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.