Full version - Living Well: A Strategic Plan for Mental Health in NSW 2014 - 2024 PDF (6.2 MB)
Living Well - Accessible version PDF (1.27 MB)
Living Well - Easy English version PDF (5.8 MB)

Commissioner's message

For most of us, most of the time, our lives centre on our own activities, thoughts and feelings, and on our interactions with parents, partners and children, friends and neighbours, employers and colleagues, and those who share our interests.

Our work, community and family lives are full of richness and texture, and they support and sustain us, just as the people in our lives draw reciprocally on our strength and experience.

This is as true for those of us who live with mental illness.

Living Well sets out directions for reform of the mental health system in NSW over the next 10 years. These directions build on those extraordinary strengths we find in individuals, families and communities and hope to supplement them, when requested, with services which respect people and offer them support in ways they find helpful and that fit well with their lives.

It maps a demanding agenda for change that puts people – not processes – at the heart of its thinking.

It insists on principles of social equity: that at any stage of life, whatever our culture, wherever we live and no matter what other health or social difficulties may complicate our lives, we are equal citizens who should expect to find high quality, timely mental health support in our community when we need it.

It demands that we not wait for a crisis. Plenty of strong evidence tells us it is possible to promote good mental health in our community and prevent much mental illness, particularly in young people. And if the signs of distress are already apparent, the course of illness can be improved if we get in early to offer support before people’s lives are badly affected.

It asks that the NSW Government recommit to completing the process of reform begun with the Inquiry into Health Services for the Psychiatrically Ill and Developmentally Disabled (Richmond Report) in the 1980s by taking two important steps. We must close the remaining stand-alone psychiatric institutions and shift the focus of mental health care from hospitals to the community.

The broad case for reform, told from the perspective of people whom it affects, is presented in the NSW Mental Health Commission’s Living Well: Putting People at the Centre of Mental Health Reform in NSW: A report, which is a companion report to this Plan, Living Well: A Strategic Plan for Mental Health in NSW 2014 – 2024 and should be read in tandem with it.

Aboriginal ideas of community, family and social and emotional wellbeing resonate powerfully as we prepare for a new generation of mental health reform. Aboriginal communities celebrate the connections among people and the strength and resilience that grow in communities when those connections are properly honoured. These ideas have been a touch point throughout the development of this Plan and underpin many of its directions even when this is not described explicitly.

Many positive changes are already under way. In NSW, government agencies and community organisations are enthusiastically embracing new approaches that acknowledge that people who experience mental illness can and should expect to live well on their own terms, in their own homes, and be empowered to make their own choices.

But we must recognise that there is strenuous work ahead to reorient a system that has emphasised hospital beds for too long at the expense of other forms of support offered in or close to people’s homes. Our supports are still, in many places, inflexible, ineffective, outdated and under-resourced, and often do not join up well when people’s needs are complex and continuing. The situation is made all the more complex by the lack of clarity about state and Commonwealth responsibility for funding and service quality.

Across Australia it is recognised that for many years governments have underinvested in mental health, particularly in community mental health. The scale of this is reflected in the fact that 14 per cent of the impact of all illness can be attributed to mental illness but mental health expenditure accounts for only 8 per cent of the NSW Health budget. While this is a crude measure, it accords with other estimates of the service gaps and underspending on mental health services.

We can see with hindsight that this underspending on community activity was in part because the hospitals were and remain such a powerful centre of gravity. They have been and continue to be in NSW and Australia more broadly the main locus of funding and the centre of professional careers. And because they are more expensive than community support, they have sucked funds out of other programs in a selfperpetuating loop.

This experience tells us we will need to drive change much harder if we are to make it stick. But in the present economic climate we know there is no promise of significant additional investment in mental health in the short term. In fact the Plan comes at a time when Commonwealth and state governments are looking for substantial savings to cope with forecast exponential growth in costs associated with demand for other hospital services and the needs of our ageing population. So we will need to do things differently: more efficiently and more innovatively.

The good news is that if we can improve mental health and wellbeing we can boost productivity and greatly reduce the high service and transaction cost to government and the human cost to our society of failing to prevent mental illness and failing to keep people well in the community. And there is much that we can and must do.

In NSW Health, we will need to put our money where our mouths are – committing growth funding to community mental health and ensuring that funding intended for community mental health demonstrably gets there.

Across government services, a shift of focus is required, from crisis-driven responses towards prevention and early intervention. The lifetime costs for the individual, community and government of not responding appropriately to issues as they emerge are well documented. We must recognise that mental health is inextricable from the patterns of our lives. Our psychological wellbeing is a continuous thread that runs though our education, work, social relationships and communities.

Consequently, action will require co-ordination and co-operation across those services that contribute to the mental health and wellbeing of children and young people and their families.

This is a strategic plan for mental health in NSW. It does not directly govern the operation of services but instead lays out directions and principles for reform which agencies and service providers must find ways to embed in the supports they offer to people in our community.

As an overarching plan, with a strong vision at its centre, this document cannot and does not replace the need for continuous planning and improvement at local and statewide levels. Excellent work is already in progress in many areas that are contained within or directly affect the mental health sector in NSW. Living Well does not replace that work; rather it gives context to, and sets person-centred directions within which to pursue such projects.

Living Well also cannot fully anticipate major changes to the environment in which these reforms will roll out. The National Disability Insurance Scheme, which will expand support choices for people with disabling mental illness, and activity-based funding, which will change how health funding flows from the Commonwealth to NSW, are two important examples of national initiatives with the potential to change significantly the lives and experiences of people in NSW.

Living Well sets a 10-year vision and describes the initial set of actions required to lay the groundwork for change within the mental health sector and our approach to mental health and wellbeing. It also provides a solid basis for a continuing engagement with service providers across a full spectrum of government and community activities, and the community itself.

Living Well will need to be revisited in the next two to three years to refocus activity on the next priorities. But now is the time to act on what we know. It is first a matter of basic fairness, but there will also be a dividend for the whole community when we achieve it.

John Feneley
NSW Mental Health Commissioner

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Last updated: 29 April 2019