Australia’s Experience In Establishing A Mental Health Commission

Professor Tim Lambert Professor Alan Rosen Sharing with Dr Chan Chung Mau 5 April 2012

Type II organizations

Incremental changesScottish commissionVisit homesIndividual cases

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

NSW’s conditionsChange 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

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

SpendingAustralia’s spending on mental health

services - >$150 per capita in Western Australia

NSW’s figures are more deceptive

Psychiatrist per personIn Australia, more in private than in public

sectorMany New Zealand psychiatrists travelled to

AustraliaRoughly 1:800 (including psychiatrists from

NZ)

Centre for young people (12-25 yrs)

Headspace.org.auOne-stop shops based in mallsFirst step is to see a GP, who then directs the

patient to mental health services

Anti-mental illness facility campaignSydney College for girls reject mental illness

centre to be built in areas nearbyIt 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

Comparison of countriesHK’s system is like the US, where people go

directly to see a psychiatristAustralia is like the UK – you need GP’s

referral

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 attendedCo-run by psychiatrists, nurses, GP, consumers4 days – separate programs for indigenous people

and families

KAC – knowledge exchange systemTo service users, workers, public, etcEg. “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

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 usefulNational scorecard is importantTargets, independent monitoring system and

funding system (based on diagnostic groups) are crucial

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

Funding systemThe funding system should provide incentives

for integrated set of services (eg, housing)

Leadership issuesDoctors 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

Community health care centresPeople 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

The professor’s perspectiveDisapprove 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