Analysis of the 1992 Australian National Mental Health Policy


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An analysis of the 1992 Australian National Mental Health Policy and other relevant policy documents. This presentation was completed in 2007.

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Analysis of the 1992 Australian National Mental Health Policy

  1. 1. National Mental Health Policy (1992) Amber Stasiuk, Kirsten Giersch & Louise Miller 2007
  2. 2. Agenda <ul><li>Policy context: </li></ul><ul><li>current understandings of mental health </li></ul><ul><li>current causation beliefs </li></ul><ul><li>historical context </li></ul><ul><li>National Mental Health Policy (1992) </li></ul><ul><li>intro </li></ul><ul><li>Policy in Action: Strategies and Plans </li></ul><ul><li>Hidden Arguments and omissions </li></ul><ul><li>The future </li></ul>
  3. 3. <ul><li>While the National Mental Health policy defines neither mental health nor mental illness....there is no common agreement elsewhere either </li></ul><ul><li>South Australian Mental Health Act 1993 : Any illness of disorder of the mind </li></ul><ul><li>High Court of Australia : An underlying pathological infirmity of the mind, be it long or short duration and be it permanent or temporary, which can be properly termed as distinct from the reaction of a healthy mind to extraordinary stimuli. </li></ul>Some definitions....
  4. 4. Definitions cont’. <ul><li>New South Wales Mental Health Act 1993 : </li></ul><ul><li>… a condition which seriously impairs, either temporarily or permanently, the mental functioning of a person and is characterised by the presence in the person of any one or more of the following symptoms: </li></ul><ul><li>a) delusions </li></ul><ul><li>b) Hallucinations </li></ul><ul><li>c) serious disorder of thought form </li></ul><ul><li>d) a severe disturbance of mood </li></ul><ul><li>e) sustained or repeated irrational behaviour indicating any one or more of the above symptoms. </li></ul>
  5. 5. Types of mental illnesses <ul><li>Mood disorders : eg. depression, anxiety </li></ul><ul><li>Psychotic disorders eg: schizophrenia </li></ul><ul><li>Behaviour disorders eg: conduct disorder </li></ul><ul><li>Personality disorders </li></ul><ul><li>Substance Abuse Disorders </li></ul><ul><li>Dementia / brain injury (??) </li></ul><ul><li>etc </li></ul>
  6. 6. Mental illness definition changes over time <ul><li>Intellectual disability : now funded under disability </li></ul><ul><li>Dementia: now funded under aged care </li></ul><ul><li>Homosexuality : until 1990 was still included in the WHO definition of mental illnesses </li></ul><ul><li>Eating disorder: mental illness or physical habituation? </li></ul>
  7. 7. And mental health? <ul><li>Health is also not defined, although the underlying assumption seems to be lack of detectable clinical symptoms. </li></ul><ul><li>Difficult to define a distinct marker btw eccentric and clinically ill, normal and abnormal. Largely, the clinician decides. </li></ul><ul><li>No difference is made between remission and cure. </li></ul>
  8. 8. Impacts of Mental Health in Australia <ul><li>Highest non-fatal burden of disease (30%) </li></ul><ul><li>Third highest total burden of disease </li></ul><ul><li>20% of Population experience Mental Health Problem each Year </li></ul><ul><li>Mental Illness affects 14% of Children and Adolescents </li></ul><ul><li>However..... </li></ul><ul><li>7% of Total National Health Expenditure </li></ul>
  9. 9. Mental Health Causation Theories <ul><li>Policy recognises: genetic, social/situational stressors, and mentions some high-risk populations. </li></ul><ul><li>Current thinking includes: </li></ul><ul><li>- Lifestyle: Social, environmental (“stress”), psychological </li></ul><ul><li>- Personal Behaviour (eg: marijuana) </li></ul><ul><li>- Biological (eg: chemical, brain injury, brain disease) </li></ul><ul><li>- Genetic </li></ul><ul><li>- Infection (tertiary syphillis, schizophrenia) </li></ul><ul><li>- Central Nervous System Developmental Theory </li></ul><ul><li>- multifactorial (problematic to address) </li></ul><ul><li>- and recognises that many causes still unidentified </li></ul>
  10. 10. History of Mental Illness <ul><li>Earliest known mental institutions established in 918AD </li></ul><ul><li>1811 – Governor Macquarie announced plans for first purpose built asylum in Australia </li></ul><ul><li>1939-45 – WWII </li></ul><ul><li>1940’s – electro-convulsive therapy </li></ul><ul><li>1950’s – introduction of phenothiazine </li></ul><ul><li>1960’s – antidepressants available </li></ul><ul><li>1960-70’s – de-institutionalization </li></ul>
  11. 11. The National Mental Health Policy 1992 <ul><li>Promote the mental health of the Australian community </li></ul><ul><li>Where possible, prevent the development of mental disorder </li></ul><ul><li>Reduce the impact of mental health disorder in individuals, families and the community </li></ul><ul><li>To assure the rights of people with mental disorders </li></ul><ul><li>De-institutionalisation </li></ul>
  12. 12. Burdekin Report 1993 <ul><li>Report of the National Inquiry into the Human Rights of People with Mental Illness </li></ul><ul><li>To increase the understanding, acceptance and observance of human rights in Australia </li></ul><ul><li>To promote a fairer society by protecting human rights and ensuring that Australia complies with its human rights obligations under international law </li></ul>
  13. 13. Australia’s National Mental Health Strategies: Policy in Action <ul><li>First National Mental Health Strategy, 1992-1998 </li></ul><ul><ul><li>Encourage a national approach to mental health policy and service delivery </li></ul></ul><ul><ul><li>Provide the impetus for reform of mental health services </li></ul></ul><ul><ul><li>Provide a mechanism for addressing agreed priority issues </li></ul></ul>
  14. 14. Australia’s National Mental Health Strategies: Policy in Action <ul><li>Second Mental Health Strategy 1998-2002 </li></ul><ul><ul><li>mental health promotion and illness prevention </li></ul></ul><ul><ul><li>service reform through development of partnerships </li></ul></ul><ul><ul><li>quality improvement in service delivery </li></ul></ul>
  15. 15. Australia’s National Mental Health Plan: Policy in Action <ul><li>National Mental Health Plan 2003-2008 </li></ul><ul><li>builds on the priorities of both earlier strategies </li></ul><ul><li>consolidates existing reforms as well as strengthens the focus in areas of particular significance </li></ul>
  16. 16. National Mental Health Policy Hidden Arguments <ul><li>1. Policy ownership </li></ul><ul><li>2. Human Rights / Consumer Rights </li></ul><ul><li>3. Public Health / Prevention </li></ul><ul><li>4. Evidence Based medicine </li></ul><ul><li>5. Disease Causation theories </li></ul>
  17. 17. What’s missing? What’s happening? <ul><li>1. Delineation of specific roles </li></ul><ul><li>2. GPs </li></ul><ul><li>3. Carers </li></ul><ul><li>4. Mental Health in detention </li></ul><ul><li>5. Workforce </li></ul>
  18. 18. The future........ <ul><li>“ Nothing in life is completely free, nor should it be.” Prime Minister John Howard </li></ul><ul><li>“ There needs to be some restraint when it comes to the availability of taxpayer funds for non-essential procedures.” </li></ul><ul><li>Federal Health Minister Tony Abbott </li></ul><ul><li>“ Taxpayer funding of health needs to be based on the likelihood of success of medical treatments.” Treasurer Peter Costello </li></ul>