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