THE National Mental Health Commission published its first report card late last year.
The report on mental health and suicide prevention, titled A contributing life, is unhappy reading. A massive task lies ahead of us. The indicators show much room for improvement.
We could start with the poor life-expectancy of those diagnosed with schizophrenia — 32 years less than the general population (with cardiovascular disease the cause of death). Or perhaps the fact that twice the number of Indigenous people with mental ill health complete suicide as non-Indigenous people.
Mental health commissions — both state and federal — have been established in the past year to ensure there is quarantined and accountable funding for mental health, as outlined in MJA InSight last year.
National Mental Health Commissioner Professor Allan Fels has argued powerfully for a far more comprehensive approach to mental health and illness than has been provided through the fee-for-service health system care. He argues that we need better connectedness and new ways of working and prioritising.
However, what underpins many of the entrenched problems identified in the report card is a system made up of parts that are not connected.
Problems related to poor life expectancy result from a failure to view people as whole — we separate the mind from both the body and the social context in which people with mental illness live their lives, and concentrate solely on their psychiatric problem.
Putting mental health in a box of its own means we treat it but are insensitive to the physical health problems or homelessness these people experience. For instance, we treat unemployment of people with mental ill health using arrangements designed for those with fixed physical disabilities. These do not work for patients with characteristically episodic mental ill health. This makes it more likely that the intervention will fail and the person we are trying to help will suffer worse problems.
The report card refers to the physical health of those experiencing mental ill health as a “spotlight issue”, along with barriers to accessing care, family and carer inclusion, employment, access to housing and suicide prevention.
These matters are central to the reasonable expectation of a “contributing life” — a life described in the report card as one of meaning and purpose, with close connections to family and friends, good health and wellbeing. Professor Fels has described it as one “where people can do satisfactory and potential activities, participate in work if appropriate, take part in family, develop relationships and achieve a good proportion of their potential”. But to achieve a contributing life requires an understanding of mental health that goes far beyond the mental health system. And herein lies the difficulty.
We can’t sit in silos and think that we have the best way — or no way — to address mental ill health. Cross-boundary learning and sharing is crucial and should involve all parts of government.
A whole-of-government approach to mental health has been a policy priority for successive state and federal governments (eg, the Fourth national mental health plan), and the governments of WA, NSW and Queensland have promised this for their mental health commissions. An aim of the NSW commission is to facilitate new knowledge development, promote knowledge sharing and grow new networks to make mental health everybody’s business.
So are the mental health commissions making a difference?
Not yet — it is too early to say — and their ability to make a difference is out of the commissions’ hands. They can bring together the right information, facilitate new systems of communication and knowledge sharing, but they depend heavily on others to complete the task — the Council of Australian Governments on one the hand, and individuals working in policy and practice on the other.
A system is a collection of people choosing to work in certain ways. A system is what we need for mental health. For its success, all those working, even tangentially, with people experiencing mental ill health must become involved and think creatively about how to make connections for change.
If the political will is there, and the commissions have the vision, at last good things might happen for those with mental illness.
Dr Jen Smith-Merry is senior lecturer in the Faculty of Health Sciences at the University of Sydney and a co-convener of the Mental Health Interest Group of the Sydney Health Policy Network.
Professor Steven Leeder is professor of public health and community medicine at the University of Sydney. He chairs the board of the Western Sydney Local Health District and works at the Menzies Centre for Health Policy (formerly Australian Health Policy Institute), where he was director from 1999 to early 2013.
Posted 11 February 2013