Council of Non-Government Organisations on Mental Health

Briefing Paper, December 2012

Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

Prepared by the Mental Health Council of Australia on behalf of the Council of NonGovernment Organisations on Mental Health, December 2012.
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Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

Introduction
The past twelve months has seen the culmination of a number of significant reforms in mental health in Australia, including the establishment of the National Mental Health Commission, the Council of Australian Governments (COAG) recent release of its Ten-Year Roadmap for Mental Health Reform and the handing down of the countrys first ever Report Card on Mental Health and Suicide Prevention. At the same time, mental health services are undergoing substantial reform, including the National Disability Insurance Scheme, the introduction of Activity Based Funding, Partners in Recovery, Medicare Locals and the new Hospital and Health Networks. Yet there are growing concerns that the direction of reforms may not be resulting in significant improvement in the lives of Australians affected by mental illness. On 9 October 2012, the Mental Health Council of Australia and the National Mental Health Commission hosted Australias inaugural Council of Non-Government Organisations (CONGO) on Mental Health in Canberra. The aim of the CONGO was to bring together senior representatives from leading organisations across the mental health, employment, housing and social welfare sectors to discuss how Australias non-government organisations can foster a better integrated, better coordinated response to mental health. The gathering committed to establishing a national vision for Australia to lead the world in mental health by 2022, so that within 10 years Australia is acknowledged internationally as a world leader in mental health services, programs, and outcomes. Since the CONGO meeting, there have been significant developments in mental health at the national level which are likely to create important opportunities for CONGO members to effect lasting impact on both the national reform agenda, as well as on the lived experience of people affected by mental health issues. Launched in late November 2012, the National Mental Health Commissions first Report Card on Mental Health and Suicide Prevention has identified the substantial gulf between our aspirations for people living with mental illness and the reality of their day-to-day lives. The Report Card presents a snapshot of Australias current position and takes a whole-of-life approach, looking at physical health, employment, relationships, education, housing and homelessness, community participation, family and child support and social justice issues for people with lived experience of mental illness. In early December 2012, COAG released its long-awaited Roadmap for National Mental Health Reform, the implementation of which will be set out in more detail in the successor to the Fourth National Mental Health Plan (due for completion by mid-2014). An Open Letter to COAG, co-signed by 70 leading mental health and social services organisations across Australia, has ensured that additional work will be undertaken by COAG members to develop effective targets and indicators to guide the implementation of the Roadmap, as well as embed those targets into the new National Mental Health Plan.

Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

For its part, CONGO has identified areas where we could set targets to measure and guide mental health planning and service delivery, as well as a broader set of actions and principles which it plans to develop further before putting to COAG members in 2013. This paper captures the range of issues agreed by CONGO members at their October meeting, as well as key findings and implications arising out of the Commissions Report Card and COAGs Roadmap. The purpose of this paper is to inform the establishment, in early 2013, of a national leadership group to take forward a reform agenda on behalf of CONGO members. It is necessarily the work of the leadership group to establish priorities and directions for future work from the range of issues presented to date by CONGO members, as well as make choices regarding the merits of priorities and targets raised by the abovementioned government-led initiatives. This paper does not pre-empt decisions and future directions which may be set once the leadership group is established. At the October meeting, CONGO members agreed to re-commit themselves to placing people with lived experience at the forefront of policy formulation, service design and evaluation. The notion of consultation was acknowledged as having inherent limitations, and CONGO has therefore agreed that new models of inclusion of people with lived experience, including more proactive collaboration and negotiation, are to be explored. The CONGO leadership group will demonstrate the application of inclusive values and principles inherent in the Collective Impact1 approach as it undertakes its important work in 2013.

Developing an Agenda for Change

CONGO members overwhelmingly agree that gains in new spending and the re-prioritisation of mental health by governments has not, as yet, resulted in lasting improvements for people affected by mental illness or their carers. The change is still too slow and the demand for services still significantly more than we can provide for people who need them. Fragmentation and a lack of coordination across the many systems that people need are uppermost in the range of factors impeding potential gains in new spending and slowing momentum towards successful outcomes for people with lived experience. A lack of coordination between NGOs, businesses, governments and within jurisdictions is leading to fragmented decision making and lack of clarity regarding respective roles and responsibilities. As a result, service delivery remains uneven and inequitably spread across Australia. In this environment, the need to address socioeconomic factors in health and social care is an aspiration as yet unrealised.

Collective Impact is a model for mobilisation of stakeholders to achieve collective goals and social change through crosssectoral coordination, as outlined in the Stanford Social Innovation Review at http://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work?cpgn=WP%20DL%20%20Channeling%20Change

Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

Importantly, CONGO members expressed that there are still too few meaningful ways to include people with lived experience as advocates and peers within the mental health system and this is further compounding perceptions that services are not catering to the needs of mental health consumers or their carers. Table 1 summarises key issues for mental health reform raised by CONGO members that will undergo further analysis and consideration in 2013 by the CONGO leadership group. These issues are accompanied by preliminary targets established as part of the development of the Open Letter to COAG, presented to the Prime Minister, Premiers and Chief Ministers ahead of the 7 December COAG meeting. A more detailed listing of these issues can be found in the CONGO Meeting Communique at Attachment A. Further background and context in relation to these issues can be found in the CONGO Meeting Report here.2 The Open Letter to COAG can be viewed here.3

2 3

http://mhca.org.au/index.php/component/rsfiles/download?path=Publications/CONGO%20on%20Mental%20Health%20Meeting%20Report.pdf
http://mhca.org.au/index.php/component/rsfiles/download?path=Publications/Open%20Letter%20to%20COAG%20on%20Mental%20Health%20Targets.pdf

Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

TABLE 1 KEY ISSUES FOR MENTAL HEALTH REFORM IDENTIFIED BY CONGO MEMBERS Key Issues for Mental Health Reform
Suicide prevention and early intervention

Basis for Future Targets

By what percentage do we intend to reduce the annual number of suicide deaths over the ten year life of the Roadmap? What proportion of our overall investment will be made in early intervention and prevention activities? What do we determine is a reasonable waiting time for people who need access to services? How quickly do we intend to close the gap in life expectancy between people living with mental illness and the rest of the community? What is our expectation of social participation for people who are living with mental illness? How many people do we intend to house in stable and secure housing in the next ten years? How many people living with mental illness will be assisted to find meaningful and productive employment over the life of the Ten-Year Roadmap? How many people experiencing mental illness will be supported to complete education? To what degree will we reduce stigma and discrimination in the community related to mental illness? How quickly do we intend to close the gap in mental health and suicide prevention outcomes between Aboriginal and Torres Strait Islander people and the rest of the community? Target areas to be identified Target areas to be identified Target areas to be identified

Creating effective mental health services and maximising access to them Life expectancy and the interplay between physical and mental ill-health for people who live with mental illness Social inclusion and participation

Access to affordable and stable housing

Participation in worthwhile and supportive employment

Participation in education

Addressing mental health stigma, discrimination and awareness

Improving the mental health and social and emotional well-being of Aboriginal and Torres Strait Islander people Economic independence and income support for people affected by mental illness Creating a central role for people with lived experience in Australias mental health system Systems issues in mental health, including; care coordination models of funding building an evidence base workforce development, including peer workers collaboration in mental health

Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

Importantly, the key issues for reform raised to date through the CONGO process align closely with those identified by the National Mental Health Commission in its first ever Report Card on Mental Health and Suicide Prevention, A Contributing Life. Table 2 summarises the Report Cards key recommendations and actions. The full Report Card document can be downloaded here.4 TABLE 2 RECOMMENDATIONS AND ACTIONS IDENTIFIED BY THE 2012 REPORT CARD ON MENTAL HEALTH AND SUICIDE PREVENTION Recommendations
There must be a regular independent survey of peoples experiences of and access to all mental health services to drive real improvement. Increase access to timely and appropriate mental health services and support from 6-8 per cent to 12 per cent of the Australian population. Reduce the use of involuntary practices and work to eliminate seclusion and restraint.

Actions
The Commission will undertake a regular national survey of people with mental health difficulties and their families and support people. The survey will consider access to services, as well as perceptions and experiences.

All governments must set targets and work together to reduce early death and improve the physical health of people with mental illness.

Include the mental health of Aboriginal and Torres Strait Islander peoples in Closing the Gap targets to reduce early deaths and improve wellbeing.

All governments must agree and meet the target proposed in the Fourth National Mental Health Plan Measurement Strategy that 12 per cent of the population should be able to access mental health services in a year. There must be agreement to this indicator with an implementation plan and investment strategy to achieve this. All jurisdictions must contribute to a national data collection to provide comparison across states and territories, with public reporting on all involuntary treatments, seclusions and restraints each year from 2013. The Commission will call for evidence of best practice in reducing and eliminating seclusion and restraint and help identify good practice treatment approaches. Enduring mental illness must be given the status of a chronic disease to give it higher national focus and support. The physical health needs of people with mental health problems need to be given a higher priority in all areas of health. The initial focus must be on rapidly reducing cardiovascular disease by reducing risk factors such as smoking, poor diet and by increasing physical activity for people living with mental health problems. All government funded mental health related programs must also be measured on how they support people to achieve better physical health and longer lives. Priority should be given to the financing of multidisciplinary primary care (through GPs and other primary health care organisations). All relevant services must give priority to tracking both the physical and mental health needs of those with enduring mental illness. Mental health must be included as an additional target in the COAG Closing the Gap program. This must be done through the development and implementation of an Aboriginal and Torres Strait Islander Mental and Social and Emotional Wellbeing Plan to commence in 2013. This must also address the current work and future findings of the Aboriginal and Torres Strait Islander Suicide Prevention Advisory Group. Training and employment of Aboriginal and Torres Strait Islander peoples in mental health services must increase. There must also be better support for Aboriginal and Torres Strait Islander families. There must be regular reporting on progress.

http://www.mentalhealthcommission.gov.au/our-report-card.aspx

Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

Recommendations
There must be the same national commitment to safety and quality of care for mental health services as there is for general health services.

Actions
All governments must agree that there is the same emphasis on improving the quality of care and reducing adverse events in mental health services as applies to other physical health services. Governments must commit to implementing nationally agreed and mandatory service standards in mental health services as they have done for other health services. The Commission will work with the Australian Commission on Safety and Quality in Health Care (ACSQHC) to identify issues affecting the uptake of national mental health service standards and make them mandatory. Increase enhanced and personalised support for parenting through culturally relevant forms of home-based visiting (ante-natal and in the first few years of life). These must be provided at a local or regional level. There must also be active follow-up where a family is under stress or experiencing tough financial or social difficulties. The Commission will form a Taskforce, including industry, government and community leaders to actively promote effective employment support programs and workplace based programs that increase the participation in employment of people with mental health difficulties. Employment support programs, initiatives and benefits must be more flexible. Programs must provide long-term support for the employee, families and support people and the employer, with appropriate incentives and milestones. All governments must implement and report regularly on the existing COAG commitment of no exits into homelessness from statutory, custodial care and hospital, mental health and drug and alcohol services for those at risk of homelessness. Discharge planning must consider whether someone has a safe and stable place to live. Data must also be collected on housing status at point of discharge and reported on three months later, linked to the persons discharge plan. Governments must commit to removing any structural discrimination barriers to people with mental health difficulties accessing social housing. Just as important is providing support to help vulnerable residents to settle in, adjust and remain in their homes. Develop local, integrated and more timely suicide and at-risk reporting and responses. These should be coordinated, community based, culturally appropriate, early response systems and suicide prevention programs. They should promote community safety, reach the most vulnerable, and use up-to-date information from the first responders such as Police officers, occupational health workers, ambulance officers and mental health workers. Programs with a proven track record (which are evidence-based) must be supported and implemented as a priority in regions and communities with the highest suicide or attempted suicide rates action needs commitment and a humane approach.

Invest in healthy families and communities to increase resilience and reduce the longer term need for crisis services. Increase the levels of participation of people with mental health difficulties in employment in Australia to match best international levels.

No one should be discharged from hospitals, custodial care, mental health or drug and alcohol related treatment services into homelessness. Access to stable and safe places to live must increase.

Prevent and reduce suicides, and support those who attempt suicide through timely local responses and reporting.

Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

Clearly there are links between the Commissions priorities for action and those identified by CONGO members which will be investigated further by CONGOs national leadership group. The Report Cards recommended actions also provide opportunities for CONGO to influence issues through new mechanisms to be established by the Commission, such as the establishment of a national taskforce to investigate ways to improve employment participation and the economic independence of people affected by mental illness, and the proposed national survey of people experiencing mental health ill-health and their families. It is anticipated that the CONGO leadership group will undertake an assessment of those elements of the Report Card which most support its own identified priorities, and identify which actions to be undertaken by the Commission can be utilised over time to support those priorities. On 7 December 2012, the Council of Australian Governments released its Roadmap for National Mental Health Reform 2012-2022. In an Open Letter more than 70 mental health and social service organisations urged the Prime Minister, Premiers and Chief Ministers to consider adopting measurable targets in the Roadmap. COAG has since announced that it will establish mechanisms to develop in more detail the priorities and strategies outlined in the Roadmap. These mechanisms will also be tasked with developmental work in the leadup to the drafting of a new National Mental Health Plan, expected to be finalised by mid-2014. Priorities for action identified in the Roadmap include: Priority 1: Promote person-centred approaches Priority 2: Improve the mental health and social and emotional wellbeing of all Australians Priority 3: Prevent mental illness Priority 4: Focus on early detection and intervention Priority 5: Improve access to high quality services and supports Priority 6: Improve the social and economic participation of people with mental illness. The 45 strategies which underpin the six priority areas are very broad in scope and will require a great deal more clarification and detail in order to effect change across mental health planning, policy development and service delivery contexts. Encouragingly, COAG acknowledges the need for further work, as well as the need to more fully engage a broader range of stakeholders in the implementation of the Roadmap and in the development of the new National Mental Health Plan. Of particular note is COAGs announcement regarding the establishment of two new groups with clear responsibilities to maximise the effectiveness of key elements of the Roadmap and make preparations to guide the drafting of the next National Mental Health Plan. A new Working Group on Mental Health Reform will be formed to ensure a high-level, national body is overseeing the detailed work on mental health reform, and that all levels of government are accountable for achieving change over the next ten years. The Working Group will report to COAG and be co-chaired by the Commonwealth Minister for Mental Health and a Minister nominated by states and territories.

Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

The Working Group has been tasked with responsibility for: 1. Improving access to data 2. Developing indicators of change 3. Setting targets for reform 4. A successor to the Fourth National Mental Health Plan. In addition, the Working Group will settle, by the end of 2013, which aspects of the Roadmap the National Mental Health Commission will report on in its three yearly reports to COAG which document progress towards achieving the Roadmap Vision. Monitoring of progress will be focused on long-term change at the national level, reflecting the ten-year span of the Roadmap. A preliminary set of eleven performance indicators and three contextual targets is outlined in the Annex to the Roadmap which will be further refined by the abovementioned Working Group by late 2013. Briefly, those targets and their proposed measures include: A society that better values and promotes good mental health and wellbeing Knowledge of and attitudes towards mental health issues and mental illness in the community, measured by the National Stigma and Mental Health Literacy Survey, reported for the Fourth National Mental Health Plan. A society that maximises opportunities to prevent and reduce the impact of mental health issues and mental illness Readmission to hospital within 28 days of discharge, reported as the percentage of in-scope overnight separations from public acute psychiatric inpatient units (state and territory data collections). Consumer experience of mental health services, reported as the percentage of consumers who are satisfied with the services received within the past 12 months (ABS Patient Experience Survey). Levels of accreditation against the National Mental Health Standards (National Minimum Data Set reported for the Fourth National Mental Health Plan and the Report on Government Services). The percentage of the population receiving clinical mental health services (Medicare Benefits Scheme, Private Mental Health Alliance and state/territory data, as reported for the Fourth National Mental Health Plan and the National Healthcare Agreement). Number of individuals receiving Commonwealth Government care co-ordination services (Partners in Recovery Program). Use of mental health services in prisons (National Prisoner Health Census). A society that supports people with mental health issues and mental illness, their families and carers to live full and rewarding lives Participation rates by people with mental illness in education and employment (National Health Survey, as reported for the Fourth National Mental Health Plan). Participation by carers of people living with mental health disorders in the labour force and the community (Survey of Ageing, Disability and Carers). Physical health of people with mental illness (National Health Survey). Housing status and experience of homelessness among mental health consumers (Fourth National Mental Health Plan, measure under development).

Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

In addition, three contextual indicators will provide important information that will help to frame and interpret the indicators listed above, but which are not considered suitable for assessing reform over time. Consequently, these indicators will not be used to measure progress against the Roadmap Vision directly. This is either because the relationship between government performance and changes in these indicators is unclear, or because data on these indicators is collected too infrequently to enable accurate measurement of change over the life of the Roadmap. The contextual indicators selected are: The rate of service use by people with mental illness The prevalence of mental illness in the community, where prevalence is regarded as the percentage of the population who have met the criteria for diagnosis of a recognised mental illness in the past 12 months an important consideration in assessing levels of access to services and in service planning The rate of suicide in Australia, as suicide accounts for approximately 1.6% of deaths in Australia, and people with mental illness are at greater risk of suicide than the general population. It could be argued that these contextual indicators can indeed be used to assess reform over time, and they are likely to be further considered by CONGO in 2013 in that context. The development of effective targets, which reflect what the broader community sees as critical to the success of Australias mental health reform agenda, will be a key area of work for CONGO in 2013. This work will open the possibility of collaboration with a broader range of stakeholders, including the private sector, in order to provide a whole-of-community balance to those priorities and targets set by governments. Recognising the importance of working in collaboration with the sector, including mental health consumers and carers, COAG will also establish an Expert Reference Group to work alongside and assist the Working Group. The Expert Reference Group will be chaired by the National Mental Health Commission and will consist of one nominated representative from each jurisdiction, such as a mental health commission nominee or representative, a representative of a peak body or advisory group, or a consumer or carer group. The establishment of the Expert Reference Group represents an ideal opportunity for CONGO to channel the outcomes of its deliberations into COAGs mental health reform planning during 2013, through Ministers on the overarching Working Group, and directly through a presence on the Expert Reference Group. Representation in this new CAOG advisory structure will be pursued by CONGO in 2103.

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Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

Implications for CONGO

There has been a great deal of movement on mental health at the national level since CONGO met in October, 2012. Both the Report Card on Mental Health and Suicide Prevention and the Roadmap for National Mental Health Reform offer significant opportunities for the non-government sector to offer its expertise in relation to policy, planning and service delivery issues under consideration at the national level and by states and territories. Clearly, a shift towards a more outcomes focussed approach to evidence is being considered as part of key mental health reform initiatives at the national level, and CONGO has undertaken to lobby both COAG and relevant Commonwealth agency heads to help guide this shift. Beyond measures of success and accountability however, there are other issues which are not necessarily best dealt with through the development of performance indicators and reporting schedules. It will be incumbent on the work of CONGO to demonstrate to governments that there are ways by which these more qualitative indicators of wellbeing can be accounted for within a performance based mental health framework. A great deal of goodwill towards a mutual agenda and shared set of priorities was expressed across organisations present at the inaugural CONGO meeting, which was in evidence again during the recent process of developing an Open Letter to COAG. Several of the new government-led initiatives mentioned above are due to report or deliver within the next 12 months. Given this, 2013 offers a unique window of opportunity within which the nongovernment sector will need to astutely direct its shared agenda in order to drive longer-term tangible and measurable improvements in the lives of people with mental illness and those who care for them. A first order priority may also be an extensive mapping exercise to determine where to begin in terms of comprehensive NGO-led responses to improved integration, coordination and collaboration, examining connectors across the system rather than cataloguing individual services.

Our Collaborative Approach

Experience has taught us that in fact the only way to get lasting solutions to complex problems that stick is for all stakeholders to collaborate to invent innovative solutions.5 In line with the commitments made at the October CONGO meeting, the new CONGO national leadership group will explore innovative models of engagement framed by the Collective Impact key elements as it seeks to achieve system-wide change. As important as inclusive and participatory values are, they must be demonstrated in action in order for the non-government sector to show leadership and deliver change that truly reflects the needs of people with lived experience of mental illness.

www.ssireview.org/pdf/collective_impact

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Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

The Collective Impact frameworks five elements were developed by researching what actually works to generate lasting change in large complex systems, which is why these elements will frame our approach. In addition we will draw on best practice tools and disciplined approaches to enable us to co-design solutions. We will adhere to the AA1000 Stakeholder Engagement Standard 20116 and apply international best practice in participation practices such as the IAP2 Public Participation Spectrum7 and an Appreciative Inquiry8 approach to ensure inclusivity, responsiveness and accountability to all stakeholders. We will look at innovative processes to ensure all angles have been thought of in the solutions we develop. There is no doubt that the level of change CONGO has ambitiously articulated is going to require long term commitment of all stakeholders across sectors and jurisdictions. The change proposed is complex and will require collaboration between many stakeholders to agree on the nature of the dilemmas and what solutions could look like. Sometimes these solutions will have to be invented, as they currently do not exist and this is going to require cooperation, collaboration and input from many. No single person, organisation, sector or entity has the solution to these complex issues, which is why they have challenged us for so long. People with mental illness and their carers have been on a long journey of change to achieve parity of access to services, which is why this next stage is critically important to get right. To be part of co-creating a shared solution we want to ensure that all stakeholders can fully participate in the process. In order for stakeholders to be willing to work in a collaborative way, advocate for themselves and those they support, share their thoughts and help define the problems, they must be confident that their contributions will be seriously regarded, that they will be provided with the space and time to develop innovative solutions and that this will lead to change that is implemented. This approach will be a deliberate departure from other less inclusive consultation processes that stakeholders may have experienced. For this reason the process will require new levels of commitment to a determined focus on outcomes for people with a mental illness and their carers and a willingness to engage in this change even when it gets difficult.

6 7

http://www.accountability.org/standards/aa1000ses/index.html https://www.iap2.org.au/sitebuilder/resources/knowledge/asset/files/36/iap2spectrum.pdf 8 http://appreciativeinquiry.com.au/

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Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

FIGURE 1 THE BACKWARDS LOGIC OF COLLABORATION

FIGURE 2 TWYFORDS 5-STEP MODEL OF COLLABORATIVE GOVERNANCE9

Further information on the Twyfords model available at www.twyfords.com.au/collaboration/collaborative-governance

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Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

FIGURE 3 AN OUTLINE FOR THE CONGO LEADERSHIP GROUP ACTION BASED ON COLLECTIVE IMPACT

Next Steps
The Mental Health Council of Australia will initiate a process in early 2013 to form a national leadership group to further progress the important work of systems reform as agreed by CONGO members in October this year. Once established, it is expected that the national leadership group will further refine a change process and timeframes for collaboration with CONGO members. Once solutions have been developed we will seek opportunities to impact decision making at the national level, with a particular focus on the intergovernmental machinery of COAG. Secretariat support for the national leadership group will be provided by the Mental Health Council of Australia while issues of ongoing sustainability are being considered. Further details will be made available to CONGO members as soon as practicable in the New Year.

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Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

ATTACHMENT A Council of Non-Government Organisations (CONGO) on Mental Health Communique Canberra, 9 October 2012
About the CONGO
On 9 October 2012, the Mental Health Council of Australia and the National Mental Health Commission hosted Australias inaugural Council of Non-Government Organisations (CONGO) on Mental Health in Canberra. The aim of the CONGO was to bring together senior representatives from leading organisations across the mental health, employment, housing and social welfare sectors to discuss how Australias non-government organisations can foster a better integrated, better coordinated response to mental health. Ninety non-government organisations attended the CONGO meeting, with keynote presentations by Robyn Kruk, CEO of the National Mental Health Commission, who presented on the progress of the Commissions National Report Card on Mental Health and Suicide Prevention; Frank Quinlan, CEO of the Mental Health Council of Australia who gave an overview of current responses to mental health in the Australian context, and; Dawn ONeill AM, previous CEO of Lifeline and beyondblue, who detailed the international experience of independent organisations working together toward shared objectives using the Collective Impact approach. A key outcome of this first CONGO meeting was a commitment by those organisations present to form a national leadership group to collaborate more effectively in order to drive better mental health outcomes for all Australians, no matter who they are and where they live.

Issues we identified
Government factors - Fragmented, short term policy environment - Ad hoc consultative processes - Fragmented service delivery system funding activities rather than outcomes - Chronic underfunding, particular outside acute settings NGO Factors - Fragmented services - Limited influence over policy and funding environment - Workforce development a significant challenge - Funding environment creates barriers to collaboration and integration - Organisations are working on a shoe-string budget - Difficulty maintaining access to information about practice and policy trends - Reliant on evidence collected by government, which often does not align with or reflect NGO programs.

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Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

Opportunities to deliver a better coordinated response

Closer alignment between NGO and government agenda Longer term policy agenda Longer term funding models built on outcomes rather than activities Stronger evidence base and culture of continuous service improvement for work across the sector.

Our commitments to each other

To develop and commit to common goals for a better integrated response to mental illness To foster a greater exchange of information between NGOs To collect mutually agreed data sets focussed on outcomes and value To commit to collaboration, in spite of government policy promoting fragmentation.

Our challenges to COAG

To commit to long term growth in investment in mental health To develop structures that allow engagement with the NGO sector at the highest level To commit to consultation and engagement in the policy development process To commit to a long term policy agenda and funding models around outcomes rather than activity To more closely align the national research agenda with policy objectives and outcome indicators in mental health To agree to ambitious but achievable targets that drive improvements in mental health services and outcomes.

Conclusion
In many fields, Australia is already a world-leader in mental health, be it the work of beyondblue, Headspace, the Early Psychosis Prevention and Intervention Centre, Inspire, VicHealth, the Brain and Mind Research Institute and so many other organisations working at the national and local levels. Taking a strengths based approach, members of the CONGO called for the establishment of a national vision for Australia to lead the world in mental health by 2022, so that within 10 years Australia is acknowledged internationally as the world leader in mental health services, programs, and outcomes. The CONGO agreed to form a leadership group and within six months identify priority issues for action and suitable measures by which to track progress. Chief among those issues are: a reduction in national suicide rates by 50% by 2022 improved employment, social housing and income support outcomes for people with mental illness, including that 40% of people with mental illness have access to meaningful employment by 2022.

In order to achieve this, CONGO attendees agreed to re-commit themselves to placing people with lived experience at the forefront of policy formulation, service design and evaluation. The notion of consultation was acknowledged as having inherent limitations, and CONGO has therefore agreed that new models of inclusion of people with lived experience are to be explored, including more proactive collaboration and negotiation.

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Council of Non-Government Organisations on Mental Health Briefing Paper, December 2012

In order to capitalise on the momentum underway as a result of the CONGO meeting, the following actions were agreed by participating organisations: 1. A commitment by those organisations present to form a national leadership group and within six months, identify priority issues for action and suitable targets and measures by which to track progress. 2. Agreement by all to re-commit themselves to placing people with lived experience at the forefront of policy formulation, service design and evaluation. 3. An undertaking to lobby both COAG and relevant Commonwealth agency heads to seek assistance in the development of more robust sources of data and evidence to support more informed approaches to mental health. A first order priority may also be an extensive mapping exercise to determine where to begin in terms of comprehensive NGO-led responses to improved integration, coordination and collaboration, examining connectors across the system rather than listing individual services. Immediately following the CONGO meeting, a group of organisations joined to form a consortium to develop a bid under the Capacity Building component of the Partners in Recovery initiative, with a view to making a direct and positive impact on the delivery of more coordinated care to people experiencing severe and persistent mental illness. The formation of this consortium represents a tangible first step by the NGO sector to work towards meaningful improvements to the lives of people affected by mental illness across Australias mental health system. The Mental Health Council of Australia and the National Mental Health Commission will release a discussion paper later in 2012, outlining in more detail options and suggested approaches to the broad commitments made at the CONGO meeting, with a view to establishing a national leadership group to progress this important work in early 2013.

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