As you may have heard in the news today, the Minister for Mental Health and Ageing Mark Butler has announced that he will chair a new Expert Advisory Group on Mental Health.
A shame that the press release says its aim is to “provide the Federal Government with advice on the important reforms needed in the mental health sector”.
I would have thought that a lot of the work that needs to happen to improve the lot of those with mental health problems (and their carers) is beyond the scope of the “mental health sector”, and includes areas such as housing, employment, social support etc. But perhaps I am just being too literal in my reading of the statement, and the group will have a broader remit.
Here is the list of members (so you know who to contact if you want to influence federal policy…)
- Professor Patrick McGorry AO, Executive Director, Orygen Youth Health and Australian of the Year.
- Monsignor David Cappo AO, Vice-Chair, Australian Social Inclusion Board.
- Professor Ian Hickie AM, Executive Director, Brain and Mind Research Institute.
- Dr Andrew Fuller, Clinical Psychologist, Department of Psychiatry, University of Melbourne.
- Dr Pat Dudgeon, Clinical Psychologist, School of Indigenous Studies, The University of Western Australia.
- Ms Janet Meagher AM, Divisional Manager (Inclusion), Psychiatric Rehabilitation Australia.
- Dr Christine McAuliffe, General Practitioner.
- Ms Sally Sinclair, Chief Executive Officer, National Employment Services Association.
- Professor Frank Oberklaid OAM, Director, Centre for Community Child Health, The Royal Children’s Hospital.
- Mr Toby Hall, Chief Executive Officer, Mission Australia.
- Mr Anthony Fowke AM, President of Association of Relatives and Friends of the Mentally Ill (ARAFMI) Australia.
- Dr Christine Bennett, Chief Medical Officer, Bupa Australia
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Meanwhile, for those with an interest in mental health, this recently released report from the NSW Auditor-General, Peter Achterstraat, on the mental health workforce looks interesting, and very relevant to the new national group’s deliberations.
The summary says:
In 2006, NSW Health announced A New Direction for Mental Health, a five-year plan committing $939m to improve mental health, with most of the workforce growth to occur in community based services.
Community mental health has not met expectations
While the Government funded over 500 new community staff by 2008-09, the net growth was perhaps half as much, as existing community positions either disappeared or were not filled.
“The Government intended to help people earlier in an illness and provide support in the community. Clearly we still have a way to go with nearly half of patients leaving hospital not followed up by community staff within seven days.
Additionally, one in three kids and two in three aged patients stay in psychiatric hospital beds for extended periods of time because there is nowhere else for them to go”, Mr Achterstraat said.
“NSW continues to spend proportionally less on community mental health than most other states”, he added.
More mental health clinicians
The number of mental health clinicians in NSW has increased over past four years. However, most of the increase has been in hospitals rather than in the community. The State now has services that didn’t exist before for our youngest and oldest mental health patients. NSW employed between 380 and 680 extra hospital staff and spread them more evenly across the State to where they were needed. These are positive outcomes.
Data integrity in question
Mr Achterstraat was concerned that NSW Health could not tell him precisely how much the mental health workforce grew. The Department advised that it employed in the range of 600 to 1000 extra staff between 2005-06 and 2008-09. Some of the higher numbers reported by Area Health Services seemed implausible.
“Health’s workforce data is inconsistent and in places inaccurate making it very difficult to organise its services to meet existing and future demand”, said Mr Achterstraat.
Money sometimes diverted to other programs
Around $20 million a year was diverted from mental health to other areas of Health. This money may not have been wasted, but it meant that the State missed out on another 150 front line mental health clinicians in the community.
What needs to be done
Mr Achterstraat recommended that NSW Health:
- keep its promise to provide more mental health care in the community so that people don’t have to wait until they are so sick that they have to be hospitalised
- spend mental health money on mental health services rather than other areas of health
- work with private and non-government services to provide the mentally ill with the care they need when they need it.
“It is important that NSW Health organise its finite workforce effectively to assist the one in six people of New South Wales who suffer with mental illness”, Mr Achterstraat said.
Couldn’t any government, just once, allow a discussion about mental health in Australia without Professors McGorry & Hicks at the helm? McGorry’s out-patient drug treatment model has dominated public mental health policy for 25 years. Its been official policy since 1996, after which we saw a spiking of the suicide rate amongst our mentally ill. That suicide rate remained alarmingly high throughout the expansion of his model in 2004, which saw him set up Headspace centres & organise ‘EPPIC service training’ for providers nation-wide. Today nearly every young person receiving treatment through the public system for serious mental illness (SMI) or ‘could-be SMI’ (the Prodromal drag-net), will be treated according to this one highly questionable model. Its not the only ‘evidence based treatment’, & Professor McGorry does not represent the opinion of all psychiatrists in Australia. Most in private practice do not prescribe according to his ‘early psychosis intervention’ model. A growing number almost exclusively use psychosocial evidence based treatments. Every time mental health is on the federal agenda, the same series of ‘moves’ & rhetoric comes out of Victoria. All this happened back in 2004! Like clockwork, McGorry throws himself into the limelight criticising govt detention centre policy; then perceived as boldly socially progressive he makes dramatic cries for ‘mental health reform’; he whips up noisy approval with progressive sounding catchcries like ‘early intervention’, ‘community based care’ & ‘quality services’; the drug-model approving ‘carers’ all jump on the bandwagon; the rhetoic is force-fed to & regurgitated by the media endlessly. The only change we ever see is EXPANSION of his model. That is not reform! Meanwhile people like me who want to see an end to involuntary drug & ECT tx, a policy of psychosocial-before-psychotropic-drug intervention ALWAYS (psychotherapy, CBT, group & family therapy), & residential rehab services for SMI sufferers including ‘wet rehab’ for dual diagnosis, just get drowned out. Has this Govt aleady fallen for the ‘sell’? Hand in glove with big pharma? McGorry and Hicks have directed policy for over two decades. Can the public memory be so short?