Our system's first steps: Australia moves towards the starting line for mental health reform

2012 was a different time. Xi Jinping was just elected leader of the Chinese Community Party. Rhi Rhi and (the honourable Prime Minister) JG weren't yet friends. And Craig Emerson was conducting perfectly normal televised press conferences.

While some things are different, many elements of Australia's mental health system remain the same. Established with a broad vision to improve mental health policy and system governance, the National Mental Health Commission remains ensconced within government bureaucracy, lacking the legal and cultural authority to drive reform.

Inquiries came and went. Down south, a Royal Commission into Victoria's Mental Health System made 74 recommendations to fix a 'broken system'. At the same time, following a cascade of previous Parliamentary and other inquiries, the Productivity Commission published 1617 pages and reams of recommendations that would only be partially implemented by the Commonwealth government. These inquiries brought together experts, but not experts by experience in any leadership positions.

That lack of lived expertise was most visible at the Commonwealth level. There has never been a national consumer voice for people who use mental health services. In 2023, we are coming to understanding the political importance, and the public policy value, of "voice" from those impacted by issues. Mental health systems have typically been built and run by people who decided what was in mental health consumers' best interests, with little space for them to voice their concerns.

In 2012 Minister Mark Butler announced funding for the establishment of a national consumer voice. 2013 brought the end of the Labor government, and with it, any real ambition on national mental health reform. In the preceding decade we've seen series of disparate announcements with no overall strategy. Importantly, there was no development on Butler's 2012 commitment: no consumer voice.

Yesterday Minister Mark Butler announced $7.5 million for the establishment of separate consumer (people who use mental health services) and carer peaks, as well as $100 000 to enable a regular forum to enable dialogues between peaks and the government. This announcement is significant and departs from worrying signs that mental health reform would again sideline people with lived experience. Separate consumer and carer peaks will enable the distinct needs of these communities to be articulated to the government, the sector, and the community.

Done well, it will also provide a foundation for national mental health reform that is being cried out for. It will allow for the kind of clear mission for mental health care needed to subordinate vested interests and professional lobbying that puts profit and prestige ahead of person-centred care. Effective peaks, in particular a national consumer peak, will help define the goals and measures of a good system for the Commonwealth government, and encourage professional lobby groups to better align their efforts to these yardsticks.

This may start with fixing Australia's stalled mental health commissions, in particular the National Mental Health Commission. After a failed experiment with the Victorian Mental Health Complaints Commissioner, the Victorian Government has acted on the Royal Commission's recommendation to establish a Mental Health and Wellbeing Commission with enhanced powers and a broader focus to hold government to account for effective performance. Something similar is needed at a national level, but it should be done in close partnership with state and territory peaks and the emerging national consumer and carer counterparts.

A consumer peak body will not just help with entrenched mental health issues but will prepare us for emerging ones. Recent work by colleagues and I mapped the emergence of digital mental health technologies, identifying both opportunities and risks. In an age of surveillance capitalism and data hacking, our digital footprint is both a commodity and risk that is not entirely within the user's control. There are now pills that track your 'compliance' with psychiatric medication regimes and automated social media processes that may call police to your home if you appear distressed. Done well, digital mental health technologies can expand on our best community and mental health service responses to distress. Poorly done, we may be sleepwalking into a web of corporate interests, representing a new digital asylum.

Consumer peaks ensure that the expansion of these new markets is stewarded towards the public interest, particularly those in distress. Grounding this market in a literacy on responsible governance and human rights will be among the first demands of consumers who have used mainstream public mental health services. A national voice will effectively coordinate responses to complex and evolving state and federal laws governing healthcare, mental health services, and personal privacy.

It's important to be realistic about what this announcement means. With a decade of delay, this just brings us to the start line. Real mental health reform can only happen when those closest to the problem are closest to the decision-making. Now that we're here, many of us with lived experience are ready to put our hand out to the government and the sector. It's time to get to work work work work work.