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Transcript of Www.cimh.unimelb.edu.au CIMH Mental Health Leadership in a Changing World Harry Minas Centre for...
www.cimh.unimelb.edu.au CIMH
Mental Health Leadershipin a Changing World
Harry Minas
Centre for International Mental Health
The University of Melbourne
Centre for International Mental Health www.cimh.unimelb.edu.au
Traditional role of psychiatrists
3% severe mental
disorders
• Psychiatrists have traditionally worked on providing the best quality clinical care to the people with the most severe mental disorders• In most countries this has meant a focus on hospital-based care for people with psychotic and severe affective disorders• Psychiatric training has focused on the development of clinical skills for this limited patient group• Psychiatrists have generally left policy and service design issues to others• Research (and research skills) has been focused on basic science of mental disorders and clinical interventions, with little interest in cost- effectiveness or in research on health systems
Centre for International Mental Health www.cimh.unimelb.edu.au
Expanded roles for psychiatrists
3% severe mental
disorders
20% total mental disorder
• Epidemiological work has increasingly focused on the high prevalence of depression, anxiety and other disorders in populations, on the high population burden due to these disorders, and the fact that most people with these disorders are untreated or poorly treated• In addition, problems with large mental institutions, and human rights concerns, have increased the pressure to move the focus from hospital-based to community-based systems• The role of psychiatrists has shifted from clinical specialist to leader of multi-disciplinary teams and negotiator with governments, families, clinician colleagues working in the community (such as general practitioners), NGOs, and other (non-health) sectors
Centre for International Mental Health www.cimh.unimelb.edu.au
Expanded roles for psychiatrists
3% severe mental
disorders
20% total mental disorder
Populationmental health
• A focus on population mental health requires that psychiatrists focus on mental health promotion, illness (and suicide) prevention, and early intervention• This requires a broader community leadership role and working with community groups, the media and governments
www.cimh.unimelb.edu.au CIMH
Leadership
The process through which an individual intentionally influences another individual or, more usually, a group in order to accomplish a goal.
Leadership involves defining and communicating a vision for the future, based on some core and explicit values, aligning people with that vision, and inspiring them to work to make it happen, despite obstacles.
Transforming the current reality into the imagined future.
Leadership is always focused on change, from how things are to how they ought to be.
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Change
Change is constant What may have been acceptable in the past is less
acceptable now. Most people with mental illness:
receive no treatment are excluded from the benefits of citizenship
work, education, decent accommodation, respect
have their rights neglected or abused have no voice
decisions are made for them by others
Mental health service = Mental Hospital Now a wide range of different types of service are expected
to meet a wide range of different needs
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Leadership
Effective leadership infects others with: Enthusiasm Energy Drive Confidence Determination Belief that the common goal of the group can be
achieved
The leader Articulates the group’s mission Gives clarity and direction to the activities of the
group Keeps the group focused and on track
www.cimh.unimelb.edu.au CIMH
Leadership - in its simplest representation
ETHICSService to others
ETHICSService to others
COURAGEAct withsustained initiative
COURAGEAct withsustained initiative
Strategy
REALITYClearanalysis of currentproblems
REALITYClearanalysis of currentproblems
VISIONCompellingimage of what is desirable and possible
VISIONCompellingimage of what is desirable and possible
www.cimh.unimelb.edu.au CIMH
Problem Definition
This is the most critical, and most neglected, part of achieving mental health system reform
Mental health is a low priority Indonesia spends 1% of the total health
budget on mental health (WHO Atlas 2005)
Mental illness has to become an important national problem Human rights Economic burden Barrier to social and economic development Key public health problem
Those who have the power to define what are the important problems get the resources Security, Global warming
There is not yet a sufficiently clear and coherent definition of the problem of mental health at national and international levels
REALITYClearanalysis of currentproblems
REALITYClearanalysis of currentproblems
www.cimh.unimelb.edu.au CIMH
Social and economic burden
We know that mental illness: accounts for a large proportion of the total burden
of disease, and that this proportion will increase is the biggest cause of disability imposes a huge economic burden on society in
terms of lost productivity, etc. can be a substantial a barrier to economic and
social development associated with descent into poverty
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Public health problem
Mental disorders and mental health problems are risk factors for: Non-communicable disease
Cardiovascular disease Diabetes
Communicable disease HIV-AIDS
Injury Deliberate self-harm and suicide
Maternal depression and child development Child malnutrition, stunting, impaired development
Comorbidity Complicates help-seeking, diagnosis and treatment, and Adversely influences prognosis
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Human Rights Problem
Is this what we wantmental services to be?
In many parts of theworld this isthe current reality
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Solutions?
We have: a better understanding of mental illness than ever
before effective and affordable treatments evidence for what kinds of service are most
effective in meeting the needs of people with mental illness
evidence for what kinds of services people with mental illness, and their families, prefer
But: We are not making effective use of this knowledge
for the benefit of people with mental illness
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Vision: What MH services should be
Mental Health Services should be: Effective - achieve clinical outcomes Appropriate - relevant to needs Efficient - cost-effective Responsive - protect rights & consider preferences Accessible and equitable - geographic and financial
accessibility, provided according to need Safe - for patients, staff, community Continuous - across time, programs, organisations Capable - knowledgeable and skilled staff
Is this vision shared by all relevant stakeholders?
or Do different stakeholder groups have very different
ideas about what the most important problems are and what a future mental health system should be?
VISIONCompellingimage of what is desirable and possible
VISIONCompellingimage of what is desirable and possible
www.cimh.unimelb.edu.au CIMH
Test of agreement on Vision for the future
If the national budget for mental health were doubled tomorrow what percentage of the additional money would you allocate to each of the following areas?
%
Building new mental hospitals
Improving the quality of care in existing mental hospitals
Establishing new general hospital inpatient psychiatry unit
Improving quality of care in existing general hospital inpatient psychiatry units
Expanding outpatient psychiatry clinics
Establishing community mental health services
Developing mental health care in primary health care services
Improving psychiatric rehabilitation services
Developing supported community accommodation
Strengthening consumer and carer organizations
Provision of community information/education about mental health and illness
Community mental health promotion programs
100
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Leadership
The highest priority issues in developing a leadership strategy are: Defining mental health as an important problem for governments Achieving agreement among key stakeholder groups about the core
elements of the vision for the future Demonstrating that solutions are available and politically feasible
Strategy
REALITYClearanalysis of currentproblems
REALITYClearanalysis of currentproblems
VISIONCompellingimage of what is desirable and possible
VISIONCompellingimage of what is desirable and possible
www.cimh.unimelb.edu.au CIMH
Stakeholders
Governments Ministries of Health,
Finance, Social Services, Employment, etc.
General community Patients and their families Service Providers
Mental Health Professionals (and their associations)
Psychiatrists, Psychologists, Nurses, Social workers, etc.
General Health Professionals (and their associations)
Health Institutions Public and private hospitals,
Health insurance organisations (public and private), Pharmaceutical industry, etc.
Universities and training colleges
The mental health sector is very broad, with many stakeholders:
www.cimh.unimelb.edu.au CIMH
Stakeholders
Governments Ministries of Health,
Finance, Social Services, Employment, etc.
General community Patients and their families Service Providers
Mental Health Professionals (and their associations) Psychiatrists, Psychologists, Nurses,
Social workers, etc. General Health Professionals (and
their associations) Health Institutions
Public and private hospitals, Health insurance organisations (public and private), Pharmaceutical industry, etc.
Universities and training colleges
The mental health sector is very broad, with many stakeholders:
CoherentDemands
www.cimh.unimelb.edu.au CIMH
Stakeholders
The three key stakeholder groups that need to persuade government to improve mental health services are:
1. The general community (issues of community safety, cost of services to community)
2. People with mental illness and their families (issues of accessibility, quality and affordability of services)
3. Service providers (Mental health professionals are only a small part of this broad group)
A mechanism is needed for these groups to talk to each other, to discover what they agree about, and to put on hold what they disagree about Who will do this? ? National NGO with representation of all the key stakeholder groups An example is the Mental Health Council of Australia
If there is no agreement between the three groups (and the sub-groups within them) about what needs to be done then taking any action is a risk for governments
When there is no clear way forward governments will prefer to do nothing
www.cimh.unimelb.edu.au CIMH
Leadership
COURAGEAct with
sustained initiative
COURAGEAct with
sustained initiative
Strategy
Taking sustained action to achieve agreement among key stakeholders about the core elements of the vision for the future is a key leadership task
REALITYClearanalysis of currentproblems
REALITYClearanalysis of currentproblems
VISIONCompellingimage of what is desirable and possible
VISIONCompellingimage of what is desirable and possible
www.cimh.unimelb.edu.au CIMH
Leadership
ETHICSService to others
ETHICSService to others
COURAGEAct with
sustained initiative
COURAGEAct with
sustained initiative
Strategy
Act with integrity in the interests of people with mental illness
REALITYClearanalysis of currentproblems
REALITYClearanalysis of currentproblems
VISIONCompellingimage of what is desirable and possible
VISIONCompellingimage of what is desirable and possible
Becomes the newReality - with newproblems to be solved
Taking sustained action to achieve agreement among key stakeholders about the core elements of the vision for the future is a key leadership task
www.cimh.unimelb.edu.au CIMH
Obstacles and Opportunities
A key obstacle to mental health system reform and development is the lack of a unified voice among key stakeholder groups about: What the most important problems are What the future mental health system should be
A key opportunity for psychiatrists is to lead in developing this consensus and in taking a common view to governments about what must be done