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7/29/2019 CONGO Briefing Paper December 2012
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Council of Non-Government
Organisations on Mental HealthBriefing Paper, December 2012
7/29/2019 CONGO Briefing Paper December 2012
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Council of Non-Government Organisations on Mental Health
Briefing Paper, December 2012
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Prepared by the Mental Health Council of Australia on behalf of the Council of Non-
Government Organisations on Mental Health, December 2012.
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Introduction
The past twelve months has seen the culmination of a number of significant reforms in mental
health in Australia, including the establishment of the National Mental Health Commission, the
Council of Australian Governments (COAG) recent release of its Ten-Year Roadmap for Mental
Health Reform and the handing down of the countrys first ever Report Card on Mental Health and
Suicide Prevention.
At the same time, mental health services are undergoing substantial reform, including the National
Disability Insurance Scheme, the introduction of Activity Based Funding, Partners in Recovery,
Medicare Locals and the new Hospital and Health Networks.
Yet there are growing concerns that the direction of reforms may not be resulting in significant
improvement in the lives of Australians affected by mental illness.
On 9 October 2012, the Mental Health Council of Australia and the National Mental HealthCommission hosted Australias inaugural Council of Non-Government Organisations (CONGO) on
Mental Health in Canberra.
The aim of the CONGO was to bring together senior representatives from leading organisations
across the mental health, employment, housing and social welfare sectors to discuss how Australias
non-government organisations can foster a better integrated, better coordinated response to
mental health.
The gathering committed to establishing a national vision for Australia to lead the world in mental
health by 2022, so that within 10 years Australia is acknowledged internationally as a world leader in
mental health services, programs, and outcomes.
Since the CONGO meeting, there have been significant developments in mental health at the
national level which are likely to create important opportunities for CONGO members to effect
lasting impact on both the national reform agenda, as well as on the lived experience of people
affected by mental health issues.
Launched in late November 2012, the National Mental Health Commissions first Report Card on
Mental Health and Suicide Prevention has identified the substantial gulf between our aspirations for
people living with mental illness and the reality of their day-to-day lives. The Report Card presents a
snapshot of Australias current position and takes a whole-of-life approach, looking at physicalhealth, employment, relationships, education, housing and homelessness, community participation,
family and child support and social justice issues for people with lived experience of mental illness.
In early December 2012, COAG released its long-awaited Roadmap for National Mental Health
Reform, the implementation of which will be set out in more detail in the successor to the Fourth
National Mental Health Plan (due for completion by mid-2014). AnOpen Letter to COAG, co-signed
by 70 leading mental health and social services organisations across Australia, has ensured that
additional work will be undertaken by COAG members to develop effective targets and indicators to
guide the implementation of the Roadmap, as well as embed those targets into the new National
Mental Health Plan.
http://www.mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://www.mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://www.mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://www.mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdf7/29/2019 CONGO Briefing Paper December 2012
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For its part, CONGO has identified areas where we could set targets to measure and guide mental
health planning and service delivery, as well as a broader set of actions and principles which it plans
to develop further before putting to COAG members in 2013.
This paper captures the range of issues agreed by CONGO members at their October meeting, as
well as key findings and implications arising out of the Commissions Report Card and COAGs
Roadmap. The purpose of this paper is to inform the establishment, in early 2013, of a national
leadership group to take forward a reform agenda on behalf of CONGO members.
It is necessarily the work of the leadership group to establish priorities and directions for future work
from the range of issues presented to date by CONGO members, as well as make choices regarding
the merits of priorities and targets raised by the abovementioned government-led initiatives.
This paper does not pre-empt decisions and future directions which may be set once the leadership
group is established.
At the October meeting, CONGO members agreed to re-commit themselves to placing people with
lived experience at the forefront of policy formulation, service design and evaluation. The notion of
consultation was acknowledged as having inherent limitations, and CONGO has therefore agreed
that new models of inclusion of people with lived experience, including more proactive collaboration
and negotiation, are to be explored. The CONGO leadership group will demonstrate the application
of inclusive values and principles inherent in the Collective Impact1
approach as it undertakes its
important work in 2013.
Developing an Agenda for Change
CONGO members overwhelmingly agree that gains in new spending and the re-prioritisation of
mental health by governments has not, as yet, resulted in lasting improvements for people affected
by mental illness or their carers. The change is still too slow and the demand for services still
significantly more than we can provide for people who need them. Fragmentation and a lack of
coordination across the many systems that people need are uppermost in the range of factors
impeding potential gains in new spending and slowing momentum towards successful outcomes for
people with lived experience.
A lack of coordination between NGOs, businesses, governments and within jurisdictions is leading to
fragmented decision making and lack of clarity regarding respective roles and responsibilities. As a
result, service delivery remains uneven and inequitably spread across Australia. In this environment,
the need to address socioeconomic factors in health and social care is an aspiration as yet
unrealised.
1Collective Impact is a model for mobilisation of stakeholders to achieve collective goals and social change through cross-
sectoral coordination, as outlined in the Stanford Social Innovation Review athttp://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-
%20Channeling%20Change
http://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-%20Channeling%20Changehttp://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-%20Channeling%20Changehttp://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-%20Channeling%20Changehttp://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20-%20Channeling%20Change7/29/2019 CONGO Briefing Paper December 2012
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Importantly, CONGO members expressed that there are still too few meaningful ways to include
people with lived experience as advocates and peers within the mental health system and this is
further compounding perceptions that services are not catering to the needs of mental health
consumers or their carers.
Table 1 summarises key issues for mental health reform raised by CONGO members that will
undergo further analysis and consideration in 2013 by the CONGO leadership group. These issues
are accompanied by preliminary targets established as part of the development of the Open Letter
to COAG, presented to the Prime Minister, Premiers and Chief Ministers ahead of the 7 December
COAG meeting.
A more detailed listing of these issues can be found in the CONGO Meeting Communique at
Attachment A.
Further background and context in relation to these issues can be found in the CONGO Meeting
Reporthere.2 The Open Letter to COAG can be viewedhere.3
2http://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdf3http://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdf
http://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdfhttp://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdf7/29/2019 CONGO Briefing Paper December 2012
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TABLE 1 KEY ISSUES FOR MENTAL HEALTH REFORM IDENTIFIED BY CONGO MEMBERS
Key Issues for Mental Health Reform Basis for Future Targets
Suicide prevention and early intervention By what percentage do we intend to reduce the
annual number of suicide deaths over the ten year
life of the Roadmap?
What proportion of our overall investment will be
made in early intervention and prevention activities?
Creating effective mental health services and
maximising access to them
What do we determine is a reasonable waiting time
for people who need access to services?
Life expectancy and the interplay between physical
and mental ill-health for people who live with mental
illness
How quickly do we intend to close the gap in life
expectancy between people living with mental illness
and the rest of the community?
Social inclusion and participation What is our expectation of social participation for
people who are living with mental illness?
Access to affordable and stable housing How many people do we intend to house in stable
and secure housing in the next ten years?
Participation in worthwhile and supportive
employment
How many people living with mental illness will be
assisted to find meaningful and productive
employment over the life of the Ten-Year Roadmap?
Participation in education How many people experiencing mental illness will be
supported to complete education?
Addressing mental health stigma, discrimination and
awareness
To what degree will we reduce stigma and
discrimination in the community related to mental
illness?
Improving the mental health and social and emotional
well-being of Aboriginal and Torres Strait Islander
people
How quickly do we intend to close the gap in mental
health and suicide prevention outcomes between
Aboriginal and Torres Strait Islander people and the
rest of the community?
Economic independence and income support for
people affected by mental illness
Target areas to be identified
Creating a central role for people with lived
experience in Australias mental health system
Target areas to be identified
Systems issues in mental health, including;
care coordination models of funding building an evidence base workforce development, including peer
workers collaboration in mental health
Target areas to be identified
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Importantly, the key issues for reform raised to date through the CONGO process align closely with
those identified by the National Mental Health Commission in its first ever Report Card on Mental
Health and Suicide Prevention,A Contributing Life.
Table 2 summarises the Report Cards key recommendations and actions. The full Report Card
document can be downloadedhere.4
TABLE 2 RECOMMENDATIONS AND ACTIONS IDENTIFIED BY THE 2012 REPORT CARD ON MENTAL
HEALTH AND SUICIDE PREVENTION
Recommendations Actions
There must be a regular
independent survey of
peoples experiences of
and access to all mental
health services to drive real
improvement.
The Commission will undertake a regular national survey of people with
mental health difficulties and their families and support people. The survey
will consider access to services, as well as perceptions and experiences.
Increase access to timely and
appropriate mental health
services and support from
6-8 per cent to 12 per cent of
the Australian population.
All governments must agree and meet the target proposed in the Fourth
National Mental Health Plan Measurement Strategy that 12 per cent of the
population should be able to access mental health services in a year. There
must be agreement to this indicator with an implementation plan and
investment strategy to achieve this.
Reduce the use of involuntary
practices and work to eliminate
seclusion and restraint.
All jurisdictions must contribute to a national data collection to provide
comparison across states and territories, with public reporting on all
involuntary treatments, seclusions and restraints each year from 2013.
The Commission will call for evidence of best practice in reducing and
eliminating seclusion and restraint and help identify good practice
treatment approaches.
All governments must set
targets and work together
to reduce early death and
improve the physical health
of people with mental illness.
Enduring mental illness must be given the status of a chronic disease to
give it higher national focus and support.
The physical health needs of people with mental health problems need
to be given a higher priority in all areas of health. The initial focus must be
on rapidly reducing cardiovascular disease by reducing risk factors such as
smoking, poor diet and by increasing physical activity for people living with
mental health problems.
All government funded mental health related programs must also be
measured on how they support people to achieve better physical health
and longer lives. Priority should be given to the financing of multi-
disciplinary primary care (through GPs and other primary health
care organisations).
All relevant services must give priority to tracking both the physical and
mental health needs of those with enduring mental illness.
Include the mental health of
Aboriginal and Torres Strait
Islander peoples in Closing
the Gap targets to reduce early
deaths and improve wellbeing.
Mental health must be included as an additional target in the COAG
Closing the Gap program. This must be done through the development
and implementation of an Aboriginal and Torres Strait Islander Mental and
Social and Emotional Wellbeing Plan to commence in 2013. This must also
address the current work and future findings of the Aboriginal and Torres
Strait Islander Suicide Prevention Advisory Group.
Training and employment of Aboriginal and Torres Strait Islander
peoples in mental health services must increase. There must also be better
support for Aboriginal and Torres Strait Islander families. There must be
regular reporting on progress.
4http://www.mentalhealthcommission.gov.au/our-report-card.aspx
http://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspxhttp://www.mentalhealthcommission.gov.au/our-report-card.aspx7/29/2019 CONGO Briefing Paper December 2012
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Recommendations Actions
There must be the same
national commitment to
safety and quality of care
for mental health services
as there is for general health
services.
All governments must agree that there is the same emphasis on
improving the quality of care and reducing adverse events in mental health
services as applies to other physical health services. Governments must
commit to implementing nationally agreed and mandatory service
standards in mental health services as they have done for other
health services. The Commission will work with the Australian Commission
on Safety and Quality in Health Care (ACSQHC) to identify issues affecting
the uptake of national mental health service standards and make them
mandatory.
Invest in healthy families
and communities to increase
resilience and reduce the
longer term need for crisis
services.
Increase enhanced and personalised support for parenting through
culturally relevant forms of home-based visiting (ante-natal and in the first
few years of life). These must be provided at a local or regional level. There
must also be active follow-up where a family is under stress or
experiencing tough financial or social difficulties.
Increase the levels of
participation of people with
mental health difficulties
in employment in Australia
to match best international
levels.
The Commission will form a Taskforce, including industry, government and
community leaders to actively promote effective employment support
programs and workplace based programs that increase the participation in
employment of people with mental health difficulties.
Employment support programs, initiatives and benefits must be more
flexible.
Programs must provide long-term support for the employee, families and
support people and the employer, with appropriate incentives and
milestones.
No one should be discharged
from hospitals, custodial
care, mental health or drug
and alcohol related treatment
services into homelessness.
Access to stable and safe
places to live must increase.
All governments must implement and report regularly on the existing
COAG commitment of no exits intohomelessness from statutory,
custodial care and hospital, mental health and drug and alcohol services
for those at risk of homelessness.
Discharge planning must consider whether someone has a safe and stable
place to live. Data must also be collected on housing status at point of
discharge and reported on three months later, linked to the persons
discharge plan.
Governments must commit to removing any structural discrimination
barriers to people with mental health difficulties accessing social housing.
Just as important is providing support to help vulnerable residents to settle
in, adjust and remain in their homes.
Prevent and reduce suicides,
and support those who
attempt suicide through
timely local responses and
reporting.
Develop local, integrated and more timely suicide and at-risk reporting
and responses. These should be coordinated, community based, culturally
appropriate, early response systems and suicide prevention programs.
They should promote community safety, reach the most vulnerable, and
use up-to-date information from the first responders such as Police
officers, occupational health workers, ambulance officers and mental
health workers.
Programs with a proven track record (which are evidence-based) must be
supported and implemented as a priority in regions and communities with
the highest suicide or attempted suicide rates action needs commitment
and a humane approach.
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Clearly there are links between the Commissions priorities for action and those identified by CONGO
members which will be investigated further by CONGOs national leadership group. The Report
Cards recommended actions also provide opportunities for CONGO to influence issues through new
mechanisms to be established by the Commission, such as the establishment of a national taskforce
to investigate ways to improve employment participation and the economic independence of people
affected by mental illness, and the proposed national survey of people experiencing mental health
ill-health and their families.
It is anticipated that the CONGO leadership group will undertake an assessment of those elements of
the Report Card which most support its own identified priorities, and identify which actions to be
undertaken by the Commission can be utilised over time to support those priorities.
On 7 December 2012, the Council of Australian Governments released itsRoadmap for National
Mental Health Reform 2012-2022. In an Open Letter more than 70 mental health and social service
organisations urged the Prime Minister, Premiers and Chief Ministers to consider adopting
measurable targets in the Roadmap. COAG has since announced that it will establish mechanisms to
develop in more detail the priorities and strategies outlined in the Roadmap. These mechanisms will
also be tasked with developmental work in the leadup to the drafting of a new National Mental
Health Plan, expected to be finalised by mid-2014.
Priorities for action identified in the Roadmap include:
Priority 1: Promote person-centred approaches
Priority 2: Improve the mental health and social and emotional wellbeing of all Australians
Priority 3: Prevent mental illness
Priority 4: Focus on early detection and interventionPriority 5: Improve access to high quality services and supports
Priority 6: Improve the social and economic participation of people with mental illness.
The 45 strategies which underpin the six priority areas are very broad in scope and will require a
great deal more clarification and detail in order to effect change across mental health planning,
policy development and service delivery contexts.
Encouragingly, COAG acknowledges the need for further work, as well as the need to more fully
engage a broader range of stakeholders in the implementation of the Roadmap and in the
development of the new National Mental Health Plan.
Of particular note is COAGs announcement regarding the establishment of two new groups with
clear responsibilities to maximise the effectiveness of key elements of the Roadmap and make
preparations to guide the drafting of the next National Mental Health Plan.
A new Working Group on Mental Health Reform will be formed to ensure a high-level, national body
is overseeing the detailed work on mental health reform, and that all levels of government are
accountable for achieving change over the next ten years. The Working Group will report to COAG
and be co-chaired by the Commonwealth Minister for Mental Health and a Minister nominated by
states and territories.
http://www.coag.gov.au/node/482http://www.coag.gov.au/node/482http://www.coag.gov.au/node/482http://www.coag.gov.au/node/482http://www.coag.gov.au/node/482http://www.coag.gov.au/node/4827/29/2019 CONGO Briefing Paper December 2012
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The Working Group has been tasked with responsibility for:
1. Improving access to data2. Developing indicators of change3. Setting targets for reform4. A successor to the Fourth National Mental Health Plan.
In addition, the Working Group will settle, by the end of 2013, which aspects of the Roadmap the
National Mental Health Commission will report on in its three yearly reports to COAG which
document progress towards achieving the Roadmap Vision. Monitoring of progress will be focused
on long-term change at the national level, reflecting the ten-year span of the Roadmap.
A preliminary set of eleven performance indicators and three contextual targets is outlined in the
Annex to the Roadmap which will be further refined by the abovementioned Working Group by late
2013.
Briefly, those targets and their proposed measures include:
A society that better values and promotes good mental health and wellbeing
Knowledge of and attitudes towards mental health issues and mental illness in thecommunity, measured by the National Stigma and Mental Health Literacy Survey, reported
for the Fourth National Mental Health Plan.
A society that maximises opportunities to prevent and reduce the impact of mental health issues
and mental illness
Readmission to hospital within 28 days of discharge, reported as the percentage of in-scopeovernight separations from public acute psychiatric inpatient units (state and territory data
collections).
Consumer experience of mental health services, reported as the percentage of consumerswho are satisfied with the services received within the past 12 months (ABS Patient
Experience Survey).
Levels of accreditation against the National Mental Health Standards (National MinimumData Set reported for the Fourth National Mental Health Plan and the Report on
Government Services).
The percentage of the population receiving clinical mental health services (MedicareBenefits Scheme, Private Mental Health Alliance and state/territory data, as reported for the
Fourth National Mental Health Plan and the National Healthcare Agreement).
Number of individuals receiving Commonwealth Government care co-ordination services(Partners in Recovery Program).
Use of mental health services in prisons (National Prisoner Health Census).A society that supports people with mental health issues and mental illness, their families and
carers to live full and rewarding lives
Participation rates by people with mental illness in education and employment (NationalHealth Survey, as reported for the Fourth National Mental Health Plan).
Participation by carers of people living with mental health disorders in the labour force andthe community (Survey of Ageing, Disability and Carers).
Physical health of people with mental illness (National Health Survey). Housing status and experience of homelessness among mental health consumers (Fourth
National Mental Health Plan, measure under development).
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In addition, three contextual indicators will provide important information that will help to frame
and interpret the indicators listed above, but which are not considered suitable for assessing reform
over time. Consequently, these indicators will not be used to measure progress against the Roadmap
Vision directly. This is either because the relationship between government performance and
changes in these indicators is unclear, or because data on these indicators is collected too
infrequently to enable accurate measurement of change over the life of the Roadmap.
The contextual indicators selected are:
The rate of service use by people with mental illness The prevalence of mental illness in the community, where prevalence is regarded as the
percentage of the population who have met the criteria for diagnosis of a recognised mental
illness in the past 12 months an important consideration in assessing levels of access to
services and in service planning
The rate of suicide in Australia, as suicide accounts for approximately 1.6% of deaths inAustralia, and people with mental illness are at greater risk of suicide than the general
population.
It could be argued that these contextual indicators can indeed be used to assess reform over time,
and they are likely to be further considered by CONGO in 2013 in that context.
The development of effective targets, which reflect what the broader community sees as critical to
the success of Australias mental health reform agenda, will be a key area of work for CONGO in
2013. This work will open the possibility of collaboration with a broader range of stakeholders,
including the private sector, in order to provide a whole-of-community balance to those priorities
and targets set by governments.
Recognising the importance of working in collaboration with the sector, including mental health
consumers and carers, COAG will also establish an Expert Reference Group to work alongside and
assist the Working Group. The Expert Reference Group will be chaired by the National Mental Health
Commission and will consist of one nominated representative from each jurisdiction, such as a
mental health commission nominee or representative, a representative of a peak body or advisory
group, or a consumer or carer group.
The establishment of the Expert Reference Group represents an ideal opportunity for CONGO to
channel the outcomes of its deliberations into COAGs mental health reform planning during 2013,
through Ministers on the overarching Working Group, and directly through a presence on the Expert
Reference Group. Representation in this new CAOG advisory structure will be pursued by CONGO in
2103.
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Implications for CONGO
There has been a great deal of movement on mental health at the national level since CONGO met in
October, 2012. Both the Report Card on Mental Health and Suicide Prevention and the Roadmap for
National Mental Health Reform offer significant opportunities for the non-government sector to
offer its expertise in relation to policy, planning and service delivery issues under consideration at
the national level and by states and territories.
Clearly, a shift towards a more outcomes focussed approach to evidence is being considered as part
of key mental health reform initiatives at the national level, and CONGO has undertaken to lobby
both COAG and relevant Commonwealth agency heads to help guide this shift.
Beyond measures of success and accountability however, there are other issues which are not
necessarily best dealt with through the development of performance indicators and reporting
schedules. It will be incumbent on the work of CONGO to demonstrate to governments that there
are ways by which these more qualitative indicators of wellbeing can be accounted for within aperformance based mental health framework.
A great deal of goodwill towards a mutual agenda and shared set of priorities was expressed across
organisations present at the inaugural CONGO meeting, which was in evidence again during the
recent process of developing an Open Letter to COAG.
Several of the new government-led initiatives mentioned above are due to report or deliver within
the next 12 months. Given this, 2013 offers a unique window of opportunity within which the non-
government sector will need to astutely direct its shared agenda in order to drive longer-term
tangible and measurable improvements in the lives of people with mental illness and those who carefor them.
A first order priority may also be an extensive mapping exercise to determine where to begin in
terms of comprehensive NGO-led responses to improved integration, coordination and
collaboration, examining connectors across the system rather than cataloguing individual services.
Our Collaborative Approach
Experience has taught us that in fact the only way to get lasting solutions to complex problems that
stick is for all stakeholders to collaborate to invent innovative solutions.5
In line with the commitments made at the October CONGO meeting, the new CONGO national
leadership group will explore innovative models of engagement framed by the Collective Impact key
elements as it seeks to achieve system-wide change. As important as inclusive and participatory
values are, they must be demonstrated in action in order for the non-government sector to show
leadership and deliver change that truly reflects the needs of people with lived experience of mental
illness.
5www.ssireview.org/pdf/collective_impact
http://www.ssireview.org/pdf/collective_impacthttp://www.ssireview.org/pdf/collective_impacthttp://www.ssireview.org/pdf/collective_impacthttp://www.ssireview.org/pdf/collective_impact7/29/2019 CONGO Briefing Paper December 2012
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The Collective Impact frameworks five elements were developed by researching what actually
works to generate lasting change in large complex systems, which is why these elements will frame
our approach. In addition we will draw on best practice tools and disciplined approaches to enable
us to co-design solutions. We will adhere to the AA1000 Stakeholder Engagement Standard 20116
and apply international best practice in participation practices such as the IAP2 Public Participation
Spectrum7
and an Appreciative Inquiry8
approach to ensure inclusivity, responsiveness and
accountability to all stakeholders. We will look at innovative processes to ensure all angles have
been thought of in the solutions we develop.
There is no doubt that the level of change CONGO has ambitiously articulated is going to require
long term commitment of all stakeholders across sectors and jurisdictions. The change proposed is
complex and will require collaboration between many stakeholders to agree on the nature of the
dilemmas and what solutions could look like. Sometimes these solutions will have to be invented, as
they currently do not exist and this is going to require cooperation, collaboration and input from
many.
No single person, organisation, sector or entity has the solution to these complex issues, which is
why they have challenged us for so long.
People with mental illness and their carers have been on a long journey of change to achieve parity
of access to services, which is why this next stage is critically important to get right.
To be part of co-creating a shared solution we want to ensure that all stakeholders can fully
participate in the process. In order for stakeholders to be willing to work in a collaborative way,
advocate for themselves and those they support, share their thoughts and help define the problems,
they must be confident that their contributions will be seriously regarded, that they will be provided
with the space and time to develop innovative solutions and that this will lead to change that is
implemented.
This approach will be a deliberate departure from other less inclusive consultation processes that
stakeholders may have experienced.
For this reason the process will require new levels of commitment to a determined focus on
outcomes for people with a mental illness and their carers and a willingness to engage in this change
even when it gets difficult.
6
http://www.accountability.org/standards/aa1000ses/index.html7https://www.iap2.org.au/sitebuilder/resources/knowledge/asset/files/36/iap2spectrum.pdf
8http://appreciativeinquiry.com.au/
http://www.accountability.org/standards/aa1000ses/index.htmlhttps://www.iap2.org.au/sitebuilder/resources/knowledge/asset/files/36/iap2spectrum.pdfhttp://appreciativeinquiry.com.au/http://appreciativeinquiry.com.au/http://appreciativeinquiry.com.au/https://www.iap2.org.au/sitebuilder/resources/knowledge/asset/files/36/iap2spectrum.pdfhttp://www.accountability.org/standards/aa1000ses/index.html7/29/2019 CONGO Briefing Paper December 2012
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FIGURE 1 THE BACKWARDS LOGIC OF COLLABORATION
FIGURE 2 TWYFORDS 5-STEP MODEL OF COLLABORATIVE GOVERNANCE9
9Further information on the Twyfords model available at www.twyfords.com.au/collaboration/collaborative-governance
http://www.twyfords.com.au/collaboration/collaborative-governancehttp://www.twyfords.com.au/collaboration/collaborative-governance7/29/2019 CONGO Briefing Paper December 2012
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FIGURE 3 AN OUTLINE FOR THE CONGO LEADERSHIP GROUP ACTION BASED ON
COLLECTIVE IMPACT
Next Steps
The Mental Health Council of Australia will initiate a process in early 2013 to form a national
leadership group to further progress the important work of systems reform as agreed by CONGO
members in October this year.
Once established, it is expected that the national leadership group will further refine a changeprocess and timeframes for collaboration with CONGO members. Once solutions have been
developed we will seek opportunities to impact decision making at the national level, with a
particular focus on the intergovernmental machinery of COAG.
Secretariat support for the national leadership group will be provided by the Mental Health Council
of Australia while issues of ongoing sustainability are being considered.
Further details will be made available to CONGO members as soon as practicable in the New Year.
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ATTACHMENT A
Council of Non-Government Organisations (CONGO) on Mental Health
Communique Canberra, 9 October 2012
About the CONGO
On 9 October 2012, the Mental Health Council of Australia and the National Mental Health
Commission hosted Australias inaugural Council of Non-Government Organisations (CONGO) on
Mental Health in Canberra.
The aim of the CONGO was to bring together senior representatives from leading organisations
across the mental health, employment, housing and social welfare sectors to discuss how Australias
non-government organisations can foster a better integrated, better coordinated response to
mental health.
Ninety non-government organisations attended the CONGO meeting, with keynote presentations by
Robyn Kruk, CEO of the National Mental Health Commission, who presented on the progress of the
Commissions National Report Card on Mental Health and Suicide Prevention; Frank Quinlan, CEO of
the Mental Health Council of Australia who gave an overview of current responses to mental health
in the Australian context, and; Dawn ONeill AM, previous CEO of Lifeline and beyondblue, who
detailed the international experience of independent organisations working together toward shared
objectives using the Collective Impact approach.
A key outcome of this first CONGO meeting was a commitment by those organisations present to
form a national leadership group to collaborate more effectively in order to drive better mental
health outcomes for all Australians, no matter who they are and where they live.
Issues we identified
Government factors
- Fragmented, short term policy environment- Ad hoc consultative processes- Fragmented service delivery system funding activities rather than outcomes- Chronic underfunding, particular outside acute settingsNGO Factors
- Fragmented services- Limited influence over policy and funding environment- Workforce development a significant challenge- Funding environment creates barriers to collaboration and integration- Organisations are working on a shoe-string budget- Difficulty maintaining access to information about practice and policy trends- Reliant on evidence collected by government, which often does not align with or reflect NGO
programs.
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Opportunities to deliver a better coordinated response
- Closer alignment between NGO and government agenda- Longer term policy agenda- Longer term funding models built on outcomes rather than activities- Stronger evidence base and culture of continuous service improvement for work across the
sector.
Our commitments to each other
- To develop and commit to common goals for a better integrated response to mental illness- To foster a greater exchange of information between NGOs- To collect mutually agreed data sets focussed on outcomes and value- To commit to collaboration, in spite of government policy promoting fragmentation.
Our challenges to COAG
- To commit to long term growth in investment in mental health- To develop structures that allow engagement with the NGO sector at the highest level- To commit to consultation and engagement in the policy development process- To commit to a long term policy agenda and funding models around outcomes rather than
activity
- To more closely align the national research agenda with policy objectives and outcome indicatorsin mental health
- To agree to ambitious but achievable targets that drive improvements in mental health servicesand outcomes.
Conclusion
In many fields, Australia is already a world-leader in mental health, be it the work of beyondblue,
Headspace, the Early Psychosis Prevention and Intervention Centre, Inspire, VicHealth, the Brain and
Mind Research Institute and so many other organisations working at the national and local levels.
Taking a strengths based approach, members of the CONGO called for the establishment of a
national vision for Australia to lead the world in mental health by 2022, so that within 10 years
Australia is acknowledged internationally as the world leader in mental health services, programs,
and outcomes.
The CONGO agreed to form a leadership group and within six months identify priority issues for
action and suitable measures by which to track progress. Chief among those issues are:- a reduction in national suicide rates by 50% by 2022- improved employment, social housing and income support outcomes for people with mental
illness, including that 40% of people with mental illness have access to meaningful
employment by 2022.
In order to achieve this, CONGO attendees agreed to re-commit themselves to placing people with
lived experience at the forefront of policy formulation, service design and evaluation. The notion of
consultation was acknowledged as having inherent limitations, and CONGO has therefore agreed
that new models of inclusion of people with lived experience are to be explored, including more
proactive collaboration and negotiation.
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In order to capitalise on the momentum underway as a result of the CONGO meeting, the following
actions were agreed by participating organisations:
1. A commitment by those organisations present to form a national leadership group andwithin six months, identify priority issues for action and suitable targets and measures by
which to track progress.
2. Agreement by all to re-commit themselves to placing people with lived experience at theforefront of policy formulation, service design and evaluation.
3. An undertaking to lobby both COAG and relevant Commonwealth agency heads to seekassistance in the development of more robust sources of data and evidence to support more
informed approaches to mental health.
A first order priority may also be an extensive mapping exercise to determine where to begin in
terms of comprehensive NGO-led responses to improved integration, coordination and
collaboration, examining connectors across the system rather than listing individual services.
Immediately following the CONGO meeting, a group of organisations joined to form a consortium to
develop a bid under the Capacity Building component of the Partners in Recovery initiative, with a
view to making a direct and positive impact on the delivery of more coordinated care to people
experiencing severe and persistent mental illness.
The formation of this consortium represents a tangible first step by the NGO sector to work towards
meaningful improvements to the lives of people affected by mental illness across Australias mental
health system.
The Mental Health Council of Australia and the National Mental Health Commission will release a
discussion paper later in 2012, outlining in more detail options and suggested approaches to the
broad commitments made at the CONGO meeting, with a view to establishing a national leadership
group to progress this important work in early 2013.