R EPLACING BALD TYRES : REFORMING MENTAL HEALTH IN A USTRALIA David Crosbie CEO MHCA April 2009...
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Transcript of R EPLACING BALD TYRES : REFORMING MENTAL HEALTH IN A USTRALIA David Crosbie CEO MHCA April 2009...
REPLACING BALD TYRES:
REFORMING MENTAL HEALTH IN AUSTRALIA
David CrosbieCEO MHCAApril 2009
Christians for an Ethical Society
WHAT I AM GOING TO TALK ABOUT
context for mental health reform
impact of mental health
what we know / don’t know
values
real reform
15 YEARS OF REFORM
‘... Under the (National Mental Health) Strategy, the Federal Government is committed to playing a leadership role in setting national objectives for reform and in measuring the progress of all governments towards them. It is important that this process is a public one, open to the scrutiny of the Commonwealth and one which makes all governments accountable within their states and territories for progress towards agreed goals’ Deputy Prime Minister Brian Howe, National Mental Health Report, 1994
THE GOALS OF REFORM
promote the mental health of the Australian community and where possible, prevent the development of mental health problems and mental disorders;
reduce the impact of mental health disorders on individuals, families and the community; and,
assure the rights of people with a mental illness.
THE NEED TO CHALLENGE
we have a responsibility, a professional responsibility, a responsibility to our consumers / carers, our peers, our organisations, our community
accepting this responsibility means striving to achieve the ideal rather than accepting imposed limitations and what we often know to be inadequate responses to our consumers / carers and our field
WHAT WE KNOW
we know a lot about the impact of mental health on our health systems
we have some information about prevalence and access to treatment
we know a little about the impact of mental health on individuals, their families and the broader community
HEALTH SYSTEM - HOSPITALS
approx 4% of hospital presentations
13% of ED presentations
approx 12% of hospital bed days
approx 3 million hospital bed days for people with mental illness as primary presentation
approximately 3 million hospital bed days for people with co-existing mental health problems (approx 4 times longer stays for cancer, diabetes, stroke, coronary heart disease)
HEALTH SYSTEM - GPS
approx 11% of all consultations, 11 million a year
depression the 4th most common GP problem with 80% patient repeat rate
approx 20% of all prescriptions (20 million per year) - antidepressants, antipsychotics, anti-anxiety
over 1 million GP mental health plans
OVERALL HEALTH SYSTEM IMPACT
mental health accounts for 36% of all health costs for people aged 15 – 44
anxiety and depression are the 2nd largest contributor to the burden of disease in Australia (behind coronary heart disease)
indirect costs are almost certainly equal or higher than direct costs - e.g. co-morbidity
93% of mental health burden is disability
mental health accounts for 24% of the total burdenof disability for all diseases
BEYOND HEALTH SYSTEM MYOPIA
lost productivity – employment participation
lost education
homelessness – impact on support systems
broken families – cascading mental health impact
prison etc.
lost potential – no figures ....
OPERATING IN BLIND SERVICE SYSTEMS
output based funding
little attempt to review need and service use
funding not tied to even the most basic of outcome indicators
no real support for service based research or follow-up
limited support for broader need and outcome indicators
DECONSTRUCTING PERSONAL EXPERIENCE
Community / primary care mental health services often provides many services: mental health assessment and intervention, vocational assessment, drug /alcohol assessment, pre-employment training, employment placement, education / training, housing, recreation, music and art therapy, family support, parent education, family/carer counselling and support, individual counselling, group counselling, legal support, etc. etc.
What do we fund?
STRENGTH = VALUES
respect dignity courage pride
meaning opportunity change honesty
care lovecommunity responsibility
hope
KNOWING WHAT IS DOES NOT TELL US
WHAT SHOULD BE
$$$ Acute / Tertiary
$$ Secondary / Specialist
$ Primary
Community
Family
Self
65+0 - 5 years of age
5 - 12
18 - 30
30 - 65
12 - 18
Health domains across stages of life
Crosbie D, Mental Health Council of Australia, Canberra 2008
(17%)
(7%)
(7%)
(7%)
(14%)
(48% of population)
$$$ Acute / Tertiary
$$ Secondary / Specialist
$ Primary
Community
Family
Self
65+0 - 5 years of age
5 - 12
18 - 30
30 - 65
12 - 18
Health domains across stages of life
Crosbie D, Mental Health Council of Australia, Canberra 2008
Approx mental health expenditure
(17%)
(7%)
(7%)
(7%)
(14%)
(48% of population)
WHAT WE WOULD LIKE TO KNOW
Is what we are doing working?
What is the impact on individuals and their families?
Why is it that only a third of people who experience a mental illness in any given 12 month period actually receive treatment ?
What is the impact on families / carers?
What is the impact on our communities?
What could we do better?
MOVING FORWARD
invest more in early intervention
invest more in community based care
invest more in linkages between health and other services – employment, housing, etc.
most importantly, measure outcomes for individuals and their families
DRIVING REFORM
enacting the values you believe in means swaying and dancing with the winds of change
the most important struggle is to:
1. retain a commitment to the fundamental value of human experience, of hope, the possibility of change, and meaningful relationships
2. strengthen your consumers / carers, yourself and your organisation = document and share how you make a difference
3. BE AN ADVOCATE