National Mental Health Strategy - Future Challenges Meeting Broader Community Need

Keynote address delivered by the the Hon John von Doussa QC,
President, Human Rights and Equal Opportunity Commission at the Mental Health Foundation of Australia Annual Conference, University of Melbourne, 27th November 2003.


Introduction

Acknowledgments: Traditional owners; Minister; experts from different fields

Allow me to begin by acknowledging the traditional owners of the land on which we meet the Wurundjeri People of the Kulin nation of peoples.

I also acknowledge experts on mental health issues here from backgrounds in the community, government, medicine, law and other fields.

Wide range of expert presentations

As you will have seen, the program for this conference includes papers on a wide range of issues, including

  • Progress in implementation of the national mental health strategy
  • Mental illness and the law
  • Mental health of children and young people,
  • Aboriginal mental health issues,
  • Transcultural issues in mental health,
  • Issues for families and carers; and
  • presentations on specific areas including dementia and depression.

Why is a human rights commission President speaking here?

Amongst all this expertise, it is fair to ask why is the President of the national human rights commission – and particularly a President who has only fairly recently commenced in this role - here presenting the keynote speech to such a conference?

There is a direct, positive answer to that, and also an indirect answer.

Human rights as an important foundation

The positive answer is that human rights thinking provides an important foundation, which helps us to focus on whole people, i.e. comprehensively on all the component characteristics of each human being, and his or her place in the community. The importance of the human rights approach is shown by the significant contribution that Australia’s national human rights commission has made to policy and public debate in this area in the past.

Human rights emphasises the whole person

Human rights considerations add important dimensions to discussions in this area.

They serve as a reminder that a person with a mental illness is not only a recipient of services or subject of treatment, but a whole person, who is likely to be facing issues in finding or keeping employment and accommodation; who may also have other disabilities; who may have language or cultural issues in dealing with mental health services and related systems

Human rights is about participation

Ultimately, the point of all the work and thinking about plans and policies and services and treatment is to enable people affected by mental illness to exercise and enjoy their rights and freedoms as members of our community as fully as possible.

Human rights are for all of us

Human rights by definition apply to all people. There is nothing complex about the fundamental notion of human rights. Human Rights discourse is based on the simple proposition that we are all born free and equal, and are entitled to live with dignity and to develop our potential as human being. Human rights have particular importance for people who are less powerful in our society:

  • people who are subject to discrimination and prejudice;
  • people who are economically disadvantaged;
  • people who are less able than others to defend their own rights and interests.

Human rights agencies and human rights laws are sometimes criticised as being for the protection of special interests or minorities rather than for the whole community.

But in fact, human rights help to define the difference between a democratic civil society, and a society where the winners take all.

Human rights principles reinforce the functioning of democratic systems by emphasising accountability, and equality of access and participation.

Human rights protections are the protections which any of us may need at some time.

People are less ready to dismiss human rights as special rights for a minority when they suddenly find themselves or members of their family in that minority.

So one of the most important things we can achieve in community attitudes to mental health problems, and attitudes to disability more generally, is to have greater realisation and acceptance that these are not things that happen to “them” but to “us” as a normal part of being human.

Human rights as a last resort

The indirect response to the question about my role here today is one that I would give based on my time as a barrister and later as a Federal Court judge: As an advocate you only start talking about human rights almost as a last resort - when the laws and systems which you expect to be able to rely on are failing to deliver for the people you are trying to represent or serve.

Why are we still talking about human rights and mental illness?

Australia is a wealthy first world country with a highly developed health care system supported by billions of dollars of public money. In any area where we even have to talk about human rights in relation to health issues it means we know we are in trouble.

The disastrous health situation for indigenous Australians is obviously one such area. Unfortunately it seems that the position of people affected by a mental illness is also one where we still need to talk about human rights, even after ten years of national mental health policy reform and ten years after a national inquiry into human rights and mental illness.

Scale of mental health issues

It is important to remind ourselves of the scale of the issues involved when we talk about mental illness and human rights.

More than one in six Australians has a mental disorder

In 1998 the Australian Bureau of Statistics estimated 2,383,000 adults in Australia had a mental disorder - more than one in six.

This included 1,300,000 people with anxiety disorders; 778,000 with depression or other affective disorders; and 1,041,000 with substance use disorders. (Adding these numbers gives more than the total number of individuals affected but that is because some people had more than one mental disorder.)

The rate of mental disorders was highest in the 18 to 24 year old age group with a staggering rate of 27%.

The ABS did not have so clear a set of figures for mental health problems in children and adolescents as for adults. But it did indicate 20% of adolescents had significant mental health problems.

We should be shocked by discrimination against so many of our people

People who have spent years dealing with human rights issues, or with mental health issues, or both, may be used to the idea that such a large section of Australia’s population could be missing out on equality in access to effective health care or in other areas like employment and accommodation.

But we should be shocked by such a situation.

Human rights principles provide one set of benchmarks to set against the realities that people affected by a mental illness experience.

Role of Human Rights and Equal Opportunity Commission

Promoting compliance with human rights commitments

The role of the Human Rights and Equal Opportunity Commission is to promote compliance with commitments that the Australian Government has made on human rights through a number of international treaties and declarations, including the International Covenant of Civil and Political Rights, the International Covenant of Economic, Social and Cultural Rights, and the Declaration on the Rights of Disabled Persons.

These human rights principles do not implement themselves or automatically become a reality in people’s daily lives.

Principles in international law in general only become part of Australian law when Australian parliaments act to make laws translating those principles into rights and responsibilities within our legal system.

Also, for many, perhaps most, human rights issues, it is not simply a matter of making laws, but of building appropriate policies and services and putting resources behind them; and beyond that the still harder tasks of changing attitudes and prejudices.

Administering discrimination laws

The Human Rights and Equal Opportunity Commission does have important roles in administering enforceable legal rights in the anti-discrimination area, including the Disability Discrimination Act which applies to discrimination against people affected by mental illness whether directly or as families and carers.

Promoting awareness and influencing attitudes

Our major role is one of education to promote awareness of human rights and to seek to influence community attitudes.

One of the methods the Commission has used has been to conduct public inquiries on human rights issues, to provide a forum for people to contribute information and expertise and to seek to gain public attention for the issues raised.

National inquiry on human rights and mental illness

The best known involvement of the Human Rights and Equal Opportunity Commission in the mental health area of course has been the conduct of the National Inquiry into the Human Rights of People with a Mental Illness which resulted in a final report in October 1993 (“the Burdekin Report”).

The inquiry was carried out over several years including hearings conducted around Australia, hundreds of submissions and extensive research.

The report of that inquiry is now over a decade old. The report has been out of print for some time.

But because of the number of requests we continue to receive for this report, we recently added the findings and recommendations chapters to the materials available on the Human Rights and Equal Opportunity Commission website, www.humanrights.gov.au.

1993 findings appear to remain relevant

Unfortunately, it seems that interest in this report, and the findings and recommendations it made back in 1993, is not only from a historical or academic point of view, but because some of the major findings remain relevant and concerning today.

National inquiry emphasised positive rights

One of the important things about this report was the emphasis it gave to positive human rights – including rights to access to health care, rights to decent housing and an adequate standard of living, and adequate representation and protection in the criminal justice system.

Rights are interconnected

Human rights practitioners often assert the unity and indivisibility of human rights - the need not to neglect economic and social rights in pursuit of civil and political rights and vice versa.

The Commission's inquiry looked at what this means in practice, not as a matter of lofty theories but in the realities of the lives of people with a mental illness.

For example, the inquiry found many people with a psychiatric disability are denied the opportunity to obtain employment commensurate with their abilities and interests.

Apart from the role of work in self realization and sense of self worth, there is the practical economic importance of employment to consider. How in our society can a person who is excluded from employment secure for themselves an adequate standard of living - at least in the absence of more accommodating and generous income support arrangements?

Then there is the issue of housing. How does a person secure adequate housing, or any housing at all, in the absence of an adequate income? This is in addition to the need of some people with mental illnesses for associated support services to maintain stable accommodation

Previously, when talking about mental illness issues, human rights advocates had given most emphasis to human rights as negative or liberty rights – mainly the rights not to be detained or subjected to compulsory treatment without proper safeguards.

These rights remain important of course. But for a person with significant mental health problems, seeing human rights only as the right to be left alone could amount to giving people only the right to be homeless and ill or in danger of harm.

Main findings of national inquiry

Let me remind you of the main themes of the Commission’s 1993 report.

Widespread discrimination and denial of services

  • The inquiry found that people affected by mental illness suffered from widespread systemic discrimination and were consistently denied the rights and services to which they are entitled.

Education needed to change community attitudes

  • The inquiry recommended a major government effort to redress negative community attitudes towards people with a mental illness.

Money saved by deinstitutionalisation was not going into adequate community services

  • It found that although the movement towards community care and mainstreaming of mental health services had reduced the stigma associated with psychiatric care, in general the money saved by deinstitutionalization had not been redirected into mental health and related services in the community.
  • Health services and other services which would enable people with a mental illness to live effectively in the community were found to be seriously under funded or in some areas just not available at all.
  • Crisis services were also found to be inadequate.
  • Treatment and discharge planning was found to be in need of major improvement.

Education needed for service providers to perform changed roles

  • Mental health professionals and allied staff working both in institutions and the community were found to require education and training in the delivery of community based services, and needs for improved education and training were identified throughout the sector.

Additional resources needed for prevention

  • The inquiry also recommended added emphasis in health budgets for prevention and for mental health research.

NGOs carrying burden without adequate funding

  • Governments were found to be relying increasingly on NGOs to provide services but to be treating NGOs as peripheral in the allocation of funds.

Lack of suitable supported accommodation

  • Accommodation for people with a mental illness was found to be particularly inadequate, with government housing support programs either excluding people with mental illnesses or failing to address their specific needs. The inquiry found that the absence of suitable supported accommodation was the single biggest obstacle to recovery and effective rehabilitation.

Discrimination in employment

  • In the employment area, people affected by a mental illness were found to be disadvantaged by negative attitudes, a lack of awareness of means of accommodating employees with a psychiatric disability, and by inadequate vocational and rehabilitation services.

Families inadequately supported

  • Families and carers were found to be badly overstretched and insufficiently supported. As well as improved crisis facilities and other community mental health services the Inquiry recommended better information for carers and greater provision for involvement in decisions.

Inadequate services for women; children and young people; non-English speaking people; indigenous people; and people with additional disabilities

  • Mental health services for children and young people were found to be seriously under developed. There were also recommendations for improvements in services for women.
  • The inquiry also made recommendations on culturally appropriate services for Aboriginal and Torres Strait Islander people and people from non-English speaking backgrounds.
  • Specialist services for the many thousands of Australians affected by mental illness and some other form of disability were found to be almost non-existent, and services in either the mental health or disability sectors to be inadequately prepared to deal with the needs of this group, with the result that people with dual or multiple disabilities were often bounced from agency to agency without finding anyone who would assume responsibility for care or support for them.

Human rights breaches in the criminal justice system

  • The inquiry found that mentally ill people detained by the criminal justice system are frequently denied effective health care and human rights protection. Procedures for detecting and treating mental illness and disorder in the Australian criminal justice system were found inadequate in all jurisdictions.

Need for improved accountability and service standards

  • The Inquiry recommended consistent accountability mechanisms and service standards.

Need for law reform

  • Laws regulating mental health services were found to be badly in need of reform.
    • On one hand, laws failed to recognise sufficiently the principle of applying the “least restrictive alternative” and gave wide discretionary powers of detention without sufficient provision for review of decisions for detention or compulsory treatment. Yet on the other hand there was inadequate provision for treatment as a voluntary patient, much less a recognised legal right to access treatment.
    • Laws providing safeguards regarding hospital treatment generally failed to extend to community treatment.
    • The relationship between the administration of mental health law and guardianship law was found to need further development to provide for appropriate decisions to be made on behalf of people at times when they lacked capacity to make their own decisions.
  • The inquiry also recommended removal of discriminatory restrictions on access to some government programs, and the enactment of protection against discrimination on the grounds of psychiatric disability in any jurisdictions which lacked that protection.

Actions following from the inquiry – the national mental health strategy

That really is only a very brief skim through the findings and recommendations of the Inquiry.

But I hope it has been enough to serve as a starting point for reflection on what has changed for the better since 1993 and what has not, and what remains to be done.

Limited scope for follow up by Human Rights Commission

I have not come here with an audit report prepared by the Commission on the implementation of its inquiry recommendations, however timely such a report could be. In the time since the Inquiry, the Human Rights Commission has had limited ability to continue a detailed monitoring role on mental health issues.

Effective implementation of human rights, in relation to mental health and in other areas, also requires that human rights be taken on as the responsibility of the mainstream agencies which control resources and policy agendas and deliver services, rather than being seen as mainly or solely the responsibility of a small human rights agency.

Importance of National Mental Health Strategy

Some of the most significant and lasting effects of the Commission's inquiry were in its contribution to the development of a national mental health strategy.

The Strategy defined the directions for reform of mental health policy and services and established a framework for collaborative effort between Commonwealth, State and Territory Governments to pursue these directions over a six year period.

The Strategy was under negotiation before the inquiry reported, but was clearly influenced by the impact the inquiry had on perceptions and policies.

Response to decades of neglect

Let me quote for a moment what the Mental Health Council of Australia said on the history of mental health reform in their report earlier this year “Out of Hospital, Out of Mind”:

In 1992, the Australian Health Ministers committed their governments to correct decades of neglect in mental health.

A national mental health policy was developed and mechanisms were described to: lift Commonwealth and State expenditures; reduce human rights abuses; move the locus of care from hospitals to the community; and, deliver quality mental health within the mainstream of Australian health and welfare services

In 1993, the Human Rights Commissioner’s Report (‘Burdekin Report’) brought the human rights issues of overt abuse within institutions, and covert neglect in the wider community, to the attention of the general public.

For the next 10 years, Australian governments implemented two five-year plans aimed at: facilitating genuine participation for consumers and carers; developing high quality community-based mental health care; and, outlining a broader population-based health promotion and disease prevention approach.

This new national focus, on a long-neglected health area, assumed that all governments would invest additional dollars in the exercise. Those persons in need of mental health services, and their families, greeted these national commitments with great enthusiasm and expectation. Everyone assumed that real change required not only large increases in resources but also promotion of genuine national leadership and widespread professional and community support.

Increased resources

It must be acknowledged that increased resources for mental health and related services did in fact accompany the new approach. In particular, the Commonwealth Government allocated funds for the first time specifically for mental health services. Federal initiatives in response to the national inquiry report included $200 million over 4 years for services either directly targeted at, or providing substantial benefit to, people affected by mental illness.

Legislative reforms

Legislative reform was an especially important element of the Mental Health Strategy.

Reform of mental health laws

An evaluation of Australian mental health legislation was conducted by an independent consultant in 2000 for the Australian Health Ministers Advisory Council, by reference to a "rights analysis instrument" based on international standards.

This evaluation shows that there has been significant progress. Every state and territory has amended or is amending its mental health legislation to move away from an emphasis on detention to a model based more properly on human rights – although the same evaluation showed that no Australian jurisdiction had achieved full compliance with the United Nations Principles for Protection of Persons with Mental Illness and for the Improvement of Mental Health Care 1991. These principles were developed at an International level at around the same time as the Burdekin Inquiry was taking place. HREOC was involved in the formulation of these principles.

Protection against discrimination

An important legal development around the same time as the release of the Commission’s national inquiry report was the commencement of the national Disability Discrimination Act, 1992 which came into force on 1 March 1993.

This Act includes mental illness in its definition of disability. It applies to discrimination on the basis of a mental illness which a person had in the past or which is imputed to a person. It also applies to discrimination against carers or other associates of people with disabilities. The Act makes discrimination unlawful in a wide range of areas of life, including employment, education, accommodation, access to premises and provision of goods and services.

All State and Territory jurisdictions – except South Australia - now also cover disabilities from mental illness within their equal opportunity or anti-discrimination laws in broadly similar terms to the national Disability Discrimination Act.

Less progress on psychiatric disability discrimination than some other areas but numerous positive outcomes for individuals

A recent draft report by the Productivity Commission on the effectiveness of the Disability Discrimination Act found that the Act had been less effective in promoting equality for people with psychiatric disabilities, and also for people with intellectual disabilities, than it had been in achieving progress for people with sensory or physical disabilities.

It is true that the major achievements through the Disability Discrimination Act which are most readily identified have been in improved physical and communications access, including standards on access to public transport (now in force); upgrading of building access requirements (almost completed).

However, I would not want to discount outcomes which have been achieved through thousands of individual complaints, including by people affected by a mental illness. These complaint outcomes are discussed in much more detail on our website and in a publication which we issued for the tenth anniversary of the Disability Discrimination Act, “Don’t judge what I can do by what you think I can’t.”

Has the picture improved since the national inquiry?

In summary, it would be possible to draw a picture of the National Inquiry and the developments which followed from it as having transformed life for people with mental illness and their families: with increased emphasis on community care, improved legal rights and protections, and increased resourcing of services.

Continuing reports of crisis despite successes

And yet – despite a policy framework often described as world leading, and particular successes in legislative reform, ten years after the Human Rights Commission inquiry we continue to see reports from inquiries and evaluations describing a situation of ongoing crisis.

Let me read you some remarks from an editorial in the Australian newspaper last April:

Despite a swath of inquiries (such as the Burdekin inquiry of a decade ago), reports and recommendations, political leadership on mental health has been abysmal. …

De-institutionalisation, begun in Australian 20 years ago, solved the problem of abuse and neglect that became a feature of so many mental asylums. It also delivered significant cost savings to governments. But the mentally ill, and society as a whole, have lost out because the replacement support services have been woefully inadequate.

The personal, social and financial burden, meanwhile, has been shifted to families and other areas of the health, community services and criminal justice systems. … Charities are bearing the brunt of the crisis but they are ill-equipped to cope. Last year, they turned away 300,000 requests for emergency accommodation. As St Vincent de Paul said recently: "Dealing with Australia's social problems must not be left to community organisations alone." State governments, as a matter of urgency, must redirect or increase mental health resources – and that means more money – so there are more hospital beds, more psychiatric and psychological services, more nurses and more properly resourced community care. …

The call for a national inquiry into the state of mental health services in Australia should be heeded. But it can't be used as an excuse for more talk, and yet another glossy report that gathers dust while the mentally ill, and Australian society, suffer the consequences.

1992 NSW inquiry

As this editorial notes, there has been no shortage of inquiries on mental health issues.

Last December a NSW Parliamentary inquiry reported a range of concerns which bear a striking resemblance to those identified in 1993 by the Commission.

This inquiry found

Lack of adequate services and support for community living

  • a lack of adequate community mental health services and other supports to enable many people with mental illnesses to live successful in the community

Many people receiving no services

  • large numbers of people with a mental illness not receiving any services at all

Lack of support for families and carers

  • families and carers frustrated at a lack of access to help when asked for and a lack of provision for information or involvement in decision making
  • insufficient use of the guardianship model to provide for decision making in the mental health area

Insufficient emphasis on rehabilitation

  • little resources being directed towards rehabilitation

GPs providing most treatment but without adequate skills and supports

  • limited general practitioner skills in dealing with mental health issues and inadequate support for GPs from specialist services in delivering mental health care

Inadequate access to appropriate services for young people; people from non-English speaking backgrounds; indigenous people or people with a dual diagnosis

  • problems in services for young people, with young people being placed in adult wards for lack of other options;
  • access problems for people from non-English speaking backgrounds, with more information needed for consumers on availability of services and more information for providers on needs and issues for people from different cultures
  • a lack of culturally appropriate services for indigenous people
  • a lack of services for people with a dual diagnosis, particularly people with intellectual disabilities who have a mental illness

Unmet accommodation needs

  • unmet accommodation needs in the wake of deinstitutionalisation, with a lack of sufficient supported accommodation, so that crisis accommodation, unlicensed lodging houses and prison are still serving as accommodation for many people;

Problems with criminal justice system

  • a range of problems when people with a mental illness interact with the criminal justice system, including :
    • inadequate provision of alternatives to prison for people with mental illnesses, and hence either detention in an inappropriate prison environment or inappropriate release
    • insufficient provision of treatment for people once detained, despite a significantly higher proportion of prisoners than the general population having a mental health diagnosis.

“A new form of institutionalisation: homelessness and imprisonment”

The Chair of this Inquiry, the Honourable Brian Pezutti, said that

“Deinstitutionalisation, without adequate community care, has resulted in a new form of institutionalisation: homelessness and imprisonment”.

Positive initiatives but overall picture is too close to 1993 inquiry findings

These findings were made notwithstanding many positive initiatives which were reported on. It indicated an 18% per capita increase in mental health spending since 1992, and a significant increase over that time in the proportion of mental health spending going towards community services (41% compared to 30%).

Yet overall the picture from this and other reports seems all too close to that found by the Human Rights Commission inquiry ten years ago.

SANE Australia’s Mental Health Report 2002-03 for example said that “mental health services are in disarray around the country, (and) operating in crisis mode…”

National mental health plan evaluation findings

One of the great virtues of the National Mental Health Strategy is that it does include a degree of open evaluation and accountability. The evaluation of the Second National Mental Health Plan, published in March this year, noted some important limitations on implementation of plans and policies to date which help to explain the picture found in inquiries such as the NSW Parliamentary inquiry:

Aims of mental health plans appropriate but implementation inadequate because of failures in investment and commitment

The evaluation stated that:

progress has been constrained by the level of resources available for mental health and by varying commitment to mental health care reform. While the aims of the Second Plan have been an appropriate guide to change, what has been lacking is effective implementation. The failures have not been due to lack of clear and appropriate directions, but rather to failures in investment and commitment.

A shorter way of saying that might be that governments have not matched words with enough dollars.

Key conclusions of the evaluation were that

Insufficient benefits achieved for consumers and carers

  • the aims of the National Mental Health Strategy have not yet been fully translated into the expected benefits for consumers and carers

Additional resources insufficient to address unmet needs

  • while there has been growth in mental health expenditure, this has simply mirrored overall health expenditure trends and is not sufficient to meet the level of unmet need for mental health services;

Full participation for consumers and carers yet to be achieved

  • despite some progress towards improving consumer rights and consumer and carer participation, full and meaningful participation for consumers and carers has not yet been achieved, particularly in relation to individual treatment and recovery plans;

Community treatment options still inadequate, with NGOs insufficiently resourced for increased role

  • while community treatment and support services have been strengthened, community treatment options are often still unavailable or inadequate, with growth in resources to the non-government sector in particular not having kept pace with their increased role

Access to care improved but still not available as and where needed

  • although access to mental health care has been improved, consumers are still frequently unable to access mental health care as and when they need to
  • in particular, follow-up care into the community after hospitalisation for an acute episode is often lacking.

Mental Health Council of Australia report

Very similar conclusions can be found in the “Out of Hospital Out of Mind” report released by the Mental Health Council in April this year in the lead up to the Third National Mental Health Plan.

Despite efforts we do not have a system of effective or accessible mental health care.

This report states simply:

Despite the efforts of many committed politicians, government officials, service providers and community advocates, we do not have a system of effective or accessible mental health care.

Failure to turn innovations in policy and treatments sufficiently into practice

As with other reports, the Mental Health Council pointed to failure to turn innovations in policy and treatments sufficiently into practice, particularly in the areas of prevention, early intervention, mental health promotion and improved public awareness, as well as in developing better partnerships between specialist resources and the GPs and community services who are providing care to most of those people with a mental illness who are receiving any services at all

Insufficient financial commitment by governments

In a recent article in the Bulletin magazine the authors of this report point the finger directly at insufficient financial commitment by governments in Australia to turn policy into reality, stating that:

  • mental health services remain the poor cousin of health in Australia
  • our comparative position relative to other first world countries is declining
  • mental disorders account for 27% of all disability costs but attract only 7% of health funding, while other OECD countries typically expend 12-15% on mental health
  • New Zealand now spends twice as much per capita as Australian Governments, and three times as much as our largest state of NSW
  • the collective failure of State Governments to implement our national mental health policy during the 1990s now leaves the architects of that policy having to defend its most basic assumption, namely the value of community-based rather than institutional care.

Call for lifting mental health expenditure

The report calls for:

  • lifting mental health expenditure to at least 12% of total health expenditure (an increase of five percent) within five years, and dedicating resources to supporting innovation in services and treatment; and

Call for Improved accountability and review

  • improved accountability and review: including a heads of government agreement for reporting on progress against agreed service indicators and establishment of a permanent independent commission to report on progress of mental health reform in Australia and investigate ongoing abuse or neglect.

Call for national mental health commission

My colleague the Human Rights Commissioner wrote earlier this year to the previous Federal Minister for Health to support the need for a positive response by Government to the Mental Health Council of Australia report.

In particular, he urged serious consideration of the Council’s call for establishment of a national Mental Health Commission such as exists in New Zealand. He wrote that

there appears considerable merit in the Mental Health Council’s view that a national Mental Health Commission would be able to make substantial contributions to policy development, monitoring and accountability, and community education regarding mental health issues.

Government response to proposal for a Mental Health Commission

The former Minister responded that the concept of a national Commission of this kind was not transferable from New Zealand to Australia’s federal system.

Human Rights inquiries not a substitute

The Human Rights Commission hopes that this is not the last word on the subject, and that further room might be found for discussion of this kind of concept between government and the mental health sector.

The ability of the Human Rights Commission to conduct national inquiries is not a substitute for ongoing mechanisms for accountability, education and policy development.

That is not to deny the contribution made by the major national inquiry which the commission conducted in this area or the importance of human rights perspectives. But inevitably, the expertise and authority of a human rights commission on design and delivery of health services will be more limited than a body established specifically to focus on those issues.

We may get the failures of governments onto the front page – which can be a powerful factor in itself of course - but we may be less successful in moving the story on from there to get lasting results beyond the headlines.

Change in community attitudes and awareness

I want to come back to the point that the experience of people with a mental illness and their families is not determined solely by the effectiveness or otherwise of mental health services. Issues of stigma and discrimination have a large impact on mental health outcomes and on the ability of people to participate effectively in society.

If we do now accept – or still accept - that people with a mental illness should as far as possible be living and working in the community, there remains the question: how prepared is the community to accept and support people affected by mental illness?

Need for major investment in community awareness

Several submissions to the Productivity Commission inquiry into the Disability Discrimination Act emphasised that improved education and public awareness efforts are required to reduce discrimination against people with mental illness and their families. The same point is made in several of the mental health inquiries and evaluation I have referred to earlier.

One submission to the Productivity Commission made the point that education to achieve greater awareness and reduced stigma was as important in achieving access and equity for people affected by mental illness as the installation of ramps and lifts is for equal participation for people with physical disabilities.

The comparison of education and awareness with physical access measures indicates the importance of education but also the scale of the task.

Clearly the Human Rights Commission is not going to be able to go out and install ramps or lifts for every building to achieve physical access across Australia.

Likewise, the Human Rights Commission is not able to deliver itself all of the information and education needed to change community attitudes and awareness regarding people with a mental illness.

There seems great force in arguments that we need an ongoing awareness and information campaign on mental health issues on the same scale as road safety campaigns, to promote prevention and access to treatment and to combat stigma and discrimination. Such a campaign, however, requires serious resource commitments and leadership.

The Mental Health Council proposal for a national Mental Health Commission contemplated public education on mental health issues as a major function.

Possible Human Rights and Equal Opportunity Commission initiatives

At the Human Rights and Equal Opportunity Commission we are looking at what more we can do in this area.

Better information for employers; review of insurance guidelines; looking at partnerships with other organisations.

This includes looking at possibilities for more and better information for employers on accommodating workers affected by mental health problems, and reviewing our guidelines on discrimination in insurance.

It also includes looking at how we can work better in partnership with other organisations in industry, in the community and in government to provide information and promote awareness and changed attitudes.

In those tasks we would welcome your input and your criticism.

Conclusions

As I said earlier it is not the role of a human rights commission to present ourselves as the ultimate authority in place of community and professional experts or to sit in judgment on what you are achieving with limited resources and increasing demands.

In the Commission’s National Inquiry on human rights and mental illness, our aims rather were to provide a forum for the experience of people affected by mental illness, as patients, families, or carers, together with community and professional service providers; to seek to refocus debate in this area as involving matters of human rights; and to draw public and political attention to this experience as a means of promoting accountability and remedies where abuses or neglect of human rights were found.

It would be sad if after all that has been done in this area we need another national inquiry on human rights and mental illness, but it seems that many of the concerns raised by the report of that inquiry remain equally valid today. I would be very glad if, at least in some part, presentations from other speakers at this conference on mental health and related services prove those fears to be wrong.

Thank you.

Last updated 7 January 2004

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