Grace Francesca C, Meurk Carla S, Head Brian W, Hall Wayne D, Carstensen Georgia, Harris Meredith G, Whiteford Harvey A
Sydney Local Health District, Canterbury Hospital, 575 Canterbury Road, Campsie, NSW, 2194, Australia.
The University of Queensland, School of Public Health, Queensland Centre for Mental Health Research, Locked Bag 500, Sumner Park BC, St Lucia, QLD, 4074, Australia.
BMC Health Serv Res. 2015 Oct 24;15:479. doi: 10.1186/s12913-015-1142-3.
Over the past two decades, mental health reform in Australia has received unprecedented government attention. This study explored how five policy levers (organisation, regulation, community education, finance and payment) were used by the Australian Federal Government to implement mental health reforms.
Australian Government publications, including the four mental health plans (published in 1992, 1998, 2003 and 2008) were analysed according to policy levers used to drive reform across five priority areas: [1] human rights and community attitudes; [2] responding to community need; [3] service structures; [4] service quality and effectiveness; and [5] resources and service access.
Policy levers were applied in varying ways; with two or three levers often concurrently used to implement a single initiative or strategy. For example, changes to service structures were achieved using various combinations of all five levers. Attempts to improve service quality and effectiveness were instead made through a single lever-regulation. The use of some levers changed over time, including a move away from prescriptive, legislative use of regulation, towards a greater focus on monitoring service standards and consumer outcomes.
Patterns in the application of policy levers across the National Mental Health Strategy, as identified in this analysis, represent a novel way of conceptualising the history of mental health reform in Australia. An improved understanding of the strategic targeting and appropriate utilisation of policy levers may assist in the delivery and evaluation of evidence-based mental health reform in the future.
在过去二十年里，澳大利亚的心理健康改革受到了政府前所未有的关注。本研究探讨了澳大利亚联邦政府如何运用五个政策杠杆（组织、监管、社区教育、财政和支付）来实施心理健康改革。
根据用于推动五个优先领域改革的政策杠杆，对澳大利亚政府出版物进行了分析，这些出版物包括四项心理健康计划（分别于1992年、1998年、2003年和2008年发布），五个优先领域为：[1]人权与社区态度；[2]回应社区需求；[3]服务结构；[4]服务质量与效果；[5]资源与服务可及性。
政策杠杆的应用方式各不相同；通常同时使用两到三个杠杆来实施一项倡议或战略。例如，通过所有五个杠杆的各种组合实现了服务结构的变革。相反，通过单一杠杆——监管来尝试提高服务质量和效果。一些杠杆的使用随时间而变化，包括从规定性的、立法性的监管使用，转向更注重监测服务标准和消费者结果。
本分析确定的国家心理健康战略中政策杠杆的应用模式，代表了一种将澳大利亚心理健康改革历史概念化的新方法。更好地理解政策杠杆的战略目标和适当利用，可能有助于未来基于证据的心理健康改革的实施和评估。
