Analysing the 2011 mental health Budget
23rd May 2011
Sebastian Rosenberg all articles by this authorTHE most interesting element of the Budget was not the quantum promised to mental health: $2.2 billion is a reasonable outcome, but only $1.5 billion of this is new money.
Over five years, and as the centrepiece health investment in a tight Budget, there is reason to be appreciative without being overwhelmed.
Fact is, the health Budget grows by around $9 billion each year. At this rate of investment, mental health’s share of the overall health Budget is diminishing.
Another interesting aspect of the Budget was the choices the Government made that reflect willingness to support innovation. There are overdue investments in the Early Psychosis Prevention and Intervention Centre (EPPIC) and also funding for headspace, new services for new clients.
But whether enough funding has been provided to enable their national deployment with integrity of their model of care is less clear.
There is new investment in flexible care packages – $343.8 million – but this funding is supposed to assist 24,000 Australians with severe, persistent mental illness over five years, equating to only $2865 per person per year.
Access to this funding is up for tender, between NGOs and the new Medicare Locals. For the Government, this is a neat way of bringing the nascent Medicare Local enterprises into the community mental health service realm. The risk here is for a continuation of a biomedical approach to these packages of care at the expense of more psycho-social approaches.
The establishment of a pool of incentive funds for states and territories to engage particularly in the development of supported accommodation is most welcome, as is new investment in e-mental health.
There is mounting evidence that for some treatments, e-mental health care is at least as effective as face-to-face services and this is critical if we are to address the needs of remote and regional Australia.
Around a quarter of the whole mental health package is funded by minor administrative changes to the Better Access program, with reductions to the Medicare rebate to GPs and a reduction in the number of subsidised sessions of psychological therapy from 12 to 10 each year.
The Better Access program now costs $10 million per week – the Department of Finance could not ignore it. The fee for service payment model militates against collaborative care.
This is why the Government reassigned funds to the Access to Allied Psychological Services program.
The establishment of a new National Mental Health Commission is exciting, offering a new level of federal scrutiny and accountability over a system characterised by an inability to demonstrate the impact it makes on people’s lives.
Again, however, the Budget papers indicate expenditure of only $12 million over five years, limiting the initial capacity of the commission to really drive new accountability.
The Federal Government has given no indication of its intention to seek state and territory support for a COAG National Action Plan on Mental Health Mk II. As it stands, the Government is bringing around $200 million to COAG, seeking co-investments from the states. By contrast, the 2006 COAG plan delivered $5.5 billion.
This Budget sets out many challenges for the sector but perhaps the most significant challenge is for the political gods to resist the urge to simply now cross mental health off their ‘to do’ list. Now is the time for advocates for mental health reform to be pointing out how much there is still to do.
People with mental illness and their families are used to waiting, often with sad, sometimes tragic consequences. This Budget does not mean that wait is over.
Sebastian Rosenberg
Senior Lecturer, Brain and Mind Research Unit, University of Sydney
