The first National Report Card on Mental Health and Suicide Prevention should be recognised as a significant effort, given the constraints under which it was produced.
But it fails to address many important issues, including the need for a systematic approach to mental health promotion and the prevention of mental illness , according to Jaelea Skehan, acting director of the Hunter Institute for Mental Health.
In the article below, she argues the case for setting national targets for:
- improved mental health and wellbeing
- reduced prevalence and incidence of mental illness, and
- reductions in suicidal behaviour.
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Feeling stuck in mental health and suicide prevention groundhog day
Jaelea Skehan writes:
This week Australia’s first National Mental Health Commission released its first ever National Report Card on Mental Health and Suicide Prevention. I was also among the lucky few that was able to attend the launch ceremony in Sydney on Tuesday.
Since then we have had many of our national mental health organisations endorsing the report card, and some individual commentators and media critiquing it. So I am going to do a little of both.
I don’t think anyone would argue that the four priorities and the ten recommendations are not all worthy and important ones. I certainly do.
But I can’t help the feeling that I am stuck in mental health and suicide prevention groundhog day.
To explain. I have only been in the mental health and suicide prevention sector for a relatively short time (12 years) compared to others who have been tirelessly leading this field for in excess of 20 and 30 years.
But, I have been hearing very similar recommendations and reading very similar data for all of those 12 years.
I was happy to read the title of the report “A Contributing Life” and to see a broader focus that looked at issues like housing, employment, social inclusion and a focus on those living with mental illness and their families.
But I was disappointed to see that, once again, the issue of mental health promotion and the prevention of mental illness was mostly absent.
Where are the targets?
I can’t imagine us having a National Report Card on any other chronic illness where we didn’t review and then set targets for reduced illness in the future. Where we didn’t review and set targets for reducing the risk factors associated with the illness. Or where we didn’t set targets for ensuring we were contributing to better health for Australians.
This is not a criticism of the Report Card alone, but a criticism of all of the National documents in the past ten or more years . Yes, they all “mention it” as a priority but none of them show any understanding of it nor commitment to it.
In 2000, The Australian Government prioritised promotion and prevention principles with the development of a National Action Plan for Promotion, Prevention and Early Intervention for Mental Health. While this laid the foundation for understanding promotion and prevention, there has been little national direction since that time.
Investing in the promotion of mental health and wellbeing and the prevention of mental ill-health leads not only to a more efficient use of mental health resources, it has a flow-on effect for a range of services including general health care, drug and alcohol services, education, child and family services and the justice system.
To give a snapshot from the evidence, we know that:
- The promotion of mental health and wellbeing helps to reduce risk behaviours (e.g. tobacco, alcohol and drug misuse), social and economic problems (e.g. school drop out, crime, absenteeism from work), and the rates and severity of physical and mental ill-health;
- A focus on the determinants of mental health can foster safer and healthier families, schools, workplaces and communities, higher educational achievement, improved relationships and personal dignity;
- Promoting mental health and wellbeing can assist in recovery from mental illness and improve quality of life for people experiencing mental illness. A point that the Report Card goes some way to address with a focus on consumer led reform, acess to housing, employment and improved physical health.
The problem is that promotion of mental health and wellbeing and the prevention of mental ill-health are often seen as separate tasks to the delivery of mental health services and have been seen as competing with service delivery for scarce resources. This may be because promotion and prevention are relevant to all people, not just those seen by the health or mental health services.
It is unclear whether the Report Card is actually designed only for mental health services or whether it is a national approach to improving mental health and decreasing the impact associated with mental illness more broadly. If it is the latter, then more attention to the different sectors involved in future plans and the settings that influence mental health is required.
A broader agenda is needed
While the Report Card does refreshingly go someway to broaden its focus beyond bed numbers and clinical data, the recommendations do not really articulate this broader agenda. A broader agenda that we need in Australia.
To provide just three examples.
- It was positive to see a focus on the poor physical health of people with a mental illness. But the opportunity to talk more broadly about inefficencies in the health system to prevent ill-health was lost. Not only are people with a mental illness more likely to develop chronic health problems but people with chronic health problems are more likely to develop mental illnesses. The opportunities we loose everyday by not having a health and mental health system working in a way to address both of these realities is a shame, to say the least.
- The inclusion of workplaces as important contributers to the mental health and wellbeing of people living with a mental illness and their families was a good step forward. But we sell workplaces short if we think this is the only role they can play in mental health more broadly. What about the role of workplaces in creating mentally healthy environments for all workers? What about the role workplaces can play in reducing risk factors associated with mental illness? What about the role of workplaces in the early identification of workers that may become unwell? What about what workplaces gain from having people (including those living with a mental illness) make a meaningful contribution to their organisation?
- The focus on the role of carers and families was one of the foundations of this report. And a good focus to have. But again, the prevention opportunities of working with families seemed to be missing. The report card acknowledged the role of carers in service delivery of their family member or friend, but did not seem to acknowledge and address the increased risk of future mental ill-health that the caring role brings. Approaches to decrease the risk of those who care for people with mental ill-health developing significant mental health problems themselves is needed.
I don’t want to be seen as too critical of this first Report card, because quite frankly getting a newly formed Commission to deliver such a report within 11 months of its tenure is no mean feat. It should be seen as something to mobilise action.
All of us in mental health, particularly those in leadership roles (including me), have an absolute responsibility to ensure we are implementing not just best-practice but ethical practice. To ensure that we spend the money given in the best way, utilising skilled and supported staff, working in partnership (rather than competition) with other organisations, and importantly people living with mental illness and their families.
But for me, part of that responsibility means continuing to advocate for a broader focus than we currently have.
I want national targets for improved mental health and wellbeing. I want national targets for reduced prevalence and incidence of mental illness. I want national targets for reductions in suicidal behaviour. I want better lives for people living with a mental illness and their families.
And I make no apologies for wanting all of those things.
• You can follow Jaelea Skehan on Twitter (including for news on mental health and digital health)
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