Mental Health Leadership in a Changing World

www.cimh.unimelb.edu.au CIMH

Mental Health Leadershipin a Changing World

Harry Minas

Centre for International Mental Health

The University of Melbourne

Centre for International Mental Health www.cimh.unimelb.edu.au

Traditional role of psychiatrists

3% severe mental

disorders

• Psychiatrists have traditionally worked on providing the best quality clinical care to the people with the most severe mental disorders• In most countries this has meant a focus on hospital-based care for people with psychotic and severe affective disorders• Psychiatric training has focused on the development of clinical skills for this limited patient group• Psychiatrists have generally left policy and service design issues to others• Research (and research skills) has been focused on basic science of mental disorders and clinical interventions, with little interest in cost- effectiveness or in research on health systems


Expanded roles for psychiatrists

3% severe mental

disorders

20% total mental disorder

• Epidemiological work has increasingly focused on the high prevalence of depression, anxiety and other disorders in populations, on the high population burden due to these disorders, and the fact that most people with these disorders are untreated or poorly treated• In addition, problems with large mental institutions, and human rights concerns, have increased the pressure to move the focus from hospital-based to community-based systems• The role of psychiatrists has shifted from clinical specialist to leader of multi-disciplinary teams and negotiator with governments, families, clinician colleagues working in the community (such as general practitioners), NGOs, and other (non-health) sectors


Expanded roles for psychiatrists

3% severe mental

disorders

20% total mental disorder

Populationmental health

• A focus on population mental health requires that psychiatrists focus on mental health promotion, illness (and suicide) prevention, and early intervention• This requires a broader community leadership role and working with community groups, the media and governments


Leadership

The process through which an individual intentionally influences another individual or, more usually, a group in order to accomplish a goal.

Leadership involves defining and communicating a vision for the future, based on some core and explicit values, aligning people with that vision, and inspiring them to work to make it happen, despite obstacles.

Transforming the current reality into the imagined future.

Leadership is always focused on change, from how things are to how they ought to be.


Change

Change is constant What may have been acceptable in the past is less

acceptable now. Most people with mental illness:

receive no treatment are excluded from the benefits of citizenship

work, education, decent accommodation, respect

have their rights neglected or abused have no voice

decisions are made for them by others

Mental health service = Mental Hospital Now a wide range of different types of service are expected

to meet a wide range of different needs


Leadership

Effective leadership infects others with: Enthusiasm Energy Drive Confidence Determination Belief that the common goal of the group can be

achieved

The leader Articulates the group’s mission Gives clarity and direction to the activities of the

group Keeps the group focused and on track


Leadership - in its simplest representation

ETHICSService to others


COURAGEAct withsustained initiative

COURAGEAct withsustained initiative

Strategy

REALITYClearanalysis of currentproblems


VISIONCompellingimage of what is desirable and possible



Problem Definition

This is the most critical, and most neglected, part of achieving mental health system reform

Mental health is a low priority Indonesia spends 1% of the total health

budget on mental health (WHO Atlas 2005)

Mental illness has to become an important national problem Human rights Economic burden Barrier to social and economic development Key public health problem

Those who have the power to define what are the important problems get the resources Security, Global warming

There is not yet a sufficiently clear and coherent definition of the problem of mental health at national and international levels




Social and economic burden

We know that mental illness: accounts for a large proportion of the total burden

of disease, and that this proportion will increase is the biggest cause of disability imposes a huge economic burden on society in

terms of lost productivity, etc. can be a substantial a barrier to economic and

social development associated with descent into poverty


Public health problem

Mental disorders and mental health problems are risk factors for: Non-communicable disease

Cardiovascular disease Diabetes

Communicable disease HIV-AIDS

Injury Deliberate self-harm and suicide

Maternal depression and child development Child malnutrition, stunting, impaired development

Comorbidity Complicates help-seeking, diagnosis and treatment, and Adversely influences prognosis


Human Rights Problem

Is this what we wantmental services to be?

In many parts of theworld this isthe current reality


Solutions?

We have: a better understanding of mental illness than ever

before effective and affordable treatments evidence for what kinds of service are most

effective in meeting the needs of people with mental illness

evidence for what kinds of services people with mental illness, and their families, prefer

But: We are not making effective use of this knowledge

for the benefit of people with mental illness


Vision: What MH services should be

Mental Health Services should be: Effective - achieve clinical outcomes Appropriate - relevant to needs Efficient - cost-effective Responsive - protect rights & consider preferences Accessible and equitable - geographic and financial

accessibility, provided according to need Safe - for patients, staff, community Continuous - across time, programs, organisations Capable - knowledgeable and skilled staff

Is this vision shared by all relevant stakeholders?

or Do different stakeholder groups have very different

ideas about what the most important problems are and what a future mental health system should be?




Test of agreement on Vision for the future

If the national budget for mental health were doubled tomorrow what percentage of the additional money would you allocate to each of the following areas?

%

Building new mental hospitals

Improving the quality of care in existing mental hospitals

Establishing new general hospital inpatient psychiatry unit

Improving quality of care in existing general hospital inpatient psychiatry units

Expanding outpatient psychiatry clinics

Establishing community mental health services

Developing mental health care in primary health care services

Improving psychiatric rehabilitation services

Developing supported community accommodation

Strengthening consumer and carer organizations

Provision of community information/education about mental health and illness

Community mental health promotion programs

100


Leadership

The highest priority issues in developing a leadership strategy are: Defining mental health as an important problem for governments Achieving agreement among key stakeholder groups about the core

elements of the vision for the future Demonstrating that solutions are available and politically feasible

Strategy






Stakeholders

Governments Ministries of Health,

Finance, Social Services, Employment, etc.

General community Patients and their families Service Providers

Mental Health Professionals (and their associations)

Psychiatrists, Psychologists, Nurses, Social workers, etc.

General Health Professionals (and their associations)

Health Institutions Public and private hospitals,

Health insurance organisations (public and private), Pharmaceutical industry, etc.

Universities and training colleges

The mental health sector is very broad, with many stakeholders:


Stakeholders

Governments Ministries of Health,

Finance, Social Services, Employment, etc.

General community Patients and their families Service Providers

Mental Health Professionals (and their associations) Psychiatrists, Psychologists, Nurses,

Social workers, etc. General Health Professionals (and

their associations) Health Institutions

Public and private hospitals, Health insurance organisations (public and private), Pharmaceutical industry, etc.

Universities and training colleges

The mental health sector is very broad, with many stakeholders:

CoherentDemands


Stakeholders

The three key stakeholder groups that need to persuade government to improve mental health services are:

1. The general community (issues of community safety, cost of services to community)

2. People with mental illness and their families (issues of accessibility, quality and affordability of services)

3. Service providers (Mental health professionals are only a small part of this broad group)

A mechanism is needed for these groups to talk to each other, to discover what they agree about, and to put on hold what they disagree about Who will do this? ? National NGO with representation of all the key stakeholder groups An example is the Mental Health Council of Australia

If there is no agreement between the three groups (and the sub-groups within them) about what needs to be done then taking any action is a risk for governments

When there is no clear way forward governments will prefer to do nothing


Leadership

COURAGEAct with

sustained initiative

COURAGEAct with


Strategy

Taking sustained action to achieve agreement among key stakeholders about the core elements of the vision for the future is a key leadership task






Leadership



COURAGEAct with


COURAGEAct with


Strategy

Act with integrity in the interests of people with mental illness





Becomes the newReality - with newproblems to be solved

Taking sustained action to achieve agreement among key stakeholders about the core elements of the vision for the future is a key leadership task


Obstacles and Opportunities

A key obstacle to mental health system reform and development is the lack of a unified voice among key stakeholder groups about: What the most important problems are What the future mental health system should be

A key opportunity for psychiatrists is to lead in developing this consensus and in taking a common view to governments about what must be done

Documents

Mental Health Leadership in a Changing World