A central feature of the Commission’s program of reform (recommendation one) is a Mental Health and Wellbeing Framework to drive collective responsibility and accountability for implementation of the reforms across all government portfolios. Among other things, there is to be a new Mental Health and Wellbeing Act. Its primary objective will be achieving the highest attainable standard of mental health and wellbeing for the people of Victoria.
According to international best-practice principles, this can only be done through a whole-of-government plan of action that is led by the apex political leadership and encompasses the social determinants of health, such as housing, education and transport. Reflecting this approach, implementation of the Commission’s program of reform is to be overseen by a Mental Health and Wellbeing Cabinet Sub-committee chaired by the Premier for at least two years.
At the service level, the primary recommendation of the Commission is to establish a responsive and integrated mental health system. By contrast with the present system, it will recognise the needs of people in their community and maximise the scope for exercising their personal autonomy. Persons experiencing mental illness are one of us. Like others who may be ill and need treatment, care or support, they belong with their family, friends and community. If at all possible, they should be free to remain close to who they know, to what they need and are familiar with and to other supports in the community. Treatment must only be delivered far away when there is no practical alternative.
Thus, under the new system, there will be a network of new services at local, area-based and statewide levels for new and older adults and separately for infant, children and youth (the latter in partnerships with government or non-government organisations). The governance and organisational details of this new multi-level system are discussed in detail in the Commission’s report. The government has promised that it will be properly funded, as it must be for these objectives to be realised.
Of the many other recommendations made by the Commission, I would highlight the various mechanisms for research and innovation that are to be established, and especially those in collaboration with people with lived experience of mental illness. The international experience is that it is hard to reform mental health systems in line with the fundamental human rights standards of dignity, equality and non-discrimination.
The usual drivers of health reform – political will and research and development – are often lacking. Wisely, the Commission has acknowledged, and the government has accepted, that the system must have an inbuilt capacity for continuous improvement. In that, it is leading the nation and most places in the world.
Professor the Hon Kevin Bell AM QC is the director of the Castan Centre for Human Rights Law, Faculty of Law, Monash University.