The local pattern of mental health care in different states/territories in Australia: a comparison of the Australian Capital Territory with other urban Australian regions and with international benchmark areas

This thesis is a comparative demonstration study, using a novel approach to mental health systems research, to: (i) analyse the pattern of care provision in an Australian health jurisdiction; (ii) compare it with that of other health districts in Australia, Europe and South America; and (iii) demonstrate its usability as a decision support aid for mental healthcare planners. Background. The outcomes of policy interventions in mental health systems are shaped not only by the intervention, but also by the characteristics of systems themselves. Knowledge of the local context is critical to enable planners to identify gaps and pathways in the system, to inform modelling, and to guide resource allocation. However, current services research and planning is based on a limited, component-based approach, with service provision at local level often informed by data aggregated at national level. In Australia, this has resulted in a system of mental healthcare delivery described as fragmented, with gaps in key areas and disproportionate investment in others, poor interaction between the different sectors of care, and confusion about accountability between different levels of responsibility. A new approach has been developed--the mental health ecosystems research approach (MHESR). MHESR provides an analysis of the whole system of care delivery at small area level, allowing identification of patterns of care and gaps in service provision, and providing more reliable data for local planning and modelling. In this thesis, I demonstrate the usability of an innovative tool based on this approach-- The Integrated Atlas of Mental Healthcare--in an analysis of the mental health system in the Australian Capital Territory, and a comparison with eight other health districts in Australia, Europe, and South America. Method. Integrated Atlases (Atlases) of Mental Healthcare provide an analysis of the whole system of care delivery in a defined region. Data, including service availability, capacity, and diversity, is collected at local level using a standardised, multiaxial service classification instrument, the Description and Evaluation of Services and Directories for Long Term Care (DESDE-LTC). Atlases also include key socio-demographic indicators and other local context information and present data using visualisation tools including Geographic Information Systems (GIS). Results. My research identified gaps in service provision in key areas in the ACT common to the Australian, but not to the international regions; as well as patterns in service provision of some types of care, particularly community care, where the ACT more closely resembled the international regions than it did its national comparators. I found that some types of care were absent or lacking in all regions of the study. ACT showed a unique difference to all other regions in its balance of psychiatrists and psychologists. The Atlas has had a moderate impact on planning agencies in the ACT. Conclusion: Integrated Atlases using a MHESR approach provide more comprehensive and reliable information about the whole system of care delivery, and are useful tools to support decision makers to improve mental healthcare planning in Australia