Fourth national mental health plan: an agenda for collaborative government action in mental health 2009-2014

Priority area 5: accountability - measuring and reporting progress

Page last updated: 2009

Summary of actions
Cross-portfolio implications
Indicators for monitoring change


The public is able to make informed judgements about the extent of mental health reform in Australia, including the progress of the fourth plan, and has confidence in the information available to make these judgements. Consumers and carers have access to information about the performance of services responsible for their care across the range of health quality domains and are able to compare these to national benchmarks.

Summary of actions

  • Establish comprehensive, timely and regular national reporting on the progress of mental health reform which responds to the full range of stakeholder needs.
  • Build an accountable service delivery system that monitors its performance on service quality indicators and makes this information available to consumers and other stakeholders.
  • Further develop mental health information, including national mental health data collections, that provide the foundation for system accountability and reporting.
  • Conduct a rigorous evaluation of the Fourth National Mental Health Plan.

Cross-portfolio implications

Responsibility for establishing an accountable mental health service system lies primarily with the health sector. Health will need to collaborate with other sectors including community services, housing, and correctional services to assist them with developing indicators to monitor the extent to which they are having an impact on the community's mental health. Health will also need to work with other sectors in the overarching evaluation of the fourth plan. Top of page

Indicators for monitoring change

  • Proportion of mental health service organisations publicly reporting performance data *


Building a more accountable and transparent mental health system is an essential step to establishing public confidence. Confidence is needed at two levels. At the broad policy level, the public needs to have confidence in the mental health reforms agreed by governments, and that governments are doing as promised. At the service delivery level, consumers and others who depend on mental health services need to be confident that those services are providing quality care in a manner consistent with modern standards. Both of these aspects of accountability have been a source of community concern, and will be central to actions taken under the fourth plan.

Processes designed to improve accountability depend on the right information being available. In the mental health sector, there is a complex mix of stakeholders, each with different information needs, but who share a common interest in knowing how the mental health system is performing. Consumers are the central group. They need the health organisations responsible for their care to make information available that allows them to understand treatment options, make informed decisions and participate actively in their care. This should include information about how the organisation performs in comparison to its peers on a range of health quality indicators, presented in a way that will assist the person to understand what they can expect as a consumer of the organisation. While there are few examples of such practice being adopted in Australian mental health services, there are multiple innovations in this direction developing overseas and in areas outside mental health within Australia. Top of page

Beyond consumers, other stakeholders have legitimate needs for information about mental health system performance. Carers need information to be able to understand the treatment being offered to their relative or friend, and the outcomes that can be expected for the person while they receive treatment provided by the organisation. Mental health service providers also need information about how the treatments they provide compare with similar organisations so that they can establish evidence based treatment systems. Service managers need information about the performance of services for which they are responsible (and other similar services), in order to make operational decisions that will affect the efficiency and effectiveness of the service. Mental health policy makers and planners need a wide range of information about how the mental health system is performing to enable them to determine priorities for resource allocation, plan and pay for services, and monitor the achievement of outcomes.

Australia's mental health sector has been a world leader in reporting on indicators of mental health reform, and has a longer and stronger history of doing so than many other sectors. The process began with the original National Mental Health Plan in 1992, when health ministers imposed on themselves the discipline of public reporting on reform progress through the National Mental Health Report. Having no international counterpart, ten reports were released over the period 1994 to 2008, charting the progress of all governments in reforming their mental health service delivery. Complementing this work, first and second editions of a national mental health information development plan were prepared to guide the developmental work needed to build an 'informed mental health system'. Top of page

These plans drove a number of major achievements, including: the implementation of routine outcome measurement for all consumers receiving care through state and territory mental health services; the development of national performance indicators for public mental health services and the introduction of service level benchmarking; the establishment of national minimum data sets to cover all aspects of public sector mental health service delivery; and the conduct of various population based mental health surveys designed to monitor the prevalence of mental illness in the community.

Despite these achievements, a range of concerns have been raised about existing mechanisms for promoting accountability. The area of reporting on mental health reform has been particularly targeted, with calls for information to be more readily available, timelier and of greater relevance to the current national reform agenda. Additionally, significant gaps remain in the information collections that underpin national reporting, restricting what we are able to routinely monitor about mental health system performance. Foremost among these are nationally consistent measures of consumers' experiences of services, recovery based outcome measures and collections that cover the growing specialised mental health non government sector. At the service delivery level, very little information is readily available to consumers and other stakeholders on the performance of their local mental health services.

The fourth plan acknowledges these concerns and responds by committing governments to a series of actions designed to build an accountable and transparent mental health system. These actions will work across both the policy level and the service delivery level, recognising that each level of the mental health system has a unique contribution to make in establishing public confidence.
  • At the policy level, accountability is about ensuring that governments are doing what they promised to do, and monitoring whether actions taken are effective. Accountability arrangements at this level primarily involve public reporting on performance.
  • At the service delivery level, processes to strengthen accountability need to be progressed within a quality improvement framework. Services that actively pursue quality inherently seek to be transparent and accountable to those they serve. Steps to build stronger accountability at this level involve providing tools and incentives to support service managers and clinical leaders to establish a culture of continuous quality improvement. Accountability arrangements at this level include such efforts as benchmarking exercises and transparent reporting of a variety of indicators across the domains of health quality.
Figure 9 summarises the approach. Top of page

Figure 9: Multi-level approach to building an accountable and transparent mental health system

Text equivalent below for Figure 9: Multi-level approach to building an accountable and transparent mental health system

Text version of figure 9

Policy level
Actions by government and central administrations.

What needs to be done at this level:
  • Appropriate resourcing of mental health services
  • Appropriate legislative, governance and service delivery frameworks
  • Follow-through on commitments to implementing the 4th National Mental Health Plan's agreed actions
Promoting accountability through:
  • Regular (annual) national reporting of the 4th National Mental Health Plan and available data on outcome indicators, via a redesigned National Mental Health Report
Service delivery level
Actions by local service providers and service leaders

What needs to be done at this level:
  • Implementation of quality improvement systems, including systems monitoring key aspects of service delivery performance against national benchmarks
  • Establishment of transparent reporting to local constituencies through mechanisms such as web-based access to information about how services compare to similar services elsewhere
Promoting accountability through:
  • Development of a range of supports and incentives to assist service organisations to introduce local transparent reporting on mental health service delivery Top of page


* This indicator requires further development