In November 2018 the Commonwealth Government agreed to a Productivity Commission inquiry into mental health. The Commission has been tasked with investigating the role of mental health in supporting economic participation, enhancing productivity and economic growth. Part of this will look at ways to improve people’s mental health and by doing so realise their economic and social participation over the long term.
In October 2019 the Commission released its draft report and asked for written submissions to provide the Commission with feedback on the draft report. WayAhead made a public submission which has been summarised below.
Our submission focussed on four main areas; Capturing the Lived Experience, Early Intervention and Prevention, Workplaces and Mental Health Workforce.
WayAhead is very supportive of recommendation 5.9 – Ensure access to the right level of care (Part II – Reorienting health services to consumers), which states,The Australian, State and territory Government should reconfigure the mental health system to give all Australians access to mental healthcare, at a level of care that most suits their treatment needs (in line with the stepped care model), and that is timely and culturally appropriate.
To achieve this will require greater involvement by consumers and carers in the development of mental health services and supports by utilising true co-design principles. We are very supportive of draft recommendation 22.3 – Enhancing consumer and carer participation but think that consumer and carer participation in service design and delivery should be a mandatory measurer for all levels of government before rolling out mental health services. There must also be a transparency reporting mechanism put in place for Australian Governments to report their progress against this measure.
We also believe that improving the mental health and wellbeing of Australians is not just a role for government and it will take a concerted effort from all parts of Australian society to make real long-lasting improvements to the way we manage mental health in Australia. Importantly, this includes a role for corporate Australia to play including insurance companies and we are very supportive of draft recommendation 24.5 Private health insurance funding of community-based healthcare. If we want to build the best mental health system possible, then it is crucial that barriers and regulations which prevent that are taken away.
Children, young people and teachers
Much of the Commission’s draft report under early intervention and prevention rightly focussed on how the health and education system can better help the mental health and wellbeing of children, young people and university students. Along with these important considerations, we were pleased to see a focus on how teachers could be better equipped to help their students.
While the Commission’s final report can be utilised to recommend new initiatives to help young people and their educators better manage their mental health, we would strongly encourage the Commission to champion the existing programs being rolled out every day by numerous mental health charities and not-for-profit organisations operating across the educational spectrum. We are not in favour of creating new programs where existing programs already exist and deliver good mental health and wellbeing outcomes to young Australians.
We would like to see in the Commission’s final report a recommendation to continue to support state and federal mental health and wellbeing prevention and education programs for young people, parents and educators which have been proven to work and be effective.
Social inclusion – combating loneliness
It was very pleasing to see that social inclusion was discussed in the Commission’s draft report. For some time now, WayAhead has seen the impact loneliness and social isolation is having throughout communities in NSW. We view loneliness as a key issue in the Australian mental health landscape and we currently provide administrative and secretariat support for the Australian Coalition to End Loneliness (ACEL).
We strongly agree with the draft report’s social inclusion reform objective of: Action and strong leadership on stigma reduction in the community and in the health workforce, and active responses to the cultural context of people and agree with finding 20.1 that social exclusion is associated with poor mental health. We agree with draft recommendation 20.1 the National Stigma Reduction Strategy. However, we also believe that the government should be funding bodies and working groups already established to help counteract these issues like ACEL which clearly demonstrates where civil society and academia have come together to produce solutions to major societal challenges.
We believe that while government and governmental bodies do and will always play an important role in fostering solutions to major issues like loneliness it doesn’t always need to be led by government and to truly solve major community issues effectively it can’t be. Again, we believe that where community and sector groups and collaboration is currently occurring to help better the mental health and wellbeing outcomes of Australians, this work should be supported by government rather than new initiatives being funded by government which in all likelihood would duplicate the work and efforts already underway.
Social inclusion – stigma reduction
It is positive to see the linkages between discrimination and social exclusion outlined in the report. We would like to see the Commission recognise that discrimination is also a human rights issue. Discrimination is resulting in people who experience mental health problems being denied the same rights and opportunities as other members of the public.
Given the significant negative effects of discrimination with regards to social inclusion and life expectancy we would recommend not waiting for more research to be done but to begin with urgency, drawing on proven international knowledge.
Internationally the move is to focus on eliminating the behaviour of discrimination first, understanding that stigma and prejudice will take more time. We support a nationally coordinated approach as outlined in the report however we would like to see a clear recommendation from the Commission that this program must be led by people with lived experience of mental health issues. They are most affected by discrimination.
Draft report feedback
We think the focus on the prevention of workplace mental health issues is a long-term investment that will bring about less people hitting crisis and create people that will be better equipped to manage their mental health and support those that need assistance. Whilst we welcome the focus the draft report had on workplaces, we were disappointed to find that most of the focus was on mental illness, recovery and return to work and psychological claims.
The draft report had little reference to the investment and expansion of prevention initiatives and ways of working, which many workplaces around Australia are already actively involved in. We absolutely welcome the report’s focus on the 20% of the adult population experiencing mental distress each year and how workplaces could better help them but we also strongly encourage the Commission to look at how workplaces can help the rest of the population, particularly those who are languishing and need some support and guidance, or those coping with life’s ups and downs and just getting by.
We think there should be more focus in this section of the report on supporting existing services and programs that aim to teach people how to maintain their mental health and wellbeing, which helps build their resilience. We would like to see a stronger focus on mental health promotion and prevention to support leaders and workplaces to be mentally healthy. There is a growing focus on the concepts of psychological safety, job design and identifying and managing psychological risk.
What we have heard from our members and observed through our industry peers, is that many already view improving and supporting their employee’s mental health and wellbeing as an important component of their work. Some have also heavily invested financially into research and pilot projects to help improve the health and wellbeing of their workers. Much of the pilot programs and longitudinal research are still ongoing with new research findings and evaluations being published every year in Australia, therefore we believe it is imperative that Australian Governments work with organisations already doing this work instead of funding new projects and strategic plans which would in all reality, could only seek to duplicate the efforts many in the sector are already doing.
Utilising what we know works
We strongly encourage the Commission to champion the existing evidence based workplace mental health programs being rolled out across all states in Australia by numerous private organisations, mental health charities and not-for-profit organisations which do this work effectively. We are not in favour of spending precious resources creating new programs.
We would like to see in the Commission’s final report a stronger voice in support of the investment in evidence-based prevention practices, tools and resources in the workplace mental health sector, alongside the focus on recovery and return to work. The investment in prevention will greatly help to build on the great research and pilot studies currently being undertaken to grow our evidence base in Australia. Moving the discussion and actions relating to mental health in Australia out of the mental health sectors basket of issues to solve, to a national discussion and responsibility across all government sectors, is a very powerful shift in the narrative; and it is much needed.
One of the ongoing workforce challenges the Mental Health Promotion and Prevention sector faces is funding uncertainty. For quite some time now funding in NSW has been provided on short term contracts, in our case, on annual contracts. Only having short term contracts makes it incredibly hard for our sector to take a longer-term approach to meet the needs of the communities which we serve and adequately plan for the community’s longer-term needs.
We are very supportive of any recommendations the Commission could make to encourage governments to implement minimum three-year funding cycles for mental health and wellbeing activities, as set out in the medium-term measurers of draft recommendation 22.3 – Enhancing consumer and carer participation. Our preference would be five-year contracts. This would help agencies retain staff and start to create longer-term plans to start implementing the various findings and recommendations of the Commission’s final report.
We also welcome draft recommendation 22.1 – Governance arrangements for the National Mental Health Commission. We see a lot of value of the Commission and its continued presence in the Australian mental health landscape. We see merit in the idea that the NMHC should become an inter-jurisdictional statutory authority with appropriate governance arrangements to enable it to effectively lead evaluations of mental health and suicide prevention programs funded by all levels of government.