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Acknowledgement
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Federal Budget 2019/20 – Mental health priorities from the health and community sectors

Continuing Croakey’s series of pre-Budget articles, today’s post highlights some of the key Budget recommendations on mental health from the health and community sectors.

See here for previous 2019/20 Budget articles on Indigenous HealthPrevention, Oral Health, Rural Health, and Climate Change.


Australian College of Mental Health Nurses

Key points from ACMHN’s Pre-Budget Submission

Mental ill-health is a significant burden for Australia in terms of health outcome, quality of life, co-occurring illness, death and disability. It impacts on individuals, families and communities; and poses significant economic and social cost to the nation.

The mental health nursing workforce is well-placed to respond to mental health demand, across the full range of clinical and service settings. However, the specialty is facing significant workforce shortages, which will impact on Australian’s ability to access suitably qualified specialist mental health nursing services into the future.

Policy decisions taken by government, higher education, professions and employers will have a significant impact on the scale of the projected workforce shortages. Given the substantial segment of the mental health workforce that MHNs represent, it is imperative that Government and the health sector respond to the existing and future mental health nursing shortages that have already been identified.

Developing and sustaining a specialist mental health nursing workforce is an important strategy to improve access and equity for people with mental health problems across the age spectrum. A multi-pronged approach is required. Education, professional development and mentoring are essential components of efforts to sustain and build the mental health nursing workforce, to cope with the current and projected demand of mental ill- health now, and into the future.

Recommendations

  • Expand access to mental health nursing services in primary care and through Mental Health Nurse Practitioners, including: MBS reform; support for Mental Health Nurse Practitioners; and credentialed Mental Health Nurses working in Primary Care.
  • Expand and increase the MH nursing workforce by establishing and supporting professional pathways into mental health for nurses, including: scholarships for nurses to undertake specialist mental health nursing post-graduate study; develop a National ‘Transition to Mental Health Practice’ program for nurses; and establish the Mental Health Nursing Preceptor & Mentoring Forum.
  • Upskill the current and future nursing and midwifery workforce in relation to integrated physical and mental health care, including: online Mental Health CPD addressing the learning needs and day to day practice issues of nurses and midwives; improving access to contemporary mental health content for nurse educators and academics through digital excellence; and Mental Health Nursing support for Rural, Regional and Remote nurses: A 1800 MHN Support Phone Line.

Australian Medical Association

Key points from the AMA’s Pre-Budget Submission

Australia currently lacks an overarching mental health ‘architecture’ that includes agreement on national policies and structures to facilitate prevention and proper care for people with mental illness.  Mental health and psychiatric care are grossly underfunded when compared to physical health.

The AMA believes that a multipronged strategy is required to improve access and care to this very vulnerable group of Australians. This strategy should encompass:

  • improved service delivery;
  • significantly increased funding;
  • improved coordination;
  • robust workforce and infrastructure solutions;
  • prevention, education and research; and
  • e-health/telemedicine solutions.

Recommendations

The AMA calls on the Government to:

  • ensure that the National Disability Insurance Scheme (NDIS) is properly and adequately resourced so that patients are not left without support or care for their mental health issues;
  • fund and resource an appropriately sized, skilled, and resourced mental health workforce – addressing workforce gaps should be a priority;
  • ensure workforce and services for the delivery of mental health care for those living in regional and remote areas;
  • commit to a level of funding that allows for a mix in the range and level of mental health care available for all Australians, regardless of their geographical location, level of income, and ethnic background; and
  • provide increased access to e-health and telemedicine for service delivery.

Australian Nursing and Midwifery Federation

Key points from ANMF’s Pre-Budget Submission

Nursing plays a central part in providing high quality, holistic, and accessible mental health care to those individuals in need. All nurses provide mental health care, with many mental health nurses also possessing post graduate mental health specialist qualifications.

Better choice and more accessible mental health care could be provided to people through different models of care, such as mental health nurse-led models, including mental health NP-led models; an increase in school nurse positions in the public school sector (for early intervention); and, quarantining of the Mental Health Nurse Incentive Payment (MHNIP) funding within Primary Health Networks to enable reinstitution of the excellent work that had been undertaken by mental health nurses in keeping people well and living in their community.

Mental health nurses, NPs, and skilled registered nurses are also well positioned to provide necessary care to residents in aged care facilities and people receiving aged care and/or disability support in the community.

Mental health services must also be appropriately tailored, accessible, and to provide effective, safe, and meaningful care to the diverse Australian population. Aboriginal and Torres Strait Islander people, culturally and linguistically diverse people (including asylum seekers, new migrants, and refugees), socially disadvantaged, and sexually and gender diverse people all face barriers to accessing safe, quality care that meets their specific needs and preferences.

As a workforce development strategy, the ANMF considers initiatives need to be developed and incentives need to be in place to retain the experienced mental health nursing workforce and recruit and mentor nurses new to mental health, to help grow the mental health nursing workforce. This includes transition to practice programs to equip both newly qualified and experienced registered nurses with the specialist skills required in mental health nursing.

Recommendations

The ANMF calls on the Federal government to:

  • Develop a clearly articulated policy framework that underpins health service provision, ensuring that the experience of mental health does not lead to and entrap individuals within homelessness.
  • Provide adequately funded community-based mental health nursing services that can deliver a timely, flexible, tailored response and that seeks to address the current gap, in accessing after hours mental health care.
  • Provide for more community based mental health in-reach nursing services to support residents within supported residential services (privately run supported housing), where they exist.
  • Invest in building mental health knowledge capacity in the nursing workforce, particularly in rural and remote areas, through resumption of quarantined scholarships for continuing professional development (CPD) and postgraduate level for registered nurses and NPs in mental health;
  • Provide positions for mental health NPs with funding models which broaden access for people seeking mental health care and which facilitate viable and sustainable practice operation.
  • Conduct a public awareness campaign to address stigma attached to those experiencing mental health issues.
  • Ensure all people experiencing mental health conditions can access effective, quality mental health care that acknowledges their particular needs and preferences for culturally safe and appropriate care particularly for Aboriginal and Torres Strait Islander people, and those from socially, culturally and linguistically diverse and/or disadvantages backgrounds including asylum seekers, new migrants, and refugees, and sexually and gender diverse people.

The Royal Australian and New Zealand College of Psychiatrists

Key points from RANZCP’s Pre-Budget Submission

Mental illness accounts for 12.1% of Australia’s total burden of disease, third highest behind cancer (19%) and cardiovascular diseases (15%). Despite this, only 7.7% of government health expenditure is dedicated to mental health-related services. This leaves significant unmet need within the Australian community.

The RANZCP advocates that a proportional increase in mental health spending, including targeted investment in several key areas, is required. We believe that directing funds towards mental health care should be understood as an investment with the potential to generate high returns and that improving the mental health of the community is likely to have flow-on effects for the broader economy including increasing workforce participation and decreasing pressure in the health, social services and justice systems.

In 2017, 3,128 people died from intentional self-harm in Australia. This was an increase of 9.1% (from 2,866) in 2016. This reflects the growing crisis of suicide in Australia, as well as the inadequacy of repeated mental health plans and strategies to curb the unacceptable increase in suicide deaths.

Statistics show that suicide deaths occur disproportionately in certain communities, cultures and demographics. Deaths from intentional self-harm occur among males at a rate more than three times greater than that for females. When age-specific rates are considered, suicide accounted for over one- third of deaths among people aged 15 to 24 years, and over a quarter of deaths among those aged 25 to 34 years.

The rate of suicide deaths per 100,000 increases consistently with greater remoteness. The rate of suicide deaths in very remote areas, 23 deaths per 100,000 people, was more than double the rate in major cities, 10.1 deaths per 100,000 people.

For Aboriginal and Torres Strait Islander peoples rates of suicide are particularly concerning. In 2017, suicide ranked as the second leading cause of death for Indigenous males, with 39.6 deaths per 100,000 persons and 7th for Indigenous females, at 11.9 deaths per 100,000 persons. For comparison, in the non-Indigenous population, suicide ranked as the 10th and 21st leading cause for males and females, respectively.

Targeted services are needed, as part of overarching programs and services, to ensure that at-risk groups are supported and engaged by a range of mental health and social supports.

Recommendations

Rural access and the psychiatric workforce

1.1 Increase the funding for project support for the Specialist Training Program and the Rural Training Pipeline for Medicine initiative by $500,000 over three years.

Alcohol and other drug services

2.1 Introduce a minimum floor price for alcohol that includes volumetric taxation with direct revenue from alcohol taxation towards preventative health activities (including a focus on alcohol-related harm) and alcohol and other drug treatment services.

2.2 Develop a national quality framework for AOD services that determines accreditation and funding of public and private services.

Aboriginal and Torres Strait Islander mental health

3.1 Increase funding for Aboriginal and Torres Strait Islander mental health and wellbeing services based on needs-based expenditure targets of at least 2.4 times greater than for the general population.

3.2 Increase recruitment of Aboriginal and Torres Strait Islander mental health workers in public health services in targeted locations, with appropriate supports provided including mentoring, debriefing and supervision.

Mental health needs of older people

4.1 Establish an Aged Care Information Strategy Standing Committee and implement a trial for the collection of operationalised indicators of compliance with best practice at a cost of $1 million over three years.

4.2 Expand the number of Specialist Dementia Care Unit beds from 371 beds to 500 beds at a cost of $25 million annually.

Disability support and the NDIS

5.1 Ensure evaluation is conducted by PHN at local levels to investigate service gaps so funding is appropriately provided to minimise people being without suitable services for their mental health care.

5.2 Clarify referral pathways and services throughout relevant health networks to ensure continuous service provision is achieved as much as is possible for those not in the NDIS and affected by the change in services. This should include communications through primary, secondary and tertiary health points to minimise patients being without appropriate services.

Mother and baby mental health

6.1 Introduce models of care for the antenatal management of severe mental illness as part of the maternity health services accessed by pregnant women and after birth.

6.2 Introduce public mental health mother and baby units in all Australian states and territories, equating to one eight-bedded unit for every 15,000 deliveries at a cost of $90 million over three years.

6.3 Improve data collection for perinatal mental health assessments by implementing a pilot trial of data collection around Australia a cost of $360,000 over three years.

Suicide prevention

7.1 Allocate funding for national suicide prevention initiatives to specifically address the needs of key population groups including males aged between 15 and 34, Aboriginal and Torres Strait Islander peoples and people in rural and remote locations.


The Royal Australian College of General Practitioners

Key points from the RACGP’s Pre-Budget Submission

Almost half (45%) of the adult population in Australia will experience a mental health issue in their lifetime, with one in five people experiencing a mental illness in any given year. Mental health is particularly prevalent in populations such as Aboriginal and Torres Strait Islander people, youth in remote areas, and low socioeconomic areas. It is therefore unsurprising that mental health is the most common reason patients visit their GP.

GPs are usually the first port of call for people seeking help with a mental illness. Patients with undiagnosed mental illness often present to their GP with physical symptoms – and determining the underlying mental health issues takes time. However, the MBS does not support mental health consultations lasting more than 40 minutes.

Australians collectively visited their GP for mental health related issues an estimated 18 million times in 2015–16. Yet, Medicare data indicates that only 3.2 million Medicare-subsidised mental health-specific GP services were provided.  One explanation for this inconsistency could be that GPs might bill a Level D (item 44 for a consultation lasting more than 40 minutes) instead of the designated mental health items. If this is the case, it is undoubtedly contributing to inaccurate data, masking the true prevalence of mental health.

Mental health services need to be supported by Medicare, and item numbers must be reviewed to ensure payments accurately reflect the complexity of services provided by GPs. The time taken to assess and diagnose the patient, create a holistic health plan and coordinate patient care, liaise with other mental health providers and complete paperwork, require MBS items to support longer GP consultations.

Recommendations

  • A Medicare item number (2713) exists for a mental health consultation longer than 20 minutes. The value of this rebate is equivalent to item 36 (Level C general consultation of 20–40 minutes).
  • The RACGP proposes additional MBS item numbers for longer mental health consultations: 40–60 minutes – $126.97; and 60 minutes or more – $166.33
  • The costs of implementing this measure will be offset by a reduction in billing for the corresponding professional attendance item.

UnitingCare Australia

Key points from the UnitingCare Australia Pre-Budget Submission

UnitingCare Australia believes that the Commonwealth Government can do more to mitigate the prevalence and economic and social costs of mental health issues in Australia. Mental health issues have the potential to impact any member of society, but it is often the most vulnerable who are least able to seek effective assistance to improve their lives.

The recent announcement of an additional $1.75b for mental health services provided by the Commonwealth to Primary Health Networks (PHNs) is a positive development, but more must be done to provide certainty to mental health industry practitioners and the people they support.

Recommendations

UnitingCare Australia recommends that the Government:

  • re-establish block grant funding for Mental Health Services as per Recommendation 7 of the Senate Committee Inquiry on Accessibility and Quality of Mental Health Services in Rural and Remote Australia;
  • develop and implement a comprehensive strategies to: increase the numbers of mental health practitioners operating in regional and remote areas; increase the numbers of Indigenous mental health practitioners operating nationally, but particularly in regional and remote communities; increase the uptake of Aboriginal Mental Health First Aid among relevant professional cohorts in regional and remote areas; and ensure appropriate financial, personal and professional supports for mental health practitioners operating in regional and remote areas; and
  • redesign funding arrangements for mental health care providers operating in regional and remote areas to provide greater certainty of funding and minimise the risks of – and associated with staff churn.

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