Overview of the budget’s mental health announcements – and some preliminary reaction

You can download the health and ageing budget papers here. And the press releases here.

Here is a quick summary of key mental health announcements (they are wide-ranging and impressive, including the focus beyond health services). Towards the bottom of the post is some of the initial reaction to these announcements (largely positive).

General announcements

$1.5 billion in mental health investments over the next five years. When combined with 2010 Budget and election commitments, which deliver $624.0 million in funding for services over the same five year period, the Government will be providing $2.2 billion over five years for mental health services.

This is partly funded by a redirection of $580.5 million from the Better Access program:
– reducing the Medicare rebate for GP mental health care plans, to better match the time usually taken for the completion of a plan, while maintaining an incentive for GPs to complete Mental Health Skills Training; and
– capping the total number of allied psychological consultations available each year under the program at 10 rather than 12, reflecting the fact that the Better Access program is aimed at providing treatment to those whose needs are not most acute.

The Government will offer a new National Partnership agreement on mental health to the states. A national funding pool will be established and states and territories will be invited to bid through a competitive process to focus on the priority areas of accommodation support and presentation, admission and discharge planning in emergency departments.

The Government will establish Australia’s first National Mental Health Commission. Based in the Prime Minister’s portfolio, the Commission will have a whole of government mandate, will provide authoritative advice to the Government and ensure a more transparent and accountable system. It will provide leadership and drive a more transparent and accountable mental health system in both the health and non-health spheres. The Commission will provide an Annual Report, through the Prime Minister, to Parliament. The core function will be to independently monitor, assess, oversee and report on how the system is performing, including the production of the Annual National Report Card on Mental Health and Suicide Prevention.

Funding for a “long awaited” new national mental health consumer representative body, to harness the experience of consumers for policy and program development.

A ten year Roadmap for Mental Health Reform will be completed by the end of this year. It will set out what Australia’s mental health system should look like in ten years, and the main steps involved in reaching this goal. It will guide future reform, as the measures funded through this Budget are bedded down and their effects evaluated.

For people with severe and debilitating mental illness

One point of contact for all of their care needs. This ‘no wrong door’ approach will mean that eligible people in selected regions will now be able to access a comprehensive multidisciplinary assessment of their health and non-health needs, leading to a tailor-made care plan. Flexible funding will also be provided to fill gaps in clinical and non-clinical support for these consumers, to meet their individual needs. This measure will be implemented through community based organisations  Medicare Locals and other non-government organisations are expected to participate.

Integrated assessment and additional services for approximately 24,000 individuals across Australia who have severely disabling, persistent mental illness and complex care needs.

More support services through the Support for Day to Day Living Program for people with severe mental illness, to assist around an additional 18,000 people over five years.

An additional 425 new community mental health workers called ‘personal helpers and mentors’ to work one on one with an additional 3,400 people with severe mental illness. They will join the 1,000 workers already providing intensive, practical support in Personal Helpers and Mentors services across the country.

Additional funding for mental health respite services to support an additional 1,100 mental health carers over five years.

Better targeting primary mental health care services

Medicare Locals will receive funding to enable the Access to Allied Psychological Services (ATAPS) program to better reach these groups who continue to miss out on Medicare funded services. Expansion of ATAPS will support over 180,000 people over five years, comprising 50,000 children and families, 18,000 Indigenous Australians and 116,000 other individuals in hard to reach groups.

The Government is also creating new treatment pathways with investment to develop online and telephone support into a single national e-mental health portal and an e-clinic, promoting self-directed and clinician assisted treatment. Increased referral and improved access to evidence based e-mental health psychological interventions will assist 45,000 people over five years.

The mental health of children and young people

More funding to achieve complete national coverage of the headspace model. In five years there will be a total of 90 sites, with the capacity to assist 72,000 young people a year.

More funding, and seek matching contributions from the States and Territories, to provide up to 12 Early Psychosis Prevention and Intervention Centres (EPPIC). In addition to the 4 additional centres committed to in the 2010 Budget, this will deliver up to 16 new EPPICs around the country.

An additional 40 Family Mental Health Support Services to provide integrated prevention and early intervention services to over 30,000 children and young people at risk of mental illness, and their families, over five years.

Increasing economic and social participation for people with mental illness

The Australian Government will improve the ability of employment service providers to identify and assist people with mental illness to gain employment. Staff will be provided with the skills to develop effective employment strategies for the recruitment of job seekers with mental illness.

Over five years, $50 million of the additional funding for personal helpers and mentors in this package will be allocated to specifically support people with a mental illness on the Disability Support Pension, or other income support payments, who are working with employment services.

In addition, major new initiatives to improve assistance for job seekers, including those with mental illness, are included in the Building Australia’s Future Workforce Package and reforms to employment services from 2012. These include the expansion of funding for training and flexible supports for job seekers as well as new, expanded wage subsidy programs for job seekers with a disability, and measures to encourage Disability Support Pension (DSP) recipients back into work, where they have some work capacity.

Family Mental Health Support

The Government will increase from 40 to 80 the number of Family Mental Health Support Services (FMHSS). These services operate alongside family relationship services and provide a way for families to get help for their children who are suffering from, or at risk of mental illness, outside of the clinical mental health system.

These new support services will provide more than 30,000 children and young people with, or at risk of mental illness with support such as counselling, and support in their own home to help them attend school and build better relationships with family and friends.

The new services will also actively work with schools, and other key agencies including Centrelink, state child protection and child and adolescent mental health services where families and children need more assistance.

The Australian Government has committed to ongoing three yearly cycles of the Australian Early Development Index (AEDI), a population based measure of how children have developed by the time they start school across five areas of early childhood development. The AEDI results will provide governments and communities with the information they need to inform policy and planning around early childhood development. Key information about children’s mental health and wellbeing will be collected through data on their social, emotional, behavioural and physical development which will be linked to the communities in which they live. The AEDI data will be publicly available for around 96 per cent of Australian local communities, including regional, remote and Indigenous communities. The results will be provided through a national report, online community maps and community profiles.

Social Engagement and Emotional Development (SEED) survey of children aged eight to fourteen years – $1.5 million over the next five years. The survey will contribute towards development of an internationally comparable school based survey to measure Australian children’s wellbeing in the ‘middle years’. It will analyse the survey data to understand patterns and variation in Australian children’s wellbeing across groups and in international comparison, with a particular emphasis on children who experience disadvantage; and to propose how policy can more effectively support ‘whole-child’ approaches to improving Australian children’s wellbeing.

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Reaction to the mental health announcements

Mental Health Council of Australia statement says: Gillard Government delivers on mental health commitments

The Gillard Government’s first budget has delivered on its commitment to mental health with a substantial funding investment and a roadmap for mental health reform in Australia.

The Mental Health Council of Australia (MHCA) applauds the measures announced by the Government, most importantly new money into new services to provide mental health care across the lifespan and the establishment of a Mental Health Commission.

“Last year the Minister for Mental Health, Mark Butler, asked the MHCA to facilitate forums across Australia so that he could hear firsthand the views of mental health consumers and carers. This budget demonstrates that the Government has listened to these concerns, especially in providing funding for adults with severe and persist mental illness, funding for youth services and young children, and better accountability and governance measures,” said MHCA CEO Frank Quinlan.

“The Government has laid down foundations for lasting mental health reform and there are many very important measures announced in this budget, delivered in tight economic circumstances.

“The Federal Government has set out a mental health reform agenda and the pressure is now on the state and territory governments to take responsibility for their share of mental health care and to work with the Commonwealth and the sector to build on these initiatives.

“The road to lasting reform will take many years but the initiatives announced tonight create an unstoppable momentum for change.

“Today is a very good day for the mental health sector – increased investment, reform and better governance and accountability in mental health,” Mr Quinlan said.full tim

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AGPN statement says: Unprecedented investment in primary mental health care is about leadership

Medicare Locals have been placed at the forefront of mental health reform in Australia following the Gillard Government’s Federal Budget 2011-2012 announcement this evening, in which a third of the extra mental health funding will be delivered through Medicare Locals.

The Australian General Practice Network [AGPN] has welcomed:

• the $344 million over five years for the provision of coordinated care and flexible funding for people with severe and persistent mental illness
• the increased funding for the Access to Allied Psychological Services [ATAPS] to the tune of $206 million which effectively doubles this program over a five year period
• the early implementation of the After Hours and Medicare Locals programs of $45 million over two years.

AGPN Chair Dr Emil Djakic said this investment demonstrates the roles of the Network and Medicare Locals in connecting care for people with mental health problems who have fallen through the cracks in the system.

“Tonight’s Federal Budget announcements on mental health are a clear indication that investing in primary mental health care is the best way to improve these services for Australia’s local communities.

“The coordinated care package has been well designed to ensure partnerships between Medicare Locals and non-government organisations are able to deliver better coordinated care for patients. This is about breaking down barriers between silos in the mental health sector giving patients better access to services that provide for their mental, physical and social needs.

“The new coordinated care program and an expanded ATAPS will build upon the mix of mental health services already available through the General Practice Network and create a broader range of services GPs can refer to and patients can access.

“The additional ATAPS funding will expand opportunities for better services for the more vulnerable and those at-risk including young people, men, those living in rural and remote Australia and those with high socio-economic disadvantage,” Dr Djakic said.

AGPN is also pleased to see the needs of Australia’s youth being addressed in tonight’s Federal Budget with the expansion of headspace sites and Early Psychosis Prevention and Early Intervention Centres [EPPIC] across Australia.

“This is about providing mental health services that are appropriate for young people in the right setting, at the right time, which is what good health care is all about,” Dr Djakic said.

“Overall, this investment in mental health defines a clear role for Medicare Locals in the health system and reflects the Federal Government’s leadership in investing in services for people with complex and serious mental health problems across Australia,” Dr Djakic said.

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The AMA is not happy.

But headspace is.

Update, 11 May
• Here is reaction from Royal Australian and New Zealand College of Psychiatrists (positive)

• The Australian Psychological Society (APS) is not happy about cutbacks to Better Access program, which it calls the “the most successful mental health program in the last 30 years”.

• The Mental Health Connect blog welcomes the new initiatives but is concerned the funding will not be enough.

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Update, 17 May

The National Rural Health Alliance has welcomed the budget’s moves on mental health

People in rural and remote areas will be pleased that this week’s Budget announcements will lead to more and better-targeted mental health services locally for those in the Bush. In particular they welcome the greater emphasis to be given to the Access to Allied Psychological Services program (ATAPS) as part of a stronger whole-of-government approach to mental health.

The Budget’s targeting of so called ‘hard to reach groups’ is an important step, with additional mental health resources to be provided for young people and those living in rural and remote areas.

When he released the review of the Medicare Better Access program in March, Mark Butler, Minister for Mental Health and Ageing, said that more needed to be done for groups missing out on mental health care. The Better Access program, while delivering over 4.6 million services in 2009 at a cost to Medicare of $478 million, is unfortunately skewed towards major cities. People living in remote areas received 60 per cent fewer services, and those in rural areas received 12 per cent fewer than those in major cities.

The much more modest ATAPS – currently $24 million a year – delivers about 45 per cent of its services in rural areas, and complements the Better Access program to some extent in areas where GPs and other mental health workers are in short supply.

This fairer distribution to rural and remote areas under ATAPS has been achieved through targeted funding for mental health workers, while ensuring that GPs are still involved in the coordination of services. Until now ATAPS has been managed and delivered through divisions of General Practice; Medicare Locals and other local service providers will also be involved in the expanded program.

The large deficit in mental health services for people in the Bush must be recognised and overcome. The 2007 National Survey showed that around 20 per cent of the population were affected by mental illness in both major cities and rural areas, but those in rural areas receive fewer mental health services.

The Alliance has drawn on the 2010 AIHW report on mental health services to estimate the total number of mental health services by geographical location. Including mental health care in hospital, outpatient mental health services, community mental health services, and services funded by the MBS through GPs, 1000 people in the major cities accessed, on average, 1201 services a year. In Inner Regional areas it was 1194 per one thousand people, and 916, 495 and 643 in Outer regional, Remote and Very Remote respectively. So people in Remote areas received less than half the total number of services for mental health received by those in the Major Cities. (Web-based services are not included in these estimates.)

The composition of the services received also varies considerably. For example, people with a mental health condition in Inner Regional areas are less likely to have accessed a psychologist or psychiatrist, but more likely to have seen a GP or visited a State-run community mental health service.

Better Access and ATAPS are only part of the overall response to mental health. It is to be hoped that, despite poorer health infrastructure and much less access to specialised mental health staff , the extra coordinated care and flexible funding for people with severe and persistent mental illness and the Headspace services boosted by this week’s Budget will be available in fair proportion to people who need them in rural and remote areas.

Given the challenges and deficits to be overcome, it will also be essential to maintain the local capacity that has been developed through modest programs designed specifically for people in the Bush, such as the Mental Health Services in Rural and Remote Areas plan. People in rural and remote areas will also be affected from time to time by natural disasters and should continue to benefit from ad hoc mental health services such as those announced by Minister Butler in January.