Dr Anthony Llewellyn's speech to MHWA Conference 22 June 2005

There has been a successive and systemic ignoring of the mental health of our nation by our Federal Government, our State Governments and by ourselves the people, Dr Anthony Llewellyn at the Mental Health Workers Alliance Conference in Sydney, 22 June 2005.

The full text of Dr Llewellyn's speech follows.

Speech to Mental Health Worker's Alliance Conference, June 22nd
Sydney Masonic Centre (Corner Castlereagh and Goulburn Streets)

Good Morning. And thank you to everyone for joining us today.
My name is Anthony Llewellyn, I am a Psychiatrist working in the NSW Public Mental Health System and I am a member of the Health Services Union.

Today, I would like to give you some information about the Alliance, how and why it was formed, what our activity and success has been up until today and how we see it progressing in the future.

Firstly, I would like to thank the Minister for his interest in the Alliance. One of the key successes that Alliance has had so far is meeting regularly with the NSW Government, via Ms Cherie Burton, The Parliamentary Secretary for Health, to give her the "inside running" on how our mental health systems are failing in NSW. One of the key goals of the Alliance is to ensure that the truth is told about our mental health system and having an opportunity to directly talk to Government means that what is happening on the ground is not lost through the filtering processes that occur as Managers report upwards through their Area Health Services to NSW Health and then to Government.

I know from our discussions with Ms Burton and what we have heard from the Minister today that there is a genuine interest in ways of improving the mental health system in NSW.

But. And there is always a but. Talk is cheap. And there has been much talk. There are and continue to be many enquiries, reports, recommendations and working parties. The problem, however, is as plain as the nose on anyone's face.

There has been a successive and systemic ignoring of the mental health of our nation by our Federal Government, our State Governments and by ourselves the people. No wonder we have reached such a point after years and years of good will, great intentions and fine speeches but ultimately neglect.

The solution is equally as obvious.

We need to devote more resources to addressing the mental health of our people.

We need to spend more money on mental health issues.

We need to train and employ more workers and continue to support their learning and respect the tough work that they perform on our behalves every day.

We need to set up an extensive network of supported community accommodation options for our severe mentally ill and get them off the streets, out of the prisons, police cells and acute hospitals and treat them with the respect that they deserve.

We need to ensure that crisis care and a familiar face is available when and where people need it 24 hours a day.

We need to ensure that when someone needs a bed in hospital it is available and they don't sit in an emergency department for 3 days waiting for one.

We need to ensure that patients have the time they need to recover in hospital so that they don't have to return again or are left fending helpless for themselves in the community.

What is required is leadership and real investment to answer the failures in our Mental Health System

The very serious problems in the mental health system are not due to a failure of policy, but the failure of Australian governments to implement policy.

It's been almost 15 years since all Australian Government's signed on to the National Mental Health Strategy.

The central reason for the stress on the mental health system is that the burden of mental illness and associated disability is not matched by investment in prevention, care and rehabilitation.

• Mental illness accounts for nearly 30% of non-fatal disease burden

• Mental health is third after heart disease and cancer in terms of disease burden

• National spending in mental health services is 6.4% of total gross recurrent expenditure on health care.

The NSW Government is proud of its increase of $241 million to the mental health sector over the next four years. We at the Alliance acknowledge that this is action and not talk. But it is clearly a start only.

$241 million extra over 4 years is a small addition to a chronically starved section of NSW Health and we think it will ultimately go to propping up already over stretched existing budgets and not produce any real change.

The current NSW Health Budget is $10.9billion. Spending on mental health is only $854million. This is only 7.8% of overall spending on health. This is far short of the 12% of budget recommended by the Alliance.

From an economic point of view this under funding makes no sense at all. It is estimated that in a developing country like Australia only 50% of the population have access to even a basic level of mental health care when they need it and by basic I mean seeing a GP for some medication.

It seems unbelievable to me that Health bureaucrats would muster arguments about how mental health has to compete for the overall health dollar when mental health interventions:

• Are well established,

• Have good evidence base

• Are easily implemented

• Are low cost and low technology

• Are holistically based

• And have the potential to have a huge impact on population health.

This is much more cost-effective than "implantable defibrillators", new MRI machines and other machines that go ping.

ABOUT THE ALLIANCE

The Mental Health Workers Alliance has been established by the NSW Nurses
Association, the Police Association of NSW, the Australian Salaried Medical
Officers Federation (NSW), the Health Services Union NSW, and the Australian
Services Union (NSW) in response to ongoing concerns among our members about the entrenched resource deficits in mental health services across NSW.

We first met in mid 2004 and immediately went about forming a strategy and developing a charter for Government.

We undertook a survey of 600 mental health workers in NSW. It revealed that frontline health, police and emergency workers were being forced to take large chunks of time away from their core work duties to care for mental health patients.
The responses showed that a lack of dedicated resources was causing massive problems for people living with mental illness and for those workers left to pick up the pieces.

From our feedback from workers we released a Charter outlining a five-step program for a saner mental health system, as follows:

1. Appropriate funding for mental health by increasing the mental health proportion of the State health budget to at least 12%, as recommended by the Mental Health Council of Australia, and for mental health expenditure to be transparent and quarantined.
2. Better resourcing for long term supported accommodation options for all people with mental illnesses, including homeless people.
3. Increasing the capacity of inpatient units and community services to guarantee 24 hour access to those in need of treatment.
4. Appropriate crisis care, including 24 hour mental health expertise in emergency departments and community teams, to alleviate pressure on front line emergency services.
5. Addressing the problems of recruitment and retention in the sector by providing incentives to enter employment, enhancing access to training schemes, and providing support for learning and development opportunities.

We launched our Alliance and Charter. We met with Government and politicians. We briefed the media and held the launch of our Alliance October last year. We set about establishing networks of concerned workers and we agreed to meet with Government to directly discuss our concerns.

Over a short period of time we have been very bust and a summary of our activity includes:

• The worker survey

• Producing a pamphlet to inform members and the public about the alliance and its activities

• Launch of the Alliance with full range of media coverage

• Establishing quarterly meetings with the Parliamentary Secretary

• Establishing a website on LaborNet

• Articles in Newspapers, including the Sydney Morning Herald pointing out shortages in St Vincent's 24hour Mental Health Service

• Radio Interviews, including participating in a Triple J Hack week long series on mental health issues

• Various Letters to the editor of Newspapers

• Politics in the Pub

• A submission to the Senate Inquiry into the Cornelia Rau incident and Mental Health generally

• A press release praising the NSW Government for some good initial steps in the last budget but calling on it to deliver real investment into the mental health sector

WERE TO FROM HERE?

We feel that it is important that the Alliance involve as many frontline workers as possible. We are seeking your assistance in further progressing the aims of the alliance by forming local networks of active workers to identify short-fallings in the system and advocate for change.

The more people we bring on board and the more we influence our local communities, the public and ultimately the politicians, the more progress we will see.

Our unions have supported the Alliance because they are genuine in their wish to improve worker conditions in mental health. It is now up to us frontline workers to take the initiative and grow the Alliance.

Thank You

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