The bits in between

Story by Frank Quinlan, Chief Executive Officer, Mental Health Australia

We currently enjoy a unique position.

In the history of community based advocacy, I can’t think of another time when an entire sector enjoyed such a remarkably high level of agreement on both the need for reform and the direction it should take.

I’m talking, of course, about the reform of what we can loosely call Australia’s mental health system. Indeed, not a single voice from our diverse range of stakeholders is in disagreement about the basic facts. Our system is broken and significant reform is needed to make it function.

Currently, our sector is in a state of flux. There is reform activity, but it is largely out of the control of non-government stakeholders. In reality, following much advocacy, our sector is now waiting for a range of government processes to complete, and for governments to respond.

These processes include a COAG mental health working group, a mental health Expert Reference Group and a suite of consultation workshops with stakeholders, run by the Federal Department of Health. 

Each of these processes is focussed on providing the Commonwealth the information it needs to respond to the National Mental Health Commission’s Review of Mental Health Services and Programmes and to the broader reform agenda. This in turn, we hope, will inform the design and implementation of a system-wide, multi-government reform program.

In addition to broad mental health reform our sector is also attempting to transition to the NDIS

The reform program itself will take years to deliver. It will require commitment from all tiers of government, national leadership at a First Minister level and funding beyond the forward estimates.  The importance of First Minister leadership was recently reinforced by the National Mental Health Commission in hearings in front of the Senate Select Committee on Health. 

With the Federal Minister for Health, the Hon Sussan Ley MP, making commitments to respond before the end of the year, we currently have a sense of an enormous number of wheels in motion.

However, there is a growing sense of disconnect between the current broken mental health system and the shiny new mental health system just over the horizon.  

The problem lies in the need to ensure a proper transition between the old and the new. A transition that allows for the services and programs that currently exist to continue at their present, or even a boosted, capacity. In public policy, the journey is just as important as the destination.

Some see reform as a reason to economically rationalise the mental health sector. However, no one could argue that a system struggling to keep up with demand, with so many falling through the gaps, should be smaller. 

While some duplication could be reduced, an efficient and effective sector must continue to grow to meet the demands of the future.

In addition, while reform is undertaken, and a new system is created from pieces of the old, a clear transition plan is needed to help keep people in the services and programs they need right now. 

Real need doesn’t go on hold, not even for a day. We can’t allow consumers to ‘go missing’ or ‘drop through the cracks’ during the transition from one system to another, or from one provider to another. 

Transition planning is needed to carefully manage change to ensure people who live with mental illness, and their carers, are both involved and engaged at all stages of the process, while continuing to manage their conditions and recover. 

This must happen before, during and after the implementation of reform.

In addition, service providers and advocacy bodies have a vital role to play, both in the transition and the reform. However, without long term understanding and long term security, many of these services will not be around once the reform is complete.

In truth, governments must fund both the reform and the transition. 

The Transition Plan should cover all Commonwealth-funded programs, including programs in scope for the NDIS.

For Commonwealth mental health programs not in scope for the NDIS, we want to see the extension of contracts with NGOs until 30 June 2017, and the inclusion of a provision for the automatic renewal of contracts for 12 months, should decisions about that program or service not be made by 31 December 2016.

For Commonwealth mental health programs notionally in scope for the NDIS, we want to see an acknowledgment of the unique contribution each program currently makes to Australia’s mental health service mix by:

  • Ensuring the services currently available through in-scope programs to the broader population of mental health consumers and carers continue to be available from 1 July 2016 until policy settings and detailed jurisdiction implementation plans are fully developed and announced.
  • Providing short-term and medium-term certainty for future NDIS providers who currently provide community-based mental health services, and who may be adversely affected by uncertainties in the lead-up to the NDIS Transition Period, by extending contracts under those programs up to 30 June 2018. 
  • Including measures to avoid the unintended consequences of NDIS rollout observed in trial sites, consistent with lessons from NDIS trial sites (or the lack thereof) to date.

It is vital that services can continue to operate now, while also planning for the future. They must be able to attract the staff and resources they need for current demand and undertake their own improvement processes to prepare for the demands of the future. 

The continued availability of services and programs is vital for the day-to-day living and recovery needs of consumers and carers, and their continued interaction and satisfaction with the current and future mental health system. 

The alternative is a shiny new system, with no services, people or expertise left to run it.

Governments should embrace the idea of a partnership with the current mental health sector. These organisations should help drive the reform and be the foundation, and backbone, of a future system while maintaining services in the present.

For this to happen, we must see a clear planned process for ensuring governments involve everyone in the implementation and monitoring of transition plans as we move towards a new system, whatever shape it takes.

We have a once in a generation chance to fix the mental health system.  The transition plan will be the most important cog of any future reform success.


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