No health without mental health: Development sector lessons

21 May 2016

Suicide Prevention Australia was proud to contribute to a report released by the Overseas Development Institute (ODI) this week, ‘Mental health funding and the SDGs: What now and who pays?” 

Our Head of Communications Kim Borrowdale was lucky enough to be in London for the launch and shares her thoughts on the panel discussion below. Many congratulations and thanks to Jessica Mackenzie and the team who worked on this piece of research and made the launch event possible.

My eyes lit up when the invitation to this report launch popped up in my inbox and I saw that former British Prime Minister Tony Blair’s spokesman, press secretary and director of communications and strategy, Alastair Campbell, listed as part of the panel.

As a communications professional (read comms nerd), this was a great opportunity to hear his perspectives on how to engage stakeholders and influence change. As Head of Communications for Suicide Prevention Australia, it was a particularly timely meeting as I was keen to hear his thoughts on how to influence Government as we head toward election time. How can we ensure mental health and suicide prevention feature in policy announcements and, more importantly, aren’t just words on a page when the real work needs to get done post election?

Joining Alastair and Jessica on the panel was Dixon Chibanda (Honorary Researcher King’s College London’s Institute of Psychiatry, and Senior Consultant in Harare, Zimbabwe) as well as Foday Sawi Lahai (Former Deputy Minister of Health and Sanitation, Sierra Leone). The Panel was chaired by Executive Director of ODI, Kevin Watkins.

Here are just a few comments that stood out for me in the discussion. I would encourage you to read the report or, at the very least, the summary booklet ’10 things to know about mental health’ when you have a moment. It is clear that investment in mental health as a priority and funding stream in the development sector leaves a lot to be desired, a sadly familiar story when it comes to domestic investment in mental health and suicide prevention.

“We are winning the battle of awareness but I worry that with this awareness and increased demand for services comes people finding the service is not there.”

Alastair started by commending the increased level of mental health awareness in the UK. Read his article "Not even republicans can fault the British Royal Family on mental health". He did however, emphasise that we are still a long way from being able to say that we have equality between physical and mental health and showed real concern at the thought of people reaching out for support finding that the service they need is just not there. 

We are already seeing evidence of this in Australia. Over the past few years we too have seen a greater level of public conversation, compassion and interest in mental health and suicide prevention. However, with this greater awareness has come greater demand for our seriously stretched services. This demand has not been matched by sustainable funding for services, particularly for our most vulnerable and those around them. This must change.

Interestingly, in his plea to mobilise both political and public stakeholders, Alastair asked us not to forget the cultural space. For example, look at popular television programs and how they can inform the public mental health conversation. Alastair referenced the work the Samaritans have done recently with top British soap opera, Eastenders and the suicide of one of the main characters, Peggy Mitchell.

This reminded me of a university subject I did many years ago where I had to write an essay on whether soap opera storylines contribute to social change or if changes in society contribute to soap opera storylines. Fascinating to think about and not to be underestimated in terms of influencing the general public's perspective on mental health.

“Just at the point that you as an expert are getting sick of what you are saying, there is an outside possibility that the outer rim of the public has heard you. Keep talking.”

This was a fantastic reminder from Alastair Campbell. Often in this job you feel like you are repeating yourself; whether it is within the sector, to politicians or to the general public. 

On getting commitment from Government, he encouraged us to look to big, powerful arguments, specifically making an economic case for change. He empasised that the Government is persuaded by campaigning and social movements for change but also suggested highlighting where other governments are doing it and using their willingness to change as a lever for our government. 

He also pointed out that finding those in the political system who believe in your cause should not be underestimated as a lobbying tool. Like him, many of our politicians and their teams have been personally affected by mental illness and suicide. We should be seeking these people out as he rightly says, "personality and politics can’t be keep apart". At Suicide Prevention Australia, we know this to be true with a number of politicians sharing their personal experiences with us as they develop policy. Suicide and mental illness touches many of us and we need to remember in our campaigning that politicians are people too.

However, to make the change we want to see Alastair insisted that not only do we need to, as a sector, decide to make the change but be focused in organising ourselves to make the change and never lose sight of the fact that we need to work together. And, once we do this, distil it down to what we would say in five minutes to the Prime Minister. Forget the elevator pitch, "what would you say on a postcard; what would you say to him or her as you pass them in the hall - what is the ONE thing you want them to do?"

This leads nicely into what our friend Mr Foday Sawi Lahai had to say.

"The Government needs to put its mouth where its money is."

Now that statement hurts my brain a little but after a few seconds (and a few repetitions from Foday) I understood what he was saying. What Foday was most passionate about was the fact that Government can speak to a commitment to mental health and suicide prevention but to show real leadership and duty of care to the health of its citizens, it must introduce a central unit sitting within Government to drive this, a unit that can go cross portfolio and drive change at every level of Government and community in a coordinated, targeted and measurable way. This make absolute sense to me.

VIDEO: Foday talks with me about importance of Government showing leadership.

“Find your heroes in small groups, leaders who get things done”

As we know, driving positive social change is not solely the Government's responsibility. Each of us has a part to play in building the resilience of ourselves and our communities. Suicide Prevention Australia and its members work hard to support communities to learn how to get help and give help, with the Communities Matter website just one of a number of resources introduced to assist small towns and local communities to take action.

Panellist Dixon Chibanda shared a great example of a community initiative that has been successful and is now being rolled out on a wider scale in Zimbabwe along with significant interest in the project from other countries - The Friendship Bench. The Friendship Bench Project aims to reduce the mental health treatment gap by using a cognitive behavioural therapy based approach called problem solving therapy on a primary care level to address kufungisisa (Shona expression for depression). 

Evidence shows that ‘task sharing’ (getting non specialist health workers to assist with delivering mental health services) can be a cost effective way to fill the gap. In Australia, our Lived Experience Network members and colleagues often tell us that they want to see more investment in peer support. I think we could learn some great lessons from this project, whether it is "lay health worker" support when someone is triaged in a hospital Emergency Department or a community peer support initiative that complements GPs, counsellors and more formal support groups. 

"Talk about what they know and how focus on mental health will benefit outcomes for other programs"

Dixon also raised the subject of integration into other programs throughout the panel discussion. That is, instead of seeking funding for a new mental health or suicide prevention program, look at how you can integrate these services or objectives into existing programs. There was a great example given by one of the audience members about pitching to a donor for a project to improve mental health outcomes. They knew that maternal health was a priority for this donor. They also knew that by focusing on mental health of new mothers in developing countries can lead to better health outcomes for the mother and the baby. So, that is exactly how they pitched the project; not as a mental health iniative but as a project to improve maternal health where an element of this was a focus on mental health. Does that make sense?

To me this is not only about reducing duplication and thinking about what programs are already available; but also a brand and marketing exercise. We need to go back to basics and think about it from our funders' perspective. What drives them to contribute to the health of our community? How can we take another look at the outcomes we are looking to achieve and "repackage" it for them? It is not about compromising your program objectives but about making the case for funding and making the project relevant to your primary stakeholders. 

Finally I want to leave you with this thought from Alastair Campbell, echoed by many others I’ve met on this trip:

“1 in 4 of us has a mental crisis each year. 1 in 1 of us has mental health.”

Many thanks to Kevin Ward, Jessica Mackenzie and the team for their kind invitation to contribute to the report and attend the launch. Special thanks to Alastair, Foday and Dixon for their time and insights. As always, if you have any questions or contacts you’d like me to add to my UK meeting schedule this month, please get in touch.

Kim Borrowdale, Head of Communications

Note. This blog has been published as part of Kim’s commitment to sharing lessons from the UK as recipient of an Ian Potter Foundation International Learning and Development Grant. She will also be reporting on findings and observations at the 2016 National Suicide Prevention Conference in Canberra in July.

 

Read 1 June blog post "National strategy and community action: Top down, bottom up and inbetween" 

Read 21 May blog post "No health without mental health: development sector lessons"

Read 19 May blog post "Give them a gift: Thinking differently about data"

Read 17 May blog post "Somewhere between heartbreak and hope"

Read 12 May blog post "Collaborative working: Moving beyond the willing"

Read 10 May blog post "So what? Translating research into practice"