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Suggesting some long-terms goals for mental health reform

(Continuing a Croakey series on mental health reform…)

In a previous post, Professor Alan Rosen urged that appropriate care and consultation be taken in developing the 10-year roadmap for mental health reform, which is due for preliminary consideration at a meeting of senior CoAG officials tomorrow.

In the article below, he suggests some concrete goals for the next decade, for health services and beyond.

***

What should we aim for?

Alan Rosen writes:

What could be the deliverables of a 10 year national mental health blueprint, overseen by our Mental Health Commissions at national and state levels, overarching all the half-baked policies plans and standards that we have inherited?

Our catch-cry and motto should be “Parity in 10 years!”  (the theme that Pat McGorry et al got rolling at CoAG  in August 2011 during their unprecedented opportunity to address all heads of Federal & State governments together).

This can be achievable if there is a bipartisan political will and a monitor, holding that political will transparently and strictly to account.

Parity in 10 years means, for example:

• Improving access of people with a diagnosable and treatable psychiatric condition from 33-46%, depending on your method of mathematical massaging of the national survey figures,  to 80%+ within 10 years, which is the level of access to clinical care by those with all other medical conditions, so it should be achievable.

• A Government commitment to improve the proportion of the national health budget spent on mental health over 10 years from 6-7% to 12-13%, which is close to the actual proportion of health burden due to mental illness.

• Coerced care or involuntary episodes of treatment to be reduced by 60-70% over 10 years, eg by more systematically employing an already known and evidence-based repertoire of strategies to build ongoing engagement, therapeutic alliances and shared decision making.

• Suicide rate to be reduced by 33% in 10 years, (or at least 25% if the GFC mark II hits Australia hard and long), for which there are ample international precedents.

• Resources and workforce deployed in community mental health services (which does NOT comprise traditional hospital outpatient care or just privatized clinic-based aftercare) should be twice those deployed in hospital based care (that is, 66%:33%).

• A defined reduction in duration of untreated psychosis (eg to less than 3 months, the current international consensus guideline) and other psychiatric conditions in young people with first episodes.

• Equity for younger people (and other age groups) with mental illnesses, with their peers, in physical care, life expectancy and in all expectancies of life, including completing education and workforce participation.

• Employment of individuals with severe and persistent mental illness to be increased from <10-15% to more than 50%.

• 300% increase in the amount of stable community based personalised housing with 7 day & night support if needed, to be provided for individuals who are recurrently displaced margin-dwellers or living in overly dependent circumstances because of their mental illness.

• Guaranteed 100% access in every catchment whether urban, regional or remote, and to every special population with mental illnesses, whether Indigenous, transcultural, forensic or comorbid, to the current range of evidence-based modules of mental health service. These include community-based mobile crisis, early intervention, residential respite and assertive community treatment teams, e-health, social support, family education and skills courses and support groups, vocational and housing services providing security of community tenure.

• Remote locations may be partially served using  telehealth and e-health strategies in conjunction with, but not replacing  face-to-face services, and possibly hub and spoke regional service models of care.

• A substantial measureable increase (to be determined) in  those who now experience personalised control and  decision making  over their own lives, possibly including budget–holding by individuals and families with mental illnesses, and in making choices between available services.

• To set up a fund providing real incentives for translating research data into effective interventions and service delivery systems,  generating practice-based evidence. And to seize the opportunity to develop and implement a longitudinal, unified, empirically tested and sound, subjective but brief recovery measures. This should include all key facets of social inclusion, from service-user, provider and family viewpoints, which employs consistent components of recovery in rating individual recovery and orientation of services towards recovery.

• Lastly, as in New Zealand and in West Australia, our National Mental Health Commission needs to be structured to outlast any one particular flavour of government, so it needs to be and be seen to be tri-partisan in its deliberations and recommendations.  All the mental health commissions now emerging in Australia need to develop an initially informal network  to ensure compatibility of purpose, coordination and non-duplication of effort,  and comparability of effectiveness. This is a tall order in their present circumstances.

Our best wishes go to our nascent Commissions, and to all who sail in them, and by their lights over the next 10 years and beyond.

We have every reason to hope that Allan Fels and Robyn Kruk, the heads of  the new national Mental Health Commission, are there to make a real difference.  Indeed, this is what the entire community of mental health stakeholders is entitled to expect of both of them and the national commission.

So many national promises, policies, plans and strategies have been made which have not made any real difference to the lives of individuals and families with mental illness. The litmus test of their work will be whether these lives are any better in 5 and 10 years time.

*Adapted from the closing plenary address 9 Sept 2011 of The Mental Health Services (Themhs) Conference of Australia & New Zealand, Adelaide, and updated in anticipation of the National 10 Year Roadmap being prepared  by DoHA for preliminary consideration at CoAG Senior Officials Meeting for 2 December  2011.

Alan Rosen is Professorial Fellow, School Public Health, University of Wollongong, Clinical Associate Professor, Brain & Mind Research Institute, University of Sydney

 ***

Previous articles in this series

• Important for mental health: a fair society and a good start to life

• Don’t rush the roadmap for national mental health reform: Alan Rosen

• What matters for people living with psychotic illness

 

 

Related Posts

Comments 2

  1. johnny says:

    Coerced care or involuntary episodes of treatment to be reduced by 60-70% over 10 years, public backlash, more than a conscience, or guilt I’d say, then this (Guaranteed 100% access in every ” catch” ment whether urban, regional or remote, and to every special population) so we will get you wherever you go. Two years ago psychiatry placed a senior psyche nurse on a special wage, in every hospital attached to emergency or waiting rooms. The idea was to catch all the kids experiencing temporary emotional or drug effected conditions and make sure they give them hallucinogens in the form of anti psychotics such as Haloperidol, Zyprexa, epilim etc, and to make them permanent money earning clients/ victims of Mental Health/ Psychiatry, at the time I remember writing about it and saying watch out they’ll be on street corners looking for potential victims next, well guess what its happening now, last night I noticed a van set up at Sunshine station in Melbourne’s west, it had Health written on it, and felt like a carnival or a doughnut van, i thought gee im a bit hungry, so i went to the front and found a mental health psyche nurse and others, and no food, just to let you know that these people are all over the place physically and treatment wise, I told the psyche nurse that mental health /psychiatry is forcefully drugging temporarily amphetamine psychosed kids with hallucinogens, when the treatment is only a course of multi vitamins, a massive dose of vitamin c, some L-tyrosine, the waylaying of drug induced thought, a safe and open environment, and plenty of sleep from two to ten days before any diagnosis should be made, and only benzodiazepams for the first five days and only if they’re not sleeping, 14 national drug rehabs and clinics treat this condition this way, so does the south Australian drug and alcohol and psyche services as well, and most caring common sense people would know and see that as obvious, would you add alcohol to a raving drunk or would you try end get them to sleep, its about the elimination of the mind altering substance in your body that needs to eliminate in care reality land that matters before anything else that counts as proper care, the sad part is that they know it yet still persist in adding anti psychotic psychotropics forcefully when they actually turn the condition and the psychosis up as stated by psyche services in SA and drug clinic practice nation wide, I was fortunate last night to also talk to one of the most respected psychiatrists in the country and quite a lovely woman with a real down to earth speaking voice at a conference earlier in the night , who i put this to, She agreed with me which surprised me a little,i could have asked her in an open forum but decided to wait until the end of the conference because i didn’t want to confront her knowing what the true answer would have to be in front of everyone, and make her feel uncomfortable in any way because of her niceness and genuine sound, I asked her why, and she said its because they want quick care because they cant afford the time, but i said its wrong, she said i know, so i said well considering that and our care and conscience what are you going to do about it, i think she was saying what can i do but her mate sensing the awkwardness and who was another nice lady, helped her out by saying we all had to leave as most of everyone had gone, apart from that i have written to every university psychiatric department in Australia seeking clarification on what they are teaching their students in relation to this treatment, and haven’t received one response, the same goes for the Chief psychiatrist and the health services commission, or the treating doctors, or the hospital that added hallucinogens, i did get one response the other day from the deputy chief psychiatrist saying that my email had been received, and had been reviewed and acknowledged whatever that means, but none of them have said they will stop poisoning my loved one with insanity injections and poisons very slowly to put it to the test, I have said if they don’t improve given that one has to go through insanity in withdrawal which they agree is true, and that if they show improvement can they stay on that track of reduction to zero, and if not they can stay on that track of medication, and none of them will answer that either, one did but said its up to the treating doctor in spite of the treating doctor not even responding, so just letting you all know what you can expect from the best carers in the land, Nothing. Which translates to be sick, stay sick, and go away. When many psychiatrists around the world say that anything over three months and at the most six months is the maximum time to give anyone psychotropics, so as to get over the stressors concerning the person, I think this might have something to do with that(A defined reduction in duration of untreated psychosis (eg to less than 3 months, the current international consensus guideline) not sure but there you go. What most people don’t get is that their kids or people who become unwell trying to get away from the despair and alienation and insanity tiredness they feel from these psychotropics, are getting unwell from withdrawal and not the fact they need poison, as mental health and psychiatry claim or paint the picture, parents and their kids they torture are insecure, they’re not sure basically, and what psychiatry do is say, see they need their medication, but the reality is that its only withdrawal thats making them unwell, apart from being isolated and feeling all the horrible feelings they feel on the poison, and so unsuspecting vulnerable and insecure victims, and parents who cant stop them anyway, have to come back on board with the torturers and abusers because they have no other option and because of their insecurity.

  2. ravenm says:

    Hi Alan
    You have said that 80% of people with all other medical conditions have access to clinical care. What is the source of that statistic?
    Thanks
    Melissa Raven

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