Assignment One – Argue for Reform

Assignment type; Debate

Word limit/length; 600 words

Minimum of 6 Reference

APA 7th edition, citation and reference must be accurate.


“To improve the mental health of the nation we need better organisation not more expenditure”

This assignment task provides you with an opportunity to reflect upon the way in which mental health services are governed and funded in Australia. The assignment item has been designed to encourage you to develop a well-supported argument in response to the proposition.

Learning outcomes

This assignment task is aligned with the following learning outcomes:
1. Identify and critique the policy and funding context of mental health service provision in primary mental health care and non-government organisation sectors
2. Deconstruct stepped care, its barriers and opportunities and its impact on consumers and their families

Assignment details

In 600 words provide a well-reasoned argument FOR or AGAINST the proposition:

“to improve the mental health of the nation we need better organisation, not more expenditure”.

In your answer you should cite evidence from relevant literature, either from resources we have provided in the unit content or from literature you have independently accessed. In your response to this assignment exercise we ask you to clearly state your position on the proposition.Assignment One Rubric

Criterion; Clear identification of position regarding the propositio

Mark; 25%;

Exceptionally well written. Choice of stance is very clearly established and justified. Available evidence exceptionally relevant.

Criterion; Critical reasoning leading to well supported position regarding the proposition

Mark; 65%;

Argument is exceptionally well developed with more than one reason and objections supported by appropriate evidence. Very succinct summation of the argument

Criterion; Writing Spelling & Grammar Referencing

Mark; 10%

Exceptionally clear, crisp and coherent style. Exceptionally well organised. Completely free of grammar and spelling errors. All citations follow required style.Australian & New Zealand Journal of Psychiatry, 52(11)

Australian & New Zealand Journal of Psychiatry
2018, Vol. 52(11) 1057 –1062
DOI: 10.1177/0004867418804066

© The Royal Australian and
New Zealand College of Psychiatrists 2018
Article reuse guidelines:


It is concerning that, despite large increases in the provision
of treatment to people with mental health problems in high-
income countries over recent decades, there has been no
detectable decline in the prevalence. This finding has been
reported for Australia, Canada, England, the Netherlands,
New Zealand and the United States (Jorm et al., 2017;
Mulder et al., 2017; Ormel et al., 2004). However, one of
the problems in evaluating the population impact of
increases in treatment, such as the steady rise in use of anti-
depressants, is that they typically occur gradually over
many years. It is possible that any effects of increases in
treatment on reducing prevalence are counteracted by other
social changes occurring at the same which are having the
opposite effect. Such counteracting social changes could
include increasing exposure to risk factors or greater
acceptability of reporting symptoms of mental health prob-
lems (Jorm et al., 2017). A stronger test of the impact of
increasing treatment on population mental health would be
provided if there were a large increase in treatment over a

short period of time, approximating an interrupted time
series. Such a situation has occurred in Australia with the
introduction of the Better Access scheme in November

The Better Access scheme was designed to greatly
expand the availability of psychological treatment under
Medicare (Australia’s national universal health insurance
scheme). Originally, Medicare only covered services by
medical practitioners, including private psychiatrists.
Access to psychological treatment was not widely availa-
ble, being provided by the public health services funded by

Australia’s ‘Better Access’ scheme:
Has it had an impact on population
mental health?

Anthony F Jorm


Background: Australia introduced the Better Access scheme in late 2006, which resulted in a large increase in the pro-
vision of mental health services by general practitioners (GPs), clinical psychologists, other psychologists and allied health
professionals. It is unknown whether this increase in services has had an effect on the mental health of the population.

Methods: The following data were examined: per capita use of mental health services provided by GPs, clinical psychol-
ogists, other psychologists, allied health professionals and psychiatrists from 2006 to 2015 according to the Australian
Government Department of Human Services; prevalence of psychological distress in adults (as measured by the K10)
from National Health Surveys in 2001, 2004–2005, 2007–2008, 2011–2012 and 20Contributing lives,
thriving communities

Report of the
National Review
of Mental Health
and Services
Volume 2
Every service is a gateway
Response to Terms of Reference

30 November 2014

Sticky Note
Mental health first aid mentioned on pages: 105, 106, 110, 128, 218 & 220

About this Review

This document is Volume 2 of the four-volume report of the National Review of Mental Health
Programmes and Services. All volumes can be downloaded from A complete list of the Commission’s publications is
available from our website.

A number of electronic fact sheets and a summary document are available on our website.

Many of the quotes in this publication come from people and organisations in Australia who
participated in the Commission’s Call for Submission process.

ISSN 2201-3032

ISBN 978-0-9874449-2-9

Suggested citation:

National Mental Health Commission, 2014: The National Review of Mental Health Programmes
and Services. Sydney: NMHC

Published by: National Mental Health Commission, Sydney.

© National Mental Health Commission 2014

This product, excluding the Commission logo, Commonwealth Coat of Arms and material owned by a
third party or protected by a trademark, has been released under a Creative Commons BY 3.0 (CC BY
3.0) licence. The excluded material owned by a third party includes data, images, accounts of personal
experiences and artwork sourced from third parties, including private individuals. With the exception of
the excluded material (but see note below with respect to data provided by the Australian Bureau of
Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW)), you may distribute, remix
and build upon this work. However, you must attribute the National Mental Health Commission as the
copyright holder of the work in compliance with our attribution policy. The full terms and conditions of
this licence are available at Requests and enquiries
concerning reproduction and copyrights should be directed to:

[email protected]

Note: Material provided by:

1. The Australian Bureau of Statistics is covered under a Creative Commons Attribution 2.5
Australia licence and must be attributed in accordance with their requirements for attributing
ABS material as outlined at

2. The Australian Institute of Health and Welfare is covered by Creative Commons BY 3.0 (CC BY
3.0) and must be attributed to the AIHW in accordance with their attribution policy at


National Review of Mental Health Programmes and Services – 30 November 2014 – Volume 2


We acknowledge those people with a lived experience of mental health issues, their families,
friends and supporters who provided input into the Review process through our public Call for
Submission process. MaAustralian Institute of Health and Welfare 2018. Australia’s health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW.








2.1 How does Australia’s
health system work?
A person is likely to use the health system in various ways throughout their life. This
pattern reflects their health needs at different life stages, the social and environmental
impacts on their health, and personal circumstances. Some people may visit a pharmacy
or general practitioner (GP) infrequently; some may have regular appointments with a
GP, specialists or other health practitioners; others may need to go to hospital for tests,
treatments or emergencies.

The World Health Organization describes a good health system as one that ‘delivers
quality services to all people, when and where they need them’ (WHO 2018).

Australia’s health system is a complex mix of health professionals and service providers
from a range of organisations—from all levels of government and the non-government
sector. Collectively, they work to meet the health care needs of all Australians. Health
services are delivered in numerous ways and settings, including through health promotion
and education programs, diagnosis, treatment and preventive services in the community,
treatment and care in hospitals, rehabilitation in hospitals and the community, and
palliative care.

A variety of organisations support these services. Health departments and other
government agencies are responsible for policy and service planning. Research and
statistical organisations collect and publish information on health conditions and issues
(including monitoring, assessing, evaluating and reporting). Universities and health
services train health professionals. Consumer and advocacy groups have a role in public
debates on health policy and regulation. Voluntary and community organisations support
health service functions through activities such as fundraising for research and raising
awareness of health issues through education programs.

This article provides an overview of the structure of the health system in Australia and
some of the many changes and challenges it currently faces.

Delivery of health care services
The health care system has multiple components—health promotion, primary health care,
specialist services and hospitals. To meet individual health care needs, a person
may need—or have to engage with—the services of more than one part of the system.

Health promotion
Health promotion focuses on preventing the root causes of ill health through activities
such as governance, promoting health literacy, and population health programs. Through
prevention and education programs and public awareness campaigns, health promotion
is geared to educating the public on health issues, preventing avoidable health conditions





Australian Institute of Health and Welfare 2018. Australia’s health 2018Barriers and facilitators to the implementation
of a stepped care intervention for personality
disorder in mental health services

1School of Psychology, University of Wollongong, Wollongong, NSW, Australia; 2School of Psy-
chology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollon-
gong, NSW, Australia; 3Institute for Positive Psychology and Education, Australian Catholic
University, Sydney, NSW, Australia

Background – Individuals with personality disorders—particularly borderline personality disorder—are high
users of mental health treatment services. Emergency service responses often focus on crisis management, and
there are limited opportunities to provide appropriate longer term evidence-based treatment. Many individuals
with personality disorders find themselves in a revolving cycle between emergency departments and waiting for
community treatment. A stepped care approach may help to triage clients and allow access to interventions with
minimal client, clinician and system burden. This study aims to understand the facilitators and barriers to real-
world implementation of a stepped care approach to treating personality disorders.
Methods – Managers and clinicians of health services engaged in implementation were interviewed to obtain
accounts of experiences. Interviews were transcribed and thematically analysed to generate themes describing
barriers and facilitators.
Results – Participants identified personal attitudes, knowledge and skills as important for successful implemen-
tation. Existing positive attitudes and beliefs about treating people with a personality disorder contributed to the
emergence of clinical champions. Training facilitated positive attitudes by justifying the psychological approach.
Management support was found to bi-directionally effect implementation.
Conclusions – This study suggests specific organizational and individual factors may increase timely and effi-
cient implementation of interventions for people with personality disorders. © 2019 John Wiley & Sons, Ltd.

Personality disorders are of high prevalence in the
general population1,2 and in mental health set-
tings.3–6 Borderline personality disorder (BPD) is
characterized by an instability of emotions, self-
concept and relationships.7 Individuals with per-
sonality disorders are high users of mental health
treatment services8,9 and often present in crisis to

emergency departments.6,10 However, inpatient
admissions may have iatrogenic effects11 and have
a high economic burden.12 An alternative treat-
ment approach is needed for people with personal-
ity disorder presenting in crisis.13 Long-term
outpatient treatment has the best evidence for re-
covery from personality disorder14; however, in

© 2019 John Wiley & Sons, Ltd.
DOI: 10.1002/pmh

Personality and Mental Health
13: 230–238 (2019-11)
Published online 14 August 2019 in Wiley OnlinE A R L Y I N T E R V E N T I O N I N T H E R E A L W O R L D

Australia’s innovation in youth mental health care:
The headspace centre model

Debra Rickwood1,2 | Marie Paraskakis1 | Diana Quin1 | Nathan Hobbs1 | Vikki Ryall1 |

Jason Trethowan1 | Patrick McGorry3

1headspace National Youth Mental Health

Foundation, Melbourne, Victoria, Australia

2Faculty of Health, University of Canberra,

Canberra, Australian Capital Territory,


3Orygen: The National Centre of Excellence in

Youth Mental Health, Melbourne, Victoria,



Prof Debra Rickwood, headspace National

Youth Mental Health Foundation, 485

LaTrobe St, Melbourne, VIC 3000, Australia.

Email: [email protected]

Aim: headspace is Australia’s innovation in youth mental healthcare and comprises the largest

national network of enhanced primary care, youth mental health centres world-wide. headspace

centres aim to intervene early in the development of mental ill-health for young people aged

12 to 25 years by breaking down the barriers to service access experienced by adolescents and

emerging adults and providing holistic healthcare. Centres have been progressively implemented

over the past 12 years and are expected to apply a consistent model of integrated youth

healthcare. Internationally, several countries are implementing related approaches, but the

specific elements of such models have not been well described in the literature.

Method: This paper addresses this gap by providing a detailed overview of the 16 core compo-

nents of the headspace centre model.

Results: The needs of young people and their families are the main drivers of the headspace

model, which has 10 service components (youth participation, family and friends participation,

community awareness, enhanced access, early intervention, appropriate care, evidence-

informed practice, four core streams, service integration, supported transitions) and six enabling

components (national network, Lead Agency governance, Consortia, multidisciplinary workforce,

blended funding, monitoring and evaluation).

Conclusion: Through implementation of these core components headspace aims to provide easy

access to one-stop, youth-friendly mental health, physical and sexual health, alcohol and other

drug, and vocational services for young people across Australia.


early intervention, integrated models, mental health, models of care, youth


headspace is Australia’s National Youth Mental Health Founda-

tion. It commenced in 2006 with funding from the Australian

Federal Government via the Department of Health in recogni-

tion of the urgent need for health system reform to respond

more effectively to the high incidence and prevalence of men-

tal health problems among young people in the adolescent and

early adult years, and their low level of mental health service

use (McGorry, Tanti, et al., 2007; McGorry, Purcell, Hickie, &

Jorm, 2007).

At the heart of the headsWonca/WHO Primary Care Mental Health Factsheet

What is primary care mental health?

WHO and Wonca Working Party on Mental Health

What is primary healthcare?

Primary healthcare is about providing ‘essential

healthcare’ which is universally accessible to indi-

viduals and families in the community and provided

as close as possible to where people live and work. It

refers to care which is based on the needs of the

population. It is decentralised and requires the active

participation of the community and family.1

Providing mental health services in primary

healthcare involves diagnosing and treating people

with mental disorders; putting in place strategies to

prevent mental disorders and ensuring that primary

heathcare workers are able to apply key psychosocial

and behavioural science skills, for example, inter-

viewing, counselling and interpersonal skills, in their

day to day work in order to improve overall health

outcomes in primary healthcare.

Integrated primary mental health services are com-

plementary with tertiary and secondary level men-

tal health services (see the ‘optimal mix of services’

information sheet), e.g. general hospital services

(short stay wards, and consultation-liaison services

to other medical departments), which can manage

acute episodes of mental illness quite well but do not

provide a solution for people with chronic disorders

who end up in the admission–discharge–admission

(revolving door syndrome) unless backed up by

comprehensive primary healthcare services or com-

munity services.

Integrating specialised health services – such as

mental health services – into PHC is one of WHO’s

most fundamental health care recommendations.2

Rationale for integrating mental
health services into primary

There are many advantages for integrating mental

health services into primary healthcare:

Reduced stigma for people with mental
disorders and their families

Because primary healthcare services are not asso-

ciated with any specific health conditions, stigma is

reduced when seeking mental healthcare from a

primary healthcare provider (compared to a stand-

alone specialised service), making this level of care

far more acceptable – and therefore accessible – for

most users and families.

Improved access to care

Integrated care helps to improve access to mental

health services and treatment of co-morbid physical



Mental health is often comorbid with many physi-

cal health problems such as cancer, HIV/AIDS, dia-

betes and tuberculosis, among others. The presence

of substantial comorbidity has serious implications

for the identification, treatment and rehabilitation

of affected individuals. When primary healthcare

workers have received some mental health training

they can attend to the physical health needs of

people with mental disorders as well as the mental

health needs of those suffering from infectious and

chronic diseases. This will lead to betSCHOLARLY PAPER


Associate Professor Patricia Davidson RN BA MEd, PhD,
School ot Nursing, College of Health and Science. University of
Western Sydney and Nursing Research Unit, New South Wales,
Sydney West Area Health Service. New South Wales, Australia

[email protected]

Elizabeth Haicomb RN BN (Hons) PhD Candidate, Senior
Research Feliow School of Nursing, Coiiege of Heaith &
Science University of Western Sydney New South Wales and
Centre for Applied Nursing Research Sydney South West Area
Heaith Service, New South Waies, Australia

Hickman i RN BN MPH PhD Candidate. Associate Lecturer
School of Nursing. Coiiege of Health & Science University of
Western Sydney, New South Wales, Australia

Phillips JRNB App Sci (Nurs) Grad Dip Health Promotion PhD
Candidate, Project Officer Mid North Coast Division of General
Practice, Coffs Harbour. NSW. Associate Lecturer School of
Nursing. College of Health & Science. University of Western
Sydney New South Wales, Australia

Graham, B RN RM MMGm (Pub Heaith) Prof Doctoral
Candidate. Clinicai Redesign Coordinator Sydney South West
Sydney Area Heaith Service. New South Waies, Austraiia and
University of Technology Sydney New South Wales

Accepted tor publicalioti May 2005

Key words: models of care, systems, health care delivery, development, evaluation


Contemporary health care systems are constantly

challenged to revise traditional methods of health
care delivery. These challenges are multifaceted and
stem from: (I) novel pharmacological and non-
pharmacological treatments; (2) changes in consumer
demands and expectations; (3) fiscal and resource
constraints; (4) changes in societal demographics in
particular the ageing of society; (5) an increasing
burden of chronic disease; (6) documentation of limit-
ations in traditional health care delivery; (7) increased
emphasis on transparency, accountability, evidence-
based practice (EBP) and clinical governance struc-
tures; and (8) the increasing cultural diversity of the
community. These challenges provoke discussion uf
potential alternative models of care, with scant
reference to defining what constitutes a model of care.

This paper aims to define what is meant by the

term ^model of care’ and document the pragmatic

systems and processes necessary to develop, plan,
implement and evaluate novel models of care delivery.


Searches of electronic databases, the reference lists
of published materials, policy documents and the
Internet were conducted using key words including
‘model*’, ‘framework*’, ‘models, theoretical’ and
‘nursing models, theoretical’. The collated material
was then analysed and synthesised into this review.


This review determined that in addition to key
conceptual and theoretical perspectives, quality
improvement theory (eg. collaborative methodology),
project management methods and change manage-
ment theory inform both pragmatic and concep582 © 2019 Indian Psychiatric Society – South Zonal Branch | Published by Wolters Kluwer – Medknow

Biopsychosocial Model in Contemporary Psychiatry:
Current Validity and Future Prospects

The biopsychosocial model (BPS) was proposed
by George L. Engel in 1977 as a needed medical
model to explain psychiatric disorders.[1] Since then,
this model had gained wide acceptability across
the globe. It systematically explained the complex
interplay of three major dimensions (biological,
psychological, and social) in the development of
psychiatric disorders. It explained that a person does
not suffer as isolated organs but rather as a whole.
This provided a holistic approach to psychiatric
illnesses. The emotional tone of a person, his/her
personality, the surrounding environment, and other
social parameters do influence the manifestation
of illness. The model established a holistic and
empathetic approach in psychiatric practice[2] Over
the past four decades, many changes happened in our
understanding of psychiatric disorders, and hence,
there is reluctance in accepting the biopsychosocial
model in reality.[3,4]



Va r i o u s b i o l o g i c a l b r e a k t h r o u g h s s u c h a s
e x p o n e n t i a l p r o g r e s s i n n e u r o i m a g i n g ,
neurophysiology, neurochemistry, neuro-immunology,
n e u ro e n d o c r i n o l o g y, a n d g e n o m i c s a n d t h e
advancements in psychopharmacology have changed
the very face of psychiatry in the last few decades.
Newer neurobiological discoveries along with advances
in science and technologies have paved the way for
a more evidence-based, objectively verifiable and
biologically grounded medical discipline of psychiatry.[5]
This progress has started giving hope of improving
the understanding of mental processes during health
and disease as well as the etio-pathological basis
of psychiatric illnesses. This biological framework
promises new and improved management strategies.
In this enthusiasm for the latest growth, psychosocial
aspects of psychiatric illnesses are being relegated to
the backside and are considered outdated. It has been
seen that there is a deficient theoretical background
regarding the content of the biopsychosocial model and
also it’s functioning. There is also a lack of consensus
on how these separate factors interact and result in
the expression of the disease. Thus, this model is being

questioned, and the biomedical model is promoted as
a marker of progressive thinking.

Unprecedented developments in biological psychiatry
have amassed a wealth of knowledge and demystified
some of the aspects of brain and mind. It has
started influencing the understanding of causation,
diagnostic, and assessment strategies as well as
management to certain extents. While working with
this new framework, it is easy to get disillusioned with
speculative and theoretical psychosocial schooInvesting
to Save
The Economic Benefits for Australia
of Investment in Mental Health Reform

Mental Health Australia and KPMG

Final report
May 2018

© 2018 KPMG, an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative
(“KPMG International”), a Swiss entity. All rights reserved. The KPMG name and logo are registered trademarks or trademarks of KPMG International.

Liability limited by a scheme approved under Professional Standards Legislation.

At Mental Health Australia, our vision is for mentally
healthy people and mentally healthy communities.

Investing to Save presents a major contribution towards that vision. It shows how we can, with the
right targeted investments, improve the mental health of our community, and in turn the mental
wealth of the nation.

There have been many reviews, inquires and other various investigations into Australia’s mental health
system. But this is a report unlike any other.

Investing to Save tackles a set of complex issues from a new perspective, and a new pragmatic
approach to the scale of the task of reforming our mental health system.

As with any area of policy, in mental health we must decide where our priorities lie and direct our
resources accordingly. But the simple question of ‘where is money best spent in mental health?’ is not
so simple to answer. Investing to Save takes into account a range of complex issues, and presents
actionable, scalable and context-specific solutions – solutions that not only provide demonstrable
health and social benefits, but quantifiable economic returns to taxpayers and to the community.
Investing to Save is a foundation for further action on mental health, beyond the measures that
governments have prioritised for themselves.

Investing to Save provides tangible options to deliver additional economic and productivity gains for
business and for the broader community. To start realising those returns, and start improving the
mental health of our community, I hope that governments can join us on the long journey of reform,
looking beyond budget and election cycles, by adopting measures which create the environment in
which such returns on investment are truly possible. Investing to Save is a new beginning, not the end
of mental health reform.

Investing to Save is not the whole story on mental health. Every day many thousands of professionals
help many thousands of consumers and carers live contributing lives in the community and in a range
of service settings, and that work must continue. But every day, many people also miss out on the
services they need, or our ailing systems fail in crucial ways.

This report makes a vital contribution to remedying some of those failures with a very specific to-do
list which makes economic sense. A list backed by evidence and sound economic modeling. A list for
governments to actLast assignment CASE STUDY feedback.

Thank you for handing in your assignment before the due date as that allowed me to start marking early. It is evident that you invested time and energy in this final work, unfortunately, it can’t be awarded with a Pass; my feedback below should make clear why that’s the case.

The assignment starts with the case study of Anton. The issues where Anton are presenting with are first addressed. Unfortunately, this reads too much like an iteration of the case scenario from the Assessment Guide. It is also really short in light of the 30% weight that is attached to the first assessment task. You should have focussed on the main physical health issue that is present in Anton’s case — the risk of developing metabolic syndrome — and how the other issues are impacting on this; one of the most important is the use of Risperdal, so we wanted you to think carefully about the impact of this antipsychotic on the risk of developing metabolic syndrome as well as its effect on potency. 

You make a strong plea in the care plan for the need of optimising physical exercise and healthy nutrition. The directions that are shared here are sound and supported by evidence from the literature. What is missing here, however, is a discussion on how these would precisely halt the development of metabolic syndrome. Similar to the first section, there is no reflection here on what should be done with the administration of Risperdal; should this antipsychotic be continued, or should we stop it or lower its dose, or consider a different antipsychotic, so that the risk of metabolic syndrome would be mitigated and Anton not any longer experiences impotency…?

A referral to an exercise therapist and a dietician would indeed benefit Anton’s physical health, as well as a sexual therapist to optimise his sexual life. However, again nothing is considered here regarding the use of Risperdal and which professional consequently should become involved.

Anton would indeed benefit from support to get over his cannabis use. But just one support group for this suffices, so why not considering as a second support group one that could help Anton getting his life back on track in terms of employment or education?

The outcome scenario provides some idea what could happen to Anton in case his care plan would be adequately implemented.

Now over to the case of Cat.
As this whole unit has been on physical health of people with a mental illness, we expected that you would have a primary focus on the physical health issues where the people in the case studies present with. In the case of Cat that was her disordered eating behaviours. The first section should have revolved around that: what underlies these behaviours and how are the other health issues impacting upon. Vital in this case was giving insight regarding weight and BMI: how much does Cat weight now, what is her BMI, and what does this BMI tell us (a little over 17, meaning that she is in the categAssignment Debate feedback.

The use of data and evidence to support your position would have improved the quality of the paper. The easiest way would have been to point out the inadequacies and in-efficiencies of the current system, its poor impact on wellbeing levels, and criticisms of the Productivity Commission and Victorian Royal Commission. All that data and information can be research out .
I understand that on occasion you have citied at the end of the paragraph but you need to cite immediately when making definitive statements. On other occasions there was imply no citation.
 You have good clarity and expression of ideas in your writing  style.  Work on improving the flow of those ideas so they connect into a coherent narrative.

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