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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 Strategy

Outcome 11 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 major activities and performance indicators published in the Outcome 11 chapter of the 2010-11 Health and Ageing Portfolio Budget Statements (PB Statements) and the 2010-11 Health and Ageing Portfolio Additional Estimates Statements (PAES). It also includes a table summarising the estimated and actual expenditure for this Outcome.

Outcome 11 was managed in 2010-11 by the Mental Health and Chronic Disease Division.

Program Name Program Objectives in 2010-11

Program 11.1:
Mental Health

Improve the capacity of the mental health system to provide better coordinated and integrated care across the spectrum of severity of mental illness.

Ensure access to targeted, effective and sustainable community-based mental health programs to support people with, or at risk of developing, a mental illness.

Support access to services for hard to reach population groups.

Program Name	Program Objectives in 2010-11
Program 11.1: Mental Health	Improve the capacity of the mental health system to provide better coordinated and integrated care across the spectrum of severity of mental illness. Ensure access to targeted, effective and sustainable community-based mental health programs to support people with, or at risk of developing, a mental illness. Support access to services for hard to reach population groups.

Major Achievements

Mental Health Reform

A major highlight of the 2011-12 Budget was the announcement of the new Delivering National Mental Health Reform package. The Government is committing $2.2 billion over five years for mental health reform, including $1.5 billion in new measures through the 2011-12 Budget package. The reforms will:

provide more and better coordinated services for people with severe mental illness;
provide more prevention and early intervention mental health services for children and young people; and
strengthen primary care to ensure services are targeted at those most in need, such as people living in low income areas, rural and remote areas and Indigenous communities.

The package will also encourage states and territories to invest more in mental health priority areas, including accommodation support and presentation, admission and discharge planning in emergency departments, through a National Partnership between the Commonwealth and state and territory governments.

In addition, a National Mental Health Commission will be established within the Department of the Prime Minister and Cabinet to increase accountability and transparency. The Commission will provide leadership and drive a more transparent and accountable mental health system in both the health and non-health spheres, and provide an Annual Report, through the Prime Minister, to Parliament.

The development of the reform measures was informed by extensive engagement with experts, service providers, consumers and carers. Implementation of the reforms will involve further engagement with these groups and with state and territory governments. Future improvements to the mental health system will be driven by the development of the Ten Year Roadmap for Mental Health Reform. The Roadmap will set out an agenda for long-term reform of the mental health system.

Revised and commenced implementation of the National Standards for Mental Health Services.
Completed evaluations of both the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative and the Mental Health Services in Rural and Remote Areas program which found that both programs have increased access to primary mental health care.
Started to implement the recommendations of the Review of the Access to Allied Psychological Services (ATAPS) program in March 2010, which found that ATAPS is an important and necessary program to complement the Better Access initiative and is very successful in achieving improved consumer outcomes.
Consolidated the Short-term Torture and Trauma Counselling service into the Program of Assistance for Survivors of Torture and Trauma, which has improved ease of access to services for vulnerable individuals who have experienced torture and trauma before arriving in Australia.
Coordinated the Commonwealth Response to The Hidden Toll: Suicide in Australia report of the Senate Community Affairs Reference Committee, outlining the Government’s commitment to reducing the impact that suicide has on individuals, families and communities as a whole.
Responded quickly to natural disasters in 2010-11 to ensure that the support and services provided to residents affected by the floods and Cyclone Yasi were well targeted and coordinated.
Led extensive cross-portfolio collaboration through the APS200 project on mental health, and assisted with extensive community and sector consultation to inform the development of the 2011-12 Delivering National Mental Health Reform Budget package.

Challenges

ATAPS fund holding arrangements will transition from Divisions of General Practice to Medicare Locals as they are established and demonstrate capacity to deliver mental health services during 2011-12. This transition will need to be managed carefully to ensure continuity of service delivery for existing and new clients.

Program 11.1: Mental Health

Program 11.1 aims to improve the capacity of the mental health system to provide better coordinated and integrated care across the spectrum of severity of mental illness; ensure access to targeted, effective and sustainable community-based mental health programs to support people with, or at risk of developing, a mental illness; and support access to services for hard to reach population groups.

Improve the Capacity of the Mental Health System

Mental health reform

During 2010-11, the department engaged extensively with external stakeholders, including experts, service providers, consumers and their carers to develop and plan implementation of the 2011-12 Delivering National Mental Health Reform Budget package. In addition, the department undertook activities to build capacity of the mental health system through existing initiatives.

In 2010-11, states and territories identified projects to deliver over 330 subacute mental health beds and services in the community over the four year period of the National Partnership Agreement on Improving Public Hospital Services. A total of $159 million in 2010-11 funding has already been provided to states and territories under this Agreement (with the exception of Tasmania) to deliver their projects across all the subacute care types, including mental health. This initiative will help to strengthen the mental health services system by improving the availability of treatment for people with a mental illness, reducing the likelihood of people going without the treatment they need and limiting admissions or readmissions to hospital.

In 2010-11, the department continued to implement the Fourth National Mental Health Plan, an agenda for collaborative government action in mental health 2009-2014 (Fourth Plan).

Qualitative Deliverable: Develop an implementation strategy for the Fourth National Mental Health Plan.

2010-11 Reference Point: An implementation strategy will be developed in collaboration with state and territory governments and presented to Health Ministers for consideration in 2010.

Result: Deliverable met.

The department worked in collaboration with the states and territories through the Mental Health Standing Committee to develop an implementation strategy outlining the process for whole-of-government implementation of each of the 34 actions set out in the plan. These specific actions will improve the lives of people with mental illness and their families and carers. This implementation strategy was agreed by all Health Ministers in December 2010 and is available online.¹⁰⁹

Qualitative Deliverable:	Develop an implementation strategy for the Fourth National Mental Health Plan.
2010-11 Reference Point:	An implementation strategy will be developed in collaboration with state and territory governments and presented to Health Ministers for consideration in 2010.
Result: Deliverable met.
The department worked in collaboration with the states and territories through the Mental Health Standing Committee to develop an implementation strategy outlining the process for whole-of-government implementation of each of the 34 actions set out in the plan. These specific actions will improve the lives of people with mental illness and their families and carers. This implementation strategy was agreed by all Health Ministers in December 2010 and is available online.¹⁰⁹

Following advice from the Australian Health Ministers’ Advisory Council, the Mental Health Standing Committee agreed on two Flagship priority areas to drive implementation of the Fourth Plan: Social Inclusion and Children and Youth. The department contributed to the development of an implementation proposal which includes details of these two Flagship priority areas. This proposal will be provided to all Health Ministers in 2011-12.

In September 2010, the Australian Health Ministers Conference endorsed the revised National Standards for Mental Health Services (2010) developed by the department. The revised standards will play an important role in guiding safe and appropriate practices and driving continuous quality improvement in mental health services.

In 2010-11, the department continued to work closely with other agencies to ensure coordination and development of mental health reform activities. A new senior leadership forum, the APS200, was established as part of the Australian Public Service Commission reforms. Led by the department, mental health was one of the first projects commissioned for the APS200 and the first project to report to the Secretaries Board. Through the APS200 project on mental health, senior public servants across eleven departments worked intensively to explore the evidence base as well as best practice mental health service delivery models, the current service gaps, the needs of particular groups with mental illness and developing a conceptual framework within which to take reform forward.

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Better Access to Psychiatrists, Psychologists and GPs

A comprehensive program evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners initiative through the Medicare Benefits Schedule (Better Access) initiative was completed by the department in 2010. ¹¹⁰

Qualitative Deliverable:	Complete evaluation of Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule.
2010-11 Reference Point:	Evaluation completed by late 2010.
Result: Deliverable met.
A full evaluation of the Better Access initiative commenced in January 2009 and was completed at the end of 2010. While the evaluation did demonstrate that access to mental health care for people with common mental disorders such as anxiety and depression has improved, it also showed that certain disadvantaged groups continue to miss out. Access to the Better Access initiative for people living in economically disadvantaged areas was around 10% lower than other areas of Australia. Those living outside metropolitan areas also experience less access to services, with approximately 12% lower access rates for people in rural areas and 60% in remote areas.
Qualitative KPI:	Increased GP skills in diagnosis and development of mental health treatment plans.
2010-11 Reference Point:	Increased number of GPs undertaking mental health skills training under the Better Access initiative.
Result: Indicator met.
In 2010-11, the department funded a number of initiatives to increase GP skills in diagnosis and development of mental health treatment plans. There was an increase in the number of GPs undertaking mental health skills training under the Better Access initiative. As at May 2011, 17,392 GPs had completed mental health skills training, an increase of 2,061 GPs from the previous year.

Access to Allied Psychological Services Program

The National Mental Health Reform package announced in the 2011-12 Budget addressed the lower rates of service for some groups identified in the Better Access evaluation, redirecting efficiencies identified in the Better Access initiative to double the number of services targeted at vulnerable and hard to reach groups through the Access to Allied Psychological Services (ATAPS) program.

Qualitative Deliverable:	Implementation of the new phase of Access to Allied Psychological Services program.
2010-11 Reference Point:	Implemented by June 2011.
Result: Deliverable substantially met.
In March 2010, the department completed the Review of the Access to Allied Psychological Services (ATAPS) program. The review found that ATAPS is an important and necessary program to complement the Better Access initiative and is very successful in achieving improved consumer outcomes. To further improve access to ATAPS services, and the effectiveness of those services, the review identified four key policy directions to guide future development of the program: addressing service gaps; increasing efficiency; encouraging innovation; and improving quality. These improvements are being implemented in a staged approach. In 2010-11, the department continued to address service gaps by improving the distribution of ATAPS funding. The department implemented the two tiered funding structure recommended by the 2010 ATAPS Review which will help ensure funding is better targeted at areas of greatest need based on population, geographic location and relative access to Medicare subsidised mental health services. Improved reporting on clinical governance and quality arrangements was introduced, with the development of improved purchasing guidance, and national support structures on clinical governance and quality assurance to occur during 2011-12. The staged introduction of efficiency indicators and activity based funding has been foreshadowed for future years. The department also sponsored a National Suicide Prevention Workshop to inform the development of ATAPS Suicide Prevention services and associated operational guidelines.

Qualitative Deliverable:

Implementation of the new phase of Access to Allied Psychological Services program.

2010-11 Reference Point:

Implemented by June 2011.

Result: Deliverable substantially met.

In March 2010, the department completed the Review of the Access to Allied Psychological Services (ATAPS) program. The review found that ATAPS is an important and necessary program to complement the Better Access initiative and is very successful in achieving improved consumer outcomes.

To further improve access to ATAPS services, and the effectiveness of those services, the review identified four key policy directions to guide future development of the program: addressing service gaps; increasing efficiency; encouraging innovation; and improving quality. These improvements are being implemented in a staged approach.

In 2010-11, the department continued to address service gaps by improving the distribution of ATAPS funding. The department implemented the two tiered funding structure recommended by the 2010 ATAPS Review which will help ensure funding is better targeted at areas of greatest need based on population, geographic location and relative access to Medicare subsidised mental health services.

Improved reporting on clinical governance and quality arrangements was introduced, with the development of improved purchasing guidance, and national support structures on clinical governance and quality assurance to occur during 2011-12. The staged introduction of efficiency indicators and activity based funding has been foreshadowed for future years.

The department also sponsored a National Suicide Prevention Workshop to inform the development of ATAPS Suicide Prevention services and associated operational guidelines.

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Short-term Torture and Trauma Counselling

On 4 April 2011, the Short-term Torture and Trauma Counselling (STTC) service, previously administered by the Department of Immigration and Citizenship, was consolidated into the Program of Assistance for Survivors of Torture and Trauma (PASTT), and administered by the department as a single program. The consolidated program will better integrate service delivery, ensuring vulnerable individuals receive the support they need at the time that best suits their needs. It will also remove the need to transfer clients between the services, thus simplifying the client ‘journey’ and providing people with greater continuity of care.

Access to Targeted, Effective and Sustainable Community-Based Programs

Child and Youth Mental Health

In the 2010-11 Budget the Government committed to improving access for children and young people to mental health services and advice by doubling the number of headspace sites. In 2010-11, the department worked with headspace to establish the first 10 of the 30 new sites funded through the measure.

Quantitative Deliverable:	Number of headspace youth-friendly service sites funded.
2010-11 Target:	≤40	2010-11 Actual:	40
Result: Deliverable met.
The locations of the first 10 new headspace sites were announced in July 2010, with the lead agencies to operate these sites announced in March 2011. All new sites will be operational in 2011. With 30 original sites operating, this brings the total number of sites funded to 40.

As the original 30 sites are now operating at full capacity, and demand is exceeding this capacity in many areas, the department worked closely with headspace to identify a sustainable funding base for these and future headspace sites. This work was essential to informing a significant expansion of headspace in the 2011-12 Budget, which will provide for 90 sustainable headspace sites by 2014-15, with a reach of up to 72,000 young people per annum.

During 2010-11, the department also worked closely with headspace to ensure appropriate targeting of high risk groups, including Aboriginal and Torres Strait Islander youth.

Qualitative KPI: Improved access to Australian Government youth mental health services for Aboriginal and Torres Strait Islander peoples.

2010-11 Reference Point: Development and implementation of an Aboriginal and Torres Strait Islander Youth Strategy by all headspace sites by June 2011.

Result: Indicator met.

A headspace led taskforce review of the organisation’s Aboriginal and Torres Strait Islander engagement strategy identified activities to improve engagement, including supporting centres to engage locally with Indigenous communities and young people with a focus on improving access and strengthening partnerships with local communities. The review also recognised the necessity of ensuring all headspace centres have guidelines and access to cultural awareness training.

The headspace National Youth Reference Group and the Aboriginal and Torres Strait Islander taskforce provide important vehicles to incorporate the feedback of young people directly into the delivery of services through headspace centres and at every level of headspace. Consultation with youth through these structures ensures that headspace advocacy for the needs of young people and their families is directly informed by youth views and feedback.

Qualitative KPI:	Improved access to Australian Government youth mental health services for Aboriginal and Torres Strait Islander peoples.
2010-11 Reference Point:	Development and implementation of an Aboriginal and Torres Strait Islander Youth Strategy by all headspace sites by June 2011.
Result: Indicator met.
A headspace led taskforce review of the organisation’s Aboriginal and Torres Strait Islander engagement strategy identified activities to improve engagement, including supporting centres to engage locally with Indigenous communities and young people with a focus on improving access and strengthening partnerships with local communities. The review also recognised the necessity of ensuring all headspace centres have guidelines and access to cultural awareness training. The headspace National Youth Reference Group and the Aboriginal and Torres Strait Islander taskforce provide important vehicles to incorporate the feedback of young people directly into the delivery of services through headspace centres and at every level of headspace. Consultation with youth through these structures ensures that headspace advocacy for the needs of young people and their families is directly informed by youth views and feedback.

In 2010-11, the department continued to improve access to child mental health services through the expansion of the KidsMatter initiative.

Quantitative KPI: Number of schools participating in the KidsMatter Primary Initiative.

2010-11 Target: 400 2010-11 Actual: 427

Result: Indicator met.

The KidsMatter Primary Initiative grew from 290 to 427 participating schools, which includes the 101 schools that participated in the pilot during 2007 and 2008.
KidsMatter aims to support mental health promotion, prevention and early intervention for all children through universal evidence-based primary school and early childhood programs.

Quantitative KPI:	Number of schools participating in the KidsMatter Primary Initiative.
2010-11 Target:	400	2010-11 Actual:	427
Result: Indicator met.
The KidsMatter Primary Initiative grew from 290 to 427 participating schools, which includes the 101 schools that participated in the pilot during 2007 and 2008. KidsMatter aims to support mental health promotion, prevention and early intervention for all children through universal evidence-based primary school and early childhood programs.

The initiative 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. The department also continued to assist parents help their children transition from preschool to primary school through the KidsMatter Parent Initiative. In addition, KidsMatter was piloted in over 100 preschools and long day care centres across Australia in 2010-11, with an evaluation of the pilot to be completed by mid-2012.

The MindMatters Initiative continues to be implemented in many secondary schools throughout Australia. The number of schools accessing MindMatters Professional Development increased from 2,600 to 3,660 during 2010-11.

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Support For Individuals at Risk of Suicide

The latest Australian Bureau of Statistics (ABS) Causes of Death, Australia 2009 ¹¹¹ report was released on 3 May 2011. In 2009 there were 2,132 suicide deaths officially recorded in Australia, representing an age standardised death rate of 9.6 per 100,000. While these figures will be revised in accordance with ABS data quality procedures in 2012, this represents a slight decrease on the revised 2008 data of 2,282 suicide deaths and age standardised death rate of 10.6 per 100,000.
To address these still unacceptably high rates of suicide, in 2010-11 the department began implementing the Taking Action to Tackle Suicide package. As part of this package, the department successfully negotiated the introduction of toll free calls from mobile telephones to Lifeline Australia for crisis counselling and provided funding to beyondblue over four years to provide more support and expanded services for men at risk.

The package also provides investment for infrastructure at suicide hotspots. As a precursor to this element of the package, the department provided funding to Woollahra Municipal Council for suicide and self-harm prevention infrastructure at the Gap Park, Watsons Bay. This included purpose built fencing, lighting, closed circuit television and signage (including support messaging).

During 2010-11, the department continued to refine components of the National Suicide Prevention Strategy.

Qualitative KPI: Components of the National Suicide Prevention Strategy meet aims and objectives of the Strategy.

2010-11 Reference Point:

LIFE Framework adopted as National framework for state and territory suicide prevention activities.
Projects under the National Suicide Prevention Action Framework implemented.
Funding under the National Suicide Prevention program provided to projects that target groups at higher risk of suicide as identified in the Action Framework.

Result: Indicator met.

Following agreement from the states and territories, the department has progressed to the Australian Health Ministers Conference the recommendation to formally adopt the LIFE Framework as the overarching national framework for suicide prevention in Australia.
The department has implemented the projects under the National Suicide Prevention Action Framework. These projects are due for completion in 2011 and aim to reduce the incidence of suicide and self harm, and to promote mental health and resilience across the Australian population.
The department funded 58 suicide prevention projects which focus on those groups identified under the National Suicide Prevention Action Framework as being at highest risk of suicide. These groups include gay, lesbian, bisexual, transgender and intersex people, Aboriginal and Torres Strait Islander people, people living with mental illness, men, young people, rural and remote populations and those bereaved by suicide.
The department also co-chaired the National Suicide Prevention Working Group and established it as a formal joint planning mechanism under the Fourth National Mental Health Plan for the Australian Government and state and territory governments.

Qualitative KPI:	Components of the National Suicide Prevention Strategy meet aims and objectives of the Strategy.
2010-11 Reference Point:	LIFE Framework adopted as National framework for state and territory suicide prevention activities. Projects under the National Suicide Prevention Action Framework implemented. Funding under the National Suicide Prevention program provided to projects that target groups at higher risk of suicide as identified in the Action Framework.
Result: Indicator met.
Following agreement from the states and territories, the department has progressed to the Australian Health Ministers Conference the recommendation to formally adopt the LIFE Framework as the overarching national framework for suicide prevention in Australia. The department has implemented the projects under the National Suicide Prevention Action Framework. These projects are due for completion in 2011 and aim to reduce the incidence of suicide and self harm, and to promote mental health and resilience across the Australian population. The department funded 58 suicide prevention projects which focus on those groups identified under the National Suicide Prevention Action Framework as being at highest risk of suicide. These groups include gay, lesbian, bisexual, transgender and intersex people, Aboriginal and Torres Strait Islander people, people living with mental illness, men, young people, rural and remote populations and those bereaved by suicide. The department also co-chaired the National Suicide Prevention Working Group and established it as a formal joint planning mechanism under the Fourth National Mental Health Plan for the Australian Government and state and territory governments.

In 2010-11, the department coordinated development of the Commonwealth Response to The Hidden Toll: Suicide in Australia report of the Senate Community Affairs Reference Committee. This response addressed the 42 recommendations of the Senate report and incorporated contributions from eight Commonwealth portfolios. This response was tabled in Parliament on 24 November 2010. The Commonwealth Response provided a cross-portfolio framework for progressing suicide prevention initiatives.

Since 2009, the department has aided more than 1,400 people who have self harmed, attempted suicide or who have suicidal ideation through the ATAPS program offered through a demonstration pilot in 19 Divisions of General Practice providing more than 7,000 services. From 1 July 2011, the initiative will be available nationally through Divisions of General Practice, and then Medicare Locals as they are established and demonstrate capacity to deliver mental health services, using funding provided through the 2010 Taking Action to Tackle Suicide package.

In 2010-11, the department continued to support community based projects under the National Suicide Prevention program to provide culturally appropriate suicide prevention services to Indigenous communities. This included the Yirriman Project managed by the Kimberley Aboriginal Law and Culture Centre in the Fitzroy Valley and the StandBy Bereavement Response Service in the Kimberley and Pilbara regions in Western Australia.

Funding was also provided to the Billard Aboriginal Corporation to deliver the ‘Stand Up For Life’ Project in the Balgo community during 2010-11. The project facilitated a series of field visits and meetings with community members and key stakeholders in Balgo that focussed on suicide prevention.

During 2011-12, priorities for the department will include the development of an Indigenous Suicide Prevention Strategy, and the continued implementation of the Taking Action to Tackle Suicide package in consultation with stakeholders, state and territory governments and the Australian Suicide Prevention Advisory Council.

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Quantitative Deliverable: Number of patient sessions delivered under the Access to the Allied Psychological Services program.

2010-11 Target: 75,000 2010-11 Actual: 152,246

Result: Deliverable met.

The department managed the ATAPS program for people diagnosed with a mild to moderate mental disorder. Services were provided throughout Australia by a range of allied health professionals engaged by Divisions of General Practice, which have been the fund holders for the ATAPS program since it was established.
During 2010-11, 152,246 sessions of care were delivered focusing on people from hard to reach groups and locations. Outcomes of treatment were measured through validated mental health instruments and demonstrated that ATAPS is continuing to achieve considerable positive clinical outcomes for the majority of consumers.

Quantitative Deliverable: Number of special purpose projects funded through the Divisions of General Practice for vulnerable populations under the Access to Allied Psychological Services program.

2010-11 Target: 60 2010-11 Actual: 106

Result: Deliverable met.

ATAPS projects targeting hard to reach populations increased by 170%, with all Divisions of General Practice funded to target a number of vulnerable populations including those at risk of suicide or self-harm, people who are homeless, or are at risk of homelessness, children with emotional or behavioural difficulties, women with perinatal depression and people who have been affected by extreme climatic conditions such as floods and bushfires.

Quantitative KPI: Percentage of Divisions of General Practice providing Access to Allied Psychological Services to hard to reach groups.

2010-11 Target: 100% 2010-11 Actual: 100%

Result: Indicator met.

In 2010-11, the department engaged Divisions of General Practice to increase service delivery to target hard to reach individuals and communities. These include individuals for whom Medicare based services are not affordable or appropriate; individuals in geographic areas which have low access to Medicare based services, including rural areas; youth and children with mental disorders; people from Culturally and Linguistically Diverse backgrounds; women with perinatal depression; people at risk of suicide or self-harm; homeless people and people impacted by extreme climatic events.

Quantitative KPI: Percentage of Divisions of General Practice providing Access to Allied Psychological Services packages of clinical and non clinical care for people with severe mental illness being managed in the community.

2010-11 Target: 100% 2010-11 Actual: 0%

Result: Indicator not met.

Following the 2011-12 Budget, the parameters for this measure have changed, with funding redirected to the new Coordinated care and assessment for people with severe and persistent mental illness with complex needs from 2012-13. The department has commenced targeted consultation on implementation of the services for people with severe mental illness to ensure appropriate roll-out for the 2011-12 period.

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Quantitative Deliverable:	Number of patient sessions delivered under the Access to the Allied Psychological Services program.
2010-11 Target:	75,000	2010-11 Actual:	152,246
Result: Deliverable met.
The department managed the ATAPS program for people diagnosed with a mild to moderate mental disorder. Services were provided throughout Australia by a range of allied health professionals engaged by Divisions of General Practice, which have been the fund holders for the ATAPS program since it was established. During 2010-11, 152,246 sessions of care were delivered focusing on people from hard to reach groups and locations. Outcomes of treatment were measured through validated mental health instruments and demonstrated that ATAPS is continuing to achieve considerable positive clinical outcomes for the majority of consumers.
Quantitative Deliverable:	Number of special purpose projects funded through the Divisions of General Practice for vulnerable populations under the Access to Allied Psychological Services program.
2010-11 Target:	60	2010-11 Actual:	106
Result: Deliverable met.
ATAPS projects targeting hard to reach populations increased by 170%, with all Divisions of General Practice funded to target a number of vulnerable populations including those at risk of suicide or self-harm, people who are homeless, or are at risk of homelessness, children with emotional or behavioural difficulties, women with perinatal depression and people who have been affected by extreme climatic conditions such as floods and bushfires.
Quantitative KPI:	Percentage of Divisions of General Practice providing Access to Allied Psychological Services to hard to reach groups.
2010-11 Target:	100%	2010-11 Actual:	100%
Result: Indicator met.
In 2010-11, the department engaged Divisions of General Practice to increase service delivery to target hard to reach individuals and communities. These include individuals for whom Medicare based services are not affordable or appropriate; individuals in geographic areas which have low access to Medicare based services, including rural areas; youth and children with mental disorders; people from Culturally and Linguistically Diverse backgrounds; women with perinatal depression; people at risk of suicide or self-harm; homeless people and people impacted by extreme climatic events.
Quantitative KPI:	Percentage of Divisions of General Practice providing Access to Allied Psychological Services packages of clinical and non clinical care for people with severe mental illness being managed in the community.
2010-11 Target:	100%	2010-11 Actual:	0%
Result: Indicator not met.
Following the 2011-12 Budget, the parameters for this measure have changed, with funding redirected to the new Coordinated care and assessment for people with severe and persistent mental illness with complex needs from 2012-13. The department has commenced targeted consultation on implementation of the services for people with severe mental illness to ensure appropriate roll-out for the 2011-12 period.

Support for Women Experiencing Antenatal and Postnatal Depression

In 2010-11, the department continued to work closely with states and territories to implement the National Perinatal Depression Initiative. The initiative focuses on improving prevention and early detection of antenatal and postnatal depression, and providing better support and treatment for expectant and new mothers experiencing depression. This work included the development of an implementation plan under the National Partnership Agreement on Health Services. It is anticipated that the agreement will be executed by the department in early 2011-12. All states now have either pre or post natal routine screening in place.

Quantitative KPI:	Percentage of Divisions of General Practice with the capacity to provide perinatal depression services through the Access to Allied Psychological Services program.
2010-11 Target:	100%	2010-11 Actual:	100%
Result: Indicator met.
During 2010-11, funding under the National Perinatal Depression Initiative was provided to all Divisions of General Practice through the ATAPS program to improve access to psychological support for women experiencing perinatal depression, build links and referral pathways with child and mental health units and primary mental health care providers and support innovative service delivery approaches. This included the extension of psychosocial therapy to women experiencing perinatal depression and their families to 30 June 2012.

During 2010-11, the department continued to fund beyondblue to develop a range of clinical support tools for primary care providers. This included the Clinical Practice Guidelines for Depression and Related Disorders –Anxiety, Bipolar and Puerperal Psychosis – in the Perinatal Period which were released in April 2011.

Access to Services for Hard to Reach Population Groups

Targeting Service Gaps

In 2010-11, through the extension of the Mental Health Support for Drought Affected Communities initiative, the department provided additional funding to affected Divisions of General Practice to continue targeting individuals and communities living in a wide range of drought-affected rural and remote communities. Transition arrangements were put in place to enable remaining clients who require continued clinical psychological services beyond June 2011 to receive services under the ATAPS program.

Qualitative Deliverable:	Mental health support for drought affected communities.
2010-11 Reference Point:	Community outreach activities and crisis counselling services delivered to drought affected individuals, families and communities in a timely manner.
Result: Deliverable met.
Through the extension of the Mental Health Support for Drought Affected Communities initiative in 2010-11, the department provided additional funding to affected Divisions of General Practice to provide innovative outreach, crisis counselling and community awareness for communities affected by severe drought.

A major challenge for the department in 2010-11 was responding quickly to natural disasters to ensure that support and services were provided to residents affected by the Queensland floods and Cyclone Yasi. The department worked closely with the Queensland Government to ensure that the support and services provided were well targeted and coordinated. The department also provided additional funding to Divisions of General Practice in those areas most impacted by the 2010-11 floods and Cyclone Yasi to increase the number of focussed psychological strategies provided to individuals affected, including those who are at increased risk of developing ongoing psychological symptoms resulting from trauma or loss associated with the floods or cyclone.

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Better Access Initiative

The Better Access initiative provided 5,801,231 services during 2010-11. This included 760,770 rebates for GP Mental Health Treatment Plans, 1.27 million Medicare subsidised Psychological Therapy services provided by clinical psychologists, 2.3 million Medicare subsidised Focussed Psychological Strategies services provided by registered psychologists, occupational therapists and social workers, and over 121,700 Medicare rebateable psychiatry services.

The evaluation of the Better Access initiative completed in late 2010 examined the uptake of services. Between 2007-09, over 2 million people received more than 11.1 million mental health services. The treatment rate also increased from 35% in 2007 to an estimated 46% in 2010.

Figure 2.4.11.1 Claims for Mental Health Care Items 1 July 2010 - 30 June 2011 Source: Medicare Australia website, Medicare Statistics, 25 July 2011.

Figure 2.4.11.1 Claims for Mental Health Care Items 1 July 2010 - 30 June 2011 Source: Medicare Australia website, Medicare Statistics, 25 July 2011
Text version of this chart

The department also completed an evaluation of the Mental Health Services in Rural and Remote Areas (MHSRRA) program in 2010-11. The Final Report produced for the evaluation is publicly available from www.mentalhealth.gov.au

Qualitative Deliverable: Complete evaluation of Mental Health Services in Rural and Remote Areas Program.

2010-11 Reference Point: Evaluation completed by late 2010.

Result: Deliverable met.

The department funded Pricewaterhouse Coopers to complete an evaluation of the Mental Health Services in Rural and Remote Areas (MHSRRA) program.¹¹³ The evaluation showed an increase in access to mental health services in rural and remote areas since the program was introduced. Since July 2007, over 40,000 clients have accessed more than 140,000 services by over 114 full-time equivalent allied and nursing mental health staff. The evaluation indicated that the MHSRRA program was perceived by professionals, communities, recipients and their families as providing an appropriate and effective response in those areas with low access to mental health care. The report also indicated that the flexibility and interdisciplinary nature of the program has enabled innovative service models to be supported. As a result of this evaluation, the MHSRRA program has been extended to 30 June 2013.

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Whole of Program Performance Information

Qualitative Deliverable:	Produce relevant and timely evidence-based policy research.
2010-11 Reference Point:	Relevant evidence-based policy research produced in a timely manner.
Result: Deliverable substantially met.
A second National Survey of People Living with Psychotic Illness was completed in December 2010. This complements the data of the 2007 National Survey of Mental Health and Wellbeing, which provided data on the prevalence of common mental disorders and services used in the general population aged 16-85 years. Data from respondents, their general practitioners and non-government service providers are being finalised, with a summary publication of the findings and journal publications to be produced in 2011-12. These will provide data on the national prevalence of psychosis, and information on the health and wellbeing, housing and employment of those being treated for psychosis, as well as information on the various services people receive. With funding announced in the 2011-12 Budget, work can proceed on development of the third component of the National Survey of Mental Health and Wellbeing, a child and adolescent survey.

Qualitative Deliverable:

Produce relevant and timely evidence-based policy research.

2010-11 Reference Point:

Relevant evidence-based policy research produced in a timely manner.

Result: Deliverable substantially met.

A second National Survey of People Living with Psychotic Illness was completed in December 2010. This complements the data of the 2007 National Survey of Mental Health and Wellbeing, which provided data on the prevalence of common mental disorders and services used in the general population aged 16-85 years.

Data from respondents, their general practitioners and non-government service providers are being finalised, with a summary publication of the findings and journal publications to be produced in 2011-12. These will provide data on the national prevalence of psychosis, and information on the health and wellbeing, housing and employment of those being treated for psychosis, as well as information on the various services people receive.

With funding announced in the 2011-12 Budget, work can proceed on development of the third component of the National Survey of Mental Health and Wellbeing, a child and adolescent survey.

Qualitative Deliverable:	Stakeholders participate in program development through a range of avenues.
2010-11 Reference Point:	Stakeholders participated in program development through avenues such as regular consultative committees, conferences, stakeholder engagement forums, surveys, submissions on departmental discussion papers and meetings.
Result: Deliverable met.
The department undertook broad stakeholder consultations with states and territories, mental health consumers and carers, service providers and other experts in the development and implementation of mental health programs. The department continues to receive and support regular stakeholder input through participation in, and secretariat support to, committees with state and territory representatives, mental health sector representatives, consumers and carers and technical experts, such as the Mental Health Standing Committee and its Mental Health Information Strategy Subcommittee. In addition, the department funded the Mental Health Council of Australia to coordinate arrangements for 14 face-to-face forums with Minister Butler and mental health consumers and carers in December 2010. These forums enabled the Minister to hear firsthand consumer and carer experiences and views on options for progressing mental health reform into the future. The department also provided secretariat support to Minister Butler’s new Mental Health Expert Working Group, and continued to provide secretariat support to the National Advisory Council on Mental Health. This extensive engagement informed the Australian Government’s commitment to drive fundamental reform in the mental health system.
Qualitative Deliverable:	Delivery of telephone and web based mental health services through the Telephone Counselling and Web Based Support measure.
2010-11 Reference Point:	Increase in access to online mental health programs and improved response/answer rates for telephone based services.
Result: Deliverable met.
During 2010-11, the range and sophistication of telephone counselling and web-based support programs funded by the department expanded. All funded organisations undertook promotional activities, with the majority utilising social networking sites to encourage help-seeking. They reported increases in client access, registration and course completion rates, and provided links on their websites to other relevant online programs that provide complementary services. In 2010, all funded organisations received additional funding to provide enhancements to existing programs. Lifeline Australia and the Kids Helpline service increased their rates of response to calls to their crisis lines. Lifeline had an average call response rate of 61% in 2010-11 (exceeding its target rate of 60%), and Kids Helpline had an average call response rate of 57% in 2011 which exceeds its rate of 49% in 2007, but falls short of its target of 20% above the 2007 rate.
Qualitative Deliverable:	Complete evaluation of COAG Telephone Counselling and Web Based Support measure.
2010-11 Reference Point:	Evaluation completed by December 2010.
Result: Deliverable substantially met.
The independent evaluation report was substantially completed by December 2010, with minor refinements occurring in 2011.
Qualitative Deliverable:	Implementation of new packages of clinical and non clinical care for people with severe mental illness being managed in the community.
2010-11 Reference Point:	Implemented from late 2010.
Result: Deliverable substantially met.
During January, February and March 2011, the department held nationwide stakeholder consultations with key stakeholders including Divisions of General Practice, clinicians, non-government organisations, organisations representing allied health professions, consumers and carers on the design and implementation of the Flexible Care Packages for People with Severe Mental Illness measure. Following feedback from expert advice and receipt of written submissions, the department introduced a staged approach to the implementation of the measure and from 1 April 2011 the first 19 Medicare Locals became eligible for funding to commence service establishment. Following the 2011-12 Budget, the parameters for this measure have changed, with funding redirected to the new Coordinated care and assessment for people with severe and persistent mental illness with complex needs from 2012-13. The department has commenced targeted consultation on implementation of services for people with severe mental illness to ensure appropriate roll out for the 2011-12 period.

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Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2010-11 Target:	≤0.5%	2010-11 Actual:	0.1%
Result: Deliverable met.
During 2010-11, the department managed Program 11.1 funds effectively and achieved a variance of 0.1%.
Qualitative KPI:	Evaluation of COAG Telephone Counselling and Web Based Support measure.
2010-11 Reference Point:	Evaluation concludes that the role of telephone and web based therapy in service provision are effective.
Result: Indicator met.
The independent evaluation by Healthcare Planning and Evaluation Pty Ltd determined the measure has been successful in increasing access to telephone counselling, self help and web-based services and has been effective in the provision of e-mental health services.

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Outcome 11 – Financial Resources Summary

	(A) Budget Estimate¹ 2010-11 $’000	(B) Actual 2010-11 $’000	Variation (Column B minus Column A) $’000
Program 11.1: Mental Health
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	182,770	182,461	(309)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	14,224	14,563	339
Revenues from other sources (s31)	297	263	(34)
Unfunded depreciation expense	359	480	121
Operating loss / (surplus)	-	1	1
Total for Program 11.1	197,650	197,768	118
Outcome 11 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	182,770	182,461	(309)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	14,224	14,563	339
Revenues from other sources (s31)	297	263	(34)
Unfunded depreciation expense	359	480	121
Operating loss / (surplus)	-	1	1
Total expenses for Outcome 11	197,650	197,768	118
Average Staffing Level (Number)	103	104	1
¹ Budgeted appropriations taken from the 2011-12 Health and Ageing Portfolio Budget Statements and re-aligned to the 2010-11 outcome structure.

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¹⁰⁹Available at: www.health.gov.au/internet/mhsc/publishing.nsf/Content/publications-1
¹¹⁰The final evaluation reports are available from www.health.gov.au/internet/main/publishing.nsf/content/mental-ba-eval
¹¹¹Australian Bureau of Statistics. 2011. ABS3303.0 Causes of Death, Australia, 2009. ABS: Canberra. Available at: www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0

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