Perspectives
CEO Blog:
Systemic change in mental health: Is it about the ingredients or how we combine them?
As the demand for mental health support and services increases, so too does the need to build a collaborative and responsive mental health and wellbeing system that moves beyond a focus on clinicians and emergency departments.
Given the mental health crisis that we now collectively acknowledge, I wonder if we need to take a different (historical) view of the problem. How did we get here and what we can do about it?
It’s clear that our mental health systems have failed too many people for too many decades. And while for many, the eye of the problem seems to be that for forty years we have underspent on our mental health budgets, I wonder if there is a little more to it.
Looking back, we really didn’t transition towards effective and collaborative community-based support for people in distress when the doors closed on the mental health institutions in the 1980s.
Back then, people had good intentions and many of the reasons for a re-structure remain today. The intention was to replace the institutions with support for people in their community. The problem is that we didn’t have a good grasp of the implementation challenges to enable this model to take root in a way that was successful and sustainable.
So, what could community-based mental health look like in practice today?
If we limit ourselves to a definition where the spectrum of solutions only includes clinicians working in community locations through a range of services and modalities, we are missing the point.
Clinicians and emergency departments will always have a role, but in a community-based system, other organisations and community services can also play a role. So can individuals – parents, family, friends, peers and community leaders.
Our teachers, neighbours, those with lived experience, allied health and social workers can all make a huge contribution in a true community-based approach to mental health and wellbeing. This is often talked about but rarely effectively implemented.
My observation is that there is not a deep understanding amongst those who work in different the fields of mental, social and emotional health and wellbeing areas in Australia as to how to collaborate effectively. Collaboration is more than a process (for planning and design, for example). It is cultural, it is organisational, and it demands appropriate and committed local leadership.
Is the co-location of services a starting point for community-based support? Perhaps. But where co-locational arrangements are being trialled, they need to go beyond sharing office space and find a way to drive engagement and ownership with their local community.
Time pressures and activity-based deliverables force clinicians to stay in their swimming lane. Let’s be very fair to them. The current system makes it too hard to implement a collaborative way of working, especially when in a crisis.
So, in my attempt to re-define the problem – perhaps its more about how we implement a different approach from the ground up rather than fixating on finding additional funding to feed the current system.
For clinicians, staying in your lane in mental health should be recognised as no longer being a metric that will give us the outcomes we are looking for.
But how can we involve others in a true community-based solution? I have mentioned the others above, but as things currently stand they are rarely part of the story. While the media narrative around the recent resignation of approximately 200 psychiatrists in NSW has been largely focussed on the payment conditions of their employment, a bigger conversation about the ‘workforce’, paid and voluntary, needs to be had.
The latest research from APS shows that 27% of psychologists report clients waiting a month for an appointment, while 15% say the wait stretches to nearly two months.
RANZCP President, Dr Elizabeth Moore commented recently that “Australia has a critical and chronic shortage of psychiatrists.”
Compounding this, regional based Australians are missing out. 70% of Australians live in our five big cities (Sydney, Melbourne, Brisbane, Adelaide, Perth) but over 80% of registered psychiatrists and psychologists live in those five cities. Sure, some of those professionals engage in fly-in fly-out arrangements to regional locations for very short periods to meet the need.
But a clinician who lives in the community, knows the community and connects with people is surely going to have a deeper understanding of the mental health and wellbeing needs of people and their families.
To get to a coordinated whole of community response to mental health we need to do more than get the ingredients right – we need to know how to put that workforce, paid and unpaid, together to provide an approach that unlocks the true potential and capability of everyone in the community.
To do this we need new structures and frameworks that communities can co-own and drive. In summary, my view of the problem is that it’s not that we don’t have enough government funding in the mental health system, the problem is that we don’t combine the existing ingredients effectively.
Keith Bryant, CEO
Three ways to spread the word about Open Dialogue training
Learn more about the Open Dialogue Approach – online or in Sydney and Melbourne.
Scholarships for organisations who need support and people with lived experience are also available!
Here’s a few snippets of feedback from some of participants:
“I now have a vision of how Open Dialogue can be implemented within my service and across the community.”
“It is important that as many people as possible do it to rebuild communities, and phase away from the “independent/individual” approach.”
“I do not believe that you can truly understand the value of Open Dialogue unless you engage in training.”
“Thank you for a life-remembering and life cherishing experience.”
For anyone who is curious:
Join our one-day online introduction to Open Dialogue: May 19th
ODC has brought together experts from different mental health regions and fields, who will draw from their unique experiences and reflect on how Open Dialogue can have a practical application in different health contexts – in Australia and globally.
For those who want a great understanding of how Open Dialogue works:
Apply now for our four-day online introduction to Open Dialogue
The virtual door is open! If you work as a clinician, counsellor or lived experience professional, this course will provide you with a good introduction to how Open Dialogue can be transformative.
Delivered across four days in two blocks.
Designed for people already working in mental health and related fields.
Block the dates for your diary in 2025:
10th & 11th June 2025
24th & 25th June 2025
For anyone who is curious: Join our one-day online introduction to Open Dialogue: May 19th
Apply now for our One-Year Foundation Course in Open Dialogue
Join us in Sydney (or Melbourne) in 2025-2026 to deepen your practice and develop new skills.
ODC’s One-Year Foundation Course is the only course of its kind in Australia with guest speakers who are developing the Open Dialogue Approach in different settings and contexts.
We are inviting mental health professionals and practitioners who work in multidisciplinary areas of health and wellbeing to have confidence and competence in facilitating Open Dialogue network meetings.
Course dates:
Block One – 12 to 16 May 2025
Block Two – 11 to 15 August 2025
Block Three – 10 to 14 November 2025
Block Four – 2 to 6 February 2026
ODC Q+A with Leanne Hall
We spoke with Leanne Hall, Lecturer and Course Director, Master of Clinical Psychology, Macquarie University about her way of working with Open Dialogue in a learning environment.
1.What is your interest in Open Dialogue and how is your work informed by the approach?
I have been a therapist for over 20 years, trained in clinical psychology. I was introduced to Open Dialogue by a colleague and attended a four-day training workshop a few years ago. It changed my practice and resonated with me on quite a deep level both personally and professionally.
I now teach post-graduate clinical psychology students, and my teaching approach is informed by dialogical principles. I have also introduced my students to Open Dialogue and have enjoyed watching them integrate dialogical practices into other treatment modalities which has been fascinating.
2. What do you think is the opportunity with learning environments today and why?
Students have become increasingly disengaged with their learning. I think this has increased since COVID. I also believe many young people in this generation (and some older people too!) have become passive learners – through the cultural shift to social media, endless scrolling and mindlessly digesting information. Open Dialogue encourages students to become more active in their learning by inviting them to engage in dialogue and reflection.
3. What do you think is the biggest problem in mental health and how can we address it?
Avoidance of discomfort, physical, psychological and spiritual. We constantly seek what’s comfortable and avoid (or numb) anything that causes us pain/discomfort (which we see as ‘bad’). Mental distress has also become over medicalised which further contributes to comfort seeking and avoidance so as not to be seen as “sick’ or “broken” by the system (which holds all the power).
We need to start to (re)value social networks and the role that communities can play through collaboration and respect. Open Dialogue is an extremely important part of this.
4.How can training in Open Dialogue be useful to the mental health workforce – particularly for those who are starting out?
It offers a way of centring lived and living experience and challenges the usual power hierarchies that we see in the mental health system. This helps to build trust and encourages people to share their vulnerabilities without fear of being judged or ‘othered’.
It also activates the healing power of social networks and communities, sharing the burden carried by the mental health system and health professionals. It offers people an alternative to seeing a health professional, by creating network where the person experiencing distress can feel ‘held’ while also receiving other forms of care.
