(Continuing a Croakey series on mental health reform…)

In a previous post, Professor Alan Rosen urged that appropriate care and consultation be taken in developing the 10-year roadmap for mental health reform, which is due for preliminary consideration at a meeting of senior CoAG officials tomorrow.

In the article below, he suggests some concrete goals for the next decade, for health services and beyond.


What should we aim for?

Alan Rosen writes:

What could be the deliverables of a 10 year national mental health blueprint, overseen by our Mental Health Commissions at national and state levels, overarching all the half-baked policies plans and standards that we have inherited?

Our catch-cry and motto should be “Parity in 10 years!”  (the theme that Pat McGorry et al got rolling at CoAG  in August 2011 during their unprecedented opportunity to address all heads of Federal & State governments together).

This can be achievable if there is a bipartisan political will and a monitor, holding that political will transparently and strictly to account.

Parity in 10 years means, for example:

• Improving access of people with a diagnosable and treatable psychiatric condition from 33-46%, depending on your method of mathematical massaging of the national survey figures,  to 80%+ within 10 years, which is the level of access to clinical care by those with all other medical conditions, so it should be achievable.

• A Government commitment to improve the proportion of the national health budget spent on mental health over 10 years from 6-7% to 12-13%, which is close to the actual proportion of health burden due to mental illness.

• Coerced care or involuntary episodes of treatment to be reduced by 60-70% over 10 years, eg by more systematically employing an already known and evidence-based repertoire of strategies to build ongoing engagement, therapeutic alliances and shared decision making.

• Suicide rate to be reduced by 33% in 10 years, (or at least 25% if the GFC mark II hits Australia hard and long), for which there are ample international precedents.

• Resources and workforce deployed in community mental health services (which does NOT comprise traditional hospital outpatient care or just privatized clinic-based aftercare) should be twice those deployed in hospital based care (that is, 66%:33%).

• A defined reduction in duration of untreated psychosis (eg to less than 3 months, the current international consensus guideline) and other psychiatric conditions in young people with first episodes.

• Equity for younger people (and other age groups) with mental illnesses, with their peers, in physical care, life expectancy and in all expectancies of life, including completing education and workforce participation.

• Employment of individuals with severe and persistent mental illness to be increased from <10-15% to more than 50%.

• 300% increase in the amount of stable community based personalised housing with 7 day & night support if needed, to be provided for individuals who are recurrently displaced margin-dwellers or living in overly dependent circumstances because of their mental illness.

• Guaranteed 100% access in every catchment whether urban, regional or remote, and to every special population with mental illnesses, whether Indigenous, transcultural, forensic or comorbid, to the current range of evidence-based modules of mental health service. These include community-based mobile crisis, early intervention, residential respite and assertive community treatment teams, e-health, social support, family education and skills courses and support groups, vocational and housing services providing security of community tenure.

• Remote locations may be partially served using  telehealth and e-health strategies in conjunction with, but not replacing  face-to-face services, and possibly hub and spoke regional service models of care.

• A substantial measureable increase (to be determined) in  those who now experience personalised control and  decision making  over their own lives, possibly including budget–holding by individuals and families with mental illnesses, and in making choices between available services.

• To set up a fund providing real incentives for translating research data into effective interventions and service delivery systems,  generating practice-based evidence. And to seize the opportunity to develop and implement a longitudinal, unified, empirically tested and sound, subjective but brief recovery measures. This should include all key facets of social inclusion, from service-user, provider and family viewpoints, which employs consistent components of recovery in rating individual recovery and orientation of services towards recovery.

• Lastly, as in New Zealand and in West Australia, our National Mental Health Commission needs to be structured to outlast any one particular flavour of government, so it needs to be and be seen to be tri-partisan in its deliberations and recommendations.  All the mental health commissions now emerging in Australia need to develop an initially informal network  to ensure compatibility of purpose, coordination and non-duplication of effort,  and comparability of effectiveness. This is a tall order in their present circumstances.

Our best wishes go to our nascent Commissions, and to all who sail in them, and by their lights over the next 10 years and beyond.

We have every reason to hope that Allan Fels and Robyn Kruk, the heads of  the new national Mental Health Commission, are there to make a real difference.  Indeed, this is what the entire community of mental health stakeholders is entitled to expect of both of them and the national commission.

So many national promises, policies, plans and strategies have been made which have not made any real difference to the lives of individuals and families with mental illness. The litmus test of their work will be whether these lives are any better in 5 and 10 years time.

*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


Previous articles in this series

• Important for mental health: a fair society and a good start to life

• Don’t rush the roadmap for national mental health reform: Alan Rosen

• What matters for people living with psychotic illness



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