Mental health has been in the health policy spotlight over the past week with Labor committing to a 50% suicide reduction target and the Coalition announcing a number of new policies, including a new text-based suicide prevention initiative.
So where does this leave the major parties on the key issue of mental health?
The Coalition is out-spending Labor but its platform has some key gaps, including a failure to recognise the mental health implications of discrimination against LGBTI people and their ongoing marginalisation by policies opposing marriage equality. The Coalition also mentioned Indigenous mental health only in relation to suicide prevention, rather than in the broader context of overall mental health and well-being.
The following is a summary of the two major parties election commitments in mental health. This is followed by a sample of the feedback from key health groups. Additional analysis and expert opinion to follow in Part 2.
Coalition mental health election policies
Total spending commitment: $192 m
- 10 Primary Healthcare Network lead sites to trial innovative approaches in mental health services including four sites to focus on suicide prevention.
- An additional eight Suicide Prevention Trials in regional, rural and remote areas. This will bring the total sites to 12, building on best practice and community models and adopting new digital technologies to assist in crisis support, clinical intervention and ongoing support for individuals. This includes Support for a Crisis Text service design and trial led by Lifeline.
- A $12m Suicide Prevention Research Fund to support targeted research, develop and evaluate regional suicide prevention models and provide a best practice hub of resources.
- Strengthening of the National Mental Health Commission, which will be charged with overseeing mental health reforms and providing direct advice to the Minister.
- Guarantee of funding for youth mental health services, through headspace, and funding for 10 new centres.
- Trialing innovative mental health care across Australia, for those with severe mental health issues.
- Promoting and supporting a more sustainable and flexible mental health nursing workforce, including a grant to College of Mental Health Nurses to fund workforce development strategy
More information on the Coalition’s mental health policies can be found here
Labor mental health policies
Total spending commitment: $84m
Labor’s policy states that it largely supports the National Mental Health Commission’s recommendations and will outline the priorities for implementation within the first 100 days of a Shorten Labor Government. Specific commitments made to date are:
- To lead the negotiation on the development of the Fifth National Mental Health and Suicide Prevention Plan. The Plan will be based on the principles of National Leadership and Regional Integration which has been recommended by the National Mental Health Commission’s review. In recognition of the need for multi-departmental engagement and cross jurisdictional sign-off, Labor will seek agreement to the Fifth National Mental Health and Suicide Prevention Plan by the Council of Australian Governments (COAG).
- To use the existing Primary Health Network structure to extend the scope of regional health services to include regionally-tailored mental health services. Integrating regional services through the Primary Health Networks will support a model of place-based care which focuses on the needs of the individual, particularly where they have multiple morbidities which require a multidisciplinary primary health care approach.
- To reduce suicides by 50 per cent over the next ten years, in line with the National Mental Health Commission’s target.
- 12 regional initiatives – six urban, four regional and two remote – as the first stage in implementation of a comprehensive, whole‑of‑system approach to suicide prevention. Regions will apply for grants to fund place-based initiatives tailored to local community needs for services and support.
- An Aboriginal and Torres Strait Islander Mental Health Plan to be developed by the National Indigenous Health Equality Council and the National Mental Health Commission. The Plan will devise strategies to improve the mental health outcomes and prevent suicides of Indigenous peoples.
- Support for the activities of the Mentally Healthy Workplace Alliance to improve mental health safety and wellbeing, self-help at work, and with reducing stigma and discrimination in the workplace.
- To restore the independence, integrity and transparency of the National Mental Health Commission and ensure it is embedded in a stronger national system of health reform.
- To make sure that people with mental illness can continue to get the support they need by working with state and territory governments and disability and mental health support and advocacy organisations to determine which community based disability and mental health services require continued funding as the NDIS is rolled out.
More information on Labor’s mental health policies can be found here
The following is a summary of the responses by mental health stakeholder groups to the election platforms of the Coalition, Labor and Greens parties.
Mental Health Australia
Mental Health Australia has prepared a comprehensive report card on the mental health commitments of the three major parties which outlines the detail of their policies but does not provide an overall assessment.
CEO Frank Quinlan welcomed the Coalition’s commitment to new investments in mental health, saying that “$192 million of new investment in mental health represents a welcome boost to programs and services. This kind of investment will save lives.” However, he also warned that “Regardless of who wins the 2 July election, the process of mental health reform will require a decade long commitment to improving mental health services and programs.”
Lifeline welcomed Malcolm Turnbull’s personal commitment to suicide prevention, particular through regional trials and funding for important services and research.
Lifeline Australia Chairman John Brogden said the new text service will be integrated with the locally-based efforts of Primary Health Networks (PHNs) to tackle the suicide emergency currently faced in Australia.
“The Government’s funding for Lifeline’s Crisis Text initiative provides enormous potential to help us in our quest to stop suicide,” Mr Brogden said. “With 2864 people taking their own lives in 2014 – the highest level in ten years – we need to find new and better ways to ensure no person in crisis has to be alone.
“We need to communicate with people using multiple technologies, and Crisis Text makes help available, simply and accessibly, across modern communication. Crisis Text will complement regionally-delivered health services and initiatives led by PHNs, providing 24/7 crisis support, outreach and referrals to local services.
“Stopping suicide is about new technology, local delivery and old-fashioned care and compassion – what Lifeline’s been doing for more than 50 years.”
Suicide Prevention Australia
Suicide Prevention Australia also stated its support for the Coalition’s $192m suicide prevention and mental health plan. This follows last weekend’s announcement of support for suicide prevention and mental health by the Australian Labor Party.
SPA CEO Sue Murray said of the announcement, “Lives depend on us recognising suicide prevention as a key national issue which requires the commitment of all parties supporting Australians to stay alive. At this time, when we face the highest suicide rate in 10 years, the commitment to funding and action is exactly what is needed.”
“The Coalition has not at this stage endorsed the goal of a 50% reduction in suicide deaths. Suicide Prevention Australia continues to believe that setting this goal is essential to galvanise government, business and community action as has occurred in Scotland and other countries. That said, we welcome the commitments that are, in the most part, aligned to the Suicide Prevention Australia 2016 Election Manifesto and the National Mental Health Commission Review recommendations.”
Consumers Health Forum
Consumers Health Forum welcomed the Coalition’s announcement, in particular the support for Primary Healthcare Networks.
“The funding gives the new Primary Health Networks resources for trials they need to start making a real difference to the provision of community-based mental health services,” the CEO of the Consumers Health Forum, Leanne Wells said.
“There will be 10 PHN lead sites to test innovative approaches in mental health services including four sites to focus on suicide prevention. Funding will provide for an additional eight Suicide Prevention Trials in regional, rural and remote areas.
“It is well accepted that in a country as diverse as ours that locally tailored, evidence-based services that take into account need, other services and available workforce, not one-size-fits-all approaches, will deliver best for communities.
“It is particularly pleasing to see the role of PHNs as the agents through which truly regionalised service innovation and development can be achieved recognised. This form of placed-based health care which puts local consumers and clinicians in the planning driving seat offers great potential in the mental health and suicide prevention arena”
“People with mental health problems invariably have associated chronic conditions such as diabetes, pain or arthritis. PHNs are well placed to not only coordinate the innovative new approaches to mental health services but critically to also ensure they are well linked with other services so that people with the complexity of combined physical and mental health problems experience a less disjointed system.
“We also welcome the plan to use digital technologies to support mental health reforms by supporting the transformation of e-mental health and other digital systems to provide 24/7 services. Australian research is showing us that the use of on-line psychological counselling has the potential to bring effective therapies to people who otherwise might not or cannot access conventional counselling.
The establishment of a Suicide Prevention Research Fund to support targeted research and development, and promised strengthening of the National Mental Health Commission to oversee mental health reforms and directly advise the Minister are welcome, as is support for a more sustainable and flexible mental health nursing workforce.
“We support the funding’s scope to enable the development of effective services through partnerships between government, non-government organisations and the private sector. We hope these fresh plans for mental health services are the promise of a more comprehensive and permanent development,” Ms Wells said.
Australian College of Mental Health Nurses
The ACMHN asked all parties and candidates to commit to five key issues which are:
- No reduction in mental health program funding
- 3-5 year quarantining of mental health nurse funding with Primary Health Networks (PHNs)
- Fund nurse workforce initiatives
- Include nurse representatives on all mental health and other relevant government committees
- Refugees and asylum seekers – Ratify the Optional Protocol to the Convention Against Torture (OPCAT) and amend the Border Force Act
The ACMHN asked members to write to the local MP and candidates asking them if they would commit to these issues, and also wrote to the three main party leaders – Liberal, Labor and Greens – asking them if they would commit.
The ACMHN supports regionally planned services that provide better care to consumers, and believes transferring mental health nurse services to PHNs offers many opportunities for Credentialed Mental Health Nurses (CMHN) to practice to their full scope and work across a range of mental health service areas.
However, this cannot and will not occur if the mental health reform changes are not transitioned in a considered and appropriately timed way, and for mental health nurse services to be equitably distributed across all PHNs,
We need to fund workforce initiatives that improve the mental health knowledge and clinical skills of all nurses, especially general practice nurses – this is in line with National Mental Health Commission report and recommendations. Nurses must also be included as equal partners in and represented at all levels of policy discussions.
Nurses work in a range of settings, including in detention facilities, and in order for them to do their job the Australian Government must ratify the Optional Protocol to the Convention Against Torture and amend the Border Force Act to demonstrate Australia’s commitment to human rights and to allow health professionals to report openly or disclose information about immigration detention centres
At the time of writing, the ACMHN had received a response from the Greens but not the other two parties. The Coalition, Labor and the Greens have released their mental health policies for the 2016 federal election. The ACMHN does not endorse any party’s election policies and notes this scorecard relates to the ACMHN election key issues.
|No reduction in mental health program funding
The Government transferred existing mental health program funding to PHNs for Headspace, the Mental Health Nurse Incentive Program (MHNIP), ATAPS, Mental Health Services in Rural and Remote Areas (MHSRRA) to create the mental health flexible funding pool.
PHN operational costs of 6% have come out of the budget for MHNIP services. However PHNs are required to continue to provide existing service levels.
Mental health election initiatives include:
· 12 suicide prevention trial sites.
· A Suicide Prevention Research Fund and Best Practice Hub to support targeted research and evaluation, and support the PHNs.
· Guaranteed funding for headspace and additional 10 headspace centres,
No specific comments about existing funding. Labor have committed to services & supports continuing for people living with mental illness, including outside of the NDIS. Labor’s interim response to the National Mental Health Commission’s review will be met from a reallocation of existing funds, as recommended by the Commission.
Labor will use the existing Primary Health Network (PHN) structure for services.
Labor will establish 12 regional initiatives – six urban, four regional and two remote. Regions will apply for grants to fund place-based initiatives tailored to local community needs for services and support.
The Greens would provide an additional $400 million for the PHNs flexible mental health funding pool.
The Greens have committed a further $1.4 billion of funding over the next four years specifically to mental health services. Both administered and departmental costs are included in this figure.
The Greens have concerns about the amount of allocated funding to Partners in Recovery from the
2019-20 financial year onwards. They will review the current funding allocation post-election.
They support existing programs with universal coverage being protected from user-pays charges.
|3-5 year quarantining of mental health nurse funding with Primary Health Networks (PHNs)
Mental health nurse funding (known as MHNIP) was quarantined for one year for 2016-17 before transitioning fully to the mental health flexible funding pool from 2017-18.
Mental health nurse services are not mentioned in Labor’s mental health election policy.
Labor has stated they will slow the pace of implementation of the mental health reforms due to concerns the process is causing stress for those living with a mental illness and across the mental health sector, and risks undermining the quality of services and achieving the longer-term benefits of the reforms.
The Greens support the responsibility for the mental health nurse program going to the PHNs, but would require a 5 year quarantine of MHNIP funding, and increase funding to the program by $280 million.
|Fund nurse workforce initiatives
The Coalition will provide $1.5 million to the Australian College of Mental Health Nurses to look at a new workforce model.
The College would coordinate with PHNs co-commissioning trials between PHNs and local area health services which would allow mental health nurses to move between the primary and acute care sectors. It would see the PHNs and local area health services both contribute to funding nurses who would work across both sectors.
Labor’s mental health policy includes the development of the Fifth National Mental Health Plan, taking into consideration the Mental Health Services Planning Framework; integrating regional services through PHNs; and establishing 12 regional suicide prevention initiatives.
Specific workforce initiatives for nurses are not discussed.
The Greens would contribute $140 million in funding to generate then implement a plan to attract and encourage more mental health workers in regional Australia and improve the skills of the workforce.
Specific workforce initiatives for nurses are not discussed, but there is an acknowledgement that mental health nurses will play an essential role and that this role should grow at all levels and types of care.
|Include nurse representatives on all mental health and other relevant government committees
Nurse representation on Government committees not discussed.
Nurse representation on Government committees not discussed.
The Greens endorse the inclusion of mental health nurses as committee members and equal members in the mental health reform process and in policy discussions.
|Refugees and asylum seekers – Ratify the Optional Protocol to the Convention Against Torture (OPCAT) and amend the Border Force Act
The Australian Government signed the OPCAT on 19 May 2009, but has not yet ratified the agreement. It went through relevant Parliamentary processes in 2012.
The Government introduced the Border Force Act including the secrecy provisions which threaten gaol for up to two years for health and medical professional who disclose information about the conditions in immigration Detention Centres.
Labor have not stated position on the OPCAT but have made verbal statements that they believe there should be increased transparency regarding detention centres.
Labor supported the introduction of the Border Force Act including the current secrecy provisions.
The Greens voted against the passing of the Border Force Act and support it being repealed in its entirety. In the alternative, the Greens are supportive of amending the existing legislation to allow health professionals to report openly on and/or disclose information about conditions in immigration detention, including the removal of criminal penalties.
The Greens are supportive of the ratification of the OPCAT and calling on whichever party forms government to abide by Australia’s existing obligations under international law.