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Major shakeup for mental health as Wade weighs "conflict" at the top

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The Government will implement a major shakeup of the mental health bureaucracy but won’t eliminate what Health Minister Stephen Wade once described as a “concerning conflict of interest” at the top till after the next election.

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In late 2017, the Weatherill Government merged the two positions at the top of South Australia’s mental health system into one.

Responsibility for policy and strategy – vested with the Executive Director of Mental Health – was handed to the Chief Psychiatrist, who had until then exclusively dealt with oversight of the system.

Then-Opposition Health spokesperson Stephen Wade told InDaily at the time that this constituted a significant conflict of interest that undermined public confidence in the independence of the Chief Psychiatrist.

He argued that former Chief Psychiatrist Dr Aaron Groves was only able to independently inquire into the abuse of patients at the Oakden Older Persons Mental Health Service because he was not involved in the design of policy and strategy in the mental health system.

Merging the roles “just undermines the people’s confidence that they’re being completely independent,” he said then.

Last Friday, the Government quietly released a major review of the governance of South Australia’s mental health system, which argues for a complete separation between the oversight and policy roles – i.e. re-establishing the Executive Director role.

“There is a common perception that the combined functions of the Chief Psychiatrist and the Director of Mental Health Strategy roles pose real and potential conflicts of interest,” the report reads.

“There currently exist insufficient mechanisms to meet the expectations of transparent role separation.

“(Role) separation is the only option that eliminates the conflict of interest by a clear delegation of functions to separate the independence monitoring of the clinical quality and safety of care from the setting and operational implementation of strategy.”

Specifically, the report recommends new lines of reporting to mitigate but not eliminate the conflict of interest in the “short / medium term” and splitting the roles entirely in the “long-term”, without defining either timeframe specifically.

The Government has “broadly accepted” both recommendations but has put off splitting the Chief Psychiatrist’s role until after the next election.

“The longer-term structural changes proposed in the report to the role of the Chief Psychiatrist and the Mental Health Strategy Unit will be implemented in the future and are not proposed during the term of the current incumbent,” the Government’s interim response to the recommendations reads.

Wade told InDaily he has “utmost confidence in the Chief Psychiatrist John Brayley to undertake his roles with independence”.

“Pending the outcome of the consultation, my current intention is to accept the recommendations of the independent reviewer and implement interim changes to the two roles of the Director of Mental Health Strategy and the Chief Psychiatrist – to reflect their differing functions.

“This would be a precursor to splitting the roles, which would happen in a staged process, as per the recommendations of the review.”

He added that the report recommends the roles not be split until there is a new person appointed as Chief Psychiatrist.

Mental health shakeup

The report, prepared for SA Health by interstate firm aspex consulting, also recommends a series of changes to the structure of the state’s mental health bureaucracy, broadly in line with what the Liberal Party proposed during the 2018 state election campaign.

It proposes a Commission for Excellence and Innovation in Health, which will “define the lead agency” for the oversight of clinical quality and safety monitoring in the physical and mental health systems.

It notes, however, that the role overlaps with the role of the Office of the Chief Psychiatrist, posing risks.

“The overlap in the performance monitoring function exposes the system to the risk that no single entity has clear accountability,” the report reads.

“It is proposed that the Commission on Excellence and Innovation in Health is best placed to define the lead agency for this essential system wide function.”

It also suggests a “Statement of Priorities” to ensure the performance the Local Health Networks – which are to be split from the three current LHNs to ten LHNs – is monitored effectively.

The report also argues that the SA Mental Health Commission should be brought under the auspices of Wellbeing SA – a new arm of SA Health that will aim to prevent unnecessary hospital admissions by promoting early intervention healthcare.

The Commission was responsible for developing the SA Mental Health Strategic Plan but the report argues that “there have been limited tangible outcomes” outside of this and there is “significant overlap” between its role and that of the existing, “and soon to be expanded” roles of SA Health.

“SA Health should be mindful that any duplication of the core roles and responsibilities of SA Health is wasteful of limited resources,” it says.

Chris Burns was appointed Mental Health Commissioner by the Weatherill Government in 2015.

The Government has “broadly supported” the report’s recommendation to consolidate SA Mental Health Commission into the functions of Wellbeing SA.

Nonetheless, Labor Health spokesperson Chris Picton told reporters this morning that the “abolition” of the Mental Health Commission would undermine oversight of the mental health system, and the Government should “reverse” the decision.

“On Friday afternoon the Government slipped out the news, uploaded on the (SA Health) website that they’re going to abolish the Mental Health Commission,” he said.

“They’re getting rid of the people who advocate for consumers, we’re getting rid of the people who have independent oversight of mental health in South Australia.

“We need this oversight. We need this independent expertise.”

The Mental Health Commission has advocacy, policy and strategy roles, but the Minister and the Chief Psychiatrist hold the pre-eminent oversight functions over the mental health system.

InDaily contacted Burns for comment, but we were referred to the Minister.

You can read the full report here and the Government’s interim response to its recommendations here.

Correction: An earlier version of this article stated that the Government had not explicitly endorsed the abolition of the SA Mental Health Commission. In fact, it endorsed the merger of the most of the Commission’s functions into Wellbeing SA and the remainder into the Office of the Chief Psychiatrist. 

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