Being Equally Well Launch Webinar 

Transcript – Part 1: Introduction & Project Summary


Rosemary Calder:

Welcome to today's webinar.

Today we're launching the report Being Equally Well:  a national policy roadmap to better physical health care and longer lives for people living with serious mental illness.

My name is Rosemary Calder, I lead the Australian Health Policy Collaboration, a national network of chronic disease and population health experts that is supported by the Mitchell Institute, at Victorian University.

Today, we will be joined by the Honourable Greg Hunt, the Minister for Health and Aged Care in the Australian Government, who will give the keynote address to this webinar.

The Minister will be introduced by the Vice Chancellor of Victoria University, Professor Adam Shoemaker.

You will also hear from the five Chairpersons of the expert working groups who have lead the word that has developed the roadmap.

I welcome them today, particularly, and will introduce you to them shortly.

A webinar can’t be as fully interactive as a face-to-face symposium, which was what we had hoped to host.

To provide as much opportunity as possible for you, the participants in the webinar to share, in an open forum discussion about this work and its future, our panel of Chairs will be joined by three discussants at the conclusion of the Minister’s keynote address. With them as a panel, we hope you will engage in discussion using a questions, answers and comments format.


I want to welcome today many of our nation's physical and mental health experts who have work with the Mitchell Institute over the past year to develop a policy report that we are launching today.

I particularly want to acknowledge James Dunbar, clinical and research advisor for the Australian Health Policy Collaboration, and Maria Duggan, policy fellow at the Mitchell Institute.

Both worked on the design of this project, contributed to the outputs of the project and work to ensure that the technical reports produced by the project faithfully reflected the work undertaking. James and Maria also have been the team behind the policy roadmap to Being Equally Well that is being launched today.

I also want to acknowledge Equally Well Australia, our collaborators in this project and acknowledge the extended collaboration we've enjoyed with them through the past two years.

To commence today's discussion, Professor Maximilian de Courten, Director of the Mitchell Institute will acknowledge country.


Maximilian de Courten:

Good morning, everyone, my name is Maximilian de Courten, I'm the Director of the Mitchell institute at Victoria University and I’d like to extend a very warm welcome to all of you for this special Mitchell Institute event.

Before we begin today's discussion I acknowledge that we are meeting virtually from many corners of this land.


Victoria University acknowledges the Ancestors, Elders and families of the Boonwurrung,

Woiwurrung and Wadawurrung  of the Kulin who are the traditional owners of our university land in Melbourne, and the Gadigal and Guring-gai people of the Eora  Nation upon whose ancestral lands our place of learning stands in Sydney.  

I acknowledge the lands of this country on which all of us reside today and pay my respects to all Elders across this land, past, present and emerging. I acknowledge and welcome all Aboriginal and Torres Strait Islanders here today.  


Now let me welcome you all to this launch of Being Equally Well and remind you, you see, on the next slide, we have a special Twitter hashtag, it's down there #BeingEquallyWell with the hash sign at the beginning in one word.


A quick word about the Mitchell Institute, it was established by Victoria University in 2013 as an education and health policy think tank to provide a platform to contribute directly to improve health and education outcomes for individuals across Australia.

The Institute has focused on translation of evidence to both policy and practice information that will lift health and education outcomes for individuals. In particular, for communities in which individual health and education opportunities are compromised by disadvantage.

And people with serious mental health illness suffer such disadvantage and that in turn leads to poor health outcomes and shorter life expectancy, we are talking today about. 

The Being Equally Well policy roadmap being launched today provides policy information to improve the health care services that are central to their physical and mental health. The Roadmap is based on detailed examination of the strongest evidence of what works and makes specific recommendations to improve health outcomes and health care for individuals.

It is a project that continues the commitment of the Mitchell Institute and Victoria University and we hope it will make a powerful contribution to our national capacity to support better health and longer lives for people living with mental illness. 

I'm very much looking forward for the upcoming discussions.


Rosemary Calder:

Thank you Max.

Now, before we move on, I need to remind you that this webinar is being recorded.

For the question and answer section today, after the Minister’s speech, please feel free to pose questions or provide comments by the Q and A function at the base of your screen. And if you would like the answer to a questions that has already been asked, you can up vote that question by using the thumbs up icon in the Q and A site.


Joining me now is Malcolm Hopwood. Malcolm is Co-Chair of Equally Well Australia, Director of the Professorial Psychiatry Unit at Albert Road Clinic, Honorary Professorial Fellow at Florey Institute of Neuroscience and Mental Health, and President of the Asian Federation of Psychiatric Associations.  

Together, we will take you through the process that has led to the development of these policy recommendations that we are releasing today in the roadmap. Welcome Malcolm.


Malcolm Hopwood:

Thank you Rosemary and on behalf of my Co-Chair Dave Peters and the team at Equally Well Australia, it's a great pleasure to join everyone today.

It seems very appropriate to begin considering the roadmap, by looking at the scope of the issue we're considering.

It's incredibly poignant to look at the accumulated data both globally and from Australia that says we're talking about a reduction in life expectancy that people with major mental illness in Australia of 14 to 23 years.

That reduction in life expectancy is mainly accounted for by the common causes of mortality in the community, occurring earlier in people with major mental illness, and sadly, progressing much more rapidly.

So, for example, people with major mental illness in Australia are six times more likely to die from cardiovascular disease, five times more likely to smoke, four times more likely to die from respiratory disease. And in terms of the scope and impact of the problem across the Australian population, this accounts for approximately one third of all avoidable premature deaths in Australia.

It's possible some may see this is a relatively small scale problem.

It’s huge in its impact. It's huge in its impact on the economy and it's huge in the impact on individuals and their families.

It's worth remembering that the best estimate data obtainable from the National Mental Health Commission suggests we’re talking at least 400,000 Australians who fit into this category.

So we're building on a body of global and Australian research and I'd like to acknowledge some of those initial endeavours.

So globally there's been some evidence now accumulating over the last two to three decades of this premature mortality.

And data best developed in Western Australia, where there was the capacity to put together mortality and mental health data, by Steve Kisely and others, showed that Australia shares this problem. And that these problems, seeing individuals with disorders, like schizophrenia, bipolar disorder and other major mental health problems.

Concern about our responses to this problem has become increasingly widespread and has led to clinical developments, like that led by Jackie Curtis in Sydney, with early intervention in the problem when people are still young to prevent the development of those problems.

During my tenure as President of the College of Psychiatrists, we noted, however, that this has not led to widespread tackling of this issue. That we've been bedevilled by a series of issues that we're going to explore in the discussion of the roadmap.

During the period 2015 to 2017 the College, both alone and in partnership with the Mitchell Institute, launched a series of publications looking at this issue and looking at its impact. And then collaborated with a number of other professional organizations, consumers and carers, under the auspices of the National Mental Health Commission to produce the Equally Well Consensus Statement in 2016, outlining a set of key aspirations in this area that can be summed up best as meeting an expectation that individuals with major mental illness in Australia should have the same life expectancy as everyone else.

The great work that was involved in this consensus statement was the production of a network of interested parties that's critical to really developing the combined effort we need to arrest this difficulty.

From that group we develop an alliance that ultimately became known as Equally Well Australia.

Russell Roberts will describe our partnership in more detail later, but essentially a collaborative network of over 90 organizations representing people across the spectrum of parties with an interest in this area and the power and capacity to resolve the problems.

But these problems are not going to be solved without appropriate policy frameworks and a roadmap to arrest these difficulties.

And that's where our collaboration with the Mitchell Institute and the related Australian health Policy Collaboration are critical and have led to the roadmap you're going to hear about today.

I think endemic or embedded in this work is the nature of collaboration and that this work involves bringing together as health and Community partners that span national, state and local jurisdictions and without that level of collaboration this work cannot succeed in solving this major public health problem.

At this point, I’ll hand back to Rosemary who’ll lead us further down this path. Thank you Rosemary.


Rosemary Calder:

And thank you Malcolm, and indeed it has been a very intensive, collaborative process of the levels of the system that Malcolm has talked about.

On the screen, you can see the collaborators or participants in this project. More than 50 people have many hours of their time and committed their personal and professional knowledge to this project, and all are acknowledged as authors of the report of the working group in which they participated.

I particularly want to acknowledge the hours of work contributed by their rapporteurs for each working group. Their reports provided the core of the technical report - very large volume - that lies behind the policy roadmap.


With complex projects such as this, and the detailed and technical nature of the reports we produced, it's common to find something missing or a typo just after you've got the report back from the printer will just after it's gone up on the web.


We’ve done the modern day equivalent of the former and I apologize abjectly to all project participants for the big glitch we discovered yesterday. The list of project participants was lost in the translation from the technical report to the policy roadmap that you've all received a copy of.

And unfortunately that is now being fixed on the copy release today on our website, but we’ll recirculate the copy to you immediately, and these are the people who did that work. Now let me show you how we did the work.

The next slide will show you the sequence of steps that we took to deliver what is 160 pages of evidence and discussion about what can be done to change the live span gap, you’ve heard about.

And what can be done at the front lines of care, the basic level of healthcare that people need to access on a regular basis, to achieve change in the outcomes that we've heard about.

The roadmap is the result of collaboration of people with lived experience - those living with serious mental illness and carers for people with serious mental illness, - chronic disease and primary care experts can mental health experts.

If we could move on to the next slide. 

The project design used a structured working method, known as the clinical micro system approach.

Five working groups were established: 

The lived experience working group, providing consumer and carer experience, their frustrations and their aspirations.

A clinical microsystem group focused on the role of general practice and primary health care.

A mesosystem group looked at sharing care across acute care, primary care and specialist mental health services.

The macro system group explored the policy leaders to support sustained improvements and physical health care and outcomes at the micro and mesosystem group. 

And the quality improvement group assessed and determined measures and models for improved physical health care and sustained health care outcomes.


The group's met separately, through a four meeting cycle, looking first at the problems, considering the evidence of what works to address those problems and using the measures of success that were developed by the lived experience group, identifying and recommending the system improvements that will build the evidence of what works into practice and into health service arrangements.

The joint meeting of the consumer and carer group and the other working group chairpersons at the midpoint of the meeting cycle directly informed the next phase of the project which looked at what to do to achieve the groups agreed measures of success.

And recommendations from a working group were synthesized into the roadmap, we are launching today through systems integration agreed of all Chair people and rapporteurs.

The work of the groups and the individual clinicians, who undertook evidence reviews for the project, are presented in detail in the two volume technical report, which we hope will be the reference resource for all those who work towards the recommended system improvements.

The Mitchell Institute team has produced the shorter policy-focused roadmap report that we're launching today.

It distils from the technical reports to provide a summary of the major changes and the roadmap of how to deliver the improvements that we propose.

You’ll learn about the recommendations from the panel of working group chair people that will each discuss the work that they lead.


Now, before we proceed to our panel, please remember to start contributing your questions and comments for the open discussion forum that will follow the keynote speech by the Minister.

You can put your questions and comments to the forum via the Q&A function at the base of your screen. And again let me encourage you to use the thumbs up / up vote function to indicate questions or comments you're interested in.