The Leadership Challenge in Mental Health Reform

John Mendoza, Adj. Professor, Health Science, USCAdj. Associate Professor, Medicine, Sydney University

Chair, National Advisory Council on Mental Health

ConNetica Consulting • PO Box 484 • Moffat Beach 4551 • Tel: 07 5491 5456 • Fax: 07 5491 5458

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...

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

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

ResultsNot done

Done!

In part

Not Done

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

Independent assessments of progressSenate

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

Leadership is a combination of strategy and character ; if you have to be without one, be

without strategy

Gen Norman Schwarzkopf

Political leadership in actionHoward and GSTRudd and economic response on Oct 11Kennedy & Cuban missile crisis 1962

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

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, purposeStrategy + tactics Build the evidenceDevelop organisational

capacityBuild alliancesCommunication &

International advocacyConfront & expose

vested interests

Leadership is fundamentally about change

Kotter’s 8-step change modelEstablish a greater sense of urgencyCreate a guiding coalitionDevelop a vision and strategyCommunicate the change visionEmpower others to actCreate some short-terms winsConsolidate gains & produce even greater

changeInstitutionalise the changes in culture

Kotter, The heart of change, HBS

Leadership and change

Vision, plans, goals and strategies

Behaviours

Attitudes, culture, habits, traditions- feelings, fears, values & beliefs

Leadership as an art Meaning – the ability to inspire purpose in people. Affiliation - ability to create a sense of belongingSecurity – the ability to make people feel secure

enough to take risks Trust – the ability to create an atmosphere of trustEnergy – the ability to inspire passion & enthusiasmResults – accepting responsibility for delivering

resultsOxford Leadership Academy

Practical leadership actionsWork to reduce traditional notions of office:

Hierarchy & statusFunctional divisions & role specificationsMove to organic forms of organisation – strategic

groupings, task groups, communities of practice (e.g. based on like clients). Human sustainability model

Eliminate patriarchal decision-makingBuild 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.

The critical question then:

What is required to avoid repeating past failure to reform?

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

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?

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

Good practice in public policyShould show:

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

Draft Policy No – cannot show u Absent Vague, inadequate

(e.g. nothing about needs

Not evident Some evidence None Nil Nil

“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...

Leadership adages to live by“Think big; Start small; Scale fast”

The McDonald’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

Thanks for Listening

Contact:John Mendoza, Chair, National Advisory

Council on Mental HealthNACMH@health.gov.au jmendoza@connetica.com.au