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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 Slide 2 Summary Setting the scene Who we are Our approach Our impact to date Critical success factors Slide 3 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 million Ageing population 85% of population live in urban areas Scarcely more than two persons per square kilometre of total land area Slide 4 Mental health in Australia Three levels of government: Federal State/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 3 rd 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 1 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 Slide 5 Slide 6 How we came to be 1990s, 2000s 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 Governments $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 Slide 7 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 Slide 8 Who we are Australias 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 Slide 9 What we do Report to Government and the community on cross sectoral performance and reform progress independent reporter through annual National Report Card on Mental Health & Suicide Prevention independent adviser to government on where we are doing well and where we are not collaborator to widen our impact, influence and leverage change New Government: New task comprehensive review of mental health programs Slide 10 What we dont 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 - were an advocate for whole of life system improvement and better accountability Were a really small group and we dont control the money. But we can be a catalyst, a collaborator and an influencer Jackie Crowe, Commissioner Slide 11 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 Slide 12 A different model to drive reform: A Contributing Life Slide 13 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 whats 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 Australias direction 10 recommendations for action Report Card 2012 Slide 14 Launched exactly one year later November 2013 Reported back on progress 8 further recommendations for action Report Card 2013 Slide 15 Slide 16 Highlights: activities & success to date What is important to a contributing life? We regularly and systematically listened to peoples experiences of mental health Promoting 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 overseas Valuing lived experience and the expertise it brings We implemented a Paid Participation Policy & Participation and Engagement Framework Measuring success in a way thats meaningful to peoples 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 2013 We forged strong relationships across Australia and overseas International meeting which led to the Sydney Declaration, signed several MOUs Slide 17 Critical success factor #1 Build 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 Slide 18 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 Slide 19 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 Slide 20 Critical success factor #2 Be relevant, dont 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 everyones business Systemic transformation: Improving life expectancy: physical health Improving community understanding, tackling stigma and discrimination: seclusion & restraint, work opportunities Its 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 Slide 21 Slide 22 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 Slide 23 TARGET: Improve population wellbeing Population wellbeing Indicator 2: Increase the proportion of the population who report positive emotional wellbeing Wider determinants of mental health and illness Indicator 3: Increase the proportion of consumers and carers in safe, affordable, appropriate and stable accommodation to meet their mental health support needs Indicator 4: Reduce the number of 16-25 year old Not in Employment, Education or Training (NEET OECD measure) Slide 24 Critical success factor #3 Relationships, 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 Commissions 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 Slide 25 Recommendation 8: Increase the levels of participation of people with mental health difficulties in employment in Australia to match best international levels. Slide 26 Critical success factor #4 Genuine 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 peoples experiences of and access to all mental health services to drive real improvement Slide 27 Its not about thembut about us Slide 28 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 Slide 29 C:\Users\pmc5288\Pictures\ join-the-conversation - Shortcut.lnk Slide 30 Slide 31 Visit us at www.mentalhealthcommission.gov.auwww.mentalhealthcommission.gov.au Slide 32 The last word Video: Reflections at the launch of the 2013 Report Card