The Leadership Challenge in Mental Health Reform

1. John Mendoza, Adj. Professor, Health Science, USC Adj. Associate Professor, Medicine, Sydney University Chair, National Advisory Council on Mental Health The Leadership Challenge in Mental Health Reform ConNetica Consulting • PO Box 484 • Moffat Beach 4551 • Tel: 07 5491 5456 • Fax: 07 5491 5458

2. Youth Youth is not a time of life; its a state of mind; it is not a matter of rosy cheeks ....; it is a matter of will, a quality of imagination, a vigor of the emotions; it is the freshness of the deep springs of life... The temperamental predominance of courage over timidity, of the appetite for adventure over the love of ease...

3. Mental health service reform – will require leadership at all levels – political, bureaucratic, professional and service. Not for Service: experiences of injustice and despair in Australia’s mental health system, Oct 2005

4. NFS – Leadership & Governance • A whole-of-gov’t service model developed & agreed to by COAG – based on collaboration, integration, community need, accountability, flexibility & innovation • Leadership for MH reform be vested in Federal Cabinet Minister • New governance arrangements for true collaboration between gov’t, NGOs, private, C&Cs • Inter-gov’t service agreements for improved w-o-g responses Results • Not done • Done! • In part • Not Done

5. Three years on ... "Carers are hurting from a number of problems endemic in the Australian system. These include a lack of co-ordination in treatment plans at the point of discharge from hospital, a drastic shortage in subsidised housing, few supported work programs and limited availability of psycho-social rehabilitation.” CEO MIFA 8 /9/08

6. Independent assessments of progress • Senate The COAG National Acton Plan lacked vision, minimal attention to evaluation & outcome measurement, critical shortages of supported accommodation ... There is no evidence of effectiveness arising under the Better Access program.(June 08) • 3rd NMHP Evaluation – Currie & Thornicoft - ? • Hickie et al “disjointed arrangements between levels of government, poorly resourced community services & an embattled public hospital sector … our persisting unwillingness to collect or publicly report key measures .. undermines community confidence” (in press) • Russell – Assessment Commonwealth MH programs July 08, Menzies Center for Health Policy

7. Leadership is a combination of strategy and character ; if you have to be without one, be without strategyGen Norman Schwarzkopf

8. Political leadership in action • Howard and GST • Rudd and economic response on Oct 11 • Kennedy & Cuban missile crisis 1962

9. What is leadership? Belief beyond self Personal resilience Integrity Driving out fear Give up position power, build personal influence Be an early adopter & innovate A focus on & determination for results

10. Lessons from Sydney 2000 “Drug cheats were exposed in unprecedented numbers with 60 athletes thrown off teams before or after their arrival in Sydney and others suddenly announcing injuries or simply not showing up, (thus) avoiding drug testing”. The Sunday Age • Clear vision, purpose • Strategy + tactics • Build the evidence • Develop organisational capacity • Build alliances • Communication & International advocacy • Confront & expose vested interests

11. Leadership is fundamentally about change

12. Kotter’s 8-step change model • Establish a greater sense of urgency • Create a guiding coalition • Develop a vision and strategy • Communicate the change vision • Empower others to act • Create some short-terms wins • Consolidate gains & produce even greater change • Institutionalise the changes in culture Kotter, The heart of change, HBS

13. Leadership and change Vision, plans, goals and strategies Behaviours Attitudes, culture, habits, traditions - feelings, fears, values & beliefs

14. Leadership as an art • Meaning – the ability to inspire purpose in people. • Affiliation - ability to create a sense of belonging • Security – the ability to make people feel secure enough to take risks • Trust – the ability to create an atmosphere of trust • Energy – the ability to inspire passion & enthusiasm • Results – accepting responsibility for delivering results Oxford Leadership Academy

15. Practical leadership actions Work to reduce traditional notions of office: • Hierarchy & status • Functional divisions & role specifications • Move to organic forms of organisation – strategic groupings, task groups, communities of practice (e.g. based on like clients). Human sustainability model • Eliminate patriarchal decision-making • Build systems to enable decision-making as close to client as possible • ‘Formal leaders’ act as strategists/coordinators/coaches – less as decision-makers on behalf of all.

16. The critical question then:What is required to avoid repeating past failure to reform?

17. Regaining National Leadership … ‘... 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, 1992

18. A need for real leadership – Draft National Mental Health Policy • Pays little regard to recent history, reviews, inquiries, evaluation of 3rd Plan – i.e. a dishonest portrayal. • Little context – almost nothing on Rudd Gov’t agenda • Has few real goals, no targets, no markers to assess progress - it commits no one to anything • No reference to the UN Charter on the Rights of People with Disability (Aug 2008) • Almost nil on co-morbidities - not just AOD Critical question: Where will it take us?

19. A case of do as I say ….. Previous head of UK Govt’s Delivery Unit, Sir Michael Barber: “leaders need excellent strategy functions and strong performance management systems, enabling them to steer well, identify flaws in implementation and intervene where necessary... The government departments responsible for major strategic reforms also need to develop this kind of capacity for themselves – and where they do not have the necessary real-time data or the skill and will to intervene where there are problems, inevitably reforms falter.” Quoted in Shergold, Oct 2006, Implementation Matters

20. Good practice in public policy Should show: Draft Policy No – cannot show u Absent Vague, inadequate (e.g. nothing about needs Not evident Some evidence None Nil Nil • Genuine consultation • A reflection of current context – progress & challenges • Statement of need • A clear, concise, meaningful vision • Principles for action • Measurable goals & targets • A staged approach to reform • Robust governance, accountability

21. “Youth” is leadership Youth is not a time of life; its a state of mind; it is not a matter of rosy cheeks ....; it is a matter of will, a quality of imagination, a vigor of the emotions; it is the freshness of the deep springs of life... The temperamental predominance of courage over timidity, of the appetite for adventure over the love of ease...

22. Leadership adages to live by “Think big; Start small; Scale fast” TheMcDonald’s Formula You miss a 100% of the shots you don’t take. David Bussau • To change is positive. To change frequently is perfect. • Leadership is a function of knowing yourself, having a vision, that is well communicated building trust among colleagues, taking effective action. Brian Bacon Get off the dance floor and stand on the balcony

23. Thanks for Listening Contact: • John Mendoza, Chair, National Advisory Council on Mental Health • NACMH@health.gov.au • jmendoza@connetica.com.au