This post is responding to a recent Croakey article, “So you’re wondering what’s happening with mental health at a federal level?”, by Professor Alan Rosen.
Sebastian Rosenberg and Professor Ian Hickie write:
Alan Rosen’s recent article raises some important points and the need to clarify a couple of issues.
He is certainly right that the recently released Blueprint to Transform Mental Health Services in Australia is not the whole solution to fixing mental health. There are evidence-based services apart from those specified that would indeed merit ongoing investment, including assertive community treatment, mobile acute teams etc. However, as services largely provided by states and territories currently, they were simply out of scope in terms of providing a budget submission to the Commonwealth.
The crazed determination to deliver a budget surplus is now forcing Prime Minister Gillard and her Ministers to seriously lower expectations about the budget, wet the ground for the traditional horror-budget which typifies the first year of most administrations. As reported in countless parliamentary and other inquiries, mental health is so far behind the game that it cannot afford to be caught up in this.
The Independent Mental Health Reform Group which prepared the Blueprint was an informal group which got together for a few weeks specifically to keep some blowtorch of pressure on the Federal Government to make good its promise to make mental health a second term agenda priority.
The Group was comprised of the usual suspects in some ways, people with a long track record of cajoling governments into greater action and investment in mental health. The Blueprint merely reflects the views of the Group, which never intended and was never resourced to undertake broad public consultation.
Unlike the impression given by Professor Rosen, the Group was not constructed, mandated or authorised by Minister Butler or anybody else and had no relationship to any existing committee or body. Minister Butler did not commission the Blueprint. The presence of Monsignor David Cappo meant that the group did have an excellent insight into how best to shape and present its advice to government however there were others on the group with an excellent understanding of the federal budget process.
The Blueprint is one of no doubt myriad budget submissions made by different professional and community groups, attempting to influence the direction and scale of Federal Budget decisions. It is certainly true that key health professional groups have already made formal budget submissions, such as the Australian Medical Association and the Australian Psychological Society. It is less clear the extent to which community sector organisations have made submissions.
Professor Rosen is correct in that the Blueprint really focuses on clearly listing actions the Federal Government is able to take autonomously, without reference to state or territory jurisdictions. This inherently limits the scope of the Blueprint but fits with the imperative to provide urgent advice about intelligent Federal spending options in the upcoming Budget.
As far as we know, there has been no commitment to establish a second National CoAG Action Plan on Mental Health, to replace the first plan which lapses this year. If a second plan is proposed, then the Blueprint lists a series of vital areas of state responsibility where their contribution to a new CoAG plan should be directed. These areas do not include continued mindless investment in new acute hospital beds.
The Blueprint also clearly states the need to ensure that mental health’s share of the promised new 1300 sub-acute beds is not allowed to create new hospital-based warehouses to catch the overflow from psychiatric wards.
Professor Rosen is correct in asserting that CoAG-type intergovernmental agreements seem to fail more often than succeed. However, should a second CoAG Action Plan be agreed, we would strongly suggest the establishment of a clear set of Commonwealth incentives and sanctions to persuade the states and territories to purposively fund the areas identified as priorities in the Blueprint, particular the type of evidence-based community services described by Professor Rosen, or other community-based innovative services. This type of approach to incentives was actually successful in the First National Mental Health Plan and really not attempted since.
While this type of coordinated action is important for holistic reform investment in mental health in the future, the Blueprint represents the vital contribution the Commonwealth can make right now. So let’s get on with it.
• Sebastian Rosenberg and Professor Hickie are from the Brain and Mind Research Institute at the University of Sydney