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Auditor-General Audit reports for 2012-13 No. 48 Performance audit Management of the Targeted Community Care (Mental Health) Program: Department of Families, Housing, Community Services and Indigenous Affairs


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T h e A u d i t o r - G e n e r a l

Audit Report No.48 2012-13 Performance Audit

Management of the Targeted Community Care (Mental Health) Program

Department of Families, Housing, Community Services and Indigenous Affairs

A u s t r a l i a n N a t i o n a l A u d i t O f f i c e

 

ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

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© Commonwealth of Australia 2013 

ISSN 1036-7632 ISBN 0 642 81366 3 (Print)  ISBN 0 642 81367 1 (On‐line) 

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ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

2

   

© Commonwealth of Australia 2013 

ISSN 1036-7632 ISBN 0 642 81366 3 (Print)  ISBN 0 642 81367 1 (On‐line) 

Except for the content in this document supplied by third parties, the Australian National Audit Office logo, the Commonwealth Coat of Arms, and any material protected by a trade mark, this document is licensed by the

Australian National Audit Office for use under the terms of a

Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Australia licence. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/3.0/au/

You are free to copy and communicate the document in its current form for non-commercial purposes, as long as you attribute the document to the Australian National Audit Office and abide by the other licence terms. You may not alter or adapt the work in any way.

Permission to use material for which the copyright is owned by a third party must be sought from the relevant copyright owner. As far as practicable, such material will be clearly labelled.

For terms of use of the Commonwealth Coat of Arms, visit It’s an Honour at http://www.itsanhonour.gov.au/coat-arms/index.cfm.

Requests and inquiries concerning reproduction and rights should be addressed to:

Executive Director Corporate Management Branch Australian National Audit Office 19 National Circuit BARTON ACT 2600

Or via email: webmaster@anao.gov.au

 

       

 

ANAO Audit Report No.48 2012-13

Management of the Targeted Community Care (Mental Health) Program

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Canberra ACT 19 June 2013

Dear Mr President Dear Madam Speaker

The Australian National Audit Office has undertaken an independent performance audit in the Department of Families, Housing, Community Services and Indigenous Affairs with the authority contained in the Auditor-General Act 1997. I present the report of this audit to the Parliament. The report is titled Management of the Targeted Community Care (Mental Health) Program.

Following its presentation and receipt, the report will be placed on the Australian National Audit Office’s Homepage—http://www.anao.gov.au.

Yours sincerely

Ian McPhee Auditor-General

The Honourable the President of the Senate The Honourable the Speaker of the House of Representatives Parliament House Canberra ACT    

ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

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AUDITING FOR AUSTRALIA

The Auditor-General is head of the Australian National Audit Office (ANAO). The ANAO assists the Auditor-General to carry out his duties under the Auditor-General Act 1997 to undertake performance audits, financial statement audits and assurance reviews of Commonwealth public sector bodies and to provide independent reports and advice for the Parliament, the Australian Government and the community. The aim is to improve Commonwealth public sector administration and accountability.

For further information contact: The Publications Manager Australian National Audit Office GPO Box 707 Canberra ACT 2601

Telephone: (02) 6203 7505 Fax: (02) 6203 7519

Email: webmaster@anao.gov.au

ANAO audit reports and information about the ANAO are available at our internet address:

http://www.anao.gov.au

Audit Team Michael DeMamiel Siobhan McDonnell Dr Andrew Pope

     

ANAO Audit Report No.48 2012-13

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Contents Abbreviations .................................................................................................................. 7 

Glossary ......................................................................................................................... 9 

Summary and Recommendations ............................................................................ 11 

Summary ...................................................................................................................... 12 

Introduction ............................................................................................................. 12 

Targeted Community Care (Mental Health) Program ............................................. 13 

Audit objective, scope and criteria .......................................................................... 15 

Overall conclusion ................................................................................................... 16 

Key findings by chapter ........................................................................................... 18 

Summary of agency response ................................................................................ 21 

Recommendations ....................................................................................................... 22 

Audit Findings ............................................................................................................ 23 

1.  Introduction ............................................................................................................. 24 

Background ............................................................................................................. 24 

Targeted Community Care (Mental Health) Program ............................................. 29 

Audit objective, scope, criteria and approach ......................................................... 32 

Report structure ...................................................................................................... 34 

2.  Program Planning and Management ...................................................................... 35 

Introduction ............................................................................................................. 35 

Program development and implementation ............................................................ 35 

Enhancement to the Targeted Community Care (Mental Health) Program ............ 41  Roles and responsibilities for ongoing administration ............................................. 42 

Risk management ................................................................................................... 43 

Conclusion .............................................................................................................. 46 

3.  Grant Assessment and Selection ............................................................................ 48 

Introduction ............................................................................................................. 48 

Program guidelines ................................................................................................. 48 

Selection processes used in the Targeted Community Care (Mental Health) Program ............................................................................................................. 49 

Recommendation No 1 ........................................................................................... 52 

Distribution of service providers .............................................................................. 54 

Conclusion .............................................................................................................. 55 

4.  Reporting and Monitoring ........................................................................................ 57 

Performance management framework .................................................................... 57 

Program evaluation ................................................................................................. 64 

Conclusion .............................................................................................................. 66 

 

ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

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AUDITING FOR AUSTRALIA

The Auditor-General is head of the Australian National Audit Office (ANAO). The ANAO assists the Auditor-General to carry out his duties under the Auditor-General Act 1997 to undertake performance audits, financial statement audits and assurance reviews of Commonwealth public sector bodies and to provide independent reports and advice for the Parliament, the Australian Government and the community. The aim is to improve Commonwealth public sector administration and accountability.

For further information contact: The Publications Manager Australian National Audit Office GPO Box 707 Canberra ACT 2601

Telephone: (02) 6203 7505 Fax: (02) 6203 7519

Email: webmaster@anao.gov.au

ANAO audit reports and information about the ANAO are available at our internet address:

http://www.anao.gov.au

Audit Team Michael DeMamiel Siobhan McDonnell Dr Andrew Pope

     

ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

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Appendices ................................................................................................................. 67 

Appendix 1:  Agency Response .............................................................................. 68 

Appendix 2:  Mental health key committee structure as at 2012 ............................. 71 

Appendix 3:  Targeted Community Care (Mental Health) Program Activities ......... 72  Appendix 4:  Targeted Community Care (Mental Health) implementation timelines.............................................................................................. 75 

Appendix 5:  Draft Revised Targeted Community Care (Mental Health) Program performance framework ....................................................... 77 

Index ............................................................................................................................. 80 

Series Titles .................................................................................................................. 82 

Current Better Practice Guides .................................................................................... 88 

Tables

Table S.1 Targeted Community Care (Mental Health) Program 2011-12 ......... 15  Table 1.1 Targeted Community Care (Mental Health) Program 2011-12 ......... 30  Table 1.2 Targeted Community Care (Mental Health) Program state and territory funding allocations and population size, 2011-12 ................ 32 

Table 2.1 Targeted Community Care (Mental Health) Program implementation 2007-10 .................................................................... 36 

Table 2.2 Targeted Community Care (Mental Health) Program risk assessment, February 2012 ............................................................... 45 

Table 2.3 Targeted Community Care (Mental Health) Program summary of service provider risk assessments, November 2012 .......................... 46  Table 4.1 Targeted Community Care (Mental Health) Program deliverables 2009-12 .............................................................................................. 59 

Table 4.2 Targeted Community Care (Mental Health) Program key performance indicators 2009-12 ........................................................ 60 

Figures

Figure 1.1 Prevalence of mental health disorders in Australia, 2007 .................. 25  Figure 1.2 Report structure .................................................................................. 34 

Figure 3.1 Targeted Community Care (Mental Health) Program, proportion of program expenditure in electorates held by political parties .......... 55 

 

   

ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

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Appendices ................................................................................................................. 67 

Appendix 1:  Agency Response .............................................................................. 68 

Appendix 2:  Mental health key committee structure as at 2012 ............................. 71 

Appendix 3:  Targeted Community Care (Mental Health) Program Activities ......... 72  Appendix 4:  Targeted Community Care (Mental Health) implementation timelines.............................................................................................. 75 

Appendix 5:  Draft Revised Targeted Community Care (Mental Health) Program performance framework ....................................................... 77 

Index ............................................................................................................................. 80 

Series Titles .................................................................................................................. 82 

Current Better Practice Guides .................................................................................... 88 

Tables

Table S.1 Targeted Community Care (Mental Health) Program 2011-12 ......... 15  Table 1.1 Targeted Community Care (Mental Health) Program 2011-12 ......... 30  Table 1.2 Targeted Community Care (Mental Health) Program state and territory funding allocations and population size, 2011-12 ................ 32 

Table 2.1 Targeted Community Care (Mental Health) Program implementation 2007-10 .................................................................... 36 

Table 2.2 Targeted Community Care (Mental Health) Program risk assessment, February 2012 ............................................................... 45 

Table 2.3 Targeted Community Care (Mental Health) Program summary of service provider risk assessments, November 2012 .......................... 46  Table 4.1 Targeted Community Care (Mental Health) Program deliverables 2009-12 .............................................................................................. 59 

Table 4.2 Targeted Community Care (Mental Health) Program key performance indicators 2009-12 ........................................................ 60 

Figures

Figure 1.1 Prevalence of mental health disorders in Australia, 2007 .................. 25  Figure 1.2 Report structure .................................................................................. 34 

Figure 3.1 Targeted Community Care (Mental Health) Program, proportion of program expenditure in electorates held by political parties .......... 55 

 

   

ANAO Audit Report No.48 2012-13

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Abbreviations

ABS  Australian Bureau of Statistics 

AIHW  Australian Institute of Health and Welfare 

ANAO  Australian National Audit Office 

APS  Australian Public Service 

APY Lands  Anangu Pitjantjatjara Yankunytjatjara Lands 

CALD  Culturally and Linguistically Diverse 

CDs  Census Collection Districts 

CGGs  Commonwealth Grants Guidelines 

COAG  Council of Australia Governments 

CRCC  Commonwealth Respite and Carelink Centre 

DoHA  Department of Health and Ageing 

DSP  Disability Support Pension 

EST  Eligibility Screening Tool 

FaHCSIA  Department of Families, Housing, Community Service and  Indigenous Affairs 

FOFMS  FaHCSIA’s Online Funding Management System 

FMA  Regulations 

Financial Management and Accountability Regulations 1997 

FMHSS  Family Mental Health Support Services 

HACC  Housing and Community Care 

LGA  Local Government Area 

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MHR: CS  Mental Health Respite: Carer Support 

MHSC  Mental Health Standing Committee 

NGO  Non‐government‐organisation 

NO  National Office 

NMHPSC  National Mental Health Performance Subcommittee 

NRDF  National Respite Development Fund 

PHaMs  Personal Helpers and Mentors 

PBS  Portfolio Budget Statement 

SACS  Social and Community Services Award 

SEIFA  Socio‐Economic Index of Disadvantage 

SPRI  Strategic Program Reform Initiative 

SQPS  Safety and Quality Partnership Subcommittee 

STO Network  State and Territory Offices Network 

TCC Program  Targeted Community Care (Mental Health) Program 

   

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Glossary

COAG  Roadmap for  mental health  reform 

An  initiative  of  the  Council  of  Australian  Governments  setting  out  the  policy  directions  for  all  governments  in  Australia  in  relation  to  improving  mental  health  services  over the period 2012-22. 

Commonwealth  Grant  Guidelines 

The Commonwealth Grant Guidelines establish the grants  policy  and  reporting  framework  for  all  departments  and  agencies  subject  to  the  Financial  Management  and  Accountability Act 1997. 

Kessler K10  A  self  reported  or  interviewer  administered  measure  of  distress  based  on  ten  questions  about  anxiety  and  depressive symptoms that a person has experienced in the  most recent four week period. The K10 is used widely in  mental health surveys. 

Mental health  Describes the capacity of individuals and groups to interact,  inclusively and equitably with one another and with their  environment,  in  ways  that  promote  subjective  wellbeing  and  optimise  opportunities  for  development  and  use  of  mental abilities. 

National Respite  Development  Fund 

A  component  of  the  Targeted  Community  Care  (Mental  Health)  Program  providing  respite  options  for  carers  of  people with severe mental illness/psychiatric disability and  carers of people with intellectual disability. 

Peer Support  Worker  A person who has had a lived experience of mental illness  and  is  able  to  share  this  experience  to  support  another 

mental health sufferer. 

ANAO Audit Report No.48 2012-13

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Glossary

COAG  Roadmap for  mental health  reform 

An  initiative  of  the  Council  of  Australian  Governments  setting  out  the  policy  directions  for  all  governments  in  Australia  in  relation  to  improving  mental  health  services  over the period 2012-22. 

Commonwealth  Grant  Guidelines 

The Commonwealth Grant Guidelines establish the grants  policy  and  reporting  framework  for  all  departments  and  agencies  subject  to  the  Financial  Management  and  Accountability Act 1997. 

Kessler K10  A  self  reported  or  interviewer  administered  measure  of  distress  based  on  ten  questions  about  anxiety  and  depressive symptoms that a person has experienced in the  most recent four week period. The K10 is used widely in  mental health surveys. 

Mental health  Describes the capacity of individuals and groups to interact,  inclusively and equitably with one another and with their  environment,  in  ways  that  promote  subjective  wellbeing  and  optimise  opportunities  for  development  and  use  of  mental abilities. 

National Respite  Development  Fund 

A  component  of  the  Targeted  Community  Care  (Mental  Health)  Program  providing  respite  options  for  carers  of  people with severe mental illness/psychiatric disability and  carers of people with intellectual disability. 

Peer Support  Worker  A person who has had a lived experience of mental illness  and  is  able  to  share  this  experience  to  support  another 

mental health sufferer. 

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Socio‐Economic  Indexes for  Areas (SEIFA)  Index of  Disadvantage 

A statistical product developed by the Australian Bureau of  Statistics that ranks areas in Australia according to relative  socio‐economic advantage and disadvantage. 

SmartForm  An electronic form used by service providers to report to  FaHCSIA under the terms of their funding agreements. 

 

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Socio‐Economic  Indexes for  Areas (SEIFA)  Index of  Disadvantage 

A statistical product developed by the Australian Bureau of  Statistics that ranks areas in Australia according to relative  socio‐economic advantage and disadvantage. 

SmartForm  An electronic form used by service providers to report to  FaHCSIA under the terms of their funding agreements. 

 

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Summary and Recommendations

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Summary

Introduction 1. Mental illness is a significant health issue in Australia affecting the lives  of individuals, their carers and the wider community1. Awareness of the scale  of mental illness, and its extensive social impact, has increased substantially  over the past decade, both by governments and the general population.2 The  Department of Families, Housing, Community Services and Indigenous Affairs  (FaHCSIA) has estimated the annual cost of productivity losses attributable to  mental illness to range from $10 billion to $15 billion.3 

2. Almost  half  the  Australian  population  aged  16  to  85  years  has  experienced a mental illness episode at some point in their life4 and for most  people who experience mental illness in adult life, the illness has its onset in  childhood  or  adolescence.5  In  2006,  following  two  reports6  highlighting  the  need  for  services  to  assist  people  with  mental  illness  and  to  increase  coordination between clinical and community‐based services, the Council of  Australian Governments (COAG) agreed on a whole‐of‐government approach  to mental health. This was implemented through the National Action Plan on  Mental Health 2006-11 (Action Plan).  

3. The four key outcomes of the Action Plan were to: 

 reduce the prevalence and severity of mental illness in Australia; 

 reduce  the  prevalence  of  risk  factors  that  contribute  to  the  onset  of  mental illness and prevent longer term recovery; 

                                                       1 Australian Institute of Health and Welfare, 2007. The burden of disease and injury in Australia, AIHW, Canberra. Levels of death and disability from a comprehensive set of diseases, injuries and risks to health are combined to measure the

total health ‘burden’. Following cancers and cardiovascular diseases mental disorders are the third leading cause of overall disease burden in Australia, accounting for 13.1 per cent of Australia’s total burden of disease and injury. 2 COAG National Action Plan for Mental Health 2006-2011, Fourth Progress Report covering implementation to 2009-

10, May 2012, p. 16. 3 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program Guidelines, Part A - June 2011, p. 6. 4

Australian Bureau of Statistics, National Survey of Mental Health and Wellbeing: Summary of Results, 2007, cat. no.4326.0, Canberra. 5

The Mental Health of Young People in Australia, Sawyer et al, Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care, 2000. 6 Mental Health Council of Australia, Not For Service: Experiences of Injustice and Despair in Mental Health Care in

Australia, Canberra, 2005. The Senate, Select Committee on Mental Health, A National Approach to Mental Health - From Crisis to Community, Final Report, April 2006.

Summary

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 increase  the  proportion  of  people  with  an  emerging  or  established  mental illness who are able to access the right health care and other  relevant community services at the right time, with a particular focus  on early intervention; and 

 increase the ability of people with a mental illness to participate in the  community, employment, education and training, including through an  increase in access to stable accommodation.7 

4. Supporting  this  agreement,  in  2006-07  the  Australian  Government  committed a total of $1.8 billion for 19 initiatives to assist people with mental  illness, their families and carers over the five year period 2006-07 to 2010-11.  Within this funding, FaHCSIA was allocated $554.7 million for the Targeted  Community Care (Mental Health) Program (TCC). The program was directed  at the Action Plan’s primary aim of improving mental health and the recovery  from  illness  through  a  greater  focus  on  promotion,  prevention,  early  intervention and access to mental health services.8  

5. The  Australian  Government  committed  an  additional  $2.2 billion  for  National Mental Health Reforms in May 2011. As part of the Government’s  additional funding, $269.3 million was allocated to FaHCSIA over five years to  provide further support to community mental health by expanding the TCC  Program to include additional service types and locations.  

Targeted Community Care (Mental Health) Program 6. The  objective  of  the  TCC  Program  ‘...  is  to  implement  community  mental health initiatives to assist people with mental illness and their families  and  carers  to  manage  the  impact of  mental  illness.’9  FaHCSIA’s  strategy  to  achieve  the  objective  is  to  provide  accessible,  responsive,  high  quality  and  integrated community‐based mental health services that improve the capacity  of individuals, families and carers to manage the impacts of mental illness on  their  lives  and  improve  their  overall  wellbeing.10  FaHCSIA  considers  that  progress  towards  this  outcome  will  be  demonstrated  by  the  social  and 

                                                       7 COAG National Action Plan for Mental Health 2006-2011, 14 July 2006. http://archive.coag.gov.au/coag_meeting _outcomes/2006-07-14/docs/nap_mental_health.pdf [accessed 15 January 2013]. 8

ibid.

9 Families, Housing, Community Services and Indigenous Affairs, Portfolio Budget Statement 2012-2013, p. 94. http://resources.fahcsia.gov.au/budget/2012-13/FaHCSIA_PBS_2012-13.pdf [accessed 5 February 2013].

10 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program, Part A: Program Guidelines, November 2012.

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Summary

Introduction 1. Mental illness is a significant health issue in Australia affecting the lives  of individuals, their carers and the wider community1. Awareness of the scale  of mental illness, and its extensive social impact, has increased substantially  over the past decade, both by governments and the general population.2 The  Department of Families, Housing, Community Services and Indigenous Affairs  (FaHCSIA) has estimated the annual cost of productivity losses attributable to  mental illness to range from $10 billion to $15 billion.3 

2. Almost  half  the  Australian  population  aged  16  to  85  years  has  experienced a mental illness episode at some point in their life4 and for most  people who experience mental illness in adult life, the illness has its onset in  childhood  or  adolescence.5  In  2006,  following  two  reports6  highlighting  the  need  for  services  to  assist  people  with  mental  illness  and  to  increase  coordination between clinical and community‐based services, the Council of  Australian Governments (COAG) agreed on a whole‐of‐government approach  to mental health. This was implemented through the National Action Plan on  Mental Health 2006-11 (Action Plan).  

3. The four key outcomes of the Action Plan were to: 

 reduce the prevalence and severity of mental illness in Australia; 

 reduce  the  prevalence  of  risk  factors  that  contribute  to  the  onset  of  mental illness and prevent longer term recovery; 

                                                       1 Australian Institute of Health and Welfare, 2007. The burden of disease and injury in Australia, AIHW, Canberra. Levels of death and disability from a comprehensive set of diseases, injuries and risks to health are combined to measure the

total health ‘burden’. Following cancers and cardiovascular diseases mental disorders are the third leading cause of overall disease burden in Australia, accounting for 13.1 per cent of Australia’s total burden of disease and injury. 2 COAG National Action Plan for Mental Health 2006-2011, Fourth Progress Report covering implementation to 2009-

10, May 2012, p. 16. 3 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program Guidelines, Part A - June 2011, p. 6. 4

Australian Bureau of Statistics, National Survey of Mental Health and Wellbeing: Summary of Results, 2007, cat. no.4326.0, Canberra. 5

The Mental Health of Young People in Australia, Sawyer et al, Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care, 2000. 6 Mental Health Council of Australia, Not For Service: Experiences of Injustice and Despair in Mental Health Care in

Australia, Canberra, 2005. The Senate, Select Committee on Mental Health, A National Approach to Mental Health - From Crisis to Community, Final Report, April 2006.

Summary

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 increase  the  proportion  of  people  with  an  emerging  or  established  mental illness who are able to access the right health care and other  relevant community services at the right time, with a particular focus  on early intervention; and 

 increase the ability of people with a mental illness to participate in the  community, employment, education and training, including through an  increase in access to stable accommodation.7 

4. Supporting  this  agreement,  in  2006-07  the  Australian  Government  committed a total of $1.8 billion for 19 initiatives to assist people with mental  illness, their families and carers over the five year period 2006-07 to 2010-11.  Within this funding, FaHCSIA was allocated $554.7 million for the Targeted  Community Care (Mental Health) Program (TCC). The program was directed  at the Action Plan’s primary aim of improving mental health and the recovery  from  illness  through  a  greater  focus  on  promotion,  prevention,  early  intervention and access to mental health services.8  

5. The  Australian  Government  committed  an  additional  $2.2 billion  for  National Mental Health Reforms in May 2011. As part of the Government’s  additional funding, $269.3 million was allocated to FaHCSIA over five years to  provide further support to community mental health by expanding the TCC  Program to include additional service types and locations.  

Targeted Community Care (Mental Health) Program 6. The  objective  of  the  TCC  Program  ‘...  is  to  implement  community  mental health initiatives to assist people with mental illness and their families  and  carers  to  manage  the  impact of  mental  illness.’9  FaHCSIA’s  strategy  to  achieve  the  objective  is  to  provide  accessible,  responsive,  high  quality  and  integrated community‐based mental health services that improve the capacity  of individuals, families and carers to manage the impacts of mental illness on  their  lives  and  improve  their  overall  wellbeing.10  FaHCSIA  considers  that  progress  towards  this  outcome  will  be  demonstrated  by  the  social  and 

                                                       7 COAG National Action Plan for Mental Health 2006-2011, 14 July 2006. http://archive.coag.gov.au/coag_meeting _outcomes/2006-07-14/docs/nap_mental_health.pdf [accessed 15 January 2013]. 8

ibid.

9 Families, Housing, Community Services and Indigenous Affairs, Portfolio Budget Statement 2012-2013, p. 94. http://resources.fahcsia.gov.au/budget/2012-13/FaHCSIA_PBS_2012-13.pdf [accessed 5 February 2013].

10 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program, Part A: Program Guidelines, November 2012.

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economic  participation  of  people  with  a  mental  illness,  together  with  their  carers and families.  

7. There are three components to the TCC Program: 

 Personal Helpers and Mentors (PHaMs). This initiative is designed to  assist  people  whose  lives  are  severely  affected  by  mental  illness  by  providing support: to  manage daily activities; gain access to needed  services such as accommodation, social support, health, welfare, and  employment services; and increase connections with their community;  

 Family  Mental  Health  Support  Services11  (FMHSS).  This  initiative  provides early intervention support to assist vulnerable families with  children and young people who are at risk of, or affected by, mental  illness. These services aim to support parents to reduce family stress  and enable children and young people to reach their potential; and  

 Mental  Health  Respite: Carer  Support12  (MHR: CS).  This  initiative  funds 650 respite care places which provide a range of flexible respite  and  support  options  for  carers  and  families  of  people  with  severe  mental illness and carers of people with an intellectual disability.  

8. The TCC Program complements clinical health services by providing  support  options  that  seek  to  promote  social  inclusion  and  recovery.  Grant  funding  is  awarded  under  the  TCC  Program  to  community‐based  not‐for‐ profit organisations and established national charitable organisations to deliver  services in sites across Australia. Table S1 shows the number of service sites  funded in 2011-12, the number of clients FaHCSIA estimates it has assisted  and the funding allocation by each service type. 

   

                                                       11 Originally known as Mental Health Community Based. 12

Originally known as Mental Health Respite.

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economic  participation  of  people  with  a  mental  illness,  together  with  their  carers and families.  

7. There are three components to the TCC Program: 

 Personal Helpers and Mentors (PHaMs). This initiative is designed to  assist  people  whose  lives  are  severely  affected  by  mental  illness  by  providing support: to  manage daily activities; gain access to needed  services such as accommodation, social support, health, welfare, and  employment services; and increase connections with their community;  

 Family  Mental  Health  Support  Services11  (FMHSS).  This  initiative  provides early intervention support to assist vulnerable families with  children and young people who are at risk of, or affected by, mental  illness. These services aim to support parents to reduce family stress  and enable children and young people to reach their potential; and  

 Mental  Health  Respite: Carer  Support12  (MHR: CS).  This  initiative  funds 650 respite care places which provide a range of flexible respite  and  support  options  for  carers  and  families  of  people  with  severe  mental illness and carers of people with an intellectual disability.  

8. The TCC Program complements clinical health services by providing  support  options  that  seek  to  promote  social  inclusion  and  recovery.  Grant  funding  is  awarded  under  the  TCC  Program  to  community‐based  not‐for‐ profit organisations and established national charitable organisations to deliver  services in sites across Australia. Table S1 shows the number of service sites  funded in 2011-12, the number of clients FaHCSIA estimates it has assisted  and the funding allocation by each service type. 

   

                                                       11 Originally known as Mental Health Community Based. 12

Originally known as Mental Health Respite.

Summary

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Table S.1

Targeted Community Care (Mental Health) Program 2011-12

Mental Health Services

Number of service sites

Number of clients assisted

Funding allocation

$million

Personal Helpers and Mentors 175 13 219 85.6

Mental Health Respite: Carer Support 195 28 745 50.0

Family Mental Health Support Services 54 82 104 20.3

Total 424 124 068 155.9

Source: FaHCSIA.

Note: Number of clients assisted includes remote participants.

Number of service sites is as at 30 June 2012.

Of the 175 PHaMs sites, 95 were in metropolitan areas, 69 were in non-metropolitan areas and 11 were in remote areas.

9. FaHCSIA is currently implementing the expansion of the TCC Program  in a staged manner. The department completed four grant selection processes  in 2012 - two PHaMs rounds and one each of FMHSS and MHR: CS - and  finalised two further FMHSS and MHR: CS rounds in April 2013. 

Audit objective, scope and criteria 10. The objective of the audit was to assess the effectiveness of FaHCSIA’s  administration  and  management  of  the  Targeted  Community  Care  (Mental  Health) Program. 

11. The  audit  focused  primarily  on  the  program’s  administration  and  management since 2010-11. This period included the: 

 finalisation of the original program measures; and  

 commencement of program expansion measures. 

12. Three  high  level  criteria  were  used  to  conclude  against  the  audit  objective. These were whether FaHCSIA: 

 established and used structured and appropriate planning processes to  support the targeting of the program; 

 managed the selection of service providers consistently with Australian  Government requirements; and 

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 developed  and  implemented  satisfactory  performance  reporting  arrangements for program effectiveness and accountability. 

Overall conclusion 13. The  Targeted  Community  Care  (Mental  Health)  Program  (TCC)  is  a  series of community‐based services designed to support people with a mental  illness,  and  their  families  and  carers.  The  TCC  Program  was  developed  to  complement  the  provision  of  clinical‐based  mental  health  services  and,  accordingly,  to  increase  access  to  a  range  of  mental  health  services.  Since   2006-07,  the  Australian  Government  has  committed  over  $800  million  to  services provided through the TCC Program. With this funding, services have  been established in 424 locations across Australia, leading to greater access to  community‐based  mental  health  services.  Further  expansion  is  underway  which will lead to the establishment of additional service models and locations  and increased access to services.  

14. Overall,  FaHCSIA’s  administration  of  the  TCC  Program  has  been  generally effective. In determining site locations for the initial program and for  the subsequent expansion, the department has drawn on available statistical  data to identify areas of high relative need and to target specific populations  within communities in line with government priorities. The expansion of the  program  from  2011  was  supported  by  the  development  of  an  appropriate  implementation  approach  which  included  strategies  for  stakeholder  communication  and  consultation  along  with  details  of  site  priorities,  development  of  new  service  delivery  models  and  funding  levels  for  each  service  site.  Timetables  setting  out  the  sequenced  implementation  of  the  expansion  were  developed  and  revised  to  reflect  actual  implementation  experience, program resources and changing program priorities. 

15. The Commonwealth Grant Guidelines (CGGs) provide the Australian  Government’s overarching framework for the management of grant programs  by agencies, and agencies are required to advise Ministers of the requirements  of the CGGs when Ministers are making decisions in relation to the awarding  of grants. The TCC Program predates the introduction of the CGGs, which  were first issued in 2009 and revised in 2013. However, FaHCSIA has in most  key respects aligned its management of the program to the requirements of the  CGGs.  

16. The  CGGs  emphasise  the  benefit  of  undertaking  competitive  merit‐based selection processes as a better practice approach to consistently 

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 developed  and  implemented  satisfactory  performance  reporting  arrangements for program effectiveness and accountability. 

Overall conclusion 13. The  Targeted  Community  Care  (Mental  Health)  Program  (TCC)  is  a  series of community‐based services designed to support people with a mental  illness,  and  their  families  and  carers.  The  TCC  Program  was  developed  to  complement  the  provision  of  clinical‐based  mental  health  services  and,  accordingly,  to  increase  access  to  a  range  of  mental  health  services.  Since   2006-07,  the  Australian  Government  has  committed  over  $800  million  to  services provided through the TCC Program. With this funding, services have  been established in 424 locations across Australia, leading to greater access to  community‐based  mental  health  services.  Further  expansion  is  underway  which will lead to the establishment of additional service models and locations  and increased access to services.  

14. Overall,  FaHCSIA’s  administration  of  the  TCC  Program  has  been  generally effective. In determining site locations for the initial program and for  the subsequent expansion, the department has drawn on available statistical  data to identify areas of high relative need and to target specific populations  within communities in line with government priorities. The expansion of the  program  from  2011  was  supported  by  the  development  of  an  appropriate  implementation  approach  which  included  strategies  for  stakeholder  communication  and  consultation  along  with  details  of  site  priorities,  development  of  new  service  delivery  models  and  funding  levels  for  each  service  site.  Timetables  setting  out  the  sequenced  implementation  of  the  expansion  were  developed  and  revised  to  reflect  actual  implementation  experience, program resources and changing program priorities. 

15. The Commonwealth Grant Guidelines (CGGs) provide the Australian  Government’s overarching framework for the management of grant programs  by agencies, and agencies are required to advise Ministers of the requirements  of the CGGs when Ministers are making decisions in relation to the awarding  of grants. The TCC Program predates the introduction of the CGGs, which  were first issued in 2009 and revised in 2013. However, FaHCSIA has in most  key respects aligned its management of the program to the requirements of the  CGGs.  

16. The  CGGs  emphasise  the  benefit  of  undertaking  competitive  merit‐based selection processes as a better practice approach to consistently 

Summary

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and  transparently  selecting  grant  recipients.  The  CGGs  also  recognise  that  there are circumstances when other selection processes may be appropriate,  although  agencies  are  expected  to  provide  clear  justification  for  not  using  competitive  merit‐based  selection  processes.  Since  the  introduction  of  the  program  in  2006,  FaHCSIA  has  made  use  of  a  combination  of  competitive  grant selection processes as well as restricted and direct selection processes to  select new providers and extend the funding agreements of existing providers. 

17. While the CGGs emphasise the use of competitive merit‐based selection  processes,  this  same  emphasis  is  not  reflected  in  FaHCSIA’s  TCC  Program  guidelines. Further, in advising the Minister, FaHCSIA provided justification  for  the  use  of  restricted  and  direct  selection  processes  but  did  not  include  explicit  advice  on  the  preference  in  the  CGGs  for  competitive  merit‐based  selection processes or the impact that alternative approaches may have on the  opportunities for other organisations to access grant funding opportunities.  

18. Assessing the overall impact of the program is a challenging process  given  the  individual  nature  of  mental  illness,  and  that  the  program  is  providing localised and specialised services in a range of different locations.  Currently  FaHCSIA  assesses  program  performance  in  terms  of  the  overall  numbers  of  people  accessing  the  funded  services.  This  is  supported  by  performance  information  relating  to  client  satisfaction  and  client  progress  against  personal  goals,  where  this  is  relevant.  Information  on  the  use  of  services  by  Indigenous  clients  and  those  from  culturally  and  linguistically  diverse (CALD) backgrounds is also collected by FaHCSIA. To assist in further  understanding the effectiveness of the program FaHCSIA has undertaken a  comprehensive evaluation, the results of which were released in May 2011.  However,  there  is  currently  limited  regular  information  available  on  the  specific contributions made by the three service streams to improvements in  community  level  mental  health.  FaHCSIA  has  reviewed  its  performance  framework for the TCC Program and is making changes which will take effect  from July 2014. Integral to the proposed revised performance framework is the  continuation of periodic program evaluations. 

19. The  majority  of  funding  agreements  with  providers  under  the  TCC  Program expire in June 2014. In planning for any subsequent grant rounds, it  will be important for the department to give appropriate consideration to the  preference of the CGGs for competitive processes and the opportunities these  afford  to  improve  accessibility  to  grant  funding.  FaHCSIA  is  also  currently  implementing  reforms  to  its  departmental‐wide  approach  to  the  administration of grant programs. There are opportunities to support a greater 

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focus on competitive processes at appropriate intervals and the ANAO has  made one recommendation in this respect. 

Key findings by chapter

Program planning and management (Chapter 2)

20. Over the period 2006-11 FaHCSIA made a number of adjustments to  the  TCC  Program  to  reflect  implementation  experience  and  increased  understanding of different needs for mental health services. The expansion of  the program announced in 2011 is aiming to build on this base by expanding  sites and the capacity of services. It further sought to refine the service delivery  models  and  introduce  program  enhancements.  In  developing  these  enhancements, FaHCSIA has actively drawn on its own experience and that of  service providers in the sector. 

21. To  support  the  expansion  of  the  TCC  Program,  FaHCSIA  has  given  appropriate consideration to key aspects of planning and administration.  A  detailed implementation plan was developed and covered essential elements  such as: stakeholder consultation and communication; the development and  refocusing  of  services  models;  the  identification  of  risks;  staged  provider  selection processes and the identification of high priority areas in which the  expansion should be focused.  

22. FaHCSIA has given appropriate attention to identifying areas with the  greatest need for community‐based mental health services such as areas with  poorer  socioeconomic  conditions  as  these  areas  tend  to  have  a  greater  incidence  of  mental  illness  than  other  areas.13  Accordingly,  to  support  the  program’s  initial  implementation  and  subsequent  expansion,  FaHCSIA  has  used data from the Australian Bureau of Statistics to identify areas of relative  disadvantage14 and to target groups such as Indigenous Australians, CALD  groups and homeless people. 

23. In  June  2012  FaHCSIA  was  funding  201  service  providers  in  424 locations  across  Australia.  The  program’s  widely  dispersed  and 

                                                       13 Australian Bureau of Statistics, Measures of Australia’s Progress, 2010, cat no. 1370.0, Canberra. 14

Socio-Economic Indexes for Areas (SEIFA) Index of Disadvantage. The SEIFA is based on National Population Census data. Australian Bureau of Statistics, 2039.0 - Information Paper: An introduction to Socio-Economic Indexes for areas (SEIFA) [Internet], ABS, Australia, 2006, http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2039.02006? OpenDocument [accessed 25 February]. SEIFAs based on 2011 Census data had not been released at the time of the audit.

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focus on competitive processes at appropriate intervals and the ANAO has  made one recommendation in this respect. 

Key findings by chapter

Program planning and management (Chapter 2)

20. Over the period 2006-11 FaHCSIA made a number of adjustments to  the  TCC  Program  to  reflect  implementation  experience  and  increased  understanding of different needs for mental health services. The expansion of  the program announced in 2011 is aiming to build on this base by expanding  sites and the capacity of services. It further sought to refine the service delivery  models  and  introduce  program  enhancements.  In  developing  these  enhancements, FaHCSIA has actively drawn on its own experience and that of  service providers in the sector. 

21. To  support  the  expansion  of  the  TCC  Program,  FaHCSIA  has  given  appropriate consideration to key aspects of planning and administration.  A  detailed implementation plan was developed and covered essential elements  such as: stakeholder consultation and communication; the development and  refocusing  of  services  models;  the  identification  of  risks;  staged  provider  selection processes and the identification of high priority areas in which the  expansion should be focused.  

22. FaHCSIA has given appropriate attention to identifying areas with the  greatest need for community‐based mental health services such as areas with  poorer  socioeconomic  conditions  as  these  areas  tend  to  have  a  greater  incidence  of  mental  illness  than  other  areas.13  Accordingly,  to  support  the  program’s  initial  implementation  and  subsequent  expansion,  FaHCSIA  has  used data from the Australian Bureau of Statistics to identify areas of relative  disadvantage14 and to target groups such as Indigenous Australians, CALD  groups and homeless people. 

23. In  June  2012  FaHCSIA  was  funding  201  service  providers  in  424 locations  across  Australia.  The  program’s  widely  dispersed  and 

                                                       13 Australian Bureau of Statistics, Measures of Australia’s Progress, 2010, cat no. 1370.0, Canberra. 14

Socio-Economic Indexes for Areas (SEIFA) Index of Disadvantage. The SEIFA is based on National Population Census data. Australian Bureau of Statistics, 2039.0 - Information Paper: An introduction to Socio-Economic Indexes for areas (SEIFA) [Internet], ABS, Australia, 2006, http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2039.02006? OpenDocument [accessed 25 February]. SEIFAs based on 2011 Census data had not been released at the time of the audit.

Summary

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community‐based  service  delivery  model  requires  clarity  in  the  respective  roles and responsibilities of FaHCSIA’s national, state and territory offices and  of  the  service  providers.  FaHCSIA’s  Common  Business  Model  for  Grants  Management  allocates  the  day  to  day  management  of  service  providers  to  FaHCSIA’s  state  and  territory  offices  while  the  overall  administration  and  development of the program is the responsibility of FaHCSIA’s national office.  Funding agreements are in place with service providers which clearly set out  their  roles  and  accountabilities.  Overall,  the  department’s  management  arrangements  provide  a  sound  framework  to  support  the  ongoing  administration of the program. The service providers interviewed as part of  the  audit  considered  the  program  was  generally  well  managed  from  their  perspective. 

Grant Assessment and selection (Chapter 3)

24. The  CGGs,  while  noting  that  several  selection  methods  are  open  to  Australian  Government  agencies,  indicate  the  Australian  Government’s  preference for using open competitive merit‐based selection processes when  selecting grant recipients. Where an alternative method is chosen as the most  appropriate  to  the  circumstances,  the  CGGs  emphasise  that  the  selection  methods need to promote transparent and equitable access to grants and that  agreement on the process needs to be given by the Minister, chief executive or  appropriate delegate. FaHCSIA informed the ANAO that a competitive merit‐ based grant process was the department’s starting position for TCC Program  grant rounds. 

25. FaHCSIA  has  primarily  undertaken  open  competitive  merit‐based  selection processes to initially select service providers but has also made use of  direct and restricted competitive processes in situations where the objective of  the selection process was to support an expansion of existing services. Direct  selection processes have also been used to extend a large number of existing  funding  agreements  to  align  their  expiry  dates,  with  the  result  that  most  current  providers  have  had  their  funding  agreements  renewed  without  a  competitive process. The use of various selection processes is provided for in  the  FaHCSIA  TCC  program  guidelines  and  Ministerial  approval  has  been  obtained in all cases in relation to the proposed selection methods. 

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26. Under  the  CGGs,  agencies  are  required  to  advise  Ministers  of  the  requirements of the guidelines. This will necessarily involve advising on the  policy  aspects  and  obligations  set  out  in  the  Financial  Management  and  Accountability Regulations 1997.15 Briefs provided by FaHCSIA to the Minister  seeking approval did not routinely include reference to the CGGs, and in this  context  the  preference  for  competitive  merit‐based  selection  processes.  FaHCSIA’s TCC Program guidelines also do not reflect the emphasis given in  the CGGs to competitive merit‐based selection processes. The TCC Program  guidelines16 list three possible selection methods but indicate that the choice of  method is at the discretion of the department. 

27. Under broader reforms, the Australian Government has committed to  strengthening the contribution of the not‐for‐profit sector to the government’s  social inclusion agenda.17 Streamlining contracting and funding arrangements  are part of the overall reform approach but the government is also seeking to  improve  the  sector’s  accessibility  to  grant  funding  opportunities.  Open  competitive selection processes would be expected to help in this regard, and it  is important that agencies give appropriate consideration to ways of increasing  access  to  grant  opportunities,  and  that  decision  makers  are  advised  accordingly. 

Reporting and monitoring (Chapter 4)

28. There  is  limited  information  available  on  the  specific  contributions  made by PHaMs, FMHSS and MHR: CS to improvements in community level  mental health. Assessing the overall impact of the TCC Program is challenging  and  FaHCSIA  recognises  the  limitations  of  its  current  performance  management  framework.  As  part  of  ongoing  program  management  and  continuous  improvement,  in  September  2010,  the  department  reviewed  the  program’s existing performance management information collections and its  needs  for  future  planning  and  monitoring.  As  a  result  of  that  review,  the  department  identified  the  following  priority  activities  to  improve  its  performance framework. These are to:  

 improve the capacity to report on Mental Health Reforms; 

                                                       15 ANAO, Audit Report No. 21 2011-2012, Administration of Grant Reporting Obligations, p. 47. 16

Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program, Part B: Information for Applicants, November 2012. 17 Australian Government Initiative, National Compact, working together, part of the social inclusion agenda.

http://www.nationalcompact.gov.au/ [accessed 10 January 2013].

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26. Under  the  CGGs,  agencies  are  required  to  advise  Ministers  of  the  requirements of the guidelines. This will necessarily involve advising on the  policy  aspects  and  obligations  set  out  in  the  Financial  Management  and  Accountability Regulations 1997.15 Briefs provided by FaHCSIA to the Minister  seeking approval did not routinely include reference to the CGGs, and in this  context  the  preference  for  competitive  merit‐based  selection  processes.  FaHCSIA’s TCC Program guidelines also do not reflect the emphasis given in  the CGGs to competitive merit‐based selection processes. The TCC Program  guidelines16 list three possible selection methods but indicate that the choice of  method is at the discretion of the department. 

27. Under broader reforms, the Australian Government has committed to  strengthening the contribution of the not‐for‐profit sector to the government’s  social inclusion agenda.17 Streamlining contracting and funding arrangements  are part of the overall reform approach but the government is also seeking to  improve  the  sector’s  accessibility  to  grant  funding  opportunities.  Open  competitive selection processes would be expected to help in this regard, and it  is important that agencies give appropriate consideration to ways of increasing  access  to  grant  opportunities,  and  that  decision  makers  are  advised  accordingly. 

Reporting and monitoring (Chapter 4)

28. There  is  limited  information  available  on  the  specific  contributions  made by PHaMs, FMHSS and MHR: CS to improvements in community level  mental health. Assessing the overall impact of the TCC Program is challenging  and  FaHCSIA  recognises  the  limitations  of  its  current  performance  management  framework.  As  part  of  ongoing  program  management  and  continuous  improvement,  in  September  2010,  the  department  reviewed  the  program’s existing performance management information collections and its  needs  for  future  planning  and  monitoring.  As  a  result  of  that  review,  the  department  identified  the  following  priority  activities  to  improve  its  performance framework. These are to:  

 improve the capacity to report on Mental Health Reforms; 

                                                       15 ANAO, Audit Report No. 21 2011-2012, Administration of Grant Reporting Obligations, p. 47. 16

Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program, Part B: Information for Applicants, November 2012. 17 Australian Government Initiative, National Compact, working together, part of the social inclusion agenda.

http://www.nationalcompact.gov.au/ [accessed 10 January 2013].

Summary

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 streamline and reduce reporting demands on providers; 

 prepare  for  the  non‐government‐organisations’  National  Minimum  Data Set; 

 focus on outcome reporting; and  

 move to client‐level data over time. 

29. FaHCSIA  is  taking  important  steps  in  the  review  of  its  current  performance management framework. A draft framework was completed in  2011 and FaHCSIA undertook a pilot of its use with service providers. The  department  needs  to  maintain  momentum  to  ensure  its  implementation  by  mid 2014. Once it is in place the new framework will assist FaHCSIA to better  monitor the ongoing service performance of providers and to access higher  level information required to report against outcomes and program objectives.  

Summary of agency response 30. FaHCSIA provided a formal response to the audit which is contained in  full in Appendix 1. A summary of FaHCSIA’s response was also provided: 

It was beneficial for the Department to be involved in the audit during its peak  phase of implementing new community mental health services nationally. 

The Department provides comprehensive advice to the Minister in relation to  grants selections and approvals. The Department’s current Delivery Reform  Agenda  will  provide  opportunities  to  further  strengthen  advice  to  systematically  provide  explicit  reference  to  the  Commonwealth  Grant  Guidelines.  

The  Department’s  approach  to  continuous  improvement  through  implementing a strengthened performance framework will assist in ensuring  greater information is available on the impacts of the Targeted Community  Care (Mental Health) Program. 

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Recommendations

Recommendation No. 1

Paragraph 3.14

In  order  to  better  support  the  Minister  in  relation  to  grant  funding  decisions,  the  ANAO  recommends  that  FaHCSIA provides more explicit advice to the Minister  on key aspects of the Commonwealth Grants Guidelines  and that agency staff are better supported in providing  this advice. 

FaHCSIA’s response: Agreed. 

 

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Recommendations

Recommendation No. 1

Paragraph 3.14

In  order  to  better  support  the  Minister  in  relation  to  grant  funding  decisions,  the  ANAO  recommends  that  FaHCSIA provides more explicit advice to the Minister  on key aspects of the Commonwealth Grants Guidelines  and that agency staff are better supported in providing  this advice. 

FaHCSIA’s response: Agreed. 

 

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Audit Findings

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1. Introduction

This  chapter  provides  information  about  the  prevalence  and  consequence  of  mental  health  issues.  It  also  describes  the  policy  intent  of  the  Targeted  Community  Care  (Mental Health) Program, and summarises the development of the program from its  inception in 2006 to the 2011-12 mental health budget measures. 

Background

Mental health

1.1 Mental disorders account for 13.1 per cent of Australia’s total burden of  disease  and  injury,  the  third  leading  cause  of  overall  disease  burden  in  Australia after cancers (19 per cent) and cardiovascular diseases (18 per cent).18  The Department of Families, Housing, Community Services and Indigenous  Affairs  (FaHCSIA)  has  estimated  the  annual  cost  of  productivity  losses  attributable to mental illness to range from $10 billion to $15 billion.19 

1.2 Results  from  the  2007  National  Survey  of  Mental  Health  and  Wellbeing20, conducted by the Australian Bureau of Statistics, indicate that of  the  16 million  Australians  aged  16  to  85  years,  almost  half  (45  per cent  or  7.3 million) had a lifetime mental disorder, that is, a mental disorder at some  point in their life, and one in five people experience one of the common forms  of  mental  illness  (anxiety,  affective  or  mood  disorders,  and  substance  use  disorders) in the 12 months prior to the survey interview. The following figure  shows the prevalence of mental illness in the Australian adult population.  

                                                       18 Australian Institute of Health and Welfare, 2007. The burden of disease and injury in Australia, AIHW, Canberra. Levels of death and disability from a comprehensive set of diseases, injuries and risks to health are combined to measure the

total health ‘burden’. 19 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program Guidelines, Part A - June 2011, p. 6. 20

Australian Bureau of Statistics, National Survey of Mental Health and Wellbeing: Summary of Results, 2007, cat. no. 4326.0, Canberra.

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1. Introduction

This  chapter  provides  information  about  the  prevalence  and  consequence  of  mental  health  issues.  It  also  describes  the  policy  intent  of  the  Targeted  Community  Care  (Mental Health) Program, and summarises the development of the program from its  inception in 2006 to the 2011-12 mental health budget measures. 

Background

Mental health

1.1 Mental disorders account for 13.1 per cent of Australia’s total burden of  disease  and  injury,  the  third  leading  cause  of  overall  disease  burden  in  Australia after cancers (19 per cent) and cardiovascular diseases (18 per cent).18  The Department of Families, Housing, Community Services and Indigenous  Affairs  (FaHCSIA)  has  estimated  the  annual  cost  of  productivity  losses  attributable to mental illness to range from $10 billion to $15 billion.19 

1.2 Results  from  the  2007  National  Survey  of  Mental  Health  and  Wellbeing20, conducted by the Australian Bureau of Statistics, indicate that of  the  16 million  Australians  aged  16  to  85  years,  almost  half  (45  per cent  or  7.3 million) had a lifetime mental disorder, that is, a mental disorder at some  point in their life, and one in five people experience one of the common forms  of  mental  illness  (anxiety,  affective  or  mood  disorders,  and  substance  use  disorders) in the 12 months prior to the survey interview. The following figure  shows the prevalence of mental illness in the Australian adult population.  

                                                       18 Australian Institute of Health and Welfare, 2007. The burden of disease and injury in Australia, AIHW, Canberra. Levels of death and disability from a comprehensive set of diseases, injuries and risks to health are combined to measure the

total health ‘burden’. 19 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program Guidelines, Part A - June 2011, p. 6. 20

Australian Bureau of Statistics, National Survey of Mental Health and Wellbeing: Summary of Results, 2007, cat. no. 4326.0, Canberra.

Introduction

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Figure 1.1

Prevalence of mental health disorders in Australia, 2007

 

Source: Australian Bureau of Statistics 21

(a) Experienced a mental disorder at sometime in their life.

(b) Experienced a mental disorder in the 12 months prior to survey interview.

(c) Experienced a mental disorder but did not have symptoms in the 12 months prior to the survey interview.

1.3 For most people who experience mental illness in adult life, the illness  has  its  onset  in  childhood  or  adolescence22  and  can  have  a  very  significant  social  and  financial  impact  on  their  lives  and  the  Australian  community. 

                                                       21 Australian Bureau of Statistics, National Survey of Mental Health and Wellbeing: Summary of Results, 2007, cat. no. 4326.0, Canberra. 22

The Mental Health of Young People in Australia, Sawyer et al, Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care, 2000.

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Unemployment, co‐morbid23 substance use and addiction, poor physical health  and a shortened life span are all serious issues faced by many people living  with severe mental illness.24 Death rates for people with any mental illness are  2.5 times higher than for the general population25 and suicide is the main cause  of premature death. 

1.4 People with mental illness are also over represented in the homeless  and  prison  populations.  Australian  data  indicates  that  up  to  75  per cent  of  homeless  adults  have  a  mental  illness  and,  of  these,  about  a  third  (approximately 29 000 people) are affected by severe disorders. Additionally,  Australian  studies  have  found  that  around  40  per cent  of  prisoners  have  a  mental illness and that 10 to 20 per cent are affected by severe disorders.26 

1.5 Mental  health  is  a  significant  area  of  government  expenditure.  In   2010-11, $6.6 billion was allocated to mental health services by governments in  Australia.  State  and  territory  governments  contributed  $4.1 billion  or  62.5 per cent,  and  the  Australian  Government  contributed  $2.5 billion  or  37.5 per cent.27 

Mental health policy in Australia

1.6 Mental health has been an area of national focus since 1992 when the  National Mental Health Strategy was endorsed by Australian Health Ministers.  This committed all governments to a reform process aimed at achieving major  improvements in the quality and range of mental health services available to  the community. Through various changes in government at the federal, state  and  territory  levels,  the  National  Mental  Health  Strategy  has  continued  as  a  consistent reform agenda and the National Mental Health Report series has  been maintained as the principal vehicle for monitoring reform progress.28 

                                                       23 Co-morbidity means the co-occurrence of one or more diseases or disorders in an individual. According to the Department of Health and Ageing, Resource Kit for GP Trainers on Illicit Drug Issues, co-morbid disorders are common,

especially in specialist mental health and addiction services. Persons who have co-morbid substance use and mental health disorders have poorer outcomes than those who have a single disorder. 24 Department of Health and Ageing, Adult Collaborative Mental Health Care - Final Report. http://www.health.gov.au/

internet/main/publishing.nsf/content/C23F4021F98C0540CA25792C00790B5D/$File/colint.pdf [accessed 13 February 2013]. 25 Coghlan R et al. (2001). Duty to Care: Physical Illness in People with Mental Illness. The University of Western

Australia: Perth. 26 COAG National Action Plan for Mental Health 2006-2011, Third Progress Report covering implementation to 2008-09, June 2011. 27

SCRGSP (Steering Committee for the Review of Government Service Provision) 2013, Report on Government Services 2013, Productivity Commission, Canberra, Part E. 28 Department of Health and Ageing, National Mental Health Report 2010: Summary of 15 Years of Reform in Australia’s

Mental Health Services under the National Mental Health Strategy 1993-2008. Commonwealth of Australia, Canberra.

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Unemployment, co‐morbid23 substance use and addiction, poor physical health  and a shortened life span are all serious issues faced by many people living  with severe mental illness.24 Death rates for people with any mental illness are  2.5 times higher than for the general population25 and suicide is the main cause  of premature death. 

1.4 People with mental illness are also over represented in the homeless  and  prison  populations.  Australian  data  indicates  that  up  to  75  per cent  of  homeless  adults  have  a  mental  illness  and,  of  these,  about  a  third  (approximately 29 000 people) are affected by severe disorders. Additionally,  Australian  studies  have  found  that  around  40  per cent  of  prisoners  have  a  mental illness and that 10 to 20 per cent are affected by severe disorders.26 

1.5 Mental  health  is  a  significant  area  of  government  expenditure.  In   2010-11, $6.6 billion was allocated to mental health services by governments in  Australia.  State  and  territory  governments  contributed  $4.1 billion  or  62.5 per cent,  and  the  Australian  Government  contributed  $2.5 billion  or  37.5 per cent.27 

Mental health policy in Australia

1.6 Mental health has been an area of national focus since 1992 when the  National Mental Health Strategy was endorsed by Australian Health Ministers.  This committed all governments to a reform process aimed at achieving major  improvements in the quality and range of mental health services available to  the community. Through various changes in government at the federal, state  and  territory  levels,  the  National  Mental  Health  Strategy  has  continued  as  a  consistent reform agenda and the National Mental Health Report series has  been maintained as the principal vehicle for monitoring reform progress.28 

                                                       23 Co-morbidity means the co-occurrence of one or more diseases or disorders in an individual. According to the Department of Health and Ageing, Resource Kit for GP Trainers on Illicit Drug Issues, co-morbid disorders are common,

especially in specialist mental health and addiction services. Persons who have co-morbid substance use and mental health disorders have poorer outcomes than those who have a single disorder. 24 Department of Health and Ageing, Adult Collaborative Mental Health Care - Final Report. http://www.health.gov.au/

internet/main/publishing.nsf/content/C23F4021F98C0540CA25792C00790B5D/$File/colint.pdf [accessed 13 February 2013]. 25 Coghlan R et al. (2001). Duty to Care: Physical Illness in People with Mental Illness. The University of Western

Australia: Perth. 26 COAG National Action Plan for Mental Health 2006-2011, Third Progress Report covering implementation to 2008-09, June 2011. 27

SCRGSP (Steering Committee for the Review of Government Service Provision) 2013, Report on Government Services 2013, Productivity Commission, Canberra, Part E. 28 Department of Health and Ageing, National Mental Health Report 2010: Summary of 15 Years of Reform in Australia’s

Mental Health Services under the National Mental Health Strategy 1993-2008. Commonwealth of Australia, Canberra.

Introduction

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1.7 In  2005,  the  Mental  Health  Council  of  Australia  produced  a  report  titled, Not for Service: Experiences of Injustice and Despair in Mental Health Care in  Australia29  and  in  2006,  the  Senate  Select  Committee  on  Mental  Health  published, A National Approach to Mental Health - From Crisis to Community.30  Both of these reports highlighted the need for services to assist people with  mental illnesses and the need for greater coordination between clinical and  community‐based services. 

1.8 In 2006, the Council of Australian Governments (COAG) agreed on a  whole‐of‐government approach to mental health, to be implemented through a  National Action Plan on Mental Health 2006-201131(Action Plan). The four key  outcomes of the Action Plan were to: 

 reduce the prevalence and severity of mental illness in Australia; 

 reduce  the  prevalence  of  risk  factors  that  contribute  to  the  onset  of  mental illness and prevent longer term recovery; 

 increase  the  proportion  of  people  with  an  emerging  or  established  mental illness who are able to access the right health care and other  relevant community services at the right time, with a particular focus  on early intervention; and 

 increase the ability of people with a mental illness to participate in the  community, employment, education and training, including through an  increase in access to stable accommodation.32 

1.9 Supporting  this  agreement,  in  2006-07  the  Australian  Government  committed a total of $1.8 billion for 19 initiatives to assist people with mental  illness, their families and carers over the five year period 2006-07 to 2010-11.  Within  this,  FaHCSIA  was  allocated  $554.7  million  for  the  Targeted  Community Care (Mental Health) Program (TCC). The program was directed  at the Action Plan’s primary aim of improving mental health and the recovery 

                                                       29 Not For Service: Experiences of Injustice and Despair in Mental Health Care in Australia, Mental Health Council of Australia, Canberra, 2005. http://www.mhca.org.au/index.php/component/rsfiles/download?path=Publications

/Not%20For%20Service%20_Full%20Report.pdf [accessed 21 February 2013]. 30 The Senate, Select Committee on Mental Health, A National Approach to Mental Health - From Crisis to Community, April 2006. http://www.mhfa.com.au/documents/SenateSelectCommitteeFinalReport.pdf [accessed 21 February 2013]. 31

COAG National Action Plan on Mental Health 2006-2011, 14 July 2006. 32 COAG National Action Plan for Mental Health 2006-2011, 14 July 2006. http://archive.coag.gov.au/coag_meeting_outcomes/2006-07-14/docs/nap_mental_health.pdf

[accessed 15 January 2013].

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from  illness  through  a  greater  focus  on  promotion,  prevention,  early  intervention and access to mental health services.33 

1.10 The  Action  Plan  ceased  in  2011,  but  mental  health  reform  was  recognised as requiring continued government commitment and renewal. To  this end, the National Mental Health Strategy (comprising the National Mental  Health Policy, endorsed in 2008 by the Health Ministers, and the Fourth National  Mental  Health  Plan  2009-2014)  builds  upon  the  whole‐of‐government  commitments  of  the  Action  Plan  and  provides  the  national  direction  and  priorities  for  mental  health  reform  within  Australia’s  health  system.  More  recently the Roadmap for National Mental Health Reform 2012-22 was approved  and  released  by  COAG  on  7  December  2012.  The  Roadmap  provides  a  pathway  towards  achieving  the  vision  of  an  Australian  society  that  values  good mental health and wellbeing and confirms the shared intents and goals of  Commonwealth, state and territory governments.34 

1.11 In  the  2011-12  Budget  the  Australian  government  announced  the  release of the Delivering National Mental Health Reform package in which the  government committed $2.2 billion over five years for mental health reform,  including $1.5 billion in new measures. The package is a cross‐sector reform  package  that  recognises  the  diverse  impact  of  mental  illness  throughout  a  person’s lifetime and is intended to build resilient children, support teenagers  and families dealing with the challenge of mental illness, improve access to  primary care and target more community‐based services to people living with  severe mental illness and their families.  

1.12 Of this additional funding, FaHCSIA was allocated $269.3 million to  provide further support to community mental health by expanding the TCC  Program  to  include  additional  services  such  as  employment  and  family  support and additional service locations. These new funds were in addition to  ongoing funding over the same period for existing providers under the TCC  Program. 

                                                       33 COAG National Action Plan for Mental Health 2006-2011, 14 July 2006. http://archive.coag.gov.au/coag_meeting_outcomes/2006-07-14/docs/nap_mental_health.pdf

[accessed 15 January 2013]. 34 COAG The Roadmap for National Mental Health Reform 2012-2022. http://www.coag.gov.au/sites/default/files/The%20Roadmap%20for%20National%20Mental%20Health%20Reform%202

012-2022.pdf.pdf [accessed 22 January 2013].

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from  illness  through  a  greater  focus  on  promotion,  prevention,  early  intervention and access to mental health services.33 

1.10 The  Action  Plan  ceased  in  2011,  but  mental  health  reform  was  recognised as requiring continued government commitment and renewal. To  this end, the National Mental Health Strategy (comprising the National Mental 

Health Policy, endorsed in 2008 by the Health Ministers, and the Fourth National  Mental  Health  Plan  2009-2014)  builds  upon  the  whole‐of‐government  commitments  of  the  Action  Plan  and  provides  the  national  direction  and  priorities  for  mental  health  reform  within  Australia’s  health  system.  More  recently the Roadmap for National Mental Health Reform 2012-22 was approved  and  released  by  COAG  on  7  December  2012.  The  Roadmap  provides  a  pathway  towards  achieving  the  vision  of  an  Australian  society  that  values  good mental health and wellbeing and confirms the shared intents and goals of  Commonwealth, state and territory governments.34 

1.11 In  the  2011-12  Budget  the  Australian  government  announced  the  release of the Delivering National Mental Health Reform package in which the  government committed $2.2 billion over five years for mental health reform,  including $1.5 billion in new measures. The package is a cross‐sector reform  package  that  recognises  the  diverse  impact  of  mental  illness  throughout  a  person’s lifetime and is intended to build resilient children, support teenagers  and families dealing with the challenge of mental illness, improve access to  primary care and target more community‐based services to people living with  severe mental illness and their families.  

1.12 Of this additional funding, FaHCSIA was allocated $269.3 million to  provide further support to community mental health by expanding the TCC  Program  to  include  additional  services  such  as  employment  and  family  support and additional service locations. These new funds were in addition to  ongoing funding over the same period for existing providers under the TCC  Program. 

                                                       33 COAG National Action Plan for Mental Health 2006-2011, 14 July 2006. http://archive.coag.gov.au/coag_meeting_outcomes/2006-07-14/docs/nap_mental_health.pdf

[accessed 15 January 2013]. 34 COAG The Roadmap for National Mental Health Reform 2012-2022. http://www.coag.gov.au/sites/default/files/The%20Roadmap%20for%20National%20Mental%20Health%20Reform%202

012-2022.pdf.pdf [accessed 22 January 2013].

Introduction

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1.13 Mental health has an extensive committee structure in which FaHCSIA  plays a part. Appendix 2 shows the 2012 high level committee structure and  the interrelations of committees and councils governing mental health. 

Targeted Community Care (Mental Health) Program

Development of the Targeted Community Care (Mental Health) Program

1.14 There are three components to the TCC Program: 

 Personal Helpers and Mentors (PHaMs). This initiative is designed to  assist  people  whose  lives  are  severely  affected  by  mental  illness  by  providing support: to  manage daily activities; gain access to needed  services such as accommodation, social support, health, welfare, and  employment services; and increase connections with their community;  

 Family  Mental  Health  Support  Services35  (FMHSS).  This  initiative  provides early intervention support to assist vulnerable families with  children and young people who are at risk of, or affected by, mental  illness. These services aim to support parents to reduce family stress  and enable children and young people to reach their potential; and 

 Mental  Health  Respite: Carer  Support36  (MHR: CS).  This  initiative  funds 650 respite care places which provide a range of flexible respite  and  support  options  for  carers  and  families  of  people  with  severe  mental illness and carers of people with an intellectual disability.  

1.15 Appendix 3 provides a detailed description of the TCC Program’s three  service components. 

1.16 The  objective  of  the  TCC  Program  ‘....is  to  implement  community  mental health initiatives to assist people with mental illness and their families  and carers to manage the impact of mental illness.’37 FaHCSIA’s strategy to  achieve this is to provide accessible, responsive, high quality and integrated  community‐based  mental  health  services  that  improve  the  capacity  of  individuals, families and carers to manage the impacts of mental illness on 

                                                       35 Originally known as Mental Health Community Based. 36

Originally known as Mental Health Respite. 37 Department of Families, Housing, Community Services and Indigenous Affairs, Portfolio Budget Statement 2012-2013, p. 94. http://resources.fahcsia.gov.au/budget/2012-13/FaHCSIA_PBS_2012-13.pdf [accessed 5 February 2013].

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their lives and improve their overall wellbeing.38 The Program complements  clinical health services by providing support options that aim to promote social  inclusion and recovery. Grant funding is awarded under the TCC Program to  community‐based  not‐for‐profit  organisations  and  established  national  charitable organisations to deliver services in sites across Australia.  

1.17 Table  1.1  shows  the  number  of  service  sites  funded  in  2011-12,  the  number of clients FaHCSIA estimates it has assisted and the funding allocation  by each service type. 

Table 1.1

Targeted Community Care (Mental Health) Program 2011-1239

Mental Health Services

Number of service sites

Number of clients assisted

Funding allocation

$million

Personal Helpers and Mentors 175 13 219 85.6

Mental Health Respite: Carer Support 195 28 745 50.0

Family Mental Health Support Services 54 82 104 20.3

Total 424 124 068 155.9

Source: FaHCSIA.

Note: Number of clients assisted includes remote participants

Number of service sites as at 30 June 2012.

Of the 175 PHaMs sites, 95 were in metropolitan areas, 69 were in non-metropolitan areas and 11 were in remote areas.

Program delivery model and services

1.18 The services offered by providers as part of the three service streams  have developed over time in step with FaHCSIA’s program evaluation and  research, and the growth and development of the capacity of service providers  operating in the community sector. Following recommendations contained in 

                                                       38 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care Program (Mental Health) Program, Part A: Program Guidelines, November 2012. 39

In the same financial year the Department of Health and Ageing’s mental health program (Program 11.1) was allocated $310.4 million to fund its mental health activities. This program includes National Partnerships paid to state and territory governments as part of the Federal Financial Relations Framework for: National Health and Hospitals Network - Mental Health - Expansion of the Early Psychosis Prevention and Intervention Centre model initiative; and The National Perinatal Depression Initiative.

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their lives and improve their overall wellbeing.38 The Program complements  clinical health services by providing support options that aim to promote social  inclusion and recovery. Grant funding is awarded under the TCC Program to  community‐based  not‐for‐profit  organisations  and  established  national  charitable organisations to deliver services in sites across Australia.  

1.17 Table  1.1  shows  the  number  of  service  sites  funded  in  2011-12,  the  number of clients FaHCSIA estimates it has assisted and the funding allocation  by each service type. 

Table 1.1

Targeted Community Care (Mental Health) Program 2011-1239

Mental Health Services

Number of service sites

Number of clients assisted

Funding allocation

$million

Personal Helpers and Mentors 175 13 219 85.6

Mental Health Respite: Carer Support 195 28 745 50.0

Family Mental Health Support Services 54 82 104 20.3

Total 424 124 068 155.9

Source: FaHCSIA.

Note: Number of clients assisted includes remote participants

Number of service sites as at 30 June 2012.

Of the 175 PHaMs sites, 95 were in metropolitan areas, 69 were in non-metropolitan areas and 11 were in remote areas.

Program delivery model and services

1.18 The services offered by providers as part of the three service streams  have developed over time in step with FaHCSIA’s program evaluation and  research, and the growth and development of the capacity of service providers  operating in the community sector. Following recommendations contained in 

                                                       38 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care Program (Mental Health) Program, Part A: Program Guidelines, November 2012. 39

In the same financial year the Department of Health and Ageing’s mental health program (Program 11.1) was allocated $310.4 million to fund its mental health activities. This program includes National Partnerships paid to state and territory governments as part of the Federal Financial Relations Framework for: National Health and Hospitals Network - Mental Health - Expansion of the Early Psychosis Prevention and Intervention Centre model initiative; and The National Perinatal Depression Initiative.

Introduction

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the TCC Program evaluation report released in 2011,40 the three service types  were aligned into two funding streams to better associate the funding with the  intended target populations. 

 Services for People with Mental Illness  

 Personal Helpers and Mentors 

 Services and Support for Families and Carers of People with Mental  Illness  

 Mental Health Respite: Carer Support 

 Family Mental Health Support Services  

1.19 Reframing and streamlining the initiatives did not change the outcomes  or intent of the overall program. 

1.20 Table 1.2 shows the program funding allocation across jurisdictions and  population in 2011-12. 

   

                                                       40 Evaluation of the FaHCSIA Targeted Community Care Mental Health Initiatives, Final Report, March 2011. http://www.fahcsia.gov.au/our-responsibilities/communities-and-vulnerable-people/programs-services/targeted-

community-care-mental-health-program/evaluation-of-the-fahcsia-targeted-community-care-mental-health-initiatives [accessed 23 January 2013].

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Table 1.2

Targeted Community Care (Mental Health) Program state and territory funding allocations and population size, 2011-12

State/Territory

Funding

allocation

$million

Percentage of

program

funding allocation

Percentage of Australian population

ACT 2.5 1.6 1.6

NSW 46.2 29.7 32.4

NT 7.2 4.6 1.0

Qld 28.2 18.1 20.2

SA 15.6 10.0 7.3

Tas 4.8 3.1 2.3

Vic 32.4 20.8 24.8

WA 19.1 12.3 10.3

Total 156.0 100.0 100.0

Source: FaHCSIA data. ABS population figures at December 2010 and approved funding as at 30 June 2012.

Note: Because of rounding, the sum of the components do not always add to the total.

Audit objective, scope, criteria and approach

Audit objective

1.21 The objective of the audit was to assess the effectiveness of FaHCSIA’s  administration  and  management  of  the  Targeted  Community  Care  (Mental  Health) Program. 

Audit scope

1.22 The  audit  focused  primarily  on  the  program’s  administration  and  management since 2010-11. This period included the: 

 finalisation of the original program measures; and  

 commencement of program expansion measures. 

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Table 1.2

Targeted Community Care (Mental Health) Program state and territory funding allocations and population size, 2011-12

State/Territory

Funding

allocation

$million

Percentage of

program

funding allocation

Percentage of Australian population

ACT 2.5 1.6 1.6

NSW 46.2 29.7 32.4

NT 7.2 4.6 1.0

Qld 28.2 18.1 20.2

SA 15.6 10.0 7.3

Tas 4.8 3.1 2.3

Vic 32.4 20.8 24.8

WA 19.1 12.3 10.3

Total 156.0 100.0 100.0

Source: FaHCSIA data. ABS population figures at December 2010 and approved funding as at 30 June 2012.

Note: Because of rounding, the sum of the components do not always add to the total.

Audit objective, scope, criteria and approach

Audit objective

1.21 The objective of the audit was to assess the effectiveness of FaHCSIA’s  administration  and  management  of  the  Targeted  Community  Care  (Mental  Health) Program. 

Audit scope

1.22 The  audit  focused  primarily  on  the  program’s  administration  and  management since 2010-11. This period included the: 

 finalisation of the original program measures; and  

 commencement of program expansion measures. 

Introduction

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Audit criteria

1.23 Three  high  level  criteria  were  used  to  conclude  against  the  audit  objective. These were whether FaHCSIA: 

 established and used structured and appropriate planning processes to  support the targeting of the program; 

 managed the selection of service providers consistently with Australian  Government requirements; and 

 developed  and  implemented  satisfactory  performance  reporting  arrangements for program effectiveness and accountability. 

Audit approach

1.24 The audit involved the examination of documents and files relevant to  the  TCC  Program.  Interviews  were  conducted  with  officers  in  FaHCSIA’s  national office in Canberra, as well as with officers in the New South Wales,  South Australian and Queensland FaHCSIA offices. In addition, the ANAO  visited a random sample of 24 PHaMs, FMHSS and MHR: CS service providers  in those same states and the Australian Capital Territory.  

1.25 The  audit  was  conducted  in  accordance  with  the  ANAO  Auditing  Standards at a cost of $340 311. 

   

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Report structure 1.26 The structure of the report is outlined in Figure 1.2 

Figure 1.2

Report structure

Chapter Description

Chapter 2

Program Planning and Management

This chapter describes FaHCSIA’s overall approach to planning and managing the expansion of the Targeted Community Care (Mental Health) Program. The chapter also examines the roles and responsibilities of FaHCSIA’s national and state and territory offices and the approach taken to risk management.

Chapter 3

Grant Selection and Assessment

This chapter examines the selection approaches taken by FaHCSIA in recent Targeted Community Care (Mental Health) Program and funding rounds.

Chapter 4

Reporting and Monitoring

This chapter examines FaHCSIA’s performance monitoring and reporting of the Targeted Community Care (Mental Health) Program and the introduction of a new performance management framework.

Source: ANAO.

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Report structure 1.26 The structure of the report is outlined in Figure 1.2 

Figure 1.2

Report structure

Chapter Description

Chapter 2

Program Planning and Management

This chapter describes FaHCSIA’s overall approach to planning and managing the expansion of the Targeted Community Care (Mental Health) Program. The chapter also examines the roles and responsibilities of FaHCSIA’s national and state and territory offices and the approach taken to risk management.

Chapter 3

Grant Selection and Assessment

This chapter examines the selection approaches taken by FaHCSIA in recent Targeted Community Care (Mental Health) Program and funding rounds.

Chapter 4

Reporting and Monitoring

This chapter examines FaHCSIA’s performance monitoring and reporting of the Targeted Community Care (Mental Health) Program and the introduction of a new performance management framework.

Source: ANAO.

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2. Program Planning and Management

This chapter describes FaHCSIA’s overall approach to planning and managing the  expansion of the Targeted Community Care (Mental Health) Program (TCC). The  chapter also examines the roles and responsibilities of FaHCSIA’s national and state  and territory offices and the approach taken to risk management. 

Introduction 2.1 High  quality  planning  underpins  efficient,  effective,  economical  and  ethical grants administration.41 To implement programs that best support the  government’s  expected  outcomes,  consideration  needs  to  be  given  to  the  planning and targeting of the program, often involving agency staff working  with stakeholders to plan, design and undertake the granting activities. Where  program delivery is undertaken in a variety of geographical locations using  local providers, clearly defined roles and responsibilities are important both  within  the  administering  department  and  with  the  network  of  service  providers.  Risk  is  an  important  consideration  for  agencies,  and  risk  management should be built into an agency’s grants administration processes  and be an ongoing element of management. 

Program development and implementation

Introduction and expansion of program services

2.2 The original TCC Program measures were implemented progressively  over  the  period  2006-07 to 2010-11.  Table  2.1  shows  the  TCC  Program  implementation over this time.  

 

 

 

                                                       41 Department of Finance and Deregulation, Commonwealth Grant Guidelines, Policies and Principles for Grants Administration, July 2009 p. 15. http://www.finance.gov.au/publications/fmg-series/docs/FMG23_web.pdf [accessed 19

February 2013].

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Table 2.1

Targeted Community Care (Mental Health) Program implementation 2007-10

Program service element Implementation Date*

Personal Helpers and Mentors (PHaMs)

Round 1: May 2007

Round 2: November 2007

Round 3: April 2009

Round 4: March 2010

Family Mental Health Support Services (FMHSS)

Phase 1: June 2007

Phase 2: December 2007

Mental Health Respite: Carer Support (MHR: CS)

Commonwealth Respite Carelink Centres: April 2007

National Respite Development Fund (NRDF) Round 1: November 2007

NRDF Round 2: June 2009.

Source: FaHCSIA program data.

* Date of Ministerial approval.

2.3 As part of the 2011-12 mental health budget measures, the expanded  TCC  Program  is  being  progressively  implemented  from  January  2012.  The  budget  measures  provide  an  additional  $269.3 million  for  expansion  which  will be invested in community mental health services over the five year period  2011-12  to  2015-16.  FaHCSIA’s  early  draft  implementation  plans  evenly  spaced  the  work  over  the  five  year  period.  However,  this  approach  was  subsequently  viewed  by  FaHCSIA  as  an  inefficient  approach  to  large  and  complicated grant processes and insufficient to meet the expected demands for  the services. FaHCSIA accordingly modified its phasing and is now working to  a  plan  that  schedules  approximately  75 per cent  of  implementation  for  completion by June 2013. 

2.4 The expansion of the TCC Program includes: 

 Personal  Helpers  and  Mentors:  $154 million  to  provide  additional  425 new  personal  helpers  and  mentors  to  assist  around  3400  people  with severe mental illness. 

- $50 million (of the $154 million) will provide personal helpers and  mentors  to  specifically  help  people  with  mental  illness  on,  or 

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Table 2.1

Targeted Community Care (Mental Health) Program implementation 2007-10

Program service element Implementation Date*

Personal Helpers and Mentors (PHaMs)

Round 1: May 2007

Round 2: November 2007

Round 3: April 2009

Round 4: March 2010

Family Mental Health Support Services (FMHSS)

Phase 1: June 2007

Phase 2: December 2007

Mental Health Respite: Carer Support (MHR: CS)

Commonwealth Respite Carelink Centres: April 2007

National Respite Development Fund (NRDF) Round 1: November 2007

NRDF Round 2: June 2009.

Source: FaHCSIA program data.

* Date of Ministerial approval.

2.3 As part of the 2011-12 mental health budget measures, the expanded  TCC  Program  is  being  progressively  implemented  from  January  2012.  The  budget  measures  provide  an  additional  $269.3 million  for  expansion  which  will be invested in community mental health services over the five year period  2011-12  to  2015-16.  FaHCSIA’s  early  draft  implementation  plans  evenly  spaced  the  work  over  the  five  year  period.  However,  this  approach  was  subsequently  viewed  by  FaHCSIA  as  an  inefficient  approach  to  large  and  complicated grant processes and insufficient to meet the expected demands for  the services. FaHCSIA accordingly modified its phasing and is now working to  a  plan  that  schedules  approximately  75 per cent  of  implementation  for  completion by June 2013. 

2.4 The expansion of the TCC Program includes: 

 Personal  Helpers  and  Mentors:  $154 million  to  provide  additional  425 new  personal  helpers  and  mentors  to  assist  around  3400  people  with severe mental illness. 

- $50 million (of the $154 million) will provide personal helpers and  mentors  to  specifically  help  people  with  mental  illness  on,  or 

Program Planning and Management

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claiming income support or the Disability Support Pension who  are also working with employment services. 

 Mental  Health  Respite: Carer  Support:  $54.3 million  for  additional  respite  services  to  help  approximately  1100  families  and  carers  to  maintain their caring role. 

 Family  Mental  Health  Support  Services:  $61 million  to  establish  40 additional service sites. 

2.5 In planning the implementation of the expansion, FaHCSIA sought to  make sure that:  

 the sites with the highest needs were selected for new and expanded  services;  

 the most capable service providers were selected; and  

 program  enhancements  were  measured  and  tested  during  implementation before being applied more broadly. 

2.6 To  support  the  expansion,  FaHCSIA  developed  an  implementation  plan that identified key tasks. These were the development of: 

 service delivery models for new service types; 

 a list of priority sites for program expansion; 

 a consultation strategy with relevant stakeholders; 

 provider selection processes; 

 new administrative processes to manage implementation and ongoing  management; and 

 an evaluation strategy for the budget measures. 

2.7 FaHCSIA’s  implementation  plan  also  incorporated  risk  identification  and associated mitigation strategies along with progress reporting. 

Site selection

2.8 The  Commonwealth  Grant  Guidelines  (CGGs)  set  out  the  need  for  agencies  to  address  relevant  planning  issues  before  granting  activities 

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commence.42 To guide the implementation of new community mental health  services,  FaHCSIA  developed  principles  to  support  site  selection.  These  principles were that:  

 additional service delivery capacity is to be targeted to areas of high need; 

 priority  is  to  be  given  to  disadvantaged  and  vulnerable  target  groups  including,  but  not  limited  to,  Indigenous  Australians,  culturally  and  linguistically diverse (CALD) groups and homeless people; 

 consideration is to be given to locations of other Australian Government  reform priorities; and 

 the equitable distribution of funding across each state and territory and a  balance of remote, non‐metropolitan and metropolitan services. 

2.9 FaHCSIA  used  a  variety  of  geographic  spatial  mapping  approaches  when  analysing  gaps  in  service  coverage,  identifying  high  need  areas  and  areas where demand for services exceeds the capacity of current providers.  These geographical areas defined by post code, local government area43 (LGA)  boundaries or Housing and Community Care (HACC) regions44 also delineate  client eligibility.  

Personal Helpers and Mentors

2.10 The analysis undertaken by FaHCSIA to identify priority locations of  PHaMs  used  Australian  Bureau  of  Statistics  (ABS)  2006  Census  Collection  Districts45 (CDs) and LGA population data. 

                                                       42 Department of Finance and Deregulation, Commonwealth Grant Guidelines, Second Edition, Financial Management Guidance No.3 June 2013, p. 32. http://www.finance.gov.au/publications/fmg-series/docs/FMG-3-Commonwealth-

Grant-Guidelines-June-2013.pdf [accessed 19 February 2013]. 43 A Local Government Area (LGA) is a geographical area under the responsibility of an incorporated local government council, or an incorporated Indigenous government council. The LGAs in Australia collectively cover only a part of

Australia. The main areas not covered by LGAs are northern parts of South Australia, a large part of the Northern Territory, the western division of New South Wales, all of the Australian Capital Territory and the Other Territories. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/2901.0Chapter23102011 [accessed 18 February 2013]. 44

The Commonwealth HACC region is the basis of the funding arrangements for Commonwealth HACC service delivery. Commonwealth HACC funding, provided under the Aged Care Funding Agreement, is for services which support frail older people and their carers, who live in the community and whose capacity for independent living is at risk, or who are at risk of premature or inappropriate admission to long term residential care. http://www.health.gov.au/internet/main/publishing.nsf/Content/2F4764279BE70622CA257A2300091BFF/$File/HAAC% 20Manual_web.pdf [accessed 18 February 2013]. 45

The Census Collection District (CD) has been designed for use in the Census of Population and Housing as the smallest unit for collection and processing. CDs also serve as the basic building block in the Australian Standard Geographical Classification and are used for the aggregation of statistics to larger Census geographic areas. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/413876F3BAE9CC70CA25720A000C428B [accessed 18 February 2013].

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commence.42 To guide the implementation of new community mental health  services,  FaHCSIA  developed  principles  to  support  site  selection.  These  principles were that:  

 additional service delivery capacity is to be targeted to areas of high need; 

 priority  is  to  be  given  to  disadvantaged  and  vulnerable  target  groups  including,  but  not  limited  to,  Indigenous  Australians,  culturally  and  linguistically diverse (CALD) groups and homeless people; 

 consideration is to be given to locations of other Australian Government  reform priorities; and 

 the equitable distribution of funding across each state and territory and a  balance of remote, non‐metropolitan and metropolitan services. 

2.9 FaHCSIA  used  a  variety  of  geographic  spatial  mapping  approaches  when  analysing  gaps  in  service  coverage,  identifying  high  need  areas  and  areas where demand for services exceeds the capacity of current providers.  These geographical areas defined by post code, local government area43 (LGA)  boundaries or Housing and Community Care (HACC) regions44 also delineate  client eligibility.  

Personal Helpers and Mentors

2.10 The analysis undertaken by FaHCSIA to identify priority locations of  PHaMs  used  Australian  Bureau  of  Statistics  (ABS)  2006  Census  Collection  Districts45 (CDs) and LGA population data. 

                                                       42 Department of Finance and Deregulation, Commonwealth Grant Guidelines, Second Edition, Financial Management Guidance No.3 June 2013, p. 32. http://www.finance.gov.au/publications/fmg-series/docs/FMG-3-Commonwealth-

Grant-Guidelines-June-2013.pdf [accessed 19 February 2013]. 43 A Local Government Area (LGA) is a geographical area under the responsibility of an incorporated local government council, or an incorporated Indigenous government council. The LGAs in Australia collectively cover only a part of

Australia. The main areas not covered by LGAs are northern parts of South Australia, a large part of the Northern Territory, the western division of New South Wales, all of the Australian Capital Territory and the Other Territories. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/2901.0Chapter23102011 [accessed 18 February 2013]. 44 The Commonwealth HACC region is the basis of the funding arrangements for Commonwealth HACC service delivery. Commonwealth HACC funding, provided under the Aged Care Funding Agreement, is for services which support frail older people and their carers, who live in the community and whose capacity for independent living is at risk, or who are at risk of premature or inappropriate admission to long term residential care. http://www.health.gov.au/internet/main/publishing.nsf/Content/2F4764279BE70622CA257A2300091BFF/$File/HAAC% 20Manual_web.pdf [accessed 18 February 2013]. 45 The Census Collection District (CD) has been designed for use in the Census of Population and Housing as the smallest unit for collection and processing. CDs also serve as the basic building block in the Australian Standard Geographical Classification and are used for the aggregation of statistics to larger Census geographic areas. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/413876F3BAE9CC70CA25720A000C428B [accessed 18 February 2013].

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2.11 Relative need was assessed through the use of a number of indicators  and  calculating  an  average  ranking  for  each  LGA.  The  indicators  used  included: 

 ABS data on Australia’s Indigenous population; 

 the Kessler K10 scale46 by LGA based on synthetic estimates from the  ABS 2007-08 National Health Survey; 

 the number of people with a Mental Health Care Plan47 based on data  from the Department of Health and Ageing 2009-10; 

 Australia’s homeless population,48 and 

 people  living  in  Australia’s  most  disadvantaged  5  per cent  of  CDs  based  on  the  2006  ABS  Socio‐Economic  Index  of  Disadvantage  (SEIFA).49 

2.12 FaHCSIA  assessed  areas  where  demand  for  services  exceeded  the  current capacity of providers by identifying the number of current providers  operating in each LGA and the number of those providers that were at or near  capacity in terms of the number of registered clients. This data was linked to  information on estimated demand to identify potential service gaps. 

Family Mental Health Support Services

2.13 For 40 new FMHSS sites, FaHCSIA drew on the same analysis that it  had undertaken for PHaMs with an additional focus on: 

 the concentration of socio‐economic disadvantage; 

 areas  with  high  populations  of  Indigenous  and  non  Indigenous  children zero to 14 years; and 

 areas with a high CALD population. 

                                                       46

The K10 is a measure of distress based on ten questions about anxiety and depressive symptoms that a person has experienced in the most recent four week period. 47 Prepared by general practice doctors under the Better Access Program 2009-2010, administered by the Department of

Health and Ageing. 48 Australian Bureau of Statistics, Australian Census Analytic Program: Counting the Homeless, Australia, 2006, cat no. 2050.0, Canberra. 49

The SEIFA is based on National Population Census data. Australian Bureau of Statistics, 2039.0 - Information Paper: An introduction to Socio-Economic Indexes for areas (SEIFA) [Internet], ABS, Australia, 2006. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2039.02006?OpenDocument [accessed 25 February].

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2.14 Because of the number of high need community sites across Australia  was expected to exceed the available funding, FaHCSIA chose to focus on new  sites where there were no current FMHSS services.  

Mental Health Respite: Carer Support

2.15 FaHCSIA  based  the  needs  analysis  for  the  MHR: CS  expansion  on  LGAs  rather  than  HACC  regions  to  better  identify  gaps  in  current  service  coverage.  The  methodology  identified  a  number  of  priority  locations  with  absolute gaps in service coverage or with very poor service coverage. 

Consultation

2.16 The CGGs emphasise the importance of collaboration and partnership  between  the  responsible  agency  and  the  program  stakeholders  when  developing or modifying granting activities.50 FaHCSIA’s ongoing consultation  with the community and key stakeholders has been a positive initiative that  has  guided  and  influenced  the  design  and  development  of  the  expanded  program. The approach taken by FaHCSIA has also been consistent with the  intent of the National Compact between the Australian Government and the  not‐for‐profit sector to genuinely collaborate to achieve shared visions.51 The  ANAO’s  interviews  with  a  sample  of  service  providers  indicated  that  FaHCSIA has built up working relationships with peak bodies and with the  major service providers.  

2.17 Following  the  announcement  of  the  program’s  expansion  in  2011,  a  specific communication strategy was developed to set out the need and type of  consultation  necessary,  the  appropriate  forms  of  communication  and  the  period over which consultation needed to be undertaken. Discussions were  held  with  FaHCSIA’s  state  and  territory  offices,  state  and  territory  governments,  peak  organisations and  service  providers  regarding  roles  and  responsibilities, to test proposals and priority areas and to inform them of the  intended  timetable  and  program  design  changes.  Following  the  budget  announcement, all TCC Program service providers were sent letters setting out  potential  changes  and  were  given  the  opportunity  to  have  input  into  the  proposed program changes.  

                                                       50 Department of Finance and Deregulation, Commonwealth Grant Guidelines, Second Edition, Financial Management Guidance No.3 June 2013, p. 36. http://www.finance.gov.au/publications/fmg-series/docs/FMG-3-Commonwealth-

Grant-Guidelines-June-2013.pdf [accessed 19 February 2013]. 51 Australian Government, National Compact, working together. Part of the social inclusion agenda. http://www.nationalcompact.gov.au/compact [accessed 25 February 2013].

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2.14 Because of the number of high need community sites across Australia  was expected to exceed the available funding, FaHCSIA chose to focus on new  sites where there were no current FMHSS services.  

Mental Health Respite: Carer Support

2.15 FaHCSIA  based  the  needs  analysis  for  the  MHR: CS  expansion  on  LGAs  rather  than  HACC  regions  to  better  identify  gaps  in  current  service  coverage.  The  methodology  identified  a  number  of  priority  locations  with  absolute gaps in service coverage or with very poor service coverage. 

Consultation

2.16 The CGGs emphasise the importance of collaboration and partnership  between  the  responsible  agency  and  the  program  stakeholders  when  developing or modifying granting activities.50 FaHCSIA’s ongoing consultation  with the community and key stakeholders has been a positive initiative that  has  guided  and  influenced  the  design  and  development  of  the  expanded  program. The approach taken by FaHCSIA has also been consistent with the  intent of the National Compact between the Australian Government and the  not‐for‐profit sector to genuinely collaborate to achieve shared visions.51 The  ANAO’s  interviews  with  a  sample  of  service  providers  indicated  that  FaHCSIA has built up working relationships with peak bodies and with the  major service providers.  

2.17 Following  the  announcement  of  the  program’s  expansion  in  2011,  a  specific communication strategy was developed to set out the need and type of  consultation  necessary,  the  appropriate  forms  of  communication  and  the  period over which consultation needed to be undertaken. Discussions were  held  with  FaHCSIA’s  state  and  territory  offices,  state  and  territory  governments,  peak  organisations and  service  providers  regarding  roles  and  responsibilities, to test proposals and priority areas and to inform them of the  intended  timetable  and  program  design  changes.  Following  the  budget  announcement, all TCC Program service providers were sent letters setting out  potential  changes  and  were  given  the  opportunity  to  have  input  into  the  proposed program changes.  

                                                       50 Department of Finance and Deregulation, Commonwealth Grant Guidelines, Second Edition, Financial Management Guidance No.3 June 2013, p. 36. http://www.finance.gov.au/publications/fmg-series/docs/FMG-3-Commonwealth-

Grant-Guidelines-June-2013.pdf [accessed 19 February 2013]. 51 Australian Government, National Compact, working together. Part of the social inclusion agenda.

http://www.nationalcompact.gov.au/compact [accessed 25 February 2013].

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Enhancement to the Targeted Community Care (Mental Health) Program 2.18 It  is  important  that  programs  remain  well  targeted  and  are  appropriately  revised  as  circumstances  change,  or  in  the  light  of  implementation  experience.  As  part  of  the  TCC  Program’s  expansions  the  Australian  Government  intended  that  new  sites  would  complement  other  initiatives  such  as  the  National  Framework  for  Protecting  Australia’s  Children52  and  the  Building  of  Australia’s  Future  Workforce53  pilot  sites.  FaHCSIA  is  continuing  to  refine  the  delivery  models  for  the  mental  health  employment component of the expanded PHaMs and the FMHSS increased  focus  on  early  interventions,  with  the  intention  that  these  models  will  be  further  refined  through  engagement  with  key  stakeholders  and  service  providers. 

PHaMs Employment

2.19 The PHaMs employment component is designed to assist up to 1200  income support and Disability Support Pension (DSP) recipients/claimants by  providing complementary assistance to help people to stabilise those aspects of  their  lives  that  are  inhibiting  their  capacity  to  engage  in  and  maintain  employment. Direct employment assistance such as job placements, job skills  or job‐readiness training is not provided as part of the PHaMs service as this  continues to be the role of employment service providers. Services are to be  located in areas of high need where there are significant populations of DSP  recipients with psychiatric conditions as their primary disability. 

2.20 As part of the planning for the PHaMs employment measure, FaHCSIA  undertook  broad  consultation  with  a  range  of  stakeholders  including  Commonwealth  agencies;  PHaMs  service  providers;  Disability  Employment  Services and Job Search Australia providers; consumers and carers; and mental  health and employment peak organisations. The consultation focused on the  implementation of the measures and to confirm that they complement other 

                                                       52 The National Framework for Protecting Australia’s Children 2009-2020, endorsed by the Council of Australian Governments in April 2009, is a long-term approach to ensuring the safety and wellbeing of Australia’s children and

aims to deliver a substantial and sustained reduction in levels of child abuse and neglect over time. 53 From 1 July 2012 new measures introduced as part of the $3 billion Building Australia’s Future Workforce package announced in the 2011-2012 Federal Budget, are coming into effect. Broadly, these measures relate to: people with

disability; the very long term unemployed; job seekers; youth and early school leavers; and tackling entrenched disadvantage. The package involves FaHCSIA, DHS and DEEWR working together and the government has identified ten Local Government Areas where additional assistance is being offered to boost participation and reduce disadvantage.

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major  initiatives  and  link  with  Commonwealth  services  and  programs  for  people with mental illness. FaHCSIA is expecting the first 12 months of the  initiative to be one of consolidation during which the model will be refined  and base line measures and performance measurement finalised.  

Family Mental Health Support Services

2.21 In line with the 2011-12 budget, FMHSS services will have a consistent  focus  on  providing  early  interventions  specifically  for  children  and  young  people. FaHCSIA has planned a progressive introduction of a new model to  strengthen  the  focus  on  early  intervention  support  for  children  and  young  people  at  risk  of  developing  mental  illness,  or  those  displaying  early  symptoms  of  mental  illness.  The  model  retains  and  enhances  the  three  elements of the current FMHSS: 

 early  interventions  and  casework  specifically  for  children  or  young  people; 

 whole‐of‐family  assistance  and  support  where  problems  within  families are impacting negatively on the mental health of children and  young people; and 

 community outreach, including group work with children and young  people,  mental  health  promotion  and  community  development  activities. 

2.22 Under the current model, service providers deliver one or more of these  elements.  However,  the  new  FMHSS  model  requires  service  providers  to  deliver  all  three  elements.  FaHCSIA  will  be  working  with  existing  service  providers to transition to the new model by mid 2014. 

Roles and responsibilities for ongoing administration 2.23 FaHCSIA’s  Common  Business  Model  for  Grants  Management  (the  Common  Business  Model),  provides  a  department‐wide  management  structure  and  approach  for  grant  programs.  In  general,  FaHCSIA’s  grant  program  management  responsibilities  are  shared  across  two  main  departmental structures: National Office located in Canberra, and the State and  Territory Office Network (STO Network).  

2.24 Under  the  Common  Business  Model,  the  National  Office  staff  are  generally  responsible  for  developing  the  overarching  documents,  tools  and  processes  for  program  management,  while  the  STO  Network  staff  are 

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major  initiatives  and  link  with  Commonwealth  services  and  programs  for  people with mental illness. FaHCSIA is expecting the first 12 months of the  initiative to be one of consolidation during which the model will be refined  and base line measures and performance measurement finalised.  

Family Mental Health Support Services

2.21 In line with the 2011-12 budget, FMHSS services will have a consistent  focus  on  providing  early  interventions  specifically  for  children  and  young  people. FaHCSIA has planned a progressive introduction of a new model to  strengthen  the  focus  on  early  intervention  support  for  children  and  young  people  at  risk  of  developing  mental  illness,  or  those  displaying  early  symptoms  of  mental  illness.  The  model  retains  and  enhances  the  three  elements of the current FMHSS: 

 early  interventions  and  casework  specifically  for  children  or  young  people; 

 whole‐of‐family  assistance  and  support  where  problems  within  families are impacting negatively on the mental health of children and  young people; and 

 community outreach, including group work with children and young  people,  mental  health  promotion  and  community  development  activities. 

2.22 Under the current model, service providers deliver one or more of these  elements.  However,  the  new  FMHSS  model  requires  service  providers  to  deliver  all  three  elements.  FaHCSIA  will  be  working  with  existing  service  providers to transition to the new model by mid 2014. 

Roles and responsibilities for ongoing administration 2.23 FaHCSIA’s  Common  Business  Model  for  Grants  Management  (the  Common  Business  Model),  provides  a  department‐wide  management  structure  and  approach  for  grant  programs.  In  general,  FaHCSIA’s  grant  program  management  responsibilities  are  shared  across  two  main  departmental structures: National Office located in Canberra, and the State and  Territory Office Network (STO Network).  

2.24 Under  the  Common  Business  Model,  the  National  Office  staff  are  generally  responsible  for  developing  the  overarching  documents,  tools  and  processes  for  program  management,  while  the  STO  Network  staff  are 

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primarily  responsible  for  funding  processes  and  direct  service  provider  management.  

2.25 Responsibilities of STO Network staff, often referred to as Agreement  Managers, include: 

 entering  funding  agreements  into  FaHCSIA’s  Online  Funding  Management System (FOFMS) and amending risk profiles as required; 

 ongoing  performance  monitoring  including  site  visits  to  ensure  compliance  with  the  funding  agreement  and  program  outcomes  are  being achieved; 

 directly liaising with service providers as required to ensure issues are  resolved at a local level;  

 undertaking an annual acquittal process against funding agreements;  and 

 providing  feedback  to  National  Office  staff  regarding  gaps,  linkages  and  overlaps  with  other  agencies  and  programs  and  other  levels  of  government  for  inclusion  and  consideration  in  national  reviews  and  evaluation. 

2.26 The purpose of the STO Network having these responsibilities is to use  local  knowledge  to  manage  Funding  Agreements  and  relationships  with  service providers.  

2.27 The  Common  Business  Model  was  introduced  in  2009  and  progressively applied to FaHCSIA’s grant programs. In July 2010 the model  was introduced to the TCC Program, providing an appropriate basis for the  identification  of  key  roles  and  responsibilities.  Similarly,  service  provider  funding  agreements  set  out  the  service  expectations  and  management  relationship between FaHCSIA and the funded organisations.  

Risk management 2.28 Both  the  CGGs  and  the  ANAO  Better  Practice  Guide—Implementing  Better  Grants  Administration,  June  2010,  emphasise  that  programs  should  include a framework for identifying and treating or minimising risks that may  have an adverse impact on the achievement of grant outcomes. FaHCSIA has  adopted a department‐wide approach to risk management across the program  life cycle. The principles of the FaHCSIA business model are underpinned by a  risk‐based  approach  to  funding  processes.  To  assess  and  manage  TCC 

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Program risks, FaHCSIA utilises two strategies. The first is a program‐wide  risk assessment and moderation strategy; and the second is a risk assessment  of service providers. 

2.29 Program  risk  tools  provide  a  standardised  approach  to  the  management  of  risk  in relation  to: the  establishment  of  programs;  selecting  service providers; and managing service delivery. The current program risk  management tools were developed and released for application in September  2009. 

Management of program risk

2.30 FaHCSIA uses a single, departmental risk assessment tool, the Program  Design  Risk  Assessment  Tool,  to  identify  risk  for  all  programs.  The  Program  Design  Risk  Assessment  Tool  generates  the  risk  profile  of  a  program  by  identifying the risk level in five risk areas of program:  

 governance;  

 financial management;  

 viability;  

 performance management; and  

 issues management.  

2.31 Responses  to  the  list  of  questions  for  each  risk  area  determine  the  likelihood rating used to calculate the risk level for each risk area. Based on the  risk  level  calculated,  control  strategies  are  generated  detailing  the  required  documentation and processes to manage risk for each of the five risk areas in  the program. 

2.32 The Program Design Risk Assessment Tool is a high level analysis which  focuses on FaHCSIA’s internal program management arrangements. Table 2.2  shows  results  of  the  TCC  Program  Design  Risk  Assessment  which  was  endorsed on 1 February 2012. 

   

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Program risks, FaHCSIA utilises two strategies. The first is a program‐wide  risk assessment and moderation strategy; and the second is a risk assessment  of service providers. 

2.29 Program  risk  tools  provide  a  standardised  approach  to  the  management  of  risk  in relation  to: the  establishment  of  programs;  selecting  service providers; and managing service delivery. The current program risk  management tools were developed and released for application in September  2009. 

Management of program risk

2.30 FaHCSIA uses a single, departmental risk assessment tool, the Program  Design  Risk  Assessment  Tool,  to  identify  risk  for  all  programs.  The  Program  Design  Risk  Assessment  Tool  generates  the  risk  profile  of  a  program  by  identifying the risk level in five risk areas of program:  

 governance;  

 financial management;  

 viability;  

 performance management; and  

 issues management.  

2.31 Responses  to  the  list  of  questions  for  each  risk  area  determine  the  likelihood rating used to calculate the risk level for each risk area. Based on the  risk  level  calculated,  control  strategies  are  generated  detailing  the  required  documentation and processes to manage risk for each of the five risk areas in  the program. 

2.32 The Program Design Risk Assessment Tool is a high level analysis which  focuses on FaHCSIA’s internal program management arrangements. Table 2.2  shows  results  of  the  TCC  Program  Design  Risk  Assessment  which  was  endorsed on 1 February 2012. 

   

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Table 2.2

Targeted Community Care (Mental Health) Program risk assessment, February 2012

Risk area

Governance Financial management Viability Performance

management Issues management

Risk level

Low Low Low Low Low

Source: ANAO adaptation of a table outlining FaHCSIA’s risk assessment for TCC Program as at 1 February 2012. The Program Design Risk Assessment is scheduled for review in May 2013.

Risk assessment of provider organisations

2.33 To  complement  the  program  level  risk  assessment,  FaHCSIA  also  undertakes  risk  assessment  of  the  service  provider  organisations.  Risk  assessments of individual service providers are completed using the Provider  Capacity Risk Assessment Tool54 and the Provider Delivery Assessment Tool.55 These  tools seek to identify and manage risks associated with the service providers’  ability  to  deliver  funded  activities  and  to  ensure  that  funded  activities  are  delivered to the agreed standard.  

2.34 Risk assessments are completed by STO Network staff. Similar to the  Program  Design  Risk  Assessment  Tool,  the  Provider  Capacity  Risk  and  Delivery  Assessment Tools assess risk in the five key program risk areas (governance,  financial  management,  viability,  performance  management  and  issues  management). Additional supporting comments can be added into the online  assessment.  

2.35 Based on the risk level, control strategies are generated by detailing the  actions required to manage risks for each of the five risk areas. If a program  risk area is identified as low risk, no control strategies are required. Table 2.3  shows a summary of the provider risk assessment for the TCC Program as at  November 2012. 

                                                       54 Risks associated with the provider organisations’ capacity to deliver quality services. 55

Risks associated with ensuring program requirements and funded activities are delivered to the agreed standard.

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Table 2.3

Targeted Community Care (Mental Health) Program summary of service provider risk assessments, November 2012

Risk summary

Financial management Governance Issues

management Performance management Viability

Low 172 175 178 176 178

Moderate 18 15 11 10 8

High 0 0 1 4 4

Not allocated 56

11 11 11 11 11

Total 201 201 201 201 201

Source: Provided by FaHCSIA.

2.36 While  FaHCSIA  assesses  and  monitors  risks  for  service  providers,  FaHCSIA also expects service providers to identify and manage their own risks  as stated in the TCC Program Guidelines Part A. 

Conclusion 2.37 Over the period 2006-11 FaHCSIA made a number of adjustments to  the  TCC  Program  to  reflect  implementation  experience  and  increased  understanding of different needs for mental health services. The expansion of  the program announced in 2011 sought to build on this base by expanding sites  and the capacity of services. It further sought to refine the service delivery  models  and  introduce  program  enhancements.  In  developing  these  enhancements, FaHCSIA has actively drawn on its own experience and that of  service providers in the sector. 

2.38 To  support  the  expansion  of  the  TCC  Program,  FaHCSIA  has  given  appropriate consideration to key aspects of planning and administration.  A  detailed implementation plan was developed and covered essential elements  such as: stakeholder consultation and communication; the development and  refocusing  of  services  models;  the  identification  of  risks;  staged  provider 

                                                       56 For 11 organisations funded under the TCC, an assessment of capacity risk has not been completed. The service delivery risk has been assessed for 10 of these organisations. For the one organisation where neither the capacity risk

nor service delivery risk has not been completed, the organisation was funded for a sum of $70 000 for development of training modules for use by community-based carers. FAHCSIA advised the deliverables under the arrangement were delivered on time, to the satisfaction of the department, and without issue.

Of the 11 organisations where the capacity risk has not been completed, 9 organisations have continued funding and FaHCSIA has indicated that organisational capacity risk assessments will be competed.

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Table 2.3

Targeted Community Care (Mental Health) Program summary of service provider risk assessments, November 2012

Risk summary

Financial management Governance Issues

management Performance management Viability

Low 172 175 178 176 178

Moderate 18 15 11 10 8

High 0 0 1 4 4

Not allocated 56

11 11 11 11 11

Total 201 201 201 201 201

Source: Provided by FaHCSIA.

2.36 While  FaHCSIA  assesses  and  monitors  risks  for  service  providers,  FaHCSIA also expects service providers to identify and manage their own risks  as stated in the TCC Program Guidelines Part A. 

Conclusion 2.37 Over the period 2006-11 FaHCSIA made a number of adjustments to  the  TCC  Program  to  reflect  implementation  experience  and  increased  understanding of different needs for mental health services. The expansion of  the program announced in 2011 sought to build on this base by expanding sites  and the capacity of services. It further sought to refine the service delivery  models  and  introduce  program  enhancements.  In  developing  these  enhancements, FaHCSIA has actively drawn on its own experience and that of  service providers in the sector. 

2.38 To  support  the  expansion  of  the  TCC  Program,  FaHCSIA  has  given  appropriate consideration to key aspects of planning and administration.  A  detailed implementation plan was developed and covered essential elements  such as: stakeholder consultation and communication; the development and  refocusing  of  services  models;  the  identification  of  risks;  staged  provider 

                                                       56 For 11 organisations funded under the TCC, an assessment of capacity risk has not been completed. The service delivery risk has been assessed for 10 of these organisations. For the one organisation where neither the capacity risk

nor service delivery risk has not been completed, the organisation was funded for a sum of $70 000 for development of training modules for use by community-based carers. FAHCSIA advised the deliverables under the arrangement were delivered on time, to the satisfaction of the department, and without issue.

Of the 11 organisations where the capacity risk has not been completed, 9 organisations have continued funding and FaHCSIA has indicated that organisational capacity risk assessments will be competed.

Program Planning and Management

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selection processes and the identification of high priority areas in which the  expansion should be focused.  

2.39 FaHCSIA has given appropriate attention to identifying areas with the  greatest need for community‐based mental health services as areas of poorer  socioeconomic conditions tend to have a greater incidence of mental illness  than other areas. Accordingly, to support the program’s initial implementation  and  subsequent  expansion,  FaHCSIA  has  used  data  from  the  Australian  Bureau of Statistics to identify areas of relative disadvantage57 and to target  groups such as Indigenous Australians, CALD groups and homeless people. 

2.40 In  June  2012  FaHCSIA  was  funding  201  service  providers  in  424  locations  across  Australia.  The  program’s  widely  dispersed  and  community‐based service delivery model requires a clear understanding of the  respective roles and responsibilities of FaHCSIA’s national, state and territory  offices and of the service providers. FaHCSIA’s Common Business Model for  Grants Management allocates the day to day management of service providers  to FaHCSIA’s state and territory offices while the overall administration and  development of the program is the responsibility of FaHCSIA’s national office.  Funding agreements are in place with service providers which clearly set out  their  roles  and  accountabilities.  Overall,  the  department’s  management  arrangements provide a sound framework to support the administration of the  program. The service providers interviewed as part of the audit considered the  program was generally well managed from their perspective.  

                                                       57 Socio-Economic Indexes for Areas (SEIFA) Index of Disadvantage. The SEIFA is based on National Population Census data. Australian Bureau of Statistics, 2039.0 - Information Paper: An introduction to Socio-Economic Indexes for areas

(SEIFA) [Internet], ABS, Australia, 2006. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2039.02006? OpenDocument [accessed 25 February]. SEIFAs based on 2011 Census data had not been released at the time of the audit.

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3. Grant Assessment and Selection

This chapter examines the selection approaches taken by FaHCSIA in recent Targeted  Community Care (Mental Health) (TCC) Program and funding rounds. 

Introduction 3.1 The original Commonwealth Grant Guidelines58 (CGGs) were issued in  July  2009  by  the  Minister  for  Finance  and  Deregulation  under  Financial  Management and Accountability Regulations 1997, 7A.59 The CGGs establish the  grants  policy  framework  and  outline  the  Australian  Government’s  expectations of agencies in respect to grants administration practices. Officials  performing  duties  in  relation  to  the  administration  of  grants  must  act  in  accordance with the CGGs.60 

Program guidelines 3.2 The  CGGs  require  Australian  Government  agencies  to  develop  and  maintain  guidelines  for  the  operation  of  grant  programs.  Agencies  must  develop  grant  guidelines  for  new  grant  programs  and  make  them  publicly  available (including on agency websites) where eligible persons and/or entities  are able to apply for a grant under a program.61 

3.3 The  TCC  Program  guidelines  provide  a  single  reference  source  for  policy  guidance,  administrative  procedures,  appraisal  criteria,  monitoring  requirements, and evaluation strategies.62 The guidelines are written in plain  English  and  provide  clear  information  for  applicants.  The  guidelines  also  provide  the  framework  for  the  implementation  and  administration  of  the  program and comprise the following documents: 

                                                       58 Department of Finance and Deregulation, Commonwealth Grant Guidelines, Policies and Principles for Grants Administration, July 2009. http://www.finance.gov.au/publications/fmg-series/docs/FMG23_web.pdf [accessed

19 February 2013]. 59 The CGGs apply to agencies subject to the FMA Act. Agencies will be required to comply with the Commonwealth Grant Guidelines Second Edition from 1 June 2013, however, agencies may adopt some or all of the requirements in

the CGGs from the date of their registration. The July 2009 CGGs will remain in force until that time. 60 ANAO, Better Practice Guide-Implementing Better Practice Grants Administration, June 2010, Canberra 61

Department of Finance and Deregulation, Commonwealth Grant Guidelines, Policies and Principles for Grants Administration, July 2009, 3.24, p. 11. 62 ibid., p. 22.

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3. Grant Assessment and Selection

This chapter examines the selection approaches taken by FaHCSIA in recent Targeted  Community Care (Mental Health) (TCC) Program and funding rounds. 

Introduction 3.1 The original Commonwealth Grant Guidelines58 (CGGs) were issued in  July  2009  by  the  Minister  for  Finance  and  Deregulation  under  Financial  Management and Accountability Regulations 1997, 7A.59 The CGGs establish the  grants  policy  framework  and  outline  the  Australian  Government’s  expectations of agencies in respect to grants administration practices. Officials  performing  duties  in  relation  to  the  administration  of  grants  must  act  in  accordance with the CGGs.60 

Program guidelines 3.2 The  CGGs  require  Australian  Government  agencies  to  develop  and  maintain  guidelines  for  the  operation  of  grant  programs.  Agencies  must  develop  grant  guidelines  for  new  grant  programs  and  make  them  publicly  available (including on agency websites) where eligible persons and/or entities  are able to apply for a grant under a program.61 

3.3 The  TCC  Program  guidelines  provide  a  single  reference  source  for  policy  guidance,  administrative  procedures,  appraisal  criteria,  monitoring  requirements, and evaluation strategies.62 The guidelines are written in plain  English  and  provide  clear  information  for  applicants.  The  guidelines  also  provide  the  framework  for  the  implementation  and  administration  of  the  program and comprise the following documents: 

                                                       58 Department of Finance and Deregulation, Commonwealth Grant Guidelines, Policies and Principles for Grants Administration, July 2009. http://www.finance.gov.au/publications/fmg-series/docs/FMG23_web.pdf [accessed

19 February 2013]. 59 The CGGs apply to agencies subject to the FMA Act. Agencies will be required to comply with the Commonwealth Grant Guidelines Second Edition from 1 June 2013, however, agencies may adopt some or all of the requirements in

the CGGs from the date of their registration. The July 2009 CGGs will remain in force until that time. 60 ANAO, Better Practice Guide-Implementing Better Practice Grants Administration, June 2010, Canberra 61

Department of Finance and Deregulation, Commonwealth Grant Guidelines, Policies and Principles for Grants Administration, July 2009, 3.24, p. 11. 62 ibid., p. 22.

Grant Assessment and Selection

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 Part  A:  Targeted  Community  Care  (Mental  Health)  Program  Guidelines â€  an  overview  of  the  Targeted  Community  Care  (Mental  Health) Program and the Activities relating to the program. 

 Part  B:  Information  for  Applicants â€  information  on  the  Application,  Assessment,  Eligibility,  Selection  and  Complaints  Processes;  and  Financial and Funding Agreement arrangements.  

  Part C 1, 2 and 3: Application Information for the Personal Helpers and  Mentors Activity, the Mental Health Respite: Carer Support Activity  and the Family Mental Health Support Services â€ specific information  on  the  Activity,  Selection  Processes,  Performance  Management  and  Reporting for each service stream. 

3.4 The TCC Program guidelines and standard funding agreement are both  publicly accessible on FaHCSIA’s website. The program guidelines are up to  date  and  generally  appropriate  for  the  program.  However,  as  discussed  in  paragraph 3.7 the guidelines do not give the same emphasis to the preference  for open competitive merit‐based selection process as is given in the CGGs. 

Selection processes used in the Targeted Community Care (Mental Health) Program 3.5 FaHCSIA  has  used  a  combination  of  competitive  merit‐based  selections, restricted competitive selection and direct selection over the course  of the original TCC Program implementation period to select service providers.  

3.6 To  support  the  subsequent  expansion,  FaHCSIA  completed  four  selection  processes  in  2012  and  finalised  two  further  tender  rounds  in  April 2013.  FaHCSIA  has  used  open  competitive  merit‐based  selection  processes in two of these rounds where new service locations were required.  The other selection processes were undertaken with the objective of expanding  existing  services  and  made  use  of  direct  and  restricted  selection  processes  depending on the circumstances.  

3.7 A key consideration in grant selection is whether decision‐makers have  equitably  and  transparently  selected  for  funding  the  application  that  represents best value for public money in the context of  the objectives and  outcomes of the granting activity, as set out in program guidelines.63 Integral to 

                                                       63 ANAO, Better Practice Guide-Implementing Better Practice Grants Administration, June 2010, Canberra

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this  consideration  is  the  CGG  requirement  that  agency  staff  should  choose  selection  methods  that  will  “.......promote  open,  transparent  and  equitable  access to grants”.64 To this end, the CGGs consider the use of open competitive  merit‐based grant selection to be better practice, but not mandatory. However,  specific agreement should be obtained to use a selection process other than a  competitive  process.65  Although  a  preference  for  an  open  competitive  merit‐based selection process is not mentioned in the TCC Program guidelines,  FaHCSIA advised the ANAO that this approach is the department’s starting  position for TCC Program grant rounds.  

3.8 FaHCSIA sought and gained the approval from the Minister to a direct  selection  processes  in  regard  to  PHaMs  expansion  stages  1  and  2  and  a  restricted  selection  process  for  the  2012  expansion  of  FMHSS.  The  ANAO  examined  the  justification  provided  by  FaHCSIA  to  the  Minister  for  the  approval of the grants selection processes for these rounds in 2012. 

3.9 The  rationale  provided  to  the  Minister  for  the  direct  selection  of  providers  for  the  PHaMs  expansion  Stage  1  was  that  this  expansion  was  focused  on  priority  sites  in  which  there  was  a  single  at‐capacity,  high  performing  provider.  Likewise  for  the  PHaMs  expansion  stage  2,  a  direct  selection  approach  was  approved  by  the  Minister  in  19  Local  Government  Areas  (LGAs)  where  a  single  suitable  provider  was  identified.  A  restricted  selection approach was agreed in a further 12 LGAs where there was more  than  one  suitable  provider.  In  the  later  instance,  FaHCSIA  noted  that  the  restricted selection approach would promote equity between providers within  the LGAs. The rationale provided to the Minister for the restricted selection of  providers in the 11 sites identified for FMHSS expansion (which was limited to  providers  currently  providing  Family  Support  Program,  Reconnect  or  Community Care services), was that this would enable FaHCSIA to engage  with  providers  with  expertise  and  good  local  linkages  and  which  were  positioned to establish new services quickly. 

3.10 The ANAO observed that FaHCSIA’s briefs did not routinely advise  the Minister on the requirements of the CGGs. The Minister’s attention was not  drawn to the CGGs preference for competitive merit‐based selection processes  and other policy and obligation requirements of the CGGs. Agency staff are 

                                                       64 Department of Finance and Deregulation, Commonwealth Grant Guidelines: Policies and Principles for Grants Administration, July 2009, p. 21. 65

ibid., pp. 21 and 29.

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this  consideration  is  the  CGG  requirement  that  agency  staff  should  choose  selection  methods  that  will  “.......promote  open,  transparent  and  equitable  access to grants”.64 To this end, the CGGs consider the use of open competitive  merit‐based grant selection to be better practice, but not mandatory. However,  specific agreement should be obtained to use a selection process other than a  competitive  process.65  Although  a  preference  for  an  open  competitive  merit‐based selection process is not mentioned in the TCC Program guidelines,  FaHCSIA advised the ANAO that this approach is the department’s starting  position for TCC Program grant rounds.  

3.8 FaHCSIA sought and gained the approval from the Minister to a direct  selection  processes  in  regard  to  PHaMs  expansion  stages  1  and  2  and  a  restricted  selection  process  for  the  2012  expansion  of  FMHSS.  The  ANAO  examined  the  justification  provided  by  FaHCSIA  to  the  Minister  for  the  approval of the grants selection processes for these rounds in 2012. 

3.9 The  rationale  provided  to  the  Minister  for  the  direct  selection  of  providers  for  the  PHaMs  expansion  Stage  1  was  that  this  expansion  was  focused  on  priority  sites  in  which  there  was  a  single  at‐capacity,  high  performing  provider.  Likewise  for  the  PHaMs  expansion  stage  2,  a  direct  selection  approach  was  approved  by  the  Minister  in  19  Local  Government  Areas  (LGAs)  where  a  single  suitable  provider  was  identified.  A  restricted  selection approach was agreed in a further 12 LGAs where there was more  than  one  suitable  provider.  In  the  later  instance,  FaHCSIA  noted  that  the  restricted selection approach would promote equity between providers within  the LGAs. The rationale provided to the Minister for the restricted selection of  providers in the 11 sites identified for FMHSS expansion (which was limited to  providers  currently  providing  Family  Support  Program,  Reconnect  or  Community Care services), was that this would enable FaHCSIA to engage  with  providers  with  expertise  and  good  local  linkages  and  which  were  positioned to establish new services quickly. 

3.10 The ANAO observed that FaHCSIA’s briefs did not routinely advise  the Minister on the requirements of the CGGs. The Minister’s attention was not  drawn to the CGGs preference for competitive merit‐based selection processes  and other policy and obligation requirements of the CGGs. Agency staff are 

                                                       64 Department of Finance and Deregulation, Commonwealth Grant Guidelines: Policies and Principles for Grants Administration, July 2009, p. 21. 65

ibid., pp. 21 and 29.

Grant Assessment and Selection

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responsible for advising the Minister in a timely manner66 and for following  the explicit requirements of the CGGs when seeking Ministerial approval to  grant issues. 

Agencies are  responsible for  advising Ministers  on  the  requirements  of  the  CGGs, and must take appropriate and timely steps to do so where a Minister  exercises the role of a financial approver in grants administration.67 [Emphasis  as per CGGs] 

3.11 As  is  noted  in  the  ANAO  Better  Practice  Guide-Implementing  Better  Practice Grants Administration it would ordinarily be prudent for agencies to  provide this advice each time a grant proposal is put forward for Ministerial  consideration, given there are steps for the Minister to follow should he or she  choose not to follow departmental advice.68 

3.12 FaHCSIA has advised the ANAO that the department fully considers  all  selection  methods  with  a  preference  for  open  competitive  merit‐based  processes. In advising the Minister, the department considers factors such as  continuity  of  services  for  highly  vulnerable  groups,  reducing  lag  time  for  service establishment, and efficient use of government funds such as utilising  existing  infrastructure.  However,  until  recently,  FaHCSIA’s  advice  to  the  Minister has not consistently outlined the requirements of the CGGs. 

3.13 Under broader reforms, the Australian Government has committed to  strengthening the contribution of the not‐for‐profit sector to the government’s  social inclusion agenda69. Streamlining contracting and funding arrangements  are part of the overall reform approach but the government is also seeking to  improve  the  sector’s  accessibility  to  grant  funding  opportunities.  Open  competitive selection processes would be expected to help in this regard and it  is important that agencies give appropriate consideration to ways of increasing  access  to  grant  opportunities,  and  that  decision  makers  are  advised  accordingly. 

                                                       66 Department of Finance and Deregulation, Commonwealth Grant Guidelines: Policies and Principles for Grants Administration, July 2009, paragraph 1.4. 67

ibid., paragraph 3.23, p. 11. 68 ANAO, Better Practice Guide-Implementing Better Practice Grants Administration, June 2010, Canberra, p. 28. 69

Australian Government Initiative, National Compact, working together, part of the social inclusion agenda. http://www.nationalcompact.gov.au/ [accessed 10 January 2013].

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Recommendation No 1 3.14 In  order  to  better  support  the  Minister  in  relation  to  grant  funding  decisions,  the  ANAO  recommends  that  FaHCSIA  provides  more  explicit  advice to the Minister on key aspects of the Commonwealth Grants Guidelines,  and that agency staff are better supported in providing this advice. 

FaHCSIA’s response: Agreed. 

Rollover of funding agreements

3.15 A related aspect of grant selection is the rollover of existing funding  agreements. Appendix 4 provides a time line of the implementation events and  the program of contract renewal over the life of the TCC Program. In all three  service streams; PHaMs, FMHSS and MHR: CS, providers have been offered  extensions on occasions through non‐competitive processes.  

3.16 On each occasion FaHCSIA has sought and obtained approval from the  Minister to renew funding agreements through direct selection. The primary  justification  for  taking  this  approach  has  been  to  maintain  continuity  and  stability in the provision of the services in the chosen sites. In regard to recent  PHaMs  renewals  FaHCSIA  advised  the  Minister  that  the  rationale  for  the  rollover of funding to 30 June 2014 was that: 

 it would allow time for new reforms to be developed and incorporated  in funding agreements in 2014 thereby bringing all 175 PHaMs services  under one approach; 

 it would relieve uncertainty post the 2011-12 budget announcement of  new mental health measures; and  

 there  was  an  advantage  of  limiting  the  need  for  services  to  bid  for  continued funding during the same time they might be seeking new  funding under the 2011-12 budget measures. 

3.17 Renewals have ranged from a year up to three years and have assisted  in  streamlining  administrative  arrangements  so  that  the  majority  of  current  agreements now expire on 30 June 2014 rather than expiring on different dates.  To  support  the  decision  to  renew  agreements  FaHCSIA  has  provided  the  Minister with information in regard to the estimated cost and impact on the  program  budget;  the  number  of  service  providers  and  sites  involved; 

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Recommendation No 1 3.14 In  order  to  better  support  the  Minister  in  relation  to  grant  funding  decisions,  the  ANAO  recommends  that  FaHCSIA  provides  more  explicit  advice to the Minister on key aspects of the Commonwealth Grants Guidelines,  and that agency staff are better supported in providing this advice. 

FaHCSIA’s response: Agreed. 

Rollover of funding agreements

3.15 A related aspect of grant selection is the rollover of existing funding  agreements. Appendix 4 provides a time line of the implementation events and  the program of contract renewal over the life of the TCC Program. In all three  service streams; PHaMs, FMHSS and MHR: CS, providers have been offered  extensions on occasions through non‐competitive processes.  

3.16 On each occasion FaHCSIA has sought and obtained approval from the  Minister to renew funding agreements through direct selection. The primary  justification  for  taking  this  approach  has  been  to  maintain  continuity  and  stability in the provision of the services in the chosen sites. In regard to recent  PHaMs  renewals  FaHCSIA  advised  the  Minister  that  the  rationale  for  the  rollover of funding to 30 June 2014 was that: 

 it would allow time for new reforms to be developed and incorporated  in funding agreements in 2014 thereby bringing all 175 PHaMs services  under one approach; 

 it would relieve uncertainty post the 2011-12 budget announcement of  new mental health measures; and  

 there  was  an  advantage  of  limiting  the  need  for  services  to  bid  for  continued funding during the same time they might be seeking new  funding under the 2011-12 budget measures. 

3.17 Renewals have ranged from a year up to three years and have assisted  in  streamlining  administrative  arrangements  so  that  the  majority  of  current  agreements now expire on 30 June 2014 rather than expiring on different dates.  To  support  the  decision  to  renew  agreements  FaHCSIA  has  provided  the  Minister with information in regard to the estimated cost and impact on the  program  budget;  the  number  of  service  providers  and  sites  involved; 

Grant Assessment and Selection

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verification of FMA Regulation 10 approval if required, and the outcome of the  performance assessment70 of providers recommended for renewal.  

3.18 FaHCSIA has not recommended all funding agreements be renewed  nor  has  the  Minister  agreed  to  the  recommendations  without  additional  information  on  aspects  of  provider  performance.  Where  providers  recommended  for  rollover  have  been  located  in  the  Minister’s  electorate  a  letter has been forwarded to the Minister for Finance and Deregulation as is  required by the CGGs. 

3.19 In the case of grant extensions, the CGGs acknowledge that granting  activity can, in some cases, ‘... support the ongoing delivery of services, with  grants provided to the same or similar organisations over a period of years’.71  However,  using  an  open  competitive  merit‐based  grant  selection  process,  where all applications are assessed as a means of a common appraisal process  is  considered  better  practice,72  rather  than  one  where  providers  have  been  assessed on their performance and not in relation to other providers. Similar to  the  briefings  provided  for  grant  selection  process,  discussed  in  paragraph  3.7 to 3.13,  FaHCSIA’s  briefings  in  support  of  extensions  did  not  make  reference to the CGGs preference for open competitive merit‐based selections. 

3.20 Many  of  the  existing  funding  agreements  expire  in  June  2014  and  FaHCSIA will need to decide on a selection process as part of its planning for  future grants round renewals. In this respect, FaHCSIA’s program guidelines  note  that  the  choice  of  selection  processes  are  at  FaHCSIA’s  discretion  and  indicate no preference. This approach does not fully accord with the emphasis  given in the CGGs to the use of open competitive merit‐based processes as the  preferred  selection  process.  A  further  consideration  is  that  the  Australian  Government’s  reform  directions  to  strengthen  the  contribution  of  the  not‐for‐profit  sector  encourage  improving  the  sector’s  accessibility  to  grant  funding  opportunities.  An  open  competitive  merit‐based  process  would  be  expected to assist in this regard. 

                                                       70 FaHCSIA reviewed the service quality and performance of providers to determine if they meet funding agreement requirements and are performing adequately.

71 Department of Finance and Deregulation, Commonwealth Grant Guidelines: Second Edition, Financial Management Guidance No.3 June 2013, p. 40. http://www.finance.gov.au/publications/fmg-series/docs/FMG-3-Commonwealth-Grant-Guidelines-June-2013.pdf [accessed 19 February 2013].

72 ibid., p. 62.

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Distribution of service providers 3.21 Australians who live in areas with poorer socio‐economic conditions  tend to have worse health than people who live in other areas. Although the  relationship  between  health  and  socioeconomic  disadvantage  is  not  straightforward, Australian Bureau of Statistics analysis shows that 16 per cent  of  Australians  living  in  the  most  disadvantaged  areas  have  mental  or  behavioural problems compared with 11 per cent of those living in the least  disadvantaged areas.73 

3.22 Access  and  equity  are  important  elements  of  the  administration  of  grant programs. ANAO’s analysis of the 2012-13 estimated total TCC Program  funding distribution across the 150 Federal electoral divisions74 ranked by the  Socio‐Economic Indexes for Areas (SEIFA) Index of Disadvantage,75 shows that  the  most  disadvantaged  20  per cent  of  electoral  divisions  account  for  24.9 per cent  of  the  program’s  funding  while  the  least  disadvantaged  20 per cent of electoral divisions account for 14.9 per cent of program funding.  

3.23 ANAO  assessed  the  pattern  of  funding  distribution  across  Federal  electorates  and  the  results  are  shown  in  the  Figure  3.1.  Of  the  estimated  $158.9 million  provided  during  2012-13,76  Australian  Labor  Party  (ALP)  electorates  received  $70.1  million,  Liberal  Party  of  Australia77  (Liberal)  electorates  received  $57.5  million,  National  Party  of  Australia  electorates  received $20.0 million and other78 party electorates received $11.2 million.  

                                                       73 Australian Bureau of Statistics, Measures of Australia’s Progress, 2010, cat no. 1370.0, Canberra. 74

Department of Families, Housing, Community Services and Indigenous Affairs, Electoral Location Report. http://www.fahcsia.gov.au/grants-funding/fahcsia-grants/grant-funding-reports-by-location/electorate-locations-report [accessed 19 March 2013]. 75

The SEIFA is based on National Population Census data. Australian Bureau of Statistics, 2039.0 - Information Paper: An introduction to Socio-Economic Indexes for areas (SEIFA), ABS, Australia, 2006. http://www.abs.gov.au/ AUSSTATS/abs@.nsf/DetailsPage/2039.02006?OpenDocument [accessed 25 February]. SEIFAs based on 2011 Census data had not been released at the time of the audit. 76

Department of Families, Housing, Community Services and Indigenous Affairs, Electoral Location Report. http://www.fahcsia.gov.au/grants-funding/fahcsia-grants/grant-funding-reports-by-location/electorate-locations-report [accessed 19 March 2013]. 77

For the purposes of the audit analysis, the Liberal Party of Australia also includes the Liberal National Party of Queensland and the Country Liberal Party. 78 For the purposes of the audit analysis other parties includes the Independents, the Australian Greens and the Katter’s

Australian Party.

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Distribution of service providers 3.21 Australians who live in areas with poorer socio‐economic conditions  tend to have worse health than people who live in other areas. Although the  relationship  between  health  and  socioeconomic  disadvantage  is  not  straightforward, Australian Bureau of Statistics analysis shows that 16 per cent  of  Australians  living  in  the  most  disadvantaged  areas  have  mental  or  behavioural problems compared with 11 per cent of those living in the least  disadvantaged areas.73 

3.22 Access  and  equity  are  important  elements  of  the  administration  of  grant programs. ANAO’s analysis of the 2012-13 estimated total TCC Program  funding distribution across the 150 Federal electoral divisions74 ranked by the  Socio‐Economic Indexes for Areas (SEIFA) Index of Disadvantage,75 shows that  the  most  disadvantaged  20  per cent  of  electoral  divisions  account  for  24.9 per cent  of  the  program’s  funding  while  the  least  disadvantaged  20 per cent of electoral divisions account for 14.9 per cent of program funding.  

3.23 ANAO  assessed  the  pattern  of  funding  distribution  across  Federal  electorates  and  the  results  are  shown  in  the  Figure  3.1.  Of  the  estimated  $158.9 million  provided  during  2012-13,76  Australian  Labor  Party  (ALP)  electorates  received  $70.1  million,  Liberal  Party  of  Australia77  (Liberal)  electorates  received  $57.5  million,  National  Party  of  Australia  electorates  received $20.0 million and other78 party electorates received $11.2 million.  

                                                       73 Australian Bureau of Statistics, Measures of Australia’s Progress, 2010, cat no. 1370.0, Canberra. 74

Department of Families, Housing, Community Services and Indigenous Affairs, Electoral Location Report. http://www.fahcsia.gov.au/grants-funding/fahcsia-grants/grant-funding-reports-by-location/electorate-locations-report [accessed 19 March 2013]. 75

The SEIFA is based on National Population Census data. Australian Bureau of Statistics, 2039.0 - Information Paper: An introduction to Socio-Economic Indexes for areas (SEIFA), ABS, Australia, 2006. http://www.abs.gov.au/ AUSSTATS/abs@.nsf/DetailsPage/2039.02006?OpenDocument [accessed 25 February]. SEIFAs based on 2011 Census data had not been released at the time of the audit. 76

Department of Families, Housing, Community Services and Indigenous Affairs, Electoral Location Report. http://www.fahcsia.gov.au/grants-funding/fahcsia-grants/grant-funding-reports-by-location/electorate-locations-report [accessed 19 March 2013]. 77

For the purposes of the audit analysis, the Liberal Party of Australia also includes the Liberal National Party of Queensland and the Country Liberal Party. 78 For the purposes of the audit analysis other parties includes the Independents, the Australian Greens and the Katter’s

Australian Party.

Grant Assessment and Selection

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Figure 3.1

Targeted Community Care (Mental Health) Program, proportion of program expenditure in electorates held by political parties

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Political parties

ALP Lib Nationals Other

 

Source: FaHCSIA, Electoral Location Report

3.24 Further analysis indicates that the median expenditure allocated to ALP  electorates  and  those  held  by  the  Liberals  are  very  similar  at  $216 000  and  $218 000 respectively. 

Conclusion 3.25 The  CGGs,  while  noting  that  several  selection  methods  are  open  to  Australian  Government  agencies,  indicate  the  Australian  Government’s  preference for using open competitive merit‐based selection processes when  selecting grant recipients. Where an alternative method is chosen as the most  appropriate  to  the  circumstances,  the  CGGs  emphasise  that  the  selection  methods need to promote transparent and equitable access to grants and that  agreement on the process needs to be given by the Minister, chief executive or  appropriate  delegate.  FaHCSIA  informed  the  ANAO  that  a  competitive  merit‐based  grant  process  was  the  department’s  starting  position  for  TCC  Program grant rounds. 

3.26 FaHCSIA  has  primarily  undertaken  open  competitive  merit‐based  selection processes to initially select service providers but has also made use of  direct and restricted competitive processes in situations where the objective of  the selection process was to support an expansion of existing services. Direct  selection processes have also been used to extend a large number of existing 

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funding  agreements  to  align  their  expiry  dates  with  the  result  that  most  current  providers  have  had  their  funding  agreements  renewed  without  a  competitive process. The use of various selection processes is provided for in  the  FaHCSIA  TCC  Program  guidelines  and  Ministerial  approval  has  been  obtained in all cases in relation to the proposed selection methods.  

3.27 Under  the  CGGs,  agencies  are  required  to  advise  Ministers  of  the  requirements of the guidelines. This will necessarily involve advising on the  policy  aspects  and  obligations  set  out  in  the  Financial  Management  and  Accountability  Regulations.79  Briefs  provided  by  FaHCSIA  to  the  Minister  seeking approval did not routinely include reference to the CGGs, and in this  context  the  preference  for  competitive  merit‐based  selection  processes.  FaHCSIA’s TCC Program guidelines also do not reflect the emphasis given in  the CGGs to competitive merit‐based selection processes. The TCC Program  guidelines80 list three possible selection methods but indicate that the choice of  method is at the discretion of the department.  

3.28 Under broader reforms, the Australian Government has committed to  strengthening the contribution of the not‐for‐profit sector to the Government’s  social inclusion agenda.81 Streamlining contracting and funding arrangements  are part of the overall reform approach but the Government is also seeking to  improve  the  sector’s  accessibility  to  grant  funding  opportunities.  Open  competitive selection processes would be expected to help in this regard, and it  is important that agencies give appropriate consideration to ways of increasing  access  to  grant  opportunities,  and  that  decision  makers  are  advised  accordingly. 

                                                       79 ANAO, Audit Report No. 21 2011-2012, Administration of Grant Reporting Obligations, p. 47. 80

Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program, Part B: Information for Applicants, November 2012. 81 Australian Government Initiative, National Compact, working together, part of the social inclusion agenda.

http://www.nationalcompact.gov.au/ [accessed 10 January 2013].

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funding  agreements  to  align  their  expiry  dates  with  the  result  that  most  current  providers  have  had  their  funding  agreements  renewed  without  a  competitive process. The use of various selection processes is provided for in  the  FaHCSIA  TCC  Program  guidelines  and  Ministerial  approval  has  been  obtained in all cases in relation to the proposed selection methods.  

3.27 Under  the  CGGs,  agencies  are  required  to  advise  Ministers  of  the  requirements of the guidelines. This will necessarily involve advising on the  policy  aspects  and  obligations  set  out  in  the  Financial  Management  and  Accountability  Regulations.79  Briefs  provided  by  FaHCSIA  to  the  Minister  seeking approval did not routinely include reference to the CGGs, and in this  context  the  preference  for  competitive  merit‐based  selection  processes.  FaHCSIA’s TCC Program guidelines also do not reflect the emphasis given in  the CGGs to competitive merit‐based selection processes. The TCC Program  guidelines80 list three possible selection methods but indicate that the choice of  method is at the discretion of the department.  

3.28 Under broader reforms, the Australian Government has committed to  strengthening the contribution of the not‐for‐profit sector to the Government’s  social inclusion agenda.81 Streamlining contracting and funding arrangements  are part of the overall reform approach but the Government is also seeking to  improve  the  sector’s  accessibility  to  grant  funding  opportunities.  Open  competitive selection processes would be expected to help in this regard, and it  is important that agencies give appropriate consideration to ways of increasing  access  to  grant  opportunities,  and  that  decision  makers  are  advised  accordingly. 

                                                       79 ANAO, Audit Report No. 21 2011-2012, Administration of Grant Reporting Obligations, p. 47. 80

Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program, Part B: Information for Applicants, November 2012. 81 Australian Government Initiative, National Compact, working together, part of the social inclusion agenda.

http://www.nationalcompact.gov.au/ [accessed 10 January 2013].

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4. Reporting and Monitoring

This  chapter  examines  FaHCSIA’s  performance  monitoring  and  reporting  of  the  Targeted Community Care (Mental Health) Program and the introduction of a new  performance management framework. 

Performance management framework 4.1 Good governance requires an agency to have a structured and regular  system  for  monitoring  and  reporting  its  performance.  This  includes  the  collection  and  analysis  of  a  balanced  set  of  performance  indicators  to  demonstrate  agency  effectiveness  against  set  outcomes,  and  efficiency  in  managing  outputs,  key  tasks  and  services.82  Adequate  performance  information, particularly in relation to program effectiveness, allows entities to  assess  the  impact  of  policy  measures,  adjust  management  approaches  as  required,  and  provide  advice  to  government  on  the  success,  shortcomings  and/or  future  directions  of  programs.  This  information  also  allows  for  informed decisions to be made on the allocation and use of program resources.  In  addition,  performance  information  and  reporting  enables  the  Parliament  and the public to consider a program’s performance, in relation to both the  impact of the program in achieving the policy objectives of the government  and its cost effectiveness.83 

Agency level performance reporting

4.2 The  Australian  Government  Outcomes  and  Programs  framework  requires entities to firstly identify, and secondly report against, the programs  that contribute to government outcomes over the Budget and forward years. A  central  aspect  of  this  approach  is  the  development  of  clearly  specified  outcomes,  program  objectives  and  appropriate  key  performance  indicators  (KPIs).84 To support this reporting, agencies need to have sound approaches to  the  collection,  analysis  and  reporting  of  relevant  performance  information,  including a combination of quantitative and qualitative data. 

                                                       82 ANAO and Department of Finance and Administration, Better Practice Guide—Better Practice in Annual Performance Reporting, 2004, p. 1. 83

ANAO, The Australian Government Performance Measurement and Reporting Framework, No. 28 2012-13, p. 14. 84 ibid., p. 15.

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4.3 The  TCC  Program  is  one  of  the  programs  that  contributes  to  the  Department’s Outcome 5: Disability and Carers. The outcome as stated in the  Portfolio Budget Statement (PBS), is: 

An adequate standard of living, improved capacity to participate economically  and  socially  and  manage  life‐transitions  for  people  with  disability  and/or  mental  illness  and  carers  through  payments,  concessions,  support  and  care  services.85 

4.4 Within  Outcome 5,  the  TCC  Program  is  program 5.1:  Targeted  Community Care, the objective of which ‘....is to implement community mental  health initiatives to assist people with mental illness and their families and  carers to manage the impact of mental illness.’86 

4.5 The program’s deliverables and KPIs are presented in Tables 4.1 and  4.2.  Changes  were  made  to  the  deliverables  and  KPI’s  from  the  2010-11  financial year. Information for 2009-10 is provided for comparison. 

   

                                                       85 Department of Families, Housing, Community Services and Indigenous Affairs, Portfolio Budget Statement 2012-2013, p. 89. http://resources.fahcsia.gov.au/budget/2012-13/FaHCSIA_PBS_2012-13.pdf [accessed 5 February 2013]. 86

ibid., p. 94.

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4.3 The  TCC  Program  is  one  of  the  programs  that  contributes  to  the  Department’s Outcome 5: Disability and Carers. The outcome as stated in the  Portfolio Budget Statement (PBS), is: 

An adequate standard of living, improved capacity to participate economically  and  socially  and  manage  life‐transitions  for  people  with  disability  and/or  mental  illness  and  carers  through  payments,  concessions,  support  and  care  services.85 

4.4 Within  Outcome 5,  the  TCC  Program  is  program 5.1:  Targeted  Community Care, the objective of which ‘....is to implement community mental  health initiatives to assist people with mental illness and their families and  carers to manage the impact of mental illness.’86 

4.5 The program’s deliverables and KPIs are presented in Tables 4.1 and  4.2.  Changes  were  made  to  the  deliverables  and  KPI’s  from  the  2010-11  financial year. Information for 2009-10 is provided for comparison. 

   

                                                       85 Department of Families, Housing, Community Services and Indigenous Affairs, Portfolio Budget Statement 2012-2013, p. 89. http://resources.fahcsia.gov.au/budget/2012-13/FaHCSIA_PBS_2012-13.pdf [accessed 5 February 2013]. 86

ibid., p. 94.

Reporting and Monitoring

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Table 4.1

Targeted Community Care (Mental Health) Program deliverables 2009-12

Deliverables

2009-10 2010-11 2011-12

Target Actual Target Actual Target Actual

Number of families and carers assisted through respite, brokerage and community-based support 19 500 48 696 .. .. .. ..

Number of people with severe functional limitations arising from mental illness assisted through recovery support services (PHaMs)

6000 9871 .. .. .. ..

Percentage and number of clients, families and carers whose lives are affected by mental illness accessing support services

.. .. NTI

95% (107 052) a

49 000 b 124 068

b

Source: Targets were obtained from the Minister’s Portfolio Budget Statements for FaHCSIA and actuals from FaHCSIA’s annual reports.

Note: NTI: no target indicated.

a. Based on the number of registered clients as a proportion of all eligible people who have applied for assistance.

b. Percentages were not provided in 2011-12.

4.6 In  2011-12  FaHCSIA  reported  that  it  had  significantly  exceeded  the  target  for  access  to  the  program.  FaHCSIA  subsequently  advised  the  Australian  Senate  that  it  had  taken  a  conservative  approach  to  setting  the  targets for deliverables and that it included various mental health community  education activities undertaken by a small number of service providers as part  of  its  calculation  for  access.87  The  target  for  2012-13  has  been  increased  to  63 000 and FaHCSIA informed the ANAO that it was reviewing the way it  calculates access numbers to provide for a more realistic assessment. 

   

                                                       87 Australian Senate, Community Affairs Legislation Committee, Estimates, Thursday, 18 October 2012, p. 95. http://parlinfo.aph.gov.au/parlInfo/download/committees/estimate/b0848147-7603-4f15-8aa2-

988570715be0/toc_pdf/Community%20Affairs%20Legislation%20Committee_2012_10_18_1473_Official.pdf;fileType= application%2Fpdf#search=%22committees/estimate/b0848147-7603-4f15-8aa2-988570715be0/0000%22 [accessed 14 May 2013].

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Table 4.2

Targeted Community Care (Mental Health) Program key performance indicators 2009-12

Key performance Indicators 2009-10 2010-11 2011-12

Target Actual Target Actual Target Actual

Percentage and number of

people accessing recovery

support services whose lives are severely affected by mental

illness

NTI

97%

(9871) a

.. .. .. ..

Percentage and number of clients who report that they are satisfied that the service they received was appropriate to their needs

NTI

93%

(10 298) a

NTI

99%

(1387) c

NTI

98%

(7873) c

Percentage and number of

families and carers assisted through respite, brokerage and community-based support

NTI

98%

(48 696) b

.. .. .. ..

Percentage and number of

registered participants

maintaining progress against individual/relevant goals

.. .. NTI

98%

(1314) c

NTI

91%

(7152) c

Percentage and number of clients from Indigenous backgrounds .. .. NTI

9%

(9496)

5%

(2400)

8%

(9921)

Percentage and number of clients from culturally and linguistically diverse backgrounds .. .. NTI

21%

(22 642)

14% (6800)

20%

(25 032)

Source: Targets were obtained from the Minister’s Portfolio Budget Statements for FaHCSIA and actuals from FaHCSIA’s annual reports.

Note: NTI: no target indicated.

a Data is comprised of client satisfaction survey responses from Mental Health Respite Brokerage and the Community Based Services.

b Data is comprised of the number of families assisted through Community Based Services plus the number of carers assisted through the Mental Health Respite Brokerage and National Respite Development Fund.

c Based on client surveys from a sample of participants.

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Table 4.2

Targeted Community Care (Mental Health) Program key performance indicators 2009-12

Key performance Indicators 2009-10 2010-11 2011-12

Target Actual Target Actual Target Actual

Percentage and number of

people accessing recovery

support services whose lives are severely affected by mental

illness

NTI

97%

(9871) a

.. .. .. ..

Percentage and number of clients who report that they are satisfied that the service they received was appropriate to their needs

NTI

93%

(10 298) a

NTI

99%

(1387) c

NTI

98%

(7873) c

Percentage and number of

families and carers assisted through respite, brokerage and community-based support

NTI

98%

(48 696) b

.. .. .. ..

Percentage and number of

registered participants

maintaining progress against individual/relevant goals

.. .. NTI

98%

(1314) c

NTI

91%

(7152) c

Percentage and number of clients from Indigenous backgrounds .. .. NTI

9%

(9496)

5%

(2400)

8%

(9921)

Percentage and number of clients from culturally and linguistically diverse backgrounds .. .. NTI

21%

(22 642)

14% (6800)

20%

(25 032)

Source: Targets were obtained from the Minister’s Portfolio Budget Statements for FaHCSIA and actuals from FaHCSIA’s annual reports.

Note: NTI: no target indicated.

a Data is comprised of client satisfaction survey responses from Mental Health Respite Brokerage and the Community Based Services.

b Data is comprised of the number of families assisted through Community Based Services plus the number of carers assisted through the Mental Health Respite Brokerage and National Respite Development Fund.

c Based on client surveys from a sample of participants.

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4.7 The  existing  performance  information  does  not  sufficiently  demonstrate how the TCC Program is contributing to the achievement of the  Program 5.1 objectives. Some of the indicators assess access to the program  while others seek to measure some impact on individuals. However, they do  not measure the program’s broader impacts or services and quality. The only  two outcome focused indicators adopted by FaHCSIA are: 

 Percentage and number of clients who report that they are satisfied that  the service they received was appropriate to their needs; and 

 Percentage and number of registered participants maintaining progress  against individual/relevant goals 

Revised performance framework

4.8 As  part  of  FaHCSIA’s  Common  Business  Model  for  Grants  Management, a Standard Performance Framework was introduced in 2009 for  program management to provide a more consistent, logical and streamlined  basis  for  monitoring  and  reporting  FaHCSIA’s  performance  in  achieving  outcomes  through  its  grants  funding  activities.  The  standard  performance  framework  seeks  to  identify  the  impact  of  services  delivered  by  collecting  information that addresses four overarching key performance indicators: 

 service outputs â€ how much was done 

 service delivery, quality and intent - how well was it done 

 immediate outcomes - did it make an immediate difference; and 

 lasting outcomes - did it make a lasting difference. 

4.9 FaHCSIA  recognises  that  the  performance  indicators  reported  in  its  Annual Reports and the Minister’s Portfolio Budget Statements, do not fully  measure  the  effectiveness  of  the  program.  Internally,  to  supplement  these,  FaHCSIA gauges the TCC Program’s effectiveness through a combination of  performance  indicators,  evaluation,  and  the  annual  survey  completed  by  participants. FaHCSIA determined that to better report on the TCC Program  against the Standard Performance Framework and to address key weaknesses  in  the  existing  performance  mechanisms  it  needed  to  review  and  revise  its  performance  framework.  A  review  of  the  existing  data  collected  from  TCC  Program  service  providers  for  program  evaluation,  ongoing  program  management  and  performance  monitoring  purposes  was  commenced  in  September 2010 and was completed in 2011. This led to the development of a  revised TCC Program performance management framework.  

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4.10 The revised performance framework has been piloted with generally  positive results. There is, however, still a substantial amount of development  work to complete. FaHCSIA has planned to work with TCC Program service  providers  to  progressively  implement  the  revised  framework  to  all  service  streams and all measurement and reporting activities by mid 2014. Support  will be provided in the form of targeted capacity building activities such as  workshops, forums and direct liaison by FaHCSIA’s STO Network. 

4.11 The  framework  incorporates  performance  information  for  the  above  four indicators (paragraph 4.8) coupled with the aim that it will: 

 have  the  capacity  to  report  on  mental  health  reforms  and  the  non‐government organisations national minimum data set;88  

 streamline the reporting process and reduce the reporting burden on  service providers; 

 link  the  performance  reporting  of  specific  activities  to  the  overall  program performance and achievement of outcomes; 

 provide  a  logical  and  consistent  approach  for  measuring  outcomes  across the TCC Program; and 

 have the capability to collect client‐level information over time. 

4.12 Appendix 5 sets out the draft TCC Program performance framework. 

4.13 The  information  proposed  for  collection,  using  standard  data  definitions,  will  assist  management  of  the  program  by  providing  a  richer  source of activity data, individual client information and service quality levels.  The  resulting  data  sets  will  provide  FaHCSIA  with  a  large  amount  of  information for analysis. Of further importance, FaHCSIA intends to conduct  periodic program evaluations as an important element of the new program  performance framework. 

Reporting requirements for individual grants

4.14 To  assess  provider  performance,  FaHCSIA  has  compliance  processes  which  primarily  rely  on  self‐reporting  by  service  providers.  FaHCSIA  uses 

                                                       88

The Australian Institute of Health and Welfare was contracted by the Department of Health Ageing (DoHA) to develop a National Minimum Data Set (NMDS) to collect establishment level data for specialised mental health services provided by non-government-organisations. It is expected that this national data collection will be mandated for all funding bodies, including the Mental Health Commission, in 2013-14.

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4.10 The revised performance framework has been piloted with generally  positive results. There is, however, still a substantial amount of development  work to complete. FaHCSIA has planned to work with TCC Program service  providers  to  progressively  implement  the  revised  framework  to  all  service  streams and all measurement and reporting activities by mid 2014. Support  will be provided in the form of targeted capacity building activities such as  workshops, forums and direct liaison by FaHCSIA’s STO Network. 

4.11 The  framework  incorporates  performance  information  for  the  above  four indicators (paragraph 4.8) coupled with the aim that it will: 

 have  the  capacity  to  report  on  mental  health  reforms  and  the  non‐government organisations national minimum data set;88  

 streamline the reporting process and reduce the reporting burden on  service providers; 

 link  the  performance  reporting  of  specific  activities  to  the  overall  program performance and achievement of outcomes; 

 provide  a  logical  and  consistent  approach  for  measuring  outcomes  across the TCC Program; and 

 have the capability to collect client‐level information over time. 

4.12 Appendix 5 sets out the draft TCC Program performance framework. 

4.13 The  information  proposed  for  collection,  using  standard  data  definitions,  will  assist  management  of  the  program  by  providing  a  richer  source of activity data, individual client information and service quality levels.  The  resulting  data  sets  will  provide  FaHCSIA  with  a  large  amount  of  information for analysis. Of further importance, FaHCSIA intends to conduct  periodic program evaluations as an important element of the new program  performance framework. 

Reporting requirements for individual grants

4.14 To  assess  provider  performance,  FaHCSIA  has  compliance  processes  which  primarily  rely  on  self‐reporting  by  service  providers.  FaHCSIA  uses 

                                                       88

The Australian Institute of Health and Welfare was contracted by the Department of Health Ageing (DoHA) to develop a National Minimum Data Set (NMDS) to collect establishment level data for specialised mental health services provided by non-government-organisations. It is expected that this national data collection will be mandated for all funding bodies, including the Mental Health Commission, in 2013-14.

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providers’ reports to monitor their adherence to the terms and conditions of  funding  agreements  and  to  obtain  information  on  performance  indicators.  Providers are also required to provide an audited financial acquittal to provide  assurance that program funding is spent appropriately. These accounts are to  be submitted by the end of October and are reviewed by the STO Network via  central acquittal teams. 

4.15 Through structured arrangements FaHCSIA receives information about  levels of client activity and the types of services used as well as assessments by  service  providers  about  their  performance.  Funding  agreements  provide  details  of  the  quality  and  performance  reporting  standards  against  which  service  providers  must  report  for  the  relevant  service  types.  Under  current  arrangements  service  providers  are  required  to  provide  six  monthly  performance reports to FaHCSIA using reporting templates provided by the  department. Reporting periods are 1 July-31 December and 1 January-30 June.  Each reporting period requires the collection and collation of qualitative and  quantitative data. 

4.16 In addition to the above information requirements, PHaMs and FMHSS  service providers are required to submit monthly data reports and incident  reports.  All  reports  are  lodged  electronically,  via  FaHCSIA’s  Corporate  Reporting Portal for PHaMs and FMHSS providers and the TCC SmartForm89,  for MHR: CS providers and reviewed by the STO’s. Discussions with a sample  of  service  providers  interviewed  as  part  of  the  audit  indicated  an  understanding  of  their  obligations  in  regard to  reporting,  but  revealed  that  many: 

 did not understand the usefulness and value of information provided  and how FaHCSIA used it; 

 felt  there  were  data  quality  issues  with  some  of  the  information  provided; 

 felt the information provided did not provide a measure of the quality  of the service they were providing; and 

 received little or no feedback on the information provided to FaHCSIA. 

                                                       89 SmartForms are intelligent PDFs that allow users to complete their reports using the Adobe Reader application in an online or offline mode and to submit it to FaHCSIA via email. SmartForms are automatically generated from FaHCSIA’s

Online Funding Management System (FOFMS).

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4.17 FaHCSIA’s National Office is responsible for monitoring the program  nationally,  and  identifying  trends  in  services  providers’  performance  and  capacity  issues.  Periodic  feedback  on  the  performance  of  the  program  can  assist individual service providers understand their contribution. Of the three  FaHCSIA  state  offices  visited  as  part  of  the  audit,  only  one  provided  consolidated state feedback to service providers on common issues contained  in service provider reports and other matters of generic interest. STO Network  staff  have  limited  opportunity  to  undertake  detailed  analysis  of  the  information provided. However, staff had a good general knowledge of their  service providers and the operation of their services and had, in most cases,  conducted site visits.  

4.18 The  periodic  reinforcement  of  the  importance  of  the  performance  information and how it is used by FaHCSIA would assure service providers of  the  continued  need  for  the  information  and  how  it  contributes  to  program  improvement. 

Program evaluation 4.19 The  evaluation  of  program  performance  provides  accountability  and  transparency,  and  assists  to  improve  program  design.  An  evaluation  of  the  TCC Program was commissioned by FaHCSIA in June 2009 and concluded in  March 2010. The evaluation was designed to:90  

 assess the performance of the TCC Program to date and to determine  changes that would enhance service policy and program design, so the  initiatives can achieve optimal results; and  

 consider  the  role  of  TCC  Program  within  the  broader  mental  health  sector and how the suite of programs integrate and complement other  services—focusing on policy direction. 

4.20 The final report to FaHCSIA was made publicly available in May 2011  on  the  FaHCSIA  website.91  In  summary,  the  outcomes  of  the  evaluation  reported were that:  

                                                       90 The Department of Families, Housing, Community Services and Indigenous Affairs, Working with Australians to promote mental health, prevent mental illness and support recovery. Evaluation of the FaHCSIA Targeted Community

Care Mental Health Initiatives, Final Report, March 2011, p. vii. http://www.fahcsia.gov.au/our-responsibilities/communities-and-vulnerable-people/programs-services/targeted-community-care-mental-health-program/evaluation-of-the-fahcsia-targeted-community-care-mental-health-initiatives [accessed 8 February 2013]. 91

ibid.

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4.17 FaHCSIA’s National Office is responsible for monitoring the program  nationally,  and  identifying  trends  in  services  providers’  performance  and  capacity  issues.  Periodic  feedback  on  the  performance  of  the  program  can  assist individual service providers understand their contribution. Of the three  FaHCSIA  state  offices  visited  as  part  of  the  audit,  only  one  provided  consolidated state feedback to service providers on common issues contained  in service provider reports and other matters of generic interest. STO Network  staff  have  limited  opportunity  to  undertake  detailed  analysis  of  the  information provided. However, staff had a good general knowledge of their  service providers and the operation of their services and had, in most cases,  conducted site visits.  

4.18 The  periodic  reinforcement  of  the  importance  of  the  performance  information and how it is used by FaHCSIA would assure service providers of  the  continued  need  for  the  information  and  how  it  contributes  to  program  improvement. 

Program evaluation 4.19 The  evaluation  of  program  performance  provides  accountability  and  transparency,  and  assists  to  improve  program  design.  An  evaluation  of  the  TCC Program was commissioned by FaHCSIA in June 2009 and concluded in  March 2010. The evaluation was designed to:90  

 assess the performance of the TCC Program to date and to determine  changes that would enhance service policy and program design, so the  initiatives can achieve optimal results; and  

 consider  the  role  of  TCC  Program  within  the  broader  mental  health  sector and how the suite of programs integrate and complement other  services—focusing on policy direction. 

4.20 The final report to FaHCSIA was made publicly available in May 2011  on  the  FaHCSIA  website.91  In  summary,  the  outcomes  of  the  evaluation  reported were that:  

                                                       90 The Department of Families, Housing, Community Services and Indigenous Affairs, Working with Australians to promote mental health, prevent mental illness and support recovery. Evaluation of the FaHCSIA Targeted Community

Care Mental Health Initiatives, Final Report, March 2011, p. vii. http://www.fahcsia.gov.au/our-responsibilities/communities-and-vulnerable-people/programs-services/targeted-community-care-mental-health-program/evaluation-of-the-fahcsia-targeted-community-care-mental-health-initiatives [accessed 8 February 2013]. 91

ibid.

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 clients  who  have  accessed  services  under  all  three  initiatives  are  achieving  significant  outcomes  in  line  with  the  objectives  of  the  program and client personal plans; 

 access by clients of Indigenous and culturally and linguistically diverse  target groups are much lower than hoped. Many systemic and cultural  barriers remain, which are largely outside the control of services;  

 despite  only  being  recently  established,  each  of  the  TCC  Program  initiatives are demonstrating quality service and making a substantial  contribution  to  the  service  system  by  increasing  access  to  services,  improving service pathways and ensuring social inclusion; and  

 management  of  the  mental  health  initiatives  is  regarded  positively  compared to programs funded by other agencies. The flexibility to meet  needs  is  valued  highly  and  there  is  a  strong  sense  that  FaHCSIA  understands the business of mental health service delivery.  

4.21 Assessing  of  the  overall  impact  of  the  TCC  Program  is  challenging.  However, FaHCSIA has implemented an evaluation approach to: understand  the  performance  of  the  program  by  service  types  and  service  provider;  potential areas of program improvement both in terms of service models and  administration; and the interaction and integration of the program with the  broader mental health service system. The March 2011 evaluation has given  valuable  insights  into  the  performance  of  the  TCC  Program  and  helped  FaHCSIA  understand  the  need  to  re‐design  the  Mental  Health  Respite  measures into a streamlined model of two service types providing services to  both carers and families. 

   

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Conclusion 4.22 There  is  limited  information  available  on  the  specific  contributions  made by PHaMs, FMHSS and MHR: CS to improvements in community level  mental health. Assessing the overall impact of the TCC Program is challenging  and  FaHCSIA  recognises  the  limitations  of  its  current  performance  management  framework.  As  part  of  ongoing  program  management  and  continuous  improvement,  in  September  2010,  the  department  reviewed  the  program’s existing performance management information collections and its  needs  for  future  planning  and  monitoring.  As  a  result  of  that  review,  the  department  identified  the  following  priority  activities  to  improve  its  performance framework. These are to:  

 improve the capacity to report on Mental Health Reforms; 

 streamline and reduce reporting demands on providers; 

 prepare  for  the  non‐government‐organisations’  National  Minimum  Data Set; 

 focus on outcome reporting; and  

 move to client‐level data over time. 

4.23 FaHCSIA  is  taking  important  steps  in  the  review  of  its  current  performance management framework. A draft framework was completed in  2011  and  FaHCSIA  undertook  a  trial  of  its  use  with  service  providers.  The  department will need to maintain momentum to ensure its implementation by  mid 2014. Once it is in place the new framework will assist FaHCSIA to better  monitor the ongoing service performance of providers and to access higher  level information required to report against outcomes and program objectives. 

 

Ian McPhee 

Auditor‐General 

Canberra ACT 

19 June 2013 

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Conclusion 4.22 There  is  limited  information  available  on  the  specific  contributions  made by PHaMs, FMHSS and MHR: CS to improvements in community level  mental health. Assessing the overall impact of the TCC Program is challenging  and  FaHCSIA  recognises  the  limitations  of  its  current  performance  management  framework.  As  part  of  ongoing  program  management  and  continuous  improvement,  in  September  2010,  the  department  reviewed  the  program’s existing performance management information collections and its  needs  for  future  planning  and  monitoring.  As  a  result  of  that  review,  the  department  identified  the  following  priority  activities  to  improve  its  performance framework. These are to:  

 improve the capacity to report on Mental Health Reforms; 

 streamline and reduce reporting demands on providers; 

 prepare  for  the  non‐government‐organisations’  National  Minimum  Data Set; 

 focus on outcome reporting; and  

 move to client‐level data over time. 

4.23 FaHCSIA  is  taking  important  steps  in  the  review  of  its  current  performance management framework. A draft framework was completed in  2011  and  FaHCSIA  undertook  a  trial  of  its  use  with  service  providers.  The  department will need to maintain momentum to ensure its implementation by  mid 2014. Once it is in place the new framework will assist FaHCSIA to better  monitor the ongoing service performance of providers and to access higher  level information required to report against outcomes and program objectives. 

 

Ian McPhee 

Auditor‐General 

Canberra ACT 

19 June 2013 

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Appendices

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Appendix 1: Agency Response

 

 

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Appendix 1: Agency Response

 

 

Appendix 1

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Appendix 2: Mental health key committee structure as at 2012

Source: FaHCSIA information

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Appendix 3: Targeted Community Care (Mental Health) Program Activities92

Services and Support for People with Mental Illness Personal Helpers and Mentors (PHaMs)

PHaMs services provide increased opportunities for recovery for people whose  lives are impacted by severe mental illness by helping them to overcome social  isolation and by increasing their connections to the community. The service  type aims to foster each individual’s sense of dignity and capacity for resilience  through stages of recovery that seek to underpin three key outcomes:  

 increased access to appropriate support services at the right time;  

 increased personal capacity and self‐reliance; and  

 increased community participation (both social and economic)  

PHaMs assists people aged 16 and over whose ability to manage their daily  activities and to live independently in the community is severely impacted as a  result of a severe mental illness. The PHaMs Remote Service Delivery model  (additional  funding  to  develop  community  capacity  and  initiate  alternate  supports in Indigenous communities) does not have an age restriction in these  sites.  

While  a  person  does  not  need  to  have  a  formalised  clinical  diagnosis  of  a  severe mental illness to access PHaMs, participation in the program requires a  functional assessment to determine the severity or impact of mental illness on  an individual’s level of functioning.  

Services and Support for Families and Carers

This funding stream adopts a flexible model of service delivery that meets the  needs  of  families,  carers,  children  and  young  people  impacted  by  mental  illness or at risk of developing mental illness and takes into account the needs  of special needs groups including Indigenous Australians and Culturally and  Linguistically Diverse groups.  

There are two service types funded under Services for Families and Carers of  People with Mental Illness. 

                                                       92 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program Guidelines, Part A - June 2011

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Services and Support for People with Mental Illness Personal Helpers and Mentors (PHaMs)

PHaMs services provide increased opportunities for recovery for people whose  lives are impacted by severe mental illness by helping them to overcome social  isolation and by increasing their connections to the community. The service  type aims to foster each individual’s sense of dignity and capacity for resilience  through stages of recovery that seek to underpin three key outcomes:  

 increased access to appropriate support services at the right time;  

 increased personal capacity and self‐reliance; and  

 increased community participation (both social and economic)  

PHaMs assists people aged 16 and over whose ability to manage their daily  activities and to live independently in the community is severely impacted as a  result of a severe mental illness. The PHaMs Remote Service Delivery model  (additional  funding  to  develop  community  capacity  and  initiate  alternate  supports in Indigenous communities) does not have an age restriction in these  sites.  

While  a  person  does  not  need  to  have  a  formalised  clinical  diagnosis  of  a  severe mental illness to access PHaMs, participation in the program requires a  functional assessment to determine the severity or impact of mental illness on  an individual’s level of functioning.  

Services and Support for Families and Carers

This funding stream adopts a flexible model of service delivery that meets the  needs  of  families,  carers,  children  and  young  people  impacted  by  mental  illness or at risk of developing mental illness and takes into account the needs  of special needs groups including Indigenous Australians and Culturally and  Linguistically Diverse groups.  

There are two service types funded under Services for Families and Carers of  People with Mental Illness. 

                                                       92 Department of Families, Housing, Community Services and Indigenous Affairs, Targeted Community Care (Mental Health) Program Guidelines, Part A - June 2011

Appendix 3

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Mental Health Respite: Carer Support

This service type provides respite and support services to assist carers of  people with mental illness (including autism) to sustain their caring role.  

The key outcome is that carers make progress towards addressing those  things that prevent them sustaining their care role, including not being able  to coordinate access to services and support for the person they are caring  for. 

Services recognise the divergent carer groups and their individual needs  such as young carers and older carers. Services recognise the importance of  readily  accessible  and  comprehensive  information  and  support  that  facilitates the family and carer’s ability to make informed choices about  their caring role and provide assistance that is appropriate to their needs  and the needs of the care recipient.  

Up to 25% of services can be aimed at providing respite support to families  and  carers  of  people  with  an  intellectual  disability  where  such  an  intervention  is  assessed  as  providing  a  preventative  response  to  mental  health needs of families and carers.  

Family Mental Health Support Services

This service type is designed to assist families, children and young people  impacted by mental illness or at risk of developing mental illness through  early and preventative interventions.  

The  key  outcome  is  that  families,  children  and  young  people  are  more  confident, resilient and better supported to manage the impact of mental  illness by:  

 empowering  and  strengthening  families  through  information,  education and skills development;  

 developing more effective parenting, relationships and communication  strategies within families affected by mental illness;  

 improving the emotional health and wellbeing of family members and  carers;  

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 increasing community awareness and understanding of mental health  issues and the impact of mental illness on families; and  

 improving family functioning and social support for families, carers,  children and young people affected by mental illness. 

 

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 increasing community awareness and understanding of mental health  issues and the impact of mental illness on families; and  

 improving family functioning and social support for families, carers,  children and young people affected by mental illness. 

 

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Appendix 4: Targeted Community Care (Mental Health) implementation timelines

Source: Information provided by FaHCSIA.

* Four sites - renewed until June 2014; two sites - review in progress as of March 2013.

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Source: Information provided by FaHCSIA.

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Source: Information provided by FaHCSIA.

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Appendix 5: Draft Revised Targeted Community Care (Mental Health) Program performance framework

TCC Program Performance Framework

Portfolio

Budget Statement PIs

Mental Health NGO National Min. Data Set

data items

Did it make a lasting difference?

Did service recipients have increased confidence, capacity and choice to sustainably manage the impacts of mental illness?

TCC Program Service Stream performance information

PHaMs Client confidence, capacity and choices to independently managing their living arrangements

Use of outcome

measurement tool

Type of outcome measurement tool

MHRCS Client confidence, capacity and choice to sustain their care role

Type of outcome

measurement tool

FMHSS Client confidence, capacity and choice to manage the impacts of mental health on their family

Did TCC Program service recipients have improvements in their life situation?

TCC Program Service Stream performance information

PHaMs Changes in well-being of people with mental illness across key life domains

MHRCS Changes in well-being for families and carers of people with mental illness

FMHSS Changes in well-being for families of people with mental illness (and children and young people at risk of mental illness)

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TCC Program Performance Framework

Portfolio

Budget Statement PIs

Mental Health NGO National Min. Data Set

data items

Did TCC Program build capacity to respond to mental illness?

TCC Program Service Stream performance information

PHaMs Changes in capacity of

organisation and

individuals to respond to mental illness (where TCC Program providers apply significant resources to capacity building activities)

MHRCS

FMHSS

Did it make an immediate difference?

Did service recipients make progress in those areas that have a significant impact on their well-being?

TCC Program Service Stream performance information

PHaMs Progress against goals in individual recovery plan (e.g. finding a job; securing a house)

Percentage of

clients reporting progress against relevant goals

(better able to

deal with the

issues that they received help

with)

MHRCS Progress against respite/carer support goals (e.g. capacity to deal with future crisis)

FMHSS Progress against family support goals (e.g. family functioning; school attendance for children & young people)

Did the service address the client’s needs?

TCC Program Service Stream performance information

PHaMs Percentage of clients

reporting that the service they received was appropriate to their needs

Percentage of

clients reporting that the service they received

was appropriate to their needs

MHRCS

FMHSS

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TCC Program Performance Framework

Portfolio

Budget Statement PIs

Mental Health NGO National Min. Data Set

data items

Did TCC Program build capacity to respond to mental illness?

TCC Program Service Stream performance information

PHaMs Changes in capacity of

organisation and

individuals to respond to mental illness (where TCC Program providers apply significant resources to capacity building activities)

MHRCS

FMHSS

Did it make an immediate difference?

Did service recipients make progress in those areas that have a significant impact on their well-being?

TCC Program Service Stream performance information

PHaMs Progress against goals in individual recovery plan (e.g. finding a job; securing a house)

Percentage of

clients reporting progress against relevant goals

(better able to

deal with the

issues that they received help

with)

MHRCS Progress against respite/carer support goals (e.g. capacity to deal with future crisis)

FMHSS Progress against family support goals (e.g. family functioning; school attendance for children & young people)

Did the service address the client’s needs?

TCC Program Service Stream performance information

PHaMs Percentage of clients

reporting that the service they received was appropriate to their needs

Percentage of

clients reporting that the service they received

was appropriate to their needs

MHRCS

FMHSS

Appendix 5

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TCC Program Performance Framework

Portfolio

Budget Statement PIs

Mental Health NGO National Min. Data Set

data items

How well did we do it?

Was service delivery in line with agreed service standards and requirements?

TCC Program Service Stream performance information

PHaMs Independent validation/self-assessment of delivery in line with PHaMS standards

Rating of delivery against relevant service standards and requirements

MHRCS Independent validation/self-assessment of delivery in line with FMHSS standards

FMHSS Independent validation/self-assessment of delivery in line with FMHSS standards

Was service delivery accessible to clients?

TCC Program Service Stream performance information

PHaMs Coverage of clients from Indigenous and culturally and linguistically diverse backgrounds Geographical coverage of services

Percentage of

clients from

Indigenous and CALD backgrounds

MHRCS

FMHSS

How much did we do?

How many service recipients were assisted?

TCC Program Service Stream performance information

PHaMs Profile of service recipients & pattern of service activities for people with a mental illness

Number of people with mental illness, families and carers accessing TCC Program services—by type of assistance

Service provider /outlet characteristics Number of clients Number of service contacts

MHRCS Profile of service recipients & pattern of respite and support services for carers of people with mental illness (including autism or people with an intellectual disability)

FMHSS Profile of service recipients & pattern of services to assist families, children and young people impacted by mental illness or at risk of developing mental illness

Source: Information provided by FaHCSIA.

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Index A 

Annual Report, 61 

Australian Government, 26, 27, 33,  38, 40, 41, 48, 50, 51, 53, 55, 56, 57 

Australian Government Outcomes  and Programs framework, 57 

Community‐based mental health,  29, 47 

Consultation, 37, 40, 41, 46 

Council of Australian  Governments, 27, 28 

Delivering National Mental Health  Reform, 28 

FaHCSIA 

Common Business Model for  Grants Management, 42, 43, 47,  61 

National Office, 42, 43, 64 

STO Network, 42, 43, 45, 62, 63,  64 

Financial Management and  Accountability Regulations 1997, 48 

Fourth National Mental Health Plan  2009-2014, 28 

Grants management 

Commonwealth Grants  Guidelines, 37, 40, 43, 48, 49,  50, 51, 52, 53, 55, 56 

Renewal of funding agreements,  52, 53 

TCC Program guidelines, 46, 48,  49, 50, 56 

Grants selection processes 

competitive merit‐based  selection, 49, 50, 51, 53, 55, 56 

competitive restricted selection,  49, 50, 55 

direct selection, 49, 50, 52, 55 

Implementation plan, 35, 36, 37, 38,  41, 46, 47, 48, 49, 52, 66, 75 

Minister, 48, 50, 51, 52, 53, 55, 56,  59, 60, 61 

National Action Plan on Mental  Health 2006-11, 27, 28 

National Mental Health Policy, 28 

National Mental Health Strategy, 26,  28 

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Index A 

Annual Report, 61 

Australian Government, 26, 27, 33,  38, 40, 41, 48, 50, 51, 53, 55, 56, 57 

Australian Government Outcomes  and Programs framework, 57 

Community‐based mental health,  29, 47 

Consultation, 37, 40, 41, 46 

Council of Australian  Governments, 27, 28 

Delivering National Mental Health  Reform, 28 

FaHCSIA 

Common Business Model for  Grants Management, 42, 43, 47,  61 

National Office, 42, 43, 64 

STO Network, 42, 43, 45, 62, 63,  64 

Financial Management and  Accountability Regulations 1997, 48 

Fourth National Mental Health Plan  2009-2014, 28 

Grants management 

Commonwealth Grants  Guidelines, 37, 40, 43, 48, 49,  50, 51, 52, 53, 55, 56 

Renewal of funding agreements,  52, 53 

TCC Program guidelines, 46, 48,  49, 50, 56 

Grants selection processes 

competitive merit‐based  selection, 49, 50, 51, 53, 55, 56 

competitive restricted selection,  49, 50, 55 

direct selection, 49, 50, 52, 55 

Implementation plan, 35, 36, 37, 38,  41, 46, 47, 48, 49, 52, 66, 75 

Minister, 48, 50, 51, 52, 53, 55, 56,  59, 60, 61 

National Action Plan on Mental  Health 2006-11, 27, 28 

National Mental Health Policy, 28 

National Mental Health Strategy, 26,  28 

Index

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Performance management, 44, 45,  57, 58, 59, 60, 61, 62, 63, 66, 77 

Standard performance  framework, 61 

PHaMs employment, 41 

Portfolio Budget Statement, 58, 59,  60, 61, 77 

Program evaluation, 30, 37, 43, 48,  61, 64, 65 

Program objective, 29, 32, 33, 49, 55,  58 

Risk management, 27, 29, 35, 37, 42,  43, 44, 45, 46, 72, 73, 77, 79 

Program Design Risk  Assessment Tool, 44, 45 

Provider Capacity Risk  Assessment Tool, 45 

Provider Delivery Assessment  Tool, 45 

Road Map for Nation Mental Health  Reform 2012-2022, 28 

Site selection, 37, 38 

Targeted Community Care (Mental  Health) Program 

Families Mental Health Support  Services, 29, 33, 36, 39, 40, 41,  42, 50, 52, 63, 66, 77, 78, 79 

Mental Health Respite Carer  Support, 29, 30, 31, 33, 36, 37,  40, 49, 52, 63, 66, 73 

Personal Helpers and Mentors,  29, 30, 33, 36, 38, 39, 41, 50, 52,  59, 63, 66, 72, 77, 78, 79 

 

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Series Titles

ANAO Audit Report No.1 2012-13  Administration of the Renewable Energy Demonstration Program  Department of Resources, Energy and Tourism 

ANAO Audit Report No.2 2012-13  Administration of the Regional Backbone Blackspots Program  Department of Broadband, Communications and the Digital Economy 

ANAO Audit Report No.3 2012-13  The Design and Conduct of the First Application Round for the Regional Development  Australia Fund  Department of Regional Australia, Local Government, Arts and Sport 

ANAO Audit Report No.4 2012-13  Confidentiality in Government Contracts: Senate Order for Departmental and Agency  Contracts (Calendar Year 2011 Compliance)  Across Agencies 

ANAO Audit Report No.5 2012-13  Management of Australia’s Air Combat Capability—F/A‐18 Hornet and Super  Hornet Fleet Upgrades and Sustainment  Department of Defence  Defence Materiel Organisation 

ANAO Audit Report No.6 2012-13  Management of Australia’s Air Combat Capability—F‐35A Joint Strike Fighter  Acquisition   Department of Defence  Defence Materiel Organisation 

ANAO Audit Report No.7 2012-13  Improving Access to Child Care—the Community Support Program  Department of Education, Employment and Workplace Relations 

ANAO Audit Report No.8 2012-13  Australian Government Coordination Arrangements for Indigenous Programs  Department of Families, Housing, Community Services and Indigenous Affairs 

Series Titles

ANAO Audit Report No.48 2012-13

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ANAO Audit Report No.9 2012-13  Delivery of Bereavement and Family Support Services through the Defence  Community Organisation  Department of Defence  Department of Veterans’ Affairs 

ANAO Audit Report No.10 2012-13  Managing Aged Care Complaints  Department of Health and Ageing 

ANAO Audit Report No.11 2012-13  Establishment, Implementation and Administration of the Quarantined Heritage  Component of the Local Jobs Stream of the Jobs Fund  Department of Sustainability, Environment, Water, Population and  Communities 

ANAO Audit Report No.12 2012-13  Administration of Commonwealth Responsibilities under the National Partnership  Agreement on Preventive Health  Australian National Preventive Health Agency  Department of Health and Ageing 

ANAO Audit Report No.13 2012-13  The Provision of Policing Services to the Australian Capital Territory  Australian Federal Police 

ANAO Audit Report No.14 2012-13  Delivery of Workplace Relations Services by the Office of the Fair Work Ombudsman  Department of Education, Employment and Workplace Relations  Office of the Fair Work Ombudsman 

ANAO Audit Report No.15 2012-13  2011-12 Major Projects Report   Defence Materiel Organisation 

ANAO Audit Report No.16 2012-13  Audits of the Financial Statements of Australian Government Entities for the Period  Ended 30 June 2011  Across Agencies 

ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

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Series Titles

ANAO Audit Report No.1 2012-13  Administration of the Renewable Energy Demonstration Program  Department of Resources, Energy and Tourism 

ANAO Audit Report No.2 2012-13  Administration of the Regional Backbone Blackspots Program  Department of Broadband, Communications and the Digital Economy 

ANAO Audit Report No.3 2012-13  The Design and Conduct of the First Application Round for the Regional Development  Australia Fund  Department of Regional Australia, Local Government, Arts and Sport 

ANAO Audit Report No.4 2012-13  Confidentiality in Government Contracts: Senate Order for Departmental and Agency  Contracts (Calendar Year 2011 Compliance)  Across Agencies 

ANAO Audit Report No.5 2012-13  Management of Australia’s Air Combat Capability—F/A‐18 Hornet and Super  Hornet Fleet Upgrades and Sustainment  Department of Defence  Defence Materiel Organisation 

ANAO Audit Report No.6 2012-13  Management of Australia’s Air Combat Capability—F‐35A Joint Strike Fighter  Acquisition   Department of Defence  Defence Materiel Organisation 

ANAO Audit Report No.7 2012-13  Improving Access to Child Care—the Community Support Program  Department of Education, Employment and Workplace Relations 

ANAO Audit Report No.8 2012-13  Australian Government Coordination Arrangements for Indigenous Programs  Department of Families, Housing, Community Services and Indigenous Affairs 

ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

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ANAO Audit Report No.17 2012-13  Design and Implementation of the Energy Efficiency Information Grants Program  Department of Climate Change and Energy Efficiency 

ANAO Audit Report No.18 2012-13  Family Support Program: Communities for Children  Department of Families, Housing, Community Services and Indigenous Affairs 

ANAO Audit Report No.19 2012-13  Administration of New Income Management in the Northern Territory  Department of Human Services 

ANAO Audit Report No.20 2012-13  Administration of the Domestic Fishing Compliance Program  Australian Fisheries Management Authority 

ANAO Audit Report No.21 2012-13  Individual Management Services Provided to People in Immigration Detention  Department of Immigration and Citizenship 

ANAO Audit Report No.22 2012-13  Administration of the Tasmanian Forests Intergovernmental Contractors Voluntary  Exit Grants Program  Department of Agriculture, Fisheries and Forestry 

ANAO Audit Report No.23 2012-13  The Australian Government Reconstruction Inspectorate’s Conduct of Value for  Money Reviews of Flood Reconstruction Projects in Victoria  Department of Regional Australia, Local Government, Arts and Sport 

ANAO Audit Report No.24 2012-13  The Preparation and Delivery of the Natural Disaster Recovery Work Plans for  Queensland and Victoria  Department of Regional Australia, Local Government, Arts and Sport 

ANAO Audit Report No.25 2012-13  Defence’s Implementation of Audit Recommendations  Department of Defence 

   

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ANAO Audit Report No.17 2012-13  Design and Implementation of the Energy Efficiency Information Grants Program  Department of Climate Change and Energy Efficiency 

ANAO Audit Report No.18 2012-13  Family Support Program: Communities for Children  Department of Families, Housing, Community Services and Indigenous Affairs 

ANAO Audit Report No.19 2012-13  Administration of New Income Management in the Northern Territory  Department of Human Services 

ANAO Audit Report No.20 2012-13  Administration of the Domestic Fishing Compliance Program  Australian Fisheries Management Authority 

ANAO Audit Report No.21 2012-13  Individual Management Services Provided to People in Immigration Detention  Department of Immigration and Citizenship 

ANAO Audit Report No.22 2012-13  Administration of the Tasmanian Forests Intergovernmental Contractors Voluntary  Exit Grants Program  Department of Agriculture, Fisheries and Forestry 

ANAO Audit Report No.23 2012-13  The Australian Government Reconstruction Inspectorate’s Conduct of Value for  Money Reviews of Flood Reconstruction Projects in Victoria  Department of Regional Australia, Local Government, Arts and Sport 

ANAO Audit Report No.24 2012-13  The Preparation and Delivery of the Natural Disaster Recovery Work Plans for  Queensland and Victoria  Department of Regional Australia, Local Government, Arts and Sport 

ANAO Audit Report No.25 2012-13  Defence’s Implementation of Audit Recommendations  Department of Defence 

   

Series Titles

ANAO Audit Report No.48 2012-13

Management of the Targeted Community Care (Mental Health) Program

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ANAO Audit Report No.26 2012-13  Remediation of the Lightweight Torpedo Replacement Project  Department of Defence; Defence Material Organisation 

ANAO Audit Report No.27 2012-13  Administration of the Research Block Grants Program  Department of Industry, Innovation, Climate Change, Science, Research and  Tertiary Education 

ANAO Report No.28 2012-13  The Australian Government Performance Measurement and Reporting Framework:  Pilot Project to Audit Key Performance Indicators 

ANAO Audit Report No.29 2012-13  Administration of the Veterans’ Children Education Schemes  Department of Veterans’ Affairs 

ANAO Audit Report No.30 2012-13  Management of Detained Goods  Australian Customs and Border Protection Service 

ANAO Audit Report No.31 2012-13  Implementation of the National Partnership Agreement on Homelessness  Department of Families, Housing, Community Services and Indigenous Affairs 

ANAO Audit Report No.32 2012-13  Grants for the Construction of the Adelaide Desalination Plant  Department of Sustainability, Environment, Water, Population and  Communities  Department of Finance and Deregulation  Department of the Prime Minister and Cabinet 

ANAO Audit Report No.33 2012-13  The Regulation of Tax Practitioners by the Tax Practitioners Board  Tax Practitioners Board  Australian Taxation Office 

ANAO Audit Report No.34 2012-13  Preparation of the Tax Expenditures Statement  Department of the Treasury  Australian Taxation Office 

ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

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ANAO Audit Report No.35 2012-13  Control of Credit Card Use  Australian Trade Commission  Department of the Prime Minister and Cabinet  Geoscience Australia 

ANAO Audit Report No.36 2012-13  Commonwealth Environmental Water Activities  Department of Sustainability, Environment, Water, Population and  Communities 

ANAO Audit Report No.37 2012-13  Administration of Grants from the Education Investment Fund  Department of Industry, Innovation, Climate Change, Science, Research and  Tertiary Education 

ANAO Audit Report No.38 2012-13  Indigenous Early Childhood Development: Children and Family Centres  Department of Education, Employment and Workplace Relations 

ANAO Audit Report No.39 2012-13  AusAID’s Management of Infrastructure Aid to Indonesia  Australian Agency for International Development (AusAID) 

ANAO Audit Report No. 40 2012-13  Recovery of Centrelink Payment Debts by External Collection Agencies  Department of Human Services 

ANAO Audit Report No.41 2012-13  The Award of Grants Under the Supported Accommodation Innovation Fund  Department of Families, Housing, Community Services and Indigenous Affairs 

ANAO Audit Report No.42 2012-13  Co‐location of the Department of Human Services’ Shopfronts  Department of Human Services 

ANAO Audit Report No.43 2012-13  Establishment, Implementation and Administration of the General Component of the  Local Jobs Stream of the Jobs Fund  Department of Education, Employment and Workplace Relations 

ANAO Audit Report No.48 2012-13 Management of the Targeted Community Care (Mental Health) Program

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ANAO Audit Report No.35 2012-13  Control of Credit Card Use  Australian Trade Commission  Department of the Prime Minister and Cabinet  Geoscience Australia 

ANAO Audit Report No.36 2012-13  Commonwealth Environmental Water Activities  Department of Sustainability, Environment, Water, Population and  Communities 

ANAO Audit Report No.37 2012-13  Administration of Grants from the Education Investment Fund  Department of Industry, Innovation, Climate Change, Science, Research and  Tertiary Education 

ANAO Audit Report No.38 2012-13  Indigenous Early Childhood Development: Children and Family Centres  Department of Education, Employment and Workplace Relations 

ANAO Audit Report No.39 2012-13  AusAID’s Management of Infrastructure Aid to Indonesia  Australian Agency for International Development (AusAID) 

ANAO Audit Report No. 40 2012-13  Recovery of Centrelink Payment Debts by External Collection Agencies  Department of Human Services 

ANAO Audit Report No.41 2012-13  The Award of Grants Under the Supported Accommodation Innovation Fund  Department of Families, Housing, Community Services and Indigenous Affairs 

ANAO Audit Report No.42 2012-13  Co‐location of the Department of Human Services’ Shopfronts  Department of Human Services 

ANAO Audit Report No.43 2012-13  Establishment, Implementation and Administration of the General Component of the  Local Jobs Stream of the Jobs Fund  Department of Education, Employment and Workplace Relations 

Series Titles

ANAO Audit Report No.48 2012-13

Management of the Targeted Community Care (Mental Health) Program

87

ANAO Audit Report No. 44 2012-13  Management and Reporting of Goods and Services Tax and Fringe Benefits Tax  Information  Australian Taxation Office 

ANAO Audit Report No. 45 2012-13  Cross‐Agency Coordination of Employment Programs  Department of Education, Employment and Workplace Relations  Department of Human Services 

ANAO Audit Report No. 46 2012-13  Compensating F‐111 Fuel Tank Workers  Department of Veterans’ Affairs  Department of Defence 

ANAO Audit Report No. 47 2012-13  AUSTRAC’s Administration of its Financial Intelligence Function  Australian Transaction Reports and Analysis Centre 

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Current Better Practice Guides

The following Better Practice Guides are available on the ANAO website. 

 

Public Sector Internal Audit  Sep 2012 

Public Sector Environmental Management  Apr 2012 

Developing and Managing Contracts - Getting the right  outcome, achieving value for money  Feb 2012 

Public Sector Audit Committees  Aug 2011 

Human Resource Information Systems - Risks and Controls  Mar 2011 

Fraud Control in Australian Government Entities  Mar 2011 

Strategic and Operational Management of Assets by Public  Sector Entities - Delivering agreed outcomes through an  efficient and optimal asset base 

Sept 2010 

Implementing Better Practice Grants Administration  Jun 2010 

Planning and Approving Projects - an Executive Perspective  Jun 2010 

Innovation in the Public Sector - Enabling Better Performance,  Driving New Directions  Dec 2009 

Preparation of Financial Statements by Public Sector Entities  Jun 2009 

SAP ECC 6.0 - Security and Control  Jun 2009 

Business Continuity Management - Building resilience in public  sector entities  Jun 2009 

Developing and Managing Internal Budgets  Jun 2008 

Agency Management of Parliamentary Workflow  May 2008 

Fairness and Transparency in Purchasing Decisions - Probity in  Australian Government Procurement  Aug 2007 

Administering Regulation  Mar 2007 

Implementation of Program and Policy Initiatives - Making  implementation matter  Oct 2006