Policy, Power and Politics in Health Care - Aboriginal Health Policy

Health Care Assessment

Case Scenario/ Task

Identify a current Aboriginal health policy (state or national) Provide a detailed analysis of the policy which includes identifying three relevant stakeholder groups and appraising their capacity to infuence decision making on the policy from a political and power perspective (see assessment marking criteria below).

10% Analyses and reframes the issue that led to the policy being developed

10% Summarizes the implementation of the policy

20% Appraises the capacity of the selected stakeholder groups to influence decision making on this issue from a political and power perspective

30% Analyses the policy clearly and comprehensively using a logical approach

10% justifies whether the policy should be considered a success or a failure based on evidence of wide reading

10% Validates perspectives through correct interpretation and explicit linkage of relevant and current literature (> year 2004) to the assessment focus

10% Produces correct grammar, spelling, formatting, style (report) and referencing

Introduction

Policy Analysis is defined as a process that is designed to provide decision makers with insights on functional aspects of a particular policy with relation to effects of the policy on social, environmental, economic and political factors (NSW Government, 2007). Analysing a policy also facilitates deeper understanding and provides valuable insights on areas to intervene while trying to improve or develop the policy further. In this context, the current attempt is aimed at analysing a state level mental health policy. The policy directive is titled as 'Aboriginal Mental Health and Well Being Policy 2006-2010' and the policy has been developed so as to help the NSW Government in providing high quality and culturally appropriate mental health care to Aboriginal and Torres Strait Islanders residing in NSW. Although developed for the time frame of 2006-2010, the policy has been reviewed in 2012 and is currently operational. While trying to analyse the policy, the impending issue for which the policy was developed will be framed followed by summarising implementation of the policy. Three main stakeholders will be identified and their decision making capacity will be commented on from a political and power perspective. The paper would also comment to determine if the policy can be considered as a success.

The Issue

Many national and state level reports in Australia have identified the need for improving mental health of Aboriginal communities and delivering more culturally appropriate care to them. Mental health needs of Aboriginal and Torres Strait Islanders are far more complex as compared to non-aboriginal communities. Inhabitants of stolen generations continue to feel a sense of loss, trauma, grief and erosion of their family structures thereby subjecting them to significant emotional burden (NSW Government, 2007). The situation is further complicated by poor physical and social well-being. Further, members of Aboriginal and Torres Strait Islander communities continue to feel that their needs are improperly recognised and represented in the healthcare system (NSW Government, 2013). This acts as a barrier and aboriginal individuals often shy away from contacting professional mental health services. Literature presents additional evidence in favour of the fact that members of the Aboriginal and Torres Strait Islander communities lack awareness about services that are present in the community so as to help them and this often complicates their state of mental health (AIHW, 2014).

Since NSW is the home to many distinct and unique Aboriginal and Torres Strait Islander communities, the government realised that it needed to do something in order to better represent the voice of these communities, increase awareness and cater to their specific needs (AIHW, 2014). Despite presence of a nationalised framework, the policy was developed so as to specifically elaborate the goals and objectives of NSW government in terms of improving mental health of aboriginal community members. Overall, the policy can be considered as a sub-set of the national mental health framework that is focused on needs of specific groups of individuals (NSW Government, 2007).

Policy Implementation

Implementation of this policy was divided into five major parts. First part in implementation involved development of a strong working relationship. With this implementation strategy, the NSW government hoped to improve participation of aboriginal communities in their healthcare (NSW Government, 2013). This implementation involved roping in General Practitioners, local mental healthcare service providers and community workers to access independent aboriginal communities in the area and access and represent their needs better. Effective referral and access pathways were established to make mental healthcare more accessible to targeted individuals (MHC, 2013).

Step two of policy implementation involved working on improved responsiveness and access. Senior members from Aboriginal Mental Health Services (AMHS) were appointed as heads of mental health service department. Mental Health First Aid courses were delivered to communities in order to raise awareness and community workers were sent out to each independent community so as to ensure that aboriginal communities at large were aware of services that existed for them (MHC, 2013).

Step three of implementation consisted of developing area specific plans. Area specific guidelines were developed for each age group and for various mental illness categories including depression, suicide intentions, schizophrenia and anxiety disorders (NSW Government, 2007).

Step four of implementation concentrated on improving knowledge and expertise. Community healthcare workers and General Practitioners were trained regarding aboriginal mental healthcare needs and a standardised patient registration network was established (AIHW, 2014).

Step five of implementation concentrated on improving the availability of skilled workforce. Scholarships were awarded to mental health professionals and additional mental health position were announced in state and community level hospitals. Workforce programs were introduced so as to train professionals further (NSW Government, 2013).

Stakeholder Groups and Decision Making

First and most important stakeholder group in this policy consists of members of Aboriginal and Torres Strait Islander communities as they also form the target population of this policy. Their power to influence decision making from a power and political perspective is fairly limited. The policy clearly specifies that attempts were made so as to increase participation from members of the aboriginal community (NSW Government, 2007). For this purpose, awareness programs were launched, senior members from AMHS were handed the responsibility of heading mental health services and additional mental health positions were created at state and community level. Community representatives, general practitioners and community service providers were also involved while creating and implementing the policy (NSW Government, 2013). However, the policy has been created based on interpretations of community representatives and heads of various community services. It is not well known if these perspectives are representatives of the actual population (AIHW, 2014). Also, representatives and senior members who were appointed as heads of mental health service provision have been largely selected by the government or by organisations that are government funded (MHC, 2013).

Therefore, it is possible that requirements and perspectives which do not agree with the government's way of working have not been represented. Finally, once the policy was created and implemented, target population did not have any power to change the manner of functioning. They could express their views and concerns with the help of participation gateways that were created, but could not influence decision making. Therefore, this stakeholder group has fairly limit power to influence decision making (NSW Government, 2007).

The second most important stakeholder group is the NSW government which is also the creator of this policy. Their power to influence decision making from a power and political perspective is supreme. Government officials were directly involved in selecting and deploying officials in each area of NSW (MHC, 2013). They also played a vital role in collecting data, interacting with chosen representatives and deciding on measures which would best serve to improve mental health of aboriginal community members residing in NSW. NSW government was also directly involved in evaluating success against defined outcome criterion post policy implementation and reserved full and complete rights to make changes as necessary (AIHW, 2014).

A third important stakeholder group consists of mental health service providers in NSW. Their power to influence decision making from a power and politics perspective is moderate. Service providers in the community were roped in to gather their perspective and the perspective of members of the aboriginal community (NSW Government, 2013). They were involved when the policy was being created and had a say when the policy was being implemented. Therefore, it was possible for them to moderately influence decisions. Also, their opinion was taken into account when policy outcomes were being reviewed and this created space for their opinion (NSW Government, 2007).

Policy Success

Looking at mental health statistics as shared by the Australian Bureau of Statistics, it can be seen that reported Aboriginal and Torres Strait Islander mental health cases slightly declined post policy implementation (NSW Government, 2007). Number of depression cases witnessed a 4% decline whereas the number of suicide intention cases witnessed a 6.2% decline (ABS, 2010). Number of reported cases for anxiety disorders witnessed a decline of 3.6% after the policy was implemented (ABS, 2010). Surveys across NSW however failed to report a major difference in mental health awareness and education and access to mental health services is still considered a major barrier. Therefore, it might be suggested that the policy was partially successful in achieving its objectives (NSW Government, 2007).

Conclusion

Looking at the policy analysis conducted above, it might be concluded that the policy titled 'Aboriginal Mental Health and Well Being Policy 2006-2010' was partially successful in achieving its outcome measures. The policy was created so as to define specific goals and objectives of the NSW government in achieving better mental health outcomes for aboriginal and Torres Strait Islander population groups residing in NSW. Policy implementation took place in five parts including pressing for greater awareness and improving participation of community members. The community members however only had a moderate say in making policy related decisions. NSW government reserved greatest decision making rights and was responsible for evaluating outcomes of the same.