Abstract
In a recent article in the Journal, Doessel et al. conclude that deinstitutionalization in Queensland was over before the National Mental Health Strategy was developed or implemented [1]. Their conclusion begs the question, Has the Strategy been a key driver for any meaningful change at all? Priebe and Turner describe reinstitutionalization where the number of forensic beds and compulsory admissions have risen, placement in private-supported housing has increased enormously (‘private madhouses’ to replace the asylums) and dilemmas exist in treating people in the community who do not want to be treated [2].
The Not For Service Report [3], while being somewhat destructive in its tone, does make some strong arguments for changes to our mental health system.
Hickie's important article outlines some of the obvious areas which could be improved [4]. The areas include implementation of world-leading innovations which have been developed in this country such as legitimate roles for consumers and carers and novel early intervention programs for young people with psychosis.
In the Foreword to the 2005 National Mental Health Report [5], the Secretary on Health and Ageing candidly admits ‘the question of whether the existing service con-figuration is appropriate to meet the demand for services, or whether a different service configuration is required remains fundamental’. He goes on to describe an impending revision of the National Mental Health Policy.
Many Australians believe that the past policies have failed us. We have slavishly followed international trends without recognizing the uniqueness of our system. We have brought in changes which have not shown clear benefits internationally. We have ignored our own sound and innovative ideas. We now have research data to show aspects of our Strategy have not driven change. Clinicians, academics, consumers and carers must now work with policy-makers to bring about sustained improvement to our mental health system as the time is clearly ripe.