Significant advances have been made over the past decade in the development of indicators for the Australian health industry, focusing mainly in the field of acute hospital care. Mental health services have lagged behind – due, in part, to the lack of suitable data sets, but more to the lack of consensus within the sector on how to apply performance measurement concepts to the mental health field. As a result, little national information has been available to provide stakeholders with insights into how services compare, or which allow normative expectations to be formed about how the mental health system should perform.
The development of performance indicators for mental health services was foreshadowed by the Second National Mental Health Plan and is emphasised further in the current Plan. The context for development is now set by a broader framework, the National Health Performance Framework, agreed to by all Health Ministers in 2001 for monitoring the performance of the health system.18
The framework identifies three 'tiers' across which indicators are needed to provide a comprehensive picture of the population's health and how the health system is performing in meeting health needs. The National Health Performance Framework is shown in Figure 4.
An important design feature of the framework is that it is intended for use at all levels of the health system – that is, for assessing an individual service or at higher levels of aggregation, such as State and Territory or national. Since the adoption of the framework, two national-level reports have been presented to Health Ministers by the National Health Performance Committee.19 The inclusion of mental health indicators in future reports has been identified as a priority.
A formal work program to apply the framework to the mental health sector was undertaken in the final year of the Second National Mental Health Plan, focused on indicators of health service performance (Tier 3). Arising from this work, a set of 'stage one' performance indicators has been agreed to by the National Mental Health Working Group for progressive implementation over the period of the National Mental Health Plan 2003-2008.20 Figure 5 summarises the new mental health indicator framework.
Figure 4: Australia's National Health Performance FrameworkFigure 4 is presented as text in this HTML version for accessibility reasons.
Health status and outcomes (Tier 1)How healthy are Australians? Is it the same for everyone? Where is the most opportunity for improvement?
- Health conditions - Prevalence of disease, disorder, injury or trauma or other health-related states.
- Human function - Alterations to body, structure or function (impairment), activities (activity limitation) and participation (restrictions in participation).
- Life expectancy and wellbeing - Broad measures of physical, mental, and social wellbeing of individuals and other derived indicators such as Disability Adjusted Life Expectancy (DALE).
- Deaths - Age and/or condition specific mortality rates.
Determinants of health (Tier 2)Are the factors determining health changing for the better? Is it the same for everyone? Where and for whom are they changing?
- Environmental factors - Physical, chemical and biological factors such as air, water, food and soil quality resulting from chemical pollution and waste disposal.
- Socioeconomic factors - Socioeconomic factors such as education, employment, per capita expenditure on health, and average weekly earnings.
- Community capacity - Characteristics of communities and families such as population density, age distribution, health literacy, housing, community support services and transport.
- Health behaviours - Attitudes, beliefs, knowledge and behaviours eg patterns of eating, physical activity, excess alcohol consumption and smoking.
- Person-related factors - Genetic related susceptibility to disease and other factors such as blood pressure, cholesterol levels and body weight.
Health system performance (Tier 3)How well is the health system performing in delivering quality health actions to improve the health of all Australians? Is it the same for everyone?
- Effective - Care, intervention or action achieves desired outcome.
- Appropriate - Care/intervention/action provided is relevant to the client's needs and based on established standards.
- Efficient - Achieving desired results with most cost effective use of resources.
- Responsive - Service provides respect for persons and is client orientated and includes respect for dignity, confidentiality, participation in choices, promptness, quality of amenities, access to social support networks, and choice of provider.
- Accessible - Ability of people to obtain health care at the right place and right time irrespective of income, physical location and cultural background.
- Safe - Potential risks of an intervention or the environment are identified and avoided or minimised.
- Continuous - Ability to provide uninterrupted, coordinated care or service across programs, practitioners, organisations and levels over time.
- Capable - An individual or service's capacity to provide a health service based on skills and knowledge.
- Sustainable - System or organisation's capacity to provide infrastructure such as workforce, facilities and equipment, and be innovative and respond to emerging needs (research, monitoring).
Figure 5: 'Tier 3' performance framework and indicators for Australian public sector mental health servicesTop of page
Large version of Figure 5 (GIF 84 KB)
Top of page
Text version of figure 5Mental health service organisation performance:
- The effective domain consists of 3 sub domains:
- Consumer outcomes - Phase 2 indicator for development
- Carer outcomes - Phase 2 indicator for development
- Community tenure - indicated by 28 day re-admission rate
- The Appropriate domain consists of 2 sub domains:
- Compliance with standards - indicated by National Service Standards compliance
- Relevance to client needs - Phase 2 indicator for development
- The Efficient domain consists of 2 sub domains:
- Inpatient care - indicated by cost per acute inpatient episode and average length of acute inpatient stay
- Community care - indicated by cost per 3-month community care period and treatment days per 3-month community care period
- The Accessible domain consists of 3 sub domains:
- Access for those in need - indicated by population receiving care and new client index
- Local access - indicated by comparative area resources and local access to inpatient care
- Emergency response - Phase 2 indicator for development
- The Continuous domain consists of 3 sub domains:
- Continuity between providers - Phase 2 indicator for development
- Cross-setting continuity - indicated by pre-admission community care and post-discharge community care
- Continuity over time - Phase 2 indicator for development
- The Responsive domain consists of 2 sub domains:
- Client perception of care - Phase 2 indicator for development
- Consumer & carer participation - Phase 2 indicator for development
- The Capable domain consists of 2 sub domains:
- Provider knowledge and skill - Phase 2 indicator for development
- Outcomes orientation - indicated by outcomes readiness
- The Safe domain is a Phase 2 indicator for development.
- The Sustainable domain covers 3 sub domains:
- Workforce planning - Phase 2 indicator for development
- Training investment - Phase 2 indicator for development
- Research investment - Phase 2 indicator for development
18 National Health Performance Committee (2001). National Health Performance Framework Report: A report to the Australian Health Ministers' Conference, Brisbane
19 National Health Performance Committee (2004). National report on health sector performance Indicators 2003. AIHW cat. no. HWI 78. Australian Institute of Health and Welfare, Canberra.
20 National Mental Health Information Strategy Committee (2005). Key Performance Indicators for Australian Public Mental Health Services. Information Strategy Committee Discussion Paper No. 5. Commonwealth Department of Health and Ageing, Canberra.