Issue 6 / 20 February 2012

MENTAL health commissions — set up to ensure there is quarantined and accountable funding for mental health — offer the chance to transform mental health services in Australia.

The commissions have been promised or implemented in four Australian states and a new national commission has been established.

The role of mental health commissions (MHCs) and how they will impact on mental health funding was the main topic of a meeting last year, which brought together academics, policymakers, consumers and medical practitioners. The meeting was hosted by the Sydney Health Policy Network — an initiative of the University of Sydney.

Speakers, including leaders in various mental health and public health fields from Australia and overseas, particularly reflected on the place for medical practitioners in the work of the MHCs.

In many countries, such as New Zealand, Canada, Ireland and Scotland, MHCs have been effective in focusing reform action with significant positive effects.

But how will MHCs implement effective reform in Australia? And how should those in the clinical practice community work with them?

How doctors work with the MHCs is an important question. Indeed, as the speakers at the event emphasised, the biggest challenge MHCs face is to effectively engage with medical practitioners for productive reform.

A commission cannot just drop into a system fully grown. It needs to grow from what is already there. Engagement with doctors and other practitioners, carers and consumers will be the key to its utility and success.

Engagement, however, is not a one-way street and it’s important that the MHCs think about their role in facilitating “knowledge exchange” — a back-and-forth process between all partners — rather than just “knowledge transfer” from the MHC to practice.

This is important if their role, as expressed by speakers at the event, is to facilitate innovation.

Reform is too often seen as a top-down process, whereas genuine reform is much more back and forth, involving the identification and fostering of successful points of innovation from all levels of the system.

Part of the MHCs’ work should, therefore, be to empower individual practitioners to innovate and productively share the knowledge gained through successful innovation. This is reform from the ground up — creating a stable base to accompany top-down reform.

But can an MHC rely on the goodwill of those within the system to come with them in their reform, especially when the changes needed are hard?

David McGrath, director of the NSW Health Mental Health and Drug and Alcohol Office, who has been coordinating the establishment of the NSW MHC, drew attention to the use of indicators and targets as key tools in ensuring that reforms would be implemented and maintained.

Indicators should offer more than just “sticks” for action and work more subtly to offer utility not only for the government, but for those practising within the system and those accessing it as consumers. Crucially, indicators should monitor how the “story” of the system has changed.

Several speakers, including chief executive officer of the national MHC Robyn Kruk, referred to MHCs as needing strong narratives to draw their work together. This is an important and interesting idea. Narratives provide a structure and impetus for action.

In Scotland, a strong anti-suicide narrative based on data and taken up in the media helped drive the implementation of a large number of reforms, including a new mental health law, new population mental health and services strategies and new government agencies. The narrative then shifted to stigma and then recovery — each of these narratives creating a new impetus for reform.

Whichever narratives are chosen by our MHCs, they need to reflect themes already existing in the field if they are to be successful.

It is, therefore, vitally important for the relevance of the commissions that practitioners get involved to ensure that the right narrative is taken up. Only then will reform reflect and build on the knowledge and strengths of the system.

Dr Jen Smith-Merry is senior lecturer in the Faculty of Health Sciences at the University of Sydney. Her research focuses on mental health policy and services, and the work of health complaint commissions. She was previously research fellow in mental health policy at the University of Edinburgh, Scotland.

Further information at Sydney Health Policy Network, NSW MHC and WA MHC.

Posted 20 February 2012

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