National mental health policy 2008

1.3 A renewed approach to mental health

Page last updated: 2009

There have been many gains during the life of the National Mental Health Strategy. These have been seen in better access to a wider range of services, improved quality in service delivery and more robust and accountable legislation. However, it is now widely recognised that an approach which incorporates a number of different areas of clinical and community support across sectors of government is necessary to reduce the prevalence of mental health problems and mental illness, maximise the mental health of all Australians and deliver health equality across all groups.

In this context the Policy brings together a range of sectors that impact on the mental health of individuals and their families and communities, including, health, aged and community care, housing, education, employment, welfare, justice and Indigenous affairs. Together, these sectors have an important role to play in promoting the mental health and well-being of the general population, and contribute to prevention and early intervention, and the recovery of those experiencing mental health problems and mental illness.

Across many areas of government, effort is being directed to achieve greater social inclusion for all of the community - but especially for those groups most at risk of social exclusion, such as those who experience homelessness, Aboriginal and Torres Strait Islander peoples and disadvantaged children. The goal of social inclusion recognises that good mental health is fundamental to the well-being of individuals, families and communities. Conversely, mental health problems and mental illness can cause high levels of disability and reduced quality of life for those who experience them, impact on their families and friends, and can have significant societal and economic consequences. In a 12 month period, one in five Australians will experience a mental health problem or mental illness. Reducing this will not only have benefits for individuals, but will benefit the whole community through increased well-being and productivity.

Mental health problems and mental illness are influenced by a complex interplay of biological, psychological, social, environmental and economic factors. This is true for all Australians, but may have particular significance in the case of Aboriginal and Torres Strait Islander peoples who view social and emotional well-being holistically.

A population health framework should underpin mental health policy and practice. Such a framework recognises the complex range of determinants and consequences of mental health and illness. In addition, it acknowledges the importance of mental health issues throughout the lifespan, and across diverse population groups. It also recognises the two-way relationship between physical health and mental health, acknowledging that each has an impact on the other. It recognises that many mental illnesses are comorbid with drug and alcohol problems and other conditions. A population health framework also stresses the importance of a strong evidence base, including epidemiological data on mental health problems and mental illnesses and evaluative data on access to and outcomes of interventions.

Central to the population health framework is a range of high quality, effective interventions that target those at different levels of risk or with different levels of need. The interventions should be comprehensive, ranging from prevention and early intervention through treatment to continuing care and prevention of relapse. There is a major focus on recovery which emphasises the development of new meaning and purpose, and the ability to pursue personal goals within the community. Mental health promotion should target the whole population and promote mental health and well-being among people with mental illness, their carers and families.

Some interventions are clearly the responsibility of the specialist mental health sector, or other parts of the health sector. For example, a mix of community-based and inpatient clinical treatment services designed to provide crisis, acute, non-acute and ongoing care should be provided by public and private sector mental health services, psychiatrists, general practitioners, mental health nurses, psychologists and other allied health professionals. Other interventions might be provided by the mental health sector or by other sectors outside health, depending on their specific approach. For example, some elements of care might be provided through ongoing contact with and support from a community mental health team, but other, equally important elements of support might be provided through a housing or employment service. Integration and coordination between these areas will enable services to be 'wrap around' the person accessing services.

Services should be responsive to the differing needs of people with mental health problems and mental illness and must be equipped to promote optimal individual and family outcomes and to assist recovery. In the mental health sector, this translates into providing appropriately-tailored, culturally-respectful, evidence-based service delivery. Services need to provide coordinated care and to respond flexibly to individual needs. These interventions should address biological, psychological and social factors and aim to intervene early to prevent or reduce individuals’ symptoms, improve their functioning and increase quality of life. It is important that people with mental health problems and mental illness have a significant say in their individual treatment, and, more broadly, in how the mental health service system is organised and run. Services must be accountable, able to demonstrate how they are achieving a desired level of quality and access, and open to review.

Beyond the mental health sector, this may involve ensuring that a person with mental illness has access to non-government services, peer support or secure long-term housing options, or can participate fully in a vocational training program. Alternatively, it may involve ensuring that a person with mental illness is no more likely than any other member of the community to be arrested or jailed. Working together in a coordinated manner will maximise the mental health of all Australians.

This Policy reaffirms the importance of good mental health, not just the absence or reduction in mental illness, for our whole community. It sets a vision for the continuing reform of mental health service delivery across all sectors. Those experiencing, or at risk of experiencing, mental health problems or illness will receive services that meet their clinical and support needs. They will be actively involved in their own care and recovery, in a system that promotes participation and collaboration across multiple sectors, levels of government and government agencies.