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National Mental Health
Strategy - Future Challenges Meeting Broader Community Need

Keynote address delivered
by the the Hon John von Doussa QC,

President, Human Rights and Equal Opportunity Commission at the Mental
Health Foundation of Australia Annual Conference, University
of Melbourne, 27th November 2003.

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Introduction

Acknowledgments: Traditional
owners; Minister; experts from different fields

Allow me to begin by acknowledging
the traditional owners of the land on which we meet the Wurundjeri People of
the Kulin nation of peoples.

I also acknowledge experts
on mental health issues here from backgrounds in the community, government,
medicine, law and other fields.

Wide range of expert presentations

As you will have seen,
the program for this conference includes papers on a wide range of issues, including

• Progress
  in implementation of the national mental health strategy
• Mental illness and the law
• Mental health of children and young people,
• Aboriginal
  mental health issues,
• Transcultural issues in mental health,
• Issues for families and carers; and
• presentations
  on specific areas including dementia and depression.

Why is a human rights commission
President speaking here?

Amongst all this expertise,
it is fair to ask why is the President of the national human rights commission
– and particularly a President who has only fairly recently commenced
in this role - here presenting the keynote speech to such a conference?

There is a direct, positive
answer to that, and also an indirect answer.

Human rights as an important
foundation

The positive answer is
that human rights thinking provides an important foundation, which helps us
to focus on whole people, i.e. comprehensively on all the component characteristics
of each human being, and his or her place in the community. The importance of
the human rights approach is shown by the significant contribution that Australia’s
national human rights commission has made to policy and public debate in this
area in the past.

Human rights emphasises the
whole person

Human rights considerations
add important dimensions to discussions in this area.

They serve as a reminder
that a person with a mental illness is not only a recipient of services or subject
of treatment, but a whole person, who is likely to be facing issues in finding
or keeping employment and accommodation; who may also have other disabilities;
who may have language or cultural issues in dealing with mental health services
and related systems

Human rights is about participation

Ultimately, the point of
all the work and thinking about plans and policies and services and treatment
is to enable people affected by mental illness to exercise and enjoy their rights
and freedoms as members of our community as fully as possible.

Human rights are for all of
us

Human rights by definition
apply to all people. There is nothing complex about the fundamental notion of
human rights. Human Rights discourse is based on the simple proposition that
we are all born free and equal, and are entitled to live with dignity and to
develop our potential as human being. Human rights have particular importance
for people who are less powerful in our society:

• people
  who are subject to discrimination and prejudice;
• people
  who are economically disadvantaged;
• people
  who are less able than others to defend their own rights and interests.

Human rights agencies and
human rights laws are sometimes criticised as being for the protection of special
interests or minorities rather than for the whole community.

But in fact, human rights
help to define the difference between a democratic civil society, and a society
where the winners take all.

Human rights principles
reinforce the functioning of democratic systems by emphasising accountability,
and equality of access and participation.

Human rights protections
are the protections which any of us may need at some time.

People are less ready to
dismiss human rights as special rights for a minority when they suddenly find
themselves or members of their family in that minority.

So one of the most important
things we can achieve in community attitudes to mental health problems, and
attitudes to disability more generally, is to have greater realisation and acceptance
that these are not things that happen to “them” but to “us”
as a normal part of being human.

Human rights as a last resort

The indirect response to
the question about my role here today is one that I would give based on my time
as a barrister and later as a Federal Court judge: As an advocate you only start
talking about human rights almost as a last resort - when the laws and systems
which you expect to be able to rely on are failing to deliver for the people
you are trying to represent or serve.

Why are we still talking about
human rights and mental illness?

Australia is a wealthy
first world country with a highly developed health care system supported by
billions of dollars of public money. In any area where we even have to talk
about human rights in relation to health issues it means we know we are in trouble.

The disastrous health situation
for indigenous Australians is obviously one such area. Unfortunately it seems
that the position of people affected by a mental illness is also one where we
still need to talk about human rights, even after ten years of national mental
health policy reform and ten years after a national inquiry into human rights
and mental illness.

Scale of mental health issues

It is important to remind
ourselves of the scale of the issues involved when we talk about mental illness
and human rights.

More than one in six Australians
has a mental disorder

In 1998 the Australian
Bureau of Statistics estimated 2,383,000 adults in Australia had a mental disorder
- more than one in six.

This included 1,300,000
people with anxiety disorders; 778,000 with depression or other affective disorders;
and 1,041,000 with substance use disorders. (Adding these numbers gives more
than the total number of individuals affected but that is because some people
had more than one mental disorder.)

The rate of mental disorders
was highest in the 18 to 24 year old age group with a staggering rate of 27%.

The ABS did not have so
clear a set of figures for mental health problems in children and adolescents
as for adults. But it did indicate 20% of adolescents had significant mental
health problems.

We should be shocked by discrimination
against so many of our people

People who have spent years
dealing with human rights issues, or with mental health issues, or both, may
be used to the idea that such a large section of Australia’s population
could be missing out on equality in access to effective health care or in other
areas like employment and accommodation.

But we should be shocked
by such a situation.

Human rights principles
provide one set of benchmarks to set against the realities that people affected
by a mental illness experience.

Role of Human Rights and Equal Opportunity
Commission

Promoting compliance with human
rights commitments

The role of the Human Rights
and Equal Opportunity Commission is to promote compliance with commitments that
the Australian Government has made on human rights through a number of international
treaties and declarations, including the International Covenant of Civil and
Political Rights, the International Covenant of Economic, Social and Cultural
Rights, and the Declaration on the Rights of Disabled Persons.

These human rights principles
do not implement themselves or automatically become a reality in people’s
daily lives.

Principles in international
law in general only become part of Australian law when Australian parliaments
act to make laws translating those principles into rights and responsibilities
within our legal system.

Also, for many, perhaps
most, human rights issues, it is not simply a matter of making laws, but of
building appropriate policies and services and putting resources behind them;
and beyond that the still harder tasks of changing attitudes and prejudices.

Administering discrimination
laws

The Human Rights and Equal
Opportunity Commission does have important roles in administering enforceable
legal rights in the anti-discrimination area, including the Disability Discrimination
Act which applies to discrimination against people affected by mental illness
whether directly or as families and carers.

Promoting awareness and influencing
attitudes

Our major role is one of
education to promote awareness of human rights and to seek to influence community
attitudes.

One of the methods the
Commission has used has been to conduct public inquiries on human rights issues,
to provide a forum for people to contribute information and expertise and to
seek to gain public attention for the issues raised.

National inquiry on human rights
and mental illness

The best known involvement
of the Human Rights and Equal Opportunity Commission in the mental health area
of course has been the conduct of the National Inquiry into the Human Rights
of People with a Mental Illness which resulted in a final report in October
1993 (“the Burdekin Report”).

The inquiry was carried
out over several years including hearings conducted around Australia, hundreds
of submissions and extensive research.

The report of that inquiry
is now over a decade old. The report has been out of print for some time.

But because of the number
of requests we continue to receive for this report, we recently added the findings
and recommendations chapters to the materials available on the Human Rights
and Equal Opportunity Commission website, www.humanrights.gov.au.

1993 findings appear to remain
relevant

Unfortunately, it seems
that interest in this report, and the findings and recommendations it made back
in 1993, is not only from a historical or academic point of view, but because
some of the major findings remain relevant and concerning today.

National inquiry emphasised
positive rights

One of the important things
about this report was the emphasis it gave to positive human rights –
including rights to access to health care, rights to decent housing and an adequate
standard of living, and adequate representation and protection in the criminal
justice system.

Rights are interconnected

Human rights practitioners
often assert the unity and indivisibility of human rights - the need not to
neglect economic and social rights in pursuit of civil and political rights
and vice versa.

The Commission's inquiry
looked at what this means in practice, not as a matter of lofty theories but
in the realities of the lives of people with a mental illness.

For example, the inquiry
found many people with a psychiatric disability are denied the opportunity to
obtain employment commensurate with their abilities and interests.

Apart from the role of
work in self realization and sense of self worth, there is the practical economic
importance of employment to consider. How in our society can a person who is
excluded from employment secure for themselves an adequate standard of living
- at least in the absence of more accommodating and generous income support
arrangements?

Then there is the issue
of housing. How does a person secure adequate housing, or any housing at all,
in the absence of an adequate income? This is in addition to the need of some
people with mental illnesses for associated support services to maintain stable
accommodation

Previously, when talking
about mental illness issues, human rights advocates had given most emphasis
to human rights as negative or liberty rights – mainly the rights not
to be detained or subjected to compulsory treatment without proper safeguards.

These rights remain important
of course. But for a person with significant mental health problems, seeing
human rights only as the right to be left alone could amount to giving people
only the right to be homeless and ill or in danger of harm.

Main findings of national inquiry

Let me remind you of the
main themes of the Commission’s 1993 report.

Widespread discrimination and
denial of services

• The inquiry found that people affected by mental illness suffered from widespread
  systemic discrimination and were consistently denied the rights and services
  to which they are entitled.

Education
needed to change community attitudes

• The inquiry recommended a major government effort to redress negative community
  attitudes towards people with a mental illness.

Money
saved by deinstitutionalisation was not going into adequate community services

• It found that although the movement towards community care and mainstreaming
  of mental health services had reduced the stigma associated with psychiatric
  care, in general the money saved by deinstitutionalization had not been redirected
  into mental health and related services in the community.
• Health services and other services which would enable people with a mental
  illness to live effectively in the community were found to be seriously under
  funded or in some areas just not available at all.
• Crisis
  services were also found to be inadequate.
• Treatment and discharge planning was found to be in need of major improvement.

Education
needed for service providers to perform changed roles

• Mental health professionals and allied staff working both in institutions
  and the community were found to require education and training in the delivery
  of community based services, and needs for improved education and training
  were identified throughout the sector.

Additional
resources needed for prevention

• The
  inquiry also recommended added emphasis in health budgets for prevention and
  for mental health research.

NGOs
carrying burden without adequate funding

• Governments were found to be relying increasingly on NGOs to provide services
  but to be treating NGOs as peripheral in the allocation of funds.

Lack
of suitable supported accommodation

• Accommodation for people with a mental illness was found to be particularly
  inadequate, with government housing support programs either excluding people
  with mental illnesses or failing to address their specific needs. The inquiry
  found that the absence of suitable supported accommodation was the single
  biggest obstacle to recovery and effective rehabilitation.

Discrimination
in employment

• In the employment area, people affected by a mental illness were found to
  be disadvantaged by negative attitudes, a lack of awareness of means of accommodating
  employees with a psychiatric disability, and by inadequate vocational and
  rehabilitation services.

Families
inadequately supported

• Families and carers were found to be badly overstretched and insufficiently
  supported. As well as improved crisis facilities and other community mental
  health services the Inquiry recommended better information for carers and
  greater provision for involvement in decisions.

Inadequate
services for women; children and young people; non-English speaking people;
indigenous people; and people with additional disabilities

• Mental health services for children and young people were found to be seriously
  under developed. There were also recommendations for improvements in services
  for women.
• The
  inquiry also made recommendations on culturally appropriate services for Aboriginal
  and Torres Strait Islander people and people from non-English speaking backgrounds.
• Specialist services for the many thousands of Australians affected by mental
  illness and some other form of disability were found to be almost non-existent,
  and services in either the mental health or disability sectors to be inadequately
  prepared to deal with the needs of this group, with the result that people
  with dual or multiple disabilities were often bounced from agency to agency
  without finding anyone who would assume responsibility for care or support
  for them.

Human
rights breaches in the criminal justice system

• The inquiry found that mentally ill people detained by the criminal justice
  system are frequently denied effective health care and human rights protection.
  Procedures for detecting and treating mental illness and disorder in the Australian
  criminal justice system were found inadequate in all jurisdictions.

Need
for improved accountability and service standards

• The Inquiry recommended consistent accountability mechanisms and service standards.

Need
for law reform

• Laws regulating mental health services were found to be badly in need of reform.
  • On
    one hand, laws failed to recognise sufficiently the principle of applying
    the “least restrictive alternative” and gave wide discretionary
    powers of detention without sufficient provision for review of decisions
    for detention or compulsory treatment. Yet on the other hand there was
    inadequate provision for treatment as a voluntary patient, much less a
    recognised legal right to access treatment.
  • Laws providing safeguards regarding hospital treatment generally failed
    to extend to community treatment.
  • The
    relationship between the administration of mental health law and guardianship
    law was found to need further development to provide for appropriate decisions
    to be made on behalf of people at times when they lacked capacity to make
    their own decisions.
• The
  inquiry also recommended removal of discriminatory restrictions on access
  to some government programs, and the enactment of protection against discrimination
  on the grounds of psychiatric disability in any jurisdictions which lacked
  that protection.

Actions following from the inquiry
– the national mental health strategy

That really is only a very
brief skim through the findings and recommendations of the Inquiry.

But I hope it has been
enough to serve as a starting point for reflection on what has changed for the
better since 1993 and what has not, and what remains to be done.

Limited scope for follow up
by Human Rights Commission

I have not come here with
an audit report prepared by the Commission on the implementation of its inquiry
recommendations, however timely such a report could be. In the time since the
Inquiry, the Human Rights Commission has had limited ability to continue a detailed
monitoring role on mental health issues.

Effective implementation
of human rights, in relation to mental health and in other areas, also requires
that human rights be taken on as the responsibility of the mainstream agencies
which control resources and policy agendas and deliver services, rather than
being seen as mainly or solely the responsibility of a small human rights agency.

Importance of National Mental
Health Strategy

Some of the most significant
and lasting effects of the Commission's inquiry were in its contribution to
the development of a national mental health strategy.

The Strategy defined the
directions for reform of mental health policy and services and established a
framework for collaborative effort between Commonwealth, State and Territory
Governments to pursue these directions over a six year period.

The Strategy was under
negotiation before the inquiry reported, but was clearly influenced by the impact
the inquiry had on perceptions and policies.

Response to decades of neglect

Let me quote for a moment
what the Mental Health Council of Australia said on the history of mental health
reform in their report earlier this year “Out of Hospital, Out of Mind”:

In
1992, the Australian Health Ministers committed their governments to correct
decades of neglect in mental health.

A
national mental health policy was developed and mechanisms were described
to: lift Commonwealth and State expenditures; reduce human rights abuses;
move the locus of care from hospitals to the community; and, deliver quality
mental health within the mainstream of Australian health and welfare services

In
1993, the Human Rights Commissioner’s Report (‘Burdekin Report’)
brought the human rights issues of overt abuse within institutions, and covert
neglect in the wider community, to the attention of the general public.

For
the next 10 years, Australian governments implemented two five-year plans
aimed at: facilitating genuine participation for consumers and carers; developing
high quality community-based mental health care; and, outlining a broader
population-based health promotion and disease prevention approach.

This
new national focus, on a long-neglected health area, assumed that all governments
would invest additional dollars in the exercise. Those persons in need of
mental health services, and their families, greeted these national commitments
with great enthusiasm and expectation. Everyone assumed that real change required
not only large increases in resources but also promotion of genuine national
leadership and widespread professional and community support.

Increased resources

It must be acknowledged
that increased resources for mental health and related services did in fact
accompany the new approach. In particular, the Commonwealth Government allocated
funds for the first time specifically for mental health services. Federal initiatives
in response to the national inquiry report included $200 million over 4 years
for services either directly targeted at, or providing substantial benefit to,
people affected by mental illness.

Legislative reforms

Legislative reform was
an especially important element of the Mental Health Strategy.

Reform of mental health laws

An evaluation of Australian
mental health legislation was conducted by an independent consultant in 2000
for the Australian Health Ministers Advisory Council, by reference to a "rights
analysis instrument" based on international standards.

This evaluation shows
that there has been significant progress. Every state and territory has amended
or is amending its mental health legislation to move away from an emphasis on
detention to a model based more properly on human rights – although the
same evaluation showed that no Australian jurisdiction had achieved full compliance
with the United Nations Principles for Protection of Persons with Mental
Illness and for the Improvement of Mental Health Care 1991. These principles
were developed at an International level at around the same time as the Burdekin
Inquiry was taking place. HREOC was involved in the formulation of these principles.

Protection against discrimination

An important legal development
around the same time as the release of the Commission’s national inquiry
report was the commencement of the national Disability Discrimination Act, 1992
which came into force on 1 March 1993.

This Act includes mental
illness in its definition of disability. It applies to discrimination on the
basis of a mental illness which a person had in the past or which is imputed
to a person. It also applies to discrimination against carers or other associates
of people with disabilities. The Act makes discrimination unlawful in a wide
range of areas of life, including employment, education, accommodation, access
to premises and provision of goods and services.

All State and Territory
jurisdictions – except South Australia - now also cover disabilities from
mental illness within their equal opportunity or anti-discrimination laws in
broadly similar terms to the national Disability Discrimination Act.

Less progress on psychiatric
disability discrimination than some other areas but numerous positive outcomes
for individuals

A recent draft report
by the Productivity Commission on the effectiveness of the Disability Discrimination
Act found that the Act had been less effective in promoting equality for people
with psychiatric disabilities, and also for people with intellectual disabilities,
than it had been in achieving progress for people with sensory or physical disabilities.

It is true that the major
achievements through the Disability Discrimination Act which are most readily
identified have been in improved physical and communications access, including
standards on access to public transport (now in force); upgrading of building
access requirements (almost completed).

However, I would not want
to discount outcomes which have been achieved through thousands of individual
complaints, including by people affected by a mental illness. These complaint
outcomes are discussed in much more detail on our website and in a publication
which we issued for the tenth anniversary of the Disability Discrimination Act,
“Don’t judge what I can do by what you think I can’t.”

Has the picture improved since the
national inquiry?

In summary, it would be
possible to draw a picture of the National Inquiry and the developments which
followed from it as having transformed life for people with mental illness and
their families: with increased emphasis on community care, improved legal rights
and protections, and increased resourcing of services.

Continuing reports of crisis
despite successes

And yet – despite
a policy framework often described as world leading, and particular successes
in legislative reform, ten years after the Human Rights Commission inquiry we
continue to see reports from inquiries and evaluations describing a situation
of ongoing crisis.

Let me read you some remarks
from an editorial in the Australian newspaper last April:

Despite a swath of inquiries (such as the Burdekin inquiry of a decade ago),
reports and recommendations, political leadership on mental health has been
abysmal. …

De-institutionalisation, begun in Australian 20 years ago, solved the problem
of abuse and neglect that became a feature of so many mental asylums. It also
delivered significant cost savings to governments. But the mentally ill, and
society as a whole, have lost out because the replacement support services
have been woefully inadequate.

The personal, social and financial burden, meanwhile, has been shifted to
families and other areas of the health, community services and criminal justice
systems. … Charities are bearing the brunt of the crisis but they are
ill-equipped to cope. Last year, they turned away 300,000 requests for emergency
accommodation. As St Vincent de Paul said recently: "Dealing with Australia's
social problems must not be left to community organisations alone." State
governments, as a matter of urgency, must redirect or increase mental health
resources – and that means more money – so there are more hospital
beds, more psychiatric and psychological services, more nurses and more properly
resourced community care. …

The call for a national inquiry into the state of mental health services in
Australia should be heeded. But it can't be used as an excuse for more talk,
and yet another glossy report that gathers dust while the mentally ill, and
Australian society, suffer the consequences.

1992 NSW inquiry

As this editorial notes,
there has been no shortage of inquiries on mental health issues.

Last December a NSW Parliamentary
inquiry reported a range of concerns which bear a striking resemblance to those
identified in 1993 by the Commission.

This inquiry found

Lack of adequate services and
support for community living

• a lack of adequate community mental health services and other supports to
  enable many people with mental illnesses to live successful in the community

Many people receiving no services

• large
  numbers of people with a mental illness not receiving any services at all

Lack of support for families
and carers

• families
  and carers frustrated at a lack of access to help when asked for and a lack
  of provision for information or involvement in decision making
• insufficient use of the guardianship model to provide for decision making
  in the mental health area

Insufficient emphasis on rehabilitation

• little resources being directed towards rehabilitation

GPs providing most treatment
but without adequate skills and supports

• limited general practitioner skills in dealing with mental health issues and
  inadequate support for GPs from specialist services in delivering mental health
  care

Inadequate access to appropriate
services for young people; people from non-English speaking backgrounds; indigenous
people or people with a dual diagnosis

• problems in services for young people, with young people being placed in adult
  wards for lack of other options;
• access problems for people from non-English speaking backgrounds, with more
  information needed for consumers on availability of services and more information
  for providers on needs and issues for people from different cultures
• a lack of culturally appropriate services for indigenous people
• a
  lack of services for people with a dual diagnosis, particularly people with
  intellectual disabilities who have a mental illness

Unmet accommodation needs

• unmet accommodation needs in the wake of deinstitutionalisation, with a lack
  of sufficient supported accommodation, so that crisis accommodation, unlicensed
  lodging houses and prison are still serving as accommodation for many people;

Problems with criminal justice
system

• a range of problems when people with a mental illness interact with the criminal
  justice system, including :
  
  • inadequate provision of alternatives to prison for people with mental
    illnesses, and hence either detention in an inappropriate prison environment
    or inappropriate release
  • insufficient provision of treatment for people once detained, despite
    a significantly higher proportion of prisoners than the general population
    having a mental health diagnosis.

“A new form of institutionalisation:
homelessness and imprisonment”

The Chair of this Inquiry,
the Honourable Brian Pezutti, said that

“Deinstitutionalisation,
without adequate community care, has resulted in a new form of institutionalisation:
homelessness and imprisonment”.

Positive initiatives but overall
picture is too close to 1993 inquiry findings

These findings were made
notwithstanding many positive initiatives which were reported on. It indicated
an 18% per capita increase in mental health spending since 1992, and a significant
increase over that time in the proportion of mental health spending going towards
community services (41% compared to 30%).

Yet overall the picture
from this and other reports seems all too close to that found by the Human Rights
Commission inquiry ten years ago.

SANE Australia’s
Mental Health Report 2002-03 for example said that “mental health services
are in disarray around the country, (and) operating in crisis mode…”

National mental health plan
evaluation findings

One of the great virtues
of the National Mental Health Strategy is that it does include a degree of open
evaluation and accountability. The evaluation of the Second National Mental
Health Plan, published in March this year, noted some important limitations
on implementation of plans and policies to date which help to explain the picture
found in inquiries such as the NSW Parliamentary inquiry:

Aims of mental health plans
appropriate but implementation inadequate because of failures in investment
and commitment

The evaluation stated that:

progress
has been constrained by the level of resources available for mental health
and by varying commitment to mental health care reform. While the aims of
the Second Plan have been an appropriate guide to change, what has been lacking
is effective implementation. The failures have not been due to lack of clear
and appropriate directions, but rather to failures in investment and commitment.

A shorter way of saying
that might be that governments have not matched words with enough dollars.

Key conclusions of the
evaluation were that

Insufficient
benefits achieved for consumers and carers

• the aims of the National Mental Health Strategy have not yet been fully translated
  into the expected benefits for consumers and carers

Additional resources insufficient
to address unmet needs

• while
  there has been growth in mental health expenditure, this has simply mirrored
  overall health expenditure trends and is not sufficient to meet the level
  of unmet need for mental health services;

Full participation for consumers
and carers yet to be achieved

• despite some progress towards improving consumer rights and consumer and carer
  participation, full and meaningful participation for consumers and carers
  has not yet been achieved, particularly in relation to individual treatment
  and recovery plans;

Community treatment options still
inadequate, with NGOs insufficiently resourced for increased role

• while community treatment and support services have been strengthened, community
  treatment options are often still unavailable or inadequate, with growth in
  resources to the non-government sector in particular not having kept pace
  with their increased role

Access to care improved but still
not available as and where needed

• although
  access to mental health care has been improved, consumers are still frequently
  unable to access mental health care as and when they need to
• in particular, follow-up care into the community after hospitalisation for
  an acute episode is often lacking.

Mental Health Council of Australia
report

Very similar conclusions
can be found in the “Out of Hospital Out of Mind” report released
by the Mental Health Council in April this year in the lead up to the Third
National Mental Health Plan.

Despite efforts we do not have
a system of effective or accessible mental health care.

This report states simply:

Despite
the efforts of many committed politicians, government officials, service providers
and community advocates, we do not have a system of effective or accessible
mental health care.

Failure to turn innovations
in policy and treatments sufficiently into practice

As with other reports,
the Mental Health Council pointed to failure to turn innovations in policy and
treatments sufficiently into practice, particularly in the areas of prevention,
early intervention, mental health promotion and improved public awareness, as
well as in developing better partnerships between specialist resources and the
GPs and community services who are providing care to most of those people with
a mental illness who are receiving any services at all

Insufficient financial commitment
by governments

In a recent article in
the Bulletin magazine the authors of this report point the finger directly at
insufficient financial commitment by governments in Australia to turn policy
into reality, stating that:

• mental
  health services remain the poor cousin of health in Australia
• our
  comparative position relative to other first world countries is declining
• mental disorders account for 27% of all disability costs but attract only
  7% of health funding, while other OECD countries typically expend 12-15% on
  mental health
• New Zealand now spends twice as much per capita as Australian Governments,
  and three times as much as our largest state of NSW
• the collective failure of State Governments to implement our national mental
  health policy during the 1990s now leaves the architects of that policy having
  to defend its most basic assumption, namely the value of community-based rather
  than institutional care.

Call for lifting mental health
expenditure

The report calls for:

• lifting
  mental health expenditure to at least 12% of total health expenditure (an
  increase of five percent) within five years, and dedicating resources to supporting
  innovation in services and treatment; and

Call for Improved accountability
and review

• improved accountability and review: including a heads of government agreement
  for reporting on progress against agreed service indicators and establishment
  of a permanent independent commission to report on progress of mental health
  reform in Australia and investigate ongoing abuse or neglect.

Call for national mental health
commission

My colleague the Human
Rights Commissioner wrote earlier this year to the previous Federal Minister
for Health to support the need for a positive response by Government to the
Mental Health Council of Australia report.

In particular, he urged
serious consideration of the Council’s call for establishment of a national
Mental Health Commission such as exists in New Zealand. He wrote that

there
appears considerable merit in the Mental Health Council’s view that
a national Mental Health Commission would be able to make substantial contributions
to policy development, monitoring and accountability, and community education
regarding mental health issues.

Government response to proposal
for a Mental Health Commission

The former Minister responded
that the concept of a national Commission of this kind was not transferable
from New Zealand to Australia’s federal system.

Human Rights inquiries not a
substitute

The Human Rights Commission
hopes that this is not the last word on the subject, and that further room might
be found for discussion of this kind of concept between government and the mental
health sector.

The ability of the Human
Rights Commission to conduct national inquiries is not a substitute for ongoing
mechanisms for accountability, education and policy development.

That is not to deny the
contribution made by the major national inquiry which the commission conducted
in this area or the importance of human rights perspectives. But inevitably,
the expertise and authority of a human rights commission on design and delivery
of health services will be more limited than a body established specifically
to focus on those issues.

We may get the failures
of governments onto the front page – which can be a powerful factor in
itself of course - but we may be less successful in moving the story on from
there to get lasting results beyond the headlines.

Change in community attitudes
and awareness

I want to come back to
the point that the experience of people with a mental illness and their families
is not determined solely by the effectiveness or otherwise of mental health
services. Issues of stigma and discrimination have a large impact on mental
health outcomes and on the ability of people to participate effectively in society.

If we do now accept –
or still accept - that people with a mental illness should as far as possible
be living and working in the community, there remains the question: how prepared
is the community to accept and support people affected by mental illness?

Need for major investment in
community awareness

Several submissions to
the Productivity Commission inquiry into the Disability Discrimination Act emphasised
that improved education and public awareness efforts are required to reduce
discrimination against people with mental illness and their families. The same
point is made in several of the mental health inquiries and evaluation I have
referred to earlier.

One submission to the
Productivity Commission made the point that education to achieve greater awareness
and reduced stigma was as important in achieving access and equity for people
affected by mental illness as the installation of ramps and lifts is for equal
participation for people with physical disabilities.

The comparison of education
and awareness with physical access measures indicates the importance of education
but also the scale of the task.

Clearly the Human Rights
Commission is not going to be able to go out and install ramps or lifts for
every building to achieve physical access across Australia.

Likewise, the Human Rights
Commission is not able to deliver itself all of the information and education
needed to change community attitudes and awareness regarding people with a mental
illness.

There seems great force
in arguments that we need an ongoing awareness and information campaign on mental
health issues on the same scale as road safety campaigns, to promote prevention
and access to treatment and to combat stigma and discrimination. Such a campaign,
however, requires serious resource commitments and leadership.

The Mental Health Council
proposal for a national Mental Health Commission contemplated public education
on mental health issues as a major function.

Possible Human Rights and Equal
Opportunity Commission initiatives

At the Human Rights and
Equal Opportunity Commission we are looking at what more we can do in this area.

Better information for employers;
review of insurance guidelines; looking at partnerships with other organisations.

This includes looking
at possibilities for more and better information for employers on accommodating
workers affected by mental health problems, and reviewing our guidelines on
discrimination in insurance.

It also includes looking
at how we can work better in partnership with other organisations in industry,
in the community and in government to provide information and promote awareness
and changed attitudes.

In those tasks we would
welcome your input and your criticism.

Conclusions

As I said earlier it is
not the role of a human rights commission to present ourselves as the ultimate
authority in place of community and professional experts or to sit in judgment
on what you are achieving with limited resources and increasing demands.

In the Commission’s
National Inquiry on human rights and mental illness, our aims rather were to
provide a forum for the experience of people affected by mental illness, as
patients, families, or carers, together with community and professional service
providers; to seek to refocus debate in this area as involving matters of human
rights; and to draw public and political attention to this experience as a means
of promoting accountability and remedies where abuses or neglect of human rights
were found.

It would be sad if after
all that has been done in this area we need another national inquiry on human
rights and mental illness, but it seems that many of the concerns raised by
the report of that inquiry remain equally valid today. I would be very glad
if, at least in some part, presentations from other speakers at this conference
on mental health and related services prove those fears to be wrong.

Thank you.

Last
updated 7 January 2004