Good mental health is a crucial aspect of good general health, and underpins a productive and inclusive society. For this reason, it is a priority area for all levels of government. This Fourth National Mental Health Plan (the fourth plan) sets an agenda for collaborative government action in mental health for the next five years. It offers a framework to develop a system of care that is able to intervene early and provide integrated services across health and social domains. It provides guidance to governments in considering future funding priorities for mental health.

A population health framework

The fourth plan adopts a population health framework. This framework recognises that mental health and illness result from the complex interplay of biological, social, psychological, environmental and economic factors at all levels. The determinants of mental health status include factors such as income, education, employment and access to community resources. The population health framework acknowledges the importance of mental health issues across the lifespan from infancy to old age, and recognises that some people may be particularly vulnerable because of their demographic characteristics (e.g. age, cultural background) or their experiences (e.g. exposure to trauma or abuse). Services must be flexible to meet the specific needs of different groups with different needs. This means that a holistic response to mental health problems and mental illness is required - one that recognises the importance of community support services and accommodation, as well as expert and appropriate clinical services. Interventions must be evidence based, comprehensive and complementary, and cover the spectrum from prevention to relapse prevention and recovery. They must also recognise the importance of self determination, self care and self help. Service development should strive to ensure equitable access and to achieve the best possible outcome. The fourth plan recognises effective linkages must be formed between different sectors for this holistic response to work.Top of page

A whole of government approach

The fourth plan operationalises the population health framework through a whole of government approach to achieving change. The whole of government approach involves a national effort which operates across Commonwealth and state/ territory levels of responsibility, and extends beyond the mental health sector, in recognition of the fact that the determinants of good mental health, and of mental illness, are influenced by factors outside the health system.

The fourth plan emphasises the way in which reforms in the mental health sector can inter-relate with policy directions of other government portfolios, with a view to ensuring that people with mental health problems and mental illness can benefit from them in the greatest way possible.

Ministerial advisory councils from beyond the health sector were involved in the development of the fourth plan. This enabled articulation of the current roles and responsibilities of other portfolios as they relate to improving mental health outcomes (see appendix 1), and constitutes recognition of the responsibility that the health sector has in engaging with other sectors to achieve demonstrable gains in the mental health and wellbeing of the community. The fourth plan recognises that a number of other sectors have begun to make headway in this regard, and builds on current developments.

The relationships between relevant portfolio areas must continue to be developed. This fourth plan provides a basis for governments to emphasise mental health in a more integrated way, as represented in figure 1. This figure shows how the fourth plan works within the existing National Mental Health Strategy and the new whole of government approach to mental health reform. At a basic level, it shows the relationship between areas of government and in doing so formally recognises that many sectors can contribute to better outcomes for people living with mental illness.Top of page

Figure 1: A whole of government approach to mental health

Refer to the following text for a text equivalent of Figure 1: A whole of government approach to mental health
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Text version of figure 1

This diagram is in the form of a building where:
  • the roof is COAG and whole of government reforms e.g. social inclusion
  • the left wall comprises the following ministerial councils:
    • Community and disability services
    • Education, employment, training and youth
    • Corrective services
    • Drug strategy
    • Police
    • Aboriginal and Torres Strait Islander affairs
    • Ageing
  • the remainder of the building shows the following interrelated boxes surrounding the Fourth National Mental Health Plan, all of which are part of the National Mental Health Strategy:
    • COAG National Action Plan on Mental Health
    • National Mental Health Policy
    • Health and mental health ministers
    • Mental Health Statement of Rights and Responsibilities
    • State and territory mental health plans and frameworks
The components of the National Mental Health Strategy are connected with each other and the ministerial councils as follows:
  • The Fourth National Mental Health Plan has two-way links with National Mental Health Policy, Mental Health Statement of Rights and Responsibilities, and state and territory mental health plans and frameworks; one-way links from health and mental health ministers and COAG National Action Plan on Mental Health; and an indirect two-way link with ministerial councils.
  • In addition, COAG National Action Plan on Mental Health has one-way links to ministerial councils and National Mental Health Policy.
  • In addition, National Mental Health Policy has two-way links with state and territory mental health plans and frameworks and Mental Health Statement of Rights and Responsibilities.
  • In addition, health and mental health ministers have a two-way link with ministerial councils.
  • In addition, Mental Health Statement of Righs and Responsibilities has a one-way link to state and territory mental health plans and frameworks.
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Scope and directions

The fourth plan targets the full spectrum of people living with mental health problems and mental illness, as well as their carers and families.

The fourth plan is underpinned by eight key principles and focuses on the following five priority areas for national action, identified through a series of national consultations:
  • Social inclusion and recovery
  • Prevention and early intervention
  • Service access, coordination and continuity of care
  • Quality improvement and innovation and
  • Accountability - measuring and reporting progress.
For each priority area, key outcomes have been identified as well as actions to achieve these outcomes. The actions have been agreed to by all governments and encompass Commonwealth and state/territory areas of responsibility. The actions require collaborative national effort across different levels of government. They build on national reforms which are already in place, and complement activities being undertaken or planned in different jurisdictions under existing state and territory mental health plans. The actions primarily relate to service planning and delivery in the health arena, but they also rely on investment by other areas of government and community.

Health ministers will lead implementation of the fourth plan. The actions will be progressed by governments both independently and nationally through the Australian Health Ministers' Advisory Council. Some of the actions will require commitments of time and effort rather than financial investment to navigate the shared issues within and across sectors; others will require new or re-focused funding.

Not all actions may be able to be fully implemented within a five year framework, but many will, particularly with the commitment of government and the community. Advancing many of the actions related to service reform will require consideration of funding and governance arrangements, operational issues, and cross portfolio and cross government structures.

Improving accountability for both mental health reform and service delivery are central to the fourth plan. The fourth plan explicitly outlines indicators against which to measure progress. For some of these indicators, data are already available; for others, further development work is required and will occur during the first 12 months of the fourth plan. Specific targets have not yet been set for any indicators, but this will also be given priority during the first year of the fourth plan. Collaboration between governments will be needed to fill data gaps and develop appropriate targets.