Nov 28, 2012

Mental health check: few new ideas in national report

The National Mental Health Commission's first report card, launched yesterday, is a funny m

The National Mental Health Commission's first report card, launched yesterday, is a funny mixture. No one can doubt the sincerity of commissioners in attempting to establish a more holistic picture of what it means to have a mental illness in Australia in 2012.  They have asserted the primacy of the notion of "a contributing life" built around access to decent services, housing, employment and social inclusion. It's a refreshing change from previous reports, which have rather depressingly focused on bed numbers or other unhelpful metrics. But there are several other issues raised that limit the utility of the report. First, there is no new data as such -- indeed, the report card goes so far as to curiously claim to have "avoided the trap of calling for new data". Instead it is a rehash of publicly available data from a variety of sources, including the Commonwealth of Australian Governments and other reports. It recommends more and better data, particular for a regular five-yearly national mental health survey starting in 2014. Optimistically, this would mean waiting until 2015 for the first blush of survey information to be available. While the report stresses the importance of knowing whether people with a mental illness are unemployed, homeless and socially excluded, no data is available -- or called for -- in the report. And the report states Australia has no nationally agreed picture of what a good mental health service framework should look like -- and doesn't offer one itself. No reference is made to the body that preceded the commission, the National Advisory Council on Mental Health (chaired by John Mendoza), which published its vision in 2009. There's no articulation of its own vision, instead suggesting faith in the National Mental Health Service Framework project currently being developed by the Commonwealth and the states. The report states the desirability of establishing a national collection of the experience of care for mental health carers and their families. On the back of comprehensive national survey of carers, the Mental Health Council of Australia currently publishes an annual collection of such experiences, reporting their views against 15 agreed indicators as the mental health carers survey report. The report card makes the point there is little or no accountability for the $6.3 billion Australia spends on mental health annually, while noting mental health spending has increased by 4.5% per annum between 2005-06 and 2009-10. It fails to contextualise this increase by stating the Australian Institute of Health and Wellbeing reports that overall health expenditure has been increasing by around 8.5% per annum over the same period, meaning mental health's share of the health budget is shrinking not growing. Ultimately, there's no proposal of any indicators or a system of accountability. Instead, worryingly, it states:
"We will also not waver from our view that governments need to agree and report on a small number of meaningful national indicators and ambitious but achievable targets."
The statement represents business as usual, largely; a situation in which governments and a small number of officials determine what is reported and how. That's wholly inadequate, disenfranchising the mental health sector, health professionals, consumers and carers from what should be their central role in determining the mental health indicators that are most relevant to them. Instead of articulating this, the report instead suggests the responsibility for establishing accountability for mental health lies with the long-mooted National Mental Health Roadmap. That began life in the Commonwealth Department of Ageing; its current whereabouts are unknown. The opportunity for the sector to shape this roadmap has been minimal. The report card purports to be an independent eye on the mental health system. The construct of the Mental Health Commission, as an office within the Prime Minister's Department, naturally means that even with highly independent commissioners and dedicated bureaucratic support there will always be a limit to the amount of independence. The commission was established largely in response to the high level of community frustration at repeated failures by the machinery of governments to properly address mental health. This first report suggests a new beginning, but seems to offer faith in existing moribund processes. This is a mirror: you can only see backwards. Perhaps the next report should focus less on the past 20 years and more about the next 20.

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