Australia’s Experience In Establishing A Mental Health Commission Professor Tim Lambert Professor Alan Rosen Sharing with Dr Chan Chung Mau 5 April 2012

Type II organizations Incremental changes Scottish commission Visit homes Individual cases

Success factors of mental health commission Need to earn trust from stakeholders Need strong and independent advocacy, which examines the whole system, advocates reform, and has critique power even if funded by government – Represent voice of stakeholders groups to the highest government – No parallel bureaucracy – Independency in monitoring – Goals combine grassroots' hopes with literature

NSW’s conditions Change of government  new commission will be formed in July, with new power and voice The federal government is increasingly active in funding health services  ABF – Activity Based Funding Impetus of commission comes from Western Australia

Australia’s health department isn’t really a health department  its 1 st priority is asset and budget management Discourages home visits on the basis of Occupational Health and Safety (OHS) Community health centers are replaced by new hospitals due to high estate costs near malls

Spending Australia’s spending on mental health services - >$150 per capita in Western Australia NSW’s figures are more deceptive

Psychiatrist per person In Australia, more in private than in public sector Many New Zealand psychiatrists travelled to Australia Roughly 1:800 (including psychiatrists from NZ)

Centre for young people (12-25 yrs) Headspace.org.au One-stop shops based in malls First step is to see a GP, who then directs the patient to mental health services

Anti-mental illness facility campaign Sydney College for girls reject mental illness centre to be built in areas nearby It is better to have community health centre with mental services in it, than having a mental health centre The government is building Medicare local facilities

Comparison of countries HK’s system is like the US, where people go directly to see a psychiatrist Australia is like the UK – you need GP’s referral

Steps taken to establish mental health commission in Australia  Start from a social / grass-root movement  Pressure groups are important  Showcase sessions  Australia has 19 years of experiences  THEMHS.org  conference in Australia and NZ 1500 people attended Co-run by psychiatrists, nurses, GP, consumers 4 days – separate programs for indigenous people and families

 KAC – knowledge exchange system To service users, workers, public, etc Eg. “how to find jobs for mental patients?” Provide information such as housing  TAMHSS – political wing  Encourage everyone to say different things is good  Australian NGOs lacks clinical piece, as it only provides support  these two elements should be combined

Peer support workers – they recovered from a mental illness themselves, so they are very empathetic Personal helpers – many withdrawals; too burnt out Silems with supportive staff are useful National scorecard is important Targets, independent monitoring system and funding system (based on diagnostic groups) are crucial

Intervention (CBT, IBT) does not equal to Delivery system (crisis team)  you need both The Aboriginal mental health care intervention usually involves mentorship from senior members  this is very useful

Funding system The funding system should provide incentives for integrated set of services (eg, housing)

Leadership issues Doctors are not necessarily better leaders – they should receive management training as well Commissioner does not have to be a psychiatrist – it just has to be someone who pushes hard, has strong commitment, and knows avenue of power A leadership group consisting of people such as psychiatrists can be formed to give advice to the commission

Community health care centres People have the perception that the taller the hospitals are, the better the health care system is  it is a myth; in many occasions, community health care centres are much more useful In Chatswood, people want to build hospital but not HCC In St Leonards, there is very few shopping areas, so there is no point in building a HCC

The professor’s perspective Disapprove of “fortress services” – keep staffs in hospitals The focus of contemporary mental health system should be in prevention, promotion and rehabilitation  mental health and long terms problems co-located