SSWAHS = SWSLHN + SLHN and the Medicare Locals - 45

Analysing the 2011 mental health Budget

23rd May 2011

Sebastian Rosenberg   all articles by this author

THE 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

SSWAHS = SWSLHN and mental health in the Southern Highlands - 7

Explaining the new blueprint to transform mental health services

April 4, 2011 – 12:09 pm, by Melissa Sweet

This post is responding to a recent Croakey article, “So you’re wondering what’s happening with mental health at a federal level?”, by Professor Alan Rosen.

Sebastian Rosenberg and Professor Ian Hickie write:

Alan Rosen’s recent article raises some important points and the need to clarify a couple of issues.

He is certainly right that the recently released Blueprint to Transform Mental Health Services in Australia is not the whole solution to fixing mental health. There are evidence-based services apart from those specified that would indeed merit ongoing investment, including assertive community treatment, mobile acute teams etc. However, as services largely provided by states and territories currently, they were simply out of scope in terms of providing a budget submission to the Commonwealth.

The crazed determination to deliver a budget surplus is now forcing Prime Minister Gillard and her Ministers to seriously lower expectations about the budget, wet the ground for the traditional horror-budget which typifies the first year of most administrations. As reported in countless parliamentary and other inquiries, mental health is so far behind the game that it cannot afford to be caught up in this.

The Independent Mental Health Reform Group which prepared the Blueprint was an informal group which got together for a few weeks specifically to keep some blowtorch of pressure on the Federal Government to make good its promise to make mental health a second term agenda priority.

The Group was comprised of the usual suspects in some ways, people with a long track record of cajoling governments into greater action and investment in mental health. The Blueprint merely reflects the views of the Group, which never intended and was never resourced to undertake broad public consultation.

Unlike the impression given by Professor Rosen, the Group was not constructed, mandated or authorised by Minister Butler or anybody else and had no relationship to any existing committee or body. Minister Butler did not commission the Blueprint. The presence of Monsignor David Cappo meant that the group did have an excellent insight into how best to shape and present its advice to government however there were others on the group with an excellent understanding of the federal budget process.

The Blueprint is one of no doubt myriad budget submissions made by different professional and community groups, attempting to influence the direction and scale of Federal Budget decisions. It is certainly true that key health professional groups have already made formal budget submissions, such as the Australian Medical Association and the Australian Psychological Society. It is less clear the extent to which community sector organisations have made submissions.

Professor Rosen is correct in that the Blueprint really focuses on clearly listing actions the Federal Government is able to take autonomously, without reference to state or territory jurisdictions. This inherently limits the scope of the Blueprint but fits with the imperative to provide urgent advice about intelligent Federal spending options in the upcoming Budget.

As far as we know, there has been no commitment to establish a second National CoAG Action Plan on Mental Health, to replace the first plan which lapses this year. If a second plan is proposed, then the Blueprint lists a series of vital areas of state responsibility where their contribution to a new CoAG plan should be directed. These areas do not include continued mindless investment in new acute hospital beds.

The Blueprint also clearly states the need to ensure that mental health’s share of the promised new 1300 sub-acute beds is not allowed to create new hospital-based warehouses to catch the overflow from psychiatric wards.

Professor Rosen is correct in asserting that CoAG-type intergovernmental agreements seem to fail more often than succeed. However, should a second CoAG Action Plan be agreed, we would strongly suggest the establishment of a clear set of Commonwealth incentives and sanctions to persuade the states and territories to purposively fund the areas identified as priorities in the Blueprint, particular the type of evidence-based community services described by Professor Rosen, or other community-based innovative services. This type of approach to incentives was actually successful in the First National Mental Health Plan and really not attempted since.

While this type of coordinated action is important for holistic reform investment in mental health in the future, the Blueprint represents the vital contribution the Commonwealth can make right now. So let’s get on with it.

• Sebastian Rosenberg and Professor Hickie are from the Brain and Mind Research Institute at the University of Sydney

Comments

1. skipjack
   Posted April 4, 2011 at 4:39 pm

   The closing of institutions has let to people being thrown onto the street and at the mercy of for profit providers of accommodation where there are no nurses or mental care at all. They call them hostels but they are really flea pits. And this was meant to be an improvement on institutional care.
   I have a mother in a mental health ward, and I just want to say that we need to bring back the word ‘insane’ to differentiate the truly sick, who need full time care, from those with temporary mental illnesses and illnesses not requiring full time care.
   Bring back care for the insane, and stop throwing them onto the street – or into the hands of private sector jocks who rip them off in flea infested hostels.

2. Tully Rosen
   Posted April 5, 2011 at 11:26 am

   Yes let’s!

   Those pushing for mental health reform may not always agree point-to-point, but we’re harmonising like never before on the basic problem – we need billions invested in the mental health system – and it must be community-integrated and ongoing!

3. Tully Rosen
   Posted April 5, 2011 at 11:27 am

   And congratulations by the way for taking the initiative.