1. The Case for Investment in Community John Mendoza Social Enterprise for Wellbeing and Mental Health Conference 24 February 2011 ConNetica Consulting PO Box 484, Moffat Beach 4551 Tel: 07 5491 5456 Fax: 07 5491 5458 Email: info@connetica.com.au

2. overview The future we face The failure of government What communities want A way forward

3. Some Likely Futures Triple health whammy – ageing, mental illness & obesity Global warming – climate change & impact on human health The ‘death of retirement’ – Lots of baby boomers – broke and demanding! Three revolutions: – Asianisation - the shift in global power – IT&T (Web 2 to Web X) – Bio-medical © All Rights Reserved

4. Ageing population We will move from 1 in 7, to 1 in 4 people aged over 65 by 2050 The number of people with dementia will grow from 230,000 to 700,000 Retirement? I remember that.

5. The Obesity epidemic Australians among the most obese. Occurred over 2 decades 61% adults overweight or obese 1 in 4 obese Costs est. at $38b Low success in change – only 11% successful with lifestyle change Image sourced from: http://graemethomasonline.com/wp- content/uploads/2010/08/human-evolution-into- obesity.jpg http://graemethomasonline.com/wp- content/uploads/2010/08/human-evolution-into- obesity.jpg

6. Mental Illness  1 in 5 adults  1 in 4 young Australians  75% of all psychoses occur < age 25  71% of those with a need < 24 do not seek help – that’s 700,000  Treatment rates for young men (16-24 yrs) are just 13%.

7. Climate change More frequent, extreme weather events Australia – high risk zone Cost of inaction will be higher than action – Lord Nicholas Stern

8. Health Reform? What part don’t you understand?

9. Daily stories of grief, despair & loss in mental health Encountering the mental health system ….

10. StateCommonwealth SupportChild (0-15)Youth (16-24)Adult (25-64)Aged (65+) Joint (State-run with Comm. funding) CAMHS (0-18 Years) Orygen GPs Private Psychologists / Psychiatrists Youth (12 to 18) Adult (18+ Years) GPs State Community Health Centres Juvenile Justice (0-18 Years) Forensicare MCH Youth services Adult MHS (16+) Aged (65+) Child Protection Job Network, including Job Network Disability-Focused Programs – eg, Personal Support Programme, Intensive Support, etc. Housing Assistance MH Branch / PDRSS Housing Centrelink DVC Employment Programs (Very Limited) PDRSS Day Programs Clinical Mental Health Care Drugs & Alcohol Employment Social Housing Health Care Social Security Education Corrections / Justice Other Age-Segment Specific Support 2-year overlap between CAMHS (0-18) and Adult MHS (16-64) 21 Adult regions, 13 CAMHS regions, 17 Aged regions, 15 regional health centres Orygen is a separate youth service in certain areas; Early psychosis services also provided by adult MH in some areas >100 different local treatment agencies Youth service officially ends at 18 but in practice continues until ~25 Many mental health consumers will cycle between State system and GPs / Private sector multiple times over lifetime Centrelink is primary referral point to Job Network programs HACC Schools Adult Corrections 18+ >100 PDRSS providers THE MENTAL HEALTH SUPPORT SYSTEM IS VERY COMPLEX Acute General Hospitals ~100 Community Health Centres ~250 locations Many mental health consumers will cycle between State system and GPs / Private sector multiple times over lifetime Multiple Job Network programs at numerous locations – mostly focussed on disabilities generically

11. They are still operating.. Every state except Victoria still has at least one stand- alone psychiatric hospital > $1 in every $6 spent in mental health spent on them Provide poor care ; history of abuse and stigma Ballie Henderson Hospital Toowoomba. Built 1890

12. Understanding Prevalence & Disability - 3 Tiers of Mental Illness Tier 3 Tier 2 Tier 1 Access to care Prevalence 3% (Severe Disability) Approx 500,00 cases Psychotic Disorder Bipolar Disorder Severe Depression Severe Anxiety Severe Eating Disorder Key Disorders 4% (Moderate Disability) 12% (Mild Disability) 650-700,000 cases Moderate Depression Moderate Anxiety Disorder Personality Disorder Substance-Related Disorder Eating Disorder Adjustment Disorder 2 million cases/year Mild Depressive Disorder Mild Anxiety Disorder About 2 in 3 have access to some level of state mental health treatment. BUT this is poor overall. Only 550 packages of care available. Many have no GP. Unemployed, in poverty Life expectancy as per Indigenous Aust. Lower rates of access to care - 25%. Almost always crisis response. Unemployed/Disability Pension Massively over-represented in prisons Rates of access for depression, overall 45% Rates of access among young people 25% Poor level of collaborative care Outcomes largely unknown

13. Just one example of massive unmet need – CAMHS Victoria (1)Child living in relative poverty (2)Includes clients with co-morbidities, and all forms of disorders (3)Currently in contact with Juvenile Justice, Child Protection and and/or Early Childhood Intervention systems, or homeless Source:Sawyer 2000; Zubrick 1995; BCG Analysis; No of children (’000s) Mild levels of risk (1) Presentatio ns of mental disorder (2) Very high risk (3) Treated by CAMHS Greater future costs to society

14. Outcome measures on mental health Suicide rates Imprisonment rates Employment participation rates Readmission to hospital rates Health outcome measures Stable housing Social inclusion We simply don’t know!

15. The Sara Lee model of planning – layer upon layer

17. John Mendoza, Winter School 08 The problem with too much thinking is that we believe we can change complex social problems through a policy paper at little personal cost.

18. John Mendoza, ausMHLP Sept 2009

19. Meanwhile in Canberra... Mental health crisis? What crisis?

21. John Mendoza, Winter School 08 The current reality … Governments are profoundly failing the most socially & economically vulnerable From local community issues to the sustainability of our planet New policy papers with many fine words about fairness, social justice, equity etc, need to be challenged – we need to focus on real outcomes, real on the ground action Too little for innovative programs New money to old programs More money to the same interests

22. John Mendoza, Winter School 08 From the 2020 Summit … The resounding messages from 2020 Summit: we want less government – set fire to red tape! we want streamlined government services that work! we want a health system that puts consumers first we want people & communities in change & not bureaucrats we want transparent & open government we want to reduce the impact on environment we want a more educated & capable workforce we want a more inclusive & tolerant society

23. Mobilise the masses! Engage the nation …. Change the Government

24. A Broader Policy Platform Health in all policies – a policy strategy that responds to the critical role that health plays in the economies and social life of 21 st C societies The development of health and social impact statements – to accompany environmental and economic statements – for informed decision making Recognise social & environmental determinants of health. Inequality within a society = health outcomes Kickbusch, 2009; Wilkinson & Pickett 2006 & 2010

25. Whole of life; whole of community Health and mental health in all public policy Mental health as a prerequisite for prosperity We don’t just want to live in Australia, we want to live in a mentally healthy Australia

26. A National Model of Care – to guide investment

27. Novel idea #1! Invest in what works! Evidence base is strongest: –Collaborative care is best –Psychosocial treatment of psychosis, including family intervention, social skills training, CBT, case management –Assertive Community Treatment (ACT) –Supported & open employment –Supported Housing –Collaborative recovery - putting recovery into practice –Peer support –E-therapy for mild-moderate mood disorders Evidence about merit of acute inpatient care - unclear Evidence about MBS funded Better Access care - unclear

28. John Mendoza, Winter School 08

29. Social Enterprises – Community Sector Mawson – Bromley-by-Bow – A focal point for the community which provide healthcare & education, creates jobs and generates wealth for the area, delivering services in new ways to overcome daily difficulties in people’s lives Noel Pearson – Cape York Partnerships – Overcoming entrenched social welfare dependency through establishing partnerships, mutual responsibilities and small local businesses © All Rights Reserved

30. Andrew Mawson Social entrepreneurs have recognised...that ideas generally emerge from the creative process that occurs when people from different backgrounds with different approaches engage effectively with each other....all of this moves many of us beyond traditional philanthropy into more sustainable models of public service which have innovation and customer focus at their core (SEs) are attempting to cut themselves free from a world in which everyone is responsible for everything yet, in practice, often no one is responsible for anything or accountable to anyone. © All Rights Reserved

31. John Mendoza, Winter School 08 A Way Forward for the Community … Build a competent organisation, governance etc. Work beyond one’s boundaries – mobilise others Build client centered services & advocate Adaptive - learn form the best & adapt Principled opportunism Genuine partnerships & alliances Build & support social ventures – private-community-partnerships Refs: 1. Grant & Crutchfield (2007) Creating High Impact Nonprofits, Stanford Social Innovation Review 2. Mawson, A (2008) The Social Entrepreneur: making communities work. Atlantic Books, London

32. Big Pharma is everywhere! 'If the light stays on for more than 4 hours, call your electrician.' And just remember …

33. Thanks for listening ConNetica Consulting PO Box 484, Moffat Beach 4551 Tel: 07 5491 5456 Fax: 07 5491 5458 Email: info@connetica.com.au

34. Social enterprise examples

35. John Mendoza, Winter School 08 The EMMA program Educating, mentoring, mothering, adolescents. Target is mothers < 18 years on Sunny Coast “all about educating & empowering young women to provide a better future for the children & themselves” Program has only 2 days a week of a teacher Relies upon individuals & community organisations to stay afloat

36. John Mendoza, Winter School 08 EMMA program Education Preparation Parenting for Birth Skills Mentoring

37. John Mendoza, Winter School 08 EMMA Program ENTER PROGRAM WHEN PREGNANT Prep for birth Parenting skills EXIT Exit strategy developed Support network in place COMPLIMENTARY SUPPORTS Case m’ment for mother & child Mentoring Volunteer services Adjunct care Counselling EDUCATION TAFE Lifeskills Tertiary Prep Skills for Future TRANSITION

38. John Mendoza, Winter School 08 Balkanu project Objectives – To further the homelands movement – To trial a partnership model of service delivery – To build capacity for a wider Cape York housing strategy Required collaboration between Aboriginal family group, Balkanu, governments (Qld & Federal) & local council Laggards were govt – others just got on without them

39. John Mendoza, Winter School 08 Social Inclusion Agenda – rhetoric & reality Rhetoric Joined up thinking Connected government Partnership with the community sector Social enterprise Etc etc Reality “we wanted to achieve the practical results which these fine words and attractive sound bites seemed to promise but which few in either the voluntary or public sectors were experienced enough o know how to deliver” Andrew Mawson, 2008