Shaping Mental Health Reform – Key Tasks for an Incoming Government

Personalised care

One size does not fit all. Using a combination of technology and best practice, mental health reform can better respond to each person’s unique needs. ⁹ The Forum prioritised community-based mental health care, including both clinical services and specialist services, especially designed and funded to work in teams to address client complexity. The Forum also prioritised psychosocial services to finally become a vibrant and professional partner in the delivery of team-based community mental health care. ¹⁰

Staging of care

75% of all mental illness manifests before the age of 25. ¹¹ Unlike the rest of health care, lack of affordable access to mental health care is primarily an issue affecting children and young people. But there are vast service gaps affecting the broader community. The Forum developed a set of reforms designed to shift mental health care towards earlier intervention in the community, away from hospital-based care and focusing on increasing the capacity of primary and community mental health care while reflecting the epidemiology of mental illness.

Digital solutions

Australia’s approach to digital mental health has grown organically. Myriad services are often poorly integrated with each other, or with existing mental health services. ¹² The Forum supported the development of regionally based systems of multidisciplinary collaboration across services and settings at scale, for the better delivery of coordinated care and integration of digital mental services with other services and face to face care.

The Productivity Commission highlighted this as the best example of return on investment. ¹³ Digital care can provide more immediately available treatment options for those stuck on waitlists for face-face care.

Continuing to build the evidence about what works

Despite repeated calls for independent oversight, monitoring and reporting, and even considering the fact that Australia now has seven mental health commissions in operation, still no model of effective, systemic oversight has emerged. ¹³

The Forum’s work and these domains were referenced by both the Productivity and Victorian Royal Commissions.^13,2 The subsequent 2021 Federal and Victorian budgets^15,16 included welcome new funding for mental health. The challenge was for this new funding to drive integration rather than further fragmentation.

This is challenging. Australian skills in system planning are rare. It is uncommon for state-funded local health districts and federally funded primary health networks to cooperate in overall systemic planning. ¹⁷ These organisations tend to focus on different client groups and settings, as well as often covering different geographies.

In developing its latest advice, the Forum used a combination of online feedback, survey voting and zoom meetings. We recognise the limitations of this approach, in comparison to other methods by which to develop consensus from a group.

Successful reform will require a whole of government, community-wide response. Issues like intergenerational discrimination, housing, employment, education, climate change were not, or only peripherally, discussed by the Forum which focused on health system reform and closely linked issues. Some participants felt this was an important limitation.

A set of structural reforms were identified, debated and prioritised. Final formulation of the Forum’s views led to the identification of two smaller subsets of strategic reforms (see Table 1): the first being five actions which were cost neutral or could be undertaken with minimal investment; the second also describing five actions requiring some realignment of existing funds and/or new funds. ¹⁸

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Table 1.

Key areas for strategic, systemic and structural mental health reform

Reform Name	Description
Immediate actions
1. Establish an independent statutory authority	This was the original intent of mental health commissions. This kind of body, armed with necessary legislative or other powers, is vital to ensure the next phase of mental health reform stays on track
2. Review the head-to-health community hubs	The Morrison government has committed to national implementation of these hubs, which is in its early phases. There is an urgent requirement to assess this process, as part of overall systemic reform
3. Decide the governance structure to support regionality	This reform would clarify how regional governance of mental health will occur, the role of different players, how funding will be organised and, importantly, how the regional planning process will engage consumers, carers, professionals and the community
4. National waiting lists, implemented regionally	Mental health needs a nationally supported but regionally implemented consumer waitlist system that transparently triages and tracks people, from the moment they seek support to the moment they get it
5. Establish an observatory for real-time monitoring of programmes	As in other places, mental health needs an independent observatory to collate and present the data necessary to drive regional benchmarking and quality improvement, and to inform the public’s understanding of progress
Actions requiring realignment of existing funds and/or new funds
1. Support staged care model for youth services	Australia’s best investment is to ensure its young people get access to the right care, first time
2. Innovation Pool for psychosocial services for 150,000 Australians	Filling a long overdue gap in Australia’s mental health service landscape, establish and evaluate new psychosocial support services, enabling them to properly partner with clinical services in addressing community mental health needs, including for those clients in the ‘missing middle’
3. Innovation Pool for multidisciplinary teams	Establish the workforce necessary to deliver and evaluate local multidisciplinary mental health teams for adults, youth and children
4. Support for digital transformation	Regional control of mental health planning and service delivery requires multidisciplinary collaboration across services and settings at scale, for the better delivery of coordinated care and integration of digital mental services with other services and face to face care
5. Implementation of the Child Mental Health and Wellbeing Strategy	This reform would provide full funding for implementation of this Strategy, to enable new and effective child mental health care to be provided regionally

Across these ten key reforms, two key themes emerged. The first was the need to create the organisational governance necessary to impel new and effective regional control of mental health planning. This has been discussed for some time ¹⁷ but remains, in engineering terms, the critical ‘yield’ point – the point at which our system collapses into bits. Simply put, there is no effective, overarching structure to regulate the governance of regional mental health planning, leaving different funders and providers to blunder along separately.

The second key theme is accountability. Mental health lacks goals and targets. A properly constituted national mental health commission, with independence and teeth, could drive the establishment of whole of government targets for mental health, encompassing not just health services but education, housing, employment and other areas. ¹⁹ This body could be supported by a mission-specific new mental health observatory^20,21 which could arrange collection and reporting of the necessary data, frequently and independently.