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Is COAG the “Temple of Doom” for mental health and health reform?

(Part 6 of a Croakey series on health reform. For another recent post on mental health reform, see here.)

Fiona Armstrong (a woman of many hats – registered nurse, journalist, public policy consultant and former chair of the Australian Health Care Reform Alliance) has a piece in the Weekend Australian that is well worth a read – and is unlikely to cheer Health Minister Rudd (but I’d guess is likely to ring bells with many in DOHA and perhaps even Minister Roxon’s office).

A brief excerpt: “These health reforms endorse the status quo of powerful providers that dictate health policy, and do little to improve the efficiency, effectiveness, quality and safety of health care, let alone place consumers at the centre of the system.”

Meanwhile, the “mess” of health reform has Sydney psychiatrist, Professor Alan Rosen, reaching for some animated analogies. He writes:

“Is Kevin Rudd still playing doctors, nurses and hospitals, his role lifted straight from the pages of Mills and Boon clinical romances, or has he morphed back yet into his more habitual block-buster action-hero mode?

The collateral damage-prone Indiana Rudd and his CoAGulites should have been ringing the changes for all health, but instead they may be ringing the death-knell for many vulnerable individuals, for community mental health services, and ultimately for all health services, if no further remedy is sought.

Mental Health should be front & centre of a health reform plan, not an inconvenient afterthought. It was ignored as long as they could by Rudd and Roxon like a pimple on the bum of health, which finally became infected and blew up just a few days before CoAG met.

Nicola Roxon was apparently just band-aiding the boil over, still allowing it to fester, as she tried to appease the burgeoning  Australian community of mental health stakeholders and the media  on the Thursday night before CoAG  who were demanding action on mental health.  She promised (Lateline 15 April 2010),  to take over 100% of Community Mental Health Services.

It was clear within a few days that the Rudd government may renege on this clear undertaking. Ian Hickie, who instantly gave her credit for this long-awaited announcement, soon realised  it was the sort of promise which wouldn’t last “from Lateline to lunchtime”.

By  20.4.10 this commitment had been withdrawn, with Ms Roxon stating that they meant only limited sessions for mild anxiety and depressive disorders in primary care settings, by slightly tweaking existing arrangements with fee-for-service allied health providers.

There is some speculation that Mr Rudd and Ms Roxon did offer to take over 100% of community mental health, but the states and territories insisted, under pressure from some of their senior bureaucrats, that these were part of specialty services and that they would “lose integration”. What integration?  There are often only fragments of community service left out there: too many have just been “integrated” back into the hospital.

Talk about cutting off your nose to spite your face. Some states would rather hang on to vestiges of community health services even though they can’t afford to fund them properly. This is a pity, as federally funded community health services would then have achieved some budget protection at last, and bankrolling of growth, and  there are much better ways of ensuring integration of ALL services via regional purchasing across the public, private and NGO sectors.

There is further speculation that a community health takeover was initially proposed by the Commonwealth only with full transfer of their funding from the states, apart from the hospital-oriented funding commitments arising from the 30% of  GST transfer. Some states may have done over their community health services and plundered their budgets so comprehensively that they would not be able to hand them over  without inflicting politically unacceptable pain to the dominant beneficiaries.

In reality, there can be no health reform without mental health reform. Without properly resourcing community-centred mental health services, emergency departments will still get overcrowded and there will be insatiable demands for more acute beds. The outcomes of properly resourcing mobile community mental health teams, is that they act as filters to prevent avoidable presentations at emergency departments and hospital admissions, while supporting both individuals and families in their homes to achieve recovery without needlessly disrupting their lives. If they really need a hospital admission, these teams smooth the way.

What a mess! The CoAG deal has left the future of Australian mental health service provision in serious doubt. Mental illness causes 24-60% (depending on age-group) of all our health related disability and it gets a paltry 2% of the enhancements. How fair is that?   Services reach only 35% of individuals with a treatable mental illness, which would be completely unacceptable for any other serious condition.

Can we still extract some equity, justice and a rational funding mechanism for mental health, and pluck the urgently needed real reform
from this seeming chaos? Don’t miss parts II and III for the next exciting instalments of Indiana Rudd and the CoAG Temple of Doom.”

• Alan Rosen is Secretary, Comprehensive Area Service Psychiatrists’ Network; Clinical Associate Professor, Brain & Mind Research Institute, University of Sydney; Professorial Fellow, School of Public  Health, University of Wollongong

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