A critical challenge for the next Federal Government is ensuring that whatever they do in mental health reform promotes integration rather than continued fragmentation of services, says Associate Professor Sebastian Rosenberg, from the Brain and Mind Centre at the University of Sydney, and Health Research Institute at the University of Canberra.
Sebastian Rosenberg writes:
As we sit on the cusp of the next federal election, it is timely to consider some of the achievements of the Federal Labor Government since it took power in 2022 in relation to mental health.
This is not as easy as it sounds. To me, it often seems as if some care is taken to make it as difficult as possible to track spending in mental health from year to year.
Accountability is missing or opaque, not clear. And in the absence of full and public evaluations, it is difficult to deduce which programs are working and which are not.
All this contributes to a fractured mental health system, incapable of quality improvement.
That said (and thanks for listening), some key reforms should be noted.
First, and as long promised, Labor delivered new peak bodies in mental health with the National Mental Health Consumer Alliance establishing the new consumer peak body and Mental Health Carers Australia the carers, family and kin peak body.
The development of organisations to deliver professional, strategic consumer and carer voices into national mental health reform is long overdue and very welcome.
Building on the existing Head to Health services, 40 Medicare Mental Health Centres have been established now in several locations across Australia, with a view to a full network of 61 such services across the country by mid-2026.
These services offer free care to anybody needing mental health support. Operating to National Service Model, the hours of operation and the staffing available vary from centre to centre and their impact on the system as a whole is yet to be understood.
Another review
Labor has also referred mental health to the Productivity Commission (again), this time focusing on the extent to which the new Bilateral Agreements made between the federal and state/territory governments have been effective.
Surely one of the first and key questions is: how could anybody tell?
These bilateral agreements, replacing the old national mental health plans (of which there were five going back to 1993), lack clear measures against which to assess their success or failure.
They clearly list the items each government will fund, but expected outcomes are scarce. For example, clause 17 of the NSW Bilateral agreement hopefully proposes it will:
- reduce system fragmentation through improved integration between Commonwealth and State-funded services
- address gaps in the system by ensuring community-based mental health and suicide prevention services, and in particular ambulatory services, are effective, accessible and affordable
- prioritise further investment in prevention, early intervention and effective management of severe and enduring mental health conditions.
How progress towards these three goals is to be evaluated is not made clear. Within this very limited remit, the Commission is not due to report until October 2025.
The Government is also continuing its efforts to reform the NDIS. Of particular relevance here are efforts to develop new ‘foundational’ psychosocial supports outside the NDIS.
These supports could be critical partners to clinical care but are woefully underdone in Australia, accounting for only about six percent of total spending.
Fuller support and clear role delineation for the psychosocial sector is surely a critical element of the next stage of national mental health reform.
Aboriginal and Torres Strait Islander mental health
Both the 2022-23 and 2023-24 Federal budgets included some specific funding designated for Aboriginal and Torres Strait Islander mental health services and programs, to be primarily delivered through Primary Health Networks, as well as through Aboriginal Community Controlled Health Services and other organisations, like the Royal Flying Doctor Service.
The term social and emotional wellbeing (SEWB) is used by many Aboriginal and Torres Strait Islander people to describe the social, emotional, spiritual and cultural wellbeing of a person. It encapsulates what many would refer to as ‘recovery’ or good health in mental health.
Despite the utility and richness of this concept, the Closing the Gap report, which sets a target of “Aboriginal and Torres Strait Islander people enjoy high levels of social and emotional wellbeing”, only provides one measure pertaining to the mental health of Aboriginal and Torres Strait Islander peoples – suicide.
In 2022, the suicide age-standardised rate for Aboriginal and Torres Strait Islander people was 29.9 per 100,000 people. This is above the rate in the previous two years and also above the baseline in 2018 (25.1 per 100,000 people).
Early intervention
One of the other more detailed promises made in the Australian Government’s 2024-25 budget was $588.5 million over eight years and $113.4 million per year ongoing to establish a new National Early Intervention Service (NEIS).
This free digital mental health service will provide support to people an estimated 150,000 people at risk of, or experiencing, mild mental ill-health or transient distress.
On this basis, each NEIS ‘package’ is worth about $750 per person, to be spent presumably on some agreed number of online sessions. By way of comparison, a telehealth appointment lasting more than 45 minutes with a psychiatrist (Medicare Item 91830) attracts a Medicare fee of $212.40.
From 1 January 2026, the service will provide free cognitive behavioural therapy (CBT) via phone or video plus tools for self-guided support. The NEIS is expected to help people who are not able to access other mental health services.
This is an important area of mental health reform and one of the most contested, because the term ‘early intervention’ can mean at least three things.
First, it can refer to ‘early in life’, with often specific reference to young people, given that 75 percent of all mental illness manifests before the age of 25. This helps to justify or explain a focus on youth mental health service development.
The second context applies to children as well as young people. With greater focus on behavioural disorders such as ADHD, the term early intervention has become associated with a broader range of services and programs aimed at younger children, not just youth. This work is not without controversy, as families and communities balance their desire to help kids with the need to resist inappropriate labelling or stereotyping.
The third context for early intervention I can think of relates to ‘early in episode’ – the idea that the earlier you intervene in anybody’s episode of mental illness the better, while a person’s symptoms are ‘mild’ or yet to become debilitating. This applies to a 40-year-old with recurring complex needs as much as it does to an 18-year-old with depression.
It is not clear into which of these three early intervention contexts the new NEIS fits. It is certainly being developed quickly.
An early draft service delivery model was developed by the consulting firm Nous. A consultation about this has just closed. Also unclear is how NEIS will dovetail with other services, such as those provided under Medicare or by community mental health services.
Integration and leadership
While people face daily critical challenges in finding any mental healthcare at all, let alone quality care, perhaps the most important task facing the Federal Government is to ensure that whatever they do promotes integration rather than continued fragmentation.
And it is worth noting that the analysis provided here has focused very much on healthcare, not on the broader social determinants of mental health, like housing, employment and the things which really matter to people. The Government’s capacity to show progress here for people with a mental illness is difficult.
While responsibilities in mental healthcare remain split between the Feds and the states and territories, when it comes to national leadership and governance, there really is only one show in town.
Whether it is in relation to early intervention, or any other mental health innovation, responsibility for setting the overall direction of national mental health reform rests with the Federal Government.
Only they can provide the incentives or sanctions required to drive better, more integrated mental health care in Australia. This is a task still facing the next Federal Government, whoever wins.
Services
Lifeline
13 11 14
Lifeline.org.au
Suicide Call Back Service
1300 659 467
Suicidecallbackservice.org.au
Defence Member and Family Helpline
1800 624 608
MensLine Australia
1300 789 978
Mensline.org.au
ReachOut
au.reachout.com
Aboriginal and Torres Strait Islander peoples
13 YARN (13 92 76)
healthinfonet.ecu.edu.au
LGBTIQ+ community
1800 184 527
Qlife.org.au
Kids Helpline
1800 551 800
Kidshelpline.com.au
Head to Health
Headtohealth.gov.au
headspace
1800 650 890
headspace.org.au/
Open Arms
1800 011 046
openarms.gov.au
Culturally and linguistically diverse communities
embracementalhealth.org.au
Beyond Blue
1300 224 636
Beyondblue.org.au
See Croakey’s archive of articles on the 2025 federal election and health
