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Agency looking for way ahead

Acouple of high-profile resignations in the field of mental health threaten to dissipate the momentum for mental health reform associated with the establishment of Australia's first national Mental Health Commission.

Technically not a resignation, Monsignor David Cappo has chosen not to take up the role of inaugural Commission Chair.

This decision is a blow to Australia's first federal Minister for Mental Health. Mark Butler has travelled widely and has proven himself a willing listener. There is never a shortage of complaints in mental health so this is no small thing. Butler is now, as I understand it, formally the Minister Assisting the Prime Minister for Mental Health. This moves him and his portfolio responsibilities clearly out of the realm of health and gives him licence, indeed obligation, to work with Jenny Macklin's Department of Family and Community Services, Tanya Plibersek and Mark Arbib in Housing, and Chris Evans and Kate Ellis in Employment and Education in relation to mental health.

The recognition of the need to view and manage mental health from this whole-of-government perspective is most welcome and explains why the Prime Minister, Julia Gillard, judiciously chose to place the new National Mental Health Commission in her own portfolio, rather than the Department of Health and Ageing. It is a much better reflection of the needs and hopes of people with a mental illness to not be defined by their illness and that their health concerns might remain but a small part of their whole lives.

Butler has stated that the Government's support for a commission is based heavily on community support for such an entity. In my view, such support reflects fatigue with the same old debates and the same old voices and interests.

Consumers and carers are used to being ignored as government departments and many service providers make arrangements to suit themselves rather than their clients.

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Poor services retain their funding while effective services miraculously lose their funding. New service options struggle to emerge and when they do, ugly and ill-founded public controversy often arises. Witness the public vitriol associated with the emergence of a national roll-out of the Orygen model of early intervention for youth psychosis. Commentators like Janet Albrechtsen criticise McGorry for his role in ''politicising'' mental health. From its base in a series of demountable dongas in Carlton, Melbourne, Pat McGorry's service has led the world in demonstrating the benefit of early intervention in psychosis in young people. Supporting this new service does not mean we ignore the mental health of children, adults or the elderly. It simply means that piece by piece, Australian governments are being poked, prodded and persuaded into developing a range of mental health services designed to cover all ages. If this is political then so be it.

It follows that a key role for the new National Mental Health Commission must be as an independent arbiter of what works, what should be funded and, importantly, what should be de-funded.

Mental health needs not only more funding but also to make sure it is spent in accordance with the evidence.

Experimentation and innovation in services will be required along the way and the Commission needs funds to nurture this.

The Government has already committed itself to the task of developing a 10-year road map for mental health, though it is yet to make clear what if any role the new commission will play in this. A simple re-hash of the fourth National Mental Health Plan will leave an expectant mental health sector feeling very let down. This plan has no goals, no targets and commits no one to anything.

The Government has clearly charged the commission with responsibility for developing a ''report card'' in mental health. Improved accountability lies at the core of reform. Are we making a difference to people's lives? Are they able to go back to work after their mental illness, complete schooling, maintain secure housing? We don't currently collect any data on these matters. Why not? This is the stuff that must be central to any report card that reflects consumer priorities.

With the accountability framework yet to be developed, also unclear is the actual remit of the national commission. With nine commissioners the new national commission is unlike commissions in New Zealand, WA or the one being finalised now in NSW. The national body will apparently not have responsibility for purchasing services, nor will it have its own specific legislation to enshrine its strategic role.

It will rely on persuasion and influence in government. Monsignor Cappo's replacement will need high-level political and advocacy skills, as will the other commissioners. Finding a suitable person will not be easy. Some kind of open process or consultation with the sector would be a key step in astute recruitment.

The Government has appointed Robyn Kruk as chief executive to the commission. An experienced and able health administrator, she will have her work cut out to bring these various threads together but in this, she will have the strong backing of a mental health sector keen to ensure that the next 20 years of plans deliver more than the past 20 years.

The capacity of the commission to build strong partnerships with key organisations in the sector will also be critical. The recent resignation of Dawn O'Neil as chief executive of Beyond Blue is a significant blow in this regard. The ex-chief executive of Lifeline and Deputy Chair of the Mental Health Council of Australia, Dawn had demonstrated commitment to reform and innovation in mental health over many years. In an environment characterised by a lack of resources, Beyond Blue is the largest non-government organisation operating in the area of mental health promotion and awareness.

Under Dawn's leadership, it had begun to show a willingness to support a range of new services and research and from such a huge and influential organisation, this was both very significant and welcome.

Another challenge for Australia's National Mental Health Commission.

Sebastian Rosenberg is a senior lecturer at the Brain and Mind Research Institute, University of Sydney.