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The National Mental Health

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Introduction

Health is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (World Health Organization, 2013). Over the years, mental health has increasingly received attention in the public light due to its myriads of presentations ranging from subtle anxiety to the most overt form of schizophrenia (Sawyer et al, 2008).

The burden of mental illness is increasing across all facets of life and culture in Australia. About 15.0% of Australians between the ages of 16 and 85 have had an affective disorder, this is equivalent to 2.83 million people today (Australian Bureau of Statistics, 2007.) One out of every 16 Australians is currently experiencing depression (Australian Bureau of Statistics, 2008). Mental illness cost the Australian government about $4000 per person, or a total of $60 billion, this is around 4 percent of the gross domestic product (ABS 2008)

This assignment seek to critique the Australian mental healthpolicy, look at areas that have been neglected and provide possible solutions to bare and grey areas of the policy.

Brief History of the national mental Health Policy

The national mental health policy initially started as The National Mental Health

Strategy which was agreed by the Australian health ministers in April 1992 and comprised of the following the National Mental Health Policy, the First National Mental Health Plan,  the Mental Health Statement of Rights and Responsibilities and a funding agreement between the Commonwealth and the states and territories (Australian Bureau of Statistics 2008).

In July 1993, the National Mental Health Strategy was incorporated in a 5 year Medicare Agreements, In March 1994 the first national mental. Health report was released. In December 1997, the evaluation of first national mental health plan was released and made available public. Then in June 1998 the second national mental health plan was commenced and is incorporated in a 5-year Australian health care agreements (Lila, Vrklevski, Kathy Eljiz, & David, 2017).

In November 2001 the international mid-term  review of the second plan was released and was evaluated in April 2003. In August 2003, the Australian heath care agreements was signed. In  July 2006 the Coalition of Australian Government national action plan on mental health was signed and that was effective till 2011 (Lila, Vrklevski, Kathy Eljiz, & David, 2017). The national mental health report was released in 2008 and the policy was revised the same year with the whole of government in focus.

The of Mental Health in Context

The mental health policy in Australia seeks to address the issues, risks and factors that affect the mental health of the population. Data from the National Survey of mental health and wellbeing carried out in 2007 by the Australian Bureau of Statistics revealed that one out of five people aged between 16 and 85, experiences a type of mental illness ranging from anxiety, depression, schizophrenia and bipolar disorders amongst others.

("Department of Health | The magnitude of the problem", 2019)

From the above data, it is evident that mental illness is most common in adolescents and people in their early adult years. The overwhelming prevalence rate of mental illness have been shown to be intensely influenced by various dynamics including social, environmental, biological and behavioural factors. The mental health policy does recognize all of these problems as hazards to mental health however, the problems highlighted in the policy are more specific and somewhat limited.

The policy addresses the issues affecting the mental health workforce. The mental health workforce has often been challenged with the recruitment and distribution of highly qualified and linguistically diverse professionals. The policy seeks to promote the benefits of employees in the workforce through proper funding, suitable training opportunities and cultural diversity.

More than half of the Australian population lack the knowledge to understand and exercise their rights to access the necessary services required for their mental health. The policy aims to solve this by educating the public on the availability of specialist mental health services and their rights to access them.

The vulnerability, stigma and discrimination affecting individuals with mental illness is a problem addressed in the policy. At both the individual and community level, the policy seeks to increase social inclusion and equity.

Mental health problems are risk factors of suicide (Patel, Flisher,  Hetrick, &McGorry, 2007). The policy highlights this issue as it aims to drastically reduce the rate of suicide mortality in Australia

The policy also tackles the issue of lack of community participation among population groups particularly the Aboriginal and Torres is trait islanders as they have the highest rate of homelessness, unemployment and regional living in Australia.

Furthermore, the policy tackles the challenges affecting health and safety of people that care for mental health patients as they are susceptible to anxiety and depression (Department of Health | National mental health policy 2008, 2019).

Although the policy recognizes the adverse effects of poor socio-economic conditions on mental health, this issue is largely hidden from the strategies and plans developed to combat mental health problems. Various social factors including unemployment, poor education, domestic violence, racism, and social insecurity have been confirmed to strongly influence the risk of mental illness (Matthew F, 2019). The policy focuses more on the biological, environmental, and behavioural causes thereby laying little emphasis on the social causes of mental health problems.

Frame of reference/dominant discourse

Suicide and mental illness prevention appear to be the common frame of reference within the policy. More than half of the strategies plans and regulations within the policy to tackle mental health issues revolves around suicide prevention and reducing the impact of mental health problems on affected individuals especially within the adolescents and indigenous population groups, this age group are form the bulk of the working population in the country and hence the socio-economic impact of mental health.

Also, the promotion of the mental health of the various population groups and early intervention during childhood and adolescent age are common discourses in the policy in that strategies were developed in the policy to effectively promote the mental health of individuals at risk particularly the indigenous people.

Promoting the mental health of the carers and mental health professionals are issued addressed in the policy. Words such as prevention, promotion, factors, mental health, suicide, community participation, social inclusion, intervention mental illness, health services and treatments are commonly used in the policy. There have been challenges in recruiting the workforce and to evenly have highly qualified professionals distributed across all facilities that needed them.

The policy requires supporting the benefits of employees’ part of the workforce that would require proper funding along with the suitable training opportunities along with cultural diversity (Fisher, Carroll, &Shochet, 2017).

Stakeholders and their Representation

The target of policy would be for people aged between 16 and 85, that can experience a mental illness that covers the anxiety, depression, schizophrenia along with bipolar disorders.

The stakeholders and their representation are the government, patients, physicians, employers, insurance companies, pharmaceutical firms, and government.

The other stakeholders identified in the policy identified are the individual nurses, nursing educators, administrators, along with the key researchers, physicians, and also includes the legislative bodies and regulators. It even includes the professional associations, and accrediting agencies. Mental illness community and mental care infrastructure would be part of the policy.

The mental health policy in Australia would require addressing the issues, risks, and factors which would be affecting the mental health of the population. It covers the mental ailments and includes the anxiety, depression, schizophrenia and bipolar disorders amongst others.

The policy involves a system of integration whereby the direct stakeholders are not the only ones involved in identifying risk factors or directing those who may have a form of mental illness to where to get help, everyone is involved. It is a system of looking out for each other and observing changes in behaviour patterns of friends, workers, staffs, colleagues etc.

Mental health illness is all over in Australia and also in other developing countries. The impact of mental illness can be seen on the personal, social and economical levels. According to National survey of mental health and wellbeing, mostly the adults aged from 16 to 85 years suffer from the mental health illness.

There are different social groups aligned to treat the mental illness like GPs, psychologists, psychiatrists, occupational therapists and social workers and also peer workers. GPs are the first health professionals who encounter this illness and psychiatrists and psychologists helps in reducing the severity and curing the mental illness. Each of these social group help people facing the mental health problems in their own ways.

In practice of mental health care, matter of cultural differences is increasing with the days. For example, belief about the psychotherapy are different among the patient and doctor. There are five different clinical scenarios that may create cultural and ethical dilemmas between patients and doctors. (Hoop, DiPasquale, Hernandez, & Roberts, 2008)

  • Maintaining therapeutic boundaries
  • Ethical issues in diagnosis
  • Ethical issues in treatment choice
  • Confidentiality and informed consent
  • Justice in the treatment of diverse population

A clinicians must be sensitive, knowledgeable, and empathetic to understand the cultural differences and then they may use there capacities in their procedures and treatment.

There were wide range of stakeholders that were involved in the success of the mental health policy. Firstly the clients of the services including their family members and friends whose services that are relevant to them and also of high quality and easily accessible for them.

Then referrers and purchasers who are responsive to clients and assure the availability after hours also. Furthermore, staff and managers are also there in the stakeholders list who promotes the shared values and commitments, provide mechanisms to patients to treat their illness and ensures that services are well managed and are appropriate according to the customer’s needs, respectively.

Some other stakeholders are also there for the development of this policy like funding bodies who provide money on different levels to support the policy, Australian community and government. Access to the services for mental health was a great issue. Clinical supervision and arrangement of structured staff support played a crucial role in the development of the policy. Approach to the GPs (general practitioners) was very easy and they were the first professionals who interacts and diagnosed the community facing mental illness.

More education and training was given to the GPs. Access to the psychiatrist was limited because of few bulk billing and also most of the psychiatrist were located in the metropolitan areas and only few of them were employed in the public sector. Community was also unaware about the social workers and occupational therapists and psychotherapists were also under-utilized in the mental health fields.

Policy process

The policy process requires consultation with stakeholders and everyone who will in some wise be connected to individual with mental illness.

Various groups represented different competing interest in the formulation of the policy and the circumstances that surrounds the care of the mentally ill. The ethical issues surrounding the care and responsibilities of healthcare providers had to be put into consideration.

A non-financial competing interest is the family and loved ones of those with mental illness, their argument over years is that of their loved ones been separated from them due to government policy to take away individuals with mental illness into specially designed areas for treatment. Academic institutions that train psychiatrist and psychologist and other governmental agencies such as trade and industry, social welfare all have vested interest in the policy making. The problem of mental illness is defines differently by these stakeholders

Agenda of mental health policy is the prevention of mental illness and stress, depression and other mental health related problems. Focus of this policy process involved the treatment of mental illness, it also consider different kind of audiences like, all ages patients who experience the mental health illness.This policy is helpful in providing the funds to the people for treatment and these funds are provides by the government.

The global burden of mental health is huge, underappreciated and sourced. This happened due to lack of appropriate and quality of mental health organizations and workforces. Therefore, the ethical implications of dissimilarities in mental health for people must be addressed to accomplish the major bioethics principles like individuals respect, justice etc.

moreover, social implications like discrimination and stigma towards individuals living with mental disorders affects on their employment and education status and access to care services. also, untreated and unmet mental health issues lead to economic loss as well (Ngui, Khasakhala, Ndetei, & Roberts, 2010).

The national mental health commissioner reviews the current programs of mental health and highlighted existing problems. More effective and supportable methods are required to improve the system for public by providing aiming efforts.

The highlighted issues:

  • Lack of planning and coordination
  • Services based on needs rather than consumer choices
  • Too long wait to get services
  • Underutilization of new methods

The government has taken opportunity to do work in ‘collaborative and consultative’ approach to make sure that better services can be delivered to public (HealthGovernment, 2015).

Policy Solutions

Australia, was the first country which establish a ‘National policy’ for mental health care. The Australian ‘federated system’ permits challenging methods to accountability with other data settings. A national method which has clear to accountability for mental health has unsuccessful to develop. The current data focused on the health services and organizational indicators, failing to reflect broader social factors with expose the quality of the life.

Moreover, the new approaches are required which can make sure that selected accountability indicators replicate social priorities and national health in which shareholders can also engage to get better outcomes. also, Australia must need to develop further methods related to mental health accountability which should be tested on both (domestically and internationally) to improve the mental health status (Rosenberg & Salvador-Carulla, 2017).

Evaluation measures of any policy are important to determined, it works well, to help services delivery and to provide evidences for keep going support of the policies. The 2nd National Mental health plan recognized ‘preventive and promotion’ as one of three priorities for forthcoming activities.

Then, the current plan recognized that ‘preventing and promoting mental health’ problem as one of four priorities. The requirement for ‘national direction’ in these two categories was recognized in a 1997 evaluation process. Additionally, a ‘National plan action’ for promotion, prevention and early intervention’ was issued with state and federal governments, funded by ‘federal government of ageing and health’ which gathers and distributes data and works together with non-government and government sectors because ‘New Approach’ has vital potential to minimize the forthcoming results for mental health. This approach really effective to increase the awareness towards mental illness in community (APH, 2010).

References
  • Department of Health | National mental health policy 2008. (2019). Retrieved 24 July 2019, from https://www1.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-pol08
  • Department of Health | The magnitude of the problem. (2019). Retrieved 24 July 2019, from https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-f-plan09-toc~mental-pubs-f-plan09-con~mental-pubs-f-plan09-con-mag
  • Matthew Fisher. Australia’s policy failure on mental health. | John Menadue – Pearls and Irritations. (2019). Retrieved 24 July 2019, from https://johnmenadue.com/matthew-fisher-australias-policy-failure-on-mental-health/
  • Patel, V., Flisher, A. J., Hetrick, S., &McGorry, P. (2007). Mental health of young people: a global public-health challenge. the Lancet369(9569), 1302-1313.
  • Fisher, O., Carroll, J. A., &Shochet, I. (2017). The mental health of parents and youth study–Intergenerational protective factors for depressive and anxiety symptoms.
  • Hoop, J. G., DiPasquale, T., Hernandez, J. M., & Roberts, L. W. (2008). Ethics and culture in mental health care. Ethics & Behavior18(4), 353-372.
  • Department of Health | Stakeholders. (2019).
  • Retrieved 26 July 2019, from https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-q-quatel-toc~mental-pubs-q-quatel-bac~mental-pubs-q-quatel-bac-sta
  • Chapter 6 - Access to mental health services – Parliament of Australia. (2019).
  • Retrieved 26 July 2019, from https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Former_Committees/mentalhealth/report/c06
  • Australian Institute of health and welfare.
  • https://www.aihw.gov.au/getmedia/0e102c2f-694b-4949-84fb-e5db1c941a58/aihw-hse-211.pdf.aspx?inline=true
  • Comprehensive mental health action plan 2013–2020
  • Retrieved from https://www.who.int/mental_health/policy/publications/en/ on the July 17, 2019
  • Lila P. Vrklevski, Kathy Eljiz, and David Greenfield, (2017)
  • The Evolution and Devolution of Mental Health Services in Australia VOL. 9 NO. 10 | PG. 1/2 | 
  • M.G. Sawyer, F.M. Arney, P.A. Baghurst, J.J. Clark, B.W. Graetz, R.J. Kosky, B. Nurcombe, G.C. Patton, M.R. Prior, B. Raphael, J.M. Rey, L.C. Whaites,  S.R. Zubrick, (2008), The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well‐being
  • https://doi.org/10.1046/j.1440-1614.2001.00964.x
  • ABS (Australian Bureau of Statistics) 2008. National Survey of Mental Health and Wellbeing 2007: summary of results. ABS cat. no. 4326.0. Canberra: ABS
  • Health Government (2015). Australian Government Response to Contributing lives, thriving communities – Review of mental health programs and services. https://www.1health.gov.au/internet/main/publishing.nsf/content/0DBEF2D78F7CA257F07001ACC6D/$File/response.pdf
  • Ngui, E. M., Khasakhala, L., Ndetei, D., & Roberts, L. W. (2010). Mental disorders, health inequalities and ethics: A global perspective. International review of psychiatry (Abingdon, England), 22(3), 235-244. doi: 10.3109/09540261.2010.485273
  • Rosenberg, S., & Salvador- Carulla, L. (2017). PERSPECTIVES: Accountability for Mental Health: The Australian Experience. J Ment Health Policy Econ, 20(1), 37-54.

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