Policy Productivity Commission’s Mental Health Inquiry Report

Productivity Commission’s Mental Health Inquiry Report: Looking from the ATSICCHO Sector lens

The Productivity Commission (the Commission) has released a landmark mental health inquiry report on its findings of how to address the wideranging issues and gaps in Australia’s current mental health system.1

The Report, which is over 1600 pages, has documented longstanding problems within the system, including: dysfunctional approaches to the funding of services; a lack of clarity between governments about their roles leading to "persistent wasteful overlaps and yawning gaps in service provision"; under-investment in prevention and early intervention, tackling stigma and eliminating discrimination; and a disproportionate focus on clinical services. The Commission’s recommendations extend beyond just the health system and into sectors that are important for an individual’s social and emotional wellbeing and recovery, for example schools, workplaces, housing, employment and justice (pages 63–83). The Report presents a long-term plan to improve the mental health system in Australia. The reform agenda seeks to shape a person-centred, but flexible, mental health system by making changes under the following five areas: 1 Prevention and early help for people: Supporting people to improve mental health outcomes and reduce the need for future clinical intervention, by tackling early mental health problems and suicide risks. Empowering Aboriginal and Torres Strait Islander communities to prevent suicide attempts, provide follow up care for people after suicide attempts, and develop a national stigma reduction strategy. 2 Improve people’s experiences with mental healthcare:

Ensuring the care received is person-centred, timely, consistent with treatment needs and does not impose undue burden on consumers or carers. 3 Improve people’s experience with services beyond the health system: Recognising numerous gateways through which people enter the mental health system and a range of services beyond healthcare (specific to psychosocial services, housing and justice), that are important for an individual’s social and emotional wellbeing and recovery. This includes a commitment to not discharge from care into homelessness and to better support people with mental illness to recover and live well in the community. 4 Increase people’s participation in further education and work: Supporting people to remain engaged in education and employment; reforms are designed to support and enable people to reach their potential, to have purpose and meaning, and to contribute to the lives of others.

5 Instil incentives and accountability for improved outcomes: Reforming the behind-the-scenes arrangements and incentives to ensure services areas seamless, connected, and timely as possible. 6 The report has quoted QAIHC, NACCHO and other affiliate and ATSICCHO responses; and has incorporated actions that are specific to improving

Aboriginal and Torres Strait Islander peoples’ mental health outcomes. These include:²

Designating Aboriginal and Torres Strait Islander Community Controlled Organisations (ATSICCOs) as preferred providers of mental health services for Aboriginal and Torres Strait Islander people (action 23.6).

1. Australian Government, Productivity Commission (2020). Mental Health Inquiry Report. pc.gov.au/inquiries/completed/mental-health/report/mental-health.pdf 2. Australian Government, Productivity Commission (2020). Mental Health Inquiry Report. Mental Health Factsheet: Aboriginal and Torres Strait Islander people. pc.gov.au/ inquiries/completed/mental-health/report/factsheets/mental-health-factsheet-atsi.pdf

WITH GOVIND OJHA, SENIOR POLICY OFFICER, QAIHC

Empowering Aboriginal and Torres Strait Islander communities to prevent suicide though selfdetermination and local leadership by: • implementing a renewed Aboriginal and

Torres Strait Islander-led “National Aboriginal and Torres Strait Islander Suicide Prevention

Strategy and Implementation Plan” to guide suicide preventionin Aboriginal and Torres

Strait Islander communities (action 9.2) • ensuring ATSICCOs are the preferred providers of suicide prevention activities for Aboriginal and Torres

Strait Islander peoples (action 9.2) • providing culturally capable aftercare to anyone who presents to a hospital, GP or community mental health service following a suicide attempt (action 9.1).

Undertaking an evaluation of programs that use traditional healers, in partnership with conventional mental health services (action 8.3).

Expediting and resourcing the development of an implementation plan for the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023. Determining that development of this plan should be led by Gayaa Dhuwi (Proud Spirit) Australia (action 22.2).

Engaging Aboriginal and Torres Strait Islander peoples in discussions to develop any targets for key mental health and suicide prevention outcomes that may affect Aboriginal and Torres Strait Islander peoples (action 24.4), including targets to reduce the gap in life expectancy between people with severe mental illness and the general population (action 14.1).

The Commission has also recommended a regional governance approach that incorporates elements of both the ‘re-build’ and ‘renovate’ funding models proposed in the draft report. The recommended approach is for Primary Health Networks (PHNs) and Local Hospital Networks (LHNs) to be given another opportunity to work together to deliver regional planning. If they fail, the Commission then recommends state and territory governments impose a new regional commissioning model under their own legislation, with pooling of PHNcommissioned funds, state and territory community funding, and psychosocial support funding (outside of the NDIS) for that region, with regional planning to incorporate the provision of services from (un-pooled) Medicare and hospital funding (pages 1148–1156).

While the Report goes a long way towards identifying solutions that are needed in the mental health system, QAIHC has found that the report does not adequately address some key issues specific to Aboriginal and Torres Strait Islander peoples, such as institutional racism and connecting actions with the National Agreement on Closing the Gap priority reforms. The table below shows QAIHC’s recommendations and the extent to which each was addressed in the Commission’s final report.

QAIHC recommendations Level of inclusion in the final report Eliminate Some actions recommended, institutional racism however need further clarification and actions on addressing institutional racism

Mandate partnership with ATSICCHO’s to deliver culturally safe mental health services as preferred providers

Support improved service integration for sustainable mental health outcomes Some actions recommended. Some actions need more clarification

Some actions recommended, not adequate

Put greater focus on developing rural remote health workforce adopting a place-based approach

Effective monitoring and evaluation; and data sharing mechanism Some actions recommended, however very limited opportunity for ATSICCHO Sector capacity development

Some actions recommended, however lacking links with the National Agreement on Closing the Gap targets

If implemented in a timely and appropriate manner, the Commission’s report will drive necessary systemlevel changes that are imperative to meet the needs of Aboriginal and Torres Strait Islander peoples. Creating an effective and culturally safe mental health system will support targets identified in the National Agreement on Closing the Gap, specifically, target one (Everyone enjoys long and healthy lives) and 14 (People enjoy high levels of social and emotional wellbeing). However, more advocacy is needed to ensure the recommendations are implemented and that the reformed mental health system truly meets the needs of Aboriginal and Torres Strait Islander peoples.