Is Anybody Getting Better? Accountability for Mental Health in Australia

Abstract

Aim This thesis investigates the extent to which Australia has developed accountability for mental health. Background Accountability for change was a core element of the first National Mental Health Policy in 1992. Weaknesses in extant systems of accountability were acknowledged and undertakings given to develop better systems. This thesis considers the extent to which these undertakings have been fulfilled. Does Australia have the robust system of accountability for mental health? Is it possible to discern the impact of care and drive quality improvement through effective benchmarking? Can you tell if people are getting better? Method This thesis provides an evaluation from three dimensions: 1. Policy Accountability - The study period was a time of unprecedented attention to mental health. Can these changes be monitored and reported in a way that drives systemic improvement? 2. Structural Accountability - Six of Australia’s nine governments have established a mental health commission. This thesis tracks their evolution, genesis and prospects. 3. Program Accountability - To June 2015 the Better Access Program has funded 53 million services, costing taxpayers $5.2bn or $15m per week. This thesis presents several articles in relation to this Program and the need for more multi-disciplinary approaches. Results This evaluation will demonstrate that accountability for mental health in Australia remains weak. Discussion This thesis then describes core elements of a better approach. Resources are too scarce to waste. Existing data collections must be traded for a more focused and strategic process. Mental health commissions need evaluation. Old models of program funding need to shift to foster collaboration. The importance of regional benchmarking has emerged. Existing systems are not fit for purpose. It is difficult to justify calls for increased expenditure in mental health. This thesis aims to record Australia’s efforts at accountability for mental health so far, and then chart a course for a more effective approach.