The Leadership Challenge in Mental Health Reform

1
The Leadership Challenge in Mental Health
Reform

• John Mendoza,
• Adj. Professor, Health Science, USC
• Adj. Associate Professor, Medicine, Sydney
  University
• Chair, National Advisory Council on Mental Health

2
Youth

• Youth is not a time of life its a state of mind
  it is not a matter of rosy cheeks .... it is a
  matter of will, a quality of imagination, a vigor
  of the emotions it is the freshness of the deep
  springs of life...
• The temperamental predominance of courage over
  timidity, of the appetite for adventure over the
  love of ease...

3
Mental health service reform will require
leadership at all levels political,
bureaucratic, professional and service. Not for
Service experiences of injustice and despair in
Australias mental health system, Oct 2005
4
NFS Leadership Governance

• Results
• Not done
• Done!
• In part
• Not Done

• A whole-of-govt service model developed agreed
  to by COAG based on collaboration, integration,
  community need, accountability, flexibility
  innovation
• Leadership for MH reform be vested in Federal
  Cabinet Minister
• New governance arrangements for true
  collaboration between govt, NGOs, private, CCs
• Inter-govt service agreements for improved w-o-g
  responses

5
Three years on ...

• "Carers are hurting from a number of problems
  endemic in the Australian system. These include a
  lack of co-ordination in treatment plans at the
  point of discharge from hospital, a drastic
  shortage in subsidised housing, few supported
  work programs and limited availability of
  psycho-social rehabilitation. CEO MIFA 8
  /9/08

6
Independent assessments of progress

• Senate
• The COAG National Acton Plan lacked vision,
  minimal attention to evaluation outcome
  measurement, critical shortages of supported
  accommodation ... There is no evidence of
  effectiveness arising under the Better Access
  program. (June 08)
• 3rd NMHP Evaluation Currie Thornicoft - ?
• Hickie et al
• disjointed arrangements between levels of
  government, poorly resourced community services
  an embattled public hospital sector our
  persisting unwillingness to collect or publicly
  report key measures .. undermines community
  confidence (in press)
• Russell Assessment Commonwealth MH programs
  July 08, Menzies Center for Health Policy

7
Leadership is a combination of strategy and
character if you have to be without one, be
without strategyGen Norman Schwarzkopf
8
Political leadership in action

• Howard and GST
• Rudd and economic response on Oct 11
• Kennedy Cuban missile crisis 1962

9
What is leadership?

• Belief beyond self
• Personal resilience
• Integrity
• Driving out fear
• Give up position power, build personal influence
• Be an early adopter innovate
• A focus on determination for results

10
Lessons from Sydney 2000

• Clear vision, purpose
• Strategy tactics
• Build the evidence
• Develop organisational capacity
• Build alliances
• Communication International advocacy
• Confront expose vested interests

• Drug cheats were exposed in unprecedented
  numbers with 60 athletes thrown off teams before
  or after their arrival in Sydney and others
  suddenly announcing injuries or simply not
  showing up, (thus) avoiding drug testing.
• The Sunday Age

11
Leadership is fundamentally about change
12
Kotters 8-step change model

• Establish a greater sense of urgency
• Create a guiding coalition
• Develop a vision and strategy
• Communicate the change vision
• Empower others to act
• Create some short-terms wins
• Consolidate gains produce even greater change
• Institutionalise the changes in culture
• Kotter, The heart of change, HBS

13
Leadership and change
Vision, plans, goals and strategies Behavi
ours Attitudes, culture, habits, traditions -
feelings, fears, values beliefs
14
Leadership as an art

• Meaning the ability to inspire purpose in
  people.
• Affiliation - ability to create a sense of
  belonging
• Security the ability to make people feel secure
  enough to take risks
• Trust the ability to create an atmosphere of
  trust
• Energy the ability to inspire passion
  enthusiasm
• Results accepting responsibility for delivering
  results
• Oxford Leadership Academy

15
Practical leadership actions

• Work to reduce traditional notions of office
• Hierarchy status
• Functional divisions role specifications
• Move to organic forms of organisation strategic
  groupings, task groups, communities of practice
  (e.g. based on like clients). Human
  sustainability model
• Eliminate patriarchal decision-making
• Build systems to enable decision-making as close
  to client as possible
• Formal leaders act as strategists/coordinators/c
  oaches less as decision-makers on behalf of all.

16
The critical question thenWhat is required to
avoid repeating past failure to reform?
17
Regaining National Leadership

• ... Under the (National Mental Health)
  Strategy, the Federal Government is committed to
  playing a leadership role in setting national
  objectives for reform and in measuring the
  progress of all governments towards them. It is
  important that this process is a public one, open
  to the scrutiny of the Commonwealth and one which
  makes all governments accountable within their
  states and territories for progress towards
  agreed goals
• Deputy Prime Minister Brian Howe, National Mental
  Health Report, 1992

18
A need for real leadership Draft National
Mental Health Policy

• Pays little regard to recent history, reviews,
  inquiries, evaluation of 3rd Plan i.e. a
  dishonest portrayal.
• Little context almost nothing on Rudd Govt
  agenda
• Has few real goals, no targets, no markers to
  assess progress - it commits no one to anything
• No reference to the UN Charter on the Rights of
  People with Disability (Aug 2008)
• Almost nil on co-morbidities - not just AOD
• Critical question Where will it take us?

19
A case of do as I say ..

• Previous head of UK Govts Delivery Unit, Sir
  Michael Barber
• leaders need excellent strategy functions and
  strong performance management systems, enabling
  them to steer well, identify flaws in
  implementation and intervene where necessary...
  The government departments responsible for major
  strategic reforms also need to develop this kind
  of capacity for themselves and where they do
  not have the necessary real-time data or the
  skill and will to intervene where there are
  problems, inevitably reforms falter.
• Quoted in Shergold, Oct 2006, Implementation
  Matters

20
Good practice in public policy

• Draft Policy

• Should show

• Genuine consultation
• A reflection of current context progress
  challenges
• Statement of need
• A clear, concise, meaningful vision
• Principles for action
• Measurable goals targets
• A staged approach to reform
• Robust governance, accountability

• No cannot show u
• Absent
• Vague, inadequate (e.g. nothing about needs
• Not evident
• Some evidence
• None
• Nil
• Nil

21
Youth is leadership

• Youth is not a time of life its a state of mind
  it is not a matter of rosy cheeks .... it is a
  matter of will, a quality of imagination, a vigor
  of the emotions it is the freshness of the deep
  springs of life...
• The temperamental predominance of courage over
  timidity, of the appetite for adventure over the
  love of ease...

22
Leadership adages to live by

• Think big Start small Scale fast
• The McDonalds Formula
• You miss a 100 of the shots you dont take.
  David Bussau
• To change is positive. To change frequently is
  perfect.
• Leadership is a function of knowing yourself,
  having a vision, that is well communicated
  building trust among colleagues, taking effective
  action. Brian Bacon
• Get off the dance floor and stand on the balcony

23
Thanks for Listening

• Contact
• John Mendoza, Chair, National Advisory Council on
  Mental Health
• NACMH_at_health.gov.au
• jmendoza_at_connetica.com.au