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Mental health reform – what does the sector want?

How well does the Productivity Commission’s draft report on its Inquiry into Mental Health respond to the needs of mental health consumers and other experts?

Croakey asked the sector what it wanted from the report and their responses are below.

Key themes include the need for a more consumer-centred and integrated system of care, clear policy direction and support for system change and an accurate assessment of the costs of poor mental health and benefits of improving access to high quality care.

Croakey will collate and summarise responses to the report from stakeholders and peak groups as they assess and comment on the PC report.

(Also, see this analysis of the report and call to action for health equity responses, as well as this 58-page compilation of the Croakey team’s Twitter summary.)


Mental health stakeholders write:

Tim Heffernan, Consumer advocate and Deputy Commissioner at the Mental Health Commission of NSW

  1. A real investment in the Peer (Lived Experience) workforce.It makes economic sense for people who have experiences MI and recovery to support others who are moving through that journey. It is ancient wisdom. I recall a consumer spruiking for people to attend my recovery group on the Wollongong MH Acute Unit “Come to Tim’s group – my grandmother used to say to me, if you are sick you don’t go to the doctor, you go to someone who has recovered from the sickness.’Workforce is critical – Mental Health is in crisis, similar to the planet in crisis from climate change. Should we continue to invest in the same old fossil fuels or should we invest in renewable resources, like the peer workforce?Designated lived experience roles should be at all levels of MH service delivery and they should be embedded across all whole of government services.
  2. A National Mental Health Consumer Organisation – we need to be able to develop a unified and representative voice to government. We are tired of others speaking for us.
  3. Consumer (Peer) run services – again it is about us doing it for ourselves. Too often the consumer peer voice is co-opted or diluted when we work in services. Independent we can partner more equally.

Dr Sebastian Rosenberg, Brain & Mind Research Institute, University of Sydney

  1. Commitment to build secondary mental health services to fill gap between GP and hospital. This must reflect both clinical and psychosocial services and deliver hospital avoidance and economic outcomes ( employment etc.)
  2. A funding mechanism that prioritizes early intervention and integrated care.  Physical health very important here
  3. Ongoing mechanisms to oversee and help implement change and systemic accountability.  This is where successive previous reports have failed. Especially important here is direct independent feedback from consumers and carers to drive quality improvement.

https://twitter.com/ktxby/status/1189449475229536256

John Mendoza, Director, ConNetica Consulting,  Adjunct Professor of Health Science USC, Adjunct Associate Professor of Medicine at the University of Sydney

  1. It must be an honest and comprehensive assessment of the economic, social and personal cost of mental health problems in Australia. This must include the impacts at every life stage – early childhood, in schools, post-secondary education, workplaces, health services, emergency and police services, justice and prisons, aged care, detention environments, out of home care for children and young people,  etc.It must cover the additional burden of disease in conditions such as CVD, some cancers, diabetes, COPD, musclo-skeletal conditions etc. It must cover the costs of people out of role to support people with mental health conditions including suicidal behavior. That is the first priority for the PC – the cost and impact. Comprehensive. Clear methodology.It must address the need for policy and program responses across the life span – maternal, child and family health and social care must be a key element of this. We know that an increasing level of burden of mental health conditions is stemming from Adverse Childhood Experiences – trauma, violence, neglect, poor bonding with parents etc. Early & assertive intervention must be the focus. Not the light touch, ad hoc, lottery arrangements we have at present. Schools have to be systematically equipped to provide a primary prevention (UNIVERSAL social and emotional learning K-12) for building the personal and social skills to survive and thrive in the 21st Century; prevention and assertive early intervention for kids with developmental difficulties (dyslexia, auditory processing, social & behavioural difficulties etc.); structured programs for parent education and support; clear linkages to primary and secondary care in the community including to specialist CAMHS; teacher and school leadership team support.
  2. We have to focus on turning down the flow of needs fronting up for MH care. There are a myriad of things to do in mental health services but these are essentially the same as they were in 2005 in the recommendations of Not for Service.
  3. CRITICALLY: A series of clear directions on governance and accountability. If 27 years of so-called National Mental Health Planning and reform tells us one thing, it is the utter failure of the governance and accountability arrangement in that period. I believe a national statutory commission with significant standing powers to direct, inquiry and report is the only way to break out of the cycle of chaos, despair and nothingness we have seen.

Related Posts

Comments 1

  1. fred says:

    Croakey – major concern that you are quoting selected individuals and representing it as though this is the view of all persons.

    the United Nations Convention on the Rights of Persons with Disabilities (CRPD) – article 12, as clarified in General Comment No. 1 makes it very clear that CRPD rights mean that *each* person needs to be facilitated in being able to access support according to their own will and preferences with no undue influence or pressure.

    It also makes it abundantly clear that the so-called ‘medical model’ of social and emotional distress should *not* be forced, reified or used to gate-keep access to decision making support or support to engage fully in participation in life – for psychosocial disability (or issues of social and emotional distress that may be debilitating, temporarily or otherwise).

    Finally, it makes it clear that support should be provided *free from undue influence or pressure* which *includes pressuring persons by making a particular type of support the only kind available* and *depriving other options for support*.

    This does not prevent persons *choosing* to view their experiences of social or emotional distress, irrespective of their severity or duration, through a medicalised lens if persons happen to find that lens particularly helpful. It does, however prevent medical practitioners or others imposing that lens on persons against their will – either by sweet talking funding bodies, governments or commissions into making themselves gate-keepers, by providing ‘education’ by means of misleading and deceptive conduct that misrepresents ideology as a ‘fact’, by directly forcing persons, by falsely representing a ‘mental health diagnosis’ as if it is an actual diagnosis of disease, or by any other means which unduly pressures or influences a person to use this type of support (including by restricting the means to even be able to conceptualise distress in any other way).

    If we proceed with implementing any of the findings of the productivity commission in such a way that is not linked with serious discussions about *full and faithful* implementation of CRPD rights – we will be moving backwards and leaving people with no right (or in some case even no means) to be able to freely explore and understand their own experiences of social and emotional life.

    Not to mention the issues that arise out of the ‘business end’ of forcing medicalised ideology – violently enforcing the indoctrination in persons experiencing severe distress who refuse it, and/or enforcing it by means of non-consensual detention (though non-consensual detention itself could be seen as a form of violence, and typically needs to be enforced by direct physical violence if persons attempt to resist or escape).

    I might point out that in 2013, UN Special Rapporteur for torture Juan Mendez concluded in his annual report that non-consensual psychiatric interventions do indeed meet the definition of torture under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment.

    The inclusion of ‘peer support’ may well be a boon for the peer support work force and for those who enjoy this type of support. But it is not action on implementing human rights.

    Human rights require persons to have full and free choice.

    The productivity commission report may provide useful information to link into discussions about CRPD rights – but it is imperative that we do start to have discussions about CRPD rights and their implementation, because we are in dire need of
    a) each person understanding what their CRPD rights are (as clarified by general comment No 1, guidelines to article 14, the two UN concluding reports on Australia and other official guiding documentation)
    b) finding out what each person’s exercise of their CRPD rights would mean to *them*

    – CRPD is about diversity, every person is different and at this juncture there has never been an ability for persons with experience of perceived or actual psychosocial disability to discuss what they want in terms of support which honours their CRPD rights. It will vary vastly. We do not have organising bodies to adequately support us in discussing and collecting our diverse needs in a faithful representation that leaves nobody out. Our organising bodies collude with medical interests.

    The medical industry has been furiously undermining CRPD rights – creating straw man arguments based on false dichotomies of force and neglect and fundamentally misunderstanding the scope of General Comment No 1. They also refuse to let go of substituted decision making, forced psychiatry, detention, drugging or ECT.

    They are a powerful guild, but only because the nation allows them to be. There is no reason why they should not resume a fair and reasonable ‘stake’ of being willing to provide *one* of many possible CRPD compliant options available for CRPD support.

    I am getting very tired of Australia treating CRPD as if it is some kind of running joke.

    CRPD is about all persons with disabilities becoming full legal persons. It is not a joke. We are well behind on implementation because it has been regarded as such.

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