Introduction by Croakey: This year’s Federal Budget highlighted a lack of serious investment in mental health care reform, opting for piecemeal funding that will further extend the fragmentation of the Australian mental health care system.
According to Dr Sebastian Rosenberg from the Brain and Mind Centre, University of Sydney, “mental health needs ongoing serious strategic planning to drive new effective, regional solutions, supported by better planning and more resources”.
In April, the Sydney Mental Health Policy Forum prepared a paper to identify priorities and opportunities for the incoming Federal government to invest in reform at the required strategic or systemic level.
Rosenberg and Professor Ian Hickie, Co-Director of the Brain and Mind Centre, discuss key aspects of the paper below, urging the incoming government “to invest in durable infrastructure for sustainable and effective reform.”
Sebastian Rosenberg and Ian Hickie write:
The Sydney Mental Health Policy Forum, comprising about 50 people from across the mental health sector, met recently to consider election priorities for reform of mental health care.
The Forum includes consumers, carers, professionals, providers, planners, funders, researchers and others, who share an interest in change. Despite the diverse nature of these perspectives, there was considerable agreement about some key things.
The first is that more of the same won’t do.
Repeated inquiries report mental health as being ‘in crisis’. Both the Federal and Victorian governments have recently put more money into mental health.
This is because of the gap that remains between mental health’s share of the total burden of disease (13% in 2018) and its share of total government expenditure on health care (about 7% in 2019-20).
According to the Australian Bureau of Statistics, suicide accounted for 115,000 years of potential life lost in 2019, far exceeding the 7,000 years lost to dementia and the 78,000 lost to ischaemic heart disease.
While moves to address this gap are welcome, with our current fragmented and disconnected system, the situation is akin to simply pouring more oil into a leaky engine.
Governments are always keen to add a new suicide prevention hotline or provide 12 months funding to this program or that.
These kinds of changes won’t deliver reform at the strategic and systemic level necessary to drive enduring, positive change in mental health care. They may even perpetuate undesirable fragmentation.
Members of the Forum shared a clear understanding of the need to concentrate the next round of mental health reform at the strategic and systemic level.
Regionality
Another shared concern expressed by the Forum was of the need for mental health planning to operate regionally.
Health planning in Australia currently focuses on the role of 31 federally-funded Primary Health Networks (PHNs). They are supposed to work closely with their state-funded local health district (LHD) counterparts to drive regional integration.
This is great in theory and the desirability of this integration in mental health has been discussed for some years, including by the National Mental Health Commission in its 2014 report. This concept of regionality is not something specific to health care.
Below is the map of 52 regions identified by Regional Development Australia, boundaries determined by natural, economic, geographic, demographic or other features.
Strongly supportive of the role of regions, the Productivity Commission’s 2020 report found that PHNs and LHDs were cooperating only rarely.
This does not mean the notion of regionality should be abandoned. It is at this regional level that community mental health needs can be properly understood, mapped, monitored and funded.
Populations are small enough to identify opportunities, respond more effectively and provide earlier intervention, diminishing our current over-reliance on expensive and often traumatic hospital-based mental health care.
At this level, one can respond more fully to the breadth of mental health needs facing communities, not just health care, but also housing, justice, employment, education and so on.
The Forum felt strongly that the time had finally arrived for regional control of mental health care to become reality.
Psychosocial services
The Forum also strongly advocated for the evolution of psychosocial services in Australia.
Funding for this sector in Australia has always been a peripheral feature of mental health spending, apart from a few years in Victoria and the ACT, particularly incorporating programs like Partners in Recovery and Personal Helpers and Mentors.
Ironically, as more money flooded into mental health care with the advent of the National Disability Insurance Scheme, funding for psychosocial services almost entirely evaporated. The Forum recognised a massive shortfall in services here, with at least 150,000 Australians missing out on psychosocial care.
The Forum strongly supported the belated evolution of a vibrant and professional psychosocial sector, as a partner to clinical care especially in the community.
Accountability
A key final point of some agreement by the Forum was on the issue of accountability. Despite numerous promises, road maps and report cards, mental health remains fundamentally blind to the everyday experience of consumers and their families.
At best, it measures inputs like funding, and outputs like beds or service numbers. It fails to appreciate the extent to which people who receive mental health care get the help they need, for their health, to get back to work or find a job, or in other parts of their lives.
The Forum agreed that there was an urgent need for a new statutory and independent mental health commission, with sufficient teeth to monitor and report on progress in mental health care.
In addition to this role, accountability for mental health in Australia would benefit from the establishment of a mission-specific Observatory, working with key players to gather, collate and report the data required to track progress. These kinds of Observatories already exist elsewhere.
The Forum paper
The Sydney Mental Health Policy Forum published a paper in April articulating these priorities and others, aiming to equip an incoming government with a menu of opportunities for reform at the required strategic or systemic level.
This paper built on key themes developed by the Forum in earlier work.
The Forum’s work focuses on the health system and closely linked issues. There is a great deal more to do, particularly across the broader social determinants of health, including in areas such as housing, financial pressure, inequity and climate change.
But of all the issues that plague mental health in Australia, it is perhaps the lack of strategic thinking that is most debilitating, leaving the community facing a fragmented, malformed and malfunctioning system. This is a workplace that struggles to keep and nurture its workforce.
The Forum’s work here, driven by leaders volunteering their views across the spectrum of mental health perspectives, is an opportunity to arrest this piecemeal approach and start instead, to invest in durable infrastructure for sustainable and effective reform.
Dr Sebastian Rosenberg is a Senior Lecturer at, and Professor Ian Hickie Co-Director of, the Brain and Mind Centre, University of Sydney.
See our archive of stories on the 2022 federal election and health.
