1. Introduction

The vision of the National Mental Health Policy 2008 is for a mental health system that:

• enables recovery
• prevents and detects mental illness early
• 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.

The National Mental Health Policy 2008 provides a strategic vision for further whole-of-government mental health reform in Australia.

The aims of the National Mental Health Policy 2008 are to:

• promote the mental health and well-being of the Australian community and, where possible, prevent the development of mental health problems and mental illness
• reduce the impact of mental health problems and mental illness, including the effects of stigma on individuals, families and the community
• promote recovery from mental health problems and mental illness
• assure the rights of people with mental health problems and mental illness, and enable them to participate meaningfully in society.

Australia has long been a leader in mental health policy and service development. Successive governments have recognised the need for continued effort, investment and reform, acknowledging the significant disability often associated with mental illness, and the burden it places on individuals and the community. The National Mental Health Strategy was agreed in 1992 and comprised:

• the National Mental Health Policy
• the First National Mental Health Plan
• the Mental Health Statement of Rights and Responsibilities
• a funding agreement between the Commonwealth and the states and territories.

As can be seen in the following diagram, the overarching vision and intent of the policy has been operationalised through three National Mental Health Plans, the most recent being the 2003-08 Plan.

While the first plan emphasised structural changes in where and how mental health services were delivered, subsequent plans have broadened the approach to give a stronger focus on partnerships between different sectors, inclusion of promotion, prevention and early intervention activity, and a greater emphasis on the roles of consumers and carers. Workforce issues have been given greater prominence, as has the importance of research, innovation and sustainability. Previous plans have been linked to funding through the Australian Health Care Agreements. Each of the plans has undergone evaluation. In addition, the Strategy led to nationally endorsed safety priorities, an information development plan and development of National Standards for Mental Health Services and Practice Standards for the Workforce.

In 2006 the Council of Australian Governments (COAG) responded to the growing recognition of the scale and significance of mental health issues and the importance of areas such as housing, employment, justice, community and disability support to enhance recovery from mental illness. The Council agreed that further effort was required to overcome historical boundaries between jurisdictions, and to better engage government portfolios to bring a whole-of-government focus to mental health reform. The resulting National Action Plan on Mental Health 2006-2011 brought a whole-of-government approach to mental health and included significant new investment and an emphasis on care coordination and governments working together. A number of jurisdictions have created new ministerial portfolios or departmental responsibilities to support this renewed emphasis on reform in mental health. Individual jurisdictions have developed mental health plans tailored to local issues or challenges, but consistent with the overarching directions of reform set by the national strategy. There has also been increased policy attention to related areas such as homelessness, social inclusion, and employment support. Top of page

As illustrated in the figure below, there is a complex interplay between areas of government endeavour in the provision of mental health services, and other services that impact on the lives of those with mental illness and contribute to their stability and recovery. This figure does not include detail regarding areas of additional work that has occurred over the life of the National Mental Health Strategy, and which continues to inform policy and service development. These areas include work on:

• National Mental Health Service Standards
• National Practice Standards
• Promotion, Prevention and Early Intervention
• Forensic Mental Health Principles.

It is in this context that the National Mental Health Policy 2008 has been developed. It recognises the need for ongoing national reform. It recognises the importance of maintaining the momentum created by the COAG process to support a vision of a seamless and connected care system which is consumer focussed and recovery oriented and where people are supported to engage with the community and participate to their full potential. It recognises that attention to promotion, prevention, and early intervention across the life span will benefit the whole community. It recognises the need for collaboration across a range of services provided or funded by different government and private sectors, non-government agencies, individuals and organisations in the community to improve the mental health of Australians. Most importantly, it recognises that to achieve the desired outcomes there must be ongoing development and support of a skilled workforce delivering quality services that are based on the best evidence and are continually monitored and evaluated.

The National Mental Health Policy 2008 acknowledges our Indigenous heritage and the unique contribution of Indigenous people's culture and heritage to our society. Furthermore, it recognises Indigenous people's distinctive rights to status and culture, self-determination and the land. It acknowledges that this recognition and identity is fundamental to the well-being of Indigenous Australians It recognises that mutual resolve, respect and responsibility are required to close the gap on indigenous disadvantage and to improve mental health and well-being.

The strategic framework provided by the National Mental Health Policy 2008 is deliberately aspirational. It should be viewed as a broad agenda to guide coordinated efforts in mental health reform over the next decade. The Policy will be operationalised and implemented through the development of national plans and those developed by individual jurisdictions. Top of page

Milestones in the development of the National Mental Health Strategy, 1991-2008

Pre First National Mental Health Plan Medicare Agreements

March 1991

Australian Health Ministers agree to the Mental Health Statement of Rights and Responsibilities

April 1992

Australian Health Ministers agree to the National Mental Health Policy

July 1993 - June 1998: First National Mental Health Plan Medicare Agreements

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 agree to the Second National Mental Health Plan

July 1998 - June 2003: Second National Mental Health Plan Australian Health Care Agreements

June 1998

Second National Mental Health Plan commences and is incorporated in 5-year Australian Health Care Agreements

November 2001

International Mid-term Review of the Second Plan released Top of page

April 2003

Evaluation of the Second National Mental Health Plan released

July 2003 - June 2008: Third National Mental Health Plan Australian Health Care Agreements

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 2006-2011 signed

2008

National Mental Health Report 2007 released

2008

National Mental Health Policy revised with whole of government focus

2008

2003-2008 National Mental Health Plan summative evaluation Top of page

Figure: Mental health and broader policy framework

Top of page

Text version of figure: Mental health and broader policy framework

This diagram is in the form of a building where:

• the roof is whole of government national reform including social inclusion
• the left wall comprises ministerial councils:
  • Community and disability services
  • Housing
  • Education, employment, training and youth
  • Corrective services
  • Drug strategy
  • Police
  • Aboriginal and Torres Strait Islander affairs
  • Ageing
• the right wall comprises policy areas:
  • children and youth
  • suicide prevention
  • multicultural
  • Aboriginal and Torres Strait Islanders
  • healthy ageing
  • veterans
  • comorbidity
  • chronic disease
• the centre of the building shows components of the National Mental Health Strategy:
  • COAG National Action Plan on Mental Health
  • National Mental Health Policy
  • Commonwealth state health funding
  • National Mental Health Plan
  • Mental Health Statement of Rights and Responsibilities
  • State and territory mental health plans and frameworks

There are two-way links between each of National Mental Health Strategy, ministerial councils and policy areas.

The components of the National Mental Health Strategy are connected with each other as follows:

• The National Mental Health Policy has two-way links with National Mental Health Plan and Mental Health Statement of Rights and Responsibilities, and a one-way link from COAG National Action Plan on Mental Health.
• In addition, National Mental Health Plan has two-way links with Mental Health Statement of Rights and Responsibilities and state and territory mental health plans and frameworks; and a one-way link from Commonwealth state health funding.
• In addition, Mental Health Statement of Rights and Responsibilities has a two-way link with state and territory mental health plans and frameworks.