7. Building the evidence base

Data, monitoring and evaluation, and research
7.1
As discussed previously in this report, mental health and suicide prevention are complex areas. Effective mental health and suicide prevention responses require robust data to identify need; monitoring and evaluation to ensure programs and interventions are achieving anticipated outcomes; and ongoing research that draws on both Australian and international experience and directions.
7.2
The Productivity Commission Inquiry Report on Mental Health (Productivity Commission Report) included advice that it had ‘experienced significant data and informational limitations’ and noted ‘there is no policy framework to guide monitoring, evaluation and research in mental health and related sectors’. Responding to this, it recommended actions to ‘drive continuous improvement and promote accountability’, including requiring ‘that government support data collection and use, transparent monitoring and reporting, program evaluations and practical research’.1
7.3
In response to this, the Australian Government allocated $117.2 million over the next four years ‘for capturing data to evaluate and measure programs, to ensure that mental health reforms have been effective at improving outcomes’. The 2021-22 Budget also provided for an additional $7.3 million for the National Mental Health Commission (NMHC) to bolster the Commission’s capacity to monitor and report on the mental health system and lead consultation with people who have experience with the system as well as their families and carers’.2
7.4
During the course of the inquiry, the Committee heard evidence about the existing knowledge base that underpins mental health and suicide prevention, and how this is impacting on capability to harness emerging evidence-based approaches to ensure effective early detection, diagnosis, treatment and recovery.
7.5
This chapter examines first some general issues in the collection and substance of data on mental health in Australia. It then examines in more detail data relating to suicide, self-harm, and suicidality reporting.
7.6
The chapter moves to discuss monitoring and evaluation of programs and interventions, along with services themselves, with a focus on outcomes. It closes by looking at how research can support best-practice approaches to treating mental illness and preventing suicide.

Data

7.7
The treatment of mental illness in Australia relies on data, specifically data that is timely, comprehensive, consistent, and comparable across jurisdictions. Without robust data, governments are constrained in their ability to understand the population requiring assistance and supports, plan service delivery, ensure an appropriately qualified workforce, allocate resources, and assess outcomes to drive continuous improvement.

Harmonisation and linkage

7.8
Previous reports in the mental health sector have highlighted the need to harmonise data standards and datasets.3 This same point was emphasised in evidence to the inquiry. The Committee heard the incomparability of existing datasets was one barrier to effective service planning and delivery.
7.9
Some of the incompatibility of datasets can be attributed to the often patchwork field of funding bodies for program delivery. Data and reporting requirements often depend on the particular funding and contractual arrangements, making consistency difficult. The Primary Health Network (PHN) Cooperative provided an example of the inconsistency:
… there is not equivalence in the minimum data or the data that's collected across different programs. With the PHN program, for example, the minimum data set has 88 items in it … But, you can compare that to Better Access [Better Access to Mental Health Care initiative], where no data is collected about Better Access. But Better Access is many times the monetary value of the psychological services that the PHN funds.4
7.10
Service delivery organisations are challenged by this state of affairs. The Royal Flying Doctor Service (RFDS) stated, ‘we struggle with the challenge of datasets changing and datasets being different for different funded programs’.5 RFDS explained:
We've got so many different contracts and different funding requirements. For some we do submit data straight into the Primary Mental Health Care Minimum Data Set, and also for drug and alcohol via a NADAbase, but it depends on who funds them as to what data they need or where.6
7.11
As a potential solution, RFDS called for the collection of a small number of agreed and well-articulated data points as part of a national database.7
7.12
Having a common minimum data set, according to the PHN Cooperative, would allow the sector to look at:
… what's happening for people, whether they engage with mental health or community services or hospital services, private, public, NGO [non-government organisation]. We need that common minimum data set not a whole series of different data sets, because then we can't compare, nor can we even begin to track, what happens to people as they move across the system as their needs change.8
7.13
This general point was supported by the Royal Australian and New Zealand College of Psychiatrists, which suggested the creation of a nationally consistent data system underpinned by clinical registries. The College stated such a data system would ‘help us get that information in a timely manner and then make those policy changes so that we don’t need another inquiry’.9
7.14
One aspect of harmonisation would be standardisation that would allow for comparisons across programs and jurisdictions. While the Commonwealth maintains the Primary Mental Health Care Minimum Data Set, the Committee was told the dataset does not allow for a solid overview of outcomes that are standardised to allow for comparison. The WA Primary Health Alliance stated standardisation would allow comparisons of regional and urban settings, amongst other matters and would drive improvements in service delivery and planning.10
7.15
Gaining the ability to link standardised data sets—for instance by linking Commonwealth and state and territory data—would give better insights into mental health and suicide prevention. The Australian Institute of Health and Welfare (AIHW) explained:
Traditionally when we've reported on services, we tend to report on them in isolation. What's really interesting is the crossover in how many people use, for example, Medicare and subsidised mental health services that are also using state and territory mental health services and the intensity of that use over time. I think where we'll make gains in understanding the mental health system are in following people and pathways through the system.11
7.16
The value of linkage, supported by strong technology, was also identified by the Australian Medical Association (AMA):
If we can move to a health system that has good data and is well connected, that would be a starting point to then be able to use technology to assist there and say, actually we can look at all the psychologists or psychiatrists in the country and see the bell curve of how many sessions are needed before discharge and how many people end up in hospital and what the suicide rate is. You could get all sorts of metrics if you had really good data, but we just don't …12

Data gaps and their consequences

7.17
The Committee heard treatment of mental health and suicide prevention requires not only consistent and comparable data, it also requires robust data across population groups and service delivery to ensure funding is best allocated to areas of need and maximises positive outcomes.

Population gaps

7.18
Gaps in existing data mean there is insufficient information on the mental health support needs of some populations. In effect, the Committee was told these populations are invisible, significantly impacting the level of support received by some sections of Australian society.13 LGBTIQ+ Health Australia urged change, stating, ‘Our communities remain on the back foot when compared to the broader community, as the data renders us invisible’.14
7.19
This was supported by research from AIHW, which identified a number of gaps in the data for national reporting purposes, including in the following areas: Aboriginal and Torres Strait Islander peoples; culturally and linguistically diverse people; lesbian, gay, bisexual, transgender and intersex (LGBTI) people; people with experience of suicide; refugees; and victims of traumatic crime.15
7.20
Without data, evidence-based resource allocation and service planning is difficult. This was highlighted by the Centre for Multicultural Youth, which told the Committee:
… we need to significantly improve the cultural responsiveness and accountability of the mental health service system to make sure it's accessible, inclusive and proactive in meeting the needs of all young people and families in our community. A critical part of this is improved data collection.16
7.21
The Trans Health Research Group at the University of Melbourne supported the need for more data on specific populations, ‘research in trans health and suicide prevention must be prioritised to reduce the health disparity and measure the success of targeted interventions to reduce suicide’.17
7.22
Unless data is collected, the Committee heard that populations who may already experience significant health disparities cannot benefit from existing programs. LGBTIQ+ Health Australia stated it is only when the Australian Bureau of Statistics (ABS) Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables, 2020 is ‘embedded into all health and social services minimum datasets, including in coroners data, that we will be able to benefit from responses such as the National Suicide and Self-harm Monitoring System’.18
7.23
Similar issues were highlighted in other areas with consequences for service delivery. The Australian Rural Health Education Network highlighted the difficulty in getting data concerning rural and remote health and called for:
Investments in data collection strategies that particularly support workforce planning for the spectrum of health professionals that might be needed, understanding levels of unmet need and also working cross-jurisdictionally—working with state and territory governments—to coordinate planning …19

Service provision gaps

7.24
In addition to gaps in data on certain populations, more generally there are gaps in data on service provision. According to AIHW, the mental health-related Medicare Benefits Schedule (MBS) items are the only source of national data on mental health-related services provided by general practitioners (GPs). However, GPs do not bill all mental health-related encounters using mental health-specific MBS items. This leads to an underestimation of total mental health-related GP activity—believed by the Royal Australian College of General Practitioners to be one of the top three reasons a patient will visit their GP.20
7.25
Furthermore, data from emergency departments, according to AIHW, ‘isn’t particularly detailed in terms of occurrence’.21 At the current time, data on the activities of PHNs, collected under the Department of Health’s Primary Mental Health Care Minimum Data Set, is not yet available for reporting.22
7.26
Added to this, according to AIHW, there is currently no nationally consistent data on the workforce, or the activities of mental health non-government organisations (NGOs). This has an impact on policy, practice, and planning of activities. This data is particularly important as NGOs play a significant role in providing non-clinical mental health-related services to people living with mental illness, their families and carers.23
7.27
Where data is collected from the non-government sector, however, its value in informing policy decisions is not clear. Existing data collection in the NGO sector was described by the Queensland Mental Health Commissioner as somewhat problematic:
… it is not as systematic as the public system and the same tools aren't used by the NGOs, so it's hard to get a sense of some of the outcomes and achievements through non-government social support.24
7.28
A further consequence of inconsistent data collection, according to Prevention United, is that it is hard to understand how health funding for mental health and suicide prevention is spent. This makes developing an infrastructure for investment in promotion, prevention and wellbeing – distinct from other forms of the mental health system – difficult.25

Gathering and compiling data

7.29
The Committee heard that agreeing on a standardised and comparable data framework and data collection itself is not straightforward—specialist knowledge is required, alongside the recognition the questions asked shape the responses received. Absent a deep understanding of these complexities, data can be misinterpreted in ways that have the potential to affect service delivery. This is particularly the case in seeking standardised data on outcomes.
7.30
While calling for the collection of outcomes-based data, AMA cautioned:
The biggest challenge there is making sure you ask the right questions, because collecting the wrong data can have unintended consequences. For example, say you were collecting suicide rates. That's a very concrete outcome. We know very little about what contributes to suicide, so that may not be an accurate reflection of someone's quality of care. If you were looking at hospitalisation rates, you may falsely presume that someone who had high hospitalisation rates was performing poorly when actually their patient base tended to be of a condition that quite frequently needs hospitalisation.
While I understand the sentiment of wanting data-driven care, and it's an emerging field across all specialities in medicine, if we are to head in that direction there needs to be significant consultation with all stakeholders, including our profession, to make sure that it's done gradually and sensitively.26

Suicide, self-harm and suicidality reporting

7.31
The importance of accessible, accurate and timely data for suicide prevention was emphasised by many witnesses during the inquiry. However, it is not only information on suicide that is required—witnesses called for a single repository for data on suicides, attempted suicides, and presentations to hospital to facilitate the coordination of information and ultimately drive improvements in outcomes.27
7.32
AIHW stated a key national goal should be suicide registries in each state and territory to provide timely data.28
7.33
The National Suicide Prevention Adviser to the Prime Minister, Ms Christine Morgan, advised that while these registers exist in most states and territories and there is a commitment from the remaining jurisdictions to establish the registers, this should be accelerated.29
7.34
Queensland established the first suicide register—a partnership between the Queensland Government, led by the Queensland Mental Health Commission, the Coroners Court and the Australian Institute for Suicide Research and Prevention at Griffith University. With this register, researchers follow trends and examine the data to develop deeper insights over time and share the data with government agencies.30
7.35
According to Ms Morgan, the registers ‘have made a significant difference, to being able to say, “This is a probable suicide that's happening,” and being able to respond’. Ms Morgan also indicated that data on deaths is not sufficient and suggested national surveys are required to understand the spectrum of ideation, self-harm and attempts, and experiences in different priority population groups. This would require agreement on a standard definition of what constitutes a suicide attempt.31
7.36
The Black Dog Institute similarly called for ambition in a national register that would provide timely and comprehensive information on suicide to inform treatment interventions:
The key problem at the moment is that the data around suicide and self-harm takes a while to come together, and so some of the timeliness of those responses is lost. It's also complex because you don't just want to know about suicide; you want to know about attempted suicides, about presentations to hospital where people have made suicide attempts. At the moment, that data is all held by different people. In those trial sites, we have demonstrated how you can bring it together in a timely way, but what really needs to happen is that needs to be happening at a national level and there needs to be a single place that it's pulled together and where it is reported.32
7.37
In some cases where data is collected, it is not always available to those who deliver services. The National Aboriginal Community Controlled Health Organisation (NACCHO) told the Committee that in many state jurisdictions, police collate information on self-harm – this is an early sign someone is in a distressed mental health state. Unfortunately, this information is not readily available across the country.33
7.38
NACCHO highlighted an arrangement in the Kimberly between the Western Australian police and the Kimberley Aboriginal Medical Services in Broome where self-harm information for the region is shared with the medical services through a formal multi-organisational regional forum. NACCHO suggested consideration be given to an expansion of this arrangement—under a formalised arrangement, where information would be shared in each jurisdiction with the NACCHO affiliate. This would allow organisations to respond quickly to incidents of self-harm.34
7.39
StandBy similarly expressed concern about the link between data and service response. However, the organisation suggested that data sharing needs to be coupled with systematised or automated notification systems linked to postvention services. However, currently there are only patchy and unsystematic arrangements in local areas and in some states.35

Committee comment

7.40
The Committee acknowledges resourcing to address mental health and suicide prevention cannot be effectively allocated absent robust data on the level of need in the community and the outcomes achieved by interventions. The deficiencies in data highlighted during the course of the inquiry show how effective planning and service delivery are potentially hampered.
7.41
This is particularly the case with some vulnerable populations whose mental health needs remain poorly understood. The Committee acknowledges that data makes communities visible so their needs may be met. The Committee supports the recommendation put forward by LGBTIQ+ Health Australia that the ABS Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables, 2020 be embedded into all minimum datasets.36 Accordingly, the Committee makes the following recommendation to this effect.

Recommendation 37

7.42
The Committee recommends that the Australian Bureau of Statistics Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables, 2020 be embedded into all health and social services minimum datasets, including coroners’ data and Census data.
7.43
The Committee acknowledges that there is a significant amount of data on mental health and suicide prevention. However, the fact much of this data is not standardised or comparable undercuts the purpose of collecting it and its value in informing service delivery.
7.44
The Committee would like to see AIHW convene a working group to establish a national data collection framework for data on mental health and suicide prevention. This should be undertaken in collaboration with Commonwealth, state and territory authorities, researchers, clinicians, and service delivery organisations, and consult people with lived experience.
7.45
This is an ambitious project as it would involve an assessment of how existing data repositories can be incorporated, and agreement on technical issues and issues that cannot necessarily be measured in one way, such as what constitutes a positive outcome.
7.46
A central repository of current, harmonised and comparable data should be established and broadly available for research and service delivery planning.
7.47
To ensure a comprehensive repository, agencies that fund mental health and suicide prevention interventions should incorporate harmonised data reporting requirements into service delivery contracts.
7.48
Such a repository would align with recommendations of other inquiries, such as the recent Productivity Commission Report that recommended, amongst other things, the Government fund regular national surveys of mental health and wellbeing, and establish a national clinical trials network.37

Recommendation 38

7.49
The Committee recommends that the Australian Institute of Health and Welfare convene a cross-jurisdictional working group, including Commonwealth, state and territory authorities, researchers, clinicians, and service delivery organisations, to establish a national collection framework for data on mental health and suicide prevention. The national collection framework must include:
a central repository of current, harmonised and comparable data from all jurisdictions which is broadly available for research and service delivery planning
harmonised data reporting requirements for inclusion in service delivery contracts.

Monitoring and evaluation

7.50
Previous reviews of mental health and suicide prevention interventions have recommended there be greater investment in collecting data on patient outcomes to ensure patients are improving as a consequence of mental health treatment—that is, determining whether interventions are achieving desired outcomes. Such data can guide improvements in services into the future.38
7.51
The Committee similarly received evidence that emphasised that there must be effective monitoring and evaluation of interventions. Investment in interventions, according to the Australian Clinical Psychology Association, must be coupled with a commitment to ensuring high quality care and evaluation of patient outcomes.39
7.52
Monitoring and evaluation, though, applies not only to programs but to the services that deliver these programs.
7.53
The importance of monitoring and evaluation was recognised by the Department of Health. It currently has underway evaluations for the Better Access initiative, headspace, HeadtoHelp, and the Improving Social Connectedness Pilot program.40
7.54
The Committee heard that while it is necessary to link desired national outcomes with evaluated services that can provide the outcomes sought, agreement on the desired outcomes at a population level is a necessary first step. According to the Brain and Mind Centre at the University of Sydney:
… we must urgently move to decide what outcomes we're trying to achieve—not what types of activities we wish to fund—and what the supply chain is. As demand for mental health services has always greatly outstripped supply, we've never agreed about what the supply chain is across the spectrum of care from indicated prevention through to continuing care, and who is accountable for that supply chain.41
7.55
The Committee heard that monitoring and evaluation of outcomes is essential to ensure appropriate care is provided—whether care is provided by trained psychologists, psychiatrists or peer support workers. Mental Health Australia told the inquiry:
… there is plenty of feedback from consumers and carers in the community who are asking for a particular type of compassionate care. I think we have a responsibility to work out how to measure impact and outcomes from whoever is providing the care, and patient-led outcome measures.42

Co-design

7.56
Witnesses told the Committee the incorporation of lived experience is likely to result in the design of more effective interventions because people receiving services are able to have input into the monitoring and evaluation of these services. Witnesses spoke to the Committee about the importance of co-design in Indigenous mental health. Gayaa Dhuwi (Proud Spirit) Australia told the Committee:
If we're looking at developing services, we need to look at how we measure services and how we do that in a way that is a co-designed, Indigenous led process … It's really about having people that are directly affected by the issues, including having lived experience, involved in the processes around evaluation, reviews or whatever it might be.43
7.57
The Consumers Health Forum of Australia stressed the necessity of including consumers in the structures to monitor and independently report on progress and achievements:
It's not good enough for mental health practitioners and other clinicians and services to measure their own effectiveness, or to focus solely on outcome reporting. We can't assume that their best intentions to deliver consumer centred care are necessarily always met. Consumers must be empowered through assessments, evaluations, patient experience and patient reported measures, not just about the outcomes of their treatment but about how they were treated, and have their voices heard on the experience dimension of care—how they were treated, respected and included as equal members of their care teams, whether as patients or carers.44
7.58
Accordingly, the Consumers Health Forum of Australia called for a ‘shared truth’ of the experiences of mental health systems and services by consumers and carers to drive reform.45

Monitoring and evaluation of health services

7.59
The Committee was interested to hear about monitoring and evaluation of services themselves, and monitoring and evaluation that has a bearing on the accreditation of mental health and suicide prevention services. LivingWorks identified that the outcomes of such a process could be challenging:
Suicide Prevention Australia have been funded by the Commonwealth government to set up quality assurance accreditation, the first in the world. We will be the first to go through with it because we have a lot of evidence … We've really welcomed it and we are going to put our programs through it. So I think that, for government and primary health networks and workplaces, having a proper accreditation process is probably the key. It will be ugly for many of us as well because we'll go, 'We're high on here but what are the other areas where we may be lower?'—but, hopefully, we will be okay.
Accreditation is important because, if you want a GP or a vaccination, you are looking for some independent evaluation to say that, besides the evidence base, it has also gone through another independent test.46
7.60
The Gold Coast Mental Health and Specialist Services (GCMHSS) explained that the successful implementation of the Zero Suicide Framework was underpinned by a ‘data-driven, continuous quality improvement approach’ and external evaluation by ‘a number of publications, including the British Journal of Psychiatry’.47

Data for monitoring and evaluation

7.61
The Committee heard of the need for technology driven monitoring and evaluation. For instance, MindSpot stated that by using technology, it measures clinical outcomes each week. These results are reported monthly to the Department of Health, and published in peer reviewed scientific journals.48
7.62
Another example was provided by GCMHSS which noted its data system previously had little capacity to identify who had presented with a suicide attempt:
Our professor of psychiatry actually created a machine-learning algorithm to trawl through huge numbers of clinical records and work out who did present with a suicide attempt. They then looked back at 10 years of data for that. It's really looking at whether this suicide prevention pathway makes a difference to the time to the next event. Suicide, as an outcome, is an incredibly tricky thing to measure … We looked at that data over four years and then the three years subsequent to that. What we found was a 23 per cent reduction, whereas previously it had been escalating. Because this is the implementation of a framework within a health service, we needed to look at data compared to our health service. There are a huge number of variables that will affect the whole-of-community suicide data, but what we have said is that you should be very cautious.49

Committee comment

7.63
The Committee agrees with witnesses to the inquiry that effective monitoring and evaluation must occur at a program and service level, and it must involve truth sharing. However, effective monitoring and evaluation requires agreement on the outcomes sought. In this sense the challenges of monitoring and evaluation mirror some of the challenges of obtaining consistent and comparable data.
7.64
As governments allocate greater resources to addressing growing mental health concerns in the community, there must be accountability for this expenditure. The Committee agrees with the Productivity Commission Report recommendation that NMHC be given statutory authority to monitor and report on reform progress.50 However, the Committee would like to see this recommendation expanded and considers it appropriate for government expenditure to be subject to parliamentary oversight.
7.65
While the Committee is encouraged to see the Department of Health undertaking monitoring and evaluations of some programs, it is mindful of evidence that there must be an agreement on what constitutes a desirable outcome prior to any independent monitoring or evaluation. Furthermore, it is concerned evaluations are undertaken in the absence of any nationally agreed standard on data.
7.66
Reflecting the need to ensure expenditure on mental health and suicide prevention interventions is effective and that consumers are actually assisted by the supports they receive, the Committee would like to see increased independence of the officers responsible for mental health and suicide prevention.

Recommendation 39

7.67
The Committee recommends that the Australian Government develop enabling legislation to make the National Mental Health Commissioner an independent officer of the Parliament with responsibility under the legislation for monitoring and reporting on outcomes of mental health and suicide prevention initiatives.

Research

7.68
Without research there cannot be evidence-informed approaches to treatment, care and support, or effective policy development, planning and investment.51
7.69
Australian Government initiatives recognise the importance of research to underpin evidence-based service provision. In March 2021, $10 million from the National Health and Medical Research Council’s Special Initiative in Mental Health was provided for a new research hub based at the University of Melbourne. The ‘Academy of Lived Experience [ALIVE] and Co-Design Living Labs’ will link research in 14 universities with the aim of delivering innovative, evidence-based mental health care.52
7.70
The Committee heard that research, to be of value to policy making and service provision, must be regularly conducted—this has not always occurred. According to the Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney:
Data from the 1997 and 2007 National Survey on Mental Health and Wellbeing provided integral information about the prevalence and distribution of mental disorders in the Australian population, which was used to inform policies around the provision of mental health services. However, there was a 14-year gap before the launch of the Intergenerational Health and Mental Health Study, which is currently underway. Funding for more regular – and ideally longitudinal – national mental health surveys would allow for important discoveries and facilitate the development of policies reflective of need.53
7.71
The Committee was told a key impediment to research and progress addressing mental health and suicide prevention is a lack of funding. The Black Dog Institute stated:
At the moment the allocation of research funding that goes to mental health is nowhere near proportionate to the level of disability and suffering that mental health causes in the community. That has definitely limited our ability to make the progress we want to make.54
7.72
Aside from shortages in funding, there are difficulties finding professionals with a clinical background who are trained to conduct research:
At the moment we have no viable training pathways for mental health clinicians, be they psychologists, psychiatrists or mental health nurses, to train to become researchers … In thinking of workforce, alongside what we have to do with the clinical workforce, we have to think about how we will have the next generation of clinical researchers to answer these questions moving forward. At the moment most universities are reliant on overseas trained researchers coming in to fill the gaps.55
7.73
The shortage is not caused by a lack of interest. Funding, according to the Black Dog Institute, plays a role:
Our trainee doctors are all interested in research, particularly in mental health, where there are so many unanswered questions. The main barriers are that, for a clinician to come across and to get involved in researching solutions, they have to take a major pay cut compared to what they could earn if they carried on doing clinical work and accept major job insecurity in that.56
7.74
While not disregarding the importance of research to establish an evidence base for mental health and suicide prevention interventions, the Committee was told there is a balance between evidence and innovation. This does not mean programs are not evidence based, but that research, monitoring and evaluation must be funded. batyr told the Committee:
The point about the evidence base is an interesting one, because I think there's obviously a bar that should be met, in terms of an evidence base, but not at the cost of innovation and the development of new programs and innovative programs for which there might not necessarily be an evidence base straightaway but for which one needs to be built up.
There's also a lot of onus, understandably, on community organisations like us, who are already resource stretched, to do that evaluative work. Within batyr, we've done a number of impact evaluations, but it takes a lot of internal expertise. It takes paying academic researchers who are able to do that work. So it takes resourcing the community sector.57
7.75
This view was supported by Western Sydney University, which urged that greater connections between community organisations and researchers be promoted:
What I've been finding, working with community organisations, is that there's a bit of a lack of understanding of what good evidence is. A lot of the time amazing projects are run without having an evaluation in mind. So they come to us towards the end of the project to evaluate the project and we're like, 'Well, we need to be with you from the start so that the evaluation is embedded throughout the delivery of the intervention that you are doing in the community’.58
7.76
The state of knowledge in mental health and suicide prevention was acknowledged by Prevention United:
We definitely know a fair bit about how to keep people well and prevent mental health conditions, particularly depression, anxiety, conduct disorders and oppositional defiant disorder, and even alcohol and other drug issues, though not for low prevalence disorders. That has to be said. Do we know everything? No way. Would it help to have more investment in research? Absolutely.59
7.77
Emphasising the connection between research and data, the Australian Physiotherapy Association stated reforming primary care and the MBS is stymied by a lack of robust data on the physical health and wellbeing of people experiencing mental illness. This lack of data reflects historic under-investment in research.60

Committee comment

7.78
The Committee is aware the three issues discussed in this chapter—data, monitoring and evaluation, and research—are interdependent. Progress in agreeing to a nationally consistent data collection framework, as is recommended, is likely to have benefits for monitoring, evaluation and research. Together, these activities will grow the knowledge base for evidence-informed interventions in mental health and suicide prevention.
7.79
All three are necessary for accountability. The Committee is strongly of the view there must be accountability for the outcomes achieved through the significant public funding expenditures for mental health and suicide prevention. Therefore, greater attention must be paid to funding appropriately the collection of data, monitoring and evaluation, and research.

  • 1
    Productivity Commission, Productivity Commission Inquiry Report on Mental Health, No 95, 30 June 2020, page 1184.
  • 2
    Australian Government, ‘Budget 2021-22: Guaranteeing the Essential Services, Mental Health – Measurement of progress’ May 2021, budget.gov.au/2021-22/content/essentials.htm#two, viewed 5 October 2021.
  • 3
    See, for instance: Primary Health Networks (PHNs) Advisory Panel on Mental Health, Report on Progress of Mental Health Reform Being Implemented Through PHNs, September 2018, page 15.
  • 4
    Mr Paul Martin, Mental Health Working Group, PHN Cooperative, Committee Hansard, Canberra, 19 July 2021, page 9.
  • 5
    Mr Frank Quinlan, Federation Executive Director, Royal Flying Doctor Service of Australia (RFDS), Committee Hansard, Canberra, 17 June 2021, page 12.
  • 6
    Ms Vanessa Latham, Manager, Mental Health Services, RFDS, Committee Hansard, Canberra, 17 June 2021, page 12.
  • 7
    Mr Frank Quinlan, Federation Executive Director, RFDS, Committee Hansard, Canberra, 17 June 2021, page 12.
  • 8
    Mr Paul Martin, Mental Health Working Group, PHN Cooperative, Committee Hansard, Canberra, 19 July 2021, page 9.
  • 9
    Associate Professor Vinay Lakra, President, Royal Australian and New Zealand College of Psychiatrists, Committee Hansard, Canberra, 6 August 2021, page 12.
  • 10
    Adjunct Associate Professor Learne Durrington, Chief Executive Officer, WA Primary Health Alliance and Chair, National PHN Cooperative, Committee Hansard, Canberra, 19 July 2021, pages 8-9.
  • 11
    Mr Matthew James, Deputy Chief Executive Officer, Australian Institute of Health and Welfare (AIHW), Committee Hansard, Canberra, 6 August 2021, page 14.
  • 12
    Dr Omar Khorshid, President, Australian Medical Association (AMA), Committee Hansard, Canberra, 6 August 2021, page 42.
  • 13
    Ms Willow Kellock, Senior Policy Advisor, Centre for Multicultural Youth, Committee Hansard, Canberra, 6 August 2021, page 31.
  • 14
    Ms Nicky Bath, Chief Executive Officer, LGBTIQ+ Health Australia, Committee Hansard, Canberra, 26 July 2021, page 2.
  • 15
    AIHW, Submission 80, page 11. See also: Sav Zwickl, Researcher, Trans Health Research Group, University of Melbourne, Committee Hansard, Canberra, 26 July 2021, page 1.
  • 16
    Ms Willow Kellock, Senior Policy Advisor, Centre for Multicultural Youth, Committee Hansard, Canberra, 6 August 2021, page 31. See also: Ms Nicky Bath, Chief Executive Officer, LGBTIQ+ Health Australia, Committee Hansard, Canberra, 26 July 2021, page 4; Dr Addie Wootten, Chief Executive Officer, Smiling Mind, Committee Hansard, Canberra, 26 July 2021, page 23.
  • 17
    Sav Zwickl, Researcher, Trans Health Research Group, University of Melbourne, Committee Hansard, Canberra, 26 July 2021, page 1.
  • 18
    Collection of accurate data, according to LGBTIQ+ Australia, is not sufficient. It needs to be underpinned by a national commitment to the coordination of investment and outcomes for LGBTIQ+ communities. Ms Nicky Bath, Chief Executive Officer, LGBTIQ+ Health Australia, Committee Hansard, Canberra, 26 July 2021, page 2.
  • 19
    Ms Joanne Hutchinson, National Director, Australian Rural Health Education Network, Committee Hansard, Canberra, 17 June 2021, page 5.
  • 20
    AIHW, Submission 80, page 11.
  • 21
    Mr Matthew James, Deputy Chief Executive Officer, AIHW, Committee Hansard, Canberra, 6 August 2021, page 14.
  • 22
    AIHW, Submission 80, page 11.
  • 23
    AIHW, Submission 80, pages 11, 17. See also: Mental Health Australia, Submission 69, page 17; Mr Matthew James, Deputy Chief Executive Officer, AIHW, Committee Hansard, Canberra, 6 August 2021, page 14.
  • 24
    Mr Ivan Frkovic, Queensland Mental Health Commissioner, Queensland Mental Health Commission, Committee Hansard, Canberra, 12 August 2021, page 4.
  • 25
    Dr Stephen Carbone, Chief Executive Officer, Prevention United, Committee Hansard, Canberra, 13 August 2021, page 20.
  • 26
    Dr Danielle McMullen, NSW President, AMA, Committee Hansard, Canberra, 6 August 2021, page 42.
  • 27
    See, for instance: Mr Samuel Harvey, Acting Director, Black Dog Institute, Committee Hansard, Canberra, 28 July 2021, pages 4-5; Mr Christopher Stone, Acting Director, Policy and Government Relation, Suicide Prevention Australia, Committee Hansard, Canberra, 3 June 2021, page 11.
  • 28
    Mr Matthew James, Deputy Chief Executive Officer, AIHW, Committee Hansard, Canberra, 6 August 2021, page 17.
  • 29
    Ms Christine Morgan, National Suicide Prevention Adviser to the Prime Minister, Committee Hansard, Canberra, 13 May 2021, page 6.
  • 30
    Mr Ivan Frkovic, Queensland Mental Health Commissioner, Queensland Mental Health Commission, Committee Hansard, Canberra, 12 August 2021, pages 3-4.
  • 31
    Ms Christine Morgan, National Suicide Prevention Adviser to the Prime Minister, Committee Hansard, Canberra, 13 May 2021, page 6.
  • 32
    Mr Samuel Harvey, Acting Director, Black Dog Institute, Committee Hansard, Canberra, 28 July 2021, pages 4-5. See also: Mr Christopher Stone, Acting Director, Policy and Government Relation, Suicide Prevention Australia, Committee Hansard, Canberra, 3 June 2021, page 11.
  • 33
    Ms Patricia Turner, Chief Executive Officer, National Aboriginal Community Controlled Health Organisation (NACCHO), Committee Hansard, Canberra, 12 August 2021, page 9.
  • 34
    Ms Patricia Turner, Chief Executive Officer, NACCHO, Committee Hansard, Canberra, 12 August 2021, page 9.
  • 35
    Mr Stephen Scott, Partnerships Manager, StandBy Support After Suicide, Committee Hansard, Canberra, 21 July 2021, page 39.
  • 36
    Ms Nicky Bath, Chief Executive Officer, LGBTIQ+ Health Australia, Committee Hansard, Canberra, 26 July 2021, page 2.
  • 37
    Productivity Commission, Productivity Commission Inquiry Report on Mental Health, No 95, 30 June 2020, page 83.
  • 38
    See, for instance: Medicare Benefits Schedule Review Taskforce, Post Consultation Report from the Mental Health Reference Group, 2019, page 44; PHNs Advisory Panel on Mental Health, Report on Progress of Mental Health Reform Being Implemented Through PHNs, September 2018, page 15; Productivity Commission, Productivity Commission Inquiry Report on Mental Health, No 95, 30 June 2020, page 83; Royal Commission into Victoria’s Mental Health System, Final Report Summary and Recommendations, February 2021, page 101.
  • 39
    Professor Caroline Hunt, President, Australian Clinical Psychology Association, Committee Hansard, Canberra, 29 July 2021, page 36.
  • 40
    Department of Health, Submission 41, pages 10-11; Department of Health, Answer to Question on Notice, 18 March 2021.
  • 41
    Professor Ian Hickie, Co-Director, Health and Policy, Brain and Mind Centre, University of Sydney, Committee Hansard, Canberra, 19 August 2021, page 27.
  • 42
    Dr Leanne Beagley, Chief Executive Officer, Mental Health Australia, Committee Hansard, Canberra, 3 June 2021, page 4.
  • 43
    Mr Thomas Brideson, Chief Executive Officer, Gayaa Dhuwi (Proud Spirit) Australia, Committee Hansard, Canberra, 24 June 2021, page 4.
  • 44
    Ms Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, Committee Hansard, Canberra, 5 August 2021, page 6.
  • 45
    Consumers Health Forum of Australia, Submission 60, page 10.
  • 46
    Mr Marc Bryant, Director, Suicide Prevention, LivingWorks Australia, Committee Hansard, Canberra, 13 August 2021, page 27.
  • 47
    Dr Kathryn Turner, Clinical Director, Gold Coast Mental Health and Specialist Services (GCMHSS), Committee Hansard, Canberra, 13 August 2021, page 13.
  • 48
    Professor Nickolai Titov, Executive Director, MindSpot, MQ Health, Committee Hansard, Canberra, 19 July 2021, page 22.
  • 49
    Dr Kathryn Turner, Clinical Director, GCMHSS, Committee Hansard, Canberra, 13 August 2021, page 16.
  • 50
    Productivity Commission, Productivity Commission Inquiry Report on Mental Health, No 95, 30 June 2020, page 59.
  • 51
    Royal Commission into Victoria’s Mental Health System, Final Report Summary and Recommendations, February 2021, page 99.
  • 52
    The Hon Greg Hunt MP, Minister for Health, ‘$10 million for National Mental Health Research Centre’, Media Release, 16 March 2021.
  • 53
    The Matilda Centre for Research in Mental Health and Substance Use, Submission 74, page [2].
  • 54
    Mr Samuel Harvey, Acting Director, Black Dog Institute, Committee Hansard, Canberra, 28 July 2021, page 3.
  • 55
    Mr Samuel Harvey, Acting Director, Black Dog Institute, Committee Hansard, Canberra, 28 July 2021, page 3.
  • 56
    Mr Samuel Harvey, Acting Director, Black Dog Institute, Committee Hansard, Canberra, 28 July 2021, page 6.
  • 57
    Tom Riley, Research and Policy Manager, batyr, Committee Hansard, Canberra, 28 July 2021, page 23.
  • 58
    Mrs Arianne Reis, Senior Lecturer, School of Health Science, Western Sydney University, Committee Hansard, Canberra, 28 July 2021, page 34.
  • 59
    Dr Stephen Carbone, Chief Executive Officer, Prevention United, Committee Hansard, Canberra, 13 August 2021, page 20.
  • 60
    Australian Physiotherapy Association, Submission 1, page 8.

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