QLD Sets Benchmark in Mental Health Reform

Queensland’s peak body for the community mental health sector has achieved what it describes as “a profound leap forward” in community sector and State Government relations, following the successful co-design of a new service provision document.

After months of negotiation and consultations following the withdrawal of Queensland Health’s disputed original Request for Offer (RFO) for community-managed mental health services, the Queensland Alliance for Mental Health (QAMH) and Queensland Health have achieved a new, co-designed RFO.

The original RFO, released last August, introduced a contestability approach as part of the Queensland Government’s reform of the mental health services sector. It gave service providers just four weeks to submit their offers.

The RFO’s release sparked an immediate backlash, with stakeholders claiming its requirements demonstrated a lack of understanding about the community mental health sector.

QAMH Director of Strategy and Partnerships Amara Bains said most of the community mental health sector in Queensland was operated by Not for Profits (NFPs) and non-government organisations (NGOs), who were not in a position to quickly launch into a contestability process.

“The first RFO came out without a realistic time frame given the capacity of this sector; it asked for things that just weren’t possible for our members to achieve in a short period,” Bains said.

“If you are trying to create a market and apply contestability principles, you need a more mature market; in our sector we have an immature market.”

Bains said policy makers also needed to allow sufficient time if they wanted to achieve sustainable policy reform, particularly when working with sectors such as theirs.

After these concerns were raised with Queensland Health and also the Department of Premier and Cabinet, the State Government decided to withdraw the RFO and consult further with the sector.

The parties later agreed to embrace an innovative co-design approach to developing a new RFO. This involved the department, QAMH and other sector stakeholders working together to hold a series of stakeholder workshops and discussions, and follow an Investment Management Standard (IMS) approach to developing a new RFO.

Bairns said the co-design process required significant organisational cultural change for both partners, and QAMH played a major role by creating an environment where stakeholders and Queensland Health could constructively work together.

The most significant feature of the RFO is the opportunity for successful bidders to negotiate the schedules of the contract, providing greater flexibility for service providers.

“That was a major breakthrough,” Bains said. “It’s a flexible, sustainable approach…It creates accountability in providing services for people and ensuring you give them the support they need, while also enabling us to build the capacity of the sector to compete and participate in reform.”

Even though each of the partners had different “drivers”, she said they were able to agree on shared values for community mental health sector outcomes, which helped them move forward.

For example, the need to provide continuity of care was used as the foundation for all the discussions.

“We have managed this well together and really ensured that the people of Queensland are not suffering from this process either; it’s about remembering what we really are here for and not just boiling it all down to achieving economic efficiency,” Bains said.

“What we get with the new RFO is a win-win situation, not just for the Not for Profit sector in mental health and the government, but also for the people relying on mental health services."

QAMH CEO Richard Nelson said the Queensland Government had stressed the need for demonstrable value for money and efficiency, as well as the need to reform the State’s community mental health sector. However, he said there hadn’t been enough focus on continuity of care.

“By focussing on continuity of care we were able to navigate through intended and unintended consequences of reforming the sector,” Nelson said.

“As a result, we have co-designed a Request for Offer that enables reform over time.  

“It includes some unique features never offered to our sector previously.

“This is a profound leap forward in the relationship between Queensland Health and the community mental health sector – we believe our relationship with Queensland Health couldn’t be better.”

Nelson and Bains said the partnership approach by QAMH and Queensland Health can be offered as an example to other states – and probably other sectors – as a means of managing reform.

Bains believes the partnership can be replicated elsewhere. She said the approach would be equally relevant for other components of the health sector as well as other sectors that have significant NGO and NFP relationships.

“There are many theories and advice columns on relationship management, but what QAMH has achieved is a real life example of relationship management in a difficult and uncertain environment,” Bains said.

“We are willing and interested to share our experience and to work with others to mobilise their capabilities to do what we have done.”