Now that the summer lull is ending, it’s time to get back to the big issue for the year ahead: health reform. If you ever need an example of why health reform is needed, and why it’s so hard to achieve, look no further than mental health.
Professor Alan Rosen, a Sydney psychiatrist and regular contributor to Croakey (see this recent piece analysing health reform proposals, for example), writes:
“Despite all the reports and proposals released over the past year on health reform, we still haven’t had the sort of recommendations that really might drive some of the improvement so desperately needed in mental health.
We can’t rely on generic health reforms to drive these service improvements. Mental health services are still too far down the pecking order to intertwine our fate completely with other health disciplines.
Mental health services and their long-term care priorities tend to get lost among general medical, surgical and other health priorities.
To ensure a real bang for the buck and transparent accountability for mental health services, at arm’s length from services and government, we need a dedicated independent national mental health commission or authority, as already exists in New Zealand and Canada. Scotland and Ireland are currently starting to head in this direction. Western Australia is likely to be the first state in Australia with a Mental Health Commission, as it was part of the government’s election platform, and the WA Government is very serious about its implementation.
Such a commission should continually consult all stakeholders, and review all current evidence regarding services that work. This clearing house of evidence based practice should be publically accessible, as in Canada.
It should then develop a vision and blueprint of evidence-based practices and service systems to be delivered consistently, as in New Zealand, and then be mandated to set the National Mental Health Policy and Strategy, as it is in Canada.
The result in New Zealand is 90% of mental health services are now provided in the community (Australia is struggling to attain even 50:50 on unreliable figures, which may often include hospital outpatient visits), with 30% of mental health budgets spent on strict contracts with the NGO sector to enhance community services (Australian states average about 6-7%), and per capita expenditure on mental health far exceeding Australia’s even with private practice included.
It should also monitor the effective allocation and use of mental health resources. This accountability mechanism requires resources and expertise to make it credible, and should be largely transparent and publically accessible.
As in Canada, a mental health commission can effectively operate in a federated context like Australia, relating to both the federal and state/provincial levels of government. It should report on an all-of-government basis to all parliaments, with a direct link to the prime minister, premiers and health ministers.
In different jurisdictions, such commissions may also be required to undertake related tasks, such as determining and monitoring the ongoing national anti-stigma and discrimination, mental health workforce and homelessness strategies, and provide specific commissioning to address gaps in key mental health services.
Australia’s pressing need for such a commission has been actively canvassed by many in the mental health community for at least a decade. Our accountability mechanisms for the quality of our mental health services are internal to the system, not at arm’s length, and so are vulnerable to spin, gloss, mangling, and even the results being completely suppressed.
While particular elements are admirable, on the whole they promote complacency, and now have been surpassed by, and compare poorly with, the nations to whose health systems ours is most closely related.”
• Stay tuned for Part Two – Should the Feds take over community health? – to be posted early next week
• Professor Alan Rosen is a Consultant Psychiatrist; Secretary, Comprehensive Area Service Psychiatrists’ Network; Professorial Fellow, School of Public Health, Faculty of Health and Behavioral Sciences, University of Wollongong; and Clinical Associate Professor, Department of Psychological Medicine, Faculty of Medicine, University of Sydney.
