The Public Mental Health System

Specialist public mental health services, like health services in general in Australia, are primarily delivered through the State system. In general, these public mental health services are provided to people with ‘serious mental illnesses’. Usually no particular diagnostic category is specified for this group but commonly it includes the more severe forms of psychotic illnesses (such as schizophrenia), mood and personality disorders or those who present in a situational crisis that may lead to self-harm or inappropriate behaviour towards others. Increasingly, adult mental health service consumers have more than one disorder, with drug and alcohol related disorders (dual diagnosis) being most common. The understanding is that disorders that may be less disabling, such as depression (in the milder forms) and anxiety disorders are cared for outside the public system, unless there are significant disabilities or risks associated with them. This means that people not suffering from 'a serious mental illness' may be referred to other agencies. These agencies will include practitioners as diverse as General Practitioners, private psychiatrists and psychologists and other qualified mental health clinicians. It all so means that public mental health services are expected to determine whether an illness is serious and to use this for their intake criteria. The clinical staff working in the public mental health system are likely to include mental health nurses, medical doctors including psychiatrists, occupational therapists, social workers and psychologists. Many of the clinicians working in community mental health may be employed as a generic case manager and may come from any of these backgrounds. The public mental health system provides assessment, diagnosis, treatment, rehabilitation and clinical case management services, and includes a crisis response and inpatient beds as well as a limited residential rehabilitation program and outpatient services. Another distinctive element of the public mental health system is its legislated mandate. Each state has a Mental Health Act that sets out expectations of treatment and care and regulates services. Importantly, it also sets out mandatory criteria which enables involuntary treatment and care of mental illness. The underlying principle that the MHA revolves around is that such treatment and care is to be provided in the least restrictive environment and balances this with the needs of the individual against the welfare of the public. The guiding principle in accessing the most applicable and appropriate form of service is determined by the immediacy of the problem, the degree of risk and the treatment approach required. One of the difficulties for people with an intellectual disability is that they may present with ‘behaviours’ that are not seen to be a mental illness and may be difficult or dangerous to manage within a mental health service. In addition, many of the problems they present with are often attributed to the intellectual disability itself rather than considering the possibility of a mental illness (”diagnostic overshadowing”). A further difficulty is that mental health services often lack the expertise and facilities to be able to provide a safe and effective service to the particular difficulties that people with an intellectual disability present with. These issues are discussed in more detail in Module 3 - Assessment. The State mental health services in Australia are bound by the National Framework for Recovery- Oriented Mental Health Services. This framework was endorsed by the Australian Health Ministers' Advisory Council (AHMAC) on 12 July 2013 and formally launched by the Chair of AHMAC at the Mental Health Services Conference (TheMHS) on 21 August 2013. The framework places the lived experience and insights of people with mental health issues and their families at the heart of recovery-oriented culture.