Introduction by Croakey: The election of a new government in New South Wales heralds an “opportunity for genuine reform to improve the people of NSW’s access to mental healthcare,” according to the Royal Australian and New Zealand College of Psychiatrists (RANZCP) NSW Chair Dr Angelo Virgona.
In a statement this week Virgona said “whilst the pre-election mental health commitments made by NSW Labor were welcome and promising, we need comprehensive reform. Other states are showing it can be done. It’s NSW’s turn.”
Together with an alliance of peak bodies representing mental health workers, consumers and carers across NSW, RANZCP has called for the NSW Government to establish an expert taskforce to determine gaps in mental health services, improve access and quality of care and inject new funding into NSW’s mental health system.
Meanwhile, Professor Ian Hickie – Co-Director of Health and Policy, Brain and Mind Centre, University of Sydney – suggests below that the NSW Government should seek to meet with Federal Health Minister Mark Butler to improve coordination between federal and state efforts. His analysis comes as the Australian Institute of Health and Welfare released new data on mental health indicators and spending on services.
Ian Hickie writes:
In the lead up to the NSW election, a coalition of mental health groups again put our major failings in mental healthcare on the political agenda.
Given the level of community concern about lack of access to quality mental healthcare, ballooning waiting lists for psychological services, prohibitive out-of-pocket costs for attending a psychologist or psychiatrist and the overwhelming pressure on Emergency Departments due to mental health crises, one might have expected to see something akin to the announcements made by the Victorian Government following their Royal Commission.
The reality is that all governments are now reluctant to engage in the scale or scope of reform that is required to construct a 21st Century health and social services system.
Why is this so?
An overarching bias is the common belief that the cause of such difficulties is either intrinsically social – for example, poverty, societal inequality, child abuse or neglect – or a more personal failure to cope with life’s challenges.
This is accentuated by the long-standing and spirited critique of the ‘biomedical’ model of mental ill-health by a range of social scientists and, increasingly, those with lived experiences of mental ill-health.
The latter are typically those people with prolonged or severe illness who have often received very poor or even harmful care from a seriously under-resourced and overly hospital-centric system. Consequently, there is also an ever-increasing call to move funds away from clinical care to schemes such as the NDIS, which are focused on more practical social support.
What has really characterised the last 20 years of mental health policy has been an emphasis on developing more reviews, blueprints, vision documents, inquiries and commissions.
As the Federal Minister of Health Mark Butler has noted, it is remarkable to return to the same portfolio he left a decade ago and find the state of basic services delivery less equitable, more stretched, lacking key professionals and cracking under the weight of increased community demand.
Recommendations
So, what can the new NSW Government really do to lift the quality of care for those in greatest need?
First, it could urgently meet with Butler and move swiftly to implement the key recommendation of the 2020 Report of the Productivity Commission. That is, serious coordination of federally-funded initiatives with those of state-funded local health services.
While the left and right arms continue to act independently, and without specific reference to agreed priorities in each community, we will get nowhere.
Governments have the capacity to share responsibility for essential infrastructure, workforces, resources, digital coordination and private-public partnerships.
There are considerable federal funds from the 2021 Federal Budget that could be repurposed to offset the costs of real structural reform and more equitable access to appropriate specialist services.
NSW could be smart and through such active cooperation move well ahead of those states that are still trying to solve some of these ‘intractable’ problems on their own.
Second, NSW could take some of the new state and federal initiatives that are potentially worthwhile and link them to much more robust systems for implementation, evaluation and effective long-term delivery.
For example, the NSW-based Safeguards program for responding to young people at risk needs to be underpinned by smart assessment and tracking technologies and actively linked with other ongoing care systems in the Federal (i.e. headspace) and private psychology and psychiatry sectors.
Another is the new federal ‘Head to Health’ specialised assessment and service hubs. If they are to add real value to the system, they must be placed appropriately, service the most disadvantaged and work to take pressure off emergency departments.
Digital innovation
Third, the state could take a national leadership position on digital innovation in the assessment, delivery and coordination of mental healthcare. NSW has been fortunate to have leaders in this area at each of its major universities, but federal support has been limited and engagement with NSW health systems minimal at best.
While the economic and social advantages associated with technological innovation in this area were recognised by Prime Minister Malcolm Turnbull back in 2016, governments have been very slow to respond. This is despite the impacts of the pandemic and the rapid implementation of basic telehealth services.
It is time we moved beyond small measures that have little real impact on the perpetual ‘crisis’ that is the reality for many of those seeking mental healthcare to coordinated actions by our respective governments.
Substantive actions are possible, but they do require committed governments and a willingness to act collaboratively in each region of the state.
Competing interests
Professor Ian Hickie acknowledges he has a 3.2 percent equity shareholding in Innowell Pty Ltd, a joint venture company of the University of Sydney and PwC Australia, delivering digital mental health capabilities to healthcare organisations in Australia and internationally.
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In Australia: If you or someone you know needs help, contact Lifeline on 13 11 14 or www.lifeline.org.au or the Suicide Callback Service on 1300 659 467 or www.suicidecallbackservice.org.au.
See Croakey’s extensive archive of articles on mental healthcare.
