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Outcome 11 - Mental Health

Improved mental health and suicide prevention, including through targeted prevention, identification, early intervention and health care services.

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Outcome Summary

Through Outcome 11, the Australian Government aims to improve services and support for people with mental illness, their families and carers. The department worked to achieve this outcome by managing initiatives under the program outlined below.

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the key strategic directions and performance indicators published in the Outcome 11 chapters of the 2009-10 Health and Ageing Portfolio Budget Statements and 2009-10 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 11 was managed in 2009-10 by Mental Health and Chronic Disease Division.

Program Administered under Outcome 11 and 2009-10 Objectives

Program 11.1: Mental Health

Ensure Australians have access to targeted, effective and sustainable community-based mental health care.
Reduce service gaps by improving access to, and the quality of, primary health care services; and strengthen prevention and early intervention activities and the promotion of good mental health.
Support effective working partnerships with states and territories to further improve the mental health services system.

Major Achievements

The Fourth National Mental Health Plan was endorsed by the Australian Health Ministers’ Conference on 4 September 2009 and was launched on 13 November 2009. The plan commits the department, in partnership with states and territories, to lead the implementation of actions that prevent and detect mental illness, ensure effective treatment and enable recovery.
Improved mental health service delivery for young people through new governance arrangements for the headspace program.
Drafted a National Framework on the Prevention and Management of Eating Disorders and established a new website <www.nedc.com.au> through the National Eating Disorders Collaboration.
Improved access to psychological support for women experiencing perinatal depression through funding for the National Perinatal Depression Initiative.

Challenges

Early identification and treatment of mental health problems leads to better outcomes, but only a third of people assessed with a mental disorder seek treatment.¹ To help overcome this challenge, the department undertook a review of the Access to Allied Psychological Services program which has led to the program design being changed to better target groups at risk and address service gaps.

Program 11.1: Mental Health

Program 11.1 aims to ensure that Australians have access to targeted, effective and sustainable community-based mental health care.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve this aim were to:

ensure access to targeted, effective and sustainable community-based mental health care to support people with mental illness; and
support access to services in rural areas including those in high-need rural areas such as drought and bushfire affected communities.

Major Activities

Access to Targeted, Effective and Sustainable Community-based Care

Mental Health Reform

In 2009-10, the department, in partnership with all states and territories, developed the Fourth National Mental Health Plan, which identifies key actions towards fulfilling the vision of the National Mental Health Policy 2008:

'a mental health system that enables recovery, that prevents and detects mental illness early and ensures that all Australians with a mental illness can access effective and appropriate treatment and community support to enable them to participate fully in the community.'

Australian Health Ministers endorsed the plan on 4 September 2009 and launched it on 13 November 2009.

The department, with state and territory health departments, also developed a draft Implementation Strategy for the plan, which was endorsed by the Australian Health Ministers’ Advisory Council in June 2010, and established a cross sectoral working group to oversee the development of a detailed approach to progressing actions within the plan that require a whole-of-government response. The plan includes indicators to monitor change in the way the mental health system is working for people living with mental illness as well as their families and carers.

Targeting Service Gaps

It is important to ensure that those with a high prevalence mental health disorder actually access health care services. The latest national survey in this field has shown that while 20 per cent of people have experienced a mental disorder in the previous year, only 35 per cent of those actually sought treatment for their disorder. Many groups within this population have problems with accessing effective mental health care.

Through refocusing the Access to Allied Psychological Services program and new two-tiered funding arrangements, access to psychological treatment has been improved and specific groups can be better targeted. The proportion of program funding allocated for psychological treatments for specific target groups increased from about 18 per cent in 2009-10 to about 30 per cent in 2010-11. Services for women with postnatal depression and people who have attempted suicide or self-harmed were key target groups for this program in 2009-10.

The review has identified several other service gaps to be targeted in 2010-11, including those for children, Indigenous people and homeless people.

Improving Quality

As part of the Better Access initiative, a new Medicare item was introduced in 2009-10 for general practitioners who have not completed Mental Health Skills Training as accredited by the GP Mental Health Standards Collaboration.

Completion of Mental Health Skills Training assists GPs to better diagnose and develop plans for people who have a mental disorder, and identify those who may need general counselling to help them deal with situational distress such as grief or relationship counselling and refer them appropriately. The department worked with the profession and Medicare Australia to implement this measure from 1 January 2010.

In 2009-10, the department introduced mandatory Continuing Professional Development requirements for registered psychologists, social workers and occupational therapists providing Focussed Psychological Strategies services under the Better Access initiative. This means that from 1 July 2011 any allied mental health professional registered with Medicare Australia to provide Focussed Psychological Strategies services who has not undertaken the required Continuing Professional Development will be removed from the list of Medicare eligible providers.

This proposal is designed to ensure that mandatory Continuing Professional Development standards for allied mental health professionals align with similar programs, and will provide a quality assurance mechanism to ensure that all Better Access services subsidised through Medicare are delivered by highly qualified practitioners who have maintained their clinical skills and knowledge base.

In 2009-10, the department funded the Mental Health Professionals Network to conduct national workshops to improve the collaborative care of people with a mental disorder. The workshops bring together mental health professionals to network, case conference and improve referrals. As at 30 June 2010, 1,169 workshops had been completed, attracting more than 15,000 clinicians.

Strengthening Prevention, Early Intervention and Promotion

In 2009-10, the department promoted mental health and provided prevention and early intervention strategies to young children through expanding the KidsMatter concept into early childhood settings through the KidsMatter Early Childhood initiative. The department also targeted children at high risk of mental health difficulties such as children of parents with a mental illness, Aboriginal and Torres Strait Islander children, and children who have experienced trauma, loss and grief.

Stigma is a significant barrier to people with mental illness seeking treatment and support. During 2009-10, the department funded a range of activities to reduce stigma, raise community awareness of mental illness and promote mental health literacy and understanding of mental illness in the broader community. Such activities included Mindframe – a national media initiative which aims to influence media representation of issues related to mental illness and suicide encouraging responsible, accurate and sensitive portrayals; SANE Australia’s ‘Stigma Watch’ – which monitors and pursues stigma against people with a mental illness in the media; and beyondblue: the national depression initiative. beyondblue has had a significant impact on raising the level of community literacy in relation to depression, with 40 per cent of respondents involved in the most recent Depression Monitor Survey (2008) indicating they had actively sought information about depression.

Parenting and School-Based Programs

The department funds both the MindMatters and KidsMatter initiatives. These initiatives provide a framework for mental health promotion, prevention and early intervention in Australian primary and secondary schools. In 2009-10, KidsMatter Primary moved from its pilot phase to national implementation. An evaluation of the pilot found very positive results in terms of educational and mental health outcomes for children. More than 168 schools, across each state and territory, have commenced implementation. In 2009-10, the department also commenced implementation of the KidsMatter Parent Initiative to assist parents help their children transition from preschool to primary school. MindMatters continues to be implemented in many secondary schools, with more than 2000 schools now committed to implementing this initiative.

National Eating Disorders Collaboration

The National Eating Disorders Collaboration brings together key stakeholders and eating disorder experts in mental health, public health, health promotion, education, and research to develop a coordinated national approach to the prevention and management of eating disorders. The collaboration focuses on developing strategies to inform young people about how to prevent and manage these disorders. During 2009-10, the collaboration convened a national workshop with more than 200 attendees, drafted the National Framework on the Prevention and Management of Eating Disorders, reviewed both the scientific literature and eating disorders resources in Australia, and established a website² which provides information on eating disorders, and the National Eating Disorders Collaboration.

National Youth Mental Health Foundation

In 2009-10, through the Youth Mental Health Initiative, the department continued to fund headspace through the National Youth Mental Health Foundation Ltd to improve access and target early intervention to mental health, alcohol and drug services for young people 12-25 years of age. This initiative is particularly important as young people are less likely to access traditional health services.

In late 2009, the department funded an evaluation of the program which showed the youth-friendly holistic model of support improves mental health outcomes for young people. The evaluation indicated that headspace is effective in attracting young people experiencing higher than average psychological distress, with 92 per cent of young people surveyed reporting improvements in their mental health and reduced levels of psychological distress.

In 2009, headspace became an independent not for profit company, limited by guarantee, with funding from the department. Previously, headspace was a project administered through a consortium of organisations led by Orygen Youth Health and the University of Melbourne. The change to the governance structure has improved efficiency and strengthened the partnership between headspace and the department in delivering services to young people. The service delivery model remains unchanged.

Commencing in 2010-11, in recognition of the success of the headspace model to date, the department will fund the establishment and operation of up to 30 new headspace sites. These sites will be fully operational by 2013-14. The department will also provide additional funding for the current 30 sites to ensure sustainability of the initiative.

Improved Services for Women Experiencing Antenatal and Postnatal Depression

In 2009-10, the department continued to work closely with states and territories towards the implementation of the National Perinatal Depression Initiative, focusing on improving the prevention and early detection of depression in the perinatal period and to provide better care, support and treatment for expectant and new mothers experiencing perinatal depression. The National Perinatal Depression Initiative Framework (2008-09 to 2012-13) was endorsed by Australian Health Ministers in November 2009, representing a significant milestone towards the comprehensive management of perinatal depression. Under this framework, all jurisdictions committed to ongoing activity and financial investment through individual investment plans. The initiative is progressing well, with screening being routinely undertaken antenatally and postnatally in most jurisdictions.

In 2010-11 to 2012-13, funding to states and territories under the National Perinatal Depression Initiative will transition to an Implementation Plan under the National Partnership Agreement on Health Services. This Implementation Plan aims to enhance monitoring and reporting on the level of perinatal screening, treatment and support being provided by the states and territories in accordance with the initiative’s framework 2008-09 to 2012-13. Ultimately, the department, in collaboration with states and territories and other key stakeholders, is driving the initiative to ensure that pregnant women and new mothers in Australia are comprehensively screened for perinatal depression; and together with their partners and families, have access to quality care, support and treatment if they do experience perinatal depression.

Further, from 1 July 2010, availability and choice of support for women experiencing perinatal depression will be strengthened, with funding to be provided to the Post and Antenatal Depression Association to expand its current Victorian-based service into a nation-wide service.

During 2009-10, funding under the National Perinatal Depression Initiative was provided to Divisions of General Practice through the Access to Allied Psychological Services initiative to improve access to psychological support for women experiencing perinatal depression and build links and referral pathways with child and maternal health units and primary mental health care providers. Funding was also provided to promote and disseminate materials and resources to general practitioners and allied health professionals to support professional practice with perinatal depression treatment and support. In 2010-11, funding will also be provided to support innovative service delivery for women with perinatal depression to ensure better targeted approaches that respond specifically to the needs of these women.

In 2009-10, the department funded beyondblue to develop a range of clinical support tools for primary care; including Draft Clinical practice guidelines for depression and related disorders – anxiety, bipolar and puerperal psychosis – in the perinatal period, and for research to build the evidence base for the treatment of perinatal depression.

Support for Individuals at Risk of Suicide

The latest Australian Bureau of Statistics figures on suicide report that 2,191 people took their own lives in 2008. Whilst these figures are slightly higher (137) than in the revised 2007 data, they have remained considerably lower than the highest recorded figures in 1997.

In 2009-10, the department continued to support projects which aim to reduce the incidence of suicide and self harm, and to promote mental health and resilience across the Australian population. The projects represent a mixture of universal programs as well as targeted programs for individuals and populations at higher risk of suicide and include the Wesley Mission LifeForce Community Network and Education and Training Project and the Koori Kids project on the South Coast of New South Wales.

The department, through the Access to Allied Psychological Services program, extended the pilot period of a demonstration project with 19 Divisions of General Practice providing better support in the community for people who have self-harmed, attempted suicide or who have suicidal ideation. This pilot is proving a valuable addition to the health system for this particularly vulnerable client group. An evaluation of the National Suicide Prevention Program is due in 2010-11.

Priorities in the National Suicide Prevention Strategy 2009-10 to 2010-11 Action Framework were progressed in 2009-10 by the department and the Australian Suicide Prevention Advisory Council. The department also co-chaired a national suicide prevention working group focused on improving coordination of investment in suicide prevention by the Australian Government and state and territory governments under the Fourth National Mental Health Plan. The department achieved a significant milestone by gaining national commitment to the Living Is For Everyone framework, which is a national approach to suicide prevention.

During 2010-11, priorities for the department will include the evaluation of the National Suicide Prevention Program and the establishment of more formal joint planning processes between the Australian Government and state and territory governments. Future suicide prevention activities will be planned and formalised in consideration of recommendations from the evaluation of the National Suicide Prevention Program, the Senate Inquiry into Suicide in Australia and advice from the Australian Suicide Prevention Advisory Council.

Responding to Bushfires, Drought and Rural Services Needs

Extension of the Mental Health Support for Drought Affected Communities

The Mental Health Support for Drought Affected Communities Initiative is part of a broader Australian Government response to drought which recognises the impact of severe drought on rural and regional communities, the environment and the broader Australian economy.

The extension of the initiative allows for early intervention services to those most affected by the impact of drought, and aims to increase awareness in these communities of mental disorders and their effective treatment.

In 2009-10, the department allocated the majority of the funding to 41 eligible drought declared rural and remote Divisions of General Practice to engage community support workers to provide community outreach and crisis counselling for distressed individuals, families and communities. Education materials and training will continue to be provided through beyondblue. To assist the community support workers, the Divisions of General Practice can access advice, including clinic support and information, through the Australian General Practice Network.

Mental Health Response to the Victorian Bushfires

The department continued to assist people who have been traumatised and experienced loss as a result of the bushfires. This included: increased funding provided through the Access to Allied Psychological Services program to Divisions of General Practice to enable ongoing provision of specialised services to people with persisting psychological symptoms; increased capacity of telephone counselling services, including Lifeline, Kids Help Line and Crisis Support Services; building the capacity of communities for psychological recovery; and funding supplementary support and training for mental health professionals providing services to people experiencing trauma and grief.

Mental Health Services in Rural and Remote Areas

The department funds Divisions of General Practice, Aboriginal Medical Services and the Royal Flying Doctor Service to deliver services to rural and remote communities that would otherwise have little or no access to mental health services. In the first two years of operation (July 2007 to June 2009) under Stage One, 15 organisations provided more than 34,000 service contacts to more than 9,500 clients. In the 2009-10 Budget, additional funding was provided to allow the extension of funding to Stage One organisations to 30 June 2011.

Under Stage Two of the program, a further 24 organisations were funded and in the first 12 months of operation (July 2008 to June 2009) almost 17,000 services were provided to about 5,500 clients. Approximately 23,000 clients in rural and remote Australia accessed more than 80,000 services. In 2009-10, an evaluation of the program commenced and the outcome of the evaluation is due in late 2010.

¹ Australian Bureau of Statistics, 2007 National Survey of Mental Health and Wellbeing. ABS Cat No 4326.0.

² Accessible at www.nedc.com.au.

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Performance Information for Outcome 11

Program 11.1: Deliverables

Qualitative Deliverables

Access to Targeted, Effective and Sustainable Community-based Care
Qualitative Deliverable:	Regular stakeholder consultation and advice to program development and implementation.
Result: Deliverable met.
The department undertook broad stakeholder consultations with states and territories, mental health consumers and carers, service providers and other experts in developing the Fourth National Mental Health Plan and in the development and implementation of mental health programs. The telephone counselling, self-help and web based programs funded by the department have regular contact with e-mental health experts and the stakeholder groups they represent.
Qualitative Deliverable:	Provision of advice from the Australian Suicide Prevention Advisory Council and the National Advisory Council on Mental Health to the Minister. This will be measured by reporting the number of briefings from the council that are provided to the Minister.
Result: Deliverable met.
The Australian Suicide Prevention Advisory Council provided advice to the Minister for Health and Ageing on a number of issues during the year, including the provision of four briefings. The council, in collaboration with the department, continued activity under the National Suicide Prevention Strategy Action Framework to guide the Australian Government’s strategic directions and priorities in suicide and self-harm prevention for the period 2009-2011. The National Advisory Council on Mental Health provided 22 pieces of advice to the Minister, government departments, and other mental health processes in 2009-10 covering a wide range of mental health issues.
Qualitative Deliverable:	The department will encourage GPs to undertake mental health training under the Better Access Initiative. This will be measured by the number of GPs who have undertaken training.
Result: Deliverable met.
In 2009-10, the department funded a number of initiatives to encourage GPs to undertake Mental Health Skills Training, including: operation of the General Practice Mental Health Standards Collaboration by the Royal Australian College of General Practitioners to develop, monitor and promote quality standards for GP education and training in primary mental health care; delivery of the mental health multidisciplinary training package for the primary care and specialist mental health workforces, to promote shared and collaborative referral and treatment strategies in communities across Australia; development of a web-based Mental Disorders Training Package for Rural Practice by the Australian College of Rural and Remote Medicine; development of six one-hour Mental Health Skills Training modules online via the Thinkgp website³; and funding to the Royal Australian College of General Practitioners to facilitate Focused Psychological Strategies Skills Training in rural and remote Australia. The department also provided training to mental health professionals in those areas affected by the February 2009 Victorian Bushfires. As at May 2010, 14,929 GPs had completed Mental Health Skills Training, an increase of approximately 6,000 GPs.
Qualitative Deliverable:	The department will make adjustments to the Medicare Benefits Schedule fee arrangements in recognition of GPs undertaking mental health training under the Better Access Initiative. This will be measured by the number of GPs who access the lower rebate Medicare item.
Result: Deliverable met.
On 1 January 2010, a new Medicare item (2702) was introduced for GPs who have not completed accredited Mental Health Skills Training, with a schedule fee of $125.95 for developing a Mental Health Treatment Plan. GPs who had completed Mental Health Skills Training accredited by the General Practice Mental Health Standards Collaboration continue to be able to access item 2710, with a current schedule fee of $160.45 for developing a Mental Health Treatment Plan. Between 1 January 2010 and 30 May 2010, 107,563 services were provided under Medicare item 2702. This compares with 182,369 services provided under Medicare item 2710.
Qualitative Deliverable:	The department will work with key stakeholders to implement Continuing Professional Development Training for allied health professionals under the Better Access Initiative. This will be measured by the number of professionals who access this training.
Result: Deliverable substantially met.
From 1 July 2011, any allied mental health professional registered with Medicare Australia to provide Focussed Psychological Strategies services under the Better Access initiative who has not undertaken the required Continuing Professional Development, will be removed from the list of eligible providers. In 2009-10, the department consulted relevant professional peak bodies (including the Australian Psychological Society, Psychology Private Australia, the Australian Association of Social Workers and Occupational Therapy Australia) to consider the Continuing Professional Development requirements of the professions and progress this measure. The department provided funding to the Australian Psychological Society, Psychology Private Australia, the Australian Association of Social Workers and Occupational Therapy Australia to assist with the implementation of the new Continuing Professional Development requirements for their professions accessing Medicare subsidies and to advise Medicare Australia of those practitioners who have met these requirements and therefore continue to be eligible to access Medicare subsidies. Implementation of Continuing Professional Development remains important for professional bodies to ensure all registered health professionals maintain their skills, regardless of the program under which they deliver services.
Qualitative Deliverable:	Provision of services delivered by telephone and/or internet, as well as online self-help programs. Each service funded under this measure will be externally evaluated. This data will feed into the overall measure evaluation which is due in 2010.
Result: Deliverable met.
The availability of telephone counselling, self-help and web based support services continued to increase through the commencement of new projects, such as Swinburne University’s anxiety online program which was launched in late 2009, enhanced capacity in telephone based services to respond to emotionally distressed callers arising from the Victorian bushfires, as well as through enhanced practices within funded projects resulting in improved capacity. All projects had processes in place to support project evaluation, as well as continuous improvement, with direct enhancements in service delivery evident across a number of projects during 2009-10. The number of telephone calls answered, for example by the crisis support services of Lifeline and Kids Help Line, continue to increase as a result of enhanced call flow and telephony processes. Online mental health projects are continually reviewing their processes to identify opportunities for improvement. In 2009-10, the Clinical Research Unit for Anxiety and Depression Clinic for example, evaluated the impact of its approach to GP engagement and is planning new strategies for 2010-11.
Qualitative Deliverable:	Trial a national dissemination strategy for the KidsMatter Primary School Initiative. The trial will be undertaken during the 2009 and 2010 school years.
Result: Deliverable met.
The KidsMatter Primary national dissemination strategy was trialled as a staged regional approach in conjunction with health and education representatives from government, catholic and independent education systems during the 2009 and 2010 school years. Education systems have nominated key personnel to be trained to work directly with interested schools over an 18-24 month period to fully implement KidsMatter Primary across the school. 168 schools in addition to the 101 pilot schools formally committed to implementation in 2010 of KidsMatter Primary.
Qualitative Deliverable:	The number of services available for women experiencing antenatal and postnatal depression will be monitored on a six monthly basis, through data collected under the Access to Allied Psychological Services Initiative.
Result: Deliverable met.
Data on services available through the Access to Allied Psychological Services initiative for women experiencing antenatal and postnatal depression is collected from Divisions of General Practice and reported to the department every six months. 106 Divisions of General Practice are providing services for the treatment of antenatal and postnatal depression throughout Australia.
Qualitative Deliverable:	Development of an evidence based framework⁴ for the promotion, prevention and early intervention of eating disorders and convening of a national workshop by the end of 2009-10.
Result: Deliverable substantially met.
In 2009-10, the National Eating Disorders Collaboration conducted a literature review and drafted an evidence-based framework for the promotion, prevention and early intervention of eating disorders. A national workshop on eating disorders was convened on 24 October 2009 in Canberra with more than 200 attendees from around Australia.
Qualitative Deliverable:	Implementation and evaluation of the National Youth Mental Health Foundation (headspace) governance structure to be completed during 2009-10.
Result: Deliverable met.
A new governance structure was implemented in 2009, with headspace: National Youth Mental Health Foundation Ltd becoming an independent not for profit company limited by guarantee. Previously, headspace was a project administered through a consortium of organisations led by Orygen Youth Health and the University of Melbourne. The new company is made up of five members: University of Melbourne; Orygen Youth Health Research Centre; Brain and Mind Research Institute, University of Sydney; Australian Psychological Society and Australian General Practice Network. Four of the eleven members of the Board are nominated by the Minister for Health and Ageing. An independent evaluation of the headspace project was undertaken in late 2009 by the University of New South Wales. The results regarding the youth focused early intervention model were very positive. Overall, the evaluation indicated the headspace model as effective in engaging young people as a high proportion of those who used the services reported improved mental health and social outcomes after accessing headspace services.
Responding to Bushfires, Drought and Rural Service Needs
Qualitative Deliverable:	The department will work with the Victorian Department of Human Services to develop and implement targeted services to assist in the psychological recovery of individuals and communities recovering from the Victorian bushfire disaster.
Result: Deliverable met.
The success of this program is evident through the high uptake of mental health services in the bushfire affected regions. Since commencement of funding in February 2009, the nine Divisions of General Practice that receive funding from the department reported more than 1,900 bushfire specific referrals and more than 10,000 sessions of care.
Qualitative Deliverable:	Continuation of established services to deliver community outreach activities and crisis support to drought affected individuals, families and communities, through eligible rural and remote Divisions of General Practice, and continued provision of mental health activities and education and training through beyondblue and the Australian General Practice Network.
Result: Deliverable met.
The extension of the Mental Health Support for Drought Affected Communities Initiative provided innovative outreach, crisis counselling and community awareness for communities affected by severe drought. In 2009-10, beyondblue worked with divisions and communities to raise community awareness of mental health disorders and contributed to education and training for health workers and community leaders. The Australian General Practice Network provided coordination and national leadership to promote linkages and integration with other relevant primary mental health care initiatives.
Qualitative Deliverable:	The department will work with organisations funded under the Mental Health Services in Rural and Remote Areas program to ensure that they are maintaining access to mental health services in rural and remote communities. The maintenance of access to mental health services in rural and remote communities will be measured by six monthly progress reports from the organisations funded under the program.
Result: Deliverable met.
In 2009-10, the department continued to work with organisations and assessed progress reports on a six-monthly basis. Organisations provide qualitative reporting on challenges met in the conduct of the program and progress in developing linkages with other organisations. Quantitative reporting included staffing and service as well as financial data. The organisations continued to meet all reporting requirements.

³ Accessible at www.thinkgp.com.au.

⁴ In the 2009-10 Portfolio Budget Statements this deliverable incorrectly referred to development of a formula.

Quantitative Deliverables

Access to Targeted, Effective and Sustainable Community-based Care
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-2%
Result: Deliverable not met.
The actual Administered expenses for Outcome 11 were two per cent less than budgeted expenses. Funds were underspent as not all fund holders were able to meet all contracted deliverables within 2009-10, resulting in a small number of payments that were not made in the financial year. The department will continue to work closely with fund holders to ensure deliverables meet the contractual requirements and outstanding payments are paid to fund holders.
Quantitative Deliverable:	Number of patient sessions to be delivered under the Access to Allied Psychological Services Initiative.
2009-10 Target:	70,000	2009-10 Actual:	110,892
Result: Deliverable met.
To support the needs of people living with mental illness in the community in 2009-10, the department managed the Access to Allied Psychological Services initiative which funds the provision of short-term focused psychological services for people diagnosed with a mild to moderate mental disorder. Services are provided throughout Australia by a range of allied health professionals employed or contracted by Divisions of General Practice, which have been the fund holders for the Access to Allied Psychological Services initiative since it was established. During 2009-10, more than 110,800 sessions of care were delivered. Outcomes of treatment were measured through validated mental health instruments and demonstrate positive outcomes of large or medium magnitude in 86 per cent of cases. The department supported 22 rural and remote Divisions of General Practice in 2009-10 to participate in a trial of telephone-based cognitive behaviour therapy. It also provided funding to 18 Divisions of General Practice to establish and operate demonstration sites to help general practitioners with patients at risk of suicide and self-harm.
Quantitative Deliverable:	Number of funded initiatives focusing on suicide prevention in identified high-risk groups.
2009-10 Target:	555	2009-10 Actual:	>56
Result: Deliverable met.
Activities targeting high-risk groups increased by 12 per cent in 2009-10, with an additional six projects funded. This was a result of policy to increase action to support those groups at highest risk of suicide. Examples of new programs funded include: General Practice Network of the Northern Territory – provision of culturally appropriate suicide prevention manuals for use by Aboriginal Mental Health Workers in five communities; and Mental Health Association of Central Australia – train the trainer sessions for delivery of training around community led responses to local suicides.

⁵ 2009-10 target of 55 was not originally published in the 2009-10 Portfolio Budget Statements.

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Program 11.1: Key Performance Indicators

Qualitative Key Performance Indicators

Access to Targeted, Effective and Sustainable Community-based Care
Qualitative Indicator:	The National Mental Health Report series is produced annually. It is anticipated that the 11th report in the series will be released early 2009-10.
Result: Indicator not met.
At 30 June 2010, the 11th National Mental Health Report was still to be finalised for release. It is now expected to be released in late 2010. The delay is due to the additional task of having to develop a redesigned 12th National Mental Health report as identified in the Fourth National Mental Health Plan.
Qualitative Indicator:	The second Progress Report for the COAG National Action Plan on Mental Health (2006–2011) is expected to be submitted to the Health Ministers in June 2009 for endorsement.
Result: Indicator met.
The second Progress Report for the COAG National Action Plan on Mental Health (2006–2011) was endorsed by Health Ministers in September 2009.
Qualitative Indicator:	The National Mental Health Policy 2008 to be completed by May 2009.
Result: Indicator met.
The National Mental Health Policy 2008 was launched by the Australian Health Ministers on 5 March 2009.
Qualitative Indicator:	The Fourth National Mental Health Plan will be presented to Health Ministers for consideration in 2009.
Result: Indicator met.
The Fourth National Mental Health Plan was endorsed by Australian Health Ministers on 4 September 2009 and launched on 13 November 2009.
Qualitative Indicator:	A review of the Access to the Allied Psychological Services initiative to be completed by July 2009.
Result: Indicator substantially met.
The review of the Access to Allied Psychological Services initiative was completed in March 2010. The delay was due to a need for detailed modelling to guide future funding arrangements. The aim of the review was to refocus the service to better complement fee for service programs, to better target particular groups, and to address service gaps in locations with limited private Medicare services. As part of the review process, the Australian Government refined the initiative to better meet the emerging needs of communities in accessing mental health services. The enhancements included: innovative service trials including Telephone Based Cognitive Behavioural Therapy and Suicide Prevention; updated guidelines to reflect and clarify modifications to Access to Allied Psychological Services since its commencement; mental health support to bushfire affected communities; and building the capacity to treat women experiencing perinatal depression through the national perinatal initiative. As a result of the review, a new funding model is being implemented to better address gaps, increase efficiency and encourage innovation. Consultation with key stakeholders on efficiency measures, guidelines and quality assurance/governance is planned for late 2010.
Qualitative Indicator:	Preliminary findings from the Better Access Evaluation will inform the 2010-11 Budget.
Result: Indicator substantially met.
The evaluation commenced in January 2009 and is expected to be completed by the end of 2010. The evaluation consists of a number of component studies which will be drawn together in an overarching summative evaluation. A project steering committee was established to oversee the evaluation. The committee met three times in 2009-10 to consider draft reports and preliminary findings prepared by consultants undertaking various components of the evaluation. The results of the component and summative evaluations will inform the Australian Government’s actions in relation to the Better Access initiative and primary mental health care more broadly. A post implementation review of the Better Access initiative was completed and the response was publicly released on 26 March 2010. In light of the post-implementation review recommendations, the requirement for GPs providing Better Access Focused Psychological Strategies Services to have practice accreditation will be removed from 1 July 2010. In addition, the number of clients required for group therapy has been reduced from six to four.
Qualitative Indicator:	Improved peer support and community awareness of antenatal and postnatal depression, measured through the range of activities available to the community, including mothers, families, health professionals and the broader community. This includes telephone based peer support.
Result: Indicator met.
The department worked with beyondblue focusing on community awareness-raising, with the specific goal of promoting and encouraging help-seeking behaviours in women and their families experiencing the effects of perinatal depression. The department supported beyondblue in 2009-10 to conduct targeted media campaigns, revise and develop written resources and their website, and provide input into service information and training materials. In 2009-10, beyondblue reported a significant increase in the distribution of perinatal resources to the general community and health professionals, including 5,500 perinatal health professional packs, 123,000 emotional health booklets and 75,000 perinatal fact sheets distributed between October 2009 and March 2010. Australian women experiencing perinatal depression will also have access to a specialised phone service run by the Post and Antenatal Depression Association from 1 July 2010, providing greater access to peer based support programs in addition to clinical and other supports. The department has worked closely with the association in the lead up to the 1 July 2010 start date, including providing a small amount of one-off funding in 2009-10 for infrastructure support. The Improving Maternity Services Package also includes funding to the non-government organisations, Bonnie Babes Small Miracles, SIDS and Kids, and Stillborn and Neonatal Death Society to provide additional services for women seeking telephone-based peer support for grief and loss during the perinatal period. The department worked with these organisations in 2009-10, to provide small one-off infrastructure funding, to build their capacity in anticipation of the 1 July 2010 start date, and facilitated the development of referral protocols between these peer support organisations and the new Pregnancy, Birth and Baby Helpline commencing on 1 July 2010.
Qualitative Indicator:	Promote mental health prevention and early intervention in schools through the KidsMatter initiative. Measured through the number of state and territory based personnel trained to deliver KidsMatter and the level of support from government, catholic and independent education systems.
Result: Indicator substantially met.
KidsMatter Primary is the national mental health promotion, prevention and early intervention initiative for Australian Primary Schools. Representatives from government, catholic and independent education systems and health representatives in all states and territories have participated in planning and implementation of KidsMatter Primary. State and territory based personnel, including 470 staff from School Action Teams, 203 implementation support personnel and 277 professional learning personnel, have been trained to deliver KidsMatter Primary nationally. The level of support nationally from the government, catholic and independent education systems has varied due to the different structures in states and territories.
Qualitative Indicator:	Access to telephone and/or internet services, as well as online self-help programs, measured through the availability of services.
Result: Indicator met.
Lifeline Australia, which was funded to provide telephone based crisis support, implemented a number of enhancements in their telephony systems in 2009-10, thus supporting a greater response rate for callers to the service. Similarly, Kids Help Line increased its capability to respond to young people in need via telephone and web-based support. Web-based mental health programs reported an increased use of their services during 2009-10. Anxiety online, an online program developed by Swinburne University and targeting people with anxiety who would benefit from a self directed or clinician supported online intervention, commenced in November 2009 and reported increasing rates of use. The Clinical Research Unit for Anxiety and Depression clinic, an online program targeting people with anxiety and depression at St Vincent’s Hospital, has seen a steady increase in the number of general practitioners registering to use the program with their patients. The clinic has been available in rural New South Wales and this will expand to a national roll-out during 2010-11. The Centre for Mental Health Research at the Australian National University developed a suite of online programs including MoodGYM, E-couch and BluePages. Rates of use in 2009-10 indicated a steady increase. Consumer feedback revealed consumers found the programs useful, enjoyable to use and importantly helped decrease their levels of anxiety and/or depression.
Qualitative Indicator:	Improved access to evidence-based, consistent information about eating disorders through avenues such as schools, the media and health service providers.
Result: Indicator substantially met.
The National Eating Disorders Collaboration completed a literature review and reviewed available information and resources on eating disorders. In 2009-10, the collaboration established a new Eating Disorders website⁶, developed a communication strategy for the promotion of evidence-based messages about the prevention and management of eating disorders through schools, the media and health service providers. This strategy will guide future work.
Qualitative Indicator:	Availability of suicide prevention programs that target population groups identified as being at higher risk of suicide, and which are evaluated as being effective in engaging these higher risk groups.
Result: Indicator met.
In 2009-10, the Australian Suicide Prevention Advisory Council and the department worked together to progress activity under the National Suicide Prevention Strategy Action Framework. Under the framework, both parties agreed to focus on the provision of investment in suicide prevention activities that support groups at highest risk of suicide including: Aboriginal and Torres Strait Islander people; men; people living in rural and remote Australia; young people; people living with a mental illness; and people bereaved by suicide.
Responding to Bushfires, Drought and Rural Service Needs
Qualitative Indicator:	An evaluation of the Mental Health in Rural and Remote Areas measure will commence in 2009-10.
Result: Indicator met.
The program evaluation commenced in February 2010 and is expected to be finalised in late 2010.
Qualitative Indicator:	Continued funding to up to 42 eligible rural and remote Divisions of General Practice.
Result: Indicator met.
The department funded 41 Divisions of General Practice throughout New South Wales, Victoria, Queensland and South Australia to deliver community outreach activities and crisis support to drought affected individuals, families and communities. Between July 2008 and December 2009, the Divisions of General Practice delivered: 6,474 crisis counselling and interventions; 2,662 individual counselling sessions; and 1,374 referrals to other services.

⁶ Accessible at www.nedc.com.au.

Quantitative Key Performance Indicators

Access to Targeted, Effective and Sustainable Community-based Care
Quantitative Indicator:	Number of National Mental Health Advisory Council meetings per year and associated secretariat support for work plan implementation.
2009-10 Target:	4	2009-10 Actual:	4
Result: Indicator met.
The National Advisory Council on Mental Health met formally on four occasions in 2009-10, in August and October 2009 and February and May 2010, allowing the Council to progress key work plan priority areas and to formulate advice to government. In 2009-10, the department continued to provide a dedicated secretariat to support the council to implement its work plan. A part-time research policy officer was also engaged for this purpose.
Quantitative Indicator:	Percentage of Divisions of General Practice with the capacity to provide perinatal depression services through the Access to Allied Psychological Services initiative.
2009-10 Target:	100%	2009-10 Actual:	100%
Result: Indicator met.
In 2009-10, the department distributed funding to all Divisions of General Practice to build capacity and provide perinatal depression services. Funding was distributed according to a formula based on population, rurality and number of births per head of population. In addition to service delivery, the Divisions of General Practice built on established linkages with local child and maternal health services and primary mental health care services to ensure that women experiencing perinatal depression and their families can access appropriate resources.
Quantitative Indicator:	Number of funded initiatives focusing on suicide prevention in identified high-risk groups.
2009-10 Target:	55	2009-10 Actual:	56
Result: Indicator met.
Activities targeting high-risk groups increased by 12 per cent in 2009-10 with an additional six projects funded. This has been a result of deliberate policy to increase action to support those groups at highest risk of suicide. Examples of new programs funded include: General Practice Network of the Northern Territory – provision of culturally appropriate suicide prevention manuals for use by Aboriginal Mental Health Workers in five communities; and Mental Health Association of Central Australia – train the trainer sessions for delivery of training around community led responses to local suicides.

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Outcome 11 – Financial Resources Summary

	(A) Budget Estimate 2009-10 $’000	(B) Actual 2009-10 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2010-11 $’000
Program 11.1: Mental Health
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	145,991	143,057	( 2,934)	173,941
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	11,491	11,319	( 172)	11,258
Revenues from other sources	204	135	( 69)	214
Unfunded depreciation expense¹	-	-	-	245
Operating loss / (surplus)	-	6	6	-
Total for Program 11.1	157,686	154,517	( 3,169)	185,658
Outcome 11 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	145,991	143,057	( 2,934)	173,941
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	11,491	11,319	( 172)	11,258
Revenues from other sources	204	135	( 69)	214
Unfunded depreciation expense¹	-	-	-	245
Operating loss / (surplus)	-	6	6	-
Total Expenses for Outcome 11	157,686	154,517	( 3,169)	185,658
Average Staffing Level (Number)	81	83	2	83

¹ Reflects the change to net cash appropriation framework implemented from 2010-11.

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