POLICY AND REFORM
Mental health as part of health
The provision of public mental health services in Australia is experiencing fundamental change with a restructuring of national and state policy agendas to promote a uniform set of recovery based principles that include mental health as a ‘whole of life ‘ experience requiring a ‘whole of government’ response.
The Roadmap for National Mental Health Reform 2012 – 2022 “confirms the intents and goals of Commonwealth, State and Territory governments to develop better mental health services and support across all relevant government portfolios” (Council of Australian Governments – COAG, 2012:8). This document serves as a guide to all national mental health policies, cross –portfolio national policies, and other relevant state and territory policies, naming the National Mental Health Plan as the principle guiding document (p. 9).
The Fourth National Mental Health Plan 2009-2014 continues the ‘whole of government’ approach to treat mental illness as part of the health needs spectrum, and therefore able to benefit from all aspects of public healthcare. The five priority areas are:
- Social inclusion and recovery
- Prevention and early intervention
- Service access, coordination and continuity of care
- Quality improvement and innovation
- Accountability – measuring and reporting progress.
(Comm. Dept of Health, 2009:3).
The Victorian policy response to federal objectives can be found in ‘Because mental health matters. Victorian Mental Health Reform Strategy 2009-2019’ (Dept. of Health, 2009); the core reform elements of: prevention, early intervention, recovery and social inclusion (p.5), sitting neatly against the federal priority areas.
Victorian Mental Health Act (MHA) 2014
The reformed Mental Health Act (2014), to become law by the first of July, 2014, is the result of a legislative process “that promotes recovery – oriented practice in the public mental health system.” (Dept. of Health, 2012:3). The Act, focused on client self-determination, family/carer involvement and a recovery oriented, community- based approach to treatment, is guided by the principles of EBP, and will have quite a significant impact on the mental health workforce (Dept. of Health, 2012:3-4). A redefined role for the chief psychiatrist is intent “on supporting mental health service providers to improve the quality and safety of the mental health services they provide” (Dept of Health, 2014:10).
The unifying approach of federal and state level health policy for the delivery of mental health service is mirrored in the provision of setting and monitoring of practice standards within health services and individual practitioners working in those services.
National framework of health/mental health governance
The relationship between health and mental health bears the structural and governance hallmarks of EBP and recovery frameworks, and this is reflected in the corporate and clinical governance structures of Victorian health services. The National Safety and Quality Health Service standards (NSQHS) (Comm. Dept of Health, 2011), as guided by the Australian Commission on Safety and Quality in Health Care (ACSQC), (Comm. Dept of Health, 2011). The NSQHS standards “provide a nationally consistent and uniform set of measures of safety and quality … They propose evidence-based improvement strategies to deal with gaps between current and best practice outcomes that affect a large number of patients” (2012:2).
Accreditation to NSQHS standards must also comply with the National Standards for Mental Health Services (NSMHS), (Comm. Dept. of Health 2010). The Australian Council on Healthcare Standards (ACHS) has performed an umbrella role for both the NSMHS and NSQHS standards, linking the shared areas in the Accreditation Workbook for Mental Health (Comm. Dept. of Health, 2012) to provide ease of credentialing and professional development within Victorian health services.
Workforce training and accreditation
The National Mental Health Workforce Strategy (NHMWS) (Mental Health Workforce Advisory Committee (MHWAC, 2011) working under the governance of the Fourth National Mental Health Plan (p. 8), “guides mental health policy and practice.” (p.1). The NHMWS recognises the broad range of roles, various challenges and support needs within the mental health workforce. “The capacity to establish an effective therapeutic relationship, refer appropriately, or to simply spend time with a consumer, may be constrained by the realities of a busy service and competing demands on workers. … This strategy considers ways of further enhancing the positive areas, and addressing some of the challenges”. (2011:6).
The five key outcome areas are stated as:
- Developing, supporting and securing the current workforce.
- Building capacity for workforce innovation and reform.
- Building the supply of the mental health workforce.
- Building the capacity of the general health and wellbeing of the workforce.
- Data and monitoring and evaluation.
The National Standards for Mental Health Services (NSMHS) “apply to the setting in which mental health care is provided” (MHWAC, 2011:9); while the National Practice Standards for the Mental Health Workforce (2013) “relate to the skills, knowledge and attitudes expected of those who work in mental health services” (MHWAC, 2011:9).
Table 1. Practice standards and related service standards.
|National practice standards 2013||National service standards 2010|
|Standard 1: Rights, responsibilities, safety and privacy||1. Rights and responsibilities
|Standard 2: Working with people, families and carers in recovery – focused ways||3. Consumer and carer participation
6. 6. Consumers
7. 7. Carers
|Standard 3: Meeting diverse needs||4. Diversity responsiveness|
|Standard 4: Working with Aboriginal and Torres Strait Islander people, families and communities||4. Diversity responsiveness|
|Standard 5: Access||10. Delivery of care (supporting recovery, access, entry, assessment and review, treatment and support, exit and re-entry)|
|Standard 6: Individual planning||10. Delivery of care (supporting recovery, access, entry, assessment and review, treatment and support, exit and re-entry)|
|Standard 7: Treatment and support||10. Delivery of care (supporting recovery, access, entry, assessment and review, treatment and support, exit and re-entry)|
|Standard 8: Transitions in care|
|Standard 9: Integration and partnership||9. Integration|
|Standard 10: Quality improvement||8. Governance, leadership and management|
|Standard 11: Communication and information management|
|Standard 12: Health promotion and prevention||5. Promotion and prevention|
|Standard 13: Ethical Practice and professional development|
(Dept. of Health, 2013:6).
Via the above Table 1., one can identify the corresponding relationship between the current national standards for mental health services, and the current national practice standards for the mental health workforce. While all practice standards are valuable to professional practice, it is important to highlight those areas most relevant to the scope of this paper.
National practice standards 2013
Standard 1. Rights, responsibilities, safety and privacy.
- Develops meaningful professional; and therapeutic relationships while
maintaining safe and professional boundaries.
Standard 2. Working with people, families and carers in recovery –focused ways.
- Works with people and their families and cares as partners.
- Applies the principles of self – determination and support people and their families in being decision – makers in their recovery processes.
Expresses hope and optimism, applying a strengths – based approach and valuing the person’s and their family/carer’s knowledge and perspectives.
Standard 5. Access.
- Collaborates with people to generate an initial recovery plan that
addresses key risk issues.
Standard 6. Individual planning.
- Collaborates with the person, as appropriate to their development level and capabilities, and family or carers and other service providers to develop and individual care plan that includes clear identification of the problem, actions and timeframes.
Standard 7. Treatment and support.
- Identifies a range of culturally and developmentally appropriate interventions that may derive from but not be limited to the following approaches.
- attachment – based
- Articulates an understanding of common interventions, including medications, commensurate with role and experience.
- Delivers treatments and interventions using a recovery and family – focused approach, along the spectrum from prevention through to tertiary treatment.
- Delivers treatments, interventions and support work in the most appropriate formats, which may include
- Sessions with individuals
- Group work
- Family or systems intervention
- Observes the dynamics of transference and countertransference processes and uses these to guide practice, seeking supervision and support if required to facilitate positive outcomes .
Standard 11. Communication and information management.
- Establishes a positive rapport with people, families and carers, adapting a communication style and using age – appropriate mediums to facilitate engagement.
- Uses culturally appropriate non – verbal communication, including eye contact and body posture.
- Demonstrates active listening skills and advanced interpersonal skills.
Standard 13. Ethical practice and professional development responsibilities.
- Demonstrates legal, ethical and accountable mental health practice and
Ethical decision – making that remains opne to the scrutiny of people with lived experience, peers and colleagues.
- Actively participates in lifelong learning and professional development for themselves and others, including supervision and peer review when appropriate.
(Dept. of Health, 2013:12-21).
Council of Australian Governments (2012). The Roadmap for National Mental Health Reform 2012-2022 Retrieved from, http://www.coag.gov.au/sites/default/files/The%20Roadmap%20for%20National%20Mental%20Health%20Reform%202012-2022.pdf.pdf 23.05.2014.
Commonwealth Department of Health and Aging (2009). Fourth National Mental Health Plan. An agenda for collaborative government action in mental health 2009 -2014. Retrieved from, http://www.health.gov.au/internet/main/publishing.nsf/Content/9A5A0E8BDFC55D3BCA257BF0001C1B1C/$File/plan09v2.pdf. 23.05.2014
Commonwealth Department of Health and Aging (2010). National Standards for Mental Health Services. Retreived from http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-servst10 18.10.2013
Commonwealth Department of Health and Aging, (2011) National Safety and Quality Health Service Standards Retrieved from, http://www.safetyandquality.gov.au/wp-contentuploads/2011/09/NSQHS-Standards-Sept-2012.pdf 17.10.2013
Commonwealth Department of Health and Aging(2012). Accreditation Workbook for Mental Health Services. Retrieved from, http://www.safetyandquality.gov.au/wp-content/uploads/2012/12/Draft-Accreditation-Workbook-for-Mental-Health-Services-Dec-2012_PDF1.pdf 21.10.2013
Commonwealth Department of Health and Aging (2013). A national framework for recovery- oriented mental health services. Policy and Theory ISBN 978-1-74186013-9. Accessed 22.10.2013
Department of Health (2009). Because Mental Health Matters: Victorian Mental Health Reform Strategy 2009 – 2019. Retrieved from, http://docs.health.vic.gov.au/docs/doc/Because-Mental-Health-Matters–Victorian-Mental-Health-Reform-Strategy-2009–2019 20.10.2013
Department of Health, (2011) Mental Health Workforce Advisory Committee. National Mental Health Workforce Strategy. http://hdl.voced.edu.au/10707/323823. Accessed 22.05.2013
Department of Health (2012). A new Mental Health Act for Victoria. Summary of proposed reforms. Retrieved from, www.health.vic.gov.au/mentalhealth/mhactreform/mhreform.pdf 23.05.2014
Department of Health (2013). Victoria’s priorities for mental health reform 2013-15. Retrieved from, http://docs.health.vic.gov.au/docs/doc/26E04BE3B1E4051DCA257C4A0012C759/$FILE/1211034_VPMH%20reform_WEB_FA.pdf 23.05.2014
Department of Health (2013). National practice standards for the mental health workforce 2013. Retrieved from, http://www.health.gov.au/internet/main/publishing.nsf/Content/5D7909E82304E6D2CA257C430004E877/$File/wkstd13.pdf 23.05.2014
Department of Health (2014). The Mental Health Bill 2014. An explanatory guide. Retrieved from, http://www.vmiac.org.au/pub/mha/the_mental_health_bill_2014_an_explanatory_guide.pdf 23.05.2014