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Not for release: On the latest instalment in the sorry saga of mental health reform

By Sebastian Rosenberg
Senior Lecturer, Brain and Mind Research Institute at the University of Sydney

The National Mental Health Commission has provided its Review of Mental Health Services to the Federal Government.

Despite the repeated requests of Shadow Minister Jan McLucas and a resolution passed by the Australian Senate, the Government has now confirmed it does not intend to publicly release the Review.

It justifies this saying that release would “inhibit the ability of Government to properly respond to the Review”.

Leaving aside the merit of this contention, of particular interest is the role of the National Mental Health Commission in this situation.

In an effort to focus new energy into the perennially troubled area of mental health, several Australian jurisdictions have chosen to invest in the commission model of administrative organisation.

The progenitor model was set up in NZ in 1996 and there is some evidence that Commission successfully sponsored some important mental health reforms. For example, NZ spends around four times as much as Australia on NGO-provided care, creating a range of non-hospital service settings simply not available in Australia’s heavily hospital-centric mental health system. There was also limited experience of commissions in some other countries. But overall evidence to support the commission-led model of reform is thin.

Australia’s dalliance with the commission model began in 2010 when WA set up its body and this has now been followed by NSW, Qld, Victoria and the National Commission. SA is now also committed to setting up a commission.

That’s a majority of jurisdictions and a huge majority of the Australian population now relying on Commissions for mental health leadership to drive reform.

While there are some important differences between the Commissions, they do share a general goal: to break a logjam in mental health reform.

Despite 2 national policies, 4 national plans, one national Roadmap, one CoAG action plan and two national report cards, plus myriad state and territory strategies, it was widely felt that mental health reform in Australia had stalled.

Commissions are meant to provide new focused leadership and impetus for mental health reform. They are meant to be champions for mental health consumers and carers, aiming to shift the mental health system to better reflect their needs and aspirations. They are meant to focus on transparent accountability, bringing new and welcome clarity to mental health reporting.

Most importantly, Commissions are supposed to build confidence in the community that it has a mental health system on which it can rely. With 32 separate independent or statutory inquiries into mental health between 2006 and 2012 alone, it is clear this confidence is severely compromised.

The National Commission was initially set up in the Department of Prime Minister and Cabinet. This was to give it some independence from traditional health interests, greater influence and foster a broader conceptualisation of recovery. Independent members, including consumers and carers were appointed, together with an authoritative and decidedly independent chair in Professor Allan Fels.

The election of the Abbott Government saw the abolition of a separate portfolio for mental health from the Ministry and a relocation of the National Commission to the Department of Health. Former CEO Robyn Kruk was succeeded by David Butt, one of Jane Halton’s senior executives from within Health.

It is unclear how much of the Commission’s Review was authored by Mr Butt as CEO and how much by the commissioners themselves. As Mr Butt himself acknowledged at a recent conference at the Gold Coast, it was a strange situation: asking a commission set up ostensibly to foster a new level of independent, community accountability to now operate largely in secret to deliver a confidential Review to government.

This is new territory for mental health commissions. The utility of the commission model of governance in mental health has barely had time to be tested. The opaque processes adopted by the National Commission in its Review threaten the integrity of this nascent model.

In this context, the Government’s decision not to release “the Commission’s” Review is anything but a surprise.

After years of stop-start reform at best and with mental health in Australia still most reasonably assessed as being in crisis, perhaps the only surprise will be if the current Review actually leads to any meaningful, positive reform.

 

Comments 6

  1. Ben Mullings says:

    Readers of the above article may be interested in the following letter of request from the ‘Australian Mental Health Party’ who are aiming to be fully established as a political party by the end of the year: http://drben.com.au/d/FOI_03-12-14.pdf

    In short, we are asking for the report to be released under the Freedom of Information Act. Let’s see what happens next.

  2. srosenberg says:

    Hi Ben, thanks for commenting. Interested in your Party – mental health certainly needs attention. Good luck.
    As an ex-public servant, I think I am right in saying that if the Review has been prepared as a cabinet-in-confidence document, it would be exempt from FOI. My understanding is that this may indeed be the case here.

  3. Ben Mullings says:

    Yes, that’s my understanding too Sebastian. Still worth a try, particularly as it is not clear whether it was specifically prepared as a cabinet-in-confidence document or not. When the Government announced the review they certainly made a lot of noise about it. The National Mental Health Commission also put in a lot of hard work to generate public interest in the report and made a really good case that there is a strong public interest in mental health care policy reforms. I know we are not alone in thinking that it stands to reason then that the public are interested in seeing the report. One would hope that our Government can see that this report is ultimately for the public.

  4. Scott says:

    Come on guys…they only refused to table the “interim” report. They have only just received the final report and it’s probably a good idea to have an internal look at it before it’s released.

    Bit of patience.

  5. Ben Mullings says:

    @Scott Refusing to release the report makes no sense. The questions contained in the review were mundane. Contributors were asked about what is working well right now and what could be improved in our mental health system. The public is asking to see what the final report says about the status of -OUR- mental health care system. This should be no secret.

    We don’t want our Government to bury the findings until people forget about it over the Christmas break. We also don’t want all of the negotiations leading up to the federal Budget in May 2015 being made in private informed only by those closest to Government and kept in the loop. It’s hard to imagine how the Government refusing to release this report could possibly be a good thing for public policy in mental health care.

  6. srosenberg says:

    Hi Scott. Appreciate your point. However, the focus of my piece was less about the Govt decision not to release the review, and more about the role of an independent community-focused mental health commission now operating in a manner different from its original intent. As I said, this is new territory for a commission and a challenge to this model of governance.

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17