Peace of Mind Podcast

Elayne: Hello and welcome to your Peace of Mind podcast. I'm Elayne Grace.

Insurance is part of the economic infrastructure of our society. It tries to give people peace of mind; to protect them from life’s uncertainties, but is it helping people who suffer mental health problems?

1 in 5 Australians are affected by a mental health condition in any 12-month period. While insurance coverage is available, there are complex challenges including:
-              subjectivity in diagnosis;
-              lack of reliable data; and
-              an ineffective regulatory framework.

Last week, we discussed some of these challenges with Geoff Atkins - co-author of our new Green Paper on Mental Health and Insurance.

Lucy Brogden, Chair of the Mental Health Commission, helped us launch that Green Paper, and she joins us now in the studio. Welcome, Lucy.

Lucy: Thank you Elayne

Elayne: It’s easy to get caught up in the challenges that mental health conditions present to the insurance industry, but there are a lot of positive initiatives going on. I think that’s what our Green Paper tries to do, to  l basically encourage a collaborative approach towards improvement. What are your observations?

Lucy: Thanks, Elayne. Well I’d like to congratulate the Institute of Actuaries on this Green Paper. I’ve been involved the mental health insurance conversation for at least 12 years, and for me this is a significant sign of progress and collaboration with the mental health sector and insurance, and actuaries being able to sit down and have a conversation and pave a clear path forward. The paper has some great recommendations and areas of focus, and I hope to see real change off the back of it.

Elayne: That’s great. Lucy, you are Co-Chair of the National Mental Health Commission, can you tell me a little about the Commissions role?
Lucy: So the National Mental Health Commission, by its name, we’re federal organisation; we have jurisdiction across federal aspects of mental health policy. We were established in 2012 and report both to the Minister for Health and the Prime Minister. We have quite a broad remit but our key stakeholders are the people of Australia and particularly those experiencing mental ill health, and those that love and care for them. We work on a contributing life framework to make sure that all Australis have that basic human right of being able to “thrive, not just survive” and participate in their community and have connection to family of choice.

Elayne: So you’ll have seen quite a significant change in that whole approach the way society deals with the issue?

Lucy: Absolutely, we have come long way and of the things that I try and do as the Co-Chair and a Commissioner is to promote the strengths of the system, and look I'm not saying it's perfect, it's far from perfect, but quite frankly if you have to be mentally unwell, it's much better to be mentally unwell today and struggling than it was ten years ago, twenty years ago and beyond.
So, we have made great progress around medications and treatment progress around understanding and supports within the community, and progress with generally just understanding that this is something that people can make a good recovery from that they can feel well supported and safe.

Elayne: Can you tell me a little bit about the distribution of mental health within society?

Lucy: Sure, so mental illness covers quite a broad spectrum. At the very far end of the spectrum, we have people who really experience severe psycho-social disability and for them, they’re well supported through programs like the NDIS and we're looking to see how that plays out along with many others.
Then we have people that sit a bit further down the spectrum with things like schizophrenia, eating disorders, severe illnesses, often episodic, who may need some hospitalisation and somewhat acute systems, and there's about 650,000 people sitting in that bracket. Then if we come up towards the middle we have around three million Australians experiencing mild to moderate mood disorders that can give them some impairment at various times in the year but are probably able to hold down a job, and participate reasonably well in community and family.
But what we know is that there's probably around 20% of the population experiencing a mental health issue at any given time.

Elayne: So it's a lot of people this isn’t a minority issue is it?

Lucy No it's very mainstream

Elayne: So how will the (announced in August this year) do you think, deliver tangible benefits to the lives of people living with mental health issues?

Lucy: The Fifth Plan, as it’s affectionately known, is actually quite a change from previous plans. Firstly, this plan that - the Minister incorporated suicide prevention into the plan for the first time and that's a great initiative. Previous plans have been very broad and tried to be all things to all people.

Elayne: not so targeted

Lucy: Not so targeted and what we’re liking and supporting in this plan is it's trying to focus down on some key areas of opportunity. Some people I think may feel that it should be a bit more focused at the treatment end, but at a Commonwealth level, and at the state level, some of the basic building blocks haven’t been well developed. So data is a key theme in this plan and that's something that's really important and particularly important for the insurance industry.

Elayne: And how important you think insurance is? Obviously it's only one part of the system but to support those facing a mental health disorder?

Lucy: Insurance is a key part of the conversation that we're having and in our person-centred approach to mental health we have the insurance sector sitting in one of those bands of significance. It provides support to those people who have had to leave work through private health insurance - it provides access to care. The Ministers recently announced a review and some fundamental changes there which I think are quite welcome, it’s going to be a challenge for the sector to respond to that but directionally I think it's a positive way to go.
We have some concerns currently that there may be barriers to help seeking, but equally we’re pleased to see that the sector is open to dialogue and conversation around this topic.

Elayne: We can see how much collaboration is needed and at least if there is the energy and commitment to do something that's a great start

Lucy: Oh absolutely

Elayne: One of the challenges for insurers is the lack of reliable data. In 2014 the Commission recommended “national targets and local organisational performance measures” to be implemented. What reliable data do we have regarding mental health on a national level?

Lucy: We have some good data but we certainly need to gather more – well actually - we need to access the good data that's out there, but it's often very siloed data and so through the Commission's work, we've done some interesting data linkage projects with the Australian Bureau of Statistics, but we're also looking to work with various sectors around the data that they have and looking forward to collaborating, particularly with the insurance sector on the data that they've got and how we can help analyse and link that to our project data as well.

Elayne: One of the things I guess we're very keen for as well is sometimes to make huge big changes to the insurance system can be difficult but can we not even do more of a project base so that actually that can just kickstart it, rather than wait till we have all the data in four years and stuff? 

Lucy: That's right and so the Commission is working with Department of Employment and CommCare on some data and pathways mapping project which I think will be quite exciting.

Elayne: At the end of the day, mental health is all around people. C an you tell us about this person-centred approach, as this was really a fundamental principle guiding the Commission's recommendations and I think it's something we're encouraging as well more in the insurance industry to, you know, put people at the centre focus.

Lucy: Yes, it's interesting when we tell the person-centred story that most people assume that that's what happens and that how it is. If we just do a quick plotted history of treatment in mental illness the patient has not been at the centre of that treatment. It's been very much a medical focus, psychiatrist led, or acute care dominated process, and today we respect that the rights of individuals to seek the care that they want and feel they need, and factor that with developments in things like technology that allows people to keep their own records, their own data, and work out who they wish to share that with. We also know that there's good evidence that when the person feels that they're in charge and in control of their treatment and recovery journey, they do much better, the outcomes are much stronger. So it puts the individual at the centre of and giving them some choice around treatment but it also recognizes the supporters and variables that will impact on their recovery journey. So we recognize the role of friends and families in the support network, we recognize the role of workplace, community, schools, the insurance sector, employment, education departments, housing is a critical function of that person centred role.

Elayne: Yeah we've seen that change coming through N.D.IS. as well where that whole and new approach in N.D.I.S has really changed  the conversation - which is fantastic.

Lucy: I think the conversations changing we need to keep the practice changing at the same pace as the conversation and I think what we've seen on some of these issues is the expectations have been raised and we have to be able to meet that new expectation.

Elayne: Yeah that's a difficulty because it's complicated again, it’s not easy, you need qualified people who are really committed. Could the Commission contribute to some progress in changing some of the relevant laws around mental health claims to improve outcomes and make dispute processes perhaps more sensitive to people experiencing mental health issues?

Lucy: I think there’s two elements to that question Elayne. We are more than happy to support the industry in terms of lobbying for some of the regulatory and legislative change that's required and we're having some of those conversations at the moment, and welcome input from others on that. In terms of the dispute management, I think a lot of that comes to education of all players and that's a function that we feel we have: is providing some of that opportunity for conversation and dialogue to inform the education changes. Some of that comes down to some fairly fundamental pre-service training in a lot of areas, not just allied health and health sectors, but even for our lawyers and our accountants and our actuaries potentially, is to understand the social determinants of health and their professions role in that social determinant of health - not just mental health but for physical health as well.

Elayne: Can you tell us about anything about the Commission’s collaboration stories, have they collaborated with others to improve its reporting, who are they working with ultimately to deliver better outcomes?

Lucy: Sure, collaboration's important to us but it's actually essential for us because we're a small unit a small organization we only have about fifteen staff. But also, co-design of what we do is an integral element of our approach and co-design is not consultation, it's actually sitting down particularly people with lived experience. And one of our operating philosophies is that a lived experience person needs to co-chair every piece of work that we do and all their working groups.

To that extent we've done some interesting work on an ‘Equally Well Consensus Statement’. One of the things we know about people with mental illness is often their physical health is not addressed simultaneously and so we've developed an ‘Equally Well Consensus Statement’ to try and inform the health sector, the allied health sector around ensuring that that they look at the whole person in the treatment strategy.

We've also got the Mentally Healthy Workplace Alliance which is an initiative of the Commission looking at how we can best help employers and employees improve their mental health and wellbeing. What we found is that most organizations appreciate that the significance and importance of this topic they're just not sure what and how to do it and so it's trying to develop toolkits and opportunities for people to develop that piece of work.

We've done some interesting work around seclusion and restraint practices in clinical care, which is a very important human rights issue, and developed some guidelines around that and starting to now analyse the data around, to ensure that those practice guidelines are being implemented. We've had some headline issues where bad practice has been occurring still, but the trends are for improvement, and that's powerful to have that data to show the behavioural change.

Elayne: Yeah that’s great. Yes, we certainly agree collaboration is key and that's certainly what Actuaries Institute is keen to do, work with the National Mental Health Commission, other industry, consumer and advocacy bodies, to ultimately improve outcomes for people experiencing mental illness. At the end of the day it's really about the people - making their lives better.

Lucy thanks so much for joining us today, and for obviously launching our Paper. Your insights have been extremely valuable as we continue this important discussion that we look forward to discussing with the in the future

Lucy: Thank you very much

Elayne: You're listening to your ‘Peace of Mind’ Podcast for the Actuaries Institute. That's all we have time for in this episode, I hope you enjoy the show. Join us next time when we'll be speaking with the C.E.O. of TAL on the products that cover mental health and how improvements can be made. I'm Elayne Grace, bye for now.