The stated aim of the draft Ten Year Roadmap for National Mental Health Reform, released this week for comment, is “to guide future action and investment across Australia over the next ten years”. Among others invited to do so, I provided detailed advice to the Department of Health and Ageing at a full-day consultation in September, and in responding at length to two previous confidential drafts.
There have been marginal attempts at improvement from earlier drafts through the addition of suggested short to long-term actions and possible indicators for monitoring these. The directions are essentially sound, but there are many stated, with no prioritising or timeframe for implementation. It is an in-principle statement.
Mark Butler, our federal Mental Health Minister, is quoted as saying, reasonably, that “it outlines what we intend to do over the long term and how we’ll get there”. In other words, “you have to start somewhere”, but the trouble is that we have started here many times before.
That’s all the federal government seems to do in mental health. It starts over and over with in-principle documents, but with little defined action or commitment, within living memory, to deliver proven cost-effective interventions and service delivery systems that would actually change lives for the better.
The core problem is that they have still arrived at so-called “action” statements without any specific numeric goals, targets or timelines for achievement of any changes to the mental health service system over 10 years or any other period. It suggests some rough ideas for possible indicators to monitor progress on these mainly uncontroversial directions (“How will we know we are doing better?” sections) again, without specifying any actual baselines, or setting any targets or achievable threshold values. This is despite having received much advice mapping out what specific goals and targets are practically achievable in this timeframe (for example, see here and here.)
It is still a roadmap with only the most vague of directions, and without any specific destinations. For example, there is no specifying of the need to roll out evidence-based effective interventions so they are accessible to all who need them wherever they may live, such as skill-enhancing family interventions, crisis and assertive community treatment teams.
DoHA commissioned only one small and gestural one-day, highly selective Noah’s Ark-style consultation of stakeholder groups in September.
The current exercise with this latest draft does not appear to be a real in-depth consultation of stakeholders, but only offers a Survey Monkey forcing stakeholders into easily codified responses. Having tried to fill it out, I found that is far too self-preoccupied and focussed on appraisal of the many motherhood statements already in the so-called roadmap, and leaves little scope for providing alternative trajectories or any other overall strategies.
The Survey Monkey is so long-winded and so time-consuming that many initially well-meaning respondents with relevant expertise may lose concentration, or may run out of steam or waking time and abandon it. And such survey tools can be misused to provide officials with a misleading and simplistic way to gain and broadcast an illusory and false impression of broad agreement with their initial premises.
This use of the Survey Monkey, like the so-called roadmap itself, essentially commits no one in their organisations (and certainly no Australian government or minister) to actually doing anything over the next 10 years. So reform stalls yet again. Same old story.
I do understand the multiple pressures that DoHA labour under and how many jurisdictional interests they consider that they have to balance, which is the main reason they recently produced such bland and non-committal products as the second national mental health policy and fourth national mental health plan, and presided over the downgrading and diluting of the national mental health service standards.
In many ways with this “roadmap”, they have essentially repeated the same exercise. So honestly, why bother?
They should never have been given this task by CoAG in the first place, and it should never have been such a rushed job. It should have been conducted at arm’s length as the first substantial task of the Australian National Mental Health Commission, which kicks off next week.
Ten years is a fine time-span for a national reform program with real goals and achievable targets. We had time to build this up steadily by in-depth national grass roots consultation with several public drafts if necessary.
If this latest draft and its survey methodology are any indications, this 10-year roadmap has been a futile exercise and a wasted opportunity. We are all capable of doing a lot better than this. Over to you, developing mental health commissions of Australia.
*Alan Rosen is Professorial Fellow, School Public Health, University of Wollongong, Clinical Associate Professor, Brain & Mind Research Institute, University of Sydney