As mentioned in the previous post, there are pros and cons to having a stand-alone minister for mental health (or any other specific area of health).

On the one hand, you might get a dedicated minister and more opportunity for engagement, and a greater slice of ministerial attention. But on the other hand, if the minister doesn’t carry clout in Cabinet, then all the symbolism and talk in the world may not translate into meaningful action.

Last night on Lateline, Health Minister Nicola Roxon’s comments on mental health didn’t strike me as particularly visionary or inspiring.

The best we got, really, was that the Government wants to bring a “more dedicated focus to mental health” and “I’m sure that many stakeholders will have different views about the best way to progress mental health policy”.

Many will be keenly waiting to get a sense of the priorities and intentions of the new Minister for Mental Health, Mark Butler.

So what do leading figures in the mental health sector make of the state of play?

Below are comments from:

• Professor Ian Hickie: Out of Cabinet, out of mind?

• Professor Alan Rosen: What is Minister Roxon’s problem with mental health?

• John Mendoza: Bypass Roxon to get real action on mental health

• Sebastian Rosenberg: Government sending mixed messages on mental health

***

Out of Cabinet, out of mind?

Professor Ian Hickie writes:

Is Out of cabinet, Out of mind? That is, the major question now facing the mental health field.

Although Julia Gillard identified mental health reform as a ‘second-term’ priority for her Government during the election campaign, her first action now sends very mixed signals.

At one level it is a clear concession that under the previous Rudd-Roxon stewardship mental health was headed rapidly backwards and there was an urgent need to start afresh.

Mark Butler had already demonstrated a capacity to dialogue with the community in his short stint as a parliamentary secretary in health.

There is certainly a great need for the Government to reconnect with the community sector on these issues and become less beholden to the traditional representatives of the health professionals.

At another level, loss of direct representation in Cabinet through the relevant Minister runs the real risk of being put aside (yet again) for another day.

It’s hard to imagine other big areas of health (cancer, infection, cardiovascular disease) being shifted to a Junior Minister and being happy about it.

Real mental heath reform will take real money. The policies offered by the Coalition and the Greens were attached to real new money.

The Gillard Government now needs to find real new money for essential youth and early intervention services, as well as capitalising on the opportunities for new services, delivered through e-health, and tied to the National Broadband Network Development.

A new junior Minister prepared to spend time with those most affected may make a real difference. If his efforts are not linked, however, with clear new deliverables, backed by new real monies then the Government can expect an ongoing
critique from the sector.

As pointed out by the independents, we’ve already had lots of reports that have never been acted on.

In mental health, after three years of dashed expectations from the Rudd Government, we now need Julia Gillard to demonstrate that she intends to act directly in concert with this new Junior Ministry.

If not, next time the polls roll around (perhaps sooner rather than later), the offers made by her political opponents will be even more appealing.

• Professor Ian Hickie is a Sydney psychiatrist and executive director of the Brain and Mind Research Institute at the University of Sydney

****

What is Minister Roxon’s problem with mental health?

Professor Alan Rosen writes:

At first sound-bite, installing the first ever Australian federal minister of mental health seemed to be a positive initial response by the Gillard Government to the considerable public outcry about mental health leading up to the election.

However, having heard Nicola Roxon on Lateline last night, I am now not so sure.

There is currently growing  concern in the mental health community about Ms Roxon having resisted the community-wide clamour for action on mental health reform, while repeatedly telling us: “you’re not ready yet, because you can’t agree among yourselves”.

This was frankly discriminatory. She would never have dared to have used this as an excuse to surgeons and physicians to delay or deny reforms and enhancements of their spheres of activities.

In fact, apart from a few professors playing turf-wars, as they do in all clinical and academic disciplines, there is broad agreement among most mental health stakeholder groups re what needs doing, in terms of urgently required  mental health service reform.

She would discover this, if she had  been able to accept the invitations to open The Mental Health Services (TheMHS) Conference, the largest annual forum of all components of the burgeoning mental health community in Australia, which is meeting this week in Sydney.

There, she would have seen  all  mental health professional disciplines,  consumers, family carers, managers, Indigenous and transcultural stakeholders working  closely together on mental health reform.

By referring to Mark Butler as what Ms Roxon pointedly called  on Lateline last night, “my junior minister” she  made it clear that she still owns mental health and its access to Cabinet through her.

Ms Roxon seemed decidedly cool and non-committal towards the proposal we have been putting to her  government for over a year now, which Leigh Sales put to her last night, quoting Professor Pat McGorry ,  that we need a prime-ministerial task group to pull together a  substantial consensus for a national mental health program, as an all-of-government priority.

She seemed to minimise the significance of his advice, and  of Professor John Mendoza’s resignation:  “I am sure that many stakeholders will have many different views”,  she said, implying yet again, that perhaps this was the main  problem with trying to do any constructive reform  in mental health.

We hope that Ms Roxon will revise her position on a taskforce to develop a national mental health program soon. This committed community is offering our hand to help her.

We hope that Mark Butler proves to be a positive influence, who will consult much more closely, widely and often with the mental health constituencies, and will be able to convey the importance of NOT putting off  real action on mental health reform  for yet another term of office.

We hope that Ms Gillard, with her historically well demonstrated understanding of the plight of Australian mentally ill individuals and families, will prevail, and form an all-of-government  prime ministerial task-force on mental health.

We hope that the Greens, with their most enlightened of the pre-election mental health policies, will pull Labor along with them.

We hope that the Coalition, with its declared commitment to mental health, will also work constructively with government to achieve a much higher priority,  much better  funding and outcomes for this arena of shared interest.

Let’s hope that reform begins with the resuscitation of all mental health services, with an emphasis on community care, well within this term of office, and at least in living memory.

• Professor Alan Rosen is Professorial Fellow, School Public Health, University of Wollongong, Clinical Associate Professor, Brain & Mind Research Institute, University of Sydney, and Secretary, Comprehensive Area Service Psychiatrists Network

***

Bypass Roxon to get real mental health reform

Professor John Mendoza writes:

Like Alan Rosen, I was prepared to view the appointment of a Federal Minister for Mental Health as a glass half full.

However, Minister Roxon, in her first media interview (on ABC TV’s Lateline) since the election has again demonstrated her unwillingness to accept the broad consensus of opinion of the need for fundamental, transformational change in relation to mental health.

She is not only a skeptic on the need for urgent action on mental health she continues to run the line that there are “a diverse range of views” and hence we don’t know what to do.

If Neal Blewett when Federal Health Minister had delayed action on HIV/AIDs prevention because there were diverse views about which course of action to take, then we would see tens of thousands more affected by that disease and many more lives lost over the last 20 years.

If Blewett and his state health minister colleagues (including the National Party’s Mike Ahearn in Qld and the Liberal’s Peter Collins in NSW), had delayed action or gone with the fringe view of zero tolerance, we would have had a public health disaster in this country.

Roxon knows mental health is a disaster but at every opportunity she uses the views of a few psychiatrists to resist taking action. The contrast between Blewett and Roxon as Labor Federal Health Minister’s could not be more stark.

Blewett didn’t need Prime Ministerial intervention to be effective – clearly, on last night’s performance, Gillard will have to work directly with Mental Health and Ageing Minister Mark Bulter bypassing Roxon to achieve real reform.

• John Mendoza is Director, Connetica and Adjunct Professor, Health Science, University of the Sunshine Coast, Adjunct Asso. Professor, Medicine, University of Sydney. He resigned as chair of the Government’s National Advisory Council on Mental Health in June.

***

Government sending mixed messages on mental health

Sebastian Rosenberg writes:

From a mental health perspective there are conflicting messages in the new ministerial arrangements.

It is great to have a specific minister responsible for mental health listed among the portfolios.

However, it is a junior minister and, in lieu of any information to the contrary, the switch to this set of responsibilities could easily be interpreted as a retrograde step, with the senior minister divesting herself of responsibility and mental health losing direct representation in Cabinet.

The changes may also mean that mental health is not central in considerations about broader issues of national health reform, such as the establishment of the health and hospital networks and Medicare Locals.

Last year’s CoAG arrangements made clear that the fate of community mental health was yet to be decided and would be subject to further CoAG consideration in 2011.  This will be a key matter for Mark Butler to steward.

Minister Roxon’s early days as the minister responsible for mental health were characterised by a willingness for frank assessment of Howard-era initiatives and a desire to establish new and independent expert sources of advice.  The high profile resignation of John Mendoza rather book-ended this period.

The extent to which the new minister moves to not only re-establish these sources of advice but also to actually implement expert recommendations and directions suggested will be a key matter, including in the lead up to CoAG.

To this mix, proponents of mental health reform of course also recall Prime Minister Gillard’s commitment to make mental health a priority for this term.

Mental health reformers must offer every assistance to her and to Minister Butler to make the path of change as clear and smooth as possible.

• Sebastian Rosenberg is Director, ConNetica Consulting Pty Ltd

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