All that glisters …


The mental health policies of the Coalition and the ALP can be best described by one word “ underwhelming. Neither leader is taking mental health sufficiently seriously as an issue “ presumably there are few votes in the marginal seats.

What’s even more galling is that Mr Howard is spending billions of dollars on middle class welfare, while Mr Latham’s supposed ‘show stopper’ – his Medicare Gold proposal – promises to be a waste of money and downright unethical.

When Mr Latham launched his mental health policy in Adelaide last Tuesday, he chose to do so in the clinical safety of a maternity ward to emphasise his fight against post-natal depression. What a pity Mr Latham didn’t head to the streets and meet with some of the thousands of homeless mentally ill people who literally have nowhere to live safely and securely.

It must also be said that Mr Latham’s promise of $100 million to tackle mental health was underwhelming. For a start it seems a pitifully small amount compared with the $1.6 billion for childcare Mr Latham announced with great fanfare a day earlier, or his $350 million for hospital emergency departments announced at his campaign launch on Wednesday.

The ALP package does not tackle the 20 year old running sore of the disaster that is de-institutionalisation. There is no plan to work with the states and territories to address the damning conclusions reached by psychiatrists Carol Harvey and John Fielding in the Medical Journal of Australia last year. Harvey and Fielding wrote that the increased number of homeless people in Australia with mental illness is likely to be a consequence of ‘inadequate implementation of the deinstitutionalisation policy and inadequate provision of alternative community mental health services.’

Having made no mention of mental health in his $6 billion re-election pitch last Sunday, Mr Howard launched his mental health policy only 24 hours after Mr Latham. Like Mr Latham’s package it throws resources at the national depression initiative Beyond Blue and GPs, but also fails to address the deinstitutionalisation crisis and is only worth $10 million more than Mr Latham’s modest proposals.

In short, both leaders have missed an opportunity to think laterally and recognise mental health as a national issue, not one where state and federal responsibilities can be neatly divided.

The Public Health Association of Australia (PHAA), a group representing thousands of health professionals, has previously made some useful suggestions that would assist individuals like Iris and Rodney Gray and ‘George’. who I wrote about last week. They include the federal government actively pushing each state and territory to deliver high quality ‘community-based treatment, care and disability support, including rehabilitation and recovery programs and pre-vocational programs.’

As the PHAA notes, because most ‘people with mental disorders and mental health problems live in the community, with relatives and friends providing the bulk of support,’ there has to be a much greater quantity and range of supported accommodation options available to ease the burden on those friends and relatives. Here the federal government should renegotiate the Commonwealth-State Disability Agreement (CSDA) to provide more targeted funding for supported housing.

In contrast to the mundane approach to mental health, Mr Latham has thrown his efforts into Medicare Gold. This proposal “ while popular it seems with those elements of the media who are more impressed by the tactics of political campaigns than the long term impact of those tactics “ is unethical and delusional.

Last Friday one of Australias most eminent and independent policy thinkers on health care, Paul Gross, wrote a scathing critique of the Latham Medicare Gold proposal in the Australian Financial Review.

These days Gross is Director of the Institute of Health Economics and Technology Assessment in Australia and Greater China, but he was previously Commissioner of the National Hospitals and Health Services Commission under the Whitlam and Fraser governments. In short, he appears to have no party-political axe to grind either way.

Gross rightly questions the ethics of Latham’s proposal. It ‘assumes that creating preferred access to a hospital bed for the elderly rather than my sick young grandchild is justified by today’s warped election calculus, and that all the elderly will value government-controlled access to a bed over the choice that they now enjoy with private health insurance,’ writes Gross.

And on Gross’s calculations Latham is deluding the public about the cost of his scheme. ‘Latham’s cost estimates are out by at least $3 billion,’ Gross argues.

This is because Latham’s scheme ‘will require new facilities in public hospitals to cater potentially for up to 442,000 elderly persons now covered by private health insurance.’ And because ‘the total number of admissions of the elderly in Latham’s scheme will rise faster than if they had remained in private health insurance.’

Then there’s the cost to the government of the extras that are currently included in private health insurance cover such as ‘costs of the bed, expensive prostheses (hips, knees, eyes, pacemakers and smart defibrillators) and the medical gaps charged by specialists.’

In short, says Gross, by July 2007 Medicare Gold will cost an extra $4 billion to $6 billion in 2004 dollars.

One can see the headlines now “ ‘Latham cuts back mental health for Medicare Gold.’

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