30 November 2014

I just want to emphasise that people

with mental health issues are a part of

the community and that our lives matter.

Not only that, but by denying people

like me the chance to have a stable life,

with stable housing and a reduction

in poverty-related stress, you are also

denying our kids and loved ones relief

from those stresses.”

Person with lived experience, Victoria

This document provides a summary and list of recommendations of the four-volume report of the National Review of Mental Health

Programmes and Services. All volumes can be downloaded from www.mentalhealthcommission.gov.au. A complete list of the Commission’s

publications is available from our website.

A number of electronic fact sheets for the Review are available on our website.

Many of the quotes in this publication come from people and organisations in Australia who participated in the Commission’s Call for

Submission process.

ISSN 2201-3032

ISBN 978-0-9874449-6-7

National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services. Sydney: NMHC

Published by: National Mental Health Commission, Sydney.

© National Mental Health Commission 2014

This product, excluding the Commission logo, Commonwealth Coat of Arms and material owned by a third party or protected by a

trademark, has been released under a Creative Commons BY 3.0 (CC BY 3.0) licence. The excluded material owned by a third party includes

data, images, accounts of personal experiences and artwork sourced from third parties, including private individuals. With the exception

of the excluded material (but see note below with respect to data provided by the Australian Bureau of Statistics (ABS) and the Australian

Institute of Health and Welfare (AIHW)), you may distribute, remix and build upon this work. However, you must attribute the National

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This Review 4

Setting the scene 4

System reform 4

A person-centred approach 10

System architecture 12

Shifting funding to rebalance the system 12

1. Set clear roles and accountabilities to shape a person-centred

mental health system 16

2. Agree and implement national targets and local organisational

performance measures 16

3. Shift funding priorities from hospitals and income support

to community and primary health care services 16

4. Empower and support self-care and implement a new model

of stepped care across Australia 16

5. Promote the wellbeing and mental health of the Australian

community, beginning with a healthy start to life 17

6. Expand dedicated mental health and social and emotional wellbeing

teams for Aboriginal and Torres Strait Islander people 17

7. Reduce suicides and suicide attempts by 50 per cent over the next decade 17

8. Build workforce and research capacity to support systems change 17

9. Improve access to services and support through innovative technologies 17

I think having two bureaucracies

(federal and state) isn’t working.

The money needs to go into one

very efficient and competently run

system—not be fragmented across

NGOs, GP-referred groups and a lot

of semi-trained/unregistered service

providers. It should be a one-stop-shop

where people tell their story once and

an appropriate referral for follow-up

is made.”

Member of the public, New South Wales

This summary document presents an overview of

the findings of the National Review of Mental Health

Programmes and Services. The Review responds to

the Terms of Reference provided to the National

Mental Health Commission by the Commonwealth

Government early in 2014.

On the basis of our findings, it is clear the mental health

system has fundamental structural shortcomings. This

same conclusion has been reached by numerous other

independent and governmental reviews.

The overall impact of a poorly planned and badly

integrated system is a massive drain on peoples’

wellbeing and participation in the community—on

jobs, on families, and on Australia’s productivity and

economic growth.

Despite almost $10 billion in Commonwealth spending

on mental health every year, there are no agreed

or consistent national measures of whether this is

leading to effective outcomes or whether people’s

lives are being improved as a result.

This Review is framed on the basis of making change

within existing resources. We consider that Australia

has a once-in-a-generation opportunity to improve

the lives of millions of Australians without additional

funding.

For example, the Review identifies measures to help

the Commonwealth maximise value for taxpayers’

dollars by using its resources as incentives to leverage

desirable and measurable results, and funding

outcomes rather than activity. It also proposes

reallocating funding from downstream to upstream

services, including prevention and early intervention.

The ultimate goal of this Review is to make a set of

recommendations for Government to consider, that

will create a system to support the mental health and

wellbeing of individuals in a way that enables them

to live contributing lives and participate as fully as

possible as members of thriving communities.

All of our recommendations and actions are designed

to collectively lead us to that destination.

To achieve the required system reform, the

Commission recommends changes to improve the

longer-term sustainability of the mental health system

based on three key components:

1. Person-centred design principles

2. A new system architecture

3. Shifting funding to more efficient and effective

‘upstream’ services and supports.

These principles underpin the Commission’s

25 recommendations across nine strategic directions.

They guide a more detailed implementation

framework of activity over the next decade,

which provides a comprehensive plan for action in

mental health reform. The planned, coordinated

implementation strategy outlined in the Review

report will give strength to the recommendations

by establishing a transparent and collaborative

governance structure to work with communities,

people, experts and those with lived experience to

hone the recommendations for national adoption.

Taken together, they form a strong, achievable plan

to take advantage of this unique opportunity to

reform Australia’s mental health system for the

wellbeing of Australia and Australians.

In conducting this Review, the Commission’s

primary areas of focus have been the efficiency

and effectiveness of Commonwealth services and

programmes and overall investment and spending

patterns. We considered programme evaluations

where available. We did not evaluate specific clinical

treatments and could not evaluate state and territoryfunded

programmes, services and systems.

The Review has been informed by the Commission’s

whole-of-life approach to mental health and

wellbeing. Accordingly, we have undertaken a crossportfolio

assessment of the strengths and weaknesses

of the mental health and support system as a whole.

The public call for submissions was a significant input

to these considerations.

There have been considerable changes in mental

health and suicide prevention policy, systems and

services in the past three decades, featuring:

• the commencement in the 1990s of a National

Mental Health Strategy and four subsequent

National Mental Health Plans

• the initiation of a National Suicide Prevention

Strategy and release of a National Recovery

Framework in 2013

• increasing recognition of the rights of individuals

and the need for least restrictive treatments, and

involvement of people and their families and other

support people in planning and making decisions

about their care and support

• the development of the community mental health

movement, supporting people in their community,

with a growing role of the non-government, notfor-

profit and private sectors

• the closure or downsizing of many large-scale

dedicated psychiatric institutions (the policy of

deinstitutionalisation)

• greater mainstreaming of services and attempts

to fully integrate them across health, housing,

employment, education, justice and welfare and

around people’s needs

• a growing recognition of the different social and

emotional needs of Aboriginal and Torres Strait

Islander people, and the need for communitybased

and controlled services

• greater community understanding of mental

health, mental illness and suicide, and a greater

willingness to talk about issues and seek help.

The need for mental health reform enjoys longstanding

bipartisan support. Yet as a country we

lack a clear destination in mental health and suicide

prevention. Our “mental health system”—which

implies a planned, unitary whole—is instead a

collection of often uncoordinated services introduced

on an often ad hoc basis, with no clarity of roles and

responsibilities or strategic approach that is reflected

in practice.

We need system reform to:

rather than providers

purchase value-for-money, measurable results and

outcomes, rather than simply funding activity

which indicate system failure and invest in

evidence-based services like prevention and early

intervention, recovery-based community support,

stable housing and participation in employment,

education and training

of people with the most severe and persistent

mental health problems who are the highest users

of the mental health dollar to purchase integrated

packages of services which support them to lead

contributing lives and keep them out of avoidable

high-cost care

families to lead fulfilling, productive lives so they

not only maximise their individual potential and

reduce the burden on the system but also can

lead a contributing life and help grow Australia’s

wealth.

(anxiety, depression etc)

complex and chronic illness

(schizophrenia, bipolar, eating

disorders, severe depression etc)

psychosocial disability

Each year, it is estimated that more than 3.6 million

representing about 20 per cent of adults. In

addition, almost 600,000 children and youth between

the ages of four and 17 are affected by a clinically

nearly half of the Australian adult population will

experience mental illness at some point—equating to

There are an estimated 9,000 premature deaths each

The gap in life expectancy for people with psychosis

compared to the general population is estimated to

while in 2007 an estimated 65,000 Australians

cause of death among people between aged 15 and

and Torres Strait Islander people, and people living

Our work has identified that many people with mental

health difficulties face compounding disadvantage—

particularly Aboriginal and Torres Strait Islander

people, people living in rural and remote regions,

those who are marginalised due to their sexuality,

gender, cultural background or their job, people who

have difficulties with alcohol or other drugs, people

living with an intellectual disability and people who

experienced childhood trauma.

The mental health needs of Aboriginal and Torres

Strait Islander people are significantly higher than

those of other Australians. In 2011–12 nearly onethird

(30 per cent) of Aboriginal and Torres Strait

there were 22.4 suicides per 100,000 Aboriginal

and Torres Strait Islander people during 2012, more

Aboriginal and Torres Strait Islander people aged 15

years and older report stressful events at 1.4 times

Many people with experience of mental illness do

not seek support for their condition. The rates of

help-seeking and treatment are much lower than

prevalence in the community.

The experience of mental ill-health ranges across a

wide spectrum, as illustrated in Figure 1.

The economic cost of mental ill-health to Australia is

enormous. Estimates range up to $28.6 billion a year

collectively $40 billion a year, or more than two

per cent of GDP. The OECD estimates that the average

overall cost of mental health to developed countries is

about four per cent of GDP (including intangible costs

such as the costs of reduced wellbeing, emotional

Australia, this would equate to more than $60 billion

or about $4,000 a year for each person who lodges a

tax return.

Mental illnesses are the leading cause of the non-fatal

disease burden and account for about 13 per cent of

Australia’s total burden of disease. This means that of

the non-fatal disease burden (i.e. years of healthy life

lost through illness and disease) in Australia, 24 per

cent were lost through the effects of mental illness.

Anxiety and depression, alcohol abuse and personality

disorders accounted for almost three-quarters of

The significance of these direct and indirect costs

means that mental ill-health not only affects

individuals and their families and other support

people, but also the standard of living of every

Australian and our communities more broadly.

Based on information received by the Commission

from 16 Commonwealth agencies, the Commonwealth

spent almost $10 billion on mental health and suicide

prevention programmes in 2012–13.

As illustrated in Figure 2, in 2012–13, the 16 agencies

spent:

• Disability Support Pension (DSP) $4,700m

• National Health Reform Agreement

(Activity Based Funding—ABF) $1,000m

• Carer Payment and Allowance (CP) $1,000m

• Medicare Benefits Schedule (MBS) $900m

• Pharmaceutical Benefits Scheme (PBS) $800m

• DVA and Defence programmes ($192.3m)

• Private Health Insurance Rebate for mental

health-related costs ($105.0m)

• Payments to states and territories for specific

programmes (perinatal depression, suicide

prevention, National Partnership Agreement

Supporting Mental Health Reform) ($169.0m)

• National Mental Health and Medical Research

Council (NHMRC) research funding ($67.1m).

3. $606 million allocated by the Department of Health

(DoH), the Department of Social Services (DSS) and

the Department of the Prime Minister and Cabinet

• DoH spent $362 million on 55 grant

programmes, including payments to 213 NGOs,

representing 11 per cent of total mental healthrelated

expenditure from this department.

• DSS spent $180 million on six grant programmes,

including payments to 196 NGOs, representing

three per cent of total mental health-related

expenditure from this department.

• DPMC spent $64 million on three grant

programmes including payments to 133 NGOs

(the proportion of total mental health-related

expenditure that this represented was not

available).

These figures show that 87.5 per cent of Commonwealth

funding on mental health is through five major

programmes. That equates to $7 out of every $8 spent

by the Commonwealth on mental health.

Four of these are demand-driven programmes

providing benefits to individuals. The fifth major

area of expenditure is an estimated $1 billion per

year provided to the states and territories under the

2011 National Health Reform Agreement (NHRA) for

treatment of patients with a mental health need in

the public hospital system, including an estimated

$280 million for patients in standalone psychiatric

institutions.

35.6% since 2008–09

52.5% since 2008–09

21.3% since 2008–09

7.6% decrease since 2008–09

(est MH share of Commonwealth hospital funding)

13.1% since 2008–09

The Commonwealth’s major funding role in mental

health creates significant exposure to financial risk.

As a major downstream funder of benefits and

income support, any failure or gaps in upstream

services means that as people become more unwell,

they consume more of the types of income supports

and benefits which are funded by the Commonwealth.

Those risks also fall back on state and territory crisis

teams, emergency departments (EDs) and acute

hospital services, so it is in the best interests of the

Commonwealth and the states and territories to work

together to achieve the best outcomes for individuals

and communities and minimise costs to taxpayers.

The Commonwealth’s five major programmes are

focused on funding activity, and include outlays

in areas which in many ways can indicate system

failure. Very importantly, as they involve payments of

pensions and health-related benefits, these are largely

areas which constitutionally are Commonwealth

exception is the payment to the states and territories

for hospital care.

If future growth in costs is to be managed, the focus

must be on these programmes.

In 2012–13 these three departments ran 64 programmes with total funding

of $606 million allocated to 542 organisations. These grants ranged from the

highest of $69.4 million (headspace) and $29.5 million (beyondblue) down to

numerous much smaller amounts below $1.0 million.

• A myriad of sources of information and advice

• Distressed individuals having to provide the same

information to multiple organisations

• Vulnerable people left to navigate a complex and

fragmented service system

• Families and support people excluded from

consultations and planning

• Limited choice

• Specialist services where the clients have to come

to them

• The Commonwealth’s main programmes focus

on generating activity: not necessarily on making

anyone better

• A high level of unmet need, with many people not

seeking necessary support. A person’s mental health

and circumstances may deteriorate and become

more complex

• Fragmentation of services

• A myriad of providers, many of them with limited

capacity and poor economies of scale

• A myriad of siloed funding streams and programmes

focused on providers

• Highly variable access to quality services largely

depending on the “luck” of where people live—or

their income—leading to great variation in services

provided and the outcomes achieved

• Poor planning, coordination and operation between

the Commonwealth and the states and territories,

resulting in duplication, overlap and gaps in services

• People being discharged from hospital and treatment

services into homelessness, or without adequate

discharge planning

• High rates of 16–25 year olds with a mental health

condition who are ‘Not in Education, Employment,

or Training’ (NEET)

• Poor physical health among those with severe and

persistent mental health problems

• High rates of unemployment among adults with

a mental illness and their support people

• A fragmented mental health workforce where many

clinicians work in isolation of each other, and do not

operate at the top of their scope of practice

• The greatest level of funding goes into high cost

areas such as acute care, the criminal justice system,

and disability support, indicating that the system

has failed to prevent avoidable complications in

people’s lives

• Research is carried out in isolation of mental health

strategic objectives, with a haphazard approach to

evidence translation into practice

• People, families, businesses, schools, etc. know

where to go to get practical information and advice

• Provide once, use often: people with a mental health

condition a priority group using e-health records

• Clear pathways provided for individuals and their

support people, with care coordination and case

management for those who need it

• Families recognised and included as vital members

of the care team

• Enhanced choice of providers

• Specialists reaching out into the community

• A focus on funding outcomes, to achieve value for

money for individuals and society. Commonwealth

funding to be focused on providing incentives to

achieve outcomes, rather than on simply generating

activity

• More people getting the services they need, when

and where they need them, with enhanced access

and participation in services which aim to keep

people mentally healthy, improve participation and

focus on recovery

• Integration of services around the needs of

individuals, with increased use of pathways and

management plans which cover the continuum of

needs of the person e.g. primary and community

based care, housing, employment, and acute care

when necessary

• Integration of providers around the needs of

individuals and communities: larger provider

organisations or networked providers providing

integrated services and economies of scale

• A person focused approach, where funding is

wrapped around support for the individual and

their families

• Greater consistency in access to services which meet

safety and quality standards

• Clarification of roles and responsibilities between

the Commonwealth and the states and territories,

with shared policy development, system design,

implementation and monitoring and reporting

• No one is discharged from hospitals, custodial care,

mental health or drug and alcohol related treatment

services without an appropriate discharge plan which

provides for necessary supports and includes regular

follow-up

• Increased productivity, participation and economic

impact: continuous improvement measured by

reductions in the NEET rate

• Reductions in risk factors resulting in high morbidity

and premature mortality of people with a mental

illness (e.g. reduced smoking rates and obesity levels)

• Improved financial position for individuals, families

and support people, better economic participation

and productivity

• A team based approach where the person, their

family and support people are at the centre of the

team, and the various members work together in

providing support and services, with an enhanced

role for peer workers. No one works alone, or in

isolation

• Shifting the centre of gravity of funding away from

the acute, crises end, towards prevention, early

intervention and community services which reduce

the onset of illness, complications and crises

• Research is priority driven in accordance with targets

and objectives, with clear pathways for translation

into practice

This Review considers a person-centred approach

to be the fundamental principle guiding its

recommendations. In a person-centred mental health

system, services are organised around the needs

of people, rather than people having to organise

themselves around the system.

Figure 3 illustrates an example of the design of a

person-centred approach.

A person-centred approach means that, as a person’s

acuity and functional impairment increase, the care

team will expand to include different support providers.

As acuity diminishes and functional capacity is

improved, the team will contract as the person can take

on more self-care. People are not transferred from one

team to another but remain connected throughout, to

a general practice or community mental health service,

and with an ongoing core relationship with their family

and other support people.

An ideal person-centred mental health system features

clearly defined pathways between health and mental

health. It recognises the importance of non-health

supports such as housing, justice, employment and

education, and emphasises cost-effective, communitybased

care.

The first priority of a person-centred system is to

enable individuals and their families to look after

themselves. For most people, self-care and support

from those closest to them are the most important

resources they have to build and sustain good

mental health and overall wellbeing, from birth until

death. Conversely, relationships that are unhealthy

or traumatic have an adverse effect, especially for

children. Resilience and wellbeing can also come from

life within a local community through social contacts

and participation in employment, education, clubs and

other activities.

Hospitals EDs Crisis teams Long term acco mmodation Rehabilitation Corrective Services

Specialist Community MH services Housing & accommodation support Employment services Welfare NGOs Private Providers

Police Primary health care GPs, Practice Nurses Allied Health NGOs Mental health nurses Ambulance ACCHOs Suicide prevention services Peer workers Family counseling

Workplaces Community Self Help Sporting & Social Clubs Churches Local Govt Schools

• Public: MBS, PBS, ABF, Welfare Benefits,

Programme grants, private incentives

• Private: PHI, self funded, commercial & social

investments

• Personal and flexible

packages of

comprehensive health

and social care

(including housing,

income and

employment support)

• Specialist mental

health and physical

health treatments

• Coordinated care: One

system, one care plan,

one e-health record

• Maintain connections

with families, friends,

culture and community

• Targeted and

integrated clinical and

social support

• Housing, income,

psychosocial supports

• Self directed low

intensity therapies

• Early intervention

• Maintain connections

with families, friends,

culture and community

• Investment in

prevention and early

intervention

• Foster healthy

communities and

encourage self help

• Foster mental

resilience (families,

schools)

Require significant clinical care

and day-to-day support

limitations on functioning

(ie. very disabling) and without

remission over long period

periods of remission

of adults will experience a

mental disorder sometime in

with need for wellbeing and

Focus on early

intervention at any

age or stage of life

Address social and

economic

determinants of

mental health

Ensure a stepped

care service model:

support is

appropriate to

need over time

Whatever the level

of need, ensure

continuing

connection with

family of choice,

social network, job

or education

level of

need

of need

for support

need for support

need for support

resilience promotion

Alongside the guiding principle of a person-centred

mental health system, the main objectives underpinning

the proposed changes to the system are that it must be:

to achieve identified objectives

net benefits to the community

The person-centred approach described above

fits within a population-based model that aims to

match available resources to identified need, placing

particular emphasis on population groups which are

at higher risk or have special needs. It is supported

by a strong focus on prevention, early intervention

and support for recovery that is not just measured in

terms of the absence of symptoms, but in the ability

to lead a contributing life.

As Figure 4 shows, the main features of such an

approach are to differently target the population as

a whole, the segment of the population with lowmoderate

needs and the segment of the population

with high-very high needs.

The realignment of system architecture as recommended

in this report also involves two other important features:

• A stepped care framework that provides a range of

help options of varying intensity to match people’s

level of need.

• Integrated Care Pathways (ICPs) for mental health,

to provide for a seamless journey through the

mental health system.

This approach shifts groups of people towards

‘upstream’ services (population health, prevention,

early intervention, recovery and participation)

and thereby reduces ‘downstream’, costly services

(ED presentations, acute admissions, avoidable

readmissions and income support payments).

A stepped care approach can also support people

to take greater responsibility for their own mental

and physical wellbeing, when accompanied by the

appropriate services and supports.

This includes innovative service delivery models such

as e-mental health which provide the opportunity to

better integrate self-help, where people know where

to go and how to access the specific information and

support they need.

This does not obviate the need for face-to-face

services. But empowering people, their families and

other support people to support themselves where

appropriate enables more cost-effective use of the

time and skills of clinical and other professionals—

and frees up the valuable personal time of individuals.

The Commission believes one of the most

fundamental elements of the stepped care approach

lies in prioritising delivery of care through general

practice and the primary health care sector.

There is international evidence that national health

care systems with strong primary care infrastructures

have healthier populations, fewer health-related

disparities and lower overall costs for health care than

those countries that focus on specialist and acute care.

Indeed, the World Health Organization (WHO) has

endorsed this approach: Integration of mental health

into primary health care “not only gives better

care; it cuts wastage resulting from unnecessary

investigations and inappropriate and non-specific

The development of 30 Primary Health Networks

(or Primary and Mental Health Networks—PMHNs)

across Australia provides the ideal opportunity to

harness this infrastructure and better target mental

health resources to meet population needs on a

regional basis.

These new entities will be the meso-level

organisations responsible for planning and purchasing

services on a regional basis. They can work in

partnership and apply targeted, value-for-money

interventions across the whole continuum of mental

wellbeing and ill-health to meet the needs of their

communities, enabling a stepped care approach with

the aims of:

• promoting mental health and wellbeing

• reducing risk factors

• preventing mental ill-health

• reducing or delaying the onset of mental ill-health

experiences

• managing and supporting people in the

community as much as possible

• providing timely access when needed to hospital

and other acute services

• managing the handover from hospital back into

the community, step-down care and rehabilitation,

aged care and palliative care

• reducing adverse events, waste and duplication.

Self-help,

prevention, early

intervention

Psychosocial/

non clinical

support (housing,

education,

employment etc)

Primary

community

mental health

services

PBS MBS Acute care Disability Support

Pension

Carer Payment Respite step-up/

step down,

rehabilitation

(sub-acute)

Model of proposed shift in resources—from high cost

activity and interventions toward prevention, early

intervention, self-care and participation (an education, a

job, meaningful relationship)—to enable contributing lives

Stepped care services would range from no-cost and

low-cost options for people with the most common

mental health issues, through to options to provide

support and wrap-around services for people with

severe and persistent mental ill-health, with the aim

that all can live contributing lives in the community.

To support this approach, evidence-based ICPs

for mental health would need to be developed

and supported by PMHNs (Commonwealth) and

local hospital networks or equivalent (states and

territories). In developing these, priority should be

given to pathways relevant to mental health conditions

with the highest contribution to service use.

Based on modelling commissioned from KPMG, the

outcome of implementing this change would be to

slow the rate of increase in Disability Support Pension

(DSP) and Carer Payment costs and the costs of acute

care and crisis management.

This would provide an opportunity to redistribute

these savings through regional integrators, which

would identify the ‘upstream’ system elements most

effective in their communities, to reduce avoidable

hospitalisations and keep people participating in

the community, with the overarching principle of

reinvesting to save (Figure 6).

For people who are high users of the mental health

system, a system of voluntary enrolment and bundled

payment models should be available. Voluntary

enrolments through general practice would provide

the extra support this group needs by enabling a

more cost-effective and coordinated approach to

the provision of wrap-around and whole-of-person

supports.

For those with very high needs, or at risk of

developing very high needs, as identified under the

risk segmentation and stratification approach, PMHNs

could work with LHNs (or equivalent) to bundle funds

from both their budgets (as well as cashing out of

MBS and PBS payments) and purchase packages of

care which can be used to keep people well and in the

community.

Community Mental Health Services

Recovery focused subacute care

Psychosocial supports, including housing,

employment and education

Child and Adolescent Mental Health Services

Primary Mental Health Care

If we look at the data, the business case for this

decade of change is not only morally and socially

compelling, it is economically fundamental.”

As a result of the work of the Review, consultation and

analysis of data and expert advice, the Commission

has identified nine strategic directions to guide reform

and proposed 25 recommendations. Together these

support a detailed framework of activity over the next

decade to take advantage of this once-in-a-generation

opportunity to reform our mental health system for

the wellbeing of Australia and Australians.

The strategic directions and recommendations take a

whole-of-life, whole-of-government approach. Some

are targeted at reform of individual programmes and

services; others are focused on leveraging change

at the system level to ensure that system and funds

are best spent to enable people with mental health

difficulties and their families and carers to enjoy

contributing lives and progress their recovery journey.

Through the more than 1800 submissions made to

the Review, the voices of people with lived experience

of mental illness, their families and support people,

as well as the views of professionals, advocates and

peak bodies were clear. The most prominent theme to

emerge from this wide range of submissions was that

the way the mental health ‘system’ is designed and

funded across Australia means that meaningful help

often is not available until a person has deteriorated

to crisis point. This is either because no mental

health supports are accessible to them, they do not

exist in their area, or they are inappropriate to their

needs. Along the way they may have lost their job,

their family or their home. Countless submissions

pointed out that this makes neither economic nor

humanitarian sense.

Another prominent area of consensus was the idea

that services and programmes should be designed in

consultation with the communities they aim to serve,

and that they should be based on formal analyses of

need. There were many examples provided to the

Review which show this is not happening, resulting

in high levels of unmet mental health need. A picture

emerged of a hit-and-miss arrangement of services

and programmes across the country, seemingly based

on no discernible strategy, creating duplication in

some areas and considerable unmet need in others.

This unmet need was highlighted particularly strongly

in relation to people living in regional, rural and

remote areas of Australia, including farmers and

fly-in-fly-out workers. Submissions conveyed that

programmes and services currently did not meet the

needs of communities with particular mental health

challenges; if services are available, they often feel

inappropriate and irrelevant to the people they are

designed for. Programmes for Aboriginal and Torres

Strait Islander communities and people who have

migrated to Australia were given as examples. People

with interrelated and complex difficulties which

include a mental health problem (including those

with substance misuse, history of trauma and abuse

or intellectual disability) also are poorly served by

a lack of collaboration across agency or disciplinary

boundaries—each of their intertwined problems is

viewed and treated in isolation.

The findings and recommendations of our report

to the Government were informed by these voices,

which revealed considerable consensus about which

elements of our mental health system are working,

and which elements need fixing.

The nine strategic directions and associated recommendations are as follows:

1. Agree the Commonwealth’s role in mental health

is through national leadership and regional

integration, including integrated primary and

mental health care.

2. Develop, agree and implement a National Mental

Health and Suicide Prevention Plan with states and

territories, in collaboration with people with lived

experience, their families and support people.

3. Urgently clarify the eligibility criteria for access to

the National Disability Insurance Scheme (NDIS) for

people with disability arising from mental illness

and ensure the provision of current funding into

the NDIS allows for a significant Tier 2 system of

community supports.

4. Adopt a small number of important, ambitious and

achievable national targets to guide policy decisions

and directions in mental health and suicide

prevention.

5. Make Aboriginal and Torres Strait Islander mental

health a national priority and agree an additional

COAG Closing the Gap target specifically for mental

health.

6. Tie receipt of ongoing Commonwealth funding for

government, NGO and privately provided services

to demonstrated performance, and use of a

single care plan and eHealth record for those with

complex needs.

7. Reallocate a minimum of $1 billion in

Commonwealth acute hospital funding in the

forward estimates over the five years from 2017–18

into more community-based psychosocial, primary

and community mental health services.

8. Extend the scope of Primary Health Networks

(renamed Primary and Mental Health Networks) as

the key regional architecture for equitable planning

and purchasing of mental health programmes,

services and integrated care pathways.

9. Bundle-up programmes and boost the role and

capacity of NGOs and other service providers to

provide more comprehensive, integrated and

higher-level mental health services and support for

people, their families and supporters.

10. Improve service equity for rural and remote

communities through place-based models of care.

11. Promote easy access to self-help options to help

people, their families and communities to support

themselves and each other, and improve ease of

navigation for stepping through the mental health

system.

12. Strengthen the central role of GPs in mental health

care through incentives for use of evidence-based

practice guidelines, changes to the Medicare

Benefits Schedule and staged implementation of

Medical Homes for Mental Health.

13. Enhance access to the Better Access programme for

those who need it most through changed eligibility

and payment arrangements and a more equitable

geographical distribution of psychological services.

14. Introduce incentives to include pharmacists as key

members of the mental health care team.

15. Build resilience and targeted interventions for

families with children, both collectively and with

those with emerging behavioural issues, distress

and mental health difficulties.

16. Identify, develop and implement a national

framework to support families and communities in

the prevention of trauma from maltreatment during

infancy and early childhood, and to support those

impacted by childhood trauma.

17. Use evidence, evaluation and incentives to reduce

stigma, build capacity and respond to the diversity

of needs of different population groups.

18. Establish mental health and social and emotional

wellbeing teams in Indigenous Primary Health Care

Organisations (including Aboriginal Community

Controlled Health Services), linked to Aboriginal

and Torres Strait Islander specialist mental health

services.

19. Establish 12 regions across Australia as the first

wave for nationwide introduction of sustainable,

comprehensive, whole-of-community approaches

to suicide prevention.

20. Improve research capacity and impact by doubling

the share of existing and future allocations of

research funding for mental health over the next

five years, with a priority on supporting strategic

research that responds to policy directions and

community needs.

21. Improve supply, productivity and access for

mental health nurses and the mental health peer

workforce.

22. Improve education and training of the mental health

and associated workforce to deploy evidence-based

treatment.

23. Require evidence-based approaches on mental

health and wellbeing to be adopted in early

childhood worker and teacher training and

continuing professional development.

24. Improve emergency access to the right telephone

and internet-based forms of crisis support, and link

crisis support services to ongoing online and offline

forms of information/education, monitoring and

clinical intervention.

25. Implement cost-effective second and third

generation e-mental health solutions that build

sustained self-help, link to biometric monitoring and

provide direct clinical support strategies or enhance

the effectiveness of local services.

It is clear that our current mental health system

suffers fundamental structural shortcomings that

contribute to poor social and economic outcomes for

individuals, communities and the nation as a whole.

The only way to address this is through whole-ofsystem

reform to build a better integrated, personcentred

system that achieves desired outcomes

through the effective use of existing resources, and a

flexible approach that recognises diversity of people,

culture, circumstance and location. Our consultation

and submissions received from the community have

confirmed this direction.

We believe that significant change is possible and

affordable.

We have provided an implementation strategy for

a clear and collaborative governance structure to

advance the directions recommended in the Review.

These structures establish a framework for the

engagement with the community, people with lived

experience of mental health difficulties and their

families and other support people; government,

non-government and private sector, and clinical and

non-clinical experts.

The Commission looks forward to the Government’s

consideration of the findings of the Review, and in

working with Government to support implementation

of the mental health reform agenda set by

Government.

This is a summary of a report to Government in

response to the Terms of Reference which was

presented in four volumes:

This volume sets out high-level findings, our strategic

directions, recommendations and practical actions

This volume presents findings against the Review’s

Terms of Reference, provides the evidence behind

This volume provides an overview of key findings

received in the generous public response to the call

for written submissions to the Review.

This volume is a collection of work undertaken

throughout 2014 in support of the Review.

Access to these volumes can be found on the National

Mental Health Commission website.

1. Australian Bureau of Statistics. National Survey of

Mental Health and Wellbeing 2007: Summary of

Results. Cat. no. 4326.0. Canberra: ABS, 2008.

2. Sawyer MG, Arney FM, Baghurst PA, et al.

The Mental Health of Young People in Australia.

Canberra: Commonwealth Department of Health

and Aged Care, 2000.

3. Margery J. Disease kills mental-health patients

earlier: report. The Australian. 2014.

4. Lawrence D, Hancock K, Kisely S. The gap in life

expectancy from preventable physical illness

in psychiatric patients in Western Australia:

retrospective analysis of population based

5. Australian Bureau of Statistics. Causes of Death,

Australia, 2012. Cat. no. 3303.0. Canberra: ABS,

2014.

6. Australian Bureau of Statistics. Suicides, Australia,

2010. Cat. no. 3309.0. Canberra: ABS, 2012.

7. Australian Bureau of Statistics. Australian

Aboriginal and Torres Strait Islander Health

Survey: First Results, Australia, 2012-13. Cat. no.

4727.0.55.006. Canberra: ABS, 2013.

8. Medibank and Nous Group. The Case for

Mental Health Reform in Australia: A Review of

Expenditure and System Design: Medibank and

Nous Group, 2013.

9. Harvey SB, Joyce S, Tan L, et al. Developing a

mentally healthy workplace: A review of the

Literature. A report for the National Mental

Health Commission and the Mentally Healthy

Workplace Alliance. 2014. http://www.

mentalhealthcommission.gov.au/media/116414/

Developing%20a%20mentally%20healthy%20

workplace_Final%20November%202014.docx

(accessed 25 November 2014).

10. Organisation for Economic Cooperation and

Development. Making Mental Health Count:

The Social and Economic Costs of Neglecting

Mental Health Care. Paris: OECD, 2014.

11. Begg S, Vos T, Barker B, Stevenson C, Stanley L,

Lopez AD. The burden of disease and injury in

Australia. Cat. no. PHE 82. Canberra: AIHW, 2007.

12. World Health Organization. The world health

report 2001 – Mental Health: New Understanding,

New Hope. Geneva: World Health Organization,

2001.

13. Mental Health Council of Australia. Grace Groom

Memorial Oration: Jennifer Westacott. 2013.

http://mhca.org.au/speeches-transcripts/gracegroom-

memorial-oration-2013 (accessed 13 June

2014).

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Services need to be more family oriented to

support the family unit as a whole. It is the

carers/families/support people who are the

one constant… family needs to be included,

listened to and informed and educated…

and not be looked on as part of the problem.

The family is very important in supporting

consumers to lead better quality of lives. We

need more understanding, less stigmatisation,

more education, and support.”

Support person, Australian Capital Territory