Funding priorities in mental health have recently been the focus of intense debate, with advocates of the community managed sector arguing that too much of the pool goes into tertiary services and hospitals stressing the importance of their role.
In this piece for Croakey laying out a pre-budget roadmap for reform, Community Mental Health Australia President Liz Crowther argues that the community managed sector is at a significant crossroads as the NDIS rolls out, but stands ready as ever to deliver.
Liz Crowther writes:
Mental health is again stated as being at the forefront of the Government’s priorities with the new Federal Health Minister Greg Hunt announcing his commitment to frontline services.
The community managed mental health sector is where frontline services happen, and where the investment delivers. The sector is predominantly made up of not-for-profit organisations providing community-based services that support recovery and help keep people well in the community.
The sector is however being significantly impacted by a range of reforms.
Community Mental Health Australia’s (CMHA) Federal Pre-budget submission outlines six key actions which should be included in the 2017-18 Federal Budget to address issues in the reform process.
1. Develop a National Mental Health Workforce Strategy
A key piece of work that is required is an examination of the overall workforce in mental health to ensure there is an informed and properly planned approach to developing, supporting and maintaining the workforce to deliver the range of mental health reforms.
The lack of a comprehensive national mental health workforce strategy has been a significant policy gap.The workforce strategies that have been developed have not addressed the community managed psychosocial rehabilitation sector, and has meant that reforms which have a significant impact have no guiding policy.
The cost for developing the strategy is cost-neutral if undertaken within an agency with the existing expertise.
2. Psychosocial services included in the services Primary Health Networks (PHNs) are able to commission
A key feature of the Government’s mental health reforms has been transferring funding for a number of federally funded mental health programs to the responsibility of the PHNs, from which PHNs will commission services. The guidance documents developed to assist the PHNs includes the directive that PHNs cannot commission psychosocial services.
Psychosocial services must be included in the services the PHNs are able to commission, as reflected in their planning and needs assessment work.
This initiative will be at no cost as it relates to the scope of services PHNs are able to commission.
CMHA supports providing regionally planned and based services through the PHNs. However, this will only happen if they are able to be truly flexible and act on the gaps in their planning processes, and work with the community-managed mental health sector which is on the ground delivering services locally and regionally.
3. Establish a cross-government and cross-sector Expert Reference Group to examine and monitor reforms impacting mental health
There are a range of mental health and related reforms occurring which will all impact each other, and there doesn’t appear to be a process of ensuring that any crossover is considered. Each of these reforms will impact psychosocial rehabilitation.
The Federal Government should establish an Expert Reference Group to examine and monitor the overlapping health and human services reforms impacting mental health. The Group should comprise representatives of relevant government departments, consumers, carers, professional organisations, peak mental health groups, PHNs, Aboriginal and Torres Strait Islander groups, and CALD groups.
The main cost would be for holding meetings.
4. Conduct regional Communities of Practice to support NDIS transition
Through the experiences from the implementation of mental health within the NDIS in trial sites, it has become evident that support is required for transition, in particular for the community managed mental health sector, to be ready and able to maintain services and support people within the NDIS.
Communities of Practice are an effective and efficient mechanism to assist organisations to transition to the NDIS, and to utilise and act on lessons learned. As states and territories are at different stages of transition, timeframes, and terms of bilateral agreements, regionally based approaches to identify innovations — in addition to national and state and territory approaches — are needed.
This initiative would be cost-neutral by prioritising the activity within existing funding for work to support the mental health sector in the NDIS.
5. Develop quality assurance processes specifically tailored for psychosocial support services as a part of the NDIS Quality and Safeguarding Framework
The NDIS pricing structure and its relationship to qualified mental health staffing is having a significant impact, with the skills and knowledge required different to the NDIS pricing structure able to fund disability support. The NDIS funds disability services not psychosocial rehabilitation services.
The Federal Government recently announced the Quality and Safeguarding Framework for the NDIS. In order to maintain and support the community mental health sector workforce and ensure the current quality of service continues through the transition to the NDIS, it is vital that quality assurance processes specifically for psychosocial services are developed.
This work can be accommodated within the existing work being undertaken by the Government to develop the Framework.
6. Develop options for funding services for people living with a mental illness who are ineligible for the NDIS and currently access Federally funded programs
CMHA has significant concerns regarding the gap in service provision that will be created with the transferring of funds for federally funded mental health programs to the NDIS – Partners in Recovery, Day to Day Living and Personal Helpers and Mentors – whilst many of the people currently receiving assistance from the funding will be ineligible for the NDIS. State and territory funding is also being removed, in particular in Victoria, leaving many people with no access to services.
The Federal Government must continue to fund a flexible, low-barrier-to-entry service that sits outside of the NDIS for people who need ongoing community and coordination support.
Consideration needs to be given to how people living with a mental illness who need to have collaborative and coordinated care continue to have this provided within a health framework, and to developing a mechanism which is workable for both the Federal Government and the community mental health sector who would provide the services.
It is estimated that the cost for undertaking this work would be approximately $70,000.
Liz Crowther is President of the CMHA, a coalition of the eight state and territory peak community managed mental health organisations providing a united voice for the community-managed mental health sector.
Closing the gap remains a myth in aboriginal community where services are either too hard to access or unable to assist due to growing numbers, this would include client who have a mental diagnosis or drug induced.
Access mental health facilities for aboriginal people here in NWS requires the person to call access line for a referral to community health here in Albury Wodonga, I am just a community mental health worker without clinical expertise. I have been working with aboriginal communities over 10years in mental health.
I have seen the mental service decay due the fact the aboriginal who studied and gained their mental health diploma have not returned to to their country but have been headhunted by other health services, this is a constant with our people gaining certification (different type of stolen generation) also aboriginal health service (AMS) are paying below wage for the workers who do not the right certifications so the minimum rate is applied.
The real problem is the lack of local and nationally aboriginal culture where these health services believe their policies and procedure are beneficial to aboriginal health, there has been too many meeting, forums and government rhetoric praising themselves for delivering much needed services in the guise of closing the gap.