What’s missing from the first national mental health report card
As outlined in the previous post, the first National Mental Health Commission’s first report card has been released.
A report card on the report card is provided below by Sebastian Rosenberg, Senior Lecturer, Brain and Mind Research Institute, at the University of Sydney.
While he welcomes aspects of the Commission’s work, he also identifies some concerns and omissions, and suggests the report puts too much faith in “existing moribund processes”.
Evaluating the National Mental Health Commission’s Report Card
Sebastian Rosenberg writes:
The Commission’s Report Card, launched today, is a funny mixture.
No one can doubt the sincerity of the Commissioners in attempting to establish a more holistic picture of what it means to have a mental illness in Australia in 2012. They have asserted the primacy of the notion of ‘a contributing life’ built around access to decent services, housing, employment and social inclusion.
This is a refreshing change from the previous national mental health reports, which have rather depressingly focused on bed numbers or other such unhelpful metrics.
However, there are several other issues raised by the Commission that limit the utility of the Report Card.
First, there is no new data as such and indeed the Report Card goes so far as to curiously claim to have “avoided the trap of calling for new data”.
So instead it is a rehash of publicly available data from a variety of sources, including CoAG and other reports. A recommendation for more or better data is made, in particular for a regular five yearly national mental health survey starting in 2014. Optimistically, this would mean waiting until 2015 for the first blush of survey information to be available.
In the meantime, while the Report Card stresses the importance of knowing whether people with a mental illness are unemployed, homeless and socially excluded, Australia cannot report this currently and the Commission refrains from calling for new data collection efforts to answer these questions.
The Report Card states that Australia has no nationally agreed picture of what a good mental health service framework should look like and does not offer one itself.
No reference is made to the body that preceded the Commission; the National Advisory Council on Mental Health (chaired by John Mendoza) which published its vision in November 2009 entitled A Mentally Healthy Future for all Australians.
Nor does the Commission take this opportunity to articulate its own vision, instead suggesting faith in the National Mental Health Service Framework project currently being developed by the Commonwealth and the states.
The report states the desirability of establishing a national collection of the experience of care for mental health carers and their families. On the back of comprehensive national survey of carers, the Mental Health Council of Australia currently publish an annual collection of such experiences, reporting their views against fifteen agreed indicators as the Mental Health Carers Survey Report.
The Report Card makes the point there is little or no accountability for the $6.3bn Australia spends on mental health annually. The Report Card does state that mental health spending has increased by 4.5% per annum between 2005-06 and 2009-10.
It fails to contextualise this increase by stating that the AIHW report that overall health expenditure has been increasing by around 8.5% per annum over the same period meaning mental health’s share of the health budget is shrinking not growing.
The Report Card does not establish or propose any indicators or system of accountability. Instead, worryingly, it states:
“We will also not waver from our view that governments need to agree and report on a small number of meaningful national indicators and ambitious but achievable targets.”
My concluding point is that this statement really represents largely business as usual; a situation in which governments and a small number of officials determine what is reported and how.
This is wholly inadequate, disenfranchising the mental health sector, health professionals, consumers and carers from what should be their central role in determining the mental health indicators that are most relevant to them.
Instead of articulating this, the Report Card instead suggests that the responsibility for establishing Australia’s system of accountability for mental health lies with the long-mooted National Mental Health Roadmap. This Roadmap began life in the Commonwealth Department of Ageing; its current whereabouts are unknown. The opportunity for the mental health sector to shape this roadmap has been minimal.
The Report Card purports to be an independent eye on the mental health system. The construct of the mental health commission, as an office within the Prime Minister’s Department, naturally means that even with highly independent commissioners and dedicated bureaucratic support, there will always be a limit to the amount of independence available for such a Report Card.
The National Mental Health Commission was established largely in response to the high level of community frustration at repeated failures by the machinery of governments to properly address mental health.
This first Report Card suggests a new beginning, but seems to offer faith in some existing moribund processes.
The Report Card is presented as a mirror. You can only see backwards in a mirror. Perhaps the next Report Card should focus less about the past twenty years and more about the next twenty.
• Sebastian Rosenberg is Senior Lecturer, Brain and Mind Research Institute, University of Sydney
A detailed summary of the national report card on mental health and suicide prevention – and some wider reflections