Mapping the forensic mental health ecosystem in Australia: A national audit
The Mapping the forensic mental health policy ecosystem in Australia: A national audit of strategies, policies and plans report, completed in January 2020, was commissioned by the National Mental Health Commission (NHMC) to examine the policy environment in Australia relevant to mental health services for adults who come into contact with the criminal justice system, and to identify any policy gaps and potential opportunities for reform. The report describes the results of an audit of high-level policies of justice and mental health agencies relevant to mental health services for justice-involved adults in Australia. The audit of documents was limited to high-level policy and strategy documents from mental health and justice agencies. The policy documents reviewed were intended to enable a snapshot of high-level policies in key areas, with a focus on systemic issues. The report is structured around key stages of criminal justice system involvement, reflecting the main intervention points for mental health services.
Key themes are:
- The policy landscape is diverse and rich. There are many examples of clearly articulated, thoughtful policy responses which seek to respond to the relevant standards, and a number of these are mentioned in this report. Viewed systemically and nationally, however, there is a major gap in overall policy coherence and sharing of information.
- There is significant system complexity and variation in approach across Australia, and within jurisdictions. Examples include where the objectives of mental health legislation are not congruent with provisions relating to standards of mental health service articulated in justice legislation; where separate pilot or specialist services operate in parallel with mainstream ones; and where strategic plans for different stages of the justice system contain very different levels of detail or a different emphasis about how mental illness is responded to. The vast majority of high level state and territory documents reviewed were produced by a single department or agency and focus on that agency’s priorities, initiatives and objectives.
- Policies frequently reflect a recognition that there are gaps in how well services in justice settings respond to gender, disability and cultural considerations, including in relation to mental health. There are multiple examples of strategies and plans relating to women, people with disabilities, and Aboriginal and Torres Strait Islander people, which acknowledge gaps in available diversionary options, court-based services, accommodation for non-custodial forensic orders, and post-release services.
- While references to principles and statements are present within policy documents and legislation, it is rare to see references to concrete indicators and outcomes through which progress towards their achievement could be measured
- At national mental health policy level there is little mention of criminal justice settings.
- Where justice settings are considered within mental health policy documents, this is also uneven. Forensic services have greater inclusion in national level policy documents than do other justice settings.
The report makes recommendations across the five areas below. The report includes suggested first steps for improvements in each of these areas.
Area 1: Systematically including justice settings and justice-involved people within population-level national mental health policies, in particular with regard to:
- Service planning
- Safety and quality
- Data collection and publication
- Workforce planning
- Inclusion of lived experience
Area 2: Development of national, evidence-informed policy guidance on identification and screening of people with mental disorders at all stages of involvement in the criminal justice system.
Area 3: Improve connections and continuity between justice settings and community mental health providers, for example through incentives linked to Medicare funding, policy settings for Primary Health Networks, and through Commonwealth leadership on information sharing.
Area 4: Development of a justice/mental health evidence and research strategy addressing key gaps
Area 5: Supporting and expanding existing efforts to prevent involvement in the criminal justice system, such as through supporting Justice Reinvestment initiatives.
In-kind support is provided from the University of Melbourne, the Queensland Centre for Mental Health Research, and the Murdoch Children’s Research Institute.
Southalan L, et al. Mapping the forensic mental health policy ecosystem in Australia: A national audit of strategies, policies and plan. A report for the National Mental Health Commission. Melbourne (Australia): University of Melbourne; 2020. Report