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Why the Fed Health Dept’s culture of secrecy is bad for mental health

As previously mentioned, Croakey has a copy of the evaluation of the 2003-2008 National Mental Health Plan, that was undertaken by US consultant Charles Curie and English psychiatrist Professor Graham Thornicroft.

Sydney psychiatrist Professor Alan Rosen has now evaluated the evaluation, and here are his conclusions:

“This summative evaluation report is very gentle, restrained and fairly muted in its critique. Why the Commonwealth Department of Health and Ageing felt the need to suppress it and cause such a fuss is a real mystery.

The evaluation is diplomatic and encouraging in tone, as would be expected of these distinguished international authors, and the context of how they were commissioned, and by whom.

This version of the report is dated 22 July 2008, about  ten or eleven months after the completion of the evaluation, and it has been suppressed for a further nine or ten months since then.

The question arises whether this leaked “final” but unreleased version is their original report or a subsequent version extensively amended by the Australian Commonwealth and State health administrations, but either never put to or not agreed to by the official authors.

Nevertheless the key concerns raised by this suppressed evaluation report, which the authors believe would require correction by the 4th Policy and Plan, are directly relevant  to the current concerns of the mental health community about the 4th  National Mental Health Policy as recently launched and the consequent 4th Plan in discussion document.

The authors concluded that “there was a consensus that the current Plan lacked a prioritization of activity and specificity around expected outcomes and agreed timeframes. Consumers and carers also felt less ownership of the current Plan than they had of the previous two Plans”.

It is hard to achieve “ownership” if the key constituencies do  not  feel  consulted properly or at all about the policy on which the new plan is to be based.

This series of events is just another example of the culture of secrecy which seems to have enveloped the Commonwealth Department of Health & Ageing in recent times.

Another example is the recent review (or downgrading) of the National Mental Health Service Standards, over which this department presided. They adopted this revised and diluted set of standards without a coherent consultation process, and without involving representatives of  most  stake-holder  groups at each stage, or in some instances, at all.

Further, one of the top priority recommendations of the summative evaluation was “That the performance of mental health services be monitored through an agreed framework of outcomes, and resources developed to allow comparison and consistency between jurisdictions and over time”.

This is consistent with current wide-spread concerns of many stakeholders about the oft- recognized inadequacies of internal accountability mechanisms of  previous Australian national Mental Health plans, proposed yet again in 4th Policy and Plan documents.

These only demonstrate the continuing complacency and unwarranted defensiveness of the government administrations proposing them.

There is a growing movement in the Australian mental health community favoring an external arms-length independent monitoring body, authority or commission, with the resources to oversee these monitoring functions.

Such an authority could report to Parliament, Prime Minister and Premiers to underline that delivering sound mental health care to our nation is an all-of-government enterprise, with many non-government and private partners.

This would ensure “comparisons and consistencies between jurisdictions and over time”, whether at national, state or regional levels.

The effectiveness of such a body has been amply demonstrated in New Zealand,  recently implemented in a federated context like ours in Canada, and is being developed by commissions in Scotland, Ireland,  and most recently by the  government of Western Australia.

The Canadian National Mental Health Commission, made up of all mental health constituencies,  has also been given the task of both compiling the latest evidence for what works in mental health services, sharing this publicly via a “quality treatment and care clearing house” or  “knowledge exchange centre”, and for independently developing the Canadian National Mental Health Strategy.

With the recent changes in personnel at the top of the Australian Commonwealth mental health bureaucracy, it would  be  a good time to seek agreement that we should start again.

We could then develop a really practical and reforming 4th National Policy and Plan, by an independent body like the Canadians’, invoking  basic concepts like  adequate consultation,  inclusivity, transparency, and working at arm’s length from all vested interests.”

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