Chapter 5
National Mental Health Commission
Introduction
5.1
In the 2011–12 Federal Budget the Government allocated $32 million over
five years for the establishment and operation of the National Mental Health
Commission (the Commission).[1]
The Commission will comprise nine commissioners, raising the profile of mental
health issues, and the provision of independent advice to improve transparency
and accountability in mental health policy.[2]
5.2
The Commission's advice and feedback on mental health policy and spending
measures is envisaged to help inform and shape future reform and spending:
The core function of the Commission will be to monitor,
assess and report on how the system is performing and its impact on consumer
and carer outcomes.[3]
5.3
In the first instance, the Commission will produce an Annual National
Report Card on Mental Health and Suicide Prevention. The Report Card will
assess the relative effectiveness of a range of mental health programs and
services, highlighting which services are actually delivering outcomes for people
experiencing mental illness.[4]
5.4
The Government intends to establish the Commission as an executive
agency within the Department of Prime Minister and Cabinet and governed by a
Chief Executive Officer. Under this model, the Commission will report to an
agency minister within the Prime Minister's portfolio, who will also be
responsible for appointing the nine commissioners.[5]
5.5
While most submitters who commented on the Commission supported the
concept of an independent voice on mental health,[6]
several suggested changing the format of the Commission, mostly with respect to
ensuring its independence from or links to government, but also its membership
and representation, accountability and operation.
Membership and representation
5.6
Under the Government's plan for the National Mental Health Commission,
the commissioners will be appointed by the relevant agency minister, presently
the Minister for Mental Health and Ageing. The Interim Office of the Commission
notes that consultation is underway to inform the selection of the
commissioners and that an announcement is expected in the coming months. The
first meeting of the Commission is planned for early 2012.[7]
5.7
Some submitters expressed views about which groups should be represented
on the Commission. The Aboriginal and Torres Strait Islander Healing
Foundation, for example, welcomed the Commission but considered that an
Indigenous Commissioner would be integral to its success in meeting the needs
of Indigenous people:
However, it is important...that any strategies to address the
mental health issues for Aboriginal and Torres Strait Islander people are
undertaken within a cultural framework and meet the diverse needs of the
Aboriginal and Torres Strait Islander community. The appointment of an Indigenous
Mental Health Commissioner will ensure that cultural responses are given
appropriate weight and the community will feel that the Federal government is
sincere in their efforts to Close the Gap at all levels.[8]
5.8
The Australian Clinical Psychology Association held the view that the Commission
may be able to facilitate better coordination of mental health service
delivery, but that it 'need[s] experts':
We may need some representation from professional bodies like
our own and others, but it needs to have experts working in the field and we
need representation from our psychology board.[9]
5.9
The Private Mental Health Consumer Carer Network considered that
consumers, carers and the private sector should be represented on the
Commission:
We are of the very firm belief that there must be a consumer
commissioner and a carer commissioner in order to bring the consumer and carer
perspectives to the very entity that is going to be looking at the transparency
of services and also looking towards policies and looking towards advising
government on perhaps where...mental health funding [is] best allocated.
I also think that the private sector is an area that too
often gets forgotten in our health system, certainly in mental health. We
have approximately 20 per cent of inpatient beds and around the same for the
mental health workforce, so it is a significant area...
We believe that the commission must have a consumer
commissioner, a carer commissioner and a commissioner from the private sector.[10]
5.10
Similarly, the National Mental Health Consumer and Carer Forum believed
that people with first-hand experience of the mental health system should be
represented on the Commission:
We believe that the development of a national mental health
commission will be an outstanding and exciting opportunity to involve mental
health consumers and carers. We are advocating for the establishment of a
consumer and carer specific advisory body to inform the commission...
It is seen as essential that there must be commissioners who
have a lived experience as a consumer and/or a carer.[11]
5.11
With respect to consumer representation on the Commission, the committee
notes that the budget overview indicates that the Government wishes to engage
consumers:
[The Commission] will also provide a strong and consolidated
consumer voice, which will contribute to more responsive and accountable policy
and program directions within the sector.[12]
5.12
The committee notes that consumer representation can be delivered in
different ways. In New Zealand consumers are members of its Mental Health
Commission Advisory Group.[13]
In Western Australia there is an association of consumers funded by the Western
Australia Mental Health Commission, as well as a Consumer Advisor appointed to
the Commission.[14]
There is consumer and carer representation on the Board of the Mental Welfare
Commission for Scotland,[15]
while there are also members with lived experience of mental illness amongst
the directors of the Mental Health Commission of Canada.[16]
New South Wales, which is currently in the process of establishing a
commission, has recognised that it will need 'designated and ongoing consumer,
carer and family engagement and representation'.[17]
Accountability and operation
5.13
Some submitters queried whether or not the Commission, as an executive
agency of the Department of Prime Minister and Cabinet, would be able to
provide fully independent advice. However, it was clear from the evidence that
the Commission's wider accountability and effective operation was also
important.
5.14
As the body promoting accountability and transparency in mental health
services, some submitters asserted that the Commission's own operation must be
accountable and transparent. The Australian Council on Healthcare Standards
expressed concern that the parameters governing how the Commission will report
on mental health services have not yet been determined:
It is encouraging to note that the Commission will ‘report on
Australian Government and state system performance against service
expectations’. It is unclear however, what system performance will be measured
against, and no reference is made to the recently updated National Standards
for Mental Health Services 2010, nor an accreditation framework to drive implementation
of, or monitor assessment against, these standards.[18]
5.15
The Australian College of Mental Health Nurses held a similar view, but
extended it to the authority of the Commission:
The ACMHN believes that the national Mental Health Commission
must operate with clear guidelines around its roles and responsibilities,
independence, and authority to implement changes.[19]
5.16
Rather than implementing changes, the Public Health Association of
Australia considered that the Commission should exert pressure on governments
to consider mental health issues in implementation across a broad range of
initiatives. It recommended that the Federal Government should:
Use the new National Mental Health Commission to advocate for
the inclusion and measurement of mental health in all government initiatives
and programs. This will allow the effect of the multiple influences on mental
health to be visible and for broad, appropriate action to be taken.[20]
5.17
The committee notes that the Commission's stated function is advisory
rather than authoritative. This advisory role is a function that some
submitters consider will only be possible in partnership with other
organisations and governments. The Mental Health Council of Australia considered
that the Commission will need to engage effectively with the states and
territories, as well as the broader health and community sectors, in order to
link the many levels of mental health services and inform 'effective planning':
Ensuring that various plans are linked to clearly defined and
reportable targets is one way of ensuring greater scrutiny of progress. Feeding
all of these processes into the 10 Year Roadmap will also be important. [21]
5.18
Similarly, Catholic Social Services Australia (CSSA) believed that the
Commission's success will 'depend on active participation by community managed
services and NGOs'.[22]
In addition, CSSA expressed concern about whether the Commission as currently
envisaged will be able to generate practical, coordinated improvements to
mental health services:
In the absence of clear terms of reference, it is hard to
comment on the Commission’s potential as an effective ‘watchdog’ and advisory
body.
The Commission will need to represent a broad spectrum of
consumer, carer, service provider and community interests in order to guide realistic
long term planning and coordination. A very real challenge for the Commission
will be to demonstrate leadership for systemic and policy change that
transcends jurisdictional and portfolio silos.
[23]
5.19
While CSSA expressed doubts about whether or not the Commission could
transcend portfolio and jurisdictional boundaries, several other submitters
suggested that the Commission must be completely independent from government in
order to deliver impartial advice.
5.20
The Department of Health and Ageing explained that the rationale for the
Commission's positioning in the Prime Minister's Department is to ensure
cross-portfolio coordination:
...really importantly, the fact that the mental health
response is not just a health response. The thinking behind having the agency
housed within the Department of the Prime Minister and Cabinet is really
recognising the need for many portfolios to be engaged in improving mental
health outcomes.[24]
5.21
Some witnesses to the inquiry considered that this arrangement will be effective,
while others suggested that the Commission should be independent from
government. Those satisfied with the placement of the Commission as an
executive agency under the Prime Minister's portfolio included the National
Mental Health Consumer and Carer Forum.[25]
5.22
The Mental Health Council of Australia explained that there could be
both advantages and disadvantages to independence from government:
We certainly have a view that the principle of independence
is an important one to the commission, but so too is the power and capacity of
the commission to get access to a range of data sources. We think that
positioning the commission within the Department of Prime Minister and Cabinet
will allow the commission to gain access to and have the authority across
portfolios within the federal government, and that is welcomed...
We will adopt a supportive but a wait-and-see approach.[26]
5.23
Beyondblue expressed a similar view, as did Professor Hickie, who
considered that the Commission needed to operate at a high level order to be
equipped to make decisions about overarching policy and funding issues:
...I think at this stage we have become more generally
concerned that we get a national commission that does operate at a higher
level; and, within the bureaucracy, Prime Minister and Cabinet is obviously the
highest level. We would expect it, however, to have the characteristics of
independence that you are talking about...[27]
5.24
Professor McGorry agreed, although noted that eventually, independence
could be better achieved outside of government:
I think the ideal is actually an independent commission—I
think that is what we should aim for in due course; that is really the only way
to guarantee independence—similar to the Human Rights Commission and those
sorts of structures.[28]
5.25
Several other witnesses were more sceptical of the level of independence
that the Commission could have if it were an executive agency within the
Department of Prime Minister and Cabinet. Professor Lyn Littlefield, Australian
Psychological Society, considered that the Commission should be independent
from government because one of its key roles is to evaluate government
spending:
It should be an independent body. I think it should be a body
that looks at transparency, accountability and evaluation of the money that is
spent in mental health. In those respects I do think it is a very important
body. It should give advice as to the best services possible for what we want
to do. It needs real experts on it.[29]
5.26
The Royal Australian and New Zealand College of Psychiatrists expressed
a similar view:
The Royal Australian and New Zealand College of Psychiatrists
supports the development of a mental health commission but that this needs to
be independent of government to objectively report on the state and progress of
mental health services.[30]
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