Data, Circumstance and Politics: Reflections on Regional Mental Health Planning
Fuller, Jeff, Edwards, Jane, Australian Health Review
We use our experience as consultants to a regional mental health planning project in South Australia to describe three practical aspects of regional health planning. First, we systematically summarised various data on socio-demographic indicators, health status and health service use along with qualitative opinion about needs and services from consultations with over 200 stakeholders. In addition to these data, we found that attention to two other aspects of planning, circumstance and politics, were of critical importance, particularly if the plan was to be implemented and as a way of turning thinking into action.
Regional planning in health has gained impetus in recent years in Australia. Recent planning initiatives include the Commonwealth Regional Health Services Program and the Aboriginal Primary Health Care Access Program that require the identification and prioritisation of local needs for service development (National Rural Health Policy Forum 1999; Fuller et al 2001; Australian Department of Health & Ageing 2002). In this context and in the context of state and national reforms in mental health, the Northern and Far "Western Regional Health Service in country South Australia engaged the Spencer Gulf Rural Health School to assist with the development of a regional mental health plan (Mental Health Branch 1999; Mental Health Services 2000). In this paper we describe the planning brief and the overt and rational data related process that we used to arrive at a plan through which 19 agencies agreed to collaborate. We then discuss the more covert circumstantial and political aspects of the planning process that we had to consider to secure this agreement.
The region in which the planning was conducted is the largest and most remote in South Australia. Two thirds of the region's 54,000 population are concentrated in only two adjacent regional cities and the remainder in eleven smaller settlements spread over 756,000 square kilometres of arid landscape (figure 1). The regional population includes the highest proportion of Aboriginal people in South Australia and there are considerable numbers of non-English speaking background immigrants, particularly in the remote opal mining settlements of Coober Pedy and Mintabee. The region has a relatively high percentage of socially disadvantagcd people who would be expected to have high human service needs (Fuller and Edwards 2001).
The planning brief called for a rational articulation of needs, a listing of the current services, identification of the gaps and the determination of priorities for responding to mental disorders and other problems such as domestic violence and drug and alcohol abuse. We were to include a focus on the prevention of mental health problems and the promotion of community social and emotional wellbeing (Fuller and Edwards 2001).
This breadth made the planning process different than if the focus had been principally on mental health services as has been the case in other regions (Piscitelli 1998). Because of the large geographic area we realised early on that to be locally relevant, as well as to have an overarching plan for the whole region, the plan had to include sub-plans that were specific to the circumstance of local communities. The purpose of the plan was to improve services through better coordination. The planning scope was wide and the Regional Health Service was clear that the process had to engage all relevant stakeholders so that broad commitment to the plan was obtained. The concern of the Regional Health Service was twofold, first that there were a number of organisations providing mental health related services in the region but whose efforts and resources were not coordinated, and second, that community mental health and wellbeing went beyond the concern and responsibility of any one agency and so required collaborative organisational and community engagement.
The planning management committee
The first task was to establish a planning management committee and the first decision was who should be represented on this committee. …