It’s taken an awfully long time and some very determined lobbying, but this budget has finally delivered some real support for Australia’s woefully under-funded mental health sector.
The reasons why mental health became the poor cousin of Australia’s healthcare system are long and complex. They include a long-standing community stigma about mental health, inadequate training in mental health issues for medical students and doctors who aren’t specialists in the field, an overall health policy mix overwhelmingly weighted towards acute care and away from chronic and primary care, and the sheer difficulty of addressing complex mental health conditions such as depression, anxiety and schizophrenia.
What we do know is that mental healthcare has been in crisis in this country for years. Talk to any doctor in an emergency department of a pubic hospital and they will tell just how much of their time is taken up dealing with acute psychiatric patients, many of whom present to our health system for the first time when they are admitted to an emergency department after a suicide attempt.
Even for those who do receive treatment, there is often no follow-up. According to John Mendoza, a Professor at the University of the Sunshine Coast and — until he resigned in frustration — the federal government’s top advisor on mental health policy, "about a third of all suicides based on the current numbers are of people who have recently had contact with acute mental health services."
In his 2010 address to the National Press Club, former Australian of the Year Patrick McGorry outlined the dismal statistics of Australian mental illness. Six Australians kill themselves every day. Suicide kills more Australians than the road toll and is the single biggest killer for those under 40. The burden of mental ill-health is just as great. Nearly 1,000 Australians with mental ill-health present to hospitals for treatment every day, and many of our nation’s homeless and unemployed are so in part because of their mental health problems. According to McGorry, mental health represents 13 per cent of the total disease burden, yet the mental health budget is just 6 per cent of the total funding mix.
So the need for mental health reform is large and pressing. Indeed, the federal government has always acknowledged this; it just hasn’t done very much about it. This is particularly true for adolescent mental health. According to the government’s budget document on the issue, "25 percent of people with a mental disorder experience their first episode before the age of 12 — half a million children — and 64 per cent by age 21. Yet treatment rates for our young people are low: only 25 per cent for those aged 15 to 24 receive treatment."
The relevant budget document, issued by Ministers Roxon, Macklin and Butler, is rather long, but it’s well worth a read. The "announceables", as Lindsay Tanner calls them, are impressive, including:
- $571 million over five years for coordinated and integrated mental healthcare.
The idea here is a "no wrong door" approach which means eligible people will "will now be able to access a comprehensive multidisciplinary assessment of their health and non-health needs, leading to a tailor-made care plan". The integrated care will feature "flexible funding … to fill gaps in clinical and non-clinical support for these consumers" and will be delivered at the local level through primary care providers such as Medicare Locals. There will be funding for some 24,000 mental health assessments
- $220 million over five years for primary mental healthcare.
This is a welcome funding increase which targets one of the obvious gaps in our current healthcare system. The government says it will give Medicare Locals funding to connect to allied psychological services through the Access to Allied Psychological Services (ATAPS) program. This will support "over 180,000 people over five years, comprising 50,000 children and families, 18,000 Indigenous Australians and 116,000 other individuals in hard to reach groups."
- $491.7 million over five years to expand and establish new youth focused mental health services.
This much-needed investment will fund things like new headspace centres, taking the national total to 90 headspace centres. There will also be support for an additional 12 Early Psychosis Prevention and Intervention Centres (EPPIC), and an additional 40 Family Mental Health Support Services "to provide integrated prevention and early intervention services to over 30,000 children and young people at risk of mental illness, and their families."
- $201 million to the states and territories to plug gaps in their own mental health services.
The government says these payments to the states will be a pooled grant fund that they can apply for funds to, in order "to focus on the priority areas of accommodation support and presentation, admission and discharge planning in emergency department."
However, as the Opposition (for once) correctly points out, only $571 million of this funding is actually new money provided in this budget. The rest has already been announced.
So far, the reaction to the package has been generally positive. Mendoza has praised it, telling the ABC that "I commend the Government for responding to not just the concerns of a few vocal advocates, but really the concerns across the Australian community."
The inestimable Melissa Sweet has a good wrap of reaction on her blog Croakey, in which she quotes the Mental Health Council’s Frank Quinlan as saying "today is a very good day for the mental health sector — increased investment, reform and better governance and accountability in mental health." Headspace has also understandably welcomed the new funding: headspace CEO Frank Tanti says that "the budget announcement showed the Federal Government understands the importance in intervening early in mental health problems."
The Royal Australian and New Zealand College of Psychiatrists has also welcomed the announcement. According to the College’s President, Dr Maria Tomasic, "mental health has been significantly under resourced, and this new commitment of significant funds, services and resources for mental health is very welcome." The College is particularly pleased with the decision to fund 96 new specialist training places for psychiatrists in 2011. "This is a substantial addition of extra staff to the mental health workforce, with long term benefits to the mental health system and expanded skills development for trainee psychiatrists," Dr Tomasic said in a media release.
Not everyone is pleased, however. The Australian Medical Association says "this is not the right approach", because of the reduction in Medicare payments to GPs for mental health consultations. But then again, the fact that the notoriously conservative AMA opposes a health reform may just be the best evidence of its value.
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