Managing Madness: Mental Health and Complexity in Public Policy


Share / Export Citation / Email / Print / Text size:

Evidence Base

Australia and New Zealand School of Government

Subject: Management


eISSN: 1838-9422





Volume / Issue / page

Related articles

VOLUME 2013 , ISSUE 3 (September 2013) > List of articles

  • |

Managing Madness: Mental Health and Complexity in Public Policy

Sebastian Rosenberg / Ian Hickie / Sebastian Rosenberg / Ian Hickie

Citation Information : Evidence Base. Volume 2013, Issue 3, Pages 1-19, DOI:

License : (CC BY-NC-ND 4.0)

Published Online: 26-December-2016



This paper explores the concept of collaborative care, particularly in relation to a range of new models of organisation and service that are emerging in response to one of the most problematic areas of public policy – mental health. These emerging models of coordinated mental health care are testing the limits of the evidence supporting coordinated care, and require critical evaluation. Myriad concepts of collaborative or coordinated care in health, including mental health, have created multiple definitions. Once definitional issues have been surmounted, however, the evidence for coordination of health care is reasonably strong. There is considerable research about which treatments and programs are best for people with a mental illness. There are few areas seemingly as complex as mental health, given that responsibility for policy and service lies across all three tiers of Australian government and across multiple jurisdictions. It also engages public, private and non-government sectors. Co-morbidities are commonplace, particularly drug and alcohol problems among younger people. Governments in Australia have traditionally taken responsibility for policy, programs and services, either as direct service providers or through contracting outputs from others. Yet the evidence indicates that for people with a mental illness, the best solutions are often not found in government but in the community and in organisations outside of government. New organisations and new structures are attempting more holistic management approaches, combining clinical care, community support, housing, employment and other services. This paper considers some of these new models in the light of existing evidence. The key challenge facing continued reform in mental health is not uncertainty regarding programs or services, but rather how to drive coordinated care for consumers across departments, governments and providers. This review will highlight the key changes that must be made for the benefit of the millions of Australians with a mental illness. Such changes need to empower users of care systems to choose options that actively support coordinated and efficient care delivery systems.

Content not available PDF Share



  1. Archer, J, Bower, P, Gilbody, S, Lovell, K, Richards, D, Gask, L, Dickens, C and Coventry P 2012. Cochrane Review: Collaborative Care for People with Depression and Anxiety, October 17. 
  2. Australian Bureau of Statistics 2008. National Survey of Mental Health and Wellbeing 2007, Canberra. 
  3. Australian Government 2011. Characteristics of Disability Support Pension Recipients, June, viewed June 2012,
  4. Australian Institute of Health and Welfare 2012. Australia’s Health, Canberra. 
  5. Australian Institute of Health and Welfare 2013. Health Expenditure Australia 2010-11, Canberra, viewed August 2013,
  6. Australian Public Service Commission 2004. Connecting Government: Whole of Government Responses to Australia’s Priority Challenges. Good Practice Guides, Management Advisory Committee, Canberra. 
  7. Australian Public Service Commission 2012. State of the Service Report, Microagency Survey Results 2012, viewed July 2012,
  8. Australian Social Inclusion Board 2011. Addressing Barriers for Jobless Families, Australian Government, Canberra. 
  9. Begg, S, Vos, T, Barker, B, Stevenson, C, Stanley, L and Lopez, A 2007. The Burden of Disease and Injury in Australia 2003, Australian Institute of Health and Welfare PHE 82, Canberra. 
  10. Betancourt, JR, Green, A, Carrillo, J and Ananeh-Firempong, O 1996. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and healthcare, Public Health Report, 118(44): 293–302 
  11. Bodenheimer, T 2008. Coordinating care – A perilous journey through the health care system, New England Journal of Medicine, 358: 1064–70. 
  12. Brown, R 2009. The Promise of Care Coordination: Models that Decrease Hospitalizations and Improve Outcomes for Medicare Beneficiaries with Chronic Illnesses, National Coalition on Care Coordination (NC3), University of Birmingham. 
  13. Cabinet Office, United Kingdom 1999. Modernising Governance, CM4310, Her Majesty’s Stationery Office, London. 
  14. Capp,o D, McGorry, P, Hickie, I, Rosenberg, S, Moran, J and Hamilton, M 2011. Including, Connecting, Contributing: A Blueprint to transform Mental Health and Social Participation in Australia, viewed June 2011,
  15. Commonwealth Ombudsman 2010. Falling Through the Cracks, Report No. 13/2010, Canberra. 
  16. Considine, M and Lewis, J 2003. Bureaucracy, network or enterprise? Comparing models of governance in Australia, Britain, the Netherlands, and New Zealand, Public Administration Review, 63(2): 131–140 
  17. Council of Australian Governments 2006. National Action Plan on Mental Health 2006-11, viewed November 2010,
  18. Council of Australian Governments 2009. National Action Plan on Mental Health, Second Progress Report, September, Canberra. 
  19. Council of Australian Governments 2011. National Action Plan on Mental Health, Third Progress Report, June, Canberra. 
  20. Crosbie, D 2009. Mental health policy – Stumbling in the dark? Medical Journal of Australia, 190(4): S43-S45 
  21. Dench McLean Carlson 2008. Final Report for Evaluation of the Prevention and Recovery Care (PARC) Services Project, viewed May 2012,  
  22. Ehrlich, CE, Kendall, E, Muenchberger, H and Armstrong, K 2009. Coordinated care: what does it really mean? Journal of Health & Social Care in the Community, 17(6): 619. 
  23. Freijser, L and Brooks, P 2013. Addressing Workforce Challenges for Youth Mental Health Reform, The Australian Health Workforce Institute and Orygen Youth Health Research Centre, viewed August 2013,
  24. Fuller, JD, Perkins, D, Parker, S, Holdsworth, L, Kelly, B, Roberts, R, Martinez, L and Fragar, L 2011. Building effective service linkages in primary mental health care: A narrative review part 1, BMC Mental Health Research, 11(72), viewed July 2012,
  25. Gorey, KM, Leslie, DR, Morris, T, Carruthers, WV, John, L and Chacko, J 1998. Effectiveness of case management with severely and persistently mentally ill people, Community Mental Health Journal, 34(3): 241-50. 
  26. Institute of Medicine 2001. Improving the Quality of Health Care for Mental and Substance Abuse Conditions, The National Academies Press, Washington DC. 
  27. Kings College London 2010. World and Challenges Survey, London. 
  28. Latham, M 1998, Civilising Global Capital, Allen and Unwin, Sydney. 
  29. McDonald, KM, Sundaram, V, Bravata, DM, Lewis, R, Lin, N, Kraft, S, McKinnon, M, Paguntalan, H and Owens, DK (eds) 2007. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, Technical Review 9.7, Agency for Healthcare Research and Quality, Publication No. 04(07)-0051-7, Rockville, MD. 
  30. McGorry, P, Purcell, R, Hickie, I and Jorm, AF 2007. Investing in youth mental health is a best buy, Medical Journal of Australia, 187(7): 5-7 
  31. Meehan, T, Madson, K, Shepherd, N and Siskind, D 2010. Final Evaluation Report of the Qld Government’s Housing and Support Program (HASP), Department of Psychiatry, University of Queensland, Brisbane. 
  32. Mendoza, J, Bresnan, A, Rosenberg, S, Elson, A, Gilbert, Y, Long, P, Wilson, K and Hopkins, J 2013. Obsessive Hope Disorder: Reflections on 30 years of mental health reform in Australia and visions for the future, ConNetica Consulting, Caloundra, Australia. 
  33. Mental Health Coordinating Council of NSW 2011, Care Coordination Literature Review and Discussion Paper, July, Sydney. 
  34. Mental Health Council of Australia 2005. Not For Service, Canberra. 
  35. Mental Health Council of Australia 2006. Time for Service, Canberra. 
  36. Mental Health Council of Australia 2009. Let’s Get to Work: A National Mental Health Employment Strategy for Australia, Canberra. 
  37. Muir, K, McDermott, S, Gendera, S, Flaxman, R, Patulny, R, Sitek, T, Abello, I, Oprea, I and Katz, I 2009. Independent Evaluation of headspace: The National Youth Mental Health Foundation, SPRC Report 19/09, Social Policy Research Centre, University of New South Wales, Sydney. 
  38. NSW Legislative Council Select Committee on Mental Health 2002. Final Report, December, Sydney. 
  39. Organisation for Economic Cooperation and Development 2008, Breaking Out of Silos: Joining Up Policy Locally, Working Paper, OECD LEED Programme. 
  40. Parliament of NSW 2012. Act to Establish a NSW Mental Health Commission 2012, viewed May 2012,
  41. Perkins, D, Owen, A, Cromwell, D, Adamson, L, Eagar, K, Quinsey, K and Green, J 2001. The Illawarra coordinated care trial: Better outcomes with existing resources? Australian Health Review, 24(2): 161–171. 
  42. Rosenberg, S, and Hickie, I 2012. Better Outcomes or Better Access – which was better for mental health care? Medical Journal of Australia, 197 (11): 619–620. 
  43. Rosenberg, S and Rosen, A 2012a. It’s Raining Mental Heath Commissions – Prospects and Pitfalls in Driving Mental Health Reform, Australasian Psychiatry, 20(2): 85-90 
  44. Rosenberg, S and Rosen, A 2012b. Can Mental Health Commissions really drive reform? Towards better resourcing, services, accountability and stakeholder engagement, Australasian Psychiatry, 20(3): 193-198. 
  45. Rosenberg, S, Russell, L and Mendoza, J 2012, Well Meant or Well Spent? – Accountability for $8bn of Mental Health Reform, Medical Journal of Australia, 196(3): 159-161. 
  46. Schifalacqua, M, Hook, M, O’Hearn, P and Schmidt, M 2000. Coordinating the care of the chronically ill in a world of managed care, Nursing Administration Quarterly, 24(3): 12–20. 
  47. Schizophrenia Research Institute 2012. About Schizophrenia, viewed July 2012,
  48. Scott, E, Naismith, S, Whitwell, B, Hamilton, B, Chudleigh, C and Hickie, I 2009. Delivering youthspecific mental health services: The advantages of a collaborative, multi-disciplinary system. Australasian Psychiatry 17(3): 189-194. 
  49. Self-Directed Care Scotland, Summary – Self Directed Care Scotland, viewed July 2012,
  50. Senate Report 2006. Select Committee on Mental Health, From Crisis to Community, Canberra.
  51. Senate Report 2010. Senate Community Affairs Committee, The Hidden Toll, Canberra. 
  52. Shergold, P 2005. Bringing Government Together, speech to the IPAA SA conference Connecting Government, 8 April. 
  53. Singh, D, and Ham, C 2005. Transforming Chronic Care: Evidence about Improving Care for People with Long-term Conditions, Health Services Management Centre, University of Birmingham, Birmingham. 
  54. Smith, T and Sederer, L 2009. A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a ‘Mental Health Home’, Psychiatric Services, 60(4): 528–33. 
  55. Tsemberis, S, Gulcur, L and Nakae, M 2004. Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals with a Dual Diagnosis, American Journal of Public Health, 94(4): 651– 656. 
  56. University of Melbourne 2008. Asia-Pacific Community Mental Health Development Project Summary Report, Melbourne. 
  57. World Health Organisation 2001. Mental Health: A Call for Action by World Health Ministers, 54th world health assembly, Geneva, viewed October 2013,
  58. Zwarenstein, M, Goldman, J and Reeves, S 2009. Interprofessional collaboration: Effects of practicebased interventions on professional practice and healthcare outcomes, Cochrane Collaboration, July 8, viewed at .



  • |