Introduction by Croakey: A recent review of the National Mental Health Commission found that the Commission’s current finance practices, systems and capabilities have not kept pace with its associated budget allocation, policy development activities and expanded scope in recent years.
Upon tabling the report on 14 September, Health and Aged Care Minister Mark Butler said the immediate priority is to ensure the Commission is positioned for the future by “providing staff with stability and a clear path forward”.
Butler has tasked the Department of Health and Aged Care to consider the report’s recommendations and oversee reforms of the Commission.
At a time when 4.3 million Australians are experiencing a mental disorder, “better planning to drive improved service delivery is essential,” according to Associate Professor Sebastian Rosenberg and Professor Harvey Whiteford.
Sebastian Rosenberg and Harvey Whiteford write:
One of the most notable findings of the recent Review into the National Mental Health Commission was the lack of technical capacity in data analysis, visualisation and critical thinking.
Without these skills, the Review found that the Commission was not able to discharge its national reporting obligations or contribute to better mental health planning:
It is not clear how the Commission’s vision is translated through organisational strategy to inform structures, work plans, program plans, priorities, resource allocation, workforce planning and performance measurement and reporting.”
These findings accord with the Productivity Commission, whose own 2020 Inquiry into mental health found significant problems with the way mental health is planned and organised.
The ‘back office’ to our mental healthcare system needs redesigning with local planning to meet local needs. Providers and governments should be held to account through the transparent monitoring, reporting and evaluation of what works, with meaningful input from those with lived experience of mental illness, and their carers.”
Planning in times of uncertainty
All these findings appear at a time of some uncertainty. The rhythmic five-year national mental health planning process, begun in 1993, was abandoned in 2022, in favour of a series of bilateral mental health agreementsestablished between the Federal Government and each State and Territory.
One legacy of the last two national mental health plans was the shift from retrospectively tracking and reporting on changes already made in service delivery, to instead require local planning and reporting on services that are intended to be delivered.
The new bilateral agreements, which are the vehicle for disbursement of some considerable new funding, continue this approach. Better planning to drive improved service delivery is essential, with new survey data from the Australian Bureau of Statistics demonstrating the scale of mental health problems affecting Australians – 4.3 million Australians aged 16–85 years experience a 12-month mental disorder.
Of these, 1.9 million (45.1%) saw a health professional for their mental health in 2020–2022, meaning that nearly 55 percent of people still receive no care.
A key challenge for mental health decision makers is that the level and mix of treatment and care is challenging to predict for different populations. One solution is for models of the system to be developed, a range of responses to be simulated, and likely outcomes projected.
Mental health system models are representations of health service components, along with social, economic and environmental characteristics that shape the mental health of populations.
Using models to describe key features of the systems and forecast how they might change over time under different conditions can lead to more accountable, transparent, effective, and ideally less uncertain decision-making.
New tools to reduce uncertainty
Acumen, the Alliance for Mental Health Systems Models, was created in 2020 and includes Australian researchers experienced in population epidemiology, mental health services modelling, health economic evaluation and mental health policy and planning.
Acumen aims to help planners better meet the mental health needs of communities through development and use of transparent, powerful and reliable modelling technologies by:
- enhancing the social acceptability and public awareness of mental health systems models
- improving the quality and usefulness of these models; supporting appropriate and impactful use of model-based decision aids in mental health planning
- providing a national reference point for expert advice and best practice in evidence-based mental health systems modelling and
- fostering collaboration, data sharing and less duplication of effort amongst mental health system modellers.
Modelling has been part of longstanding and well-developed health technology assessment in Australian government decisions on subsidising pharmaceutical therapies and Medicare-rebated procedural interventions.
Traditional planning methods, including in mental health, are typically based on combining the historical trajectory of service usage with necessary budgetary adjustments. By contrast, system models can allow a greater range of relevant sociotechnical factors to inform mental health service planning and policy development.
Mental health system models typically synthesise a range of data – for example, demography, epidemiology, service utilisation and other social, economic and community drivers of mental health – to forecast likely demand for healthcare and optimise responses to the demand for healthcare.
These models also reflect the inherent multi-dimensionality of mental health and the need to consider issues beyond the health sector, encompassing social and economic factors.
Next steps
A key element of existing national mental health policy is intergovernmental agreement to use the National Mental Health Service Planning Framework (NMHSPF) as the basis for the next phase of planning. From this foundation, Acumen is providing a forum for Australian expertise in mental health system planning to grow and evolve.
Deep, practical expertise in needs-based planning, Markov models, statistical-learning, system dynamics, discrete event simulation, agent-based models and hybrid approaches are emerging as diverse and complementary tools available to local mental health planners.
It is not likely, or even desirable, for one planning tool or method to fit all mental health planning needs. But there is already a route forward, to move past the technical limitations and capability gaps identified by recent reviews and inquiries into mental health, towards a more sophisticated, effective, 21st Century approach to informing mental health planning.
The challenge of implementing this kind of change is clear. This new approach must engage with local communities, including with local providers, mental healthcare consumers and carers, so that new models to really reflect the situation on the ground and for solutions to be understood and supported.
Getting this ‘back office’ work right is key to the next phase of Australian mental health reform, so that effective planning drives better organised local responses to mental illness.
About the authors
Sebastian Rosenberg is a Senior Lecturer, at the Brain and Mind Centre, University of Sydney and Associate Professor at the Health Research Institute, University of Canberra.
Harvey Whiteford is a Professor at the Queensland Centre for Mental Health Research.
Rosenberg and Whiteford are both members of the Acumen Alliance.
See Croakey’s archive of articles on mental health
