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Article
Publication date: 23 September 2022

Alan Rosen and Douglas John Holmes

This study aims to demonstrate how service providers, service users and their families should be able to share the co-leadership, co-auspicing, co-ownership, and…

Abstract

Purpose

This study aims to demonstrate how service providers, service users and their families should be able to share the co-leadership, co-auspicing, co-ownership, and co-governance, of a the mental health-care ecosystem, at every level, as it develops upwards and wider, in a process of inclusivity, conviviality and polyphonic discourse, via the overlapping phases of co-creativity, codesign, co-production, co-delivery, co-evaluation, co-research and co-replication, to achieve outcomes of co-communal or organisational well-being.

Design/methodology/approach

“Co-design” is shorthand code for encouraging multiple pathways and trajectories toward forming and sustaining a sparkling web or vibrant network of inclusive opportunities for stakeholder participation and a collaborative partnership in organizational development, in these circumstances, for more effective mental health services (MHSs).

Findings

In a co-design framework, all partners should be entitled to expect and “to have and to hold” an ongoing equal stake, voice and power in the discourse from start to finish, in a bottom-up process which is fostered by an interdisciplinary leadership group, providing the strong foundation or nutrient-rich and well-watered soil and support from which a shared endeavor can grow, blossom and generate the desired fruit in ample quality and quantity.

Originality/value

The authors should be working toward co-design and co-production of contemporary MHSs in a mental health-care ecosystem.

Details

Leadership in Health Services, vol. 36 no. 1
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 24 November 2009

Vivienne Miller, Alan Rosen, Peter Gianfrancesco and Paula Hanlon

The Australian National Standards for Mental Health Services (Commonwealth Department of Health and Family Services, 1996) were developed as a plank of the first National…

Abstract

The Australian National Standards for Mental Health Services (Commonwealth Department of Health and Family Services, 1996) were developed as a plank of the first National Mental Health Plan (Commonwealth Department of Human Services and Health, 1992). Over the two subsequent national five‐year plans, they have become the basis for accreditation surveys for all Australian mental health services, both hospital and community components, whether acute or rehabilitation oriented, throughout the psychiatric career of all mental health service users and their families. The development and implementation of these standards are described. Innovations in this set of standards are detailed, specifying requirements of each phase of care, including access, entry, exit and re‐entry, and the parallel development and training of paid consumer and family carer surveyors. Largely due to the brevity and clarity of these innovations, because of a broad consultation process, and incorporation of interventions and service delivery systems that are both evidence‐based and congenial to service users, they have achieved a wide acceptance among, and championing by, service user and family carer networks. A recent review of the national standards was timely and welcomed, but is still incomplete, contentious in its protracted process, has a lack of consistent consultation and contains diluted and disorganised results. Implementation guides will now be developed to be superimposed on this revision in an attempt to improve and navigate it.

Details

International Journal of Leadership in Public Services, vol. 5 no. 3
Type: Research Article
ISSN: 1747-9886

Keywords

Article
Publication date: 30 November 2012

Alan Rosen

The aim is to provide a brief overview of a series of articles tracing the emergence of several Mental Health Commissions (MHCs) in developed countries over recent years…

321

Abstract

Purpose

The aim is to provide a brief overview of a series of articles tracing the emergence of several Mental Health Commissions (MHCs) in developed countries over recent years, sometimes to enhance mental health law administration, but often in connection with mental health reform strategies. The paper seeks to review the functions of, and elicit a framework for, Mental Health Commissions (MHCs) as effective vehicles for effective operation and reform of a mental health service system.

Design/methodology/approach

The approach of the paper is to identify the functions and limitations of Mental Health Commissions and then cluster them to form a typology of commissions.

Findings

There are broadly three types of MHCs: the first is more inspectorial and focussed on issues, concerns and complaints affecting the care of individuals, and is more restricted investigating the mental health service and the workings of mental health laws mainly to these ends; the second type is focussed on the entire mental health service system, including relevant all‐of‐government operations, concentrating on monitoring for and promoting system‐wide reform. While this appears to constitute a spectrum, with different MHCs mandated to work mainly at either end of it, there is conceivably a third type which has a combination of these functions. This occurs with some commissions, though an equal balance between these functions is unusual, so they usually can be assigned to a type on the basis of their predominant functions.

Research limitations/implications

There was a limited sample size, obliging a non‐statistical descriptive analysis which may well affect the validity of these distinctions.

Practical implications

There is sometimes a combination of functions encompassing some features of both of these types. While type I MHCs can ensure that individual rights are upheld and that mental health laws and regulations are adhered to, to improve service quality, type II MHCs are likely to be more effective in achieving system‐wide mental health service reform.

Social implications

MHCs can contribute to more holistic, evidence‐based and recovery‐oriented service delivery, which are more likely to lead to more desirable health and wellbeing outcomes for all mental health service users, their families and the community.

Originality/value

This typology provides a useful provisional framework for understanding the roles of MHCs in mental health services and in reform of the whole mental health service system and related systems.

Article
Publication date: 30 November 2012

Sebastian Rosenberg

This article aims to describe the process by which the new NSW Government executed its election promise to establish a Mental Health Commission for NSW.

153

Abstract

Purpose

This article aims to describe the process by which the new NSW Government executed its election promise to establish a Mental Health Commission for NSW.

Design/methodology/approach

This case study draws on observations of the author who was expert facilitator to the Taskforce to establish the new NSW Commission. The paper synthesises the work of the Taskforce, the input of a consultation process that engaged more than 2,000 people, through six state‐wide community fora, online survey and other means. In describing the nature of the new NSW Commission, the paper will also reflect on key learnings from the Taskforce's interactions with other mental health commissions, including in New Zealand, Western Australia and Canada.

Findings

Widespread concern about the lack of access to quality mental health care was reflected in broad support for a new Mental Health Commission. Opinions varied about how such a new body could be effective. Strong bipartisan political support is key. Also critical is ensuring the new body has sufficient legislative power and reach.

Research limitations/implications

This paper relies on the observations of a key participant in a reform process. This brings the limitations of potential bias as well as the strength of understanding that is difficult for outsiders to access. The actual impact of the new NSW Mental Health Commission will only become apparent following its 1 July 2012 start‐up.

Practical implications

Many jurisdictions are turning to specialised governance models, such as a Commission, to drive mental health reform. This paper identifies some of the key issues to consider in pursuing this strategy.

Social implications

Commissions need to have strong engagement with consumers, carers, service providers and the general community. This paper highlights some key issues in building these links.

Originality/value

The work of the Taskforce to Establish a NSW raised a range of issues relevant to any mental health reform process. Given the level of community concern about mental health care, these are important lessons.

Details

Mental Health Review Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1361-9322

Keywords

Article
Publication date: 30 November 2012

David Goldbloom and Louise Bradley

This paper aims to examine the progress of the Mental Health Commission of Canada (MHCC) over the first five years of its existence toward stated goals while existing…

1253

Abstract

Purpose

This paper aims to examine the progress of the Mental Health Commission of Canada (MHCC) over the first five years of its existence toward stated goals while existing outside the constitutional framework of health care funding.

Design/methodology/approach

The paper is a review of the outputs of the MHCC with emphasis on its first‐ever mental health strategy for Canada, knowledge exchange network, anti‐stigma initiatives, randomized controlled trial of housing‐first initiatives for the homeless mentally ill, as well as other completed projects.

Findings

Consultation and collaboration are essential aspects of working successfully with people with lived experience of mental illness, their families, health professionals, and governments. At the same time, when expectations are high, needs are great, and opinions are varied, disappointment and frustration are inevitable.

Research limitations/implications

Although the MHCC initiatives include the largest single funded research project in mental health in Canadian history, and evaluation is built into other initiatives, the political dimension of its work does not lend itself to research evaluation.

Practical implications

The creation of an organization outside the constitutional framework of health care funding may allow for a catalytic role in precipitating change.

Social implications

The emphasis on anti‐stigma campaigns targeted at defined populations (youth, health professionals, workforce, journalists) may combat the discrimination people with mental illnesses and their families experience.

Originality/value

The paper shows that the Canadian experience is, to date, largely undescribed in the peer‐reviewed literature and may influence other jurisdictions. One of its interventions is already being replicated internationally.

Details

Mental Health Review Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1361-9322

Keywords

Article
Publication date: 30 November 2012

Peter McGeorge

The aim of the paper is to describe the “organisational lifecycle” of the New Zealand Mental Health Commission (NZ MHC) including factors that led to it being established…

Abstract

Purpose

The aim of the paper is to describe the “organisational lifecycle” of the New Zealand Mental Health Commission (NZ MHC) including factors that led to it being established, the evolving phases of the work it undertook and its key achievements, the critical success factors, the rationale behind its disestablishment and transfer of its core functions to another entity.

Design/methodology/approach

The methodology is a review of relevant documents and interviews of previous Commissioners, and insights of the final two Chair Commissioners and authors.

Findings

The NZ MHC was established to provide government with independent advice on how to develop the capacity and capability of mental health and addictions services for those people with the highest and most complex needs, estimated to be approximately 3 percent of the population. Having successfully led changes to achieve this goal as set out in The Blueprint of 1998 it is now influencing government policy and services to achieve better mental health and well‐being for the whole population as per Blueprint II, published in 2012. The NZ Government clearly values the role of Mental Health Commissioner which has been transferred to the Office of the Health and Disability Commissioner from July 2012 at the time the Commission is disestablished.

Research limitations/implications

The paper relies on insights of those in Commission leadership roles.

Practical implications

Other Commissions may gain insight into their own evolutionary pathways and proactively manage them.

Social implications

Optimal mental health and wellbeing for society requires policy that simultaneously takes a “whole of society” approach and focuses on responding to people with the highest needs.

Originality/value

The paper shows that there are significant concerns about the disestablishment of the Mental Health Commission in New Zealand and little understanding of the underlying rationale for the organisational changes.

Article
Publication date: 30 November 2012

Robyn Kruk

Mental health reform needs to engage leaders across jurisdictions and governments/communities. This paper aims to describe the history leading to the establishment of the…

387

Abstract

Purpose

Mental health reform needs to engage leaders across jurisdictions and governments/communities. This paper aims to describe the history leading to the establishment of the Australian National Mental Commission (the Commission) in 2012 and to identify opportunities/challenges in cross jurisdictional/sectoral reform of mental health services.

Design/methodology/approach

This case study is based on the observations of the author who has held lead state and national roles prior to leading the Commission. It sets the establishment of the Commission in the broader context of changing community attitudes, strong consumer/carer advocacy, increased financial support for mental health and establishment of state commissions.

Findings

Cross sectoral/jurisdictional reform needs leadership from government heads and central agencies. Risks relate to the need to effectively articulate state and national commissions and challenges accompanying multilateral stakeholders with high and often conflicting expectations, and tensions with other high priority issues that also require alignment between Federal and State leaders and agencies.

Research limitations/implications

There may be potential bias based on the perspective of the narrator, and the benefits of direct experience in multiple jurisdictions.

Practical implications

The paper identifies critical success factors in the establishment/operation of the first national Commission and the establishment of relationships with state commissions, relevant to other cross jurisdictional bodies.

Originality/value

The paper provides an insight into the factors leading to the establishment of the first national Commission and its articulation with state commissions and the early operational challenges facing cross jurisdictional reforms in changing political climates.

Details

Mental Health Review Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1361-9322

Keywords

Article
Publication date: 30 November 2012

Lesley van Schoubroeck

Machinery of government changes and budget strategy are powerful levers to drive reform in the public sector. The purpose of this paper is to describe the rationale…

Abstract

Purpose

Machinery of government changes and budget strategy are powerful levers to drive reform in the public sector. The purpose of this paper is to describe the rationale, progress and challenges in the establishment of Western Australia's Mental Health Commission in 2010 with policy, planning and purchasing powers to drive reform.

Design/methodology/approach

This case study is based on the observations of the author who had a lead role in the establishment of the Commission over its first two years. It sets this reform in the context of the whole of government reforms as well as demands for reform from stakeholders within the mental health sector.

Findings

It is demonstrated that externally imposed change is often necessary to fundamental reform. However, it also comes with risks of alienation of key stakeholders in powerful roles and an under‐estimation of the factors that will hamper change. Central government support has been essential to the establishment of the Commission.

Research limitations/implications

The paper relies on the observations of a key participant in the reform process. This brings the limitations of potential bias as well as the strength of understanding that is difficult for outsiders to access.

Practical implications

The paper identifies some of the practical strategies that mitigate the risks associated with system change.

Social implications

This reform has been useful to showcase a range of other social policy reforms demonstrating the opportunities that strong political leadership offers when linked to policy and administrative change.

Originality/value

This analysis of the progress of reform highlights a range of issues that can inform other governments and community stakeholders undertaking major reform in the public sector as well as particular issues for reform in mental health.

Details

Mental Health Review Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1361-9322

Keywords

Article
Publication date: 30 November 2012

Donald Lyons

The experience of the individual patient can be an important driver in improving care. This paper seeks to outline the way the Mental Welfare Commission for Scotland…

127

Abstract

Purpose

The experience of the individual patient can be an important driver in improving care. This paper seeks to outline the way the Mental Welfare Commission for Scotland (MWCS) uses individual cases to influence policy makers and service providers.

Design/methodology/approach

Through visiting people, monitoring the use of mental health legislation, giving advice and conducting investigations, the MWCS has concrete examples of influencing significant change. Specific examples demonstrate how this has been achieved.

Findings

With regard to visits: findings from individual visits have resulted in action to improve services and preserve individual rights; in monitoring: services have used monitoring data to change service provision in order to comply with legislation; in investigations: high profile investigations into abuse have resulted in new protective legislation; with regard to advice: collection of advice on difficult legal/ethical/treatment dilemmas have resulted in improved practice guidance.

Research limitations/implications

Individual case examples are not necessarily indicative of general populations. Many factors result in improvement. Actions by the MWCS are not necessarily the only factor.

Practical implications

An organisation that focuses on safeguarding individuals can use its influence to effect service improvement.

Social implications

Bringing individual matters to the attention of policy makers has resulted in legislative and policy change.

Originality/value

Other jurisdictions may wish to consider the value of the Scottish model that is highlighted in the paper.

Details

Mental Health Review Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1361-9322

Keywords

Article
Publication date: 30 November 2012

Kenneth S. Thompson

This paper aims to review the background, history and results of the three Federal Commissions addressing mental illness and health in the United States of America.

124

Abstract

Purpose

This paper aims to review the background, history and results of the three Federal Commissions addressing mental illness and health in the United States of America.

Design/methodology/approach

This is a historical review of key articles and commentary.

Findings

Despite significant handicaps, imposed by the structure of government in the United States, the limits of knowledge and conflicts of between stakeholders, the evidence appears to suggest that Federal Commissions have been productive, even when there is little power to enact their recommendations, to the degree that they concentrate knowledge and effort in an advancing but generally quite disjointed field.

Research limitations/implications

The Commissions touch on a vast number of subjects and actions and do so in the context of the moving target of time. Historical review can only capture so much and the likelihood of errors of omission are significant, as is the possibility of errors of commission due to the requirement of interpreting historical evidence.

Social implications

The social implication of this study is that the political effort to create and implement Federal Commissions has been worthwhile. The question now is what kind of entity and political effort will be necessary in the future?

Originality/value

Federal Commissions have had a practical utility in the USA of periodically bringing the field together with a shared agenda. The question is, as behavioral health care increasingly melds into general health, what force will help the field focus on behavioral health initiatives. Will we even need such a force?

Details

Mental Health Review Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1361-9322

Keywords

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