The budget holds two particularly promising developments for health, says Robert Wells, Director of the Menzies Centre for Health Policy at the ANU.
Firstly, the mental health announcements suggest some realisation of the long-stated ambition for whole-of-government policies in health. And the emphasis on Medicare Locals in these announcements is also good news, he says.
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All things considered, the budget reflects well on health portfolio
Robert Wells writes:
Ross Gittins makes the comment in the Sydney Morning Herald (11 may 2011) with respect to the 2011 Budget that ‘there’s nothing like having your back to the wall to focus your mind’.
This comment is particularly apt in relation to the health component of the Budget.
For the first time in many budgets, health has had its back to the wall and has come up with the goods.
Not only are the measures just what is called for, especially in mental health, they are targeted, challenge many of the vested health interests and are sufficiently modest in scope to have a good chance of effective implementation now.
Others will comment on specific measures – or complain about what has been left out.
I want to highlight what are two of the most promising features – the ‘whole of government’ approach to mental health; and the linking of delivery of implementation to the new reform structures, Medicare Locals.
‘Whole of government’ has been a rhetoric of successive governments since the mid ‘noughties’ and of profound pronouncements by the Council of Australian Governments (COAG).
Unfortunately the reality has been well short of the rhetoric, with a couple of exceptions.
The 2011 mental health measures correct the rhetoric/reality imbalance with a coordinated strategy across DoHA, FAHCSIA and DEEWR to tackle the social, housing and service access issues that have bedevilled attempts to tackle mental health in Australia.
This will all be overseen by a new National Mental health Council located within the Prime Minister’s portfolio.
Further, the implementation of key elements of the mental health package will be delivered through the new Medicare Locals, key planks in the primary health care reform.
Medicare Locals should be the best place to embed these new measures – the flexibility inherent in several of the measures will allow local responses to locally identified needs and in a timely way.
There are of course some major challenges ahead – not the least of which is that the Medicare Locals do not yet exist and getting them up and running as well as taking on the challenges of mental health reform will be a big ask indeed.
Our mental health system is an ill system. And there’s no category in the DSM (yet!) for this degree of blindness at the Government level. Medicare rebates are offered to people with a care plan seeing psychologists, who may or may not have any psychotherapy or counselling training whatsoever. Yet members of PACFA, many of whom have years of counselling training and experience in treating mental health issues, are being discriminated against through exclusion from the Better Access to Mental Health Scheme (scam).
While the Federal Budget allocated new funding into mental health, what it did not announce was the cuts in the number of Medicare supported sessions for a person to obtain treatment from psychologists. The Federal Government is ignoring the results and feedback from its own comprehensive Post-implementation review of the Better Access scheme which concluded: that the psychological services were cost-effective, reached a wide range of people in need, treated mostly people with moderate to severe (not mild to moderate) mental health problems (mostly depression and/or anxiety) and that the MBS was the most efficient and effective means to providing these services. Why has the Governmnet cut such a successful and highly sort after program? The Post-implementation Review of the Better Access intiative was released in April 2011 and can be found on the Department of Health and Aging website. Please investigate this tradegy of cutbacks before it is set in concrete.
Thank you
Dr. Jillian Horton
Clinical Psychologist WA
While this Budget does focus attention on people with the more entrenched mental illnesses, I think there are still going to be problems with getting better health outcomes for people with serious symptoms and comorbidity.
The organisations and NGOs charged with delivering services to those with mental health issues generally do not cross the clinical divide readily, probably with good reason. There needs to be an enormous amount of training provided to allow rehab workers to more easily address the health needs of their clients.
The kind of services that are required are consistent transport to hospital for tests, medication etc, coordination with hospital staff when people are hospitalized and other kinds of case management. It needs to be established whether the Government expects rehab workers to be case managers. If it does then considerable amount of training would be required. Otherwise it would have been a whole lot better to increase numbers of mental health nurses, spend more money on free GP services (such as screening) and provide funds for more case managers.
http://stopthrashingaround.wordpress.com/2011/05/12/budget-blues/
Just to correct a previous comment about the training of psychologists. It is important to be clear that for a person to use the title “psychologist”, they must have completed a 4 year undergraduate degree in psychology at an accreditated university program and then have done 2 years of practical supervision. To use the title “clinical psychologist” (or any of the specialist titles in psychology), a person has to have completed a 4 year undergraduate program in psychology AND a two year post graduate Masters program (at least, and often people have studied longer) AND have done 2 years of supervised practical supervision. These post graduate university standards and supervision requirements are the ONLY level of training which meets international training standards for the assessment and treatment of psychological disorders, and is a level of training Australia should be aiming to provide to people in the community who need the expertise and training they deserve to assist them.