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John Mendoza’s damning assessment of Labor’s mental health history

This article was published today in the Crikey bulletin.

John Mendoza, Adjunct Professor of Health Science, University of Sunshine Coast, writes:

“On Tuesday Julia Gillard made her first policy announcement on mental health, Mental health: taking action to tackle suicide. The new PM has made the point publicly on several occasions that she understands the issues in mental health and has reminded us of her significant cultural capital in this regard.

I, like many in the sector, expected her to take a very different policy stance to her predecessor and to dig Minister Nicola Roxon out of the hole she continues to dig for herself on mental health.

In her speech to the Committee for Economic Development in Brisbane, Julia Gillard made much of Labor’s credentials in health reform, citing reform going back to Chifley and the PBS, Whitlam and Medibank and Hawke and Medicare. Fair enough.

She said “a nation’s health system is a measure of the nation itself… a test of a nation’s prosperity … and accessibility …a test of its fairness”. She set out the case that health reform is part of the Labor Party’s DNA. Seems reasonable.

Someone clearly didn’t point out to the PM that Ben Chifley actually signed a deal with the States to reduce funding for mental health in 1949 (“Mental Disease Benefits”) that significantly reduced services and beds for mental health care. Following a wave of national concern about over-crowed and “sub-human conditions” in mental health institutions, PM Menzies commissioned a national inquiry.

State Labor Governments (in every state except South Australia) resisted meeting then Federal Health Minister, Earle Page, to address the problems, which forced Menzies to set up the Stoller inquiry in 1954.

It was the Menzies Government who led the first national response to mental health which saw a large increase in funding to the states, the updating of state mental health laws and the scraping of such archaic institutions as the Lunacy Court in NSW despite resistance from the then Labor Premier John Cahill.

Of course there have been a dozen or more major inquiries or Royal Commissions into the state of mental health since the 1960s and all have had much the same to say about the sector – underfunded, overcrowded, poor quality of care, inaccessible services, human rights abuses etc etc. The 1961 Royal Commission in NSW, headed by Justice McClements, even set out some fundamental human rights for the mentally ill: “the right to have his right to liberty balanced against community concerns; the right for the hospital to care and teat him and if possible rehabilitate him; and the right to work”.

Regrettably nearly fifty years later, people with serious mental health problems still have these basic rights ignored or abused.

Quite correctly, as a nation we moved to reduce the number of beds in standalone psychiatric institutions from the 1960s but not until Burdekin’s report in 1992, and under Health Minister Brian Howe’s leadership, did we even attempt to have a planned approach to this extraordinary social change.  Only one State Government, Victoria under a so-called Thatcherite Jeff Kennett, fully implemented the agreement to close all standalone psychiatric institutions.

As of today, we continue to see these institutions in every State which happens to have had a Labor Government over most of the past decade.

Since Burdekin, for nearly 20 years, Australians have been told that mental health is a national health priority. To show this commitment, every five years since 1992, all Australian governments have signed five year National Mental Health Plans. Minister Roxon signed off, against the advice of the National Advisory Council on Mental Health, on the Fourth Plan in August last year. This is a plan that commits no one to anything; a plan that simply contains a range of suggestions for action; a plan that like the one before, contains no specific spending commitments. What I would call the ‘Fourth National Mental Health Deception’.

Deceptions because the percentage of healthcare spending in mental health has remained largely unchanged since the First Plan in 1993. The only exception to this was in 2006 under the CoAG National Action Pan on Mental Health lead by John Howard and Morris Iemma when $4b over five years (ultimately$5b) was injected in the sector. Howard and Iemma acted in the face of denial of any problems from the health bureaucrats, advisers and the Minister’s of the day, but fortunately Iemma and Howard listened to the voices of mentally ill and their families.

The national health priority on mental health for the past 18 years has been one long deception on the Australian community.  While there has been change, there has not been reform nor a response to the changing mental health needs of the community.  Just the same old rear-view mirror perspective of the state mental health directors and co.

Gillard knows that there is deep trouble in mental health. In 2005 at the time of the release of the Not for Service report,  she stood outside the Brain and Mind Research Institute and called for national leadership and promised to “hold the feet of her Labor (State/Territory) colleagues to the fire on reform”.  She strongly endorsed the recommendations in that report that called for national leadership, national accountability, national infrastructure akin to that established by Neal Blewett in the drug research, and new investment in new innovative services.

Tuesday’s latest policy announcement on mental health is not about mental health reform. I’m not even sure there is a lot of suicide prevention in it when one sees almost all the funds directed to crisis intervention and the largest single investment for support services for those with severe mental illness.  Aside from the one investment of a woeful $9m in building safety infrastructure at suicide hotpots, there was not one innovation in the announcement.

Gillard knows a lot about mental health but the policy announced on Tuesday is straight out of the top draw of Roxon and the bureaucrats at DOHA (Health and Ageing) responsible for this shambles and mirrors the same old scatter-gun, incoherent strategy we have seen for too long in mental health and suicide prevention.  Knowing Gillard and knowing what she knows of mental health and suicide prevention, this is not her work.

The history of mental health reform would suggest that as a test of political party values, as a test of fairness, the conservative side of politics in Australia has a greater number of reform DNA polymer chains than the ALP. I find this hard to explain when the Gillard Government knows that it is people on pensions, on lower incomes and in minority groups that have higher rates of suicide, higher rates of mental illness and have even less access to care.

If, as Gillard purports, ‘health reform is in Labor’s DNA’, then she had better find the genetic links to the likes of Morris Iemma, Neal Blewett and Brian Howe – and not the chain linked to Nicola Roxon and Ben Chifley.”

• John Mendoza resigned last month as chair of the National Advisory Council on Mental Health

Comments 4

  1. Mikhail says:

    We have heard so often that change and reform is just around the corner.
    That corner has become so big – it’s become a circle.

    Accountability & Transformation is a necessity. Accountability is at the heart of both community participation and customer focus. It entails an explicit or public responsibility to someone or some agency for an action untaken or supported for an omission of action. We need legislation that ensures accountability and we need to measure what is happening to people and if it isn’t – people need to be held accountable. Health professionals also, are to be held accountable for quality (efficiency, timeliness, appropriateness) of their practices and procedures. Transformation is about new values new attitudes, and new beliefs; it is about how these changes are expressed in the behaviours of people and institutions.

    The rhetoric has been right for a long time but the reality is not there.

    Will someone just do it….

  2. Jenny Haines says:

    John, you are forgetting that unions have tried over the years to address many of the mental health service provision issues as well as the demands of their members for job security and wages and conditions improvements, and been pilloried for it. in 1985 as General Secretary of the NSW Nurses Association, I, and the mental health nurses of the system fought off the worst rationalising aspects of the Richmond Report. We didn’t win all our demands, but we tried, and I remember well, the families of mental health consumers being extremely grateful for our efforts. Now unfortunately, the unions are not as active on policy and service provision issues. Even if they were, governments would not listen to them. So old fashioned to have to listen to a union official talking about the provision of services to meet people’s needs, when it is all about budgetary stringency and efficiency.

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Croakey Conference News Service 2013 – 2019
2013 conferences
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Closing the Credibility Gap 2013
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Racism and children/youth health symposium 2014
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