**16. Conclusion**

234 Health Management – Different Approaches and Solutions

Porter further notes that such outcomes should involve survival, functional status, sustainability of outcome and "others". Eriksson (2011) comments on a number of preconditions to enhance individual social capital, a significant component of human value, which then results in enhanced health. These are a Macro Structure (Social and Political conditions, Income distribution) and Social Network Characteristics ( Internalised Norms, Group Solidarity and Reciprocity) that lead to enhanced social support, social influence, social control, social participation and material resources) which lead to health benefits such as access to support, health enhancing behaviours, increased status and rewards, enhanced cognitive skills, belongingness and meaning of predicament along with improved access to health services and job opportunities. Eriksson (ibid) reports that trust and reciprocity are essential cognitive features of such collective and individual social capital and that these appear to be core elements for creating a health supporting environment, one of the five action areas for health promotion defined by the Ottawa charter. It could, therefore be argued that

elements of the above should underpin any governance to enhance mental health.

shortage in about a decade.

increasing recognised (Parker et al 2010).

Other key aspects of governance as outlined by O'Connor and Paton above is the development of appropriate mental health legislation and mental health service policies to protect patients, their carers and the community and comparative surveillance of such developments. The Mental Health Atlas (World Health Organisation 2005) reports and compares the presence in and population coverage of mental health legislation and mental health service policies in a range of world regions. The Atlas similarly reports on workforce for mental health. However, statistics do not necessarily supply the full picture of emerging trends. An example is the significant potential decline in numbers of mental health nursing workforce in Australia. Changes to nurse education in the 1980's along with the changing nature of work in psychiatric nursing appear to have significantly reduced the entry of young people into the profession. As a result, there may be major problems replacing the current workforce as they retire, leading to a severe workforce

Mental health consumer employment within mental health services is an emerging and welcome development with consumer assisted services enhancing consumer outcomes with improved social functioning and reduced symptom severity and hospitalization (Nestor & Galletly 2008). However, it is essential that such consumer consultants be supported with training in addition to appropriate pay and conditions (ibid). The value of the role of family and carers in the management of people affected by severe mental illness is also being

The increasing use of outcome measures to assess disability and recovery as well as benchmarking where mental health services are gauged against each other and a number of key performance indicators (Coombs et al 2011) is another emerging mechanism in governance that needs to be considered. Porter (2010b) goes on to suggest a revised tier of hierarchies that is appropriate to assessing health outcomes. Tier One is whether the patient's health status is achieved or retained. Tier Two is the process of recovery of the patient and involves the time taken to achieve recovery and best attainable function in addition to the "disutility" of the care process (complications of treatment such as missed diagnoses and the ability to work whilst undergoing treatment). Tier Three involves the sustainability of the treatment process itself as well as any new health problems related to treatment. Such work encourages different ways of viewing different aspects of recovery in mental health and may

allow a more accurate estimation of the economic basis of mental health management.

The previous chapter has briefly outlined eight potential "mental health pillars of wisdom" that should be a strategic focus in any mental health funding formula to emphasise Recovery. The formula can obviously be adjusted to local economic social and cultural needs but provides a more comprehensive vision of a future for the provision of mental health. The "pillars" are also useful entities to attach specific funding priorities as well as benchmarks to assess achievement in each area.
