Balneus

Australian Lefty on Politics, Governance, Science and Info Management

Missing in action: the key KPI for government

Posted by Dave Bath on 2009-11-18


"Life, liberty, and the pursuit of happiness" is an oft-quoted phrase describing rights of persons and therefore the duties of government, yet these are not measured as directly, nor as often, as much more indirect and much less relevant measures of government performance.

Perhaps the best way of assessing government performance quarter by quarter is to provide an indicator of the frequency and depth of depression in the community.  We might not be able to measure how successfully everyone in the community is pursuing happiness, but we can certainly measure how many are in the clutches of misery.

If a government is doing its job to perfection, then there would be zero incidence of depression that is a reaction to external circumstances, although there would be a small incidence of endogenous depression that would happen to a few unfortunate individuals however pleasant their circumstances.  Conversely, if nearly everyone has some degree of depression, even if only mild, and there are no signs of improvement, then any government that has been in power for more than a few months deserves to be ousted for incompetence (or malice).

It is fairly easy to measure depression incidence and depth as a number of indices exist, some of which can even be self-scored by patients and used as a quick screening tool.  These indices should also be used as a screening tool for government competence.

One of the many rating scales for depression, the Major Depression Inventory has been designed for consistency with the WHO ICD (World Health Organization International Classification of Diseases, used by health agencies in Australia for reporting) and the DSM (Diagnostic and Statistical Manual of Mental Disorders), and considered very suitable for epidemiological or population studies.

How hard can it be for the ABS (Australian Bureau of Statistics) to select a statistically valid sample, collect the results of the Major Depression Inventory, and report them every quarter, a period roughtly consistent with the time a person’s underlying mood can change?  It is surely easier and more reliable than metrics such as "Business Confidence" or "Consumer Confidence", less subject to fudging than the Consumer Price Index that is sensitive to the selection of the items in the basket.

It is also reasonable to consider indices of population depression as lead indicators, even as lead economic indicators.  Depressed workers are less productive.  While complicated by the real (and sometimes helpful) phenomenon of "retail therapy", community-wide depression can affect consumer confidence, sales in shops, and housing prices.  Stress and depression can affect incidence of domestic violence, drug dependencies, other crimes, and suicide attempts, and thus provide input into forward estimates for health and welfare budgets.

So, given that there are easily collected metrics that are direct indicators of the performance of a government in its basic duties, why does the ABS not report on these more frequently, why do the politicians not include them in media releases as KPIs (Key Performance Indicators), and why should they not receive just as much, if not more prominence in the media as quarterly trade flows, economic activity indices, and the like?

Why when I use Google to look for documents within the ABS mentioning both the words "depression" and "mental" over the last year do I get only a couple of dozen documents returned?  Why are the ABS Statistics 4326 and 4327 which relate to National Surveys of Mental Health and Wellbeing (included in the health subdivision of social indicators), only available for 1997 and 2007, even though basic moods of people can change in only a few months?  Why do these Mental Health Statistics have such a large focus on indirect indicators (such as divorce rates, etc) rather than have a statistic that concentrates on the direct indicators of misery levels?

The reason for the lack of collection and publication of these statistics is not the difficulty in collecting them, not the difficulty of interpreting the results, even if you do break them down by age, geographic region, and the frequencies of different score ranges.  The more likely reason is that the politicians know that collection and publication of such statistics, the KEY Key Performance Indicator of government action, would leave the politicians red-faced.

If a government was competent, especially after a change of government, we’d have ministers proudly showing graphs and trending figures about how much they were lowering misery, in as many press conferences as they could muster, pushing the sound bites into the news.  We don’t see that.

Instead, on the key business of government, the happiness of citizens, we get spin on indirect indicators, announcements claiming a deep concern, with the only real figures put before the public that amount of money politicians are spending, however uselessly, on the problem of misery.

A recent report from the Victorian Auditor General on the handling of Mental Health Crises, crises being defined as times the individual is a risk to themselves or others, had the following in the summary of findings, each paragraph separated from the others in the report:

There is a lack of information showing the effectiveness of triage and CAT services, and police and ambulance responses to mental health crises.  This prevents quantitative analysis and robust performance monitoring, allowing service gaps to go unaddressed

DOH lacks useful data about triage and CAT service responses to mental health crises. CAT services have run for 15 years, but DOH does not know the number of urgent referrals received, how services respond, their timeliness or the outcomes.

Until agencies have access to robust information about response effectiveness, they cannot identify successes or areas to improve in their own crisis response operations, nor can they review their joint performance to identify system-wide issues.

Thus, even for crises that have a huge impact on not only the individual in the crisis, and if not handled correctly, contribute to further crises, but also affect the families and friends of those unfortunate people, perhaps pushing others into misery and possibly crises, almost no useful data is available to assess performance and effectiveness.

There is a truism in management and performance improvement: "If it isn’t measured, it can’t be managed".  Our politicians must understand this, but use the corollary: "If it isn’t measured, we can weasel our way out of accountability".

The auditor mentions 15 years.  For a system to be in place that long, and yet there to be no useful data to demonstrate effectiveness, is not mere incompetence, which would probably have taken 5 to 10 years to produce decent data collection systems.  It seems likely that this lack of information is the product of deliberate inaction by politicians, or perhaps the intentional sabotage of the efforts of the competent and well-meaning public servants across a range of departments who would be wanting to get the data, assess the effectiveness of measures, and institute improvements where so often necessary.

While depression is not the only mental health issue, depression and associated stress are major contributing factors to other mental health disorders becoming visible in an individual, changing from a subclinical condition to something more obvious, touching the lives of all around them.

With the Victorian Auditor General noting that "nearly one in five Victorians experience mental illness each year", the domino effect upon families and friends, the consequent impact on budgets for health and policing, as well as the consequences for workforce productivity, it is fairly obvious that prominent quarterly depression incidence statistics would be useful indicators of government performance as a whole, could force governments to be accountable and take action.

If a political party seeking office has the courage to promise frequent publication of such indicators, to ask voters to use these to assess government performance, then we might not be able to judge ability to make a difference, but we can at least conclude that they think they can govern well, manage perhaps the most important duty of a government, the happiness of the citizenry.

Until we get such promises, we can be assured that no major political party has the intent to govern in the public interest or the confidence that they can perform their core duty.


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22 Responses to “Missing in action: the key KPI for government”

  1. If a government is doing its job to perfection, then there would be zero incidence of depression that is a reaction to external circumstances, although there would be a small incidence of endogenous depression that would happen to a few unfortunate individuals however pleasant their circumstances. Conversely, if nearly everyone has some degree of depression, even if only mild, and there are no signs of improvement, then any government that has been in power for more than a few months deserves to be ousted for incompetence (or malice).

    Dave, you provide a fascinating insight into the mind of a lefty – the idea of government as saviour. This is so dangerous because government has no special talents or abilities, and doesn’t do anything, ever, except through the people. Government cannot deliver an optimal set of external circumstances, and any improvements in external circumstances that do come about have come from the efforts of the citizens anyway. If the citizens can’t create happiness or good external circumstances for themselves, the government can’t do it for them. To use a simplistic example, it’s kind of like the government claiming it kept the nation safe from an external threat by deploying military forces, but really it’s the citizens volunteering and dying in combat that kept the nation safe. Government is simply a tool used by the citizens designed for a few, admittedly very special, circumstances. All the left wing (and to be honest, right wing) efforts to use this tool in ways it does not rationally lend itself actually have a greater chance of decreasing utility and happiness within the citizenry.

    If it’s OK with you, I’m going to link this post, and the quote above, on a couple of other sites because I think it really does give a good insight into the lefty mindset.

  2. Dave Bath said

    Michael@1 said: “it’s kind of like the government claiming it kept the nation safe from an external threat by deploying military forces, but really it’s the citizens volunteering and dying in combat that kept the nation safe.”

    Hmmm… the equivalent domestically sounds like a justice system versus vigilates.

    And more importantly…. I didn’t talk about what KIND of state.

    If, as Herodotos argued, the psychology of different groups is affected by geography, then the means of achieving a lack of misery will differ from one place to the next.

    So, whatever keeps a low incidence of mental health disorders (and I’d imagine that if many people are chronically ill, or dying of malnutrition, or indeed, if people really valued freedom and felt too enslaved to be happy, then stress and depression in the population would rise considerably), then I’d be all for it. Why should I object if the state is run on libertarian, socialist, or indeed monarchical means, as long as people aren’t unhappy?

    Why should I care HOW the cat is skinned, as long as it ends up skinned? Assuming that I’m neutral about how much pain the cat goes thru… ;-)

    All I’m talking about is having lots of use of measures of the happiness of the population by as direct a set of indicators as we can get, and using those as a kpi for those in power (or even an anarchical system without no-one in power).

    Now… if self-identifying libertarians OBJECT to direct measures of happiness/unhappiness as a means of assessing a system of government, or a particular implementation of government… then I must ask WHY such indicators are considered inappropriate. Don’t you think Libertarianism can achieve a population of happy people? Or is human happiness (or at least the lack of unhappiness) on a population-wide level NOT the aim of libertarians, the aim merely being the ability of SOME people, the chosen few, to be happy and to hell with the rest?

    (No… not saying you in particular, nor many of your mates, are that uncaring…. but sure as hell we lefties think many of the robber barons and uber-capitalists ARE, merely using libertarian arguments not from principle, but merely because they are already in a privileged position).

    Be sure to mention this comment… I think you missed the focus on outcomes, and the measurement of those outcomes directly.

  3. Libertarianism is a political philosophy, so it’s aimed at providing the individual the best opportunity to pursue happiness. I have no problems with the (attempted) measurement of happiness. I just have problems with using this data for social engineering. I have a general problem with the government having policies of social engineering.

    As a personal philosophy, I think everyone should make pursuing happiness their prime objective. In fact, I think it’s the moral purpose of human existence.

  4. Jayjee said

    DB

    There’s a really great work of literature pertinent to your scary ideas about the relationship between the state, utopia, and happiness: It is called Brave New World by Aldous Huxley. You would do well to read it.

  5. Jayjee said

    MS

    DB is not talking about that state as “saviour”. After all, we already have that through Medicare and the mental health system. Dave is advocating the state as active causal agent!

  6. Dave Bath said

    Jayjee…. read it, and Huxley’s “Brave New World Revisited”, and pretty much everything he ever wrote, but most of them I haven’t read for some time.

    Again, like Michael, you seem to have projected your own assumptions onto my piece. All I’m talking about it the collection of direct metrics to assess how things are going. I did /not/ mention any means a state might use, or whether it might happen in an anarchy.

    Anyway, on BNW (1) the alphas were NOT evil … the gammas were probably happier doing their work than people doing the same work in our world. (2) If we handed out soma (assuming something so harmless could be found, read Huxley and you’ll see he thought we may have already discovered it), then what the hell is wrong with that? There might be even less conspicious consumption or other energy-expensive ways of seeking self satisfaction and maybe this would help limit carbon emissions

    Huxley’s own review of the issues (“Brave New World Revisited” is a series of essays written in the 50s/60s on his book) points out that the alphas were being both well-intentioned and competent. The object of their work was to create a society full of happy people, and they succeeded, although it wasn’t a perfect solution. Thus BNW was not, strictly speaking, a dystopia in the 1984 sense. The BNW version of “Room 101” wouldn’t have had a big book listing the fears of each individual, and a storeroom of all the scary stuff, but more like store of nice trinkets, moderately healthy snack foods even if they did taste a bit bland, and inoffensive DVDs.

    Bottom line: the happiness (or at least, lack of misery) of a population should be the aim of a society, and we should be measuring it directly, and reporting regularly. The only reason for objecting to this is if you are either an arsehole, or if your favorite political system (or lack of a system) has no hope of leading to better figures.

  7. Dave Bath said

    Jayjee@5 (we must have been typing at the same time) “Dave is advocating the state as active causal agent!”

    No!! No!! No!! I am NOT talking about cause.

    Surely the libertarians who think meddling states cause misery would want the misery/happiness indicators reported, hoping to see direct misery indicators rise soon after increased state control of things, and lowering when states become smaller. If “hands off” on a particular thing, or in general, leads to better figures, then more hands off I say. If “hands on” in one way or another leads to better figures, then more hands on I say.

    CAN ANYONE POINT TO ANYTHING IN MY POST THAT ADVOCATES ANY PARTICULAR ACTION, OTHER THAN MEASUREMENT AND REPORTING OF A KEY INDICATOR????

    When I said something like “if a government is doing it’s job perfectly”, that could mean ANYTHING, including doing a perfect job by doing nothing…. or everything.

    CAN ANYONE TELL ME A BETTER KEY PERFORMANCE INDICATOR THAT CAN GO UP AND DOWN IN 3 MONTHS? ONE THAT BETTER REFLECTS THE TOTAL IMPACT OF ALL POLICIES ON THE CITIZENRY AS A WHOLE WITH RESPECT TO THE REASON WHY STATES SHOULD (OR SHOULDN’T) EXIST? WHAT ELSE SHOULD BE THE END OF A SOCIETY THAN HAVING SUSTAINABLY HAPPY CITIZENS?

    Pretty darn basic I’d have thought.

    My guess is that I’ve put up a kind of political Rorschach test…. and the political equivalent of Sigmund Freud would have a field day nutting out why you are projecting so much onto null statements about the efficacy of any particular political philosophy.

  8. Jayjee said

    Perhaps Rudd should be delivering each household a Santa sack containing Ritalin, Prozac, Lithium, Seroquel, Xanax, and a few other goodies to meet your “KPIs”? Oh wait, the State-BigPharma Complex ALREADY does that.

  9. Dave Bath said

    jayjee@8 talked of santa sacks of band-aid pharmaceuticals.

    Obviously, if you are on an antidepressant or other medication, that’s an unequivocal big black mark on the KPIs. Go to black mark, go directly to black mark, do not pass Go, do not collect brownie points.

    And long-term Ritalin on developing brains just causes more misery down the track, as anyone could have guessed, but the papers are only now starting to come out with the horrifying numbers on what Ritalin-like drugs have done to so many who were maltreated during the fad.

    Note too that many drug “abusers” are to some extent self-medicating… the body is choosing a somewhat appropriate poison. Many of those using “uppers” for example have an underlying depression, for example.

  10. Jayjee said

    Perhaps they are self-medicating their unhappiness. As said medication is marketed, encouraged, and subsidised by the State,you should be tickled pink.

  11. Dave Bath said

    to jayjee@10:

    No, I’m not tickled pink for a couple of reasons.

    Dosing people up on the drugs you mention, except where the reason for the medication is primarily endogenous and would be needed regardless of however pleasant the environment is, is only suitable as a stop-gap measure while better treatment methods are brought into play and can take effect. Those treatment methods involve treating the root cause of the distress…. sticking your finger in a severed artery is fine in the short term, but the real treatment is surgery.

    In the case of psychological distress, for the majority people, changing the environment, and/or modes of thinking about circumstances, are the only effective treatments, and indeed, the only cost-effective treatment in the long run. Chronic use of drugs affecting the nervous system only leads to problems, including the need for more drugs to deal with side-effects. (I should know, the anticonvulsants I need have done a fair bit of damage over the years – the alternatives are either illegal or a ketogenic diet guaranteed to lead to a rapid heart attack and/or type 2 diabetes. My neuro when first diagnosed said “You can take drug A and fry your brain in 10 years, or drug B and fry your liver in 30… take your pick”. Even in my case, lower stress means fewer seizures, so a better society would do wonders for my overall health.

    Unfortunately, the Howard government changed the structure of the committees deciding what gets money from the government: power of medical professionals was shifted to representatives of the drug companies.

    But this is getting off-topic (my own fault here a bit, but you raised the red herring, and not the first one, the first one being what the system or policies might be, rather than concentrating on the fact that KPIs can and should be used to assess and consequently manage issues, and that mental health indicators reflect the sum total of all the other things in the environment, from the economic circumstances, to social harmony, to fear of crime… you name it).

    Again, you’ve missed my point: while I may have mentioned some screening methods as candidates, an obvious tweak to the screening questionnaire is “are you being treated for any psych issue”, then, if so, “go directly to black mark on whoever is in power and/or their policies”.

    On this post, the issues of particular systems of government, or particular policies, are closed. Moderation scissors will be wielded ruthlessly.

    If you want to comment on the RELEVANCE of KPIs that involve mental health indicators as indicators of total policy success or failure, how those KPIs and the means of calculating them might be made better, how the figures could be “gamed” (pointing to weaknesses of the indicator and the need for tweaking) or the obvious (remember the “one-in-five” from the Victorian Auditor General) significance of the issue and the facts that such KPIs would doubtless reflect poorly on our current system of government and the policies that have been pursued, then that’s on topic and go for it.

  12. Jayjee said

    Whooooaaaahhh Boy! Calm down, dude Dave. This is just a blog chat, not the Spanish Inquisition!! :)

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  14. sigh.
    ‘happiness’ is the pointy bit of Maslow’s Hierarchy Of Needs and because I am still down at the base of his chart, I worry not, and until I read down to JayJee’s lithium crack, I was going to mention my personal economy theory that lithium in the water supply would assist the nation’s wealth, then I got to your brain in 10, liver in 30 conundrum and had to ditch that stance … while still pondering that being an alpha blogger is dangerous because others decide to link one’s posts all over the web and instead of having fun, one has to fend off RWDB’s from everywhere.
    I have been treated for depression over 5 decades since I was 14.
    ‘Despondency’ is what’s caused by external factors.
    The only thing i know about Huxley is that he lolled about Los Angeles droppin gacid with Harpo Marx and Greta Garbo, and if he had a book about that published, I would have enjoyed it.
    My own Brave New World involves a great deal of assassination.
    peace and love to you dear Dave

  15. Jayjee said

    BWCA Brownie

    I’m gonna give it to straight, m’dear. You have been MIStreated for depression for over 5 decades.

  16. Dave Bath said

    jayjee@15

    It’s a bit hard to “treat” depression when environmental factors are involved in the causal chain, and those environmental factors aren’t changed.

  17. Jayjee said

    Well, BCWA does not give us anything to speculate on “environmental factors”. If we accept the current psychiatric division of unipolar depression into melancholic (endogenous/biological) and non-melancholic (just got divorced, favourite pet/friend/family member died), I’d surmise that 50 years of treatment strongly suggests melancholic depression. This form is the most responsive to drugs, even as the first type of attack.

    Given the SS/NRIs have been around for nearly twenty years, along with Lithium much longer, the much-improved ECT, trans-cranial massage, various types of effective psychotherapeutic bullets, insights into exercise, diet, hormone treatments (DHEA, testosterone), and so on, for BCWA to have suffered unremitting depression during that entire 5 decades strongly suggests one – or both – of two things.

    1. At birth, BCWA was dealt the most abominable neurotransmitter hand ever dealt, and my god, does my heart go out to him/her.

    2. His/her treatment professionals really, really, REALLY suck.

  18. Dave Bath said

    Jayjee@17
    bwca doesn’t give details in public on the environmental factors. They are there. Tread carefully.

  19. Jayjee said

    DB

    I will say no more, unless invited to. Don’t worry, I fully appreciate the physical reality of mental illnesses in the modern world, but when someone says “fifty years of depression treatment” eyebrows are justifiably raised pending more data.

  20. John H. said

    In the case of psychological distress, for the majority people, changing the environment, and/or modes of thinking about circumstances, are the only effective treatments, and indeed, the only cost-effective treatment in the long run. Chronic use of drugs affecting the nervous system only leads to problems, including the need for more drugs to deal with side-effects.

    Depression rates have been rising for some time, the rise is so rapid depression is now one of the most common medical conditions and is reaching epidemic proportions. The USA consumes 73% of all antidepressants(old study but the figures will still hold in that region). Why is the the purportedly best country to live in the world so reliant on drugs to keep the populace happy?

    Governments and economists seem to think that all you have to do is keep the economy healthy and people will stay happy. There is no evidence to support this. Achieving income and financial stability to safeguard the future increases happiness but beyond that there is little to no benefit in happiness. Security, both the in present and as anticipated in the future, is a vital component of being happy. This might explain why Australians rejected the philosophy behind Workchoices. As soon as you threaten the populace with the prospect it is easier for them to lose their job then anxiety increases and so too will depression. One of the best predictors of depression is not genetics but unemployment.

    For all the issues people have with antidepressants it is worth keeping in mind that if not for these drugs we would have psychiatric hospitals dotted over the landscape. The principle reason this approach is used all too often is because of economic considerations. Psychotherapy takes too long and costs a bundle. As for changing the environment, in our society the individual can have little impact on their environment.

  21. […] political systems.  (See my ideas on measuring overall government performance easily in "Missing in Action: The Key KPI for Government"). Donors are placing nonprofits on the hot seat to measure social performance.  Problem […]

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