CONGO Briefing Paper December 2012

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Council of Non-Government

Organisations on Mental HealthBriefing Paper, December 2012


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Council of Non-Government Organisations on Mental Health

Briefing Paper, December 2012

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Prepared by the Mental Health Council of Australia on behalf of the Council of Non-

Government Organisations on Mental Health, December 2012.


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Introduction

The past twelve months has seen the culmination of a number of significant reforms in mental

health in Australia, including the establishment of the National Mental Health Commission, the

Council of Australian Governments (COAG) recent release of its Ten-Year Roadmap for Mental

Health Reform and the handing down of the countrys first ever Report Card on Mental Health and

Suicide Prevention.

At the same time, mental health services are undergoing substantial reform, including the National

Disability Insurance Scheme, the introduction of Activity Based Funding, Partners in Recovery,

Medicare Locals and the new Hospital and Health Networks.

Yet there are growing concerns that the direction of reforms may not be resulting in significant

improvement in the lives of Australians affected by mental illness.

On 9 October 2012, the Mental Health Council of Australia and the National Mental HealthCommission hosted Australias inaugural Council of Non-Government Organisations (CONGO) on

Mental Health in Canberra.

The aim of the CONGO was to bring together senior representatives from leading organisations

across the mental health, employment, housing and social welfare sectors to discuss how Australias

non-government organisations can foster a better integrated, better coordinated response to

mental health.

The gathering committed to establishing a national vision for Australia to lead the world in mental

health by 2022, so that within 10 years Australia is acknowledged internationally as a world leader in

mental health services, programs, and outcomes.

Since the CONGO meeting, there have been significant developments in mental health at the

national level which are likely to create important opportunities for CONGO members to effect

lasting impact on both the national reform agenda, as well as on the lived experience of people

affected by mental health issues.

Launched in late November 2012, the National Mental Health Commissions first Report Card on

Mental Health and Suicide Prevention has identified the substantial gulf between our aspirations for

people living with mental illness and the reality of their day-to-day lives. The Report Card presents a

snapshot of Australias current position and takes a whole-of-life approach, looking at physicalhealth, employment, relationships, education, housing and homelessness, community participation,

family and child support and social justice issues for people with lived experience of mental illness.

In early December 2012, COAG released its long-awaited Roadmap for National Mental Health

Reform, the implementation of which will be set out in more detail in the successor to the Fourth

National Mental Health Plan (due for completion by mid-2014). AnOpen Letter to COAG, co-signed

by 70 leading mental health and social services organisations across Australia, has ensured that

additional work will be undertaken by COAG members to develop effective targets and indicators to

guide the implementation of the Roadmap, as well as embed those targets into the new National

Mental Health Plan.
http://www.mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://www.mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://www.mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://www.mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdf


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For its part, CONGO has identified areas where we could set targets to measure and guide mental

health planning and service delivery, as well as a broader set of actions and principles which it plans

to develop further before putting to COAG members in 2013.

This paper captures the range of issues agreed by CONGO members at their October meeting, as

well as key findings and implications arising out of the Commissions Report Card and COAGs

Roadmap. The purpose of this paper is to inform the establishment, in early 2013, of a national

leadership group to take forward a reform agenda on behalf of CONGO members.

It is necessarily the work of the leadership group to establish priorities and directions for future work

from the range of issues presented to date by CONGO members, as well as make choices regarding

the merits of priorities and targets raised by the abovementioned government-led initiatives.

This paper does not pre-empt decisions and future directions which may be set once the leadership

group is established.

At the October meeting, CONGO members agreed to re-commit themselves to placing people with

lived experience at the forefront of policy formulation, service design and evaluation. The notion of

consultation was acknowledged as having inherent limitations, and CONGO has therefore agreed

that new models of inclusion of people with lived experience, including more proactive collaboration

and negotiation, are to be explored. The CONGO leadership group will demonstrate the application

of inclusive values and principles inherent in the Collective Impact1

approach as it undertakes its

important work in 2013.

Developing an Agenda for Change

CONGO members overwhelmingly agree that gains in new spending and the re-prioritisation of

mental health by governments has not, as yet, resulted in lasting improvements for people affected

by mental illness or their carers. The change is still too slow and the demand for services still

significantly more than we can provide for people who need them. Fragmentation and a lack of

coordination across the many systems that people need are uppermost in the range of factors

impeding potential gains in new spending and slowing momentum towards successful outcomes for

people with lived experience.

A lack of coordination between NGOs, businesses, governments and within jurisdictions is leading to

fragmented decision making and lack of clarity regarding respective roles and responsibilities. As a

result, service delivery remains uneven and inequitably spread across Australia. In this environment,

the need to address socioeconomic factors in health and social care is an aspiration as yet

unrealised.

1Collective Impact is a model for mobilisation of stakeholders to achieve collective goals and social change through cross-

sectoral coordination, as outlined in the Stanford Social Innovation Review athttp://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-

%20Channeling%20Change
http://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-%20Channeling%20Changehttp://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-%20Channeling%20Changehttp://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-%20Channeling%20Changehttp://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-%20Channeling%20Change


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Importantly, CONGO members expressed that there are still too few meaningful ways to include

people with lived experience as advocates and peers within the mental health system and this is

further compounding perceptions that services are not catering to the needs of mental health

consumers or their carers.

Table 1 summarises key issues for mental health reform raised by CONGO members that will

undergo further analysis and consideration in 2013 by the CONGO leadership group. These issues

are accompanied by preliminary targets established as part of the development of the Open Letter

to COAG, presented to the Prime Minister, Premiers and Chief Ministers ahead of the 7 December

COAG meeting.

A more detailed listing of these issues can be found in the CONGO Meeting Communique at

Attachment A.

Further background and context in relation to these issues can be found in the CONGO Meeting

Reporthere.2 The Open Letter to COAG can be viewedhere.3

2http://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdf3http://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdf
http://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdf


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TABLE 1 KEY ISSUES FOR MENTAL HEALTH REFORM IDENTIFIED BY CONGO MEMBERS

Key Issues for Mental Health Reform Basis for Future Targets

Suicide prevention and early intervention By what percentage do we intend to reduce the

annual number of suicide deaths over the ten year

life of the Roadmap?

What proportion of our overall investment will be

made in early intervention and prevention activities?

Creating effective mental health services and

maximising access to them

What do we determine is a reasonable waiting time

for people who need access to services?

Life expectancy and the interplay between physical

and mental ill-health for people who live with mental

illness

How quickly do we intend to close the gap in life

expectancy between people living with mental illness

and the rest of the community?

Social inclusion and participation What is our expectation of social participation for

people who are living with mental illness?

Access to affordable and stable housing How many people do we intend to house in stable

and secure housing in the next ten years?

Participation in worthwhile and supportive

employment

How many people living with mental illness will be

assisted to find meaningful and productive

employment over the life of the Ten-Year Roadmap?

Participation in education How many people experiencing mental illness will be

supported to complete education?

Addressing mental health stigma, discrimination and

awareness

To what degree will we reduce stigma and

discrimination in the community related to mental

illness?

Improving the mental health and social and emotional

well-being of Aboriginal and Torres Strait Islander

people

How quickly do we intend to close the gap in mental

health and suicide prevention outcomes between

Aboriginal and Torres Strait Islander people and the

rest of the community?

Economic independence and income support for

people affected by mental illness

Target areas to be identified

Creating a central role for people with lived

experience in Australias mental health system


Systems issues in mental health, including;

care coordination models of funding building an evidence base workforce development, including peer

workers collaboration in mental health



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Importantly, the key issues for reform raised to date through the CONGO process align closely with

those identified by the National Mental Health Commission in its first ever Report Card on Mental

Health and Suicide Prevention,A Contributing Life.

Table 2 summarises the Report Cards key recommendations and actions. The full Report Card

document can be downloadedhere.4

TABLE 2 RECOMMENDATIONS AND ACTIONS IDENTIFIED BY THE 2012 REPORT CARD ON MENTAL

HEALTH AND SUICIDE PREVENTION

Recommendations Actions

There must be a regular

independent survey of

peoples experiences of

and access to all mental

health services to drive real

improvement.

The Commission will undertake a regular national survey of people with

mental health difficulties and their families and support people. The survey

will consider access to services, as well as perceptions and experiences.

Increase access to timely and

appropriate mental health

services and support from

6-8 per cent to 12 per cent of

the Australian population.

All governments must agree and meet the target proposed in the Fourth

National Mental Health Plan Measurement Strategy that 12 per cent of the

population should be able to access mental health services in a year. There

must be agreement to this indicator with an implementation plan and

investment strategy to achieve this.

Reduce the use of involuntary

practices and work to eliminate

seclusion and restraint.

All jurisdictions must contribute to a national data collection to provide

comparison across states and territories, with public reporting on all

involuntary treatments, seclusions and restraints each year from 2013.

The Commission will call for evidence of best practice in reducing and

eliminating seclusion and restraint and help identify good practice

treatment approaches.

All governments must set

targets and work together

to reduce early death and

improve the physical health

of people with mental illness.

Enduring mental illness must be given the status of a chronic disease to

give it higher national focus and support.

The physical health needs of people with mental health problems need

to be given a higher priority in all areas of health. The initial focus must be

on rapidly reducing cardiovascular disease by reducing risk factors such as

smoking, poor diet and by increasing physical activity for people living with

mental health problems.

All government funded mental health related programs must also be

measured on how they support people to achieve better physical health

and longer lives. Priority should be given to the financing of multi-

disciplinary primary care (through GPs and other primary health

care organisations).

All relevant services must give priority to tracking both the physical and

mental health needs of those with enduring mental illness.

Include the mental health of

Aboriginal and Torres Strait

Islander peoples in Closing

the Gap targets to reduce early

deaths and improve wellbeing.

Mental health must be included as an additional target in the COAG

Closing the Gap program. This must be done through the development

and implementation of an Aboriginal and Torres Strait Islander Mental and

Social and Emotional Wellbeing Plan to commence in 2013. This must also

address the current work and future findings of the Aboriginal and Torres

Strait Islander Suicide Prevention Advisory Group.

Training and employment of Aboriginal and Torres Strait Islander

peoples in mental health services must increase. There must also be better

support for Aboriginal and Torres Strait Islander families. There must be

regular reporting on progress.

4http://www.mentalhealthcommission.gov.au/our-report-card.aspx
http://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspx


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Recommendations Actions

There must be the same

national commitment to

safety and quality of care

for mental health services

as there is for general health

services.

All governments must agree that there is the same emphasis on

improving the quality of care and reducing adverse events in mental health

services as applies to other physical health services. Governments must

commit to implementing nationally agreed and mandatory service

standards in mental health services as they have done for other

health services. The Commission will work with the Australian Commission

on Safety and Quality in Health Care (ACSQHC) to identify issues affecting

the uptake of national mental health service standards and make them

mandatory.

Invest in healthy families

and communities to increase

resilience and reduce the

longer term need for crisis

services.

Increase enhanced and personalised support for parenting through

culturally relevant forms of home-based visiting (ante-natal and in the first

few years of life). These must be provided at a local or regional level. There

must also be active follow-up where a family is under stress or

experiencing tough financial or social difficulties.

Increase the levels of

participation of people with

mental health difficulties

in employment in Australia

to match best international

levels.

The Commission will form a Taskforce, including industry, government and

community leaders to actively promote effective employment support

programs and workplace based programs that increase the participation in

employment of people with mental health difficulties.

Employment support programs, initiatives and benefits must be more

flexible.

Programs must provide long-term support for the employee, families and

support people and the employer, with appropriate incentives and

milestones.

No one should be discharged

from hospitals, custodial

care, mental health or drug

and alcohol related treatment

services into homelessness.

Access to stable and safe

places to live must increase.

All governments must implement and report regularly on the existing

COAG commitment of no exits intohomelessness from statutory,

custodial care and hospital, mental health and drug and alcohol services

for those at risk of homelessness.

Discharge planning must consider whether someone has a safe and stable

place to live. Data must also be collected on housing status at point of

discharge and reported on three months later, linked to the persons

discharge plan.

Governments must commit to removing any structural discrimination

barriers to people with mental health difficulties accessing social housing.

Just as important is providing support to help vulnerable residents to settle

in, adjust and remain in their homes.

Prevent and reduce suicides,

and support those who

attempt suicide through

timely local responses and

reporting.

Develop local, integrated and more timely suicide and at-risk reporting

and responses. These should be coordinated, community based, culturally

appropriate, early response systems and suicide prevention programs.

They should promote community safety, reach the most vulnerable, and

use up-to-date information from the first responders such as Police

officers, occupational health workers, ambulance officers and mental

health workers.

Programs with a proven track record (which are evidence-based) must be

supported and implemented as a priority in regions and communities with

the highest suicide or attempted suicide rates action needs commitment

and a humane approach.


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Clearly there are links between the Commissions priorities for action and those identified by CONGO

members which will be investigated further by CONGOs national leadership group. The Report

Cards recommended actions also provide opportunities for CONGO to influence issues through new

mechanisms to be established by the Commission, such as the establishment of a national taskforce

to investigate ways to improve employment participation and the economic independence of people

affected by mental illness, and the proposed national survey of people experiencing mental health

ill-health and their families.

It is anticipated that the CONGO leadership group will undertake an assessment of those elements of

the Report Card which most support its own identified priorities, and identify which actions to be

undertaken by the Commission can be utilised over time to support those priorities.

On 7 December 2012, the Council of Australian Governments released itsRoadmap for National

Mental Health Reform 2012-2022. In an Open Letter more than 70 mental health and social service

organisations urged the Prime Minister, Premiers and Chief Ministers to consider adopting

measurable targets in the Roadmap. COAG has since announced that it will establish mechanisms to

develop in more detail the priorities and strategies outlined in the Roadmap. These mechanisms will

also be tasked with developmental work in the leadup to the drafting of a new National Mental

Health Plan, expected to be finalised by mid-2014.

Priorities for action identified in the Roadmap include:

Priority 1: Promote person-centred approaches

Priority 2: Improve the mental health and social and emotional wellbeing of all Australians

Priority 3: Prevent mental illness

Priority 4: Focus on early detection and interventionPriority 5: Improve access to high quality services and supports

Priority 6: Improve the social and economic participation of people with mental illness.

The 45 strategies which underpin the six priority areas are very broad in scope and will require a

great deal more clarification and detail in order to effect change across mental health planning,

policy development and service delivery contexts.

Encouragingly, COAG acknowledges the need for further work, as well as the need to more fully

engage a broader range of stakeholders in the implementation of the Roadmap and in the

development of the new National Mental Health Plan.

Of particular note is COAGs announcement regarding the establishment of two new groups with

clear responsibilities to maximise the effectiveness of key elements of the Roadmap and make

preparations to guide the drafting of the next National Mental Health Plan.

A new Working Group on Mental Health Reform will be formed to ensure a high-level, national body

is overseeing the detailed work on mental health reform, and that all levels of government are

accountable for achieving change over the next ten years. The Working Group will report to COAG

and be co-chaired by the Commonwealth Minister for Mental Health and a Minister nominated by

states and territories.
http://www.coag.gov.au/node/482http://www.coag.gov.au/node/482http://www.coag.gov.au/node/482http://www.coag.gov.au/node/482http://www.coag.gov.au/node/482http://www.coag.gov.au/node/482


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The Working Group has been tasked with responsibility for:

1. Improving access to data2. Developing indicators of change3. Setting targets for reform4. A successor to the Fourth National Mental Health Plan.

In addition, the Working Group will settle, by the end of 2013, which aspects of the Roadmap the

National Mental Health Commission will report on in its three yearly reports to COAG which

document progress towards achieving the Roadmap Vision. Monitoring of progress will be focused

on long-term change at the national level, reflecting the ten-year span of the Roadmap.

A preliminary set of eleven performance indicators and three contextual targets is outlined in the

Annex to the Roadmap which will be further refined by the abovementioned Working Group by late

2013.

Briefly, those targets and their proposed measures include:

A society that better values and promotes good mental health and wellbeing

Knowledge of and attitudes towards mental health issues and mental illness in thecommunity, measured by the National Stigma and Mental Health Literacy Survey, reported

for the Fourth National Mental Health Plan.

A society that maximises opportunities to prevent and reduce the impact of mental health issues

and mental illness

Readmission to hospital within 28 days of discharge, reported as the percentage of in-scopeovernight separations from public acute psychiatric inpatient units (state and territory data

collections).

Consumer experience of mental health services, reported as the percentage of consumerswho are satisfied with the services received within the past 12 months (ABS Patient

Experience Survey).

Levels of accreditation against the National Mental Health Standards (National MinimumData Set reported for the Fourth National Mental Health Plan and the Report on

Government Services).

The percentage of the population receiving clinical mental health services (MedicareBenefits Scheme, Private Mental Health Alliance and state/territory data, as reported for the

Fourth National Mental Health Plan and the National Healthcare Agreement).

Number of individuals receiving Commonwealth Government care co-ordination services(Partners in Recovery Program).

Use of mental health services in prisons (National Prisoner Health Census).A society that supports people with mental health issues and mental illness, their families and

carers to live full and rewarding lives

Participation rates by people with mental illness in education and employment (NationalHealth Survey, as reported for the Fourth National Mental Health Plan).

Participation by carers of people living with mental health disorders in the labour force andthe community (Survey of Ageing, Disability and Carers).

Physical health of people with mental illness (National Health Survey). Housing status and experience of homelessness among mental health consumers (Fourth

National Mental Health Plan, measure under development).


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In addition, three contextual indicators will provide important information that will help to frame

and interpret the indicators listed above, but which are not considered suitable for assessing reform

over time. Consequently, these indicators will not be used to measure progress against the Roadmap

Vision directly. This is either because the relationship between government performance and

changes in these indicators is unclear, or because data on these indicators is collected too

infrequently to enable accurate measurement of change over the life of the Roadmap.

The contextual indicators selected are:

The rate of service use by people with mental illness The prevalence of mental illness in the community, where prevalence is regarded as the

percentage of the population who have met the criteria for diagnosis of a recognised mental

illness in the past 12 months an important consideration in assessing levels of access to

services and in service planning

The rate of suicide in Australia, as suicide accounts for approximately 1.6% of deaths inAustralia, and people with mental illness are at greater risk of suicide than the general

population.

It could be argued that these contextual indicators can indeed be used to assess reform over time,

and they are likely to be further considered by CONGO in 2013 in that context.

The development of effective targets, which reflect what the broader community sees as critical to

the success of Australias mental health reform agenda, will be a key area of work for CONGO in

2013. This work will open the possibility of collaboration with a broader range of stakeholders,

including the private sector, in order to provide a whole-of-community balance to those priorities

and targets set by governments.

Recognising the importance of working in collaboration with the sector, including mental health

consumers and carers, COAG will also establish an Expert Reference Group to work alongside and

assist the Working Group. The Expert Reference Group will be chaired by the National Mental Health

Commission and will consist of one nominated representative from each jurisdiction, such as a

mental health commission nominee or representative, a representative of a peak body or advisory

group, or a consumer or carer group.

The establishment of the Expert Reference Group represents an ideal opportunity for CONGO to

channel the outcomes of its deliberations into COAGs mental health reform planning during 2013,

through Ministers on the overarching Working Group, and directly through a presence on the Expert

Reference Group. Representation in this new CAOG advisory structure will be pursued by CONGO in

2103.


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Implications for CONGO

There has been a great deal of movement on mental health at the national level since CONGO met in

October, 2012. Both the Report Card on Mental Health and Suicide Prevention and the Roadmap for

National Mental Health Reform offer significant opportunities for the non-government sector to

offer its expertise in relation to policy, planning and service delivery issues under consideration at

the national level and by states and territories.

Clearly, a shift towards a more outcomes focussed approach to evidence is being considered as part

of key mental health reform initiatives at the national level, and CONGO has undertaken to lobby

both COAG and relevant Commonwealth agency heads to help guide this shift.

Beyond measures of success and accountability however, there are other issues which are not

necessarily best dealt with through the development of performance indicators and reporting

schedules. It will be incumbent on the work of CONGO to demonstrate to governments that there

are ways by which these more qualitative indicators of wellbeing can be accounted for within aperformance based mental health framework.

A great deal of goodwill towards a mutual agenda and shared set of priorities was expressed across

organisations present at the inaugural CONGO meeting, which was in evidence again during the

recent process of developing an Open Letter to COAG.

Several of the new government-led initiatives mentioned above are due to report or deliver within

the next 12 months. Given this, 2013 offers a unique window of opportunity within which the non-

government sector will need to astutely direct its shared agenda in order to drive longer-term

tangible and measurable improvements in the lives of people with mental illness and those who carefor them.

A first order priority may also be an extensive mapping exercise to determine where to begin in

terms of comprehensive NGO-led responses to improved integration, coordination and

collaboration, examining connectors across the system rather than cataloguing individual services.

Our Collaborative Approach

Experience has taught us that in fact the only way to get lasting solutions to complex problems that

stick is for all stakeholders to collaborate to invent innovative solutions.5

In line with the commitments made at the October CONGO meeting, the new CONGO national

leadership group will explore innovative models of engagement framed by the Collective Impact key

elements as it seeks to achieve system-wide change. As important as inclusive and participatory

values are, they must be demonstrated in action in order for the non-government sector to show

leadership and deliver change that truly reflects the needs of people with lived experience of mental

illness.

5www.ssireview.org/pdf/collective_impact
http://www.ssireview.org/pdf/collective_impacthttp://www.ssireview.org/pdf/collective_impacthttp://www.ssireview.org/pdf/collective_impacthttp://www.ssireview.org/pdf/collective_impact


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The Collective Impact frameworks five elements were developed by researching what actually

works to generate lasting change in large complex systems, which is why these elements will frame

our approach. In addition we will draw on best practice tools and disciplined approaches to enable

us to co-design solutions. We will adhere to the AA1000 Stakeholder Engagement Standard 20116

and apply international best practice in participation practices such as the IAP2 Public Participation

Spectrum7

and an Appreciative Inquiry8

approach to ensure inclusivity, responsiveness and

accountability to all stakeholders. We will look at innovative processes to ensure all angles have

been thought of in the solutions we develop.

There is no doubt that the level of change CONGO has ambitiously articulated is going to require

long term commitment of all stakeholders across sectors and jurisdictions. The change proposed is

complex and will require collaboration between many stakeholders to agree on the nature of the

dilemmas and what solutions could look like. Sometimes these solutions will have to be invented, as

they currently do not exist and this is going to require cooperation, collaboration and input from

many.

No single person, organisation, sector or entity has the solution to these complex issues, which is

why they have challenged us for so long.

People with mental illness and their carers have been on a long journey of change to achieve parity

of access to services, which is why this next stage is critically important to get right.

To be part of co-creating a shared solution we want to ensure that all stakeholders can fully

participate in the process. In order for stakeholders to be willing to work in a collaborative way,

advocate for themselves and those they support, share their thoughts and help define the problems,

they must be confident that their contributions will be seriously regarded, that they will be provided

with the space and time to develop innovative solutions and that this will lead to change that is

implemented.

This approach will be a deliberate departure from other less inclusive consultation processes that

stakeholders may have experienced.

For this reason the process will require new levels of commitment to a determined focus on

outcomes for people with a mental illness and their carers and a willingness to engage in this change

even when it gets difficult.

6

http://www.accountability.org/standards/aa1000ses/index.html7https://www.iap2.org.au/sitebuilder/resources/knowledge/asset/files/36/iap2spectrum.pdf

8http://appreciativeinquiry.com.au/
http://www.accountability.org/standards/aa1000ses/index.htmlhttps://www.iap2.org.au/sitebuilder/resources/knowledge/asset/files/36/iap2spectrum.pdfhttp://appreciativeinquiry.com.au/http://appreciativeinquiry.com.au/http://appreciativeinquiry.com.au/https://www.iap2.org.au/sitebuilder/resources/knowledge/asset/files/36/iap2spectrum.pdfhttp://www.accountability.org/standards/aa1000ses/index.html


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FIGURE 1 THE BACKWARDS LOGIC OF COLLABORATION

FIGURE 2 TWYFORDS 5-STEP MODEL OF COLLABORATIVE GOVERNANCE9

9Further information on the Twyfords model available at www.twyfords.com.au/collaboration/collaborative-governance
http://www.twyfords.com.au/collaboration/collaborative-governancehttp://www.twyfords.com.au/collaboration/collaborative-governance


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FIGURE 3 AN OUTLINE FOR THE CONGO LEADERSHIP GROUP ACTION BASED ON

COLLECTIVE IMPACT

Next Steps

The Mental Health Council of Australia will initiate a process in early 2013 to form a national

leadership group to further progress the important work of systems reform as agreed by CONGO

members in October this year.

Once established, it is expected that the national leadership group will further refine a changeprocess and timeframes for collaboration with CONGO members. Once solutions have been

developed we will seek opportunities to impact decision making at the national level, with a

particular focus on the intergovernmental machinery of COAG.

Secretariat support for the national leadership group will be provided by the Mental Health Council

of Australia while issues of ongoing sustainability are being considered.

Further details will be made available to CONGO members as soon as practicable in the New Year.


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ATTACHMENT A

Council of Non-Government Organisations (CONGO) on Mental Health

Communique Canberra, 9 October 2012

About the CONGO

On 9 October 2012, the Mental Health Council of Australia and the National Mental Health

Commission hosted Australias inaugural Council of Non-Government Organisations (CONGO) on

Mental Health in Canberra.

The aim of the CONGO was to bring together senior representatives from leading organisations

across the mental health, employment, housing and social welfare sectors to discuss how Australias

non-government organisations can foster a better integrated, better coordinated response to

mental health.

Ninety non-government organisations attended the CONGO meeting, with keynote presentations by

Robyn Kruk, CEO of the National Mental Health Commission, who presented on the progress of the

Commissions National Report Card on Mental Health and Suicide Prevention; Frank Quinlan, CEO of

the Mental Health Council of Australia who gave an overview of current responses to mental health

in the Australian context, and; Dawn ONeill AM, previous CEO of Lifeline and beyondblue, who

detailed the international experience of independent organisations working together toward shared

objectives using the Collective Impact approach.

A key outcome of this first CONGO meeting was a commitment by those organisations present to

form a national leadership group to collaborate more effectively in order to drive better mental

health outcomes for all Australians, no matter who they are and where they live.

Issues we identified

Government factors

- Fragmented, short term policy environment- Ad hoc consultative processes- Fragmented service delivery system funding activities rather than outcomes- Chronic underfunding, particular outside acute settingsNGO Factors

- Fragmented services- Limited influence over policy and funding environment- Workforce development a significant challenge- Funding environment creates barriers to collaboration and integration- Organisations are working on a shoe-string budget- Difficulty maintaining access to information about practice and policy trends- Reliant on evidence collected by government, which often does not align with or reflect NGO

programs.


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Opportunities to deliver a better coordinated response

- Closer alignment between NGO and government agenda- Longer term policy agenda- Longer term funding models built on outcomes rather than activities- Stronger evidence base and culture of continuous service improvement for work across the

sector.

Our commitments to each other

- To develop and commit to common goals for a better integrated response to mental illness- To foster a greater exchange of information between NGOs- To collect mutually agreed data sets focussed on outcomes and value- To commit to collaboration, in spite of government policy promoting fragmentation.

Our challenges to COAG

- To commit to long term growth in investment in mental health- To develop structures that allow engagement with the NGO sector at the highest level- To commit to consultation and engagement in the policy development process- To commit to a long term policy agenda and funding models around outcomes rather than

activity

- To more closely align the national research agenda with policy objectives and outcome indicatorsin mental health

- To agree to ambitious but achievable targets that drive improvements in mental health servicesand outcomes.

Conclusion

In many fields, Australia is already a world-leader in mental health, be it the work of beyondblue,

Headspace, the Early Psychosis Prevention and Intervention Centre, Inspire, VicHealth, the Brain and

Mind Research Institute and so many other organisations working at the national and local levels.

Taking a strengths based approach, members of the CONGO called for the establishment of a

national vision for Australia to lead the world in mental health by 2022, so that within 10 years

Australia is acknowledged internationally as the world leader in mental health services, programs,

and outcomes.

The CONGO agreed to form a leadership group and within six months identify priority issues for

action and suitable measures by which to track progress. Chief among those issues are:- a reduction in national suicide rates by 50% by 2022- improved employment, social housing and income support outcomes for people with mental

illness, including that 40% of people with mental illness have access to meaningful

employment by 2022.

In order to achieve this, CONGO attendees agreed to re-commit themselves to placing people with

lived experience at the forefront of policy formulation, service design and evaluation. The notion of

consultation was acknowledged as having inherent limitations, and CONGO has therefore agreed

that new models of inclusion of people with lived experience are to be explored, including more

proactive collaboration and negotiation.


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In order to capitalise on the momentum underway as a result of the CONGO meeting, the following

actions were agreed by participating organisations:

1. A commitment by those organisations present to form a national leadership group andwithin six months, identify priority issues for action and suitable targets and measures by

which to track progress.

2. Agreement by all to re-commit themselves to placing people with lived experience at theforefront of policy formulation, service design and evaluation.

3. An undertaking to lobby both COAG and relevant Commonwealth agency heads to seekassistance in the development of more robust sources of data and evidence to support more

informed approaches to mental health.

A first order priority may also be an extensive mapping exercise to determine where to begin in

terms of comprehensive NGO-led responses to improved integration, coordination and

collaboration, examining connectors across the system rather than listing individual services.

Immediately following the CONGO meeting, a group of organisations joined to form a consortium to

develop a bid under the Capacity Building component of the Partners in Recovery initiative, with a

view to making a direct and positive impact on the delivery of more coordinated care to people

experiencing severe and persistent mental illness.

The formation of this consortium represents a tangible first step by the NGO sector to work towards

meaningful improvements to the lives of people affected by mental illness across Australias mental

health system.

The Mental Health Council of Australia and the National Mental Health Commission will release a

discussion paper later in 2012, outlining in more detail options and suggested approaches to the

broad commitments made at the CONGO meeting, with a view to establishing a national leadership

group to progress this important work in early 2013.

CONGO Briefing Paper December 2012

Documents

Transcript of CONGO Briefing Paper December 2012