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Hong Kong Mental Health Council Conference: “Building a better mental health system through engagement” GEORGIE HARMAN, ACTING CEO NMHC Australia 11 January 2014. Summary. Setting the scene Who we are Our approach Our impact to date Critical success factors. The Australian context. - PowerPoint PPT Presentation
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Hong Kong Mental Health Council Conference: “Building a better mental health system through engagement”
GEORGIE HARMAN, ACTING CEONMHC Australia11 January 2014
Summary
• Setting the scene• Who we are• Our approach• Our impact to date• Critical success factors
The Australian context
2.5% Aboriginal /
Torres Strait
Islander
25% born overseas 43%
were either born overseas or have one
parent who was born overseas
Population 23.3
millionAgeing
population
85% of population live in urban areas
Scarcely more than two
persons per square
kilometre of total land area
Mental health in AustraliaThree levels of government:
FederalState/territory
local governments
2010-11 AUS $6.9 billion spent on mental health
services ($309 per Australian)
Annual average increase of 4.5% in expenditure since
2005-06
Mental illness is experienced by nearly
half of Australian adults at some point in their life (45% of
population)
Largest non-fatal burden of disease in Australia, 24% of total healthy
years of life lost are due to mental illness
3rd largest burden of disease overall after cancer and cardiovascular disease
Nearly two thirds of people with
anxiety/affective disorders have had
their first episode by age 21 years
About 1.9 million Australians (9% of
population) received public or private mental health
services in 2010-11
Less than half of Australians with
symptoms of mental illness in past year, consulted a health
service
People with severe mental illness live between 10 – 32
years less than the general population
Costs Australian economy $20 billion annually in
lost productivity and labor participation
Poor workforce participation: rate of
people not in workforce is 1½ times that of general
population
42% with severe mental illness live
in unstable housing
Indigenous Australians have hospital
admission rates due to mental illness at 2.2x rate of other
Australian men, and 1.5x rate of other
women
2000+ reported suicide deaths
each year. 65,300 reported suicide
attempts. Over 20% of all deaths for young men and women are by
suicide
Suicide accounts for 4% of total
Indigenous deaths, compared
to 1.5% for non-Indigenous Australians
How we came to be1990’s, 2000’s
• Growing awareness: researchers and advocates highlight the need for reform and call for an independent national body
2006• Political attention: Council of Australian Governments consider mental health for first time,
big new public investment
2008• Groundswell of change: mental health is the third most important issue concerning
Australians, after the economy and the environment
2010• Leaders and community speak out: call for greater transparency and accountability. Prof
McGorry is Australian of the Year. Senate Inquiry into suicide
2011• National leadership: Australian Government’s $2.2 billion national reform package
2012• 1 January 2012: National Mental Health Commission established
2013• New Australian Government elected. Commission asked to conduct a national
review of mental health programs
“In a field where there has always been a wide range of views, the establishment of a mental health commission was one area where there was broad bi-partisan consensus.” Rob Knowles, Commissioner
Who we are • Australia’s first national mental health commission,
established 2012• Funded by Australian Government … but
independent and have bipartisan support• 10 commissioners (including CEO) who bring different
perspectives and experience, 12 staff• Work across all sectors and all levels of government• Use a partnership model to influence and drive
positive change
What we do• Report to Government and the community on cross
sectoral performance and reform progressindependent reporter through annual National
Report Card on Mental Health & Suicide Preventionindependent adviser to government on where we are doing well and where we are notcollaborator to widen our impact, influence and leverage change
• New Government: New task – comprehensive review of mental health programs
What we don’t do• Run services, programs or hold funds• Implement policy• Not an apologist• Reinvent the wheel – we work with others• Get involved in individual cases or advocate for
individual people- we’re an advocate for whole of life system improvement and
better accountability“We’re a really small group and we don’t control the money. But we can be a catalyst, a collaborator and an influencer” Jackie Crowe, Commissioner
“People with mental health problems want
the same things as everyone else.
Even the most disadvantaged should be able to live a
‘contributing life’ – whatever that means for them – a stable home, a
decent education, a job, family, friends and healthy relationships,
good treatment and rights.”
Commissioner Janet Meagher
A different model to drive reform: A Contributing Life
• Launched November 2012
• A new narrative, a new view of mental health in Australia
• Goes far beyond the clinical and the medical to the whole of life
• Laid out our big picture view:• mental health must be a national priority for all
governments and the community
• agreeing on the right incentives to drive good services
• providing ‘a complete picture’ of what’s happening and closely monitoring and evaluating change
• analysing the gaps and barriers to achieving a contributing life and putting a framework in place that sets Australia’s direction
• 10 recommendations for action
Report Card 2012
• Launched exactly one year later – November 2013• Reported back on
progress• 8 further
recommendations for action
Report Card 2013
Highlights: activities & success to dateWhat is important to a contributing life?
We regularly and systematically listened to people’s experiences of mental healthPromoting mentally healthy workplaces
We established the Mentally Health Workplace Alliance, a national coalition of business, community and government leaders
Working to eliminate the use of seclusion and restraint We started an independent project to look at good practice approaches nationally and overseasValuing lived experience and the expertise it bringsWe implemented a Paid Participation Policy & Participation and Engagement FrameworkMeasuring success in a way that’s meaningful to people’s experiences In 2012 we called for national goals and targets to improve mental health and reduce suicide. We led a national consensus building process and provided a framework to governments in September 2013We forged strong relationships across Australia and overseasInternational meeting which led to the Sydney Declaration, signed several MOUs
Critical success factor #1Build evidence, be honest and credible, “tell it how it is”• Strong leadership• Independent commentary and recommendations,
especially in absence of legislative or regulatory powers• Constant presence: report back on progress• Focus on outcomes for people and families, not activity• Highlight gaps, good and bad practice• Whole of life approach• Broaden the evidence base – qualitative data
Independent recommendations & annual progress reports
2012 Recommendation: 2013 How we reported progress:
The Commission is DISAPPOINTED about the lack of leadership by our governments
The Commission is HEARTENED by the co-operative approach across the country to openly report public service seclusion rates as a first step But the Commission is DISAPPOINTED that we remain distant from our target to end the use of seclusion and restraint and will continue to push for action
Recommendation 2: Increase access to timely and appropriate mental health services and support from 6-8 per cent to 12 per cent of the Australian population
Recommendation 3: Reduce the use of involuntary practices and work to eliminate seclusion and restraint
Independent recommendations & annual progress reports
2012 Recommendation: 2013 How we reported progress:
The Commission was ENCOURAGED by governments’ commitment to develop national targets and indicators for mental health reform The Commission is DISAPPOINTED that while targets have been developed and submitted there is no commitment yet to adopt them
Recommendation 4: All governments must set targets and work together to reduce early death and improve the physical health of people with mental illness
Critical success factor #2Be relevant, don’t over promise and pick issues to
drive the biggest system changes• Aspirational but also understand constraints, strong “internal
compass”, clear values and priorities• Publicly available work plan
• Make reform everyone’s business
• Systemic transformation: • Improving life expectancy: physical health• Improving community understanding, tackling stigma and discrimination:
seclusion & restraint, work opportunities• It’s about the economy, stupid: Mental wealth of the nation• National performance targets and indicators that the community will
understand: streamlining data, outcomes focused, all of life
Physical health of people with severe mental illness
Indicator 1: Improve life expectancy of adults with a mental illness to achieve parity with adults without a mental illness. Focus on:
• Reducing smoking rates of adults over 18 years with a mental illness by 30% in four years and 60% in 10 years
• Increasing the proportion of adults over 18 with a disclosed mental illness who are screened every 12 months for physical and dental health issues by 40% in four years and 90% in 10 years
TARGET: better physical health and improved life expectancy
TARGET: Improve population wellbeing
Population wellbeingIndicator 2: Increase the proportion of the population who report positive emotional wellbeing
Wider determinants of mental health and illnessIndicator 3: Increase the proportion of consumers and carers in safe, affordable, appropriate and stable accommodation to meet their mental health support needsIndicator 4: Reduce the number of 16-25 year old Not in Employment, Education or Training (“NEET” – OECD measure)
Critical success factor #3Relationships, relationships, relationships
• First priority was to build relationships• Influence the actions, advocacy and behaviour of others,
and not just the “usual suspects”: e.g. Business Council of Australia
• Amplify the Commission’s efforts through key partnerships: e.g. with Australian state mental health commissions, Health Workforce Australia
• Inside the tent: respectful relationships with government• International links – Canada, New Zealand etc
Recommendation 8: Increase the levels of participation of people with mental health difficulties in employment in Australia to match best international levels.
Critical success factor #4Genuine participation and engagement• Listening not just talking• Agile and non-bureaucratic• Ask people what works
Recommendation 1: “Nothing about us, without us” – there must be a regular independent survey of people’s experiences of and access to all mental health services to drive real improvement
It’s not about “them”…but
about us
Visit to Santa Teresa community, near Alice Springs
Support us to develop our
own models of care for
ourselves, our families and
our community
Include us in decisions
that affect us
Listen to us
C:\Users\pmc5288\Pictures\join-the-conversation - Shortcut.lnk
Click icon to add picture
Visit us at www.mentalhealthcommission.gov.au
The last word…
Video: Reflections at the launch of the 2013 Report Card