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The reform of mental health care is elusive and tantalising. In my 40 plus years in psychiatry, I have seen the system repeatedly cycle between scandal and the promise of a new era.
Hope and optimism flatter to deceive, and what feels like a tipping point always turns out to be a mirage.
In a triumph of hope over experience, I really thought that the landmark Royal Commission into Victoria’s Mental Health System would break this cycle. However, this has turned out not only to be a mirage, but another false dawn.
The royal commission was necessary because of the collapse of the public mental health system which, after the ultimately reckless closure of the standalone mental hospitals, had been downsized and absorbed into general hospitals in the 1990s and neglected ever since.
The Victorian government was the first – and so far only – state government to own this policy failure, admitting the system was “broken” and establishing a royal commission in 2018.
The commission’s expert advisory committee, which I had the privilege to chair, produced a carefully formulated and sequenced blueprint with 74 transformational recommendations.
At that time, the political will and community support was unprecedented. There was bipartisan support and a historic joint sitting of the parliament launched the final report.
It seemed that the fair go that people with mental illness and so many dedicated colleagues had dreamed about would finally be realised.
The early signs were promising. Mental health was committed to as a signature reform, powered by a groundbreaking new levy to future-proof the rebuild, anticipating looming financial challenges. The then-deputy premier James Merlino took on the role of minister for mental health. Regional mental health boards were established to independently commission services, and an independent Mental Health Commission was set up by the government as a statutory authority to keep itself and future governments honest – and to safeguard the reform.
Over the past three years, whatever momentum there once was has now evaporated. We have seen a revolving door of ministers, with the issue being marginalised and now buried within the main Health portfolio.
The Victorian Department of Health, which assumed a much more powerful role, made the fatal mistake of entrusting departmental officials who lacked crucial experience of mental health care and system reform, and who have been stubbornly immune to advice from experts.
The mental health levy raises more than $1 billion a year from the business sector. But with major budget pressures afflicting the government, many in the sector believe this funding is being diverted to prop up the broader hospital system and state finances. If true, this would represent a major breach of faith.
In 2017, I delivered the Redmond Barry Public Lecture at the State Library with the title “Victoria’s Mental Breakdown”. This speech helped to create momentum for the royal commission.
Almost a decade on, Victoria still hasn’t recovered from the breakdown. Today, the culture and quality of mental health services are worse.
The ambulances are still all at the bottom of the cliff. Acute units remain custodial and
non-therapeutic. Clinical research, a cornerstone of health care, is an endangered species, and in contrast to the rest of health care, few if any of recent treatment advances are available to patients.
The core system is not a priority. The risks to patients, to staff through both moral and physical injury, and to the wider community have continued to worsen as the workforce wilts and
demand surges.
This is the worst kept secret in Victoria and a once-in-a-generation opportunity has so far been squandered. It is a classic case of implementation failure, which no amount of spin can conceal.
Yet for the past three years, the government has claimed progress is being made in line with the spirit and recommendations of the royal commission.
This gaslights not only people and families of their own experiences, but also frontline clinicians and their leadership, who are denied the right to speak publicly.
Further evidence of bad faith over the past two years is the undermining of watchdog and accountability mechanisms – notably the scrapping of the regional boards, which were to commission mental health services, the sidelining of lived experience, the shrinkage and weakening of the Mental Health Commission, and the dramatic reduction in funding for the peak body, Mental Health Victoria.
The end result is that people with severe mental illnesses remain banished to the margins of society, consigned to languish in their bedrooms, or suffer on the streets or in jail.
But the mirage can be transcended with solutions.
Mental health care desperately needs government failures to be acknowledged, and a new direction. As the state election looms, Victorians deserve to know that mental health is a top priority that both sides of politics are committed to reforming.
Patrick McGorry is a professor youth mental health and the University of Melbourne, and served as chair of the expert advisory committee of the Royal Commission into the Victorian Mental Health System.
Patrick McGorry AO is Professor of Youth Mental Health at the University of Melbourne, Executive Director of Orygen, and a psychiatrist.From our partners
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