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Senior advisor attacks “mad” health reform for its neglect of mental health

(Part 1 of a series of articles on health reform)

John Mendoza is chair of the National Advisory Council on Mental Health, which was established in 2008 as an election commitment to advise Government on mental health issues “as requested by the Commonwealth Minister for Health and Ageing”.

Today, however, he’s going public with his advice. Like many of his colleagues, he has grave concerns that mental health has been one of the big losers out of health reform.

Mendoza writes:

“The Prime Minister and Minister for the Health and Ageing claim that the reforms agreed to by COAG constitute “a comprehensive health care reform package”.

Since the COAG announcement there has been a chorus of criticism from health reform experts and advisors – many of whom have been handpicked to provide advice to the Government which it duly has ignored. In essence the critique is that the PM has delivered little more than a refinancing package for our public hospital system.

There is precious little in relation to mental health, Indigenous health, dental health, primary care, community health and most aspects of prevention, and indeed the entire private hospital sector. The Government’s narrative is that these areas will improve simply because we have thrown more resources at our ‘over-stretched hospital sector’.

In mental health, the COAG package provides just $115m new funds over four years. There is a return of some of the previously reduced funding for mental health nurses (just $13m) and a further $57m of redirected funds from the Better Access program to tally up to the headline figure of $174m.

And yes there is a commitment to build and fund on a recurrent basis some 1,300 sub-acute beds across a range of areas – palliative, aged, respite, mental health and others. Even if every one of these went to mental health, and had an appropriate model of step-up step down care, we would still be a 1,000 short of the number of sub-acute beds that existed in the mid-1990s and we would again be putting another patch on a broken system.

The only aspect of the announcement which deserves praise is the commitment of a further $20m in funding to headspace, the national network of youth friendly mental health services.

However, even here the Government’s numbers look dodgy. The Government claims an extraordinary number of young people will benefit (20,000) and up to 30 new sites will be established, extra findings for the existing 30 sites and even telephone and other services. Some of the existing sites are already struggling to remain open given the Government’s failure last year to fully fund the expanding network.

To paraphrase another PM’s rhetoric from another era ..’never before has so much health care been achieved for so little’.  To realise these claims more of the headspace services would have to rely on fee-for-service arrangements or other sources of funding – hardly the way to encourage young people to seek help.

The other aspects of the COAG announcements on mental health are more of the same as we have seen time and time again when it comes to mental health – “a recognition that more needs to be done”, “(an intention) to take a greater policy and funding role for mental health services over time” and “providing a foundation for better coordinated care for people with mental health disorders into the future” and on and on it goes.

These are the same statements in some cases and the same hollow promises that have been spruiked by successive Governments (Federal and state/territory) for the past two decades since we began the national mental health reform strategy in 1992.

While the quantum of funding for mental health in these announcements beggars belief, what funding is there is largely misdirected. Take the $57m over four years for “up to 25,000 people with severe mental illness living in the community”. Anyone working in the mental health sector would have choked on their Weeties reading that line in the morning newspaper!

That’s just $2,280 per person. It compares with a $10,000 package per person under another existing Commonwealth program and between $30-70,000 packages provided by several state governments for people with severe mental illness or high levels of disability as is often the phrase.

Further nonsense is the plan to send those people with “common disorders such as anxiety and depression” off to primary care services funded by the Federal Government and all those with other mental illnesses off to the states/territories.

So do we have a sign post for these people at the state run community mental health service saying “no stalkers with depression or anxiety allowed here”? Where do those with treatment resistant depression, co-morbid but common conditions or moderate anxiety disorders and phobias go?

Bring back John Cleese and co – there’s new material here for them to work with!

In mental health we know what madness is like, and this is simply mad policy that will simply result in more preventable deaths every day of Australians unable to access the mental health care they and their working and non-working families and friends desperately need.

It will result in thousands more Australians every day being turned away from EDs and hospitals looking for mental health care services for which they have a fundamental human right.  It will result in more lost productivity, family trauma and separation, child abuse and neglect every day because people cannot get access to effective care when and where they need it.

The Prime Minister said on December 7th 2009, that “a lack of early identification and intervention forces people suffering from acute mental illness to turn to hospitals … as their only option for help”. He was correct in identifying that systemic problem.

He went on to ask “why is it that mental health problems are so often picked up Police and drug workers, not our health services. This is the problem today, but it will become a greater problem in the future”.

And under the reform package he is right on that point as well.”

• Croakey will run a series of articles this week on the implications of the health reform package, so stay tuned…

Comments 6

  1. Sam Battams says:

    It is disappointing that the government seems to be paying lip service to mental health and the state-commonwealth divide issues in its ‘reform of the money flow’. I agree these initiatives are going to lead to more fragmented services – if states are now doing the community mental health care with funded NGOs – and the commonwealth is managing hospitals and GPs (except where COAG initiatives like PHaM are funded by the commonwealth). Fragmented services mean more difficulties in ‘access to services’, for a group which we already know has poor access to services.
    These new initiatives also seem to go against a ‘human rights and health’ approach and the UN Convention on Rights of Persons with Disability, where the government is required to report on how it is going in relation to the fulfilment of a range of rights, showing a progressive increases in resources e.g. resources to support the right of people with psych disability to health care. Paul Hunt recently did an interview on the lack of understanding of health professionals of human rights which seems relevant here:
    http://www.iuhpeconference.net/pages/you_at_the_conference/presenters/keynote_speaker_hunt_details.php

    Regarding the PM’s question ‘why is it that mental health problems are so often picked up by Police and drug workers, not our health services?’ Clearly people who are picked up by the police are not people with high prevalence disorders, or ‘mental health problems’. We know that people with mental disorders often do not seek access to health services – and that, despite carer legislation and policy, carers may have trouble getting the same services to listen to them regarding concerns about a family member who is ill. Libertarian practices may allow people to become extremely ill, lose their housing, etc until something publicly unacceptable occurs and they are picked up by the police or enter prisons (which are the biggest ‘mental health facilities’ in the US). Once in services, health professionals may not be skilled in developing therapeutic alliances with caregivers, or have confidentiality practices which don’t allow for optimum care (claiming that the Hippocratic oath or confidentiality law prevents them from communicating with other agencies or families). As a large UK government report by the former Disability Rights Commission also showed there is also often ‘diagnostic overshadowing’ where GPs treating people with severe mental health disorders overlook routine health checks, leading to their poor health status. All of these issues will be potentially made worse where there are fragmented systems and services (state-commonwealth, public-private, public-NGOs, private-NGOs), different funding sources and different guidelines, policies and cultures. What happened to the initial government plan to take over mental health?
    Now the commonwealth is shying away from this group of people with a severe mental illness and leaving it up to states for community based care – who are variable in their responses – whilst money is pouring into general practice & psychology (sometimes for the ‘worried well’ who might otherwise have paid for private psychology). Where GPs are treating people with severe mental illness – as is being encouraged under ‘shared care’ and ‘better mental health care initiative’ arrangements – they may have little understanding of severe mental illnesses, and be focused on a bio-medical framework rather than an ecological or ‘systems approach’ and so not consider issues like housing, social support, training and employment. Allied health practitioners funded under national programs and connected to GPs may not have a role in offering the practical help needed where people are disabled by their condition – e.g. help in accessing housing, help with cooking/buying food, getting to the shops, cleaning, etc. How do they link in with NGOs or state mental health services where the structural arrangements are not in place?
    Now we have the commonwealth funded Personal Helpers and Mentors Scheme which only allows 2 hours per week support – and can be accessed by people not connected to mental health services (but who admit they have a problem). For other ‘recovery’ services funded by states, people must be connected to state mental health services and under a Community Treatment Order (which seems to be the pre-requisite for access to these services). These different access points and criteria are confusing – the new initiatives seem to be encouraging two confusing systems.

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
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Closing the Credibility Gap 2013
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FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
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AIDA Conference 2014
Congress Lowitja 2014
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Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
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Population Health Congress 2015
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Australian Palliative Care Conference
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