4698 Organisational Governance And Performance Management 2

4698 Organisational Governance And Performance Management 2

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4698 Organisational Governance And Performance Management 2

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4698 Organisational Governance And Performance Management 2

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Course Code: 4698
University: Western Sydney University

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Country: Australia

Question:
Topic: Mental Health Reforms
Rationale: Implementing governance reforms is a central task for any health manager and reforms permeate all levels of the organisation/health system. Making the link from strategic to operational planning and implementation and avoiding any implementation gap is the difficult part of the manager’s role. Implementations issues, problems and unexpected or adverse effects of reform can sometimes be identified. Feedback on this is important for all stakeholders to advance health system development.
Task:
Identify a recent health reform of your choice, within the last five years or less. Students may analyse the recent Australian health reforms or select a reform from another country after discussion with and approval by the lecturer. Using report format interpret the objectives of the reform, critically evaluate the strategy and explore opportunities for further reform development.
 
Answer:
Introduction
Mental health disorders can be referred to as a wide range of cognitive disorder that affects the mood, thinking, behaviour. Mental health disorder affects social, professional as well as the personal relationship of the patients. It also causes marginalisation and social isolation, impact their interaction with the community (Bauer & Moessner, 2012). Some of the most common mental health disorders that can be found in Australia are depression, dementia, bipolar disorder, and schizophrenia and anxiety disorder.
This report will discuss about the E mental health reforms made by the Australian government for providing online mental health care to the mental health patients.
Mental health illness prevalence in Australia
Mental health illness is very common in Australia. One in five of the Australians experience from mental health problems. The common mental health disorders that the Australian faces are anxiety disorder that could develop depression. Out of 20 % of the Australians suffering from mental health disorders, 11.6 % suffer from one disorder. Depression has been found to be one of the non-fatal disease in Australia (23%) (Australian Department of Health. 2012). While suicide accounts for relatively a small proportion of death for the young people within the age 15-24. Suicide due to mental health disorders has been found to be a matter of concern. Some of the groups that are vulnerable to suicide due to mental health disorders are aboriginals and the Torres Strait Islander. Females are more likely than males to face from anxiety disorders (Australian Department of Health., 2012). A wide number of social factors have been found to be associated with mental health disorders, such as isolation and marginalisation, racism and discrimination, marginalisation, poverty, substance use or dementia like neurodegenerative diseases.
Till now the Australian government had been trying their best to reduce several mental health reforms for improving the quality of life of the people with mental health illness. Most of the mental health policies under the National Mental Health Strategy has led to a significant change in the mental health services in Australia, including the inclusion of the mental health services in the primary care services, compared with the heavy dependence on the inpatient services, which features the mental health system of Australia (Meurk et al., 2012).
 
E Mental health strategy
The choice of topic for this discussion is the ” E-mental health strategy in Australia”. The main aim of the E-mental health strategy is to provide a successful online mental health and crisis support services for the public. It aims to provide services to the people at times and place that is convenient for them and offer an effective alternative treatment that is effective for people living in remote areas with limited services (Australian Government Department of Health and Ageing, 2016).
The main rationale for the government to build such services is that, government has recognise that access to appropriate health care services and to engaging people with online and telephone support is required to assist people with the mental health disorders .
The Australian government has invested about $ 70.5 million for the development of the e-mental health services, which has given rise to several online therapies and phone based automated services (Australian Government Department of Health and Ageing, 2016). A youth focussed telephonic and online counselling service in intended for enabling the young people to access the e-mental health service that has been specifically designed as per the needs of the patient. An E-mental health portal has also been made that would provide accessible pathways for the carers and the consumers for navigating and accessing the online health service. The e- mental health will provide all the information about mental health (Australian Government Department of Health and Ageing, 2016). A guided search tool will be available to understand the health needs of the person. It will also provide a variety of links to several self-help program. It will also provide an additional avenue to the traditional face to face services and also allow for providing feedbacks by the customers. One of the most notable reforms that the government has made are the virtual clinic and the Australian government had spent about the $23 million dollar for the establishment of the virtual clinic, that will provide therapy options for those individuals looking for an online counselling program. These online counsellor are normally counselled by a trained counsellor (Australian Government Department of Health and Ageing, 2016). The virtual clinic also has provisions for making referrals to other mental health care services. This type of facilities are normally useful for those patients suffering from mild to moderate anxiety and depression. Furthermore the Australian government has also allocated $38.6 million by the help of Telephonic Counselling, self-help and the web based counselling. E-mental health support services has been established to work on the traditional primary care providers for promoting the online services and fir developing strong linkages between the two sectors (Mucic & Hilty, 2015). The E-mental health support services has a wide range of responsibilities such as providing clinical support, including the promotion of the e-mental health to the health professionals (Lal & Adair, 2014). As per the reform then by the Australian government, the e-mental health services training should be given to the health professionals keeping the aboriginal at the first priority. The service has also promised to provide a basic training that is required by all the health professionals (Lal & Adair, 2014). They will also examine as to what cognitive behavioural therapies could be given to the workers providing support to the online clinical services (Wozney et al., 2013).
 
Benefits
There are several benefits of the E-mental health services. Patients can easily get access to an app or website via their phone and can access them at any time of the day. Apps can also utilise the social media for encouraging the patient to remain adhered to the treatment. Social support in e mental health services can occur through several web based formats like bulletins, discussion group, blogs, chat room and social media (Mucic & Hilty, 2015). Lal & Adair, (2014), has opined on a pilot study that evaluated the effectiveness of the online electronic bulletin board for providing social support to the parents of the children suffering from mental health disorders. It has been found that the parents actively responded in the bulletin board by posting and responding to the messages to each other about the illness of their children (Musiat & Tarrier, 2014).  Sensors are built on the phone for incorporating the environment specific cues and the appropriate responses. Mood GYM is web based program that is freely available to the public and has been evaluated in several randomised control trials (Van Der Krieke et al., 2013). The purpose of this web based therapy is to increase the copping skill related to depression and anxiety and also includes workbooks, assessments and online exercises. The website is now freely available to the public and has been translated into several languages (Lal & Adair, 2014).
 
Limitations
Christensen & Petrie, (2013), have analysed the E-mental health services to be one of the costliest service of treatment; hence the rationale behind the government to involve the aboriginals in the E-mental health is questionable. Jorm, Morgan & Malhi,  (2013) ,have questioned as whether the current E-mental health are effective than the traditional mental health treatment. There had been issues related to the privacy around the implementation of the E-mental health service. There are some apps that transmits the patient identifying information, raising a huge flag as that can lead to the information being accessed by the unintended parties (Andersson & Titov, 2014). Security threat might occur due to the design and the probability. Normally. The monitoring system helps to record the health care data of the patient from the BANs to be transferred to the health care providers. Unauthorised developers can build system for spying on the patient data. Again patient information interception during their transmission through the hospital LAN can also occur. Attacks may also cause at the storage level such as modification of the patient information or changing the configuration of system monitoring services.  Also there are several apps that are available but it is not known which are effective. Again, the cost of accessing the therapy on the basis of the app might cause some issue to the patients, depending on the situation of the insurance and finance. Some of the eMH do not help the patient to file for a reimbursement. Other programs need to be subscribed. These type of approach might not be helpful for most of the population who are at risk, as in most of the cases the vulnerable groups belong to low socio-economic status and cannot afford any kind of subscription based treatment. Again many of the states do not allow any psychologist that does not stay in the same state, hence the service provider has to be licensed in the home state of the patient. Jorm, Morgan & Malhi,  (2013) have also stated that online therapists cannot respond quickly to crisis situations. For example, it is very difficult to manage a client having suicidal thoughts. Hence, E-therapy is not suitable for serious psychiatric illness that requires close supervision and direct treatment. Although online therapies removes geographic restraints, many of the online therapists cannot see the facial expressions, body language or the vocal signals (Smeets, 2016). Body language are sometimes helpful in giving a clear version of the feelings, thoughts, behaviours or moods of the patient. There are some delivery methods such as voice over internet technology, but that lacks the privacy, but lack intecracy or the intimacy of real life face to face conversations. Since, the online therapies limits the geographical constraints, it causes the enforcement of the legal, code and the ethics a bit difficult. Therapists can treat clients from anywhere in this world and all the states has got different licensing requirements and treatment guidelines (Andersson & Titov, 2014).  
 
Recommendations 
Based on the limitations of the e mental health therapy, current approaches for increasing the effectiveness of this e mental health reform should be made. In regards to the funding, government funding has to be increased in terms of staffs training and tightening of the cyber security to avoid breaching of the privacy and confidentiality. In relation to the cyber security, there should be proper multitiered security frame work that is based on the key-pre-distribution schema, biometric based security frame- work has to be made (Musiat & Tarrier, 2014). Biometric based security frame-work has to be made for the data authentication between the WBAN. In order to utilise such high technologies extensive governmental funding is required. One of the important recommendation is based on the fact, that in most of the cases, the e therapies cannot be accessed by the low-income group, in this cases cost friendly programs and apps can be made for providing care to the vulnerable group (Reynolds et al., 2012). E Mental health promotion program is required to be robust for disseminating the aims and the objective of the e mental Health strategy. Effective campaigning in the remote areas, providing them information about the use of the apps can be effective. Furthermore, focus should be given on the cost management of the online therapies such that they can be accessible to all, irrespective of the socio-economic status.
Conclusion
In conclusion it can be said that, although the E-mental health can be effective in providing mental health care to the people residing in the remote areas or in any parts of the world from any therapists of the choice, but the care service provision is surrounded by several barriers such as confidentiality and privacy . Furthermore, the e- therapies are also not suitable for the patients belonging to low socio-economic status and hence the recommended way for the improving the reform is to make out cost effective ways of providing E-mental health services to the people who are at risk.
 
References
Andersson, G., & Titov, N. (2014). Advantages and limitations of Internet?based interventions for common mental disorders. World Psychiatry, 13(1), 4-11.
Australia, Department of health. (2012).Progress of mental health system reform in Australia. Access date: 1/11/2017 Retrieved from: https://www.health.gov.au
Australian Department of Health., (2012).Prevalence of mental disorders in the Australian population.Access date: 1/11/2018. Retrieved form :https://www.health.gov.au
Australian Government Department of Health and Ageing, (2016). E?Mental Health Strategy for  Australia .Access date: 1/11/2017 Retrieved from: https://www.health.gov.au/internet/main/publishing.nsf/Content/7C7B0BFEB985D0EBCA257BF0001BB0A6/$File/emstrat.pdf
Bauer, S., & Moessner, M. (2012). Technology-enhanced monitoring in psychotherapy and e-mental health. Journal of Mental Health, 21(4), 355-363.
Casey, L. M., Joy, A., & Clough, B. A. (2013). The impact of information on attitudes toward e-mental health services. Cyberpsychology, Behavior, and Social Networking, 16(8), 593-598.
Christensen, H., & Petrie, K. (2013). State of the e-mental health field in Australia: where are we now?. Australian & New Zealand Journal of Psychiatry, 47(2), 117-120.
Jorm, A. F., Morgan, A. J., & Malhi, G. S. (2013). The future of e-mental health.
Lal, S., & Adair, C. E. (2014). E-mental health: a rapid review of the literature. Psychiatric Services, 65(1), 24-32.
Meurk, C., Leung, J., Hall, W., Head, B. W., & Whiteford, H. (2016). Establishing and governing e-mental health care in Australia: a systematic review of challenges and a call for policy-focussed research. Journal of medical Internet research, 18(1).
Mucic, D., & Hilty, D. M. (Eds.). (2015). e-Mental health. Springer.
Musiat, P., & Tarrier, N. (2014). Collateral outcomes in e-mental health: a systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health. Psychological medicine, 44(15), 3137-3150.
Reynolds, J., Griffiths, K. M., Cunningham, J. A., Bennett, K., & Bennett, A. (2015). Clinical practice models for the use of e-mental health resources in primary health care by health professionals and peer workers: a conceptual framework. JMIR mental health, 2(1).
Smeets, O. (2016). E-mental health. Bijblijven, 32(5), 359-363.
Van Der Krieke, L., Wunderink, L., Emerencia, A. C., De Jonge, P., & Sytema, S. (2014). E–mental health self-management for psychotic disorders: State of the art and future perspectives. PsychiatricServices, 65(1), 33-49.
Wozney, L., Newton, A. S., Gehring, N. D., Bennett, K., Huguet, A., Hartling, L., Dyson, M. P., … McGrath, P. (2017). Implementation of eMental Health care: viewpoints from key informants from organizations and agencies with eHealth mandates. BMC medical informatics and decision making, 17(1), 78. doi:10.1186/s12911-017-0474-9

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