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“Mental health and suicide prevention are now red hot national political issues”

On Monday, mental health advocate Professor John Mendoza was invited to attend a community symposium on mental health, to be held in Sydney on March 10. He can’t make the event, but replied with this letter, which was also widely copied to politicians, journalists and others in his field.

John Mendoza writes:

I just have returned from community led meetings/conferences in the Nambucca Valley and Canberra in the past 2 weeks. The community is becoming increasingly energized by the lack of Federal Government leadership on this issue after three years in office.

As my colleague and former senior adviser to Julia Gillard, Dr Lesley Russell said in the Canberra Times earlier this week, Federal Labor has only cut funding to mental health programs (all of them commenced by the Howard Government) since elected in 2007.  (The article can be downloaded here).

Good programs such as PHaMs, the respite program, the mental health nurse program, headspace and ATAPS are all in need of substantial new investment. Headspace is now nothing like the model of care that was originally envisaged when it was designed back in 2005.

Services are now grossly underfunded and having to charge out-of-pocket fees to stay open. This is to meet the Government target of 60 sites within the funding allocation. The services will resemble the facades from a Hollywood Western  – just a shop front and no real service.

The headspace service in the Nambucca Valley has now closed and the community is desperately trying to find ways and means to keep some sort of service operating. The Government knows all this and it also knows that it must make reforms to the Better Access program to ensure those in need can afford access to psychology services.

The much trumpeted suicide prevention funding announced during the Federal election campaign last year totaling $277m will see just $9.1m spent this year.  Again this is symbolic of a Government that talks the talk but fails the test of real action.

Mental health and suicide prevention are now red hot national political issues. This is in part due to the continuing delays on any real reform or action by the Federal Government despite having more advice than any previous government on what actions are required.

It has had dozens of program-specific advices from the National Advisory Council on Mental Health and overall system reform from NACMH and the National Health and Hospitals Reform Commission – almost all of which it has ignored.

It knows what the priorities for investment are – prevention, early intervention, community support services including supportive accommodation, research and new governance and accountability.

And its only action since the election last August is to appoint a Minister (Mark Butler) and another expert panel chaired by the Minister (who also now chairs the NACMH). Yet more advice.

To his credit the Minister did undertake 14 community consultations attended by consumers and carers and hear first hand their concerns. I believe he is trying but like many before him, he is running into the same road blocks when it comes to significant new funding.

There is always a reason for delaying real reform and action on mental health it seems.

Almost on a daily basis I receive phone calls and emails from distressed Australians who cannot access care or have dreadful experiences in acute care and then no community support for very ill family members.

In Bowraville last Thursday I assisted an Indigenous mother whose son had been placed on a community treatment order six months ago. He committed a crime to gain admission to Port Macquarie Hospital. He has been seen for a psychiatric assessment just once in that time and despite being heavily medicated and suicidal last week and was again refused admission or an assessment. If he had presented with an equally life threatening case of chest pain, he would have been immediately admitted and received good care.

Recently I have spoken at length with a deeply distressed mother from Queanbeyan who has lost her son to mental illness – or more correctly to the NSW Health system.

Last week it was Wagga with a very public suicide of a young man and several suicides here on the Sunshine Coast; previously six in the small community on the Darling Downs late last year and almost a dozen suicides in the Kimberley in the last few months.

I could go on and on with systemic failures across the nation. With the exception of the events in the Kimberley and action by the WA Mental Health Minister Helen Morton, there has been no response from either state or Federal governments to these tragic events and the many systemic failures of care.

While it’s too early to make a judgment on the new Victorian Government’s actions on mental health, the Stanhope Government in the ACT is tackling the problems of access, care continuity and quality and is increasing investment in community services.

They stand out from other governments in their approach to mental health.

I am optimistic that should a Coalition Government be elected in NSW at the end of this month, they too will tackle reform and direct substantial funding into evidence-based community services and not continue the failed hospital-centric approach of the current administration.

• John Mendoza is Adjunct Professor, Health Science, University of the Sunshine Coast, and Adjunct Associate Professor, Medicine, University of Sydney. Last year, he resigned as Chair of the National Advisory Council on Mental Health.

Comments 4

  1. Murf says:

    Professor Mendoza- about the Better Access system failing- its not just psychologists that we can’t afford to pay, its the bl**dy psychiatrists! Can you persuade some of your colleagues to accept the scheduled fee for a limited number of patients per year? I come from both sides of the system- major depression all my life, but also worked in mental health for over 15 years. Last year I was suicidal for months and only kept going in the hope that there must be another avenue of care for me somewhere. I reported to my GP, got the maximum allowed prescribed quantity of the pills that seemed to work, went to a psychologist who just wasn’t equipped to handle the severity of my depression and absolutely begged the GP to refer me to a psychiatrist. (I knew most of them here anyway and knew some would be helpful). Eventually, 6 months later I got my appointment, had my pills upped to the max, but nearly fell over at the second appointment when I was asked to pay “the gap”! That gap is massive enough if you are on Centrelink benefits- and when you have no independent income at all, its crushing. I was extremely lucky that my shrink took pity on me and agreed to take just the scheduled fee. Now I am well, but plenty of my friends and acquaintances are not, because they cannot afford to see a psychiatrist and have their medication managed better. You MUST DO something about this! I am quite resourceful for someone who has been depressed- most aren’t, as you would realise on reflection. YOU and your colleagues need to consider the public health implications of handing over this mental health epidemic to the cheapest services. They are NOT enough.

  2. Melissa Sweet says:

    Chris Tanti, Chief Executive Officer of headspace, has asked for this comment to be posted:

    We know the mental health sector is underfunded and continue to call for increased funding. Both sides of government are clear on our position in this regard.

    But it is inaccurate to suggest that headspace is not delivering help to young people that was envisaged when the headspace model was established.

    headspace has helped more than 37,000 young people so far and 96 per cent of our clients value the service.

    Importantly headspace has been very successful engaging two groups that are traditionally hard to reach. Young men make up 42 percent of our clients and 7 percent are Indigenous Australians – well above the mental health sector average.

    Mendoza is also misinformed about headspace funding. Funds have not been taken or transferred from the 30 existing centres to meet the governments’ target to operate up to 60 centres over the next three years. Additional funding has been received to open these new centres, 10 of which are due to open later this year. Funding was also received to boost the capacity of the majority of existing centres. These funds have already been distributed to these centres.

    Finally, it is rare that clients are charged for our services.

    I suggest that Mendoza visits one of our centres to really understand the positive difference our services are making to the lives of thousands of young people.

  3. Melissa Sweet says:

    John Mendoza asked me to post this comment on his behalf:

    I welcome the comments from the CEO of Headspace central Chris Tanti as this assists in providing some transparency to the operation of headspace.

    As Chris knows I am a very strong advocate for the headspace model, having worked with the winning consortium and later the then responsible Minister (Christopher Pyne) to get the initiative up and running. The model is a very good one – my concerns are about the level of funding after the initial four-year fund finished.

    Having the opportunity to visit headspaces centres in four jurisdictions during my time as Chair of NACMH (and since) and discuss the roll out of the program with those at the coalface has enabled me to keep informed on what is happening to this critical initiative.

    I have become increasingly concerned about the sustainability of the program with 1) several changes in a relatively short time to the lead agencies at a number of sites 2) the reported necessity to introduce fees for allied health consultations and 3) growing criticisms of the headspace program from a range of service providers.

    To clarify these issues I suggest that headspace central provide answers to the following:

    1. How many lead agencies have changed? Where these have occurred? Why have these occurred?

    2. What is the annual funding provided to each headspace site since the establishment of each site? What is the forecast allocation to each site during the expansion to 60 sites nationally? Does this allocation take account of projected growth in demand as well as cost increases?

    3. What is the percentage of consultations (by type – GP, social worker, Psychologist etc) provided at no cost to the client?

    4. What are the average out-of-pocket or co-payment for each service across the sites?

    5. Will headspace release the full independent evaluation on services? If not why not?

    This would certainly set me straight and ensure that headspace centres can contribute to the mental wellbeing of young Australians and not be subject to political argy-bargy over funding.

    One final comment – 42% of clients are reported as being male. This is pretty much in step with overall MBS rates for males. I would have hoped that headspace would after six years of operations, be achieving at least 50-50 in gender profile given the origins of the model.

  4. rob says:

    Professor Mendoza may well hold the view that Headspace is like a Hollywood Western Pub, but apart from being grossly inaccurate, his letter only further muddies the waters around what could have been a genuine attempt to throw sunlight on the real issue : What will improve the mental health of our young people?

    Professor Mendoza’s preoccupation with who the lead agencies are and whether the clients are seeing social workers or GP’s is surely irrelevant. The young people who come to Headspace will be best served by being referred to a practitioner who has the appropriate skill set for the issues they present with. Not exactly rocket science.

    Similarly, why is the Headspace model suddenly broken because some centres are requesting a small co-payment so they that can continue to offer their services to the maximum – and increasing – number of people who walk through the door ? Co-payments are not exactly a rare animal in the provision of health services, in fact name a health discipline that doesn’t do it?

    These are at best red herrings.

    If Professor Mendoza is wishing to channel the Spanish Inquisition, he would do well to start with BeyondBlue, The National Depression Embarrassment.

    After a decade and more than $200 million of (largely) public money, what have we got?

    Well we certainly don’t have the much promised guidelines on adolescent depression – guidelines which were released in draft form and promptly derided as useless because they completely ignored the issue of sexual orientation and systemic discrimination as one of THE major cohorts to be addressed. Nine months later we are still waiting.

    Interestingly, Headspace is one of the few organisations in the mental health sector, and probably the only one at a national level that has managed to bring GLBTI mental health ‘out of the closet’. An achievement that Professor Mendoza curiously ignores, given that he must know of the excellent work Headspace and their CEO Chris Tanti have done in this sector, and how there can be no meaningful reduction in youth suicide without addressing the GLBTI component.

    Quite frankly, it does appear that Professor is trying to ‘unburn’ the bridges he so publically set on fire when he resigned last year. There can be no doubt that bringing about meaningful mental health reform is frustrating – and the lack of funding makes it doubly so – but pointless sniping is only going to further, not reduce, the frustration levels.

    Rob Mitchell
    Independent Member, Governance & inclusion Project

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