Staff in the Department of Health and Ageing are drafting a 10-year roadmap for national mental health reform, which is scheduled for preliminary consideration by a meeting of senior CoAG officials on Friday.

Psychiatrist Professor Alan Rosen urges that the process not be rushed, ahead of the establishment of the National Mental Health Commission.

(Continuing a Croakey series on mental health reform…)

Alan Rosen writes:

Apart from some real national initiatives in early prevention and intervention of mental illnesses in young folk, the crowning glories of the Federal Government’s  May 2011 budget enhancements for mental health were threefold.

Firstly, the rushed development over the last  few months (to be considered for adoption by all CoAG jurisdictions by mid-December) of a 10-year roadmap for the future.

Secondly, the  instigation of a national mental health commission (MHC) by January 1st  2012.

Thirdly, a bunch of “flexible care” packages and coordination teams for extended mental health care, so far untested in the mental health field,  are to be tendered out to Medicare Locals, NGOs or private interests. They have already been given a very substantial allocation in the budget ($343.8 million) for a national roll-out, with no stated prior requirement for piloting, evaluation or rigorous research.

Compare this to the considerable research evidence-base for modules of public community mental health services which will remain as abandoned orphans, sinking in a turbulent sea of hospital-centric activity based funding. This is because of a lack any directional financial signals to the states in the federal budget to retain and redevelop them.

So what will be left of community mental health services to coordinate?  And how will inexperienced  largely non-professional coordinators be able to effectively  pull off the formidable  feat  of herding clinical cats?

The Roadmap is being pulled together in typical DoHA style within an impossibly short timeframe and with minimal consultation.

This is the agency that inspired such confidence with the mental health sector by giving us the dysfunctional 2nd policy and  3rd and 4th  National Mental Health Plan,  developed with no specific deliverables, with only gestural, stage-managed consultation, and who presided over the review of the National Mental Health  Standards which needed to reach a higher bar, but instead  were watered down.

We were told by a DoHA official at that time that “aspirational” was a dirty word. There is no clear role for the National Mental Health Commission (MHC) in the development or monitoring of the roadmap, as it doesn’t even open its doors for business until 2012, after the roadmap has been signed,  sealed and delivered.

But, what is a roadmap without clear directions and destinations?  How can  we ask “are we there yet?” in 10 years, if there is no “there” there?  There are some encouraging winds of constructive change at DoHA, but they are yet to emerge as the dominant narrative.

Due to the usual state and federal  jurisdictional pressures upon and within DoHA not to commit to specifics, there is still a danger that the roadmap will be foisted on the national MHC and all of us without any destinations, in terms of any distinct goals and targets over its 10 year timeline.

With respect, these federal initiatives are already a tangled and disconnected mess, fragmented and in danger of being discredited before they even get going, but we mustn’t allow this to be a wasted opportunity.

We need Government to start hearing voices, to listen to all our voices, those of all stakeholders, in this awesome mental health community,  as this is real social inclusion in action. We do need to start again, and we do need to be visionary, aspirational and practical, and we DO need a 10 year timeframe to make a real difference for all disorders and every phase of care.

We don’t need to rush the 10 year roadmap through, lest it be like a faulty GPS, directing us up blind alleys and leading us nowhere. We do need to learn from the New Zealand experience, where constructive bipartisan use was made of  their National MHC and its  blueprint for more than the first 10 years of its existence.

We need to listen to the wisdom in the story of the Irish farmer who was stopped on the road by a man who wanted to know how to get to Cork. The farmer replied, thoughtfully scratching his head: “Well if I wanted to be getting  there, I wouldn’t be starting from here”.

The following is a proposal put to the cross-sectional national workshops conducted  by the Mental Health Council of Australia  for the Hon Mark Butler, Federal  Minister for Mental Health, on September 5th and 6th 2011 on  the role of the Mental Health Commission and the parameters of the 10 year national mental health services road map.

The proposal is to turn the 10 year roadmap into a temporary bridging document, a draft framework only, to meet the imposed timeframe and commitment, already announced by government, to report to CoAG  before the end of this year (December).

There is no chance that it could be a completed national mental health guide achieving widespread stakeholder consultation, consensus and credibility by the end of this brief timeframe. At CoAG, it could seek all jurisdictions in principle support for its draft  trajectories, and for the following course of action: That the roadmap should be regarded as a rough initial guide only, a provisional statement of intent, to be eclipsed and replaced by a 10 year overarching blueprint or mental health program, with a specific action plan with clear interim targets and timelines to be built up thru nationwide bottom-up  grass-roots consultation.

This should be the first priority and task of the National MHC – to build up trust and credibility. As Senator Claire Moore says “You can’t legislate trust”. You must earn it. Then the National and state MHC’s can expect all CoAG jurisdictions to consent and buy-in to its implementation over 10 years.

Then the MHC should take responsibility for its monitoring & reporting on its progress and gaps in delivery and resourcing.  It should not be DoHA’s program, or CoAG’s,  or the Mental Health Commission’s, or the Mental Health Ministers’ or the Prime Minister’s, but all of these, and moreover it will then be OUR 10 year national mental health program, co-owned by all stakeholder constituencies.

* Adapted from the closing plenary address 9 Sept 2011 of The Mental Health Services (Themhs) Conference  of Australia & New Zealand, Adelaide, and updated in anticipation of  the National 10 Year Roadmap being prepared by DoHA for preliminary consideration at CoAG Senior Officials Meeting for 2 December  2011.

Alan Rosen is Professorial Fellow, School Public Health, University of Wollongong, Clinical Associate Professor, Brain & Mind Research Institute, University of Sydney

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Previous articles in this series

• Survey of people with psychosis reveals the importance of non-clinical concerns

 

 

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