Suicide Prevention Communications Project
Australian Institute of Family Studies
The National Youth Suicide Prevention Strategy was developed and implemented in a complex policy environment. If we understand the problem of youth suicide and its prevention within a biopsychosocial model then we can see that many government departments have policies and programs that are relevant to the mental health and wellbeing of young people.
With increasing emphasis being placed on intersectoral collaboration and partnership within many areas of government concerned with social policy there is a need for improved communication between different sectors about the policies and programs that address related concerns.
This paper provides an overview of a range of current national policies and programs in the areas of mental health and the health and welfare of children and adolescents that can be seen as complementary to the National Youth Suicide Prevention Strategy. These policies and programs signal infrastructure and levers that are available to support intersectoral collaboration at national, state and local levels.
The National Youth Suicide Prevention Strategy (NYSPS) was an effort of the Commonwealth Government to provide a comprehensive and coordinated approach to youth suicide prevention throughout Australia.
The goals of the National Youth Suicide Prevention Strategy were to:
The NYSPS was the responsibility of the Minister for Health and Aged Care, the Hon Dr Michael Wooldridge MP, and was administered and coordinated through the Mental Health Branch of the Commonwealth Department of Health and Aged Care (formerly Health and Family Services).
Advice from stakeholder representatives was provided by a number of bodies including the Youth Suicide Prevention Advisory Group (July 1995 to June 1998) and the National Advisory Council on Youth Suicide Prevention (from July 1998). Technical advice on the conduct of project evaluations was provided by the Evaluation Working Group.
A total of $31 million was allocated to the Strategy from July 1995 to June 1999. Funds were distributed across over 80 different projects and activities including 42 National Demonstration Projects. Funds were allocated via a number of processes including competitive tendering and selective tendering.
The NYSPS was based on the belief that youth suicide is a complex phenomenon which is caused by a number of interacting factors including biological, psychological, social and cultural factors. This understanding is widely referred to as the biopsychosocial model. The Strategy has also been guided by, and has sought to promote, the principles of the Public Health Approach to enhancing population health and wellbeing.
Consistent with the biopsychosocial model of causality and the principles of the Public Health Approach the NYSPS employed a comprehensive variety of interventions including those that modify individual risk factors and protective factors; as well those that modify the physical, social and cultural factors that shape environments.
A major emphasis of the NYSPS was on building the capacity of existing services and programs to provide more effective responses to the needs of young people rather than creating new services and programs. System level activities aimed to facilitate the adoption of evidence-based practice throughout all the service systems relevant to youth suicide prevention and included:
The new National Suicide Prevention Strategy entitled Living is for Everybody (LIFE) adopts a whole of life span approach to suicide prevention, however young people remain a major focus of the new Strategy.
Extensive reform has been taking place in mental health services in Australia over the past six years. The National Mental Health Strategy (NMHS) was initiated in 1992 in response to a widely acknowledged need for major reform in the way mental health services are provided to people affected by mental illness. The National Mental Health Strategy was endorsed by all Australian Health Ministers and has provided a comprehensive and detailed policy framework guiding reform in a number of areas.
The Commonwealth provided in excess of $250 million over the period 1 January 1993 to 30 June 1998 to assist implementation of the National Mental Health Strategy. Of this, $190 million was made available to States and Territories for service reform.
The philosophy of the Strategy and recommendations for action in twelve priority areas for reform are articulated in five major documents:
Some of the major areas of reform tackled under the NMHS that are relevant to the NYSPS include: changes in service mix; linking mental health services to other sectors; consumer and carer rights and participation; and prevention and promotion.
Changes in service mix have included a shift of resources from hospital-based services to community-based services, a shift from stand-alone psychiatric hospitals to general hospitals and health services, and an increased diversity of community-based services. It is anticipated that these changes will enhance the accessibility of mental health services to young people. For example location of outpatient mental health services in the grounds of psychiatric hospitals has been identified as a major barrier to the provision of appropriate mental health care to young people (Hearn 1993).
Improved linkages between mental health services and other sectors could be anticipated to provide a basis on which to facilitate early intervention in mental health problems for young people.
Increasing consumer and carer participation in service development activity has received strong emphasis in the NMHS. Creation of structures to support participation has been fostered at all levels of administration.
Children and adolescents are identified as one of six special at risk groups whose needs must be addressed. Other special groups include: older people; people from non-English speaking backgrounds; Aboriginal and Torres Strait Islander people; people living in remote and rural areas; and offenders with a mental disorder. The strategy identified for ensuring the needs of special groups are addressed is consumer and community participation in the planning of services, specifically at the local service level. Apart from this, the National Mental Health Strategy does not identify specific strategies for ensuring that mental health services address the needs of children and young people.
An evaluation of the NMHS completed in December 1997 reported considerable impacts of the NMHS. These include a substantial shift of resources from stand-alone psychiatric hospitals to community based mental health services and enhanced consumer participation in service development activities. However the Evaluation found that little progress had been made in linking mental health services to other services within and outside the health sector and that services for special needs groups such as young people and Aboriginal people remain underdeveloped.
In response to the need to continue to address improvements in mental health care, the Commonwealth will provide a further $300 million for mental health over the five-year term of the new Australian Health Care Agreements, as well as $28 million over three years for national projects. This funding will be used to maintain the level of mental health reform funding available to States and Territories under the first National Mental Health Strategy, and to fund further major reform activities within the framework of the Second National Mental Health Plan 1998-2003.
The Second Plan was endorsed by all Health Ministers on 30 July 1998 and will expand the focus of mental health reform by focusing on prevention, promotion and early intervention; the development of partnerships other health services, other sectors, non-government organisations and consumers; further reform in the private sector (including General Practitioners) and improved quality and effectiveness of mental health services.
A Mental Health Promotion and Prevention National Action Plan has recently been released (Commonwealth Department of Health and Aged Care 1999) and a National Action Plan on Depression is currently being developed.
A national initiative to improve the emotional and social wellbeing (mental health) status of Aboriginal people and Torres Strait Islanders has been underway since 1996/1997. The Aboriginal and Torres Strait Islander Emotional and Social Well-Being (Mental Health) Action Plan is being administered by the Office for Aboriginal and Torres Strait Islander Health. Funding of $20.5 million has been allocated over a period of four years, until 1999/2000.
The aim is to provide a coordinated approach to the development of a wide range of mental health services and activities that are accessible and culturally appropriate to the needs of Aboriginal people and Torres Strait Islanders. The Action Plan incorporates three interlinked approaches:
More generally Aboriginal and Torres Strait Islander health policy is based strongly on the principle of primary health care delivered by Aboriginal community controlled organisations. Implementation of this policy is facilitated by the work of peak bodies representing Aboriginal community controlled health organisations in each state and territory as well as the National Aboriginal Community Controlled Organisation (NACCHO).
An important mechanism for planning is the State and Territory Agreements on Aboriginal and Torres Strait Islander Health. These involve signed agreements between all State and Territory Health Ministers, the Commonwealth Minister for Health, the Aboriginal and Torres Strait Islander Commission and the various state and territory peak bodies representing Aboriginal community controlled health organisations. The aims of the Agreements are to improve health outcomes for Aboriginal and Torres Strait Islander peoples by:
Planning at state, territory and regional levels is coordinated through State and Territory Forums that include representation from all signatories to the Agreements. At a Commonwealth level planning is coordinated through the Aboriginal and Torres Strait Islander Health Council which includes representation from NACCHO, the Commonwealth Department of Health, the Australian Health Ministers Advisory Council, ATSIC, the Torres Strait Regional Authority and the NH&MRC.
The agreements explicitly recognise that involving Aboriginal and Torres Strait Islander peoples in planning requires the maintenance of "a viable and independent Commonwealth funded National Aboriginal Community Controlled Health Organisation" and a viable and independent state/territory body representing the community controlled sector.
The Agreements and Forums are important mechanisms through which other national, state and local initiatives can coordinate with activities and programs of Aboriginal community controlled health organisations.
A philosophical framework guiding the development of health services for young people is provided by The Health of Young Australians: A national health policy for children and young people which was endorsed by the Australian Health Ministers Conference in June 1995. Its associated Action Plan, The National Health Plan for Young Australians was endorsed by the Australian Health Ministers Conference in July 1996.
The National health policy for children and young people articulates a number of key understandings regarding the health needs of children and young people that find further expression in the philosophy and principles underlying the National Youth Suicide Prevention Strategy. Specifically the policy recognises that the health and health service issues affecting children and young people are special and sometimes unique and that ongoing, positive investments are needed for an infant to grow into a competent, participating member of society. It is recognised that the health of young Australians is influenced by a wide range of social, cultural, physical, environmental and economic determinants. Because many of these determinants are outside the control of the health sector, the policy incorporates strategies by which the health sector can cooperate with and influence other sectors which impact on health.
No funds were allocated to The National Health Plan for Young Australians, rather the Child and Youth Section of the Population Health Strategies Branch of the Department of Health and Aged Care works collaboratively with other arms of government to assist them develop programming consistent with the Policy and Plan. The major area of activity initiated under the Plan is the development of mechanisms for collecting and processing data to monitor health outcomes and indicators for young Australians. As part of this initiative the Child and Youth Section of the Population Health Strategies Branch of the Department of Health and Aged Care is working collaboratively with the Department of Family and Community Services to develop an agreed set of indicators of social and family functioning. A literature review and consultation process is being conducted by the TVW Telethon Institute for Child Health Research in collaboration with s Steering Group. A report with recommendations for furthering the process is expected in June 1999.
A review of the child and youth surveillance and screening program is being managed by the Population Health Strategies Branch. Indicators of mental health are likely to be included in the new guidelines.
The Commonwealth Government has provided support to family services through its Family Relationships Services Program for the past four decades. The purpose of the Program is to promote and maintain quality family relationships. The Program is administered by the Family Services Branch within the Legal Aid and Family Services Division of the Attorney-Generals Department pursuant to provisions in the Marriage Act 1961 and the Family Law Act 1975 and other administrative arrangements. Grants have been provided to both secular and church-based organisations. There are currently around 60 non-government agencies in receipt of grants through this Program.
The Program began with grants to organisations offering marriage counselling services in the 1960s and has since been substantially expanded. There are currently three major categories of funding under the Program:
The Program also supports an internet based information system called FAMnet.
Three recent initiatives administered under the Family Relationships Services Program are of particular relevance to suicide prevention. These emerged from a National Domestic Violence Summit held in Canberra in 1996.
In April 2000 the Commonwealth Department of Family and Community Services launched its new Stronger Families and Communities Strategy. The Strategy represents the Governments primary response to the recommendations of an inquiry into aspects of family services initiated by the Attorney-General and referred to the House of Representatives Standing Committee on Legal and Constitutional Affairs. The results of this inquiry are documented in a report entitled To Have and To Hold which was released in 1998.
The Stronger Families and Communities Strategy aims to shift the focus of family and community services towards prevention and early intervention while maintaining support for families and communities at greatest risk. The philosophy underlying the Strategy is that by helping to build stronger family and community relationships, we can do much to prevent difficult and expensive problems that arise if those relationships break down or do not work as well as they should. Another key principle of the Strategy is its emphasis on helping local communities to develop their own solutions to local problems. Thus families and community members will be encouraged to be involved in developing projects funded under the Strategy.
The Government has committed $240 million to the Stronger Families and Communities Strategy over a period of 4 years. These funds are being allocated across nine different initiatives:
Substance misuse has been the focus of concerted strategic action at the Commonwealth level since 1985 with the initiation of the National Campaign Against Drug Abuse (NCADA).
The National Drug Strategy launched in 1993 was a cooperative venture between the Commonwealth and state/territory governments which aimed "to minimise the harmful effects of drugs and drug use in Australian society" (Ministerial Council on Drug Strategy 1997). Over $266 million was allocated by the Commonwealth to the NDS between 1993 and 1997, $199.7 million through a cost-sharing arrangement with matching contributions from state/territory governments, and $66.4 million on national initiatives such as research centres and other drug programs. The NDS is based in the philosophy of harm minimisation and has supported a balanced range of interventions targeting the misuse of both licit and illicit substances.
An evaluation of the NDS was completed in 1997 (Single & Rohl 1997). Following the recommendations of the 1997 evaluation a National Drug Strategy Unit was established within the Department of Health and Aged Care to provide improved coordination of the ongoing National Drug Strategy and a new National Drug Strategic Framework was developed for 1998-99 to 2002-03.
The renewed National Drug Strategy is being overseen by a number of councils and committees that provide mechanisms for intersectoral collaboration and expert and community involvement. The Ministerial Council on Drug Strategy (MCDS) is the peak policy and decision-making body. It brings together Commonwealth, State and Territory Ministers responsible for health and law enforcement to collectively determine national policies and programs as well as national consistency in state and territory activities. The Australian National Council on Drugs (ANDC) consists of people with relevant expertise from the health, law enforcement, education and social welfare sectors as well as government , non-government, community and volunteer organisations. The Intergovernmental Committee on Drugs (IGCD) is a Commonwealth-State-Territory government forum consisting of senior officers from health and law enforcement and other relevant departments who provide policy advice to Ministers and are responsible for implementing decisions made by the Ministerial Council on Drug Strategy. These three peak bodies are provided with further specialist advice by National Expert Advisory Committees. These currently include four priority areas of concern: tobacco, alcohol, illicit drugs and school based drug education.
A key strategic objective of the NDS between 1993 and 1997 was the development of an intersectoral partnership between health and law enforcement. The evaluation (Single & Rohl 1997) identified major progress in the development of this partnership as one of the key factors behind the success of the NDS. The further development of this partnership as well as new partnerships with other sectors is a major focus of the new Strategic Framework. One key area identified for attention is the creation of links with other national strategies such as the National Youth Suicide Prevention Strategy.
In addition to the development of partnerships and links with other strategies the new National Drug Strategic Framework maintains a continuing commitment to the principle of harm minimisation. Increasing the communitys understanding of drug-related harm, supply reduction, preventing use, access to treatment, professional education and training and research and data development are the other priority areas.
The National Drug Strategy does not focus on any particular population groups as in need of prioritization or special attention. It is recognised that services need to be appropriate and sensitive to the needs of certain subpopulations such as young people and Indigenous people and women with children. However the issues affecting these groups are not articulated and no specific strategies are identified for addressing the special needs of these populations. Young people are addressed implicitly via mention of the future development of school-based primary prevention activities. The needs of certain high risk groups are identified, specifically people with mental health and drug problems and people involved in the criminal justice and juvenile justice systems.
The component of the National Drug Strategy that places most emphasis on young people is the National School Drug Education Strategy which was released by DETYA on 25 May 1999. The National Advisory Committee on School Drug Education was established in April 1998. Initially the Commonwealth Government was to provide $7.5 million over 3 years for the school drug education component of the National Illicit Drug Strategy 'Tough on Drugs'. In early May it was announced that additional funding totaling $19.8 million over four years will be provided for two complementary measures. This brings the total funding for drug education initiatives in schools to $27.3 million as part of the National Illicit Drug Strategy 'Tough on Drugs'. The total funding for the Tough on Drugs Strategy is now over $500 million. (Source: DETYA media releases, 11 May 1999, and 25 May 1999)
The National Campaign Against Violence and Crime (NCAVAC) was a 3 year strategic approach to the prevention of violence and crime in Australian communities. Administered through the Commonwealth Attorney-General's Department, $13 million was allocated to the Campaign.
NCAVAC was a program of research and action. It included national research projects, national pilot projects, local prevention activities, communication activities and training for crime prevention professionals. NCAVAC also reviewed government policies and programs to minimise duplication of crime prevention initiatives. In addition to crime prevention initiatives, NCAVAC aimed to reduce community fear of violence and crime and provide education to address widely held myths. Under NCAVAC attention was directed to issues of crime and young people including tackling false community perceptions about young people being major perpetrators of crime.
A new Commonwealth initiative entitled National Crime Prevention has recently replaced NCAVAC. National Crime Prevention aims to find and promote ways of preventing crime and fear of crime in Australian communities. Linked to this is the National Anti-Crime Strategy which is a shared initiative of the State and Territory governments in partnership with the Commonwealth which aims to harness Australias crime prevention talent and ensure that all agencies and officials cooperate to develop and promote best practice in crime prevention. Young people and crime prevention is an area of high priority. Initiatives under National Crime Prevention and the National Anti-Crime Strategy focusing on young people include projects on the use of public space, public events, domestic violence, early intervention and homeless youth. Reports on domestic violence, public space and early intervention have recently been released.
Hanging out: negotiating young peoples use of public space (National Crime Prevention 1999a) reports the results of a literature review, interviews with young people, authority figures and older people, planners, designers and architects and proposes and presents key elements that should comprise a strategic framework for youth crime prevention through the development, management and regulation of public space.
Pathways to prevention: Developmental and early intervention approaches to crime in Australia (National Crime Prevention 1999b) is a report of an interdisciplinary research consultancy. The consultancy carried out a selected review of the international literature on human development and early intervention, audited several hundred early intervention programs and services in Australia and formulated a policy framework for planning developmental prevention initiatives. The policy framework includes 16 recommendations and clear articulation of the roles and responsibilities of various agents, sectors and population groups in preventing child abuse and juvenile crime.
The recent gun buy-back scheme which was implemented by the Attorney-Generals Department under The National Firearms Program Implementation Act 1996 and 1997 is another initiative from within the criminal justice sector that has important implications for youth suicide prevention. Following a national public education campaign, the gun buy-back scheme secured the surrender of 640,000 self-loading rifles and self-loading and pump-action shotguns as well as other prohibited firearms nationwide. The effectiveness of the gun buy back scheme is currently being evaluated by the Australian Institute of Criminology.
Supported Accommodation Assistance Program
The Supported Accommodation Assistance Program (SAAP) is currently the primary service delivery response to homelessness in Australia.
SAAP is a cost-shared program between the Commonwealth and state and territory governments. The Commonwealth Department of Family and Community Services and the states and territories are jointly responsible for setting national priorities, monitoring and evaluation. The states and territories are responsible for the management and administration of the Program at the state/territory level. The Program is subject to the SAAP Act and the Bilateral Agreements between the Commonwealth and the States/Territories.
SAAP provides transitional supported accommodation and support services to people who are homeless, and people who are in crisis and are at imminent risk of becoming homeless, including those who are escaping domestic violence. The goals of SAAP are to resolve crises, break the cycle of homelessness and re-establish independent living or other long-term housing arrangements as soon as possible.
The Program provides funding to approximately 1200 community agencies across Australia. Besides providing supported accommodation, they provide meals, counselling, referral, mediation and advocacy support. Thirty-eight (38) per cent of SAAP clients are aged between 15 and 24 years. The main reason for young people using SAAP services is family or relationship breakdown.
In 1998/99 the Commonwealth contributed $129m while the states/territories contributed $101m. In addition to cost-shared moneys provided under the SAAP Agreement, in 1993/94 the Commonwealth provided $17.4 over five years for reforms to the program. Some states and territories have also contributed funds to this process. Reforms have included:
SAAP is currently being evaluated.
Youth Homelessness Pilot Program and the Prime Ministerial Taskforce
The Youth Homelessness Pilot Program and the Prime Ministerial Youth Homelessness Taskforce were established by the Prime Minister in 1996 in response to concerns raised by some parents and community groups that existing programs placed too little emphasis on assisting young homeless people and their families to achieve reconciliation.
The Taskforce established 26 pilot projects which focused on identifying young people
who were at risk of homelessness or who had recently become homeless, and supporting young people and their families in the reconciliation process. The pilot projects emphasised the principle of working with the young person, their family and if possible, both together.
The program aimed to assist young people between 12 and 18 years and their families in the following target groups:
The 26 pilot projects were established across Australia and covered a wide variety of cultural, regional, remote and metropolitan areas. In addition to family reconciliation the pilot projects found it was necessary to assist young people at risk of homelessness to re-engage in work, education, training and life in the community.
The Youth Homelessness Pilot Program was evaluated and a report entitled Putting Families in the Picture was released in November 1998 (Prime Ministerial Youth Homelessness Taskforce 1998). A major finding of the Taskforce Report is that making the transition from dependence on family and other support networks to independent living in the community has become increasingly difficult for many young people since the 1970s. The impact of these changes has been particularly significant for families with limited resources. A key recommendation of the Taskforce Report is that the Commonwealth Government develop a National Youth Pathways Action Plan. The aim of the Plan would be to improve coordination of policy and programs for young people at the Commonwealth and State/Territory levels.
The Department of Education, Training and Youth Affairs (DETYA) provides special assistance with training and employment to young people through its Job Placement, Employment and Training (JPET) Program.
JPET is an Australia-wide Commonwealth Government program which assists young people aged 15 to 21 years affected by a variety of disadvantages to overcome barriers preventing them from maintaining stable accommodation and entering into full-time education, training or employment.
The major focus is on students and unemployed young people who are homeless or at risk of becoming homeless. Assistance is also provided to young people who are, or have been, wards of the State, are refugees, or have been in the juvenile justice system. These young people need not necessarily be homeless to be given support, as they encounter similar barriers to employment, education and training as homeless people.
JPET provides a holistic approach which offers ongoing support and referral services to overcome barriers such as housing difficulties, family problems, substance abuse, sexual or other abuse, lack of self-esteem and income support difficulties.
Community organisations are funded to provide JPET services to assist young people in the target groups listed above. These organisations must have good links with other community organisations and previous experience in assisting disadvantaged young people. There are 102 JPET services around Australia and these provide support to around 10,500 young people each year.
Funding for the JPET Program is currently due to cease at the end of June 2000. The Prime Ministerial Youth Homelessness Taskforce Report (1998) recommends the continuation and expansion of the JPET Program as part of a range of supports needed for young people who are homeless and at risk.
Income support to people of all ages requiring assistance is provided by Centrelink. Centrelink has recently been restructured to operate as a one-stop-shop for Commonwealth services. A new approach to customer service is also being designed to improve access to services. The needs of young people have been an important consideration.
Centrelinks new customer service delivery model is a combination of a One Main Contact Model and Life Events Model. One Customer Service Officer takes responsibility for all of the customers business and service focuses on the life events currently being experienced by the customer. Under the old model of service delivery customers were required to know which benefit they wished to apply for and what questions to ask. This model was focused on the needs of the service rather than the customer.
Under the new customer focused approach the customer explains their current life circumstances or needs to the Customer Service Officer and the CSO explains the full range of products and services that may be appropriate to the needs of the customer. A package of services is then tailored around the specific needs of individual customers.
The One Main Contact Model facilitates a holistic approach that takes account of all aspects of a customers life. Centrelink staff believe this model will be particularly beneficial in identifying young people at risk of a range of negative outcomes, including self-harming behaviour and suicide, and directing them to appropriate early intervention services. For example, Centrelink has been an important partner in a number of the Youth Homelessness Pilot Program projects (see above).
Another key aspect of Centrelinks approach to service delivery is outreach and out-servicing. Community education is provided to ensure people are informed about Centrelink services and customers are provided with a wide range of access points including the internet, kiosk, over the phone, and in person. Customer Service Officers can also deliver services in a wide range of locations where customers are located including homes, prisons, refuges and any other location in the community. There is no need for customers to come into a Centrelink office. A Community Agent Program has been established which enables other services in remote locations to act as agents for Centrelink. Conversely Centrelink is offering to deliver services, such as generalist social work, for other agencies in underserviced locations that it is able to reach. Outreach has also been fostered through Centrelinks involvement in local community forums and interagency meetings and projects.
As a result of the current restructuring and ongoing service development process within Centrelink, senior staff have identified Centrelink has having the capacity to play a major role in early intervention in suicide prevention. Centrelink Customer Service Officers are often first point of contact for young people experiencing a wide range of difficulties and needs in addition to income support. The One Main Contact Model of service delivery means that CSOs will have the opportunity to develop personal relationships with young people and enhanced capacity to identify problems and engage young people in help-seeking and problem solving.
One of the major assets of Centrelink in relation to early intervention is the sheer size and breadth of its service delivery infrastructure. Centrelink has a network of 20,000 Customer Service Officers located in 296 Customer Service Centres throughout metropolitan, regional and rural Australia. Its capacity for outreach beyond these centres will further facilitate a role in early intervention with high risk young people who have historically been difficult to reach using centre based interventions.
Maximising the ability of Customer Service Officers to effectively identify these problems, engage with these young people and provide appropriate access to Centrelink social workers and other community resources is paramount to assisting in the overall prevention of youth suicide/self harm nationally. Customer Service Officers in several Centrelink Service Centres have recently undergone Youth Service delivery training. Modules of this training aim to increase awareness and understanding of issues that impact significantly on youth and effect their emotional and physical wellbeing. Centrelink is seeking to expand provision of this training to cover all staff working with young people. In addition to providing a first point of contact and case-management function, Centrelink employs a large number of social workers who can provide casework services on an ongoing basis.
Implementation of the One Main Contact Model in existing Customer Service Centres is expected by June 1999. Centrelink is also currently conducting an evaluation of the Youth Allowance scheme.
The National Health Priority Areas (NHPA) initiative builds on previous activity that took place under the banner of National Health Goals and Targets. The NHPA initiative seeks to focus public and health policy attention on those areas that contribute most to the burden of illness in the population and on areas of activity that can lead to significant reductions in the burden of illness.
Beginning with the National Health Goals and Targets, this initiative has instituted an increased commitment to the systematic monitoring of health outcomes. It has stimulated considerable activity related to the development and improvement of information systems capable of providing information on health status and needs at a population level as well as monitoring activity and outcomes in the areas of prevention, early intervention, treatment and ongoing management of chronic conditions.
The five National Health Priority Areas are:
Issues and activities related to suicide prevention are integral to the priority areas of mental health and injury prevention and control.
The Australian Institute of Health and Welfare has the responsibility for monitoring and reporting national progress in the priority areas and is also playing a major role in data development.
The National Public Health Partnership, endorsed by the Australian Health Ministers on 4 July 1996, is a new working arrangement between the Commonwealth and the states and territories to plan and coordinate national public health activities. It provides a more systematic and strategic approach for addressing public health priorities and a vehicle through which major initiatives, new directions, and best practice can be assessed and implemented.
In late 1998 the Commonwealth Department of Health and Family Services (now Health and Aged Care) initiated the National Research and Development Collaboration on Health and Socioeconomic Status for Australia. The Collaboration aims to increase understanding of, and the capacity to act on, social inequalities in health. The Collaboration will enable health system policy development to be informed by relevant research, and policy makers and practitioners engaging with health and socioeconomic status issues to have timely evidence to support their efforts. Intersectoral collaboration will receive high priority among the policy and structural issues to be explored.
The Youth Bureau in the Department of Education, Training and Youth Affairs (DETYA) has been given responsibility for overall coordination of youth affairs at the Commonwealth level. This remit includes development of policy with respect to the roles of a wide range of youth services. This group of services is highly varied and includes those fully and partially funded under, or administering projects, in most of the program areas outlined above. These services and programs are funded and administered by a wide variety of Commonwealth and state/territory government departments and units. Local government is also responsible for provision of generalist youth services in some states. Non-government agencies continue to play an increasingly prominent role in provision of services to young people.
Given the complexity of structures and programs in the youth sector the importance of improving collaboration between the various initiatives concerned with the social and emotional wellbeing of young people is recognised by the Youth Bureau of DETYA. Specifically the importance of developing policy coordination has been identified. The Youth Bureau is currently exploring ways to position itself to do this effectively.
A significant development in youth affairs generally is the recommendation of the Prime Ministers Youth Homelessness Taskforce to develop a National Youth Pathways Action Plan. The aim of the Plan would be to build and strengthen pathways for young people at risk in making the transition from dependence to active social and economic participation in the community. One major strategic objective is coordinating the efforts of the range of programs currently targeting young people including youth homelessness, youth suicide prevention, drug and alcohol and employment programs. The Taskforce also recommended "that the Prime Minister ensure a concerted whole-of-government approach to the development of Commonwealth youth policy, including a clear point of accountability and ongoing processes for community participation in the provision of advice to government" (p30).
An Interdepartmental Committee (IDC) has been established under the Department of Prime Minister and Cabinet to consider the establishment of a National Youth Pathways Action Plan. The IDC aims to provide a response to Cabinet in July 1999.
Coordinated care trials
The February 1994 meeting of the Council of Australian Governments (COAG) endorsed the need for reform of health and community services. Following this meeting, COAG recognised that profound structural change was needed in the health and community services system. A model consisting of three streams was proposed: general care; acute care and coordinated care. The Coordinated Care stream was identified as the priority for development. It was envisaged that the Coordinated Care stream would allow freer flow of resources to follow the patient rather than being locked up in individual providers and programs (Marcus 1999). In mid 1995 the Commonwealth developed proposals for a set of Coordinated Care Trials to test whether wider reforms were possible. Thirteen trials are currently being run in 15 locations across Australia. Each trial consists of:
Four of the 13 trials target indigenous peoples. Of the nine mainstream trials 5 have targeted the aged population with complex care needs and four have targeted various groups with no age restrictions. No trial has a special focus on young people or people whose complex health problems include mental disorders or suicidal behaviour. However the four trials targeting various groups may include young people with these problems.
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