<< back to archive index Other Speeches Date: 22nd May Subject: Step Up and Take Control Speech at the Schizophrenia Fellowship "Two Aspects I ask myself when asked to give a talk: Why I am invited? Because I set up the NSW Mental Health Inquiry. What can I say that is of interest or use? The Problems The observations that led me to set up the Inquiry were: 1. I looked at Homelessness in Wooloomooloo and the people there were too scared to go to Matthew Talbot as they said there were a lot of mentally ill people there. 2. At a Youth Homelessness workshop, a Community Mental Health Nurse told me that she went around after long weekends to se how many clients were still alive. 3. In the Prisons Inquiry there was a lot of discussion about what percentage of prisoners had mental health issues. Initially the Department said half a percent, an expert said 23%, and better screening suggests about 11%, not counting depression or drug addiction, which is very common. There was poor diversion of people with mental health problems. All agreed it was easier to get into gaol than to get mental health help. 4. A forensic psychiatrist said that he had noted an increase in the suicide rate- the ultimate failure of psychiatry. 5. Carers talked of their problems keeping track of their son, and managing to get him accommodation. 6. NAPP (National Association of Practising Psychiatrists lobbied and said that things were worse than they had ever been. The Inquiry Dr Brian Pezzutti did a good job as chair and is now on the implementation taskforce. One Area Heath Director of Mental Health has said that this is the biggest shake-up of mental health in NSW that he has seen in 25 years of practice. Another said that mental health practitioners were now more willing to stand up for their rights and budgets within the health system. The government response to the Mental Health inquiry is on the Health dept website, and the responses to their response were due by 30/4/04. Current Status of the Mental Health Issue Mental health is now discussed, in the movies, Shine, Rain Man, A Beautiful Mind, and the ballet Swan Lake, in an historical new choreography by Graham Murphy. This is huge improvement from the days when mental health movies were 'Psycho' or 'Strait-Jacket'. Mental health is getting more attention than it ever has, and this aspect of politics must be capitalised on. Politics and Getting Heard Politics is about power and resources, but it exists within the framework of the values-system of the time, and is subject to fads, as much as the fashion industry. Good politics is the ability to observe the big trends and use them, as a sailor uses the winds and tides to get to his destination. Current Trends There is an obsession with money, and short-term outcomes. This is partly because the longer term is harder to measure, but also because many people want to judge outcome and results in the short-term. Contracts have short-terms, political cycles are 3-4 years, so decisions are made in that time. There has been a loss of faith in some aspects of society- the major losers have been the bureaucracy, and the professions. The bureaucracy have been seen to be too remote and entrenched in their ways, doing things that were not necessary at large cost, and not doing things that are necessary. 'Yes Minister' is a comedy, but it suggests acceptance of a very negative view of bureaucracy. The professions also are under attack. They are seen as cartels or bastions of privilege. They have worked on certain aspects of problems, but neglected others, perhaps because these were less interesting, or less lucrative. This has been exacerbated by the role of profit and technology. Intensive care is exciting. It gives job satisfaction where there is success, and consumes high technology equipment, making big profits. Similarly highly technical surgery has become a commodity. The rarity of its practitioners allows what economists would call supernormal profits. As some areas of the medical profession have become attractive and lucrative, others, which offer only an hourly rate, or poorer chance of success languish. There has been a notable gap between what is supplied and what is needed. Some of this gap has been perceived by consumers, and some by the increasing power of the rising class of managers who have had increased power relative to the professions in general, (except where the professions have held out as cartels). Institutions are also under threat. The asylums that once held the mentally ill as huge hostels were abolished. But as their power was taken, the people in them did not have enough power to retain their budget and have it put into services. Now the disabled, mentally or physically are being de-institutionalised, but the guarantees of services are hard to get, or they will be given as packages to those who come out of the institutions, with no guarantee that the new generations of disabled will get guarantees as their need arises. Yet institutions remain well organised compared to the community. The institutions have public relations staff and their resources and role definitions allow them to fight against any funding cuts. They do not oppose community facilities per se, but lobby against the transfer of resources that make the community facilities possible. An example of this assumed superiority of the institutions is if a nurse is missing on a night shift, call are made, agencies tried, until replacement staff are found. Yet, in the community sector, people are often not replaced when they are on holidays and community mental health teams remain with places unfilled, to correct budget deficits. Institutions run by the public sector are also being replaced by the private sector. Partly this is driven by the lack of responsiveness of the old public sector, but also there have not been many wars lately in terms of ones involving western societies and the need to rebuild nations. There is therefore a lot of capital looking for a return. The market has looked at getting some of the money that the public sector has. So they want to run things, getting taxpayer money to do so. The profit sector says it has so much better expertise than the 'not for profit sector' that it can deliver better services than the not for profit sector at the same price. Many feel however that the human side is lost, much as the human side is lost as the professions are forced to be more money-conscious. Also non-government organisations are subject to whims of fashion and funding that ensures that they deliver what the political masters demand, even if this is a servile compliance, with no advocacy. Many resources are wasted in repeated short-term funding applications, and big organisations are favoured, as the government finds then easier to deal with as there are fewer contracts and someone else is dealing with the problem of organising services in small or distant communities. But it was ever thus. Small organisations way from the mainstream have always had a hard time getting funding. With increasing demands on charities, the ethos of 'business is all', and fundraising being increasingly professionalised, the more grass roots organisation are having a hard time competing. But consumer pressure must be used to keep them funded on the grounds of their being able to deliver more appropriate services. But my key point is that times are changing and organisations are able to capitalise on that. People want services in the community, so institutions will have to transfer resources and new methods of delivery will have to be found. Results are paramount so it is up to consumers and clients to make a noise. If services are not delivered, at least the flexibility of services now, and the short-term contracts give the opportunity for a change in resource allocation formulae, as contracts are only for a few years. The times are changing. This can be seen as a bad thing, or it can be seen as a good thing. It is better seen a neutral. It is the way things are and it will favour groups that can adapt to it, and lobby within it. The bureaucracies must please their clients to survive; the professions are no longer sacrosanct. The managers are starting got the blame for not solving the problems, and people sick of money being everything. People understand that everyone has the right to a decent life, and no one is expected to go into an institution to get it. The NSW Mental Health report found that more community-based NGOS are needed, which was similar to the report into de-institutionalisation of disabled people. So if pressure is intelligently maintained, mental health can get a larger share of resources, and these can be community-based. Step up, and Take Control."

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