Introduction: The election campaign is bringing welcome promises for some serious investment in mental healthcare, but prominent mental health reform advocate Professor Ian Hickie AO cautions against investing “in poorly-functioning systems”.
Rather, he urges community and regionally-led approaches to ensure affordable, coordinated access to more specialised health and social care early in the course of illness, with local leadership that holds providers accountable.
“We need everyone to know what best care looks like, who can deliver that care close to where you live, and how governments can best support local services – financially, workforce, infrastructure, innovation – to deliver that care,” he writes.
Ian Hickie writes:
As the election campaign heats up, it’s very encouraging to see an issue that resonates with local communities hitting the headlines. Serious mental health investments are now on the table.
Finally, Labor has put a significant amount of new money on the table – in the order of $1 billion, just enough to overshadow the $900 million offered earlier by the Coalition. Both sides have appropriately placed a clear focus on enhanced specialist care for young people.
Now, the real danger is that the major parties tie these funds to short-term promises that appear likely to deliver more services but in reality don’t deliver or even make the situation worse.
It’s very easy to make simple promises (like increasing Medicare support for psychology back to 20 sessions ) or commit to open many new ‘shop-fronts’ (like headspace or more specialised treatment centres) in marginal and regional electorates.
While all Federal Governments have been investing in enhanced mental healthcare over the last two decades, we can’t just do more of the same and expect better outcomes.
The truth is that it’s not easy to deliver affordable and effective care, backed by skilled workforces, in each of the 50 urban and regional communities that exist across our country.
Over the last 25 years, we have placed great emphasis on simply increasing access to very basic care, rather than emphasising rapid access to effective and affordable care.
The consequence is the equity gap Âbetween an ideal focus on early and skilled intervention and the reality of late and rather generic care has simply widened. This has been especially true for those who live in outer suburban, less wealthy and regional communities compared with those who reside in wealthier and inner city electorates. Â ÂÂ
Equitable access to affordable care has declined rapidly over the last decade. Out-of-pocket costs have sky-rocketed and are now having their greatest negative impacts on young people.
Those communities with the highest levels of psychological distress have the least access to effective care. Even in our wealthier communities, the costs of effective care are high, and the services provided are poorly co-ordinated between federal, state and non-government services.
New approaches needed
More detailed modelling of what initiatives would have real impact, and are truly cost-effective indicate that a much more sophisticated approach is urgently required (for details, see here, here and here).
For many young people, that really means affordable, coordinated access to more specialised health and social care early in the course of illness. Achieving that is well beyond the scope of the brief interventions and limited assessment provided by most headspace centres.
Hence, both major parties now committing to more specialised hubs. However, headspace and other linked initiatives have really struggled to recruit experienced clinical staff.
These new centres won’t deliver unless they are clearly linked with state government commitments to provide training psychiatrists, clinical psychologists and mental health nurses.
They also need to embrace new ways of identifying complex needs, ensuring that those needs are met and that the interventions provided do result in better clinical, education and employment outcomes.
To really make any of this work, our centre has promoted the concept of ‘Right Care, first time, where you live’ (supported by the BHP Foundation).
This approach is being evaluated in eight regions across the country, bringing together all the local players in regions like western Sydney, Nepean-Blue Mountains, Brisbane South and Albany in Western Australia.
It uses new modelling techniques to simulate which investments, like more health services (for example, more general practitioners, more psychologists) or new interventions (for example, technology co-ordinated care, specific post-suicide attempt services, school or family-focused initiatives) are most effective.
Leadership matters
What has been really interesting is who is most interested in these 21st Century, and community-based responses to reform.
Politically, it’s been the independents, and most notably the ‘teals’ like Allegra Spender in Eastern Sydney and Zoe Daniel in South-eastern Melbourne who have really spent time and effort engaging with their local communities and advocating genuine system changes. We need smart new investments, at scale and well-coordinated responses.
Allegra Spender has directly engaged with our team to support the development of a specific dynamic model for youth in her electorate and has engaged State and Federal Government Health Ministers, as well as local health authorities, to scope possible implementation.
Zoe Daniel has advocated specifically for enhanced eating disorders services for young people and has invited mental health experts onto her podcast to explore optimal policy options.
Local leadership that really engages the community, and then holds local providers accountable, is what is genuinely required.
From the community, it’s organisations like Australians for Mental Health who are now running an electorate by electorate analysis of genuine needs, service maps and costs.
Inspired by 2010 Australian of the year, Professor Pat McGorry, AFMH was established in 2014, as a grassroots organisation to build community support for long-term and serious structural reform of mental health. Initial funding was provided by various philanthropic sources. It has led advocacy efforts prior to the last three Federal elections.
This 2025 analysis is designed to help you ask your local representatives what they are really doing to lift the level of care locally.
Unless there is genuine and widespread support across the often-polarised political divide we won’t see progress.
These community and regionally-led approaches are radically different to the traditional pre-election focus on big dollar announcements or simple solutions (for example, new Medicare item numbers or bulk-billing for all) that don’t really translate into enhanced care at the local level.
There is a great danger that good new monies will be invested in poorly-functioning systems.
Genuine data collection on the outcomes being achieved is essential. Who is receiving care? Who has been left out? Are those receiving care really benefiting? Is it the right mix of health and social care being delivered?
We don’t need more national averages that just paper over the ever-widening cracks.
When our mental health system fails, it often makes national news (as in the Bondi Junction tragedy).
Where and when it is genuinely improving, it is not often show-cased. We need everyone to know what best care looks like, who can deliver that care close to where you live, and how governments can best support local services – financially, workforce, infrastructure, innovation – to deliver that care.
Author details and declarations
Professor Ian Hickie AO is Co-director of the Brain and Mind Centre at the University of Sydney. He was a National Mental Health Commissioner from 2012-2018, and is a Patron for Australians For Mental Health. University of Sydney operates a Headspace Centre at Camperdown, and he is a 3.2% shareholder in Innowell Pty Ltd, which operates technology-based assistance to mental health service providers in Australia and Canada.
See Croakey’s archive of articles on mental health
I very much agree with Ian’s analysis of the needs and am grateful and relieved that the Government and Opposition have taken this on board. Most, perhaps all, of the independents are also in full support of better mental health care for young people. The election commitments are highly attuned to this analysis and have drawn carefully upon evidence based models of care, notably headspace (which while still effective and cost effective) has been heavily challenged in the face of the youth mental health crisis (with a 50% increase in prevalence) and is in need of re-engineering, equitable funding in comparison with the Medicare MH Centres, and thus a new much stronger and sustainable financial model. This is being appropriately addressed in the welcome bipartisan election commitments. Similarly the early intervention for psychosis model – another Australian innovation which has spread around the world, established in 6- 8 regions only in 2012 by then Mental Health Minister Butler, and yet is still not the routine standard of care across most of Australia, will be broadened, based in part on our experience over 20 years at Orygen in developing a transdiagnostic multistream model of care, and with additional evidence based inputs, to include the full range of more serious mental disorders in new youth specialist platforms of care in 20 regions. These are absolutely the best bets and foundations in youth mental, which are also open to new thinking and also additional elements – notably digital, psychosocial augmentation, and flexible adaptation to local needs. These matters are being examined by a consortium of youth sector organisations, commissioned by the Federal Dept of Health to provide advice to the Australian government, of which the Brain and Mind Centre (and therefore Ian as Co-Director) is a member and is providing invaluable input. We have an excellent opportunity now to work together to build the next stage of much needed reform and much greater free coverage for young Australians whose lives and futures are threatened by mental ill health as never before.