Introduction by Croakey: The release last week of the final report from the Productivity Commission’s Mental Health Inquiry received a mixed reaction.
While many health organisations have welcomed the report’s wide-ranging recommendations, others have decried its lack of focus on the social determinants of health.
Ms Nicole Bartholomeusz, CEO of Victorian not-for-profit community health service cohealth, said in a statement that the Federal Government controlled several major social and economic levers that can impact people’s mental health.
“They can choose to reduce poverty by raising Jobseeker payments, increase social and affordable housing so that people aren’t living in unsafe accommodation or homelessness, improve social inclusion by investing in anti-racism programs, and acknowledge the devastating impact that climate change has on people’s mental health, especially that of young people,” Bartholomeusz said.
Here, Dr Sebastian Rosenberg, of the University of Sydney’s Brain and Mind Centre and the Australian National University, writes of the high expectations surrounding this report and his hopes that this report, unlike those before it, will set us on “a decisive course towards reform in mental health”.
Sebastian Rosenberg writes:
Something jarred last week as Prime Minister Morrison made public the findings of the Productivity Commission’s Inquiry into Mental Health.
The PM labelled this the most comprehensive report into mental health ever undertaken in Australia. That’s a big call given how often mental health is subject to statutory inquiry. There have been literally dozens of such inquiries by governments, commissions, agencies, federal and state over the past two decades.
Expectations surrounding this report are high. The Commission’s attention to mental health was important recognition that it is a key driver of economic participation and productivity in Australia. They estimated the economic cost of mental ill-health and suicide in Australia at $220 billion annually, equivalent to 10% of total economic production in 2019.
Mental health and illness – even without the additional pressure of a global pandemic – impact incomes, living standards, social engagement and connectedness. Improved community mental health can reduce costs to the economy over the long term.
Support for change
And, starting in November 2018, this has been an extensive and expensive exercise. Community support for real change in the way Australia addresses mental health care is clear. More submissions were provided to this inquiry than any other in the history of the Productivity Commission.
A central and most welcome recommendation made by the Commission was that mental health is best dealt with by all governments and across all portfolios, including those outside of the health sector. This picked up on the Agenda for Collaborative Government Action, which underpinned the 4th National Mental Health Plan in 2009.
Person-centred care
The Commission’s flagship concept of ‘person-centred care’ recalled a key capability identified in the Australian Government’s 2013 National Framework for Recovery-oriented mental health services.
The Commission also gave prominence to the rights of consumers and carers to participate fully in all aspects of mental health system planning, design, monitoring and evaluation. A noble sentiment, also expressed in the first National Mental Health Strategy in 1992, that: “The quality and effectiveness of mental health services are enhanced if the services are responsive to their consumers and communities and if avenues are created for participation in decision-making about the development of services and about an individual’s own treatment.”
The Commission recommended continuing regionalisation, stating that governments should strengthen co-operation and joint planning between Primary Health Networks (PHNs) and Local Hospital Networks (LHNs). The National Mental Health Commission also advocated this regional approach to mental health planning in its 2014 review.
The Commission acknowledged the variation in mental health care depending on where you live. It suggested harmonisation of mental health laws across jurisdictions, a recommendation made by the Senate Inquiry into Mental Health in 2006.
Prioritising young people
Recognising the emergence of mental illness among children and young people, the Commission called for special attention to their needs and those of parents, echoing the same priority first identified in the 3rd National Mental Health Plan in 2003.
Some things have moved on. The 2nd National Mental Health Plan (1998) spoke of the need to foster partnerships with clinicians, particularly general practitioners.
By 2020, the Commission rather despondently reported that “while many GPs do an excellent job, some lack knowledge and skills in mental health, and rely too readily on medication as a treatment option”.
The Commission’s recommendations put a question mark over the ongoing role of GPs in primary mental health care.
Other key issues raised by the Commission in fact look like they might have been better dealt with previously. For example, while the Commission has certainly recommended more focus on community mental health, the 2006 Senate recommendation was to actually build up to 400 community based mental health centres nationwide.
So this is what jarred – a deep sense of déjà vu. Solemn and terribly committed politicians. An enthusiastic, even desperate mental health sector. Consumers and their families urging change. A weary and confused community, failing to understand how after 30 years of promised mental health reform, we can still have so much work to do.
Empty promises?
Australians are accustomed to data showing their health system as world’s best. This data never includes mental health. A new report from the Australian Institute of Health and Welfare shows Australia has the sixth highest rate of deaths due to mental disorders and is the third highest consumer of anti-depressants in the OECD.
A recent tweet from former Australian of the Year Professor Pat McGorry suggested the Commission’s report should be read more like a guide than a blueprint. A guide to what – a sort of ‘best of’ hits compilation of recommendations previously ignored? An anthology of empty promises?
The Government has now given itself until November 2021 to determine the next steps. Mental health will continue to wait, at a terrible cost to individuals and families, exacerbated by COVID-19.
While waiting, we must stop looking backwards and instead set a decisive course towards reform in mental health, intelligently configured with technology to meet the diverse needs of communities and individuals across Australia in the 21st century.
Dr Sebastian Rosenberg is Head, Mental Health Policy Unit, Centre for Mental Health Research, Australian National University, and Senior Lecturer, Brain and Mind Centre, University of Sydney.
