POLICY ANALYSIS AND ADVOCACY STRATEGY FOR MENTAL HEALTH
Health is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (World Health Organization, 2019). Over the years, mental health has increasingly received attention in the public light due to its myriads of presentations ranging from subtle anxiety to the most overt form of schizophrenia.
The burden of mental illness is increasing across all facets of life and culture in Australia. About 15.0% of Australians between the ages of 16 and 85 have had an affective disorder, this is equivalent to 2.83 million people today. One out of every 16 Australians is currently experiencing depression. Mental illness cost the Australian government about $4000 per person, or a total of $60 billion, this is around 4 percent of the gross domestic product (ABS, 2008)
This assignment seeks to critically analyze the Australian mental health policy, look at areas that have been neglected and champion an advocacy campaign to bare the grey areas of the policy.
The problem and context
The national mental health policy initially started as The National Mental Health Strategy which was agreed by the Australian health ministers in April 1992 and comprised of the following the National Mental Health Policy, the First National Mental Health Plan, the Mental Health Statement of Rights and Responsibilities and a funding agreement between the Commonwealth and the states and territories (ABS, 2008).
In July 1993, the National Mental Health Strategy was incorporated in a 5-year Medicare Agreements, In March 1994 the first national mental health report was released. In December 1997, the evaluation of first national mental health plan was released and made available to the public. Then in June 1998 the second national mental health plan commenced and was incorporated in a 5-year Australian health care agreement (Vrklevski, Eljiz, & Greenfield, 2017).
In November 2001, the international mid-term review of the second plan was released and evaluated in April 2003. In August 2003, the Australian heath care agreement was signed. In July 2006, the Coalition of Australian Government national action plan on mental health was signed and was effective till 2011 (Vrklevski et al., 2017). The national mental health policy was released in 2008 and the policy was revised the same year.
The mental health policy in Australia seeks to address the issues, risks and factors that affect the mental health of the population. Data from the National Survey of mental health and wellbeing carried out in 2007 by the Australian Bureau of Statistics revealed that one out of five people aged between 16 and 85, experience a type of mental illness ranging from anxiety, depression, schizophrenia and bipolar disorders amongst others.
("Department of Health | The magnitude of the problem", 2019)
From the above data, it is evident that mental illness is most common in adolescents and people in their early adult years. The overwhelming prevalence rate of mental illness have been shown to be intensely influenced by various dynamics including social, environmental, biological and behavioral factors. The mental health policy does recognize all of these problems as threats to mental health however, the problems highlighted in the policy are more specific and somewhat limited. The policy addresses the issues affecting the mental health workforce. The mental health workforce has often been challenged with the recruitment and distribution of highly qualified and linguistically diverse professionals. The policy seeks to promote the benefits of employees in the workforce through proper funding, suitable training opportunities and cultural diversity.
More than half of the Australian population lack the knowledge to understand and exercise their rights to access the necessary services required for their mental health. The policy aims to solve this by educating the public on the availability of specialist mental health services and their rights to access them. The vulnerability, stigma and discrimination affecting individuals with mental illness is a problem addressed in the policy. At both the individual and community level, the policy seeks to increase social inclusion and equity.
Mental health problems are risk factors of suicide (Patel, Flisher, Hetrick, & McGorry, 2007). The policy highlights this issue as it aims to drastically reduce the rate of suicide mortality in Australia
The policy also tackles the issue of lack of community participation among population groups particularly the Aboriginal and Torres is trait islanders as they have the highest rate of homelessness, unemployment and regional living in Australia. Furthermore, the policy tackles the challenges affecting health and safety of people that care for mental health patients as they are susceptible to anxiety and depression (Department of Health | National mental health policy 2008, 2019).
Although the policy recognizes the adverse effects of poor socio-economic conditions on mental health, this issue is largely hidden and overlooked from the strategies and plans developed to combat mental health problems. Various social factors including unemployment, poor education, low-income, racism, and social insecurity have been confirmed to strongly influence the risk of mental illness (Matthew, 2019). The policy focuses more on the biological, environmental, and behavioral causes thereby laying little emphasis on the social causes of mental health problems.
Frame of reference/dominant discourse
To frame is to select some aspects of a perceived reality and make them more salient in a communicating text, in such a way as to promote a particular problem definition, who caused the problem, moral evaluation and how should this problem be fixed. Suicide and mental illness prevention appear to be the common frame of reference within the policy. More than half of the strategic plans and regulations within the policy revolves around suicide prevention and reducing the impact of mental health problems on affected individuals especially within the adolescents and indigenous population groups, this age group form the bulk of the working population in the country and hence the socio-economic impact of mental health. Also, the promotion of the mental health of the various population groups and early intervention during childhood and adolescent age are common discourses in the policy in that strategies were developed in the policy to effectively promote the mental health of individuals at risk particularly the indigenous people. Promoting the mental health of the carers and mental health professionals are issued addressed in the policy. Words such as prevention, promotion, factors, mental health, suicide, community participation, social inclusion, intervention mental illness, health services and treatments are commonly used in the policy. There have been challenges in recruiting the workforce and to evenly have highly qualified professionals distributed across all facilities that needed them.
The policy requires supporting the benefits of employees’ part of the workforce that would require proper funding along with the suitable training opportunities along with cultural diversity (Fisher, Carroll, & Shochet, 2017).
Targets, Stakeholders and their Representation
The target of the policy is for people aged between 16 and 85, that susceptible mental illness. The stakeholders and their representation include the government, patients, physicians, employers, insurance companies and pharmaceutical firms. The other stakeholders identified in the policy are the nurses, nursing educators, administrators, along with key researchers, biostatisticians, legislative bodies and regulators. It also includes the medical associations and mental health workers. The policy involves a system of integration whereby the direct stakeholders are not the only ones involved in identifying risk factors or directing those who may have a form of mental illness on where to get help, everyone is involved.
Mental health illness is all over in Australia and also in other developing countries. The impact of mental illness can be seen on the personal, social and economic levels. According to National survey of mental health and wellbeing, mostly the adults aged from 16 to 85 years suffer from the mental health illness. There are different social groups aligned to treat the mental illness like GPs, psychologists, psychiatrists, occupational therapists and social workers and also peer workers. GPs are the first health professionals who encounter this illness and psychiatrists and psychologists helps in reducing the severity and curing the mental illness. Each of these social group help people facing the mental health problems in their own ways.
In practice of mental health care, matter of cultural differences is increasing with the days. For example, belief about the psychotherapy are different among the patient and doctor. There are five different clinical scenarios that may create cultural and ethical dilemmas between patients and doctors. (Hoop, DiPasquale, Hernandez, & Roberts, 2008)
- Maintaining therapeutic boundaries
- Ethical issues in diagnosis
- Ethical issues in treatment choice
- Confidentiality and informed consent
- Justice in the treatment of diverse population
There were wide range of stakeholders that are involved in the mental health policy. Firstly, the clients of the services including their family members and friends whose services that are relevant to them and also of high quality and easily accessible for them. Some other stakeholders are also there for the development of this policy like funding bodies who provide money on different levels to support the policy. Access to the services for mental health is a great issue. Clinical supervision and arrangement of structured staff support play a crucial role in the development of the policy. Approach to the GPs (general practitioners) is very easy and they were the first professionals who interacts and diagnosed the community facing mental illness. More education and training were given to the GPs. Access to the psychiatrist was limited because of few bulk billings and also most of the psychiatrist were located in the metropolitan areas and only few of them were employed in the public sector. individuals are also made aware of the availability and rights to access allied health professionals including social workers and occupational therapists and psychotherapists who specialize in delivering mental health assistance in their community.
Policy Process and Solutions
The policy process requires consultation with stakeholders and everyone who are connected to individuals with mental illness. Various groups represented different competing interest in the formulation of the policy and the circumstances that surrounds providing care and support to mentally ill individuals. The ethical issues surrounding the care and responsibilities of healthcare providers had to be put into consideration. A non-financial competing interest is the family and loved ones of those with mental illness, their argument over years is that of their loved ones been separated from them due to government policy to take away individuals with mental illness into specially designed areas for treatment. Academic institutions that train psychiatrist and psychologist and other governmental agencies such as trade and industry, social welfare all have vested interest in the policy making. The problem of mental illness is defined differently by these stakeholders
Agenda of mental health policy is the prevention of mental illness and stress, depression and other mental health related problems. Focus of this policy process involved the treatment of mental illness, it also considers different kind of audiences like, all ages patients who experience the mental health illness. This policy is helpful in providing the funds to the people for treatment and these funds are provides by the government.
The global burden of mental health is huge, underappreciated and sourced. This happened due to lack of appropriate and quality of mental health organizations and workforces. Therefore, the ethical implications of dissimilarities in mental health for people must be addressed to accomplish the major bioethics principles like individuals respect, justice etc. moreover, social implications like discrimination and stigma towards individuals living with mental disorder affects their employment and education status and access to care services. Also, untreated and unmet mental health issues lead to economic loss as well (Ngui, Khasakhala, Ndetei, & Roberts, 2010).
The national mental health commissioner reviews the current programs of mental health and highlighted existing problems. More effective and supportable methods are required to improve the system for public by providing aiming efforts. The highlighted issues:
- Lack of planning and coordination
- Services based on needs rather than consumer choices
- Too long wait to get services
- Underutilization of new methods
The government has taken opportunity to do work in ‘collaborative and consultative’ approach to make sure that better services can be delivered to public (department of health, 2015).
Australia was the first country which establish a ‘National policy’ for mental health care. The Australian ‘federated system’ permits challenging methods to accountability with other data settings. A national method which has clear to accountability for mental health has unsuccessful to develop. The current data focused on the health services and organizational indicators, failing to reflect broader social factors with expose the quality of the life. Moreover, the new approaches are required which can make sure that selected accountability indicators replicate social priorities and national health in which shareholders can also engage to get better outcomes. also, Australia must need to develop further methods related to mental health accountability which should be tested on both (domestically and internationally) to improve the mental health status (Rosenberg & Salvador-Carulla, 2017).
Evaluation measures of any policy are important to determine it works well, to help service delivery and to provide evidence for keep support of the policy. The 2nd National Mental health plan recognized ‘preventive and promotion’ as one of three priorities for forthcoming activities. Then, the current plan recognized ‘preventing and promoting mental health’ problem as one of its priorities. The requirement for ‘national direction’ in these two categories was recognized in a 1997 evaluation process. Additionally, a ‘National plan action’ for promotion, prevention and early intervention’ was issued with state and federal governments, funded by ‘federal government of ageing and health’ which gathers and distributes data and works together with non-government and government sectors because ‘New Approach’ has vital potential to minimize the forthcoming results for mental health. This approach is really effective to increase the awareness towards mental illness in community (APH, 2010).
Highlight of the advocacy campaign
According to World Health Organization (WHO, 2013), mental health is a situation of which every individual is able to know about their potentials, can deal with his/her stresses of life, can work effectively and capable to make contribution for their community, but when individual has any condition that effects on their mental health, its affects their general well-being and productivity in the community. In Australia, mental illness is very common. According to current Australian Bureau of Statistics (ABS) “National health survey” assessed that 20.1% of Australians have mental health or behavioral conditions in 2017-18, this saw an increase of 2.6% from the survey carried out in 2014-15 (APH, 2019).
In addition to it, researchers are still finding and trying to understand the exact cause of mental illnesses, there is not only one cause for mental illness, but some of the factors that are associated with mental illnesses or disorders include genetic factors, socioeconomic factors, biological, personality and environmental factors. however, mental health is threatened to a great extent by the socioeconomic and physical environment of individuals (McLaughlin, Costello, Leblanc, Sampson, & Kessler, 2012). Research has provided conclusive evidence that low socio-economic status is systematically related with higher rates of depression. To sort out this issue, the social determinants should be the main focus to minimize the issue of mental illness in the population. Moreover, there is an interrelated correlation between the socio-economic conditions and mental health. For example, mental illnesses lead to lower employment and income level, which establishes poverty within an individual’s life and that will go on to develop more mental health issues because of stress outcomes or workloads. It is therefore imperative to tackle the issue of poor socioeconomic conditions particularly in individuals with the vulnerable age group. This will then reduce to a great extent, the burden of mental illness in the population.
Frame of reference
It is evident that socioeconomic factors are significant determinants of the health and well-being of any population. The level of an individual’s income, education and employment plays a huge role in their health outcomes. Its been researched that people with low socioeconomic conditions experience worse health status compared to people in high socio-economic groups (Mackenbach, 2015). Statistics gotten from the ABS survey done in 2014-2015 shows that about 22% of people in low socioeconomic situations experience mental illness in Australia. This is 1.4 times higher than people with better socioeconomic status (ABS, 2015). A study found that occurrence of anxiety and depressed mood was nearly 3 times more in young people age up to 35 years with lower socioeconomic status compared to individuals with higher status (Isaacs, Enticott, Meadows, & Inder, 2018). People with mental ailments bear the brunt of the social stigma along with the government regulated policies and framework (Roberts, 2018).
Mental health problems can occur as a result of multiple factors, but our advocacy campaign focuses on addressing the socio-economic factors and physical environment of the population particularly the vulnerable groups. To balance the forces, it is important to integrate various actions that can focus on balancing a major structure along with significant attitudinal barriers that can aim to achieve positive mental health results within the population. It has been observed that people with low socioeconomic rank such as individuals who are unemployed, uneducated and homeless tend to face more mental health disorders. The role of the advocacy campaign is to shed light on the adverse effect of poor socio-economic conditions to mental health and canvass for a change in the mental health policy to include this issue as a top priority in its intervention plans.
Within the policy, there has been no exclusive coverage of the provision of better living and working conditions for individuals. Therefore, it is important to hold equal values towards providing a resolution to the mental health policy. The government needs to take corrective steps such as providing immediate assistance to the unemployed people and curbing the issue of homelessness. For this, we are campaigning for the provision of both state and federal assistance to the population to reduce poor socio-economic conditions by providing better living and social environment to improve mental health.
Objectives of the advocacy campaign
Poor Socioeconomic factors are known to be risk factors in of the mental illness, though these were not given much consideration in the formation of the Australian mental health policy. The policy focused mostly on the treatment of mental health with limited attention given to its prevention. Employing a totalitarian and holistic approach will ensure that all interests are adequately represented and well taken care of. Mental health can lead to homelessness as well as homelessness could equally lead to some form of mental illness. Mental illness is known to be more prevalent in the low socioeconomic areas. Homelessness has been on the rise and the government has the responsibility to tackle this rising problem.
First and foremost, by stabilizing people through shelter, moving them into permanent housing, and implementing assistance programs to keep them in their housing, government is indirectly reducing the burden of mental illness in the community. The government both at the federal and state levels can employ the strategy of housing assistance schemes (Smith & Hagan, 2019). This will provide flexible subsidy that will be adjusted with family income. Studies have shown that in places where this strategy has been implemented, homelessness is significantly low. Another strategy that has been shown to work which the policy makers can advocate for is “housing first” (Smith A.C, Hagan T. P., 2019). This was first introduced in New York city whereby an approach that involves moving long-term street homeless individuals — the majority of whom are living with mental illness, substance abuse disorders and other serious health problems — directly into subsidized housing and then linking them to support services, either on-site or in the community. Research studies have found that the majority of long-term street homeless people moved into “housing first” apartments remain stably housed and experience significant improvements in their health.
The proportion of people living with mental illness is higher among poorly educated individuals. This is due low levels of education being linked to low income earning and in some cases unemployment which can be a vicious cycle that eventually cascades into mental illness. The problem of unemployment can be eradicated by improving on the curriculum in schools and making sure everyone who passes through the four walls of a school gains some skill which enhances their employability. Our advocacy campaign seeks to enlighten the government on how low socio-economic factors affect mental health probably more than any of the factors highlighted in the policy. The solution our campaign seeks to achieve is to draw the attention of the government and policy makers to effect change in the mental health policy to include reduction of poor socioeconomic states as its top priority.
Advocacy campaign strategies
Our advocacy campaign aims to petition for a change in the mental health policy to focus on the prevention of mental illness through the reduction of poor socio-economic conditions amongst the population. Mental Health Australia promoted the rights and interests of the mentally sick population and is urged to protect their interests.
Vecchi, Kenny and Kidd (Vecchi, Kenny, & Kidd, 2015) suggested that various recovery-oriented service provisions and relevant stakeholders, are available in Australia which ensures the recovery process of the mentally ill persons from organisational and individualistic points. Such organisations include the Secure Extended Care Units (SECU) which provides rehabilitation programs, involuntary residency and support to individuals with mental health issues. Other stakeholders include the department of health, medical and allied health professionals, health NGOs etc. Our group can engage the attention of these stakeholders by organizing meetings and consultations where they will be compelled to take urgent actions in agitating for an improvement in the socio-economic status of the population. It is important to build a strong coalition with these stakeholders by jointly working together to carry out the campaign’s activities. Movements and protests will be built with the help of the stakeholders to raise awareness educating both the public and the government on the adverse effects of poor social and economic conditions to the mental health of individuals as well as provide solutions (Vecchi et al., 2015).
Australian Government Department of Health (2019) have emphasized that to prevent relapse of mental health disorders, or to improve the situation of these patients, the role of the community and the public attention is indispensable. Our campaign will engage and collaborate with the community to bring about public campaigning and advocacy. The family and friends of affected individuals will be included in the campaign and provided with information that is necessary to assist them in providing appropriate support and care the individuals by developing and implementing given strategies while campaigning for better resources. Naslund (Naslund, Aschbrenner, Marsch, & Bartels, 2016) suggested that peer support and engagement in social media have immense effects on the mental health conditions of the people. They have revealed that support from friends, and development of a supportive online community can help to ease the situation of individuals vulnerable to mental illness as a result of poor socio-economic conditions. There is a huge amount of relief and advancement in the mental and physical wellbeing of such individual, when they are comfortable when sharing their concerns and procuring support from friends and family. Peer advocacy, professional advocacy and citizen advocacy is useful here. Along with this, social media can be considered as one of the most effective tools for informing and educating the public and government on how poor socio-economic conditions affects mental health and advocate for better policies and governmental actions that will improve socio-economic condition.
World Health Organisation (WHO, 2019) suggested that advocacy done for the improvement of the mental health of a population should include increasing mental health awareness as a national agenda of the Government. Our advocacy campaign will utilize media groups and advertising agencies in raising awareness and championing solutions to the hostile effects of low socio-economic factors to mental health. Mass media campaigns which includes national television, newspapers, magazines, pamphlets, radio etc, will be utilized by voicing and publishing articles that will highlight the issue and campaign for solutions. Another form of national level campaign can be done by attracting the attention of film makers to shed light on the current poor socio-economic conditions of individuals and how it is relatively connected to the development of mental illness through film portrayal. This can influence and empower a large mass of population through entertainment to join in advocating for change and better outcomes. Maintaining continuous coalition with the media, grabbing their attention about the issue, urging them to frame the issue in such a way that it will expose the effects of low socio-economic status on mental health. In the United States, a campaign happened where nationally in movie theatres the film Schizo was shown. It was evident that people had a change in attitude and perspective towards mental illness and its risk factors after watching the movie (Booth, Allen, Jenkyn, Li, & Shariff, 2018).
According to Bromley (Bromley, Mikesell, Jones, & Khodyakov, 2015), health promotion and raising public awareness regarding the mental health disorders by health advocates can raise a variety of ethical issues because it is often concerned with modifying people’s views and lifestyles. There are various ethical committee which can solve such issue, such as Australian Health Ethics Committee (NHMRC), Australian Medical Council and Government of Australia Department of Human Rights. While carrying out the campaign, the verbal and written consent of the participants will be taken into consideration. From the very beginning, the ethical frameworks of NHMRC will be followed and consent before any campaign from the Australian Medical Council and Human Rights Authority must be given before strategies are implemented. Bromley (Bromley et al., 2015) suggested that health advocates and campaigners must not involve controversial issues while campaigning. It is very important that sensitive contents of individual personal lives, omission of any information, adding extra unnecessary contents, are avoided during the course of our campaign.
Evaluation of the advocacy campaign
Advocacy is one of the proven methods to ensuring long-term change in the policy environment. However, it is important to monitor and evaluate our advocacy campaign in terms of performance management, accountability and improvement. Evaluating our strategies and input by means of indicators to assess its effectiveness, will assist stakeholders involved in understanding the concreteness of effecting changes in policy setting. Owing to unprecedented fluctuations that occur in the political atmosphere, it is important to keep up to date with these political changes while implementing our campaign. By effectively monitoring and evaluating our campaign strategies, we can guarantee a mutual understanding of what our campaign intends to accomplish as well as develop ways to measure and record its success.
Jones (Jones, 2011) acknowledges the fact that it can be quite difficult to monitor the effectiveness of an advocacy campaign as it involves making changes to a policy agenda while effecting and maintaining behavioural changes among the public. However, there are several indicators that can be used to evaluate the influence and progress of our campaign. First, we will measure the implementation process and output of our strategies by documenting the total meetings and sessions held with the official stakeholders plus the amount of people who actively participated in the protests and movements organized by the campaign. Secondly, we will evaluate the outcome of the campaign’s output including the intermediate and long-term outcomes by measuring the behavioural changes in the public in voicing their distress towards the policy by conducting surveys and interviews in the community.
We will also take into consideration the various statements given by decision makers regarding the policy. Documenting the number of policy makers who communicated supportive dedication take action on the concern, will indicate how effective our advocacy campaign is. Also, the NGO’s and similar interest groups who have willingly built a coalition with the campaign, jointly organizing activities and pressuring policy makers will be surveyed to determine the progress of our campaign. Furthermore, the effectiveness of the campaign will be evaluated by continuously monitoring the role of the media by recording how many articles, advertisements, movies, online ads. Etc that have been geared towards buttressing the issue of our campaign.