Mental health commissions are a mess and we're suffering

Inconsistencies among our mental health commissions are hurting the well-being of Australians and making it difficult to achieve necessary reform, writes Simon Katterl.

IT’S BECOME a truism of progressive politics to lament our lost decade on climate action. I would argue this applies just as well to mental health policy.

For mental health policy to be effective, governments must make effective decisions based on sound evidence. Mental health services and governments need to be assessed and monitored for the quality of their performance. They need effective players to guide and deliver the system and strong umpires to monitor the rules of the game.

For many of us in the mental health sector, Australia’s mental health commissions were hoped to play a key role. However recent revelations about the potential poor performance and culture within the National Mental Health Commission’s operational leadership point to broader concerns many of us on the coal-face and in policy have about all mental health commissions. Namely, they’re not very effective.

Except for Tasmania and the Northern Territory, all Australian jurisdictions contain some form of mental health commission. Despite similar names, these commissions (or offices in the case of the A.C.T.) have many inconsistencies.

Mental health reforms dying at the altar of politics

An announcement by the Victorian Government of a new mental health commission is worthless when mental health laws are being routinely broken.

For example, New South Wales, Queensland and the A.C.T. tend to focus more on informing strategic planning of the mental health system, while the Western Australian Commission has a more prominent role in funding decisions, with the Victorian Commission having a yet different role in regulating mental health services. Some commissions, such as the Victorian and Queensland commissions, are created as independent statutory bodies, while others such as those in Western Australia and the Commonwealth are creatures of existing health departments.

This level of inconsistency amongst commissions is both a product and producer of policy paralysis in Australia. Nobody knows what the other is doing, it is difficult to compare them and they have done little to coordinate national reform amongst governments.

Despite the many differences, these commissions have common challenges and critiques.

Independence is high among them. The National Mental Health Commission had originally been intended as an authority to monitor government and mental health system performance. But former chair Allan Fels recently reflected that it gradually eroded into an internal advisory branch of government. The new South Australian Government has committed to reinstating a full-time commissioner after this had been broken up by the previous government.

Another issue is credibility with the community. All commissions talk a strong game on the importance of lived experience, but their approach to it often appears ad hoc. Appointment processes for commissioners appear opaque and the potentially toxic work environment revealed in the National Mental Health Commission raises questions about its authority to advise on workplace well-being.

People living inside our mental health system must not be left outside its reform

For too long, people with lived experience of mental health have been excluded from policy discussions, like the upcoming debate over Medicare rebates.

Other shortcomings relate to enforcement. The Victorian experience is instructive in this context. With sweeping powers to protect human rights and ensure compliance with mental health laws, the Mental Health Complaints Commissioner never issued a single compliance notice against services across 14,000 complaints and nine years of operation (as of 2023). This, despite evidence that rights were breached with such regularity as to render them ‘illusory’.

Resolving these issues should start with simple questions, like what are mental health commissions for? Are they there to advise government, or are they there to hold governments and mental health services accountable? In most cases, governments have preferred the former. It may be time that we shift to the latter, while uplifting their department’s ability to do the former. We should not fool ourselves into thinking that commissions can do both — you can’t play and umpire the game at the same time.

Whatever we do on this front, serious thought should be given to coordination amongst governments to enable some degree of consistency. Shared venues for commissions in different jurisdictions to speak authoritatively as one should also be prioritised. Doing so would allow us to better link cross-portfolio and cross-jurisdictional social policies that impact mental health, such as income support, housing, discrimination, family violence and climate change.

One thing is unavoidable: if we are to improve the mental health and well-being of Australians, the National Mental Health Commission will need to be provided – and then step into – its power. To date, successive mental health plans (now in its fifth iteration) have been ignored by state and territory governments in a cost-free political environment. A truly robust and independent national mental health commission should be able to speak to the public about the under-performance of governments on the mental health policies that impact it.

Taking this step may feel unnatural to governments. Shining a light on one's performance creates obvious political risks. But it is only in this space between government, the sector and independent accountability that real innovation and reform can occur.

EDITOR'S NOTE:

The following response to this article was received on 4 May 2023 from Chair Commissioner, Mental Health and Wellbeing Commission, Treasure Jennings:

Although the MHCC is not a regulator and doesn't have full system oversight, we work to safeguard the rights of consumers through the complaints and investigations process. The new Mental Health and Wellbeing Commission will play a pivotal role in achieving that, backed by stronger legislation through our new Mental Health and Wellbeing Act to give our new Commission the powers they need to launch investigations and manage complaints.

Simon Katterl (he/him) is a mental health and human rights advocate with lived experience of mental health issues. He has advised government ministers and legal and mental health services. You can follow Simon on Twitter @simonkatterl.