PART THREE: RESULTS OF SURVEYS

• 3.1 Survey One: A review of implementation of community priorities in mental health
• 3.2 Survey Two: Consumer and carer experiences of care

After the Mental Health Council of Australia (MHCA) launched its national review of mental health services in Australia in 2003 ("Out of Hospital, Out of Mind!"), it set about gathering more specific data from government agencies about the status of mental health services at local, regional and state/ territory levels. Together with the Brain and Mind Research Institute (BMRI), the MHCA developed two surveys as tools to collect the relevant information. This process was completed prior to the commencement of community consultations with the Human Rights and Equal Opportunity Commission.

The following data summarises the results of those surveys.

3.1 SURVEY ONE: A REVIEW OF IMPLEMENTATION OF COMMUNITY PRIORITIES IN MENTAL HEALTH

The first survey, conducted over 2004-04, sought the views of mental health stakeholders about the progress in the implementation of community priorities in mental health. The survey was divided into three sections:

• The first asked some demographic information about the respondent and their service.
• The second asked the respondent to rate how the priorities have been implemented or supported within their LOCAL area.
• The third asked respondents to rate how the priorities have been implemented or supported at a STATE level.

3.1.1 SURVEY ONE - NATIONAL DATA SET

As of 2 November 2004, 714 complete surveys had been received. The majority of respondents described their role within the mental health sector as public providers of specialist treatment (n=246, 34%). This is followed by consumers and carers (n=162, 22%) and then non-government community service providers (n=74, 10%). Across Australia , most respondents were located in New South Wales (NSW; Table 3.1.1.1).

Table 3.1.1.1: Total number of respondents by state; N=714.

With regards to the national priorities as identified in "Out of Hospital, Out of Mind!", respondents rated the extent to which they have been implemented or supported in their LOCAL areas (Table 3.1.1.2).

Table 3.1.1.2: Implementation or support for priorities at a LOCAL level; N=714.

*Where numbers do not tally to 714 (100%), respondents have either responded "Don't know" or left the question blank.

Next, respondents rated the extent to which priorities have been implemented or supported within their STATE (Table 3.1.1.3).

Table 3.1.1.3: Implementation or support of priorities at a STATE level; N=714.

*Where numbers do not tally to 714 (100%), respondents have either responded "Don't know" or left the question blank.

Finally, respondents living and/or working in regional or rural and poorly resourced areas were asked to rate the extent to which such factors have been implemented or supported within their STATE (Table 3.1.1.4).

Table 3.1.1.4: Implementation or support for regional or rural and poorly resourced areas.

** The total number of respondents answering this question reduced from 714 depending on whether the respondent identified as living in either a rural or regional area (n=366) or a poorly resourced area (n=369).

Table 3.1.1.5: Implementation or support of TOP TEN national priorities at a LOCAL level; N=714.

*Where numbers do not tally to 714 (100%), respondents have either responded "Don't know" or left the question blank.

** The total number of respondents answering this question reduced from 714 depending on whether the respondent identified as living in either a rural or regional area (n=366) or a poorly resourced area (n=369).

Conclusions

The responses of local providers of services, and many consumers, carers and non-government organisations, indicate clearly that the key community priorities for national mental health reform have not been implemented. The results are an indicator of the performance of government in turning mental health policy into real local action in Australia . Very basic structural issues of implementation of the National Mental Health Standards, accountability for funds, involvement of consumers and carers and engagement and support of the non-government sector have not been attained. Real program development such as implementation of early intervention strategies, management of concurrent alcohol and drug problems and development of a greater range of acute care settings remain largely on the drawing board. Rural and regional areas and areas within states with low levels of other resources still appear to be neglected. The perceptions of the providers and users of services continue to reinforce the data originally described in "Out of Hospital, Out of Mind!".

As there are likely to be significant variations by both region and state in the degree of mental health reform, this same data is presented on a state-by-state basis.

3.1.2 SURVEY ONE - NEW SOUTH WALES

Table 3.2.1.1: Implementation or support for priorities at a LOCAL level in NSW; N=239.

*Where numbers do not tally to 239 (100%), respondents have either responded "Don't know" or left the question blank.

Next, respondents rated the extent to which priorities have been implemented or supported within their STATE (Table 3.2.1.2 ).

Table 3.2.1.2: Implementation or support of priorities at a STATE level in NSW; N=239.

*Where numbers do not tally to 239 (100%), respondents have either responded "Don't know" or left the question blank.

3.1.3 SURVEY ONE - VICTORIA

Table 3.1.3.1: Implementation or support for priorities at a LOCAL level in VIC; N=134.

*Where numbers do not tally to 134 (100%), respondents have either responded "Don't know" or left the question blank.

Next, respondents rated the extent to which priorities have been implemented or supported within their STATE (Table 3.1.3.2).

Table 3.1.3.2: Implementation or support of priorities at a STATE level in VIC; N=134.

*Where numbers do not tally to 134 (100%), respondents have either responded "Don't know" or left the question blank.

3.1.4 SURVEY ONE - QUEENSLAND

Table 3.1.4.1: Implementation or support for priorities at a LOCAL level in QLD; N=95.

*Where numbers do not tally to 95 (100%), respondents have either responded "Don't know" or left the question blank.

Next, respondents rated the extent to which priorities have been implemented or supported within their STATE (Table 3.1.4.2 ).

Table 3.1.4.2: Implementation or support of priorities at a STATE level in QLD; N=95.

*Where numbers do not tally to 95 (100%), respondents have either responded "Don't know" or left the question blank.

3.1.5 SURVEY ONE - SOUTH AUSTRALIA

Table 3.1.5.1: Implementation or support for priorities at a LOCAL level in SA; N=69.

*Where numbers do not tally to 69 (100%), respondents have either responded "Don't know" or left the question blank.

Next, respondents rated the extent to which priorities have been implemented or supported within their STATE (Table 3.1.5.2 ).

Table 3.1.5.2: Implementation or support of priorities at a STATE level in SA; N=69.

*Where numbers do not tally to 69 (100%), respondents have either responded "Don't know" or left the question blank.

3.1.6 SURVEY ONE - WESTERN AUSTRALIA

Table 3.1.6.1: Implementation or support for priorities at a LOCAL level in WA; N=99.

*Where numbers do not tally to 99 (100%), respondents have either responded "Don't know" or left the question blank.

Next, respondents rated the extent to which priorities have been implemented or supported within their STATE (Table 3.1.6.2 ).

Table 3.1.6.2: Implementation or support of priorities at a STATE level in WA; N=99.

*Where numbers do not tally to 99 (100%), respondents have either responded "Don't know" or left the question blank.

3.1.7 SURVEY ONE - AUSTRALIAN CAPITAL TERRITORY

Table 3.1.7.1: Implementation or support for priorities at a LOCAL level in the ACT; N=43.

*Where numbers do not tally to 43 (100%), respondents have either responded "Don't know" or left the question blank.

Next, respondents rated the extent to which priorities have been implemented or supported within their STATE (Table 3.1.7.2 ).

Table 3.1.7.2: Implementation or support of priorities at a STATE level in the ACT; N=43.

*Where numbers do not tally to 43 (100%), respondents have either responded "Don't know" or left the question blank.

3.1.8 SURVEY ONE - NORTHERN TERRITORY

Table 3.1.8.1: Implementation or support for priorities at a LOCAL level in the NT; N=9.

*Where numbers do not tally to 9 (100%), respondents have either responded "Don't know" or left the question blank.

Next, respondents rated the extent to which priorities have been implemented or supported within their STATE (Table 3.1.8.2 ).

Table 3.1.8.2: Implementation or support of priorities at a STATE level in the NT; N=9.

*Where numbers do not tally to 9 (100%), respondents have either responded "Don't know" or left the question blank.

3.1.9 SURVEY ONE - TASMANIA

Table 3.1.9.1: Implementation or support for priorities at a LOCAL level in TAS; N=26.

*Where numbers do not tally to 26 (100%), respondents have either responded "Don't know" or left the question blank.

Next, respondents rated the extent to which priorities have been implemented or supported within their STATE (Table 3.1.9.2 ).

Table 3.1.9.2: Implementation or support of priorities at a STATE level in TAS; N=26.

*Where numbers do not tally to 26 (100%), respondents have either responded "Don't know" or left the question blank.

3.2 SURVEY TWO: CONSUMER AND CARER EXPERIENCES OF CARE

This survey mechanism introduced through the Mental Health Council in 2004, seeks to record ongoing experiences of care by those who actually use mental health services. It extends a framework initially developed in other areas of heath care to measure the quality of services provided (Hickie et al 2003). It is in marked contrast to the mechanisms currently used or even proposed by the responsible governments. It relies on actual experiences of care and is not simply limited to critical incident reporting or ad hoc surveys of consumer participation or satisfaction with services.

As of 2 November 2004, 228 complete surveys have been received, including 127 (56%) from consumers, 58 from carers (25%) and 43 (19%) from family members or close friends. All respondents had experience (either direct or indirect) with mental health services during the previous twelve months. Forty-one percent (n=94) had contact with public health services, 30% (n=69) with private health services, and the remaining 29% (n=65) a mixture of the two.

Eighty percent (n=182) of the sample was female with an average age of 41 years. The majority of respondents (67%) resided in major urban areas, with only 13% of the sample from rural areas with populations less than 10,000. Across Australia , most respondents were located in Victoria (31%) and New South Wales (31%; Table 3.2.1).

Table 3.2.1: Total number of respondents by state; N=228.

Only 57% of respondents (mostly consumers and carers) said they were treated with respect and dignity nearly always or always (Table 3.2.2).

Table 3.2.2: The extent to which health professionals treated the consumer or someone close to them with respect and dignity.

The majority (69%) felt they did not have adequate access to services (Table 3.2.3), with 20% not being able to find a health professional to talk to about their concerns.

Table 3.2.3: The extent to which access to adequate services for mental health problems was achieved.

Over one third (41%) of participants felt they were given insufficient or no information about the condition or treatment. Of those respondents who wanted information given to family and friends, more than half (99/165) felt that not enough information was given. In situations were medication was prescribed for the mental health problem, only 24% responded that the purpose, benefits and side-effects were fully explained (Table 3.2.4).

Table 3.2.4: The extent to which medications prescribed for a mental health problem was explained in terms of purpose, benefits and/or side effects; N = 215.

Approximately one third of the sample (35%) said that the health professionals involved agreed always or nearly always with one another. Over one third (39%) did not feel they had enough say in decisions about care and treatment (Table 3.2.5), and 19% had not had the diagnosis discussed with them (17% of consumers, 10% of carers and 37% of family members or close friends).

Table 3.2.5: Whether the consumer, carer or family member/close friend felt they had enough say in decisions about care and treatment.

Eighty-seven consumers answered more detailed questions regarding their care and treatment. The majority (86%) had seen a psychiatrist in the previous 12 months (see Table 3.2.6 for ratings), only 26% a community psychiatric nurse and 70% had seen some other mental health professional. All but six consumers had taken medications for mental health problems in the last 12 months and 66% had received a talking therapy. Half the consumers (50%) had an after hours contact in a mental health service, and of these people 60% had used this form of crisis care in the previous 12 months.

Table 3.2.6: Consumer ratings of psychiatrists they had seen in the last 12 months; (n=72).

Only five consumers (6%) had received a care plan, which is a document that outlines mental health needs and who will provide services. About one third (33%) of consumers rated the healthcare received in the last 12 months as poor to very poor, 30% as fair to good, and 37% as very good to excellent.