general practice

Feb 16, 2012


(Update on March 1: Links to more reading have been added to the bottom of the post).

Huge amounts of media space are being consumed by furore over the NHS reforms in England (though I haven’t seen much coverage in Australia).

According to the official summary of The Health and Social Care Bill 2010-12, the reforms will create an independent NHS Board, promote patient choice, and reduce NHS administration costs, by:

• establishing an independent NHS Board to allocate resources and provide commissioning guidance

• increasing GPs’ powers to commission services on behalf of their patients

• strengthening the role of the Care Quality Commission

• developing Monitor, the body that currently regulates NHS foundation trusts, into an economic regulator to oversee aspects of access and competition in the NHS

• cutting the number of health bodies to help meet the Government’s commitment to cut NHS administration costs by a third, including abolishing Primary Care Trusts and Strategic Health Authorities.

You can get some sense of the extent of  concerns from this recent joint editorial by the editors of the BMJ, Health Service Journal, and Nursing Times, describing the reforms as divisive and destructive. The resulting upheaval “has been unnecessary, poorly conceived, badly communicated, and a dangerous distraction at a time when the NHS is required to make unprecedented savings”.

“Worse, it has destabilised and damaged one of this country’s greatest achievements: a system that embodies social justice and has delivered widespread patient satisfaction, public support, and value for money. We must make sure that nothing like this ever happens again.”

The editors say a lesson from “this debacle” is that sustainable reform requires politicians to be clear about the problem they are trying to solve: “A recurrent and justified criticism of these changes has been their failure to express a clear rationale. We also need clarity on the methods proposed to solve the problem.”

Meanwhile, Australian health policy expert Professor Stephen Leeder writes below that he has been reminded of the cartoon world of Mr Magoo.






*** Continue reading “On health reform in England, and Mr Magoo”

health reform

Feb 16, 2012


For those wondering what is happening in the world of Queensland health reform, here (PDF alert) is a report from KPMG, outlining the planned restructure of Queensland Health. (This Courier-Mail report suggests, however, that the future of the reforms is uncertain in view of next month’s election, with the Opposition opposing the restructuring).

A brief excerpt from the report follows below and then there is an article in which health policy expert Dr David Briggs gives his assessment of the reforms, as “a step in the right direction”. He also calls for national and state efforts to boost health manager numbers and training.


Summary of KPMG report

The report says the drivers for restructuring include:

• Recent high profile incidents within the corporate services area of the organisation (e payroll system and fraud problems), and broader concerns about the current organisation of Queensland Health.

• That a large centralised department is not consistent with the devolution policy underpinning the creation of Local Health and Hospital Networks.

• The roles in Queensland Health have become confused, with its head office both overseeing the total system and delivering services itself.

• As Queensland Health head office has grown, the senior executive finds it more difficult to attend thoroughly to all of its areas of responsibility. Understandably, priority is given to clinical services, and the same attention has not been given to corporate services.

• Concerns have been raised about the culture of Queensland Health, including a lack of trust and confidence: a reluctance of the head office to trust in the capability of local management, and conversely, a lack of confidence in the ability of head office to deliver on its core responsibilities. Continue reading “Restructuring of Queensland Health: a step in the right direction”

global health

Feb 14, 2012


Twitter recently introduced me to a US-based enterprise called Blue Zones, which says its aim is show communities, schools, businesses and individuals how to be healthier, to live longer, and to be happier.

It is based upon the work of Dan Buettner, who written a popular book about “blue zones”, places known for longevity. According to this National Geographic site, Buettner’s research was funded in part by the National Geographic Expeditions Council and the National Institute on Aging.

Twitter had directed me to this Blue Zones blog saying that much can be learnt about health and happiness from Denmark. I asked health economist Professor Gavin Mooney to comment on its analysis, knowing that he and I share connections to that country (and a fondness for the Danish sense of humour).


What can we learn from Denmark?

Gavin Mooney writes:

The Danes are happy despite paying such high taxes. But why?

There are now numerous surveys that tell us that the Danes are the happiest people on the planet. Melissa passed to me this almost eulogistic recent assessment of the happiness of the Danes.

I lived there for 5 years and it does seem to me that they are a happy bunch. In fact they seem more interested in being happy than healthy! Indeed they are pretty healthy but just not as healthy as their Scandinavian colleagues in Sweden and Norway. Continue reading “What is the Danish connection between high taxes and happiness?”

adverse events

Feb 13, 2012


Science + democratic participation = better health outcomes, according to Sophie Hill, the editor of a new book called The Knowledgeable Patient.

To find out more about this equation, see the clip and the article below by Hill, the Head of the Centre for Health Communication and Participation in the Australian Institute for Primary Care and Ageing at La Trobe University, provides more detail about the book below.

In a sign of the times, I first heard about it late last week as the result of a tweet circulating this YouTube clip about the book.

[youtube] [/youtube]
  Continue reading “What makes a “Knowledgeable Patient”? On communication and other matters…”

The previous Croakey post looked at how the response to homelessness varies between Sydney, Brisbane and Darwin and according to whether it is framed as a health or a law and order issue.

The article below, by Heather Holst from HomeGround Services, looks at what can be learnt from the unprecedented public and government response to the survivors and the communities affected by the 2009 Victorian Bushfires.

It originally appeared in the December 2011 edition of Insight, published by the Victorian Council of Social Service (VCOSS), which can be downloaded in full here.


What does an effective response to homelessness require?

Heather Holst writes:

Many thousands of people were made homeless by the 2009 Victorian Bushfires. Several homelessness services, including HomeGround Services, found themselves responding, alongside a wide range of professionals and volunteers.

In contrast to this one-off disaster situation, homelessness services are part of a cluster of services that respond to personal emergencies whenever they happen.

This article considers how our ‘day-to-day’ crisis response to homelessness differs from the response to the bushfire disaster.

There were several linked components of the response to the 2009 Victorian Bushfires that were integral to its success:


The teams that were quickly assembled and coordinated soon knew who had to be assisted in terms of numbers and locations. It took longer to fully understand needs, but there were concerted efforts to do so. This may seem a simple point, but it differs from day-to-day homelessness services where it is a case of waiting to see who comes on a one-by-one basis through the door seeking assistance. Continue reading “What we can learn from large-scale disasters about responding effectively to homelessness”

Health inequalities

Feb 13, 2012


In the first of two Croakey articles that examine services for homeless people, Caroline Chen reports on a recent analysis suggesting people receive very different types of services depending upon whether they are in Sydney, Brisbane or Darwin, and depending upon whether homelessness is framed as a health issue or a law and order issue.

Chen is a health communications graduate from the University of Sydney, who is volunteering for a stint as Croakey’s first intern.

The second article in this series will examine some recent lessons from Victoria, and highlights differences between the response to homelessness following disasters and the response to the “personal emergencies” faced by homeless people every day.


Government outreach policy for rough sleepers a work in progress

Caroline Chen writes:

For people who are homeless, the type of services offered may vary considerably according to where they are based, a recent analysis suggests.

People who are homeless in Darwin get quite different treatment from those who are homeless in Sydney, for example.

Homeless people in Sydney may benefit from a comprehensive assertive outreach service that not only provides much-needed housing, but also assistance in maintaining a home and improving physical and mental health states.

The situation is similar in Brisbane where outreach is available to people on the street and post-housing, though the capacity for delivering health services is somewhat limited by lack of professional support.

In Darwin, assertive outreach does not address housing or health care issues but rather focuses on preventing ‘antisocial’ behavior by ‘moving on’ people who dwell in public places. Those who are visitors are also encouraged to ‘return to country’.

One of the questions this raises is whether law and order perspectives dominate policies for Indigenous people (in the NT anyway) rather than a more holistic health and welfare approach employed in other places. Continue reading “How the response to homeless people varies between Darwin, Sydney and Brisbane”


Feb 13, 2012


Amongst all the talk about mental health reform and health reform more broadly, we haven’t heard much about the role of the community mental health sector.

But the sector is facing profound challenges as a result not only of national health reform, but also disability sector reforms, suggests a recent paper from VICSERV, which represents the Victorian sector.

The consultation paper, Community Managed Mental Health: an Agenda for the Future (PDF alert), says the sector is fragmented (reflecting historic funding patterns), and needs to become more flexible, accountable and easier for clients to navigate.

The paper says the proposed National Disability Insurance Scheme would change the policy, service system and organisational context of mental health significantly, as well as almost doubling fundings for community managed mental health services in Victoria.

The paper also urges the community mental health sector to contribute to the development of Medicare Locals. “Organisations focussed on working with people who face serious mental health issues need to recognise the broad mandate that Medicare Locals appear to have. The original framing as new primary care infrastructure has perhaps led to some organisations regarding the new bodies as less relevant than the current evidence suggests,” it says.

The paper notes that Victorian Government funding for the sector has fallen from 10.62% of the state mental health budget in 2002–03 to the current 8.88% in 2011–12. It says Aboriginal Community Controlled Organisations in particular need more support.

It notes that community managed mental services focus on people with serious mental illnesses and those facing significant social and economic disadvantage, and provide support to people in managing their mental illness and building their skills for life in the ways they choose. “It is the part of the mental health service system where there is the strongest evidence of commitment to a recovery approach and of the building of skills and systems that underpin effective practice,” says the paper.

More detail on the paper is provided in the article below, from Kim Koop, CEO of VICSERV, and and Elizabeth Crowther, President, VICSERV and CEO of the Mental Illness Fellowship Victoria.


Community mental health services shape up for bigger role

Kim Koop and Elizabeth Crowther write:

Victoria’s community managed mental health sector has recently released an extensive reform agenda which is seeking major change in the way Victorians use mental health support services.

Made up of 130 individual agencies of varying size across Victoria, the community managed mental health (CMMH) sector delivers support services to 20,000 Victorians a year who have severe mental health issues. Continue reading “Plenty of challenges and opportunities ahead for the community mental health sector”

general practice

Feb 10, 2012


Among the many competing principles in healthcare delivery and policy are the notions of providing the ‘best possible care for any individual’ versus ‘doing the best for the most at a population level’.

Tied up with this are questions of how to achieve the fairest distribution of healthcare resources, and of health.

On such themes, here is a column, first published in the 10 February edition of Australian Doctor, by the magazine’s political editor, Paul Smith.

It is particularly timely given the current focus on the impact of private health insurance incentives, which, it could be argued, have helped distort health funding towards the procedural end of medicine.


How to address the problems of medical specialisation?

Paul Smith writes:

I heard this story* in the Australian Doctor office last week. It was about a patient, a GP, who went to see a specialist because of problems with her eye.

During the consult, the specialist confirmed a retinal tear, but he had to refer her to someone else because he was millimetres beyond his scope of practice. Turns out he was a peripheral retinal surgeon, not a central retinal surgeon.

These experiences are not uncommon, although super specialisation and the way it affects the health system is a vexed issue not discussed enough in the public domain.

You could argue that the rise of the specialist common to most health Western health systems will drag them all towards the financially crippling horrors of the US, a country tragically dominated by the sort of people who proudly claim to be experts in the left big toe.

The issue is on the agenda here because the bloke leading Health Workforce Australia, a relatively new bureaucratic colossus with hundreds of millions in its budget balance, has now started talking about the need to resist. Continue reading “What to do about the problems caused by super specialisation in medicine?”

consumer health information

Feb 10, 2012


Here is an interesting juxtaposition of two sets of research findings about doctors’ disclosures of their financial relationships with pharmaceutical companies…

In the US, a survey of almost 2,000 doctors found nearly two-fifths did not completely agree they should disclose their financial relationships with drug and device companies to patients.

The survey, by researchers from the University of Massachusetts in Boston is reported in the current edition of Health Affairs, and also covers broader ethical issues (for example, about one-third of doctors did not completely agree with disclosing serious medical errors to patients).

Commenting at the HealthNewsReview blog, Harold DeMonaco, Director of the Innovation Support Center at the Massachusetts General Hospital, says this is a “mind boggling” finding: “I would personally want to know if my physician was prescribing a drug based in some measure on a financial relationship with the manufacturer.”

Meanwhile, the Australian arm of GlaxoSmithKline has released the results of a survey of 1,007 Australians aged 18 to 64, which concludes “there is widespread scepticism and little support for the current system in which pharmaceutical companies pay undisclosed fees to healthcare professionals. Overall, those that disapprove of these payments (44%) outnumber those that approve (21%) by a factor of two to one.”

Two-thirds of those surveyed said they would prefer that the pharmaceutical companies disclose each and every individual sponsorship of specific doctors and specialists.

It is worth noting that the survey questions put the best possible gloss on the relationships between pharma and healthcare professionals – suggesting that payments are made for research funding, advisory committee work on new medicines, and clinical education. No mention that experts might be involved in industry marketing campaigns, for example (not that a firm line can always be drawn between these and research/education initiatives anyway).

As previously reported at Croakey (see here and here), Deborah Waterhouse, General Manager of GlaxoSmithKline Australia, is keen to see greater transparency around payments to health professionals, and has committed to working towards her company disclosing these on an individual and institutional basis. It has been disclosing individual payments to patient and community groups for the last three years.

In the article below, Deborah Waterhouse summarises the survey’s findings. Beneath her article, Dr Wendy Lipworth, who researches conflict of interest matters, cautions that focusing on transparency can distract us from more important matters – such as the impact of such financial relationships and whether they should be allowed in the first place.

*** Continue reading “What many patients want to know, but many doctors don’t want to tell”

adverse events

Feb 10, 2012


(Update, Feb 27: Links to further reading have been added to the bottom of the post)

The NPS recently launched an education initiative for health professionals as part of a new five-year effort to address “the critical issue” of antibiotic resistance. A campaign targeting the general public is due to start in April.

The NPS is encouraging health professionals to tell patients they are twice as likely to carry resistant bacteria after a course of antibiotics as someone who has not taken them. “It may help to explain that antibiotics are less likely to be effective if they need them to treat a severe infection in the near future,” says the NPS.

Meanwhile, in its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports on a recent randomised controlled trial in the UK, which suggests that interventions to tackle antibiotic prescribing can make a difference.

Hopefully the NPS will be evaluating the impact of its campaign, and releasing the results, so we can compare its impact with those of efforts elsewhere.

Update (13 Feb): The NPS has also drawn readers’ attention to a Swedish campaign that has been effective in reducing antibiotic prescribing, especially for preschool children. More details here and here.


Overprescribing of antibiotics can be tackled, suggests UK program

Olga Anikeeva writes:

Over-prescribing of antibiotics has been identified as a key challenge for Australia’s health system by the AIHW. While an awareness campaign in 2006-2008 contributed to a reduction in the number of antibiotic prescriptions, numbers rose again following the swine flu epidemic in 2009.

Currently, Australians are estimated to be one of the highest users of antibiotics in OECD countries, with health professionals dispensing approximately 22 million prescriptions annually, of which 3 million are for viral infections and therefore unnecessary.

A similar problem exists in the UK, which prompted researchers to assess the effectiveness of a flexible, multifaceted educational intervention aimed at reducing antibiotic over-prescribing in primary care. Continue reading “Tackling the overuse of antibiotics: a call to action”

health reform

Feb 8, 2012


Do most Australians really want a healthcare system structured to ensure that the better off get better access to health services?

Or to put it another way – designed to ensure that those most in need of health services are least likely to have access?

If you doubt that this is what we have, read this review of the research on socioeconomic status and healthcare, recently published by the Primary Health Care Research and Information Service. It says equity in healthcare service delivery means that people’s access to or use of services is based on the need for those services.

The private health insurance rebate, Medicare Safety Net and co-payments for primary healthcare are given as examples of policies that contribute to inequities. The review says:

“For example, private health insurance may contribute to inequity because it prioritises care to those who are able to pay. Higher income groups that are more likely to have private health insurance may also benefit from tax rebates (totalling over $200 million per year), which are redistributed back to higher income groups.

Similarly, the Medicare Safety Net policy may inadvertently maintain or even increase inequity in primary health care access and utilisation. The Medicare Safety Net was introduced at a time when Australians faced substantial increases in out-of-pocket costs and it was designed to provide additional financial relief for those most in need. However, an evaluation of the policy in 2008 showed that 55% of all reimbursements by the Medicare Safety Net were distributed to the top quintile of Australia’s least socioeconomically disadvantaged population, whereas the most disadvantaged quintile received 3.5% of the total Safety Net reimbursements.”

Meanwhile, in the Sydney Morning Herald , economics editor Ross Gittins reviews the history of private health insurance subsidies, and cites a recent paper by John Menadue and Ian McAuley published by the Centre for Policy Development (and covered previously at Croakey), in arguing that subsidising private health insurance doesn’t only advantage the better-off but also makes healthcare more expensive than it needs to be.  Continue reading “Who wants a health system designed for the better off?”

global health

Feb 8, 2012


The Public Health Advocacy Institute WA has kindly agreed to share its JournalWatch service with Croakey readers.

Below is a brief description of the service – and its latest “must read” article, about Germany’s role in undermining tobacco control.


Finding the findings that matter for policy and practice

Dr Melissa Stoneham writes:

Our JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice. Continue reading “What’s hot in public health journals: Germany’s role in undermining tobacco control”

Indigenous health

Feb 7, 2012


Sixty-two per cent of voters support changing the Constitution to recognise Indigenous people as the country’s first inhabitants, according to a poll reported today in the Sydney Morning Herald. (

In the article below, Professor Pat Dudgeon, an Indigenous psychologist, continues the theme of recent Croakey articles exploring the health implications of such recognition. (This article was first published in the Crikey bulletin:


Putting the focus on “protective factors” for Indigenous mental health

By Professor Pat Dudgeon

The symbolism behind recognising Aboriginal people in the Constitution shouldn’t be mistaken as some lofty or empty ideal with no effect on real people and real communities. Until the possibility of this moment, we have grown up an Australian society that has not recognised Australian Indigenous people as genuine or valued citizens. There is almost a sense of hoping we would fade away. We come from a history of colonisation that has denigrated Aboriginal and Torres Strait Islander people and culture — a history where we were painted as savages, as less than human.

Over past decades a process has been under way of indigenous cultural renaissance through decolonising ourselves and reclaiming and reconstructing our cultural identity. The struggle for survival and to be recognised as human, and for Indigenous people to name themselves and their realities is a continuing concern. To be recognised as different but equal is not a privilege many of us have experienced.

The appalling statistics of our disadvantage is a consequence of this history and lack of recognition. As someone who has seen the toll of suicide on our young people and our families first hand, and who has researched the causes of community distress in Australia and overseas, I believe taking this big positive step forward in our nation’s founding document will help to make our communities, and especially our young ones, feel stronger. Continue reading “Constitutional recognition and Indigenous health”

adverse events

Feb 7, 2012


Thanks to Fron Jackson-Webb for providing this latest wrap of reading from The Conversation (

It includes articles about universities teaching complementary medicine, the Medicare Safety Net, new research on caesarean sections, e-prescriptions and hospital errors, and urban development.

You can also read an article from The Conversation’s editor, Andrew Jaspan, on mining magnate Gina Reinhart’s ambitions for Fairfax.

*** Continue reading “Latest wrap of health and medical reading from The Conversation”

child health

Feb 6, 2012


Note: apologies to readers but system glitches are making it difficult to insert links at the moment.

The Australian Psychological Society recently claimed ( that the Better Access program had been “the most successful mental health initiative of the past 30 years”.

This followed the Federal Government’s announcement that it would put in place transition arrangements for patients requiring long-term treatment who had been adversely affected by the reforms announced in the May budget, until other service models are more developed (also in the face of a Greens threat to block the reforms).

In a story for Crikey last week (, I suggested the program’s success should be judged not only on whether it had increased access to services (which it clearly has) but also on equity and effectiveness (about which there are question marks – and you can read more on some of these in the commentary at the bottom of this post)

Coincidentally, today’s edition of The Medical Journal of Australia ( brings reminders of the importance of equity considerations, highlighting the unmet needs of two groups – Indigenous Australians and children in out-of-home care – and the downsides of fee-for-service healthcare. Continue reading “Making equity part of the discussion on mental health (including new publications in Indigenous mental health)”


Feb 3, 2012


On the eve of World Cancer Day, Claire Maskell of Palliative Care Australia describes global variations in access to palliative care, particularly in the Asia-Pacific region.


LIFE before death: the film

Claire Maskell writes:

Palliative and end of life care doesn’t get much attention in the public health world. Prevention and health promotion might not seem to immediately fit with death that cannot be averted.

But there is a lot we can do to ensure that the end of life and the process of dying are well managed, with quality care, and free from preventable pain.

Unfortunately, we are currently failing to do this for 4 out of 5 people in the world.

Figures released by the Union for International Cancer Control (UICC) estimate that more than 3.3 million terminal cancer patients die each year without getting adequate pain treatment (

We mustn’t forget this is just the tip of the iceberg – these are just deaths from cancer, never mind other forms of life threatening disease.

This is a huge public health crisis, yet one that doesn’t get enough media coverage to arouse public concern and drive political and systems change.

It’s not that we don’t have a solution, we do, and it’s called morphine.

Morphine is safe, effective, inexpensive, easy to use and administer. Yet barriers such as ignorance, a lack of public and medical education, myths and laws restricting the use of narcotic drugs, prevent millions of people from getting access, forcing them to live and die with treatable pain.

But this is by no means a burden shared equally across the world – 99.9% of these deaths occur in low to middle income countries and the percentage of the world’s medicinal narcotics they receive is just 6%. Continue reading “World Cancer Day, inequities in global access to palliative care – and a film that will matter to us all, sooner or later”

evidence-based issues

Feb 3, 2012


Doctors are often encouraged to “prescribe” exercise to sedentary patients, but it’s not been clear whether such initiatives make any difference, to either peoples’  level of activity or their health.

In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) highlights a recent systematic review and meta-analysis investigating the issue.


An important question in need of an answer: how to get patients moving?

Amanda Carne, Research Associate, Primary Health Care Research & Information Service (PHC RIS), writes:

Moderate physical activity has been consistently identified as a key factor in the improvement of health and overall wellbeing.

Yet many Australians appear to ignore the recommendation to achieve at least 30 minutes of moderate intensity physical activity throughout the day, with an alarming one in four Australians classified as obese. The consequences of obesity include increased risk of chronic health conditions, increased service use and increased mortality, and represent a significant burden on the health care system.

With the recent Healthy Weight Week (22-29 January 2012) and current reality TV weight loss shows going head-to-head in evening television, it is timely to consider the question of whether prescribing exercise improves health outcomes. Continue reading “When doctors “prescribe” exercise, does it make any difference?”

Indigenous health

Feb 2, 2012


A recent Croakey post suggested that Constitutional reform could bring important health benefits for Indigenous Australians.

The article below argues that a clear legal framework is needed for better Aboriginal health, citing a paper recently released by the Lowitja Institute, Legally Invisible – How Australian Laws Impeded Stewardship and Governance for Aboriginal and Torres Strait Islander Health.


The law is a powerful lever for improving Aboriginal and Torres Strait Islander health

By Adjunct Associate Professor Genevieve Howse (LaTrobe University), Mr Dave Moodie (The Lowitja Institute), and Professor Judith Dwyer (Flinders University and The Lowitja Institute)

Australia is one nation, yet its federal structure and Constitution have not encouraged laws creating a clear governance structure for Aboriginal and Torres Strait Islander health.

At present, health services are governed by a bewildering array of laws and policies that differ across the States and Territories. In particular, apart from a few recent exceptions, these legislative arrangements do little to create clear governance and accountability for the provision of appropriate health services to Aboriginal and Torres Strait Islander people.

With a national conversation now taking place about recognising Aboriginal and Torres Strait Islander people in the Constitution as Australia’s First Peoples, the Lowitja Institute – Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research 0 has recently published a paper entitled Legally Invisible–How Australian Laws Impeded Stewardship and Governance for Aboriginal and Torres Strait Islander Health.

Written by La Trobe University legal academic Genevieve Howse, the paper argues the time has come to consider implementing a consistent and comprehensive national legislative framework to support the delivery of Aboriginal and Torres Strait Islander health services, with constitutional recognition of Australia’s First Peoples as the cornerstone. As the paper says, ‘recognition in law is powerful’. Continue reading ““Legally invisible”: Law reform matters for Aboriginal health”

health reform

Feb 2, 2012


Thanks to The Conversation for allowing republication of this article.

Jon Jureidini, professor of psychiatry at the University of Adelaide, writes:

As the Commonwealth Government’s community consultation period for mental health reform comes to an end this week, health bureaucrats will begin finalising Australia’s Ten year roadmap for national mental health reform to “guide future action and investment”.

The consultation period was deliberately short – just two weeks – because it’s the tail end of a long reform process, leaving little room for the community to provide feedback to the Department of Health and Ageing.

The roadmap correctly identifies two fundamental priorities in mental health reform: addressing the social determinants of health and injecting greater resources and energy into supporting those with serious mental illness.

But the 42-page document is based on some problematic assumptions about the causes and prevention of mental illness, and conflates illness with other forms of distress. Continue reading “Outlining some priorities for mental health reform”


Feb 1, 2012


How well do you and your neighbours know each other?

In the season of fires and floods, this is an important question, as research shows that well-connected communities do better at responding to and coping with disasters, according to public health researcher Professor Penny Hawe.

In the article below, she explains why social capital is especially important in times of disaster.

This article was first published in the December 2011 edition of Insight, published by the Victorian Council of Social Service (VCOSS) with the theme, Emergency Management: Trauma and Resilience. It can be downloaded here:


Resilience: finding the right ingredients

Penny Hawe writes:

The day before I was due to pick up two dozen cupcakes from the bakery in Lorne, there was a message on my phone asking what kind of passionfruit icing I wanted.

The butter cream swirly type or the hard shiny fondant?

I took a note of the name of the caller and phoned back. The swirly type please.

The next day 24 little works of art were stacked up into three boxes waiting for me. As the baker’s daughter and I carried them to my car, I said:

“You’re Cleo, right?”

“Yes,” she replied.

“I’m Penny.”

“Yes, I knew you, but I didn’t know your name. Hi.”


I now know 23 people in Lorne by name to say ‘hello’. I know some people well enough to stop and chat. Two and a half years ago I would not have known any of them.

Nor would I have appreciated the significance of this. Continue reading “Community connections and social capital: especially important in times of disaster”