Comorbidity Action in the North (Can) Launch
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Playford Civic Centre
25 February 2011
Thank you to Cherrie and Charlotte for inviting me here today and Margot for your incredibly powerful story. I am the first Minister for Mental Health that Australia has had at a national level. You won’t be surprised to know that when I was appointed in September, there was a long line of people flying to Canberra to tell me what they thought the priorities for mental health reform should be in Australia. The Mental Health Council told me very early on in my time as Minister, that in addition to those very valuable discussions, it was important that I get out and hear stories like Margot’s.
Through December, the Mental Health Council and I travelled the country. We conducted 14 forums in 14 different cities and towns around the country with consumers, carers and family members. It was a pretty hectic period and emotionally a very difficult period because of the breadth and the depth and the power of the stories that I was able to hear from those sessions around the country, stories like Margot’s and like Nicholas’. I must say that I learnt more from that month in my time as Minister for Mental Health than I have in the other four or five months that I’ve spent battened down with mental health experts trying to work out what next for Australia in this very challenging area of policy. Margot’s story was a very powerful story and it’s not the only story and not the only tragedy, unfortunately, that Australia has of this type.
I want to talk a bit about mental health before I talk about the CAN project because we are at an important juncture in Australia in terms of mental health policy. The Kings College, which is an university in the UK, released some research late last year and it’s a survey they conduct from time to time across a range of different countries, some developed countries like Australia and some developing ones.
They asked a series of questions. Over a thousand Australians were surveyed and one of the questions they asked people across the world was ‘what are the two or three things that most concern you about your country, the two or three things that keep you awake at night?’ Pretty much every citizenry across the world named jobs or the economy and climate change or global warming as the top two. However, what was unique about Australia was that 35 per cent of Australians named mental health as one of the two or three things that most concerned them about their nation. No other country came close to that. I think the average across the world was 10 per cent.
So, on the list of things that keep Australians awake at night, there is climate change, there is the economy and number three is mental health. For someone who has been in politics, not necessarily Parliament, for a while, that was an extraordinary result. I’m very confident that it’s not a result that you would have got in 2009 in that survey.
My analysis of that result is this; that there has been a very deep sense of unease in our nation for a long time about how we support Australians and their families who experience mental illness. From time to time, mental health has come into the public realm through courageous stories like Jeff Kennett’s and John Brogden’s and a range of other people, and a range of family members, like Margot, who are willing to stand up in forums like this.
I think what happened last year though, is that Patrick McGorry’s tenure as Australian of the Year gave the issue a sense of shape and legitimacy, particularly in the area of youth mental health, that it just didn’t have before. Mental health was transformed from being a second or third order political issue, which it has been during most of my adult life, to being very much a first order political issue. I’m sure none of you can remember a federal election campaign where mental health was one of the key issues of debate, not just between the major parties, but broadly in the community.
After the Prime Minister was appointed to head the new Government, she appointed me as the first Australian Minister for Mental Health. If that’s all we do, then that will be a terrible shame. Appointing a Minister for Mental Health is a means to an end. It gives someone with Ministerial rank the time to work with the mental health sector, consumers, carers, mental health professionals, anyone else with an interest in the area, to work on our priorities for reform. It’s simply a level of time and energy that a general Minister for Health is not able to dedicate to mental health or any other sector of the health system. That is very important.
Over the last several months, I’ve been able to engage very deeply with mental health stakeholders and with the community about what they think we should be doing better as a nation.
One of the things that the Prime Minister, Nicola Roxon and I have done in the last few months is to establish an expert working group. We’ve pretty much finished the first stage of our work now, but this group has worked with me over several weeks very intensively to recommend some options for reform to present to the Prime Minister and the Cabinet. That group includes people like Patrick McGorry, Ian Hickie, David Cappo from here in South Australia - who headed the inquiry that led to the Stepping Up Report that I was a part of five or six years ago – and a range of people from the sector. The head of Mission Australia is there because of their experience in housing policy. The head of employment services is there because of the importance of getting and keeping work for people experiencing mental illness. There are people with education and training experience.
What we’re trying to do is to reinforce very clearly that mental health is not purely a health issue. It is an area that is quite unique in the health space, that crosses way beyond health into a whole range of non-clinical, social support services. Frankly, government in Australia and I suspect elsewhere, traditionally has not been very good at working across portfolios and mental health is one of those areas that inconveniently refuses to stay within one portfolio area.
We’ve been working hard at developing some options. It won’t surprise any of you who work in this field to know that the areas of priority that we have identified need more work as a nation align very closely with the areas dealt with in this research project. The first area is youth. We know that about two thirds of common mental health disorders emerge before 21, so intervening in early years is critical if we’re able to get to people before the mental disorder sets in deeply and a whole range of other issues in their life become affected, and young Australians become seriously socially excluded. Patrick McGorry articulated that to the community very, very clearly last year. We also know that this is an age of the highest vulnerability to the abuse of drugs and alcohol. This project ticks a very important box for us and that is that we need to, as a Commonwealth, invest heavily in the area of youth mental health.
The second box it ticks is the integration of services. The lack of integration of services, for people who have co-morbidities on other areas of physical health, and who have non-clinical needs like their housing is unstable, they’re falling in and out of education and training if they’re young, or out of work if they’re not so young. These things are incredibly important to wrap around the person if they’re going to be effectively supported. Time and time again, as I went around the country in December talking to consumers, every single table in every single room identified the lack of good coordination of services as their major concern.
That can range from being deeply inconvenient and annoying for people who have to tell their stories over and over to different people, or it can have utterly tragic consequences as Margot has talked to us about this morning. Either way, whether it’s a matter of tragedy, or whether it’s a matter of effectiveness, efficiency and convenience, we need to do better in this area. That is very easily said; it is not so easily done. That’s why this is a very important project which will help us learn at a national level what sort of models work, what does help policy-makers and service-deliverers work well together so that their services wrap around the individual, rather than wrap around the bureaucracy.
The third thing in terms of the boxes that this project ticks is research. I have responsibility for medical research in the Government. One of the common complaints from the mental health sector is that this area of health which causes the greatest burden of non-fatal disease in the country by a long way – about a quarter of all the non-fatal disease in the country is caused by mental health –and which is identified as a national health priority, does not get enough of the funding from the National Health and Medical Research Council (NHMRC).
Australia, as you know, is a country that performs extraordinarily well in traditional biomedical research. And there is good biomedical research going on, supported by NHMRC grants into, for example, the biomarkers for schizophrenia. But, if we are going to have a sector that has more investment, that has better joined up services, it also needs to be one which is constantly self improving. The only way we can do that is through research and through evaluation like the evaluation being undertaken in this project.
It’s really a great pleasure to come and launch this project, obviously as the national Minister for Mental Health, but also because Salisbury is an area that I represent as the Member for Port Adelaide. The border of the electorate that I represent comes up to Waterloo Corner Road, so I know that the catchment of this project is important to the community that I have the privilege of representing.
Congratulations to Cherrie and Charlotte and to the rest of the team who are undertaking this incredibly important work. It’s great to read that there are PhD students who will be involved in this. It’s a project that will span the full spectrum from the Professors sitting at the front here to PhD students who will be the Professors of the future.
Lastly, can I also thank the collaborating partners, Health SA, or the Central Northern Adelaide Health Service, the Northern Division of General Practice, and the Aboriginal Health Council. When I talk to the Prime Minister and to Nicola Roxon about how the primary care reforms, how the development of Medicare Locals can benefit mental health, I very much have in my mind the two resplendent ladies in white at the front and the work that they do in the Northern Division of GP, which I think is some of the leading work around the country.
It’s a project that has great collaborating partners. I know it will do great things for the community of northern Adelaide, and I also know that we’ll be able to learn a lot as a country from the work that you’re doing.
Thank you for having me here.
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