Residential Aged Care Lacks a Mental Health Benchmarking Tool
Residential aged care facilities in Australia have no structured mechanism to monitor and improve mental health care for people living with changed behaviours and psychological symptoms. The protocol for the Mental Health benchmarking Industry Tool for residential aged Care (MHICare Tool) responds to that gap with a deliberately participatory design process rather than a top-down checklist. The goal is not simply to measure what happens in facilities; it is to identify which mental health practices matter most to residents, family and care partners, and staff, then convert those priorities into performance indicators that can be used across the sector.
Mental health care in long-term residential settings is often treated as secondary to physical health surveillance, even though psychological symptoms and behaviour changes can determine quality of life, safety, and the burden placed on staff and families. A benchmarking tool can change the conversation from anecdote to visible performance. In a setting where care needs are complex and often chronic, the absence of a mental health-specific metric system leaves facilities without a shared language for improvement.
Two-Stage Codesign Will Shape the Indicator Set
The study uses a two-stage sequential and mixed methods codesign methodology. Stage 1 begins with qualitative interviews and focus groups that will include residents, family or care partners, and residential aged care staff. Those conversations are designed to surface the mental healthcare practices and outcomes that each group regards as most important. Rather than assuming that external experts alone can define quality, the protocol places lived experience and frontline care into the same developmental frame.
Adapted concept mapping methods will then be used to rank the issues identified in Stage 1 by both importance and changeability. In practice, this matters because a benchmarking framework loses clinical usefulness if it includes problems that staff cannot realistically influence. A measure that is important but inert has little value at the bedside. The process is meant to filter the broad set of concerns into draft quality indicators that are both meaningful and actionable within residential aged care operations.
Stage 2 moves from local experience to wider consensus. A Delphi procedure will gather views from an expert panel drawn from aged care industry, academic, and clinical backgrounds. The intent is to test whether the proposed indicators are acceptable across stakeholder groups and to refine the tool into a final codesigned version. This sequence gives the project a clear logic: first define what matters most in day-to-day care, then pressure-test those priorities against expert agreement.
Why Mental Health Measurement in Aged Care Needs Its Own Framework
Mental health in residential aged care cannot be reduced to a single diagnosis or a narrow symptom checklist. Changed behaviours and psychological symptoms often arise from overlapping contributors, including cognitive impairment, unmet social needs, environmental stressors, pain, and communication barriers. A benchmarking tool built specifically for this setting has the potential to capture those realities more faithfully than generic quality systems.
Because the project is anchored in codesign, it also acknowledges that mental health care in aged care is relational as much as it is procedural. Residents may experience distress differently from staff who document it, and family or care partners may notice changes that formal systems miss. A tool that emerges from those perspectives may be better positioned to identify gaps in recognition, response, and follow-up. In a sector where care decisions are often made under pressure, even a small improvement in how symptoms are identified and tracked could alter day-to-day clinical management.
One sentence captures the core problem. Australia currently lacks a mechanism to benchmark mental health care in residential aged care.
Ethical Oversight and Research Governance Are Already in Place
The protocol has been reviewed and approved by the University of Queensland Human Research Ethics Committee under HREC/2019002096. The project will follow the National Statement on Ethical Conduct in Human Research (2007), which is especially relevant when research involves residents of aged care facilities and the people who support them. Interviews and focus groups in this context demand careful attention to consent, vulnerability, and the possibility that participants may be discussing distressing experiences or sensitive care failures.
The publication pathway is straightforward. Findings will be reported in peer-reviewed journals and disseminated through national and international conferences as well as social media. That dissemination plan fits a project intended to shape practice across a system rather than answer a narrow mechanistic question. If the final MHICare Tool is adopted, its value will depend on whether facilities can actually use the indicators to compare performance and drive improvement over time.
What the Protocol Can and Cannot Claim Yet
This paper is a protocol, not a completed outcomes study. It does not yet provide the finished indicator set, a validation analysis, or evidence that the MHICare Tool improves resident outcomes. What it does provide is a structured roadmap for developing a mental health performance indicator tool for Australian residential aged care, with stakeholder engagement built into each stage of the process.
That distinction matters clinically. A well-designed protocol can set the conditions for a credible quality measure, but the eventual usefulness of the tool will depend on how the final indicators perform in real facilities, how staff interpret them, and whether they reveal actionable differences in care. The more difficult question is not whether residential aged care needs better mental health measurement; it clearly does. The question left open by this protocol is how well the final benchmark tool will capture the complexity of psychological care without becoming too cumbersome for routine use.
The study’s strongest feature is its mixed methods structure. Qualitative work is used to identify what people value, concept mapping narrows and prioritizes those issues, and Delphi consensus then tests the proposed indicators against broader expertise. That layered approach gives the project a strong methodological backbone and increases the chance that the final tool will be credible to residents, carers, clinicians, and aged care administrators alike. The real test will come after development, when the indicator set is asked to do the harder work of measurement, comparison, and improvement inside residential aged care facilities.