Below is some reaction to mental health elements of the federal budget
Mental Health Takes the Night Off – Budget 2012
By Sebastian Rosenberg, Senior Lecturer, Brain and Mind Research Institute, University of Sydney
From a mental health perspective, the budget was an alarmingly quiet affair, with the Government content to rest on its $2.2bn laurels from last year. A ‘control F’ search of Budget Paper 2 for the word ‘mental’ yields only 2 results. Slim pickings.
It was not our turn. It was aged care’s turn, with the Budget delivering $3.7bn package over the next five years. In health specifically over the next four years, the Budget also promised $0.5bn for dental care, $233m for ehealth and $50m for bowel cancer. This is in addition to the Federal Government’s $1bn investment in the National Disability Insurance Scheme. Not our turn.
In such a tight fiscal environment, it was perhaps not surprising that the hard copies of the health budget package didn’t even make it to the Treasury lock-up where I spent many happy hours this evening.
There were still some points to note.
Funding for the Mental Health Nurse Incentive Program has been maintained but capped, with $17.6m provided over the next two years. Based on the increased numbers of people receiving care in 2010-11, the Australian College of Mental Health Nurses estimate around 30,000 people with severe mental illness will miss out on care due to this capping.
The Government will provide $21.0 million to fund additional allied mental health services for patients under the Better Access initiative. Under current arrangements, patients can access up to ten subsidised mental health services through the Medicare Benefits Schedule (MBS). These funds will allow access to a further six MBS-subsidised mental health services for some patients up until December 2012. This was the compromise change forced on the Government by the Greens. However, the funding is not new, with the Government reducing the Flexible Care Packages Program by $16.3m and the Better Access Training Initiative by $4.7m.
Perhaps the only exception to the general silence on mental health in the Budget was $115m over five years directed towards better mental health care for veterans.
While the National Disability Insurance Scheme is clearly a worthy headline, the extent to which it will cover people with a mental illness is unclear. This is clearly an issue of real significance for people with severe illnesses such as schizophrenia.
Previously announced changes to the Disability Support Pension kick in from 1 July and the impact these will have on people with a mental illness needs careful scrutiny. There are some measures in the Budget designed to assist the unemployed find work.
While there was an almost complete absence of mental health-related activity, the Budget still offers some gems of information.
New spending of $9.1m will permit the Australian Bureau of Statistics to conduct its Survey of Disability every three years, rather than every six years, from 2014‑15. The ABS Survey into Mental Health and Wellbeing of course occurs only every decade. These types of surveys give us unparalleled understanding of issues and the paucity of this kind of data in mental health explains why we are currently ‘outcome blind’.
A budget Press Release by Minister Brendan O’Connor re-affirms the 2008 commitment made by Labor to halve the rate of homelessness by 2020 and makes the striking claim that the Government has already spent $5bn on this cause. A large chunk of this funding was for 20,000 social housing places. Again, without baseline data it is not possible to understand the impact such key initiatives are having on people with a mental illness who require housing support. Funding is required to procure this information.
Last but not least is the statement made in the Budget that Commonwealth outlays on health have now reached $61bn. This represents a 37% increase on 2007-08 levels. Though last year’s funding for mental health was welcome (the $2.2bn was over 5 years), this year there is practically nothing while the rate of increase to the overall health budget continues largely unabated. Mental health’s share of the overall health budget is in decline.
In announcing the Commonwealth’s commitment to the $5.5bn 2006-11 National Action Plan on Mental Health, then Prime Minister Howard recognised that mental health required more than one-off attention. It needed the ongoing political and financial support of governments, to build the community service infrastructure not built following the closure of Australia’s asylums. While some important steps have been taken since 2006, there is no new CoAG National Action Plan and there is a long, long way to go.
Wait your turn.
Still waiting from last year’s budget
By Professor Pat McGorry
While there is relief in some quarters that mental health has at first glance does not appear to have been cut in this budget, there are three areas of concern.
Firstly, the long term structure of Better Access remains uncertain beyond 2012 as far as one can tell. Furthermore a much needed “stage 2” program with enhanced multidisciplinary skills, for the subset of people with more complex and persistent disorders who run out of Better Access credits yet have no hope of access or tenure in the heavily constrained State public mental health system, is not even in prospect.
Secondly, there is concern about the capping of the mental health nursing initiative, one of the most valuable of the recent reforms.
Thirdly, there are in fact latent cuts to projected mental health expenditure arising from the fact that several major programs announced last year have yet to surface. For example, the largest single program of 2011, “Partners in Recovery” for severe and enduring mental illness, had not been designed when announced in the budget and has had a consequently long gestation, while the upscaling of EPPIC has been delayed despite committed and genuine efforts by the Minister and senior DoHA officials, solely due to the requirement under the NPA mechanism to deal with State health departments rather than directly with major providers.
This has meant that despite the best of intentions, nationwide policy support from all jurisdictions and desperate community need, no new services have yet been opened. I believe the global solution is a much stronger role for the Commonwealth in the design, funding, integration and national standardisation of community mental health services in close association with enhanced primary care, allowing the States to focus on their heartland of hospital care.
Finally we must remember that our 10 year goal is equal access and quality for mental and physical health for all Australians, which means progressive real increases in mental health investment as a share of the health budget.