I just have returned from community-led meetings/conferences in the Nambucca Valley and Canberra in the past two weeks. The community is becoming increasingly energised by the lack of federal government leadership on the issue of mental health after three years in office.
As my colleague and former senior adviser to Julia Gillard, Dr Lesley Russell said in the Canberra Times earlier this week, federal Labor has only cut funding to mental health programs (all of them started by the Howard government) since elected in 2007. (The article can be downloaded here).
Good programs such as PHaMs, the respite program, the mental health nurse program, headspace and ATAPS are all in need of substantial new investment. Headspace is now nothing like the model of care that was originally envisaged when it was designed in 2005.
Services are now grossly underfunded and having to charge out-of-pocket fees to stay open. This is to meet the government target of 60 sites within the funding allocation. The services will resemble the facades from a Hollywood western — just a shop front and no real service.
The headspace service in the Nambucca Valley has now closed and the community is desperately trying to find ways and means to keep some sort of service operating. The government knows all this and it also knows that it must make reforms to the Better Access program to ensure those in need can afford access to psychology services.
The much-trumpeted suicide prevention funding announced during the federal election campaign last year totaling $277 million will see just $9.1 million spent this year. Again this is symbolic of a government that talks the talk but fails the test of real action.
Mental health and suicide prevention are now red-hot national political issues. This is in part due to the continuing delays on any real reform or action by the federal government despite having more advice than any previous government on what actions are required.
It has had dozens of program-specific advices from the National Advisory Council on Mental Health and overall system reform from NACMH and the National Health and Hospitals Reform Commission — almost all of which it has ignored.
It knows what the priorities for investment are — prevention, early intervention, community support services including supportive accommodation, research and new governance and accountability.
And its only action since the election last August is to appoint a minister (Mark Butler) and another expert panel chaired by the minister (who also now chairs the NACMH). Yet more advice.
To his credit, the minister did undertake 14 community consultations attended by consumers and carers and hear first hand their concerns. I believe he is trying but like many before him, he is running into the same road blocks when it comes to significant new funding.
There is always a reason for delaying real reform and action on mental health it seems.
Almost on a daily basis I receive phone calls and emails from distressed Australians who cannot access care or have dreadful experiences in acute care and then no community support for very ill family members.
In Bowraville last Thursday I assisted an indigenous mother whose son had been placed on a community treatment order six months ago. He committed a crime to gain admission to Port Macquarie Hospital. He has been seen for a psychiatric assessment just once in that time and despite being heavily medicated and suicidal last week and again was refused admission or an assessment. If he had presented with an equally life-threatening case of chest pain, he would have been immediately admitted and received good care.
Recently I have spoken at length with a deeply distressed mother from Queanbeyan who has lost her son to mental illness — or more correctly to the NSW Health system.
Last week it was Wagga with a very public suicide of a young man and several suicides here on the Sunshine Coast; previously six in the small community on the Darling Downs late last year and almost a dozen suicides in the Kimberley in the past few months.
I could go on and on with systemic failures across the nation. With the exception of the events in the Kimberley and action by the WA Mental Health Minister Helen Morton, there has been no response from either state or federal governments to these tragic events and the many systemic failures of care.
While it’s too early to make a judgment on the new Victorian government’s actions on mental health, the Stanhope government in the ACT is tackling the problems of access, care continuity and quality and is increasing investment in community services.
They stand out from other governments in their approach to mental health.
I am optimistic that should a Coalition government be elected in NSW at the end of this month, they too will tackle reform and direct substantial funding into evidence-based community services and not continue the failed hospital-centric approach of the current administration.
*John Mendoza is adjunct professor, health science, University of the Sunshine Coast, and adjunct associate professor, medicine, University of Sydney. Last year, he resigned as chair of the National Advisory Council on Mental Health.
…and I too have many discussion with rural families about the needs for ACCESSIBLE rural mental health services in every community.
One of the big concerns I see is that our health system entry criteria doesn’t accommodate the types of entry level mental health problems that real people have! To be seen in many locations you need a diagnosis…. a label. We are not good with labels….. they are hard to apply, and they frequently don’t fit well – but our health systems persist with trying to squish ‘square pegs into round holes’. The access to health care system doesn’t fit the mental health problem profile of people…..
It is well beyond time that we ditch the problematic systems and find new and innovative ways to provide mental health help to individuals, families and communities. And there are many commentators with good ideas about how to proceed on this front. Many of them are nurses…. but we have so few, and they are underfunded – So their voice is not as loud as it needs to be to enact change at a policy level.
John Mendoza has a very good point about notions of how to proceed – prioritize ‘prevention and early intervention’. As a rural mental health nurse I would add health promotion…. and I would have to suggest that early intervention is too little too late! Why do we think that it is OK to let people become so unwell (and to the point of suicide) ? Why do we settle for early intervention – when so much needs to be done on a far more proactive front to improve the mental health of our communities???? Should we promote health earlier than this?
Nurses are experts in health promotion, health and well being and recovery – It is time to utilize this highly skilled population of mental health professionals more effectively, to fund them properly, and give them space in the policy arena to redevelop mental health promotion for the nation.
NSW does have an election looming! With the coalition in a strong position for a win…time for change! Time to do something very courageous and appoint a mental health nurse tasked (and resourced) to lead metal health promotion reform for NSW….. Challenge cast….
Rhonda Wilson RN MHN
mental health clinician, academic and researcher. (@RhondaWilsonMHN)
A huge amount of money is spent on the psychology rebate with most of the psychologists (I find this an odd name) charging above the rate, so average joe/ jane can’t get a look in. All this spent without any outcomes.
People who don’t really need professional mental health care are getting the lions share and the people who really need it get put in a line but it seems that funding someone to talk about their relationship breakup is more important than funding care for someone with schizphrenia. Rhonda seems on the ball with prevention being part of the mix but Rhonda nurses aren’t on the whole listened to but should be. My suggestion to help out a wee bit would be to tell people if they are going to drink themselves stupid with a depressant then you’re going to get depressed and maybe want to top themselves. Our emergency departments are full of these people.
Actually I have to agree with Sparky on this one, regarding the Mental Health plan. I am a practice manager in a CBD psychology practice. I believe I’m on record here in the past as having expressed despair at the amount of highly paid professionals coming in to see psychologists after having been to the GP to put themselves on a plan and getting a rebate of either half the session rate (with psychs) or over two thirds (with clinical psychs). We call them the worried well. Firstly, anyone on over 100K per annum can afford to pay full session price and is most likely have top cover to claim back from private health anyway (which is also bloody rebated by the government as well!). Secondly, GPs are putting people on plans (many with relationship issues) under the general ‘anxiety’ label which allows them to attend as a couple when this is NOT a mental health issue. GPs get a higher rate when they do a mental health review as it is a longer consult for them. I believe that Medicare has started auditing GPs who are notching up a high rate of plans for their patients. Why can’t the government do a simple means test for eligibility? It makes me so mad I can’t believe it. They would save a packet and could redirect the funds to where they are sorely needed.
There are several inaccuracies in this article.
We know the mental health sector is underfunded and continue to call for increased funding. Both sides of government are clear on our position in this regard.
But it is inaccurate to suggest that headspace is not delivering help to young people that was envisaged when the headspace model was established.
headspace has helped more than 37,000 young people so far and 96 per cent of our clients value the service.
Importantly headspace has been very successful engaging two groups that are traditionally hard to reach. Young men make up 42 percent of our clients and 7 percent are Indigenous Australians – well above the mental health sector average.
Mendoza is also misinformed about headspace funding. Funds have not been taken or transferred from the 30 existing centres to meet the governments’ target to operate up to 60 centres over the next three years. Additional funding has been received to open these new centres, 10 of which are due to open later this year. Funding was also received to boost the capacity of the majority of existing centres. These funds have already been distributed to these centres.
Finally, it is rare that clients are charged for our services.
I suggest that Mendoza visits one of our centres to really understand the positive difference our services are making to the lives of thousands of young people.
Chris Tanti
Chief Executive Officer
headspace
I’m welcome the comments from the CEO of Headspace central Chris Tanti as this assists in providing some transparency to the operation of headspace.
As Chris knows I am a very strong advocate for the headspace model, having worked with the winning consortium and later the then responsibile Minister (Christopher Pyne) to get the initiative up and running. The model is a very good one – my concerns are about the level of funding after the initail four-year fund finished.
Having the opportunity to visit headspaces centres in four jurisdictions during my time as Chair of NACMH (and since) and discuss the roll out of the program with those at the coalface has enabled me to keep informed on what is happening to this critical initiative. I have become increasingly concerned about the sustainability of the program with 1) several changes in a relatively short time to the lead agencies at a number of sites 2) the reported necessaity to introduce fees for allied health consultations and 3) growing criticisms of the headspace program from a range of service providers.
To clarify these issues I suggest that headspace central provide answers to the following:
1. How many lead agencies have changed? Where these have occurred? Why have these coccurred?
2. What is the annual funding provided to each headspace site since the establishment of each site? What is the forecast allocation to each site during the exapnsion to 60 sites nationally? Does this allocation take account of projected growth in demand as well as cost increases?
3. What is the percentage of consultations (by type – GP, social worker, Psychologist etc) provided at no cost to the client?
4. What are the average out-of-pocket or co-payment for each service across the sites?
This would certainly set me straight and ensure that headspace centres can contribute to the mental wellbeing of young Australians and not be subject to politcial argy-bargy over funding.
One final comment – 42% of clients are reported as being male. This is pretty much in step with overall MBS rates for males. I would have hoped that headspace would after six years of operations, be achieving at least 50-50 in gender profile given the origins of the model.
John Mendoza