Replacing bald tyres: reforming mental health in Australia

1. Replacing bald tyres:reforming mental health in Australia David Crosbie CEO MHCA April 2009 Christians for an Ethical Society

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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)

8. 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

9. 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

10. 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 ....

11. 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

12. 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?

13. strength = values respect dignity courage pride meaning opportunity change honesty care love community responsibility hope

14. Knowing what is does not tell us what should be

17. 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?

18. 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

19. Driving reform • enacting the values you believe in means swaying and dancing with the winds of change • the most important struggle is to: • retain a commitment to the fundamental value of human experience, of hope, the possibility of change, and meaningful relationships • strengthen your consumers / carers, yourself and your organisation = document and share how you make a difference • BE AN ADVOCATE