Australia’s Experience In Establishing A Mental Health Commission

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

2. Type II organizations • Incremental changes • Scottish commission • Visit homes • Individual cases

3. 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

4. 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

5. Australia’s health department isn’t really a health department  its 1st 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

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

7. 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)

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

16. 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

17. 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

18. 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