R EPLACING BALD TYRES : REFORMING MENTAL HEALTH IN A USTRALIA David Crosbie CEO MHCA April 2009 Christians for an Ethical Society

W HAT 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

T HE 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.

T HE 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

W HAT 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

H EALTH 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)

H EALTH SYSTEM - GP S approx 11% of all consultations, 11 million a year depression the 4 th 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

O VERALL HEALTH SYSTEM IMPACT mental health accounts for 36% of all health costs for people aged 15 – 44 anxiety and depression are the 2 nd 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 burden of disability for all diseases

B EYOND 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....

O PERATING 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

D ECONSTRUCTING 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 couragepride meaning opportunity change honesty care love communityresponsibility hope

K NOWING WHAT IS DOES NOT TELL US WHAT SHOULD BE

W HAT 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?

M OVING 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

D RIVING 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