Following on from his brief overview of the impact of Tuesday’s federal budget on mental health, Dr Sebastian Rosenberg from the Brain and Mind Centre, University of Sydney, provides a more detailed analysis of the specific budget measures relevant to mental health.
He highlights the ongoing need for structural reforms in this sector, specifically in the areas of technology, workforce and governance.
Sebastian Rosenberg writes:
The mental health sector is often characterised as fractured. This has not been my experience at all.
In fact, on the relatively rare occasions when mental health professionals, community service providers, planners, researchers, consumers, carers and policy makers get together, there quickly develops a strong, general accord about priorities for reform. In some ways, this is easy, given how critical the deficiencies in our system are.
The establishment of an agreed set of strategic priorities to guide funding and service development would be a relatively simple policy challenge, given half a chance. It is remarkable this has not happened.
The key word I would use to characterise the mental health sector is patient (no pun intended).
Budget 2023 provides a further test of this patience. At $586m over four years, it is a slightly larger allocation of new funds than usual.
But it would not be enough to materially shift the needle regarding mental health’s share of overall health spending which, as shown below, hasn’t changed in 30 years of national plans, policies and strategies.
Structural investments now
The 2021 Morrison Budget provided $2.3bn for mental health, by contrast. Much of the funding was directed towards individual or siloed programs or services.
One of the key challenges now is attempting to keeping track of this spending, to find out who this money went to, what they did with it and if it made any difference to people’s lives.
This 2023 Budget was a bit different. Rather than perpetuate piecemeal, fragmented investments in mental health and suicide prevention programs, this Budget provided modest investment in some longer-term, structural changes. Key to this was health-wide investment in Medicare and bulkbilling.
Lifting the rate of JobSeeker and some other allowances, as well as rent and energy bill relief also provides practical relief likely to be important to many people with a mental illness, though increases were small. These kind of measures are consistent with the Government’s interest in wellbeing and building the Mental Wealth of Australia. They recognise the key contribution of women, carers and volunteers in enriching community life.
The Budget demonstrates the Government’s interest to revamp primary care.
Investment in new training opportunities for mental health professionals, including psychologists and in nursing, are most welcome structural investments, as are changes to the way medication is made available to people, including those with a mental illness.
There is explicit support for preferential development of multidisciplinary care and teams to work in primary mental healthcare, rather than relying on singleton professionals. MyMedicare also suggests new willingness to offer pathways for better organised, data-driven care of people with more complex needs. The Budget buttresses the role of Primary Health Networks.
New support was also provided for the mental health of First Nations People in the lead up to, during and following the Voice referendum and also to multicultural mental health. The gaps in relation to language and culturally appropriate mental health supports for multicultural communities remains colossal.
Already announced but confirmed in the Budget was $8.7m over three years to support new national consumer and carer peak bodies in mental health, to provide professional representation, advocacy and research.
The Budget also provided additional funding for urgent care clinics. These focus more on general health rather than mental health, and aim to avoid admission to hospital emergency departments.
However, with the Government’s existing and growing commitments to both adult and child mental health-specific ‘head to health’ hubs across Australia, as well as headspace of course, there are key questions about overall system design and the need to coordinate across federal and state services.
What’s next?
While these structural initiatives are welcome, they must represent just the start of long overdue, organised national mental health reform.
There is an urgent need to support investments like MyMedicare with new digital infrastructure to support continuity. This goes beyond My Health Record, enabling every GP practice, key NGO service providers (which did receive some funding in the Budget) and others to link and share information.
This is about plugging the famous ‘cracks’ through which people with a mental illness currently often disappear. This will be very important for those frequent users of hospital mental health services who, with proper community and primary supports, might find the care they need outside of hospital emergency departments.
More broadly, it is vital that mental health comes to grip with workforce design problems, not just through recruitment but also through basic workforce design and role clarity.
This kind of planning infrastructure was a key part of the recommendations made by Curie and Thornicroft, back in 2008 when providing their ‘summative evaluation’ of the 3rdNational Mental Health Plan. This workforce design must necessarily include the emerging peer workforce, the psychosocial sector and related workforces. Just relying on recruitment of health professionals will not be enough to close the gap between demand for mental health care and supply.
In addition to technology and workforce, the other key area for urgent structural reform is governance.
The final model of governance to drive mental health reform was not specified by the Productivity Commission in its 2020 review into mental health. However, the leading role to be played by PHNs was clear, working with local state health district counterparts to develop a guiding planning framework for mental health reform, services and investment, region by region.
PHNs and LHDs are supposed to be developing these documents now. The Government should focus on this, with a view to establishing effective, new regional mental health planning models right across Australia by the end of 2023.
These regional plans should be informed by new modelling systems and processes, building on a foundation provided by the National Mental Health Service Planning Framework, to include other tools and issues beyond healthcare, like employment, education, housing and so on. The plans require a new element of prospective, dynamic scenario modelling, not just historical data analysis. Tools are available now.
The final key structural element is surely accountability. Thirty years after the first national mental health plan promised “greater accountability and visibility in reporting progress”, Australia still lacks regular, regional, useful mental health data and any process of systemic quality improvement. Technology permits this, as well as validated approaches to the collection of consumer outcomes.
Several mental health observatories have been established, not to collect more data, but to collate and present existing information more effectively. There are national data processes already underway which could provide the equipment an Australian observatory would need to equip regional planners to do better.
Deadlines, deadlines
Which gets us back to ‘patience’. Mental health is done waiting. This Budget has set us up.
The time for supported implementation of genuine and systemic reform is now. Let’s aim to make 2023 the year we finally leave fragmentation behind and start to build the infrastructure mental health needs not merely to survive, but to flourish. Gotta be starting something.
See here for Croakey’s coverage of the federal budget 2023-24
