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Professor Allan Fels: Meaningful mental health reform can happen right now, together

Last week the ABC published leaked sections the National Review of Mental Health Programmes and Services which was undertaken by the National Mental Health Commission and completed last year.  Two days after the initial leaks Croakey was first to release the full report to the public. While the review has now been released, Health Minister Sussan Ley has suggested that the government are still considering some recommendations and has announced an Expert Reference Group and a range of advisory committees.  

In this post Professor Allan Fels, Chair of the National Mental Health Commission shares his thoughts on why now is the time for action and warns of the potential barriers that must not be allowed to hijack the process.

Professor Fels writes:

Now that the National Review of Mental Health Programmes and Services that the National Mental Health Commission provided to the Australian Government has been made public, we must overcome two potential barriers to meaningful reform that have thwarted the best efforts of others in the past.

The first is barrier would be to lose sight of the fact that this is about people with lived experiences of mental illness and their families and carers. Yes, it is about ‘the system’, but it is about a system being reoriented to focus on the need of individuals, families and communities, rather than supply as determined by funders and providers. Certainly it’s not about debating the merits of one service provider over another and it’s not about robbing Peter to pay Paul.

Millions of Australians are being let down by the current state of affairs in mental health. Individuals, their families and support people, indeed whole communities, are paying a heavy price. There’s no single answer to this problem, no silver bullet to fix it all in an instant.

The recommendations contained within the Commission’s report are significant and detailed, incorporating advice from more than 2,000 submissions and the results of ten months of comprehensive work.

We know that worthwhile, productive reform will take time, and consultation and a collaborative approach between federal and state and territory governments, and NGO and community organisations is essential. But we should not be daunted by this process.

Every day that reform is delayed is another day that we are letting everyday Australians down. People are falling through the cracks, people are being left to a life of unemployment and poverty, and people are dying. We cannot afford to delay any longer. Our priority must be to meet the urgent needs of individuals, their families and support people.

We are not the first to say this. When it comes to mental health programmes and services, we’ve had more than 20 years of national planning, almost a decade of COAG planning and dozens of major inquiries. It’s widely understood that Australia can and must do better when it comes to mental health and suicide prevention.

The second barrier we must overcome is the temptation for individuals and sectional interests to commandeer debate to pursue their own agendas. This issue is bigger than any one group, and it requires a cohesive, integrated response. The Minister for Health, The Hon Sussan Ley MP has identified this, noting: “We cannot continue to place Band-Aids on the mental health system and expect it to heal itself.”

“Solutions” that serve the interests of a small section of service providers without care or consideration for the bigger picture are Band-Aids, and they are no solutions at all. We simply cannot afford to allow the discussion to be hijacked by those who are prepared to put self-interest ahead of the collective good and lose our chance to achieve sustainable, effective change.

Meaningful reform is achievable. The Commission has offered 25 deliberate, integrated recommendations across nine strategic directions that will work together to transform Australia’s mental health system over the next ten years.

A central theme underpinning these recommendations is a move to a model of person-centred care, where the system is designed to fit around the needs of people, not around what service providers have to offer, with funding aligned to outcomes, rather than activity. Far from advocating for a reduction in services we are calling for better services that are, in fact, improving people’s lives.

We are also proposing a regional approach to improve equity of access to services, and to engage and empower communities in identifying priorities and developing local solutions – not having cookie-cutter models imposed on them from afar.

Those of us in the sector have an obligation to show leadership and work constructively together, and with government, to achieve better outcomes for individuals and their families and support people. If we pledge to work constructively and cooperatively to achieve the very best outcomes for those Australians who need our help, then we can final take advantage of the opportunity for meaningful, lasting reform.

Comments 2

  1. Ben Mullings says:

    The NMHC Report recommends that we redirect $1 billion in hospital-based mental health funding to community-based services. That will result in less hospital beds for acute mental health care. We all want a better mental health care system, but can we afford to make the problem worse at our psychiatric hospitals?

    My understanding is that the terms of reference for the NMHC Report prevented the Commission from recommending additional funding be directed to mental health. When we look at the cost of mental health conditions in terms of years of life lost, this represents 13% of all years of life lost due to health issues. Yet we only apportion 9.6% of our health expenditures to mental health. In terms of funding that difference equates to $5 billion (see http://drben.com.au/?p=522).

    We are not investing enough into mental health care in the first place. The danger of pulling funding from hospital-based mental health care in that context is that many people who reach a dire state will be turned away or discharged prematurely. Sadly that happens already, so we probably aren’t going to address that problem by taking even more funding away from acute psychiatric care in hospitals.

    In other words, part of the problem is robbing Peter to pay Paul in mental health care. Can’t we find another way?

  2. Kristin Gillespie says:

    I find Professor Fells’ statement quite worrying. Take “this is about people with lived experiences of mental illness…” with “We know that worthwhile, productive reform will take time, and consultation and a collaborative approach between federal and state and territory governments, and NGO and community organisations is essential”: on the one hand the people with lived experience are supposed to be central to the process, and yet when it comes to mentioning stakeholders in reform they don’t so much as rate a mention (or carers/family) – just govts and organisations.

    Whilst this situation/attitude remains then quite frankly they can throw as much money as they like at MH and it won’t improve much. People with MI will continue to be treated like footballs by the mental health system until they are part of the process making and refereeing the rules. If you haven’t been there yourself you can’t really “get it”, and whilst no two people’s experiences are the same there is much in common across diagnoses and experiences which a non-sufferer is unlikely to “get”.

    And Ben I completely agree – “robbing Peter to pay Paul” is not going to work. Too many are being turned away from acute care (and dying, or self-harming and surviving somehow) right now. Taking money out of this end to put it into early intervention is condemning many who are acutely ill to the scrap heap, in the hope of stopping more from getting there. Personally I am very much in favour of early intervention – it’s essential. But if people are dying now because acute care is inadequate (availability and often actual “treatment”) then even more people will die if they reduce the funding to this sector.

    The brief of no increase in funding for the sector is a poor joke on the part of govt, at the report’s commissioning.

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justice
Justice Reinvestment
NBN
Newstart
poverty
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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
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
#WCPH2017
Australian Palliative Care Conference
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
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