This section provides an overview of and context for the revised National Standards for Mental Health Services (national standards) with a particular focus on their implementation in the non-government community mental health sector. Some of the issues covered in the introduction are addressed in more depth in later sections.
Background to the revised National Standards for Mental Health Services
The revised National Standards for Mental Health Services
The non-government community mental health sector context
Why the national standards are important
The place of the national standards in the delivery of quality services
Standards and accreditation
Background to the revised National Standards for Mental Health ServicesThe National Standards for Mental Health Services were first introduced in 1996 with the endorsement and support of the Commonwealth, state and territory health ministers. Their development was guided by the principles contained in the national mental health policy of the time and the United Nations' Principles on the Protection of People with Mental Illness. The national standards were designed primarily for the public specialist health system and were adopted subsequently by all public specialist mental health services and private mental health hospitals across Australia. While some non-government community mental health services adapted elements of the national standards to their own agency settings with some success, a majority found it difficult to apply many of the national standards to the community, organisational and service provision context within which they operated.
The context in which mental health services are delivered has changed over the last decade, with both clinical and non-clinical services being more frequently delivered in community rather than hospital settings. There has been a consequent increase in non-government and private sector involvement and in the role of the primary care sector in mental health service delivery. In response to these changes, a review of the national standards was started in November 2006, in consultation with a wide range of stakeholders including consumers and carers. The revised national standards are the result.
The revised National Standards for Mental Health ServicesThe revised standards have taken into account what worked well with the earlier standards, but better reflect contemporary mental health practices and the current and anticipated environments within which services are delivered. Unlike the earlier national standards, the revised standards have been designed so that they can be incorporated into the broad spectrum of services within the mental health sector.
The revised national standards will therefore apply to a wide range of mental health service providers, for example public mental health services, private mental health services, GPs, and non-government providers of community mental health services. They must also be appropriate in a diverse range of communities across Australia. How 'community' is defined varies depending on the purpose, structure and type of service. For example, it could be a geographic catchment area or a target population group. Given the diversity of service types and of settings in which mental health services are now offered, this shift to a system of standards that apply to the whole service system presented significant challenges as the revised standards were developed.
One of the challenges was that not all of the national standards are equally relevant to different service types and settings. For example, standards that are critical in an inpatient setting, such as seclusion practices, and trying to achieve a voluntary rather than an involuntary admission to hospital, are not relevant to non-government providers of community mental health services. Some that apply to services which provide accommodation (for example, a hospital or supported community accommodation facility) are not relevant to community-based recovery services.
Some standards need to be interpreted differently for different sectors and settings. For example, the context in which the word 'treatment' is used in the national standards implies medical treatment, which few non-government community mental health services would provide. A more relevant term for non-government providers would be 'services'. To address the challenges created by the diversity in the service delivery system, and to customise the national standards for implementation by different parts of the mental health service delivery system, a decision was taken to develop a series of implementation guides to help different sectors and service settings as the new standards are implemented. This document is one of those guides.Top of page
The non-government community mental health sector contextThere is diversity between different sectors of the mental health service system and diversity within each of those sectors. The range of services delivered by the non-government community mental health sector also varies from state to state.
Services range from intensive personal recovery support to day activity programs and have diverse target groups—for example, a geographic community, people with a particular service need such as accommodation, or people who share a common characteristic such as being carers or being from an Aboriginal and Torres Strait Islander background.
The organisational complexity of the service providers also varies enormously. Some are large national organisations, some are multi service and multi site agencies within states and others are very small organisations with few paid staff and a heavy reliance on the contribution of dedicated volunteers.
Given these wide variations, there will be circumstances in which there will be different expectations of compliance to a particular standard for different types of service provision.
Across all services in Australia the implementation of the national standards in the non-government community mental health sector will require the involvement and commitment of boards, staff, consumers, carers and funders. Measuring levels of achievement against the national standards will be an important means of accountability to consumers, carers, community, staff and funders.Top of Page
Why the national standards are importantThere are many reasons why the national standards are important to the mental health service system, including the non-government community mental health sector. These reasons include:
1. Assurance to consumersThe revised standards provide an assurance to people living with a mental illness and to their carers and families that all mental health service providers have similar levels of service safety, quality and accountability. This applies to services in the public, private or community mental health sectors, whether in acute, post acute or community recovery settings. The standards must be met in metropolitan, regional, rural and remote Australia.
The national standards encompass all of the things an organisation should be doing to provide effective, consumer focussed services. They establish common expectations and support consistency and continuity in care and support services right across the mental health service system. The national standards assist consumers to understand what they should expect when they access any service in any part of the mental health service system in any state or territory.
2. A framework for consumer participationThe national standards will provide a consistent and accessible framework through which people living with a mental illness, their carers and families will be able to participate in service planning, implementation, review and evaluation processes.
3. Transparency and accountabilityBy defining expected levels of service and providing a framework for service monitoring (further discussed in Section 3 Implementation tools of this guide) the national standards allow service providers to demonstrate that their services are transparent and are meeting their funding accountability requirements.
4. Service monitoring and continuous quality improvementThe national standards support internal service monitoring and review which can enhance organisational performance. They will assist in the orderly and systemic identification of those areas in which services are performing well and in recognising opportunities for service enhancement. The standards will identify areas that need improvement.Top of page
5. Promoting respect and trust between different parts of the service systemThe history of the mental health service system in Australia, and in most other first world countries, is one in which the medical model of service delivery has predominated.
Acute medical interventions and a continuing medication regime will continue to be an essential component of the support provided for many people living with a serious mental illness; however, it is now understood that recovery from mental illness often requires a range of skilled interventions and supports which are not in the medical domain.
There have been barriers between the acute public mental health sector and the non-government community mental health sector. These will diminish as the validity and effectiveness of recovery interventions delivered and managed through the community sector are better understood and respected across the whole of the service system. The standards will have all parts of the service system using the same language in the way that they are accountable to consumers and each other. This will be an important context within which respect and trust can be developed over time.
6. Providing strategic information at a sector and service system levelThe implementation of common standards across the whole of the mental health service system will provide opportunities for the development of a much better strategic understanding of the Australian mental health service system and its component parts. Many of these opportunities will not be realised in the short term, but implementing the revised standards will pave the way for strategic analysis in the future.Top of page
The place of the national standards in the delivery of quality servicesService delivery in the non-government community mental health sector is influenced by a number of quality, safety and performance requirements other than the national standards. Some of these are obligatory, some are voluntary. Compliance requirements that contribute to the quality management and service delivery in the non-government community mental health sector include:
- specific state legislation such as the state and territories’ Mental Health Act, Occupational Health and Safety Act, Anti-Discrimination Act, Incorporated Associations Act
- the professional regulation requirements which must be met by some practicing mental health professionals
- obligatory external accreditation processes
- service quality conditions set through service purchasing and funding agreements.
By incorporating the national standards and these obligatory requirements into a cohesive quality framework, service providers can save themselves work as some requirements overlap or duplicate each other. Incorporating all requirements also gives a systematic, transparent and accountable way for organisations to assure themselves and their consumers about the overall quality of their management and services, and helps them to improve their performance.
Service providers must recognise that the national standards are only one element of an effective quality assurance system that provides internal and external ways of assessing their service system and of ensuring ongoing improvements in service delivery. Service providers should see the national standards not just as a compliance requirement but as an integral part of a quality assurance system that is appropriate to the size and service range of each organisation.Top of page
Standards and accreditationThe national standards set out the minimum requirements for all service providers in the mental health service system. As noted above, the national standards will be most effective if they are seen as an integral part of each service provider's quality assurance system, rather than as a stand-alone obligation.
Accreditation is one means of providing an independent assessment of performance against standards.
A formal accreditation process supports continuous quality improvement in service provision. However, the national standards do not have to be incorporated into formal accreditation to be meaningful and useful to the non-government community mental health sector.
Accreditation is only one mechanism through which compliance can be monitored, quality improved, and achievements reported. Other ways include the use of reporting frameworks such as key performance indicators, internal monitoring arrangements, internal and external evaluations, and peer review processes. All of these can prove that a service is committed to improving the quality of care, and for all of them the national standards will be a useful reference point.
Some states already have a strong emphasis on accreditation. In some states, individual agencies have chosen to become accredited with an external accreditation provider. While it is anticipated that the national standards will be incorporated into relevant accreditation programs, states and territories will make their own decisions on whether accreditation will be mandatory for non-government community mental health service providers.
Service provider organisations will be encouraged to introduce other practices to complement, or in some cases replace, the criteria listed against each standard. What is important is that they demonstrate how they meet the standard.