Abuse and mental health policy: a (dis) connection?

Originally submitted for Australasian Digital Theses (ADT) database.

Submission note: A thesis submitted in total fulfilment for the requirements for the degree of Doctor of Public Health [to the School of Public Health], Faculty of Health Sciences, La Trobe University, Bundoora.

Abstract: Family violence and sexual abuse are serious issues for people with mental illness. The literature on abuse and mental illness provides evidence about the prevalence of abuse in the lives of those with mental illness and the connection between abuse and the development of mental illness. Mental health policy ought to direct mental health services as how to prevent (further) abuse, and how to ensure sensitive approaches to detecting and responding to the abuse histories of mental health clients. This research project investigates the level of policy guidance on abuse for mental health services. The study followed a qualitative research framework, integrating the Australian Policy Cycle developed by Bridgman and Davis (Bridgman & Davis, 2004) as a framework for the investigation of mental health policy. Two studies were undertaken: Study one, conducted a document analysis of mental health policies, with the sample comprising all available mental health policy from both the Commonwealth and Victorian Governments, as well as specific policies on abuse for mental health services. Utilising content analysis, the researcher developed a coding system and analysed those policies that include references to 'abuse'. For Study two key stakeholders in NSW and Victoria were interviewed. The researcher developed two interview schedules in accordance with findings from Study one, which found different levels of policy in those two states. The results of this research are consistent with the Australian Policy Cycle. The findings on drivers and barriers were consistent with the stages of 'agenda setting' and 'implementation' proposed by this approach. The study found a lack of policy guidance for mental health services in Victoria. In contrast the NSW state government provided clear guidance and expectations of how to work with clients with abuse histories. Its marked lack of policy direction has left Victoria without a statewide strategy and out of step with international developments. Lack of policy guidance leaves it up to individual mental health services or individual staff to find ways to address abuse issues within mental health care provision. The thesis concludes with a discussion of its limitations and makes suggestions for future studies which could focus on the impact of policy variations on consumers, and/or the degree of difference these variations have had on mental health clinical care. To conduct a comprehensive analysis of success and failure of such policies, a thorough evaluation of the NSW experience could be undertaken. The thesis concludes with recommendations about policy development and implementation needed in Victoria, if the Victorian state government were to seriously engage with addressing the abuse issues of those with mental illness. Building on the experience from NSW, Victoria could develop policy for mental health services that addresses both sexual assault and family violence in a coordinated way. The associated implementation process could be linked to existing training bodies; and the evaluation strategy could ascertain the level of change and quality of service delivered to those members of society often deemed as 'most vulnerable'. Such coordination in order to prevent and remediate abuse would not only provide those with mental illness who have abuse histories with high quality support, but would facilitate the implementation of mental health care in accordance with a population health framework, and would include mental health promotion and prevention—as has been advocated throughout Australia and internationally.