National mental health report 2013

1.3 Setting the scene: the national mental health reform context

Page last updated: 2013

Overview of the National Mental Health Strategy
Framework for national action

Overview of the National Mental Health Strategy

The National Mental Health Strategy has provided the overarching policy framework that has guided an extensive process of mental health reform in Australia for the last 20 years. Commencing with the endorsement of the National Mental Health Policy in 1992, the concept of the National Mental Health Strategy has grown to encompass the range of national policy and planning documents relating to mental health reform that have been agreed by all governments, either through their respective Health Ministers, or at the level of First Ministers through the Council of Australian Governments (COAG). These include four five year National Mental Health Plans covering the period 1993 to 2014, a revised National Mental Health Policy released in 2008,15 the COAG National Action Plan on Mental Health endorsed in 200616 and, more recently, an agreement by COAG in December 2012 to the Roadmap for National Mental Health Reform 2012‑2022.1 As a national agreement endorsed by all heads of governments, the Roadmap represents the most current statement of intergovernmental commitment to mental health reform as an ongoing national priority, and outlines the directions that reform will take over the next 10 years.

The direction of reform has changed considerably over the 20 years that the National Mental Health Strategy has been in place, reflecting both the achievement of previous objectives and the incorporation of new priorities, driven by emerging knowledge and changing community expectations. A brief, chronological history of the policy directions of the Strategy is provided below.

The First National Mental Health Plan (1993‑1998) represented the first attempt to coordinate mental health care reform in Australia. It focused primarily on state and territory mental health services and advocated for major structural reform, with a particular emphasis on decreasing the reliance on stand‑alone psychiatric hospitals, expanding community based care alternatives, and ‘mainstreaming’ the delivery of acute inpatient care into general hospitals. Top of page

An evaluation of the First National Mental Health Plan was conducted in 1997.17 This was generally positive, but observed that there were some areas that could be strengthened. As a result, when the Second National Mental Health Plan (1998‑2003)18 was released in 1998 it continued the work of the First Plan towards structural reform, but expanded into additional areas such as mental health promotion, mental illness prevention and destigmatisation. In terms of mental illnesses, the remit of the Second Plan was broader than that of the First Plan; it moved beyond the severe and disabling disorders that are typically treated in state and territory‑funded services, and also considered more prevalent conditions like depression and anxiety. It also fostered important partnerships – between the public and private sectors, between specialist services and primary care providers, and, more broadly, between the health sector and sectors outside health that have an influence on people’s lives.

The Second National Mental Health Plan underwent a mid‑term review in 2001.19 It was evaluated more formally in 2003,20 and the Third National Mental Health Plan (2003‑2008)21 was released later that year. Again, the findings of the review and evaluation of the Second Plan helped to shape the directions of the Third Plan. The Third Plan set out to consolidate the achievements of the previous two plans by taking an explicit population health approach and reaffirming an emphasis on the full spectrum of services that are required to assure the mental health of Australians. It focused on mental health promotion and mental illness prevention, improving service responsiveness, strengthening service quality, and fostering innovation.

Both the Second and Third Plans emphasised the importance of cross‑sectoral partnerships in supporting mental health and wellbeing, and the need to respond to mental illness through a whole‑of‑government approach. These themes were elevated as priorities in 2006 when COAG agreed to the National Action Plan on Mental Health. The National Action Plan was developed by governments to give further impetus to mental health reform and sharpen the focus on areas that were perceived by stakeholders to have not progressed sufficiently under the first three National Mental Health Plans. It represented the first time that heads of governments had focused on the issue of mental health and agreed to a national plan of action to reform mental health services. It took the delivery of services for people with mental illness into areas beyond the boundaries of traditional health care. Key human service programs operating outside the health system with major responsibilities under the COAG National Action Plan include housing, employment, education and correctional services. The National Action Plan also emphasised the role of the non‑government sector in the delivery of a wide range of community support services. Top of page

In 2008, the National Mental Health Strategy was extended through a new National Mental Health Policy, endorsed by Health Ministers. The new Policy carried forward the central tenets of the previous Policy, but updated various elements of it to bring it into closer alignment with the whole‑of‑government approach articulated in the COAG National Action Plan. The new Policy provided an overarching vision for a mental health system that enables recovery, 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.

2008 also saw a summative evaluation of the Third National Mental Health Plan,22 the findings from which influenced the Fourth National Mental Health Plan which was released in the following year. The Fourth Plan specified priorities for collaborative government action, identifying 34 reform actions to be undertaken across five priority areas, namely:

  • social inclusion and recovery
  • prevention and early intervention
  • service access, coordination and continuity of care
  • quality improvement and innovation and
  • accountability.
In 2010, Health Ministers endorsed the Implementation Strategy for the Fourth National Mental Health Plan that detailed specific implementation strategies against each of the 34 actions in the Fourth Plan, and the first report on implementation progress was released in 2011. More recently, the Australian Health Ministers’ Advisory Council endorsed a more focused approach to implementation, with a view to integrating mental health reform efforts outlined in the 2011‑12 Federal Budget and broader reforms that are being progressed through the COAG National Action Plan. The result of this decision was that the approach to implementation of the Fourth Plan became more streamlined and strategic in focus. Emphasis was given to 22 of the actions that were identified as capable of being progressed independently of the wider national reforms, and this was later increased to 23. Top of page

In January 2012, the Federal Government established a new agency – the National Mental Health Commission – to provide a new approach to guiding and monitoring mental health reform in Australia. The Commission’s core function is to monitor and evaluate the mental health system as a whole, and do this by working closely with consumers, carers, stakeholders and all jurisdictions. The Commission is located in the Prime Minister’s portfolio, recognising the importance to mental health reform of cross sectoral, whole‑of‑government leadership. Similar state‑level Commissions have also been established by New South Wales and Queensland. The Western Australian Mental Health Commission, the first in Australia, was established with a broader range of functions including the responsibility for public investment in mental health.

Most recently, in December 2012, COAG agreed to the Roadmap for National Mental Health Reform that outlines the directions that will be taken by governments over the next 10 years. The Roadmap set out new governance and accountability arrangements designed to directly engage stakeholders and ensure that governments are held to account. These new arrangements include the establishment of a COAG Working Group on Mental Health Reform that is required to develop, for COAG’s consideration by mid‑2014, a successor to the Fourth National Mental Health Plan that will set out how the Roadmap will be implemented.

Alongside the above national activities, states and territories have developed their own mental health plans that have reflected the goals and principles of the national approach, but have been tailored to meet local requirements. Jurisdictions’ own plans remain the key documents for setting out the specific details of how they will work towards achieving the objectives agreed under the National Mental Health Strategy.

A summary of key milestones in the life of the National Mental Health Strategy is provided in Figure 2. Top of page

Figure 2: Milestones in the life of the National Mental Health Strategy


Refer to the following text for a text equivalent ofFigure 2: Milestones in the life of the National Mental Health Strategy

PDF version: Larger version of Figure 2 (PDF 576 KB large file)

Text version of figure 2

  • March 1991 - Australian Health Ministers' agreement to Mental Health Statement of Rights and Responsibilities
  • April 1992 - Australian Health Ministers' agreement to National Mental Health Policy
  • First National Mental Health Plan (1993-1998)
    • July 1993 - National Mental Health Strategy incorporated in 5 year Medicare Agreements
    • March 1994 - First National Mental Health Report released
    • December 1997 - Evaluation of First National Mental Health Plan released
    • April 1998 - Australian Health Ministers' agreement to the Second National Mental Health Plan
    • June 1998 - Second National Mental Health Plan commenced
  • Second National Mental Health Plan (1998-2003)
    • November 2001 - International mid-term review of Second Plan released
    • April 2003 - Evaluation of the Second National Mental Health Plan released
  • Third National Mental Health Plan (2003-2008)
    • July 2003 - National Mental Health Plan 2003-2008 released
    • August 2003 - Australian Health Care Agreements 2003-2008 signed
    • July 2006 - COAG National Action Plan on Mental Health signed
    • 2008 - Australian Health Care Agreements extended to June 2009
    • July 2008 - Third National Mental Health Plan summative evaluation
    • December 2008 - revised National Mental Health Policy released
  • Fourth National Mental Health Plan (2009-2014)
    • July 2009 - National Health Care Agreements 2009-2014 signed
    • November 2009 - Fourth National Mental Health Plan released
    • January 2012 - National Mental Health Commission established
    • December 2012 - Roadmap for National Mental Health Reform 2012-2022 released Top of page

Framework for national action

From its inception, the National Mental Health Strategy has been premised on an understanding of the complementary roles of the Australian Government and state and territory governments.

The states and territories have traditionally been responsible for the funding and provision of the public sector mental health services that provide specialist care for people with severe mental illness. These include services delivered in inpatient settings and services delivered by community‑based teams. As the main source of both funding for specialised mental health services, the states/ territories have occupied a central position in Australia’s mental health system.

For its part, the Australian Government is responsible for providing leadership to guide national action, and monitoring the reform process. It also funds a range of services for people with mental illness via the Medicare Benefits Schedule, the Pharmaceutical Benefits Schedule and programs administered by the Department of Health and Ageing (DoHA), the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) and the Department of Veterans’ Affairs (DVA). Its role expanded substantially as a result of the COAG National Action Plan on Mental Health in 2006, and more recently through a broad range of new and expanded programs announced in the 2011 Federal Budget. These included the expansion of mental health services subsidised by Medicare, and a range of mental health specific community support programs managed through the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA). The Australian Government also funds a range of mainstream programs and services which provide essential support for people with mental illness. These include income support, social and community support, disability services, workforce participation programs, and housing assistance.