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Chapter 1 Section C: Policy, organisational frameworks and practice approaches in the mental health service system

This section provides an introduction to:

1C.1: Australian Mental Health Policy and Organisational Frameworks

The responsibility for policy and provision of mental health services in Australia rests with both Commonwealth and State governments. Delivery of services occurs through the public inpatient and outpatient community-based services; community managed (non-government) organisations and private and for-profit sectors.

State and Territory governments fund not only inpatient and out-patient services, but community-managed services that offer a range of specialist services and programs targeting people living with mental health conditions and psychosocial disability, their families, carers and support persons. The Commonwealth funds a range of specialist services for persons with mental health conditions provided by private practitioners, including GPs and Primary Health Networks that are responsible for commissioning services in the community according to demographic needs. The Commonwealth also funds a range of community sector services and programs designed to support people with psychosocial disability and their families to live well in the community.

Both the Commonwealth and NSW have established Mental Health Commissions that contribute to the review and reform of the mental health system. These Commissions broadly aim to create a more positive experience for people with mental health conditions, their families and carers, and to identify the barriers that exist to access to services including stigma and discrimination, and their potential to enjoy a quality of life and social inclusion.

1C.1.1: The Mental Health Commission of NSW

The Mental Health Commission of NSW is an independent statutory agency “responsible for monitoring, reviewing and improving the mental health and wellbeing of the people of NSW.” It works with Government and the community to promote these objectives and to support Government service planning and strategic advocacy.

The Commission is working with the mental health sector and to broader community towards sustained improvement in the support offered to people living with mental health conditions and to enhancing their access to employment, education, housing, justice and general healthcare.

In its first 5 years, as a driver of reform, the Commission undertook to develop a whole-of-government Strategic Plan for Mental Health in NSW which aimed to support people living with mental health conditions, their families and their carers to live full and rewarding lives. That Plan entitled: Living Well: A Strategic Plan for Mental Health in NSW 2014-2024, has been subjected (by the Commission) to a monitoring and reporting process in relation to its implementation along with reviewing, evaluating, reporting on and advising on service and program developments and improvements.

The Commission’s functions also include undertaking and commissioning research and policy development and promoting innovative programs; sharing knowledge about good practice in mental health promotion, prevention, early intervention, care and treatment.

The Commission does not investigate individual complaints of services or oversight professional standards and penalise or sanction doctors, nurses or other mental health professionals. These roles fall to other agencies and bodies, click here. Likewise, the budget for government expenditure on mental health services is not held by the Commission and it does not provide services or advice directly to individuals.

Find out more on the Commission website.

1C.1.2: NSW Strategic Framework and Workforce Plan for Mental Health 2018-2022

The NSW Strategic Framework and Workforce Plan for Mental Health 2018-2022: A Framework and Workforce Plan for NSW Health Services provides overarching guidance for NSW Health strategic action over the next five years. The strategic actions aim to improve the mental health and wellbeing of people living with mental illness, their experience of care including for their families, carers and supporters.  This is in addition to the actions that promote best practice and foster good experiences for the workforce in relation to education, support, wellbeing and sustainability.

You can read more by following this link.

1C.1.3: Implementation Plan – NSW Strategic Framework and Workforce Plan for Mental Health 2018- 2022

The Implementation Plan for the NSW Strategic Framework and Workforce Plan for Mental Health 2018-2022 guides the Mental Health Branch and partner organisations on key elements of implementation required to achieve the goals up until 2022. An accompanying Excel Implementation Plan has been developed. The Excel document provides more details information on all actions for implementation and related performance measures.

You can read more by following this link

1C.1.4: Strategic Framework for Suicide Prevention in NSW 2018-2023

The Strategic Framework for Suicide Prevention in NSW 2018-2023 started the journey of the Towards Zero Suicides in NSW initiative. It sets out the State’s priorities for further coordinating, integrating and investing in suicide prevention activities, while building on what is already in place.

The framework has been developed by the NSW Mental Health Commission and the NSW Ministry of Health in collaboration with people with lived experience of a suicide attempt or suicide bereavement, government agencies, mental health organisations and experts in suicide prevention.

You can read more by following this link

The NSW Government has invested in new suicide prevention initiatives to be implemented over the three years to 2023. The Towards Zero Suicides initiatives seek to provide best practice crisis care and support, build local community resilience and improve systems and practices to reduce the suicide rate in NSW. The Towards Zero Suicides initiatives support the goals and priorities of the Strategic Framework for Suicide Prevention in NSW 2018 – 2023. They contribute to achieving the NSW Premier’s Priority goal of reducing the suicide rate by 20 per cent by 2023.

The initiatives are being developed and delivered with a major focus on the involvement of people with lived experience of suicide and all key stakeholders. Together these initiatives will support communities around NSW to start the journey towards zero suicides.

1C.2: National Mental Health Commission

The National Mental Health Commission provides independent policy advice and evidence on ways to improve Australia’s mental health and suicide prevention system, and acts as a catalyst for change to achieve those improvements. Through the monitoring and reporting of initiatives and investments, the Commission guides system reforms to ensure all Australians are able to prioritise their physical and mental health equally. Through collaboration and engagement, they incorporate information and data from a broad range of sources, both inside and outside traditional health or mental health areas, across sectors, jurisdictions, communities and internationally to provide evidence-based reports and advice that represent diverse perspectives and are connected to community need. The Commission works across all areas that promote mental health and prevent mental illness and suicide, this includes health, education, housing, employment, human services and social supports, so that all Australians achieve the best possible mental health and wellbeing and are able to lead contributing lives within thriving communities.

The Commission has a strong consumer and carer focus and is motivated by a concept of a ‘contributing life’ and advocates a ‘recovery-oriented practice approach’ for working with people living with mental health conditions and psychosocial disability. This is described in the National Recovery Framework: Guide for Practitioners and Providers and the National Recovery Framework: Policy & Theory.

Vision 2030 for Mental Health and Suicide Prevention

Vision 2030 is the Commission’s national direction for mental health and wellbeing. It is being promoted as a blueprint connected mental health and suicide prevention system and is part of the federal Department of Health’s ten-year plan, it takes a long-term approach to change and improvement. Vision 2030 proposes a whole-of-community, whole-of-life and person-centred approach to mental health; providing easily navigated, coordinated and balanced community-based services that are offered early to meet each individual’s needs and prevent escalating concerns.

Vision 2030 aims to maintain consistency with the Productivity Commission inquiry several other states, territory and national activities. Vision provides a framework through which current recommendations, future strategies and plans can be viewed to ensure consistent approach towards the same goals for the future mental health system of Australia.

You can find out more about the National Mental Health Commission and its work by following this link.

1C.2.1: The Productivity Commission Inquiry

In 2018, the Productivity Commission was asked to undertake an inquiry into the role of mental health in supporting social and economic participation; and enhancing productivity and economic growth. By examining mental health from a participation and contribution perspective, the inquiry ask how people can reach their potential in life, have purpose and meaning, and contribute to the lives of others, in a way that is good for individuals and for the whole community. The inquiry final report was handed to the Australian Government on 30 June 2020 and made Public on 16 Nov 2020; and it is expected that the Government’s response will further shape Vision 2030. Its alignment with the Fifth Mental Health and Suicide and Implementation Plan is yet to be determined.

1C.2.2: The Fifth National Mental Health and Suicide Prevention Plan (the Fifth Plan) and its Implementation Plan

The Fifth National Mental Health and Suicide Prevention Plan (the Fifth Plan) and its Implementation Plan were endorsed by the Council of Australian Governments Health Council (COAG Health Council) on 4 August 2017.

You can read more by following this link.

The Fifth Plan commits to a nationally agreed set of priority areas and actions, that are designed to achieve an integrated mental health system and that will be used to build a stronger, more transparent, accountable, efficient and effective mental health system. These actions represent what governments and the sector believe are achievable and measurable improvements to the current functioning of the mental health system.

The Fifth Plan seeks to establish a national approach for collaborative government effort from 2017 to 2022 across eight targeted priority areas:

  • Achieving integrated regional planning and service delivery.
  • Effective suicide prevention.
  • Coordinated treatment and supports for people with severe and complex mental illness.
  • Improving Aboriginal and Torres Strait Islander mental health and suicide prevention.
  • Improving the physical health of people living with mental illness and reducing early mortality.
  • Reducing stigma and discrimination.
  • Making safety and quality central to mental health service delivery.
  • Ensuring that the enablers of effective system performance and system improvement are in place.

The Fifth Plan is accompanied by an Implementation Plan that sets out who will be responsible for undertaking the actions agreed in the plan and how implementation will proceed and be coordinated across governments.

1C.2.3: National Disability Strategy 2010 – 2020 and Beyond 2020

The National Disability Strategy 2010-2020 (the current Strategy) is Australia’s overarching framework for disability reform and sets out a ten-year national plan for improving the lives for Australians with disability, their families and carers. The current Strategy is about creating a more inclusive society that enables Australians with disability to fulfil their potential as equal citizens.

It is also the main way Australia implements the United Nations Convention on the Rights of Persons with Disabilities.

The Australian Government is leading the development of a new National Disability Strategy (the new Strategy) for beyond 2020. Commonwealth, state, territory and local governments across Australia are working together in consultation with people with disability to develop the new Strategy.

The Department of Social Services has now undertaken the second stage of consultations on the new Strategy as set out in the National Disability Strategy position paper, which was completed in October 2020.

To read the Consultation Reports and Outcomes Framework click here

1C.3: Public Mental Health Care and Treatment in NSW

The Mental Health Branch is responsible for developing, managing and coordinating NSW Ministry of Health policy, strategy and program funding relating to mental health. The Branch also supports the maintenance of the mental health legislative framework.

The work of the Mental Health Branch is delivered mainly through the mental health programs in partnership with local health districts and specialty health networks, non-government organisations, research institutions and other partner departments.

To read more about Mental Health Branch follow this link

1C.4: Community Managed Care and Support in NSW

In NSW, many services are delivered in the community by non-government organisations (NGOs). (The sector’s preferred language is Community Managed Organisations (CMOs)). CMOs offer a wide range of psychosocial rehabilitation and support services and programs in which the approach used is described as ‘Recovery Oriented Practice’.

Services are provided by a diverse workforce that includes mental health professionals and peer support and rehabilitation workers; social workers, care co-ordinators and case managers; volunteers; alcohol and other drug specialists and counsellors as well as other specialist counsellors and psychologists; and community workers. Some CMO programs and services include other practice professionals including psychiatrists, GPs, mental health nurses, occupational therapists, allied health and physical health specialists.

CMO services receive State and/or Commonwealth funding according to the program type.

These services fall into a number of categories defined under the National Minimum Data Set (NMDS) which broadly include:

  • Counselling – face-to-face, support, referral and information by telephone or online
  • Mutual support and self-help
  • Personalised support (linked to housing) and other
  • Staffed residential services
  • Group support activities
  • Family and carer support
  • Individual advocacy
  • Service integration infrastructure (Hubs, multiple services co-located or connected)
  • Care – coordination
  • Education, employment and training
  • Sector development and representation
  • Mental health promotion
  • Mental illness prevention

Note: The National Minimum Data Set (NMDS) is a core set of data elements agreed by the National Health Information Management Group for mandatory collection and reporting at a national level in public services which are now identified for the collection of data from the CMO sector moving forward.

You may access some of these services through a referral from a public service or facility, a psychiatrist or GP, or a psychologist or other health professional. However, you can also self-refer directly to most community managed organisations.

To find a service in the community, please follow this link to The Way Ahead directory of services in NSW.

1C.5: Private Mental Health Care and Treatment in NSW

The private mental health system provides care and treatment for a range of mental health conditions. Services you can access through private providers include:

  • services provided by General Practitioners (GPs);
  • services provided by psychiatrists, who are doctors specialising in psychiatry, usually on referral from a GP;
  • services in private psychiatric hospitals and out-patient clinics, usually accessed with financial support from private health insurance cover and arranged by private psychiatrists and psychologists;
  • services provided by psychologists or social workers qualified in a variety of specialities, usually on referral from a GP;
  • services provided by counsellors or psychotherapists trained and accredited by state and national bodies (that are not government accredited), that do not require a referral;

Generally, people experiencing some mental health conditions (such as anxiety disorders, depression and compulsive disorders) may access support through referrals from their GP to a combination of services that include medication and/or psychotherapy from a psychiatrist and counselling or psychotherapy from a psychologist or social worker.

Over the last few years the number of mental health online support services has grown. Some have been developed by the public health system whilst others are available from large national or state-based organisations such as Beyond Blue and the Black Dog Institute. Many smaller organisations representing special interest groups have their own online support services.

To find more information about some of the services available go to the Way Ahead resource.

1C.6: Emerging, competing and complementary theoretical and practice approaches for people living with mental health conditions

There are competing and complementary theoretical and practice approaches for working with people living with mental health conditions, generally utilised by professionals and practitioners, and largely dependent on the discipline in which they were trained. Nevertheless, mental health policy and practice frameworks in Australia and internationally are generally reflective of a trauma-informed recovery-oriented approach and reference alignment to a social model of disability and a human rights perspective reflected in the UNCRPD. The following are four examples of contemporary theoretical and practice approaches:

1C.6.1: The Recovery-Oriented Approach

Increasingly, across the mental health system in Australia and in NSW there is a move towards a recovery-oriented approach. Reflecting this cultural shift the concept of ‘recovery’ was embedded not only as a principle in the National Mental Health Service Standards, and the National Mental Health Practice Standards, but was articulated in the National framework for recovery-oriented mental health services: policy and theory and the guide for practitioners and providers.

The concept is also reflected in amendments to the Mental Health Act 2007(NSW) that occurred in 2015. This change in thinking, is demonstrated for example where the Act refers to ‘Recovery’ in its Objects (section 3) and the intentions of the legislation with regards to the care and treatment of people under the Act.

What we now see is a greater acknowledgement of the importance of ‘recovery’ as a practice approach in public mental health services, although the medical model still remains the dominant approach particularly in inpatient settings.

Community-managed mental health organisations generally embrace principles of recovery in order to recognise a person’s strengths, maximise their autonomy and enhance their individual recovery journey. Recovery oriented practice is a holistic approach that seeks to acknowledge all aspects of a person’s life, including their mental and physical needs, goals and aspirations including social, economic, education, employment, housing and other aspects of their life concurrently, whilst maximising the potential to live well and thrive in the community, independently. The focus is on the individual and their needs first, and on their symptoms second.

‘Recovery’ is described as a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life, even with the limitations experienced by a person as a consequence of mental illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the challenging impacts of, for example: the symptoms of a mental illness and other factors such as the side effects of care and treatment. Recovery in the broadest sense is about finding a way to get to health and wellbeing after experiencing an episode of or the effects of a mental health condition.

The principles of recovery on an individual level include, but are not limited to:

  • Hope
  • Meaning, purpose and direction
  • Rights and personal responsibility
  • Equality and respect
  • Empowerment and self-determination
  • Social inclusion and connectedness

Reflecting a best practice approach; by including every aspect of recovery in service delivery, organisations and agencies provide opportunities for people living with mental health conditions to participate in self-advocacy as well as in the collaboration and co-design of services and programs and participate in discussions as to how they are provided and evaluated. A recovery focus implies that policy and protocols are developed that reflect its principles and this includes a genuine support for a peer workforce and consumer led activities.

Contemporary best practice is a trauma-informed recovery-oriented approach. They are not two separate approaches but an approach that takes into account the prevalence of trauma as part of the lived experience of many people living with mental health and psychosocial difficulties.

1C.6.2: Trauma-Informed Care and Practice

Trauma-informed care and practice (TICP) is an approach to mental health and human services that recognises the high prevalence of prior and ongoing trauma in the lives of people who use mental services (either voluntarily or on an involuntary basis) and who engage with a diversity of related human services and programs. The approach also acknowledges the serious neurological, biological, psychological and social impacts of trauma of any kind on an individual.

Whilst trauma can occur as a result of a number of/or one off experiences, , (such as an accident or natural disaster) that may lead to a number of serious impacts including Post-Traumatic Stress Disorder (PTSD) the trauma particularly referred to in the context of TICP is known as ‘Complex Trauma’ – the product of overwhelming stress that is interpersonally generated.

A trauma-informed approach involves mental health practitioners adopting ‘universal precautions’ to avoid triggering trauma responses and creating further trauma for the person they are working with. It calls for the consideration (and where appropriate assessment) of symptoms concurrently with other interventions, and avoidance of interventions that are re-traumatising for example: restraint, seclusion and involuntary detention and treatment; and ensuring collaborative practice and power sharing between the practitioner and the patient/client and the individual’s personal support network; careful use of objective neutral language to describe situations; and, an understanding of the function of certain behaviours as coping adaptation.

You can read more about trauma-informed care and practice (TICP) resources by visiting by following this link.

1C.6.3: Human rights approach

The human rights approach to mental health and human services is reflected in the Convention on the Rights of Persons with Disabilities (CRPD). In this respect, the CRPD is to be considered in contrast to earlier work on human rights and mental illness substantially based in a medical model understanding of mental health conditions and psychosocial disability.

The human rights approach emphasises respect for the inherent dignity and individual autonomy of the person, including the freedom to make one’s own choices, and the independence of persons. It also emphasises the right to full and effective participation and inclusion in society, and prohibits deprivation of liberty and segregation based on psychosocial disability.

Specifically, a human rights approach recognises the right of persons with psychosocial disability to be respected in terms of their mental and physical integrity, which includes the right to freedom from involuntary detention, restraint (both physical and chemical), seclusion and the right to refuse treatment with medication. The human rights approach requires that mental health care and treatment is only provided on the basis of the informed consent of the person.

The human rights approach promotes supported decision-making where required, and the eradication of all forms of substitute decision-making based upon the perceived incapacity of the person. It places major emphasis on the provision of the support and adjustments that will enable the person to make their own decisions, including in relation to their treatment, care and the supports they receive.

You can read more about the application of this approach to issues affecting persons with psychosocial impairments in the work of the United Nations Committee on the Rights of Persons with Disabilities.

1C.6.4: Social model of disability

The social model of disability is a core element of the human rights approach which exists in contrast to the medical model of mental illness. The social model views impairment as an ordinary part of human diversity and promotes respect for individual difference. It emphasises acceptance of difference by mainstream society rather than the treatment and cure of person with impairments so as to ‘fit in’ with a perceived norm.

The social model of disability requires adjustments to be made to enable persons with disability to participate on an equal basis with others. With respect to mental health care, treatment and support, it suggests a more active and supportive approaches rather than resorting to involuntary treatment options.

You can read more about the social model of disability, including as it relates to persons with psychosocial impairment by following this link.

Updated June 19, 2021