Why the “stunning lack of success” in mental health advocacy?

Below is a searing and well-informed analysis of the Federal Government’s efforts in mental health.

Sebastian Rosenberg is Senior Lecturer, Mental Health Policy at the Brain and Mind Research Unit, University of Sydney and a member of the Preventative and Community Health Committee of the National Health and Medical Research Council.

He writes:

“Budget night can be busy.  But not last night, not for mental health.  Nobody expected a lot and expectations were more than met.

In the face of what appears like overwhelming disinterest from key decision-makers, it is surely time for mental health advocates to take stock and examine the reason for our stunning lack of success.

On the plus side is now irrefutable evidence about the effectiveness of a range of treatments and services, some clinical, some psycho-social. These services have now clearly demonstrated their capacity to engage people in care, improve their quality of life, obviate the requirement for expensive and often traumatic hospital care and get people back to work.

We also know that these treatments and services can help even supposedly difficult groups, like younger people.  Professor McGorry has been working hard from his platform as Australian of the Year to make this clear and is being heard in all the right places in Canberra.

Mental health advocates have also worked tirelessly to demonstrate the colossal cost of inaction with regards to mental illness.  19 million absentee days from the workplace nationally and a $20bn a year impact on the national economy through lost productivity. Mental illness accounts for more disability than any other cause and is the third highest burden of disease, after cancer and cardio-vascular diseases.

Advocates can now also reasonably claim the horrific statistics that every day:

• 330 Australians present to Emergency Departments with serious mental illnesses only to be turned away, with less than 1 in 15 referred to any other service

• Over 1200 Australians are refused admission to a public or private psychiatric unit

• At least 7 people die as a result of suicide in Australia (road accidents account for less than 4 deaths per day)

• Another 180 Australians attempt suicide (one every 8 minutes) and of these 84 are hospitalised.

It is highly likely that none of these statistics are new to readers of Croakey.  Nor are they news to our politicians, many of whom mirror the general community in having some intimate, personal or family experience of mental illness.

But even when armed with key statistics demonstrating the scale of this continuing tragedy affecting the Australian community,  plus a strong recent history of some bipartisan political understanding and support (CoAG 2006 for example, led by Iemma and Howard), and more sympathetic media attention than ever before, mental health still can’t crack the big time.  Or even the little time really.  Let’s quickly examine the budget.

The Government is able to point to some increase in mental health spending largely because of the Better Access Program.  Now costing around $400m per year, this program is apparently undergoing an evaluation, but this is occurring well away from independent public scrutiny or involvement.

Simply put, we have no idea whether the hundreds of thousands of Australians treated under this program are any better as a result of this expenditure.  We hope so.  We do know that like all fee-for-service programs, there are significant issues in delivering services under Better Access in non-metro areas.  We also know that it is likely that some key groups such as young men are not being seen under this program and that out of pocket costs are a real deterrent for some people.

The Better Access Program was a Howard Government initiative. The Rudd Government was made aware of several problems with the program on taking office and provided with solutions but has failed to implement these.  The ability to point to a massive increase on spending, particularly on new services provided by often brand new registered psychologists seems justification enough for continuation of this program.

Another Howard initiative, the Personal Helpers and Mentors Program has just been continued under the CoAG programs committed to in this Budget.  This Program is now fully rolled out nationally and is employing around 20% of the total number of Mentors than were originally envisaged under this model of care.  Still, let’s just continue on.

As with the Mentors Program, the Respite Program is another Howard initiative, now rolling on, and to be delivered through the new primary health organisations to be known as Medicare Locals.  The Respite Program also provides support to carers of people with intellectual disabilities meaning the funds are shared with mental health.

In rolling this program out, it was found that few respite service providers knew a lot about mental health and some were frightened of providing care to people with a mental illness.  In an environment generally characterised by under-servicing, the effect was that the Respite program went underspent.

Still, with Better Access, PHAMs and Respite, the Government is able to demonstrate its commitment to primary mental health care and that box is ticked.

The hospital care box is ticked by naming mental health as one of the potential beneficiaries of new sub-acute beds.  The reality is that the model of mental health sub-acute, or step-up/step-down care, is at best fragile and needing careful development.  The clear emphasis on the Government’s push for sub-acute care across rehabilitation, mental health and other services is to clear out non-acute patients from hospitals. This is a recipe in mental health for turning these beds into patient dumps.  The Budget also contains no new funding for community psycho-social rehabilitation type services on discharge from a sub-acute service.

With these programs, it is possible to paint mental health as having already received generous funding and even being ungrateful. But the Government and decision-makers knew about these problems with Howard programs and also appreciated that mental health was coming from a long way behind in funding terms. In last night’s budget, we lost more ground.

So why does mental health miss out again?  I can only think it is because some people, despite the evidence, cannot make the association between mental illness, treatments, services and recovery.  For these people, mental illness remains a life sentence and spending on the terminally mad is simply bad spending. In combination with those professionals who are profiting from the mental health system as it is currently arranged, this stigma appears enough to halt progress towards a genuine national mental health reform program.

So I had the night off.”