Mental health has been identified by the government as one of its ‘four pillars’ in health, and advocates are hoping for a boost in tomorrow night’s Federal Budget.
In this piece for Public Health Research & Practice and reproduced here with permission, Mental Health Commissioner Jackie Crowe argues that the digital revolution has ushered in a new era for mental health, breaking down stigma and empowering patients to demand more from a siloed system.
Jackie Crowe writes:
A very long time ago a person described his journey from mental ill-health to mental health: “Too many years lost, too much suffering, too many shut doors”.
He shared his pain and despair of recovering in a mental health system that was beyond broken and organised not around consumer’s needs, but instead around clinician/service/organisation/government need.
Throughout the years his words have echoed over and over again in the stories of far too many people that have spoken of their heartbreaking experiences to me and in many national inquiries.
Successive Australian governments have made significant policy, funding and legislative commitments in the effort to reform the mental health system or parts thereof. Their intent was not access to poor care, the objective not inadequate quality, the pursuit was not to deliver bad results or be misaligned with the interests of consumers and families.
Yet the reality of many consumers’ lived experience, as well as independent inquiries into mental health have agreed; reform efforts and funding have not made the transformations we should be seeing, or giving people the outcomes we should be expecting.
Given the entrenched interests and practices of many decades, expecting mental health transformation that only comes from within the system is unrealistic.
Navigating a siloed system
In fact, to describe Australia’s mental healthcare sector as a “system” would be incorrect. What we have is a whole set of silos in health and mental health that barely connect.
This silo mindset did not appear accidentally. Successive Government funding models have supported it, along with entrenched systemic cultural issues within providers, organisations and government entities.
Many are wedded to old ways of doing business and are far too comfortable with the construct of silos to want to change.
You’ve got to be a savvy consumer to make sure your needs are met in Australia’s three-tiered system of health care. Coordinating care and service navigation often becomes the responsibility of the consumer and/or their family.
At a time when a person is unwell, may have multiple health, psychological or social needs, or be contemplating suicide — and while their families are desperately worried — this is simply unacceptable.
In recent times there has been a noticeable unrest stirring within our communities, a budding revolution. People, advocates and communities are expecting more. They are demanding an open, transparent and seamless enabled system of care and support.
Where once mental illness was talked about in hushed tones and suicide never mentioned, consumers, families and communities are speaking out about their experiences — from service provision, to recovery and system failure — publicly, to their communities and the world.
They are aided in this by the evolution of the internet, the social web and mobile technology. The internet has turned advocacy as we knew and understood it on its head. The proliferation of digital platforms and devices gives people greater access to information, and the means for communication and collaboration.
This increasingly networked society is a petri dish for engagement, connections and partnership advances and a revolution in mental health care.
Demand and disruption
Consumer participation has been the foundation of all reform activities over the decades, albeit never sustainably funded or supported. However, participation as we once knew it is no longer equipped to meet the changing landscape.
Once it could take weeks, at the discretion of the provider, to get a response about a complaint. Now a strategic social media post can get that same service contacting you within hours to enquire about your experience.
Social media has disrupted the way service providers handle complaints. Similarly, blogs, social media, personal web pages etc. are beginning to disrupt the way we think about how people can participate in service planning and improvement.
Providers, organisations and government would be wise to pay heed.
People are becoming increasingly active in posting their thoughts, ideas and needs to the world. Forgetting to ask consumers to be involved in key activities can now result in a social media feed reminding the organisation of “nothing about us, without us”. The challenge for providers and Governments is how to face the implications of digital change, in particular, the loss of control over the consumer relationship.
Increasing consumer, family and community involvement into all processes and at all levels will become the number one objective for services and organisations if they wish to stay relevant and competitive in a changing market where new technologies and digital tools are empowering people at a pace not ever seen before.
Opportunity or risk?
Our smartphones can now know more about our health, mental health and wellbeing status than our primary health care provider or specialist. Both an imperative and a challenge for providers will be how to innovate and engage with the consumer using digital health technologies for improved consumer outcomes.
Unfortunately, solutions to address this often focus on the risks of people using health technology or on reinventing the wheel rather than building robust platforms, infrastructure, and shared services that complete the circle of care.
Digital mental health must be seen much more as an opportunity to be tapped than as a risk to guard against.
Technologies that have thrived, from electricity through to the digital age, have grown, not because they deliver more, but because they deliver better.
Sink or swim
In industry, disruptive innovation sneaks in from below. In community, revolution starts with a few committed people and grows to a tipping point. System reform is built on past foundations.
Providers can be so focused on their services or products, their research, education or training, processes and procedures, and fitting people into their type of service, that they fail to see the average person doesn’t want or like what’s on offer. They miss the signs of disruption and revolution and dismiss and resist reform in an effort to preserve their traditional market hegemony.
Given a choice, most of us will opt for stability over change. Ignoring what’s coming may not be wise.
For the times, they have changed.
Jackie Crowe is one of Australia’s National Mental Health Commissioners, a mental health & suicide prevention consultant, speaker and blogger. She tweets at @jackiecrowe24