Shaping mental health policy in Australia, 1988-2008

Abstract

This thesis uses the theoretical framework developed by John Kingdon to analyse, from the perspective of the Commonwealth government, the problems, policy solutions and political context that led to the opening of three mental health policy windows in Australia: the adoption of Australia's National Mental Health Policy and first National Mental Health Plan in 1992, the adoption of the Second National Mental Health Plan in 1998 and the adoption of the Council of Australian Governments' National Mental Health Action Plan in 2006. Data was assembled from four sources: firstly political party documents, ministerial speeches, Parliamentary debates and government documents; secondly a systematic review of literature published in academic journals; thirdly interviews with key informants; and fourthly my own observations as an expert key participant in mental health reform. From a thematic analysis of data from the first three sources five themes emerged that describe the issues shaping the mental health policy debates over the twenty year period covered by the thesis. These themes are human rights and community attitudes, community need, service structures, service quality and effectiveness, and resources. For each of the periods that led up to the opening of the policy windows in 1992, 1998 and 2006, the problems confronting the Commonwealth government and the policy solutions proposed were identified in each of the five thematic areas. The political response that occurred at each time is also discussed. For each policy window a set of defined problems and policy solutions, specific to that window, were identified. While taking action suited the political agenda of the government, each occasion was also associated with a highly publicised mental health issue that had dominated the media and demanded a policy response. Over the twenty years mental health became a much more prominent issue and the policy space in mental health much more contested with multiple agendas competing for government attention. Because the Kingdon model was used to organise the information collected it could not be used to also validate the model. However it was not difficult to find, for each policy window, clear problems, policy solutions and a political context within which the opening of the window occurred. The events shaping the political stream were largely independent of those shaping the problem and policy streams, which themselves were not independent of each other. In most cases, the individuals who had identified the problems were also promoting and advocating policy solutions to those problems. While the Kingdon model establishes a preconfigured cyclical dynamic and does not predict when a policy window might open, it did provide a useful framework for identifying and explaining factors important in mental health policy development and adoption. Show more