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Lessons from Aotearoa/New Zealand on the road to mental health reform

Victoria is at the “sharp end” of mental health reform and must be as ready as possible so that it does not squander the opportunities about to unfold but can make the most of them, a webinar hosted by hosted by Mental Health Victoria and the Victorian Healthcare Association heard recently.

Croakey journalist Marie McInerney covered the event for the Croakey Conference News Service and reports on the discussions below. You can also read a Twitter thread of #MHReform here.

McInerney also covered an earlier session in the webinar series on lived experience: you can read her report here.


Marie McInerney writes:

Victoria’s mental health system is on the cusp of monumental change but the sector has been warned to expect external and internal frustration with the pace and scale of change and urged to not look for a “rescue party” or rely on buckets of money to deliver a transformed system on their behalf.

That’s the advice from Robyn Shearer, Deputy Director-General of Mental Health and Addiction in Aotearoa/ New Zealand, who is steering major system reform that was launched there in late 2018 with the release of the He Ara Oranga report from the nation’s Mental Health and Addiction Inquiry.

“I think there is a tendency to look to the rescue party over the hill that will save us all from what we think is wrong,” Shearer told a Victorian webinar on implementation of mental health reform hosted this month by Mental Health Victoria, the Victorian Healthcare Association and Deloitte Access Economics.

“There is not someone coming to make this happen, it is us (who have to do so),” she said.

Shearer was invited to the #MHReform webinar to talk about New Zealand’s experience in reform, given it is about 12 months further down the path than Victoria.

Victoria has this year been implementing a number of practical reforms, including via the creation of Mental Health Reform Victoria, which were recommended in the interim report of its Royal Commission into Victoria’s Mental Health System.

The Royal Commission’s final report will be handed to the State Government on 5 February 2021, but mental health reform is not confined to the state or to state changes.

The national mental health sector is also waiting on the final report of the Productivity Commission inquiry into mental health, which was handed to the Federal Government on 30 June but not yet been released and was not factored into the 2021-21 Federal Budget, as many had hoped and expected.

Its release is expected any day now but required by early December.

“Twin wicked challenge”

Having promised to implement its Royal Commission’s findings in full, the Victorian Government on Thursday announced its 24 November State Budget would include $868.6 million to deal with the ‘twin wicked challenge’ of a broken mental health system and the impact of the global pandemic — welcomed by Mental Health Victoria as a “downpayment” for next year’s full report.

Today the State Government announced $5.3 billion to construct more than 12,000 new public and community housing units throughout metropolitan and regional Victoria, which includes 2,000 for people with mental health issues, taking new mental health funding announced so far for this Budget to more than $2 billion, Mental Health Victoria said.

But Shearer, former CEO at Te Pou o te Whakaaro Nui, a national centre of evidence-based workforce development for the mental health, addiction and disability sectors, told the webinar that while significant financial investment is critical to mental health reform, it’s not the panacea to all issues when transformational changes is required and ordered.

New Zealand’s He Ara Oranga report found the system there was “under pressure and unsustainable”, with escalating demand for specialist services, limited support for people in the community and difficulties recruiting and retaining staff and unmet needs and poorer outcomes for particular groups.

They were particularly so for Māori — who the report found are subject to much greater use of compulsory treatment and seclusion, and for Pacific peoples, disabled people, LGBTIQ communities, prisoners, and refugees and migrants.

Also regarded as presenting a ‘once in a generation’ opportunity for change, as is Victoria’s Royal Commission, the report noted a striking degree of consensus in New Zealand society for an emphasis on wellbeing and community, with more prevention and early intervention, expanded access to services, more treatment options, treatment closer to home, whānau- and community-based responses and cross-government action.

The New Zealand Government’s commitment to that change was clear in the $1.9 billion allocation for mental health and addiction in the last national budget, but that level of funding “comes with some inherent tensions in seeding expectations that are not able to be quickly met”, Shearer said.

That includes where government may think it’s easy to roll out a new program to give better service options and don’t understand you “can’t just find people to suddenly deliver those new options to people” or there may be difficulty integrating new services with current programs.

But it’s not just government. Expectations also need to be managed within the sector and the community amid excitement about announcements of funding that can turn to frustration or concern: ‘This is fantastic. Where is the money now? Why isn’t that happening? Why isn’t it happening quickly enough?’, she said.

“It’s not just throwing money at the problem, there is the whole leadership and system transformation process that needs to occur,” she said. That includes having a well-developed framework and evidence base, and strong communication and engagement via skills that may need to come from outside — in her case at times with New Zealand’s chief COVID-19 communicator Dr Ashley Bloomfield.

“It requires really determined leadership at all levels and you need champions who are going to be on the journey, sharing learning and also working with you through some of the mistakes that will inevitably, inevitably happen,” she said. “Life is not perfect or ever smooth sailing.”


Shearer said her department had focused on four priorities for the past year:

  1. Setting up a Mental Health and Wellbeing Commission, mandated not for service or strategic work but to monitor New Zealand’s response to He Ara Oranga. (See also the scorecard on the first year’s work from the Mental Health Commissioner, who authored He Ara Oranga and warned, in June 2020, “we are moving backwards when it comes to Māori)
  2. Repealing and replacing the Mental Health Act, with the aim to support people to get help early and minimize use of the Act, particularly for Maori and Pacifica New Zealanders.
  3. Expanding access and choice of mental health services, starting with primary health.
  4. Developing a Suicide Prevention Office, “knowing that suicide is not just related to mental illness or addiction, but actually to financial and economic situations, unemployment (and) trauma”.

The COVID-19 pandemic had been a major interruption but it had also allowed a lot of trial and innovation around education, digital tools and policy approaches, enabling her team to “use the opportunity to try some new options for people and have a much stronger focus on wellbeing”.

Participant comments


The cross winds of a pandemic

The silver lining of COVID-19 was echoed by others in the webinar, including Mental Health Reform Victoria CEO Pam Anders.

She said the new agency, which has been rolling out the Royal Commission’s interim recommendations, looked to take a systems approach through 2020: “how do you think and work with complexity, all of this within the cross winds of a pandemic”.

Anders said COVID had defined much of 2020 for people in Victoria, personally and professionally, creating different pressures and different risks in different parts of the population.

But, she said, it had also seen “an incredible amount of agility and ability to scale innovation across the sector”, for example through the mainstreaming of telehealth services, increased collaboration and localized responses, and the rollout in a record four weeks of 15 ‘pop-up’ mental health clinics across Victoria.

“Whilst COVID has amplified many of the reasons why we have had an inquiry (into the mental health system) at the state level, I think it’s also demonstrated simultaneously that capability of the sector to reform and to transform,” she said.

Also at the forum, Victoria’s Mental Health Complaints Commissioner and the Disability Services Commissioner Treasure Jennings urged an overall focus on co-design, saying she is concerned that the voice of lived experience and the efficacy of people with disability to press for co-design in services is more advanced than the mental health sector and noted that Australia has a less developed lived experience workforce than other comparative nations.

Jennings predicted the Royal Commission would recommend expansion of the peer support workforce, but warned the sector it would need to address a number of barriers, such as inconsistency of development across services, reasonable accommodations, credibility, and career pathways.

Having taken up the position in July 2020, Jennings said she was pleased to have inherited “a very well-formed lived experience strategy and framework” – Driven by lived experience– beginnings, present & future from her predecessor Dr Lynne Coulson Barr, and saw an early opportunity in her work ahead to support mental health services to “better develop their own internal complaint handling skills, especially at the coalface of those services”.

Mental Health Victoria CEO Angus Clelland said the forum was held to inform a “capstone” policy paper to be put to the Victorian Government on how best to implement the Royal Commission reforms, aiming to avoid the risks often involved with major reform processes, where they can “lose momentum, they can make mistakes, and they can leave people and communities behind”.

“We are absolutely committed to making sure that that doesn’t happen…and to make sure that we’ve learned the lessons that have been learned from other reforms, and of course from our colleagues from overseas,” he said.

Participant comment

Notes from the breakout sessions

Planning

  • Importance of developing of new leadership capabilities
  • Shared understanding of reform and what success will look like
  • Achieve quick wins while still having time for ongoing/iterative planning
  • Need for overhaul of IT, information management and sharing infrastructure, so the system can talk to itself and establish good understanding through data
  • Need to build adaptive leadership throughout the system
  • Need to manage competing cultures: eg state level programs that might promote greater collaboration versus federal funding of greater competition.

Collaboration

  • Importance of data collection, to inform representation for collaboration to ensure have all the right people around the table, based on where the need is and the data from the sector.
  • Need for sufficient time and planning to ensure authenticity of collaboration
  • Finding the balance between “making sure that we hit the ground running, but putting the time in to ensure that that’s done effectively and authentically”.
  • Addressing power dynamics whenever talking about collaboration between services and consumers
  • Ensuring committees and working groups have clear goals and outcomes: “important to ensure motivation and engagement over the course of the reform process”
  • Need to ensure compensation for lived experience is a priority.

Communication

  • Mass/mainstream communication of public health issues is often very problematic, which was to be seen in many early COVID-19 communications in Australia. They should be as diverse as each community.
  • There are many stories of communications done badly, but also some amazing examples that often come out of Indigenous health or a rural or regional town that “bucks the curve”.
  • Importance of honesty, consistency, plain speaking: “keep the health speak and government speak to an absolute minimum, communicating in a way where people can easily absorb that information and make sense of it in their own lives”.
  • Importance of two-way messaging, so people can ask questions, get answers and engage.

Capacity building

  • Better data collection so organizations and regions can really use it well, to improve capacity building.
  • Better resourcing for data collection activities, making sure that there’s an appropriate feedback loop so that “when we collect data, we give it out”, with proper analysis and response.
  • Need to integrate different data systems, including across the public/ private divide, and across national, state, local areas.
  • Better governance for organisations, including proper consumer feedback mechanisms, compassionate board culture, consumers and carers involved in all stages of decision including co design
  • Need to develop metrics that are actually constructive, not just focused on compliance.


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What people say about Croakey

Croakey Health Media was the official media partner for VicHealth’s Life and Health Reimagined series (2020). Croakey’s indepth coverage of the five-week series amplified the conversation about how we can make life after coronavirus better and healthier for everyone.
Croakey’s coverage included compelling articles about each week’s topic and wrap-ups of the live-streamed events, live tweeting, a Twitter takeover of the @WePublicHealth account and a podcast summarising the series.
Having Croakey as our media partner enabled us to reach a more diverse public health audience and introduced new voices and experts to the discussion. Croakey’s team also generated a lively dialogue on social media about the series, driving debate and frank discussion on the important topic of how do we create a healthier, fairer, better world post-pandemic.
I would highly recommend Croakey Conference News Service to anyone seeking an innovative and collaborative media partner for a conference or event.

Rachel Murphy

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