Driving Mental Health Reforms in Australia using the PDIA approach

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Guest blog by Kerry Hawkins, IPP 2021

When I signed up for Implementing Public Policy (IPP) Online course, I thought it would be a lot of implementation theory within a public policy setting, possibly with some change management within a government context. I didn’t expect it to be so experiential, practice-oriented and expansive in its values and generosity of spirit, these were unexpected joys.

Throughout the course, I had lots of reflections that I have tried to summarise in the list below.

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  1. The flexibility and depth of the Problem Driven Iterative Adaptation (PDIA) approach seems to be able to accommodate most challenges.
  2. There is power in bringing the different perspective of a discipline outside mental health to the conversation – most people are caught up in the frustrations and politics of a sector that is both insular and caught in health paradigm. Raising up some of the issues to a proposition and challenge of implementation makes people curious.
  3. Adopt an ‘Organized to Learn’ posture. Professor Matt Andrew’s mantra “What did you do? What did you learn? What are you struggling with?” creates a sense of safety and intellectual curiosity that enables people to feel more comfortable taking risks.
  4. Understand the importance and power of productively and attentively delegating work.
  5. The 4 P’s – particularly being alert to perceptions, correcting if necessary, and the power of process positively impacts perceptions of you at the same time.
  6. The fine art of both taking brave risks and letting people down slowly.
  7. Validation of an expansive generosity of spirit and power of it.
  8. Becoming a PDIA practitioner means holding a position of enquiry, exploration and learning.
  9. The value of exploring the problem and pulling apart the various elements has been a powerful way to both manage the unmanageable (conceptually) but also provide a solid platform for communication with people.
  10. The value of internalising and diarising the logging and reflecting on learnings, leads, and struggles. This is a practice I will continue.
  11. Change crawl spaces! I now seek them out and hunt them down.

For IPP Course, I chose to work on the mental health reforms in Australia – in particular the shift from a health lens to a social lens. We are working on dismantling the power and clinical/government machinery that underpin it, moving towards a whole of government approach. This means changes in models of service, inter-government approaches, reforming data/evaluation, workforce re-skilling, workplace changes, rebalancing of funding etc.

Mine was a big and complex challenge and so breaking it right down into problem-origin and component parts was really helpful to conceptualise change crawl spaces. I’ve made significant progress in three major components to my fishbone, and found some allies to work on some of the other trickier components such as short term political cycles.

In particular, I’ve progressed the area of lived experience infrastructure (across lots of areas nationally and at state level) to the point where people are talking publicly about ‘tipping points’ and have two invitations to collaborate on academic papers. In the data space, also, there’s now a stronger awareness of the dreadful limitations of the current indicators and frameworks, and funding commitment to develop lived experience indicators.

This will have whole of government implications and the creation of a mechanism for whole-of-government mechanisms. I’ve also now got a coalition of clinicians and people with lived experience putting forward a proposal for a translation centre to enable rapid implementation of research into innovative models of service.

As part of this intentional approach, it’s given me the confidence/bravado to talk more openly with politicians, which has also provided significant opportunities for allyship in areas where it’s hardest to break through, in developing the infrastructure for work that won’t be realised for several political cycles (social determinants, early intervention in understanding child mental health etc).

My motivation is both personal and a social justice motivation, which I’m finding continues to resonate with people because it’s mental health. It’s an instant point of connection and allyship building. And because it’s mental health, it’s an issue that touches nearly every family and broaching the subjects becomes a topic people instantly want to be a part of working towards a solution. This approach – if you have a way of holding people through a process, continues to pay off for me.

I’m continuing to use the Fishbone Technique that I have developed it for one of the sub-problem areas as part of a collective exercise. I’m going to repeat this process for several of the ‘bones’ on my original fishbone too, as opportunities arise. Doing this exercise really helps in building relationships, particularly if you come across someone who is a potential ally in a particular area. You can immediately build a connection and have a useful conversation, not only because you’ve thought about the problem at length, but may have already built connections in this area, or have some work underway they can tap into as part of the snowflake.

I think one of the useful learnings for me has been the 4 P’s and the importance of process – and of being organised, with time management tips. This is a practice I need to develop more, but I really notice the responsiveness I get from people when I’m able to attend to preparation for meetings, workshops or other collective work.

Someone once told me, “In the history of the world, miracles have only happened when action is taken!” There is something about the power of taking action in a positive, controlled, intentional and inclusive way that enables shifts to occur. I hope that PDIA practitioners all over the world remember this while driving their efforts to make the world a better place for everyone.

This is a blog series written by the alumni of the Implementing Public Policy Executive Education Program at the Harvard Kennedy School. Participants successfully completed this 6-month online learning course in 2021. These are their learning journey stories.

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