Fourth national mental health plan: measurement strategy

Section 1 Introduction and background

Page last updated: May 2011

1.1 The fourth national mental health plan
1.2 A history of measuring and reporting progress
1.3 Building an accountable and transparent mental health system
1.4 The measurement strategy

1.1 The fourth national mental health plan

The Fourth National Mental Health Plan (the Fourth Plan) was agreed by Australia's Health Ministers in September 2009. The Fourth Plan follows on from the work of the previous three national mental health plans in collaboratively shaping mental health sector reform by identifying priority areas for reform and committing governments to a set of agreed actions. This plan also builds on previous national, state and territory initiatives, including the Council of Australian Governments (COAG) National Action Plan for Mental Health 2006-2011, and jurisdictions' mental health plans.

The Fourth Plan is based on a population health framework that focuses on a range of factors impacting on the mental health of all Australians across the life span, recognising that as well as biological and psychological factors, economic and social factors such as education, employment, housing and income, along with participating in the community and having social connections, are all vital to promote good mental health and wellbeing and prevent mental illness occurring. This plan also acknowledges that when mental illness does occur, access to assessment and treatment should be available at the earliest opportunity to prevent further deterioration and aid recovery.

Recognising that factors outside the health system impact on mental health and mental illness, the Fourth Plan commits governments to reform beyond the mental health sector and from portfolios outside of health. This whole-ofgovernment approach articulates the collaboration required between agencies, and promotes greater awareness of mental health issues across human services at all levels of government and the community.

The Fourth Plan identifies five priority areas:

  • Priority Area 1 – Social inclusion and recovery.
  • Priority Area 2 – Prevention and early intervention.
  • Priority Area 3 – Service access, coordination and continuity of care.
  • Priority Area 4 – Quality improvement and innovation.
  • Priority Area 5 – Accountability—measuring and reporting progress.
Desired outcomes and agreed actions are detailed within each priority area. Improving accountability for reform and service delivery is integral to the Fourth Plan, and each priority area contains indicators to monitor change. For the first time, the Fourth Plan also commits governments to the establishment of nationally agreed targets to drive reform and quality improvement. Top of page

1.2 A history of measuring and reporting progress

Australia's mental health sector has been a world leader in reporting on its performance in implementing reform. A number of publications contribute to information available in the public domain.

National Mental Health Report. Having no international counterpart, eleven reports were released over the period 1994–2010, charting the progress of all governments in reforming their mental health service delivery. Each report provided detailed information about the performance of the Australian and state and territory governments in implementing the policy directions agreed under the Strategy.

Subsequent to the introduction of the National Mental Health Report, three additional nationallevel reports were developed that specifically covered the mental health sector:

  1. The Mental Health Services in Australia report is prepared by the Australian Institute of Health and Welfare on an annual basis. To date, twelve reports have been released providing a detailed picture of the national response to the mental health care needs of Australians. Data from a wide range of collections are presented, both as annual snapshots and changes over time.
  2. The Steering Committee for the Review of Government Service Provision, introduced the separate reporting of mental health service performance in its 1999 annual Report on Government Services. Previously, mental health services had only been included within the reporting of acute hospital performance. The data provided in this report has continued to be refined, and now includes a range of performance indicators covering three broad categories: equity, efficiency and effectiveness.
  3. Following the agreement by COAG to the National Action Plan for Mental Health 2006–2011 in July 2006, annual reports are prepared for COAG on the progress of the Plan that summarise progress against 12 performance indicators. To date, two reports have been released covering progress to 2008–2009. Top of page

1.3 Building an accountable and transparent mental health system

Central to the Fourth Plan is a commitment by governments to improve accountability and transparency within the mental health sector through a multi-level approach – at the policy level of governments and central mental health administrations; and at the service delivery level. Figure 1 summarises the approach agreed in the Fourth Plan for strengthening accountability at both levels. Together, the two levels of reporting will provide coverage of the mental health sector and will place a wide range of performance information into the public domain.

Figure 1: Multi-level approach to building an accountable and transparent mental health system

Text equivalent below for Figure 1: Multi-level approach to building an accountable and transparent mental health system Top of page

Text version of Figure 1

The figure shows two levels: the policy level and the service delivery level.

The required actions for both levels are as follows:
  • Appropriate resourcing of mental health services.
  • Appropriate legislative, governance and service delivery frameworks.
  • Follow through on commitments to implementing agree Fourth Plan actions.
  • Implementation of quality improvement systems, including systems monitoring key aspects of service-performance against national benchmarks.
  • Establishment of transparent reporting to local constituencies.
Promoting accountability through:
  • measuring the effect of actions in progressing reform.
  • publicly reporting results and progress through a revised National Mental Health Report.
  • 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

The policy level

For the first time, this national mental health plan specifically identifies a set of indicators that focus on measuring and reporting performance at the policy level, to monitor progress towards reform of the mental health sector. In line with the whole-of-government approach underpinning the Fourth Plan, the indicators will also measure and report on other health areas and more broadly from other portfolios, using a range of data sources including population and service data. The Fourth Plan commits governments to strengthen the foundation for accountability for the mental health sector by reporting against the 25 indicators in a revised National Mental Health Report.

The service delivery level

The Fourth Plan also commits governments to publicly report service delivery performance. Under previous national mental health plans there was significant development of mental health information and performance measurement systems, principally in public state and territory services and the private hospital sector. The National Mental Health Performance Framework 1 . Details of the National Mental Health Performance Framework and associated national mental health key performance indicators are available from provides a platform for mental health services to measure their own performance and benchmark against the performance of their peers. However, despite the progress made, there has not been widespread public reporting of this performance information. The 2010 COAG National Health and Hospitals Reforms include the establishment of a National Performance Authority to publicly report service delivery performance. It is anticipated that the extensive work already undertaken by the mental health sector will contribute to the work of the National Performance Authority once it is established. Top of page

1.4 The measurement strategy

The Measurement Strategy focuses on the policy level performance indicators, and represents the culmination of extensive collaborative work by representatives from jurisdictions, a number of Australian Government agencies, the private and non-government sectors, consumers and carers, and clinical experts.

This initial edition of the Measurement Strategy describes the approach taken by the mental health sector to develop the Fourth Plan indicators and targets. It provides a high-level overview of the indicators and targets, details on indicator specifications, and planned developments.

Appendix 1 provides detailed technical information for each of the indicators with agreed specifications. It is important to note that the specifications will be enhanced over time as technical conventions are determined and the outcome of data development activity becomes available. Future editions of the Measurement Strategy will communicate these enhancements to facilitate consistent construction of the indicators and improve the comparability of results.

The Measurement Strategy has been produced by the National Mental Health Performance Subcommittee (NMHPSC) on behalf of the Mental Health Standing Committee's Mental Health Information Strategy Subcommittee (MHISS). Information on the committees and their reporting structure is contained in Appendix 2.


1 Details of the National Mental Health Performance Framework and associated national mental health key performance indicators are available from the Mental Health Standing Committee website.