Alastair Campbell: Setting the mental health agenda

Ian Hickie: So welcome. I'm Professor Ian Hickie. I'm the co-director of Health and Policy at the Brain and Mind Centre here at the University of Sydney. And this is a Sydney Ideas event, so we are live streaming and recording. Be careful what you say. Mainly, I should be careful about what I say, but Alastair, don't be careful.

Say whatever you think. It's fine to speak Australian here. It is a very important day for us as part of Sydney Ideas. As many of you would know, the goal of Sydney Ideas and of the University of Sydney is to be more engaged with the societies in which we live. And to take up the hard issues, the difficult issues and have those conversations that we need to have.

So it's a great pleasure today to have Alastair Campbell here. But not only to have Alastair, but to have the Minister Rose Jackson, who's responsible for mental health. And many other important things here in New South Wales. And our representatives from both the Matilda Centre, with Marie Teesson here in the front row; we have Tanya; we have Zsofi, also a young person here, to discuss what's going to happen.

Now, you will be able to put in questions and comments on slido.com to follow the event. So if you want to get in your favourite question now, you can go to that as we go. The running of events is going to be, I'm going to do a very short introduction, then Alastair's going to speak, then we're going to have a panel, which also includes the most important woman in Australia, Sam Mostyn, but we'll come to that shortly.

And there's a serious sucking up we'll go on, and it'll become obvious why I'm seriously sucking up with her as we go. Just as we start though, it's important to recognise the traditional owners of these lands. The Gadigal people of the Eora Nation, and we at the University of Sydney recognise what they have learnt and shared in these lands for tens of thousands of years.

Those of us in Anglo Saxon traditions washed up on boats a short time ago. Those cultures have been here for a very long time and our learnings are important. If Jacqueline Troyer, the Director of Indigenous Research, was here with us today, she'd say: You're a funny lot. You're always asking are you okay?

What you really should be asking is, is the mob okay? Are we okay?" And central to today's discussion, are young people in Australia okay, and what is the future of that? So I just want to give a short background, because what we want to talk about is not the nature of the problems, but what is to be done.

Having Alastair, with his background in politics and the minister here, that's the kind of focus. But just to give you some idea, without re-describing the problem of the size of the problem that we actually have. I want to share a little bit of data with you. But that's the agenda for us - beyond awareness raising.

We are gold medal winners in Australia on awareness raising in mental health. Our status of implementing change consistent with that is much more questionable, particularly for young Australians. In health, everyone says cancer, heart disease, everything else. There are more productive years of life lost every year due to suicide in this country, by far the biggest health problem from productive years of life lost. When it comes to where's the problem start? In young people. In depression before the age of 25, and most worryingly in the most recent data out of the HILDA surveys in Australia, what is happening in psychological distress in young people has increased.

This was not simply a COVID problem. It was evident in the decade before COVID, although it's very long standing, people forget that the first national suicide prevention strategy we had in Australia was a youth suicide prevention strategy in the 1990s, pre Facebook, pre social media, pre the new technologies.

There are bigger social factors that have been running for a long time, but certainly in the last decade and certainly since COVID that has accelerated and it has not gone away. We might have all gone back to work, kids might have gone back to school, but the problems for young Australians relative to all other Australians continue to increase.

The other thing where gold medal winners in Australia is at inquiries. We love a good review. Sam Moss and I are National Mental Health Commissioners, a big one with the government. We were part of what had precipitated the Prime Minister at the time, to speak to the Treasurer at the time, that guy Scott Morrison, to send something off to the Productivity Commission.

This is about economics. And the biggest review we ever had was not the Victorian Royal Commission, it was actually the Productivity Commission report. There's a lot of recommendations. And one out of that that I really want to highlight today is place based solutions. We have endless discussion about our complicated governance in Australia between the national government and the states but New South Wales as a state is a very different place.

The Minister is the Minister for the North Coast, along with everything else in the emergency response there. Across Australia, many people will be aware that we have about 52 different regions in Australia where we need to bring our communities together to have that discussion. One of you is in Eastern Sydney, obviously those people from South Western Sydney and Western Sydney and other parts, North and South Coast, would be aware we're a very different set of places.

So what we really want to do is not just describe the problem, but it's important to know that the problem is bad and worsening. Sam and I have been discussed in pretty intense discussions with the current government, federal government, also because of demand issues over the last decade. We've been so successful at awareness raising that demand for services has gone up.

Inequity in access to those services has also gone up. And the cost of arriving and receiving those services has gone up, leaving many people in greatest need further behind. So we not only have the challenges of how common is the problem, we have challenges in our system about how to respond at a community level, but also through our whole services systems.

So for us, it's a political problem. It's a community problem. Some of us have the ear of Mark Butler, of our current National Health Minister, and he was the Minister for Mental Health 10 years ago in the Gillard government. He's back. A bit unusual for a politician to return to where you've been before and go, what happened?

We didn't seem to solve it. It got worse and the equity issues got worse as well. He makes a very important comment though. Without community support for action, it's unlikely that there will be further action. The priorities, cost of living, intergenerational issues, housing - another one of the minister's responsibilities, are huge.

So, today, we're so lucky to have someone like Alastair, who's been at the centrality of government and a communications director in government for the Blair government. And a pretty interesting character, I must say, along the way. What many of us would call the H. G. Nelson of communications. I'll join the H.G. later on. On the podcast, The Rest Is Politics, they talk about his twin. I'll show him his twin later on. Which is clearly H. G. Nelson. But a reputation for cuts, for just saying it how it is. And in conversation with Rory Stewart in the very successful podcast. Some of us do podcasts and think they're moderately successful, you know, 250, 000 downloads. The Rest Is Politics, has 7 million downloads a week or a month. He's lost track. They're about to fill the O2 stadium in London with an audience. Which is really interesting for us at the University of Sydney as well. Because people are interested in having those discussions to disagree agreeably, to have conversations that we need to have.

But then action to follow. So I'd like to invite Alastair, who's very kindly shared his experiences of mental ill health, gone on to be very successful in government, written fabulous books on mental health, I quoted in my own book recently some of his direct experiences for talking how it is. Alastair, how might we influence the political agenda to actually get things done for young Australians?

Alastair Campbell: Thank you. Thank you.

Right, thank you, thank you very much. How do you influence government? I mean, I have this kind of mantra for all campaigns and all communications. Are there any Scandinavians here? No? No Scandinavians? Because I once went to Norway and did a speech where I said the three most important letters in the alphabet are O, S, T.

And they all laughed because I didn't know until that point that O, S, T is every Scandinavian language for cheese, okay? But it remains the case that for me, O S T are the three most important letters. So what does O stand for? O is your objective. What does S stand for? S is your strategy. What does T stand for?

T are the tactics. And the answer to that question, how do you influence government? For me, you set that objective very, very clearly. And where I think you're right, Ian, I think both here and in the UK. We set ourselves an objective quite a long time ago now to raise awareness, and I think both of us have had incredible success at that.

But actually, looking back, it was in, it was evidence of how bad things were that we felt we had to set that as the objective, as opposed to what the real objective should be, which is that, and I would put the objectives like this, what do we actually want from governments around the world in relation to mental health?

First of all, we want there to be genuine parity between mental and physical health. Above all, I think we want to have an approach in government that is about trying to help people stop becoming mentally ill. And that means, you know, I think the minister's got a lot of responsibilities, but I can see why actually housing and mental health is not a bad way to kind of think about things.

Environment, education, there's different ways you can do it. But actually, to have a preventive approach. And then the third thing is to have, once people feel that they need services, that the services are going to be there. And the worry I have of the relative success of the campaigns that we've all been engaged in, on awareness, is that we've driven up the levels of awareness.

We've then propelled people towards feeling, right, well I'm going to be open as well. And I'll go and tell my friends, tell my parents, tell my sister, tell my brother. Go and see a doctor. And then they get to see the doctor and they find, I don't know what it's like here, but certainly in our country, well that's very, sorry to hear all that, you probably need to see somebody that's more expert in this than I am, and you're going to have to wait for quite a few months.

And I think the net effect of that, there's a risk that actually we end up making, I sometimes feel we end up making things worse. Because unless we persuade governments that this genuinely is a priority, and when I say priority, what, you know, what does priority mean? Priority means more important than other things.

So it's about where it stands in the hierarchy. And you have to make noise. We all have to make noise about this. Government's in the main. I mean, I've been, I've worked in a government. You're bombarded. Everybody thinks that what they're doing and their cause is just. Everybody thinks that the money that they're asking for, they deserve it more than other people.

So you actually have to build the arguments. And you have to build them, and communicate them, and narrate them over time. And the way to do that, I think this is where the awareness and the services can link up together. The way to do that, is actually through storytelling. We all have stories. And we have to tell them, and we have to join the dots over time.

And you've, I think what's really interesting about Australia, you've got compulsory voting right, I wish to God we did. You've got compulsory voting, which means that young people are voting. Young people are voting. But when you see, and it's the same in our country, the biggest killer of young men in the UK is suicide.

There is an anxiety epidemic amongst young women in particular. And we sort of blithely tell each other, oh well it's social media, it's Mark Zuckerberg's fault, and it might be social media. But we don't know that. We don't really have the, we haven't really done the sort of work to drill down on why this happens.

And so I think that is about people. The reason why to me openness is so important is because it's only if we get the openness that we start to join the dots together. Where politicians start to, start to realise that every time they go out to an event, people are raising the same issues. Every time they get their constituency surgeries, they're actually talking to people who are there because the problems that they're bringing to them are related to the fact that they might have a mental health condition that is not properly being addressed.

And you build the story over time like that. It's not easy, it takes time, it's not straightforward, but that in the end, I think, is how you make change. You make change by people coming together and saying, we are going to make change. And we had, you know, you probably won't be surprised to hear that I think the current British government is the worst British government in history.

They are truly awful. But one of the worst things they did, they actually, they actually cut the funding for the Time for Change campaign, which is the nearest we've got to Beyond Blue, probably. It's a similar, it's not, it's not identical, but it's a similar sort of thing. And they cut the funding for it, so it stopped.

But worse than that, what it did was, it sent out a signal, this is not a priority for us. And I tried to whip up all the reaction and so forth, but people just weren't interested enough. They weren't interested enough. There were too many other things going on. So I would say, if you really want to engage with, and influence, and get government, to listen to you - you have to shout louder. You have to shout louder in a perfectly nice, calm, civilised disagree agreeably kind of way. But your arguments have to be so compelling that they cannot be ignored at the ballot box. And when they think, if they actually start to think that people, when they go to vote, they're not just voting about cost of living, they're not just voting about all the issues that we know about, but they're actually voting because they think we do not have the services that we do, we need.

We don't have, we haven't built on the progress in awareness in a way that we should. And I think we all have to take ownership and responsibility for that. So there's no simple way of doing it, but I've written a lot of books and as Ian said, I've written quite a few about mental health and my, you know, I don't have any more right to talk about this than anybody else other than the fact that I do have lived experience of psychosis and of depression, of addiction and kind of more, the one thing that, the thing that drives me even more than that is if I had a brother who had schizophrenia and I'll be angry for the rest of my life that he died 20 years younger than he should because of the medication that he took for the time that he had this, this disease.

And there's no, there's no, you imagine if, I mean I'm an asthmatic, imagine if we knew that that took 20 years off my life, okay? Imagine if we knew that, then nobody's gonna let me use it again. And yet we know there are drugs that take, and the drugs were great, by the way, in terms of they help to live a reasonably good life.

But, and that's about research. And the fact that we can't even persuade the scientific community and the universities and so forth to say, this really matters. So if we're not even at the priority on that level, it shows how far behind we are in terms of influencing the politicians to get it up their level of priority.

So, I was one of the first to be open in the UK, frankly, because I had no choice. Because I was quite well known, and I had a psychotic breakdown, and I was arrested. And I was, and so it was quite a big thing, there was no, I couldn't hide from it. And so, I just said to myself, from the word go, I'm going to talk about it, I'm going to talk about what happened, I'm going to try and explain what happened.

And, and here's the thing about leadership, leadership in this is so important. And this is about sending a signal. So I've just been talking to Zsofi here, who's going to be on the panel, who's done a podcast interview with Ian and talked about her own lived experience. And, for me, being open has been the best thing I've ever done in my life.

Ever. In that, I feel no shame, I feel no stigma, I feel no taboo, and that is what allows me to go out and campaign. But I know so many other people who aren't there yet. And unless we all kind of jump together, and people see that we're jumping together, And then what happens is that we all realise, do you know what, there's more of us than we realise.

And we have this, in the campaign space in the UK, we use this thing, one in four, one in four people will have a mental health condition. And I've been trying to persuade them to get rid of that. The way to campaign on this is one [00:16:00] in one, one in one of us has mental health. And sometimes it's great, and sometimes it's less good.

But we all have it. And that's what takes you into the preventive space. If we all understand, we all have our own mental health, then we can start to do the things that we can do for ourselves. And I won't explain it now, but I've developed, I've written a whole book about the tactics that I've developed to deal with my own mental health struggles.

You know, including in one of the most stressful jobs that is known to man, which is being the kind of communications director to a prime minister of a country that used to be really serious. Before Brexit. And so, I think you have to put those things together and I've invented this word. I've invented a word.

I'm obsessive with Shakespeare and if you're ever bored just go online and Google words and phrases first used by Shakespeare, right? We all say dozens of them every day, okay? I've invented a word which I am determined to get into the Oxford English Dictionary, and the word is persevilience. Persevilience, which is not just perseverance, and it's not just resilience.

Persevilience is not just keeping going, because you know, actually, that ultimately there has to be change in this space. But it's also learning and adapting from the setbacks. You've just had, I mean, I'll try not to be too political about your government, having been quite political about my country. But I do think, in Australia, my experience, I remember coming out here in Victoria when they were doing the Mental Health Commission.

I thought it was one of the best pieces of work I've ever seen in this area. I know the work that you guys are doing, the Federal Mental Health Commission. And I just sort of feel that in both our countries we've gone backwards, we've gone backwards. Now how do you go forward? You go forward by people in leadership deciding we're going to lead you in a forward direction.

And what we all have to do is to push them. And honestly, the more you push, the more in the end they will [00:18:00] go. And we can all be involved in that. That's why ultimately this is a campaign. And it's a campaign that we should all be very, very proud to play a part in. Because ultimately we will get to a place where people will say "Did it really used to be that you thought that somebody who had schizophrenia was likely to be a murderer? Did we really used to live in a world where we thought it was OK for people with mental illness to live on the streets? Did we really used to live in a world where people had medication which took 20 years off their life?" Now I am utterly convinced, maybe by the time I'll be dead, but I'm utterly convinced that there will come a time where we'll look back at mental health service provision that we've endured for decades and centuries and we'll think that that was not a mark of a civilised society.

So that's what we go for. We keep the vision thing. We get persevilience. And eventually you batter down the doors of government and you get them to see unless they do this, they're in trouble.

Ian Hickie: Thank you Alastair. I think I'm going to have to work at that persevilience. I can see myself mispronouncing it. Now we have four people to join us who are particularly relevant to this discussion. Two young people, which people will appreciate. Zsofi and Tanya, do you want to come up? And then, two others. Rose Jackson, who is the minister, and Sam Mostyn, who is now the chair of Beyond Blue.

And we might start with the perspectives of younger people because you want to focus on the next generations. Hopefully in our lifetime things will change more, but where it really matters is for the future. So Zsofi, who is a psychologist herself, has a lived experience of bipolar disorder, is an advocate now doing her PhD with us in research.

Zsofi, what's your feeling about where we're at and what really needs to urgently change?

Zsofi de Haan: I think at the moment one of the things has been we take a reactive approach. Like Alastair said, we need to take a preventative approach. One of the things I think about in terms of my education to becoming a psychologist is that there's so much time spent on diagnosis and key criteria.

Now, psychologists are trained to see if someone checks those boxes. But what we don't look at is how do we identify people early on, before the condition progresses to that stage. In terms of training and education for mental health clinicians, they're not taught those things at this stage. They're not taught about personalised and measurement based care.

They're not taught about clinical staging. They're not taught about lived experience. Here at the University of Sydney, for the first time in the entire School of Psychology, for the first program in Australia, we're integrating lived experience into the Master of Clinical Psychology program. We're giving people the ability to also not just see people as symptoms and look out for checklists, but also to consider them as people and have that humanity and those types of things integrated.

So really, I think for me, one of the primary things is looking at how can we educate our next generation of mental health clinicians. It's to not only look at and wait for people to tick those boxes, but to actually get ahead of things and provide that measurement based and personalised care early on.

Ian Hickie: Tanya, who's been kind enough to fly in from Western Australia to join us, is on the Youth Advisory Board from the Matilda Centre. We have Marie Thiessen here as the Director. I mean, you just pop in from Western Australia. But Tanya's been working with communities, with young people in the Pilbara kind of area, and particularly the issues in Australia.

We are a big place. We're not a small island in the North Atlantic. We're a really big place where geography, communities, disconnection really matters. What's your perception of the situation, particularly people in regional rural Australia?

Tanya Dearle: Yeah, I guess, regional rural Australia is often left out of the conversation very often.

It's one of those topics, one of those places where topics like this is often not discussed. And I find that young people in these areas, especially in WA where the majority of our young people currently live, is in those regional rural areas, and there is a lack of support for them. There's a lack of actual psychologists, there's a lack of doctors, there's a lack of the entire medical profession in general, but they're often left out of the conversation, and it's a too hard - too hard basket. It's too hard to get out there and talk to these young people. It's too hard to get them to come. So, An example and don't get me wrong. It's been an amazing show of bringing youth voice into Parliament as well as bringing a youth voice into developing strategies, and that's the Federal Minister for Youth has currently been doing the youth strategy, touring Australia, doing amazing work and having meetings in capital cities around Australia.

The one thing that I wish that she actually did was went rural. I travelled from Karratha down to Perth to participate, but there was a lack of Aboriginal Torres Strait Islander young people in the conversation. There was a lack of general rural, regional young people in the conversation and their access to these opportunities are often left off the table.

So I guess for me as someone that's lived regional rural as well as lived metropolitan, there is this big need to kind of start broadening our view.

Ian Hickie: Thanks, Tanya. Now, I want to put Sam on the spot here because I want to say a whole lot of nice things and then be a bit difficult with Sam before a bit difficult with the Minister.

Sam is one of the most connected people in Australia. Sam and I were National Mental Health Commissioners when we were first appointed by the Gillard Government, which was to introduce accountability, to hear the community voice, which was not being heard through the usual bureaucratic and professional agencies, to give voice to that, and to hold our system to account.

And we did have a review of services, et cetera. Sam has also been one of the first and only, I think, still female, if there's more than one, AFL commissioners. She cares about football, particularly the Sydney Swans. She's also the chair of the National Foundation for Young Australians. In addition to having been the CEO, of the chair of Diversity Australia, but now she's the chair of Beyond Blue.

And this is really important. So then the Geoff Kennett went over to Julia Gillard. Now she's the chair of our most important kind of national agency for a lot of the public discussion. So Sam, of course, we've, we've discussed, we've been very successful in awareness raising. There's always had a downside, which is to drive demand.

Inequity, other sets of problems, and in a crisis during COVID, what do we hear? More awareness raising. And some of us have sort of modelled that as the problems that actually creates because more people who need often miss out as more of those other people come forward. So Sam, now that you've taken over this most important role, the chair of Beyond Blue, and you're so involved with the government, particularly through the Women's Economic Task Force for the Prime Minister, what do you see as the big issues we really need to address in implementation of change?

Sam Mostyn: Well, thank you, Ian, and as ever, you're overly generous in your introduction. I think I'd start by going back to those early days of the National Mental Health Commission over a decade ago, where the members of the commission who were, had lived experience, brought us back always to the notion of, could our ambition be to create mental wealth?

So seeing the, seeing this in the context of how does a country actually define itself, and their comment all the time, I don't know if you supported it. was, why did we not think about this in terms of the wealth of the nation? That our mental health is a, is a factor of mental wealth. They also reminded us, and I've thought about this a lot in the time since to Alastair's point about one in four or one in one.

Every person in this room, I'm sure, is only one family member, or one extended family member, away from a suicide. Somewhere in your world, somewhere in your life, if it's not direct, you've had a conversation or been through the tragedy of experiencing a suicide close to your family, if not through your colleagues.

So the numbers you see say one thing, but we have all, I think in this room and on the podcast, experienced the death of someone through a suicide. Often a young person, not exclusively. Often a man, but not exclusively. But it's, it's, it's important that we actually keep reminding ourselves that this keeps happening despite 11 billion, 12 billion dollar worth of Commonwealth funds that go into our mental health system every year.

So I think we've done a fantastic job as Alastair's pointed out raising the consciousness of being able to talk about mental health, taking stigma away. And I think everyone on the panel has already indicated from different perspectives. We are not good at implementation because I think we start at these big systems level and we fail to listen to community.

We don't listen to young people. We don't listen to rural people. We don't actually listen to what's happening in organisations and communities that teach us what we need to know about the place of connection, about the place of local communities that actually provide so [00:27:00] much of that social fabric from which we derive our sense of well being.

And we often go straight to the big systems, and we make them complex, expensive, and, and many people who need the most find the hardest way in. So at Beyond Blue we have been, I'm very conscious that I'm brand new, I've been on the board for a year, but only chair for a month or so, and stepping in behind Julia Gillard and then Jeff Kennett before her who, to give Jeff his absolute credit, was the first person really to stand up in this country and make money directed towards the knowledge and understanding of the stigma.

Julia has lifted the organization in the past decade together with Georgie Harman and the team to look at where does, where does getting rid of the stigma and being able to talk about it take you and it's meant a new strategy for Beyond Blue. And that, that strategy is very, very simple. It's earlier, easier, together.

Now the earlier is about the point that you made for young people and others that we're not understanding the early, early form of anxiety and mental health crises that people experience very early in their mental health or mental illness journey. So why do we do? Why do we not do that? Because we're always at the acute end looking at people turning up for services when things may be too late or too long in the process.

So, early intervention. Beyond Blue has a service that is low intensity counselling with CBT for people to ring early and about 7 out of 10 of the people who ring in to get low intensity services say they've actually solved a problem before it began to be critical so they, they remove themselves from the, the mental health system and then go more into the wellbeing and, and do much more about their own personal wellbeing.

But they, they do make that call. The second about, about just easier. The, the mental health system in this country, as in most countries, is complex, it's, it's huge, it's not connected and people very rarely know where to go to open that first door, or if they do, the referral system off into the unknown world of medical services is, is frightening and, and turns many people away from seeking help.

The third about, in, in partnership and, and together, we've recently announced a partnership with Lifeline. Because the wrong people ring us that should ring Lifeline. So we've said quite clearly, we are in the early intervention space at Beyond Blue. But if you need critical care, right now, you go straight to Lifeline and services that deal with critical needs.

But that's meant the system having to accept that we work together. And I think it's been a system, that where you get the money into yourself, you promote your own services and systems, rather than finding a way to operate collaboratively. Last thing I'd say, Ian, is I can see Mark Mordue here from Addison Road Community Centre and Bill Crews here from the Bill Crews Foundation.

We have got to sit and listen in community forums with people who provide the supports day to day to those who are actually in need, quite far down the path of a mental health crisis, or in the beginning stages of anxiety, food security, housing insecurity. Those communities, and you'll all know the ones in your community, that's where we learn the richness of what friendship means, of respect as we find people, how we have those conversations, how we actually help direct people to the right sort of early intervention.

Not assuming that the system at the top end can always solve those things And it's always about a hospital or a clinician, despite the fact that I'm very supportive of wonderful clinicians. But we're not focusing enough on place based intervention where we actually work and, and give money and resources with a trusting hand to those that understand community and the place that community has in our mental, mental wealth.

Ian Hickie: Thanks Sam. Now, just down you see, ask a question at slido.com. If you're sitting there and thinking, I'd really like to. Let's challenge something that's being said. Get on the Slido thing now, so we can collect the questions as we go, because shortly we'll come around to what people in the audience want to ask.

But before we get to that, somebody who's actually in the hot seat at the moment is a Minister. And boy, does this Minister have some responsibility. She's obviously a very capable Minister, because the Premier said, here, have this housing, which is what has to be the hardest issue in the country. In Australia, water is the second hardest issue in the country.

Then you can have youth, because that's obviously important, the reconstruction of the northern Rivers, the northern New South Wales, and mental health. Now this is a kind of priority question as well. It's great to have a Minister who can do those so many jobs. They are really hard jobs, they're all hard economic jobs.

We are part of, I might say, glad Sam raised it, a mental wealth initiative here at the University of Sydney between the Brain and Mind Centre and the Business School about how do we invest in these things, how do you convince treasurers, how do you convince economists, how do you convince companies to do stuff.

So Minister, you come in, you see this thing, colleagues say it was bad and perhaps it got worse, and it seems there's both the minister for young people, and for mental health, where do you see the prioritisation at the moment?

Rose Jackson: I mean, I do see the prioritisation as intervening at that early stage with young people. I think that the decision to link the mental health portfolio with housing and homelessness and also young people was deliberate. And I want to lean into that intersectionality as much as I possibly can. There is clearly a substantial amount of work that needs to be done you know, we can talk about all of the different points at which the system is failing people, I, like I think Alastair has mentioned and others and, and you Ian in your introduction, I prefer not to admire the problem, I prefer to get serious about how to prioritise solutions and I do think the clearest way we can do that is by looking at what is happening with young people and what is happening with the increasing prevalence of experiences of mental ill health and the increasing complexity of them.

So, you know, I'm happy to extend the conversation into what we actually do, but in answer to your question, where in the broad spectrum of work do you start? To me, That is an incredibly important one. The other one that I will mention I think it's important to have priorities. It's okay to have more than one, Alistair, surely.

Ian Hickie: Top three?

Rose Jackson: Is, obviously the relationship with homelessness. And again, it's partly because of my portfolio relationships, but also because You know, the cost of us failing to address that is obviously substantial, not just for those individuals and the dignity of their lives, but also because the broader cost to society of chronic long term homelessness is significant.

And this is one where we know, we know what to do. It frustrates me because chronic long term homelessness caused by mental illness is absolutely something that we can do something about, and we know where to start, and yet governments have failed. And it's, I'm very determined not to fail. And you know, I think partly in terms of those conversations about how do you get political momentum, early wins help.

I think Alastair, you know, you'd agree, if you're, if you're trying to take on something like the prevalence and complexity of mental illness in our community, and that's a pretty overwhelming and big challenge. Getting people behind the idea that stuff works, you can make a difference, you do something and it makes things better, that really helps to build and keep that momentum going and that is an area, the relationship between mental illness and long term chronic, chronic homelessness, where I think we can actually do some stuff.

Get some of those wins. Get some of those momentum. Show my colleagues in the cabinet. Show the community, Nah, if we, if you shout and make that noise, it makes a difference. And so that's why it's a priority as well, because I think that can actually change in a period of time that is comprehendible for people.

So those would be two early reflections on priorities from my end.

Ian Hickie: So the priorities thing is interesting. Liz and my partner and I, we were recently in California, where Gavin Newsom is up for re election. And he has a proposition, proposition number one. And it's treatment, not tents. It's actually, the situation is so deteriorating in California, the degree of homelessness, the degree of people untreated on the streets, has now become a high priority.

But only by letting it deteriorate, to such a point. Do you think this is kind of like, one has to have a crisis? People just see this as sort of endemic, like this is a bit like poverty, it's a bit like -. It's just there all the time. You know, I've asked Alastair this as well. Do you, you know, do you have to kind of have a crisis before you get that kind of response, or at what point? Because we've had awareness raising, good work, lots of commitment. We've had Prime Ministers, we've had people talk about their mental health problems, and yet we get to the other end. That priority list is long.

Alastair Campbell: I wish you didn't. I mean, I think often you do, it is a crisis that will provoke a reaction, but often if it comes from a crisis, the reaction will be short term, temporary, sticking plaster stuff.

So if you think about the last kind of global crisis, COVID. We have a real problem with homelessness in London with a lot of people, particularly, you know, a lot of veterans and immigrants have come in and got lost in the system who live on the streets. Okay, COVID came along and because suddenly the kind of nice, cuddly, white, middle class people thought, you know, I'm at risk everywhere I go.

The government felt we've got to get these people off the streets. And they did. And they got them off the streets.

Ian Hickie: Yeah.

Alastair Campbell: And they found the places to live.

Ian Hickie: Yeah.

Alastair Campbell: And the ones that then were in places to live, that were identified as having real chronic mental health needs, they suddenly found places to help them as well.

Yes. And then as soon as COVID went, they're back on the streets.

Ian Hickie: So what does that tell us about where the issues really stand, the degree to which people still distance themselves from people, how, you know, we could solve it. And the same happened here in New South Wales, happened right here in central Sydney.

Suddenly, we can not only house, we can provide clinical support, we can deal with the medical problems and we started to talk about, I think, homes, not just housing.

Alastair Campbell: That's I think, it's this thing about care, it's about all of this care, signalling how much we think this matters. And that's why, I mean, the thing about priorities, what I think, government, if a government comes in and says, mental health is a priority, they have then to, as you say, you then have to show it.

You have to show the progress, you have to show that you win. One of the things I'm most encouraged about with the Labour government, if we get one after the next election, they have actually said there will be mental health hubs in all our schools. Which again, is a start. It's a start. Because, and what that says to me, is that they are signalling a direction of travel.

Now, if they fail on that, We have to give them help, all of us. People have to get engaged and get involved and show that they care. And that, what I worry about is that we, we stop caring about the stuff that we know is wrong. And until we, we all signal that and don't tolerate it, then governments aren't going to.

Ian Hickie: So they're probably the principal advocate of the care economy in Australia we have with us today.

Sam, you've been trying to convince governments of the value of the care economy, the future of the care economy. How are we doing?

Sam Mostyn: We're getting better. We're getting much more focus on the drivers of where care is delivered and it wouldn't be surprised to anyone in this room to know that women provide so much of the care that has not been paid for and gets us through our crises and one of the things about the economics of care is we don't value it, we don't pay for it, therefore we don't understand how care works.

So there's a, there's a systems issue there that we need to be clear about and I think there's lots of work going on to identify that. But I think there's a point, Alastair, you've raised that, that I found, I listened to one of your, or I listened to many of your Rest Is Politics -

Ian Hickie: Some of us are addicted to the podcast, yes.

Sam Mostyn: One most recently, you talked about why do we use the language of expense. You're talking particularly about investment in the arts and culture in, in your country, and saying that it, people say it's too expensive, we don't do it, and yet it's a, it's something that binds communities and people together is the arts and culture.

It's the same I think in all of our conversations, we talk about this as a cost, we don't talk investment, we don't let ourselves have the benefit of working out where that money and where that time and care is best spent, because we always look at it through a lens of cost. And yet we know what the cost of failing in this environment is.

And, and at the risk, there's one of the oldest people on this panel. I just want to make a comment about young people for the Minister to back, back your comments in. Sharing something called the Foundation for Young Australians, which has been around for many years. We put a lot of money into civics for young people.

It's one of our most popular programs around the country. So this is a program where kids as young as 12 can [00:39:00] vote to become, or can nominate and then run campaigns to be the mayor, the young mayor of their communities. We need just one community in Mackay, so a regional community. Over 800 young people wanted to be the young mayor.

The young man who successfully ran for young mayor campaigned on mental health. And the thing he campaigned on was getting funds and focus in Mackay to show how young people will go peer to peer when they first start feeling the distress of mental challenge. And so there's no program in Mackay at the moment that means when you go to school you can talk to a peer to actually divulge the fact that you're not feeling great and know that that conversation might take you in the right direction.

So kids then don't talk about it. This young man, who's going to be the young mayor of Mackay, and we hope is indicative of the young mayors right around the country, he's campaigning to get money locally directed into peer programs in schools, a bit like the school program, I think is anticipated for the UK.

But it's a young person's crisis, and young people know the solutions, and when we listen to young people, and we actually listen and trust and care I think we find those things are self evident about how we're going to solve this. But it will take a different form, a much more flexible form of funding and support, not through the typical.

I don't know if you're aware of that Minister. That's what I think makes a big difference for a young person, is to be heard and seen. Not just be described as the future tragedy or the future crisis.

Ian Hickie: So the investment in the future. We did have, once have a Prime Minister, we've mentioned Julie Gillard, we've mentioned one of the other ones Malcolm Turnbull, who said there's more value to be had in the minds of young Australians, than to be dug up and sold from the ores and minerals of Western Australia. It was a good thing to say at the time. Turning it into actually something we did through investment and education, investment for young people, support in those areas, obviously investment in the care economy has been really hard.

Now, moving on to the Q&A part of this, I've got a whole great, people have been filling it in. There's about a hundred questions here already. And we will also have some roving microphones. We have if people want to draw my attention to various bits. See Bill over there. But I've just got to go one, because it's been asked about five times here already on the pad.

And it's got to do of course with what we've all got in our own pockets. Is social media the cause of all mental health problems? Now some of us, and I must declare some personal interest in this, think that digital innovation is part of the solution. People like myself spend a lot of time out of the country in developing countries in the future, where the future I must say, of mental health at a community level, prevention level, intervention level, is smart technology.

Here in Australia, we're pretty much bricks and mortar and clinics people. But, on the issue of, is it the cause? Well, Zsofi and Tanya, what do you reckon? Do you reckon it's all just because Instagram ruined the world? Is that the explanation?

Zsofi de Haan: No it's not the explanation. I would agree that digital innovation is actually key in mental health care here in the country.

Really when it comes to digital technologies, it's fundamentally about how it's used and what it's used for It's actually a great way for young people to connect. It's a great way for anyone to connect. It can facilitate interaction both through social media, but also social media is also used to facilitate interaction offline as well.

You know people use it to create events to, to catch up together or things like that as well. I think, again, you know, what we need to look at is not saying that social media is the problem, but also looking at why are people leaning into social media instead of leaning into other forms of connection.

That's what it's fundamentally about. And at the moment, we have a loneliness epidemic in Australia, particularly among young people. And it's a connection issue. Social media can provide connection. There are other ways of finding connection as well. And digital health is imperative, you know, and it's something we need to integrate within mental health care more broadly.

It can be used, you know, people can use apps to, to track their symptoms, to communicate with their clinicians, you know. It can be used to inform their care. It can be used in mental health services to triage young people and identify those young people that might need to be seen earlier. Digital innovation is fantastic and it's something we really need and I think we need to err away from just saying that social media is the problem.

Ian Hickie: The problem which is easily fixed, which is regulated. Stop it being used. Tanya, in real and regional Australia, the idea that you're just going to get rid of it and that'll solve things?

Tanya Dearle: Getting rid of it's not going to solve it. Yes, bringing technology into the picture and social media has brought the issue to the forefront.

It is actually brought it up more and it created that awareness and that's saying that we're all know has been successful in Australia is creating awareness. Young people are going to use it more to talk, but I'm kind of the opposite in that sense of yes, digital interventions have a role in the future for intervening with mental health in young people.

But one thing we need to consider is what about our most vulnerable? In their communities that have that lower digital literacy, that can't read or write, that have a disability and can't actually use these digital interventions. And on top of that, the lower socioeconomic groups who can't afford to get a phone, get a laptop, get an iPad, that will have to go to a library.

That'll, that's if they still exist. But, they can't easily grab it and access that intervention. So although it does play a key role in the future for interventions for mental health in young people, and it can be something that can be done very successfully, we cannot forget that traditional methods of communicating and of intervening is also necessary.

One thing that's often brought, that was brought up in our research paper. with the Matilda Centre was you can invest as much money as you want in prevention but you can't forget about the ones that are suffering now. And this data shows that it's the ones, our most vulnerable groups in Australia that are in those communities that have that lower socioeconomic tag flagged on them.

Ian Hickie: So they've raised the dual issue, which is connecting with the most vulnerable. It's important to highlight the work of the Matilda Centre, I think, particularly people with substance misuse and using technology to connect for services, for treatments, for people [00:45:00] who never come to services. And this issue around the country, I would just, Liz and I had the pleasure, over Christmas, to be in the Amazon of all places, where the number one objective of the local mental health plan is good quality telecommunications.

To use digital communications. But to do that, you've got to use public communications, the public spaces. We used to, in the previous work we did in Broken Hill, the kids knew how to use the school internet system, but New South Wales Education wanted to lock them out of that for the purposes of their healthcare.

You know, we have a lot of public space. In the telecommunications, which is doing it smart, but of course, making sure that those who are most disadvantaged are important. Speaking of disadvantaged, Bill Crews, I saw him over there, his name got mentioned earlier on. Bill, you've been dealing with the homelessness issues here in this state for, let's just say, I've known you for a long time and you're a young man still, but for many decades.

Where do you reckon we are on the home security front?

Rev Bill Crews: Oh, exactly where we were when I started 50 years ago.

Ian Hickie: You sound like my kids. Dad, what have you done in 30 years? Because it sounds like the same story.

Rev Bill Crews: No, I, I was listening to, I, I once took a whole lot of really problem kids out the bush with some Aboriginal elders.

And in the bus you almost needed a security guard to keep them, whatever. They all go into the bush and the elders give them the connection with the land and the animals and whatever. And the kids who came back were different. Totally different, because they felt connected. They felt connected to something and then they began to feel, and I was just listening to all of this and I was thinking, I learned to read through phonetics at , and then one day it all came together and I could read and we send, we tend to deal problems of society like phonetics, that we never put it all together.

We never put it all together. And, and all the things you talk about, a connection and all of this sort of stuff that we need has been said for thousands of years. We [00:47:00] know what to do. We don't do it. The first thing we've got to do is get everybody out of their houses talking to their neighbours. We get people talking to their neighbours, get them understanding other people, then they'll understand other people and then things start to go.

But we tend to professionalise it all, make it all, um, um, um, um, um. So it's this section and that section and whatever. And the whole person, the whole person in the whole environment gets left out of it and begins to feel alienated and alone. Then we give them a pill.

Ian Hickie: So Bill you raised a really important issue and it's been raised on several of the questions here which is, there's a danger, I think a danger here in the UK is to say what will government do?

As distinct from what do communities do? Sam's very involved in the business world, what do we all do in communities and picking up Zsofi's point, to reconnect. I mean, do you want to comment on this, Minister, when people turn around and say, you know, what's government going to do? Do you ever turn around and say, what are you doing?

Rose Jackson: I, I choose not to say that. When people say, what are you going to do? I say, what are you going to do? No, I don't do that. But I mean, it's a valid point. And I think, you know, particularly in the mental health space, that, you know, it is true that government alone is not going to be able to solve this problem.

That's true. And if we're having an honest conversation, and everyone who comes to Sydney Ideas is up for an honest conversation, of course government needs to do more. Of course our systems are fragmented, they're far too hard to get into, bits of them that need to be funded are underfunded we've got to try and move from prevention without sort of defunding the crisis services as they are now.

Government has got a lot of work to do to get its house in order and welcome conversations about how to do that. But if that is going to deliver the change that we really want to see, yeah, it needs to be broader than that. I mean, people spend how much of their lives, their personal individual lives, in their workplace.

And yet, are we having an honest conversation with corporate Australia about whether our workplaces are well set up to support mental health? I mean, a lot of the times it's like, here, have a cupcake at our sort of, you know, once a year morning tea, and that's it, mental health in the workplace. No. We're not having honest conversations about what is happening in people's workplaces.

Yet, they're spending an inordinate amount of time there. You know, we're not talking about family relationships. We're not talking about those dynamics. People aren't encouraged, I think to reflect honestly on the dynamics of their own lives. Do they know their neighbours? And when was the last time they volunteered?

You know, we all know there's an immense personal sense of satisfaction as well as the contribution you make from volunteering. But yet, perhaps that isn't platformed and prioritised. And so, in answer to your question, yes, I do think this is something that, as a whole, society is going to have to honestly self reflect and think about what we can do.

But I don't want people to think I say that to let government off the hook. I don't. I recognise we have a lot of work to do too.

Ian Hickie: So Sam, you sit on a lot of boards in the corporate world and Sam was going to accompany us to the forum we had at Davos, actually, generally, which was actually with corporations about mental wealth.

And actually, a lot of corporations worldwide are saying, okay, but what do we do? Sam, when you sit in these [00:50:00] larger directors meetings, you know, what's the nature of the conversation? Is it token, or is it getting to the serious, what do we collectively need to do, like, in the workplace, in larger corporations?

Sam Mostyn: Rose makes a very valid point that our workplaces is where we spend so much of our time. Many of those workplaces are not psychologically safe and fit places, and despite what we've said about about stigma, they're places where people do not want to disclose. A lot of the time that they have an underlying mental health issue or anxiety.

And I think there's a huge amount of work to be done in workplaces. It's good, it's very, very good that there is legislation under Workplace Health and Safety now that puts a positive duty on all employers to provide psychologically safe environments. And the fastest rising set of claims against workers health, workers compensation in this country are psychosocial claims.

They're not physical harm, they're psychosocial. So people are feeling that and bring those claims, but I think we've lost the, to Bill's point, to, I mean, the whole panel's point. We have lost the ability to engage with one another in a very human way, whether it's inside our, our neighbourhoods and reaching out to the neighbour next door, or talking to our, our colleagues at work.

We beg and we then typically, in most cases, many cases, go back into a social a social media world, and posit our ideas there, and have enormous fights, and, and I think it's a very dangerous place where, you know, good ideas get destroyed, and people feel feel hit upon. So I think we've got to get much, much better.

There is a lot of money that goes into this, but I think it's got to go beyond the R U OK? type of process. It's got to be a fundamental understanding of how do we work with one another, productively support one another and find these non, these areas where we're not always at a, at a fighting point over the answer.

But we work together, it's not easy.

Tanya Dearle: Before you go to the next question, I just want to bring a point to what Bill, bring awareness to a point that Bill made. And that's when he's taken out a group of young people, taken them back out on land, on country, and it was reconnected. And that brings us back to that, we can learn so much from the Aboriginal, Torres Strait Islander [00:52:00] culture, in terms of healing.

And, I've had the pleasure of working alongside them. Some elders the past three years up in the Pilbara that have changed my view and have changed so much for me and how many of us go for a walk? When we're feeling stressed how many of us go and exercise or go to the beach or something? That is our way of connecting to land what if we actually look at it at a different perspective that we can learn so much from this culture that has that strong connections already and In terms of healing.

Ian Hickie: To land and place, yeah.

Audience Member: My name is, my name is Gerard Ogier, and what Bill said there, I've had that very same experience in Indigenous primary school. This debate is a policy debate, and there's lots and lots of moving parts. Some are very obvious, and there's lots of entrenched positions. But, there's also I have experience with a group of 15 people I know, and three have made it from high school.

And, it sort of, one of the things was this responsibility of institutions. Responsibility of school. Responsibility of media. Responsibility of gambling organisations. And, I, I feel that, like, for example, ABC, on the night of one of the deaths, had a show that showed somebody talking about suicide, with close ups of ropes, and how she got them in bunnings. And then, on the next show, they had a drama, with somebody, slow mo being in slow motion, being hanged. And, you know, all the other institutions, I don't want it to be prescriptive or anything like that.

I think there is like an understand, there needs to be an understanding. And I don't want policy to come where institutions have very prescriptive things, and they do performative acts. It has to be deep and cultural and understand how things can come up. And, you know, I think it warms people's hearts.

So, why don't we go to Alastair here, because you're right, there are two issues. Alastair, do you want to comment on the Yeah. Yeah.

Ian Hickie: Well, I think one of the issues that comes up constantly in the Rest Is Politics is, in liberal democracies, how do you hold institutions accountable? This is, and Alastair and Rory discussed cognitively, the prison situation, the health situation, the housing situation, the role of others. What do you think, Alastair, about, we'll come back to the disclosure one later on, but this issue about how in our society, We do hold institutions accountable for what they are actually doing, other than through just legislation, other than just through work health and safety, or you can't do something, as distinct from what we positively need those institutions to do, to lead.

Alastair Campbell: Well, you, in the question, you mentioned several kind of framework, frames of institutions. I've spent a lot of time wrestling with the media, and you're going to wait a long, long time for them to become very, very responsible, I would say. And I think you've got a similar problem to us on that front. But what I would say, again, is this comes back to people.

Why do we consume this stuff? Why do we watch it? Why don't we actually say, Do you know what? I've had enough of this. I'm sick of this stuff being pushed at me the whole time. That is wrong. And again, we can make a change. We can make a change. I'll tell you a story about, about this in relation, it wasn't a suicide, but it was, it showed how this thing was changing.

One of Rupert Murdoch's papers in the, in the UK, The Sun, there's a very well known boxer, former world champion boxer called Frank Bruno, who's has chronic depression. And a while back, he was in, he was sectioned and he was sectioned under the Mental Health Act, he was taken to a psychiatric institution.

And the Sun front page was Bonkers Bruno locked up. Okay? And on Newsnight, which is a BBC 10. 30pm programme, they flashed up the front page, okay? So many people were so angry at that front page that by the morning it had changed to, Sad Frank taken to hospital. Now it's a tiny thing, but my point is, people express themselves, and on that series of, the, the, the, I don't think you can be prescriptive about, saying to the media, you can't cover suicide, you can't say this, you can't say that.

I agree with you on that. However, one thing we have managed to do through the now sadly scrapped Time to Change campaign, we actually did get agreed media guidelines about the reporting of suicide. We changed the language on suicide. You know, they no longer say commit suicide because it's not a crime and it's not a sin.

You know, we changed the language and most of the media bought into it because we brought them into a process. So, but this thing about institutions, this, this is what worries me about the whole world at the moment, is that we're, we're on, there's so much deliberate undermining of the institutions that uphold the values that we really believe in and that's why, you know, we have to protect those institutions.

And whether that be in media, whether that be in broadcasting, whether that be in people that are meant to be looking after the accountability functions of public services, but I I feel what you're saying. They're very very strongly I've had suicide in my family and it's we've got to but if we don't Constantly say, this is what we demand and this is what we want, it won't happen, and we all have to deal with it.

Ian Hickie: In the minute we've got left, Alastair, just to go back to the disclosure thing, it's been raised by several people. I love the way in the podcast, this with the First Minister of Scotland, Hasmail Youssef, and to ask them about their personal experiences, and then they do share quite openly in terms of changing those.

I love the way you do this. What actually happens when you do pursue people in current leadership positions about their mental health?

Alastair Campbell: Well, I never said, I had a very good friend who was a Liberal Democrat MP who's dead now, he died of alcoholism. And I used to say to him, look, you've got a problem, you know you've got a problem.

Everybody knows you've got a problem. He was the leader of a political party, and that is tough. He's the leader of a political party, he had chronic alcoholism and it killed him. But he couldn't admit it, he couldn't admit it even though everybody knew. And so what I find is I never say to people, you should be open, but for example, we had the first minister of Scotland on recently and I said, look, you know, is it true that you had, you had to go for psychiatric counseling at one point in your life and he just opened up.

Yeah. And he talked about the value of it and talked about needing to do it while he was in the position there. Yeah. I'm glad you've actually reminded me of that because do you know what, now that I'm first minister, I've got an even more pressured job, I need to go back and do it again. And so, I think, I think people I never force people to be open.

I wouldn't, if I, if I thought they were uncomfortable, I wouldn't push them. But I'm amazed that nine times out of ten, they'll be open. And it goes back to this one in one. There's not, listen, you know this, there's not a single person in politics who hasn't got something weird going on up here. Right.

Ian Hickie: Well, we had a campaign here in Australia, the Mental Health Council of Australia, trying with every family.

Every family knows. Every person knows, someone in their direct world who's affected. And yet, so why isn't it higher up? So on the question of why it isn't, we have got to the end of time. There are a lot of other questions here that we will try and also pick up and distribute as part of the discussion.

But I'd like to ask you to join me in thanking Alastair for taking out of his busy schedule to come, the Minister, Tanya and Zsofi, and Sam. I hope she's back in the Prime Minister's office putting it on the national agenda.

Now there are some, if you want to hang around, there are some food and drinks at the back. Feel free to mix and stay. Try and get anything you want on Alastair's actual next podcast. Keeping that on the agenda, seven million people listening regularly every time. Particularly the Leading, I'd really recommend to people the Leading podcast as well.

About the pursuit of leaders and the roles that they can make. There's a whole heap at Sydney University about leadership and what we should be doing. There's no doubt the critical role of influencing those people in those positions is a major contribution through your ongoing broadcasting work. Thank you.

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Alastair Campbell, writer, podcaster and strategist

Tanya Dearle, Matilda Centre Youth Advisory Board member

Zsofi de Haan, psychologist and Brain and Mind Centre researcher

The Hon. Minister Rose Jackson MLC, NSW Minister for Mental Health

Sam Mostyn AO, business leader and sustainability adviser

Host: Professor Ian Hickie AO, Co-Director, Health and Policy at Brain and Mind Centre

Alastair Campbell: Setting the mental health agenda

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Why mental health matters

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