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    david mckinnon

    Mental Health policy and funding has been out of touch with reality since de-institutionalisation. At that the time there was not enough on community support. The failures of the past have just continued to fester and grow to such an extent that no government can fix the systemic problems in one budget. There are huge infrastructure projects that must be undertaken as well as the various community programs.

    Anything is better than nothing and there is now a recognition that mental health is a real issue on the social and political agenda. There is not an acceptance, as yet, that many $billions must be spent over a number of years to catch up.

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    Historically State-based services have provided for the “severely mentally ill” (usually taken to mean schizophrenia and severe borderline personality), with Federal the rest (which includes high-mortality/high-impairment disorders such as anorexia and bipolar, this has never been about “worried well”)
    The new ATAPS “complex case-management” and Federal EPPICs seem to mean the Feds are “muscling in” on State territory, probably because State services are seen as inadequate. Understandably Roxon is hardily going to hand the States a blank cheque to fund their services, as the States will simply reduce their own contribution by the same amount, but the alternative runs the risk of some very expensive duplication and additional complexity.

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    Thank goodness some one is talking about evidence-based reforms and evaluation of quality and effectiveness.

    The routine provision of evidence based treatment and best practices in mental healthcare is an international challenge, and a significant priority for Australia.
    A large number of bio-psycho-social empirically supported therapies have been available for many years but there is little evidence to suggest that the clinical workforce has begun to deploy these treatments.
    The challenge for all mental health services (Government, Private and Non-Government) is to overcome workforce barriers to implementation.
    The Australian Government and state Governments can throw all the money it likes into these services, but the challenge will still exist for mental health services to develop their clinical workforce to practice in accordance with the evidence.
    Inadequate practices are ingrained and for the most part, unconscious at the individual level. They seem to occur at both clinical and managerial levels across the mental health system. Naively they are introduced and sustained, embedded in culture; intermittently reinforced by colleagues, work teams, service managers, management groups and funding personnel that have governance accountabilities.

    It is time for managers and leaders to concentrate their efforts with the clinical workforce towards the implementation of what works and in doing so maximize the effectiveness of known treatments to their consumers, families and communities

    As well, Consumers, Carers/families and the consumer and carer movements across Australia should be informed of the provision of bio-psycho-social evidence based treatments and best practices so they can advocate for them on a national, state and service level

  4. 4


    Evidence about the effectiveness of headspace is also weak, contrary to the prevailing gospel. Those who laud headspace would do well to look at the actual evidence about it. The independent evaluation by Muir et al. ( did not compare headspace with a control group. Muir et al. reported: ‘Inclusion of a control group was precluded by the timing, budget and funding requirements for the evaluation, coupled with the introduction of the new model and delayed implementation of the initiative. This limits the validity of the outcomes because it is not possible to determine what would have occurred if young people had not received the headspace intervention’ (p. 134). The evaluation concluded: ‘there is little tangible evidence to conclude the extent to which services are evidence based’ (p. xv).
    However, Patrick McGorry repeatedly refers to headspace as an ‘evidence based’ model, and this is accepted at face value.

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    I’m interested to hear that about the headspace research. I personally think it could lead to excessive diagnosing in young people.

    I think a better idea would have just been to provide more counsellors in Colleges. Unis etc. Also beef up support for GPs.

    I’m interested to know how the Early Intervention and Prevention of Psychosis can happen? Could someone enlighten me how they intend to prevent Psychosis?


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