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Fitting the pieces together in mental health: beyondblue and the future of mental health promotion in Australia

beyondblue is one of the highest profile health bodies in Australia.  With an ex-Prime Minister taking over from former state premier as Chair, not to mention a raft of TV personalities, Olympians and other sports stars as ambassadors, the organisation attracts the sort of media that other health groups can only dream of.

Since its establishment in 2001, beyondblue has grown significantly, now attracting over $50m p.a. in revenue from the Federal and state/territory governments which it uses to run a range of well-resourced programs and campaigns focussing on depression and anxiety.

There is no doubt that beyondblue has played an important role in raising awareness of depression and anxiety issues within the general community.  The de-stigmatisation of mental illness has come a long way over the past 15 years and beyondblue has been a key player in driving this social and attitudinal change.

However, how does beyondblue fit within the broader mental health sector, including integrating with other less well-resourced groups and peak bodies, such as Mental Health Australia?  Does the high profile and success of one organisation in a sector as diverse as mental health compromise the ability of the sector as a whole to collaborate on key priorities and a shared agenda?

In the following article Dr Sebastian Rosenberg, Senior Lecturer, Brain and Mind Centre, University of Sydney and Adj Assoc Prof John Mendoza, Brain and Mind Centre, University of Sydney question the record of beyondblue in delivering outcomes commensurate with its level of resourcing. They also discuss how they see it as isolated from the rest of the mental health sector which still struggles to obtain adequate resources to meet community needs.

Following this piece, beyondblue CEO Georgie Harman responds to the issues raised by John Mendoza and Sebastian Rosenberg, outlining the processes by which her organisation works with all Australian governments to develop and implement its programs tackling depression and anxiety.


John Mendoza and Sebastian Rosenberg write:

The announcement in March this year that former Prime Minister Julia Gillard will take over from Jeff Kennett as Chair of beyondblue marks a critical moment in the evolution of Australia’s approach to promoting mental health.

Mr Kennett’s leadership created an effective structure for garnering regular contributions from each of Australia’s nine governments.  beyondblue: the national depression initiative was founded in 2001 with funding from the Victorian and Federal Governments. beyondblue is an Australian public company, limited by guarantee.

The Members of beyondblue are the Commonwealth of Australia and each State and Territory government.  While beyondblue also receives individual donations, the bulk of funding is derived from governments. This has resulted in beyondblue now having around $50m in assets, with revenue increasing from around $29m in 2010 to more than $50m in 2013.  Mr Kennett was not an easy man to say no to.

By contrast, organisations like Mental Health Australia and SANE Australia are each operating with budgets of around $3m.  In short, in an environment of meagre resources in mental health and constant calls to do more with less, beyondblue is a large elephant in a small room.

The obvious question is to consider what beyondblue has done.

Raising awareness

The “Independent Evaluation of beyondblue” conducted by Nous Consulting certainly gives the organisation marks for raising awareness, particularly about depression, less so regarding anxiety.  Most people would be aware of the range of wrist bands on offer.  Like many males, the authors have found themselves in the male public toilet at Tullamarine Airport and looked up from the trough at a key moment to see an ad posing the question “Feeling Depressed?”  Talk about product placement!  beyondblue had arranged for the same question to be posed to all travellers via the massive advertising billboard at the airport entrance off the freeway.  The Nous report confirmed that brand recognition is indeed high.

beyondblue funded a multi-million dollar Australian trial of the UK’s IAPT low intensity psychological support program, a new service involving peer support coaches now being adopted by several Primary Health Networks around Australia.

Similarly, the organisation’s Way Back Suicide Support Service is also receiving greater attention, particularly in the light of increasing concern about both completed and attempted suicides in Australia. Unlike the established rigour associated with the development and evaluation of tobacco prevention campaigns, there has been little in the way of pre and post evaluations of various beyondblue campaigns. For example, the ManTherapy campaign was short-lived, with several million dollars invested without any evaluation – independent or otherwise.

Standing alone

However, and more generally, the key issue is that beyondblue has for a long time stood apart from the rest of the mental health sector.  It may have felt there were advantages to this approach.  But it meant that the largest single mental health promotion organisation operating in Australia was not well connected to the range of other organisations also operating in this space.  Partnerships were typically eschewed.  The Nous report commented that beyondblue was often poorly coordinated even with initiatives run by the state governments that provided it with funding.

This isolation has meant that even when beyondblue has evaluated its own activities, these evaluations have been subject to critique as lacking scientific and properly independent rigour.  It has also prevented the further development of sector-wide expertise in mental health promotion and the deployment of more thorough national approaches. There is better understanding than ever about what works to drive behaviour change in mental health but beyondblue has often chosen to pursue its own agenda of awareness-raising rather than work collaboratively at this level.

Impact on care

And while awareness about depression may indeed have grown, there is nothing so stigmatising as poor care, or no care.  beyondblue has been operating for many years but fundamental shifts in mental health care are yet to emerge.  People still typically find it extremely difficult to find any mental health care, let alone anything registering as quality care.  The Federal Government’s continued support for the Better Access Scheme has lifted the rate of access to psychology services though their impact, at $15m per week, is unclear.

The rate of public access to State and Territory mental health services remains extremely low.  Spending on early intervention remains a peripheral element of the mental health budget.  Our continued failure to invest in community mental health care means that if you cannot get the help you need from your GP or psychologist, then by and large your next stop is the Emergency Department of your nearest public hospital.  Demand here is such that you must be perilously unwell to gain admission.  Mental health remains the subject of regular inquiries and commissions with the system fairly characterised as in crisis.

Julia Gillard’s role

What a critical moment for Julia Gillard to take the reins of the biggest single mental health promotion organisation in Australia.  As shadow Health Minister in 2005, Ms Gillard spoke with both understanding and commitment at the launch of the (then) Mental Health Council of Australia’s seminal Not for Service report.  The report was an Australia-wide anthology of the depth of the crisis facing mental health and in responding, Ms Gillard clearly understood the magnitude of the task.

What a gift it would be to see beyondblue rejoin the mental health sector’s struggle to design an effective response to mental illness fit for 21st century Australia.

John Mendoza and Sebastian Rosenberg were CEO and Deputy CEO respectively of the Mental Health Council of Australia in 2005.


In response to the above article, Georgie Harman, CEO of beyondblue writes:

beyondblue is, and always has been, open to constructive criticism.

We don’t have all the answers. We are not perfect. Sometimes we make mistakes.

But we always strive to do better, to not stand still, to be professional and constructive. We are bipartisan. We apply rigorous standards to our programs, campaigns, research and evaluation, and forensic examination to our financials and governance.

So I am pleased to respond to A/Prof Mendoza’s and Dr Rosenberg’s assertions and provide the facts, starting with our leadership, governance and funding.

Mendoza and Rosenberg acknowledge our founder and Chairman, Jeff Kennett’s, effectiveness in creating a national initiative that has the support of the Commonwealth and every state and territory government for the direct benefit of the Australian community.

It is, indeed, a singular achievement.

They say “Mr Kennett is not an easy man to say ‘no’ to”. I say ‘what a good thing that is’.

Coordinating efforts

Representatives of all governments come together around our Board table to observe and participate in deliberations about strategy, actions and expenditure for initiatives to maximise the mental health of all Australians. They have done this six times a year for 12 years. They have open access to our accounts, budgets, plans, policies and reports. We report several times a year individually to each of our government funders on what we are achieving for their investment. We plan annually together to leverage and coordinate effort.

Every government – across all political divides – has had a voice and been prepared to listen to our views in the beyondblue boardroom. Advocacy can take many forms.

Government funding of beyondblue has grown over the years, but so too has our reach, the number and type of programs and services we provide and public demand for them. We have been awarded significant extra work on our merits.

Diversifying revenue

Even so, we are not immune from the fiscal realities of the public purse. Complacency is a deathnell, as is inaction. That is why we – like many of our sector colleagues and quite frankly any forward-looking not-for-profit – are consciously diversifying revenue so we can do more now and tomorrow.

A substantial and growing proportion of our income comes from foundations, corporates, and donations. My experience of the last three years working for beyondblue, is that the vast majority do so because beyondblue was there for them or a loved one at a really difficult time. I

Comparisons are odious things, particularly when we are not comparing like with like. We have a different mission and mandate to the examples given by Mendoza and Rosenberg.

Different missions

Mental Health Australia, for example, is the peak mental health body representing 63 national organisations, including beyondblue. beyondblue is a paying member and an active participant. Members work together to influence and improve outcomes through a strong and united voice in the best interests of the majority. This is not attention-seeking grandstanding. This is grunt work, the behind-the-scenes slog we all hope will bring fundamental change for the better to the lives of countless Australians.

So there is much more to today’s beyondblue than “awareness-raising”.

The results are plain to see. Data from independent research on mental health literacy and stigma shows we, like SANE and others, are making a difference and that more people than ever before are reaching out for support.

Rigorous evaluations

To suggest beyondblue does not conduct rigorous pre and post evaluations of our campaigns and projects is simply not true. Our evaluations are conducted at arm’s length using the methodology expert evaluators deemed most appropriate.

ManTherapy – the example cited by Mendoza and Rosenberg – was developed in response to the findings of independent formative research; the campaign was rigorously focus tested; and pre, mid and post-campaign evaluations conducted for every single burst of activity. It achieved its objectives. But as ManTherapy started to tire as a campaign, we stopped or changed activity from its original form. That is the right thing to do.

And while we are on message cut-through, we use ‘convenience advertising’ on the back of toilet doors not for brand or product placement but because it is proven as one of the cheapest and most effective ways to reach many people. I apologise to Mendoza and Rosenberg for distracting them in what is known in the trade as “dwell time”.

Three independent evaluations of beyondblue also acknowledge our successes, although Mendoza and Rosenberg choose to selectively focus on our imperfections.

National Review

The National Mental Health Commission’s 2015 national review of mental health programs and services found that beyondblue was one mental health organisation that could demonstrate evidence of evaluation and supported its continuation as a national initiative. It is my view that big is not bad.  It often leads to better results for people and better value for the taxpayer.

We take the message to the people – whoever they are, wherever they may be – that looking after your mental health is as important as looking after your physical health.

I am pleased for Mendoza and Rosenberg’s mention of “a multi-million dollar Australian trial of the UK’s IAPT low intensity psychological support program” Our NewAccess program is doing exactly what they are calling for: providing a cost-effective, new model of early intervention that challenges the status quo.

New Access

beyondblue, knowing that over half of all Australians with a mental health condition were not accessing support and treatment (despite the ballooning costs of the Better Access scheme), took the initiative – without government funding – to develop an alternative. We partnered with The Movember Foundation to research, design, trial and independently evaluate New Access.

Unlike many mental health services, outcomes, including recovery rates, are measured every step of the way so the social, health and economic returns are transparent. This was a program seven-years in the making, reviewed, refined, reviewed again, trialed and independently evaluated. The evaluation found that 67.5 per cent of participants achieved clinical recovery; 88 per cent of people completed the course; and men were particularly attracted and highly engaged with the service.

We put a business case to the Commonwealth and in November 2015 it was announced that Primary Health Networks would include low-intensity coaching services in a new model of stepped care from June 2016. At the time of writing, ten PHN regions inhabited by 6.6 million Australians have or will have a NewAccess service, and we estimate there has been $5.3 million invested in this proven, new way of doing things.

The Way Back

Mendoza and Rosenberg also mention our Way Back Suicide Support Service. I am delighted for the attention because The Way Back fills a gap – providing psychosocial support for people who have attempted suicide – and it works. What started as a small scale trial in the NT has spread; today there are services in the NT (now funded by the NT Government and private local donations), in the Hunter region in NSW (delivered in a partnership between beyondblue, Movember, Hunter Primary Care, Calvary Mater Hospital, the Hunter Institute of Mental Health and Relationships Australia), and the ACT (funded by the ACT Government and delivered in partnership with Woden Community Service).

We estimate the Hunter service alone will in two years support over 600 people who have attempted suicide. A rigorous, mixed method evaluation will measure reattempt rates, suicidal behaviour and economic impacts.

These initiatives are characterised by partnerships. We have strong relationships with significant organisations, both within and outside of the mental health sector.

The attacks on beyondblue by Mendoza and Rosenberg go back many years and one could get distracted by trying to understand what motivates them.

It is not our job to criticise and complain. It is our job to find solutions and deliver results.

Jeff Kennett understood the magnitude of the challenge when he founded beyondblue in 2000.

I am confident that Julia Gillard is well aware of the enormity of the on-going task.

Georgie Harman is the CEO of beyondblue

 

 

 

 

Comments 5

  1. rob donovan says:

    I think it’s a bit strong to call Mendoza & Rosenberg’s comments an “attack” on bb – I took their main point as funds for mental health should be more fairly distributed rather than focusing funds for mental health in one organisation – and, from my point of view as the founder of a mental health promotion campaign, this particular focussing tends to discount the value of promotion and prevention campaigns.

    ps I believe the short-lived man therapy initiative was not so much the result of independent formative research but simply somebody’s idea to copy the US man therapy campaign (mantherapy.org)

  2. John Mendoza says:

    I just wish to respond to the statement that “The attacks on beyondblue by Mendoza and Rosenberg go back many years and one could get distracted by trying to understand what motivates them.”

    I’m not aware of any comments/critiques or “attacks” on beyondblue made by myself or my co-author ever. I would appreciate if the alleged attacks could be cited or the comment withdrawn.

    Further, the pre- and post evaluations of beyondblue campaigns are not in the public domain nor reported in the professional literature. Given the very generous level of government funding for beyondblue, that would seem to be reasonable.

    • I can only agree with what you have posted John. It is not an attack to point out that an organisation may not be operating in the most effective manner, or reaching all of its intended target group, etc. I made an opening statement to the NDIS Joint Standing Committee into psychosocial, and name Beyound Blue, and 2 other NGO’s as not being effective in dealing with the cohort who have moved to the Chronic depressive state, with these people actually having their condition exacerbated by their contact. They then reach out to untrained and unpaid people like myself. That statement will be in Hansard. And I, a sufferer of Depression, will no doubt be accused of attacking a “sacred cow”. The prevention of suicide is necessary, as the number grows. But we need to target the way we try and do this more effectively.

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