Mental Health Reform
In 1992, Australian Health Ministers committed to correct decades of neglect in mental health. A national mental health policy and mechanisms were developed to:
- lift Commonwealth and State expenditures
- reduce human rights abuses
- move the focus of care from hospitals to the community, and
- deliver quality mental health to mainstream Australian health and welfare services 1.
In 1993, the Burdekin Report (Human Rights Commissioner's Report) drew the public's attention to human rights issues: overt abuse within institutions, and covert neglect in the wider community.
For the next 10 years, Australian governments implemented two 5-year plans to:
- facilitate genuine participation for consumers and carers 2
- develop high-quality, community-based mental health care
- outline a broader approach to population-based health promotion and disease prevention.
This new national focus on a long-neglected health area assumed governments would invest additional dollars. People in need of mental health services, and their families, greeted the national commitment with great enthusiasm and expectation. Everyone assumed that real change required not only large increases in resources, but genuine national leadership and widespread professional and community support.
In 2002, after 10 years of this national approach, the Mental Health Council
of Australia (MHCA) reviewed whether substantial change had been achieved.
MHCA's national review from August to December 2002 involved over 400 organisations
and individuals. It focused on a range of national bodies representing consumers
and carers, professional groups, non-government organisations and local service
providers.
The major conclusion of the MHCA's review is stark.
Despite the efforts of committed politicians, government officials, service providers and community advocates, we do not have an effective or accessible mental health care system. At all levels of government, within some professions and in the wider community there is a perception of apathy, lack of accountability and lack of commitment to real change. Public understanding of mental health is improving but it remains relatively ignorant of the service crisis. It is only when a family member needs help that the public becomes aware of the gross deficits in care.
People with mental disorders, and their families, feel frustrated and let down by the system. Their goodwill, patience and support for the protracted nature of genuine health care reform have been dissipated. They are willing to back another 5 years of government national planning - but only if it is supported by genuine national leadership and commitment.
Those who require services today need an urgent and substantial improvement in our mental health care system. It is recognised that mental health reform is difficult - requiring years rather than months to occur - but the current inadequate pace of reform condemns disadvantaged and ill members of our community to more years of abuse, neglect and poor mental and physical health. It puts at great risk the well-being of Australian families who will require mental health care services for the first time in future years.
Community-based voices now favour a more proactive, more critical and more political approach. National and state governments have substantially underestimated this groundswell of disenchantment. Enquiries within several states over recent years have only scratched the surface of experiences of poor quality care. More agreements between governments are in danger of being perceived as hollow and without integrity. Mental health care reform needs to be extended, beyond the National Mental Health Working Group of the Australian Health Ministers Advisory Council, to include heads of government.
1 Commonwealth Dept of Health & Ageing 2002
2 Report by the Mental Health Council of Australia: Authors Dr Grace Groom & Professor
Ian Hickie April 2003