Responses to the opinion-based algorithms driving the National Mental Health Service Planning Framework

Response to:

Rosen A, Rock D and Salvador-Carulla L (2020) The interpretation of beds: More bedtime stories, or maybe they’re dreaming? Australian and New Zealand Journal of Psychiatry 54: 1154–1156.

Whiteford H and Diminic S (2020) The National Mental Health Service Planning Framework: Where has it come from and what is its future? Australian and New Zealand Journal of Psychiatry 54: 1152–1153.

To the Editor

Australia has ‘de-hospitalised’ by closing psychiatric hospitals without commissioning sufficient new beds, and in a recent article we argued that de-hospitalisation left the nation with fewer beds per capita than most high-income countries, according to the World Health Organization Atlas for Mental Healthcare (Allison et al., 2020). Furthermore, we concluded that the National Mental Health Service Planning Framework (NMHSPF) targets for hospital beds are too low. The NMHSPF’s algorithms are not determined empirically, but derive from expert opinion, and the low targets are based on the ‘premise that the nation needs fewer beds per capita than other high-income countries’.

Rosen et al. (2020) proffer an alternative point of view. They defend the participation of experts in deciding the NMHSPF’s algorithms, but strongly object to comparing their low targets with the international benchmarks. International comparisons are complex due to variations in health systems and data definitions (Allison et al., 2020), and Rosen et al. (2020) cite methodological issues as a rationale for avoiding these comparisons. Instead, they focus on the largely untested field of ‘mental healthcare ecosystems’ and regional atlases. However, they acknowledge that regional atlases also indicate that Australia has fewer beds per capita than Western Europe. And policymakers find international comparisons to be useful signposts for Australia’s performance. Australia is honoured to be a top-20 country in the rankings for government, human development, global citizenship, the economy, education, health and lifestyle (Australian Department of Foreign Affairs and Trade: www.dfat.gov.au/trade/resources/publications/Pages/australia-is-a-top-20-country). Thus, the World Health Organization should continue to refine their Mental Healthcare Atlas, rather than abandon the project due to the methodological challenges.

In their response, Whiteford and Diminic (2020) acknowledge the role of expert opinion, given ‘data gaps in efforts to set targets for the appropriate number of mental health beds in an integrated system’. They suggest that the NMHSPF’s modelling will improve as the evidence strengthens. Research on inpatient care lapsed during the era of de-hospitalisation. Future studies of the 24-hour care needs of people with severe mental illness (SMI) should include their requirements for community residential and hospital non-acute beds. To this end, we suggest conducting a snapshot survey of people with SMI across Australia’s local health areas and correctional facilities. This survey would need to be formally agreed to and funded by Australian governments. Thus, a renewed commitment to expanding the evidence base for inpatient care would improve the accuracy of the NMHSPF estimates.