Tomorrow night (Tuesday, June 22), I have the opportunity to grill the Australian of the Year, Professor Pat McGorry, at an Australian Institute of Health and Welfare function.
I recently put out a call to regular Croakey contributors to ask for their suggestions about what I should ask. Their responses follow below.
But I’m also keen to hear from Croakey readers. What would you like asked? Please speak up asap…
And, while I’m busy picking your collective brains, two more questions. I will also be giving a talk to the AIHW function around the themes of equity and transparency.
I’d also like to hear your thoughts on what are the most glaring examples of inequity in health and the health system more broadly; and what are some concrete examples of where you’d like greater transparency from the health sector?
Meanwhile, here are some of the questions for Pat McGorry (I hope to report back on his answers later in the week).
Professor Philip Davies, Professor of Health Systems and Policy, University of Queensland:
Q: Two of the things we do really badly in health are mental health and Indigenous health. What they have in common is that progress relies on whole of government action. They will not be fixed simply by more money for health or medical services. What they need is coordinated and concerted action from health, housing, and employment and other areas of government – both State and Commonwealth. How can we get effective across-government action in mental health?
Ms Carol Bennett, Executive Director, Consumers Health Forum of Australia:
Q: It seems the government make the right noises on mental health but does not deliver. Is this because it is too hard, or the ask is too big, or because it is seen as an area that has been addressed a few years ago with the COAG Action Plan on Mental Health, or because State and Territories are not willing to come to the national mental health ball game?
Professor Alex Wodak, drug and alcohol physician
Q: Would Australia be better off investing more resources into the small minority of the mentally ill with very severe problems or the very large majority of the mentally ill with much less severe problems [don’t allow him to say both need more]
Q: The physical health of Australians is petty good by international standards – life expectancy, infant mortality, maternal mortality etc – how about mental illness?
Q: Given that so many mentally ill Australians also have an alcohol and drug problem and that so many people with an alcohol and drug problem are also mentally ill, could we also improve the mental health of Australians by improving alcohol and drug treatment? And if yes, how would we do that?
Q: What are the main things we should be doing to prevent mental illness?
Q: Prisons are wharehouses for mental illness, Aboriginal Australians and people with severe alcohol and drug problems. What can be done to reduce the number of Australians behind bars? What can be done to improve the mental health of Australians behind bars? Do we need to reform our drug laws so that we don’t have so many drug dependent people behind bars?
Professor Stephen Leeder, Menzies Centre for Health Policy, University of Sydney:
Q: You might ask him why psychiatrists are now seeing fewer patients and why they have given up bulk billing in any form. Have they become just money grabbers treating the vaguely ill and having long holidays?
Professor Lesley Barclay, Northern Rivers University Department of Rural Health:
Q: How can health professionals work to improve the transparency and equity of a health system that still appears to be built on too much privilege and political positioning rather than need? This is really pertinent to mental health services which have also been underfunded greatly as we ‘normalised’ mental illness, making this a community, primary health care-based concern.
Professor Simon Willcock, GP and University of Sydney academic:
Q: Young Australians (Gen Y if you like) are often criticised for being self interested and for not sticking to a job or task. Yet these criticisms are usually made by baby boomers who have all the assets (including the real estate and the superannuation investments) who seem reluctant to share their bounty with Gen Y, who have been described as the first generation who may never be as wealthy as their parents or own their own home. Is it time to challenge current concepts about young people and to start challenging the baby boomers about their need to control everything?
Q: Our son, now almost 30 years old and in good health, had about three years of severe mental illness in his adolescence – on several occasions close to suicide. We were impressed by:
• The five-day week, 9 – 5 attitude among private sector psychologists, psychiatrists, neurologists. The people who stood out in strong contrast were the public sector mental health crisis teams – there around the clock. The private sector people saw him by appointment, which, almost by definition, was not when he was demonstrating psychotic behaviour – almost useless.
• The lack of integration of records between different professions and different individuals, at times leading to conflicting possible therapies.
• The lack of data capture. Our son, fortunately, had a quick and unexplained recovery. There could be several causal factors, but apart from some anecdotal guesswork, no one will ever know why. Maybe his progressive easing off drugs and eventually going cold turkey, maybe a change of social surroundings that occurred at the same time, perhaps even a change in diet. Data capture and consolidation for research may reveal some patterns, and save many lives (and dollars). But everyone concerned had no interest – just relief at another case off their hands. And even if they were interested, there was no database to which they could contribute.
Professor Glenn Salkeld, Sydney School of Public Health, University of Sydney:
Q: Where do kids (and their families) with mental illness find hope?
Professor Gavin Mooney, health economist:
Q: Why does the AMA seem so uninterested in mental health?
Q: I did a questionnaire survey of participants at a mental health conference in Perth. One question asked: if one more person could be recruited to the mental health team you are most familiar with, from which discipline would that be? The least votes went to psychiatrists. How do we change the dominance of the ‘medical model’ in mental health?
Prue Power, Australian Healthcare and Hospitals Association:
Q: What are the most important strategies we should be implementing to reduce preventable presentations to public hospitals for mental health conditions?
Barbara Hocking, Sane Australia
Q: What community-based services would he like to see for people who become too old for the Orygen/Headspace program and who, in spite of the program, still struggle with a mental illness?
Q: How does Pat address the criticism that there is lack of evidence of any demonstrable longer term benefits from early intervention in psychotic patients?
John Menadue, health policy expert
Q: How is it possible to reduce the dependence of the media on hand-outs and briefings by special interests/providers. Do you think that the Australian community has a quite unrealistic expectation of what health services can provide?. Are there effective lobbyists for mental health and who are they?
Associate Professor Gawaine Powell Davies, UNSW Research Centre for Primary Health Care and Equity:
Q: How can we get health reform to go beyond reform of the system to reform of health care?
Q: What would the health system look like if we had a more accepting approach to the inevitability of ill health and death?
Q: How can the medical profession become a stronger force for social progress?
Liz Harris, Centre for Primary Health Care and Equity, UNSW:
Q: What are the values and beliefs of Australian society that you feel work against greater investment in early intervention programs and services for young people?
Q: How can we inspire young people to want to work in this area? How do we provide them with the working conditions and support that will protect their own mental wellbeing?
Associate Professor Nicholas Wilcken, cancer specialist, Sydney:
Q: Can he make a philosophical/semiotic connection between our obsession with sport and our treatment of people arriving in leaky boats?
Update, 22 June. Some more questions have landed:
Professor Judith Dwyer, Flinders University:
Q: How can parents and other carers of young people with mental illnesses be better incorporated in the care team for their children, while still recognising the rights of the young person?
Professor Ian Olver, Cancer Council Australia:
Q: The main question is how to raise the Government’s interest in mental health initiatives.
Dr Tim Woodruff, Doctors Reform Society:
Q: Given that a huge burden of mental illness is dealt with by GPs in daily practice often dealing with comorbidities, is the push for separate mental health funding the best way to go or would it be better to have proper funding especially at the primary care level, on the basis of need which would inevitably require addressing mental health funding requirements. Ie isn’t separate funding just a second best way of getting mental health recognised with the potential to create other silos of health care rather than an integrated system?
Dr Ruth Armstrong, medical editor:
“I’d like to know how much he thinks the field of mental health can contribute to the wider concept of preventive health. It seems to me that mental wellness if going to be an essential element in motivating people to look after all aspects of their health.”