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What’s missing in #Budget15 – mental health

It’s only been 48 hours since the Treasurer brought down the 2015-16 Federal Budget, but already the health component of #Budget15 it is becoming better known for the issues it ignored, rather than the ones it addressed.  Mental health falls squarely into this category and in the following piece Sebastian Rosenberg, Senior Lecturer, Brain and Mind Research Institute, University of Sydney, provides the following analysis of the mental health measures in the Budget and how far they are from what is needed to reform the mental health sector.

***

Sebastian Rosenberg writes:

While the Department of Health has suffered some cuts in Budget 2015, it appears as if there have been few if any changes to funding for mental health programs. Funding to existing programs will be delivered, at least until those programs are due to lapse.  For example while there is no cut to the Mental Health Nurse Incentive Program, neither has there been any extension or growth. 

It was only weeks ago that the report of the National Mental Health Commission was first leaked and then released.  The Budget provided no funding in response to this report.  Instead, as already flagged by Minister Sussan Ley, the Budget reaffirms the Government commitment to establish some key expert advisory groups to consider the Commission’s review and its recommendations.  

Australia has already had four national plans, one roadmap, two report cards, one National Action Plan, two national policies and now one national review.  Ever since the first national mental health plan these documents have generally become less and less useful.  The National Commission’s Review threatened to buck this trend.  It set out a new regional approach to planning and delivering mental health reform.  This was always likely to be challenging for many health bureaucrats more disposed towards the Stalinist approach to centralised health planning.  The Budget also tasks the Commission with setting up a new reporting framework to permit monitoring of progress against the Review.  But this will supersede the two report cards already built by the Commission rather calling into question what happens to this work and the Commission’s commitment to report against identified priorities. 

Which does cast a pall over the Budget’s other mental health commitment which is for the Federal Government to consult with States and Territories about a new national mental health plan by August 2015.  The prospect of new funding into old and failed systems is a demonstrated risk here.   

It also sets up a rather confused governance arrangement.  Who exactly is leading mental health reform?  Is it the National Mental Health Commission, which survived the Budget and indeed received an increase in staffing from 13 to 14 people?  Or is it the new Expert Advisory Groups?  Or is it the usual mix of government bureaucrats?   

There is a modest increase in funding directed towards the KidsMatter mental health promotion program.

The Budget also establishes a new Primary Health Advisory Group and a Carers Advisory Group to make recommendations in these areas – relevant to mental health of course.

The Government has been keen to de-couple the Medical Research Future Fund from the ill-fated Medicare co-payment and so has announced the first draw down from this Fund – $10m – to be added to the research funds distributed by the NHMRC.

Beyond the health portfolio, there are a couple of small programs designed to help young people with a mental illness find employment.  Two specialised models of employment will be trialled nationally targeting this group in particular costing around $19.4m over four years.  The first will link the headspace youth mental health service with Individual Placement and Support (IPS) employment services. 

The second will again look to apply IPS but this time to 200 participants in Disability Employment Services

Also of interest is the Budget’s $20m commitment (over 4 years) to develop a new Investment Approach to welfare.  Based on the NZ experience, this approach attempts to alter prospective long term trajectories of welfare dependence by designing and implementing early interventions.  Again, this has strong implications for mental health where trajectories of lifetime disadvantage are common.

Funding for the National Disability Insurance Scheme rollout is maintained.  However there is a deal of confusion about when and which mental health programs become part of the Scheme.  This was not a matter for resolution in this Budget.

In summary, and despite the clear findings of the Review, this Budget squibbed on the big challenges facing mental health reform; implementing effective regional approaches to mental health service integration and suicide prevention.

In launching the 2006 CoAG National Action Plan on Mental Health which provided more than $5bn of new funding, then Prime Minister John Howard stated that there was “no quick fix” to mental health in Australia, the issue of mental health reform would need continued attention and funding.  The Health Minister at that time was Tony Abbott.  Now, as Prime Minister and at least judging by this Budget, Mr Abbott is prepared to let the task wait.