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New national mental health policy is a disgrace: Prof Alan Rosen

Following on from the previous post, Sydney psychiatrist Professor Alan Rosen* explains his concerns:

“The 4th Australian Mental Health Policy is  a huge disappointment and
should never have been approved in this form. It is  superficial,
complacent & self-congratulatory about weak partial achievements.

It glosses over many important deficiencies in the 2nd and 3rd policies and
plans. It lacks vision, and  has no clear direction, goals or objectives
or constructive signals which will make any difference to those of us
who run services on the ground.

I agree with Lesley Russell and Bob Wells about the 2 major problems stated with this
policy.

I agree that it is a major limitation that the evaluation of the 3rd report, which should have been crucial to informing the 4th policy and plan,  was never released and was actively suppressed by the Commonwealth Department of Health and Ageing and some state administrations on flimsy grounds.

This evaluation was never even revised in consultation with the authors for obscure reasons.  What could these administrations have to fear? Was it really that critical?
If this is not so, why not release it, and allow the stakeholders, some of whom gave their precious time contributing to this evaluation,  to judge for themselves?

The irony was not lost on many of us, that this policy was launched at an International Mental Health Network Leadership Meeting in Brisbane, which was sponsored by the Australian Government, and  whose major theme was Social Inclusion.

A key tenet of Social Inclusion, as emphasised there, is ensuring that the voices of all stakeholders are heard. There was no open public consultation regarding the draft policy.

Only 100 people were selected and invited, largely at their own or their employers’ expense,  to a brief national consultation on the draft policy last September.

The organisers  rejected most substantive concerns, as well as specific and goal-focussed recommendations. They then did not release for comment the amended draft, which was largely unchanged from the original draft, even to participants,  before
prematurely presenting it to all the Health Ministers for sign off.

What a waste of expense, goodwill and gathered expertise. What discourtesy and disrespect shown to the wider mental health community.

At the launch, to our collective relief, the Hon. Claire Moore, representing Minister Roxon,  put in parentheses much of the excessively laudatory language provided by the bureaucracy for her to read out in this prolonged commercial for this phantom policy, which was not produced for perusal, either in summary or whole, even at its own
launch.

I publicly requested a right of reply,  but was refused by the chairing Australian administrator.

This irony must have been fairly obvious to the gathered international
audience, and was embarrassing for all the Australian service users and
providers present who knew what was really going on.

Below is a letter sent to Nicola Roxon on 20th February regarding my
serious concerns about her approval of this policy, to which I have received neither acknowledgement nor reply.”

* Alan Rosen is Secretary. Comprehensive Area Service Psychiatrists’ Network;
Associate Professor Department of Psychological Medicine, University of Sydney;
Professor, School of Public Health, University of Wollongong

20th February 2009

Hon Nicola Roxon
Minister for Health & Ageing
Commonwealth of Australia

Dear Minister,

RE: NATIONAL MENTAL HEALTH POLICY

I am writing to about my concerns regarding the National Mental Health Policy, recently approved by you and the Australian State Health Ministers.

I was invited to the national consultative meeting regarding the draft policy. I now appreciate that the policy adopted by health ministers is almost identical to the draft we considered at that meeting except for the preamble.

The policy states that this policy “provides vision”, but little substantive or practical vision is evident.

The whole document is set out like a discussion paper giving history of the reforms in mental health over years, but it is almost complacent and self congratulatory about diluted partial achievements. There is no clear and constructive direction or guidance given.

Please see detailed comments appended.

Conclusions

1. None of this policy document will change what currently happens in Australian MHS.  As I stated publicly at the end of the invited stakeholder forum concerning the draft policy held in Sydney in September 2008, none of the distilled recommendations would make any real demands of or difference to any participants such as me, who run services on the ground. There was a flaw in the instructions to the facilitator, in the way more practical recommendations from the floor were filtered out of the discussion and did not make it into the final recommendations, which were largely in-principle or motherhood statements. These flaws are reflected pretty faithfully in this document.

2. The roles of public, fee-for-service, and non-government sectors are all essential to the development and reform of mental health services in Australia. However their functions are presently fragmented in funding, organisation and delivery. There is insufficient attention paid in this policy to joint planning, co-ordination and management on a local and regional basis, and of practical integration of services between them.

3. There is no specific requirement to definitively shift the balance and centre of gravity of mental health services towards 24/7  community based mental health services, integrated with primary health and other community health and hospital services to provide one-stop shop holistic health services at convenient co-location in community transport hubs and shopping centres for psychiatric clientele. In fact there is tacit support for retaining partially institutionalized and “fortress hospitals” concentrated services, as no real goals are set to counter these prevailing trends in some jurisdictions. This is contrary to the international evidence and all major global initiatives on mental health service system reforms.

4. There is a complete lack of attention to the need for a proper independent monitoring and accountability mechanism or organisation. There is no specific recommendation or requirement for an external arm’s length independent accountability monitoring body, authority or commission. Health bureaucracies in Australia and internationally have amply demonstrated their inability to accurately monitor internally and insist upon the full implementation of national mental health reforms, without the aid of such an independent authority or mechanism.

5. The lack of any substantive practical reforming vision and lack of specific targets goals and benchmarks would be merely disappointing, if it was not so potentially disastrous for people with mental health needs in Australia.   There is a complete lack of articulation between this policy and the following anticipated practical plan due to the failure to provide clear goals and targets.

6. Some of the time in reading this document, you hardly notice that the authors are talking about mental health. You could be forgiven for wondering whether much of it could apply as generalizations about any type of disability.

7. These concerns also extend to the consultation now happening around the new national mental health plan. It appears that these consultations are squarely based on  this seriously flawed policy, and undoubtedly are being undertaken in a way which is un-representative of senior clinicians actually running services and other stakeholders on the ground, much like the process that preceded it.

I hope this is received in the spirit conveyed, writing as an experienced clinician who has been committed to the implementation of all the National Mental Health Policies and Plans since their inception, and who is the clinical director of an integrated hospital and community mental health service.

Best Wishes,
Alan Rosen

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