to improve rehabilitation and recovery outcomes for people with severe
mental illness. Achieving a more coordinated response to client need by improving planning,
coordination and collaboration between providers of rehabilitation and recovery services and
public clinical mental health, primary health care and social support services, was a focus of
this analysis.
Drawing on this information, the Department has developed a strategic framework to achieve
improved efficiency and effectiveness of stated funded rehabilitation and recovery services
through practice change, system development and innovation, program remodelling and
structural reform. This framework will be finalised in 2011 in consultation with stated
funded mental health services and key stakeholders.
The Department of Health, in consultation with clinical mental health and PDRSS sectors,
has developed a recovery orientated practice framework. The framework identifies principles,
capabilities, practices and leadership needed to support the specialist mental health service
sector to delivery recovery-orientated services which emphasis social inclusion, personal goal
setting and self management. The framework is intended to complement existing professional
standards and competency frameworks.
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Strengthening pathways to care
Building clear, easy-to-access pathways to public and private mental health care for the
Victorian community has been an area of ongoing focus. A further $2.7 million over four
years was committed in 2010-11 to continue to build a more accessible ‘front door’ to the
specialist mental health services system. This strategy will ensure people experiencing
psychiatric symptoms are proactively supported to access the right mental health care that
best meets their needs.
Strengthening specialist support to high need clients
$4.9 million over four years was committed in 2010-11 to support older people who are
acutely unwell, to avoid, where possible, admission to hospital and provide a ‘step-down’
sub-acute option to support early discharge from hospital.
A three year formative and summative evaluation project commenced in 2010-11 to evaluate
client and system impacts and outcomes related to Victorian Government’s $11 million per
annum investment package in a set of adult measures designed to address system pressures,
risks and opportunities associated with high risk/high need adult clients. The outcomes of
this evaluation will inform program design and future investment decisions.
Increasing mental health bed capacity
In 2010-11, $56 million in capital funding was allocated to develop 42 new mental health
beds as part of the new Bendigo Hospital and $14.2 million for a new 22 bed Community
Care Unit at The Austin Hospital.
Partnerships
The Community Mental Health Planning and Service Coordination initiative has engaged a
range of service sectors in building local area population and service planning capacity for
mental health. This initiative has contributed to the development a broader, more responsive
system of mental health care through selected projects. The use of a population health
approach has been key building collaboration and a shared, evidence-based understanding of
the needs to be addressed. Around 30 projects across the State are in various stages of
development.
ACTION AREA 3: PARTICIPATION IN THE COMMUNITY AND EMPLOYMENT,
INCLUDING ACCOMMODATION
The Victorian Government is committed to reducing the often devastating impact of mental
illness, particularly homelessness, social exclusion and unemployment. The development
and reform of the Psychiatric Disability Rehabilitation and Support Service sector will
sharpen focus on achieving tangible client outcomes in these areas, as well as building
individual resilience and capacity for self management and generating supportive community
environment for people with mental health problems.
Care Coordination
Victoria is trialling a new care coordination which will support 300 clients at any one time
with multiple needs to access the range of health, community and social services they require.
Early evidence from the formative and summative evaluation, show promising client and
system impacts are being achieved.
COAG National Action Plan on Mental Health - Progress Report 2010-11
53
Queensland
On 14 July 2006, the Queensland Government announced its initial contribution of $366
million to the COAG National Action Plan on Mental Health 2006-2011 (NAP). Across the
five years of the NAP, the Queensland Government has made an unprecedented investment
of over $989 million in mental health. Queensland Government achievements against each of
the priority areas in the fifth and final year of the NAP are detailed below.
Queensland Centre for Mental Health Promotion, Prevention and Early Intervention
The Queensland Centre for Mental Health Promotion, Prevention and Early Intervention
(QCMHPPEI), established in January 2009, continues to plan and implement a range of
innovative mental health promotion, prevention and early intervention initiatives and
programs around the state. These include activities aimed at enhancing the awareness,
understanding and detection of mental illness throughout the Queensland community and in
key settings; reducing the stigma and discrimination experienced by people living with
mental illness; and specific actions in priority settings targeting groups at increased risk of
developing mental health problems.
Key achievements include significant investment directed to supporting Mental Health First
Aid (MHFA) delivery and program sustainability across Queensland including funding to
support over 90 Queensland Health and cross-sectoral staff to be trained as Mental Health
First Aid instructors; the development of the MIND (Mental Illness Nursing Documents)
Essentials resource for use by general nurses and other health professionals and distribution
across all public health hospitals and key general health settings in Queensland; continued
implementation of the Queensland Ed-LinQ Initiative; continued work with MATES in
Construction aimed at improving mental health and wellbeing for workers in the building
and construction industry; and the development of the Queensland Government Suicide
Prevention Action Plan: Taking Action to Prevent Suicide in Queensland 2010-15.
The Queensland Government has also provided $8.5 million over four years (2010-14) for
the development of a statewide stigma reduction strategy which will be based on the
implementation of a social marketing campaign.
Suicide Prevention in Queensland Schools
The Queensland Government is currently drafting suicide prevention and postvention
guidelines for use in schools. The guidelines will provide comprehensive information about
responding to suicide and suicide crisis and direction for accessing referral pathways and
coordinating care. Existing resources on suicide prevention and intervention are currently
being redrafted to reflect contemporary best practice and ensure coordinated referral
pathways for care.
Mental Health Literacy Training
Queensland Police Service has engaged an external provider to develop and deliver
customised mental health literacy training. A Certificate in Mental Health Awareness and the
Applied Suicide Intervention Skills Training package have also been rolled out.
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COAG National Action Plan on Mental Health - Progress Report 2010-11
School-based Initiatives
In 2010 the Queensland Department of Education and Training developed and implemented
the Supporting Students’ Mental Health and Wellbeing policy. The policy will enhance
referral pathways and coordination of care for students identified as at risk. Regional Contact
Officers have been established across Queensland to work alongside schools and facilitate
early intervention and responsiveness to students at risk. Seven Youth Support Coordinators
have also been established across the state, further enhancing the capacity of schools to
identify and respond early to students at risk.
Primary Mental Health Care
In 2010-11, Queensland Health allocated $900,000 and continued to work with General
Practice Queensland (GPQ) to implement the Partners in Mind (PIM) initiative, a key
component of the Queensland Framework for Primary Mental Health Care. At each of the 12
PIM sites, Divisions of General Practice and district mental health services work
collaboratively to improve the local sector to achieve better outcomes for people with a
mental illness. Primary Care Liaison Officer (PCLO) positions coordinate and develop
effective partnerships between mental health services, general practitioners and other public
mental health service providers. During 2010–11, a self-evaluation framework was developed
to provide a continuous improvement focus for PIM stakeholders. Initial data found that the
PCLO positions and the transparent communication methods adopted by sites, were strengths
that drove the success of the PIM initiatives within the local areas.
Queensland Health and GPQ continue to work collaboratively on the activate: mind & body
project to build the capacity of district mental health services and general practitioners to
more effectively address the physical and oral health needs of people with severe mental
illness. In 2010-11, Queensland Health and GPQ worked collaboratively to develop and
implement a range of resources and training packages. These resources were implemented
across district mental health services and general practice and included the activate: mind &
body handbook, for the physical and oral health management of people with severe mental
illness, health promotion materials aimed at consumers and carers and an interactive
website. The training packages implemented across general practice and non government
agencies educated clinicians and mental health workers on how to better support and manage
the holistic health needs of people with severe mental illness.
Community Mental Health Services Enhancements
As at the end of 2010-11, Queensland Health has 67 per cent of the number of community
mental health staff needed to meet the 2017 clinical staffing target of 70 FTE per 100,000
population. Since 2007-08 an additional 569 full time equivalent (FTE) positions have been
established, representing an a substantial increase in capacity in community settings.
Transcultural Mental Health
The multicultural mental health coordinators funded in 2006-07 under the NAP have
expanded to 13 full time positions across Queensland. These positions continue to deliver a
mix of clinical services such as consultation and liaison, and service development activities
aimed at supporting Culturally and Linguistically Diverse consumers and carers. In 2009-10,
the Queensland Transcultural Mental Health Centre also commenced the development of a
Queensland Plan for Multicultural Mental Health and Wellbeing, due for release in 2011.
COAG National Action Plan on Mental Health - Progress Report 2010-11
55
Housing and Support Program
The Housing and Support Program (HASP) is a recovery-oriented model for the coordinated
provision of clinical and non-clinical support and social housing to enable people with a
mental illness and psychiatric disability to live in the community. HASP is an innovative and
collaborative partnership involving Queensland Health, the Department of Communities, and
the non-government service sector. In 2007-08 the State Budget allocated $10M recurrent
equity funding for housing stock and a total of $22.45M over four years for non-clinical
support for individuals with a psychiatric disability, with clinical support to be provided
through existing infrastructure. Results of an external HASP evaluation finalised in 2011
demonstrate that given adequate community support, stable housing and good clinical case
management, people with mental illness and psychiatric disability are able to live and
successfully participate in their community of choice. Under HASP more than 240
consumers have been housed and provided support from 2006 to 2011, thereby exceeding
initial program targets.
Employment Initiative
The Queensland Health Employment Specialist Initiative was established in 2007 to assist
people living with severe and persistent mental illness to transition into competitive
employment. Based on the collocation of Disability Employment Service specialists within
public mental health services, the model recognises the importance of employment to
economic growth and social inclusion and provides intensive support to mental health
consumers. Throughout 2010-11, the Employment Specialist Initiative continued to expand
from eight sites in 2007 to 26 sites across Queensland, with a number of other services
planning to implement the initiative. Preliminary data indicates high placement rates for
consumers into competitive employment and vocational activities.
Working Together to Change: an initiative in clinical reform
The Queensland Health Clinical Reform Initiative continues to develop statewide models of
service to facilitate integrated service delivery that is evidence-based, recovery focussed and
able to be measured. This initiative aims to embed an ‘every door is the right door’ approach
in mental health services through targeting improvements in access, consistency, quality,
efficiency, safety and responsiveness.
To complement this work, Queensland Health has developed a policy management
framework based on the National Standards for Mental Health Services 2010. This
framework will support broader health system reforms by providing statewide mental health
system management which is inclusive of system planning, coordination and standard setting.
Mental Health Intervention Program
During 2010-11 Queensland Police Service has consolidated the Mental Health Intervention
Program which aims to improve collaborative responses between the Queensland Police
Service, Queensland Ambulance Services and public mental health services. Resources from
this program are supporting the six month trial of a co-responder model in Cairns between
April and October 2011. The co-responder trial involves a police officer working full time
with a clinical nurse attending to all mental health related police call-outs that fall within the
Cairns Police District. The main aim of the model is to assist the consumer by having the
capability to assess them in their home or other community based setting without the need to
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COAG National Action Plan on Mental Health - Progress Report 2010-11
take them to hospital, which saves both hospital beds and police and emergency department
time and resources.
Workforce development in schools
In 2010-11 approximately 70 frontline staff from a range of schools attended a master class
for leaders in education on social and emotional wellbeing. During this same period,
approximately 200 staff from across the state attended suicide prevention and intervention
training programs including Applied Suicide Intervention Skills Training and SafeTALK.
Care Coordination Model
The Care Coordination Model targets people with severe mental illness and complex care
needs who are at risk of falling through the gaps in the current service delivery. It aligns with
State and Commonwealth priorities recognising the importance of recovery and social
inclusion as well as general health and wellbeing. In 2010-11, 20 Service Integration
Coordinators across the state continued to develop effective working relationships between
government, non-government and the private sector to provide coordinated support for this
target group. Two statewide forums brought Service Integration Coordinators together to
consider opportunities and challenges in broader National Health Reforms.
Governments Working Together – Beyond the COAG NAP
Following the release of the COAG NAP, the Premier established the Queensland COAG
Mental Health Group to provide cross-sector leadership and realise the full benefits of
investment in NAP initiatives across the state. With the COAG NAP concluding in 2011, and
the release of the Fourth National Mental Health Plan in 2009, this group was realigned and
became the Queensland Mental Health Reform Committee (QMHRC). The Committee’s
scope was also broadened to enable it to provide high level advice for a range of state and
national mental health reform agendas. QMHRC reports to both the Queensland Ministers for
Health and for Mental Health.
Beyond the term of the NAP, QMHRC will provide the ongoing executive level committee
for mental health reform in Queensland. It has proven one of the most successful whole-ofgovernment and community partnerships established under the NAP and will continue to
provide an important forum for collaboration across sectors and with consumers and carers
for better outcomes in mental health in Queensland.
COAG National Action Plan on Mental Health - Progress Report 2010-11
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Western Australia
SIGNIFICANT DEVELOPMENTS IN 2010-11
The 2010-11 financial year was the first full year of operation for the Mental Health
Commission, which commenced on 8 March 2010. During this year the Mental Health
Commission has focused on leading the development of strategies that deliver better mental
health outcomes for Western Australians. This work has involved strengthening engagement
with the community, building a new vision for reform, and working with key government and
non government partner agencies.
The Mental Health Commission finalised the mental health strategic policy which was
launched by the Premier, Hon Colin Barnett, on 11 October 2011. Mental Health 2020:
Making it personal and everybody’s business – Reforming Western Australia’s mental health
system outlines a ten year vision for mental health in Western Australia that complements
national policies and plans. Mental Health 2020 is based upon key reform areas that were
identified during extensive stakeholder consultation and establishes a clear direction that
encompasses a whole of government and community focus with increased emphasis on the
important role of a sustainable and high quality community services sector, and opportunities
for more personalised supports and services. Three key reform directions of Person centred
supports and services, Connected approaches and Balanced investment are articulated in
Mental Health 2020 www.mentalhealth.wa.gov.au as follows:
BEYOND 2011
Mental Health is a priority for the WA State Government and over the next ten years, the
Mental Health Commission will collaborate with all stakeholders to implement these critical
and timely reform directions in a staged approach to build enduring capacity and a strong
foundation to progress the nine action areas articulated in Mental Health 2020. Significant
funding has been committed to the reform process including:
 $55 million to purchase houses and approximately $30 million recurrent over four years
to purchase packages of individualised support for people to move out of long stay
institutionalised hospital facilities to live in their own homes in the community with
access to a range of community based activities, supports and clinical services.
 $12.8 million in capital funding to build two subacute facilities with a combined capacity
of 44 individual units. Further sub acute units are planned for regional WA.
 $5 million over two years to trial a dedicated mental health court diversion and support
program, as well as $1.7 million over two years to place specialised mental health
expertise within the Perth’s Children’s Court.
 $16.5 million over 4 years to implement new legislation (the Green Mental Health Bill)
and associated quality assurances processes.
 $15.3 million over 3 years for Western Australia’s first Early Psychosis Youth Centre for
intervention and treatment of young people with severe mental illness.
ACTION AREA 1: PROMOTION, PREVENTION AND EARLY INTERVENTION
A range of initiatives within the WA Suicide Prevention Strategy were implemented in
2010-11. The Ministerial Council for Suicide Prevention (MCSP) leads the Strategy and
oversees the implementation of initiatives that are aimed at improving resilience, expanding
community education, conducting research and supporting capacity building in communities
at increased risk of suicide and self harm. The key initiatives in 2010-11 included employing
community coordinators to establish and implement sustainable community action plans. A
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number of high risk communities were identified across the State as priorities in 2010-11,
including people living in rural and remote areas, Aboriginal people, young people, and
mining communities with fly-in fly-out workers.
Young people were one of the key priority areas of focus for promotion and prevention
initiatives in 2010-11. To engage young people, the Mental Health Commission invested in
Music Feedback, an innovative multimedia anti stigma campaign. Music Feedback reached
over 40,000 young people aged 12 to 25 years. The program encouraged young people to
talk about mental health issues, seek help early and promote social inclusion. It was delivered
in partnership with schools, youth groups, local councils, mental health services and the
music industry. A statewide publicity campaign to launch the 2011 CD/DVD
production during National Youth Week was undertaken in April 2011, and a DIY Events
Toolkit was also developed for young people to host their own Music Feedback branded
events.
The Mental Health Commission undertook a range of community awareness and antistigma initiatives in 2010-11 that were aimed at improving understanding of mental illness.
These initiatives included:
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Four ‘Let's Talk Culture’ series forums designed to increase understanding of mental
health issues and improve services for culturally and linguistically diverse and Aboriginal
communities. More than 700 people attended the forums which were a partnership with
the University of Western Australia, Department of Health and Transcultural Mental
Health Service.
A free public forum on ‘Taking the Stigma out of Mental Illness’ attended by more than
150 people - approximately 88% of attendees reported learning new ways to counter
stigma as a result of the forum.
In addition, ‘Lifeline’ was funded to expand the telephone counselling service in Western
Australia.
ACTION AREA 2: INTEGRATING AND IMPROVING THE CARE SYSTEM
The Mental Health Commission invested in a number of partnership initiatives in 2010-11
to ensure the development of a more effective system of supports and services. More
specifically funding was provided to: the Department of Sport and Recreation to improve
social inclusion for people with a mental illness through the development of a community
grants scheme to for physical activities; the Department of Corrective Services and the
Department of the Attorney General for training in risk assessment and mental health first
aid; the Drug and Alcohol Office for collaborative initiatives for co-morbidity; seven
agencies in a cross-government program to provide intensive assistance for people with
exceptionally complex needs (PECN). Evaluation of the PECN program found that most
clients made significant improvements and two clients exited the program due to
improvements in their life circumstances.
The new 30-bed acute mental health inpatient unit at Rockingham opened in October
2010, with 20 beds for the general adult population and 6 beds for older adults became
operational in February 2012. In addition, construction commenced on a 14 bed acute mental
health inpatient unit in Broome; the new service is expected to commence in early to mid
2012.
COAG National Action Plan on Mental Health - Progress Report 2010-11
59
The new dedicated Statewide Specialist Aboriginal Mental Health Service commenced
operation in 2010-11, funded through the National Partnership Agreement on Closing the
Gap in Indigenous Health Outcomes. The Mental Health Commission led the development
and implementation of a service model that was suitable for delivery in both metropolitan
areas and in isolated remote communities spread throughout the state. The model includes
specialist teams located in metropolitan and rural hubs, with support from a single statewide
workforce development resource to assist with mentoring and training for Aboriginal and non
Aboriginal staff. The new statewide service aims to improve service access and effective
treatment and discharge planning, and to increase the employment of Aboriginal people in
mental health services
As a signatory to the National Partnership Agreement on Improving Public Hospital
Services, funding received will be invested in additional mental health services over 4 years
from 2010-11 to 2013-14. The new mental health services include:
 Subacute care services at Joondalup and Broome
 Child and adolescent mental health outreach teams
 Emergency mental health clinical service redesign
 Capital upgrade to the adolescent mental health inpatient unit
 Community and inpatient services for older adults in Rockingham
 Community mental heath teams for older adults in the South West and Peel
 Day therapy unit in the Great Southern.
ACTION AREA 3:
PARTICIPATION IN THE COMMUNITY AND
EMPLOYMENT, INCLUDING ACCOMMODATION
To support and promote the introduction of increased personalisation, choice and
individualisation in the provision of services and supports, the Mental Health Commission
funded a range of training and developmental opportunities for individuals, families and
carers, non government organisations and specialist mental health services in 2010-11. The
aim of these initiatives was to focus on enhancing capacity and understanding of
personalisation of services in the mental health sector through the building and promotion of
joint partnerships.
Significant supported accommodation developments in 2010-11 included the further
development of the individual supported accommodation program. In 2010-11, 30 new
dwellings for people with a mental health problem and/or mental illness were made available
through the Nation Building Housing Stimulus Program in partnership with the Department
of Housing. Nine units in the south metropolitan area and 21 in the north metropolitan area
were provided for people who were homeless or at risk of homelessness.
The Mental Health Commission provided significant investment to build the capacity of non
government mental health service providers including funding to the WA Association for
Mental Health to engage with service reforms that address community needs and service
sustainability.
ACTION AREA 4: INCREASING WORKFORCE CAPACITY
Developing the capacity of the mental health workforce in Western Australia is a priority and
the Mental Health Commission invested significant funding in this area in 2010-11 including:
 support for the peak Non Government sector agency to provide development and training
opportunities for staff across the non government mental health sector;
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


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additional child and adolescent psychiatry training positions in public mental health
services;
scholarships for post graduate studies in infant mental health;
advanced training courses for rural and remote professional staff and perinatal mental
health education for primary care professionals;
scholarships for nurses to attract them to pursue a career in mental health and for staff
working in mental health services to undertake postgraduate studies in advanced mental
health practice; and
supporting the development of the national cultural competency tool (NCCT) which
assists those working with people from culturally and linguistically diverse backgrounds
who have mental health issues.
ACTION AREA 5: COORDINATING CARE
The key coordination initiative developed by the Mental Health Commission in 2010-11 is
strengthening the interface between primary care and specialist mental health care. The
Mental Health Commission has a critical role in facilitating partnering amongst these
providers to provide a seamless transition of care for people who move between governmentprovided and non government provided services. A number of strategies to develop effective
integration between primary health care and specialist services are being developed
including:
 Increasing confidence in mental health issues for primary health care providers,
 Developing consistent referral pathways to primary care for people with long-term
mental health problems
 Encouraging participation in Commonwealth-funded programs such as Access to
Allied Psychological Services, GP Psych Support, and General Practice Mental
Health Standards Collaboration; and
 Developing more flexible use of mental health specialists across the primary health
care sector.
VARIATIONS AND ADDITIONAL FUNDING COMMITMENTS IN 2010-11
The funding allocation for 2010-11 was greater by $22.96 million than the allocation in
2009-10. This is largely due to the development of new acute inpatient services (Rockingham
and Broome) and initiatives related to the Statewide Specialist Aboriginal Mental Health
Services under Action Area 2 as well as the rollout of initiatives related to the WA Suicide
Prevention Strategy under Action Area 1 and the capacity building of non government
organisation service providers under Action Area 3.
KEY BARRIERS TO IMPLEMENTATION
WA faces significant challenges in ensuring that people living in rural and remote areas have
access to a comprehensive range of supports and services. The tyranny of distance and
remoteness is exacerbated by the lack of primary care services in many rural and remote
areas placing an additional burden on state funded services. Attraction and retention of the
health workforce and affordability of housing continue to remain major barriers in mining
locations in WA. The continued development of strong partnerships and innovative models of
service delivery are required in order to improve access to the supports and services that
individuals and their families need in order to live well in the community.
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South Australia
During the 2010-11, the Government of South Australia continued to make significant
progress in the implementation of its commitments under the National Action Plan for
Mental Health 2006-2011. Key highlights in each of the action areas for 2010-11 are
outlined below.
ACTION AREA 1: PROMOTION, PREVENTION AND EARLY INTERVENTION
Promoting mental health
The partnership between the Government of South Australia and beyondblue continued
during 2010-11 to promote awareness of depression and increase help-seeking behaviours of
South Australians.
Following the completion of a communication plan for the period 2010-12, South Australia
commenced the development of a media campaign to address the stigma and discrimination
associated with mental illness. The campaign will involve advertising on television and radio
as well as in bus shelters and websites. It is expected that the campaign will be launched in
2011-12.
In 2010-11, the South Australian Government commenced the strategic development of a
comprehensive Suicide Prevention Strategy for South Australia. The development of the
strategy will involve wide public consultation and will be completed in 2012. Objectives of
the strategy will be to reduce the rate of suicide in South Australia by:

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Increasing the effectiveness of services and support available to people at risk of suicide
or who have attempted suicide.
Influencing and addressing, as far as possible, the risk and protective factors which are
known to reduce the risk of suicide, particularly for high risk groups.
Increasing community awareness about suicide and suicide risk factors.
Promoting a comprehensive, coordinated response to suicide prevention across a range of
government and community sectors.
Eating Disorders
A new statewide service model for eating disorder services was developed during 2010-11.
The new Model of Care advocates a ‘hub and spoke” structure, which will modernise and
improve existing services and reach out to people in country areas. The hub of specialist
clinicians will work with other services including general practitioners, community mental
health or other agencies, to offer clinical advice and guidance to manage eating disorders.
Services will include both residential and day programs, encompassing all age groups and
expanding the range of prevention, intervention and treatment services available across the
State.
Perinatal Depression
The national perinatal depression initiative, in conjunction with the Commonwealth
Government, continued during 2010-11. Over 1700 clinicians received training. Training
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was also provided to midwives in country areas, General Practitioners and private sector
nurses, midwives and obstetricians. A training resource manual for health care workers in
Aboriginal communities is currently being upgraded and will be completed by September
2011.
ACTION AREA 2: INTEGRATING AND IMPROVING CARE SYSTEMS
Redevelopment of Glenside Campus
Construction of the new 129 bed Glenside Hospital and Redevelopment is now at an
advanced stage. All the service infrastructure elements are expected to be completed by mid
2013.
Investment in non-government organisations
South Australia significantly increased funding to non government organisations since
reforms began in 2007-08. As part of these reforms, new service specifications were
developed. During 2010-11 work was undertaken to retender these services as well as the
development and contracting of new supported accommodation services.
New Mental Health Act
Implementation of the new Mental Health Act commenced on 1 July 2010. One of the
requirements of the new Act was to establish a Community Visitor Scheme in South
Australia to provide further protection of the rights of people with a mental illness who are
admitted to treatment centres in South Australia. The Community Visitor was appointed and
the services commenced in 2010-11. A range of publications and resources were developed to
accompany the implementation of the Community Visitor Scheme, including: an Introduction
to the Community Visitor Scheme booklet, Community Visitor Scheme Information
Brochure and Community Visitor Scheme Information Brochure for Service Providers. In
addition, the new Act established the Office of the Chief Psychiatrist and the first Annual
Report for the Office of Chief Psychiatrist was presented to Parliament.
Shared care with General Practitioners
The contract for a Shared Care with General Practitioners was re-contracted in 2010-11. The
contract provides for 30 mental health professionals to work with GPs in their clinics to assist
people with a mental illness. Over 1,000 people receive a service through this contract each
year.
Improving access to acute and community-based clinical services
A new organisational structure has been developed to support the implementation of
integrated teams for all community based mental health services across each geographic area
in the metropolitan area. Six centres have been identified for development to provide these
services that will enable consumers to have their needs attended to in a single location. The
first of these centres was completed at Marion in the inner south and opened in May 2011. A
second centre is under development at Tranmere in the eastern sector. All six centres are
expected to be completed by 2013-14.
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Improving Forensic Mental Health
Funding was allocated for the upgrade of the James Nash House forensic facility and to
expand its capacity from 30 to 40 beds. During 2010-11 a project team was appointed and
design work commenced on a preferred concept option. The procurement process to appoint a
managing contractor has commenced and a short-list of potential tenderers has been
established.
Improving Services to Older people
A final design plan for the new 20 bed Older Persons Mental Health acute unit at The Queen
Elizabeth Hospital was completed. It is expected that construction will be completed by the
end of 2012. New and expanded accommodation developments for older persons community
mental health teams commenced for the Salisbury and Woodville teams in preparation to
expand staff to provide in-reach services to the wider aged care residential sector in 2012-13
ACTION AREA 3: PARTICIPATION IN THE COMMUNITY AND EMPLOYMENT,
INCLUDING ACCOMMODATION
Intermediate care
Construction was completed for the first two 15 bed intermediate care facilities at Glenside
and Noarlunga. Construction of a third 15 bed facility in the western metropolitan area at
Queenstown is advanced and will be completed in October 2011. A site for a fourth 15 bed
unit has been identified in the northern metropolitan area. Services commenced for 20 non
facility based intermediate care places in country South Australia at Whyalla, Kangaroo
Island, Mount Gambier and Port Lincoln.
Supported accommodation
Building work commenced on 20 supported accommodation units on the Glenside site and
these are expected to be completed by August 2011. The units will be provided with 24/7
support through non government organisations. In addition, work commenced on the
construction of 59 houses across the metropolitan area with 24 completed in 2010-11 and the
remainder by 2011-12. Consumers in these houses are provided with up to 24 hour support,
depending on their needs. In addition 203 of some 262 social houses were constructed under
the Commonwealth Government’s Economic Stimulus program. Psychosocial mental health
services are provided to mental health consumers in these houses by the State Government.
ACTION AREA 4: INCREASING WORKFORCE CAPACITY
Nurse Practitioners
As part of mental health reform, it was identified that eight nurse practitioners would be
recruited over four years to provide a better services to country South Australia. This
recruitment program continued in 2010-11 and it is expected that the process will be
completed in 2011-12. As reported previously, these country positions have been developed
to supplement the shortage of GP services in many areas, and the limited pool of visiting
psychiatrists.
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ACTION AREA 5: CO-ORDINATING CARE
One of the key aims of the National Action Plan for Mental Health 2006-2011 is to improve
the care coordination process for people with severe mental illness and complex needs. In
2010-11, the Government of South Australia continued to implement the new models of care
as part of the new stepped system of care. New infrastructure associated with the new
stepped system of care started to come on stream in 2010-11 and will continue for the next
two years.
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Tasmania
1. Highlights over 2010 – 2011 in one or more of the Action Areas
ACTION AREA 1: PROMOTION, PREVENTION AND EARLY INTERVENTION
Implementation of Building the Foundations for Mental Health and Wellbeing, A
Strategic Framework and Action Plan for Implementing Promotion, Prevention and
Early Intervention (PPEI) Approaches in Tasmania
In December 2010, the Tasmanian Government released the Tasmanian Suicide Prevention
Strategy 2010 – 2014, A Strategic Framework and Action Plan (the Strategy). The Strategy
was developed under the Building the Foundations framework, released in 2009, to reflect a
whole of government and whole of community approach to suicide prevention and a
framework for action. The Strategy is in line with the National LiFE Framework and
identifies five key areas for action: Governance; Primary Prevention; Secondary Prevention
and Early Intervention; Tertiary Prevention; and Evaluation and Quality Improvement of
Services.
Release of the Strategy was a significant step forward for Tasmania.
Implementation of the Strategy is overseen by the Tasmanian Interagency Working Group for
Mental Health which has representation from across government agencies, local government
and the Mental Health Council of Tasmania. On release of the Strategy in December 2010,
funding was allocated to various community sector organisations to deliver primary
prevention initiatives including mental health counselling and support to dairy farmers and
their families in Circular Head; mental health and suicide prevention interventions for
Tasmania’s more rural and remote communities with a focus on men; and increased support
for the work of the Oz Help Foundation to deliver training increase suicide prevention
literacy in the building and construction industry. The Tasmanian Suicide Prevention
Steering Committee began a review of governance and leadership in suicide prevention in
Tasmania, in line with Priority Area One of the Strategy.
Promotion, Prevention and Early Intervention Training
The Tasmanian Government continued to build understanding of the conceptual framework
underpinning the Building the Foundations framework through investment in cross sectoral
mental health PPEI training delivered through the community sector organisation Aspire. A
group of eight new trainers were engaged to complete a Train the Trainer package to increase
the capacity within Tasmania to roll out the former Auseinet Training, Understanding Mental
Health and Wellbeing, An Introduction to Mental Health, Mental Health Promotion,
Prevention of Mental Ill-health and Early Intervention.
Consumer and Carer Participation
The Tasmanian Mental Health Consumer and Carer Participation Review Report was
finalised with a key aim of the Review the identification of an optimum model for mental
health consumer and carer participation within Tasmanian and to inform the implementation
of Tasmania’s Consumer and Carer Participation Framework. A Consumer and Carer
Participation Review Implementation Advisory Committee was established to provide
support and advice in relation to the implementation of recommendations from the
Participation Review. A Consultation Paper outlining the proposed objectives and principal
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functions for a new Tasmanian mental health consumer organisation was released in July
2010 with a new organisation likely to be established by August 2011. There has also been
ongoing development of training and support programs for mental health consumers, their
family members and carers.
ATOD PPEI Framework
During 2010, work began on the development of an Alcohol, Tobacco and Other Drugs
(ATOD) Promotion, Prevention and Early Intervention (PPEI) Strategic Framework, a key
strategy identified in the Tasmanian Alcohol Action Framework 2010–2015 Rising Above the
Influence and is an identified priority area under the Alcohol and Drug Services (ADS)
Future Services Directions Plan. The ATOD PPEI Strategic Framework project is an
interagency collaboration – overseen by the Inter Agency Working Group on Drugs
(IAWGD) – designed to advance the PPEI agenda in relation to ATODs, and to complement
ongoing National and Tasmanian-based initiatives including Building the Foundations. A
Discussion Paper was released for public consultation in May 2011.
Tasmanian Perinatal Depression Initiative
Implementation of the National Perinatal Depression Initiative continued in Tasmania with
the Tasmanian Project Officer working with an Advisory Group to develop an
implementation plan to improve the prevention and early detection of antenatal and postnatal
depression, and to provide better care, support and treatment for expectant and new mothers
experiencing perinatal depression.
ACTION AREA 2: INTEGRATING AND IMPROVING THE CARE SYSTEM
Accreditation
Statewide and Mental Health Services, including the corporate support State Office,
commenced accreditation through the Australian Council on Healthcare Standards (ACHS)
Evaluation and Quality Improvement Program (EQuIP). In May 2011, key service streams
with SMHS completed the certification review. This process included a widespread and
significant review of clinical and administrative policies, procedures and protocols to ensure
compliance with mandatory / non-mandatory criterion. This process also included the
development of a new Infection Control Framework and a Risk Management Framework for
Statewide and Mental Health Services.
Agenda for Children and Young People
In July 2010, the Tasmanian Government released a Consultation Paper to the community
seeking feedback on the development of a Roadmap for government services for the next ten
years to work more collaboratively, across identified priority areas including mental health, to
nurture, educate and protect Tasmanian children and young people. A key focus of the
Roadmap was to establish whole-of-government and community partnerships to deliver early
intervention and prevention approaches that ensure children and young people receive the
timely support they need and to establish high quality, integrated service delivery systems
and processes that support working in partnership. The Roadmap was due for release in midJuly 2011.
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ACTION AREA 3: PARTICIPATION IN THE COMMUNITY AND EMPLOYMENT
INCLUDING ACCOMMODATION
Tasmanian Homelessness Plan
The Tasmanian Homelessness Plan 2010 – 2013: Coming in from the Cold was released in
2010. The five objectives of the plan include: Prevention and early intervention; improved
connections to family and community, education and employment; improved access to
appropriate housing; effective service responses; and continuous improvement and quality.
Statewide and Mental Health Services worked in partnership to support the development and
implementation of a Common Assessment Framework to deliver better access to appropriate
housing and support for clients and better arrangements to assist vulnerable Tasmanians
through improved collaboration between mainstream and specialist services, such as mental
health.
SMHS also worked closely with Housing Tasmania and other stakeholders to provide
appropriate mental health in-reach to clients within Supported Accommodation Facilities
(SAFs). SMHS supported the implementation of the KEYS (Keys to the Future) initiative in
partnership with Housing Tasmania and Colony 47 and STAY, which is managed by
Centacare Tasmania in partnership with Australian Red Cross. Together, KEYS and STAY
target young people leaving care and youth justice facilities, adults leaving correctional
facilities and health facilities and people who have been chronically homeless with high
needs.
ACTION AREA 4: INCREASING WORKFORCE CAPACITY
Workforce Development and Training
The Workforce Development Unit, within Statewide and Mental Health Services, continued
to provide core competency training to SMHS staff.
A four day legal and legislation training program was conducted for over 100 SMHS staff
which covered key aspects of the legislative environment in which SMHS operates including
the Mental Health Act 1996 and the Guardianship and Administration Act 1995.
During 2010-11, Tasmania’s Statewide and Mental Health Services Workforce Development
Unit led the development of an e-learning package to support the roll-out the National Mental
Health Standards 2010.
ACTION AREA 5: COORDINATING CARE
A New Governance Structure - Forensic Health Services
During 2010-11 the integration of the Correctional Primary Health Services (CPHS), the
Community Forensic Mental Health Service (CFMHS) and the Forensic Mental Health
inpatient facility the Wilfred Lopes Centre (WLC) under a single governance structure,
Forensic Health Services, within Statewide and Mental Health Services was finalised.
Integrated governance arrangements will enable the service streams to operate with formal
linkages and processes focused on the coordination of services within the forensic
environment and will maximise the coordination of services across the same streams. This
new structure will also provide better coordination of care and in turn greater improvement in
continuity of client care.
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A New Strategic Plan
Preliminary work was completed on the development of a service planning framework for
Mental Health Services to inform the development of a new Tasmanian Mental Health
Services Strategic Plan.
2. Information on variations to, and any additional funding commitments and allocations
that may have occurred during the previous year.
Increased funding to Community Sector Organisations as below.
Rural Alive and Well (RAW) – funding provided to undertake and deliver a psychosocial
needs analysis report of community members in the Dorset and Break O Day municipal
areas; and provide rural counselling, support and educations services to community members
in the Glamorgan and Spring Bay municipal areas.
OzHelp – funding provided to assist OzHelp Tasmania Foundation support the health and
wellbeing of young workers in the Tasmanian Building and Construction Industry.
Aspire – funding provided to increase awareness of mental health promotion, prevention and
early intervention in Tasmania.
3. State and territory approach to care coordination
Described above under Action Area 5.
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Australian Capital Territory
1. Highlights over 2010 – 2011 in one or more of the Action Areas
ACTION AREA 1: PROMOTION, PREVENTION AND EARLY INTERVENTION
Mental Health Nurses in TCH Emergency Department
The funding for this measure in 2010-11 has been included within the allocated funding for
the Mental Health Assessment Unit within the Emergency Department at The Canberra
Hospital.
Young Aboriginal and Torres Strait Islander Mental Health and Wellbeing Program: Through
the 2010-2011 ACT Budget Initiatives, and contributing to the National Partnership
Agreement on Closing the Gap, the ACT has funded a community sector program targeting
young Aboriginal and Torres Strait Islander people at risk of mental health problems. The
focus is on early intervention through creating a youth outreach network to support early
diagnosis, treatment and advice to at-risk Aboriginal and Torres Strait Islander young people
and assisting them access mainstream mental health services.
Short term early intervention in home support (Step-up/ Step-down)
The provision of short term, (for a period up to 3 months) “step up, step down” intensive
outreach support, including after hours, using a case management approach for adults
suffering from mental illness was provided in the ACT Health Budget Initiatives 2010-2011.
The service is aimed at mental health consumers suffering sub-acute mental illness. The
short term support assists mental health consumers in the community to receive appropriate
additional support if they are at risk of hospitalisation, as well as assist in the transition back
to the community following discharge from hospital.
ACTION AREA 2: INTEGRATING AND IMPROVING THE CARE SYSTEM
Significant Infrastructure Funding
In 2010-11, the ACT Government allocated significant expenditure for the building and/or
refurbishment of a number of Mental Health Facilities in the ACT. These included the Adult
Mental Health Facility and the Youth Mental Health Facility. The new Mental Health
Assessment Unit – Infrastructure (Action Area 2) and the Mental Health Assessment Unit –
Staffing (Action Area 4) attracted a combined funding of $2.1million.
Mental Health Legislation Review
The Mental Health (Treatment and Care) Act 1994 continues to be reviewed over the
2010-2011 period and is expected to be tabled in the ACT Legislative Assembly in late 2013.
Enhancement of Community Mental Health Teams
Mental Health Growth Funding of $500,000 was allocated to the enhancement of Community
Mental Health teams including 2 consumer consultants; family mental health training and
supervision, and the introduction of a Dialectical Behaviour Therapy coordinator.
Family Support (respite)
The ACT community mental health respite program had shown a strong improvement in
client outcomes and outputs, reflected by an increase in referrals and client numbers. This
contributed to a large unmet need within the program. As a result new funding was allocated
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within the ACT Health Budget Initiatives 2010-2011. This initiative allows an additional 500
hours of mental health respite to be provided to address this local and systemic need.
Mental Health Strategic Oversight Group
The Mental Health Strategic Oversight Group (SOG) continues its role as an advisory group
to the Chief Executive of ACT Health, and its main purpose is to develop an implementation
plan for the period of the ACT Mental Health Services Plan 2009-2014 (MHSP) to guide and
monitor progress toward achieving MHSP vision. It will also monitor the implementation of
the National Action Plan for Mental Health 2006-2011, the Fourth National Mental Health
Plan 2009-2014; and the National Standards for Mental Health Services. At the local (ACT)
level, the SOG is also providing an oversight on the review of the Mental Health (Treatment
and Care) Act 1994.
Mental Health Community Service Sector Development - Mental Health Community
Coalition
A focus on the development of Community Sector capacity through the Mental Health
community services of the Mental Health Community Coalition of the ACT. Sector
Development – Quality Initiatives including Outcome Measurement Tool Development,
Workforce Project, and Organisational and Service Delivery Standards initiatives have been
funded in 2010-2011.
ACTION AREA 3: PARTICIPATION IN THE COMMUNITY AND
EMPLOYMENT, INCLUDING ACCOMMODATION
Individual Advocacy Support
Funding was provided within the 2010-2011 ACT Budget to support a significant number of
people with mental health issues appearing at the ACT Mental Health Tribunal. This
initiative enables ADACAS to meet growing demand and provide appropriately trained
individual advocates to assist individuals fronting the Tribunal with information about the
process, assisting them to speak before the Tribunal or representing the person’s wishes to the
Tribunal, particularly when the Tribunal is considering making or reviewing a treatment
order, a community care order, a financial management order or a guardianship order.
ACT Housing and Assistance Support Initiative (HASI)
ACT has established the HASI program that provides intensive support for people with
mental illness to maintain long-term accommodation and participate in the community.
HASI recognises the high incidence of people with mental illness who are homeless or at risk
of homelessness and their need for intensive support to enable independent living. (4
Providers support 10 clients)
ACTION AREA 4: INCREASING WORKFORCE CAPACITY
Whole of Sector Mental Health Workforce Strategy
Development of the strategy commenced during late 2010 as a collaboration between Mental
Health Community Coalition and Mental Health ACT.
ACT Mental Health Consumer Training and Scholarship Scheme
ACT Health, in partnership with the Mental Health Consumer Network ACT, has contracted
CIT Solutions Inc. to provide training under the ACT Mental Health Consumer Training and
Scholarship Scheme commencing in early February 2011. This supports mental health
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consumers to study a nationally recognised qualification of Certificate IV in Mental Health
at the Canberra Institute of Technology.
Mental Health ACT Psychology Staff
Additional funding has enabled implementation of a special employment agreement to aid the
retention of psychologists within Mental Health ACT.
Mental Health Assessment Unit Staffing
Recruitment of specialised mental health clinicians for the Mental Health Assessment Unit
attached to the Emergency Department at Canberra Hospital commenced during 2010/2011
period.
2. Information on variations to, and any additional funding commitments and allocations
that may have occurred during the previous year
The ACT Government has made significant commitments to the mental health sector for the
past four years for the key action areas of the COAG National Action Plan on Mental Health.
Successive budget commitments have included increased funding to support mental health
service sector growth. Budget increases for 2010-2011, in addition to the Capital Asset
Development Plan commitment (made during 2009-2010).
Mental Health Growth - $1,000,000 (50% to public mental health and 50% to community
sector mental health)
The community sector mental health services received funding targeting people with mental
illness exiting detention, supported accommodation, vocational rehabilitation, mental health
training for teachers and emergency service workers and community sector development.
Mental Health ACT (the public mental health clinical service) continues to experience
significant demand for clinical services and seeks to deliver high quality services at all times.
Recent service reviews (Crisis, Assessment and Treatment Team, Community Teams, Child
and Adolescent Mental Health Service, Psychiatric Services Unit and Eating Disorders) have
provided a large number of recommendations that Mental Health ACT is progressively
implementing as funding becomes available. This funding will continue to support the reform
direction set out in those service reviews and ensure that Mental Health ACT is able to
deliver the most effective and appropriate clinical services to the population of ACT.
Total Funding Commitment/Allocation
The Adult Mental Health Unit was completed during 2011-12 with funding committed during
the 2010-11 period. The total funding committed during the life of the National Action Plan
on Mental Health 2006-2011 period was $71.56 million. The funding allocation
(expenditure) for the ACT totals $76.96 million.
3. Key Barriers faced in implementation (where applicable)
Not applicable.
4. State and territory approach to care coordination
Embedded into mental health service practice and reported in 2009-2010.
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Northern Territory
The Northern Territory Government committed funding over the five years of the duration of
the National Action Plan totalling $14.5 million across activities within the four action areas.
Initiatives under the NT areas of responsibility have now been either fully implemented or are
in the final stages of implementation. A summary of progress in key areas includes:
ACTION AREA 1: PROMOTION, PREVENTION AND EARLY INTERVENTION
Suicide prevention and response
Funding initially led to the creation of an NT Suicide Prevention Coordinator position, and
to improve suicide prevention and response activities. Additional funding has subsequently
been committed to suicide prevention and early intervention activities.
Suicide Prevention
Progress to date:
This included: expansion of the Life Promotion Program in Central Australia to Tennant
Creek; provision of suicide prevention training throughout the NT, including rural and remote
communities; additional funding for crisis counselling services in the Central Australian
Region and provision of funding for bereavement support for people affected by a completed
suicide in Darwin.
Since 2009-10,
o Ongoing implementation of the three year NT Suicide Prevention Action Plan 200911, based on the Northern Territory Strategic Framework for Suicide Prevention. The
plan was developed by the Cross Government Co-ordinating Committee for Suicide
Prevention.
o The NT Department of Health and Families committed additional funding of
$330,000 over the first 18 months of the Action Plan. Initiatives funded include
suicide intervention training that targets both Indigenous and non-Indigenous
populations and the development of appropriate resources providing information on
suicide and self harm prevention and bereavement support for use by a wide range of
service providers and members of the community. A further $200,000 was
committed in 2010/11 to continue these initiatives.
o In April 2011 a further $2.4 million was committed by the NT Government over the
next three years to build on the work that has already been done. This will include
training for frontline workers, increased education in schools, targeted interventions
for young people at risk, improved data collection and research and targeting of
hotspots (communities and groups with high suicide and self harm rates).
Early Intervention
Progress to date:
This included: the establishment of headspace Top End; the creation of a primary health
service established within the public mental health service in Central Australia; and
implementation of National Perinatal Depression initiative.
Since 2009-10,
o headspace sites in Central Australia and Darwin are fully operational.
o Implementation of the National Perinatal Depression Initiative project is continuing
with establishment of a new NT specialist service to undertake complex assessments
and support primary care providers.
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o A pilot program to identify culturally appropriate screening tools and resources for
remote indigenous women is progressing, including translation of the Edinburgh
Postnatal Depression Scale and community awareness resources into language using
audio technology.
o Data collection systems in the NT have been adapted to better facilitate minimum
data collection for evaluation of the perinatal initiative.
ACTION AREA 2: INTEGRATING AND IMPROVING THE CARE SYSTEM
Sub-acute beds
24 hour supported community based services as an alternative to hospital admission or to
facilitate intensive support following discharge from hospital.
Progress to date:
This initiative is now fully implemented. Construction of an 8 bed sub-acute facility in
Darwin was completed in August 2008. A more flexible model was established in Alice
Springs, comprising four beds. These services complement sub-acute individual care
package programs and provide 24 hour support for people who are unable to be intensively
supported in their own home, including people from rural and remote areas.
Since 2009-10,
o The 8 bed sub-acute facility in Darwin opened in October 2008. This service is now
fully functional and has proved successful in providing care for people at risk of
hospital admission and for those who require intensive time-limited post-discharge
support.
o The findings of a comprehensive project to identify the need for accommodation and
support services in Alice Springs, auspiced by the Mental Health Association of
Central Australia has informed planning to address shortages.
Secure Care beds
Progress to date:
o NT Government allocated additional funding of $4.5M (Capital) and $3.8M
(Operational) to establish additional mental health inpatient beds in Darwin (5
additional beds) and Alice Springs (6 additional beds) under the Secure Care
Initiative.
o Construction of the new beds commenced. It is anticipated the beds will be
commissioned late 2011/12.
Rural and remote services ($4.0 million)
Increased services to rural and remote communities.
Progress to date:
This included: expansion of adult mental health services to increase the frequency and
duration of visits to rural and remote communities; additional child and adolescent positions
to facilitate regular visits to regional centres; increased consultant psychiatrist services and
funding for Aboriginal mental health programs in the non-government sector.
o In April 2011, the NT Government committed an additional $1M in 2011/12,
$2.12M in 2012/13 and $2.2M recurrent from 2013/14 to expand the capacity
of specialist child and adolescent mental health services to respond to increased
demand for services by young people in both urban and remote areas.
74
COAG National Action Plan on Mental Health - Progress Report 2010-11
o This will include specialist assessment and treatment for young people with
severe mental illness and increased support to GPs, health centres and schools
to better support young people with mental health problems.
Prison in-reach services ($3.5 million)
Increased services to people in correctional facilities who have a mental illness, acquired
brain injury or intellectual disability.
Progress to date:
This included: appointment of additional forensic psychiatrist and mental health clinicians,
behavioural and Aboriginal Mental Health/Disability Worker positions which provide
enhanced in-reach services to people in correctional facilities in Darwin and Alice Springs.
o The NT Government announced a Forensic Mental Health and Behavioural
Management Facility to provide secure care for people found unfit to plead or not
guilty due to mental impairment and to provide a sub-acute level of care to remand
and serving prisoners experiencing an exacerbation of their mental illness.
Construction of the new facility will commence in 2012?
Amendments to the Mental Health and Related Services Act
Progress to date:
Following a review of the Mental Health & Related Services Act, a number of amendments
were made. A 2nd Edition of Approved Procedures has been developed along with a range of
materials for clinicians, consumers and carers to assist with developing a clear understanding
of the legislation and its operation.
Amendments and new materials were implemented in March 2009.
Since 2009-10
o Work undertaken to amend the Mental Health and Related Services Act, Child Protection
Act and Disability Services Act to provide a legislative framework for the new Secure
Care initiative.
o Amendments to the Mental Health and Related Services Act introduced in December
2011. Work is currently underway to draft Approved Procedures to support the new
provisions.
ACTION AREA 3: PARTICIPATION IN THE COMMUNITY AND EMPLOYMENT,
INCLUDING ACCOMMODATION
Rehabilitation and recovery services
Increased funding for rehabilitation and recovery and carer support services provided by the
non-government sector.
Progress to date:
This initiative has been fully implemented, including increased funding for consumer and
carer support and expansion of recovery and support services to Katherine.
COAG National Action Plan on Mental Health - Progress Report 2010-11
75
ACTION AREA 4: INCREASING WORKFORCE CAPACITY
Progress to date:
A comprehensive training and orientation program was rolled out across the Territory to train
staff regarding amendments to the Mental Health & Related Services Act.
This training also included a focus on documentation and risk. Subsequent mandatory
training for all staff was conducted in 2011.
ACTION AREA 5: CO-ORDINATING CARE
An essential element of the CoAG NAP was to improve ‘coordinated care’ for people with
severe mental illness and complex needs. This has been difficult to progress in the NT in part
because this aspect of the NAP was unfunded, and in part because it concerned both
conceptual elements as well as practical implementation.
Progress to date:
Care coordination working groups were established including an NT wide Care Coordination
Working Group and regional sub groups. An NT Care Coordination Policy Paper was
completed.
Since 2009-10,
Coordinated Shared Care
o Implementation of a framework to facilitate a ‘Shared Client Case Management’
process across NT Department of Health and Families programs, which includes
guidelines for the delivery of coordinated and case managed services to clients
concurrently engaged with two or more of the following programs: Alcohol and
Other Drugs; Aged and Disability; Families and Children and Mental Health. This
framework will be used as the basis for coordinated care of individuals referred to
new secure care services.
o The intent of this process/framework is to ensure that multi-service clients receive
targeted and coordinated services aligned to the complexity of their individual needs
and intensity of their risk, in recognition that this will result in better client outcomes
and more effective service responses.
o Work completed to adjust NT government electronic client records system to allow
clinicians from different departmental health programs to be notified if other service
providers are in contact with the same client.
o These new case management and IT processes were developed in recognition that
any client concurrently engaged with multiple services would benefit from
coordinated service responses.
76
COAG National Action Plan on Mental Health - Progress Report 2010-11
APPENDIX 1
Action Plan
funding
commitments and
allocations
This section of the report presents jurisdictional funding
summary tables by Action Area.
Details are included of each government’s original commitment,
additional funding commitments announced subsequent to
signing of the Action Plan (14 July 2006), and funding
allocations for five years of the Action Plan.
77
Explanatory notes to Appendix 1 tables
The tables in this appendix present data on funding commitments and allocations for the
individual initiatives listed by each jurisdiction in the Action Plan, grouped into four ‘Action
Areas’. Data prepared by jurisdictions also allowed for reporting of new additional mental
health funding allocations in areas where the activity is directly relevant to the Action Plan
objectives and where the associated additional funding commitments were announced
subsequent to signing of the Plan (14 July 2006).
For all funding data, the amounts shown are in millions, rounded to two decimal places, and
reported in current year prices relevant to the reference year. To aid the readability of the
tables, cells in which the value is zero are shown as blank.
Action Plan funding commitment 2006-11
Figures entered in this column list the total funding commitment as specified in the Action
Plan for each initiative, recognising that for some jurisdictions, the amounts include
allocations in years prior to the first year of the Plan (2006-07) or do not extend across the
full 2006-11 period.
Subsequent additional mental health funding commitments 2006-11
Figures in this column present aggregate amounts for any new funding commitments
covering the period 2006-11 in areas that are directly relevant to the Action Plan objectives,
and where those funding commitments have been announced by the relevant government
subsequent to signing of the Action Plan (14 July 2006). The amounts reported show the
cumulative total funding commitment over 2006-11.
Funding allocated 2006-07, 2007-08, 2008-09, 2009-10 and 2010-11
These columns provide details, for each initiative, of the funding expended or provided to
services by the relevant government in the 2006-07 to 2010-11 years. Data reported in last
year’s report have been amended where jurisdictions have provided more accurate updates of
actual expenditure.
Cumulative funding allocations from July 2006
This column provides details, for each initiative, of the cumulative funding allocations since
1 July 2006. For all jurisdictions except Western Australia, this equals the total of the
amounts reported for 2006-07, 2007-08, 2008-09, 2009-10 and 2010-11. For Western
Australia, which included pre-COAG agreement funding commitments (i.e. years prior to
2006-07) in its Individual Implementation Plan, pre-1 July 2006 allocations are included.
Other new mental health funding allocations relevant to COAG Action Plan objectives
Any initiatives grouped in this category present information relating to new funding
commitments made subsequent to 14 July 2006 that are directly relevant to the Action Plan
but cannot be grouped under one of the four Action Areas.
78
COAG National Action Plan on Mental Health - Progress Report 2010-11
Australian Government
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
10.28
10.85
12.34
13.69
Funding Cumulative Note
allocated
funding (a,b)
2010-11 allocations
from
July 2006
Action Area 1: Promotion, Prevention and Early Intervention
Expanding suicide prevention programmes
62.38
Alerting the Community to Links between Illicit Drugs and
Mental Illness
21.60
-21.16
0.40
0.04
New Early Intervention Services for Parents, children and
young people
28.14
0.30
1.90
2.55
5.72
7.54
11.40
29.11
Community based programmes to help families coping with
mental illness
45.22
3.23
11.17
11.12
11.11
8.60
45.23
Increased funding for the MHCA
1.04
0.20
0.20
0.21
0.21
0.22
1.04
Perinatal depression initiative
n.a.
26.70
6.01
8.75
11.89
26.66
d
Taking Action to Tackle Suicide
n.a.
9.39
7.37
7.37
e
Total Action Area 1
158.38
Action Area 2: Integrating and Improving the Care System
15.22
62.38
0.44
17.08
16.01
24.82
35.40
41.29
56.20
173.72
333.91
442.02
525.37
614.24
2,048.15
f
g
Better Access to Psychiatrists, Psychologists, GPs through
MBS
538.00
215.77
132.60
New Funding For Mental Health Nurses
191.60
-127.00
1.82
5.45
14.02
22.72
28.72
72.72
Mental Health Services in Rural & Remote Areas
51.70
9.10
5.35
14.33
12.04
14.06
16.56
62.35
Improved Services for People with Drug and Alcohol
Problems and Mental Illness
73.90
3.25
12.45
23.98
18.26
17.53
75.46
Funding for Telephone Counselling, Self-help and Web
based Support Programmes
56.93
7.02
11.96
12.78
14.70
15.20
61.67
New Personal Helpers and Mentors
284.77
5.08
37.58
73.90
83.61
84.60
284.77
0.40
2.80
1.70
1.20
1.30
7.40
1.70
0.90
1.40
4.00
5.11
5.14
5.04
20.24
4.07
Veterans' mental health care - improving access for
younger veterans
n.a.
14.72
Other DVA initiatives
n.a.
7.70
Mental Health Support for Drought Affected Communities
Initiative
n.a.
10.10
COAG National Action Plan on Mental Health - Progress Report 2010-11
c
4.95
79
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Expansion of Early Psychosis Prevention and Intervention
Centre (EPPIC) model
Total Action Area 2
n.a
6.20
1,196.90
139.95
155.53
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
Funding Cumulative Note
allocated
funding (a,b)
2010-11 allocations
from
July 2006
0.09
0.09
423.42
587.25
685.97
784.67
2,636.84
7.52
8.40
2.74
15.09
39.80
10.57
45.54
Action Area 3: Participation in the Community and Employment, including Accommodation
Helping People with a Mental Illness Enter and Remain in
Employment
39.80
Support for Day to Day Living in the Community
45.96
Helping Young People Stay in Education
59.53
More Respite Care Places to Help Families and Carers
224.66
Total Action Area 3
Action Area 4: Increasing Workforce Capacity
369.95
-0.50
103.48
0.11
Additional Education Places, Scholarships and Clinical
Training in mental health
6.05
-0.50
5.38
9.61
9.57
10.41
6.13
12.48
12.80
12.96
13.35
44.09
63.47
52.09
51.70
224.70
30.91
73.70
94.24
78.19
92.49
369.54
9.72
16.77
23.34
26.11
26.85
102.79
44.37
Mental Health in Tertiary Curricula
5.60
1.26
1.16
1.09
1.13
0.56
5.20
Improving the Capacity of Health Workers in Indigenous
Communities
20.75
1.43
4.93
3.62
3.27
4.00
17.24
12.77
21.60
28.07
31.35
31.70
125.50
215.22
543.54
744.97
836.80
965.07
3,305.59
Total Action Area 4
129.83
0.11
Other new mental health funding allocations relevant to COAG Action Plan objectives
Total Other initiatives relevant to Action Plan
Total funding commitments/allocations
1,855.07
156.64
Notes to Australian Government table:
a.
The Australian government announced a major mental health package in its 2011 Budget, with initiatives totalling approximately $1.5 billion in additional spending over the next five years.
These are not included in the above table because they do not impact on spending over the period 2006 – 2011.
b.
All figures refer to actual expenditure and, for programs managed by the Department of Health and Ageing, include departmental components
c.
Funding reallocated following market research finding that a specific campaign regarding the issue was not necessary. See Australian Government report, Part B.
d.
New national initiative covering 2008-09 to 2012-13.
80
COAG National Action Plan on Mental Health - Progress Report 2010-11
e.
Package of initiatives announced as part of the 2010 Election Commitments.
f.
Increased funding to this initiative was provided in the 2008-09 Federal Budget. Some elements of Better Access expenditure on Medicare rebates are notionally offset by the cost of services
that would otherwise have resulted in Medicare claims. These offset services are general medical services and not specifically for the provision of mental health care. For the purpose of this
report, the Commonwealth's expenditure on Better Access Medicare rebates does not 'net off' other Commonwealth mental health expenditure.
g.
Under the 2008-09 Federal Budget, program funding was adjusted to reflect lower than anticipated demand, with a commitment that funding levels will be reviewed should demand increase
above what is expected. Consistent with that commitment, additional funding was allocated to the program in the 2011 Federal Budget.
COAG National Action Plan on Mental Health - Progress Report 2010-11
81
New South Wales
$MILLIONS
Action Plan Subsequent Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
7.20
5.70
1.71
0.18
6.80
7.70
3.25
0.46
6.80
9.95
8.17
0.14
Funding Cumulative Note
allocate
funding
2010-11 allocations
from
July 2006
Action Area 1: Promotion, Prevention and Early Intervention
Expanding university based research
10.00
10.00
Expanding early intervention services for youth
Specialist assessment of the needs of older people
State wide 24 hour mental health access by telephone
Safe Start - Maternal & Infant Care
Expanding University Based Research - Grants to Brain &
Mind at Institute University of Sydney
28.60
37.30
26.30
n.a.
1.40
4.00
3.50
n.a.
16.00
16.00
Total Action Area 1
Action Area 2: Integrating and Improving the Care System
Enhancing Community Mental Health Emergency Care
Expansion of community forensic mental health services
Better integration of mental health services with drug and
alcohol services
Supporting people with Mental Illness in the prison system
Further increasing the number of acute and non acute
mental health beds
Building and operating new forensic facility at Long Bay
Prison
Expansion of community based professional mental health
services including child and adolescent services
Specialist mental health services for older people
Improving mental health clinical information and
accountability
Building new facilities to accommodate new mental health
beds including works at Lismore, Illawarra and Bloomfield
Hospital
Redevelop and integrate mental health services with drug
102.20
19.50
31.40
14.79
18.21
25.06
32.24
121.70
51.40
6.50
6.76
1.30
6.76
1.30
11.03
1.30
13.45
1.30
13.40
1.30
51.40
6.50
17.60
5.12
3.21
3.41
3.29
2.57
17.60
5.00
1.00
1.00
1.00
1.00
1.00
5.00
151.70
15.01
22.60
33.21
38.80
42.08
151.70
3.80
66.10
40.03
25.00
26.70
161.63
14.30
1.50
3.20
3.20
3.20
3.20
14.30
10.80
2.10
2.15
2.20
2.25
2.10
10.80
7.60
1.50
1.50
1.50
1.50
1.60
7.60
117.00
13.60
42.70
26.80
10.90
7.40
101.40
23.00
23.00
82
171.60
-10.00
10.00
6.40
9.95
13.17
2.72
28.60
37.30
26.30
3.50
16.00
23.00
COAG National Action Plan on Mental Health - Progress Report 2010-11
$MILLIONS
Action Plan Subsequent Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
and alcohol services at St Vincent's Hospital
Refurbishing and relocating mental health facilities at
Concord, Gosford, Newcastle, and Orange Hospitals
Establishing Psychiatric Emergency Care Centres
Eating Disorders
Child & Adolescent mental Health Outpatient Services
Total Action Area 2
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
Funding Cumulative Note
allocate
funding
2010-11 allocations
from
July 2006
117.40
-16.70
15.00
26.00
12.80
19.40
26.80
100.00
5.80
n.a.
n.a.
11.10
4.10
15.80
3.40
6.10
0.80
2.00
2.30
1.22
4.65
3.20
1.27
4.65
1.90
0.81
4.50
16.90
4.10
15.80
699.70
4.30
93.09
185.42
144.65
129.21
135.36
687.73
Action Area 3: Participation in the Community and Employment, including Accommodation
Housing Accommodation and Support Initiative
58.80
1.89
Community Rehabilitation Services
41.50
3.08
Enhance NSW Family and Carer Mental Health Programme
13.50
1.03
Aboriginal Housing and Accommodation Support Initiative
n.a.
15.30
11.80
5.60
3.01
12.82
8.43
3.00
0.84
12.85
10.58
3.00
4.33
19.44
13.81
3.46
4.00
58.80
41.50
13.50
9.17
Total Action Area 3
6.00
20.41
25.09
30.76
40.71
122.97
2.20
1.52
2.20
2.05
2.20
2.84
2.20
2.84
2.20
2.95
11.00
12.20
3.72
4.25
5.04
5.04
5.15
23.20
134.21
224.87
192.99
190.07
213.46
955.60
Action Area 4: Increasing Workforce Capacity
Mental Health Workforce Programme
Aboriginal Mental Health Workforce Programme
113.80
15.30
11.00
12.20
Total Action Area 4
23.20
0.00
Other new mental health funding allocations relevant to COAG Action Plan objectives
Total Other initiatives relevant to Action Plan
Total funding commitments/allocations
938.90
39.10
Notes to New South Wales Government table:
a.
Enhancements to funding announced by the New South Wales Government after submission of data for this report may not be included in the amounts reported in the column titled
‘Subsequent additional mental health funding commitments.’ Where applicable, these will be incorporated in future reports.
COAG National Action Plan on Mental Health - Progress Report 2010-11
83
Victoria
$MILLIONS
Action Plan Subsequent Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Action Area 1: Promotion, Prevention and Early Intervention
Expanding early psychosis programs
16.90
9.97
2.84
Expanding conduct disorder programs
8.40
2.19
1.39
Support for children of parents with a mental illness
2.40
2.46
0.35
Postnatal depression support services
4.90
0.65
New Centre for Women's Mental Health
1.10
0.19
Expanding counselling in community health services
2.60
0.50
Expanding primary prevention and promotion programs
Mental Health Research
National Perinatal screening and support for mothers
Funding
allocated
2008-09
Funding
allocated
2009-10
5.01
1.58
0.47
0.93
0.20
0.51
5.87
1.67
1.28
0.96
0.22
0.52
6.02
2.47
1.32
0.98
0.22
0.53
6.17
2.86
1.35
1.00
0.27
0.55
25.91
9.97
4.77
4.52
1.10
2.61
7.20
8.00
7.20
7.20
7.20
0.39
1.66
1.66
36.00
8.00
3.71
1.74
4.56
6.30
0.74
0.74
26.36
103.62
17.75
1.88
65.50
8.54
5.40
22.89
8.92
17.97
4.38
15.29
3.64
20.21
5.46
19.63
42.27
17.40
59.53
10.47
36.00
8.00
n.a.
3.70
Youth early intervention teams
n.a.
6.45
Youth suicide prevention community support program
n.a
0.86
80.30
25.63
13.11
23.90
18.11
22.14
47.30
18.97
8.12
10.33
13.84
15.46
1.50
1.54
1.79
1.83
Total Action Area 1
Action Area 2: Integrating and Improving the Care System
Expand child and adolescent, adult and aged specialist
community services
Expanding dual diagnosis services
Expansion of mental health teams in Hospital Emergency
Departments
Supporting transition to the community for long term residents
of extended care facilities
Expanding capacity in bed-based Forensic Mental Health
Services
Additional step up/down PARC Sub-acute Places
Hospital Demand Management
Increasing the acute mental health bed capacity
Improving triage practice
84
7.20
Funding
allocated
2007-08
8.90
15.60
8.31
2.98
4.02
5.18
5.31
6.60
14.90
0.66
1.30
1.33
5.76
2.59
4.12
4.22
4.32
1.19
3.32
7.59
0.54
4.22
3.40
8.38
0.55
6.65
3.48
10.59
0.56
14.92
3.56
12.76
3.36
21.10
25.10
17.40
39.90
2.80
29.74
19.87
8.69
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
COAG National Action Plan on Mental Health - Progress Report 2010-11
$MILLIONS
Action Plan Subsequent Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Building better mental health facilities - Heidelberg,
Shepparton, Bouverie Centre relocation
Cost growth in forward estimates over the 5 years of the Plan
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
20.50
18.00
4.57
12.50
7.80
8.20
79.60
4.67
15.12
15.49
17.08
17.99
Building better mental health facilities - Northern Hospital,
Deer Park, Preston & Broadmeadows, Heidelberg, Ringwood,
Monash, Frankston, Ballarat
n.a.
128.00
1.50
5.25
23.85
17.90
Improving access to mental health residential beds
n.a.
2.27
0.05
0.45
0.46
0.75
13.64
7.50
6.50
0.06
0.59
0.06
Improving services
n.a.
7.50
Enhanced support for carers
Expanding services to drought affected areas
n.a.
n.a.
0.24
0.59
24/7 mental health information and referral service
n.a.
7.69
Eating Disorders
n.a.
1.85
Mental Health Act Reform
n.a.
0.46
0.60
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
1.00
18.44
34.07
84.12
81.00
129.50
0.80
2.51
4.90
4.88
37.42
0.06
0.06
0.24
0.59
2.56
2.63
5.19
0.63
1.85
0.26
0.26
0.62
Total Action Area 2
284.80
271.75
63.37
Action Area 3: Participation in Community and Employment, including Accommodation
Growing Psychiatric Disability Rehabilitation Support Services
38.60
9.69
7.20
79.70
103.99
120.26
192.63
559.95
7.93
8.13
11.32
12.17
46.75
Expanding Community Care Units
7.50
0.91
1.46
1.51
1.54
1.56
6.98
Supported Accommodation for vulnerable people
Homelessness and mental health initiatives
40.40
8.00
11.00
5.77
7.35
2.23
7.35
0.43
7.35
0.94
7.35
0.86
40.40
10.23
Cost growth in forward estimates over the 5 years of the Plan
8.20
1.59
1.63
1.67
1.71
1.75
8.35
0.21
0.22
0.43
26.47
20.60
19.09
23.07
23.91
113.14
Reducing inequalities in Aboriginal mental health
Total Action Area 3
2.23
n.a.
0.43
102.70
12.35
COAG National Action Plan on Mental Health - Progress Report 2010-11
85
$MILLIONS
Action Plan Subsequent Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Action Area 4: Increasing Workforce Capacity
Enhancing workforce capacity
4.40
4.22
Service systems through planning and governance
n.a.
2.03
Department of Education and Early Childhood Development
n.a.
0.71
Total Action Area 4
4.40
6.96
Other new mental health funding allocations relevant to COAG Action Plan objectives
Total Other initiatives relevant to Action Plan
Total funding commitments/allocations
472.20
316.69
0.84
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
0.86
0.88
1.80
2.49
6.87
0.71
1.03
1.74
0.71
0.71
0.84
0.86
0.88
2.51
4.23
9.32
103.79
125.06
142.07
167.98
247.13
786.03
Notes to Victorian government table: Nil.
86
COAG National Action Plan on Mental Health - Progress Report 2010-11
Queensland
$MILLIONS
Action Plan Subsequent Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Action Area 1: Promotion, Prevention and Early Intervention
Early Years Service Centres
Prevention strategies in schools (reprioritising budget to
allow development)
Dual Diagnosis Positions
Transcultural Mental Health Workforce
Qld Centre for Promotion, Prevention & Early Intervention
(PPEI)
Innovative technologies in PPEI
Cross-sectoral strategies to reduce suicide risk
Perinatal & infant mental health hub
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
1.02
1.29
1.29
1.300
4.900
0.29
0.24
0.22
0.24
0.24
0.240
0.800
1.200
0.909
0.091
0.532
0.177
1.365
0.137
0.800
0.266
1.322
0.133
0.774
0.258
1.375
0.138
0.806
0.268
4.970
0.500
2.912
0.970
1.223
1.223
0.53
3.26
4.32
4.02
5.35
17.48
0.08
0.24
9.23
11.60
18.00
1.62
1.30
3.60
1.36
1.70
4.50
11.50
0.43
0.24
8.37
11.60
18.00
2.10
0.70
4.59
1.66
1.50
9.00
8.20
0.43
0.24
0.43
0.24
0.43
0.24
0.00
11.60
26.16
1.35
0.70
5.99
1.90
1.50
1.30
1.80
1.20
17.60
58.00
114.50
7.61
4.10
25.35
8.60
7.70
17.50
19.70
4.90
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
0.00
0.80
1.20
n.a.
n.a.
n.a.
n.a.
0.29
0.24
4.97
0.50
2.91
0.97
Stigma reduction strategy
n.a.
1.22
Total Action Area 1
Action Area 2: Integrating and Improving the Care System
Blueprint for the Bush Service Delivery Hubs
Indigenous Domestic and Family Violence Counselling
Child Safety Therapeutic and Behaviour Support Services
Health Action Plan - Existing Service Pressures
Community Mental Health Services – Enhancement
Dual Diagnosis Positions
Mental Health Intervention Teams
Forensic Mental Health Services
Transcultural Mental Health Positions
Area Clinical Mental Health Networks
Alternatives to Admission
Responding to Homelessness
6.90
10.58
1.80
1.20
17.60
58.00
114.50
4.70
4.10
14.80
6.80
7.70
17.50
19.70
COAG National Action Plan on Mental Health - Progress Report 2010-11
2.92
10.55
1.80
11.60
26.17
1.16
0.70
5.31
1.78
1.50
1.40
11.60
26.17
1.38
0.70
5.87
1.91
1.50
1.30
a
b
87
$MILLIONS
Mental Health Services in Prisons
Mental Health Capital
Primary care liaison coordinators
Implementation of "Partners in Mind"
Consumers Consultants
Child and Youth Mental Health Services
Adult Community Mental Health Services
Older Person's Community Mental Health Services
Mobile Intensive Treatment Services
Extended Hours Acute Care
Consultation Liaison
Centre for Rural and Remote
ATSI Mental Health
Administrative support staff
District leaders, supervisors and quality & safety staff
Intellectual disability & mental health
Eating Disorders
Sensory impairment and mental health
Implementation of Butler recommendations
Total Action Area 2
Action Plan Subsequent Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
8.60
2.38
12.00
204.36
12.00
n.a.
3.24
n.a.
1.42
n.a.
2.97
n.a.
37.66
n.a.
9.44
n.a.
18.70
n.a.
11.55
n.a.
27.59
n.a.
9.63
n.a.
2.36
n.a.
5.15
n.a.
5.70
n.a.
15.32
n.a.
0.97
n.a.
2.71
n.a.
1.12
n.a.
53.51
289.00
428.66
79.11
Action Area 3: Participation in the Community and Employment, including Accommodation
Housing Capital
20.00
40.00
20.00
Health Action Plan Non-Government Organisation Funding
25.00
5.00
Disability Services Respite and Sector Capacity Building
12.00
2.40
Employment and Training
5.00
1.00
Mental Health Services in Prisons
2.20
2.20
DSQ - NGO personal support & accommodation
n.a.
35.34
DSQ- Personal support in social housing
n.a.
28.54
88
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
2.38
13.69
0.53
0.23
0.49
6.19
1.55
3.08
1.90
4.52
1.58
0.32
0.85
0.85
2.52
0.16
0.45
0.18
1.28
25.05
0.75
0.33
0.69
8.73
2.19
4.33
2.68
6.37
2.23
0.66
1.19
1.47
3.55
0.22
0.63
0.26
1.28
43.77
0.99
0.43
0.91
11.52
2.89
5.72
3.53
8.40
2.95
0.68
1.58
1.76
4.69
0.30
0.83
0.34
1.28
121.86
0.96
0.42
0.88
11.22
2.81
5.57
3.44
8.30
2.87
0.71
1.53
1.61
4.56
0.29
0.81
0.33
8.60
216.36
3.24
1.42
2.97
37.66
9.44
18.70
11.55
27.59
9.63
2.36
5.15
5.70
15.32
0.97
2.71
1.12
13.01
12.96
13.58
13.96
53.51
120.86
125.86
157.23
234.59
717.65
10.00
5.00
2.40
1.00
10.00
5.00
2.40
1.00
10.00
5.00
2.40
1.00
10.00
5.00
2.40
1.00
6.12
2.43
10.20
6.13
10.58
8.23
8.44
11.75
60.00
25.00
12.00
5.00
2.20
35.34
28.54
COAG National Action Plan on Mental Health - Progress Report 2010-11
$MILLIONS
DSQ- Early intervention for young people
Total Action Area 3
Action Area 4: Increasing Workforce Capacity
Increased Workforce Remuneration
Mental Health Transition to Practice Nurse Education
Programme
Workforce development & research
Growth funding
Information management
Total Action Area 4
Action Plan Subsequent Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
n.a.
4.34
64.20
108.22
5.80
0.30
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
2.17
2.17
4.34
30.60
26.95
34.73
39.38
40.76
172.42
1.16
1.16
1.16
1.16
1.16
5.80
1.57
4.00
10.21
2.46
13.00
4.96
3.15
13.00
2.41
0.82
13.00
2.18
0.30
8.00
43.00
19.76
16.94
21.58
19.72
17.15
76.86
1.40
1.64
1.71
4.75
1.40
1.64
1.71
4.75
187.89
221.99
299.57
989.15
0.30
n.a.
n.a.
n.a.
8.00
43.00
19.76
6.10
70.76
1.46
Other new mental health funding allocations relevant to COAG Action Plan objectives
Care Coordination
n.a.
4.75
Total Other initiatives relevant to Action Plan
Total funding commitments/allocations
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
0.00
4.75
366.40
622.96
111.70
168.01
c
Notes to Queensland government table:
a.
b.
c.
Funding of $2.4m for Blueprint for the Bush Service Delivery Hubs was committed in 2007/08.
Funding of $9.23 and $11.2 for Child Safety Therapeutic and Behaviour Support Services were committed in 2006/07 and 2007/08 respectively.
DSQ - Early intervention for young people: A total of 6.5m was committed in the Queensland 2009-10 State Budget over the 3 years 2009-10 to 2011-12.
COAG National Action Plan on Mental Health - Progress Report 2010-11
89
Western Australia
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Action Area 1: Promotion, Prevention and Early Intervention
Multi-systemic Therapy for Adolescents
10.50
2.31
1.91
Post-natal depression services
2.00
2.87
0.72
Assertive case management systems
45.20
-0.56
6.31
Homeless clinical services
1.00
17.31
Intensive community youth services
2.00
3.67
0.98
Promoting mental health
n.a.
7.51
0.75
Development of the WA Suicide Prevention Strategy
n.a.
13.00
Total Action Area 1
Action Area 2: Integrating and Improving the Care System
ED mental health liaison nurses and on-duty registrars
Acute observation ED Beds
Rural and Remote medical cover
Increase in Acute Inpatient Facilities
Hospital demand management
Specialist services
Specialist Statewide Aboriginal Mental Health Services
(Closing the Gap)
Interagency collaboration
Funding
allocated
2008-09
Funding
allocated
2009-10
Funding
allocated
2010-11
1.99
0.75
7.80
1.01
0.85
2.07
0.78
7.74
6.51
1.05
0.84
2.14
0.81
10.56
5.17
1.09
1.11
2.23
0.92
10.98
5.38
1.43
2.26
2.11
Other
Cumulative Note
Funding
funding
Allocated allocations
from
July 2006
(a)
b
2.44
12.78
0.95
4.93
6.36
49.75
0.00
17.05
0.40
5.97
1.90
7.71
2.11
60.70
46.10
10.66
12.40
19.00
20.88
25.31
12.04
100.30
24.50
20.10
9.00
n.a.
n.a.
n.a.
3.89
1.71
2.46
141.72
1.38
11.24
4.00
3.59
1.73
18.08
4.51
2.61
1.91
30.25
4.69
2.90
1.98
24.35
0.44
1.98
4.85
2.57
2.05
22.61
0.46
1.95
5.04
2.67
2.13
32.63
0.48
4.67
5.24
2.92
1.63
12.65
0.00
0.00
28.33
17.26
11.44
140.56
1.38
10.14
1.53
n.a
2.36
0.50
n.a
Total Action Area 2
53.60
162.41
27.40
Action Area 3: Participation in the Community and Employment, including Accommodation
Intermediate care units
25.00
0.74
3.07
Day treatment programme
29.00
1.15
4.41
Supported community residential units
27.20
20.29
6.30
Licensed psychiatric support expansion
10.00
-2.34
1.03
NGO Psychosocial Support Expansion
10.00
-3.32
1.03
90
Funding
allocated
2007-08
c
2.36
0.50
40.81
36.35
34.49
50.49
22.44
211.97
2.73
5.35
7.86
1.09
1.09
2.84
5.44
13.33
1.37
1.14
1.90
5.63
9.34
1.43
1.21
1.95
5.86
8.63
1.64
1.28
0.40
3.41
0.89
1.98
1.00
12.89
30.09
46.34
8.54
6.75
COAG National Action Plan on Mental Health - Progress Report 2010-11
c
$MILLIONS
Clinical rehabilitation teams
Community options
Capacity Building NGOs
Total Action Area 3
Action Area 4: Increasing Workforce Capacity
Workforce and Safety Initiatives
Workforce development and expansion
Standards and implementation monitoring
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
28.20
21.13
0.19
n.a.
14.85
0.32
n.a
2.46
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
Funding
allocated
2010-11
0.73
1.88
1.97
1.71
1.64
3.21
1.71
3.60
2.46
129.40
10.23
16.35
20.74
27.80
24.36
27.12
2.30
5.50
1.00
2.30
-2.59
12.97
1.46
1.65
1.30
1.30
0.26
1.25
3.49
0.54
3.27
0.39
1.00
1.50
2.66
Total Action Area 4
8.80
12.68
Other new mental health funding allocations relevant to COAG Action Plan objectives
Total Other initiatives relevant to Action Plan
4.41
2.82
7.29
2.89
2.66
Total funding commitments/allocations
58.82
252.50
231.43
Other
Cumulative Note
Funding
funding
Allocated allocations
from
July 2006
(a)
0.00
6.24
0.50
11.23
2.46
8.19
124.55
0.66
2.60
7.29
6.11
9.92
3.26
23.32
e
f
76.76
90.44
82.62
105.58
45.93
460.15
Notes to Western Australia government table:
a.
The reported WA cumulative funding allocation from July 2006 is greater than total funding allocated for 2006-07 to 2010-11, because, for some initiatives, expenditure prior to July 2006 was
included in the WA Individual Implementation Plan.
b.
Initiatives under WA Suicide Prevention Strategy include fast tracking the blueprint for community suicide prevention plans.
c.
The increased funding is related to the opening of the specialised mental health inpatient unit in Rockingham, funding provided through the Closing the Gap Specialist Statewide Aboriginal
Mental Health Services and other specialised mental health services.
COAG National Action Plan on Mental Health - Progress Report 2010-11
d
91
South Australia
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
0.28
5.52
2.31
0.28
9.92
2.71
0.28
10.94
2.70
0.28
7.23
2.80
1.39
36.57
11.13
0.49
0.50
0.99
Action Area 1: Promotion, Prevention and Early Intervention
Promoting mental health
1.11
Preventing mental illness by building resilience
29.60
Early intervention with young people
8.80
0.28
6.97
2.33
Perinatal Anti-Depression screening
n.a.
0.99
39.51
10.56
3.85
8.10
12.91
14.41
10.81
50.08
10.00
2.89
0.74
2.74
3.08
3.12
3.20
12.89
3.50
1.19
0.76
0.98
0.98
0.98
8.00
6.70
1.68
1.73
0.71
1.59
1.58
1.71
2.60
1.71
2.40
1.71
0.99
2.40
1.71
4.69
9.68
8.43
22.70
5.69
5.68
5.68
5.68
5.68
7.60
1.90
1.90
1.90
1.90
1.90
5.69
1.90
28.39
9.51
5.10
1.28
1.27
1.27
1.28
1.28
1.28
12.00
n.a.
1.90
12.00
0.38
0.38
0.38
0.38
6.38
12.00
1.90
n.a.
1.47
0.47
0.49
0.51
n.a.
1.84
0.57
0.60
n.a.
36.80
9.99
10.29
n.a.
11.95
0.43
0.52
Total Action Area 1
Action Area 2: Integrating and Improving the Care System
Shared care with general practitioners
Improving services to people with mental illness and drug
and alcohol issues
24 hour mental health access by telephone
Enhancing emergency department responses
Improving access to acute and community-based clinical
services
Increased services for people in country areas
Extra support for Aboriginal and Torres Strait Islander
people
Community support
New Model of Care
Provision of priority access to services for people with
chronic and complex needs
Smooth transition between the current system and the five
new tiers
Non-clinical community support funding to NGO's for people
with a mental illness
Establishment of 6 community mental health centres across
Adelaide over the next 4 years
92
0.28
2.96
0.61
5.95
0.38
1.47
0.68
1.84
10.57
36.80
11.00
11.95
COAG National Action Plan on Mental Health - Progress Report 2010-11
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Establishing a new 129 bed specialist mental health service
at Glenside
n.a.
57.14
Expansion and Upgrade of James Nash House Forensic
Unit
n.a.
1.31
Upgrade of Noarlunga Hospital Mental Health Unit
n.a
3.62
1.00
n.a.
1.60
n.a.
1.60
Total Action Area 4
1.00
3.20
Funding
allocated
2008-09
Funding
allocated
2009-10
1.40
4.10
13.64
0.31
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
38.00
57.14
1.00
1.31
0.55
2.42
0.65
3.62
33.73
45.73
79.44
207.99
0.31
0.25
3.83
6.17
3.09
4.26
7.22
10.68
0.56
9.99
7.35
17.90
0.26
0.54
0.80
1.00
1.60
0.38
0.39
0.41
0.42
1.60
1.00
0.38
0.65
0.95
1.22
4.20
29.87
32.54
47.85
71.08
98.82
280.17
Total Action Area 2
75.60
132.38
25.02
Action Area 3: Participation in the Community and Employment, including Accommodation
90 New intermediate care beds
n.a.
7.22
73 supported accommodation beds
n.a.
10.68
Total Action Area 3
Action Area 4: Increasing Workforce Capacity
Peer Support Workers
Eight mental health nurse practitioners in regional areas
Establishment of a team to provide outreach services to
young people experiencing their first episode of mental
illness
Funding
allocated
2007-08
24.06
17.90
1.00
Other new mental health funding allocations relevant to COAG Action Plan objectives
Total Other initiatives relevant to Action Plan
Total funding commitments/allocations
116.11
164.04
Notes to South Australia Government table: Nil
COAG National Action Plan on Mental Health - Progress Report 2010-11
93
Tasmania
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Action Area 1: Promotion, Prevention and Early Intervention
Kids in Mind Tasmania
One off funding for 2008 - 09
Funding under Suicide Prevention Strategy
PPEI Training
Total Action Area 1
Action Area 2: Integrating and Improving the Care System
Improved Alcohol and Drugs programmes
Secure Mental Health Unit
Improved access to acute psychiatric care, including
emergency, crisis, acute inpatient and community services
Improved youth health services (CAMHS)
Increased funding of $17 million of 5 years for Alcohol and
Drug Services, commencing in 2008 - 09 with $1.8 million
Increased funding of $1.5 per annum to increase bed
numbers at the Secure Mental Health Unit
Accreditation
2.00
n.a.
n.a.
n.a.
0.22
0.13
0.05
0.18
2.00
0.40
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
0.21
0.59
0.25
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
0.29
1.52
0.13
0.05
0.13
0.05
0.18
0.21
0.59
0.25
0.47
1.70
2.00
12.50
0.40
2.50
0.40
2.50
0.40
2.50
0.40
2.50
0.40
2.50
2.00
12.50
1.50
0.28
0.28
0.28
0.28
5.10
1.90
1.95
1.97
2.03
0.30
2.05
1.42
9.90
5.27
10.57
0.11
1.50
0.76
4.50
0.87
n.a.
11.00
1.80
3.50
n.a.
4.50
1.50
1.50
n.a.
Total Action Area 2
21.10
15.50
5.08
Action Area 3: Participation in the Community and Employment, including Accommodation
Additional accommodation for people with mental illness
6.30
1.40
Support to the non government sector to provide quality
5.00
0.57
services to people with mental illness
5.13
8.45
10.32
12.78
41.75
1.60
1.70
3.10
3.16
10.96
1.99
2.00
2.06
2.10
8.72
Total Action Area 3
Action Area 4: Increasing Workforce Capacity
Improve the working conditions and remuneration for
doctors and allied health professionals
94
11.30
1.97
3.59
3.70
5.16
5.26
19.68
8.60
1.72
1.72
1.72
1.72
1.72
8.60
COAG National Action Plan on Mental Health - Progress Report 2010-11
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Total Action Area 4
8.60
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
1.72
1.72
1.72
1.72
8.95
10.65
14.46
17.44
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
8.60
Other new mental health funding allocations relevant to COAG Action Plan objectives
Total Other initiatives relevant to Action Plan
Total funding commitments/allocations
43.00
15.90
20.22
71.72
Notes to Tasmanian government table: Nil
COAG National Action Plan on Mental Health - Progress Report 2010-11
95
Australian Capital Territory
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Action Area 1: Promotion, Prevention and Early Intervention
Perinatal and Infant Mental Health Services
Community Education
Children of Parents with a Mental Illness
Workplace Mental Health Promotion
Early Recovery Support
Mental Health Nurses in TCH Emergency Department
Transcultural MH Liaison
Womens & Childrens MH Promotion
Mental Illness Education ACT (MIEACT)
Belconnen Community Service Bungee
MH Training-teachers and emergency service workers
New Young Aboriginal and Torres Strait Islander Program
New Adult short term in home support
Total Action Area 1
Action Area 2: Integrating and Improving the Care System
Improving the General Health of People with a Mental
Illness
Increase Capacity for Carer and Consumer Participation in
Service Planning
Mental Health Legislation Review
Mental Health Services Plan
Intensive Treatment and Support Programme for People
with a Dual Disability
New Enhancement of older persons inpatient unit
Enhancement of Adult MH Inpatient Care
96
0.90
0.40
0.30
0.70
1.00
1.48
0.30
0.26
0.14
0.24
0.60
0.15
0.37
3.30
0.80
0.40
Funding
allocated
2008-09
Funding
allocated
2009-10
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
0.18
0.07
0.05
0.12
0.18
0.36
0.23
0.08
0.05
0.13
0.18
0.36
0.10
0.09
0.24
0.08
0.06
0.10
0.22
0.41
0.10
0.09
0.07
0.12
0.30
0.18
0.09
0.06
0.15
0.24
0.10
0.10
0.07
0.12
0.30
0.15
0.37
1.00
0.39
0.27
0.50
1.00
1.48
0.30
0.28
0.14
0.24
0.60
0.15
0.37
3.53
0.83
0.96
1.21
1.78
1.93
6.71
0.39
0.13
0.15
0.28
0.30
0.33
1.19
0.67
0.07
0.06
0.06
0.07
0.06
0.02
0.33
0.08
0.43
0.04
0.27
0.15
1.17
0.39
0.08
2.02
0.93
1.22
1.65
0.30
0.30
0.46
2.13
0.48
0.48
7.95
0.48
1.54
0.20
0.08
10.00
n.a.
0.18
0.07
0.05
0.00
0.18
0.35
Funding
allocated
2007-08
0.48
1.82
a
b
c
COAG National Action Plan on Mental Health - Progress Report 2010-11
$MILLIONS
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
0.01
0.01
0.64
0.01
0.32
0.12
0.64
0.08
1.34
0.35
1.92
0.13
0.15
0.15
0.02
0.05
0.14
1.14
0.11
10.01
0.88
0.29
0.58
n/a
0.16
0.03
0.05
0.14
0.03
2.42
0.20
11.67
1.37
2.21
0.71
0.15
0.31
0.05
0.10
0.28
0.03
Total Action Area 2
11.48
22.60
2.34
Action Area 3: Participation in the Community and Employment, including Accommodation
Youth Supported Accommodation
2.80
1.04
Adult 'Step-up Step-down' Supported Accommodation and
n.a.
3.97
Outreach
Mental health vocational enhancement
n.a.
0.32
Mental Health accommodation enhancement
n.a.
0.29
The Lodge Supported Accommodation
n.a.
0.24
Samaritan House Accommodation Support
n.a.
0.51
ACT Housing and Assistance Support Initiative (HASI)
n.a.
0.40
1.56
3.30
7.84
17.25
32.29
0.55
0.93
1.00
1.01
3.49
0.24
0.99
1.01
1.04
3.28
0.10
0.10
0.10
0.10
0.12
0.25
0.20
0.11
0.10
0.12
0.26
0.20
0.31
0.30
0.24
0.51
0.40
Total Action Area 3
0.79
2.78
2.84
0.64
1.24
1.32
1.36
5.18
0.14
0.17
0.18
0.17
0.15
0.17
0.16
0.18
0.63
0.69
Enhancement of community mental teams
Individual Advocacy Support
Adult Mental Health Facility
Secure Mental Health Facility
Mental Health Assessment Unit - Infrastructure
Youth Mental Health Facility
Community Sector Review
Community Sector Development MHCC
Womens' Centre for Health Matters - MH
Supported Hospital Exit Program (SHEP)
Forensic MH Liaison
New Family Support (respite)
Additional Medical Workforce Positions
Mental Health Community Sector Quality improvement and
sector development
Growth funding for clinical training
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
n.a.
2.42
n.a.
0.17
n.a.
21.20
n.a.
1.20
n.a.
2.01
n.a.
0.78
n.a.
0.15
n.a.
0.32
n.a.
0.05
n.a.
0.10
n.a.
0.36
0.03
2.80
6.77
3.10
1.98
n.a.
n.a.
COAG National Action Plan on Mental Health - Progress Report 2010-11
0.56
0.53
0.62
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
8.52
97
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
n.a.
0.31
n.a.
0.07
n.a.
2.00
n.a.
3.00
Update clinical database
Mental Health Consumer Scholarships
MHACT Psychology
MH Assessment Unit Staffing
Total Action Area 4
3.10
8.45
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
0.10
0.10
0.10
0.03
1.00
1.50
0.62
1.05
1.69
4.64
3.79
4.34
8.31
16.68
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
0.10
0.03
1.00
1.81
0.40
0.07
2.00
3.31
12.27
Other new mental health funding allocations relevant to COAG Action Plan objectives
Total Other initiatives relevant to Action Plan
Total funding commitments/allocations
20.68
41.35
26.66
59.78
Notes to ACT government table:
a.
The funding for this allocation in 2010-11 was absorbed within the allocated funding for the Mental Health Assessment Unit within the Emergency Department at The Canberra Hospital.
b.
2007-08 Enhancement for Older Persons MH Inpatient Unit – did not proceed due to staff recruitment and retention issues. The funds were redistributed within Calvary Hospital to other health
priorities. Funds allocated for all outyears at 0, therefore this has been deleted from the Action Plan Funding. In 2010-11 this enhancement is being progressively implemented through other
funding sources.
c.
Adult Mental Health Unit facility was completed during 2011-12 and was operational April 2012 with the original commitment of $21.2 million fully expended..
98
COAG National Action Plan on Mental Health - Progress Report 2010-11
Northern Territory
$MILLIONS
Action Plan Subsequent
Funding
funding
additional
allocated
commitment mental health 2006-07
2006-2011
funding
commitments
2006-2011
Action Area 1: Promotion, Prevention and Early Intervention
Suicide Prevention and early intervention
1.00
Funding
allocated
2007-08
Funding
allocated
2008-09
Funding
allocated
2009-10
Funding Cumulative Note
allocated
funding
2010-11 allocations
from
July 2006
1.04
0.47
0.76
0.81
0.74
0.66
3.44
1.04
0.47
0.76
0.81
0.74
0.66
3.44
0.75
0.80
0.45
0.82
0.86
0.77
0.85
0.96
0.85
0.89
0.99
0.88
0.78
1.21
0.92
4.09
4.82
3.87
0.05
0.21
Total Action Area 1
Action Area 2: Integrating and Improving the Care System
Sub-acute Beds
Rural and Remote Services
Prison In-reach Services
1.00
Mental health Act amendments and materials
n.a.
0.16
Secure Care
n.a.
3.50
5.50
4.00
3.50
0.16
1.12
1.72
2.84
Total Action Area 2
13.00
3.66
2.00
Action Area 3: Participation in the Community and Employment, including Accommodation
Rehabilitation and Recovery Services
0.50
1.09
0.39
2.45
2.82
3.88
4.68
15.83
Total Action Area 3
Action Area 4: Increasing Workforce Capacity
Workforce development
Total Action Area 4
0.59
0.61
0.54
0.26
2.39
0.50
1.09
0.39
0.59
0.61
0.54
0.26
2.39
n.a.
0.10
0.04
0.04
0.05
0.08
0.19
0.40
0.00
0.10
0.04
0.04
0.05
0.08
0.19
0.40
2.90
3.84
4.29
5.24
5.79
22.06
a
Other new mental health funding allocations relevant to COAG Action Plan objectives
Total Other initiatives relevant to Action Plan
Total funding commitments/allocations
14.50
5.89
Notes to Northern Territory government table: Nil
a.
Capital construction costs for 1. Extensive refurbishment of Top End inpatient annex to meet requirements for 5 new beds ($1m). 2. Construction of new building annex to extend existing
Central Australian inpatient unit for 6 new specialist beds ($1.5m). 3. Service development staff and operational expenditure for new bed establishment ($0.34m). Construction is still
underway in Central Aust and will not be completed until late 2011-12 when balance of expenditure will be allocated.
COAG National Action Plan on Mental Health - Progress Report 2010-11
99
APPENDIX 2
Technical Notes
This section of the report presents explanatory notes for the
indicators and statistics presented in Chapter 3 of the report.
101
Indicator 1 – Prevalence of mental illness in the community
The 1997 estimates of mental illness prevalence for people aged 18 years and over are based
on the 1997 National Survey of Mental Health and Wellbeing, as published by the Australian
Bureau of Statistics. Estimates for children and young people in the age range 4-17 years are
based on a parallel survey of children and adolescents, conducted by the University of
Adelaide in 1998.
The 2007 estimates of mental illness prevalence are based on data from the 2007 National
Survey of Mental Health and Wellbeing 2007, released by the Australian Bureau of Statistics
in October 2008.
There were several methodological differences between the 1997 and 2007 National Survey
of Mental Health and Wellbeing (NSMHWB). These include:

The 1997 survey was focused on providing prevalence estimates of mental disorders over
a 12 month time frame but the 2007 survey was designed to provide lifetime estimates.
The estimates of 12 month prevalence of disorders derived from the two surveys are
therefore not strictly comparable.

The 1997 survey covered people in the age range 18 years and older; the 2007 survey
covered people aged 16 to 85 years.

The 1997 survey had a substantially higher response rate (78% compared with 60% in
2007).

Based on development work over the preceding decade, the 2007 survey used new and
different algorithms to derive diagnoses to those used in 1997.
Each of these factors could have impacted on the comparability of the findings. Further
detail on the differences between the surveys is provided in the recent (2008) publication by
the Australian Bureau of Statistics, who advise that caution is required when comparing data
from the two surveys.
It is important to note that the ‘all population’ prevalence estimates shown in Figure 10 (18%
for 1997, 20% for 2007) are based on the more common (‘high prevalence’) disorders that are
found in the population, primarily anxiety, depression and alcohol/drug related disorders.
These disorders are amenable to accurate enumeration in large-scale population surveys that
use lay interviewers. The estimates do not include a range of less prevalent conditions, such
as schizophrenia and other psychotic illnesses, eating disorders, personality disorders and a
number of other conditions. Collectively, these add 2-3% to the total number of Australians
affected by mental disorders. When these are added to the group of people affected by the
more common disorders, it is estimated that 20-22% of the total Australian adult population
are affected by one or more mental disorders in any given year.
Splits by severity levels shown in Figure 11 are based on population planning norms
published by New South Wales. New South Wales estimates are derived from extensive
definitional work and epidemiological studies completed in the United States, and incorporate
data gathered in the Australian National Survey of Mental Health and Wellbeing (1997). In
brief, severity is judged according to the type of disorder (diagnosis), the intensity of
symptoms, the length of time symptoms have been experienced (chronicity), and the degree
of disablement that is caused to the person’s functioning. This approach differs from the
102
COAG National Action Plan on Mental Health - Progress Report 2010-11
classification of severity used by the ABS in its analysis of the (NSMHWB) which is based
only the World Mental Health Survey Initiative severity measure.
Sources:
Australian Bureau of Statistics (1998), Mental Health and Wellbeing: Profile of Adults,
Australia 1997, ABS Cat. No. 4326.0. Commonwealth of Australia, Canberra.
Australian Bureau of Statistics (2007), National Survey of Mental Health and Wellbeing:
Summary of Results, ABS Cat. No. 4326.0. Commonwealth of Australia, Canberra.
Centre for Mental Health, Department of Health New South Wales (2001) Mental Health
Clinical Care and Prevention Model: A Population Mental Health Model
Sawyer M, Arney F, Baghurst P et al. (2000) The Mental Health of Young People in
Australia. Commonwealth of Australia, Canberra
Indicator 2 – Rate of suicide in the community
Source used for all data presented under this indicator:
Australian Bureau of Statistics (2013), Causes of Death 2011. ABS Cat. No. 3303.0.
Canberra, Australian Bureau of Statistics.
Indicator 3 – Rates of use of illicit drugs that contribute to mental illness in young people
Indicator 4 – Rates of substance abuse
Sources:
Australian Bureau of Statistics (2007), National Survey of Mental Health and Wellbeing:
Summary of Results, ABS Cat. No. 4326.0. Commonwealth of Australia, Canberra.
Australian Institute of Health and Welfare (2005). 2004 National Drug Strategy Household
Survey: First Results. AIHW cat. no. PHE 57. Canberra: AIHW (Drug Statistics Series
No. 13).
Australian Institute of Health and Welfare (2011). 2010 National Drug Strategy Household
Survey report. Drug Statistics Series no. 25 Cat. No. PHE 145. Canberra: AIHW.
National Drug and Alcohol Research Centre (2007), Illicit drug use in Australia:
Epidemiology, use patterns and associated harm. Second edition. NDARC.
COAG National Action Plan on Mental Health - Progress Report 2010-11
103
Indicator 5 – Percentage of people with a mental illness who receive mental health care
Estimates of health services used by adults with a mental disorder (Figure 16) are based on
Department of Health and Ageing analysis of the 1997 and 2007 National Surveys of Mental
Health and Wellbeing, as published by the Australian Bureau of Statistics.
As noted in the Technical Notes for indicator 1 (see 102), there were important differences
between the 1997 and 2007 surveys that warrant caution when comparing the findings.
These include differences in the way that information was collected from people on the type
and range of health professionals consulted for a mental health problem. These differences
could have impacted on the comparability of the service utilisation findings, but the extent to
which this is the case is unknown. A recent ABS Service Users Guide provides more details
on how the 2007 survey differed from the 1997 survey in the methodology used to gather
information about service utilisation.
Sources:
Australian Bureau of Statistics (1998), Mental Health and Wellbeing: Profile of Adults,
Australia 1997, ABS Cat. No. 4326.0. Commonwealth of Australia, Canberra.
Australian Bureau of Statistics (2007), National Survey of Mental Health and Wellbeing:
Summary of Results, ABS Cat. No. 4326.0. Commonwealth of Australia, Canberra.
Australian Bureau of Statistics (2009), National Survey of Mental Health and Wellbeing:
Users’ Guide, ABS Cat. No. 4327.0. Commonwealth of Australia, Canberra.
Pirkis J, Harris M, Hall W and Ftanou M (2011), Evaluation of the Better Access to
Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits
Schedule Initiative: Summative Evaluation. Department of Health and Ageing, Canberra.
Source data prepared by each jurisdiction and the Private Mental Health Alliance used for
Figure 19 and Figure 20 are presented below.
Table 12: Number of people receiving clinical mental health care, 2006-07 to 2010-11 a,b
State
Private
Community hospitals e
Mental Health
Services c, d
Medicare-funded mental health services f
Private
Psychiatrists g
New South Wales
Victoria
104
2006-07
108,169
6,566
89,966
General
Practitioners h
140,908
Clinical
Psychologists i
14,972
Allied
Health j
All MBS
funded
services k
40,615
222,627
2007-08
104,346
7,315
89,443
252,942
41,253
91,998
343,554
2008-09
108,106
7,709
91,030
313,837
57,528
118,416
412,947
2009-10
112,162
8,145
94,440
346,958
66,177
139,517
454,542
2010-11
115,090
8,255
97,854
396,331
76,431
157,185
505,019
2006-07
58,444
6,093
77,801
115,252
12,717
40,862
185,897
2007-08
57,197
6,224
76,179
203,602
32,172
91,798
284,190
2008-09
57,860
6,355
77,840
254,348
41,581
117,994
342,738
2009-10
59,080
6,544
79,089
288,441
51,034
137,127
382,115
2010-11
59,695
5,660
81,015
328,850
60,955
150,474
423,455
COAG National Action Plan on Mental Health - Progress Report 2010-11
State
Private
Community hospitals e
Mental Health
Services c, d
Queensland
Western Australia
South Australia
Tasmania
ACT
Northern Territory
Australia l
Medicare-funded mental health services f
Private
Psychiatrists g
General
Practitioners h
Clinical
Psychologists i
Allied
Health j
All MBS
funded
services k
2006-07
72,856
4,965
49,689
69,428
4,743
25,280
115,254
2007-08
75,541
4,789
49,269
131,805
15,376
56,987
181,940
2008-09
72,989
5,266
49,921
173,448
23,953
74,363
227,807
2009-10
72,670
5,392
51,168
200,050
30,255
88,663
258,056
2010-11
77,033
5,622
53,456
233,235
37,526
99,467
292,580
2006-07
37,787
2,168
20,953
33,622
8,373
5,099
52,876
2007-08
37,459
2,181
21,032
63,313
21,562
12,884
85,873
2008-09
39,518
2,630
22,244
79,808
27,127
17,968
105,202
2009-10
42,380
3,047
23,480
89,495
30,520
21,948
117,704
2010-11
44,493
3,255
24,279
101,033
32,158
26,514
129,870
2006-07
26,877
*
24,665
25,731
2,833
6,108
48,525
2007-08
27,626
*
24,749
49,498
10,947
13,644
73,257
2008-09
30,408
*
24,885
64,925
16,921
16,511
89,932
2009-10
30,790
*
25,686
74,385
20,911
19,485
101,222
2010-11
31,434
*
25,524
85,988
25,948
21,529
112,996
2006-07
8,492
*
4,778
8,482
1,417
2,676
12,799
2007-08
9,499
*
4,572
15,236
4,109
5,374
20,274
2008-09
9,362
*
4,863
18,414
5,669
5,965
24,217
2009-10
9,435
*
5,233
20,825
6,456
7,176
27,474
2010-11
10,052
*
5,243
24,045
6,793
9,075
30,892
2006-07
6,765
*
3,486
5,360
704
1,611
8,513
2007-08
6,800
*
3,483
9,958
2,136
4,159
13,778
2008-09
7,343
*
3,516
12,331
2,667
5,449
16,694
2009-10
7,637
*
3,715
13,640
3,291
6,149
18,451
2010-11
8,076
*
4,059
15,402
4,449
6,402
20,422
2006-07
4,770
n.a
751
1,584
118
320
2,259
2007-08
4,721
n.a
759
3,084
304
887
3,900
2008-09
5,008
n.a
768
4,130
394
1,223
5,041
2009-10
5,544
n.a
860
5,067
621
1,577
6,123
2010-11
5,817
n.a
864
5,636
749
1,675
6,756
2006-07
324,160
22,520
272,214
400,497
45,894
122,613
648,987
2007-08
323,189
23,155
269,609
729,675
127,905
277,843
1,007,117
2008-09
330,594
24,528
275,226
921,557
175,903
358,048
1,225,056
2009-10
339,698
25,536
283,844
1,039,270
209,347
421,861
1,366,285
2010-11
351,690
25,710
292,499
1,191,141
245,168
472,629
1,522,830
* Numbers suppressed to preserve hospital confidentiality
n.a No statistics are shown for the Northern Territory because there are no private hospitals with psychiatric beds
in that jurisdiction.
Notes to Table 12:
a.
Estimates are based on unique counts of individuals receiving care within the year,
within each service stream, where each individual is only counted once regardless of
the number of services received. The columns cannot be added to give a total count
across jurisdictions because people may be seen by more than one service stream. For
example, it is estimated that up to 95% of people treated in private hospital psychiatric
COAG National Action Plan on Mental Health - Progress Report 2010-11
105
units are also treated by Medicare-funded private psychiatrists. Additionally, most
people seen by clinical psychologists and allied health providers are included in the
counts of persons seen by GPs, because referral by a GP is necessary for these services
to be accepted by Medicare Australia for billing purposes. Options for developing
non-duplicated estimates of the number of people receiving mental health care across
all service streams will be explored for future years.
b.
Data submitted by all providers update the preliminary estimates presented in last
year’s COAG Progress Report for years prior to 2010-11.
c.
Person counts for state and territory mental health services are confined to those
receiving one or more contacts provided by ambulatory mental health services. This
approach was adopted to improve consistency across the service streams (particularly
for comparison of state and territory services and Australian Government-funded
Medicare mental health services) as well as picking up most people seen in state and
territory inpatient services. All service contacts are counted in defining whether a
person receives a service, including those delivered ‘on behalf’ of the consumer i.e.
where the consumer does not directly participate. This approach was taken to ensure
that the role of state and territory mental health services, in providing back up as
tertiary specialist services to other health providers, is recognised.
d.
State and territory jurisdictions differ in their capacity to provide accurate estimates of
persons receiving ambulatory mental health services due to the lack of unique patient
identifiers, or data matching systems, in some jurisdictions. Tasmania and South
Australia indicated that the data submitted was not based on unique patient identifier or
data matching approaches. Additionally, jurisdictions differ in their approaches to
counting clients receiving services. While most jurisdictions aim to record and count all
persons seen, some jurisdictions – Victoria in particular – only count the person once a
clinical decision has been made to accept the person for treatment or care. The
exclusion by these jurisdictions of persons who are seen but who do not progress to
treatment can contribute to significant under-estimation and reduces the utility of the
measure for use in comparing treatment rates across jurisdictions. Work is currently
underway to address this issue in the context of National Healthcare Agreement
indicators.
e.
Private hospital estimates are of unique counts of individuals receiving specialist
psychiatric care within the private hospital service stream, including both overnight and
sameday admitted patient care, using information submitted to the Private Mental
Health Alliance's Centralised Data Management Service (CDMS) by private hospitals
with psychiatric beds. Due to the fact that not all such hospitals submit data to the
CDMS (it is a voluntary collection) the statistics are estimates that include person
counts for both participating and non-participating private hospitals with psychiatric
beds. Services provided to patients with a principal psychiatric diagnosis by other
private hospitals (that is, those without designated psychiatric beds) are not included.
No statistics are shown for the Northern Territory because there are no private hospitals
with psychiatric beds in that jurisdiction. Data for jurisdictions marked by an asterisk
have been suppressed for confidentiality purposes.
f.
All Medicare funded data are based on year of processing (i.e. date on which a
Medicare claim was processed by Medicare Australia year), not when the service was
rendered. Data are as provided by the Australian Government Department of Health
and Ageing and based on billing data maintained by Medicare Australia. The use of
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COAG National Action Plan on Mental Health - Progress Report 2010-11
data based on when the claim was processed rather than when the service was rendered
provides little difference in the total number of persons included in the numerator term
for the reference period. A significant component of the data includes services
provided under the Australian Government Better Access to Mental Health Care
initiative, which commenced on 1 November 2006. MBS estimates for 2006-07 are
therefore part-year only for these services.
g.
Private psychiatrist data represents a unique count of people seen who received one or
more consultant psychiatrist attendance items billed to Medicare Australia.
h.
General practitioner data represents a unique count of people who received one or more
general practitioner attendance items, billed to Medicare Australia, that are mental
health specific. These include items under the Better Mental Health Outcomes
initiative for 2006-07, new items under the Better Access to Mental Health Care
initiative (available 1 November 2006 onwards) and a small number of other mental
health related items (Family Group Therapy). A small proportion of this latter group
may also be provided by other medical practitioners. The count does not include
people receiving GP-based mental health care that was billed as a general consultation.
i.
Clinical psychologist data represents a unique count of people who received one or
more clinical psychologist attendance items, billed to Medicare Australia, as introduced
under the Better Access to Mental Health Care initiative. These commenced in 1
November 2006.
j.
Allied health data represents a unique count of people who received one or more
attendance items provided by registered psychologists, social workers or occupational
therapists, billed to Medicare Australia, as introduced under the Better Access to Mental
Health Care initiative. The person count also includes a small number of services
provided by allied health professionals provided under the Enhanced Primary Care
Strategy.
k.
‘All MBS funded services’ provides a unique count of persons receiving one or more
services provided under any of the Medicare-funded service streams described at (g) to
(j). Persons seen by more than one provider stream are counted only once. Note
however that persons seen in more than one jurisdiction are counted in each jurisdiction
but only once in the national total. The sum of state and territory person counts for
each Medicare-funded service stream is therefore greater than the national total.
l.
Population rates presented as percentages in Figure 17 and Figure 18 are calculated
using ABS estimates of state and territory populations at December, based on the 2011
census.
COAG National Action Plan on Mental Health - Progress Report 2010-11
107
Indicator 6 – Mental health outcomes of people who receive treatment from state and
territory services and the private hospital system
Estimates of the number of episodes with complete outcome data for state and territory
mental health services are based on a revised analytic approach and cannot be reliably
compared with the data published in the 2009-10 COAG Annual Report.
Estimates of the estimated sample coverage for state and territory mental health services are
as provided by the Department of Health and Ageing.
Estimates of the number of episodes with complete outcome data and sample coverage for
private hospitals are based on information provided by the Private Mental Health Alliance,
using information submitted to the Centralised Data Management Service by private hospitals
with psychiatric beds.
Notes to Figure 19 and Figure 20:
a.
For the purpose of this indicator, assessment of clinical outcomes is based on the
changes reported in a consumer’s score on a rating scale known as the Health of the
Nation Outcomes Scale (HoNOS), or in the case of children and adolescent consumers,
the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA).
Developed originally in England in the 1990s, these ratings scales comprise 12 standard
items that are rated by a clinician to measure the severity of the consumer’s symptoms
or disability across a range of domains (for example, depressed mood, hallucinations,
substance use, suicidality, overactivity, activities of daily living, cognitive impairment).
The HoNOS/HoNOSCA form part of small suite of standardised rating scales used to
monitor outcomes across state and territory public sector mental health services and
private hospitals with a specialised psychiatric unit.
b.
Complex conceptual and technical issues are faced when using these standardised
outcomes scales to generate a summary picture of ‘average outcomes’ for consumers of
mental health services in Australia. A single score, ‘one size fits all’ approach does not
do justice to a complex service system in which services are delivered across multiple
settings (inpatient, community, residential) and provided as discrete, short term
episodes of care to some consumers but to others, over prolonged, indefinite periods.
The measures themselves are imperfect and relatively crude instruments that, while
useful for some purposes, have restrictions. Foremost amongst these is the fact that
they only tell part of the story about outcomes, from the clinician’s perspective. The
approach used in this report to present a summary picture from the HoNOS/HoNOSCA
data represents ‘work in progress’ and involves a series of compromises. It is likely
that, with increasing experience, new approaches will evolve for use in monitoring
consumer outcomes.
c.
Figure 19 summarises mental health outcomes at the national level for four different
cohorts of consumers, all based on the most current data available (2009-10).

Group A: People in ongoing community care (State and territory mental health
services)
This group covers people receiving relatively long term community care from a
state/territory mental health service. It includes people who were receiving care for
the whole of 2010-11, and those who commenced community care sometime after
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COAG National Action Plan on Mental Health - Progress Report 2010-11
1 July 2010 who continued under care for the rest of the year. The defining
characteristic of the group is that all remained in ongoing care when the year ended
(30 June 2011). Outcome scores were calculated as the difference between the total
HoNOS/HoNOSCA score recorded on the first occasion rated and the last occasion
rated in the year.

Group B: People discharged from community care (State and territory mental
health services)
This group covers people who received relatively short term community care from a
state/territory mental health service during the 2010-11 year. The defining
characteristic of the group is that the episode of community care commenced, and
was completed, within the year. Outcome scores were calculated as the difference
between the total HoNOS/HoNOSCA score recorded at admission to, and
discharge, from community care. A subgroup of people whose episode of
community care completed because they were admitted to hospital is not included
in this analysis.

Group C: People discharged from hospital (State and territory mental health
services)
This group covers people who received a discrete episode of inpatient care within a
state/territory designated psychiatric inpatient unit during the 2010-11 year. The
defining characteristic of the group is that the episode of inpatient care commenced,
and was completed, within the year. Outcome scores were calculated as the
difference between the total HoNOS/HoNOSCA score recorded at admission and
discharge. The analysis excludes episodes where length of stay was less than
3 days because it is not meaningful to compare HoNOS/HoNOSCA admission and
discharge ratings for short duration episodes.

Group D: People discharged from hospital (Private hospital psychiatric units)
This group covers all separations of people discharged from private hospital
psychiatric units that occurred in the period 1 July 2010 – 30 June 2011, where the
length of stay was 3 days or more. Outcome scores for this group were calculated as
the difference between the total HoNOS/HoNOSCA score recorded at admission
and discharge.
d.
For all 4 groups, outcome scores for each episode was then classified as either
‘significant improvement’, ‘significant deterioration or ‘no significant change’, based
on Effect Size. Effect size is a statistic used to assess the magnitude of a treatment
effect. It is based on the ratio of the difference between pre- and post- scores to the
standard deviation of the pre- score. As a rule of thumb, effect sizes of 0.2 are
considered small, 0.5 considered medium and 0.8 considered large. Based on this rule,
a medium effect size of 0.5 was used to assign outcome scores to the three outcome
categories. Thus individual episodes were classified as either: ‘significant
improvement’ if the Effect Size index was greater than or equal to positive 0.5;
‘significant deterioration’ if the Effect Size index was less than or equal to negative 0.5;
or ‘no change’ if the index was between -0.5 and 0.5.
e.
Figure 20 takes the same approach but presents the data for consumers of state and
territory mental health consumers for each jurisdiction. As noted in the main body of
COAG National Action Plan on Mental Health - Progress Report 2010-11
109
this report, caution is required in interpreting differences between jurisdictions because
the data are of variable quality, and with different levels of coverage, and therefore
subject to variable measurement error. For some jurisdictions, the number of
observations of consumer outcomes for some care types is too low to publish because
conclusions based on such low numbers are known to have high levels of unreliability.
For the purposes of this report, the threshold for the minimum number of observations
to be reached was set at 200. This is the working standard that has been in place for
many years in the development of casemix classifications in Australia, particularly the
AR-DRG system. Under the AR-DRG standards, a minimum of 200 observations per
year of a particular episode type is required to justify the creation of a new class.
f.
The data analyses presented in this report were provided by the following:

State and territory data – analysis conducted by the Australian Mental Health
Outcomes and Classification Network (AMHCON), using data submitted by states
and territories to the Australian Government Department of Health and Ageing. To
be considered valid, HoNOS/HoNOSCA data needs to be completed correctly (a
specified minimum number of items completed) and have a ‘matching pair’ – that
is, a beginning and end rating are needed to enable an outcome score to be
determined. It is not possible to accurately estimate the sample coverage of valid
data in the public sector but estimates made by the Department of Health and
Ageing suggest that valid outcomes data were available in 2010-11 for 34% of
potential inpatient episodes and 23% of community care episodes. Estimates of
coverage for each jurisdiction vary widely and are provided in Table 13 below.

Private hospital data – analysis conducted by the Private Mental Health Alliance's
Centralised Data Management Service using data submitted by private hospitals
with psychiatric beds. The same data validity requirements were applied as
described above for state and territory data. Valid data for private hospitals in
2010-11 covered 80% of in scope inpatient episodes, substantially higher then state
and territory services.
Table 13 summarises the number of observations on which the outcomes indicator
is based for each jurisdiction or sector, and the estimated sample coverage.
Estimated sample coverage refers to the percentage of total episodes for which there
were valid and complete data – that is, episodes that have a valid beginning and an
end HoNOS rating.
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COAG National Action Plan on Mental Health - Progress Report 2010-11
Table 13: Number of episodes with complete outcome data and estimated sample coverage for
state and territory mental health services and private hospital psychiatric units, 2010-11
GROUP A: People
in ongoing
community care *
GROUP B: People
discharged from
community care *
GROUP C/D: People
discharged from
hospital *
Number of episodes
Estimated coverage
Victoria
6,020
2,309
5,937
19%
6%
27%
Number of episodes
Estimated coverage
8,165
10,243
8,249
35%
55%
53%
Queensland
Number of episodes
Estimated coverage
7,146
3,537
2,515
37%
12%
20%
Western Australia
Number of episodes
Estimated coverage
4,453
1,351
3,236
45%
10%
42%
South Australia
Number of episodes
Estimated coverage
3,150
1,473
2,288
39%
14%
37%
Tasmania
Number of episodes
Estimated coverage
703
583
443
32%
25%
27%
ACT
Number of episodes
Estimated coverage
466
-
87
14%
-
9%
New South Wales
Northern Territory
Number of episodes
Estimated coverage
National total for states
and territories
Number of episodes
Estimated coverage
Private hospital psychiatric units
Number of episodes
Estimated coverage
354
50
200
39%
3%
32%
30,457
19,546
22,955
31%
16%
34%
n.a
n.a
20,194
80%
* Estimates of coverage for state and territory services are crude and made by Department of Health and Ageing based
on available data. Estimates for private hospitals are based on more accurate data and provided by the Private Mental
Health Alliance’s Centralised Data Management Service.
COAG National Action Plan on Mental Health - Progress Report 2010-11
111
Indicator 7 – Rates of community follow up for people within the first seven days of
discharge from hospital
Estimates shown for Indicator 7 (see Figure 21, page 31) are based on source data submitted
by jurisdictions, as shown below. Averages shown in Figure 21 are unweighted.
Total number of admitted patient overnight separations from the
state/territory acute psychiatric inpatient services occurring within the reference period
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
2005-06
24,891
11,986
14,326
6,375
5,352
2,617
1,136
1,158
2006-07
26,656
12,577
13,534
6,141
5,316
2,381
1,100
1,045
2007-08
27,103
13,306
13,600
5,705
5,489
2,116
1,148
980
2008-09
27,035
13,428
14,147
6,022
5,373
2,121
1,233
924
2009-10
26,403
13,672
14,061
6,197
5,463
2,011
1,184
863
2010-11
26,932
14,291
14,634
6,924
5,805
1,747
1,185
878
2009-10
11,864
9,170
6,417
3,689
2,276
584
873
148
2010-11
12,811
10,257
7,696
4,074
2,640
765
932
171
Total number of admitted patient overnight separations for which a community
mental health contact was recorded in the seven days immediately following separation
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
2005-06
10,695
7,502
6,488
3,136
1,611
n.a
769
150
2006-07
11,539
7,806
6,833
3,164
1,499
n.a
759
196
2007-08
10,856
8,387
7,094
3,059
1,897
433
827
191
2008-09
11,078
8,734
6,228
3,442
2,194
461
901
165
Notes to Indicator 7:
a.
Specifications for this indicator were revised for the current report to align with
specifications for the nationally agreed key performance indicators for public mental
health services.1 Specifically, the revised indicator focuses on follow up care for people
discharged from acute psychiatric units only, rather than discharges from all psychiatric
units. To align the indicator with the national specifications, revised data for all years
were re-submitted by all states and territories.
b.
Based on all ‘in scope’ separations from state and territory psychiatric acute inpatient
units, where ‘in scope’ is defined as those separations for which it is meaningful to
examine community follow-up rates. The following separations were excluded: same
day separations; overnight separations that occur through discharge/transfer to another
hospital; statistical discharge – type change; left against medical advice/discharge at
own risk and death
c.
Data for all years reflect full year activity – that is, all in scope separations from public
sector acute psychiatric units between the period 1 July and 30 June for each financial
year are included.
d.
Community mental health contacts counted for determining whether follow-up
occurred are restricted to those in which the consumer participated. These may be faceto-face or ‘indirect’ (e.g., by telephone), but not contacts delivered ‘on behalf of the
client’ in which they did not participate (Exception: Northern Territory includes all
1
AHMAC Mental Health Standing Committee (2011) Key Performance Indicators for Australian Public
Mental Health Services. Second Edition. Mental Health Information Strategy Sub Committee Discussion Paper
No.8, Commonwealth of Australia, Canberra.
112
COAG National Action Plan on Mental Health - Progress Report 2010-11
contacts, but advised that the impact on the indicator is believed to be marginal).
Contacts made on the day of discharge are also excluded.
e.
Only community mental health contacts made by state and territory public mental
health services are included. Where responsibility for clinical follow-up is managed
outside the state/territory mental health system (e.g., by private psychiatrists, general
practitioners), these contacts are not included.
f.
States and territories vary in their capacity to accurately track post-discharge follow up
between hospital and community service organisations, due to the lack of unique
patient identifiers or data matching systems. Two jurisdictions –Tasmania and South
Australia - indicated that the data submitted were not based on unique patient identifier
or data matching approaches. This factor can contribute to an appearance of lower
follow-up rates for these jurisdictions.
COAG National Action Plan on Mental Health - Progress Report 2010-11
113
Indicator 8 – Readmissions to hospital within 28 days of discharge
Estimates for Indicator 8 (see Figure 22, page 33) are based on source data submitted by
jurisdictions, as shown below. Averages shown in Figure 22 are unweighted.
Total number of admitted patient overnight separations from the
state/territory acute psychiatric inpatient services occurring within the reference period
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
2005-06
25,087
11,986
14,326
6,375
5,352
2,617
1,136
1,158
2006-07
26,767
12,577
13,534
6,141
5,316
2,381
1,100
1,045
2007-08
27,202
13,306
13,600
5,705
5,489
2,116
1,148
980
2008-09
27,101
13,428
14,147
6,022
5,373
2,121
1,233
924
2009-10
26,447
13,672
14,061
6,197
5,463
2,011
1,184
863
2010-11
27,083
14,291
14,634
6,924
5,805
1,747
1,185
878
2009-10
4,094
2,038
2,092
749
457
316
51
75
2010-11
4,274
2,143
2,391
899
518
263
63
105
Total number of acute admitted patient overnight separations that were followed by a
readmission to a state/territory acute psychiatric inpatient service within 28 days of discharge
NSW
Vic
Qld
WA
SA
Tas
ACT
NT
2005-06
4,057
1,707
2,754
760
629
334
152
132
2006-07
4,526
1,862
2,230
719
484
325
123
126
2007-08
4,716
1,969
2,176
700
605
353
114
117
2008-09
4,344
1,995
2,291
730
503
302
68
88
Notes to Indicator 8:
a.
Specifications for this indicator were revised for the current report to align with
specifications for the nationally agreed key performance indicators for public mental
health services. Specifically, the revised indicator focuses on readmissions of people
discharged from acute psychiatric units only, rather than discharges from, and
readmissions to, all psychiatric units. To align the indicator with the national
specifications, revised data for all years were re-submitted by all states and territories.
b.
Based on all ‘in scope’ separations from state and territory psychiatric inpatient units,
defined as those for which it is meaningful to examine readmission rates. The
following separations were excluded: same day separations; overnight separations that
occur through discharge/transfer to another hospital; statistical discharge – type change;
left against medical advice/discharge at own risk and death.
c.
Data for all years reflect full year activity – that is, all in scope separations from public
sector acute psychiatric units between the period 1 July and 30 June for each financial
year are included.
d.
For the purposes of this indicator, a readmission for any of the separations identified as
‘in-scope’ is defined as an admission to any another public acute psychiatric unit within
the jurisdiction that occurs within 28 days of the date of the original separation.
e.
No distinction is made between planned and unplanned readmissions because data
collection systems in most Australian mental health services do not include a reliable
and consistent method to distinguish a planned from an unplanned admission to
hospital.
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COAG National Action Plan on Mental Health - Progress Report 2010-11
f.
As for Indicator 7, data for this indicator is collected by all states and territories but
varies depending on whether the jurisdiction has a system of state-wide unique client
identifiers in place, or equivalent data matching systems. Those jurisdictions with
state-wide unique client identifiers or data matching systems have the capacity to track
whether a person is readmitted to any hospital in the jurisdiction. Jurisdictions without
this capacity can only monitor whether a readmission occurs back to the same hospital
from which the person was discharged, and thus may underestimate the true
readmission rate. Different readmission rates will be obtained depending on the
method used, reducing the validity of comparison between jurisdictions.
g.
All states and territories except Tasmania and South Australia advised that state-wide
unique client identifier systems or data matching processes were in place for all years to
enable tracking of readmissions across hospitals. Tasmania advised that such capacity
was in place from 2007-08. South Australia advised that it did not have the capacity to
uniquely track client readmissions across multiple hospitals for any of the years
reported. This factor may have contributed to the appearance of relatively lower
readmission rates for South Australia for most years reported.
Indicator 9 – Participation rates by people with mental illness of working age in
employment
Estimates of the annual losses to national productivity caused by untreated mental illness in
the employed workforce are based on a publication by Hilton, Whiteford and colleagues in
the WORC study (Work Outcomes Research and Cost-Benefit). Funded by the Australian
Government, this study was conducted by the University of Queensland in collaboration with
Harvard University.
Estimates of employment rates for people with mental disorders (Table 10) are based on
analysis of the ABS 2007-08 National Health Survey, reported in the Report on Government
Services 2012 and the ABS Australian Health Survey 2011-13, as reported in Report on
Government Services 2013. In both surveys, people with a mental illness are defined as those
with self-reported mental and behavioural problems that have lasted for six months, or which
the respondent expects to last for six months or more. This approach to identifying mental
illness yields lower population prevalence estimates of mental illness than methods that rely
on independent assessment against objective criteria. For example estimates of mental illness
found in the 2007-08 NHS were 12.8% compared with 19.9% found in the 2007 National
Survey of Mental Health and Wellbeing.
The term ‘not in labour force’ is as defined in the Australian Bureau of Statistics’ Labour
Force Statistics publications and refers to persons who were not in the categories ‘employed’
or ‘unemployed’ as defined by the ABS. Employment is defined as any type of paid work
including casual, temporary or part-time work, if it was for one hour or more. It includes
unpaid work in a family business or farm.
Data on the number of people on Disability Support Pensions (DSP) over the 2001-2011
period was taken from the June 2011 publication of Characteristics of Disability Support
Pension Recipients released by the Department of Families, Housing, Community Services
and Indigenous Affairs (FaHCSIA, see http://www.facsia.gov.au/internet/facsinternet.nsf/ ).
The number of DSP recipients represents a point in time count of current and suspended
Disability Support Pension customers who have identified themselves as having
COAG National Action Plan on Mental Health - Progress Report 2010-11
115
psychological/psychiatric disability as the primary condition. Estimates based on DSP
recipients ‘primary condition’ need to be interpreted cautiously. These clients may have
multiple disabilities, including psychological/psychiatric disability.
Estimates of the number of working age Australians with mental disorders who are not in the
labour force are based on analysis by the Australian Government Department of Health and
Ageing, using prevalence statistics presented in Indicator 1.
Estimates of the prevalence of mental disorders in income support recipients are based on
published studies by Butterworth et al that analysed data collected in the 2007 National
Survey of Mental Health and Wellbeing, conducted by the Australian Bureau of Statistics.
Sources:
Butterworth P, Burgess P and Whiteford H (2011) Examining welfare receipt and mental
disorders after a decade of reform and prosperity: analysis of the 2007 National Survey of
Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 2011
Jan;45(1):54-62. Epub 2010 Oct 26 .
Department of Families, Housing, Community Services and Indigenous Affairs (2011)
Characteristics of Disability Support Pension Recipients June 2011. Available at:
http://www.fahcsia.gov.au/sa/disability/pubs/policy/Pages/payments-dsp_reports.aspx
Hilton M, Sheridan J, Cleary C, Morgan A, Whiteford H. (2007) The concealed
burden of mental health. Australian & New Zealand Journal of Psychiatry, 41
[Supplement 1], A32.
Hilton M, Scuffham P, Vecchio N, Whiteford H (2009) Using the interaction of mental health
symptoms and treatment status to estimate lost employee productivity, Australian & New
Zealand Journal of Psychiatry, 44:151-161.
Laplagne P, Glover M, Shomos A. (2007) Effects of health and education on labour force
participation. Staff Working Paper, Productivity Commission, Melbourne.
Steering Committee for the Review of Government Service Provision (2012), Report on
Government Services 2012. Productivity Commission, Canberra.
Steering Committee for the Review of Government Service Provision (2013), Report on
Government Services 2013. Productivity Commission, Canberra.
Indicator 10 – Participation rates by young people aged 16-30 with mental illness in
education and employment
Estimates of employment and education participation rates for people with mental disorders
aged 16-30 are based on analysis of the ABS 2007-08 National Health Survey and ABS
Australian Health Survey 2011-13, reported in the Reports on Government Services 2012 and
2013, as cited above for Indicator 9.
Indicator 11 – Prevalence of mental illness among people who are remanded or newly
sentenced to adult and juvenile correctional facilities
Sources:
Mullen P E, Holmquist C L, Ogloff J R P. (2004) National Forensic Mental Health scoping
study. Canberra: Department of Health and Ageing.
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COAG National Action Plan on Mental Health - Progress Report 2010-11
Australian Institute of Health and Welfare 2011. The health of Australia's prisoners 2010.
Cat. no. PHE 149. Canberra: AIHW.
Indicator 12 – Prevalence of mental illness among homeless populations
a.
Data presented for this indicator is based on analysis of the SAAP National Minimum
Data Set 2005-06 to 2010-11, conducted by the Australian Institute of Health and
Welfare. Source data for 2010-11 were prepared by AIHW and are presented in Table
14 below. Data for previous years are available in the 2009-10 annual progress report
to COAG.
b.
Quantifying the extent to which people with a mental health problems or problematic
substance use issue appear in the SAAP population can be difficult, as there is no single
data item that allows easy identification of clients who have these issues. The SAAP
client population is divided into four main client groups, defined as follows:
-
Mental health: Clients who were referred from a psychiatric unit; reported
psychiatric illness and/or mental health issues as reasons for seeking assistance;
were in a psychiatric institution before or after receiving assistance and/or needed,
were provided with or were referred on for support in the form of psychological or
psychiatric services.
-
Substance use: Clients who reported problematic drug, alcohol and/or substance use
as a reason for seeking assistance and/or needed, were provided with or were
referred on for support in the form of drug and/or alcohol support or intervention
-
Comorbidity: Clients who reported at least one of the mental health characteristics
and at least one of the substance use characteristics listed above in the same support
period.
-
Other: Clients who met none of the criteria used above.
Table 14: SAAP clients with mental health, substance use and comorbid problems, 2010-11
2010-11
Mental health only
%
Total SAAP
clients
No.
16,300
Substance use only
%
No.
12,900
Comorbidity
%
Other
No.
10,000
%
Total
No.
103,300
%
No.
142,500
16,300
Sex and age
Males
39.3
6,400
57.8
7,400
60.3
6,000
32.8
33,900
37.8
53,800
0–24 years
24.5
1,600
27.2
2,000
21.7
1,300
35.0
11,900
31.2
16,800
25–44 years
47.3
3,000
48.8
3,600
56.5
3,400
40.8
13,900
44.5
23,900
45–64 years
25.6
1,600
22.1
1,600
20.9
1,300
20.9
7,100
21.6
11,600
2.5
200
1.8
100
0.9
100
3.3
1,100
2.7
1,500
65+ years
Males total per
cent
Females
0–24 years
100.0
100.0
100.0
100.0
100.0
60.7
9,900
42.2
5,400
39.7
4,000
67.2
69,400
62.2
88,700
31.0
3,100
33.1
1,800
34.8
1,400
35.5
24,700
34.9
30,900
COAG National Action Plan on Mental Health - Progress Report 2010-11
117
2010-11
Mental health only
Substance use only
Comorbidity
Other
Total
25–44 years
48.2
4,800
51.4
2,800
51.8
2,100
48.3
33,500
48.6
43,200
45–64 years
19.0
1,900
14.6
800
12.9
500
14.3
10,000
14.8
13,100
1.8
200
1.0
100
0.5
<50
1.8
1,200
1.7
1,500
65+ years
Females total
per cent
c.
d.
100.0
100.0
100.0
100.0
100.0
For the data presented in Table 14 above:
-
Number excluded due to errors and omissions in sex and age (weighted): 0.
-
Client groups are mutually exclusive - clients indicated as having only mental
health issues, or only substance abuse issues, exclude clients with both mental
health and substance abuse issues. A client can have more than one support
period in a year and their circumstances might vary between support periods.
In addition, a client can report mental health and substance use criteria within
the same period of support. Note that this approach differs from previous
reports, where client groups were not mutually exclusive.
-
Figures have been weighted to adjust for agency non-participation and client
non-consent.
Data summarised in Figure 24 of the main report are sourced from the ‘High and
Complex Needs Census’ conducted by staff of the Housing and Homelessness Unit,
AIHW, from 932 SAAP agencies, covering 69% of eligible SAAP agencies. The
census collected information on the level and complexity of the needs of 10,683 clients
who received assistance over a one-week period in June 2008. Source data prepared by
AIHW are provided in the tables below.
Table 15: SAAP clients by needs area – high and complex needs study
Male
Female
Not
stated
Total
Housing
Money management/finances
3,167
5,654
98
8,919
Percentage of
full sample
83%
1,995
3,686
55
5,736
54%
Alcohol & other drug use
1,650
1,580
38
3,268
31%
Mental health issues
1,325
2,264
39
3,628
34%
Disability
891
1,307
28
2,226
21%
Exposure to/effects of violence
Needs area
956
4,073
46
5,075
48%
Challenging behaviour
1,136
1,182
29
2,347
22%
Personal safety and wellbeing
1,121
2,464
42
3,627
34%
Physical health and self care
1,237
2,025
38
3,300
31%
Accessing services
1,578
3,146
51
4,775
45%
Access to social supports
1,353
2,948
41
4,342
41%
Parenting/caring
449
2,651
35
3,135
29%
Accompanying children
184
2,715
31
2,930
27%
Total
10,683*
*Note: Total is a unique count of clients, excluding overlap in identified needs areas.
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COAG National Action Plan on Mental Health - Progress Report 2010-11
Table 16: SAAP clients by report mental health issue – high and complex needs study
Mental Health Needs area
Male
Female
Not
stated
Total
Mental Health issues
1,325
2,264
39
3,628
Known diagnosis of mental disorder(s)
Self reports as having a mental illness
790
1,230
25
2,045
314
686
11
1,011
Suspected to have a mental illness
392
648
12
1,052
Current use of specialised mental health service
412
700
12
1,124
4
9
0
13
Not stated
e.
Additional analysis used in this section is based on the AIHW publication Australia’s
Welfare 2011.
Sources:
Australian Institute of Health and Welfare (unpublished data)
Australian Institute of Health and Welfare 2011. Australia’s welfare series no. 10. Cat. no.
AUS 142. Canberra: AIHW.
Johnson G & Chamberlain C 2009. Are the homeless mentally ill? Paper presented at the
Australian Social Policy Conference, University of New South Wales, July 2009. Australian
Policy Online. As reported in AIHW Australia’s welfare 2011.
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