16 August 2017

It is five years since the Mental Health Commission of NSW was established in response to the tireless advocacy of people whose lives are affected by mental illness. It is also the end of my own term as Commissioner.

At this threshold point in our journey I want to take a moment acknowledge everyone who has travelled the road with me. As I look back over these five tremendous years it is quite staggering to see how much we achieved together, from a standing start. Central, of course, is the Commission’s delivery on behalf of the NSW community of Living Well: A Strategic Plan for Mental Health in NSW 2014-2024, and the Government’s acceptance of its person-centred agenda. 

A year of achievements

Beyond Living Well, the projects in which the Commission has been involved are far too numerous to mention, and so I would like to focus just on the work we have done over the last 12 months. It was a year of landmark achievements that illustrate the very best of this small agency – we are still fewer than 30 people – and its skill at scaling up good ideas through partnerships and alliances to make a disproportionately large impact.

At the invitation of the Premier and the Minister for Mental Health the Commission led the development of a Mental Health and Wellbeing Strategy for First Responder Organisations in NSW. The Commission’s unique independent status allowed us, in partnership with the Black Dog Institute, to bring first responder agencies together - including the police, ambulance fire services and volunteer organisations - into a conversation to make this commitment. The strategy, and accompanying video resources, provide the basis for individual agencies to strengthen their support of these key workers who give so much to the community and are exposed in the process to traumatic situations that can have an enormous impact on their own mental health. I am exceptionally proud that the Commission was able to make this contribution to the wellbeing of these community heroes.

Two years in the making, the Commission hosted the International Initiative for Mental Health Leadership (IIMHL) Exchange in February and March 2017. It was a great honour to bring this truly global event to Sydney, in partnership with the Ministry of Health. The connections made through a series of two-day meetings across Australia and New Zealand under the IIMHL banner offered NSW mental health professionals exceptional insights that help them implement positive, person-centred practice aligned to Living Well: A Strategic Plan for Mental Health in NSW 2014-2024.

Sydney contributed a number of innovations to the IIMHL program, including a hugely successful satellite meeting on Urban Planning for Health and Wellbeing hosted by the Greater Sydney Commission, which attracted participants from cities all over the world, including London, Vancouver, Philadelphia and Mumbai. This meeting was an illustration of a key Commission belief: that good mental health is fundamentally about how we live well in our communities, much more than how we respond to illness.

It was a particular pleasure for the Commission, in partnership with the National Mental Health Commission, to bring emerging leaders - from all over Australia and from disciplines as diverse as peer work, occupational therapy and social work to psychology and psychiatry - into a special two day leadership training program and also to participate in the IIMHL conversations. 

Our Check-up from the Neck-up events were another highlight. They bring mental wellbeing conversations into some of the most public spaces – like Martin Place in central Sydney, Chatswood Mall and the Royal Easter Show – helping people who may need support but also demonstrating a powerful truth: that mental health is an issue for all of us, at any time and in any place.

The year also marked the completion of the phased transition of the Institute of Psychiatry (IoP) from a separate enterprise to become a central element of the Health Education and Training Institute. This was the Commission’s first review, undertaken at the request of the Minister in 2013, and work towards this staged transition has progressed since then. It ensures IoP’s unparalleled understanding of the development of psychiatrists and other mental health professionals in NSW is retained and applied within a modern education framework. 

Reform that really matters

In just the last month we have launched three publications that consider particularly challenging issues relating to mental health.

The Commission’s Review of transparency and accountability of mental health funding to health services, describes in detail for the first time how the continuing transition towards activity-based funding (ABF), which follows the 2011 National Health Reform Agreement between the Commonwealth Government and the states and territories, is being applied to mental health services. The report also highlights what additional action is required in NSW if we are to make the most of the new funding mechanisms at both the Commonwealth and state level. The report is important because it should increase understanding of the funding system and the confidence of clinicians and the community that the state’s investment in mental health is being appropriately applied in this complex new environment.

Towards a just system: mental illness and cognitive impairment in the criminal justice system details opportunities to reorient our responses to some of the most vulnerable people in our community, who deserve support and early intervention for their complex challenges. Failure to provide appropriate services for people with mental illness and cognitive impairment is taking a huge financial and social toll, with too many ultimately coming into contact with the criminal justice system. Everyone stands to gain if we focus on helping people to live a contributing life instead of isolating them in the prison system, which compounds their problems.

Living Well in Later Life: The Case for Change and A Statement of Principles extend the universal objectives of Living Well and consider how they relate to older people; it is clear their access to good mental health and wellbeing is complicated by service gaps, generational misunderstandings and plain old discrimination. We can do much better by our mature citizens and these resources present a roadmap for change.

All three reports were the culmination of long and respectful engagement with partners across the mental health system, other government agencies and the community. They are emblematic of how the Commission works; we believe the process of deliberating, and refining our thinking through the views of others, is just as important as the final work. It is through these collaborations that we can be sure we are reflecting genuine issues and solutions that will make a positive impact in people’s lives.

Our shared journey

Now when I look back, it is clear how foundations and principles like these, which we set in the early days, have travelled with us and remained at the heart of the Commission’s best and most lasting work.

The Mental Health Commission Act, under which we were established, requires us to do something which is both obvious and radical: to always put people with a lived experience of mental illness at the centre, treating them with dignity and respect and insisting that the mental health system responds holistically to their needs. I believe we have honoured and amplified the wisdom of lived experience which is now deeply ingrained in policy and planning in NSW and is an essential touchstone in the Commission’s own work.

We have, I believe, reframed the mental health conversation in NSW, which is now oriented to the values reflected in Living Well. State agencies, local governments and employers are now able to talk in concrete terms about positive mental wellbeing. I am proud that our work is widely cited by others to make the case within and beyond their own organisations to move towards recovery-oriented, trauma-informed practices that are inclusive of the whole community.

Over the coming months the Commission’s work, and its Act, will be reviewed by the Government in accordance with legislation and usual practice. This review will shape expectations of the Commission for the years ahead, and will influence its priority activities and how it is able to work with other Government agencies.

It is my strong view that the objectives and functions set out in the Mental Health Commission Act will remain highly relevant until we have a service system that truly values everyone who seeks  help, invests in their recovery, and until human wellbeing is embedded deeply throughout policies and practices not just in health services but across the whole of government and the community.

Following the tragic events at Lismore Hospital and the Government’s announcement of a review into seclusion and restraint practices, I have called for the Commission to be given additional powers to require Government agencies to produce information. The Commission already has a statutory function to monitor, review and improve mental health services in NSW, but it cannot perform these roles fully when it does not have complete access to documents such as critical incident reports. This change, and a related requirement for Government agencies to respond to the Commission's recommendations, would allow the Commission in its next five years to fulfil its true mandate, honouring the experiences of the people who fought so hard for its creation.

I have been supported over these five years by a tremendous staff, who have brought skill, commitment and humanity to our fast-paced work program. I thank also the past and present Deputy Commissioners, whose particular insights and leadership have shaped the Commission’s identity. Catherine Lourey, now a Deputy Commissioner, will take the helm as Commissioner from August 18 and I wish her every possible success in guiding the Commission’s work to new heights in this next stage of the journey.

I thank our Community Advisory Council, who have been our reality-check for new ideas and have introduced many of their own, and I am grateful to the mental health services sector for meeting the Commission with an open mind and being prepared to join us in a new kind of dialogue.

Above all I thank the NSW community for caring about this work and so generously sharing their experiences as we work together for better mental health and wellbeing for everyone.

John Feneley

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Last updated: 15 August 2017