Indicator 22: Proportion of services reaching threshold standards of accreditation under the National Mental Health Standards

Key messages:

• In 2010-11, 84% of specialised mental health services in Australia had undertaken external accreditation and been judged to meet all standards set out in the National Standards for Mental Health Services (Level 1). A further 8% met some but not all standards (Level 2), 4% had made some progress towards external review (Level 3) and 4% did not meet criteria for Levels 1-3 (Level 4).
• In two jurisdictions (the Australian Capital Territory and the Northern Territory) 100% of services met the standards set for Level 1. Three others (Queensland, Victoria and South Australia) came close to this, with at least 96% of their services achieving Level 1. In other states the proportion of services achieving Level 1 was lower. In New South Wales (79% at Level 1) and Tasmania (48% at Level 1), the balance of services had undertaken external review and reached threshold for Level 2, whereas in Western Australia (49% at Level 1), the balance had not completed external review and were graded as Levels 3 or 4.
• Ongoing effort is required to ensure more uniform levels of accreditation across jurisdictions.

The implementation of the National Standards for Mental Health Services (National Standards) was agreed by all jurisdictions in 1998, as a basis for assessing service quality and guiding continuous quality improvements. The first National Standards were released in 1996, and focused on improving the quality of state and territory funded specialist clinical mental health services. They included eleven standards grouped into three categories: 1-7, universal issues of human rights, dignity, safety, uniqueness and community acceptance; 8-10, mental health service organisational structures and links between parts of the mental health sector, and 11, service delivery processes and types of treatment and support.

Revised National Standards ⁷² were endorsed in 2010. They have a greater emphasis on recovery and are intended for use within the full range of mental health services, including public sector mental health services, non-government organisations, private hospitals and private clinic-based providers. The revised National Standards comprise ten standards covering aspects of service delivery, compliance with policy directions, standards of communication and consent, and monitoring and governance (see Table 12). Each standard is supported by a set of criteria. All of the standards are designed to be assessed, except the consumer standard which comprises criteria included under other standards.

Services undertake accreditation against the National Standards via an external review process. Information about the proportion of services assessed as reaching threshold standards of accreditation under the National Standards is available through the National Minimum Data Set (NMDS) - Mental Health Establishments (MHE) collection. The indicator grades services according to four categories reflecting their status with respect to external review and, if reviewed, the extent to which they have met the standards:

• Level 1: Services that have been reviewed by an external accreditation agency and judged to have met all National Standards for Mental Health Services.
• Level 2: Services that have been reviewed by an external accreditation agency and judged to have met some but not all National Standards.
• Level 3: Services that are either in the process of being reviewed by an external accreditation agency but the outcomes are not known; or are booked for review by an external accreditation agency.
• Level 4: Services that do not meet the criteria detailed under levels 1 to 3.

A high proportion of services graded at Level 1 is desirable, and may be interpreted as an index of service quality.

Figure 66 shows that nationally, in 2010-11, 84% of services met all standards (Level 1). A further 8% met some but not all standards (Level 2), 4% had made some progress towards external review (Level 3) and 4% did not meet criteria for Levels 1-3 (Level 4). Several jurisdictions reported at 100% or nearly 100% of services at Level 1, namely the Australian Capital Territory (100%), the Northern Territory (100%), Queensland (99%), Victoria (96%), and South Australia (96%). In New South Wales and Tasmania, 79% and 48% of services respectively had achieved Level 1, with all or virtually all of the balance of services having completed external review and graded as Level 2. In Western Australia, 49% of services were graded Level 1, with the balance of services having not completed external review and graded at Level 3 (29%) or Level 4 (23%). More detailed jurisdiction-level information is provided in Part 4.

Ongoing effort is required to ensure comprehensive implementation of the National Standards across all jurisdictions and service sectors.

Table 12: National Standards for Mental Health Services (2010)

1. Rights and responsibilities
2. Safety
3. Consumer and carer participation
4. Diversity responsiveness
5. Promotion and prevention
6. Consumers
7. Carers
8. Governance, leadership and management
9. Integration
10. Delivery of care Top of page

Figure 66: Percentage of services reaching threshold standards of accreditation under the National Mental Health Standards

Text version of figure 66

	2005-06	2006-07	2007-08	2008-09	2009-10	2010-11
Level 1 - meets all standards	82.7	74.7	80.7	82.6	81.3	84.0
Level 2 - meets some standards	1.1	7.4	7.4	7.2	11.9	8.0
Level 3 - review book/ in progress	13.9	14.3	9.6	9.6	5.7	4.3
Level 4 - does not meet criteria for levels 1-3	2.3	3.6	2.3	0.6	1.1	3.6