Fourth national mental health plan: an agenda for collaborative government action in mental health 2009-2014

Progress of mental health system reform in Australia

Page last updated: 2009

The last decade and a half of mental health system reform under the National Mental Health Strategy has led to significant change. Public sector specialist mental health services are now staffed by a significantly larger mental health workforce. Nationally, the number of state and territory employed professionals who work directly with consumers in specialist mental health settings grew by 51% between 1993 and 2007 (figure 6). This workforce is complemented by employed consumer consultants and peer workers who did not previously exist as a professional group but are now growing in number.

Care is now delivered primarily in community settings, compared with the previous heavy reliance on inpatient services that characterised Australia's mental health system. At the commencement of the strategy, 29% of state and territory mental health spending was dedicated to caring for people in the community; by 2007, the community share of total mental health expenditure had increased to 53% (figure 7). There has also been an increased emphasis on the safety, quality and outcomes of care, as evidenced by activities like the routine measurement of clinician rated and consumer rated outcomes in all services.

Access to mental health care in primary care settings has been substantially increased as a result of changes to the Medicare Benefits Schedule at the end of 2006, with more than 1.3 million mental health treatment plans developed by general practitioners, and 4.95 million services provided by psychologists and other allied health professionals through Medicare subsidised services.

The 2007 National Survey of Mental Health and Wellbeing provided evidence of the impact of these changes, with the finding that the percentage of those with a mental illness who saw a mental health professional in 2007 was almost double those who did so in 1997 (figure 8).

Community mental health literacy has also improved during the life of the National Mental Health Strategy, indicating that the substantial investment in mental health promotion initiatives - particularly those driven by beyondblue - are bearing fruit. Research undertaken by the University of Melbourne has demonstrated an increase in awareness of depression and the issues associated with it (e.g. discrimination) between 1995 and 2004, which was most pronounced in states and territories that contributed funding to beyondblue.

The broader, cross sectoral activities are gaining traction too. Across most states and territories, work in the housing sector has begun to recognise the needs of those with mental illness when planning social housing initiatives. Similarly, developments in the justice sector have seen diversionary programs developed for people with mental illness or substance dependency. In other areas, state and territory cross portfolio COAG mental health groups are beginning to take forward whole of government initiatives and foster stronger partnerships.

These achievements have led to Australia being regarded as a world leader in mental health system reform, but the fourth plan acknowledges that there is still much to be done. While the directions of each of the previous plans have been broadly supported, the pace of reform has varied, often considerably, across jurisdictions. The prevalence and impact of mental health problems remain significant issues, and, according to the 2007 National Survey of Mental Health and Wellbeing, only one-third of those with a mental illness receive mental health services each year. Major disparities continue between different states and territories in the mix and level of services. Demand for mental health care - particularly for acute and emergency care - continues to outstrip supply. Challenges in recruiting, retaining and supporting a workforce with appropriate competencies also continue to compromise the quantity and quality of care available. Consumers and carers still report that they experience difficulties in accessing the right care at the right time, and that they experience discrimination from within the mental health system, from other sectors with which they come into regular contact, and from the general community.

The fourth plan extends the reform efforts of the National Mental Health Strategy to improve the mental health of all Australians. Its whole of government emphasis distinguishes it from the three previous national mental health plans, and it gives particular consideration to a collaborative approach that will foster complementary programs that deliver responsive services. Top of page

Figure 6: Growth in the state and territory clinical workforce 1993 to 2007

Text equivalent below for Figure 6: Growth in the state and territory clinical workforce 1993 to 2007

Source: Australian Government Department of Health and Ageing

Text version of figure 6

Service1992-932006-07
Inpatient services
10,020
10,726
Ambulatory care services
3,358
8,776
Community residential services
706
1,705
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Figure 7: Community based services as percentage of total state and territory spending on mental health services, 1992-93 and 2006-07

Text equivalent below for Figure 7: Community based services as percentage of total state and territory spending on mental health services, 1992-93 and 2006-07

Source: Australian Government Department of Health and Ageing

Text version of figure 7

1992-93

  • Community - 29%
  • Hospitals - 71%

2006-07

  • Community - 53%
  • Hospitals - 47%
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Figure 8: Percentage of people with a current mental illness who consulted a mental health professional, 1997 and 2007


Text equivalent below for Figure 8: Percentage of people with a current mental illness who consulted a mental health professional, 1997 and 2007

Sources: Based on a supplementary analysis of data collected in the Australian Bureau of Statistics 1997 and 2007 National Surveys of Mental Health and Wellbeing.

Text version of figure 8

Percentage of people with a current mental illness who consulted a mental health professional by year:
  • 1997 - 12%
  • 2007 - 22%
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