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'beyondblue' - national depression initiative

Country: 
Australia
Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
(4)2004
Author(s): 
Rob Anderson
Health Policy Issues: 
Prevention, Political Context, Quality Improvement, Others, Responsiveness, HR Training/Capacities
Others: 
Community awareness and destigmatisation; Carer support; Applied research
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no
Featured in half-yearly report: Health Policy Developments Issue 4

Abstract

'beyondblue' is a national, independent, not-for-profit organisation working to address issues associated with depression, anxiety and related substance misuse disorders in Australia. It is a joint initiative of the Australian federal, state and territory governments. beyondblue works in partnership with health services, schools, workplaces and many other agencies towards raising community awareness about depression and reducing stigma associated with the illness.

Purpose of health policy or idea

beyondblue was established to provide a national focus and community leadership to increase the capacity of the broader Australian community to prevent depression and respond effectively to it.

beyondblue is a national, independent, not-for-profit organisation working to address issues associated with depression, anxiety and related substance misuse disorders in Australia.  It is a joint initiative of the Australian federal, state and territory governments.  beyondblue works in partnership with health services, schools, workplaces and many other agencies towards raising community awareness about depression and reducing stigma associated with the illness.

Approximately half of expenditure goes towards preventative and research programs, 30% to community awareness and literacy, and 20% to training and workforce support.

Main points

Main objectives

The five priorities of beyondblue are:

  1. To increase community awareness of depression, anxiety and related substance misuse disorders and addressing associated social stigma.
  2. To provide people living with depression and their carers with information on the illness and effective treatment options and promoting their needs and experiences with policy makers and healthcare service providers.
  3. Developing depression prevention and early intervention programs.
  4. Improving training and support for GPs and other healthcare professionals on depression.
  5. Initiating and supporting depression-related research.

Type of incentives

There is a wide range of initiatives that thave been fostered or provided by beyondblue initiative, each with a different range of incentives.  For the initiative as a whole however, there are obviously major non-financial incentives for being involved - many partner organisations are donating funds or services in kind to support the work of the initiative.  For example, a major television-based depression awareness/destigmatisation campaign in 2004 had broadcasts donated free-of-charge by a major TV Network.

Groups affected

People and their families/carers living with depression, anxiety and other related disorders, The wider Australian community, Providers of services for people with depression, anxiety and related disorders

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Characteristics of this policy

Degree of Innovation traditional innovative innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal neutral fundamental
Public Visibility very low very high very high
Transferability strongly system-dependent rather system-neutral system-neutral

beyondblue is an interesting and innovative agent for change within a health system.  It seems to be a hybrid organisation which while being largely government-funded, is independent.  It is focussed both on system improvement and "patient" advocacy (especially destigmatisation, but also better services).  It is focussed on changing attitudes - raising awareness and understanding - as well as improving the situation of people living with depression in other ways.  It has attracted support from an extremely wide-range of partner organisations.

The initiative is not really intended to have any structural impact on the health system, but probably does aim for a general system-wide recognition of depression and related disorders in other policies.

Because of the focus on raising awareness in the community it has high public visibility.  This is enhanced by the established public/political figures who are heading the organisation.

Political and economic background

It was established partly in the context of the World Health Organisation's projections of an increasing global burden caused by depression (e.g. currently it is the highest medical cause of disability worldwide, and it has been estimated that in Australia depression results in the loss of half a million working days every month).

Depression-associated disability is estimated to cost the Australian economy $14.9 billion annually.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Origins of health policy idea

The beyondblue initiative was established in October 2000 as a national five-year initiative to create a community response to depression, to move the focus of depression away from a mental health service issue to one which is acknowledged and addressed by the wider community.    The initiative explicitly recognises that: many of the impacts of depression are related to a lack of awareness and understanding of people living with depression; there was a lack of recognistion of the signs and symptoms of depression; and a low likelihood of receiving treatment.

The two original partners in 2002 were the Federal Government and the Government of the State of Victoria, and they are still the main funders.  By 2003 there were also smaller funding commitments from all States and Territories except NSW and WA, and various financial and 'in-kind' donations from other organisations.

Two other important factors leading to the establishment of beyondblue were the personal commitment of Jeff Kennett, then Premier of Victoria, to tackle the problem of depression and community awareness and understanding of the problem, and; the release of a study in 1999 that showed, amongst other things, that the prevalence of depression in the Australian community was much higher than expected, and the poor availability and range of services for people with depression and related disorders.

Approach of idea

The approach of the idea is described as:
new:

Innovation or pilot project

Local level - beyonblue has trialled various depression prevention programs, targeted at a variety of at-risk groups

Stakeholder positions

Since its first year (2000) beyondblue has gained the support of an impressively large range of national and State/Territory partners, including:

  • health professionals (e.g. Australian Medical Association, Royal Australian and New Zealand College of Psychiatrists, Australian Divisions of General Practice).
  • Consumers and carer groups 
  • sports associations (e.g. Australian Football League, Athlete Development Australia).
  • health and social care charities (e.g. Lifeline Australia, SANE Australia)
  • social and health care charities (e.g. Mission Australia)
  • media/broadcasting outlets (e.g. Network Ten, DMG Radio Network)
  • private health funds

Since its creation, it has had Board of Directors that includes national and international leaders in: psychiatry, law, mental health policy, general practice, media, education, patient advocacy, as well as former politicians including -as the Chairman of the Board - the former Premier of Victoria (nb. Premier = the State's Prime Minister).

It clearly has excellent partnerships with the various national organisations representing general practitioners (GPs) since a significant proportion of the organisation's activities to date have been targeted at GPs.

The state of New South Wales and Western Australia are absent from the list of funders.

Influences in policy making and legislation

The establishment and activities of beyondblue have not, to our knowledge, required any special legislation or regulatory changes.

Adoption and implementation

Since beyondblue currently only has a staff of ten people it achieves nearly all its changes through working with other organisations, sometimes jointly funding the activities.  The main partners since 2000 have been: the mental Health Council of Australia; state/territory and federal governments; national bodies representing GPs, psychiatrists and psychologists; and VicHealth.

Other examples of how beyondblue "works in partnership" with others include:

  • with Rotary Clubs, who help fund and run Cummunity Forums at which information about depression, anxiety and related disorders is disseminated.
  • with the Health Foundation, conducting joint research into depression as a risk factor in heart disease.
  • with VicHealth, co-funding prevention programs.

Also, by driving the government initiative Better Health Outcomes in Mental Health, beyondblue has played a fundamental role in progressing initiatives that have ultimately led to changes in how Medicare reimburses certain types of primary care activity.

Monitoring and evaluation

beyondblue produces annual reports (most recent is for 2002-03) in which it reports on its activities in relation to each of its priorities.

Since 2000 (and except 2003) it has also been conducting an annual national telephone survey - the beyondblue Depression Monitor - which provides state-level estimates of community knowledge and awareness of depression, anxiety and related disorders.  In 2004 the survey will have a sample of over 4,000 Australians.

Another study is using data from a rolling national survey of general practice attendances to measure changing patterns of use of medicines/prescriptions for depression.

Evaluations of specific initiatives, like the depression in the workplace program, have also revealed significant positive impacts.

Results of evaluation

Since April 2001, the number of visits to the beyondblue website has increased from 5,000 'hits' to over 30,000 'hits' per month.

Currently (October 2004) an external evaluation of beyondblue's activities from 2000 to 2004 is under way by the Centre for Program Evaluation, University of Melbourne - but the results are not yet in the public domain.

Expected outcome

4 years into its initial 5-year existence, the beyondblue initiative appears to be having significant impacts in relation to most of its stated objectives.  Their document 'beyondblue: The Way Forward 2005-2010', describes the following outcomes.  beyondblue has:

  • Created greater opportunities to share experiences amongst people living with depression, and their families and friends; 
  • Spread insights into how to promote community understanding and influence development of mental health services;
  • In partnership with the Australian media, expanded quality coverage of issues surrounding depression;
  • Been instrumental in establishing a mental health training program for general practitioners, which has now reached over 4,000 practitioners.
  • Successfully advocated changes to the Medicare rebate system that enable primary care professionals to be remunerated for providing a wider range of care options for people with depression and related disorders.
  • Provided significant funds for academic research into prevention, treatment, and comorbid linkage of depression with other chronic illnesses.
  • Engendered a coherent focus at all levels of government on the prevention and care issues related to depression.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable four system more equitable
Cost Efficiency very low neutral very high

Without more data from formal or independent evaluations of component initiatives it is difficult to reliably judge the overall impact of the beyondblue initiative on the quality of health care services or the cost-effeciency of systems to prevent depression or support people living with depression.  In terms of equity, the greater national profile and increased public understanding of depression must surely be a good thing; reducing the stigma associated with depression and related disorders.

References

Sources of Information

www.beyondblue.org.au

Author/s and/or contributors to this survey

Rob Anderson

Suggested citation for this online article

Rob Anderson. "'beyondblue' - national depression initiative". Health Policy Monitor, October 2004. Available at http://www.hpm.org/survey/au/a4/1