4th Johore Mental Health Convention 23 - 24 August 2002 Hyatt Regency Hotel Johor Bahru  Scott Henderson MD (Aberd), hon MD (UNSW), DSc (ANU), FRACP, FRCP, FRCPsych, FRANZCP Professor Emeritus, ANU, Clinical Adviser in Mental Health, Commonwealth Dept of Health, Canberra Plan for Address The Global context - current social forces Changes seen in Australia The National Mental Health Strategy Much still to be done…The Big Issues Some general principles for Advancement THE GLOBAL BACKGROUND The scientific growth of Psychiatry & Neurosciences Training & Education of Medical Graduates, Nurses & Allied Professionals Public attention: fiction, TV, films, newspapers THE GLOBAL BACKGROUND (cont) Public & private discussion Leaders who have ‘come out’ ! The Pharmaceutical Industry Human rights for the mentally ill THE GLOBAL BACKGROUND (cont) The visibility of Consumers & Carers What patients ask for, or expect Secular changes in symptoms? or in Suicide Rates? An unprecedented situation Now consider the forces currently active – globally - the "ZEITGEIST" And those in Malaysia – in Health Services, in the fabric of society in social development, people’s expectations THE CURRENT SITUATION IN AUSTRALIA The National Mental Health Strategy Australia’s mental health services Mixed public-private system Most responsibility is with States and Territories Early reforms Most effort under the First National Mental Health Plan directed at improving public sector services Triggered by concern about gross inadequacies in systems of care State inquiries highlighted abuse and violation of rights   National spending on mental health increased by 46% in real terms Shift to community-based service system Reduced reliance on inpatient services Reduced isolation from mainstream health care Expansion of community disability support services Savings from reduction in institutions redirected to new services National Projects National Mental Health and Well Being Survey Mental health funding models, including population-based and casemix approaches Community awareness and attitudes Service standards Legislative reform Consumer outcome measures Workforce reform including public-private interface Clinical information systems and minimum data sets Service innovation   International perspective "Australia has articulated a national mental health policy through the National Mental Health Strategy, has provided flexible resources to facilitate system transitions from an inpatient to a more balanced service delivery system, has engaged consumers and carers in focal roles and has emphasised concerns with quality and outcome as major system goals. Taken together, these four elements reflect the cutting edge of mental health at the international level. ………" Evaluation of the first 5 years "The evidence is compelling that the shape of mental health services has changed substantially over the five year Strategy period. …." "…… there is broad consensus that the range and quality of mental health services available in 1997 have improved substantially over those that existed in 1992." "….. the National Mental Health Strategy has been instrumental in producing, or at least, accelerating the change process …" … but much remains to be done "…. current services fall far short of the Strategy vision for Australia … the structural reform agenda is not finished ..." "For the community, the mental health system remains relatively feared and unknown and, according to consumers, continues to stigmatise and discriminate against those affected by mental illness." … but much remains to be done "Consumer, carers and service providers at all levels … indicated that the Strategy has failed to reduce the high levels of stigma and discrimination directed toward consumers by the community." Need greatly exceeds supply Who provides treatment? Two thirds of Australians with a mental health disorder receive no treatment (Source: National Survey of Mental Health & Wellbeing, ABS, 1997) The disability associated with mental disorders is far greater than most recognised. 15% of the Total Burden of Disability third cause after heart disease & cancer   A broader Mental Health Strategy Service Quality and Effectiveness Strengthen the focus on consumer outcomes Support improvements in service quality Shift the focus of concern from cost to value for money Improve understanding of population needs Partnerships in Service Reform Within Human Services Primary care providers esp. GPs Consumers and carers ‘empowerment’ Services for ‘dual diagnosis’ consumers ‘Strategic alliances’ with related reform agendas e.g. Aboriginal health; National Health Priority Areas Workforce development Partnerships in Service Reform With the general community Mental Health Council of Australia Rotary International Health Research Fund Education and training institutions Priority areas under the National Mental Health Strategy 1.      Consumer rights 2.      The relationship between mental health services and the general health sector 3.      Linking mental health services with other sectors 4.      Service mix Priority areas 5.      Promotion and prevention 6.      Primary care services 7.      Carers and non-government organisations 8.      Mental health workforce Priority areas 9.     Legislation      10. Research and evaluation 11. Standards 12. Monitoring and accountability DEPRESSION ACTION PLAN The general population: Increase mental health literacy Primary Care (mainly GPs) Mental Health Services (public & private) MENTAL HEALTH LITERACY Mental health literacy Community Awareness Program Key messages included: all people have a dimension of mental health which can be protected and promoted ‘ordinary people’ experience mental health problems It’s just like any illness mental health problems are curable help is available   What was achieved? Positives: increase in awareness improved attitudes to mental health disorders tolerant attitudes reinforced contributed to improved consumer self esteem increase in awareness of help services Effects were small But strong support for the campaign, high level of demand for educational materials Increased consumer participation in decision making THREE CHANGES IN GENERAL PRACTICE Better recognition & management of CMDs Changes in Fee Structure Much better clinical support BETTER MANAGEMENT Awareness of the treatment options Brief psychological treatments by GP Others by clinical psychologists/counsellors The right medication & dosage MUCH MORE SUPPORT Better use of psychiatrists and others Don’t have psychiatrists paid only for face-to-face work Locally-made arrangements for support from psychiatrists CLINICAL GUIDELINES They may help in better recognition They may help in better management Limitations: OTHER MENTAL HEALTH STAFF Clinical psychologists Mental health as a political issue 84% of Australians believe that mental illness is a serious community problem 80% believe mental illness is hard to identify 59% have a close friend or family member who has suffered a mental disorder in the past 12 months 79% believe mental illness is more prevalent than it was 10 years ago Women and parents are particularly aware of the need for the problem to be addressed Current "Big Issues" The good & the bad in Community Care Deskilling Poor Rehabilitation Services Indigenous Australians Current "Big Issues" The homeless Accident & Emergency experiences Acute GH beds. Restraint, seclusion   Current "Big Issues" (cont) Young psychotic people Cannabis, amphetamines Youth suicide rates Rural & remote populations Forensic services Current "Big Issues" (cont) The Public and Private Sectors Are CMDs neglected nationally? Disability +++! Recruitment of human resources Research Policy for Mental Health Some General Principles for Advancement Is Policy to be driven by data, Or current enthusiasms, Or vested interests? Consider the burden of disability from Mental Disorders Should this guide action? Some General Principles for Advancement Develop the National Mental Health Plan – 5 years Mainstreaming of MH Services Invest in expanded Primary Care for all groups Some General Principles for Advancement Compromise between Severe MDs and CMDs Try different policies, but evaluate each - incl $ Could Community Case Managers be enhanced? Some General Principles for Advancement INVEST in postgraduate training of psychiatrists, GPs and nurses Harnessing the Private Sector in relation to population health needs Promotion of Health Services Research in Universities and Hospitals   INFLUENTIAL FRIENDS & ADVOCACY Respected ‘icons’ - sport, business, the arts… Chief Medical Officer’s Report for 2003 on ‘Australia’s Mental Health’ Industry, Banks, Rotary, Media Partnerships Beyond Blue - National Depression Initiative Australian Rotary Health Research Fund Want to know more ? www.mentalhealth.gov.au And remember, Psychiatry should be enjoyable to practice!