Congratulations David Clark! In a Government where initiating a review has been a substitute for doing anything, he has become the first Minister to have both established a major review - into Mental Health - and to have received the final report of the finished review, complete with a comprehensive set of recommendations.

But, unfortunately, that is where it stops so far. The Mental Health review has made 40 specific recommendations for change to a system that it describes as broken and long overdue for major change. However, Dr Clark has indicated the Government will not finalise its response until March next year. So, the prospects for urgent action on the report’s recommendations are not high.

Assuming the Government adopts the recommendations - by no means a certainty - the Minister will need to have funding bids in for the 2019 Budget, meaning definitive action is unlikely to come on stream before the latter half of next year at the earliest. If new legislation is required to implement any of the recommendations, it will probably be well into 2019 or even 2020 before it passes, meaning those changes would not take effect until after that.

And some of the recommendations are beyond the Government’s control at this stage. For example, the recommendations regarding decriminalising drugs will not be able to proceed before the recreational cannabis referendum, apparently now scheduled to be held at the time of the next election. The government has yet to indicate whether it will regard the outcome of that referendum as binding, and what steps it will take in the event of a vote for recreational cannabis decriminalisation.

So the path to the positive future recommended by the Mental Health review is a long and uncertain one yet. But none of this should detract from the importance of addressing comprehensively the Mental Health review’s recommendations. There are too many individuals and families suffering to allow that.

And despite the public expectation for swift action, due in part to the Government, as usual, overselling its intentions, it is more important that the Government introduce a comprehensive and integrated response, rather than an ad hoc and piecemeal approach. And that will be a difficult balancing act because the public’s hopes are so high.

In the meantime, the Government may have to do something Labour Governments of late have been loathe to do - make full use of non-government agencies and their skills and experience. There are several hundred such agencies active in the mental health and addictions fields, and there is no reason why they could not be utilised more fully, alongside the services provided by District Health Boards. Indeed, the review provides the opportunity to rationalise the respective roles of the non government agencies and the District Health Boards, and establish a long overdue partnership between them. The obstacle, though, is Labour's long held view that such matters are primarily the province of the state to control.

The Mental Health review opens up the possibility of the most profound changes since the Mason Report of the late 1980s. The Government’s response in March must set out a clear and integrated way forward, together with an interim pathway towards achieving it.

Dr Clark may well feel satisfied that the Mental Health review has been completed on time, and is comprehensive. But for patients and their families, the agonising wait while the review was underway will continue and reach its crescendo when the Government responds in March. In that sense, the mental health challenge is now only just beginning.

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