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What Pat McGorry and others are telling the Feds on mental health

The previous post included John Mendoza’s letter resigning as Chair of the National Advisory Council on Mental Health. Here are some responses from Australian of the Year, the Melbourne psychiatrist Professor Pat McGorry, and others….

Pat McGorry:
“John’s resignation is an expression of the extreme frustration felt by the entire mental health field at the enduring neglect of people with mental ill health.  There is simply no excuse for this since we have 21st century models ready to go and a set of practical recommendations from the NHHRC.  We urgently need a commitment from both sides of politics to end the inequity in investment between physical and mental disorders  accompanied by immediate investment from the present government in those programs which are not dependent on the major restructure of the mental health system that Federal and State governments all acknowledge is required.  We must not delay this until late 2011  People’s lives are at stake.  I am convinced if the government commits to this they will regain the confidence of the whole health sector and revive widespread support across the community who understand the importance of mental health in the modern world.”

***

Dr Lesley Russell, Menzies Centre for Health Policy, University of Sydney:
“The resignation of John Mendoza as the Chair of the National Advisory Council on Mental Health must send a clear message to the Rudd Government,the Department of Health and Ageing, the health care community, and the voting public that the status quo, where mental health is not a priority – is arguably not even on the radar screen, is no longer acceptable.  We are talking about an illness that at some time in their lives will affect around one in five Australians, and yet the Government can commit only $117 million ( over 4 years) in new funds for mental health services in a bundle of so-called reforms costing $7.3 billion.

When our most committed advocates like John give up a crucial task in absolute frustration, it makes it very clear how lack of support and interest and any idea of strategic planning  or a vision for the future has undermined the effectiveness of the Advisory Council.  As someone who served as an advisor to the Council, preparing analyses and writing reporrts, I can readily bear witness to that.  The efforts of DoHA staff to rewrite my reports, modilfy.my language and conclusions, and then limit distribution led me eventually to refuse their funding.  The  last report I prepared for the Council was done gratis.

My small contribution to mental health advocacy has been to analyse the data, highlight how little value we are getting from the costly blowouts in the Better Access program, and write increasingly biting commentary.  I’d much sooner be working on building a better mental health care system for all Australians.  So would everyone else, especially those individuals and families who live with the burden and cost of mental illness.

So let’s all join John Mendoza and send a clarion call to the Prime Minister and his Cabinet (because mental illness is not just an issue for the health portfolio) – it’s time for action and commitment, not during the election campaign not after COAG has considered, not after 2011, but NOW!”

****

Sebastian Rosenberg, Director, ConNetica Consulting Pty Ltd and Senior Lecturer, Brain and Mind Research Institute, Sydney Medical School:
“The establishment of the National Advisory Council on Mental Health was a Labor commitment dating back to the Beazley days.  It indicated Labor’s support for new processes of engagement with sector expertise, including professionals, consumer and carers.  It also indicated Labor’s appreciation that in Government it would need to establish new and broader sources of advice about mental health policy and programs, beyond the channels provided by either narrow, vested interests or even by the Commonwealth Department of Health and Ageing.

The NACMH provided several important papers and briefs to the Rudd Government, outlining suggestions for how to improve Australia’s struggling mental health system.  By and large, as with several other high profile reports from advisory bodies (the Prevention Taskforce, the Primary Health Care Taskforce, indeed even the National Health and Hospital Reform Commission itself), the NACMH’s advice has been politely ignored.  John Mendoza’s resignation sheets home how much work there is still to do to effect the real, national mental health reform promised under the CoAG of 2006 by Prime Minister Howard and Premier Iemma.  The political landscape and faces may have changed, but the desperate plight of many people living with a mental illness remains.”

Comments 3

  1. Lynn says:

    There will never be major change in the health system while we focus on doctoring (medical services) as the mainstay of health. We need a major restructure whereby nursing is seen as the hub of health care because nurses are trained for this work. Nurses are trained in all the disciplines which gives a synergistic power to nursing care that is lacking in the other health services providers.

    I remember at least 20 years ago nurses were identifying problems with the health system (actually back in the 40’s when enrolled nursing began in the UK) – a primary problem being that there were not enough nurses. Young people who once may have gone into nursing now go into the para nursing fields that developed originally out of nurses perceived needs for development – physiotherapists and occupational therapists and even ambulances who were originally ‘manned’ by female nurses. The medical union co-opted this nursing crisis and overlaid their own voices to obscur nurses … and why is that despite the fact that the Garling Report stated we had more doctors per head of population that recommended by WHO do we still persist in this misconception that we need more doctors. We do not need more doctors in the urban regions – they are already co-opting nursing work to supplement their incomes and turning their practices into little 9-5 hospitals. They personify the privatisation of health care with a guaranteed income under medicare as a basis on which to charge more fees.

    We do need doctors in the non popular regional areas where nurses are actually doing a great job independently of medical practice. Doctors do not supervise nurses – unless those nurses are doing doctoring work which happens increasingly in the regional areas – just as they are doing the physio and the x-rays and the admin work as well as the nursing work of caring for the individual. Nurses supervise nursing work and present day ‘National Guidelines’ and ‘Frameworks” and medical algorithms are based in the nursing practice of using procedure manuals and nursing processes to standardise relevant treatments and practices. (Thank you Florence Nightingale!)

    Person centred therapeutic approaches have been written about in literature since the early 1950’s but whilst is was not popular with doctoring nurses were ignored. Evidence based practice (as it isnow called) was initiated by Florence Nightingale the statistician and epidemiologist but ignored by medical practice generally when nurses had to defer to medical ego’s and sneak in evidence based care in a non threatening manner. Positive psychology and early intervention – all things that nurses generally and especially in the mental health field are trained in and well documented but being co-opted by medicine and psychology and associated with those fields. BUT and it is a big ‘but’ () the very clear side lining of nurses in the health care debate and especially in mental health care is about economics. Who is making the money in health care? How much money goes on nurses wages now compared to the 1970’s, what are the their percentages of the health care budget. What percentages goes into medical wages? and please include private doctors as they are supported by the taxation system under medicare and via the funding of private health companies. What about the blowout in payments to psychologists once they received their medicare provider numbers? I want the details please!

    General Practice is co-opting mental health nurses and “skimming the pot” under the Mental Health Nurse Incentive Scheme because this govt was not brave enough to make that final step and fund nurses in private practice under MHNIP or just give nurses in the category of 8th year thereafter the opportunity to go into private practice in whatever capacity. They are tied to medical practices via the need for an eligible organisation number which then allows those same medical practices (who are paid between $5K – $10K to set up and run the system) to charge the MHNIP nurses working under that system. It is shameful and exploitive. As a nurse I am trained in mental health promotion, I learnt how to write programs both for individuals and for groups, I learnt a plethora of therapeutic techniques that meant I could be flexible and seek a fit for the client not have the client fit the technique, I learnt nutrition, physical, mental and emotional development (normal and abnormal), I learnt about alternative therapies!, I learnt the strengths based model of care and that many people do get better in mental health – I learnt several different models of care and that was just the bare basics. I learnt about lifelong learning and that as a nurse I had a responsibility to maintain and build upon my knowledge. I learnt that I would never stop learning! I am glad that the rest of the health ‘world’ is catching up to nursing and indeed that lifelong learning is now recognised and required in most fields.

    Give nurses some of the money that you are throwing at GP’s so that we can work for ourselves- $25K will go a long way in setting me up in private practice and I for one would like to access that money (reference to GP’s being given $25k to hire practice nurses) – and maybe the $5K GP’s received for computerising their offices and was it another $5K for the software systems? and what other freebies they have received from the Fed Govt. AND given that, I will not see people in 10 minute increments but increments of an hour! becasue I will be engaging with clients and using all my skills to establish a therapeutic environment that is positive and healing. NOt rushing them through to see the next person.

    The unique aspect of nursing is that the client/patient/customer is the total focus of our attention, that we act synergistically and think wholistically. We reflect on our practice and we listen. We are there ‘in the moment’ with the client/s and the knowledge that we bring is no less or more important than our social iq which works in conjunction to maximise outcomes for our clients. However under economic rationalist thinking (which is an oxymoron if ever there was one) nursing is paying the price for health disciplines whose focus is on status through income and training levels – why is nursing still a 3 year u/g degree? because we need more nurses in hospitals so lets get ‘them’ out there more quickly. What is lost in this reductionist thinking – the wholistic nature of nursing which is about the person not just about the illness. What else is lost – the independent nature of nursing work: what happened to nursing diagnoses and care plans? What has happened to presence of nursing in national health policy development? Why dont I hear from the Chief Nursing Officer in media releases (do we have one still?)

    Nursing is being fragmented – we are losing our identity as nurses to take up the banners of specialisations but it is the basis of the wholistic and well rounded training that we recieve in mental, physical, emotional, develomental, social and whatever that makes us unique. Yay we can then go on to specialise in our chosen fields but we do so with a basis of understanding and a conception of the individual.
    I love being a nurse – it is engaging intellectually and emotionally – and it is immensely satisfying … I cant think of a better job (except maybe being the first person to walk on the moon or the first person to walk on Mars – very cool that!)

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