Hong Kong Mental Health Council Conference: “Building a better mental health system through engagement”

GEORGIE HARMAN, ACTING CEONMHC Australia11 January 2014

Summary

• Setting the scene• Who we are• Our approach• Our impact to date• Critical success factors

The Australian context

2.5% Aboriginal /

Torres Strait

Islander

25% born overseas 43%

were either born overseas or have one

parent who was born overseas

Population 23.3

millionAgeing

population

85% of population live in urban areas

Scarcely more than two

persons per square

kilometre of total land area

Mental health in AustraliaThree levels of government:

FederalState/territory

local governments

2010-11 AUS $6.9 billion spent on mental health

services ($309 per Australian)

Annual average increase of 4.5% in expenditure since

2005-06

Mental illness is experienced by nearly

half of Australian adults at some point in their life (45% of

population)

Largest non-fatal burden of disease in Australia, 24% of total healthy

years of life lost are due to mental illness

3rd largest burden of disease overall after cancer and cardiovascular disease 

Nearly two thirds of people with

anxiety/affective disorders have had

their first episode by age 21 years  

About 1.9 million Australians (9% of

population) received public or private mental health

services in 2010-11

Less than half of Australians with

symptoms of mental illness in past year, consulted a health

service

People with severe mental illness live between 10 – 32

years less than the general population

Costs Australian economy $20 billion annually in

lost productivity and labor participation

Poor workforce participation: rate of

people not in workforce is 1½ times that of general

population

42% with severe mental illness live

in unstable housing

Indigenous Australians have hospital

admission rates due to mental illness at 2.2x rate of other

Australian men, and 1.5x rate of other

women

2000+ reported suicide deaths

each year. 65,300 reported suicide

attempts. Over 20% of all deaths for young men and women are by

suicide

Suicide accounts for 4% of total

Indigenous deaths, compared

to 1.5% for non-Indigenous Australians

How we came to be1990’s, 2000’s

• Growing awareness: researchers and advocates highlight the need for reform and call for an independent national body

2006• Political attention: Council of Australian Governments consider mental health for first time,

big new public investment

2008• Groundswell of change: mental health is the third most important issue concerning

Australians, after the economy and the environment

2010• Leaders and community speak out: call for greater transparency and accountability. Prof

McGorry is Australian of the Year. Senate Inquiry into suicide

2011• National leadership: Australian Government’s $2.2 billion national reform package

2012• 1 January 2012: National Mental Health Commission established

2013• New Australian Government elected. Commission asked to conduct a national

review of mental health programs

“In a field where there has always been a wide range of views, the establishment of a mental health commission was one area where there was broad bi-partisan consensus.” Rob Knowles, Commissioner

Who we are • Australia’s first national mental health commission,

established 2012• Funded by Australian Government … but

independent and have bipartisan support• 10 commissioners (including CEO) who bring different

perspectives and experience, 12 staff• Work across all sectors and all levels of government• Use a partnership model to influence and drive

positive change

What we do• Report to Government and the community on cross

sectoral performance and reform progressindependent reporter through annual National

Report Card on Mental Health & Suicide Preventionindependent adviser to government on where we are doing well and where we are notcollaborator to widen our impact, influence and leverage change

• New Government: New task – comprehensive review of mental health programs

What we don’t do• Run services, programs or hold funds• Implement policy• Not an apologist• Reinvent the wheel – we work with others• Get involved in individual cases or advocate for

individual people- we’re an advocate for whole of life system improvement and

better accountability“We’re a really small group and we don’t control the money. But we can be a catalyst, a collaborator and an influencer” Jackie Crowe, Commissioner

“People with mental health problems want

the same things as everyone else.

Even the most disadvantaged should be able to live a

‘contributing life’ – whatever that means for them – a stable home, a

decent education, a job, family, friends and healthy relationships,

good treatment and rights.”

Commissioner Janet Meagher

A different model to drive reform: A Contributing Life

• Launched November 2012

• A new narrative, a new view of mental health in Australia

• Goes far beyond the clinical and the medical to the whole of life

• Laid out our big picture view:• mental health must be a national priority for all

governments and the community

• agreeing on the right incentives to drive good services

• providing ‘a complete picture’ of what’s happening and closely monitoring and evaluating change

• analysing the gaps and barriers to achieving a contributing life and putting a framework in place that sets Australia’s direction

• 10 recommendations for action

Report Card 2012

• Launched exactly one year later – November 2013• Reported back on

progress• 8 further

recommendations for action

Report Card 2013

Highlights: activities & success to dateWhat is important to a contributing life?

We regularly and systematically listened to people’s experiences of mental healthPromoting mentally healthy workplaces

We established the Mentally Health Workplace Alliance, a national coalition of business, community and government leaders

Working to eliminate the use of seclusion and restraint We started an independent project to look at good practice approaches nationally and overseasValuing lived experience and the expertise it bringsWe implemented a Paid Participation Policy & Participation and Engagement FrameworkMeasuring success in a way that’s meaningful to people’s experiences In 2012 we called for national goals and targets to improve mental health and reduce suicide. We led a national consensus building process and provided a framework to governments in September 2013We forged strong relationships across Australia and overseasInternational meeting which led to the Sydney Declaration, signed several MOUs

Critical success factor #1Build evidence, be honest and credible, “tell it how it is”• Strong leadership• Independent commentary and recommendations,

especially in absence of legislative or regulatory powers• Constant presence: report back on progress• Focus on outcomes for people and families, not activity• Highlight gaps, good and bad practice• Whole of life approach• Broaden the evidence base – qualitative data

Independent recommendations & annual progress reports

2012 Recommendation: 2013 How we reported progress:

The Commission is DISAPPOINTED about the lack of leadership by our governments

The Commission is HEARTENED by the co-operative approach across the country to openly report public service seclusion rates as a first step But the Commission is DISAPPOINTED that we remain distant from our target to end the use of seclusion and restraint and will continue to push for action

Recommendation 2: Increase access to timely and appropriate mental health services and support from 6-8 per cent to 12 per cent of the Australian population

Recommendation 3: Reduce the use of involuntary practices and work to eliminate seclusion and restraint

Independent recommendations & annual progress reports

2012 Recommendation: 2013 How we reported progress:

The Commission was ENCOURAGED by governments’ commitment to develop national targets and indicators for mental health reform The Commission is DISAPPOINTED that while targets have been developed and submitted there is no commitment yet to adopt them

Recommendation 4: All governments must set targets and work together to reduce early death and improve the physical health of people with mental illness

Critical success factor #2Be relevant, don’t over promise and pick issues to

drive the biggest system changes• Aspirational but also understand constraints, strong “internal

compass”, clear values and priorities• Publicly available work plan

• Make reform everyone’s business

• Systemic transformation: • Improving life expectancy: physical health• Improving community understanding, tackling stigma and discrimination:

seclusion & restraint, work opportunities• It’s about the economy, stupid: Mental wealth of the nation• National performance targets and indicators that the community will

understand: streamlining data, outcomes focused, all of life

Physical health of people with severe mental illness

Indicator 1: Improve life expectancy of adults with a mental illness to achieve parity with adults without a mental illness. Focus on:

• Reducing smoking rates of adults over 18 years with a mental illness by 30% in four years and 60% in 10 years

• Increasing the proportion of adults over 18 with a disclosed mental illness who are screened every 12 months for physical and dental health issues by 40% in four years and 90% in 10 years

TARGET: better physical health and improved life expectancy

TARGET: Improve population wellbeing

Population wellbeingIndicator 2: Increase the proportion of the population who report positive emotional wellbeing

Wider determinants of mental health and illnessIndicator 3: Increase the proportion of consumers and carers in safe, affordable, appropriate and stable accommodation to meet their mental health support needsIndicator 4: Reduce the number of 16-25 year old Not in Employment, Education or Training (“NEET” – OECD measure)

Critical success factor #3Relationships, relationships, relationships

• First priority was to build relationships• Influence the actions, advocacy and behaviour of others,

and not just the “usual suspects”: e.g. Business Council of Australia

• Amplify the Commission’s efforts through key partnerships: e.g. with Australian state mental health commissions, Health Workforce Australia

• Inside the tent: respectful relationships with government• International links – Canada, New Zealand etc

Recommendation 8: Increase the levels of participation of people with mental health difficulties in employment in Australia to match best international levels.

Critical success factor #4Genuine participation and engagement• Listening not just talking• Agile and non-bureaucratic• Ask people what works

Recommendation 1: “Nothing about us, without us” – there must be a regular independent survey of people’s experiences of and access to all mental health services to drive real improvement

It’s not about “them”…but

about us

Visit to Santa Teresa community, near Alice Springs

Support us to develop our

own models of care for

ourselves, our families and

our community

Include us in decisions

that affect us

Listen to us

C:\Users\pmc5288\Pictures\join-the-conversation - Shortcut.lnk

Click icon to add picture

Visit us at www.mentalhealthcommission.gov.au

The last word…

Video: Reflections at the launch of the 2013 Report Card