The evolution of mental health services: a Q & A with SANE’s Barbara Hocking

After 17 years at the helm of SANE Australia, Barbara Hocking OAM is about to retire (her last day on the job is July 13).

SANE Australia is a national organisation helping people affected by mental illness (consumers, their family and other carers), through education, applied research and campaigning for improved services and attitudes.

In the online Q and A session below, Barbara Hocking reflects upon some of the successes and disappointments that she’s seen over that period.

Her priorities for mental health into the future include:

• Decent, comprehensive, coordinated community-based care rather than the ongoing crisis-oriented system.

• A social inclusion campaign to reduce the loneliness and isolation experienced by many people living with mental illness.

• Research, including to provide evidence of effectiveness of current activities.

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Learning from a voice of experience

Q: When you started the job in 1995, what did you picture as the main challenges and issues that you and SANE Australia needed to address?

The main challenges as seen from SANE Australia’s perspective were reducing stigma, advocating for good treatment for the person with mental illness and support for families.

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Q. Has your understanding of those changed over time? If so, how?

These are still critical issues but we also have a greater understanding now of the importance of a complete treatment package which incorporates psychological and medication treatments, decent accommodation, employment and community support programs to reduce isolation and to promote social inclusion.

I often say to clinicians that having someone symptom free in the back room of a boarding house with nothing to do and no friends is not a great success story.

There is also better understanding and recognition now that providing good mental health care is an important suicide prevention strategy.

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Q. What do you think have been the major gains in mental health over the past 20 years? And the biggest disappointments?

There have been many gains over the past 20 years but not enough – the rhetoric is all there but the reality is still slow in coming.

Major gains include:

1. Greater understanding by government and the community of mental health problems and their impact as a political issue – Pat McGorry, during his time as Australian of the Year, and Get Up really helped to politicise the issues. Certainly from a personal perspective I can say that when I first started working in this area, mental illness stopped conversations, now it starts them!

2. The introduction of the Better Access program has transformed many lives although we still have to get the formula right so that people in all parts of Australia and in all income groups can benefit.

3.The introduction of federal funding is welcome – more needed and long-term.

4. The voice of people living with mental illness is now being heard and their active role in their own and their peers’ recovery (peer workers), is increasingly and rightfully being seen as an integral part of treatment.

Disappointments include:

1. The fact that while there is improved understanding of depression because of the work of beyondblue and the Black Dog Institute, we still have much to do to reduce stigma and promote inclusion for people with psychotic illnesses, who still live lonely lives and experience major physical health problems in addition to their mental illness. Myths still need to be dispelled – we want people to know that e.g. families do not cause mental illness, people being treated for mental illness are not more violent than others, rather they are more likely to be victims.

2. State/federal issues always complicate and delay provision of good mental health care – very frustrating! Eg some states not yet matching federal funding for some programs (such as EPPIC) which delays their establishment.

3. The voice of families is not yet heard loudly enough and more recognition needed of the value of providing them with training/education and support.

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Q: What did you do before joining SANE?

I worked in education and then health promotion before mental health – both areas have greatly influenced my thinking and practice!

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Q. Personally, what are you most proud about regarding your own work in the sector? Any regrets?

I’m proud of all we do, however, I’ll highlight – being able to facilitate people with mental illness having their voices heard at last – e.g. SANE Speaker stories through mass media, with government and other decision-makers are central to humanising mental illness.

This, along with our other media/StigmaWatch work, I believe has made a significant contribution to improving attitudes/reducing stigma.

The consumer and family carer voice is central to everything that SANE does and this adds authenticity and integrity to our work.  I feel I’ve been able to form a bridge from them to politicians, clinicians and other decision-makers at a time when there was no direct pathway.

I think we’ve also done terrific work with our user-friendly multi media education resources, website and Helpline services to help people make sense of mental illness as a first step to dealing with it.

Not sure that I have any regrets as such. I guess it could include not being able to keep up with all new developments re funding (and don’t even mention new acronyms!) – we’re still not sure how Medicare Locals will impact on mental health care….

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Q. What are your top three priorities for mental health (whether policy, community, research etc)?

Decent, comprehensive, coordinated community-based care – policies are all there, but implementation has not yet really happened across the board. This results in the system still being crisis oriented, with only the very sickest getting treatment.

Social inclusion campaign – both local activity and mass media work to reduce the loneliness and isolation many people living with mental illness experience

Research – not just for new treatments but also to provide evidence of effectiveness of all activity currently being undertaken.

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Q. It is my perception that the divisions in mental health are more pronounced than in some other areas of health. Do you agree? If so, please explain your views of what the divisions are and what they reflect. If you don’t agree, please explain why.

In my early days in the area there were few organisations, working hard to raise their own funds and competing for whatever small funds were available.

There are many more players now than there have ever been, partly because there is more funding available, but also as there is clearer recognition that mental health is not just a health issue, it impacts on all areas of life – clinical, community, housing, drug and alcohol, employment, criminal justice etc.

So more people are competing for the dollars.

Governments have also adopted a competitive tendering model, which hasn’t helped.

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Q. If you were Prime Minister for a day… (what would you do?)

My personal view is that the environment is the number one issue – everything else is secondary to that. However, as mental health will also be impacted in a big way by environmental changes, then it would have to be next on the list!

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Q. What have you learnt about the intersection between the media and policy, and between the media and community behaviour during your time at SANE Australia?

The media are very important partners in influencing policy. Politicians take great notice of what’s in the media – on the front page, polling figures etc – as this provides an indication of what is likely to be a voting issue.

Likewise, the way in which media reports mental health/illness will impact on (at the very least reflect and reinforce) community attitudes and behaviour towards people affected by mental illness.

So it is essential to work closely with media to help change government and community attitudes and get support for increased funding.

Use of social media also critical – Get Up’s involvement was instrumental I believe in bringing about recent changes….

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Q. What are the most important pieces of research related to mental health during that time?

The Burdekin Report, Not for Service report, and the two reports on People Living with Psychotic Illness are pieces of research that have been of most relevance to SANE.

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Q. What is the best book you’ve read recently?

Most recent is ‘How I became a famous novelist’ by Steve Hely, a very funny and clever book highlighting the formulaic approach sometimes used to write best-sellers/top rating movies etc