**5. Conclusions**

Australia has not produced a comprehensive report or evaluation of its national mental health planning effort. This means that, despite myriad plans and reports, it is not possible to assess the extent to which this work has translated into effective change, the costs, nor the impact on individual outcomes or systemic improvement.

Even where partial data have been reported, there was no independent verification of the data provided and, particularly in the first years, the quality and range of data varied between jurisdictions. There was no way to marry annual mental health budget allocations to actual expenditure or to the costs of services. These matters limited the extent to which data could be usefully interpreted for benchmarking between jurisdictions. Australia has lacked consistent data sets. Overlapping reports, indicator sets and report cards have perpetuated confusion, not clarity.

The 1992 National Mental Health Reform Strategy had broad aspirations and called for reporting on areas of consumer and carer rights, legislation and other matters. Unable to meet the challenge of this breadth, initial reporting focused on the regular publication of mostly public mental health service activity data and related issues, such as expenditure and staffing. Some resources were provided initially to support the reporting process, but these were discontinued. This limited the further expansion of the reporting process.

As new plans emerged, the focus of mental health reforms shifted, seeking to consider issues beyond the health system. Since the CoAG in 2006, the reporting process has been subject to increasing pressure as competing policies and plans frequently emerged.

The initial clarity of purpose became confused. Commitments to better accountability were made, but resources were not provided. Mental health reporting has been managed and proceeded largely unchanged under MHISSC, leaving other mental health stakeholders outside the design process. All these factors have contributed to making the mental health data collection and reporting process less relevant over time.

Other existing mental health reporting mechanisms provided by the AIHW and the Productivity Commission focus on health services and operate without set targets. Neither impels identifiable processes of quality improvement. The new National Cabinet reporting arrangements established under COVID have diminished the mental health accountability obligations of all governments.

In 2020, the AIHW sought stakeholder views regarding a future National Health Information Strategy, considering issues such as data collection, access, reporting, privacy and so on, but without specific reference to mental health data. In response, some stakeholders suggested an urgen<sup>t</sup> need for patient-reported outcome measures in mental health [68]. Mental Health Australia, the peak body, did not provide a submission to the AIHW. The separation of mental health data development from the rest of health has been a defining feature of the past thirty years of Australia's mental health strategy. There are clearly risks that this unhelpful separation could continue.

As of early 2022, the Australian governmen<sup>t</sup> has been announcing a series of bilateral agreements with each of the eight states and territories which will form the backbone of the sixth National Mental Health and Suicide Prevention Plan [69]. Details of these arrangements, including data collection and reporting obligations, are ye<sup>t</sup> to be made public.

The establishment of an entirely new accountability framework was a key recommendation of the Productivity Commission [46]. This framework will need to facilitate new approaches to regional modelling, governance and reporting across the whole 'ecosystem' of mental health. It will require expertise and resources. It must be based on a robust process of co-design, properly accounting for the different, but related, needs of planners, funders, service providers, consumers, carers, researchers and others. These are the ingredients for effective systemic oversight and local quality improvement. Such a system can build new community trust in our mental health system.

**Author Contributions:** S.R. prepared the manuscript of this article. L.S.-C., G.M. and I.H. provided comments and edited the paper. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.
